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SIEFKER #3 LT 8C
ef ker #3 Lot SC #015-281-66 SUBMITTAL Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP121141 PID Number: 015-281-66 Dwelling: R Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New N Upgrade Name: LARRY NELSON ABSORPTION FIELD ❑ Deep Trench Q Shallow Trench EI Bed EI Mound Address PO BOX 240365 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPDlSF 7 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5 F] Gravel depth beneath pipe 2 & 2.2 Ft. Subdivision Block Lot SIEFKER #3 8C Fill added above original gradeGravel 0-1 FL length 2 X 45 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines NA Distance between lines I NA Ft. SEPARATION DISTANCES TO Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 64.2 Ft' 2 10 Ft. Well >100' TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Gal. Surface water > 100' Material Number of compartments Lot Line >10' NA Foundation >10' LIFT STATION Manufacturer Capacity Gal. Curtain Drain >20' Remarks INSTALLED BULL RUN DIVERTER Pump on level at in. Pump off level at in. High water alarm at in. VALVE AFTER SEPTIC TANK Pump make and model 7_T� l Inspections performed by PIPE MATERIAL House to tank Tankto3034 drainfield Installer ISAAC'S EXCAVATING Drainfield F810 CO/Mr Inspector ANSON MOXNESS BENCHMARK (Assumed elevation) 100 ft Inspectiont" 6/11/13 6/12/13 Location and description pia dates: 3" 6/13/13 0 BOTTOM SIDING @ "1" COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL En Or O Conditional Approval: Date c'Q� OW T ti ..... I�� = S1PUgURKLANO.' *y Approved 4/ Date Dl"Flplo Inspection Rep6rt_9-1-12!6oc` Septic Area J+ — — — — — j�x,to, TIL FsMr — 4�-� 10' UTR ESMT INSTALLED 4-8£DROOM SEPTIC SYSTEM I v? EXISTING 1500 GAL. SEPTIC TANK VERIFIED TANK INTfGfRITY TRENCH LENGTH 2 X 45 FEET WIDTH 5 FEET MAXIMUM EXCAVTION DEPTH 7 FEET SEWER ROCK 2 FEET k 2.2 FEET K raa . .'.. au , 1. 'rf,P SCOPE' - 5X ti ti 001 HUFFMAN ROAD SCOPE - sX LOT sC EVES ! SWING TIES F-1 -72—T 3 A 15.5 157.5 D 17.5 58.5 C 24.0 63.5 D 26.0 65.0 E 30.0 49.0 F 17.0 37.0 G 18.0 19.5 H 405 200 ! 32.5 47.5 ✓ 35 0 36.5 K 1 51.01 39.0 N07£.• THIS 1S NOT A SURVEYED PLAT. WELL k SEPTIC 'th ......................... LOCATKNS TAKEN FROM ON-SITE WATER AND WASTE WAlE7P /"" """ / DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. •• •:• ••• •••••••••••••••• ....;� S SPURKLANDJj No. cF E�isoo 'AV ti i C 0 2s so 75 14V 25 !so • c '' • L6 d ``:•• SCALE., 1' = 50 FT, BENCH MARK ���������� •••••• ASSUMED ELEVATION 100.00 FT SPURKLAND ENGINEERING 203 W 15TH. AVENUE SIEFUR 13 LOT 8C SEPTIC SYSTEM ASBUILT ANCH. AK. 99501 LARRY NELSON DATE. JUNE 17, 2013 (907) 279-3916 11 12320 J£RMOME ST.. ANCHORAGE. AK 99516 SHEET. 213 GRID. 2755 On -Site Wastewater Disposal System Permit Permit Number: OSP121141 Tax Code Number: 01528166000 Work Type: Septic Permit Effective Dates: July 05, 2012 Design Engineer: SPURKLAND EN( Subdivision: SIEFKER #3 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade to July 05, 2013 Site Legal Address: SIEFKER #3 LT 8C G:2735 Owner/Address: NELSON LARRY C & ROBIN M P O BOX 240365 ANCHORAGE AK 995240000 Site Mailing Address: 12320 JEROME ST, Anchorage This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank Lot Size in Sq Ft: 56018 Total Bedrooms: 4 N Privy N private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: QZ MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D._ Ol5-ZSI-1C Property owner(s) _ L AR!y N61 son Day phone 230J443 443 Mailing address PO box 2403!,5 l Anctto a Ak M529 Site address 123DO TFonmi Legal description (Sub'd., Block & Lot) SEA Legal description (township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms `{ THIS APPLICATION IS FOR: THIS APPLICATION IS AN: . (® all that app!» Absorption Field Initial ❑ Septic Tank ❑ Upgrade �. Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. i Roo owner or Permit/Rush Fees: _ ��d Waiver Fees: Date of Payment: (p�/`7!' Date of Payment Receipt Number:Q a.WJ 6 Receipt 'Number: Permit No. GcS%J/at fIC/1 Waiver No. G:1BuildinglOn SitelFormslClient FormslPermH App_010411.doa (Rev. 1/11) GpwM and Engomrrong Environmental Consulting and Design SEPTIC SYSTEM DESIGN Siefker 93 Lot 8C Municipality of Anchorage June 13, 2012 Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 Subject: Septic System Installation Permit 12320 Jerome Rd., Anchorage, AK 99516 Ladies and Gentlemen: I am writing to request a septic system upgrade permit for the above referenced property. The existing septic system is no longer functioning adequately. The proposed system will serve a 4 - bedroom single-family residence. A soils log, design calculations, a site plan, design drawings and construction specifications are enclosed for your review. Design Cales: Groundwater observed at a depth of 11.7 feet below ground surface (5/17/2012). Soil Rating. From testhole 5/10/12 5 min/in =1.2 gal per sq.ft/day No. of Bedrooms 4 Required Area per Bedroom: 150/ 1.2=125sq.ft. Total area required: 125 x 4 = 500 sq.ft. Use shallow trench with 2 feet effective depth. Reduction Factor 0.7 Minimum Trench Length: 500/ 5* 0.7= 70 feet System: Existing 1500 gallon tank, followed by a bull run diverter valve, and a shallow trench absorption field consisting of 2 trenches 45 feet long with 2 feet of sewer rock (642 sq. ft. absorption area) Soils: A test hole was excavated on May 10th, 2012. See the attached soil logs. Beneath a layer of organics, disturbed silt with organics were observed to a depth of 4 feet. From 4 feet to 14.5 feet silty sand with sand pockets were observed. Minor melt water seeps were observed at a depth of 8 feet. These dried up and ground water levels were observed at 11.7 feet on May 17`h, 2012. The ground water level was checked on June 7th, 2012 and observed at a depth of 12.1 feet. 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net SPUTE and En onauffig Environmental Consulting and Design Surface Water: There are no surface waters within one hundred feet of the proposed septic system upgrade. Topography: The ground level slopes down towards the north at a grade of approximately 5%. Waivers: None The installation of this septic system will not prevent wells and septic systems 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. If you have any questions or concerns, please contact me at 279-3916. Si cerely, ars kland, P.E. Civil Engineer 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net I- I I f II WIII jF Lai LOT 7C I III ----��I-- --I Atli IF LOT 7AI C7B I SlTRACT A UTI---- I - - t 0' UAL £SMT rzi � I I LOT 8B LOT 8C HUFFMAN ROAD NOTE. THIS IS NOT A SURVEYED PLAT. WELL & SEPAL LOCATIONS TAKEN FROM ON-SITE WATER AND WAST£ WATER DEPARTMENT DOCUMENTAAOM. ALL LOCAAONS SHOWN ARE APPROXIMATE: 50 0 50 100 150 200 250 300 SCALE., 1' = 100 FT II II III I I I II II III III II kq SPURKLAND ENGINEERINGI I SIEFIIER 13 LOT 8C (( SEPTIC SYSTEM DESIGN 203 W K. 9950! TH. AVENUE ANCH. AK. LARRY NELSON IL DA 7F. JUNE 7, 2012 (907) 279-3916 72310 J£RMOME ST., ANCHORAGE, AK 99516 SHEET • 1/3 GRID: 2735 PERMIT #17SP1210XX PID # 015-281-66 SIEFKERUL8CSC100.DVG ArLn 7' UTIL £SMT 50 FEET DOWN �<e� 10' UTI[ EsM1 INSTALL 4 -BEDROOM SEPTIC SYSTEMu� EXIS17HO 1500 GAL SEPTIC TANK VERIFY TANK INTEGERITY INSTALL BULL RUN D(VERTER TRENCH LfNGHT 2 X 45 FEET WIDTH 5 FEET MAXIMUM EXCAVWN DEPTH 7 FEET LOT 8C SEWER ROCK 2 FEET COVER 4 FEET MINIMUM THS OF THE PROPOSED ABPE - R HUFFMAN ROAD SYCPf ^ SX NOTE. THIS IS NOT A SURVEYED PUT. WELL 4 SEPTIC 49th LOCATIONS TAKEN FROM OM -SITE WATER AND WASTE WATER - •""'5Z DLPARTAW DOCUMENTATION. ALL LOCATIONS SHOWN ARE Wi .... ..................0 APPROXIMATE.•• L SPURKL•'.•• ... ••A D •.'� tv fAF No ctts 25 0 25 50 75 100 125 150 ��..�•�UO� SCALE,• 1' = 50 FT. BENCH MARX �����"� ���•• ASSUMED ELEVATION 101[00 FT AND ENGINEERING 203 W 1STH. AVENUE SIMER 13 LOT 8C SEPTIC SYSTEM DESIGN ANCH. AK. 995LARRY NELSON 203 W [ DATE: JUNE 7, 2011 (90) 199 3916 1 11320 JERMOME ST., ANCHORAGE AK 99516 SHEET •215 GRID. 1735 PERMIT # 17SP121OXX PID # 015-281-66 SIEFKER#3L8CSC50DVG T O Fxf TING C'R'IB Install 50/50 flow splitter O O a, � � j oz Existing 1500 gal i z Septic tank Verify tank Integrity ti A o +. o a o � Shallow Trench L22 5' Wide 2 x 45' Long O 7' Max. Depth O 2' Sewer rock 4' Cover rain. ND SCALE Trench Elevation (typd Cleonouts Silt Barrier Mordto 4' Cover 4.XPCE........,'♦♦♦♦♦ 2.0 Ft of Septic Rock : 49th '♦� .....°.......................... ....:.� ... . . ........... i SPURKLAND No. C 11500 ♦♦�, �:, SPURKLAND ENGINEERING SIEMER 13 LOT 8C SEPTIC SYSTEM SCHEMATIC 203 W15th Ave Anchorspe Ak 99501 LARRY NELSON DATEt JUNE 7, 20f2 279-3916 - !2320 ✓FROM£ ST., ANCHORAGE, AK 99518 SHEETS 3/3 GRID; 2539 PERMIT / OSPI21OXX PARCEL ID 1015-281-66 S1EFKERjX8CD3.DWG Municipality of Anchorage ;RFl� Development Services Department Building Safety Division y�r On -Site Water and Wastewater Program I I 4700 Elmore Road i P.O. Box 196650 Anchorage, AK 99507 r www.ci.anchoraqe.ak.0 I• • ' (907) 343-7904 ", P.,9r R F- :-LANDr r Soils Log -Percolation Test I .&_ Lar N �ll Performed For: Larry Nelson Date Performed: MRSF 10, 201Q:,' Legal Description: SIEFKER #3 LOT 8C Township, Range, Section: 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- ®1 FA SAI so, WISPpD k4TS (SM) 310 Site Plan WAS GROUNDWATER NO' ENCOUNTERED? 5 IF YES, AT WHAT DEPTH? - L Depth to Water After P 11.7' r Monitoring? 11.7' Date: 5/17/12 Reading Depth Gross Time Net Time (Feet) Net Drop 11-I11( 09GANu5 1 12.25" 2- 9�I S; IE, 0;6rumw 10 MIN 12.3125" oarAutO 3 d (ML) 4 5- E 3.3125" 10.5" t 2:35 PM 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- ®1 FA SAI so, WISPpD k4TS (SM) 310 Site Plan WAS GROUNDWATER NO' ENCOUNTERED? 5 IF YES, AT WHAT DEPTH? - L Depth to Water After P 11.7' r Monitoring? 11.7' Date: 5/17/12 Reading Date Gross Time Net Time Depth to Water Net Drop 5/10/12 2:05 PM 0 MIN 12.25" 8.75" 5/10/12 2:15 PM 10 MIN 12.3125" 3.5" 9" 5/10112 2:25 PM 10 MIN 12.5" 3.3125" 10.5" 5/10/12 2:35 PM 10 MIN 12.5" 2" 10.625" 5/10/12 2:45 PM 10 MIN 12.75" 1.875" 10.75" 5/10/12 2:55 PM 10 MIN 12.75" 2" :10.75" 5/10/12 3:05 PM 10 MIN 2" PERCOLATION RATE 5 (minutesfinch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN 5 FT AND 6 Fr COMMENTS PRE-SOAKED. "MELT WATER SEEPS O�ERED AT DEPTH OF 8'. PERFORMED BY: LARS SPURKLAND 1 PV`,, 014 111 ^L� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNI(PAL GU LINES IN EFFECT ON THIS DATE. DATE: 5/18/12 Municipality of Anchorage Page I of 2.. 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: ~Cl~Ol?? PID Number: Name: Address: /z~z~ ~- 5~ ABSORPTION FI.ELD ~o~ ~ ~1~ ~ rench ~ ShallowTren~h ~ Bed ~ Mound ~ Other GPD/Sq. Ft. Lot: ~[~c~: Subdiv~ion: Depth to pipe bottom from oriole: Gravel depth beneath pipe Township: ] Range: Section: Fill added above original grade: ~th: Ft. Ft. WELL: D New ~ Upgrade Gravel width: Number of lines~etween lines: Ft.]~ Ft. Classification (Private, A,B,C): ~/~, Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Slalic Water Level: Installer: Date installed: Yield: GPM ~ Pump Set at: Ft. Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES ~eptic ~ Holding ~ S.T~E.P. To Septic Absorption Lift Holding ~ublic/Pr[vale Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~HO/~ ~ Material: Number of Compa~ments: Sudace Water ~GO ~ ' ~ ~ LIFT STATION Lot ~facturer: ~1 "Pump on" level at: ~~ High water alarm at: Foundation Cu~aiDrainn ~d~ ~0 ~ Pump Make & Model Electrical inspections pedorm~ ~ ~ ?~ ~ r /~ Location and Description: Assumed Elevation: ENGINEER'S SEAL 17034 Eagle River Loop Road, No, 2~ Inspections performed by: Eddie River, Alaska 99~77 Dates: 1st ~ -~g -~ Department of Health and Human Services a~proval Reviewed and approved by: Date: Z¢~$- ¢¢ 72-013 (Rev. 9/91) MOA 25 Permit No.Sw940188 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report .... SEIFKER SUBDIVISION #5, LOT 8C Legal L)escnpuon: PID No.: 01528166 CO1 CO~ ~NEW 1500 GAL. iSEPTIC SCALE f' = 40' WIRE FENCE- ::- LOT 8C A B FC0 16.0 56.0 CO1 17.0 58.5 C02 23.5 53.0 C03 26.5 65.5 COY' '2710 66~U Ar ~- EXIS[F]NG Ct~IB APPROX. SIZE AND .~,~YJ.OI~ .................................. OF PORCH ENGINEER' SEAL RAIL /',, ~shai'z- -'~ FENCE 72-013 A (1/93) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940188 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WEBER JOHN A JR & GRACIE J OWNER ADDRESS:12320 JEROME ST ANCHORAGE, AK 99516 DATE ISSUED: 6/22/94 EXPIRATION DATE: 6/22/95 PARCEL ID:01528166 LEGAL DESCRIPTION: SIEFKER #3 LT 8C LOT SIZE: 56018 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK 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 (iSAAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ISSUED BY: _ ~. DATE: DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. June 20, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAiN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SiTE PLANS ROAD DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Siefker Subdivision 93; Lot 8C Request you issue a permit to replace the septic tank serving the five bedro~mhouse on the referenced property. 9~4E. EXISTING 1500 GALLON SEPTIC TANK HAS COLLAPSED AND SEWAGE IS SPILLING ONTO THE PROPERTY. Because of unsanitary conditions and safety hazards, we would appreciate you expediting a permit to replace the existing septic tank. We do not anticipate any adverse effects on neighboring properties by the replacement of this septic tank. If you have any questions or require any additional information, please contact us. t A. Shafer, P.E. SOIL TEST /LSU/jk PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 o Z C) ,og = ,,L NVqd 311S ON-SITE WASTEWATMR DISPOSAL SYSTEM CONSTRUCTION PRACTICES MAT~acI AL SPECIFICATIONS REFERENCE: Siefker Subdivision ~3: Lot 8C 1. The scope of this project includes the installation of a 1500 gallon septic tank to serve the five bedroom residence located on the referenced property. The existing 1500 gallon septic tank is to be excavated, pumped, crushed, and abandoned in place. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4' of cover shall be insulated. Page Two Siefker Subdivision ~3~ Lot 8C June 20, 1994 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. MINIMUM M~'£sIAL 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: Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 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. Type of Pipe Perforated Solid Page Three Siefker Subdivision ~3; Lot 8C June 20, 1994 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 tank has been set; lines, cleanouts, standpipes, and insulation are in place and prior to backfilling. 2. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. 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 QGRF NAME LOCATION_ ER ANCHORAGE AREA BO' Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 JGH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS 2'70 .~ /~-~./)~A/' LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL ~¢'~. INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL/_~_'¢/--¢¢,¢ NUMBER OF COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY--/2%~ ~ GALLONS, SEEPAGE PIT: NUMBER OF PITS DIAMETER _ LINING MATERIAL~/4/~(?£4.,CCRiB SIZE: DIAMETER_ BUILDING FOUNDATION_~¢)~/,'/~ NEAREST LOT LINE~ ADDITIONAL ABSORPTION ~-o I OR WIDTH LENGTH /"'~ ! '" , DEPTH ~' DEPTH_ ~ ! DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (W,A ,L.L AREA)~ ~2..~ ¢ ~:~'~'o.g,.~.j .SQ. FT. TYPE _~ bi, ---CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION_ , LOT LINE__ SEWER LINE CESSPOOL OTHER SOURCES DEPTH DISTANCE FROM: SEPTIC~''(p' ~z~. -, TANK /~-¢ / SEEPAGE SYSTEM /0-¢ / APPROVED - DISAPPROVED - REMARKS DISTANCES~ INSTALLED BY: _ /t/~: ,~ ~,,'.,',,/ PIPE MATERIAL: ~_~ 4- ,~,~t~ .._ LOT SLOPE~_ REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM DATE G.A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. . 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE ~74-4~61 /t/~_~.,/_.) ~-/~9 ./u/~' 7~'' SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOil TEST RESULTS ~T--' , DRAIN FIELd] // , OTHER TO BE INSTALLED DY ,~:./20/~ ~L'~.~ NOTE; THIS PERMIT I$ NOT VALID WITHOUT SOIL, TBS'I' DOMPLET, O. DATE ^.T,O,PATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL iNSPeCTiON BY'THE D~PARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY Will BE SUBJECT TO PROSECUTION. i,, SEPTIC TANK SIZE /~ TYPE ff~--~C SEEPAGE ARBA SIZE /"' TYPE MINIMUM DISTANCES, REQUIREMENTS ~,5-* / FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT -~ SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK--~/ , SEEPAGE PIT TO NEAREST LOT LINE. '~LL TO SEPT,C TANK /0-~ / / DRAIN FIELD /aU ~ /o/ , DRAIN FIELD DRAIN FIELD SEEPAGE PIT ALSO CONSIDEr AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, //~L~ / , SEEPAGE PIT · SEEPAGE Pit ., DRAIN FIELD TO RIVER, LAKE, STREAM, CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND seePAGE PIT FITTED WITH AIRTIGHT REMOVABLe CAPS, DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFORM TO ~IOROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER DATE -- ' J APPLICANT'S SIGNATURE~~ ~~ ~ ~ 7/~/ r FORM NO. EQ-OI 6 AKPvivt Municipality of Anchorage ...; Development Services Department 1\� Building Safety Division On -Site Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.cl.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-281-6tA HAA# 050:3(rt'�) 1. GENERAL INFORMATION Expiration Date: — / % — ;2. Complete legal description SIEFKER SUBDMSION #3: LOT 8C. Location (site address or directions) 12320 JEROME STREET • ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address PETE k TAMMY SCOTT Dayphone 345-0235 12320 JEROME STREET. • ANCHORAGE. AK 99516 Day phone TAMMY STURGILL W/ SELL FOR FREE Dayphone 561-3733 7731 E. NORTHERN LIGHTS BLVD. 111 250 • ANCHORAGE, AK 99504 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 SYSTEM SIZED FOR 5 BEDROOMS 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineees work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the onsite water supply and/or wastewater disposal system is(are) 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 tiles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 " ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _jz� Approved for 14 bedrooms. Disapproved. Phone 337-6179 Date 7 S 05— Conditional approval for bedrooms, with the following stipulations* `tt(W....O...rrr�/ii ON-SITE gPATERAR6 m-_ WASTEWATER - RAM Attachments: HAA Checklisty Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By. 17/ Original Certificate Date: L7 — 2 ` d `�— (Ray 17.01) Municipality of Anchorage .° Development Services Department i1+J Building Safety Division ` On-SBe Water & wastewater Program 4700 South Bragaw SL P.O. Box 196850 Anchorage, AK 995198650 www.ci.anchorage ek us 1 (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SIEFKER SUBDIVISION #3: LOT 8C, Parcel ID: 015-281–Bila A. WELL DATA *PER 1992 HAA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed *PRIOR TO 1975 Sanitary seal (Y/N) YES Total depth ° 130 ft. Cased to 40+ ft. FROM WELL LOG Date of test 4 Static water level Well production p. M. WATER SAMPLE RESULTS: Coliform _0 colonies/100 mi. Nitrate 0.301 mgA. Well Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 6/29/2005 63 ft. 5.65 — g -p.m - Other bacteria 0 colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 6/29/2005 Collected by: GEG. LtD. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 6/24/1994 Tank size 1500 gal. Number of Compartments E Cleanouts (YM) YES Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A Date of pumping 6/28/2005 Pumper ANCHORAGE CESSPOOL C. ABSORPTION FIELD DATA "AND TRENCH Date installed 1974 Soil rating (g.p.d./ft o /bd 125 System type SEEPAGE PIT W/ TRENCH Length 17 ft. Width 17 ft. Gravel below pipe 6 ft. Total depth $12-2 ft. Eff. absorption area "625 ft' Monitoring lune YES Depression over field NO Date of adequacy test 6/29/2005 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 59 in. Water added 785 gal. New depth!2781n. 122/7 Elapsed Time: 1207 min. Final fluid depth 70.25/66 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date – ***FILLED TO TOP OF ASSUMED DISTRIBUTION LINE. SYSTEM OPERATING IN UPPER PORTION OF DRAINFIELD. D. LIFT STATION Date installed Size in gallons "Pump on" level at _in. E. SEPARATION DISTANCES Manhole! High water alar level at in. Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic lank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main t 00'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank t 00'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 50+ Absorption field 5'+ Water main N/A Water service line 100+ Surface water 100'+ Wells on adjacent lots 200'+/100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parldng/vehicie storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 1000+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certNy that I have determined through field inspections and e ! 4 A ! 'a review of Municipal records that the above systems are in """• "' .... conformance with MOA HAA guidelines in effect on this date. ::.f y ...G...ess:... Engineer's Printed/Name JEFFREY A GARNESS Data •orffip� HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 12101) 0 07/25/2005 09:06 9072432081 FRED WALATKA & ASSO ■o■ ---------------------- PAGE 01 0e Q " • • '� .O i%.' �I • a All ft.,, fie• ,I ����� L F I � m 6/J,PAfa�trt ,�"�. `N't�"i.14'y;`'•F' Y. r'��:;�`'�� � I.i. L, 96.2 264 � . •.::. •ij,' • x �Lc—x—x—k j�' %_%max well —"o ,� yti�; 'a� �� = JT'• o '�C '(J of GCL Y, o, •+ •F i'• Z. -l. ©' .55.0 N N ,•;_�T 3'JT•:• '' i- / �• I f Z8 T' �: (Zwi� �FncG F'i, er t' �b '`J 1 "• �- / R,:/ �ence WES000 ArcamriFIaO 7- 2e -OS (� - .. Recerfi4ied 3-/0-77 a. 7•29-87f)r A5 �L//LT dol eVE eve Cos, Set I hereby certify that I have surveyed the following described property: / -Or C5 CA OF A; It S/EGKE� /uBD ADD, N4,3 �►.CPi' p• ratiufrl� sh.• a �_.�.� "• �' i R r.feCJ�! b: '.fir Anchorage Recording precinct, Alaska, and that the I,••.:w, , improvements situated thereon are within the property . i�/�_•'•',�,,�y^Yvt n � lines and do not overlap or encroach on the property 'v.•"1,�.• • �A.O-,-{„!-, �.,��•t... ?, lying adjacent thereto, that no itnpruvements on prop. 1• t erty lying adjacent thereto encroach on the premises in . tree! WMIlte •A.•� question and that there are no roadways, transmission •- t , • NO. 33555. ta. p . Imes or other visible casements on said property except l F^ • ..` r as indicated hereon. •J�ALE /'�=317 � �) Fovo ••.»...••y:� :� �� aFFsslnan�T.�+► Dated a��Anchorage. Alaska 11ti1�1►� thh day Of �W 19 '75 Wr-NICNTS OF RECORD. OTHER THAN FRED WA.LATICA ds ASSOCIATES 'ItOSF. SHOWN ON THE RECORDED Engineers and Surveyors PLAT ARE NOT SHOWN HEREON, Fa '%'/j P 07-07-05;13:09 ; -&a%- SCS Ref 0 1053840001 Client Name Gamess Engineering Group, Ltd ProjectNameHf Lt SCSiefler#3 Cllent Sample iD Lt 8C Sicfler 03 Matrix Drinking Water Sample Remarks: ;907 561 5301 # 2/ 4 All Dotcsfrlmcs are Alaska Standard Time Printed Datc/rlme 07/072005 11:47 CollectedDate/rime 06282005 8:35 Received Datc/rime 06292005 9:39 Teehnleat Director Stephen QEde Allowable Prep Analysis Parameter Results POL Units afdMd Container 10 Limits Data Date Init Haters Department Nitrate -N 0.301 0.100 MierebielogX Laboratorx Total Coliform 0 mg/L EPA 300.0 B ("101 0629/05 JJB eoV100mL SM20 92228 A (<-I) 0689/05 TLF P. 01 t � I \ � it � � � ,..►' . r' i n Y = O gm cSQ V Y O m Nmr"� M xC•°tyii to rn N?zZr C, LO m ' Z i.pop 'k•' �r A z, w., i n Y = O gm cSQ V Y O m Nmr"� M xC•°tyii to rn N?zZr C, LO m ' Z Municipality of Anchorage Development Services Department 45.1'111� Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 198850 Anchorage, AK 99519-850 www.ci.anchorage.ak.us (907) 3437904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Jeff Gamess Legal description: Slefker #3 Lot 8C The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. % t ❑ Additional soils information needed. r„� peft�k is o"t_Ic ❑ Water monitoring results inadequate. _ loe�Q.n F�WAo (A"t o sne.-t if — ® Discrepancy in information submitted. is effective depth (sewer rock 1 of system 5' or 8' ? ❑ Topographic information missing or inadequate. _ ❑ Incomplete; missing ❑ Incomplete; missing ❑ Additional adequacy test Information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. _ ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ❑ Other. Name of reviewer: Jeff Date: 7/28/2005 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK 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 Lot 8C; Sief~r Subdivision Location (site address or directions) 12320 Jerome Street Property owner Mailing address Lending agency Mailing address. Bill Blalo ck 12320 Jerome Street 345-3158 Day phone Anchorage, Alaska 99516 Day phone Agent Mike Lewis PHH/HOMEQUITY ¢12520-30085 400 bast Las colinas Boulevard Address Suite #300 Day phone 214-506-8808 Irving, Texas 75039 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XX 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 Holding tank Community on-site NOTE: XX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev 1/91) Front MOA ~21 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/orwastewaterdisposalsystem is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, lfurtherverifythat 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 Address Engineer's signature DHHS SIGNATURE Approved for Disapproved. C~.~nal approval for $ & $ ENGhNEERING '17034 Eagle River Loop Road No, 204 Eagle River, Alask,~ 99~77 Phone Date ~.~1 bedrooms. bedrooms, with the following stipulations: Additional Comments 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. 72~)25 (Rev. 1/91) Back MOA ¢t21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegaIDescription: (' oq- ~/ ~,¢_p:cP-.& ~'//"3 ti~ ParcelI.D. A. WELL DATA Well type ~)t~tOPc-f~_ Log present (Y/I~ Total depth Sanitary seal (~/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~FORe. )~";7 Driller. Cased to ~0'+ Casing height Wires properly protected ~'N) FROM WELL LOG AT INSPECTION Date of test Static water level / Well flow Pump level Sewer service line SEPARATION DISTANCES FROM WELL TO: Septic/~tank on lot Absorption field on lot Public sewer main gO '+ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~Ot~E /0o WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: ~:~ - I ~ - c~ ~ B. SEPTIC/i~I~I~FTANK DATA Date installed Cleanouts ~_.~N) High water alarm (Y/(~) Date of pumping SEPARATION DISTANCES FROM SEPTIC/I--I~Ea~ TANK TO: Well(s) on lot IO~r/T° ~.T. c/o Onadjacentlots /00'~ To property line ~ 0 ~IL Absorption field Surface water/drainage lO0 ~7), ~L.H r~'/.e... Other bacteria Collected by: .~ Iq,':~cl Tank size I ~:'-~OO GAO Foundation cleanout (~N) Alarm tested (Y/~_~ Compartments Depression (Y/I~) Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION / Vent (Y/N) "Pump--~-orCU~vel at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed JCJ~'~ Soil rating /o~ r~F/~CJ'L System type o~Ep_Cqf....¢_ ~T m/77~H Length J '~-' Width / ~'' ~" (~' Gravel thickness Total depth pFf Total absorption area ~c° S¢ 1k ~¢.~JF¢~.p Cleanouts present (~)'N) Or~ Depression over field (Y~i) [k.)O/ ,q/..L. bE. uP-L. G-P-~JP Date of adequacy test Results ([~s/fail) ~/'¢r$~ for Peroxide treatment (past 12 months)(Y/~j) ~-(' ~-AJOuJ¢ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: (~¢ Well on lot //f~' On adjacent lots /~0 ~'/- _Property line~0 To building foundation lO Lf- To existing or abandoned system on lot /U///Z)- On adjacent lots o¢2-h---° ''fCutbank /'~//~, Water main/service line Surface water /00 ~-h Driveway, parking/vehicle storage area Curtain drain ~,) eN E. E, ENGINEER'S CERTIFICATION '~ I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec Signature Engineer's Name Date S & S ENGINEERING 17034 Eagle R vel* Loo~ Road Nh_ ¢__t~. Eagle River, Alaska 99577 HAA Fee $ /7 Date of Payment Receipt Number c.~:~J~C.,.date of this inspection. Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING h ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 552-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE ~ 54944 Chemlab [{ef.~ 92.2884 Sample ~ 1 ~{atrix: WATER Client Sample ID : DRINKING WATER LSC SLEEKER S/D ~ ~ PWSID : UA Collected : JUN 16 92 @ 15:55 hrs. Received : JUN 17 92 fi 16:50 hrs. P~eserwed with : AS REQUIRED Analysis Completed : JUN 20 92 Laboratory Supe~visor :/~TEPHEN C, EDE Client Name :S ~ S ENGINEERING Client Acct :SNSENGP BPO# : ~oq# : Ordered By :R. SHAFER PO# :NONE RECEIVED Send Repo~ts to: 1)S & S ENGINEERING Pa~ametex Results Units Method Allowable Limits NITRATE-N O. 24 re<g/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: J.W. Remarks: i Tests Performed ' See Special Instructions Above UA=Unavailable ND- None Detected "See Sample Remarks Above NA= Not Analyzed LT=Los8 Than, GT~G~eate~ Than SG-~ Member of the SGS Group (SociOt~ G~n~rale de Surveillance) MUNICIPALITY OF ANCHORAGE 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 ' Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL! (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner Ro~ -..ce'~'er-t Telephone: Home .~,5'"' ~7 ~ Business Mailing Address I~'~0 ~om~ ~, ~ ~C~O~ ~ (c) Lending institution Nor~la~ ~r~ Telephone Mailing Address ~ ~O ~. ~0~ ~ ~ ' (d) Real Estate Company and Agent ~0~ 8[ ~(tm~ - Address ~ ~OI De~ ~ I ~' Telephone ~ ' O~ ~/ (e) Mail the HAA to the followina address: or: Check here ~, if hold for pick up, List contact person and day phone number below. TYPE OF RESIDENCE Single-Family [] Number of Bedrooms WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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 fRev 8/863 Fronl 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 regulations in effect on the date of this inspection. Name of Firm F(~,~"J~O ~"~..~/t/¢~/ .~e'V'~'~c~./ Telephone Date DHHS APPROVAL Approved for "~/'w~-,C¢ bedrooms by.,~ Approved Disapproved Conditional Terms of Conditional Approval Date 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 fRev R/86) Rack WELL DATA Well Classification Well Log Present (Y/N) N MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICtPALt~¥ OF ANCHO~ffilECKLIST ' FEBRUARY 1984 5NVi~ONMF-N~'AL S~:RVtCES DtVtStON 264-4744 /: tG 71987 i¢' r~ ~'~ ~ If A, B, C, D.E.C. Approved (Y/N) Date Completed ~ Iq 'f"/ Yield Total Depth 13o ' Static Water Level Cased to ~' yo' -7¥~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Legal Description: To Septic/Holding Tank on Lot I O 8 To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N, ,4.. Cleanout/Manhole N, Depth of Grouting ,%,4,, Pump Set At ~ ,~$ ' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~.. ¢,o, ; On Adjoining Lots ~ ! ¥¢' -/o ¢.o, ; On Adjoining Lots ~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by -r'r=t''t ; Date Water Sample Test Results _~cz~'u~c_~,r'/y - O ~of,~r~ //~0~1/ B. SEPTIC/HOLDING TANK DATA Date Installed Iq ~ It Standpipes (Y/N) ~ Depression over Tank (Y/N) N Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) N,~, Separation Distances from Septic/Holding Tank: To Water-Supply Well ! o~" To Property Line Size 15'-~0~''~/ No. of Compartments Air-tight Caps (Y/N) ~' Foundation Cleanout (Y/N) Date Last Pumped ~/'/ ~ 7 / Iq, ~'. ; for ~l, ,~, Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water Main/Service Line N,A-. Course To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 77-026fRev 8/861 Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line i .Z...,- c~ '//~c~-,~, Type of System Design Length of Field Depth of Field ~¢ ' Gravel Bed Thickness ¢,~~,~,4//' Standpipes Present (Y/N) Date of Last Adequacy Test ~r -~ ~r~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line ¢ o ' To Existing or Abandoned System on On Adjoining Lots ;~ 3¢'~ To Cutbank (if present) N, ,¢ , ~ Ioo ~ D. LIFT'STATION J~,A.. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection· Company F[~ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 [Rev 8/86) Back r,N, 500 NEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE. ALASKA 99518 TELEPHONE (907) 5622343 FEDERAL TAX ID N 92-0040440 A.SnLYSIS REPORT BY VINKE Client POt : VEPV1 Req t: Client Sal ID: LEL^ SEIFL_v'? 8-3-87 San;le Recd : AUG 3 87 Ordered By : Mi MOGRE Send Reports To: FLATTCP TECEEJICK SE?.7ICE 145n ECEO ST VEZPAGE, Al. 995416 Special ROUTINE MME CCLLECIED 6-3-87 by T. NOOSE. Instruct: Che --lab Ref t: 7152 Lab SSI ID: 1 Pars_eter Tested NITZIM-N Matrix: Water ResiIt/Onits 0.16 co Sa ale RCUTINE SA"TLE Re ks: ASALYSIS CCPPLEIED: 6-5-87 LAEGRATORY SCPMISOR: STUFM C. VE :. 1 Tests Performed k See Special Irstruetleas Abc7e ND= None Detected is See Sa.-Ple Remarks Above M. No; Analred LT=Less Than, GT=Greater Than York Order No. : 2031 Client Aoccunt : PLATTOT Tate Report Printed: AUG 6 87 Released By : 2 ,, Reports Address t2 Allaaable Method Limits 10 9 10:4C GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality "C" Street, Anchorage, Alaska 99503 274-4561 Date Received February 23, 1977 Time of Inspection Date of Inspection - -~u3£. REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: Post Office Box 4-2090 99509 2. Property Owner: Ronald J. & Leila M. Segers Mailing Address: Unknown Cony. First National Bank of Anchorage, Southcenter Phone: 274-1521 x 55 Phone: 349-2362 3. Legal Description: Lot 8C Siefker Subdivision 4. Location: NHN Jerome Street 5. Type of facility to be inspected 6. Well Data: A. Type Individual C. Construction 7. Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: 8. Distances: A. Well to: Septic tank Single Family No. of bedrooms 5 On-site System l, Size 1. Absorption Area Total length of lines B. Depth D. Bacterial Analysis B. Installer 2. Manufacturer 2. Material 130' , Absorption area , Sewer Lines , Nearest lot line ., Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Rec ;t for Approval of Individual S ~r & Water Facilities Legal Description Lot 8C Siefker Subdivision Comments Approved ~ ?/~/~/_ ~j~sapproved Date Approval kValid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) /~UNI~IPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEOTIONENVIRONMEN?AI ?ROT[CTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 FE i~ 2 L5 1977 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES RECEIVED 1. Type of Inspection: CMRO VA.. FHA CONY ×× 2. Property Owner: Ronald J. & Leila M. Segers Mailing Address:. unknown 3. Name of Buyer: n/a Day Phone: 349-2362 Mailing Address: 4. Name of Lending Institution: Mailing Address: Bo× 4-2090 Anch. 99509 5. Name of Realtor or Agent: n/a Mailing Address: 6. Legal Description: Lot 8C~ Location: Day Phone: First National Bank of Anchorage - South Center Branch Phone: 274-1521 ex. 55 Siefker S/D NHN Jerome St. Anchorage~ Ak. Phone: 99507 Type of Facility to be Inspected:_. single family dwelling Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served No. Bdrms. 5 Individual XX one If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation 130' Public Utility unknown Individual (on-site) XX 72-003(3~76) V . — GREATER ANCHORAGE AREA BOROUGH / Department of Environmental Quality 3330 "C' Street, Anchorage, Alaska 99503 274-4561 ' 1 Date Received (p Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF 9:te L-sL(e--Is INDIVIDUAL SEWER & WATER FACILITIES Cxxr ' 1. Approval requested by: , ° i sir Mailing Address: T— Phone: .2 7 iL X 2. Property Owner: Phone: %+Z Mailing Address: 3."Legal Description: 01 4. Location! 5. Type of facility to be inspected s ,0=4b No. of bedrooms 6. Well Data: A. Type C. Construction B. Depth D. Bacterial Analysis 7. Sewage Disposal System: A. Installed / q 7 a B. Installer )Itt) C. Septic Tank: 1. Size / 7r 2. Manufacturer /'vim / D. Seepage Pit: 1. Absorption Area IW_ 2. Material i E. Disposal Field: Total length of lines �� "`" 8. Distances: /y -- A. Well to: Septic tank �� / Absorption area / Sewer Lines Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages i v 8dge 2 of two pages - Re('~` t for Approval of Individual `-%r & Water Facilities LegaT Description Comments Approved sapproved Date ��z2 Approval;Valid for one year from date signed Greater Anchorage Area Borough. Department of Environmental Quality DIAGRAM OF SYSTEM n� w I 3RD E� r� 2f 24 / S r I certify that the information contained in this request for al accurate representation of the subject sewer and water facilit are operating satisfactorily. SIGNED EQ -034 (1/74) 3 to be a true a#d' these facilitt GR'.'AI,:R A~,~/.HORAGE AR[;,$ i30ROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 6-5-75 1. Type of :~nspeci:iorl: CMRO V'A 2, Property Owner: Ronald J, & Leila M, Segers Mailing Address: NHN Huffman Rd. 3. Name of Buyer: FHA x CONV DSZ Phone ~'~r=-5~2-~ .,, i,lailin9 Address: 0~7 Phone 4, Name of Lending IIIsi:'i'ttl'~.ion: First Nationai Bank of Anchorage Mailing Address: PO Box 4-2090 Phone 274-1521~41 5. Name of Realtor or Agent: Mailing Address: Phone Legal Description: _Lo~_8C ,..Siefk,e.r S,/D ~3 L o c a t i o i1: Huffman Rd. 7. Type of Facility to be inspected: 8. Water Supply SFD No. Bdrms. 5 Type of SuPl)ty: Public Ui:ility __ Individual If Individual, number of dwellings presently served If Individual, clep'ch o'F well Sewage Disposai. Sysi:,'.m'l X 1 i'ype .of S~,s'i:em: Public Utilil;y Individual, date of installation Incl'~ v'idual (on-site) x 7,0'9 0 FO