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HomeMy WebLinkAboutSEIDLER #1 BLK 2 LT 1NX oma- X31 -SSI q -63 Municipality of Anchorage Page t of z DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Dox '196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5Wgg00 N9 PID Number: Od6/3/ry _ Name: 1-1:z ex)F y . T. G /aa (F-1) Wastewater System: ElNew X Upgrade Address1 171�i `fiur2lG C/f�cc.c". ABSORPTION FIELD Phone: No. of Bedrooms: /41 Deep Trench El Shallow Trench El Bed 1:1 Mound 11 Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: • � GPU/Sq. Ft. 9 Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe FL S Ft. Township: Range: Section: Fill added above original grade Gravel length: D Ft. SU Ft. _ _ WELL: ❑ New ❑ Upgrade Gravel width: Num her of lines: Distance between lines: Z � 5- Ft. 2- /O Ft. Classification (Private. A,B.C): Total Depth: Cased To: Total absorption area: Pipe material:' P,e/v,47*F Ft. Ft. 6_00 SQ. FL 19S7/N Odo3N 4 FF/o p� Driller. Date Drilled. Static Water Level: Installer: 1 ��lG. Date installed [� /� �g Ft. I I�E�D _4 / Yield 1 Pump Set at: Casing Height Above Ground: TAN GPM Ft Ft. SEPARATION DISTANCES X Septic ❑ Holding ❑ S.T.E.P. ® To Septic Absorption Litt Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Well ao / /00 _— _. y $ /¢ Material: 5Fff e— Number of Compartments. Z /00 /�� '- -- LIFT STATION Watere Lot51 allons: Manufacturer: Line Foundation / 'Pump on" level at off" level aC High water alarm at: /U Curtain X0/u6.. _4000 10 Pump Make &Model Electrical Inspections perfon _Drain Remarks: BENCH MARK Location and Description: % oP of /'"O0A,09 /0N lu ny LL Assumed Elevation: /Do,OFj _ ENGINEER'S SEAL D FROINEEKINU 17034 Eagle River Loop Road, No. 204 ^; Inspections performed by: Eagle River, Alaska 99577 Dates:lst a 2nd 3-3o`4'`L �- Department of Health t�tl'Hum S t ices approv I " Reviewed and approved by: Date: Z % 72-013 (Rev. 9/91) MOA 25 Permit No. SW940049 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:SEIDLER SUBDIVISION, BLOCK 2, LOTS 1,2,&�ID No.: 05013154 t;01 CO2 99.1' C06 M CO3 MT2[ 98.0' g8.1' NEW ......... _...._. ....._ __.... ....._._ ..... ... g3 1 1250 GAL g3.2' S.T. SR,SR 93.1' 93.1' 88.1' .................. .................... ....... ....... .._.....;.......68,.1. ......................>......A 81.3' NO- WATER FOUN.D...................._... A B C FCO 17.0 26.5 - CO1 10.0 16.5 - 0O2 19.0 19.5 - 0O3 35.0 36.5 - 004 23.5 19.0 - 005' 32.5 25.5 - 006L8.5. 28.0. MT1 25.5 23.5 - MT2' - 18.5 29.0. P LOT 1 WALL OF FOUNtlAiIOTJ-� ......._, WALL _ ......_...... .. ..... ..._ ..___....._ .__ _....._.. A I 72-013 A (1/93) - 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 Mic ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940049 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:GREEN IRENE H J OWNER ADDRESS:11719 LAURIE CIR EAGLE RIVER, ALASKA 99577 PARCEL ID:05013154 LEGAL DESCRIPTION: SEIDLER #1 BLK 2 LT 1 LOT SIZE: 63624 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DA'Z'E ISSUED: 3/15/94 EXPIRATION DATE: 3/15/95 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 OR 343-4681 AFTER BUSINESS HOURS 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 PROVISIONS: APPROVAL 'FRENCH NO SLOPE. GRANTED TO PLACE THE PROPOSED WASTEWATER DISPOSAL CLOSER THAN 30 FEET BACK FROM THE TOP OF THE 30% RECEIVED BY: ISSUED BY: DATE: DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 SEWER &WATER Anchorage, Alaska 99519-6650 MAIN EXTENSIONS REFERENCE: Seidler Subdivision; Block 2; Lot 1 SEWER &WATER INSPECTION Request you issue a permit to upgrade the septic system serving the ENGINEERING STUDIES four bedroom house on the referenced property. AND REPORTS A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the test WELL INSPECTION hole has been checked and found to be dry' p Attached is the proposed 8 FLOW TEST upgrade design. The existing septic system is an undocumented system and is encroaching the 100' creek setback, therefore we request an upgrade of the system. SITE PLANS Please issue a waiver for the horizontal separation distance for a change in slope of greater than 25% to 30'. The area remaining after creek setbacks and 100' well radius is limited. ROAD DESIGN We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. SOILTEST If you have any questions, or require additional information for your review, please contact us. ly, PERCOLATION TEST A. Shafer, P.E. obb STRUCTURAL&MECHANICAL U�]k INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 V)Z O F- fl� O Z W Z V O �3 aa� on� _= F—�� I 0 Z<O CD O N Z N d U Q z j�L'JinVF W W a]W=W �aZLt. 0 Z WwHNNi H O Yr -_14 O a LLJ r a� t LA V) OF' -1 L, wtn0�JZwd VtO� O> w=v� NLJZZ VI LA _J LLI Z 0 O 4} V U w m F- IH�O� = w O boa - Z O a of x r� H r�v w aCY O �� J z _fir zE J oc�O o W U N W O 00 Q ��W a IIS II "� ww �' IN . % n. w o O H '• . �z�Y P, � �TTa w iN O ZFa-0 0¢101-aHO U 0 a- � v -a H'� d; � U rUff�tt �1 � mJ O O IV) w FC�4 O E"� � � N N Lr) V)Z O F- fl� O Z W Z V O �3 aa� on� _= F—�� I 0 Z<O CD O N Z N d U Q z j�L'JinVF W W a]W=W �aZLt. J ~ of Z w�J O Z O O v g < LLJ r a� F w v a co co w �F-Q zctf wtn0�JZwd VtO� O> w=v� NLJZZ VI w w a O � _J LLI Z 0 O 4} V U w m F- IH�O� = w O boa - Z F =Z !u(na O/_no F-oc) O I- O J 1 W� \ a t, M, G�� o \a�w W U m w i� 0,, _o F�w� z O I� Y�Yo W G W www0 cewm_ J G�� ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Seidler Subdivision; Block 2; Lot 1 1. The scope of this project includes the installation of a 1250 gallon septic tank and a leachfield trench to serve the four bedroom residence located on the referenced property. The existing septic tank is to be excavated, pumped, crushed, and abandoned in place. The existing trench is to be abandoned in place. 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. 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. 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. Page Two Seidler Subdivision; Block 2; Lot 1 March 08, 1994 4. Septic tanks installed with less than 4' 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' 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_ and installed approximately in the locations shown on the design. 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 Seidler Subdivision; Block 2; Lot 1 March 08, 1994 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: Type 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 140/N, 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. Page Four Seidler Subdivision; Block 2; Lot 1 March 08, 1994 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. 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 contractor's 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 contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. Page Five Seidler Subdivision; Block 2; Lot 1 March 08, 1994 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 Municipality of Anchorage 0* DEPARTMENT OF HEALTH & HUMAN SERVICES 825 '•L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ��iviJE C, DATEPERFORM LEGAL DESCRIPTION �1 �� ���Dt>vt1 l!J Township, Range, Section: SLOPE r ' WAS GROUND WATER �t 10 ENCOUNTERED? ,. S 11 IF YES, AT WHAT p 12- 13-0 213 6 10. ✓• 15 I ZAirli, 16- 17 18 19 20 COMMENTS DEPTH? P E Depth to Water After g d Monitoring? bs Date: ` SITE (ENGINEER'S SEAL) Y' r 0. r O Ru - =n' 1 G - S(Uly SP&40y G wi;7- 2 Wi SducF- &z6P'N(C-5 -Vo A D5P7H of e�•S` 01219AM 0 v SSW 4 ' uroi,F 2A SANS 5 W17H 6-MLE GWS r LI6H S�-7. 7 �. Q 8 .. 9 r SLOPE r ' WAS GROUND WATER �t 10 ENCOUNTERED? ,. S 11 IF YES, AT WHAT p 12- 13-0 213 6 10. ✓• 15 I ZAirli, 16- 17 18 19 20 COMMENTS DEPTH? P E Depth to Water After g d Monitoring? bs Date: ` SITE (ENGINEER'S SEAL) Y' r 0. O =n' 01219AM PERCOLATION RATE S �(�minutes/in`ch) PEERC HOLE DIAMETER TEST RUN BETWEEN 6c_ r) AND 't FT S & S ENGINEERING PERFORMED BY. 17034 DUN RIVUF Loop . nnr�eed��yy� �6XM�� ACCORDANCE w&gkLRbwT0kkQ19geKnwMAL GUIDEL{60 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: A. Iv 00c. (71-1. IN." N CIA M, W E L L ks 1% �IkfrRFI P.O. I,1OX 610212. 0I-1tWIW Al ASKA 99E,07 - 1LEEPHONE 680 2759 OWNE R 0 F IA KI) , M 11 ADDRFSS A"" ti !-j I 1 I K' IA \ H. OF S`I \1 I P F 1. LEGAL MISCRU, I ION I (Aded 11S III -P IIR PHZiNfif NUMBIAZ K I \ 1) 0 f IN .... .. . ... MIND M It ()RO,m fr,? From- 1, 1 49 to- Frorn I't. 10 i I non, It [o From I 10! 1 1. F rom F'oln i to From k 16 c- FrOA-11 I'mill I to 7"1'T I to From e 1:1 1 oil Yro)111617 to ter A?, Frorl), I I loll Front lot)) 5 1'81111 --Fi to J4, FI rom P) r Font 1: Frow.Ay.), lo to 0 M RECEIVED JUL 11 1995 municl Pality W At'10110rcie NO. HGalth & Human Sera�lces UI;I11,F.R'S NANI F < t t ,t Ire DOC Co. ata P.O. BOX 670272, CHUGIAK, ALASKA 99567 • 'rELEPHONE 688.2759 OWNER OF I.AND .jOue?«.1l .-;F-_- A� \) ri %A_fgejie, ADDRESS LEGA L1)LSCRII']ION /,lU17e- . it I _.s DA'I F. - Started -- -- _ Ended ---53 PERMIFNUMBER _ KIND OF FORMATION: DI:P1H OF WELL 40 � STALK LE�1:1 Of- WATER F} _ �-------- _--_- DRAWDOWN 11 — _--- GALS, PER FIR KIND OF CASING_✓ From-. ___Ft. to - -.-FL_. Cl�JilJt From._—. .- FI. to. From___ . 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F�LC/4DC�- ��A ��_ 1P(} Prom_------_VguatG / 6`� I �„� Pti,4.4 % �FS.i.rV From --Ft. q " fits _C ___-_,6I(N y _--- From- ---FL _Ft. to__ t. to--- to- to--- to_--. - _FL RECEIVED . Ft._--_-- ---- ptliaty-joJ-ArC170rage Crept. Health & Human Services t' - - - --Ft.----- From Ft. toFt._ --_.---- _ From_. - - -Ft. to ------ Ft_.. MISCL. INFORMATION: �f do J Q��nu �b� �M Ur�� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950055 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:FRANK DUANE A & ALENA A OWNER ADDRESS:PO BOX 771912 EAGLE RIVER, ALASKA 99577 PARCEL ID:05013154 LEGAL DESCRIPTION: SEIDLER #1 BLK 2 LT 1 LOT SIZE: 63624 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 4/20/95 EXPIRATION DATE: 4/20/96 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 PROVISIONS: RECEIVED BY: ISSUED BY: La 0a Juc( DATE: DATE: I, A -an 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 WELL SYSTEM PERMIT PERMIT NUMBER:SW950053 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:FRANK DUANE A & ALENA A OWNER ADDRESS:11719 LAURIE CIR EAGLE RIVER, ALASKA 99577 PARCEL ID:05013154 LEGAL DESCRIPTION: SEID.LER #1 BLK 2 LT 1 LOT SIZE: 63624 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF - WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE W_ PAGE 1 OF 1 DATE ISSUED: 4/20/95 EXPIRATION DATE: 4/20/96 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPEC:CFIED IN ANCHORAGE ICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STA E OF ALASKA W STEWATER DISPOSAL REGULATIONS (18AAC72) AND D KI WATER R GULATIONS (18AAC80) 3. THE ENGINEER MUST NOTIFY DHH AT L ST 2 HOURS PRIOR TO EACH INSPECT_ P VIDE TIFICATION BY CALLING 343-4744 ( 24 HOU ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 1 A UBSURF CE SOIL ABSORPTI SYSTEM UNDER CON TR TION URING FREEZING WEATHER ST BE EI'PHER: \ A. OPENED CLOSED ON THE AME DAY B. COVERED, SEALED AND HEATE TO REVE T FREEZING 5. THE FOLLOWI G SPECIAL PROVISI NS. SPECIAL PROVT,$"TO /l s RECEIVED BY: --` DATE: C ISSUED BY: a (�-(/ fc _ DATE: "- �U� \D QJ _ 0-1 cmj_L� Vn j-'tibUo • 7 1 �r �t afV 1 5. 1 i , MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel LD. # S O —I 3 I - '{ HAA # 1. GENERAL INFORMATION Complete legal description Lot l; Bto'6z 2; Sei.d2yc SubcLiv tion #1 LocatLon,,(site address or directions) 11719 LauA-.e C,i.ne,2e ' ^: Eagte Riven., AK Prope'r#y owner=. Duane Frank Day phone 696-4151 "Mailirig addre'ss ;I"..,P•.0. Box 771912 Eagte RiveA, AK 99577 `Lending agency. �' Day phone Mailing address_,s9 - Agent Day phone Arl rl rocc r\VVIVVV n Unless otherwise requested, HAA will be held for pickup. - � v 2. NUMBER OF BEDROOMS: 4 t'r'y ru K _ 3. TYPE OF WATER SUPPLY: a < O m -n � z n Individual well XXX © ca N z 0 Community well — o m z Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site _ XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72.025(R".1/81) Front MOAN21 R 5. 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 6 cl — a (� 7 °/ 17034 Eagle River Loop Road No. 404 Address i le River.Alaska 99577 oe Engineer's signature f&& Date `1 �2� �\ ROBERT C. COWAN r@ CE - 8801 v 6. DHHS SIGNATURE Approved for A'21 bedrooms. 7 Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ,V pp BY: Date _� — '/S The Munic$ality of`AocAorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M(Rw.1/81) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lcyf 2 Se -0 Io 1 Parcel I.D. 05-01 3l A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (�)N) Date completed -5--757 Driller �� Li L t -r v.J _ Total depth qba r Cased to Zv ,� 4 b_4 Casing height iI--, ,i �- _ Sanitary seal,Y&) Date of test Static water level Well flow Pump levell Wires properly protected(j�N) FROM WELL LOG 670 g.p.m. SEPARATION DISTANCES FROM WELL TO: AT INSPECTION Septic/holding tank on lot ; On adjacent lots / UU ` Absorption field on lot /SS ; On adjacent lots o o r —1 Public sewer main -'A Public sewer manhole/cleanout 4 Sewer service line ZS r� Petroleum tank G X 15'Y 1 '\ (I "A \\ -DS A c p WATER SAMPLE RESULTS: 2S- (f - Coliform D Nitrate i Other bacteria z - 9S Collected by S & S ENGINEERING i/M Eagle River LUOPDate of sample: % - /MUOUNO. — 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed .. � ��c> Tank size IZ- Compartments 2 ClednoutsON) —�_ Foundation cleanout ON) �_ _Depression (Y/o High water alarm (Y& r� _Alarm tested (Y/N) A Date of pumping � _Pumper 'Tie Py✓Li��„% SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot -vAt _On adjacent lots (+ Foundation To property line _�,D �4 Absorption field 1 Surface water/drainage _ on (0( Water main/service line ) o ' �- 72-026(3W)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE D. ABSORPTION FIELD DATA Cycles STATION TO: On adjacent lots "Pump off" Surface water Date installed 4;?- 3�plli Soil rating (GPD/Ftz) /1 2 System type TKP,ry(L)F Length Sa Width 7-.S7- Gravel thickness 6 --Total depth 9' Total absorption area o Cleanout present/N) Depression over field (Y( Date of adequacy test 1 Results (pass/fail) J14 for ' _Bedrooms Water level in absorption field before test o After test til 4 Peroxide treatment (past 12 months) (Y/& If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / On adjacent lots is o ' Property line /0, To building foundation ( 3 ` To existing or abandoned system on lot /0 4 - On adjacent lots �a ` Cutbank 2,01 Water main/service line Surface water /Do ' Driveway, parking/vehicle storage area Curtain drain '1 la E. ENGINEER'S CERTIFICATION � /% ! certify that t have checked, verified, or conformed to all MOA and HAA guidelines in effect� is inspection. Signature`- Engineer's Name 1 l o A i- A1 C• Cow Date `7 6-0 o /`1s HAA Fee $ `N Date of Payment Receipt Number CZ 72-026 (3193)' Back Waiver Fee $ Date of Payment Receipt Number 4-_ ROBERT C. COWAN c,•.� CE�88o1 ,1�Z�, � 4w 87/19/95 14:55 COMMERCIAL TESTING � 9076941211 AL ANIAL ME Environmental Services Inc. sr 9 Laboratory Division cT&E Ref.II 95,2921.1 Laboratory Analysis Report Matrix WATER Client Oample ID Ll 131,K2 SEIDLER 8/0 #1 Client Name 9 & 9 NNOINEERING WORK Order 16293 Ordered By R. COWAN Printed Date 07/19/95 Q 11:29 hre. Project Name Collected Date 07/12/95 0 10:05 bra, Project# Received Date 07/13/95 O 12:00 hre. PWSID UA Technical Director STEPHEN C. SDE Released 13y Sample Remarks: SAMPLE COLLECTED BYi RAY. NO. 915 D02 QC Allowable Ext. Anal Parameter Rpeults Qual Unite Method Limits Da" Date Init Nitrate -N 1.61 D L EPA 353.2 10, 07/14 /99 CMR .•�.. OL9AO�f91.Yyr................... W,.... ................. ­......... W,........Y..........., 1......... ........... See Special Inatructlons Above UA Vnavailablp 90e Sample Remarke Above NA - Not Analyzed Undetected, Reported value ie the practical quantificatlon limit. LT + Lesu Than IY = Secondary dilution. OT a Greater Than 200 VV Potter Drive, Anchorage, AK 99518.1605 —Tel: (907) 5822343 Fax: (907) 581-5301 FNVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA