Loading...
HomeMy WebLinkAboutSMITH LT 2Smith Lot 2 #05 ! - ! 54- 52 { Municipality of Anchorage Oevelopmoat Services Department ! · ~uilding Safety Division '~ OmSite Water and Weetewater Program, 47~ EImore Road P,O, Box 1966~0 Anchorage, AK 99507 Page ! of www. ci.anehorage,ak, us (907) 343-7~04 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Numbe[; swoooos9 PiD Number; 051-154-52 Nam°,- OREO PEARCE Waatewatar System: L'D New [] Upgrade 200~3 CPu~BTREE STREET ABSORPTION FIELD Phor~e:......... N~ml:~r of Be~lg~m: :3 [] Deep Treilc:h ~ $imllowT~nd3 [] E~ed [] Mound I-I Otho~: ,..'..Coil Ratlnll: ..... T~l Depth from LEGAL DESCRIPTION 4~0 e.rm~ 4,~ Well: ~ New ~ Up~ S.0 ~t. ~ [N/A ~ISTING PRIVAT~ / ~t. ~, ~ ~= ASTM 30~/ABS/FS~0  D~ GREEN 612o/2009 ~m ..... ~='1 .... e, TANK SEPA~TION DISTANCES ~ s~tic ~ H~d~ng ~ ~.T.E.P. ~ Other: To ~eptte Ab~or~on L~ Holding *ubli~Private ~nu~aurer: ~ep~: ' ~ Tank Field Station Tank Sewer L~e ANCHO~GE TANK 1250 ~ 100'+ 1~'+ 25'+ ~TEEL 2 ~.~..w~. ~oo'+ _ LIFT STATION Development Sewlces Depa~ment Approval .... , / ~,~ //~ ............... PERMIT NO SW090059 PAGE 2 OF 4 Municipo, Lit;y oF' Anchopo, De DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, /-+700 BRAGAW STREET P,B, Box 1966p, 0 e Anchoroge, ALosR~ 99519-6650 · A TeLephone: (907) 343-7904 ·www,ci,onchoro, ge,o,k,u: ON-SITE WASTEWATER DISPOSAL :::SYSTEM AND/OR WELL INSPECTION REPOR' LEGAL LOT 2; SMITH S/D P.I.D. NO. 051-154-52 EXISTING ~ / SHED / \ -FC01 / -- % ~ / ~ FCO2~S.T.E.P. TANK - ' ISCONNECTED o ~c~¢09 MH EXISTING TREN( ~~~d,~;~ ~ ~ ks)~.~// FOR LATER US, . NEW SHALLOW '.;.""'.'l.':'." ',.-'."}.'~"; '-."'"" :":r': ~ r . ' ELECTRICAL EASEMENT 'R.O.W. E~SEMENT ~TH~2 TARIKA AVE. PERMIT NO. SW090059 PAGE 3 OF 4 hdunicip~Lity ©¢ Anchonage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, &700 BRAGAW STREET P,D, }}ox 196650 t Anchorage, A~osko 99519-6650 t TeLephone: (907) 343-7904 ·www,ci,anchorage,ak,u: ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR' LEGAL LOT 2; SMITH S/D P.I.D. NO. 051--154--52 100' WELL RADIUS o~00 / 1' = 50' PERMIT NO. SW090059 PAGE 4 OF 4 MunicipaLity o~' AnchoP~ge DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, /-+700 BRAGAW STREET p,rl, ]}ox 195650 t Anchorage, ALaska 99519-6650 ®TeLephone, (907) 343-7904 ·www,ci,cnchorage,ck,us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR' LEGAL LOT 2; SMITH $/D P.I.D. NO. 051-154-52 FINAL ST1 / GRADE II / · . .............. II .................................................. .!, M;.._~ TOP OF TANK T~NEW 1250 ~ , INLE ALLON STEE =96.1 S.T.E.P. TANK - 96.9' MT2 MT2 94.9'~ MT1  FINAL GRADE = 100.:l' __ ~ ~-~ORIGINAL GRADE = 99.4' ........... .~ 2" INSULATION -~ DISTRIBUTION PIPE ~%-MT1 = 94.9' 96.9' · WATER FOUND ® 87.4' B.O.H. 89.9' A B C DBL FC01 10.2' 9.9' DBL FC02 10.8' 10.7' ST 14.5' 15.5' MH - 20.6' 22.9' MT1 77.0' 42.2' MT2 55.1' 58.5' N. T. S. MUNICIPALITY OF ANCHORAGE Development Se~/ices 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: May 14, 2009 Expiration Date: May 14, 2010 Permit Number: SW090059 Legal Description: SMITH LT 2 Design Engineer: 0003 S & S ENGINEERING Owner Name: GREG PEARCE Owner Address: 20013 CRABTREE STREET CHUGIAK, AK 99567-5924 Parcel ID: 051-154-52 Site Address: 020013 CRABTREE ST Lot Size: 39120 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] 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. 5. The following special provisions. THE ENGINEER NEEDS TO DO AN ADDITIONAL PERCOLATION TEST PRIOR TO CONSTRUCTION OF THE SEPTIC FIELD. THE PERCOLATION TEST PROCEDURE IS TO FOLLOW TABLE 3-8 OF THE EPA DESIGN MANUAL. PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE AS-BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE SYSTEM WILL STOP PENDING ON-SITE REVIEW AND APPROVAL. Received By:. Date: Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmora Road P,O. Box 196650 Anchorage, Alaska 99507 www. muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 0.51 - 1.5 Property owner(s). (~REG PEARCE Mailing address 20013 CI:~.BTREE, CHUGIAK AK. Site address SAME Legaldescription (Sub'd., Block& Lot) SMITHS/D, LOT2 Legal description (Township, Range & Section) Lot Size ,~_~C~, I ~) Sq. Ft. Day phone 688-8926 .Zip Code 99567 Zip Code Number of Bedroon~ THIS APPLICATION IS FOR ([~] all that apply): Absorption Field [] Septic Tank [] Holding Tank [] Priw [] Private Well [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] Water Storage __ [] I certify that the above ixp~co/ect. I further certify that this application is made for a Single Family Dwe~ in acc~r'ance with applicable Municipal Codes. being Permit/Rush Fees: Date of Payment: Receipt Number. (Rev 11/05) Waiver Fees: Date of Payment: Receipt Number, ROBERT C. COWAN . CIVIL ENGINEERING May7, 2009 PH: 907-694.2979 FAX: 907-694-1211 S0~1. TEST MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 2; Smith S/D it is requested that you issue a permit to install a new pressurized septic system to serve the peoposed three bedroom dwelling on the referenced property. Two test holes were excavated and percolation tests performed by S & S Engineering. The approximate locations of the test holes are located on the attached site plan. At the time of excavation (4-27-09 'rH#1, 5-7-09 'Df#2) water was found at I0 feet on test hole #1 and test hole #2. After seven days of monitoring, ground water ~vas found at 8.8 feet on test hole # 1. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction ofthis system will not prevent any futura development on any ofthe adjacent properties. If you req~nal information, please contact us. Enclosure 15861 S. Blrchwood Loop Road - C. hugiak, Alaska 99567 SITE-PLAN DESIGN 'iS 33~18¥~3 iN3M]$¥] 9¥31a13313 ~ ~033931 1"=40' zr~ II II Municipality of Anchorage Development Services Department 4700 South 8ragaw SI. 5- 6- 7- 8, 9- 10. 11- 12- 13- 14- 15- 16- 17- 18- 1g- 20, Slope Site Plan WAS GROUND WATER ENCOUNTERED'/ IF YES. Ar WHAT DEPTH? /O' Monltodng? Re.ding ////~O;~ ~,Ol. Time Net T',.. ! Dep,,to W..,, N.I I~op /0 /~ /~ ~., i ,' i~ ~ II ', i~,, I" ID '~ [[" /~" PERFORUED BY: I CERItFY TIIAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAl. GUIDELINES IN EFFECT ON THIS DATE. DATE: Legnl L.~saiplion: 11- 12- 13- 14- 1,5- 1~- 17- 18- 20. Municipality of Auchorage Development Services Oepadmenl BulMing Safely ~slon ~-SIIo Water a~ Wast~aler pr~ram · ~zoo South e.a~ S~ ~.munl or ~onsilo Soils Log - Percolation Test WAS GROUNO WATER E.COU. TEREO~ ~ S IFY~S.A~.~TOEpT.? IO~ o~ Re ~dlng Dale GrOl! Time Nel Tbne ! Deplh Io W~ler Nel Drop PERFORMED BY: I CER! IFY THAT TNIS TEST WAS PERFORMED IN ACCORDANCE W1TF! ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON IHIS DATE. DATE: ROBERT C. COWAN. CIVIL ENGINEERING PH: g07-694.2979 FAX: 907-694.1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 2, Smith S/D May 7, 2009 GENERAL: The scope of this project includes the installation of a new 1000 gallon HDPE septic tank, a new pump basin, and a new pressurized shallow trench to serve the proposed 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. 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 Development Services Department or ADEC if required, for system installations. Owners installing their ova systems must also receive prior approval from the respective agency. 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. Ail HDPE septic tanks are required to have a 4" monitoring pipe installed next to the tank extending to the bottom of the tank. 15861 S. Birchwood Loop Road - C. hugiak, Alaska 99567 The septic tank shall be sufficiently bedded to prevent settling of shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. All HDPE septic tanks are required to be covered ~vith a minimum of 2" direct burial insulation, and a maximum of 4 feet of cover. A foundation cleanout shall be installed one to four feet from the building foundation. 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 side,vails of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level xvith the holes faced downaard. The distribution piping is to be of PVC (ASTM D3034 or equal). AIl joints are to be solvent cemented. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches ofcover 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 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 ns 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. I~ 7,~0~ 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, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leaehfield gravel layer and the native soil backfill. 6. All lcactffield 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, which ever specifications applies. P~ge 4 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 ofany gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 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 th,tn 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 ns 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 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/OF1 WELL INSPECTION REPORT NAME PHONE ~RES~ & ~ t6,~IN~RIN ~ ~GAL DESC ~UPGRADE /_. "Z ~ ~ ''~ ~ Inside le~gth Material beneath tile //,f~ ¢! inches Depth NO, OF BEDROOMS Liquid depth PERMIT NO, Liquid capacity in gallons Distan~cg~ines Total fec[~iv¢_absorp '(fn are8 PERMIT NO. DISTANCE TO: Crib depth Building foundation Driller Building foundation Sewer line Total effective absorption area Nearest lot line Distance to lot Jine Septic tank OTHER PIPE MATERIALS sol L TEST ~ATI~ INSTALLE . PERMIT DA ]"l!!: J;SSUED: 840845 :1. 0/()4/84 APF:'I...ICAIq"I": CIO S & S i!~N~'G. ED SCOT'T hDDRESS: SRB :L96X EAGLE RIVER~, AK ~295~77 CON'~AC]" F:'HONI}:: 694-2979 15N L. OT: 2. BLO(]I<: NA RANGE: I_i!~rLe!d below al'e t. h0~ optic)rls avai].al::)le t.o you zn syst, em. Cl"loc)se the) opt.:i, ol] tl'aa't. L,x,~st f'i{s youP DEF:'TH TO PIPIE: BOTTOM (1"""'1".) 4 GI::~AVFZL. D[L:'F~TH (FT.) TO'I:AL DEF::'"FH (F"T'.) 4 ,, 5 5,, 0 GRAVIF]... WIDTH fi:T. ) 14,, 0 5.0 GRAVIZL I....IENE)TH (FrT',,) 28.0 40. GR~VEL VOL, UME (CU. YDS,, ) :1.4,, 6 14,, 9 TANI< SZZE (GALS) 1,000.0 '~"x' ],()()(),,0 '~' '}~',~- DEF:'TH TO F'IF:'F BOT]'OM < 4.,,0 F:'T,, MAY' REC~LU:I::dZ A L. IF:'T' ['YFA'I"I[)N '~ TANK MLIS]' HAVE AT I. EAST TWO C[)I~IPAIRTMIZNTS c:et't :L t'y that: I am t'amiliar' wit. h thc: r, equil'~!merrLs for' or'l.,-sit, c~ !sewers arid wells as f'-or'tll by t,h~:~ Mur~ic:il]a].:Lt:.y o~" aFrlc]hoPa~]J:'~' (M[]~) ~AI'IQ t, he St, ate of' Alaska,, I will :i.l-lst. all the sys'Lem :i.n ac::cc)r'dartc:~::~ wi'Lb all MOA c:ocl0)s and i'et:ju].a'Lior'H~i ar'id in c:c:)mp],ianc::e with 'Lh(c~ design cr'iter'ia of' th:Ls per'mit.. d ista['lC:((~s [' pofll c~l"ly E)I.( J,~'[. J,I]~:J ~:.)], ], ~ WJLI~B'I',(~v~at,~.)P d :LSl:)c>sa]. sys:[:em or' pul:) sewePago system on thi~i oP any ad.jac:er'rL oC ne~ar'l~y lot. I Lu]dI:]P~t.F,~FId that 'Lh:i.s I:)((~H"ffliC :i.~B val:i.d roi" a max:i, mum o[' :3 I::~e~dr'c:~c)ms and any erl),apge)m~rvt, v~J. ll c[]clt.tir'e an add:i, tional :1: F' , A t,. I FT STAT I I::)N I S I IxlSTALJ.I!!i:D I Iq AN AREA C[)VI!3::li~i:)] BY MOA BI.J :1: LD I NG CODI!ii:!!',;, 'IT'IIL~]',I (1) AN li:]_EC, TF~hI_ F:'EF~MIT AND :I:N[~I::'ECTION MUS'F BE OBT~:I:NE:D: (2) ~S'"'BUILTS WIt,I,.,j. NO]~ [~E AF'F'~[?) WITHOUT ~N 13,,,.EC'?~r~{~l... INSI?ECTZ?N RIECF:'ORT;' AND C3) THE I-I..I..L,I I~].[,.,~1.. ~I~--B/~:IF~: L,Y A L.I. CI....I~,.~LJ.) LL. LC Ih.I. CIAI I,, Al I-L..I.(,AIII. ~d:[l EII[~ [.~. E.,D ,~COTI MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchora~le, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [{ SOILS LOG [] PERCOLATION TEST 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS '~ ~: SRB 196X . W^S ODNOWATER SLOPE SITE PLAN IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~/' ~/t I *"//// (minutes/inch) TEST RUN BETWEEN -- . FT AND ---- FT OWNER OF LAND ADDRESS LEGAL DESCRIIrflON DATE - Started PERMIT NUMBER by DOG Go. dba SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 I)EI'TIt OF WELL · STATIC LEVEL OF WATER F'F. I)RAW DOWN F'F. . Ended · GALS. PEF, HR KIND OF CASING KIND OF FORMATION: 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. Frmn , ' 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. Frmn____Ft. to _____Ft, From____ Ft. to____ Ft. From Ft. to _Ft~ From _ Ft. to ..... Ft_ From Ft. to Ft, From Ft. DEPT. O~ HEALTH & From Ft. to from Ft. to Ft. From Ft. to _Ft .,on, _ ,RECEIV2D From ~Ft. to~Ft From~Ft. to _Ft. From ~Ft. to~ _.Ft From Ft. to_ Ft. From Fl. to Ft. From Ft. to~ Ft~ MISCL. INFORMATION: DRILLER'S NAME PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND NUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910151 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:~MI~ DAVID G OWNER ADDRESS:20013 CRABTREE ST CHUGIAK, AK 99567 DATE ISSUED: 6/12/91 EXPIRATION DATE: 6/12/92 PARCEL ID:05115452 LEGAL DESCRIPTION: SMITH LT 2 SEC 8, T15N, R1W, SM LOT SIZE: 39120 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IlS FOR THE CONTRUCTION OF: WELL SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: EXISTING WELL TO BE, ABANDONED. ISSUED BY: ~/~~~~ DATE: DATE'. ECEI ED Municipality > S .?rage Dept. Health'& Hun an ~ervice ASBUIL~-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESORIBED PROPERTY~ Lot 2, Smt th Subdi vision AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDIDATED. IT IS THE RESPONSIBILITY OF THE OWNE~ TO DETERMINE TIlE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRIOTIONS WHIOH DO NOT /~PEAR ON THE REOOROE~ SUBDI- VISION PLAT. UNDER NO 61RCUMSTANCES 8HOU~ ANY DATA HE~EON BE USED FOR CONSTRUCTION OF FENCE LINE8~ OR FOR ESTASLISHIN6 BOUND- ARY LINES, L SCALE, 1" = 30' DATE, 6-7-91 5/12/91 ' 8RID; NWl 257 -- FB 20'-51 DRAWN' DNS ASBUILT-NO CORNERS SET THIS [)ATE. SEWARD & ~SSOCIATES LAND .SURYEYINB 688-45.' FOLLOWING DESCRIBED PROPERTY: Lot Z, Smith Subdivision DATE: 6-7-9] AND ~AT NO EN~OACHMENTS EXIST ~CE~ AS 5/12/91 '~.. INDICA~D. IT IS THE RES~NSIBILITY OF THE .... ~N~ ~ D~ERMINE THE EXISTENCE OF ANY ~RID~ f. ...................... WHICH DO NOT ~PEAR ~ THE RE~D~ ~BDI- VISION PLAT, UNDER NO CIRCUMSTANCES S~ FB:FB 20151 ~Y DATA H~EON BE USED FOR CONSTRUCTION {~*'t%~/~ ...... ~,' OF F~NCE I. INES~ OR FOR BST~LISHING ~ND- DRAWN~ ARY LINES. DMS I-,o ABBUILT-NO CORNER8 SET THIS DATE. ] HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DI~SCRIBED PROPERTY: Smi th 8ubd:i vJ sion AND ~AT NO EN~OACHM~NT8 EXIST EXCE~ AB INDICATED. IT IS THE RES~NSIBILITY OF THE ~N~ TO D~ERMINE'THE EXISTENCE OF ANY E~EMENTS~ COVENANTS~ OR RESTRICTIONS WHIOH DO NOT ~PEAR ~ THE RE~D~ VISION PLAT, UNDER NO OIRCUMSTANCES ~Y DATA HI.EON BE USED FOR CONSTRUCTION OF FENCE LINESl OR FOR EST~L, ISHING ~ND- AEY LINES. SEW;J~D 1" = 30' 5/12/91~6/25/ ORID~ FB 20-51 DRAWN~ DM8 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER b) DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUG]AK, ALASKA 99567 · TELEPHONE 688-2759 ,~'TQJ i',:'// DEPTH OF WELL _ ~ t'I(' LEVEL OF WATER F r, '~ ) ~ ~ ;__~L_ /, ~X~ '~A,, DOWN / Ended t~/ y/ GALS. PER HR KIND OF CASING KIND OF FORMATION: From [~ Ft. to~? __Ft. - . " ( '' ..... From From, /__Ft. to Ft. F) (1(,:/;, fi~ d,:~¢;L:i~-_.J_ Frmn From / } Ft. to~ Ft, /~g))~t,~ ?~ ("x)~ From From~':'(~ Ft. to"/-}~Ft. =f-'/ ~t~/l ~'_~ ~' From From Ft. to Vt.r' :,."~: ' · From ~ '' ~d, ...... ' From ~ Fl, lo/~ Fl, .~/<~.~ '' ~ ~ ' ' ':; Fmm~ Ft, to__FL ~/;' /< ¢ · From From /"~ Ft. to fl () Ft.~)"~ 'O/2 ~z ~:,-¢- From~ From Ft. to _~Ft. L~,r ~ ~ l.': From~ 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 Ft. to .... Ft. Ft. to_ _Ft. Ft. to Ft. Ft. to_ _FI.,. FI, to -Ft, Ft. to___ Ft. Fl. to Ft. Ft. to Ft. Ft. to___ Fl, Ft. to_ _Ft. Ft. to_ __Ft. Ft, to Ft. __Ft, to__ _Ft Ft, to__Ft, FL to Ft. Ft. to Ft. _Ft. to_ _Ft MISCL. INFORMATION: DRILLER'S NAME 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1, GENERAL INFORMATION Complete legal description Location (site address or directions) 20013 Crab~ee Property owner Mailing address Lending agency Mailing address Dave & Vivian Smith 688--2858 Day phone Box 3572 Chugiak, Alaska 99567 Day phone_ Agent Darlene Nicholays~n RE/MAX OF EAGLE RIVER Day phone Z694-4~00 Address 16600 Ccntcrfield Driv~ #201 Eaql~ Riv~r~ Alaska 99577 Unless otherwise requested, HAA will be held for pickup. 2, NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well XX Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Hotding 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. 79-025 {Rev. 1/91) Fronl MOA ~21 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 heroin. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastew, ater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations [n effect on the date of this inspection. Pho.e _ .~ ?~ .~ ENGIN~'ERING 17034 Eagle River Loop Road No, 204 Name of Firm _ Address _ Engineer's signature bedrooms. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, with the fellowing stipulations: Additional Comments Date 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 n the professional engineer s wor . 72-025 (Rev, 1/91) Back MOA/~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D.. A. WELL DATA Well type Log present (~)/N) Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number '"¢ Date completed L,, r ~\ Driller Casedto_ -~c~' c1~ Casing height _ Wires properly protected (~N) ~ FROM WELL LOG Date of test C0 - ~ t Static water level Well flow - Pump level g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line AT INSPECTION ; On adjacent lots ; On adjacent lots . Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Date of sample: ( ¢,_ ,~_~ Nitrate Collected by: B. SEPTIC/HOLDING TANK DATA Date installed \O~¢¢~ Cleanouts~N) _ ~ High water alarm (Y~ Date of pumping -'/'l~/ I/ Other bacteria .,*40,4 ~_~ S & S. ENGINE[RING Eagle River, Alaska 99577 Tank size ~, OOO Compartments 'Z.- Foundation cleanout~/N)_ ",/ Depression (Y~' . Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~. 0 (.~ ~ / .c- To property line /o On adjacent lots ~ ~ ~ Foundation Absorption field ~- ~ Water main/service line /~ Surface water/drainage 72-026 (Rev. 3/91) Fron[ MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~ Meets M OA~~ ¢~ DISTANCE FROM LIFT STATION TO: ~ on lot On adjacent lots Manhole~_ ~ "Pump off" level at Cycles tested Surface water D, ABSORPTION FIELD DATA Date installed Length "~C> Total absorption area ~.~"~' Depression over field (Y~ /4' Results ~fail) Peroxide treatment (past 12 months) (Y~) Soil rating Gravel thickness Cleanouts present Date of adequacy test for If yes, give date System type '~¢/-..-z~.., Total depth Y bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /,OC~ To building foundation /o On adjacent lots Surface water Curtain drain /'J//x- E, ENGINEER'S CERTIFICATION On adjacent lots tOo ~" Property line To existing or abandoned system on lot Cutbank '~//¢¢ Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA, rte of this inspection. Signature Engineer's Name S & $ ENGINEERING 'i 7034 Eagle River Loop Roa~l NO, 204 Bate l~at, lle River, Alaska 99577 HAA Fee $ ,/~/~D Dateof Payment -/' I .-- 72-026 (Rev. 3191) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number //~ CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING Date ~eport P£inted: JD~ 2B 91 ! 16:D$ Client Name P~SID Collected JUN 26 91 ~ 14:30 hts. aPO ! Received JUN 27 91 ~ 16:45 h~. Req ! p~e~etved with :AS RBQUISED Ordered By Chemlab kef I: 913072 Lab Smpl ID: 3 ~(attix: Allo~abl~ Po:a~ete~ To,ted ~eault Unit~ ~ethod Limits ND= None Detected "Lee Sample ge~ackl Above NA- Not ~nalyzed L~-Le,~ ~h~n, OT.Gzeatet ~han MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONK~,NTAL HI{ALTH DEPARTMENT OF HEALTH AND BNVIRONMENTAL i~IOTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1o (~neral Infol~nation Application Data (a) Legal Description (include lot, block, subdivision, sect{~n~ to~mship, range) noca lon 9 3d?nsa of direction) (b) Applicants Name~' ¢ ' ~ ~'~d Tel ne" Home Business (C) Applicant is (cheek one) La,ding I..,itu,lou Buyer ~ ; O~her ~I <=plain); (d) Lending %ns'citution____~o~ ........ _%_'~!ep_hjn_.e ......... ~j Address (e) Real Estate Co. & Agent /,~/~ ~'~? Address Telephone (f) M~rti the HAA to the following ~xldress: ~T~ Residence Single-Family ~ Multi-Family ~l Number of Bedrooms . '1~ .......... Other (describe)~ ....... %ndividual Well ~ Community ~ Public --~----I Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. C)nsite~:'~~ Public ~7__q Community ~._~ Holding Tank ~ Note: If community well system, must bare written cmafirmation from ~he State Department of Enviromaental Conservation attesting to ~he legality and statua. [Page 1 of 2] 5- E~ineerin~. Firm Pro~v_idln?~I~jjn~p~e~.:tlons~, T_es~t:.~q~_!?ile Search, Data and Info'nua~ion As certified by my seal affixed hereto and es of the validation date .~ho~m~ below~ I verify ~ha~. my investigation of thim Health Au~horlty Approval show~ t:hat the on-slue water ~upply and/or wastewater disposal system is ~afe, functional and adequate for ~he number of bedroom~ and type of structure indicated herein°. I furt. her verify that, based on the informa~ion obtained from the Municipali(:y of ~~qchorage files and from invsstiga~iom sa~d inspection~ the on--site ~ratsr supply and/or wastewat~er disposal system is in compliance with all Municipal and Stage codes, ordinances, and regula- ~ions an effect o~ the date of this inspection. Name of Fi~:m Telephone DHEP A_~roval Approved for- '~'- ~'?I~ Jfei'~boms Approved ?~ Disapproved Terms of Condition&l Approval By Conditionel CAUTION T}/E MUNICIPALITY OF ANCHORAGE DEPARTMENT OF H>]ALTH AND ENVIKONM~NTK[, PROTECTION (DNEP) ISSI~S llFakLTN AUTHORITY APPROVAL CERTIFICATES BASED SOI2;LY UPON T}hE RFfPRESENT~ ATIONE GIVEN IN PARAGRAPH 5 ABOVE., BY AN I_NDEPENDENT PROFESSI0~IL ENGINEER REGISTERED IN 'llqE STATE OF ALASKA° THI~ DHEP DOES %%1IS AS A COURTESY TO PURCHASERS OF HOMES AND TtR~,IR [J~NDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUYJlE~- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFI. CA%~ IS ISSUED. 'I~IE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBI~: FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (])HEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEAL~ ~/3THORITY APPROVAL (HAA) 1905 CHECKLIST - FEBRUARY 1984 ~1]. Classification ~/~ If A, B, ~ C, D.E.C. ~pro~d(Y~) .... ~/. Total ~p~ ~ ~sed to ~ ' -5 ', ' ' z ' Static Water Level ~ ~ Pump Set At Casing Height Above Ground ~ Electrical Wiring in Conduit V Separation Distances f~c~ Well: To Septic/~.~ Tank on Lot. Sanitary Seal on Casing ~/N) Depression Around Wellhead .(~6~ . __; On Adjoinzng Lots_ To Neam.~st Edge of Absc~lption~ield on Lot ~"~ ' _1 (~ Adjoining ~ts /OO To Ne=est ~blie ~ Li~~u ~'¢ /O/~ TO ~=est Public Wate~ S~le Test t~sults .B~ ~f/~ F~q ( '~' ~7 SEPTIC~ TANK D~rA Date I?stall, d /O~A/~/ Size /~67~5? No. of Ccmpalztn, nts ~- Standp1.pes~/~,)' AiI?-tight Cap,~_~ Foundation Cleanout~Y~) Dep~,ession eve, Tal~k (~ Date Last P,~'~ed .,4.3 e ~-J' Pumpi. ng/Mainte?ano~. Con=act on File (Y/N/~f~$ ; for ---- Holdlng Tank High-Water Alarm (Y/N)ZU/~ Temporal.~y Holding Tank Permit (Y/N)/~/)~k Separation Distan=~s E=cm Septie/%~t~a~ Tank: To Water-Supply WeJl ,/~- ~-~ ~ To Property Line _ To Water Main/Se=vice Li~e Course Comments To Building FoundatioD ~ To Disposal Field ff ' //O ~- TO Stmeam, Pond, Lake, c~ Major D~ainage Receipt # Date Paid: /~moun~: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils P~ting in Absorption St2ata Date.Installed Width of Field Square Feet of Absorption ~A~ea _ Depression OVer Field (2/~ Results of Lest Adequacy Test Date of Lest Adequacy Test Length of Field Depth of Field ~ Gravel Bed Thickness Separation Distance f~cm Absc~ption Field: To Water-Supply Well / 75 ( To P~operty Line To Building Foundation ZO t To Existing or' Abandoned System Lot /~/~D~_3~ ; On Adjoining Lots ~r3 To Water Main/Service Line /O ~ To Cutbank(if p~esent) To Stream/Pond/Lake/or Major D~ainage Cctn~se /%/o To D~iveway, Pa~king A~ea, or Vehicle Storage A~ea ~ Con,cents ~ O ,~J ~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High WeteE Alarm Level at Tested for Electlrical Codes(Y/N) Comments ~ D~nsions /'/ anh, o /Access (_Y/N) ~ ,/'~f" Level at ~ ~ Vent (Y/N) Pumping Cycles ~ing Adeq~ ~st. Msets MOA ~* Check Permitted Bed~ocra Rating Against HAA Request I certify that I have checked, verified, c~ oonfc~m~d to all MOA HAA Guideli¢~s in effect on the date of this inspection. Sigaed _~'-~ ~ ~.~i?4~RINtl Date ~ O ~ C~n~any ~ ,...,~,L~II~E~. A~ASK~ ~ MOA No. KB1/d5/s [Page 2 of 2] 2-15-84