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Home My WebLink AboutSCIMITAR #1 BLK 2 LT 20 Municipality of.Anchorage ~b ~%.. Development Services Department .:~ Building Safety Division : On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Ancflorage, AK 99519-6650 Page J of www. ci.anchorage.ak, us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL I"SPECTION REPORT-' Permit Number:. 5 {~t~O ~ ~' PID Number:. ~ '~/-" / "~2'-'~ ili P3,, -km,m WastewatorSystem: []New ~,Upgrade ;~'~ J,~?~d,'lve bJ. /~t~;I/,,~/V-?£OYq -~3:3 ABSORPTION FIELD I>none: -3 I~Dee~Tm/ch-- r'lITrenc~ r'lBed rlMound I-IO~lec. '" To~ Dep~ fr~m original grade: LEGAL DESCRIPTION s~.~.~ I.~ c.~ 13 ~,. r~. T~n~%0: ~nge:, Set,on: Fa added ~ 0,1~ grade:D .)" ~. -. 35-.. Well: [] New [] Upgrade ~ ~ ~r,. .~m~l.~,,~: ' I~a"c~'~'"'~"":'' FH - ~, TANK SEPARATION DISTANCES I8 se,~c El HoUng [] S.T.E.P. [] TFmm"~ SeplJc Absorption Uft Holding =ublic/Pdva,esew~Une ~,~3 --~,~---' ~/g~ S~;~'~',(---,.,',-' Tank Field Station Tank ~"'I'"L~/?I, ~/' Gal. ~ in. c~,,o~,,, ...____- /,/~, ~ .__.._ Retrains: IF.- ~ ~ .~ 7' e /,/c ~ ~-./'7 , c_ 7-g/v-,~. BENCH MARK Engineer's Stamp S & $ ENGINEERING '~' ""' ' ~,~ '. ,,~., / ~.t~ Inspections performed by: .......... ,~. "~/..V:/,-,7/-~--,,~ ......... '-' 2~ I~- q-g3,-l~f~/_ /~12.._-- fi 1'~-~% ROBERTC. COWAN Development~_ ~/'/Services Department Approval ¢6 ~};,, CE-8801 and aaoroved by: ~ z,~-//..."/~ .,,,'/'/./~. Date: 3 - q-E)~ ~. :,,... .... Reviewed .,,, ::(,,,, J/f~/'"~ '. '~.'.' · '. · ,. .............. ..... - .,-'.,,,..,~;..-.,, ·. ;.; .~.'"~,.; PRRMIT NO. SW030485 PAOP. 2 OF 3 Municip. atit:v oF' Anchor'aae DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ehnchorage, Ataska 99519-6650eTeteohone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOT 20, BLOCK 2, SCIMITAR S/D #1 P.i.D. No. 051-132-28 · LOT 19 I Il 100' WELL RADIU ,, J j L"x~x IBM ~ B GRAVEL DRIVEWAY I VALVE) NEW 1000 GALLON I ' "' ~ ~ ~/~.~,~.,~,~ I PERMIT NO. SW050485 PAGE 5 OF 5 Municip. ati-'cv oF' Anchor'acie DEPARTMENT OF HEALTH AND HUI'4AN SERVICES ENVIRONMENTAL-SERVICES DIVISION P.O. Box 196650 eAnchorage, Atasko, 99519-6650eTetephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 20, BLOCK 2, SCIMITAR S/D #1 P.LD. NO. 051 - 15.52-28 ~ ST1 ST2 ~ 98.'4-' FINAL GRADE-/ 2" INSULATIOI~ 93'8'J JFCCT~Y~ET~"'Y~¢E'"'r4~: J ~- 9,.3.5' FINAL GRADE/ A B DBL1 57.5' 57.5' DBL2 57.5' 58.5' ST1 45.0' 55.0' ST2 47.0' 56.5' TMT 45.5' 57;5' DBL5 50.5' 62.0' DBL4 51.5' 65.0' DV 55.0' 64.5' C01 67.0' 75.0' C02 64.0' 86.5' MT1 66.5' 71.5' MT1 =87.3'-~ C01 =99.8' 2=100.0' ~,.,~-~*! ~ C01=93.5' C02=93.6' NO WATER FOUND 81.3' B.0.H. 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 Date Issued: Nov 19, 2003 Expiration Date: Nov 18, 2004 Permit Number: SW030485 Legal Description~.~SCiMITAR'#11BLK ~;'2 LT.."20~;~ Design.Engineer: 0003 S & S Engineering Owner Name: Olli Backman Owner Address: 20870 JACQUARD AVENUE W LAKEVILLE , MN 55044-0000 Parcel ID: 051-132-28 Site Address: 019971 TULWAR DR Lot Size: 50859 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [~] Disposal Field I'~ Septic Tank [--] Holding Tank [ZZ] 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 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. Received By: ~~/2. ~ Date: ][/z~ /~ _,3. Municipality of Anchorage Development Services Department Building Safely Division On-Site Water and Wastewater Program 4700 South Bragaw SI. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON--,-OiYE SEWER/VVELL-PERMIT APPt. ICATiON FOR A SINGLE FAMILY DWELLING Permit Number .SW OF t~d ~.,q'" .. O I I; Mailing address (2) ~ ~X[t~ ~l. ~ ~~q ~Zip Code Legal description (Lot. Block & Sub'd.) ' ~~ ~ B~O~, Legal description (Section, Township & Range) I qqq I Lo~ 8ize~ Ac~e~ Numbe~ o~ Bedrooms ~ THIS THIS APPLICATION IS FOR: Sewer Only [-1 Well Only [-1 Sewer and Well r-I Water Storage [] Sewer Upgrade ~[ PROPERTY CONTAINS: Hot Tub r-1 Jacuzzi [] Swimming Pool I--I Water Softening Unit I--I Therapy Pool [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. ~2m ~.~,~ S&SENGINEERING 17034 Eagle River Loop Road No. 204 __ E_~l_e ~lwr: Alaska 99577 (Signature of property owner or authorized agent) Permit Fees: c/~ /-/ O Z). "~ Waiver Fees: Date of Payment: If /I ~- / 0:3 Date of Payment: Receipt Number: O ~ W 5/.~ b'"'-t,,~ '.3/ Receipt Number: I'~r. AI.TH AUTHORmf APPROVALS SEWER & WATER MAJN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELl. INSPECTION & FLOW TEST SEE PLANS ROAD DESIGN SOII~TEST F~RCOI.ATION TEST STRUCTURAL& MECHANk3~L INSPECTIONS ON$1TE WASTEWATER I:XSPOSALSYSTEM DESIGN meemnq ROBERT C. COWAN, RE. ROBERTA. SHAFEP~ P.F. November 10, 2003 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 20; Block 2; Scimitar # 1 Subdivision It is requested that you issue a perm,it to install a new trench"to serve the existing three bedroom dwelling on the referenced property. A test hole was excavated, and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 10/16/03 no water was found. After monitoring, ground water was not found. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation ofthe proposed septic tank. The installation of this trench will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. C0wan, P.E. RCC/mjc Enclosure 17034 NORTH EAGLE RIVER LOOP · surrE 204 · EAGLE RIVER, ALASKA 99577, 1" = 50' SCALE DESIGN SITE-PLAN m o 2-5% 0 UTILITY EASEME 0 0 ,--3 OO 2-5% c.nO 0 ,--] Performed For: Legal Description: 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- i2- i3- 14- 15- i6- 17- 1B- 19- 20- rvlunicipality of Anchorage Development Services Department Buildlng Safely DMslon On-Site Water and Wastew'ater Program 4700 Soulh Bra~w St. P.O. Box 196650 Anchorage. AK ¢J951.~-6650 ~vw.cl.anchomqe.ak.us (.c07) 34~-7904 Soils Log - Percolation Test Slope COMMEHTS WAS GROUND WATER ENCOU:~-=.=-r-O? /~ O s .,-"- IF YES. AT Vrr'AT DEPTH? . O Deplh to Water After p t,'lonltodng? ~/~Y, E Date Performed: Site Plan Net Time Depth to Watei I Net Drop I0 /0 !0 I0 FERC HOLE OlAM=_TER PERFORMED IH ~CC~DANC~ WITH ~ t STAT=- ~};D ,%!UNICIPA'L GL~ID=-LINES IH E~F=-CT OH THIS DATE. DATF.: /O/D-¥/O .~ ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. meemn CIVIL ENGINEERS · (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITf SEWER & WATER MAIN EXTENSIONS SEWER&WATER It~PECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS SOETEST PERCOLATION TEST STRUCTURAL & MECHAMCAL INSPECTIONS C~I SITE W.a~TEWATER I~SP~ SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 20; Block 2; Scimitar # 1 Subdivision November 10, 2003 GENERAL: The scope of this project includes the installation of a 1000 gallon HDPE septic tank and a new trench to serve the existing three bedroom residence located on the referenced property. 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. 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. 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: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent s~ttling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP * SUITE 204 * EAGLE RIVER. ALASKA 99577, Page 2 Lot 20; Block 2; Scimitar # I Subdivision November 10, 2003 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 fi. of cover shall be insulated. 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. o Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 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 (ruffed-up) before gravel (sewer rock) placement. o 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. 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. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shoxvn 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 &the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 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. Page 3 Lot 20; Block 2; Scimitar # 1 Subdivision November 10, 2003 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality &Anchorage: Twe of Pirie Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use ora type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 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. o · All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. Page 4 Lot 20; Block 2; Scimitar # 1 Subdivision November 10, 2003 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: 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. o 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. 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 GREA,~J( ANCHORAGE AREA BORb_oH O Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTE/~ SEPTIC TANK~ FROM WELL MANUFACTURER f' MATERIAL__ COMPARTMENTS_ INSIDE LENGTH P ] . __ INSIDE WIDTH _ LIQUID DEPTH _ __LIQUID CAPACITY. .j ~*..~.'.,L~..~ GALLONS, SEEPAGE ,~IT: I..~ NUMBER OF I~I-T~S ~ . DIAMETER LINING MATERIAL BUILDING FOUNDATION__ ADDITIONAL ABSORPTION__ ~__OR WIDTH CRIB SIZE: DIAMETER NEAREST LOT LINE Y-~ ,,-~ / / LENGTFIc2<N '~, DEPTN ~ DEPTH__ DISTANCE FROM: WELL , {~'G ~---. TOTAL EFFECTIVE / ABSORPTION AREA (WALL AREA) ~ (~ _SQ. FT. WELL: 'TYPE ~ BUILDING FOUNDATION -- CESSPOOL APPROVED CONSTRUCTION_ NEAREST LOT LINE OTHER SOURCES DISAPPROVED. NEAREST SEWER LINE REMARKS__ DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK __ SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIALr LOT SLOPE: REMARKS: DATE APPROVEE A.A.B. A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 ,/~,~ /v///>,, DEPTH OF WELL ~:? // Ended OWNER OF LAND ADDRESS LEGAL DESCRIPTION /,/ DATE - Started , / PERMIT NUMBER STATIC LEVEL OF WATER ItT. DRAW DOWN FT. / ~ ' GALS. PER HR ':' KIND OF CASING KIND OF FORMATION: Fronl __Ft. to--Ft. From Ft. to ~: Ft. From __Ft. to ' ; Ft. FrOlll _ Ft. to ," Ft. From Ft. to ' _Ft From :' : Ft. to ,' i'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. Fronl_ Ft. From Ft. to From __ Ft. to From__Ft. to From Ft. to__ From___ Ft. to :, ? .... -~'. From__ Ft. to (:~&~l'/,;,:., c- · , ::~ ' ~ ' ~ :~/ qCarOln Ft. to From Ft. to From Ft. to_~ From Ft. to Frmn Ft. to~ From~ Ft. to.~ From ~Ft. to From~Ft. to From Ft. to From Ft. to. Ft. Ft. __Ft. _Ft~ Ft Ft. Ft. Ft. Ft. Ft. __Ft Ft. _FI Ft Ft. Ft. __FI MISCL. INFORMATION: DRILLER'S NAME PERMI"F NO. RPF:'L I CI::II'.4T OLL I E:RC:KMRI',I. L.OCF:IT I Z.~I'.,I PETER% _.F..I::.EI.... LEGRI .... L20 E;2 E;C I M ! 'TF:'IR :5 JE:D PO E ZX 8470 L 0]' .:, .. ,:. 'f"¢F'E OF' S::ZL~ FiEE]F.'EFf'ZCN ::, _-FEll I:z, fFEi'.,I_.FI MR::.::IMIJi"I N .i','IE:ER OF BE[:,ROOI"1S = ]: SI]IlL. F~:F:I"FIt"4G (::j(;:! FT,.."E:R)= :=5 TFIE R'E]'. IRE[:' ::,I,:::.E OF "/'HE SOII.. FIE:SORPTION ]"HE LENGTH D I MENS ]; ON I S THE L..ENGTH ':.' I i",l FEE]' ) OF "f'HE TI';.':Ei",IC:I-'] ErR DRFII NF' ~[ [i:l...[:'. ]'HE DEPTH OF R TRENCH OF.: F'I"I" I5 THE B, ISTRI",ICE E~E:'f't.,.IEEt',I THE SURFFICE OF: THE GF.:OUND FINE.'., THE BOTTOM OF THE Ek. lCR',,,'ta"f'IOl",l ,::ZN F'I:~::ET). THERE IS NO SET 14I[:,TH FOR TRENCHES. ']"HE ('.~iRFtVEL. [:,EF'TH IS ]'t41E I',l:[NIf,lUr'l DEPTH OF' GRFI',,,'EL 8ET.brlEEI'.~ THE OUTI:::'F:ILI.. F:'II::'E RI'ID THE BCITTOM OF:' THE IE',:.::CR',,,'FITION ,::IN FLEET). BF'ICI-(:FILL. IIqG OF F¢.,l't' S"r'%TEM 14I]"HOU]" FII",IFtL INBPEC.:TIOI",I RN[:' FIF'PRO'v'Rt... 8'¢ 'I"I"IIS DEPFIF.'.TMF.:'NT H ILL E:E ~-:.;IJBJECT TO PROSECUT I O1",1. MII",IIMUM D!.51"F:INCE BETtdEEN FI HELL FIN[:' FIN"d OI",I-%Z"FE :~!;EI4FIGE ;t..OO FEET F'OR FI PRIVRTE WELL. OR 200 FEE:T FOR F:I PUBLIC HELL t.,.IELL L, O65 RRE REQUIRED RN[." MUST BE RETURNED TO THE OF THE WELt_ COi"IF'LETIOI",I. SPEC I F I CRT I O1",1% RI'iD COIqSTRUC:'f' 101"',1 D I FIGRFII"'IS RF.'.E R',,,'FI I LIABLE T 0:1: 1",t':SUI'~:E F'ROF:'I:~:R I i"4D;TRLJ..FFf' I ON. ]: CER'f'IF"r' THRT :i.: I FIM FRMILiRR WITH ]'PIE RE6~UIREI"IEI"~T:E; FOR ON-:'SITE FOF.':TH E,"¢ ]"HE 1'4UNICIPFILIT"r' OF FINC':HORRGE. 2: :[ 1.4It. L INSTFILL 'f'HE S'¢STEM IN RCCORI)IaI",ICE FIITH 'f'HE CODES. :~:: I UNDER'=;TF:IND ]'HRT THE ON-SZ'rE S:;E:I.,.IEF.'. S'¢~STEM I','IFI'¢ RE6!I...IIF..:E EI'.,tI._.F:IF.'.diEME]'.,FT IF' ]'HE RE2;):E:,ENCE IS REMODELED TO :INCLUDE FIOF.".E THRN ]!: E:[::[:,ROOM:~;. s ]: ci ', Er.::: .... .... F:IF'F'L I CRi'.,IT OLL I E,'FICKMFIN Performed For Legal qescri~tion: This Form Re~orts Soils Loq 2204 Cleveland Anchorage, Alaska 99503' Olli ~m~ ~¢~A/' Date Performed 5~10/76 · ~x.~z~,'%~ ~ ~; 'sion Lot 20B]0ck 2 Subdivision ~-]~e~%ar ~um~zvx Yes Percolation Test_____._~__ Oeoth Feet Soil_ Ch~ra.c_teristics Sandy Gravel (GP-GW) 18~ Bottom of test hole .,, Was Ground Water Encountered?~, No Im Yes, At what Depth? Gross Time Net Time Depth to H20 Net Dron Percolatio Rate Minute Prn~os d Inst~-i]-~-~on: SeepaQe Pit__ Dra n Field Deoth f Inlet Dep%h To Bottom Of Pit Or Trench C~PENTS: 85 Square feet drainage area requi~,~per,, bedroom No bedrock encountered J '111,;b~ M INAR'k' desc'~ibed property:~- t-' g. ~:- ~. /~'/~'~. ~' ;Z _ ~'~' ',. "~'.' ~' ". ~.~'.-' (.).t~.'l ~.l~.,, '~m'hcr~lle llecm'dim~ ]h'ecinc~, Alaal~a, and film /he pro- v.'dt be within fl~,~ lWOperly line:; a'~d will not ov~rm- ~ ~;, - } ~ }'~:t,'h ]{ix'er. l'}mHuI'd,It .... , ,h 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 Parcel I.D. 051-132-28 GENEi~L INFORMATION Complete legal description Location (site address or directions) ..19 9 71 Tu 1wa r D r., Expiration Date: ~:) _ C~ _ O /'~ Lot 20; Block 2; Scimitar #1 Subdivision Chugiak, AK 99567 Current Property owner(s)Olli Backman Mailing address. 20870 Jacquard Ave. We~ Day phone Lak~ville, MN 55044-0000 Lending agency Mailing address Day phone Real Estate Agent Day phone Mailing Address ,Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 e TYPE OF WATER SUPPLY: ' Individual Well Individual Water Storage Community Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: 'Individual On-site 3[[] Individual Holding tank '[] Community On-site [] Public Sewer [] I The Municipality of Anchbrage 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 pdvate 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. 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: L~-i--- '~o; '('"~'t.o¢.~<' ~-; ~ ~/ii,~k-g._ ~ Ii Parcel ID: A. WELL DATA If A, B, or C provide PWSID # Sanitary seal (Y/N) ~ Cased to 40 ~'it.' ft. g.p.m. Nitrate O.~"/?, rog.II. Date of sample: ~/ ]/O~ wel!'type Dat~ ~ompleted .~/---~. Tota'l depth "~'1 ] ft. "~ FROM WELL LOG Da~e of test Static water leve~ '; W~ll~:productiq~.. WATER SAMPLE Coliform ~ coloaies/~ 00 . ~I I Ars~dic: ~ mg.ll. ' ;. ,~, B. SEPTIC/H6H:D'rNG TANK DATA TSqlk?ype/Material ~O'~-IC.-] I"J'~ ~!k?size ~O0(~ gal. Number of Compartments__ Foundabon cleanout (YIN) . Depression over tank (Y/N) ~ ~ateo[ pumpin~ ~[ Pumper / C. ABSORPTION FIELD DATA ~a(einstalled ~_f~ 10} Soil rating (g.p.d.lftt orft'lbdrm) ~ · ~ ~eXCth ~¢-~ Iff. Width ~ ft. Well Log (Y/N), ~ Wires properly protected (¥/N Casir~§'height {above §round) AT INSPECTION Other bacteria Collected by: ~.~ Date installed [ "'Z-'/~=.:z~ / Cleanouts (Y/N) .N.// High water alarm (Y/N) g.p.m. colonies/100 mi. ,Toial depth f 0 ft. 'Da!e of adequacy test '~l~Jli0, depth in absorption field before test/ in. i~'l!¢:ed Time: min. Fina¢id depth :,~n;?,rejuvenation treatment (past 12 (~o.) (YIN & type) System type /' ~-"t'JL.~'~- Gravel below pipe ~¢, ', ft. ~ ~'~"U Results (Pass/Fail) ¢~r S'5 For ~ bedrooms .Water added .gal. NewTpth~ i in. in. Absorption rate >= /i g.p,d. If yes, eiv~/date. 3- b-04; 2:33PM; ;907 5615301 ~ 2/ 3 SGS Ref.# Client Name Project Named# Client Sample ID Matrix 1041036001 S &: S Engineering Lot 20, Blk2 Scimitar #1 Lot 20, Blk 2 Scimitar #I Drinking Water All Date~/Times are Alaska Standard Time Printed Date/Time 03/05/2004 9:56 Collected DntedTime 03/01/2004 11:00 Received Date/Time 03/02/2004 11:15 Technical Dlrector~ Stephen C. Ede Released By~" ~'q~ ~ Sample Rcmerks: Allowable Pr~p Analysis Parameter Results PQL Units Mothod Container ID Limits Date Dat~ Inlt Waters Department Nitrate-N 0.947 0.100 mi',/L EPA 300.0 B (<=10) JIB Microbiology Laboratory Total Coliform 0 col/100mL SMI8 9222B A (<=I) 03/02/04 DKC 3- 3-04;13:47 ;CT eno E :, ~Tk CT&£ Environmental Se~i~ces, Inc. ~ ~,_ ~borato~ Division 200 W. Potter Drive Drinking Water .~nalysis' Rep6rt for Total Coliform BacteriaTe~:A"ch°r'°'m07) 562-2a4a^K SgS~.~O~ READ INSTRUCTIONS ON REVERSE SIDE 'BEFORE COLLECTI~IG SAMPLE Fax: (907) 561-5301 'MUST BE COMPLETED BY WATE~.'SUPPLXER TO BE COMPLETED BY LABORATORY O PUBLIC WATER SYSTEM i.D. # I IIIIIJ An~.,ysis shows this Water SAMPLE to be: - 13~ Satisfactory O Unsatisfactory PRIVATE WATER SYSTEM I O S~mplc over'30 hours old, results may c~,~,,,~,. I bc un~cliablc I 0 Sample too long in transit; sample should t,, ~=,~- .... I--~ . ~ not bc ovcr~ours old at examination . [ n~ Il Il I 1o indicate reliable~suits. Please scad L~ I ~ ~ [ new sample ~a special delive~ mail· ' ' I ~imcReceived ' Phone ,Number Send Invoice nm( n Se,d Resutts City Zip C~c Month Day SAMPLE TYPE: ~' Routine ' O ~ Repeat Sample (for routine sample ~' ~vith lab ref. no. ) O Special Purpose Year Treated Water Untreated Water Analysis Began Analytical Method: Time Collected Collected I1:oo ~,~ ~o~ Co~,,~, plaue Print SAM PLE LOCATION t-or ~xo 15Cst ;L S ct.~,r~ fl-/ ~cmbrane Filter O MMO-MUG 1 041036' / "qO ml. Result* Anch Fbks Jun Date: Time: Client notified of unsatisfactory results: Phoned Spoke with Date: _T ~'~ -O.~ Time: ~ "~ Analyst [] Foxed Foxed Comments: BACTERIOLOGICAL WATER ANALYSIS RECORD. MMO-MUG Result: Total Coliform Membrane Filter:. Direct Count Verification: LTB Fecal Coliforr~ Confirmation Final ~,mbralf~Filter Results'. ' ~'~ E. Coif Colonies/100 mi COLIFIRM Coliform/lO0 mi Time ! :~: re hfs T.VFC- r~ Numero#$ To Count OB - Orker Bacteria " ~ ~.l~S Member of the SGS Group ,Soc,,,, G,n,rale.~.~ Surveillance} ENVIRONMENTAL FACILITIES IN ALA$10~,. ~kLIFORNIA, FLOSIOA, ILUNOI-q. MARYlaND. MICHIGA~,'~ISSOURI. ~N JERSEY. OHIO. WESl I I AS-~UmT I hereby certify that I have surveyed the following dcscrl?ed,pro~erty' L~" ,7-.~::~j ~"/i¢'~'~ ,..,¢~.~ . I~ ~/~4.~Z.~." ~, -~/-¢ ~ ,, Anchorage Recording Precinct. Alaska, ~nd that .the improvemenls situated thereon are within the property lines and do not overlap or encroach on the property lying 'adjacent thereto, that' no improvements on prop- erty lying.adjacent thereto encroach on the premises In question and tlmt there are no ~oadways, transmission lines or other visible easemerds on said property exeepl ~ indicated hereon. Dated at E~le River, Alaska. t~.~z~ d.y o~ ~%'~ ~' ROBERT C. ~O]tNSON ~: SCA~E: ~egl~tere~ Land Surveyor No. l'= //-~ / Box 456, Eagle lilt, er, Alaska Phone 694-2543