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HomeMy WebLinkAboutRAVEN WOODS #1 BLK 4 LT 3P-aven Woods
Block 4
Lot 3
#015-232-30
Municipality of Anchorage
Development Services Department ?�?
Budding Safety Division
On -Site Water and Wastewater Program. 4700 Bragaw St
P.O. Box 196650 Anchorage. AK 995198650 Page of S
www ci.anchorage.ak us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW070199 PID Number: 015-232-30
Noma
Randy & Susan Heaston Wastewater System: ❑ New © Upgrade
aaoaa 6231 Trappers Trail Rd
ABSORPTION FIELD
Pl p rdndard Bsaddma
4 RDW Trarrd 0 SMao-s Tnrxm O Bed 0 Ma 0 Omar
LEGAL DESCRIPTION SW Re" '°Moto iyb' or ""°"JF
0.7 GPwF 12
&ah
4 3 s'�°"M0A Doom ti, ww eonam tram oronr paa cnei aew� eansam woo
Raven Woods #1 3.5
FI. 8.0
Tpmtlq Rwlaa SxTan FI
FJ tl0ad tlOw «pnr draw Grave Carpio
0 FI. 54 FI.
Well: ❑NeWGnwl wgln rrnowaenaa walnwa Dwwasn rte
❑ Upgrade 2.5 FI. 1 NIA
Cr"rolan (Pn. A a. C) rdw Dean Csasd MIdr FI
tlaawcn ru Hps ManarW
FI. A 864 FI' PVC, F-810
D1ie°• Dar D'Jsd suet Warr Lwwl InrM Dwa mwaead
FI A+ Home Services 8/20/2007
year P,ariP Sw r
Inspections performed by: Cindy Ellis Dates: 1" 8/20/07
1.
•• ,'.'? ; 2ne
8121107
Development Services Department Approval,:
Conditional Approval Date:
Reviewed and approved by:
IRn (Wn)
24a,e: 5 ,z7-
100.00 A
Engineer's Stamp
'dY W. Ellis
CE • IOS77 .'
Gvp Flagnl Addw Gmwa
GPM
FI.
FI
TANK
SEPARATION DISTANCES
Aseptic [I Holding OS.T.E.P. [:I Other.
To
Septic
Absorption
LM
HolOing
utNiUPnvate
M «
a" ty
Fran
Tank
Field
Station
Tank
serer Lma
Anchorage Tank & Welding
1500 Gr
Woe
128'
115'
128'
NIA
103'
Ma'—
Steel
NamM d Compammwxa
2
Surface Www
100'+
100'+
100'+
N/A
LIFT STATION
40'
10'
40'
N/A1500
STEP Gr
Anchorage Tank & Welding
26'
25'
26'
N/A
'Pomo an rM"
32
'Poop dr rw w
Mpn wow rrm a
m
22 .136
m
Cunrl Orael
NIA
N/A
N/A
N/A
Nano Mws a Mad"
Erclncw Inepw . wdanntl by
ax O O
MOA
R«nrar
Old septic tank was abandoned in place, per code.
BENCH MARK
Inspections performed by: Cindy Ellis Dates: 1" 8/20/07
1.
•• ,'.'? ; 2ne
8121107
Development Services Department Approval,:
Conditional Approval Date:
Reviewed and approved by:
IRn (Wn)
24a,e: 5 ,z7-
100.00 A
Engineer's Stamp
'dY W. Ellis
CE • IOS77 .'
100' well radius
NN 54' long & \ I
S 76°5719 8' effective e
— — � MT1I
g0 K O MT2 TH#
R' TH#1 Location of line
r is uncertain
Manhole , ST2 STI A u
DC01 0
CO2 civ
ggpygC r
h
Sum \ t°
1976 drainfield �
�FI1gy 1500 gal. \c m O
2
STEP Tank
Concrete septic tank
abandoned in place. \
r
11
r
0
0
o
1
I�
m
ft7
,7
I�
A B
DC01 22.2 41.3
00O2 22.9 41.9
ST1 27.4 45.2
ST2 35.3 51.6
MH 53.1
1° AS-BUILT
CL Based upon a survey
by Shane Hoft, LS-6914
8/29/07
N 89°36'20"W
Raven Woods #1 Blk 4 Lot 3
Record Drawing of Septic Upgrade
Randy & Susan HeastonEngineering,QE.ACq'
Parcel ID No.: 015-232-30 Watkins Inc.
Permit No: SW070199 `2
Cindy
Cindy W. Ellis, P.E. E W; t"S ;
May 19, 2008 P.O. Box 110443
Anchorage, Alaska 99511-0443
Scale 1 inch = 30 ft Phone: (907) 349-1851, Fax: (907) 349-1934
37.3
MT1
34.9
27.5
MT2
75.5
78.6
Sump
90.5
107.7
DCO
91.76
Raven Woods #1 Blk 4 Lot 3
Record Drawing of Sept;c Upgrade
Randy & Susan Heaston
Parcel ID No.: 015-232-30
Permit No: SW070199
Final Grade
= QR dR
w
J
O
X
Z
Q
1500 GALLON
STEEL STEP TANK
SEPTIC SECTION
N.T.S.
Note: Benchmark= Garage Slab=100.00
MT2 Final Grade=103.35 MT1
1.25"0 PIPE
SEWER ROCK
TRENCH
N.T.S.
Note:
Test Hole Relative Depth= 85.76
No Water
Watkins Engineering, Inc
To Existing
Drainfield
(1976)
NOTE:
ORIGINAL GRADE=
102.80 - 103.76
AS -BUILT
OF qt':.
0. 49 TH i 9
Dy Vi EMS
Cindy W. Ellis, P.E. P.O. Box 110443 DE -1057
May 21, 2008 Anchorage, Alaska 99511-0443
No to Scale Phone: (907) 349-1851, Fax: (907) 349-193
oQ0000ppp4
OF &� 44
>,�QP•� .S' Opp
.......................... a
Z, //.af— . 4
•. vv -ter. YY GYJ..iL7
NOTE:
THE REBARS SHOWN AS FOUND WERE
USED FOR THE PURPOSE OF THIS SURVEY
THE COMPUTED POSITIONS AS DETERMINED
FROM THE SUB BOUNDARY ARE FROM 1.21'
TO 2.39 FROM THESE FND. REBARS.
THE RIFORMATION HEREON 6 FOR THE USE OF LENIOIW SSTRRRKONS BPEGFIOLLLY TO SHOW ANY CON.LICTS BETWEEN
EMTRA2 BTRUCTIRES AND PATTED LOT LMES OR EABEMENTB AND 6 WT TO BE USED FOR POWT1ON iW ADDTHXIAL
STRUCTURES OR FENCEUNES,
EASEMENTS OF RECORD. OTHER THAN T1OBE SHOWN ON THE RECORDED R.AT. ARE WT SHOWN HEREON
NOTE. ANY FENCELWES SHOWN ARE LOCATED APPROKRMTELY AWARE
OR LOCATE BTRU ES NOT TO BE USED lO DETERMINE PROPERTY LSEB
ANY ►AVI Sq WN MAY BE APPROK TE DUE TO SN OVI WIp}gNS
T SURVEY
V-40'
1 HEREBY CERTIFY THAT I HAVE PERFORMED A
MORTGAGEES INSPECTION OF THE FOLLOWING
DESCRIBED PROPERTY.
LOT 2. BLOCK 4. RAVEN WOODS NO.1 SUB.
ANCHORAGE RECORDING DISTRICT. ALASKA AND THAT
THEVTSIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND THAT NO VISIBLE
ENCROACHMENTS EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE. ALASKA THIS _,9TH
DAY OF_AUGUST 2907
HOLT LAND SURVEYW 110519. FB1262.12888
TEL 245-5512
ALIG-27-2007 07:30A FROM:
T0:3491934
P: V1
from ApplSadlttcrosyxta� ►rl Z4 Aup 2_007 C:.7J,58 Ar AKDT
Page 1 6! 1
MUNICIPALITY OF ANCHORAGE, BUII DINO SAFETY DIVISION
4=0NOUIH Bf4AGAW
INSPECTION INFOHMATION i HELP: 343-7982
INSPECTION VOICE 343-e3C0 IN`P."T:^N FAX r 777
A^7:.^.L7-7 rns:7 tu.tni M�EO'i^.SFeI;!i•:^4 Nf't
NAItE: NONE
PERMtT A: 67-Cda2
COMPANY: EDS ELECTRIC IN'+PECT DATE- D.124.12W7
PHONE c cc3-0(xx - PHONC M:
ADDRESS: ri231 TRAPPE:l£ TRAIL a.1
LOT 3 ELOCY, d S IBDIVIC40N: RAV-N'N0003 sf
COMMENTS or DIRECTIONS
PO9 SEPTIC LIFT STATON CAL:. TO MEET
TYPE OP INSPECTION: .. %iral Eltnneal
COMMCNTS: (POR INSPECTOR USE ONLY
r
PRINTED NAME
RUC -24-2007 FRI 01:54PM I0:
PHONE M:
GRtO+' SYJJ7.38
DATE:. _
PAGE: I
MUNICIPALITY OFANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519.6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 09, 2007
Expiration Date: Aug 08, 2008
Permit Number: SW070199 Parcel ID: 015-232-30
Legal Description: RAVEN WOODS #1 BLK 4 LT 3
Design Engineer: 0844 WATKINS ENGINEERING Site Address: 006231 TRAPPERS TRAIL RD
Owner Name: RANDY & SUSAN HEASTON Lot Size: 58370 SO. FT.
Owner Address: PO BOX 927 Total Bedrooms: 4 Permit Bedrooms: 4
BARROW. AK 99723-0927
This permit is for the construction of:
❑✓ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907)343-7904(24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
l
Received By:
Issued By: l3 A
Date:
Date: 8 K
Municipality of Anchorage
Development Services Department
a�
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onshe
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D. 015-232-30
Property owner(s) Randy & Susan Heaston Day phone
Mailing address PO Box 927, Barrow, AK Zip Code 99723
Site address 6231 Trappers Trail Rd, Anchorage Zip Code 99516
Legal description (Sub'd., Block & Lot) Raven Woods #1 Blk 4 Lot 3
Legal description (Township, Range & Section)
al.� •Vii
-p a
a
ZD
Lot Size 58,370 Sq. Ft.
Number of Bedrooms 4
THIS APPLICATION IS FOR (® all that apply):
THIS APPLICATION IS AN:
Absorption Field El
Initial
❑
Septic Tank (]
Upgrade
Holding Tank ❑
Renewal
❑
Privy ❑
Private Well ❑
Water Storage ❑
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.
(Signature of
or authorized agent)
Receipt Number. C g 2 % Receipt Number.
(Rev. 11105)
Watkins Engineering, Inc
RO Box 110443, Anchorage, AK 99511
(907)349-1851 cwellis@gci.net
August 3, 2007
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
RE: Raven Woods #1 Bilk 4 Lot 3
Proposed Septic System Upgrade
To Whom It May Concern:
Attached please find the application and supporting documentation to upgrade the
septic system for the referenced 4 bedroom house. The original septic system was
installed in 1976, and the drainfield is now surcharged. It is proposed to retain the
drainfield for future use. A lift station will be required for the new drainfield, so the septic
tank will be abandoned in place.
The proposed design is based upon a test hole dug on July 23, 2007. Test hole #2 was
dug to 18 ft with no water encountered. After a 7 day monitoring period, no water was
detected. Test hole #1 was dug to 13.5 ft and had water at 12 ft; no development is
planned around TH#2. The proposed drainfield will be installed in a silty sand layer
between 7 ft and 12 ft. A percolation test between 6.5 ft and 7 ft resulted in a rate of 13
minutes per inch. An application rate of 0.7 gpd/ft2 is used in the design. The soil log is
attached.
Proposed Soil Absorption System:
4 Bedrooms x 150 GPDBR =
600 GPD
System Type:
Deep trench
Application rate:
0.7 gpd/ ft'
600 GPD / 0.7 gpd/fe =
857 ft' required
Maximum Depth:
12 ft
Effective Depth:
8.0 ft
Proposed Length:
54 ft
Absorption Area:
864 ft2
Sewer Upgrade Permit Application torRaven Wood Blk 4 Lot 3
Watkins Engineering, Inc.; August 3, 7007; page Z
There are no surface waters or private wells within 100 ft of the proposed septic system.
There are no slope concerns.
I am not aware of any adverse effect that this upgrade would have on any adjacent
properties' water and wastewater treatment needs.
Thank you for consideration of this permit application. If you have any questions or
need further information, please call me at 349-1851.
Sincerely,
Cindy W. Ellis, P.E.
President
r—R=toa
1 WELL
6
WELL
Septi
I
Septic Area \ /
\ Block 1 /
\ — l
/ z
/ WELL
>
Septic Area m
U)
U)
>0 5 �I
------------------ co
------�----------\ a I
Septic Area
WELL
Raven Woods #1 Bik 4 Lot 3
Site Plan
Randy & Susan Heaston
Parcel ID:015-232-30
Cindy W. Ellis, RE
August 3, 2007
Scale- 10 - 100'
Block 4
Proposed
Septic
System
2 I•
I
\\k I I
I I
I I
Tract C
"Existing I \ I
/ 4BR Hou
I 5
stove / I I I
tea'► WELL I
I � I
i3Ov I I Z
Existing Septic System j O
t-----� _
It.
4 /�\
>
I
I
U.
�
WELL
I
0
Appx.I
Location
I
n�
GRIZZLY AVE_
5
I
Watkins Engineering, Inc.
P.O. Box 110443
Anchorage, AK 99511-0443
Phone: (907) 349-1851 Fax: (907) 349-1934
3
49 TH+ "A;
W ELLIS
10377
DESIGN DETAILS
4 BR, 600 GPD
0.7 gpd/ft2
Requires 857 ft2
Deep Trench
8.0 ft effective
54 ft long
Max 12 ft deep
Proposed trench: 54' long
8' effective, max depth 12'.
1.25" pipe with
.25" holes 24" OC.
-76052'19"W
MT \
S
TH#2
TH#1
0
°
30ft
T
° Install DCO
(no FCO)
Proposed
gal steel STTEPEP tank 0
location of line
dual outlets
is uncertain
�PNgCT
_ _
oRr
qr
1250 concrete
tank (1976)
4s°
R HO�se�
to be abandoned
in place
Existing 52 It trench,/
\
7 ft effective (1976)
to be retained
r
t, Test
Hole #2 Proposed
tO 7/23/2007 Trench
0
o Organic
0.5
ML
1.5
4.0 1.25" PVC
fl SM/
pipe
N ML
8.0 ft sewer
N
rock
~�
m, No Water
12.0
�\O�
0
5GP��
o- BOH
18.0 G�0�.e\o
11
�O
N 89036'20"W
Raven Woods #1 Blk 4 Lot 3
OF At op
Proposed Septic Upgrade
p p pg
Watkins Engineering Inc''
q�s°oo
Randy & Susan Heaston
vo f D
49 TM r D
Parcel ID No, 015-232-30
v .`?'
........................:..
Cindy W. EIAs, RE
August 3, 2007
P.O. Box 110443
D: ci W. ELLIS : v
GD• •.. -1osn : •.moo
Op'•, '
Scale 1 Inch - 30 ft
Anchorage, Alaska 99511-0443
Phone: (907) 349-1851, Fax (907) 349-1934
•... `',•��
4�4o4pO�p0`�pc
DESIGN DETAILS
4 BR, 600 GPD
0.7 gpd/ft2
Requires 857 ft2
Deep Trench
8.0 ft effective
54 ft long
Max 12 ft deep
Municipality of Anchorage 4
Development Services Department
Building Safety Division ,r s
a,t Onsite Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage. AK 99519-6650 I^dY VI/. Ellis
www cl.anchorage akus \t CE.tosn
(907) 3417904'+., r
Soils Log - Percolation Test�10NP'c
Performed For. RANDALL & SUSAN HEASTON Date Performed: 7232007
Legal Description: RAVEN WOOD #1 BLK 4 LOT 3 Township. Range. Section:
Test Hole #1
Dpw upper zoneperc
(Feet)
Organic
1 -
1
1
17-
18-
19 -
ML
She Plan
ATTACHED
Reading
WAS GROUND WATER
Gross Time
SM
ENCOUNTERED? Yes
Net Drop
1
7252007
S
10
IF YES. AT WHAT DEPTH? 13.0
L
2
Depth W Water Alter
0
P
10
Monitoring? 12.0
E
3
Date: 6101107
3:38-3:48
She Plan
ATTACHED
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
1
7252007
3:16-3:26
10
6"-3"
3.0"
2
7252007
3:27-3:37
10
6"-3"
3.0"
3
7252007
3:38-3:48
10
6"-3"
3.0"
4
7252007
3:51-4:01
10
6"-2.5"
3.5"
5
7252007
4:024:12
10
6"-3.5"
2.5"
6
7252007
4:13-4:23
10
6"-3.5"
2.5"
7
7252007
4:24-4:34
10
6"-3.5"
2.5"
PERCOLATION RATE 4.1.1 (.-A&VI ch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN 2 FT AND 2.5 FT
COMMENTS 4 hour presoak prior to test
PERFORMED BY: Cindy Ellis/ Rocky Trainor ) ��. , ,`{,(o. CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI S IN EFFECT ON THIS DATE. DATE: N -3—o-7
Municipality of Anchorage
Development Services Department
Building Safety Division
�,.. Onsite Water and Wastewater Program
4700 South Bragaw Sl.
P.O. Box 196650 Anchorage, AK 99519-6650
Www ci anchorage sk us
(907) 343-7904
Soils Log - Percolation Test
Performed For: RANDALL & SUSAN HEASTON
Date Performed:
Legal Description: RAVEN WOOD #1 BLK 4 LOT 3 Township, Range, Section:
ML
15-I BOH
ATTACHED
WAS GROUND WATER
ENCOUNTERED? Yes
IF YES, ATWHAT DEPTH? 13.0
Depth to Water After
Monitoring? 12.0
Date: 8101107
Reading
Test Hole #1
Depth
lowerzoneperc
(Feet)
Organics
ML
15-I BOH
ATTACHED
WAS GROUND WATER
ENCOUNTERED? Yes
IF YES, ATWHAT DEPTH? 13.0
Depth to Water After
Monitoring? 12.0
Date: 8101107
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
1
7252007
2:43-3:13
30
6"-3"
3.0"
2
7252007
3:14-3:44
30
6"-3.5"
2.5"
3
7252007
3:454:15
30
6"-3.5"
2.5"
4
7252007
4:164:46
30
6"-3.5"
2.5"
PERCOLATION RATE 4.0 11 PERC HOLE DIAMETER 6
TEST RUN BETWEEN 4.5 FT AND 5 FT
COMMENTS 4 hour presoak prior t0 test.
PERFORMED BY: Cindy Ellis / Rocky Trainor I 4fi 4el P 6v �>� CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELittS IN EFFECT ON THIS DATE. DATE: 9-3-07
Municipality of Anchorage *'Li
Development Services Department r�
Building Safety Division �� N
y1 Onsite Water
and South Bragawter St Program
4700
P.O. Box 196650 Anchorage, AK 99519-8050 C'l y W Ellis
Www.cl anchorage ak.us '' CE -10577 '
(907) 343-7904 ''., ,.,4
Soils Log - Percolation Test �10"A`c
Performed For. RANDALL & SUSAN HEASTON Date Performed: 7232007
Legal Description: RAVEN WOOD #1 ELK 4 LOT 3 Township, Range. Section:
Test Hole #2
DepN
;Feet) Organics
ML
16-
17-
19-:— — H
Site Plan
WAS GROUND WATER
ENCOUNTERED? No
IF YES, AT WHAT DEPTH?
Depth to Warr Amar
wonhonmg? None
Date: 7/30/07
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
1
7252007
2:48-3:18
30
6"-3.75"
2.25"
2
7252007
3:19-3:49
30
6"-3.5"
2.5"
3
7252007
3:50.4:20
30
6"-3.75"
2.25"
4
7252007
4:214:51
30
6"-3.75"
2.25"
5
7252007
4:52-5:22
30
6"-3.75"
2.25"
PERCOLATION RATE 13 (n nAnAnc A) PERC HOLE DIAMETER 6
TEST RUN BETWEEN 6.5 FT AND 7 FT
COMMENTS 4 hour presoak prior to test
PERFORMED BY: Cindy Ellis / Rocky Trainor I `V &(, CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDEL#ES IN EFFECT ON THIS DATE. DATE: g -3--o7
GREA �R ANCHORAGE AREA BORA :-GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM p
NAME,-eMAILING ADDRESS
LOCATION�M� J'u- r� LEGAL DESCRIPTION L- 3 4 '`a'.'�'- `-hP SIP
SEPTIC TANK:
DISTANCE ((��
FROM WELL MANUFACTURER
INSIDE LENGTH INSIDE WIDTH
TILE DRAIN FIELD: j ,vl11. 1
NUMBER OF 21
-MATERIAL COMPARTMENTS
LIQUID DEPTH LIQUID CAPACITYZ-:LS—Z GALLONS.
TOTAL LENGTH
DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE OF LINES +5�'
NUMBER OF LINES
f DISTANCE BETWEEN LINES TRENCH WIDTH_ IN. TOTAL EFFECTIVE
ABSORPTION AREA ,a-6 SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE � ' IN. ABOVE TILE IN.
WELL:
TYPE_� 4"'� CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION , LOT LINE . SEWER LINE . TANK . SYSTEM ,
CESSPOOL . OTHER SOURCES
APPROVED DISAPPROVED REMARKS —.
DISTANCES:
INSTALLED BY: C. o'.
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form EQ -032
DIAGRAM OF SYSTEM
- -E Y t • H t_ Y -f- •� • �-� f= F=i t --i t.;1 -i �a E = : f=E �� L
t 11_i t, Y
DEPARTMENT /~ HEALTH AND EN'•+'IPC�Nt9EtJTNL/"t-1`TECTIOhJ
%
251C. E. � ,� UDOP RD. , RNr_.HORAr,E: AF:. •
276-2221
J..iF-l_L t=ir•FG: C�tJ—•=ITE _ F-IJEK f=•[_FOt•1 I T
FERHIT NO- c 76.715 ?
0PF'LICnNT �TCIF OYVFRSON
SpA Box 1501P. 744-6549
LOCATION TPH&KKK'_• JRHiO kC�IIBD J#1
L07 SIZE `;C. oo SQUARE FEET
LEGAL L-: 04 PAVENW ODS
TYPE OF SOIL ABSOPBTION 5r'STEM IS: TRENCH
NO:;It1Utl NUMBER OF BEDROOMS = }
SOIL RATItJG C50 FTiDR.?= 180
E `OIL ABSORPTION SYSTEM IS:
THE REQUIRED SIZE OF TH—
�'F•TF-i= 1�% t_f=tJGTH=
t yy r3i=�r l!E=L-•EF'TH=
THE LENGTH DIMENSION IS THE LENGTHECDISTANTE BBETWEEN SURFACEF THE TRENCH OF R FFTHEL
THE DEPTH OF 0 TRENCH OR. PIT IS
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET?.
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIF
AND THE DOTTOM OF THE EXCAVATION CIN FEET?.
T I rl t-4 L• i=i F<- E F= E r! t_t I F. E G•
BA&MLLING OF ANY SYSTEM WITHOUT FINAL INSPECT
IOtJ AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION. - SYSTEM I
MINIMUM DISTANCE BETWEEN A WELL AND AJY 011 -SITE
SEWAGE DISPOSALSF'ilSALIS� - =i1 DAYS
1� 0 FEET FOP. A PRIV6TE WELL OP. 200 FEET FOR: A PUBLIC WELL. -
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN
OF THE WELL COMPLETION.
SPECIFICATIONS ANC, CONSTRUCTION DIFGRHh#S ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
F' i'= F=' t• 1 I T •:' H L I C• F =' �=E f<: E_� t -J E Y F. i� F<_ F = �. i_i t•1 I c =.1_i E
I CERTIFY THAT
1: I AM FAMILIAR WITH THE P,EOUIREMENTS FOP ON-SITE SEWERS AND WELLS AS SE
FORTH E1'r' THE MUNICIPALITYOF
INrA FOF:CANCE WITH THE CODES.
I WILL INSTALL THESYSTEM MAY
RESIDENCE IS REMODELED THAT THE ON-SITE
SEWER THANEM BEDROOMS-
--------------------
SIGNED:,
EN
LAF:GEMEhJT IF THE
SIGNED:-+------- - -- -------`
-------------
APF'LICAtJT NEVE _ r JEP_r N
ISSUED B'
LZ5`� - ---GATE---5?--- -- / �6
T,,
I
82_76
I
Yl
ORGANIC MATIj2 L::
SIl1PWISOMF `GRAVEL '
& TRACE'SRND
.i
_
. 6.0'
e "
SAND e
— 7.0'
a
f
z
z
Y�
'%
'T H
t:
-
r�>
z.
15. Q' T.D
SIO-tAA7ER' TABLE,'.W.b,.
PERCOLATION TEST
GORDON FRANKIE
R & M NO. 656257
DROP
ELAPSED
INCHES
INCHES
TIMETIME
19.0
0 '
9:30
0
19.5
0.5
9:31
1
19.5
0.0,
9:31
1
19.5
0.0
1 9:33
1
20.0
0.5
9:34
1
20.0
0.0 .
9:35
1
20.0'
0.0
9:36
1
20.5
0.5
9:37
1
20.5
0.0
9:36
1
20.5
0.0
9:39
1
21.0
- 0.5
9:40
1
21.5
0.5
9:45
5
-
22.0.
0.5
9:50
5
22.5
0.5
9:55
5
5
23.0
0.5
10:00
23.75
0.75 .
10:10
10'
24.5
0.75,
.10:20
10
25.25
0.75 .
10:30
10
6.25.E .
60 minutes
i
9.60 min/inch
n
0
n o M
R&M CONSULTANTS,INC. •w u�r ••ter. w�. ww �o�r �wewo��o�, .r. ��eo• •.w. wr•wr•.awo • raw. coo weu.a
September 3, 1976
Mr. Gordon Frankie
Able Body Shop
Box 1702 Star Route
Anchorage, Alaska
R & M No. 656257
RE: Test Hole and Soil Log Report for Sanitary System
Lot 3 Block 4 Ravenwood Subdivision #1
Dear Mr. Frankie:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This in-
vestigation was performed in accordance with your request of September
2, 1976 and those procedures outlined in a letter dated July 15,
1976, by Mr. Rolf Strickland of the Municipality of Anchorage,
Department of Environmental Quality.
A single test hole was put down within the subject site area for the
purpose of defining general subsurface soil conditions for the proposed
sanitary system. Excavation was accomplished with an auger type drilling
rig and the test hole was extended to a total depth of 15 feet below
ground surface. The final log prepared for the test hole ahs been
included in Drawing A-01.
Groundwater was not encountered in the test hole while drilling.
A percolation test was performed from a depth indicated and reflects
average infiltration from that depth to the bottom of the hole.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
R & M CONSULTANTS, INC.
James W. Rooney
Vice President
JWRJpe
xe: Municipality of Anchorage
ANCHORAGE FAIRBANKS JUNEAU
0
n .la M
R&NI CONBULTANTs.INC. AA• EAST a+AT. AVE. • SOA 0041 • ANCNORAOU.Ar.09000 . P.w.w+•970•04.3 . ♦.x. oso.ena.a
June 24, 1976 R S M No. 656257 MUNICIPALITY OF ANCHORAGEDEPT. OF HEALTH L
ENVIRONMENTAL PROTECTION;
Gordon Frankie
Able Body Shop JUN 3 01976
Box 702 Star Route
Anchorage, Alaska RECEIVED
RE: Test Hole and Soil Log Report for Sanitary System
Lot 3 Block 4 Ravenwood Subdivision 01
Dear Mr. Frankie:
we are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This investigation
was performed in accordance with your request of June 21, 1976 and those
procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland
of the Municipality of Anchorage, Department of Environmental Quality.
A single test hole were put down within the Lot 3 area for the purpose
of defining general subsurface soil conditions for the proposed sanitary
system. Excavation was accomplished with an auger type drilling rig and
the test hole was extended to a total depth of 1EL5 feet below ground
surface. The final log prepared for the test hole has been included in
Drawing A-01.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
R & M CONSULTANTS,
INC.
%��
�124viv
`V _Jamesy
Vice -President
JIWDFJ/ddp
xc: Municipality of Anchorage
ANt "CAAG8 FAICISANK9 -JUNEAU
N
a
H
rl H Ln
En
ly
f=
D
a
H
I
Log Represents Location
of Test Hole
Lot 3 Block 4
RAVENWOOD SUBDIVISION
16.0
SILT W/TRACE SAND (ML)
18.5 T.D.
NO WATER TABLE
Mr
MAM %rC.S3 tD� F.8
Log of Test }toles
CKD: R&M CONSULTANTS, INM GRID
DATE: '»'""" "" """' " ' Frankie
Gordon PROINO 656257
SCALE: I"=3' -O" Anchorage, Alaska DWG.NO. A01
TH 1
6-24-76
0.0
1 N
ORGANICS
1.0
->l'
r
000
d.ea
lob°¢
' a
C)
op±
GRAVEL W/SOME
oQ°
-
SAND AND TRACE
SILT (GM)
M H
a
co
0
. F
7VQ
N
a
H
rl H Ln
En
ly
f=
D
a
H
I
Log Represents Location
of Test Hole
Lot 3 Block 4
RAVENWOOD SUBDIVISION
16.0
SILT W/TRACE SAND (ML)
18.5 T.D.
NO WATER TABLE
Mr
MAM %rC.S3 tD� F.8
Log of Test }toles
CKD: R&M CONSULTANTS, INM GRID
DATE: '»'""" "" """' " ' Frankie
Gordon PROINO 656257
SCALE: I"=3' -O" Anchorage, Alaska DWG.NO. A01
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH 8L HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # I-) I' -:i— a '2)-Q -.V(1
1. GENERAL INFORMATION
Complete legal description
HAA # - 1� Q9 I Q LI _i(
Lot 3; litoch 4; Raven Woods Subdivision 01;
Location (site address or directions) 6231 T4appea6 Trait
Property owner Patsy T. F4anhe Day phone
Mailing address 6231 T4appeA6 Taaft Anchotage, Ataska 99516
Lending agency ceatrre Vt)Ntgege ATrN• re„/n Day phone 549-5626
Mailing address
AgentNe-it Tomtinson FORTUNE PROPERTIES, INC. Day phone 562-7653
Address 3000 A StAea Anchoaage, Ataaka 99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well xx
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.. .
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
rtms (R«. 1N1) Fran, Moi m
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate 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 Phone
5&SENG
Address 17034 Eagle
River Loop Road No. 204
Ea,Av River, Aiaska 99511
Engineer's signature Date /0-5-9/
PROFESSO
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved. /
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By: __ .c�,t.Lt— Date — / o— /o - c/
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 orderto 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-M (p••. 1l91) 8• MOA W
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:4a AjAUcc k-4)tFrA�^ 100CA1 51% Parcel I.D.
A. WELL DATA
O/S%23x-3o
Well type�La f If A, B. or C, attach ADEC letter. ADEC water system number tj /18
Log present (Y/N) A) Date completed 1711 Driller U 1�
Total depth l) 15� Cased to �4 O /-I` Casing height I'Z �� t
Sanitary seal (Y/N) G Wires properly protected (Y/N)
ROM WELL LOG AT INSPECTION
Date of est �� ��� t 5R,PALITY OF ANCHORAGE
Static
NVIRONMENTAL SERVICES DIVISION
water level t7 7 — Q
Well flow�- �« . ; g.p.m. s-�-S gp.m. 19��
Pump level
SEPARATION DISTANCES FROM WELL TO:
-RECEIVED
Septic/holding tank on lot too/f ; On adjacent lots / DO 't
Absorption field on lot 1 d0 i� ; On adjacent lots 7 no
Public sewer main /J 1A Public sewer manhole/cleanout N
Sewer seryice line 2.S t Petroleum tank t 2,0 NC �iJOLJ A)
WATER SAMPLE RESULTS: �-
Coliform 6r17)S f ctorI_ Nitrate 4SAt iiQc-1 4 (�)-N) Other bacteri �-*n2"
Date of sample: O/ Collected by: 4 S AELJa i to e�.IT i Na
B. SEPTIC/HOLDING TANK DATA
Date installed l) --,4-1 Io Tank size ! Z 50 G 0 1 Compartments z
Cleanouts (Y/N) _ Foundation cleanout (Y/N) ti Depression (Y/N) )0
High water alarm (Y/N) tj 1A Alarm tested (Y/N) �{Q
Date of pumping "' 1—Z-4 -qD Pumper At" t4onMc Scr17tce5
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlot L 100 t On adjacent lots t n0 ,+ Foundation S t
To property line (n f Absorption field S ) Watermain/service line ( O
r .
Surface water/drainage
72428 (Rev. 7/91) Prom CONTINUED ON BACK PAGE
C. LIFT STATION
Date Installed .
Size in gallons
Vent(Y/N) _
High water alarm level
"Pump on" level at , .
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access(Y/N)
"Pump off" level at'
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Surface water
Date Installed 3 b Soil rating 19_0 0,1gP- System type Q roe,-
Length < � Width 'A Gravel thickness :" - Total depth
Total absorption area ::7 2 RCleanouts present (Y/N) 1U
Depression over field (Y/N) A.) Date of adequacy test - ((- Z 3 - 9 O
Results (pass/fail) .4 S S for
bedrooms
Peroxide treatment (past 12 months) (Y/N)1w If yes, give date _
i
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot nn It r
( One tots � �� o � Property line (D 014 -
To building foundation r f To existing or abandoned system on lot 0 14
On adjacent lots 3� f Cutbank_e2/1Watermain/service line J n rf
r
Surface water ( oe3 '} Driveway, parking/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that t have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
S 8 S ENGINEERING
17034 Eagle River LoRoad No�a yam`:' >y-�� � •;.•+j;.4e
Signature
;eSignature 4 �
Eagle River, Alaska 99577 .. ..... .. • • �i
Engineer's Name /
Date�c.... giadls`Ba •.E. ��%
f (' l \Fp PROFESStONP��?�r
0
HAA Fee $ / 70 v Waiver Fee: $
Date of Payment ID - •) ' Date of Payment
Receipt Number ;2-3/2 Receipt Number
72-026(A". 1191) Back MOA 21
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING 3 ENGINEERING CO.
6633 B STREET ANCHORAGE. ALASKA P9518 TELEPHONE (901) 682.2343 FAX: (90
AULISIS DEPORT II SIMPLE for /OSRordest 3482S
Det* Report Printed: OCT 191 4 01:10
! Client Unit ID:L1 14 RMI KOpS S/D EI
PMSID :Ol Client Meee is t, S IMGIM1112M0
Collected OCT 1 91 1 his, Client lcet :SYSIMOP
Recalled OCT 1 91 4 13:50 hue. IPO I PO I MODE RECEIVED
Preserved with :13 IIQCIRID 1eq I
Ordered IT :1. SUPER
13e4118 Coefleted OCT:2 91
Releret 0ased i Supe rls r T1PU�C. 110 SeI) Isparta 3IIN to:
Released II : �� 1)S R S tRC2A6I1IIC
2)
...............................................................
Cheuleb Ref 1: 93511! Lob Sepl ID: 1
Famuter Tatted
............................
MITA1TE-M
Metric: MATER
Result units Method
---------------------------------------
MD(0.10) e?/1 IPI ISI.2
Stals '=TINT SAMPLI COLLECTED IT: R.D.J. TAG 11111111) SAMPLI COLLICTID 11
Ramat'" 1400 IDIS, ME AEC11VID SAMPLE It 1350 SIS.
Allowable
Llaite
10
• ••-1 Tests'Perfotmad •••••••••••••.••���iel Instructions bore
111- Mot It:alTsed .p�o'•-•••••••••••••••••••••••••••••••••••
n- Ron* Detected Dl•O:tireilebl*
e' See 342PIe Remarks lbovs
LT•Le1e Than, GT -Greeter Ihen
*SGS Member of the SOS Group (SCCIC6 Gdnersle do Surveillance)
CHEMICAL & GEOLOGICAL'LABORATORIES OFALASKA, INC.
TELEPHONE (907) =Z-ZJ4J $833 b Sire%
! Anchorage, Alaska 09516
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
0 PUBLIC WATER SYSTEM 1.01
.K PRIVATE WATER SYSTEM
Name
Phone No.
S & S ENGINEERING
Mating Addnee 70 4 Ea' a ver oop koa 0.2
Eagle River, Alaska 99577
eiir Tule zip code
SAMPLE DATE: ®
Mo. Day Year
SAMPLE TYPE:
Z Routine
❑ Check Sample (for routine sample
With lab ref. no. ) r Treated Water
G Special Purpose O Untreated Water
SAMPLE
NO. LOCATION Tlme Collected
Collected gv
2 L 1
4 L�
5
/ o, AT
\
TO BE COMPLETED BY LABORATORY
Analys Shows this Water SAMPLE to be:
Satlsfactory
❑ Unsatisfactory
❑ Sample too long In transit; sampte should
not be over 30 hours old at examination
to Indicate reliable results. Please send
new sample via special delivery mall.
Date Received )O -//
Time Received —12dD
Analytical Method: Membrane Filter
' No. Of colonies/100 ml.
10% Rot. No. Result' Analyst
91.5174Q © _
- M
�--� m
ED
WATER ANALYSIS RECORD
READ INSTRUCTIONS Membra Ilter. Direct Countr�
�-"�CoGformn00 ml
BEFORE Verification: LTO_ ec0_� ,
COLLECTING SAMPLE Final Membrane Filter Results t�
jo 'L 9Collformn00 ml
Reported eye _ ste_.�
Time:' fcaa > a.m.
TNTC = Too Numerous To Count p.m.
OB = Other Bacteria Held For Confirmation
CHEAlICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING ENGINEERING CO.
y...e..,..,e, TELEPHONE (907) 562.2343= 5633 B Street
Anchorage. Alaska 99518
i
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
❑ PUBLIC WATER SYSTEM I.D. tt
)1 PRIVATE WATER SYSTEM
S & S ENGINEERING
ea.na Aa* s 17034 Eagle River Loop Read No. 204
Eagle River, Alaska 99577
car swe Za ewe
SAMPLE DATE:
Mo.
SAMPLE TYPE:
EE
Day Year
Routine
❑ Check Sample (for routine sample
vrith lab rof. no. 1 ❑ Treated Water
❑ Special Purpose ❑ Untreated Water
SAMPLE Time Collected
Ito. LOCATION Collected By
21 I
3
4 I
SI I
TO BE COMPLETED BY LABORATORY
shows this Water SAMPLE to be:
RECEIVED
❑ Unsatisfactory OCT 10 1931
❑ Sample too long in transit; samplege
.,zhput
not be over 30 q y� 9 4
to Indicate relic e , I ease se Services
new sample via special delivery mail.
Date Received /0�//;
Time Received 3 T 5
Analytical Method: Membrane Filter
No. of colonies/100 ml.
t jResuIt* Analyst
0-7—
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS Membrane Filter: Direct Count �� Collfornv100ml
Verification: LSB
BEFORE
Fecal Coliform Confirmation
ece
COLLECTING SAMPLE Final Membrane Fl Ser Results �y coliform/100 ml
Reported ey r—�r_ v,/�/�/.•� a --;,ate
TNTC = Too Numerous To Count Time: °.m.
p.m.
OB = Other Bacteria
•, MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
• DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel l.D.# f'l�a—a2,�—�� HAA# /Z ILA
AUE
1. GENERAL INFORMATION (Must be completed prior to submittal) )nRe,%,. ' VICE �U MSI
ENVd.�N��1EN1Al SERVICES DIVISION
(a) Legal Description (include lot, block, subdivision, section, township, range) (JOV 27 1990
Lot 3: Block 4: Raven Wood." $1
Location (address or directions)
6231 T4appem Taait
(b) Property owner paiAy T_ Fhnnko Telephone: (home) Business
Mailing Address 6231 Tkappeh6 Trail Anchorage, Ataaka 99516
(c) Lending Institution
Telephone
Mailing Address
(d) Real Estate Company and Agent VISTA REAL ESTATE ATTN: Chki6 Jame6
Address41'a6ka-99503
Telephone 562-6464 FlobiF. 0229-8511
(e) Mail the HAA to the following address: (or check here Wxif hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
17031 Eagle River Loop_ltQadNo.204
1E.. I[& River, Alrska 99577
2. TYPE OF RESIDENCE
Single -Family IXx Number of bedrooms _4
3. WATER SUPPLY
Individual Well EXx Community ❑ Public O
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site IBx Public O Community ❑ Holding Tank 13
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-0 2S (R•v. 7/8E) Page 1 of 2
5. 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
G S
Addresk/'3a=,�i, Riva leap Road No. 204
Ea0le River, Alaska
Date
Telephone 417 1716/-1- /
i.a A. Uaf.a•
U" W748
6. DHHS APPROVAL �/
Approved for _L_ bedrooms by Date 0
Approvedix--Disapproved Conditional
Terms of Conditional Approval
CAUTION
J
The Municipatityof Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above byan 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
oranalyzedata before a certificate is Issued.The Municipalityof Anchorage Is not responsible forerrors oromissions
in the professional engineer's work.
n-025 (R.. 7M) B"k Page 2 of 2
IV
�. .... , ........
i.a A. Uaf.a•
U" W748
6. DHHS APPROVAL �/
Approved for _L_ bedrooms by Date 0
Approvedix--Disapproved Conditional
Terms of Conditional Approval
CAUTION
J
The Municipatityof Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above byan 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
oranalyzedata before a certificate is Issued.The Municipalityof Anchorage Is not responsible forerrors oromissions
in the professional engineer's work.
n-025 (R.. 7M) B"k Page 2 of 2
WL"C'PAL" 01 A MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH (MOA
)
Health Authority Approval (H
ENMOWENTAL PRO CHECKLIST- F FEBRUARY 1984)
�1f 2 ^ Igt] 343-4744
RECEIVED
A. WELL DATA
Legal Description: —L Q -r J 11Lnf L Or
Well Classification __-fe�Dl V I L1.>fK_ If A, B. C, D.E.C. Approved (Y/N) Ip
Well Log Present (Y/6) N Date Completed l_ Yield 4,5 lUPri
Total Depth OV— Cased to aa'* Depth of Grouting
Static Water Level Q Lr' Pump Set At 131 +
Casing Height Above Ground ►Z" ` Sanitary Seal on Casing (DN)
Electrical Wiring in Conduit (6/N) 1J Depression Around Wellhead (Yo _ 0
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 1004- ; On Adjoining Lots 10w
To Nearest Edge of Absorption Field �o�»
n Lot 1r" - ; On Adjoining Lots 106 �
To Nearest Public Sewer Line ^ tom_ To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot 7 -
Water Sample Collected by Date 11 -IS -90
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Ji -A -11. Size 12'Sb No. of Compartments Z -
Y
Standpipes a/N)y Air -tight Caps ON) !q IFoundation Cleanout (Y NQ
Depression over Tank (Y/O tJ Date Last Pumped 11-2"1--`1
Pumping/Maintenance Contact on File (Y/N) A %�a- ; for
Holding Tank High -Water Alarm (Y/N) 40- Temporary Holding Tank Permit (Y/N) AJ A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well xoo`4' To Building Foundation 57 r
To Property Line -- 101 4- To Disposal Field
To Water Main/Service Line /C 04-
To
fTo Stream, Pond, Lake or Major Drainage Course /va
CommentsRompfz4� SL,•t P llonE SGA l,e es
72-M(Rw. 7/88)F,wl Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 1& 04 )�,e- Type of System Design' -57 -"cat
Date Installed ()- 4-1t, Length of Field SV
Width of Field °SV~ Depth of Field
Gravel Bed Thickness %
Square Feet of Absortion Area 7z 8 Statndpipes Present &N)
Depression over Field (Y& Date of Last Adequacy Test 1l- L3-90
Results of Last Adequacy Test 4 845,
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well 1 o0 '+ To Property Line 10,*
To Building Foundation ' 1a To Existing or Abandoned System on
Lot
On Adjoining Lots 3°
To Water Main/Service Line 108`- To Cutback (if present) ^f
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Installed
Size in G 110
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical
Comments
Dimensions
Manhole/Access (Y/N)
"Check Permitted Bedroom Rating Against HAA Request'
"Pump Off" Level e
(Y/N)
Cycles during Adequacy Test.
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
Inspection.
S & S ENGINEERING
Signed 17-011
oa No.30q
Company Eagle River, Al==
Date L 0
MOANS 0-6 ° - ao-7.-
Receipt No.
Date of Payment �l Z.3 " g0
Amount: $
Receipt No.
Waiver Fee: $
Date of Payment
72-M (R«. neat Back Page 2 of 2
f' CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
ll a
5833 B STREET - ANCHORAGE, ALASKA 99518 - TELEPHONE (907) 582-2343
FEDERAL TAX I.D. #92-0040440
ANALYSIS REPORI RI SAMPLE for Work Order 1 30203
Date Report Printed: NOV 19 90 4 09:05
Client Sample ID:L3 14 RAVEN WOOD 11
PWSID :OA
Collected NOV 15 90 4 14:50 hrt.
Received NOV 16 90 4 15:00 his.
Preserved with %AS REQUIRED
Client Nana S & S ENGINEERING
Client Acct SNSENCP
P.0.1 NONE RECEIVED
Req 1
Ordered 1y : R. SHAPER
Analysis Completed :NOV 16 90 Send Reports to:
Laboratory Supervisor : . REN C. EDE 1)S 6 S ENGINEERING
Released 1y : 2)
Z4-vv
::.......................................................................................
Special
Instruct:
Chenlab Ref 1: 904859 Lab Smpl ID: I Matti:: WAIER
Parameter Tested
NITRAIE-N
Sample ROUTINE SAMPLE.
Remarks: SAMPLE COLLECTED BY RAY.
Result Units Method
---- --------.
ND(0.10) sq/l EPA 353.2
Allowable
Limits
10
..............................................................................................................
1 Teets Performed See Special Instructions ►hove UA -Unavailable
ND. None Detected " See Sample Remarks Above
NA- Not Analyzed LT -Less Than. CT -Greater Than
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 5622343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY
❑ PUBLIC WATER SYSTEM I.D.N Anal Is shows this Water SAMPLE to be:
,,;4 -PRIVATE WATER SYSTEM Satisfactory
��� Z�7� ❑ Unsatisfactory
Name Phone No.
S E S ENGINEERING ❑ Sample too long in transit; sample should
not be over 30 hours old at examination
Mailing AddQ934 Eagle River Loop to indicate reliable results. Please send
Eagle River, Alaska 99577 new sample via special delivery mail.
City State Zip Code r ��
rr� Date Received
SAMPLE DATE: m m E Time Received /5Dd
Mo. Day Year
SAMPLE TYPE:
4n—Routine
❑ Check Sample (for routine sample
with lab ref. no. 1 ❑ Treated Water
❑ Special Purpose ❑ Untreated Water
SAMPLE
NO.
1 I L
LOCATION
>T ;:, 5t.oc-e— 4
Time
Collected
I L�
Collected
By
1�4-
2
3 1
4 l
sl
I
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Analytical Method: Membrane Filter
No. of colonies/100 ml.
Lab Ref. No. Result* Analyst
90.4659 Z. FTa
ED
U m
U m
U m
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Fllter. Direct Count
Verification: LTB
Final Membrane Filter Results
Reported By
TNTC = Too Numberous To Count
OB = Other Bacteria
ml
Time: �� a.m.
p.m.
PART ONE IF TWO
REMAINDER TO FOLLOW