Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
T11N R3W SEC 3 E2SE4NW4SE4
TIINI R3WI Section 3 E24, sE4, NW41 SE4 #020-092-09 Municipality of Anchorage Page f of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: -_5 w 4407 a;z o Zo—oqz-oq PID Number: Name: /—PC iRAPIeja C as r Wastewater System: O New ❑ Upgrade AOOre s: 662�vZr,_70 IL 44s76 ABSORPTION FIELD Phone: S33 No. of Bedrooms: Deep Trench D Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grad;: LO[: Block: Subdivision: r spryNtaV sir/ `��LO• GPD/S Ft Depth to pipe bottom from Original grade: 4R Gravel depth beneath pipe Township- / P' Rangy w Sectio : .yr Ft Fill added ab ve original grade: 3 Ft. Gravel length: WELL: V;tNew ❑ Upgrade 21 Ft. Gravel width.,/ 63 r Ft. Numberpflinea: Detambetwmlines CIa anon (Private, A,B,C): Total Depth: Cased To: a, t C7AT� / Ft. OS Ft. +-'f- 3 Ft. Total absorption area: Y L Ft. Pipe DO material: F�/O 13a3yP Driller. Date Df mqa Static Water Leval: 'TZ n44 8�4 Q 3 S Ft. SO, Ft, Installer. a w Date installed: 4 /zl yield: Pump Set at: Casing Height Above Ground: '0, q 4 GPM Ft. 2 a Ft. TANK SEPARATION DISTANCES septic C3 Holding 0S.T.E.P. To From SepticAWorption Tants Find Lm H-1619 bbWriwte Manufacturer. Capacity in gallons: Station Tank Sewer Linea a P W¢Ih/.23,4 :G$'t //p a Material: Number mpartments: Surface Water �GM LIFT STATION Lot Line /30r /'ZOt Size in gallons: Manufacturer. Foundation /ib / O t "Pump on' level at: "Pu evel et: High water elerm at: Curtain Drain Pump Ma oriel I Electrical Inspections Performed by: Remarks: N -mi, Qa c r BENCH MARK Location and Description: • 'tT r2r21L0 it CO fLt.Ct[� QQ 12 Assumed Elevation• Z Ft • :::•% ENGINEER'S SEAL 7WO Inspections performed by: 6 •R %73AA»0" rT• ¢ Dates: is 9 yz/9 2nd 'Y/16149 7 ;.0AL, IVI'vIQQ .9nww R. femw,a Department of He h and H man rvices approval ' yy jf 14 Reviewed and approved by: Date:// 29-99�rs:� � L *` 72-013 (Rev.11,11) MOA 25 PERMIT NO, SW990237 AS -BUILT WASTEWATER ABSORPTION SYSTEM E2SE4NW4SE4 SA, TItN,R3W CO A B TI 52.3 59.8 T2 59.5 66.2 Cl 60.9 67.7 C3 67.5 73.8 T1 C2 z C3 18.9 7.2 MT 45.6 44.0 RESERVE LauTH24 ---------C4 71.1 70.4 DIVERTER VALVVV��� �,,••.....-...,� NEV DRA FIM FUTURE CM4TRULTIDN � pp 3'y3' EFF. D 7'ca _ 6 SF TQTAL C ac 94S NEV 12S0��S�TP �• MT 1 SEPTIC T T? '=CQ�` C PC _._ .. .... ... ......... ........ _........ .... .... I .....,_....... _. -., _ - EXIST'G WELL) / 492 R. Pannonel Mr. Lee Casebler C 8149�� 6660 Round Tree Drive Anchorage, AK 99516 (907) 346-1533 C vrr_o-o4 z- P.I.D..qD. NO, 81�21� 2Iq 0 z i 7:03'39' R� 53,60 T=27. 51.44 Td PANNONE ENG. SVC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 Phone & Fax 1TEs 11-3-99 AS -BUILT '- PERMIT NO, SW990237 AS -BUILT DETAILS P.I.D. NO, 0Z7-121_62 -07 WASTEWATER ABSORPTION SYSTEM 3/Y E2SE4NW4SE4 S3/, T1?N,R3W N l=7 G\Work\DRAWING\3-1SLAKE.DWG 49—TH wen Rwen R. P�nannonej No. CE 8149 4 s Ln m K n W H �z O z r« in IU ly �]� P W MONUM LL_ mmw3m/o/�ff� �t as }k LL. /l U a W inONUM 1nONV317 lmNV3m 1nDvi= 1noNV3M NOTIV6Nn0! MtrA6(L1J r UK, PANNONE ENG. SVC. Mr. Lee Casebier P. ❑, BOX 102954 6660 Round Tree Drive Anchorage, AK 99516 ANCHORAGE, ALASKA 99510 (907) 346-1533 272-8218 PHONE S FAX DATE, li- -9 AS -BUILT NOT To SCALE W LL_ mmw3m/o/�ff� }pf as ru ill iii666 2t LL. /l inONUM 1nONV317 lmNV3m 1nDvi= 1noNV3M NOTIV6Nn0! MtrA6(L1J r UK, PANNONE ENG. SVC. Mr. Lee Casebier P. ❑, BOX 102954 6660 Round Tree Drive Anchorage, AK 99516 ANCHORAGE, ALASKA 99510 (907) 346-1533 272-8218 PHONE S FAX DATE, li- -9 AS -BUILT NOT To SCALE MUNICIPALITY OFANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 )���Vls STOP_-PC'VWM ON -SITE WASTEWATER DISPOSAL SYSTEM PERMIT Renewal 9-x-99 1 ?m n OLY\ n - q -a(o -,m CAU -)1 - Date Issued: Jul 29, 1999 Expiration Date: Jul 28, 2000 Permit Number: SW990237 Parcel ID: 020-092-09 Legal Description: T1 IN R3W SEC 3 E2SE4NW4SE4 Design Engineer. 0003 S & S Engineering Site Address: 016740 BETTIJEAN ST Owner Name: Lee R Casebier Lot Size: 217900 SO. FT. Owner Address: 6660 Round Tree Drive Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage , AK 99516-0000 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (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. This is a renewal of permit #SW980177. Received By: Issued By: z4" Date: ? —79-9 9 Date: 9.79 1?.01 ^^r on^ `t. X0515 ANcxxoRAGE, ALASKA ' 344-7714 SIX INCH WATER WELL DRILLED ---------r OUT TO THE DEPTH OF 535 fe^t. DRILLED AT THE RATE OF ~P5'00t^e]. cr ^ink ^-^tec out to 105 ft. PER FOOT. r p ^r t 1• r�i C^�rbi_Fr �C.�_15z3 ".nCh, .'1' Og5n7 PROPERTY OWNER .. , _ ff LOCATION OF WELL SITrnlPer tr; e,•• nr, E J --n) DRILLER P^rni' Cl -11 ^ of ^-n• rrt 7). 111i,nr, '''nrlrr. WELL LOG: "ilty c^n�lr fine rr^vel e•ith 30n.' bro,••r cl.— IA - 1161 TT-_ rr?•r.rn� " Cnrnentn.1 n n ,lot but not ••"ter-ror7ucin�,, 105 - 5'5' Pc'rock. ^ Rolim-nt^ry rock. Thi.r -rn^c of cr-ck�. P. fiF^uree: vi.Ale. min_ -l. count Of V!'te.r. " r, :n -n- fro^ ?)75 ::,-At- z n A fent-hn,•,,r. 1/? m vinlr'. ^r-ru*.rr -rer of rocl: fro^ zq0 to 3911 fgn_t .rinjr7e• nrin r*^.].].7n y.er�nlniltr of1••^t^^, fr•rt clln:•r.. Jv^*n++ n y l a _.. in - ^r-nu].^r ty!' o rock "h -t V;nl_% i.° inn Cl. Tot-' "rinl_rl ,•r- _ in th._r t^r "Cnl.l ; ^ ,rt^^^nt 1 ^0 -1.1 r _.„r I-olir, ^r' ?_rcrn^rp^ for r_hr):r r. +; -. _ .. , _ . ' -.. .. .... ..t 'L..,�...�nT: �ttm"=nF', to 15n .n.^11'0')” Or l:^ur ^ft^^ ^ul.]. (ar:.l'.r (1017n. %C, Or •••:•,t -r ,Or foot ^t -nein- in c''�!tir^ b^ck ue to 35 fejt of eurfrce. `^hero r!n� no appreciable fror+ h50 to 535 f6et, rt •••^F r'v rinni•,; rtj ' —rmount of rr^tcr viola fnurd of the 7-7.3 ^r l rh• r- _on to rnarti Z^ th-t cont out ov^r foot for C:Sn font ori]. r on^thof ^IZlby TnnP5.0O.:cr ft. r, 1,.�0 ft:�'til ,P50.0n, "?,?00.rl0 ^i^ u; front r -r bi r. '.1,050. no to bo ^;_r. T'n oth.rr chrr^'p^ for COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF S I DRILLING. o r)obi1�_^-tl ^ l nr (r-,obiliz^ti.nn out. ,r p U..,. .. n COF-t f,)r. .•;n .l_ r^--. WRITE_Y�IECK PAYABLE, TO RAMPART DRILLING WORKS FOR TH iSU OF F�en5n.00 „n .•i nv nn r--3.nF, nn Ch^rrn. 7pr, v,. "T •, p+n C• 1r1R, th. THANK YOU VERY MUCH. �t it�1l BERNIE CLAUS OF RA PART DRILLING WORKS DATE '112a^t 5, long SERVICE CHARGE OF 1K% PER MONTH WILL BE ASSES6ED ON PAST DUE ACCOUNTS. "r• 46 - S?' Cn7rne rr.^,rel P brn,l. .c mhc p;^tnri^l y^F ..rpt but not ,..^t^r-b ^grin �? _ oar ^i 7.t.r r„cr^pnl 1••ith �0"; rPr' l .r, "r7ter , te_ ••�� roovir.�^ thr^tlrh this rare^. from gR to a0 feet ^t rbnt,t on, ^]]or. ;rr r'inntp vielr). The, nu^li.ty Of "'-tnr ,•• -nor. Nnrn lion - l r,rry of fit)n^r,A rnr: rl^v miv ^•' - 105' brok.^r_ b^Arccl: cl^tori. 1. ` cnn-lom-r!•te. This brnlon mntnri^l ,lot but not ••"ter-ror7ucin�,, 105 - 5'5' Pc'rock. ^ Rolim-nt^ry rock. Thi.r -rn^c of cr-ck�. P. fiF^uree: vi.Ale. min_ -l. count Of V!'te.r. " r, :n -n- fro^ ?)75 ::,-At- z n A fent-hn,•,,r. 1/? m vinlr'. ^r-ru*.rr -rer of rocl: fro^ zq0 to 3911 fgn_t .rinjr7e• nrin r*^.].].7n y.er�nlniltr of1••^t^^, fr•rt clln:•r.. Jv^*n++ n y l a _.. in - ^r-nu].^r ty!' o rock "h -t V;nl_% i.° inn Cl. Tot-' "rinl_rl ,•r- _ in th._r t^r "Cnl.l ; ^ ,rt^^^nt 1 ^0 -1.1 r _.„r I-olir, ^r' ?_rcrn^rp^ for r_hr):r r. +; -. _ .. , _ . ' -.. .. .... ..t 'L..,�...�nT: �ttm"=nF', to 15n .n.^11'0')” Or l:^ur ^ft^^ ^ul.]. (ar:.l'.r (1017n. %C, Or •••:•,t -r ,Or foot ^t -nein- in c''�!tir^ b^ck ue to 35 fejt of eurfrce. `^hero r!n� no appreciable fror+ h50 to 535 f6et, rt •••^F r'v rinni•,; rtj ' —rmount of rr^tcr viola fnurd of the 7-7.3 ^r l rh• r- _on to rnarti Z^ th-t cont out ov^r foot for C:Sn font ori]. r on^thof ^IZlby TnnP5.0O.:cr ft. r, 1,.�0 ft:�'til ,P50.0n, "?,?00.rl0 ^i^ u; front r -r bi r. '.1,050. no to bo ^;_r. T'n oth.rr chrr^'p^ for COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF S I DRILLING. o r)obi1�_^-tl ^ l nr (r-,obiliz^ti.nn out. ,r p U..,. .. n COF-t f,)r. .•;n .l_ r^--. WRITE_Y�IECK PAYABLE, TO RAMPART DRILLING WORKS FOR TH iSU OF F�en5n.00 „n .•i nv nn r--3.nF, nn Ch^rrn. 7pr, v,. "T •, p+n C• 1r1R, th. THANK YOU VERY MUCH. �t it�1l BERNIE CLAUS OF RA PART DRILLING WORKS DATE '112a^t 5, long SERVICE CHARGE OF 1K% PER MONTH WILL BE ASSES6ED ON PAST DUE ACCOUNTS. "r• •� -� Municipality of Anchorage Department of Health and Human Services Rick Alystrom. 625 "L" Street htavor P.O. Box 196650 Anchorage. Alaska 99519-6650 http://www,ci.anchorage.ak.us July 8, 1999 Lee & Markie Casebier 6660 ROUND TREE DRIVE Anchorage, AK 995166815 Subject: TI IN R3W SEC 3 E2SE4NW4SE4 Permit # SW980177 PID # 020-092-09 The subject permit, issued 6/16/98 by this office for a single family well and/or on-site wastewater system, has expired as of 6/16/99. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as -built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. When applying fora new permit, the fees are: $320.00 for an on-site wastewater permit and $120.00 for a well permit. If you have any questions, please call this office at 3434744. Program Manager On-site Services enc: Copy of Permit 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 AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW980177 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:CASEBIER LEE R &,TIRKIE S OWNER ADDRESS:9201 SPRING DRIVE ANCHORAGE ALASKA 99507 PARCEL ID:02009209 LEGAL DESCRIPTION: T11N R3W SEC 3 E2SE4NW4SE4 LOT SIZE: 217900 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 6/16/98 EXPIRATION DATE: 6/16/99 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: �`^ `7' DATE: G /7 - ISSUED %-ISSUED BY:,y[/l.t�.✓ W. �y�, DATE: CD-IG'�� S& Jun 2, 1998 ROBERT C. COWAN, P.E. CML ENGINEERS (907) 6942979 FAX(907)694-1211 IEALTHA RHORM APPROVALS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 SEWER&WATER Anchorage, AK. 99519 IWN D(TEMONS REFERENCE: E 1/2, SE 1/4, NW 1/4, Section 3, TI IN, R3W SEWER & WATER wrimcnON Request you issue a permit to install a septic system and well to serve the proposed f our bedroom house on the referenced property. ENONEERINGSTUOIES One test hole was excavated and a percolation test performed. The approximate ANDREPORTS location of the test hole is located on the attached site plan. At the time of excavation 4/14/97, water was not encountered in the test hole. After WELL WSPEcnON seven days ground water monitoring the monitoring tube was checked and the hole was SFLOWTEST found to be dry. We do not anticipate any adverse effects on neighboring wells, septic systems or SITEPLANS drainage patterns by the installation of the proposed septic system There are no points of contamination within the proposed well radius that can be seen RDAD DESIGN on the attached site plan. If you require additional information, please contact us. SOIL TEST Sincerely, ///� PERCOLAnON (. TEST Rob . Cowan, P.E. RCC/mg STRLLTURALa Enclosure MECHANr& WSPECTIONS ONSITE WASTEWATER DMPOSALSISTEM DESrN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 60' DESIGN DETAILS SCALE rr ofc¢ 'O W Oy0 O �• F;C-32 0 c u V cn m' W C !C A N co 0•3 m to A d z v UNDEVELOPED ��= a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: L f f C• A S a t E DATE LEGAL DESCRIPTION: E V.2 I'Si vy I A/ u �y + S E Xy Township, Range, Section: 7-/? A/ IV V SEC. 3 DEPTH SLOPE SITE PLAN IJFEET1 1 ?e:1.; 7 /ota! ss to- it - 12 0 11 12 t� 13- 14 3 14 15- 16- 17-- 18- 19- 20- COMMENTS 5 16 17 181920COMMENTS ORGAN+cS Y S"lr_— GM s IL , sn�'o d Gkevs� n/X7uRL S PAI a.o./l. WAS GROUND WATER A/ O ENCOUNTERED? S IF YES, AT WHAT L DEPTH? 0 P E Beeth N atu lute y Batt y/ Monitoring? U Reading Date Gross Time PERCOLATION Net Depth to Net Time Water Drop 17 loJ� l .1 vy PERCOLATION RATE Immuteamp� chlPERC HOLE DIAMETER ,I TEST RUN BETWEEN °Z FT AND _.3—b_FT PERFORMED BY: S & S ENGINEERING A I—T=c�Fj f�� CERTIFY THAT THIS TEST WAS PERFORMED IN • ay rver Loop Road No. 404 ACCORDANCE GUIDELINES IN EFFECT ON THIS DATE. DATE: -- Y /a 1 / 9 7 72-008 (Rev. 4/65) HFALTHAUTHORTY APPROVALS SEWER 6 WATER MNN DnNSIONS SEWER 8 WATER NSPECTION ENGINEERINGSTUDIES ANDREPORTS WELL INSPECTION SFLOWTEST SITE PIANS SOILTEST PERCOLATION TEST STRUCTURAL& LAECHAWAL INSPECTIONS ONSITE WASTEWATER CISPOSALSYSTEM DESIGN ROBERT C. COWAN, P.E. CML ENGINEERS (907)6942979 ON-SITE WASTEWATER DISPOSAL SYSTEM FAX(907)694-1211 CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: E 1/2, SE 1/4, NW 1/4, SEC. 3, TI IN, R3W Jun 2, 1998 GENERAL: 1. The scope of this project includes the installation of a 1250 gallon septic tank and a leachfield trench to serve the proposed four bedroom residence located on the referenced property. 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. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577 Page Two E2, SE4, NW4, SE4, Sec. 3, TI IN, R3W Jun 2, 1998 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 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. Page Three E2, SE4, NW4, SE4, Sec. 3, TI 1N, R3W Jun 2, 1998 111INIb1U111 MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: .e 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 leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. 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. Page Four E2, SE4, NW4, Sec. 3, TI IN, R3W Jun 2, 1998 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. 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 j - war mcnoragn Municipality of Anchorage Department of Health and Human Services Auk Division of Environmental Services On -Site Services Section 825 `V Street Room 502 P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-092AWC fl HAA # I. GENERAL INFORMATION Expiration Date: Complete legal description r Location (site address or directions) 16740 Betty Jean Anchorage AK 99516 Current Property owner(s) _Ue & Markle Casebier Day phone 346-1533 Mailing address 16740 Beni Jean. Anchorage AK 99516 Lending agency Day phone Mailing address Real Estate Agent _Marcl Newman Day phone 345-5666 Mailing Address Alaska's Finest Real Estate Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 19 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ID Individual Holding tank ❑ Community On-site ❑ Public Sewer n The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on -she wastewater disposal and/or water supply system. DHHS also Issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. m... t„M) S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for this 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 applicable Municipal and State codes, ordinances, and regulations In effect at the time of Installation. Name of Firm Pannone Eng. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 9gMMW 6. DHHS SIGNATURE ✓ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, the following stipulations: with Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By:! / � ��,y . �z2A::�� Original Certificate Date: Expiration Date: Reissue Date: QUV.11M) Municipality of Anchorage • Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 V Street Room 502 P.O. Box 196650 Anchorage, AK 99519-66.50 wwW.d.anchorage.ak.us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: N2SE4NW4SE4. S33 T12N R3W E9 !�Y' • J - I r Parcel I.D.:_QZQ& 92-09 A. WELL DATA 5 E Well type PHLYATE If A. B, or C provide PWSID # _ Well Log y Date completed Ms zs Sanitary seal y Wires properly protected y Total depth _ft Cased to 105 ft Casing height (above ground) 24 In. FROM WELL LOG AT INSPECTION Date of test 8/15t1999 2!18/200.5 i Static water level 35 It 32 ft Well production 2 g.p.m1A - 9.p.m WATER SAMPLE RESULTS: L. Coliform ted'- colonies/too ml Nitrate mW Other bacteria —D—colonies/100 ml Date of sample: 2Ji8/20D5 Collected by: _Laura Pannone B. SEPTIC/HOLDING TANK DATA Tank Type/Material _ STEEL Date installed -99ALtB;t;t Tank size 1250 gal Number of Compartments 2 Cleanouts y Foundation cleanout y Depression over tank N High water alarm N/A Date of pumping 12/1612004 Pumper At Home Services C. ABSORPTION FIELD DATA Date installed 9,26[1 Soil Soil rating (g.p.d./It2 or ft2/bdrm) ],Z System type Deep Trench 3 Length _03_1t Width 1t Gravel below pipe :2;r ft Total depth 10.75 ft Effective absorption area §Kft2 MonitcrWq tube y r Depression over field N Date of adequacy test IMM Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 31 in Water addedW gal. New depths in. Elapsed Time: 1-440 min Final fluid depth 81 in Absorption rate >_ §QQ_+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date (Rev. I IM) D. UFT STATION Date installed a in "Pump on" level at_ In"Pum omtPf, Datum / Cycles E. SEPARATION DISTANCES ns WA Manhole/Access In High water alarm level at —In Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1232 On adjacent lots 100+ Absorption field on lot 105A Public sewer main N/A On adjacent kris 100+ Public sewer manhole/cleanout N/A Sewer /septic service line 110 Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 40 Property line _ 30 Absorption field 10 Water main 50 Water service line 100+ Surface water 100+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 120 Building foundation 60 Water main 65 Water Service line 65 Surface water 100+ Driveway, parkingNehide storage 30 Curtain drain 100+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through ee/d Inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on " thisdete. j.Steven R. Po .onej ♦ ; No. CE 8149 Engineer's Printed Name Steven R Pannone P E eek+Q�'�': • Date _74"a ff g h / V� .,' d• HAA Fee $ cl) Waiver Fee $ Date of Payment /3 C, J Date of Payment Receipt Number UJ Z/, t3 U v� Receipt Number (Rev. 1 IM) 02-24-05 08:59" FM#-a&E ESI, SOS ENV SERVICES SG!9I SGS ReLM 1050828001 Client Name Pannone Eng. Srv. Protect NamNM 16740 Betty lean Cllmt sample TD 16740 Betty Jean Matrix Drinking Witter PWSTD 0 90T5615301 T-983 P.02/02 F-611 All Date&Mmes are Alaska Suadard Time Printed DoteMme '02/2412005 7:43 Collected DateMine 02/1812005 14:00 Received Date/time 02/189C 5 14:22 Technical Director C. Ede Released j Sample Remarks: Allowable Prep Analysis o.....,.... Rualts 1'Ql. Uain MarMd ConMnerID Limid Dete Dere Inil Haters Department Titrme-N 0.10011 0.100 mg/L EPA 300.0 B (U10) Microbiology Laboratory TotalColiCorm 0 CoV100mL SM209222B A (<-1) 02/18/05 XM MJ18A3 DKC TRACT A DON JACK SUED. S 69055'05'E 330.05'. mm tun U m C,q N •\ N 2 z � v, .A N 8 p O 3E y _ m m - n A yylQ N N v OX \ N \\i m 2; 0 E 6M2 ..-- - - Lh-9L \\ 174.2 O 1 n \ r " 306 ro 0IOIN Iw r �— S 89°56'S6'E 689.81 (M AS) • (BASIS OF BEARINGS) LOT 3' : LOT I LOT 2 I IK PLI, PARK PLACE SUBDIVISION Nm mo V p a ^ o£�n avv Z n g ^pp �^ ^ 05 £ us� 'i �aoo^m � --jA-' - A-- -421 O c W p ch o p o n�: nmo—oo 1Mouc no nom'^ w$ rn m C N i c3 rn m a ^ • m .a C) � m Z O N g :3p Cs I.'W W� H A nK O n •^i O M A C � 9 N O �� a u O 1 n \ r " 306 ro 0IOIN Iw ,E cca h�(Cll.-1 w1 --� 4..unicipality of Anchorage ., �• -- Department of Health and Human Services Division of Environmental Services V17 On -Site Services Section e25 'L* Street Room 502 GRov P.O. Box 196650 Anchorage, AK 99519.6650 www. ci. anchorage. a k. us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-092-0'% HAA #jUI Q O_S_�Z Expiration Date: 1. GENERAL INFORMATION Complete legal description _,F2SE4NW4SE4, S3 Ti I N,R3W Location (site address or directions) _Endof Bettviean Drive off Ransom Ridge Current Property owner(s) Lee & Markle Casebier Day phone 346-1533 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 6660 Roundtree_Drive, 99516 Day phone Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Hclding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Aperoval (HAA) basea only uocn the recresentancns given in paracrach 5 by an independent prcfess,enai cavil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site westesvarer cisposai anc/cr water supply system. DHHS also issues HAAs upon request to nome owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Cass C weii ana may be reissued with new water sample results less than 30 gays cic. Certificates are valid for one year for progenies served by Class A or 6 wells or a public water system The Mun:c:ca!ity of Arcncrace :s nct responsible for errors or cm!ss,crs in the professional enc;reer s wcrK. Pp. 11 9 • 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 based on procedures outlined in the Health Authority Approval Guiceunes for this Heann Autnonty Appluvdl 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Eng. Svc. Phone 272.8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 7127/2000 6. DHHS SIGNATURE �# (/ Approved for I_ bedrooms. # 72 .•° �: Disapproved.44 111-11 Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Suoolemenml Engineers Re:crt Other By: / La. .O� Original Certificate Date:_ 6 - NatRe:ssue Date- g— -C C ,Fav 11.951 C " Municipality of Anchorage Dr- �• "`� Department of Health and Human Servf�&/^ E1 VED AOM Division of Environmental Services On -Site Services Section 825 OV Street Room 502 AUG O2 2000 P.O. Box 196650 Anchorage, AK 99519-6 www.ci.anchorage.ak.us De ealalityo machora (907) 343-4744 pL Health & Human �ryl�oes HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ;2SE4NW4SE4, S3 T11N, R3W Parcel I.D.: 020-092-09 A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID # Date completed 815/1999 Sanitary seal Y_ Total depth 535 ft Cased to 105 ft FROM WELL LOG Date of test 8/15/1999 Static water level 35 ft Well Log Y Wires properly protected Y Casing height (above ground) 24 in. AT INSPECTION NEW It Well production 2 g. p.m g p.m WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml Nitrate 0.51.1 mg/I Other bacteria 6 colonies/100 ml Date of sample: 7/27/2000 Collected by: S.R.PANNONE B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 9/261199 9 Tank size 1250 gal Number of Compartments 2 Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm NIA Date of pumping 9/26/1999 — Pumper NEW C. ABSORPTION FIELD DATA Date installed 912611999. Soil rating (g.p.d./fe orft2/bdrm) 1_2 System type DT Length 63 ft Width 3 ft Gravel below pipe 6.3 ft Total depth 8_5 ft Effective absorption area 793 ft2 Monitoring lube Y Depression over field N Date of adequacy test 9/26/1999 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test NEW in Water added_ gal. New depth_ in. Elapsed Time: _ min Final fluid depth _ in Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date (Rev. 11199) D. LIFT STATION Date installed Size in gallons NIA Manhole/Access •r 'Pump on" level at in"Pump off" level at —in High water alarm level at _ in Datum Cycles tested Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 123.2 On adjacent lots 100+ Absorption field on lot 105.4 On adjacent lots 100+ Public sewer main NIA Public sewer manhole/cleanout NIA Sewer /septic service line 110 Holding tank 100+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 40 Property line 130 Absorption field 10 Water main 50 Water service line 100+ Surface water 100+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO. Property line 120 Building foundation 60 Water main 65 Water Service line 65 Surface water 100+ Driveway, parking/vehicle storage 30 Curtain drain 100+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION +`� ��♦i♦ I certify that I have determined through field inspections and`''� ♦♦ review of Municipal records that the above systems are in ""' ""'""'""'"""""0 conformance with MOA HAA guidelines in effect on this date. - •• - • Engineer's Printed Name Steven R. Pannone. P.E. ♦♦;n•.• a r t� Date 7-27-00 ��♦ it '64 HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. i M9) 06-01-00 16:23 FRW-M BVIRONANTAL 4mL 6615301 ME Environmental Services Inc. Laboratory Division )rinIdng Water Analysis READINSTRUCTIONSONJ a PUBLIC WATERSYSTEM tA. o V, PRIVATE WATER SYSTEM NOT P.03/03 F-612 RECEIVED AUG DePE Health 100 W Potrer rt for Total Coliform Bacteria Ancmorapa. A Tol:(9071562 SIDFJEFORS COLLBCT&CSAMPLE Fac nGT sal -•>^�. T., —,7.� _esus w 0 Sad 9-1 0 Sra1I•..In cQNr� rJ C s J C Sr �f2 w 4 recab SAMPLE DATE: Month SAMPLE TYPE: a Routine a Repast Sample (for reudae tons Wisp lsb ref. n0. TCF- Special Purpose SAMPLE LO: AT90N !J. 40S&%((3 Conrocnts: Dail OO Day Yea a Treaud Water a Untreated Water Time Collected collaersd By .1232.E �a rb. PIs Anchorage man Services t1 B•l a0b Anslyms shows this Water SAMPLE to be: Sadsforwy a UnsailsWxry a Satsiple Over 30 hours Old. TOU101 rosy be umshable 0 Sample Too long in ransm sample should not be Dues 48 hours old u otaminanon to mdicate reluble results. Please send new sample via special del' v maul. Date Recdved - 2 7;Lat Time Reesivad ^ Atusb* Eehe Aaaty" Medrod:�Mambrane idler o O -MUG .L •.A+ambec.Oftotapisb+t� ml. 1004125 AT Loh. —In - Analyst c Joe Fasts! Mat aodffcd of astudofectory rants: ❑ ❑ ryaad Spa with Pased ECA: T" BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Rssair Tata! CallforM E. can Membrane Men Dina Cont La Dqz) O C &I _ ColooWloO mt Vedfleanes: LTB W3 COLIFIR.4 rwrc-T.n....-.T.C. Fecal Collform Coorksatim as -0.... sW.... Fuel Meabraaa Aber Resaks comb 00 s1 Rcporu4lh Dau Time _.-K7 nus •S'6a7R.7i7 MsmMret Ma S4i Group lSoaaq GanMeYMSunanpneal L T ENVIRONMENTAL FA01J ES IN ALASKA GUFORNN, FcOINDA WNW. MARYWID. WM4 M. MISSOUPo, NEW JERSEY . wEST VIRQAuI a 06-01-00 16:22 FRW-CTE ENVIRONANTAL 5615301 T-107 P.02/03 F-612 �- c7'E pnvlronmarttal lsrvlow Inc - RECEIVED ME mviioMilWSNi- AUG 02 2000 Se:vle Rcrdaiks .v7orablr N.p Aoal�su Parunan > d AQC Upas Mcdgd L.mu D+W Dar tra Wat:ars Dsyartaosai N:vate V 0.5000 0.500 uWL EPA300.0 lornax 07127,00 SCL xiarobiolopy Laborssosy Taal Gliforrn S 09. No Co:i eoV100rnL 514 1 9 022 2 8 0/27,00 KA.." Municipality of Anchorage 1004125001 CDast POA Dept. Health & Human Services CTOE Reiss Aatuwae Elsa. SlV. E Printed DatcTame 0810112DOO 14:09 [tient Name ameNam Collected Drurrlmr 07;27/2000 12.05 Project s Lee Cae Reealeed Daus 1019 0727/2000 1525 Cissas Sample M Tl Hou Bib TerCole U Dlrnter Stephen C. Ede Mattis Dri4=g Water Ordered By Reln.ed B'10 MUD 0 Se:vle Rcrdaiks .v7orablr N.p Aoal�su Parunan > d AQC Upas Mcdgd L.mu D+W Dar tra Wat:ars Dsyartaosai N:vate V 0.5000 0.500 uWL EPA300.0 lornax 07127,00 SCL xiarobiolopy Laborssosy Taal Gliforrn S 09. No Co:i eoV100rnL 514 1 9 022 2 8 0/27,00 KA.." MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH b 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 I.D. # -c� c 9 Z HAA JA99D55e-7� 1. GENERAL INFORMATION Complete legal description Location (site address or directions) e�i-- 'Rm-rrcl_TP-Ati &P:r- R J+N s e,.•1 2rD c1 � Property owner •_ astAA2kto.ca&s.Rit:M_ Dayphone Mailing 'address. b66o P-00e3D -IC•rzMc'tQ Ves 90si6 :.Lending agency_ Day phone •'�Maiiinn"i:1NrlrPcs'`•� � :: - .. Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water -1. 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 a - 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-=(FkW.1/91) Fm MOAR1 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 forthe number of bedrooms and type of structure indicated herein. I further verity 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 H)Ati,n�Ioavx & AA - 'S%4c- Phone 'z 7--57t16 Address 4. o o x /4;'2-9-5'q l4 N old A!c- go�S7o Engineer's signature Date 4'?M03 6. DHHS SIGNATURE XApproved for -4 bedrooms. Disapproved. Conditional approval for Additional Comments M 1t1TIr Steven L Vann ' bedrooms, with the following stipulations: 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. ri.m m" IM) Ben WM m KECEIVED Municipality of Anchorage NOV 04199 DEPARTMENT OF HEALTH & HUMAN SERVICES 1CIYAlIfY OF AN Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907 15V SERVICE Health Authority Approval Checklist oZo-oq2-oq Legal Description: N2dC'gA1w46Ey S33,-ntA.J,0-31.1 Parcell.D.: 9d fel z A. WELL DATA Well type' �rnuA7-U If A. B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed S Total depth S"39- Cased to / ex' Casing height (above ground) Z r Sanitary seal (Y/N) Date of test Static water level Well production FROM WELL LOG WATER SAMPLE RESULTS: Coliform — O — 25 1,51 g s :36-1 Wires property protected (Y/N) Y AT INSPECTION Nitrate O •SC,> U Other bacteria — O— Date of sample: - /o/ 9 9 Collected by: S f2 Ip . B. SEPTIWHOLDING TANK DATA Data installed 4 2614 9 Tank size 176t> Number of Compartments Z_ Cleanouts (Y/N)i_ Foundation cleanout (Y/N) �t Depression (YM) High water alarm (YM) — Date of Pumping `t l2 t l4 l Pumper U &?- C. ABSORPTION FIELD DATA Date Installed Y 1'2 61411 Soil rating (g.p.dAP or ft'/bdrm) !. 2 System type b-T— Length &_3 Widths 33 Gravel thickness below pipe 6.3 Total depth Effective absorption area b� Monitoring Tube present (Y/N)Y Depression over field (YM) c_1_ Date of adequacy test P 0- w Results (Pass/Fail) 'TA SS For Cr bedrooms Fluid depth in absorption field before test (in.); Immediately after_ -gal. water added (in.): = Fluid depth — (ins) Minutes later. -- Absorption rate = — a.p.d. Peroodde treatment (past 12 months) (YM) If yes, give date 72-0213 (Rev. 3198)• D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level E. SEPARATION DISTANCES 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons SeptiGholding tank on lot 123 3 On adjacent lots Absorption field on lot /©S A On adjacent lots Public sewer main Sewer /septic service line .v(A //o "Pump otr level at' /Oco -t- / cb'T- Public sewer manhole/cleanout . y lad Lift station / CrJ T SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Foundation `I O` Property line /201 Absorption field 1 v r Water main/service line -: 3 Surface waterldrainage /CvT Wells on adjacent lots oo SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /z o r Building foundation 6 C', Water main/servics line �--Sr Surface water /00 t Driveway, parking/vehicie storage area 3 o r Curtain drain L C.y Wells on adjacent tots l0 F. ENGINEER'S I car* that I have delemuned thin Held inspections and review of Munfcipa/ records 4 rrrs are in conformance *1M MOA HAA guidelines in e8ed on this date. �:^ w,'4s Signatu 49Ek . En ineer's NameSZ�� ✓ Q2Q� �1Gs , (n ,JL Mrwn� � Date !1 �3 l4 R �C/s� CE -5149 Z'4, NAA Fee $ 3 O d O O Date of Payment I ( (� C1 `I l Receipt Number -6 72-026 (Rev. 3196)' Waiver Fee $ Data of Payment Receipt Number NOV-02-63 16:31 FROO-M ENVIRxNITAL 5616301 T-558 P.03/03 F-363 L16 ME Environmental Services Inc. Laboratory Divitlon 200 W. Porta Or ve Drinking Water Analysis Report for Total Coliform Bacteria Anchorage. AK 99518.1609 Tat: 69071662.2343 R£AD1ASTRIXTIOAS0tin£YERSESIDEBEFORE COLLECn.VGSAMPI£ Fax. (907) 581-5301 MUST BE CO%,;PLE'fED BY WATjER SUPPLIER �� TO BE COMPLETED BY LABO?ATOttY 6-I-_L�1-�--I Analysts sh" tPU Wale' SAYtPLE to bc. C PUBLlC*,VATEPSVSTt.Nil.D.tl Satisfactory PRIVATEwATERSYSTEM >CD Unsansfactory C lendRrwLt C S.nllwraa C Samp a over 30 hours old, results may be unreliable o Sample too lona to isnot; %staple should not be over 48 hours old at examination to iad,caw reliable rerJlts. Please send new sample via special delivery mail. Dam Received _ 10—,2L JM TtwRecehed 404,5 z VC� SrM RrrtJa 0 S.n1laysur Aaalys4 saw s oao u ^ptgli:al5lttbod: NkMembrmeFilta 0 1vLM0•MUG 111110 Mi.s ' Resuh* ARa1)tt 9959?9 SAMPLE DATE: "*at$ ® Year SAMPLE TYPE C Rolidne a TreareIlWater scot SoA 114.1.. Anee ibks Jun 0 Fates C as Sample (for routine Sample O Untrow" W°ur Dam Tlmc wltb lab ref. no. ) c Special Purpose Collcaxed Client notlned of unatlsfaetory resod:: TUM SAMPLE LOCATION Collllectteed' ra13 spoke wits F0 p telly �Or /s AJ E ✓ CO -TO ♦� aZl f�f �� Data Tune err err BACTERIOLOGICAL WATER ANALYSIS RECORD Mb10-MUG Reran Teal C6116cm _ L Can )kmbraoer9ur.DU+ctcouor. 0 _ColealesIm1 Vsrttlanot: LT9 6C6 COCIFIIL1f carr-r..w..... y. r.. qI �Nawa�r.r Fecal ColUarm[oaMmaibo Final Membreas Aher Ro"Its Collformil00 iii{ u I� L'I Time X101 t) an Rcponec By Commcntc: 0EUM Member of ma, Sas Group (Societe GenerawaSurvellunal _ nvotchMahM. FACt.M1111 IN ALASKA CALIFORNIA, FLORIDA LLAOIS, MARYLAND. M:CHIGAh. MISSOUR6 NSW JSRSEf. OHIO. WEST ARG?. NOV-02-00 16:31 FRW-CTE ENVIRCNIENTAL A& ME Environmental Services Inc. CUE 3W.9 153979001 Client Tame Pacooae Eng. Srv. Project.Name/# N2 S4 NW4 SE4 S33 T12N RM cuem Sample M ®EntnMec to House Mattis Driahicg Went Ordered By PWSID 0 SAMPIC R=Uk3: 6616301 T-330 P.02/03 F-333 Client PO/ Prl"Date/Tlme lIAW" 11:52 Collected Dawn'tme 10!8/99 17:30 Xecsived DetcMme 10/2619914:05 Tecdokal�Sfede ,�/„t e RdeasM LWi A1104- to Prep Anstysls Parsemte: Aesults POL units Marnee Limits We 0s:e Inst TOaI COII?Orm 0 Col/1001. anal 97228 10126/99 RAP nitrate•N 0.500 u 0.500 e0/L 1PA 300.0 IC mu 10/26/99 10/26/99 ICL