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HomeMy WebLinkAboutBOB WELLS BLK 1 LT 1Bob Wells Block 1 Lot 1 #067-042-01 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161184 Tax Code Number: 06704201000 Work Type: Septic Upgrade Permit Effective Dates: August 16, 2016 to August 16, 2017 Design Engineer: NORTH RIM ENGINEERING Subdivision: BOB WELLS Site Legal Address: BOB WELLS BLK 1 LT 1 G:0363 Owner/Address: ANDERSON -SMITH DEBORAH J 26031 LOG CABIN CIR EAGLE RIVER AK 995779631 Site Mailing Address: 26031 LOG CABIN CIR, Eagle River Lot Size in Sq Ft: 47467 Total Bedrooms: 5 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: 1. A complete testhole for the alternate site is to be done prior to construction. Submit soils log with IR. 2. Additional perk required for the primary field is to be done prior to construction. Submit soils log with IR. Received By: Issued By: Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.orgiOnsite Development Services Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV161096 COSA#: Permit#: OSP161184 PID#: 067-042-01 Legal Description: Bob Wells B1 L1 Engineer: North Rim Engineering Applicant: Anderson -Smith Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the excessive slope has been approved. The approved separation distance is 35.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. (l Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: g/-06- Approved by: ame of Review **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. O67— 04(2.- 0/ Property owner(s) .4 AVER Sc' — ITN irk 44 Day phone 301- c/793 Mailing address ZG G3! L,oc C.4R/,.J e - Site address S.4•44& Legal description (Sub'd., Block & Lot) ,g d'pj IA/Lett s- 8/ L/ Legal description (Township, Range & Section) Lot Size 477 4/67Sq. Ft. Number of Bedrooms APPLICATION IS FOR: (® all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage APPLICATION IS AN: Initial Upgrade Renewal S — JE s / Cm s/ zE TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property o or authori r zed agent) 1- Permit/Rush Fees: tsz 5' 0 0 Date of Payment: 4 Receipt Number: OGa3lo4 Permit No. orf/6 fig Permit App_9-1-12,doc Waiver Fees: 2 / Li Date of Payment: 945-4 Receipt Number: 057g00 Waiver No. DSU /6.096 9 �CRTH"I M ENGINEERING Date: 7/2/16 To: MOA On -Site Services MEMO Steve Eng, PE, PH P.O. Box 770724, Eagle River AK 99577 (907) 694-7028 SteveEngPE@gmail.com Subject: Bob Wells Block 1 Lot 1 Septic System Upgrade Number of Pages: 5 An existing trench/tank has failed on the subject lot; upgrade design attached. The design is for a larger 5 -Bedroom septic system. The home is currently 4 -bedrooms. A new soil test was used for design- excellent soil. The design calls for a deep trench, and a new septic tank. The entire subdivision is on private water wells and septic systems. The terrain slopes to the southwest at about 5 % at the new trench site; a small cut -bank exists along the driveway. Please review the 5 -Bedroom wastewater system design for the existing 4 bedroom home. I have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Thanks -Steve ENGINEERING Bob Wells, Block 1, Lot 1 17/1-C ; SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: Design is for a new 5 -Bedroom septic system; serving an existing 4 -bedroom, single family home. This is a developed subdivision. These lots are over 1 acre and are served by private wells and septic systems. No adverse impacts are expected from trench/tank upgrade. No conflicts to the other lots will take place by this septic system construction. The easements are located on the drawing and are not encroached upon. A new test hole used for design. An application rate of 1.2 GPD/FT2. Trench Length = 625 FT2/5.5'x 2 = 56.8' trench, say 59'. A new 1500 gallon septic tank will be installed; Decommission old tank/trench per UPC. Alternate Field Advanced System Design @ 6 GPD/FT2: L = 125 FT2/5.5'x 2 = 11.36' trench, say 12'. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment, New 1500 gallon septic tank. Install new Double Cleanouts. • 5' minimum between the tank and trench. 10' to property lines. • 3' of cover or insulation is required for trench; 2" Minimum thickness for insulation can substitute for 1' cover. • Tank & solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain -rock. • Drain rock to be '/2 inch to 2 '/2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down. • Silt barrier (filter fabric) to be installed above the drain rock. • Smeared trench sides must be raked or scarified before drain rock placement. • Backfill over drain rock must not be less than 36". • The finish grade must be mounded to promote drainage away from trench. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) DESIGN NOTES: 1. 5— Bedroom Septic System Design. 2. Sewer Service Line minimum 2% slope. 3. Replace Septic Tank/Decommission Old Tank Per UPC. 4. Lots Served by Private Water Wells. 5. Verify Well Se.ar.tion Prior To Construction. 6. Check Pipe Br . e And After septic Tank. Replace Pipe N: essary. 7. No Surface W. - Is 'resent ithin 200'. 8. Alternate Tre h "-qui -s C k T III Wastewater Sys em. 9. Additional Te ole Re. it d At Construction. Septic Lot 2 Well Over 100' �� vteyll NORTHRIM „ ENGINEERING ' * :49m PO Box 770724W Eagle River, Alaska 99577 -/ I1�` , a//-ea��a:1 907. 694. 7028 �0 �/J�li�' \-09 BOB WELLS BLOCK 1 LOT 1 WASTEWATER DESIGN UPGRADE SEPTIC 1" = 40' PLAN LAYOUT ;Date: EET 8/15/16 2 of 4 Cleanout Opposing Cleanouts Between Septic Tank & Trench N O C d U dC L N 0 U d +' 3 O Cr' O W LL v o To New Trench Monitor Tube a 0 N L +. d L N O d d L O U LJ o C L N Q O DESIGN NOTES: on Compacted, 0 U CO d) 73 N0 a, aU N U O > J W d l/) +' = UI d LN N Ld • N U U -- _4 u UL Z 73 £ L�1' N Qv� 0 '3 3c, +' O £ F +' d £ W L dH L N tb:0 wig (cur 0 754- N O� L • aN �� a 444 aQ6L�JU i' O0• 3OO� `,,,�wwww��c d N U U \ £ O L �±~ Cu ▪ OcQ -, 7q d V7 N _- U £ U) O Z N m v+' d N N�3 Q0u a �W ne m al 0_ 3 a N at J NUN N Z x `0 nv1 CU v)CU 3V)Q !-7U (� m O o ri m . .-i (U MVLn\O IMOD Z�ZII 4 001 W, N 'y 6 N 0 0 0 w J _j UJ J Li m 0 O 00 0 I z w I H X w \c TF -RIM ENGINEERING S❑ILS LOG - PERC❑LATI❑N TEST Date Performed: 6/21/16 Performed For: Anderson -Smith Legal Description: Bob Wells B1 L1 1 - 2 - 3 DEPTH (FEET) Organic 4 - u.: SP Sand 5 - w/ Gravel 6 8 10 Cobbles 11 - Denser 12 - 13 - 0' 14 �. 15 16 - 17 - 18 - 19 - 20 - 21 - Percolation Rate 3 min./inch Perc Hole Diameter 6" Test Run Between 3' and 4' Comments: Presoaked, Measured to nearest 1/16th inch. Performed By NorthRim Eng. I t CERTIFY THAT THIS TEST WAS Performed in Accordance with All State/Municipal Guidelines in Ef'f'ect ON THIS DATE. DATE: 6/21/16 T.H. Location: See Attached Design Groundwater? No Depth Water Depth After Monitorinq,None Date: 6/29/16 # Date Gross Time Net Time Depth Net Drop 1 6/21 0 -- 7" -- 2 6/21 10 10 min, 10.5" 3.5" 3 6/21 12 -- 7" -- 4 6/21 22 10 min. 10.5" 3.5" 5 6/21 25 -- 7" -- 6 6/21 35 10 min. 10.5" 3,5" 7 6/21 37 -- 7" - 8 6/21 47 10 min, 10.5" 3,5" 9 6/21 50 -- 7" -- 10 6/21 60 10 min, 10.5" 3.5" NOR THRIM ENGINEERING PO Box 770724 Eagle River, Alaska 99577 907.694.7028 TESTH❑LE LOG GE❑TECHNICAL TH1 !Dates.__ __._. _.� CET: 6/29/16 I1 FD 3 1/4' .BRASS MOM SE 1/16 S23 0 co t>~ 0' cu N 99°51'49' 1J 110,00' so. J.\ 7 1 SW STREAM MAINTENANCE EASEMENT DETAIL ( Not to Scale 5o %g. FD 1/2' Rag; o_ 0 0 LOT 1 See Detail / rillistai 4a.8 o*' Area of future addition = 120 sq.ft. / SHED 12'x12' ED 1/2' RBR 'GRAVEL DRIVE O IR=225.001 L=6.95' N15.335a0°.. 5°3 00'.E 25r CIRCA z — 52) ger i I hereby certify that 1 have surveyed the following described property: Lot 1, Block 1, Bob Wells Subdivision, Plat No. 7942, Anchorage Recording District, and that no encroachments ' exist except as indicated hereon. This As -built will only show the easements that appear on the mottled subdivision PIatNo. 79-32, AnchorageRecording District; under no circumstances should this data hereon be used for the construction or establishing ofbotmdary or fence lines. to lei LEGEND WELL SSEPTIC PIPE -II A `I' POWER POLE it TELEPHONE FED ELECTRIC PED fir' 49111W ccktA €xly P. eon No. 10393 g bss.. scion �� SCARE V1 PEEt sotlwetts Subdivision Art n 1 ASBUILT SURVEY [ Lot 1 Block 1 Anderson -Smith Deborah J `APB LeLand$UiV@y i1L As Depicted aoPIn 4 . No. 78 ae ^` .28037 I.oP Cabin CNde 12204 East Prince of Peace 7N NA BL • ,l : MUNICIPALITY OF ANCHORAGE f r DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION < < Q ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME �+ A Nder SDtt) v 111 j t PHONE Ur NEW ■ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION lo Z / 3/k.1- Z6 tue/4 &bd. LOCATION We /4 Cir /e /((9/e Riuer Rod. NO. OF BEDROOMS ✓ SEPTIC TAN K DISTANCE TO: Well /, 2 Absorption area � Dwelling/0 ✓ PERMIT,,,I4D. 0 off Manufacturer /grid. TO Materi I 7-Y7 No. of compartments 2 Liq. capacity in gall ns /260 IF HOMEMADE: Inside length Width Liquid depth Y JAZ Z FQ- DISTANCE TO: Well/ f Dwelling PERMIT NO. Manufacturer " /2 Material Liquid capacity in gallons 0 w FJ-- Z z Q 0: DISTANCE TO: Well,/ 130 Foundatio p 70 Nearest to line b ,ct-. 'PERMIT ND 9d/90 No. of lines Length 0h l e1V TT Total lengthof�iYes Trench dth Distance between lines ��inches Top of file tp firnish grade Q T t Material��l�ene�h file 7 (84inches,[� Total effectjvg sorption area LO/ SEEPAGE PIT Length Width ' r / `� , .- Depth PERMIT NO. Type of crib Crib diametee// Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J LI Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption weals) OTHER! , �� l— PIPE MATERIALS Ca61frory 44 3o3/ •��.iw -- n SOIL TEST RATING T/ 99 LWXrbsfi- � I 60 INSTALLER`` i0,r/*MON VeUet $ CCOUS7JJ* 1. REMARKS 1 2bo ff(+) "TM," Creek G IM !_ _ ` 301� le , �^ Ir/%3o • r t O,,,,, '' Y ________\ V s. s 4. P. d:-aux2964 ANCHORAGE, 73 X09 APPROVED DATE LEGAL Le f, / Bk1 Bob We//t5 Soir 1, eAtI4AigiaPAd 7//1/97 sec_ 213 'r/N i "a A./h- 72-013 (Rev. 3/78) imoup4x IAP4C:11-1C3EZX0410EE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION u' 825 L STREET, ANCHORAGE, AK 99501 264-4720 DP4_-r e: F"laFtri x'�` PERMIT NO: DATE ISSUED: APPLICANT: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: LOT LOCATION: MAX BEDROOMS: 840556 07/&0/84 C/O BOB BUSH ANDERSON SMITH BOX 4-2964 ANCHORAGE, AK 99509 266-1581 SUBDIVISION: BOB WELLS SECTION: 23 TOWNSHIP: 14N 48659 (SQLFT. OR ACRES WELLS CIRCLE/EAGLE RIVER ROAD 4 LOT: 1 RANGE: IW Listed beloware the options available to you in designing system. Choose the option that best fits your site. ------- DEpTH TO PIPE BOTTOM (FT.) 4.0 4.0 GRAVEL DEPTH (FT.) 70_ 0.5 TOTAL DEPTH(FT.) 11.0 �^� 4.5 GRAVEL WIDTH (FT.) 2.5 17.0 GRAVEL LENGTH (FT.) ) 28.() 34.0 GRAL VOLUME ) 19.4 21.4TANK SIZE (GALS) 1,250.0 ** 1,250.0 ** SOIL RATING (SCA.FT./BR) 96 96 . ** TANKMUST HAVE AT LEAST TWO COMPARTMENTS BLOCK: 1 your septic ][IN 4°W 3.5 7.5 5.0 42~0 31.1 1,250.0 ** 96 I certify that: i~ I am familiar with the requirements for on-site sewere/and wellsasset forth by the Municipality of Anchorage (MQA) and the State of Alaska. 2. I will install the system in accordancewith all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements' for -the set back distances from any existing well,wastewater disposal system or public sewerage system, on this or anyadjacent or nearby lot. 4. I understand that this pe'rmiti`a valid for a maximum of 4 bedrooms and anyenlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED' (2) AG_B0ILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY LICENSED ELECTRICIAN.- SIGNED APPLICANT: C/O BOB BUSHAANDERSON SMITH ISSUED BY DATE: DATE: 2/70/s PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 8 9 10 11 12 13 14 15 16 17 18 19 20 Frxtt T1 —42z5- 19 26 1 o• 0, i� • 0. 00, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST /2,vcJev5 to LTJ 8A'1. A We //'5 si 7 ^�LJ� SOILS LOG PERCOLATION TEST DATE PERFORMED: 7�f Q/(9J roP so 1 1 / I SLOPE 5 01 svR l s Dope Rocks GU—GP L f'l e C;Me s .Sam L *eye Bo 1(14,5 /25- r f4N9act, m,/ 'erAt/ aX Ob WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? No . s L 0 P SITE PLAN L gG L -- r 5b / da. iimumnomms mmormine ��■■■�ii„■i ■■■■■■■Iiui. Reading Date Gross Time Net Time Depth to Water • Net Drop 3=2" y�// ac• 3-�z�. 1 " 29soe. 3 rt � a / g‘3-2" t PERCOLATION RATE TEST RUN BETWEEN COMMENT SEF 477/51c#10j2 LS e, f f Fran, Pe rC. Tia f T'ejAl2 PERFORMED BY: 72-008 (6/79) ©tv /40%!N/3rAis (minutes/inch) g FT AND FT LOC. DIV 20d Be kw ar CERTIFIED BY: ecome a DATE: //'4/8 7 1.4 • • • 61 inQUJ 'h 3 2. z - -I i x p- ti 4 4 n‘ N 1'4 u . z 0 o •ef 12'099 1. • A1„h2,h0 0005 1 "••••• i hi 89651.49" V/ r- 0 0 00 '5 I vI kir 04° 014. 55"E 166.20 5 0• ort • al ‘ou-ilt.%1Y £P.Sfilf.v41 0 1- • VI W 1.4 0 12 ht 12•57Z r- °." 0 00'0hr „O O. 0 E N too 15 • 1 '"?. • 1% q/-'4' / • fele • ri r' • .4'. • 6 14 q/c 0,1 • ;IS • • tit 4.1 QD , 0 o.ii 71:4.•-- Pe'to ••••,. 4i• a 659 3.1.1,0 .00-rit --•••• - .10 0 1• • , • o 044 el - ti a.2 la 0 r. N cO et "4 0 • 0' z Municipality of Anchorage POL.,H 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOW( FS. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840556 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 1 Block 1 Bob Wells Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, 17 Keith E. Bandt, Supevisor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 • ��1_11INIIIIC 1Hr- PHIL_ I *1- N' • C) F7 CA-111:111H):JrloCaE: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 PERMIT NO: • 850065 DATE ISSUED: 03/15/85 DATE CLOSED: 03/15/85 APPLICANT: ADDRESS: • LEGAL DESCRIP: LOT SIZE: DEBBIE ANDERSON SMITH SR 1796 E R ROAD EAGLE RIVER, AK 99577 SUBDIVISION: WELLS SECTION: TOWNSHIP: 14N 48659 • (SQ.FT. OR ACRES) LOT: 1 RANGE: 1W LO BLOCK: 1 ~ • I certi{y that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the •Municipality of Anchorage (MOA) and the State of Alaska. • 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. • 3 ll dh all MOA d State � Alaska requirements for the set back . I wi a er� '- a an a e o a diStancelivrrom ''ny existing well, wastewater disposal system or public sewera'='=yste'c�~ this or any adjacent or nearby lot. SIGNED ��,"� APPLIC1:41101°°4 Aipv zBBIE ANDERSON SMITH ISSUED BY COs2-4-0.11-Z•t- DATE: DATE: 53- � ����_ ....... WE SERVE ALL ALASKA POST OFFICE BOX 42 - CHUGIAK, ALASKA 99567 DEPTH OF WELL OWNER OF LAND STATIC LEVEL OF DATE - STARTED DATE - ENDED KIND OF FORMATION: MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal.Description (include lot, block, subdivision, section, to ip, r�nge) 2A Location (address o ,directions) (b) Applicants Name ,6;6. c.lC�%G t1C1,t.r,. - - ,,d /[.Telephone - Home Applicants Address Business (c) Applicant is (check one) Lending Institution Buyer ; Other [(explain); (d) Lending Institution Address ; OWner/builder x (' /7_a�;-, �l /Telephone /.L-12- yt l {- c: , /Y- 71 ,,z • t' /� -e' �t .� (e) Real Estate Co. & Agent Address Telephone (f) /e1 the HAA to the following address: _ 130X 2. Type of Residence Single -Family j Multi -Family) iekther (describe) Number of Bedrooma_, C Y f- ply .„ -;-z - 3. Water Supply Individual Well y Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Fri Public f1 Community 11 Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 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 regula- tions in effect on the date of this inspection. Name of Firm Address Date 3on, Telephone 6. DEEP Approval Approved for int, bedrooms By Approved Disapproved Terms of Conditional Approval Date CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DEEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DEEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DEEP 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. (DEEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. WELL DATA Weil Classification Well Log Presen (CA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST FEBRUARY 1984 264-4720 Legal Descriptio t D`T + t\k 1.. 41RIV iA-"t•-S If A, B, C, D.E.C. Approve Date Cometed P114- COQ- 8� Yield .E ! gA5 b s4, Total Depth %'4/0 ' Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Electrical Wiring in Condui t) Depression Around Wellhead (1$46; Separation Distances from Well: To Septic/Holding Tank on Lot .30 Sanitary Seal on Casing ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot (10 ; On Adjoining Lots �`rd To Nearest Public Sewer Line /Or- To Nearest Public Sewer Cleanout/Manhole PV At" _. To Nearest Sewer Service Line on Lot Z sitsG,,.eir-"A-eC • Date 3A27 -8 -5. -- Water Sample Collected by Water Sample Test Results Comments .'"'----- B. SEPTIC/TANK DATA Date Installed g'19: -C43 V Size 4,2 `) No. of Compartments Standpipes OM Air -tight Caps ON Foundation Cleanout ON Depression over Tank (W/O ,� / ate Last Pumped 1V‘/ Pumping/Maintenance Contract on File (Y/N) / ; for rl Holding Tank High -Water Alarm (Y/N) r -VA' Temporary Holding Tank Permit (Y/N) // Separation Distances from Septic/Fisisli g. Tank: To Property Line w e ve- To Disposal Field L r To Water Main/Service Line /0 ' . � c.(�., Course �' 7"r"'. 2-0 o ( 4- -5-417 A L 4- S7Irea l4,7 Comments To Water -Supply Well To Building Foundation /6 To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strat t Date Installed / y�.e7t Width of Field x0, Square Feet of Absorption Area gale) Depression over Field I j Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot J r Type of System Design Length of Field Depth of Field Gravel Bed Thickness A/A 3o/ //#! 7/ Standpipes Present 6/. i) Date of Last Adequacy Test r To Property Line To Water Main/Service Line ; On Adjoining Lots y To Existing or Abandoned System on /0 7Z- To Cutbank,(if present) F' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ZOO .90 ( f N ti E D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Acess (Y/N) "Pump On" Level at "Pu11: Level at High Water Alarm Level at �/ (Y/N) Tested for dr/ -umping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) / Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify thht ertsteffiegintlijed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed SRS 196X Company 3_11• 69M2979 - Date MOA No g.---c%o Receipt No. J ,J O cn Date of Payment 3 - Amount: $ LLS -00 Page 2 of 2 72-026 (11/84) F 1.. Aid II • --. _r �k i * �. pabert A• Shafer ; 4 ' �% Na. 1457-E ,! • �1 lb . 4 e ��*0 FE'64aa�".v CIJEMICAL do C 'OLOGICAL LABORATORIL OF ALASKA, INC. TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. No. r (•) See h on back Water System Name 8.4 e EgaiNEERINn Phone No. SAB 196X ,3LEtIVEA, AtA8Kit . /19577 PH. 6$44978 Mailing Address City SAMPLE DATE* ( 1 L1 Day SAMPLE TYPE: tutine ❑ Check Sample (for routine sample with lab ref. no. ❑ Special Purpose SAMPLE NO. LOCATION State Year Zip Code ❑ Treated Water Untreated Water 1 (1�, 2 1 l),,GLr� 3 1 -7* -4 ,- --1 •�:. `�7 4 1 5 1 Time Collected Collected 2 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: (Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received .1 Time Received 1 Y Analytical Method: ❑ Fermentation Tube fcivlembrane Filter Lab Ref. No. Result* Analyst i7',z,,o1 7 1 1 1 111 •No. of colones/100 mi or No. of Positive portions. O8122O (b) Rev. 1983 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter. Direct Count Verification: LTB BGB Final Membrane Filter Re BEFORE Reported By , - Date Coliform/100m1 Time: COLLECTING SAMPLE TNTC = Too Numerous To Count Collfprm/100m1 7.7j7-7 / �7 0 a.m. a.m.