HomeMy WebLinkAboutHILLSIDE NORTH #3 BLK 2 LT 1Onsite File
Hillside North #3
Block 2
Lot 1
#041-021-72
, ~ ' Municipality of Anchorage Page ? 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
PermitNumber: ,.~'y/ 9~'0o(~/ PIDNumber: o~//~o
Name: / 0~/'~ ~, ~A~ ~ Wastewater System: ~New ~ Upgrade
Address: ~O ~,~ sr~¢ ABSORPTION FIELD
I No. of ~edrooms:
Phone: ~_ { ~O ~ ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound D Other
LEGAL DESCRIPTION so, Rating: ~, ~ GPD/Sq. Ft. Total Depth/j/fro~ original grade:
__ Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe
Lot: / Block: ~ ' 4~Z~;~ ~/~.¢//~ ~ Ft. p Ft.
Township: Range: ~ Section: Fill added above original grade: Gravel length:
WELL: ~ New ~ Upgrade Grave~ width: Number of lines: Distance between lines:
~ Fi. / -- Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area:~ Pipe material:
Driller: Date Drilled: Static Water Level: Installer: Date installed:
Pump Set at: Casing Height Above Ground:
Yield: ~ GPM I ~ /'1 ,~ ,~. 3 ,,. TANK
SEPARATION DISTANCES s Septic ~ Ho~d~,g ~ S.T.E.P.
To Septic Absorption Lift Holding =ubiic/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~ ~ ~ ~
/ Material: Number of Oompa~ments:
we~ /~o~ /~o ~ ' ~ ~ ~
~'~ ' ' ~ ~ ~ LIFT STATION
w~ter /00~ /00 ~i
Lot / Size in gall°ns: I ~
Line ~5
/ "Pump on" level at:~ ~e at:
Cu~ainDrain ~ ~/~ ~ ~ ~ Pump Make & Model Electrical Inspections pedormed by:
Remarks: BENCH MARK
Location and Description:
/
Assumed Elevation:
5 & S EN~?EERING ~ates' let ¢/' ~ ) ~ v , ' '
Inspections pedormed ~H ~iver [.p koa~ No. ~ '2nd ¢/~ ~/~ Y '~~~--J" '"'"*'~-
Department of Health and Human Se~ices approva~ ~- ~b, ,.
Reviewed and approved by: ~.~/~/, ~Date: ~-/~'q~ ~-"'"~ .....
72-013 (Rev. 9/91) MOA 25
r~i~' No. SW980064
PAOE 2 OF 5
Municipo,!,i-t o-F' Anchorc~oe
DEPARTMENT OF HEA~-THAND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ~_Amchorage, Alaska 99519-6650 · Telephome~ 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEH AND/OR WELL INSPECTION REPORT
LEGAL LOT 1, BLOCK 2, HILLSIDE NORTH #5 S/D ?.I.D. NO. 041-05-182
LOT
~ \~ /'l oo~
i... -~-NEW DRAIN FIELD
PERMIT NO. SW980064 PAGE `3 OF 3
Municip. aLi~c oF Ancho~'ac~e
DEPARTMENT OF HEA~_THAND HUKAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 I Anchorage, ALaska 99519-6650·Te[ephone~ 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~.ECA~. LOT 1, BLOCK 2, HILLSIDE NORTH #5 S/D P.I.D. NO. 041--05--182
NEW
1250 GAL ~
.9'
TANK
A B C D
:CO .35.5' 21.0' - -
ST1 - 24.0' .37.5' -
ST2 - 24.0' .31.5' _
DBL1 - 25.5' 29.5' -
DBL2 - 26.0' 29.0' -
C01 - 29.5' 22.5' -
MT - 70.5' - 6.3.0'
C02 - 75.0' - 66.5'
GRADE~x~ CO~,,,/_C
MT ~,no CO1 = 102'
02 99.5'
MT = 90.~' .~
96.5'
NO WATER FOUND
8S.7' B.0.H.
SCATM 1" = 40"
LOCATION OF WELL
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING & WATER MGMT ~?(/-'f~OI--
WATER WELL RECORD
~OROUOH
SECTION QTRS
MERIDIAN
LOCATION/SKETCH:
DEPTHS MEASURED FROM:[]casing top u~,ground surface
~OREHOLE DATA: Depth
Material Type ~nd Color From To
WELL OWNER;
WELL DEPTH: ...~
Dcpthof hole:._,~/ 2'~ ~j~ ' ff
Depth of casing:, ft
DATE OF COMPLETION
DEPTH TO STATIC WATER LEVEL;
,~.,O ~ ft beJow../~'t0p Of Casigg
. ,.-> ¢'
[] ground surface
IVtETHOD OF DRILLING; ~.~.air rotary ~] cable tool
[] other
USE OF WELL:~'1~ domestic [] irrigation []
monitor
L-~ public supply ~ othe'r
CASING STICK-UP:
Casing type:~',~'"
ft. Diam: in. to
WELL INTAKE OPENING TYPE: [~ open end
[] perforated /~ open hole
Depths of Openings: to
screened
SCREEN TYPE: Diam: in.
Slot/Mesh Size: Length: ft
GRAVEL PACK TYPE:
Volume used: r__ Dept~ to to, p:, ·
Depth: from It to ft
"EVELOPMENT M TR? :
Duration; ~/
PUMPING LEVEL AND ,fIELD:
~ ~,~_.~Tt after ~ hrs pumping ..~?..., gpm
PUMP INTAKEDEPTH~ __ft HorsepOwer: ~
WELL DISINFECTED UPON COMPLETION? ~,YES [] NO
CONTRACTOR INFORMATION: , . REMARKS:
,,~ ~' ~ '~ · ..., , ~.~,
,c~ster~ Busisess Name '/ -- ~
. .. ,¢ WHITE
. .1 .r'~ ....... ' /~" --~ % ~ ~'~'' ~ Q D
Signature of Authorize8 ReSpresen[a~ ~ N~/DIVISI~_QF.MINtNG & WATER
' ' ' ~601 C St, Suite 800
ANCHORAGE A~ 99~03-5935
Phone (9071269-8633. Fax !907)562.13Bo,
ROBERT C. COWAN, RE.
ROBERT A. SHAFER, RE.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAl. &
MECHANICAL
INSPECTIONS
ON SITE
W,~T EWATE R
DISPOSAL SYSTEM
DSSIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
MAY 15 1998
Municipality of Anchorage
Oept Health & Human Services
REFERENCE: LO~ I ~ Lo c~ ~ ~;Lu~D~ ~O~rE ~Y~
The septic inspections for t~e/referenced property were
performed on ~/~ ~ and ~3/q~ . Prior to submitting
the On-site Wastewater Disposal System and/or Well Inspection
Report we are waiting for the F~,~,~/~8~r ~,~o be
completed.
If we may be of further service please contact us.
Sincerely,
Robert C. Cowan, P.E.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, AL/~KA 99577
PAGE
1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW980064
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:EDWARDS LOUIS A & JUDY E
OWNER ADDRESS:2511 RIDGE POINT DRIVE
ANCHORAGE, AK 99515
DATE ISSUED: 4/16/98
EXPIRATION DATE: 4/16/99
PARCEL ID:04103182
LEGAL DESCRIPTION:
HILLSIDE NORTH #3 BLK
2 L1 1
LOT SIZE: 70247 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
DATE:
DATE:
ROBERT C. COWAN, P.E.
April2,1998
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
iNSPECTiONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
MUNICIPALITY OFANCHORAGE
DepartmentofHealthandHumanServices
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 1, Block 2, Hillside North Subdivision, Addn. #3
Request you issue a permit to drill a well and install a septic system to serve the
proposed three bedroom house on the referenced property.
A test hole was excavated and a percolation test performed. The approximate location
of the test hole is located on the attached site plan.
At the time of excavation no water was encountered, and after seven day ground water
monitoring the monitoring tube was found to be dry.
This property has enough area for a future septic upgrade which can be seen on the
attached site plan.
There are no points of contamination within the proposed well radius which can be seen
on the attached site plan.
We do not anticipate any adverse effects on neighboring wells, septic systems or
drainage patterns by the installation of the proposed septic system.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/mg
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, AI./~KA 99577
/ ~ zo
' '1 .... = 40' DETAIL DESIGN
· , SCALE -- i
~ x x /
.........
~0 ~ ~ ~ ~
PERFORMED FOR:
LE,GAL DESCRIPTION:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMEC
Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
G.d.fl.
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
neplh tO Water Alter
Monitoring? . Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
/o/,.~1,~7 "3,'.v5- - ~'- %" -
~ ~ ~ 7 ~ ~,~ ~ '/~" '/Y"
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN -7 FT AND ~ FT
COMMENTS .~'~ ~'7/~8t~4.._ F-O,E Oxv$, 2"~ ~T/C ~YST~ ~
, /
PERFORMED BY: ........ '- ~[;';7 [==~ "''a .... "~ I ' CERTIFY THAT T~IS TES~WAS PERFORMED IN
.CCO.D*NC~ W~S~~8~*L GU,gEUN~S ,N ~.FECT O. TH~S O*T~. D*TE:
72-008 (Rev, 4/85)
ROBERT C. COWAN, P.E.
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE'WATER
DISPOSAL SYSTEM
DESIGN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
REFERENCE: Lot 1, Block 2, Hillside North Subdivision, Addn. #3
April 2, 1998
GENERAL:
The scope of this project includes the installation of a 1000 gallon septic tank
and a leachfield trench to serve the proposed three bedroom residence located on
the referenced property.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
o
The contractor shall be responsible for obtaining any necessary underground
utility locates.
Unless specifically agreed otherwise, the property owner shall be responsible for
final grading areas subsequently depressed from soil settling.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing their
own systems must also receive prior approval from the Municipal Health
Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent settling or shifting of the
tank.
All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
4. Septic tanks installed with less than 4 fi. of cover shall be insulated.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577
Page Two
Lot 1, Block 2, Hillside North Subdivision, Addn. #3
April 2, 1998
o
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.
Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of
the excavation shall be within 2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock)
placement.
Once the gravel is installed, the distribution pipe is to be installed level 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.
A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the
locations shown on the design, and extend a minimum of 12 inches above final grade.
The portion of the monitoring tube extending through the gravel shall be perforated
from the bottom of the trench to the invert of the distribution pipe. This is equivalent to
the effective depth of the gravel as noted on the design.
Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent the formation of a
depression after settling.
Page Three
Lot 1, Block 2, Hillside North Subdivision, Addn. #3
April 2, 1998
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
T.vpe of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting
engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco,
or equal).
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.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
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:
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
Lot 1, Block 2, Hillside North Subdivision, Addn.//3
April 2, 1998
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
Parcell.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
041-03-182
"Wiff i1m-AMINIMekl5T. 00111
HAA# o503[
Expiration Date: . / D — 7 " 0 .S
Complete legal description Lot 1; Block 2; Hillside North Addition #3
Location (site address or directions) 9551 Burning Bush Anchorage
Current Property owner(s) Tex Edwards Day phone 440-9847
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
9551 Burning Bush Anchorage. AK 99507
Day phone
Day phone
Unless otherwise requested, HAA will be held by DSD for pickup. 7W�` 7
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
Ek
Individual On-site
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 sample results. (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 engineer's work.
4. 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 application, shows that the on-
site 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 files 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 S 6 S Engineering
Phone
694-2979
Address 17034 N. Earle River Loop Ste. 204 FnZIr, River, AK 99577
Engineer's Printed Name Robert C. Cowan Date -7/s-/Os-
E01 /S-/oS
5. DSD SIGNATURE ROBERT C. COWAN
1 O�,•� CE -8801
✓ Approved for 3 bedrooms. '++�i` ••. „,_„ n�!
111ZF�OicSSI ti�
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: G✓ Original Certificate Date: 7-
(Rw. 01M2)
Municipality of Anchorage
• Development Services Department
Building Safety Division '
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lo r / a Lcc/c "oL NILL.) i42 n/o. 404.4'3 Parcel ID: 6.41-0 3 – /Y1
A. WELL DATA
Well type PRI .4T4'
Date completed s�/3A
Total depth 36�- ft.
Date of test
Static water level
Well production
If A, B, or C provide PW SID # =
Sanitary seal ®/N) KL5
Cased to -74 ft.
FROM WELL LOG
6'11:) /4) Y
WATER SAMPLE RESULTS:
G 6 ft.
?-.() g.p.m.
Well Log&N) %' E Jr
Wires properly protected (DJ) Y4 -f
Casing height (above ground) f in.
AT INSPECTION
(,l9/oS
7 s ft,
3'. g.p.m.
Coliformcolonies/100 mi. Nitrate0.23 N mg./I. Other bacteria O colonies/100 mi.
Arsenic: mg./I. Date of sample: 6 �a�O r Collected by: S Z S ENGINEERING
d No. 404
B. SEPTIC/HOLDING TANK DATA Eagle Rhw, Ala&& 99377
Tank Type/Material S EP r' c. /" ST c it i Date installed S// z/ q Q
Tank size i a. SO gal. Number of Compartments 2 Cleanouts ON) Vi s
Foundation cleanout &N) Y61 Depression over tank (Y69 /''0 High water alarm (YA® -" a
Date of pumping 5 � 18 � 0 t Pumper P --'O &—,H
C. ABSORPTION FIELD DATA
Date installed S'�r W 9 Y Soil rating g.p.d./ft' r ft2/bdrm) System type 7-R F r c/!
Length 5-0 ft. Width
3
ft. Gravel below pipe 6 ft.
Total depth 9_ ft. Eff. absorption area (v co ft' Monitoring tube YX_f Depression over field N o
Date of adequacy test G / 949 r Results a— Fail) #P-4JJ For �7 bedrooms
Fluid depth in absorption field before test (,a , in. Water added
y S i gal. New depth 2 Sin.
Elapsed Time:G Oo min. Final fluid depth I!O in. Absorption rate >= -J� S O g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) Now- kf#-W If yes, give date
D. LIFT STATION
Date installed Size in gallons
'Pump on' level at —in. `Pump off" leve
Datum Cvcles tested
E. SEPARATION DISTANCES
High water alarm level at
Meets alarm 8 circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ) e D ,' On adjacent lots
Absorption field on lot 1 fO c 14 On adjacent lots
Public sewer main N / /1 Public sewer manhole/cleanout 1✓ 1,4
Sewer /septic service line a` S 'f Holding tank N�A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation a l Property line a i Absorption field S +
Water main NIA Water service line /0 r Surface water f o c '4-
Wells on adjacent lots 100 ff
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line SO / Building foundation ;Lo Water main NA
Water Service line /0 '+ Surface water ) a o i+ Driveway, parking/vehicle storage t ,
Curtain drain rjs r L k.l it w Wells on adjacent lots 1004
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and i••
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date. A,\ROetRT'C. COWAN
Engineer'si�OeQE.tit– �. Cow.i✓ c�r:�� C.-8801
Printed Name
Date
HAA Fee
30, 09
Date of Payment 7 / r/ ) S
Receipt Number O -7 0 tf y
(Rev. 12/01) K4
Waiver Fee $
Dale of Payment
Receipt Number
in.
06-28-05;13:35 ; ;907 661 6301 # 2/ 4
SGS R*U
1053291001
pleat Name
S & S Engineeting
ProjectNamdY
L1 B2 Hillside N Addition #3
Client Sample 1D
Lot 1, Blk 2, Hillside N. 93
Matrix
Drinking Water
Sample Remarks:
All Datea/rleses are Alaska Standard Time
PrintedDattmme 06/14/2005 16:3S
CelleetedDatdIlme 06/091200714:45
RteelvODatelf1mv 06/09/2003 16:31
TabnlcalDireetoe Stephen G Ede
Allowable Prep Analysis
Parameter Renin POL units Method Cw,,;=,ID Ltm;ts Date Dtee knit
Maters Departzaant
Ninte•N 0.234 0.100
Microbiology Laboratory
Total Coliform 0
mg/L EPA 300.0 B (a10) 06/10/05 JJB
ooVl00mL SMO 9=13 A (<-1) 06/09105 TLP
204
PLAT PN AS BUILT SCALE dJ t 40
UI GRID Prof No.
L.S.1771 George Bell Circle
K*21IR& G. L�mLe
ss SAnchorage, Alasks:99515 (907) 343-6476
y,a;•.. e.rty
1 Bw.hy ceniry that 1 ba+• ioryaY•d the foliewlad described iJt¢; t(R.a•T em -ft:)
Lm�L—•81ock
OL(
sr
sILNORIC*lt Recording District- AIHka, and that the Improvcmeaa almated W. . • t' ,
thereon an within the property lines -and do ant encroach onto the property • r ..•' j
adjacent thereto, that ee improvements on the property IYinp adlarroat therate s J, +•'. \ •' 'e
encroach oa the a,rveyed premise, sed that the.. are to roadways. IraHmiseloo �•t
lines or ether visible easements as Hid property saeepl H indicated herwe. �, t
` d !^' ewe.•. 6. Irty / j JS J
Dated this Ih..17�. Day er—h4nvs wpat ll - 19'�... et Aechenpc, Aluha' d 5 '., L`,. S]O?
r S •
It is the respossiumvy girth• own" to determine the Hineac• eremy ereem•ats, ddb «•
eoveo.ats. at resrricttnn, whit), do ant eppeer on the recorded 1.1,4M ion plat. e��a•.aa►