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TELEMARK HILLS LT 4
T I merk Hill Lo1- 4 #015-251-90 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage -' -'. Development Services Department Building Safety Division '"~ I][~ · On-Site Water and Wastewater Program. 4700 Elmore St.~, ~,~ P.O. Box 196650 Anchorage. AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: _ 5~d o~o 31o PID Number: 0~5- z3t- qo H,~.~ ;[ ']~n,~;~'~ 3~,{ k~r Wastewater System: [] New I~ Upgrade {,soo ABSORPTION FII=tn SEPARATION DISTANCES ~Septic ~Holding ~8.T.E.P. ~Olhe~ Tank F~ld Slalio~ Tank 8~r Line ~.--w.,. MO. ~1~/LIFT STATION Gal Inspections pedormed by: L~ ~ur~l,~ Dates 1" 9fi31o6 DevelopmentSewmes Depa~entAppro~al ff :'&9~H Conditional Approval Date: 1, ~,, ~S E, Reviewed and approved bY: ~ Date: ~ -~ ~-0~ T N SWING K $£,4LE~ 1' = 50 FT, ~_i_b ~-S~S If'ELL -~ LDT 4 205 ~, ~$ry. A v£~u£ II ~ycy. ~zc. ~$o~ II (9o7) P79-3916 U_ T£LP, YARK LOT 4 EpYSTEWA$$uy r T. 17, 2008 .U SMEO': 2/8 Go/O: 2789 HOCAN S~IELKER GSO0 lt~EST£ORD I~NE PERMIT # SV070310 P1B # 015-831-90 TELEMARKL4DB. BVG TO EXISTING DRAIN FIELD DOUBLE CLEANDUTS ~ Trench #I 5-Vide Trench: 5' Vide 55' Long 5.9' Peep 3.1' Sewer Rock 2' InsulQ f/on ~5' Cover N T.S FounclQfion Oe~n out o NO SCALE ynltor , Trench #la~ Bier. 90.~ ........ 3.1 ft oF Septic ~ock / Effective NO SCALE EXISTING 1888 GAL STEP TANK · ~.o.,. ~,,.-- ~z.~' &'-~,~. ............ ~%.. ~-'..~ m 49th ~ . e "~ ......... ~......7.1...~.....~.....~ ~..~ =_.~t.~......~ Bench Jlark Cement Patio NE Corner House, Assumed Elevation lO0' ~ ENGINEERING~ELEM~L~KHILL9 LOT 4 ~ SEPTIC SYSTE:. AS-DU~ ~03 ~/15t;h Ave DATE, ~ ~ ~O ~E SHEET~ 2/2 G~lg, PERJZlT ~ SYt070310 PID~ 015-231-90 TdemarkH#1sL 4O3.dwg 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.munLorg;onsit e [907) 343-7904 Soils Log - Percolation Test t.~ 4 Slope ¢~.' ~ ..;~ r /49TH~ '. ~1~-... ,,,~0 ...~ Date PedDled: T~nship, Range, Se~on: Site Plan 2- 3- 4- 5- 6- 7. 8. 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED? $ iF YES. AT WHAT DEPTH? I. Depth to wirer After O Monitoring? E Reading Date Gross Time Net Time Depth to WaterNet Drop ':t" ,, ~,:~o ^,.. zo ..;.. ID ~/0" -~%" PERFORMEOS,: , /,-., CERT,P T ,T, ,STEST, AS PERFORMED IN ACCORDANCE ~VlTH ALL STATE AND MUNICIPAL GUIDELINES IN I[FFECT ON THIS DATE. DATE: MUNICIPALIT~ OF ANCHORAGE Development Set.ices 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: Nov 16, 2007 Expiration Date: Nov 15, 2008 Permit Number: SW070310 Legal Description: TELEMARK HILLS LT 4 Design Engineer: 0014 ANDERSON ENGINEERING Owner Name: HOGAN & JENNIFER SMELKER Owner Address: 6800 WESTFORD LANE ANCHORAGE, AK 99516-1882 Parcel ID: 015-231-90 Site Address: 006800 WESTFORD LN Lot Size: 54450 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail requirements specked 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. 5. The following special provisions. Engineer needs to do an additional percolation test during construction of septic field. The percolation test procedure is to follow Table 3-8 of the EPA Design Manual. Please submit stamped and signed results with the As-built Inspection Report. If the results require a design change, construction of the system will stop pending On-Site review and approval. Issued B y:.~J~- Date: Date: //-/'7-o-7 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www. muni.org/onsite (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-231-90 Property owner(s) Hogan & Jennie Smelker Mailing address 6800 Westford Lane Anchorage, AK Site address 6800 Westford Lane Anchorage, AK Legal description (Sub'd., Block & Lot) Lot 4, Telemark Subdivision Legal description (Township, Range & Section) Lot Size 54,450 ' Sq. Ft. Day phone Zip Code 99516 Zip Code 99516 Number of Bedrooms Three (3) THIS APPLICATION IS FOR (~] all that apply): Absorption Field [] Septic Tank [] Holding Tank [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] 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 Cedes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number:, _ (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) November 13, 2007 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Su~e~: Lot 4, Telemark Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption trench on the subject lot has failed and must be upgraded to prevent effluent from backing into the house. We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the three-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the proposed septic system. The existing septic tank has been in place for slightly more than 10 years and is suitable for continued use. The existing well and estimated location of the water service line are shown on the plan. No conflicts exist between the proposed septic system and the wells on this or adjacent lots. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test holes placed on the lot during the initial septic system construction indicated well graded gravel (GW) to depths of 10'. The pemolation rate was determined to be 4 to 5 minutes per inch. We are proposing to construct a new 44' long by 5' wide absorption trench with 3' of gravel beneath the distribution pipe. The distribution pipe in the trenches will be placed at 4' below the surface with the total depth at 7'. No groundwater was encountered during placement of the test hole and none developed during the monitoring period. A new test hole will be placed during construction to verify the soil depths and percolation rates. A revision to the design will be completed if required. A flow diverter valve will be placed and the existing absorption trench tied in for future use. The ground surface on the lot slopes slightly to the north in the area of the absorption trench. The trench will be placed parallel to the contours of the ground as much as Lot 4, Telemark Subdivision November 13, 2006 Page Two possible and in conformance with design criteria. A minimum of 100' will be maintained between all components of the septic system and the proposed well and from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments 0 LOT4 X X X AREA MAP SCALE 1' = 100' T LOT 4 / I TELEMARK HILLS / I s~BD~v~s~o~ /! , ~4.,~o s.F. / , SITE PLAN SCALE 1' = 40' LOT 4 TELEMARK HILLS SUBDIVISION 54,450 LOT 4, TELEMARK HILLS SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home Deep Trench System Peru. Rate: <5 Min./Inch 1,250 Gallon Septic Tank Application Rate: 1.2 GPD/SF 3' Drainfield Rock 3 Bedrooms X 150 GPD/1.2 ( Application Rate) = 375 SF Absorption Area 375 SFI5 SFILF*.58 (Red. Factor) = 43.5 LF Trench Length THEREFORE: Construct a 44' Long x 5' Wide x 4' Effective Depth Absorption Trench at the Location Shown. Flow Line Elevation in Trench to be 4' Below Odginal Ground Surface. Total Depth to be 7' Below Existing Ground. Provide 3' Cover Over Absorption Trench. Maintain 100' Separation from Wells in the Area. Natural Backfill Geotextile Fabric 4" Perforated PVC (Holes Down) Drainfield Rock 5' WIDE TRENCH SECTION (NO SCALE) NOTE: Minimum 6' Separation From Bedrock. Minimum 4' S,eParation From Groundwater. ~:~.'".'"~.'"~""~" Minimum 100 Separation From Wells in the Area Minimum 100' Separation From Surface Water or Streams.- ~,,;.... No. cE-~.~, .."~_~ Municipality of Anchorage Page. DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal Syslem and/or Well Inspection Report ~ ~ ~ 5~-~ ~ ~ Waslewaler Syslem: ~New D Upgrade ~b ~ ~o. ~. I~ ABSORPTION FIELD ~t - ~ ~ DeepTrench ~ShallowTrench O Bed O Mound O Ot~er WELL: ~New O Upgrade ~.~ wi~m: Numar of li~: I Da~e DrllI~: Satlc wat~ LMI: Ins~lle~ Date I~alled: SEPARATION DISTANCES ~i~ ~ ,o,~i~ o s.t.~.,. Sudace wate~ ..... LI~ STATION LOt ~ ~t Line ~. ~ ~ ~ ~ ~ / Size In gallons: Remarks: BENCH MARK I ENGINEER'S S~ ........ Inspections pedormed by: ~z,~ ~, [. ~.~ Dates: 1st ~/~/% Depadment of He~ th an ~lces appreval Reviewed and approved b ~ /~ ~//~ Date. Permlt No. ~t~ q~- Page -q' of :~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Descflption: /ol' ~ 'rr~_~,~..~- Jlu-~ PID No.: ENGINEER~ SEAL % C LOT 4- TELEMARK HILLS SIX-M CEDAR HOMES - HARTEN RESIDENCE CHUCK EGGENER CONSULT;NG F'NGINEFRS ANCHORAGE, ALASKA 907-549-1010 - ON MATT MATTHEWS SITE WASTEWATER DISPOSAL SYSTEM ~'~,~.-. ........ .--.,~.~.:.' ~',: 49~J)~, ~.,~. AS-BUILT SHEET 5 OF 4 i $ I ~. I \ I \ I. \ I , I r ........................ ~- ................ ~ ............ -~--, ...... ~ ....... I ! '~' \ ~ I I ' ~RV~ ~T~ ~AN ~ ~'- 20 ~. NO~S: 4. KP~C S~ WAS ~S~ ~ ~P~ 24. LOT 4 TELEMARK HILLS - ON SITE WASTEWATER DISPOSAL SYSTEM SIX-M CEDAR HOMES - MATT MATTHEWS HARTEN RESIDENCE ~*~ 49~ ~.~ CHUCK EGGENER CONSULTING ENGINEERS ~. ~. ~,~-~ . ANCHORAGE, A~S~ SHEET 4 OF 4 907-349-1010 ' · SAMUEL COURT LOT 4 ~,', ~ ~ ,,~ I I I 1 IN. = 100 FT. LOT 5 LOT 6 LO~ ~ J I LOT e I / / ~ -,~_ -~ ~ ,/~, h,, I I I L~-- ~--~--X---X---~--~- J NOT SUBDr,ID~ //~ ~~ I ? , / -- LOT 4 TELEMARK HILLS - ON SITE WASTEWATER DISPOSAL SYSTEM SIX-M CEDAR HOMES - MATT MATTHEWS H~RTEN RESIDENCE ~A~.. ....... CHUCK EGGENER AS-BUILT ~ ~ C~S L~ CONSULTING ENGINEERS ~&~ .o. ANCHO~GE, A~SKA SHEET 1 OF 4 907-349-1010 ' I ,- J~ 4'1 / ~ / / / ~1 / ~/. ~.~ .,~ , , / / / / ~ ~ // / /, / // ~ .~ ~/ / I ./z~/ // // .~ ~/ I ~ ..................................... ~:~--~ ................ I ' ~TE PLAN DEP~ (FT.) L TY~AL TR[~ CROSS SECTI~ LOT 4 TELEUARK HILLS - ON SITE WASTEWATER OISPOSAL SYSTEM SIX-M CEOAR HOMES - MATT MATTHEWS HARTEN RESIDENCE ..... CHUCK EGGENEfl AS-BUILT CONSULTING ENGINEERS ~ ~.... ...~e, ANCHORAGE, A~SKA SHEET 2 OF 4 907-549-1010 Mun;cipaUty ©f A~chorage DEPARTMENT OF HEALTH & HUMAN $ERVtCE$ P.,:~.R "L' Rtr~'.t. AncAor3~e. ~a~ka 99502~6~ SOILS LOG -- PERCO~TION TEST L~GAL D~SCRIPTmON: ~ ~ ~~ ~C~ I 4- 5' 7 8 9. 10, 18- 1 own$~p. Range. Sect Jori. StO~K ENCOUNTERED' SITE Pt. AN Municipality ©f Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES E:).~ "L' ~r~.t. An,'hor3~e. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION; 2 4 ?- 8 t~ ~$ Charles L No. 4158-E COMMENTS 1 ownsh~p. Range. Section. SLOP~ ENCOUNTERED~ ~ 12-0C8 (Rev. 4/~ ..,, OCT ~8 1996 D Municipality ut Ancnorag epb Health A Human Se~l Mun~cipaUty ©f A~chorage DEPARTMENT OF HEALTH & HUMAN SERVICES £~ "L' Rtr~t. Ancl~oraoe. Alaska 99502-0650 SOIt.S LOG -- PERCOLATION TEST LEGAL 3 4 6 7 8 9. 10- 11 13- 14- 16- 16 17 18 19 20 L. Ho, I ownShlp. Range. Section. SLO~t ENCOUNTERED~ hSO StTE Pt, AN liST RUIN I~t TV*'bI'N ~ I ! ANt) [Rev. 4,,~ OCT 2S 1996 Dept. Health & Human LOCATION OF WELL STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD LOCATION/SKETCH: DEPTHS MEASURED FROM:[~e~ing top nground surface BOREHOLE DATA: Material Type and Color Depth From To Ow WELL OWNER: WELL DEPTH: Depth of hole: Depth of casing: tt DATE OF COMP, rlON i i, .. c/ ,. PC-' DEPTH TO STATIC WATER LEVEL: _~"~ ft below ,~ top of casing [] ground surface METHOD OF DRILUNG: [~air rotary []'cable tool [] other USE OF WFII: ['~omestic [] brigation r-I monitor [] public supply [] other CASING'b'rlCK.Up: _ c~ · ft. Dian~:: ~ ,i~. t.~ Cas~ng ~e: ~ _ ~ to WELL INTAKE OPEniNG TYPE: [] open end ' I-1 screened [] perforated ~¢,open hole Depths of openings: -. to, SCREEN TYPE: , Slot/Mesh Size: GRAVEL PACK TYPE:. Volume used: Diam:, in. ft Depth to top: GROUT TYPE: Volume: Depth: from ft to. ft Duration: )OD: PU~G LEVEL AND YIELD: ft after ~. PUMP INTAKE DEPTH: WELL DISINFECTED UPON I hfs pumping ~0 gpm ft Horsepower:. [] NO CONTRACTOR INFORMJ~TION: REMARKS: Regis~i~cl Business Name, / / .... ~' OCT ? ~ g~ture of A~nzed Respre~ntative ~ ~IUIVISION OF MIN~G & ~ M~ & Human~u ~ c~ 3601 C St, S~te 800 ANCHO~GE AK ~9503-5935 Phone 1907~269~639, F~ (907J562-1384 Chuck E ener Consultin En 'neers October 23, 1996 Mr. Jim Williams Municipality of Anchorage Dept. of Health and Human Services 825 L Street Anchorage, AK. 99501 Re: Well and Septic System As-builts Lot 4 Telemark Hills Subdivision Dear Mr. Williams, Please find enclosed the as-built information for the Lot 4 Telemark Hills septic system and the additional soils investigation results that you requested for the reserve system design. The soils in the reserve area are indeed similar in nature to the soils found in the vicinity of the primary system, and the preliminary reserve system design will remain unchanged. Also included with this information is the well log as completed by the well contractor. I appreciate the assistance you have given us and look forward to working with you and your office again in the future. If you have any further questions or comments regarding this project, please feel free to call at any time. Sincerely, Chuck Eggener, P.E. Principal, Chuck Eggener Consulting Engineers. RECEIVED OCT 28 199G · Munic:pal,ly o! A.cno~ Dept. Health & Human Services P.O. Box 232946 * Anchorage, AK 99523.2946 * (907) 349.1010 * Fax:. (907) 349-1015 Chuck Eener Consultin En 'neers CLIENT: DATE: RESERVE SYSTEM DESIGN CALCULATIONS PROJECT: Lot 4 Telemark Hills Subdivision Six-M Cedar Homes - Matt Matthews September 9,1996 3 Bedroom home - I000 gallon, two compartment tank. ttydraulic Application Rate Based on Percolation Tests: 1-6 min/inch, use 1.2 gpd/SF Square feet required per bedroom = 150 SF Area Required = 3 bedrooms X 125 SFfoedroom = 375 SF Wide Trench Len_tnh Required: Trench Width = 5 feet Effective depth of sewer rock = 3 feet Reduction Factor = .58 350 SF / 5 FI'. X .58 = 43.5 Ft. ~ (Test holes performed 6/21/96) Test Hole No. 3 Depth 0-1ft. 1-3 ft. 3-9 ft. 9-14 ft. 14ft. Soils OL - Rich Brown Topsoil GM - Silty gravel GW - Good gravel ML - Silts with gravel Percolation Rate at 5 feet = 4.21 mindinch Bottom of Hole - No ground water encountered RECEIVED OCT 2 C, 1996 D Mu[lic:pahly o! A,icr, o, age ept. Health & Human So.ices P.O. Bar 232946 * Anchorage, AK 99523.2946 · (907) 349-1010 * Far:. (907) 349-1015 Test Hole No. 4 Percolation Rate at 5 feet = 4.44 mlnJinch Depth 0-1ft. I-3 ft. 3-8 ft. 8-14 ft. 14ft. Soils OL - Rich Brown Topsoil GM - Silty gravel GW - Good gravel ML - Silts with gravel Bottom of Hole - No ground water encountered RECEIVED OCT 28 199~ tvlumc paPty ut Ancno, a~o Dept. Health & Human Servicee MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE i OF 1 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960227 DESIGN ENGINEER:CHARLES L. EGGENER, P.E. OWNER NAME:MATT MATTHEWS - 6M CEDAR HOMES OWNER ADDRESS:3340 ARCTIC BLVD. ST. 106 ANCHORAGE, ALASKA 99503 DATE ISSUED: 8/01/96 EXPIRATION DATE: 8/01/97 PARCEL ID:01523190 LEGAL DESCRIPTION: TELEMARK HILLS LT 4 LOT SIZE: 54450 (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 (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: PERFORM ADDITIONAL SOILS/PERCOLATION TEST(S) FOR THE REPLACEMENT SYSTEM AND INCLUDE REPLACEMENT SYSTEM AND TEST HOLE LOCATIONS ON ASBUILT. RECEIVED Chuck Eener Consultin En 'neers July 17, 1996 Mr. Dan Roth Municpality of Anchorage Dept. of Health and Human Services 825 L Street Anchorage, AK. 99501 Re: Septic System Design Lot 4 Telemark Hills Subdivision Dear Mr. Roth, Attached is the permit application for installing a septic system on the above referenced lot. Below is a narrative of the probable impacts to adjacent properties. (Refer to drawing sheet 1 of 3) 2[fl~x, nL.W.r,~ - There are no existing wells within 100 feet of the proposed new septic system or the reserve drainfleld site for Lot 4. Ad_iaeent Wastewater System - The proposed wide trench absorption system will not adversely effect the future well sites on the adjacent lots. ~ - Soil conditions encountered on LOt 4 are relatively uniform and meet DHHS standards for on-site absorption systems. There is enough room for a future system to the south of the proposed system as shown on the drawings. 12rilinlgt. - Positive drainage away from the field will be maintained. No concentrated surface water will be directed toward the field and no streams are within 100 feet of the proposed absorption field or reserve site. The installation of this on-site system will have no probable impacts to the adjacent well or septic systems. The proposed system's separation distance will include portions of the adjacent lots, but will not interfere with the on-site systems on these lots. Very Truly Yours, Chuck Eggener, P.E. Principal, Chuck Eggener Consulting Engineers. P.O. Box 232946 · Anchorage, AK 99523.2946 · (~07) 349-1010 · Fax:. (907) 349.1015 Chuck E 'ener Consultin En 'neers July 31,1996 00~(z2 Mr. Jim Williams Municipality of Anchorage Dept. of Health and Human Services 825 L Street Anchorage, AK. 99501 Re: Septic System Design Lot 4 Telemark Hills Subdivision Dear Mr. Williams, Please find enclosed the additional information that you requested for the Lot 4, Telemark Hills on-site septic system design. I have included the test hole information submitted on the Municipalities standard forms and a design for the reserve system. The reserve system was designed based on the assumption that the soils in the reserve area are similar in nature to the soils tested for the primary system. I am requiring that two additional test holes be dug and the soils tested in the reserve area during the construction of the system (see sheet titled Reserve System Design). The soils information on these test holes will be submitted to your office with the as-built information. Should the soils prove to have less absorption capacity than assumed, the reserve system will be re-designed and submitted to your office at the same time. I hope this will clear up any questions or concerns that you have regarding this project. If you have any further questions or comments, please feel free to call at any time. Very Truly Yours, Chuck Eggener, P.E. Principal, Chuck Eggener Consulting Engineers. P.O. Bo~r 232946 · Anchorage. AK 99523.2946 · (907) 349-1010 · tax: (907) 349-1015 Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES ~P.~ '*L' Rtre~.t. Ancnor3ge. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST I'ERFORt~eO FD~ ~- LEGAL DESCRIPTION; / I ownsh*p. Range. Se,;tlon. SLOP'~ 8 10- 11 13- ENCOUNTERED~ ~ 14- 16- 17- 18- COMMENTS I I,~ ~It e-y I Is~- -- frAko,~"5- rr IIERFORM;O FOR: Mun;cipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES P..?.R "L' ,RIr~I. Anchora0e. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S LEGAL DESCRIPTION: 1 I ownsh~p. Range. Se¢1~on. SLOP[ $1T~ PLAN 7 8 9 10 11 t2 ~3 14 15 16 19 20 Ill III *2tll II1' I1'1 III III III III I~ I~ YES./~T WHAT (, i ¢ o,o= 6"-"1 (.:tkll! ~ INA1 1~S %EST WAS PERFORMED IN ,.,,,, ~/~l/~ Chuck Eener Consultin En 'neers DESIGN CALCULATIONS PROJECT: Lot 4, Telemark Hills Subdivision - Harten Residence CLIENT: Six-M Cedar Homes - Matt Matthews DATE: July 17, 1996 3 Bedroom home - 1000 gallon, two compartment tank. Hydraulic Application Rate Based on Percolation Tests: 1.2 gpd/sf Square feet required per bedroom = 150 SF Area Required = 3 bedrooms X 125 SFfoedroom = 375 SF Wide Trench Len~h Required: Trench Width = 5 feet Effective depth of sewer rock = 3 feet Reduction Factor = .58 350 SF/5 FT. X .58 =43.5 Ft. ~ ~ (Test holes performed 6/21/96) Test Hole No. I Depth 0-1ft. 1-9 ft. 9-15 ft. 15 ft. Percolation Rate at 5 feet = 2.67 min./inch Percolation Rate at 10 feet = 65 min./inch Soils OL - Rich Brown Topsoil GW - Well graded gravel ML - Tight Silts, some gravel Bottom of Hole - No ground water encountered Percolation Rate at 5 feet = 2.67 mlndinch Depth 0-1ft. 1-9 ft. 9-14 ft. 14ft. Soils OL - Rich Brown Topsoil GW - Well graded grovel ML - Tight Silts, some gravel Bottom of Hole - No ground water encountered P.O. Box 232946 · Anchorage. AK 99523-2946 · (907) 349.1010 · Fax:. (907) 349-1015 Chuck E 'ener Consultin En 'neers ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES MATERIAL SPECIFICATIONS Reference: Lot 4 Telemark Hills Subdivision July 17, 1996 The scope of this project includes the installation of a 1000 gallon septic tank and a ieachfield trench to serve the proposed 3 bedroom residence located on the referenced proper~y. 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. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifc..ally 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. The 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. Septic tanks installed with less than 4 feet of cover shall be insulated. 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. These cleanouts shall be located on undisturbed soil no more than 10 feet P.O. Bor 2329.16 * Anchorage, AK 99523-2946 * (907) 349.1010 * Fax'. (907) 349-1015 · Lot 4Telemark Hill Subd. · July 17, 1996 from the septic tank. The first cleanout, in line, shall be to clean towards 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/Dralnfield Installation: Excavate the proposed trench to the dimensions shown on the approved design. The bottom of the excavation shall be 2 inches within level over its entire length. If the sidewalls become smeared, they must be raked or scratched prior to sewer rock placement. Once the gravel is installed, the distribution pipe is o be installed level with the perforation facing 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 that the silt barrier covers the entire gravel surface before placing backfill. Monitoring 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 gravel as noted on the design. Backfill over the final gravel layer must not be less than 24 inches. Insulation must be installed when the backf'dl depth is less than 36 inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Minimum Material Specifications: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Pipe Type or Approved as Approved as Cast Iron ASTM D3034 (PVC) ASTM F789 (PVC) ASTM D2751 (ABS) ASTM D2661 (ABS) Yes Yes Yes Yes Yes Yes No* Yes Lot 4 Telemark Hill Subd. July 17, 1996 ASTM FS10 (HDPE) o Yes No D2751 may be approved as standpipe material ff the minimum wall thickness is 0.18 inches (4.57 mm), SDR 23.5. D2751 will not be approved as a stand pipe material if the minimum wall thickness is 0.125 inches (3.18 mm), SDR 35. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI-35 or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable non-toxic silt barrier (Typar 3401, Mirafi 140N, or equal) mast be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5 inch to 2.5 inch screened gravel with less than 3% passing the #200 sieve. Typically there will be a minimum of three inspections required during the installation ofthe wastewater disposal system. These inspections shall occur as follows: 1. Thc fa'st inspection must be conducted after thc excavation of ditches or trenches and before the placement 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 shall occur upon final grading of the property. Thc inspecting engineer shall be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. 3 '-, SAMUEL COURT _ _ Lx--x--x x~ x xJ LOT 4 TELEUARK HILLS - ON SITE WASTEWATER DISPOSAL SYSTEU SIX-M CEDAR HOMES - MATT MATTHE~ HARTEN RESIDENCE ~,. ........ b~-...~....~ ........... CHUCK EGGENER ~~' CONSULTING ENGINEERS ~. _ ANCHORAGE, A~SKA SHEET 1 OF 3 907-549-1010 45' SITE PLAN DEPTH (FT.) 7 LOT 4 TELEMARK SIX-M CEDAR HOMES - MATT MATTHEWS HARTEN RESIDENCE HILLS - ON SITE WASTEWATER DISPOSAL SYSTEM CHUCK EGGENER CONSULTING ENGINEERS SHEET 2 OF 3 ANCHORAGE, ALASKA 907-349-1010 LOT 4. TELEMARK HILLS - SIX-M CEDAR HOMES HARTEN RESIDENCE ON SITE - MATT MATTHEWS CHUCK EGGENER CONSULTING ENGINEERS ANCHORAGE, ALASKA 907-,349 - 1010 SHEET 5 OF 3 WASTEWATER DISPOSAL SYSTEM ~,.L',,~. ......... ~..' ~.~.~.............~..........~ *,,~ss~ . ........... ~-~- I ....... ~m ~ ~XCAVA~ ~ I ' ~ ' I I LOT 4 TELEMARK HILLS - ON SITE WASTEWATER DISPOSAL SY5TE~ ~lX-~ CEDAR HOUES - UATT UATTHEW~ HARTEN RESIDENCE ~.. ......... ~*: 49~ ..~ OHUCK EGGENER CONSULTING ENGINEERS ~;~2'.. ...NF ~ ~'~i,, ANCHO~GE, A~S~ RESER~ SYS~ DESIGN t~ss~~ 907-549-1010 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. OI5- GENERAL INFORMATION ~' Complete legal description Location (site address) Current Property owner(s) Mailing address COSA # ("),4~. o Expiration Bate: ~-~ -/~,. -// Lo-l- Day phone Lending agency Mailing address Day phone Real Estate Agent · Mailing Address Day phone Unless Otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: .,~ TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Pubiic Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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 Certificate of On-Site Systems 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 Address 7-O3 k/, 15{'1" Engineer's Printed Name DSD SIGNATURE U/'// Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (Rev. 11/05) Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343'7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DA'~A Well type ~'glUATe Date completed q/.~,/~'~?("* Total depth ~ f. Date .of test Static water level "~/.~/vtAtZ. K ~41LL~ L.'0 7L- ~ ParcellD: OtS-Z~l- ?O IfA, B, or C provide PWSID # -- Sanitary seal (Y/N). '7' Cased to (~0 ft. FROM WELL LOG Well Log (Y/N) 1 Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION /3 ft. Well production ~O g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform A/'~,,G-colonies/100mL Nitrate 2,q:~ mg/L Arsenic: Collected by: ~!~ ,,~Z:~,~' kJ~: B. SEPTIC/HOLDING TANK DATA ' Tank Type/Material GP,.E/=E./~7'E-~L Tank size IOOE) gal. Number of Compartments. Foundation cleanout (Y/N). Date of pumping C. ABSORPTION FIELD DATA Date installed '~/~-~/fZoo~ SOil rating ~ or~/bdrm) Length ~',~ ff.. ' Width 5 ff. Total depth./.~,.,(~ ft.. Date of adequacy test Fluid depth in absorption field before test ~ in. Elapsed Time: Z~0 min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) Depression over tank (Y/N) /V' Pumper Date installed Cl~anouts (Y/N) High water alarm (Y/N) ~(~'u,/~. System type .-('~ IIm~ Gravel below pipe ~,[ Eft. absorption area ~/'~ ~ Monitoring tube ~ Depression over field ¢~///~.~/I Results (Pass/Fail) ~, For ~ bedroonls Water addedt/~0 gal. New depth ~ in. . in. Absorption rate >= /~g0 g.p.d. / //V~e.f, k~014~ Ifyes, givedate ---- J D. LIFT STATION Date installed ~,~'~ze in gallons~~~anh°le/Access (Y/N)~ ~ ~pump on" level at~ in. "Pump off' level at ~ High water alarm level at ~ in. Datum / Cycles tested / Meets alarm & cir/ents? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /OO ~ Absorption field on lot ( OO ~4-- Public sewer main A//,~. Sewer/septic service line 7.~ ~-f- Animal containment areas ~ 14'' On adjacent lots On adjacent lots Public sewer manhole/cleanout .~V'/,,~. Holding tank .x~/~l, Manure/animal excrete storage areas /'~ ~' Absorption field Surface water SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '/" Water main Wells on adjacent lots Property line $ ~ Water service line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line J O t./. Building foundation JO t~- Water Service line JO ~.F Surface water JOO t 'f" Curtain drain 5'0 ~ ~'/I/,o.) Wells on adjacent lots ~O~) ~.f-. COMMENTS Water main /V'/~ Driveway, parking/vehicle storage 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 COSA guidelines in effect on this date. ~, " ~ Engineer's Printed Name L~l~.~ '~l~,J ~ ~~~~'~ Date, ~/l~ol, COSA Fee $ ~ fl 0 ~ Waiver Fee $ Date of Payment 5 ~ ~ fl ~ ~ ~ Date of Payment Receipt Number ~ ~ ~ ~ Receipt Number (Rev. 4/10) SGS Reft# 1110791001 Client Name Spurkland Engineering Printed Date/Time 03/11/2011 11:57 Project Name/# Telemark Hills L4 Collected Date/Time 03/04/2011 16:10 Client Sample ID Telemark Hills L4 Received Date/Time 03/04/2011 16:50 Matrix Drinking Water Technical Director Stel~hen C. Ede Smnple Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS na, ui,c~= as CaCO3 190 5.00 rog/l, 5~[20 2340B C vo, oo, x,o ........ 03/i0/i I SCL Waters Department Total Nitrate/Nitrite-N 2.97 0.100 mg/L. SM20 4500NO3-F B 03/07/11 AYC ~icrobiology Laborator~ E. Coli Negative 1 100mL SM209223B,.,~ I!:,~ A;,m. 03/04/11 DLC Total Coliform Negative 1 100mL SM20 9223B. - A 03/04/11 DLC Private Individual Analysis Alkalinity Aluminmn Antimony Arsenic Barium 68.9 Cadmium 0.500 U Calcium 55700 Chloride 9.84 Chromium 2.00 U CO3 Alkalinity 10.0 U Conductivity 289 Copper 78.7 Fluoride 0.158 HCO3 Alkalinity 114 Iron 261 114 10.0 mg/L SM20 2320B D 22.2 ............ 20.0 ................... ug/E ....... EP200.8 C .... 1.00.U 1.00 ug/L EP200,8 ~',,:~.: C, ~1~ (<6) 5.00U 5100 ....... ~ig~ Ep-2~.~- ......... ~ .....~i0) 3.00 ug/L EP200.8 C (<2000) 0.5,0.0 ug/L. EP200.8 C (<5) 500 ug&~. ' EP200.8 ~ 0.100 m~ EPA 300.0 D (<250) 2.00 u~ EP200.8 C (<100) I0..0 rog& S~0 2320B D 1.00 ~os/cm S~0 2510B D 1.00 ug& EP200,8 C (<1300) 0.100 m~ EPA 300.0 D (<2) mg& S~0 2}20B D 250 ug~ EP200.8 C (<300) 03/07/11 SDP 03/08/11 03/10/11 SCL 03/08/11 03/10/11 SCL 03/08/11 03/10/11 SCL 03/08/I1 03/10/11 SCL 03/08/11 03/10/11 SCL 03/08/11 03/10/i1 SCL 03/07/11 03/08/11 SDP 03/08/11 03/10/11 SCL 03/07/11 SDP 03/07/11 SDP 03/08/11 03/10/11 SCL 03/07/11 03/08/11 SDP 03/07/11 SDP 03/08/11 03/10/11 SCL WELL LOT 4 /o 25 ACRE $ BO~- -/Oo_ Lot ~;Z , Block 7-e/emqr/< . l-Il~Is (85-£) Anchorage Recording District, Alaska LOT SURVEY CERTIFICATION I hereb~ ca~flfy that I hove surveyed the property shown and de$oribed hereon, Qnd that the improvements situated thereon are within the prop- erty tine· and do not overlap or e~orc~ooh on odJeonnt property and that no im~roveme~tl off adjacent pro~erty overlap or eneroQoh on tho premleae In question and that there are no roadwayl, utility tim, ~' oth~ ¥1nlble ea·emente on ·aid property except as indioated hnroo~. Scale 'Ref. WES TFO~ D L.A A/E ~ Easement. of reoord otb.er than tho~e ~hown on 0~'/0'/// the plat of raoord ore not shown hereon unlisa~ of#arwlaa noted. LEGEND Brass or Aluminum copped monument recovered 0 Iron pipe and/or rebor recovered. [3 2 x 2 hub Ex tack reoovered · 5/8" x ~0' rebor set this survey 7_ Date © 0 -27-04 EB. No. -056 Prepared by: tEL. BUTTON /?eg/stered /ond Surveyor ~19 ~ £/ghfh Ave. Anchorg~e AI~s#~ 99501 AECEATIFIE ) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 ParcelI.D.# CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description L~' ~/ 7'E~-~,~v-- ~~Lc<~ Location (site address or directions) Mailing address ~'~-j40 Lending agency ~.~-w' Mailing address I;31 Property owner ~-r~-~'~'rT~'~, ~'~ C~:~ Agent ~'~J~L~ "~,'zou~.~-l- Address I~.t b~. ~,~.~..~.c~ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: Individual well V~ Community well Public water Dayphone ~-~1- ':/'177 v... Day phone A,-~¢~, ~-- Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: Individual on-site ~ 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. ,, STATEMENT OF INSPECTION BY ENGINEER. , As certified by my seal affixed hereto and as of the vardahon 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 verity that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm~_p~.~., ~"'-,'.~,.~-~L t",~,-~,~.~,O~ ~F"-'~C=.~-<~ Phone ~J~/~/' Address ~.o. '~o~,- ~%2,~/~, A~c~.~_..~.: A[~. Engineer's signature ~/'~ /~-~j..g.~ ¢~,~4....,, Date ~ DHHS SIGNATURE -*{~' APproved for Disapproved. 7-~EE ~} bedrooms. Conditional approval for _. bedrooms, with the following stipulations: Additional Comments By:. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certifi.cates based only upon the representations given in paragraph 5 above by an independent professional engmeer ragisterad in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions In order to satisfy certain federal and state requlraments. 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. Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICE~ E C E ! V E b Environmental Services Division 825 L Street, Room 502. Anchorage, Alaska 99501. (907) 3~(~4~ 1996 ...... Municipality of Anchorage Health Authority Approval ~necKIIS[Dept' Health & Human Services Legal Description: Parcel I.D.: A. WELL DATA Well type '-t>~,~~,'r~ Log present (Y/N) Total depth ~ Sanitary seal (Y/N) If A, B. or C, attach ADEC letter. ADEC water system number Date completed W/5!~, Cased to CO Fl' .. Casing height (above ground) FROM WELL LOG , Wires properly protected (Y/N) AT INSPECTION Date of test Static water level ~O Fr' Well production ~0 & 1','.4 · g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: tt Nitrate Z. 0,[ ~,~ /~. Other bacteria ~ Collected by: ~tz~,~ ~.,'-,~',.~ ~ ~'.1. r' B. SEPTIC/HOLDINGTANK DATA Date installed '//3q/'/~.' Tank size ~ Number of Compartments ,3 Cleanouts (Y/N) ,~c_~. Foundation cleanout (Y/N). ~ Depression (Y/N) ~o Highwater alarm (Y/N) ~3/A, Date of Pumping ~ Pumper C. ABSORPTION FIELD DATA Date installed _q I3~t !,~ ~ Length ~5'- ~ .Width Effective absorption area ~q, Monitoring Tube present (Y/N) W~-% ,.~/~ Date of adequacy test ~,~¢L.3 %'4~-,'C~,'~, Results (Pass/Fail) Fluid depth in absorption field before test (in.); Immediately after Fluid depth . (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Soil rating (g_.p.d.llt] or It~A3drm) ~ .9. System type .~r Gravel thlckness below pipe ~ Fr. Totaldepth For gal. water added (in.): Absorption rate = ~.p.d. If yes, give date Depression over field (Y/N) ~ bedrooms 72-026 (Rev. 3/96)' D. LIFT STATION Date Installed. ~3 Ih Manhole/Access (Y/N) High water alarm level at* Cycles tested Size in gallons. 'Pump on" level at* *Datum 'Pump off" level at' E.' ,SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot I ~.l r-'r; Public sewer main ~ Sewer/septic service line 3~o ~1'. On adjacent lots 15-"~- ¢-~. On adjacent lots 1%5' r-~ Public sewer manhole/cleanout. ~/^ Lift station __~..~Ar SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation I~; :~', Properly line. ~' r--~-, · Water main/service line ~ r-r Surface water/drainage .. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Properly line ... ~ ~¢'. Building foundation Surface water ... ~ Ix Curtain drain ~' F. ENGINEER'S CERTIFICATION Absorption field Wells on adjacent lots _ 1'~5' r-~ Water main/service line. Driveway, parking/vehicle storage area _ Wells on adjacent lots 15"~ I certify that I have determined thru field inspections and review of Municipal records that the'abo~e ystems are in conformance with MOA HAA guidelines in effect on this date , Da,e H~ Fee $ Waiver Fee Date 0f Pa~ent t t -,~ ~ -~ Receipt Number 72-026 (Rev. 3/96)* Date of Payment Receipt Number