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HomeMy WebLinkAboutSOUTHFORK NORTH BLK 2 LT 3SnLIahne (\1164k IA old- qk%12) T3/oc y municipality of Ancnorage Page i of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Syi Q-7 y 33 & PID Number: d 78 P41 — )?> Name: Se. (.t, o C- vi h e wta,vt � ri Wastewater System: El New Upgrade Address: 3 � n l %..t 1/ ABSORPTION FIELD r �2c'<.0 •a- . c� ttcr✓i C7C+ Phone: No. of Bed rooms: 3 O Deep Trench )d Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: 2 GPD/Sq. Ft. Lot: Block: t�Subdivision:: 1 j 3 Depth to pipe bolt m from or' final grade: ' Gravel depth beneath pipe o�- *J V TPJ r 110 �"Yr'1 .'Z. Ft. FI. Township: Range: Section: Fill added above original grade: Gravel length: +� Ft. 3 Ft. WELL: ❑ New ❑ Upgrade Gravel width: _ Number of lines: Distance between lines `� Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: v Pipe material: Sr. Llo Ft. Ft. 7 b SQ. Ft. N.L d4,ck P /c— Driller: Date Drilled: Static Water Level: Installer: \\ Dale insta�ll^ed: 7 -16, Yield: Pump Set at: Casing Height Above Ground: TANK�/e) GPM Ft. Ft. C' SEPARATION DISTANCES ❑ Septic O Holding O S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines C 16 B --o Well- 1�d t �.2U 7 /f7 % �✓ Material: 1 y� be ✓' (ck ` Number of Compa tments: %^ LIFT STATION Watere o Lot.� �• Size in gallons: /l Manufacture/f) L Line 6V T Foundation na � Gc 2.7 � d "Pump on" level at: ..Pump off" level,at: High water alarrrr��� at: o` Curtain i`i i 0 Pumq f'aCkkee-& Model Electrical Inspections performed by: NON Drain (l Remarks: BENCH MARK Q��X Location and Description: i Cn�S a�ct�( Gr S ee� In �e— - Assumed Elevation: 6r, f>O� ENGINEER'S SEAL j i I L��C�/G^// !/ !0l f� G Q Inspections performed by: __ _ .LLGGi Dates: 1st_ 2nd Department of Health and Human Services approval Reviewed and approved by: Date: f5 2-013 (Rev 9.91)1,70/.25 4—INCH INSULATION O �J = O O = 101.35 AIRCOMPRESSOR ++ AlR LINES t++ + + ' SAND BACKFILL + + + ++ + + + = -17= + o 3 O +. + O + + + + 51.1 BIOCYCLE 6000 1-114 PVC WITH 118" HOLES AT 30" 5 X 37.5 DRAINFIELD 2 FT TOTAL DEPTH 1 FT SAND BLANKET CPP ROAD SAND .5 FT EFFECTIVE ROCK 3 FT COVER lD1f UTO nUnc) n 96.6 96. -J 95.85 SILT BARRIER NO SCAL E LEGEND: 1. PRIMARY TREATMENT, SEPTIC TANK 2. AERATION TANK rr J. CLARIFICATION TANK OF 14t ♦♦♦ 4. DISCHARGE TANK P,.•• ............. S ••.,• / ♦♦ 5. SOIL ABSORPTION ZA 0• 49th TUBBfN SPURKLAND - - ?Aw No. CE -2225 ���Aw Ar TOBBEN SPURKLAND P.E. SOUTHFORK NORTH, BK 2, LOT 5 WASTEWATER SYSTEM SCHEMATIC 203 W15Ih Ave BIOCYCLE WASTE WATER SYSTEM DATE. OCT. 6, 1997 Anchora e Ak 99501 '279 JSCHOENEMANN SHEET. 3 3 GRID: SW95 PERMIT # sws7o338 PID # 078-141-13 SFN02033•D616 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:SW970338 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:SCHOENNEMAN BRIAN J & KARI A OWNER ADDRESS:935 DEAN DRIVE GARDNERVILLE, NV 89410 PARCEL ID:07814113 LEGAL DESCRIPTION: SOUTHFORK NORTH BLK 2 LT 3 LOT SIZE: 62000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 9/30/97 EXPIRATION DATE: 9/30/98 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 B ISSUED BY: DATE: /I/q-7 DATE: c3D A T.SPUSAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN SOUTHFORK NORTH, BLOCK 2, LOT 3 BRIAN AND KAKI SCHOENEMANN MILE 7 HIGHLAND ROAD, E.R. Municipality of Anchorage Department of Health and Social Services 820 I Street Anchorage, Alaska 99501 September 10, 1997 We are submitting an application for the installation of a septic system upgrade for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. As can been seen from the testhole log, groundwater was observed at 10 feet on the day the testhole was excavated. Eight days later 5 feet of water was observed in the monitor tube. We have experienced unusual heavy precipitation over the last several weeks, and the amount of groundwater can probably be attributed to the rainfall. It can also be expected that during spring snowmelt the groundwater level will be higher than the level observed normally during the summer months. A BioCycle system is therefore the system of choice. The drainfield will be located at one foot depth, 4 feet above the observed groundwater. A one foot sandblanket will act as a polishing media before the effluent enters the natural soil. The combined treatment of the BioCycle and the sand blanket will protect the groundwater from contamination of bacteria. A literature survey shows that less than 12 inches of fine grained soil will filter standard septic tank effluent. The effluent from a BioCycle typically contains less than IOppm TSS and less than 10 ppm BOD. Even if the groundwater rose to within one foot of the ground surface, contamination is unlikely. Soil Rating Testhole #1 5 min/in = 2.4 gal per sq.ft/day with BioCycle No. of Bedrooms 3 Required Area per Bedroom: 15012.4 = 62.5 ft. MINIMM ENTAL SERVICESpgITy OF DIVISION Total area required: 62.5 x 3 = 187.5 sq.ft. ENVIRON Use 5-wide11 1997 Total Length 187.5 / 5 = 37.5 ft. �JEP Bottom Rock At 1 foot Rock Depth 5 inches effective RECEIVED Cover 3 ft. 2 feet of additional fill material. Install 12 -inch filter/leveling sand blanket under rock. The installation of this septic system will not prevent wells from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. \ \ o J 1 \ o \0 2 C� I AlF AlF 49th . •�..•• \\ O • ... J : T BBEN SPURKLAND,.1 qmr o y \ NO. CE -2225 AV ••♦���I�pA)DFE�N��• \ o \ o 150 200 250 300 ' \°=196 FT�� , ..:3 3 o\ o / ,\ o \ \ \ vdoo \ Well \ CD 0 TOBBEN SPURKLAND P.E. OUTH FORK NORTH BK 2 LOT 3 SEPTIC SYSTEM DESIGN 203 W TH. AVENUE MILE 7 HIGHLAND ROAD DATE: SEPT. 6, 1997 (NCH. AK. 99501 907 279-3916 BRIAN AND KAKI SCHOENEMANN SHEET. • 1/3 GRID:SW959 PERMIT It PID # a 6- - j y1-13 SFN02031.DW6 �I 49th .V 'No. CE -2225 I .. 25 0 25 50 /5 100 125 SCALE: L° - FT. 4 TOf e ABANDON T. S. T -� Well ed / INSTALL BIOC CLE 6000 00 \ ♦ ♦ 100 10 IZ to ♦ ♦ ♦ Well to I TOBBEN SPURKLAND P.E. ir UTH FORK NORTH BK 2 LOT 3I I SEPTIC SYSTEM DESIGN 203 W AK. AVENUE MILE 7 HIGHLAND ROAD DATE: SEPT 6, 1997 INCH. AK. 99501 BRIAN AND KARI SCHOENEMANN SHEET- 2/3 GRID:,W591 /on�l ��o_aola I PERMI T# PID # o,7 f.- % L/ /- 15 SFN0203L�', DWG i 150 \ \ • INS "At 5 -WIDE A.F. \ ' 37. FT LONG FT DEEP \ ' 12 -INCHES SAND BLANKET \ 5- INCHES SEINER ROCK • 3 FT COVER \ -� Well ed / INSTALL BIOC CLE 6000 00 \ ♦ ♦ 100 10 IZ to ♦ ♦ ♦ Well to I TOBBEN SPURKLAND P.E. ir UTH FORK NORTH BK 2 LOT 3I I SEPTIC SYSTEM DESIGN 203 W AK. AVENUE MILE 7 HIGHLAND ROAD DATE: SEPT 6, 1997 INCH. AK. 99501 BRIAN AND KARI SCHOENEMANN SHEET- 2/3 GRID:,W591 /on�l ��o_aola I PERMI T# PID # o,7 f.- % L/ /- 15 SFN0203L�', DWG i 4 -INCH INSULATION !ro O 1-1/4 PVC WITH 1/8" HOLES AT 30" UTO 5 X 37.5 DRAINFIELD 2 FT TOTAL DEPTH % 1 FT SAND BLANKET f �� �'� �� ` LEGEND: AIRCOMPRESSOR .5 FT EFFECTIVE ROCK —� AERATION TANK J. — 3 FT COVER DISCHARGE TANK 5. + AIR LINES +++ III -III -III -III -III -III- 6" MIN SAND BACKFILL — + + + " o - o - o - U v v noono( + + �1 - 3 O 2O + + SILT BARRIER 5'-2' MIN 6'-0" MAX + + NO SCALE BIOCYCLE 6000 LEGEND: 1. PRIMARY TREATMENT, SEPTIC TANK 2. AERATION TANK J. CLARIFICATION TANK 4. DISCHARGE TANK 5. SOIL ABSORPTION 49th ♦� I••TOBB• N SPURKLAND 7 W �Aw TCE-22.�......was 0. 25� 1UHULN SYUKALANU V.t.I I SOUTHFORK NORTH, RK 2, LOT 5 I I WASTEWATER SYSTEM SCHEMATIC 203 Wcge Ave BIOCYCLE WASTE WATER SYSTEM DATE: SEPT. 6, 1997 77.9—.3.97 6 Anchorage A!c 99501 SCHOENEMANN SHEET- J/3 GRID: SW95 PERMIT # PID # 078-141-13 SFN02033,DVG 0 Munlcipallty of Anchorage a DEPARTMENT CF HEALTH & HUMAN SERVICES t 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST { (ENGINEER`S SEAL)' 'fit yky� .1 Ir Pn.a. a PERFORMED FOR: �C,Vt��N�YJ/i �,N yJ t L�+r-i ctvr 4 �L oar i DATE PERFORMED:_/�t'II LEGAL DESCRIPTION:_SSDUTH POCK- NUe-T14 Township, Range, Section: DEPTH 1_&T 3 �V •� SLOPE SITE PLAN (FEET) 1 � c a 2 l t 3 � c 4 m u 5 s `, 6 } ✓ 9 7 YJ 8 O C 9 P 10 %;1 1 I'l /JS'X>1� la roe t,t-CX _ 3 Ql a� $n 110 VA pE_ 11 12 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? 10 O P E Depth to Water Alter Monitoring? fJ Dale: /`f/Y - Reading Date Gross Time Net Time Depth to Water Net Drop 7/ -33 ✓/ 3 v Y7 5 / 20{ I 9 fM ETfir' Iul PERCOLATION RATE `� (minutes/inch) PERC HOLE DIAMETER b t TEST RUN BETWEEN L FT AND FT DISCLFlIMFR (rnundwitAr ronditl�nS indiretPl arA for th datp hown only. Past and future presence and/or depth of groundwater can not be predicted from ese o scow ions. r� PERFORMED BY: _ i CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: 72-008 (Rev. 4/85) ` MUNICIPALITY OF ANCHORAGE % DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME 'beA*" PHONE I P!�fJEW e�Q%e.(� I �q — - ' ❑ UPGRADE MAILING AD1dVS S to LEGAL DESCRIPTION j pp --77Al LOCATION NO. OF BEDROOMS Uy Well/ Absorption area % DISTANCE TO: � Dwelling � /'.jm 2 PERMIT N w2 Q Manufacturer / Mate' I No, of compartments '7 � cJ� rn Liq. ca acp ity in gallons IF HOMEMADE: Inside length Width Liquid depth y DISTANCE TO: Well Dwelling / PERMIT NO. JOZ /Y 0Z O Z Q Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well / �� Foundation Nearest lot line 7 j PERMIT N w = (� �� J E Z No. of lines Length of e e/ Total lengj�i4li/iy Trench wid Distance between lines /1( A F,?� t.J ✓ �L! ZI� inches Q F- p Top of tile to finish grade / Material beneath tile Total effectiv b�r on a '.'L T .71- inches Length Width Depth PERMIT NO. LU 0 All I F Type of crib Crib diameter Crib depth Total effective absorption area Lu w DISTANCE TO: Well Building foundation Nearest lot line J Class D th Driller Distance to lot line PERMIT NO. J Lu 3: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING loosP INSTALLER REMARKS a^ooaa 'T_t1 �, �jesa *Aq T w o X' 1 �4.au ap J • a A� D 16bod A. ftojor k DATE APPROVpYrD;�„-�y�y '{g�c.s,��g6�A/Yv /' 01AI �i8'RY{'.Tf �SV �✓1 l9 ��%�YT.{'� f�f nrti� L // ��. (.: Il f s • l � a °?;isy„1 (/fes le ` 72-073 (Rev. 3/78) -__ FA Trriffirb Uri th ugirwalgr by DOC Co. dba SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 - OWNER OF LAND 661111 10 4s!"s.'J DEPTH OF WELL ADDRESS �5 !:' r'4 'A STATIC STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION Z- 3 rs �� � -'� ��� ; l %" •If9 F DRAW DOWN FT. 5 DATE - Started Ended `` ems_ GALS. PER HR ' r? (Q� PERMIT NUMBER KIND OF CASING 's C ' KIND OF FORMATION: Ft. to Ft. From r Ft. to 2' Ft. U c a of `„a From. _ Ft. to -LI ;. Ft.fFt`47 .m) From%r- _Ft. to '_,317t. From t °• Lx 6� From Ft. to Ft. to Ft. From .:q From '.j Ft. to .�.""t Ft. - 4ily As;e 1�, From '�.:. Ft: to -4 Ft. From Ft. to Ft <"tit From `�R Ft. to Ft. From Ft. to Ft. +— jc:�'7 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. MISCL. INFORMATION: From Ft. to Ft. i From Ft. to Ft. Ft. -Ft. �NICIPALITY OFA CHORAGE From Ft. to F .EPT. OF HEALTH & From Ft. to Ft Ft. T 1984 From Ft. to Ft From Ft. to Fk r uV z 0 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 .= I; Ft. to -Ft.,, Ft. From From Ft. to Ft. to Ft. -Ft. From Ft. to Ft. From Ft. to Ft. DRILLER'S NAME rq fro t r— I' t� L I T •-e Cl F = t 4 FR till E DEPARTMENT OF HEALTH AND Et•J'vIRONMENTAL PROTECTION 825 L STREET., ANCHORAGE, AK 99501 264-4720 ll q_et:i— g T� E:w1=F�> e� 1t�t�B_ PERMIT'.NO: 840298 DATE -'ISSUED: 05/07/84 -APPLICANT: C,'O S &" = ENG' G. DEAN CONSTRUCTION ADDRESS SRB 1966 EAGLE RIVER.- Alf 99577 CONTACT PHONE' 694-2979 F=b E F;? r-1 I _r LEGAL DE'SCRIP : SUBDIVISION.' SOUTH FORK NORTH LOT: 3 BLOCK: 2 SECT I ON: : 4 TOWNSHIP: 13N RANGE: 1W LOT.. SIZE:' (F22000. L (Sa. FT. OR ACRES) MAX -:BEDROOMS: 3_ LISTED'-BELOW`FIRE THE OPTION S- AVAILABLE TO `T`OU IN DESIGNING YOUR SEPTIC "SYSTEM.- THE OPTION THAT BEST FITS YOUR SITE. e DEPTH TO' PIPE " BOTTOM r FT. 7 4.0 4.0 4.0 GRAVEL 'DEPTH 'f FT. 7.._ 0 0.5 <. TOTAL 'TEPTH FT. 1.0.0 4 5 , 5 GRAVEL J+IDTH .( T. � ..2 5 20:.0, 5.0 GRA�i'EL "LENGTH' (FT. " 42.: O 3v. 0 54.0 VOLUME - . GRAVEL +� OLUME' _,� r_:t t. YDS. r5. c t 28.1 40.0 TANK ;SIZE ( GALS) 1., 000. 0 +;�►: 1. 000. 0 + � i, 000. 0 i SOIL ' RATING (w.n. FT. ;SBR) ,._ -165 155 165 srx. `TAhIF MUST HAVE AT LE PST TWO COMPARTMENTS I" "CERTIFY-THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS 'FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY -THE MUNICIPALITY OF ANCHORAGE (MOP) AND THE STATE OF ALASKA. .„2:.,I WILL INSTALL: THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONSA AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. T WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENT= FOR THE SET BACK :DISTANCES FROM'ANY-EXISTING WELL: WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEt1ERAOE SYSTEMON THIS OR ANY ADJACENT OR NEARBY LOT. 4: I UNDERSTAND THAT THIS PERMIT I=: VALID FOR A MAXIMUM OF 3 BEDROOMS AND' ANY`ENLARGEMENT.WILL REQUIRE AN"ADDIT-IONAL PERMIT. t -.IF A --LIFT STATT ON IS "INSTALLED IN AN 'AREA COVERED BY MOP BUILDING CODES, THEN (1) SAN . ELECTRICAL PERMIT .'AND ` INSPECTION MUST' BE OBTAINED; (2 ) AS -B1 t I LTS WILL NOT BE APPROVED -WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL -"WORK MUST BE DONE BY A LICENSED' ELECTRICIAN. _ DATE: ADPL IOANT : i:r'O 8: EN/G G.. DEANiltJ �TR� t In i1N T SSUED "BY,-� C RTE��� ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE H' PERCOLATION - o DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG PERCOLATION TEST PERFORMED FOR: h/df-- uIV LEGAL DESCRIPTION; Cr El! DEPTH (FEET) 2- 3- 4- 5— DATE 34 5 6 6 w 8- 9- 10 10 11 21314 12- 13- 14 16 ���,� ° A 17�La ® 1 18 � �0 ; Ross&] 19- 20 9 20 COM PERFORMED BY: 72-008 (6/79) DATE PERFORMED: / SLOPE SITE PLAN ' ®.mow WAS GROUND WATER - S ENCOUNTERED? U OL P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop 7 /07/ (p 23 o lU 11/iU�t it PERCOLATION RATE � ,r 1,(minutes/inch) TEST RUN BETWEEN FST AND g9 FT DATE: �1 W MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES IPALITY OF ANCHORAUt: Division of Environmental Services ENTAL SERVICES DIVISION On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 OCT p 7 1997 343-4744 CERTIFICATE OF HEALTH AUTHORITY RECEIVED APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # b' S r j VI — % 3 HAA # IA (-L�or� n Ll (0-1 1. GENERAL INFORMATION Complete legal description SOU-rH F 0 2 V_ Mo rZT N 13K 01, LOT I Location (site address or directions) �-e- -7 a 4 I',&41(_� lam'-° `_ Property owner �J40"We-mew 0 � 1z a", Day phone Mailing address Lending agency Day phone Mailing address Agent EFVA Loyip-i-I l/IS 1 A Day phone 6SI-4oY7 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well 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 Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOAB21 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 7d u -e P1 3P U y- k is �t�e Phone �79"3 y � k Address a2d yJ 7t �C':S Engineer's signature Date �04l / a7 6. DHHS SIGNATURE JApproved for .5 bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Servicer (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. 72-M(Rw. 1/91) Back MOA k21 41UNIGPAL17 OF Municipality of Anchorage EMvIR©NMENTALSERVCEN DEPARTMENT OF HEALTH & HUMAN SERVICES OCT 0 ? 199 Environmental Services Division dhl'15 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) Set/ Health Authority Approval Checklist ED Legal Description: SQy T N Fd P V- NbR: N Parcel I.D.: 07&- )ql - 13 A. WELL DATA 'B °2 I LO 1 Well type If A, B, or C, attach ADEC letter. ADEC water system number�� Log present (Y/N) �/ Date completed 3/g- Y Total depth Cased to 53" Casing height (above ground) Sanitary seal (YIN) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test l 9� y �f/9 J e1 J Static water level Well production 75 g -p -m- � g.p.m. WATER SAMPLE RESULTS: Coliform IN P % Nitrate R ID Other bacteria Date of sample: 47/`11) q-7 Collected by: �- B. SEPTIC/HOLDING TANK DATA h C- Y(- L-. F Date installed %0 9 7 Tank size 16990 Number of Compartments Cleanouts (Y/N)—�f— Foundation cleanout (Y/N)_ Depression (Y/N) High water alarm (Y/N) Date of Pumping ty Pumper N /� C. ABSORPTION FIELD DATA / 9 Date installed !�4a ` 4'7 Soil rating (g.p.d./ft2 or ft2/bdrm) n*. 17 System type - J e- i I � I �s �i / f3 r! Length 37. Width Gravel thickness below pipe � 46 Total depth � e Tr iITar4 ot fLwcCz.. Effective absorption area 7. Monitoring Tube present (Y/N)-Y-- Depression over field (Y/N) Date of adequacy test N Resulttssj(PPass/Fail) --? For bedrooms Fluid depth in absorption field before test (in.); Immediately after zgal. water added (in.): Fluid depth ✓ (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* /r If yes, give date t1- D. LIFT STATION l Date installedI D/ f0 �R i� Size in gallons _ //0 Manhole/Access (Y/N) "Pump on" level at*` 15 -"Pump off' level at* High water alarm level at* v z *Datum Cycles tested N E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /septic service line 1 10 + 1 Z o •F On adjacent lots On adjacent lots 1 10 + 1`41A Public sewer manhole/cleanout r4 /" Lift station J 1 f% SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: / Foundation a? _3 Property line %D Absorption field /0 Water main/service line Surface water/drainage f4 D Wells on adjacent lots > I� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line "T LL Surface water I -A l I0 Curtain drain N l,'© F. ENGINEER'S CERTIFICATION Building foundation a-7 Water main/service line >i;26 Driveway, parking/vehicle storage area Wells on adjacent lots _ > / 0-U I certify that I have determined thru field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name 0! Date HAA Fee $ 3 Date of Payment 11017#7- Receipt Number A?G� 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 0 -T -1? -1957 1453 CT&E ESI HNCHORRGE c"lir-:" erne Pro,�t amelN Client Sample ID Nlatrix Ordered By PWSTD 4 i &E Environmental Services Inc. 976103002 Tobben Spurkland P.E. NIA Lot3, 111U, SFN Drinking Water Parameter Results Tota: conform 0.00 PQL 3075615301 P.03i05 Client POS, Printed slate/Time 10/13/97 10:39 Collected Date/Titre 10/06/97 16:00 Received Date/Time 10/07/97 0$:40 Technical Director: Stephen C. Ede Released Ey Al.tokable Prep Units Method Limit$ Pate col/100mL sMia 9222E Analysis 0at2 ]nit '0/07197 TMw CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID CT&E Environmental Services Inc. 975212002 Tobben Spurkland P.E. N/A South Fork North Drinking Water Client PO# Printed Date/Time 09/08/97 15:44 Collected Date/Time 09/04/97 15:00 Received Date/Time 09/04/97 17:00 Technical Director: Stephen C. Ede 0 Released By Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Nitrate -N 0.500 U 0.500 mg/L SM18 4500-NO3F 10 max 09/05/97 JBL Total Coliform 0.00 col/100mL SM18 92228 09/04/97 TMW MUNICIPALITY OF ANCHORAGE D f 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 4_1/3 Application Date January 7,_ 1988 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3• Block 2• Southfork North Subdivision Location (address or directions) (b) Property Owner AHFC Telephone. Home Mailing Address Anchorage/ Alaska (c) Lending Institution City Mortgage Telephone Business Mailing Address Anchorage, Alaska (d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER — Eva Loken Address 16600 Centerfield Drive, Suite 201, Eagle River, Alaska 99577 Telephone oy�±-:F4Vv (e) Mail the HAA to the followina address: or: Check here M, if hold for pick up. List contact person and day phone number below. S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family U Number of Bedrooms 3 3. WATER SUPPLY Individual Well ly� Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ® Public ❑ Community ❑ 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 8/8M 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, 1 verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address S & S ENGINEERING 17034 Eagle KI.Ver Date e i away A,aska 99577 A� 0 6. DHHS APPROVAL Approved for 7-,A-4e bedrooms by Date Approved 6e Disapproved 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 iRev 8'W Back MUNICIPALITY OF ANCHOP.ACfAUNICIPALITY OF ANCHORAGE (MOA) LNVIr,ONMENTA1 SERVICES DIV14iLTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 n(i 264-4744 � . iv Legal Description: Z A. WELL DATA Well Classification 'FA If A, B, C, D.E.C. Approved (Y/N) Well Log Present (9N)-- `�-- Date Completed e Yield � Ph1 fi Total Depth �� t Cased t�o�t t Depth of Grouting Static Water Level �I Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (PN) S_ Sanitary Seal on Casing ®N) — Depression Around Wellhead (Y/4? Separation Distances from Well: I I To Septic/Fla" Tank on Lot ��� ; On Adjoining Lots 4— To Nearest Edge of Absorption Field n of 1�� ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer / Cleanout/Manhole To ``Nearest Sewer Service Line on Lot �ZZ Water Sample Collected by `�2 �$' INf Uri ; Date Water Sample Test Results Comments N -A- B. SEPTIC/FI6t$tld6 TANK DATA Date Installed Size \r_a7pr_2— No. of Compartments Standpipes OV) --4 Air -tight Caps N) — T Foundation Cleanout (DJ) _- y Depression over Tank (Y69 Date Last Pumped '�— Pumping/Maintenance Contract on File (Y/N) � ; for � Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from SepticfHeldia9 Tank: To Water -Supply Well «�i� To Building Foundation -2--2? To Property Line Oc> — To Disposal Field' " To Water Meirm/Service Line �i b + To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026 (Rev. 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design �'��-1 A-4 Date Installed (.C7 -q - Length of Field/ Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area �� Standpipes Present 6N) —_Y-, Depression over Field (Y(9 Date of Last Adequacy Test _ -6e�- Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well V-27 E5 To Property Line To Building Foundation Lot To WaterAtais/Service Line (ors)Ik To Stream%Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Da ailed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Existing or Abandoned System on On Adioinino Lots mol -f- N To Cutbank (if present) - I, Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) ng Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA,gu delines in effect on the date of this inspection. Sig�g S�NGINEERING Date /l/�� +tom ' Eagle River Loop Road No. 20 — —� p 3 MOA No. ? 2 ' , Co 1,7 < �Eag a Rrver, a�a Receipt No. /Do/ O 612-1✓ ep? Date of Payment � Amount: $ �� O% �y. , '., gjqeprSdeal 0 Page 2 of 2 72-026 (Rev 8/861 Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE Client PO# : VERBAL Req #: Client Snpl ID: LOT 3 BLK 2 SOUTHFORK NORTH S/D Sample Recd : JAN 8 88 Ordered By Send Reports To: S & S ENGINEERING R SCHAEFER 17034 EAGLE RIVER LOOP RD,, #204 EAGLE RIVER, AK. 99577 Special COLLECTED 1-8-88 Instruct: Chemlab Ref #: 8792 Lab Spl ID: 1 Matrix: Water Parameter Tested Result/Units NITRATE -N 0.30 mg/l Sample ROUTINE SAMPLE Remarks: ANALYSIS COMPLETED: 1-11-88 LABORATORY SUPERVISOR: STEPHEN C. EDE V 56 - 1 Tests Performed ND= None Detected NA= Not Analyzed Work Order No. : 4663 Client Account SNSENGP Date Report Printed: JAN 12 88 D 13:33 Released By : 2,A% Reports Address #2 M e". 7.x"e See Special Instructions Above * See Sample Remarks Above LT=Less Than, GT=Greater Than Allowable Method Limits 10 2N �14UN''ICIPALI)} l2QiVM IVTAI. OFv`LS U2ACf /vL,IOIv 1 j(�%fid .MUNICIPALIT ' F c`3€iC E1f.A4 DIVISION Off' F_%NIR0iT--i: N1r_i DEPARTMFN7 OF HEALTH f= MIROIN-J,T,NT.#L P TLCT1Q APPLICATION FOR 17ALTH AUTHORITY APeROV"f CERTLF',CATF 1. General Information Application Date i (a) Legal Description (include lot, block, subdivision, section, township, rai e) G f /5� %6r Location (address or directions) (b) Applicants Namec.c>Telephone -1iom�&--mess 1 Applicants Add-ress__Z__7t_ % 31 .S - - (c) Applicant is (check one) Lending Institution ; Owner/builde.�1 Buyer F�_ ; Other [:::I (explain); (d) Lending Institution Telephone Address -- (e) Real Estate Co. & Agent Address - Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Number of Bedrooms 3. Water Supply Individual Wellq) 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 F-1 Community F-7 Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 21 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 r A���� r,��i�F7' _'�- Telephone Address4� Date �����/ i ��`OF.4�tt� .vim • • : (ENGINEER SEAL) �}vHiz oaaca e.a°� dQ,o� o. 2225_U p� 6. DHEP Approval {� �••• JUNE 25, 1371 1 / Approved foo bedrooms By "a .•..Da Approved X_ Disapproved Condit Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF D'dEP 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 7-1984 1 r MUNICIPALITY OF ANCHORAGE (MOA) �' 71 1 HEALTH AUTHORITY APPROVAL (HAA) G, AVO CHECKLIST - FEBRUARY 1984 N01M31 V1 v :_ Legal Description: Z7"- a '8 d: A. WELL DATAc irk dvv210HZ)NV do uiiv Well Classification rLi v If A, B, or C, D.E.C. Approved(YM) Well Log Present (Y/N) T% Date Ccopleted Yield Total Depth 5-3 Cased to 1-/5-' Depth of Grouting Static Water Level S / Pump Set At 43- sz' 6!? ' Casing Height Above Ground �2/ Sanitary Seal on Casing (YM) Electrical Wiring in Conduit (Y/N)/ Depression Around Wellhead (YM) Separation Distances from Well: lav To Septic/Holding Tank on Lot On Adjoining Lots �U� To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line fid- To Nearest Public Sewer Cleancut/Manhole ��� _ To Nearest Sewer Service Line on Lot /env Water Sample Collected By ynV,.,,le, Date �?/�^�ZE4 Water Sample Test Results Se s Comrents B. SEPTIC/HOLDING TANK DATA Date Installed //06;-V Size 1k? 00 No. of Compartments Standpipes (Y/N_ ) Y Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Al Date Last Pumped itle-r.� Pumping/Maintenance Contract on File (YM) for Holding Tank High -Water Alarm (YIN) Temporary Holding Tank Permit -(YM) Separation Distances from Septic/Holding Tank: 0-3 To Water -Supply 1KJe11 To Building Foundation To Disposal S' To Property Lire /0 1�sal Field To Water Main/Service Line 16::)+ To Stream, Pond, Lake, cr Major Drainage Course _ /V avxA Comments 75'ym LL anc �i73 ®ioa� �n Y/r✓� i [Page 1 of 21 ECSC C 3c) -1 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Ids- `Xf,.t Type of System Design Date Installed Length of FieldD Width of Field Depth of Field fez:?,-, Wil, Gravel Bed Thickness 7•,7- '' Square Feet of Absorption Area L/ cz�,5 19� Standpipes Present (Y/N) Depression over Field (Y/N) `V Date of Last Adequacy Test /l/< (,O Results of Last Adequacy Test Separation Distance from, Absorption Field: i To Water -Supply X11 /Z�-? To Property Line o761-' To Building Foundation -36 To Existing or Abandoned System cn Lot/'✓� On Adjoining Lots i �?p .t To Water Main/Service Line �OJ'� To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Courser - To Driveway, Parking Area, or Vehicle Storage Area --3Z>''-" Commnts A-te �-ky'rL D. LIFT STATION _i Date Installed Dimensions Size in Gallons "Pump On" Level at Manhole/Access (Y/N) "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for _ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Ccmwnts ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed 0- 6e.s -O Date ,� L •.� F� Company T � 1�cx S,�-�r��d�/�.,a( .v�"L� MOA No stay -,•.;v //p°° g o *.4 KB1/d5/s ..i .,d....,. 2225-E= �5 JUNE 25, 1971 0io - - (Page 2 of 21 • ' 2-15-84