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Home My WebLink AboutRIVER VIEW ESTATES BLK 8 LT 14 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 System and/or Well Inspection Report Permit Number: ..~'UL) _C~O~-/<~) PlO Number: (~'O 7<~'~L'.~'''' ~,., t p~ ~ ~¢~ ~.,.A ~ Wast~ator System:,, ~ Now D Upgrade ,_,~ ' A~PTION, FIELD I .~ O Deep Trench ~ailowTrench D Bed D Mound O Olher I WELL: ~w D Upgrade Gravel w,dth: Number el I,nes: Classd~cah~fl (~rtvale, A.B.C): Tolal Oeplh Cased To Tolal absorphon area P~po maler~al~ Drd(nr , L . .~' ' DateDrdl~d: StahcWalecLe~el Oalei~slalleO: / SEPARATION DISTANCES ~i~ ~ Ho~.g ~ S.~.~... wa~ L I FT STAT! O N Lot S~ze~n gallons: Manulacl~er: ~ Remarks: ~-I) ~ A L~n)~D ~7~ BENCH MARK Local,on and Oescripbom/ /~ ......... AssumedElevahon: /O~ ~{, Inspections performed by: /~/~ Dates: 1st '/~ ~[~ Department of Health..g~d Hum,a~$~[vlces approv~ ~>,~: ........... '~~~~ ' ~ ~ ' Date: ~ / . / , Rev,ewed and approved 72-OI3(Rev 9iht)MOA25 Permit No. '~' ~' c} :~E~D Page ~ , 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 Description: /--¢'~' /N/, '8 LoQ(_ ~ ~,~%U'l~El,~1 CS-F- , PID No.: PermltNo._ ~Jq~O~O Page.__.__~ 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 Description: 12:~,,,..~,j ~T~'~' ~'~D No.: STATE OF ALASKA DEPARTMENT OF NATURAl. RESOURCES DIVISION OF WATER WATER WELl. RECORD LOCATION OF WELL iioRot.I OH SUBDIVISION LOT ~ILOCK SECTION OTfla tIECTION TOWNI~IiP ~GE MfiRIDIAN DN LOCATION/SK~CH: WELL OWNER= DEPTHS M~SURED FROMt~oastn~ top ~ground surface WELL DEP~; DATE OF COMPL~ION BOREHOLE DATA: Depth Depth of casino',~ ' ft / /~/~ Martial T~pe and Color From To . ..~ ~ I~ D~THTO~TATICWATERL~Et~ c ~ M~HOO OF DRILLING= ~air rotary ~ ceblo toot USE OF WE~L= ~domesdc ~ irrigation ~ monitor _~_ ~ ~' U public Supply U other CASING STICK-UP: ~ ft. Diem: ~in'. to~ WELL INTAKE OPENING TYPE: ~ open end ~ screened .............. ~ p~rforated ~ open hole SCREEN TYPE; Diem: in. Slot/Mesh Size: Length:~.~_ GRAVEL PACK TYPE: GROUT TYPE: Volumo: Depth: from ft to ft ....... R C IV [ D Duration: ......................... M-~l1-2 5 1994 PUMPING LWEL AND yIELD: .......... ~Hr~i~i.,.,H~, ,.~, ~ ....... ~ ft after ~_hrs pumping, / _gpm Dept. Health & Human Set' ices PUMP INTAKE DEPTH: ~ ft Horsepower: WELL DISINFECTED UPON COMPL~ION? ~ YE~ ~ NO CONTRACTOR INFORMATIONt REMARKS; ,-~ ',~ter Business _Nature .,. ./~ ~r 2% ~ , ' -- PLEASE MAIL WHITE COPY OF LOG TO: ~3r.~ /:' ~' ¢~ DNR/DIVISION OF WATER :.~nature of Au~orized Res~esemati~ Dat~: PO BOX 772116 EAGLE RIVER AK 99577-2116 CALCULATED CHECKED BY OATE SCALE i~,~1 i~'~ 2 I~, 3 I~- 5 IO~ 6 '1tlr' 7 :1¢° 9 10 11 12 13 14- 15 17 18 lg- 20- ,,-9~ 2 ")r~ 13 15 16 17 18 19 (FEET) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ILl Ld ! / i / ?' HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SiTE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. March 24, 1994 MUNICIPALITY OF ANCHORAGE Department of Health and Human S~rvices P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 14; Block 8; Riverview Estates CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 RECEIV D MAR 5 1994, ~unici'~sli[Y ol Ancl~orage M . } .... ~-~-man Services Dept, Idea ~n ~ -,* S & S Engineering performed design and engineering of the on-site wastewater disposal system constructed on the reference property. Specifications provided by S & S Engineering were made a condition of M.0.A. peJ~it #SW930480 dated 11/15/93 and required inspections/ documentation of the system when constructed. The owner contracted with an excavator to perform the work as outlined in our specifications and plans, however S & S Engineering was not the owner's representative and did not inspect the contractors a~tivities. Therefore, S & S Engineerin~ shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on th~ project, or the fail~re of the contractor to carry o~t the work in accordance with our construction do~,ents. If you require additional information please contact us, Since~ 'p.[. ENC LOSURES 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 March 22, 1994 RECEIVFD Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 MAR 2 2 1994 Municipahty c; A.,ui),,,, .:~ 8 Dept. t-lealth & Hlm'ia¢~ St:; v (';es Attention: Robbie Robinson Subject: Lot 14, Block 8, Riverview Estates Notice of Violation No. 4440 Dear Robbie: In late December Alan Harala was contacted by Whitters Excavating to perform an inspection of a septic system Whitters was placing on Lot 14, Block 8, Riverview Estates. We were totally unfamiliar with the design of the system as it had been completed by S & S Engineering and we were not provided a copy of the design until Mr. Harala arrived onsite for the first inspection. At that time the Whitters crew had completed the layout of the system, placed the septic tank and had completed nearly the entire excavation of the drainfield. It was evident after briefly studying the design that the crew had placed the system in the wrong location and were nearly off the lot with the excavation of the drainfield. Mr. Harala immediately told the foreman the system was being constructed in the wrong location and should be moved to the proper designed area. The foreman then stated he did not wish to move the system due to increased costs and other commitments for his equipment. He asked that Mr. Harala do whatever was necessary to redesign the system to fit the current location. A testhole was immediately excavated at the location shown on the attached site plan. Percolation test results indicated rates nearly identical to those achieved by S & S Engineers in their testholes. Since the soils were very similar to those at the original design location it was determined the system could be placed in this area with some changes in the configuration of the drainfield. Two trenches were required to achieve the proper length as Whitters excavation was nearly off the property and encroached within 10' of the lot line. Mr. Harala has stated that he called you to discuss the change in the Lot t4, Block 8, Riverview Estates March 22, 1994 Page Two drainfield location. He was apparently unclear in the information he gave you as you have little or no recollection of the phone call. He stated you told him to place the drainfield at a suitable location on the lot but to make sure to achieve the minimum of 4' separation from the seep level (8') shown on the S & S Testhole No. 1. The drainfield was laid out in this manner, but the northern end of the easterly trench was nearer than 50' from a 30% break in grade and, therefore, had to be moved. We have redesigned the drainfield to utilize one of the trenches originally placed by Whitters' crew. The other will be abandoned. A new trench will be placed near the originally designed location. The attached site plan shows the location of the new system as well as the reserve site. In addition, we have included a profile view of the new system. Rather than a splitter box we are proposing a wye in the line from the septic tank. The legs from the wye will remain at the same elevation for a distance of 10'. The laterals will then drop at different slopes to each leg of the drainfield. Placement of the distribution lines in this manner should allow an equal amount of effluent from the septic tank to each leg of the drainfield. We will continue to keep you appraised of any design changes made in the field on all future projects. In this case, the reluctance of the contractor to move the drainfield to the design location after he had nearly completed it in the wrong location led us to the situation we are in today. We appreciate your cooperation in resolving this problem and will make every effort to see it does not occur in the future. Sincerely, Michael E. Anderson, P.E. SHEET ND. ~'' ~'~ j) '~ / CALCULATED BY. CHECKED BY SCALE 15 16 17, 18 19 2O 15 io(,, 3 I*~' 5 ~¢ lO .~1 12, ~13 14 15 16 17 18 19 '-:' ~i: Tom Fink, Mayor .hiunicipality Anchorage Department of Health and Human Services 825 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 March 10, 1994 Michael E. Anderson, P.E. Anderson Engineering PO Box 240773 Anchorage, Alaska 99524 Subject: Notice of Violation(s) #4439 Lot 3 Block 7 Riverview Estates Subdivision, PID ~050-791-03 Notice of Violation(s) #4440 Lot 14 Block 8 Riverview Estates Subdivision, PID #050-792-45 Dear Mr. Anderson: On the two above referenced lots, your company was contracted to provide engineerinq services for the installation, inspections, and submittal of as-built drawings. On each of these lots, a specific design was submitted by another engineering company and both designs were approved and permitted for installation by this office. In both instances, changes or modifications were made to the approved design without obtaining approval from this office, and without submitting a revised site plan and design under your engineerinq seal. Under the terms and conditions of the subject Notice of Violations, the below listed discrepancies must be corrected: Lot 7 Block 3 Riverview Estates Subdivision 1. The well serving this lot was completed at a location approximately 140' west of the approved site. The well must be properly abandoned and re-drilled at the approved site and so reflected on the as-built drawing and attachments with appropriate setbacks shown. 2. The approved and permitted drainfield design specified 1" diameter lateral distribution lines with ¼" diameter holes (10 per lateral) spaced 1.4' oc. Your as-built shows the distribution laterals to be 1¼" diameter with no hole size or spacing indicated. Anderson Engineering March 10, 1994 Page Two' Calculations ~ust:~be provided which show how the hole size and spacing was determined and the as-built must reflect the correct hole size and spacing. Lot 14 Block 8 Riverview Estates Subdivision 1. The approved and permitted design for the absorption field on this lot specified one wide drainfield 79' long, 5' wide, 4' deep with 2' of effective gravel. The primary drainfield was to run east to west approximately 125' south of the road ditch. The alternate site was located apprximately 15' north of the primary drainfield. The 30' effective radius of test holes #1, 2 covered both the primary and alternate drainfield sites. A recent site inspection by this office showed there to be two drainfields (instead of one) one of which was approximately 30' from the cutbank at the road drainage ditch. This office was not contacted regarding this change in the approved design nor was a revised design criteria and site plan submitted under your enqineerinq seal. You must submit your revised si!re plan showing the location of the wide drainfield, the location of any new test holes, setback from slopes, and any other changes made in the original approved design. By not later than April 15, 1994, your must provide this office with site plans and design criteria, with your engineering stamp affixed thereto, reflecting the changes and revisions described above. If there are any questions, please call our office at 343-4744. Civil Engineer On-site Services RWR/ljm cc: John Smith, P.E. Program Manager On-site Services MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930480 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:ALASKA USA FEDERAL OWNER ADDRESS:P. O. BOX 196613 ANCHORAGE, ALASKA 99519-6613 DATE ISSUED:il/15/93 EXPIRATION DATE:il/15/94 PARCEL ID:05079245 LEGAL DESCRIPTION: RIVERVIEW ESTATES BLK 14 8 LT LOT SIZE: 41131 (SQ. FT.) NUMBER OF BEDROOMS: 3 THiS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / 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 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: ~ ~%-'C~ DATE: DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. November 3, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipafity of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Riverview Estates Subdivision, block 8, Lot 14 Request you issue a permit to drill a weft and install a septic system to serve the proposed three bedroom house on the referenced property. Test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation water was seeping at 8 feet and after seven day ground water monitoring no water was found. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Sincerely, ~,P.E. RAS/LSU/Isu 17034 NORTH EAGLE RIVER LOOP , SUITE 204 · EAGLE RIVER, ALASKA 99577 RIVER Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:J~ [ ~-~ LEGAL DESCRIPTION: 2~ 4 8 9 10 11 12 13 14 15 16 17 18 19 20 ,,., '(ENGINEER?SISAL) ~.~ ~:~Township, Range, Section: SLOPE SITE PLAN IF YES. AT HAT DEPTH? V~HA' ~ <:~) / p, , ff. Oeplh to WalBr Alter Gross Net Depth to Net Reading Date Time Time Water Drop :. ~q Io -' ¢" l" PERCOLATION RATE I(~ (m~nutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN '~ .-~ 4;L)T AND 6.~ FT COMMENTS ' 17034 ~gle River Loop Road No. ~ PERFORMED ~Y~ ~I .... AI..I.. ~ I ~///~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN. CT ON THIS DATE DATE: 72-008 (Rev, 4~85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 8 9 10 11 12 13 ~ -- - ~,b, ~-I, 18 20 DATE~ Township, Range, Section: SLOPE ' :' ii(,~l N:I~ EI~'$ SEAL) Nc. 1 AiT,b ENCOUNTERED? ~-~ DEPTH? S §eplh Io Waler Alter I SITE PLAN Gross Net Depth to Net Readin§ Date Time Time Water Drop --'~"~ G.~e,,¢ ~-.~ ~. '-- /c~l~l~ ~.'~ - ~v,,,, _ PERCOLATION RATE '~ (mmutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN -- ~ r ~ F.~T AND FT 17034 Eagle River Loop Road No. 2~ I ____ _ C PERFORMED B~:agle River, Alaska ~577 ~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINI DATE: 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN ON-SITE WASTEWA TER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Riverview Estates Subdivision, Block 8, Lot 14 GENERAL: 1. The scope of this project includes the installation of a 1000 gallon septic tank and three five foot wide drainfields to serve the proposed three bedroom residence for the referenced property. Construction shaft be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and aft applicable State and Municipal Wastewater Disposal Regulations. The contractor shaft be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shaft be responsible for final grading areas subsequently depressed from soft settling. On aft leachfie/d mound systems, the property owner shaft be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shaft be sufficiently bedded to prevent settling or shifting of the tank. o Aft standpipes on the septic tank shaft extend a minimum of 12 inches above final grade. Page Two Riverview Estates Subdivision, Block 8, Lot 14 November 3, 1993 Septic tanks installed with less than 4 fl. of cover shall be insulated. A foundation oleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soft not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists a way from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of/eve/. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is instal/ed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire grave/surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Riverview Estates Subdivision, Block 8, Lot 14 November 3, 1993 MINIMUM MA TERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes ASTM D3034 (PVC) Yes ASTM F810 (HDPE) Yes ASTM D2662 (ABS) Yes Y~s Yes No Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shaft be at least 2" thick extruded direct bur/a/polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shaft be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, M/raft 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. o Aft leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Riverview Estates Subdivision, Block 8, Lot 14 November 3, 1993 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the instal/at/on of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any grave/. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. R'TVER PARK DR:[VE '180, ./ / -/ \ · CANT 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUIVlBER OF iBEDROOB/tS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from Sfate ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site ?<;x X Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ¢21 5. STATEI~JtENT 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 typeofstructureindicated herein, I furtherverifythatbased on the information obtained from the Municipality of Anchorage files and from rny 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 ~l~f..¢ b -~-FL%o~ ~-~ ~//-J ~-c--~/~ ~ ~r~ _ Phone Address 'lb..(). l~oy.- Z.¢O 7 7~ ~-t4(:.~/%-~-~;~, /~ I/--- Engineer's signature / ,~/~cJ~-. ~-~ ~-~ ~ ~, Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, bedrooms, with the following stipulations: Additional Comments 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 order to satisfy certain federal and state requirements. Employees of DHFIS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or emissions in the professional engineers work. 72~)25 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: L4o"~ /l '~c¢~,(':,,c ~_~ I~,qb3L~Jr£;L,~ ParcelI.D, A. Well Data Well type ~¢(~7-'¢ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) '~' Date completed ¢~/~' Driller Total depth ~'Z~ ~ Cased to ~-Z. ~ Casing height Sanitary seal (Y/N) ~' Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG Absorption field on lot Public sewer main Sewer service line SEPARATION DISTANCES FROM WELL TO: t Septic/holding tank on lot A~ /xDO' AT INSPECTION MUNICIPALITY OF ANCHORAGE ~J~IRONMENTAL S~:RVICES DIVISION g'~'"~f~ ~)5 1994 RECEIVED ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank / >/00 >/o 0 WATER SAMPLE RESULTS: Coliform C-.-~ Date of sample: Nitrate ~ JO /v~4./L.. Other bacteria ~/i /¢c./~ Collected by: 4 B. SEPTIC/HOLDING TANK DATA Date installed /2/~(~)/~,'~ Tanksize //c/)~)(~) ~/'~,i) L Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) '"¢/[ ' Depression (Y/N.) High water alarm (Y/N) /'~ Alarm tested (Y/N) . f',-/'//~ Date of pumping /'..[ ~l/-J ~,Or,J ~j'9/Lu ~::lioid Pumper ,/~/~. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /' 0 To property line ~¢ Surface water/drainage On adjacent lots Absorption field /",] o ~.td-7 Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed 'Z-/~'/~, ~/Z.'~//¢¢ Soil rating (GPD/Ft2) Length "~ ~/' ~--" Width /*'~ / Gravel thickness System type Total depth Total absorption area -~'~"?. ~ '¢;r;;Z' Cleanout present (Y/N) '"(/ Depression over field (Y/N) Date of adequacy test /'~-L,J ~L,-4.5~'-;' Results (pass/fail) ~-~"~,-%~ for ~ Water level in absorption field before test ~J After test ~ Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots '%/0 0 r ,/ Property line /Z ~/~ / ~ To existing or abandoned system on lot /'-.J 6~ ~ -~. Cutbank /~ o /.3 ,~- Water main/service line ~ 'Z~O ' Driveway, parking/vehicle storage area ~> ~0; E. ENGINEER'S CERTIFICATION I ceftin/that I have checke~, vexed, or con[ormed to all MOA and H~ gui~l?seg.[D':e~Oct o~ the d~ ¢( thts tnspectton. Engineer's Name HAA Fee $ .Z.~OO ° o Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ · Date of Payment //~'~ '~) Receipt Number CT&E Ref.# Client Sample ID Matrix Commercial Testing & Engineering Co. Environmental Laboratory Services ~/×~,~z/~z/z/z~,~.~,~/~/;~./_~-///~z~~~ LABORATORY ANALYSIS REPORT 94.0887-1 PRIVATE WELL L14 B8 RIVERVIEW ESTS. S/D WATEK Client Name ANDERSON ENGINEERING WORK Order Ordered By ALAN Printed Date Project Name Co llected Date Project# Received Date PWSID UA 76207 03/03/94 @ 15:24 hrs. 03/01/94 @ 13:45 hrs. 03/01/94 @ 16:20 hrs. Technical Director STEPIIEN C. EDE Smnple Remarks: ROUTINE SAMPLE COI,LEC'IEI) BY: A. IiAILALA. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date hilt Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 03/02/94 LLH * See Special Instructions Above ** Sec Sample Remarks Above U - Undetected, Repo~ted value is the practical qmntifi cation limit. D = Secondary dilution. UA = Unavailable NA - Not gnmlyzed LT= Less Than (~1'- Greater "lhan 5633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA