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Home My WebLink AboutMOUNTAIN VALE LT 5AOnsite File Mountain Vale Lot 5A #020-581-72 Formerly Lots 5 and 6 Municipality of Anchorage Page / of ,-~ 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: ~'~/ (~ o~('¢ O PIDNumber: Name: ~/~/~ ~ ~..~.~ Wastewater System: ~New ~ Upgrade Address: ~7~ ) P~t~ ~/~/¢¢p,~fo¢- ~¢ ¢~-~ ABSORPTION FIELD Phone: ~ '~ ~ ~ No. of~.~drooms: D Deep Trench ~ Shallow Trench DBed ~Mound ~Other LEGAL D ESCR I PTI O N sci, Rating: Total Depth fro~%riginal grade: ~, ~ GPD/Sq. Ft. Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township:_~ Range: -~. Section~ Fill added above, or~%nal~ grade: Ft. Gravel length: Ft. WELL: B New D U pg rade Gravel width: Number of lines: Distance between lines: ~ ~t. / ~ ~t. Ciassification~ / ¢ ~ '~(Private' A,B,C): Total~Depth: Ft. Cased~.To: Ft. Total absorption.~,~oarea: ~ SQ. Ft. ~Pipe material:~O~¢ Driller: . Date Drilled: Static Water Leveh Installer: ~ Date installed: P~mp Set at: Casing Height Above Ground: ~'~: // ~.~ 5 ¢ ~,. O ~,. TANK SEPARATION DISTANCES ~s~tio ~ ,o~n~ U TO Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: Number of Compadments: Surface Wat.r ~00'~ ~0~'~ LIFT STATION LineL°t ~ / ~ / Size in gallons: M~~ Foundation ~/ ~/ ""urn" °n" 'avel at: I "~ump o~" lev~water alarm a,: CUDrain~ain ~ ~0~/~~ /~0~1( ,~. Pump Make & Model Electrical Inspections pe~ormed by: Remarks: BENCH MARK Location and Description: Assumed Elevation: X9¢ inspections performed by: s & s ENGINEERING Dates: 1st ~,-¢28-¢ 7 ~ ~gle River, Alaska ~gS~ 2nd · ~ ~ ,o~,~ c. cow,, Department of Health and Human Servicesapproval ',, ~',..... ..... ... Reviewed and approved by: ,~~~ ~ Date: ¢-/°'¢2 '.<:. 72-013 (Rev. 9/91) MOA 25 ~ERMI~ NO SW970260. PAGE 2 OF 2 _. MuQi_cip.a_Li~.y_o.P Anchoraae DEPARTMbN/ Oh HbAL/H AND HUIVrAN SERVICES ENVIRONiVlENTAL SERVICES DIVISION P.O. Box 196650 ~_Anchorage, A~task~ 99519-6650 · Telephone, 343-4744 ON-SITE WASTEWATER DISPOSAL 5YSTEM AND/OR WELL INSPECTION REPORT LSCAL LOT 5, MOUNTAIN VALE S/D P.I.D. NO. 020--111--10 ST! ST2 I£ 94,4' A B ~,/ /FINAL GRADS FCO 57.5' 32.5' ST1 44.0' 52.0' 9~ ST2 47.5' 57.0' NEW ~'89.5' COl DBL1 50.5' 61.5' 8 %.T. MT~-C02 MTt~co1 = 93,7' DBL2 51.5' 62.5' / IC02 93.9' C01 72.0' 98.5' /FINAL ORADE MT1 71.5' 95.5' C02 59.5' 39.5' MT2 58.0' 42.5' ---~ ~co,: ~.~' IC02 89.5' MT2 = 85,5' MT1 = 85.3' WATER FOUND From : rLPINE DRILL 907 345 0202 Aug.04.1998 10:00 PM P01 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD LDCATION OF WELL lOT /LOCK t[CTION OTn/ /[CTION aDWN/Nle UNDF MCNIDINr ❑N ❑E Ifonouo"Louonn,101 U� S ❑s owl LOCATIONISKETCH: WELL OWNER: r r DEPTHS MEASURED FROM:❑casing top DOround surface W EPTH: �. It DATE OF COMPLETION Depth of holo: Depth of C0341g: r�—tt BOREHOLE DATA: Depth Material Type and Color From TO DEPTH TO STATIC WATER LEVEL: ..�+ �,-Z 7 it below N top 01 Casing ❑ ground surface !late:/ 1 !9_1 v/ METHOD OF DRILLING: Qalr rotary ❑ cable tool _ /r n other USE OF WELL: domestic ❑ Irrigation ❑ monitor �2 ❑ public supply ❑ othor —^ CASINO STICK- It. Diam: in, t It p'�S Casing lupe: in. to.S`S F _ J.� I+W!.Ll INTAKE OPENING TYPE: open and ❑ screened •a ❑ perforated ❑ open hole J I„� Depths of openings; to It SCREEN TYPE: Diam: In. Slot/Mesh Sira: Length: It GRAVEL PACK TYPE: Volume used: Depth 10 top: -.. j mB, 4ROUT TYPE:RECEIVED Depth: from It to It _ DEVELOPMENT ET CD: wo Uwauon: 4 AUG _ ^PUMPING LEVEL AND IELD: MUItICi alit ut AItC00 a81 �_ W It Otter hrs pumping ppm ep ua mAcfd8 rM , I PUMP INTAKE DEPTH: It Horsepower: WELL DISINFECTED UPON COMPLETION? LYES ❑ NO CONTRACTOR INFORM TION: REMARKS: e tt e0 VFmes e v ,y —�A� Z_.J(.}- iJ U Irl DNRIDIASE VISION OF MINING &AIL WHITE PWATER M MT Y OF LOG O: 10nature o ut ores Resoreso 111, ate 3601 C St, Suite 000 ANCHORAGE AK 99503.6938 Phone 19071289.8039,Fax (9071562.1354 Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 August 13, 1997 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 5 Mountain Vale Subdivision Waiver Request #WR970046, PID #020-111-10, Dear Mr. Cowan: Your request for a waiver of the required 10 fgot horizontal separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is i foot from the absorption field to the property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there are any further questions or concerns regarding this waiver, please call our office at 343-4744. Sincerely, On-site Services Bassatt MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ WR9700R46 PID# 020-111-10 Date Received: August 12, 1997 HA% Permit Legal Description: Lot 5 Mountain Vale Engineer: Robert C. Cowan, P.E., S & S En~ineerin~ 17034 Eagle River Loop road, Suite 204, Ea~le River~ Alaska 99577 Applicant: Jeff Bassett Waiver Requested: lot line waiver of ???? Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: Points: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: Na~f'Reviewer Rec #: 03054/2071 Amount: $ 115.00 Date Paid: Au~ 12. 1997 HAR-28-2000 15:29 S~S ENGINEERING 90? 694 1211 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor http://www,ci,anchorage,ak.us P,02/02 August 10, 1998 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle. Ri~er, Alaska Subject: Waiver Request for Lot 5 Mountain Vale Subdivision Waiver Request #WR970046 AI~ENDED, PID 020-111-10 '" Dear Mr. Cowan: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance has been amended from the waiver issued on August 13, 1997 to 0 feet as per the as-built drawing dated August 26, 1997~(permit #SW970260). This approval applies to the existing on-site wastewater disposal system lot line separation only, Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744, Sincerely, Jeffrey W. Poet Engineering Tech On-site Services ljw #7 TOTAL P,02 ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. HEALTH AUt HORleY APPROVAL8 SEWER&WATER I',,'~JN D'C[SNSION~ SEWER&WATER ENGINEERINGSTUDIES AND REPORTS WELL INSPECTION & FLOW TEST SI]'E pLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUC'rURAL & MECHANICAL INSPECTIONS ON SllE WASTEWA'i'E R DISPOSAL SYSTEM DESIGN Date.' CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Municipality of Anchorage DEP/~RTMENT OF HE/X~TH AND HUM32q SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 RECEIVED ~Vlu~c~t)ah~y ot A/lc Dept, Healtb& H .... h~orag, e REFERENCE The septic inspections for the referenced property were performed on ~/~6/q 7 and ~/~7 . Prior to submitting the On-site Wastewat~r. Disposal System and/o~We, ll Inspection Report we are waztlng for the ?o~,~r/~,~/~,~-Jb~v~yto 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 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUM_AN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970260 DESIGN ENGINEER: %h~ ~X~Uf~X~ ~-~-~ OWNER NT~ME:BASSETT, JEFF OWNER ADDRESS:1311 WEST llTH AVE. ANCHORAGE, ALASKA 99501 DATE ISSUED: 8/15/97 EXPIRATION DATE: 8/15/98 PARCEL ID:02011110 1 OF 1 LEGAL DESCRIPTION: MOUNTAIN VALE LT 5 LOT SIZE: 51977 (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: THE ATTACHED APPROVED DESIGN. 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) . 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) 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 THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: '~~' ISSUED BY: DATE: DATE: Rick Mystrom. Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 August 13, 1997 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 5 Mountain Vale Subdivision Waiver Request #WR970046, PID #020-111-10, Dear Mr. Cowan: Your request for a waiver of the required 10 f~ot horizontal separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 1 foot from the absorption field to the property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval fi'om this department. If there are any further questions or concerns regarding this waiver, please call our office at 34%4744. Sincerely, On-site Services Bassatt ROBERT C. COWAN, P.E. August 5, 1997 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER k~,lN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION &ELOWTEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSIIE WASTEWATER DISPOSAL SYSTEM OESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, Ali. 99519 REFERENCE: Lot 5, Mountain Vale Subdivision Request you issue a permit to drill a well aud install a septic system to se~-ee the proposed three bedroom house on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation water was encountered at 1 ~i feet and after seven day ground water monitoring water was found at 14 feet. 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. If you requh'e additional information, please contact us. Sincerely, RCC/mg Enclosm'e 17034 NORTH EAGLE RIVER LOOP "SUITE 204 · EAGLE RIVER, ALASKA 99577 60' SCALE SITE-PLAN DESIGN __ OC) Z --t II / NO WELLS/SEPTIC WITHIN 200'+ OF PROPOSED WELL/SEPTIC O ~ 0 ? PERFORMED FOR: LEGAL DESCRIPTION:LO'T '~' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMEO ~.~ ".~,~,~.,~' ~ Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS /3.0. d, SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? E Depth to Water Alter ) ~ (~ 7 Monitoring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop " PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN__~ FT AND --(O FT $ &S ENGINEERING "-~/2 PERFORMED BY: 17UT&R. ~.agie ~iwr Loop ~oaci i'~o, -2(~q I~ '~'-¢, _ .c// ~/~'- ~' CERTIFY THAT TrOiS TES: WAS PERFORMED IN ACCORDANCE wLC~ig~T~I,~II~J~IAI~PAL GUIDELINES IN EFFECT ON THIS DATE. DATE: (~ / '''~'~ C2/ ~ 72-008 (Rev. 4/85) ROBERT C. COWAN, P.E. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE W,~STEWAT ER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 5, Mouintain Vale Subdivision August 4, 1997 GENERAL: The scope ofttfis project includes the installation of a 1000 gallon septic tank and a 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 fi.om 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. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 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 5, Mouintain Vale SubdMsion August 4, 1997 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 leacklield 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 deanout, 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/DRAINF]ELD 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 (rufted-up) before gravel (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 bacldill. 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 glade. The portion of the monitoring tube extending through the gravel shall be perforated fi'om 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 backfdl 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 sealing. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page Three Lot 5, Mouintaln Vale Subdivision August 4, 1997 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 Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) 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. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the/3200 sieve. When sand is being used as a filter material, its gradation specifications must conform to cmrent M.O.A. or D.E.C. requirements, which ever applies. 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 3. The final inspection is to occur upon final grading of the property. Page Four Lot 5, Mouintain Vale Subdivision August 4, 1997 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. 8 & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors actMties. 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 & 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. # 1. GENERAL INFOR~ATIOF! Complete legal description HAA # v'4 L tZ ._Fi 0 Locat(on (~ite address or directions) :.... P operty owner ':;J- !-) ,~:' -'~ :¢ ,:'- ;- Mailing address !;?-t' ,' .",': .,. :.t ~tt~,;; ~) Day phone., ;) /'/~/' - ¢? ,z C (~ Lending agency :Mailing address_ Day phone Agent Address Day phone Unless otherwise requested; HAA will be held for pickup. NUMBER OF BFDROOIVIS: TYPE OF WATER SUPPLY: Individual well 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. 72-025 (Rev. 1/91) Front MOA121 Name of Firm Address Engineer's signature STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. Phone (~'q/'~ ";;L ¢/ '7 ~' S & S ENGINEERING Eagle River, Alaska 99577 DHHS SIGNATURE ' Approved for ~'/'/~ ~ ~' bedrooms. Disapproved. Date Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of'Health and Human Services (DHHS) issues Health Authority Approval Oertificates 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 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 engineers work. 72-025 (Rev. 1/91) Bsck MOA ~1 Legal Description: Municipality of Anchorage AU6 DEPARTMENT OF HEALTH & HUMAN SERVl~u.iy o~^~ Environmental Services Division .,~,~,o~M~N,'A~,_S~~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 AUG 0 6 J998 Health Authority Approval Checklist MUNICIPALITY OF ANC~HORA~E ~ o v,~ T 4,,,~ 'v'/~ ~ E' Parcel I.D.: O A. WELL DATA Well type P/~ ~ v R ~'~ Log present ON) ¥ & -~'' Total depth ~ '-o'-- Sanitary seal (~/N) Cased to IfA, B, or C, attach ADEC letter. ADEC water system number Date completed z//$ 0 /~/~' Casing height (above ground) FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: 't t/ ,~ '5 / ~ ~ B. SEPTIC/HOLDING TANK DATA Date installed ~/,zro/e-/ Tanksize /ooO g.p.m. Wires properly protected AT INSPECTION Foundation cleanout, t~/N),. Date of Pumping N/;¢' -- ~¢~., ,-Pumper -- C. ABSORPTION FIELD DATA. . Date installed f Length (o I Width g.p.m. Other bacteria ? O S & S ENGINEERING Eagle River, Alaska 99577 Collected by: Number of Corn 3artments ;~ Cleanouts ((~N).)~--J' · '¢ O High water alarm (Y,lJ~ ,,~ o System type T,~.~ Total depth rating g p d/ft~or C~. ~ Soil ~ fF/bdrm) ~ ' Gravel thickness below p~pe /f Effective absorption area (2 / 0 ~- ' ~- Monitonng Tube present ~'N)¥¢ J Depression overfield (Y/~) /v o Date of adequacy test i-'/4- - ~'~ ~,-' Results (Pass/Fail) For ~ Fluid depth in absorption field before test (in.); ~.------g~~d~t (in.): Fluid depth . (ins) Minutes later.9~.~.--/ Absorption rate = g.p.d. Peroxide treatment (past l~months) (Y/N) If yes, give date bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles t~e~stod-~'~ Size in gallons ~ l~"--'--~ "Pump off" level at* *Datum E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: ! Foundation ~- w Properly line ~ ~4 Absorption field t' r Water main/service line /0 4- Surface water/drainage ) dO + Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line O ( ~,1. v,,~ ~Bu~lding foundation ~' ~ Surface water ? o O f-/- Driveway, parking/vehicle storage area Curtain drain fy o ,.,,£ ~c ~o ~ ,./ Wells on adjacent lots ) ~) ~ Water main/service line /.~ I certff that I have determined thru field mspecOons and revzew of Mumczpal are in conformance with ~40.A H A..~ gu idelin,s in effect on this da re. Signature '~~ ~ Date HAA Fee $ L-~M' Waiver Fee $ / \,~O(D ~ Date of Payment Receipt Number CPO Y 72-026 (Rev. 3/96)* Date of Payment Receipt Number JUL-31-OB )3:02 FROM-GTE ENVIRONMENTAL 55i530i T-O1Z P.)O/IO F-O)5 CT&E Environmental Services inc. ,rinking Water Analysis Report for Tom[ Coliform Bacteria ~w ~,,., o..o An~llm~#. A% ~9518-1605 ClO I,VETRUCT[ON5 0,~ REVERE $IDE ~EFORE COLLK~ING ~MPEE T.I: (~7) 562-2343 " ~tUST BE'COMPLE'~ED~-. W~TER SUPPLI£& o PUBLICWAT[RSY~EM ~ PRIVATE WATERSY~M ~:~x: (9071 561.5301 "---~O-BF-.'¢O,~'~'L~.T£D ~)Y L^BOR~TOR, Y An~71i$ :~howS t~is W~[~r SAMPLE IQ ~ ~mm ,,,17,i, ~Km, . ~/z ~7/_./.7: ~ · Numix'r ofcolonit~,/I00 mi. .... Rflulr, e EI 3EI i5 Il lrbk~ Jam C1lenl notJl'[~l of #nsm~faclory r~.l~l: El · JUL41-g8 1~:00 FRO~('CTE ENVIROH~E~ITAL Ztk CT&E Erlvironmental Services Inc. 5615301 T-OlZ P.05/lO F-O15 CT&£ Ref.# 983855005 Client Name S & S Engineering Project Name/# N/A Client Sample I~ L~ 5 Moun[am vale Matrix Drinking Wa[er Ordered By PWSID Sample Remarks: Cliff I'O# l'rinted Date/Time 07/31/98 12:20 Collected Date/rime 07123/98 14:45 Received Date/Time 07/23/98 16:00 Technical Director: Stephen C. Ede Released TOla[ Coliform 10 OB NO COkl ni~ra~e-N 1,B1 O.lOO rr~/~ EPA )OO,O 10 m~x 07/Z0/98 07/~6/98 GCP