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HomeMy WebLinkAboutNORTH SLOPE #1 BLK 3 LT 1North Slope #1 Lot 1 Block 3 #050-511-18 Municipality of Anchorage Page ' of 3 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: 450 OO©I I PIO Number: QSO — $ t I ^ I g NAmuA. /Q 1 n i 50 11 e t l 1 Wastewater System: KNew ❑ Upgrade A ,es,/— o 0 o A rP • 915 ABSORPTION FIELD ,/ Phone' 6 1p61-579 No of Bedrooms' O Deep Trench Shallow Trench O Bed O Mound ❑Other LEGAL DESCRIPTION sell Rating D $ Total [).Pill Ito. Original grAde' I` � CPO/Sq FI Lot' Block: SubdiAsion- Iva fkPlh to Piryr hollom I," o09prlr. a Ft Gravel depth twneath pi M FI township: fiance' Section' rill added shove odtfInat grnde� Gra", llenoth- .r FI — rl WELL: WNew DUpgrade Gravel width: Namur of line, I ontw@beta.`. tins' FI FI CtaHillcation lPrnnlvate�A,B.C,1'{, P71 Vel / ' Total Depthj4i total sh,orption area 5550. PI ematrdat. D,R Drilbr. • 1 1 j 5 I an C/�/L I Date Drilled D- FI Insist,.,: �jj IaJC� e401 IA DATA IMtalled- 5-311_(! Yield. IQ Pump Set at: Carlini; ti ghl A G,ou d e TANK GPM t. u FI. SEPARATION DISTANCES septic El Holding 0S.T.E.P. To From SrPlic Ahsaptbn Field LAI Station Holding Tank Icm'lvme Sewer 1.1 MAnufactinv- s preml 0. S v , Cepacily In gAaons' ^ w 0 s/�0 Well /T�aa.k / ('t .4., �M „y_ Imo)[" O(' Material: D pt /Y Numher of COmparimenh' Surface I�+ /1n.L1 LIFT STATION Lot Line A LW' \T o size In gallons: Manu .r: Foundation ISL ' "Pump on' level at: 'p I' leve Irish wAter alarm in. Curtai Drain Drai Dn A' p nlmlp Mab I m Electrical Inspections performed by nemarks: BENCH MARK Location and Description: e e 0 om s in + .in u AssumAd Elevation: I co EN y�r'c .. » 7q 7" r �. 9 S 8 S ENGINEEkiNG 17034 Eagle River Loop Road, No. 404 Inspections performed by: Eagle River. Alaskaggm Dates: lst S 70 -CO ' �2 .......... I I, p�1it ROBERT C COWAN FrnAI 7-10-00CE-0801 Department of Health and Human Services approval P �e Reviewed and approved by: Date: 9-26" ° •iiz_.►� arvp NQ^ n PERMIT NO. 119 1 9 PAGE 2 OF 3 Municipalityof Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Tele e hon343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 1, BLOCK 3, NORTH SLOPE #1 P.I.D. NO. 050-511-18 COt STI • NEW 1000 GALLON MT1 ST2 • HDPE SEPTIC TANK NEW TRENCHES DBL1 & D8L2 C04 DV (DIVERTER VALVE) MT3 , CO3 yam/ MT2 CO2 \ c \\\ c H -\ ACTS \ LOT 9 \\\\\ V_ 40' r i RMM C. COWAN `c,% CE 4801 PERMIT N0. 119 1 9 PACE 3 of 3 Municipalityof Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 •Anchorage, Alnsko 99519-6650 • Tele e hon343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 1, BLOCK 3, NORTH SLOPE #1 P.I.D. NO. 050-511-18 ST1 ST2 -,-96.8' FINAL GRADE NEW 93.3'1000 GALLON POLYETHYLENE SEPTIC TANK Col MTI n CO2 NIT1 = 91.2' MT2 COI = 94.9' CO2 = 94.1' ,,-FINAL GRADE 2" INSULATION 93.1' CO3 MT3 CO3 = 90.8' C04 = 90.1' 1101 -.-2" INSULATION 0' = 87.6 Flag F MT2 = 91.2' NATER FOUND © 83.0' 7g.0' B.O.H. MT3 = 87.0' N. T. S. A B C FCO 5.0 - 31.0 ST 1 19.5 - 44.0 ST2 22.0 - 47.5 DBL1 24.0 - 50.0 DBL2 25.0 - 51.0 DV 26.0 - 52.0 C01 25.5 19.0'- MT1 25.51 19.0 - CO2 65.0- 83.0 MT2 65.0 - 83.0 CO 44.0 60.0 77.0 MT3 43.0 41.0 - 004 43.0 41.0 - MT2 = 91.2' NATER FOUND © 83.0' 7g.0' B.O.H. MT3 = 87.0' N. T. S. FROM DISOTELL CONSTRUCTION FAX NO. : 1 9076960215Sep. 08 2000 04:55PM P3 /� a (IT �J►3 S L `L��il�l n .by DOC Co dta SULLIvAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA99567 • TELEPHONE 688.2759 OWNER OF LAND (: Ad JQ 30607'e/1- ADDRESS (0/50 i L'=/1 - ADDRESS LEGAL DESCRIPTION lz A3 40 i PERMIT NUMBER 000 Date of. Issue T R0•t() TAX INDENTIFICATION NUMBS ' 0 0 � �o Is well located at approved permit location? Q Yes 6<0 Method of Drilling: air rotary Q cable tool Depth of well: 10t Casing Type TE«- Wall Thickness inches Diameter %-/ inches, depth /2 feet Liner Type: A)or3'- Casing Stickup Above Ground: 02• feet Static Water Level (from ground level): o?O feet Pumping level:_feetaher hrs..pumping __gpm Recover Rateh3l' gpm Method of Testing: '4/1 Well Intake Opening Type: pen End Q Open Hate Q Screened; Stag feet Stopped feet Q Perforations Start fegj Stoppedr� feet Grout Type: A3F.4 7 C,eFVolume Depth: from feet. feet, to feet Pump Intake Depth: feet Pump Size hp Brand Name gro o d CAS...)6 oZ S o..tc.� (3JR46.J a� 1,4-JQ CXAJs'c.'s 6A]47-�Ell Well Disinfected Upon Completion? 6Ws Q No Method of Disinfection: - Cf/t o4....1c S" b /pM Comments: V�1a n Driller's Name ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Hutnan Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation.` . TEALTHARHONTY APPROVALS SEWERS WATER M INEXTENSIONS SEWERS WATER INSPECTION ENCNNEERMSTIAIES ANDREPORTS WELLNSPECTION S FLOW TEST SITE PLANS I� i!AA:33E2:1 SOILTEST PIRCOIATICN TEST STRUCRXVLS AEOVW.AL INSPECTIONS CNSITE WASTEWATER DISPOSALSYSTEM CESIGN Date: i ////00 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: LOT 16 L-0 c- v- 3 N0x7-1T`sLo,o,f. a I ROBERT C. COWAN. P.E. ROBERTA. SHAFER. P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 The septic ins ecpions for tFe referenced property were performed on 30 o 0 and (, rloy Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the c. -A- CA A.OiNG 4 to be completed. 3.80'�r sVAVEi If we may be of further service please contact us. Sincerely, Robi!rt C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE 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 ONSITE WASTEWATER DISPOSAL SYSTEM /WATER SUPPLY PERMIT Initial rMT6,CiW 513b1oo @ /aPV 5>13��@ � Date Issued: May 23, 2000 Expiration Date: May 23, 2001 Permit Number: SW000119 Parcel ID: 050-511-18 Legal Description: NORTH SLOPE #1 BLK 3 LT 1 Design Engineer: 0003 S & S Engineering Site Address: Owner Name: Carl Disoteli Lot Size: 42561 SO. FT. Owner Address: PO Box 770210 Total Bedrooms: 3 Permit Bedrooms: 3 Eagle River , AK 99577 - This permit is for the construction of. g Disposal Field Q Septic Tank Holding Tank E] Privy Q 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) 3434744 ( 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, seated, and heated to prevent freezing. Received By: Issued By: Date: 2— Date: Date: S— 23 — OQ liMMAIniIaITr APP110VALS SEwEns WATEn sEwEntwAtEn NSI'ECI1m DMiEfrIMSttots ATAnfoonts WE I.*JSIECT" S rtow lESI S1IERANS IgMOESM Wk TEST PEnCCEAT*" TEST SIINCIvnAL S waw+1CAI. "PECT10NS CNSIIE WASIEWATEn OISPCSALST3TE4 brs"i S&SN pneem"G noOEnr C. COWAN, P.E. CIVIL ENGwEEn3 (907)694-2979 rAx(9o7)694-1211 April 20, 2000 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 1, Block 3, North Slope S/D It is requested that you Issue a permit to install a well and a septic system to serve the proposed three bedroom dwelling on the referenced property. Two test holes were excavated, and percolation tests were performed. The approximate location of the test holes is located on the attached site plan. At the time of excavation 9-15-99, water was found at 5 feet. After seven days of ground water monitoring, water was found at 5 feet. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, •7wz Lfz� Robert C. Cowan, P.E. RCC/bjj Enclosure I7o04 NonTN EAGLE ntvEn Loop • SUITE 204 • EAGLE nIVEn, ALASKA 90577 0.4 A 5 0 N 10 04 4 c+ CNK CO4 vt i 60' I DESIGN I SITE -PLAN Y / ---HARCA STREET -- a N V A m r W • M� Z p n ►•rl �Z A .. O W O D -3 co C')� co U p,n� v9 O O o ulco fp nmo 0, C) N � Z N Y' N v �J s oyo >�p r m r W • M� Z p n ►•rl �Z A u < co C— r 'Oo O O o G] fp nmo Z Y' �J s oyo >�p r Z - K K N O A ^n s s ymp Z O O PRIF"URMED Foil: LEGAL DESCIIIPIION OFP[JI In( I�CCjI yl_• — / 23- 4 _4_ 7— f 9 _ i. 10_ 13.0t��• WASGNOUNOWAIER ENCOUNIEnED7 _, 1 I--- 13- IF YES, AT MAT �� L---DEPTIA 7O12- P----Bepth to Water ABh • y,,7 -s7-- - - - -- - Monitoring7 Bale: 14 - 15 J'IN I�-0 1G- `eJr 17 18 19 heading Dare Gross Time Net Time Depth to Water Net Drop -'moi L Iup N n E (Gi'.E a— - ��— l2' — 10_ 13.0t��• WASGNOUNOWAIER ENCOUNIEnED7 _, 1 I--- 13- IF YES, AT MAT �� L---DEPTIA 7O12- P----Bepth to Water ABh • y,,7 -s7-- - - - -- - Monitoring7 Bale: 14 - 15 J'IN I�-0 1G- `eJr 17 18 19 heading Dare Gross Time Net Time Depth to Water Net Drop -'moi L Iup n E (Gi'.E a— - ��— l2' 20 - PEnCOLATIONRATE �l Immutevatch) PEnC IIOLE DIAMETER ` J a C0A1MEN75 T # � IESI nt7N BE1WEEN FT AND '? FT PERFORMED BY: ' o a . 17034 R ACCODANCE Wil/1 ha %Tj 72 0081Rev. 4,851 paL. •`•/i:✓n�= CEn11fY IIIaIAI T IIS IESI WAS PEnl0i1LIED IN IN EFFECT ON IIIIS DATE. DATE: 9 /�F l� • Munlclpality of Anchorage UEPAf11MEN r OF IIEALIII 6 IIUMAN SEFIVICES 825"L" Street. Anchorage. Alaska 99502-0850 SOILS LOG — PERCOLATION TEST r. 2 PERFORMED FOR: 1�1)k\: ,�-/� 1aI^l�t�. (:,� DATE PEnr ORmE LF.GALOESC1RPIION �–� f3 .j f•+�. SLuNE It I lownship•Nange•Secliom gErun SLOPE SITEi lycTs) U(�- f—TTl-1 12 13 14 15 18 17 18 19 G ROBERT C. COWAN CE -8801 Date Gtoss Time 2 Depth to Water Net MOP J. c��tJ ut.dr s )L f 3 — 4 _ y 5- • — lY 7 ~' 19e •9 e' fill n_. 10- 0 -II / % au" 7 +• 11 1i•B•Fn. 12 13 14 15 18 17 18 19 G ROBERT C. COWAN CE -8801 ENCOUNTERED? WATER— ENCOUNTERED7 S IF YES. AT WHATI' 1 L — DEPTIt7 O P Depth to Whet fillet 1 /7'- L / y -a f fy — — — — — — — — Menlletinp7 Date: /' neaJ6tg Date Gtoss Time Net 7ime Depth to Water Net MOP N E, F-> — — 19e •9 10 .at 1 .••r at / % au" 7 ENCOUNTERED? WATER— ENCOUNTERED7 S IF YES. AT WHATI' 1 L — DEPTIt7 O P Depth to Whet fillet 1 /7'- L / y -a f fy — — — — — — — — Menlletinp7 Date: /' neaJ6tg Date Gtoss Time Net 7ime Depth to Water Net MOP E, F-> 19e •9 10 .at 1 .••r at / % au" 7 20{ 1 ,. UPERCOLATION RALE /0 Immulevtachl PERC HOLE DIAMETER (+' COMMENTS TN-*:ika TEST RUN BETWEEN F1 AND % Fl PERFOnMED DY: S & S ENGINEERING I Y ��" - ' ;'�� CERTIFY lllAt 11115 TEST WAS PEnFORLIED IN ACCORDANCE WI !jW l %;,Eagle RIY•Ir Loo Road LGILOMS IN EFFECT ON THIS DATE. • DATE: el /J-9 �sgl� I�va�,,cns�t':���i�f 72 ous (nev. oras) "M11IN7I0Omiv APMOVAtS SEWEna WATEn TMINEXTEAI K" SEWEnSWATE" MSrECTK)N EPONEMMSTUORE.S NRn of rI MTS Mt VISPECTM A ELow TEST TOIE PLMS AOAOUESMN SORE TEST PETTCOLANON TEST SYM)CIUnALA MEOVMAL MSrmnom ONSITE WASTEWATEn CISMOA1SYSTEM OESRON n00EII r C. COWAN. P.E. CIVIL ENGINEEnS (907)6942979 FAX(9o7)694.1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 1, Block 3, North Slope S/D April 20, 2000 GENERAL: I. The scope of this project includes the installation of a 1000 gallon septic tank and a, new trenchrto serve the proposed three 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. 17034 Nonni EAGLE nNEn LOOP -SUITE 204 -EAGLE nIVEn. ALASKA 99577 Page 2 Lot 1, Block 3, North Slope SID April 20, 2000 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. 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 fl. 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 TRENCHIDRAINFIELD 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. 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. 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 3 Lot 1, Block 3, North Slope SID April 20, 2000 MINIMUM 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: R, 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: Page 4 Lot 1, Block 9, North Slope SN April 20, 2000 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. 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. CONTRACTORIINSTALLER 1 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 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-511-18 1. GENERAL INFORMATION v a� 3• ar• HAA# 02506Lt Expiration Date: 2 — I — ro Complete legal description rr,t 1 ni r4 z• xz s, Sellope Sebd4yisien #1 Location (site address or directions) 31130 Kuparuk Ave. Eagle River, AK 99577 Current Propertyowner(s) Scott Henrickson Dayphone 622-1661 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address same Unless otherwise requested, HAA will be held by DSD for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: - 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Ek Individual On-site R 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-faniily 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 engineers 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 b S Engineering, Address 17034 N. Eagle River Lp, ✓7204 Eagle River, Engineer's Printed Name _ - Robert C. Cowan Phone 694-2979 AK 99577 Date Jo 3s�oS 5. DSD SIGNATURE ROBERT C. COWAN y`c : CE -8801 ,-jL Approved for 3 bedrooms. s-\ f Disapproved. `ti ��AOra Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: � Original Certificate Date: % - L 0 (Rw. OM) 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: LPT h` 4�PE ; / Parcel ID: 0 A. WELL DATA Well type�I V WT E If A. B, or C provide PW SID # _ Date completed (wZ 2600 Sanitary seal t[f5S Total depth 10 I ft. Cased to FROM WELL LOG Date of test 00 Static water level 2b ' ft. Well production i Z 9.p -m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate 5 mg./l. Arsenic: — mg./I. Date of sample:o 640 S B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5E-?T�J4 br& Tank size lQ00 gal. Number of Compartments Well LogON) ��b5 Wires properly protected?! J) YES_ Casing height (above ground) (R11 t n. AT INSPECTION S &7/6(l �" t te'5izCi+'ft. Se 3 g.p.m. Other bacteria 'D colonies/100 ml. Collected by: S4 -S 7�ita6/x9tt¢ tom, Date installed . An a0 CleanoutsON) 6S Foundation cleanout(LVN) � Depression over tank (Y& _�O High water alarm (Y& AJ 0 Date of pumping 10 b 6 Pumper ���� I?U1i)1P1 K%a C. ABSORPTION FIELD DATA Date installed Od Soil rating g.p.d./ft2 r ft2/bdrm) _Qe-9 System type S f+"trccJ T Length I/ �' t r ft. Width S r ft. Gravel below pipe d �J t ft. Total depth 305 ft. Eft. absorption area ftZ Monitoring tube J6-�, Depression over field#� Date of adequacy test 5 1 O 4 Result Pas ail) 36_S5 For - bedrooms Fluid depth in absorption field before test jCZ in. Water added g55gal. New depth_ in. Elapsed Time: ]ZQ min. Final fluid depth 0" in. Absorption rate >= !(SO + g.p.d. Any rejuvenation treatment (past 12 mo.) (Ye type) l.7 e) If yes, give date D. LIFT STATION t3hi Date installed Size in gallons "Pump on' level at _ in. "Pumr) Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 1 Septic tank/lift station on lot /00 41- r Absorption field on lot 106 -- Public sewer main $3 r Sewer /septic service line - 26 * High water alarm level at Meets alarm & circuit requirements? r On adjacent lots On adjacent lots /00 r( - Public sewer manholelcleanout 1-4 Holding tank A�J4 in. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r r Building foundation 6+ Property line S + Absorption field , ; - ' 5 r4 - r I Water main A31/1 Water service line / D + Surface water /Gb t Wells on adjacent lots r00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1 I Property line to -t- Building foundation f -I- Water main JU Fi f I � Water Service line +' Surface water Driveway, parking/vehicle storage r o r Curtain drain its' Wells on adjacent lots !Eb F. COMMENTS O'S • G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in �,. - =• conformance with MOA HAA uidelines in effect on this date. s+ uoaeu-a 400wAN yj OCN CE - Boot Engineer's Printed Name 486,41' C. CDaIA✓ yt�'f,f•�. ..• � Date %fl /aS /0 r �� '; t HAA Fee $ Al 7 d• a v Date of Payment 10 / a r. /0J— Receipt Number O -7r933 (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number LUUJ,U61/LJ/IUL UI.LL 1w ASBUILT I HEREBY CERTIFY -THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY] �tfll/t o�fl�B .. iY�/lOT/.mak!. 7 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSISILITY•OFTHE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR iR THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHdULD ANY DATA HCONSRUCTION OF FENCE LIINSNENOR FOR ESTBE USED ABLISHING BOUND- ARY LINES.. DATE= GRID= . S'e' FB- /off 6d DRAWN, 0 11. UUP/UUI N y OF At � s xe ., Duan. Mark 0award Jr �a LS ,6918 ; � ' e �� �•' .... • • S'c+t *a•wt�r. 10-24-05;10:30—S&%— ; ;907 561 6301 # 2/ 4 SCS Ref.# 1056813001 All Datcdrlmes art Ahuka Standard Time Client Name S & S Engineering Printed DateTme 10/212005 14:09 Project Name/# Lot 1 Block 3 North Slope No 1 Collated Datelrime 10/122005 143S Client Sample ID Lot I Block 3 North Slope No I ReceivedDate/Time 10/121200516:2$ Maw Drinking Water Teehn-ral Director StephenC.Ede SampleRemwics: Allowable PMp Analysis Pa ctrr Results FOL Units Method Coneaincrto Limits Duro Date Tait Nitrate -N 0.651 0.100 mg/L EPA3S32 B (0.10) 10/12105 A2S MLcrobiology Laboratory Total Coliform 0 col/100m1 SM20 92228 B . (.0-1) 10/12/05 TLF Municipality of Anchorage 1�1'O ''fit •6i • ,,'jl)(},✓yy�_"1/'/. Development Services Department's << Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.akus (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING + Parcel I.D. 050-511-18 HAA# Cq bZq 3 Expiration Date: q-9-04 1. GENERAL INFORMATION Complete legal description Lot 1; Block 3; North Slope Subdivision Al Location (site address or directions) 31130 Kuparuk Ave. Eagle River, AR 99577 Current Propertyowner(s) Gary Wheeler Dayphone 694-2350 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. � Z (+iZ . _ 6 A /O y 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY:, TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site R Individual Holding tank ❑ Community On-site ❑ 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 S S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date G 7 /o ye r; Y 6. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. ROBERT C. COWAN CE -8801 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: �i`�l / Gfl. ✓ - Original Certificate Date: (w. GIM2) 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: /,e 7- /y' Z% Lase -7 / lk9Z7- t fGhPL Parcel ID: /g5U - -5//- �$ A. WELL DATA Well type SF If A, B, or C provide PWSID #= Well Log (YM) Y Date completed / 2000 Sanitary seal (YM) Wires property protected (Y/N) Total depth aQA_fL .Cased to 40 �ft Casing height (above ground) /R It, in. Date of test Static water level Well production FROM WELL LOG zhoy ZO WATER SAMPLE RESULTS: /Z Coliform colonies/100 ml. Arsenic: I mg.A. 9— p.m- AT INSPECTION 1 O 4G1c67L®� ft. S.3 g.p.m. NitratiD r4 m_9A. ,[ Date of sample:0 � , /,4 B. SEPTIC/HOLDING TANK DATA Tank Type/Material 6ITr I &' I H D PC Tank sizeO/ OD gel. Number of Compartments Other bacteria c colonies/100 ml. Collected by. 5 �n l- /N alve— Date Installed S 3 040 d Cleanouts Foundation cleanout (Y/N) _V _ Depression over tank (YIN) High water alarm (YIN) AJ Date of pumping /S �3 Pumper C. ABSORPTION FIELD DATA Date installed S 30 00 Soil ratingp.d./ft2 Ielbdrm) a_8 System type sk -4rlye' -/ tOi S ft. Length 1 17 ft. Width S rL Gravel below pipe Total depth 5 d ft. Eff. absorption area or—fe Monitoring tube Depression over field n Date of adequacy test 51 z9f Results (Pass/Fail) /4 For 3 bedrooms Fluid depth in absorption field before test SL in. Water added -42; -oaf. New depth in. Elapsed Time: k min. Final fluid depth in. Absorption rate >= 4S;7)g.p.d. / Any rejuvenation treatment (past 12 mo.) (Y/N & type) A If yes, give date D. LIFT STATION Date Installed J'11A Size In gallons "Pump on" level atin. Cycles ump otr level at _ in. Datum tested E. SEPARATION SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lif-statlon on lot /049 .; Absorption field on lot 100,4 Public sewer main J f A Sew r /septic service line `Z S Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots IooIt— On adjacent lots /00".1- Public OOr'rPublic sewer manhole/cleanout A-) A Holding lank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: fr,� S Building foundation 4- Property line rr Absorption field Water main A11A Water service line / O Surface water Ir Wells on adjacent lots D r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 r't Building foundation /O r � Water main IIJ/ A i Water Service line t;- Surface water X00 r -f- Driveway, parking/vehicle storage / Q Curtain drain A4,Wof, fcWells on adjacent lots 14961, F. COMMENTS HAA Fee 5 °i3 0. Dateof Payment C /-7 /0 Receipt Number C75 -333t (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number F%r C f G. ENGINEER'S CERTIFICATION �'c� '' / _:` :,'•; I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. %1•- ROBERT C. COWAN C. �oWN..� 2� 7fP< CE -8301 /n Engineer's Printed Name Go822r Il ,rl'` Date L /-7 /Ottt� �Fd':iCSY- HAA Fee 5 °i3 0. Dateof Payment C /-7 /0 Receipt Number C75 -333t (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number JUIJ-10-2004 11:12 S:S EI GINEMItJG SCS Rets 1043084001 Client Name S & S Engineering Project Names North Slope S/D sl. Ll, B3 Client Sample ID North Slope SID 01, Ll, B3 Drotria Drinking Water 907 694 1211 P.02/05 All Dates/Times are Alaska Standard Time Printed Date/time 06/08/2004 8:24 Collected Datdrime 06/032004 15:05 It"eivedDste/17me 06/03/100415.40 Technical Dtreetor Steppe Ede Released / Paeanem ResuRs POL units MOMCodain<rID Allowable Prep Analysis Limite to D>re ]nit Waters Derartmont Nitrat" 0.2$4 0,100 mp/L EPA 303.0 B (o-10) 06/04/04 JJu Microbiology yaboratory Total Cohroan 0 COYI00ML SM1892220 A (czl) 063104 DKC HARCA STREET 20 Q O N m g d C 6 0 D V 0 03�.'LSm.u; .n p m FL E B' o n�- rm E'o !8 o co C sod y�i.: : yF Coa V '^xyij v W N V V ♦ •� • �� i Qok�Ar/ O C •� O V V H V O P �w \t% 4W>v yn „t J Mw0 1r\��w Eh�=„oou „o o xa2 IT o„ d O J 2 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services -� On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchcrage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. 050-511-18 iMCIZI►I: ft7�4t.1; 107 MIT IIs] Ii HAA# 0 0 0 4 6 7 Expiration Date: Complete legal description Lot 1, Block 3, North Slope Subdivision #1 Location (site address or directions) NHN Ffarca Street Current Propertyowner(s) Disotel Consrtruction Dayphone 694-5797 Mailing address PO Box 770210, Eagle River AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: C1/3L/ao ❑ Individual On-site El ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ 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-site 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. 72 =5 ipev 01 00)' 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 Guidelines for the Health Authority Approval application show 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. 5 8 5 ENGINEERING Name of Firm 17034 Eagle River loop Read No. 204 Phone G Qt'/ - - Address • agle River, Alaska 99577 Bober[ C. Cowan CI/ac/cc Engineer's Printed Name Date —, 6. DHHS SIGNATURE ✓ Approved for bedrooms. Disapproved. Conditional approval for Additional Comments OP b•t--RCSERT C. COWAN .... ��c��'•y CE -9001 bedrooms, with the following stipulations. Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: ✓ G<%. Original Certificate Date: %' 2 O c all Expiration Date: _ [ �)_ - *:�. 6 - O D Reissue Date: ,2 V 5;ev 01.001' Municipality of Anchorage AIAL • Department of Health and Human ServicesR E Division of Environmental Services C C' On-Slte Services Section 825 `L" Street Room 502 C V Ad P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us SEP 1 2000 (907)343-4744 HEALTH AUTHORITY APPROVAL CHECI�LNSf[�10f> OF AN Legal Description: LOT 1 13 LOGk 3 AloATN SI,0/04- ;0- / Parcel I.D.: A. WELL DATA Well type P RrvATC If A, B, or C provide PWSID # Well Log W S Date completed 6 •c Sanitary seal Y 4 f Wires properly protected YE s Total depth ) 0 IL it Cased to 101 ft Casing height (above ground) / T+ in. FROM WELL LOG AT INSPECTION Date of test 6 /-a /a o j b � Static water level oZ O ft fi It Well production 9 -p.m 9 -p.m WATER SAMPLE RESULTS: Coliform o colonies/100 ml Nitrate O -CM mg/I Other bacteria O colonies/100 ml Date of sample: `f / 5100 Collected by: s & s ENGINEERING B. SEPTIC/HOLDING TANK DATA 17034 Eagle River Loop Road No. 204 Esoo River, Alsalw 99577 Tank Type/Material . 5A,- n c / H D P E Date installed '57/73i/* Tank size /000 gal Number of Compartments Cleanouts YES Foundation cleanout Y* -s Depression over tank �' 0 High water alarm ro Date of pumping r4 fr q — N a w C. ABSORPTION FIELD DATA Pumper S/3o 0o �^w N���o� Date installed t/ Soil rating dt r ft2/bdrm) (9.1 System type 57- Length 1 / 7 ft (rro,a-) Width r ft Gravel below pipeO. E ft Total depth 3 --Y It Effective absorption area S Srft2 Monitoring tube YA'l Depression over field f40 Date of adequacy test u Results (Pass/Fail) For 3 bedrooms Fluid depth in absorption field before te=fluid n Water added gal. New depth in. Elapsed Time: Finth in Absorption rate >= g.p.d. Any rejuvenati atment (past 12 mo.) (Y/N & type) If yes, give date 72-026 (Rev- 01100(• D. LIFT STATION Date installed "Pump on" level at in E. SEPARATION DISTANCES Size in gallons in High water alar level at in Cycles tested Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 10 o t On adjacent lots /00 Absorption field on lot 10 U On adjacent lots /0 .0 Public sewer main N /A Sewer /septic service line a S- f- Public sewer manhole/cleanout Holding tank I 7✓IA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S + Property line S f Absorption field S Water main tJ / A Drainage NSA Water service line l0 * Wells on adjacent lots ) o D if Surface water J 0 d 4 - SEPARATION SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line )0 f Building foundation 10 t Water main M' 14 Water Service line /0 } Surface water 10 0 —" Driveway, parking/vehicle storage )0 t Curtain drain M-4- x rOw ✓ Wells on adjacent lots 10 0 4 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and gj 1:1" review of Municipal records that the above systems are in 4. "-- conformance with MOA HAA guidelines in effect on this date. �7 p, X%**T C. COWAN Engineer's Printed Name /� D A i r C Co vs,, ` J� CE -8801 /4 -, Date 01/ao/ 00 � .........,....,•;`C: t�s_mvr HAA Fee $ �y • -I) Date of Payment 910g1/Pp Receipt Number .; CJ 9 72 0261Rev. 01N0)' L__ Waiver Fee $ Date of Payment Receipt Number 09-11-00 17:18 FROM -CTE ENVIRONW11TAL 5615301 T-008 P.02/03 F-386 AL..__...__._---" CTaE Environmental Services Inc. _._. C`r&E Rer.N 1005315001 Client PON Client Name S & S Engineering Printed Datdflme 09/11)2000 14:09 Project Name/N Ll B3 No. Slope SID Collected Datef"me 09/05/2000 11:30 Client Sample 1D Ll B3 No. Slope S/D Received Date/19me 09/06/2000 8:20 Matrix Drinking Water Technical Director Stephen C. Ede Ordered By Releued B / n ��yW�C PWSD 0 w � Sample Remarks: Allowable Prep Analysis Parametcr Resell PQL Units Method Limit, Dam Date [nit Waters Department Nitratc-N 0.659 0.500 mgfL EPA 300.0 10 max 09/06/00 SCL Microbiology Laboratory Total Coliform 0 col/100mL SM18 9222E 09/06/00 KAP