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HomeMy WebLinkAboutSKYLINE VIEW BLK 1 LT 15Skyline View Lot 15 Block 1 #051-192-40 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: -~JCl ~ O~Oo PID Number: ©5~ i - J~Z_ - ~O Name: ~'t'~¢'-,'~.~ tot ~-O~ ~.or~ Wastewater System: ~' New ~ Upgrade Address: ABSORPTION F~ELD No. of ~drooms: Phone: ~¢iH - ~¢i~& ' o DeepTrench '~ Shallow Trench ~ Bed ~ Mound D Other LEGAL DESCRIPTION SoilRating: i',~ GPD/Sq. Ft. TotaIDepthfr~¢riginalgrade: Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: ~ ~ Range: Section: Fill added above original ~rade: Gravel length: ~ '~ ~'"~¢~' Ft. ~I Ft. WELL: ~ New ~ U pg rade Gravel width: i Number of lines: Distance belween lines: ~ Ft. ~ '~ Ft, Classification~14 ~(Priwte' A,B,C): To~h: Ft. Cased~To: Ft. Total ~bsorption,~.7~area: SQ. Ft. Pipe material:/ ~'i~ ~ ~ ~ Static Water Level: Installer: Date inst~lled: Yield:¢ ~0 GPM P"~/~ ¢~S~' at: Ft. Casing Hei~ov, Ground:Ft. TAN K SEPARATION DISTANCES e Septic U Holding U S.T.E,P. Capacity in gallons: To Septic Absorption Lift Holding Public/Private Manuf~cturer~ ,~ O ~¢0 ~ ~ ~ From Tank Field Station Tank Sewer Lines Number of Compadments: Well- i¢oi.~ jO~jI ~ ~ .~i~ Material: ~ su,~o~ ~ + ' LIFT STATION Water iCC I f~O~ '~ ~ ~ ~ Lot ~ Size in g~llons: Manufacturer: Line '~i lO~ --' ~ ' I "Pumpon"teve]at: ~~ve'at: IHighwateralarmst: Foundation '~ .. ~ I'~ ..... Cu~ai.Drain ~ -- ~ O'~ 2 I~C, ~¢4 "-- ~ pu~~I. Electrical Inspections pedormed by: ' BENCH MARK Remarks: ~Pp¢~WIL OF '~.,~' Location and Description:  Assumed Elevation: Inspections performed ~'~ s ~mNe Dates: 1st iu , ~ -,~¢ ,.~ 1,?034 {tagte~lvarl.ep Road, Ne,~ 2nd iC ~i~ '{J~ ~ R~ERT Department of Health and Human ~ervice~ approval %.,,~z,.,,~ ...... .,,,,...,, Reviewed and 8pproved by: ~ ~- ~ Dnte: IZ'~ .gD '~~ 72-013 (Rev. 9/91) MOA 25 Permit No. SW950500 2 2 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 LegalDescri~tion:LOT 15, BLOCk 1, SKYLINE VIEW 051-192-40 I"' I !.J I'~10,: FCO 2.~P 37.0' ST2 ~-O.:i' 39.5' DBL1 14.1)' 39'.0' f C01 20 i' 35.5'- ~o u?zk ~S~T. C02 477 i' -17.5' -............. :_MT1 41. ~' 1 4.5' WELLc WELL  -NEW TRENC-I ~ 3 .~ ~---_ 7NEW 1000 GAL. / oV~--~ )EPTIC T/,NK 85.5' B.O.H. 72-O13 A (Rev. 9/91) MOA 25 ROBERT C. COWAN, P.E. CIVIL ENGINEERS October 1, 1997 (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN Dept. of Health and Human Services Attn.: Donna Mears PO Box 196650 Anchorage, AK 99519-6650 REFERENCE: Lot 15; Block 1; Skyline View Subdivision Dear Dorma, Request approval for the separation distance between the tank and foundation on the referenced property at 2.5". We do not anticipate any adverse effects by allowing this separation distance as the foundation is over seven feet deep. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk. 17034 NORTH EAGLE RIVER LOOP o SUITE 204 ° EAGLE RIVER, ALASKA 99577 PO Box 4534 Eagle River, AK 99577 December 23, 2997 Ms Donna Meats Health and Human Services Municipality of Anchorage 835 L Street Suite 502 Anchorage, AK hand delivered Dear Ms Mears: Thank you for your assistance to my wife and myself in the permitting process for our home in Chugiak, on 19326 Iris Street, Lot 15, BIk 1, Skyview Terrace Subdivision. Regarding my construction experience: I have worked as a project manager for light and heavy commercial projects for 20+ years, 15 years of those in Alaska. I was senior project manager for the Aleutian Regional School District when the False Pass and Akutan Schools were constructed, as well as major renovations throughout the district. I also managed the construction of the City of Cold Bay Municipal Building, and worked as a consultant of building projects or proposed projects for varied clients including Brown and Root and, even, the MOA. For three years I served as facilities manager for the Alaska Court System where I was responsible for all of the courts building projects statewide, including projects in Kotzebue, Kenai, Bethell, Juneau and Anchorage. For most of the rural projects and some projects in the municipality, septic systems were used. I am very familiar with design and construction parameters of septic systems. When my wife and I decided to build our own home in Chugiak, we decided to use our expertise to save funds by installing the septic ourselves. The design was provided by S&S Engineering, who also provide on- site inspection. The tank, drain field, etc were provided by Anchorage Tank and washed rock by a local vendor. The septic was installed as per design parameters. The project was inspected for depth, location and installation by S&S Engineers, who were on site for at least three inspections during the installation process. Please call if I can provide any further information. Sincerely, Chris Benediktsson ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. I'tEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAO OESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE W/~TEWATER DISPOSAL SYSTEM DESIGN Date: Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECEIVED 9 1996 Municipality o~ A~chorage Oept. Health & Human Services REFERENCE: The septic inspections for the refere]]ced property were performed on 1o-%~-9~- and ~-~-~ · Prior to submitting the On-site W~stewater DispoSal System and/or Well I~spection Report we are waiting for the ~o ~~{ to be completed. ~ If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP , SUITE 204 · EAGLE RIVER, ALASKA 99577 PAGE 1 OF 1 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:SW950300 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:BENEDIKTSSON CHRIS M OWNER ADDRESS:P.O. BOX 4534 EAGLE RIVER, ALASKA 99577 DATE ISSUED: 9/28/95 EXPIRATION DATE: 9/28/96 PARCEL ID:05119240 LEGAL DESCRIPTION: SKYLINE VIEW BLK 1 LT 15 LOT SIZE: 15750 (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 RECEIVED BY: ISSUED BY: DATE: ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER M~IN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN September 14, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 15, Block 1, Skyline View S/D Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on the referenced property. Two 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 no water was encountered in the test holes and after seven day ground water monitoring, the monitoring tubes were found to be dry. 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 wells, septic systems or drainage patterns by the installation of the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/g : Enclosure 17034 NORTH EAGLE RIVER LOOP, SUITE 204 · EAGLE RIVER, ALASKA 99577 0 10' UTILITY EASEMENT 0 ~ o o S~ OPOSED THREE )OM 140USE m~ A 0~0 ~ ~zm ~ o~O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION:~-r.,.~I'- ~.~" ~.~ [ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- ~'~, D, ~. Oepth Io Water Alter Monitoring? ~ (E~) DATE PERFORMED: Township, Range, Section: ~ N(, ~.~J SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? DEPTH? pO E Gross Net Depth to Net Reading Date Time Time Water Drop '/,"E. PERCOLATION RATE '~ tmmutes/~nch) PERC HOLE DIAMETER Lc, "' TEST RUN BETWEEN ~'~ FT AND ~'~ FT COMMENTS .S.! ,,3:~..~ & $ ENGINEERINGRiver ROad NO, 2 ~'"/'~ PERFORMED BY: ,~J~,7[e Loop £04 ~j ~1 p CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH A~Si~,A;'[~C/'~..ty~{~t~cC~Cr~7¢UIDELINES IN EFFECT ON THIS DATE. DATE: C~ ,., [ (,.~.O~ ~' 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~::"~ \~- 1 2 3 7 10 11 ~2 13 14- 15- 16- 17- 18 19 20 DATE Township, Range, Section: SLOPE WAS GROUND WATERy-,x,~'() ENCOUNTERED? ,E YEs, AT WNAT ~ ~ ~O DEPTH? E Depth Io Water Alter monitorino? ['~/ Dale: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop ~ ~ ~ ~,~ q' ,1~" PERCOLATION RATE -- 7EST RUN BETWEEN ~ (minutes/tach) PERC HOLE DIAMETER q FTAND ~'~ F1 COMMENTS Il & S ENGINEERING PERFORMED BY: --~4~EeE~Or L~Ro~t4~teo ~21M ~A'v~v%, ~ ~ CER] IFY 7HAl THIS TEST WAS PERFORMED IN ACCORDANCE WITH AL~LQ~I~¥~e~O~t~;I~7(~TUIDELINES IN EFFECT ON THIS DATE. DATE: 72 008 (Rev 4¢85) ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER MAfN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 15, Block 1, Skyline View S/D September 15, 1995 GENERAL: 1. The scope of this project includes the installation of a 1000 gallon septic tank and five foot wide drainfield to serve the proposed three bedroom residence for the referenced property. 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 specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall 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. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3e Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP . SUITE 204 . EAGLE RIVER, ALASKA 99577 Page Two Lot 15, Block 1, Skyline View S/D September 15, 1995 Septic tanks installed with less than 4 ft. 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 (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil 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 away 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 level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before grave[[ (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade· The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less 'than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Lot 15, Block 1, Skyline View S/D September 15, 1995 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: T_y~2e of Pip_~ Perforated Solid Cast Iron ASTM 93034 (PVC) ASTM F810 (HDPE) ASTM 92662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other 'than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the I~200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E0C. requirements. Page Four Lot 15, Block 1, Skyline View S/D September 15, 1995 INSPECTIONS= Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 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. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to documen't the contractors activities. Final acceptance of the contractors work rests with 'the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/OWNER Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.ancho rage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUT ( iT 'A PRovAL FOR A SINGLE FAMI[y:DWE£LING'' Parcel,I.D. 051-192-40 ;f. GENERAL NFORMATION · , "Complete legal descril~tion I, ot " 'Location (site addi:ess or directions) ~Current Property o~ner(s) Chris Benediktson Mailing address PO Bo× 4534, Lending agency HAA# ,,~ ¢/7/ / Expiration Date: 15~ Block 1, Skyline View Subdivision NHN Iris Way Day phone EaRle River~ AK 99577 Day phone 688-2287' Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [] Community On-site Public Water System [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 01/00)* 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show that the on-site water supply and /or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. $ & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone Address Eagle River, Alaska ~9577 Engineer's Printed Name DHHS SIGNATURE Approved for __ Disapproved. Conditional approval for Robert C. Cowan Date ~ / J//0 cl ~'?<. '¢' ............ '~? o~i~ ~&~ ROBERT C. COWAN j~ ~ bedrooms. , ~,.~. % ,,' ~.,~ ~ . bedrooms, wRh ~he following slipul~ions. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: Reissue Date: 72-025 (Rev. 01/00)' Municipality of Anchorage Department of Health and Human Servic~ E C E I V E Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK t99519-6650 www. ci.anchorage.ak:us SEP 1 1 ZOO0 (907) 343-4744 MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL CHEC~tI'~-~)NMENTAL SERVICES DIVISION Legal Description: A. WELL DATA Well type ~/v'/t-f~ , I[ A, B, or C provide PWSID # __ /~//~(-' Sanitary seal Date completed Total depth ~~ft Cased to ¢O/f- ft Date of test Static water level Well production FROM WELL LOG g.p.m WATER SAMPLE RESULTS: Coliform 0 colonies/lO0 mi [/'~/~"-¢d ~//'~ Parcel I.D.: O -I- /'¢Z- Well Log ¢'-5 Wires properly protected Casing height (above ground) . Z ~/~in. Nitrate 3. ~'? mg/I AT INSPECTION ft g.p.m ~ ~{l~(~C~ Other bacteria (3 colonies/lO0 mi Date of sample: OY/¢~/'~/'~ / ~ Collected by: $&SENGINEERING / 17034 Eagle River Loop Road NO. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaslca 99577 ~ i~Ys~ill~lc~t ~~--~ ~n/k s~i zTX~/J-0' gal Number of Compadments ~ Cleanouts ~ Foundatio~cleanout ~ Depression over tank ~(~ High water alarm ~ ' Date 0~ pumping ~ Pumper ~ f~ C. ABSORPTION FIELD DATA Date installed /~//~/~ Soil rating (g.p.d./,2 o~) /- ~ System type ~~ ~ ~ / Length ~( ft Width ~ ff Gravel below pipe ~ff Total depth ~ Effective absorption area~ff~ Monitoring tube ~ Depression over field ~ ~ Date of adequacy test ~ Results (Pass/Fail) ~ For ~ bedrooms . Fluid depth in absorptio~ find before test ~ in Water added ~gal. New depth~in. Elapsed Time: ~ min Final fluid depth ~ in Absorption rate =~ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type)~O~ /~ If yes, give date ~ 72-026 (Rev. 01/00)* D. LIFT STATION Date installed /"~ize in gallons Pump on level atc~?__ln "l-'ump off level at Datum /~ Cycles tested SE PARATION'N'N'~DISTANC ES in Manhole/Access High water alarm level at __ in Meets alarm & circuit requirements Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: Sephc tank/ ........ '~n on lot Absorption field on lot On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/~NG TANK ON LOT TO: Building foundation ~).,~: ' Properly line ~-- Water main /\//~ Water service line / Drainage / ~ /~ Wells on adjacent lots Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~'~/ Building foundation /0 /--/~ Water main Water Service line /(~ ~ Surface water / Curtain drain -/f¢.z/'/¢,g,,V~¢'/¢'- Wells on adjacent lots Driveway, parking/vehicle storage /'0 /~- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date· Engineer's Printed Name ~Oc%'J ,Z.,.z.'r- ~" (--~,4¢¢ Date ~1 /)' /~ 0 HAA Fee $ '~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00)* 09-13-00 09:~5 FRO~I-CTE EN¥1RON~NTAL ~1~ C T&E Environ men tal Services lnc, 5615301 T-IlO P.03/05 F-507 CT&l~ Ref.# ] 005401002 Client Name S & S Engineering Proieet Name/# N/A Client Sample ID Ll5 B1 Skyline View Matrix Drinking Water Ordered By PWSID 0 Client PO# Printed Date/Time 09/12/2000 21:31 Collected Date/Time 09/06/2000 17:I0 Received Date/Time 09/07/2000 17:10 Technical Director Stephen C. Ede Released ~ ~ Sample Remarks: Allowable Prep A~mlysis parameter Resulls PQL Units Method Limits Dale Da~¢ lllit Nitrale-N 3.87 0.500 mg/L EPA 300.0 10 max 09/07100 SCL lliorobioloqv ~.aboratoz-v Total Colitb~m co[/100mL SMI8 9222B 09/07/00 JDT 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O,~'/-/R;z-~O HAA# 1.. GENERAL INFORMATION Complete legal description Lot 15; Block 1; Skyline View Subdivision Location (site address or directions) NHN Iris Street Chuqiak, AK , Property owner ' Chris Benediktsson )',,: .' . :. ," .., ,Mailing address ' .~.o;~-sox 4534 Eagle River, :;,'Lending agency ' ':'" ~'. Mailing address Day phone AK 99_577 Day phone 694-2946 _ Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER 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. xxx 72-025 (Rev. 1/9~) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm '" Address Engineer's signature $ &$ ENGINEERING 17034 Eagle River Loop Road No. 204 Phone Date DHHS SIGNATURE / Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments f: , Jl[fli The Municipality of Anchorage Department of Health and Human Services (DHHa) 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 pu rohasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Munioipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~1 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVlCESoEtfi Environmental Services Division Health Authority Approval Checklist , 51/,,clLf, N~- Vlfh4 ~p Parcel I.D.: Legal Description: J~¢'T Ir~,~ ~D06~- I J A. WELL DATA Well type I2~ ~ v~,'rT¢-- If A, B. or C, attach ADEC letter. ADEC water system number Log present(l~N) I,J, .~_, ~ Date completed Total depth ~.:Z.~. / Cased to ,~,cL,,,-~ / FROM WELL LOG Casing height (above ground) Sanitary seal ~) Date of test Static water level  roperly protected(~lN) AT'~CTION Well production WATER SAMPLE RESULTS: g.p.m. Coliform Nitrate Other bacteria Date of sample: I ¢,'11'~1 ~ ~ B. SEPTIC/HOLDING TANK DATA Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Engle River, Alaska 99577 Date installed [I Foundation cleanout {~N) Date of pumpi.g Tanksize ~0oo Number of Compartments ~, Cleanouts ~,g$ Depression (V~) ~rb High water alarm (Y~) · Pumper ""---- C. ABSORPTION FIELD DATA Date installed II"~-'~'" ~'(o Length ~r! / Width rating ('g,p.d,/f~ or ft2/bdrm) 1, ?..- System type Gravel thickness below pipe ~,, ,-~ Total depth Effective absorption area ~ :~5 -rfc/' Monitoring Tube present ~1'4) ~1P~5 Depression over field (Y~') .~.O Date of adequacy test I~ E.'~ Results (Pass/Fail) "------- For_ '-~./4¢ bedrooms Fluid depth in absorption field before test (in.); ~ - - Immediately after ~ gal. water added (in.): Fluid depth "------ (ins) Minutes later: ~ Absorption rate = ' ~' g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date ¢--~ 72-026 (Rev. 3/96)* Date installed ' ~~.._ .....Size in gallons _ _ ,, Manhole/Access (Y/N) __ , "Pu~el at* __ "Pump off level at* High water alarm level at* _ *Datum. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL.ON LOT TO: Septic/holding tank on lot loc ~ 'P On adjacent lots /oo' ' -)' Absorption field on lot lO o On adjacent lots Public sewer main ,~ ~Je Public sewer manhole/cleanout )bo 'q' Sewer/septic service line ,~ir,¢; / '/' Lift station lbo SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation X, ~' Property line /Z) ~¢' Absorption field Water main/service line 10 Surface wateddrainage lDO!¢' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~o Building foundation I"~ / Surface water Ibc' + Cudain drain k~r~ E ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal rec! in conformance with MOA HAA~quidelines in effect on this date. Signature ~/~/~-A.~ ~,''r'''~''~'~ Engineer,s Name ~ ~,~,¢ ~Lf', C0 tw ~¢,,,, Driveway, parking/vehicle storage area Wells on adjacent lots Water main/service line Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ~r~pl¢ Remake; ........ ' i~tnted I~t~,vq'Lmt 12/22/97 I,~:~ Colle¢'t,~l ~te/Th~e 12/17/97 14:40 R,ceive~ De~e~Time 12/i8/~}? 09:45 Te~hniml Dlr,x'tor~ Stephen C. We U~ft$ M~th~ Limits O~te 0~ ln;C Tor~t coLfform 0,100 ~/L B{~A ~lO0,O 10 ~aX 1Z/18/~? l~ 1~/18/97 TN~