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Home My WebLink AboutRABBIT CREEK BLK 3 LT 4 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: ~',J~ "'/oo ~,'~ PID Number: OJ'7 '- OG~ Name: _l~14e~/~--r~,J~ ~'~9c'n~ .... Wastewater System: ~ New .. U Upgrade Address: '~ No. of Bedrooms: Phone: ~ ~ .. g ~ ~ ~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other , Total Depth fro~r[ginal grade: Lot: ~, Block: ~ ~l~Subdiv~[°n: ~ Deplh lo pipe bollom~ original grade: Ft. Gravel depth beneath~l pipe Ft. Township: Range: Seclion: ~ Fill added above original grade: Gravel length: t WELL: ~New D Upgrade Gravel width: ~l Number ol gnes: Dislance belween lines: , Ft, ~ ~ FL ~lasslfication (Private, A,B,C): Total Depth: ~ased To: Tolal 8bsorption area: Pipe material: Dine Drilled: StalicWater Level: Installer: Date Insl~lled; Pump Set ah Casing Heigh~Above Ground: SEPARATION DISTANCES U Septic D Holding D S.T.E.P. TO Septic Absorption Lift Holding ~ubllc/Prlva~e Manufacturer: ~ ~ From Tank Field Slalion Tank SewerLInes , ..... ~C~G~ ~)~ Capacitylngailons: Number of Compadmenls: Sudace Water fOOL+ ~o~+ .... LIFT STATION Lot I~ ~ ~J Size in gallons: ~ I ...... "Pump ~~ High water alarm at: Foundation ~ ~ ~ on" level ~t: -- CudalnDrain ~O~{ ~o~d J P~Eleclrlca. lnspeclions performed by: Remarks: ~ ~E~q~'c' ~ ~ L~r L~ BENCH M~RK Localion and Description: Assumed Elevation: Inspecbons penormea Dy Reviewed and approved bY: ~~ ,~ Y~ Date:~- ~-¢~ ,t,,..' ........ / 72-013 (Rev. {}/91} MOA 25 PERMIT NO. SW970038 PAGE 2 OF 2 Hunicig .oJ.ti~y~g? AnchoF'o, oe DEPARTMENT OF HI ALIIH AND MU AN SERVICES ENVIRONMENTAL SERVICES DOVOSOON , P.D. 9ox ~96650 ~ncho~~e, At~sk~ 995~9-6650~Te~ephone. 343-4744 ON-S~E WASTEWATER ~ISPOSAL SYS~EH ANO/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 3, RABBIT CREEK S/D P.I.D, NO. 017-063--19 i ~ 100' WELL RADIUS ~ WELL° Q~'~ I $ BDRNt '~ HOUSE NEW 1000 GAL. I SEPTIC TAN K-x FCO 10.5' 5.$' NEW DRAINFIEL ST1 24.5' 20.~ ~~ > ST2 28.5' 21.5' ~' ~ DBL1 31.0' 22.5' 5'W~:R~~~~'~TH'~ __ ~ DBL2 35.0' 253' .o,~%' ~-f..- ~ MT1 39.5' 28.0' MT2 71 58.0' .... ' ~ ~ALT. SITE scA~ 1"=4o' i '~ ~'~ EAST 1~2NO AVENUE STI / Og.o,ST8 FINAL GRADE~ MT2 /MT~ 9g.l' · ,~ -G,, . ...... ~?-., ~> <.>' ...... .,'<-.~ SEPTIC TANK~- MT1 = go.a~ / MT8 90.~ &86.8' WATE~ YOU,D 80.8 B.O.H. A B FCO 10.5' 5.5' ST1 24.5' 20.~r ST2 28.5' 21.5' DBL1 31.0' 22.5' DBL2 35.0' 253' MT1 39.5' 28.0' C01 71.5' 58.0' MT2 71.5' 58.0' M-W DRILLING, inc. P.O. Box 110370 · 10390 Old Seward Highway (907) 349.8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner~ INNOVATI. V~E CON~B--~URNEY ' MARK & MARY _Use of Wel[~0MESTI--C - Location (address of: Township, Range, Section, if known; or distance main road ~_RAB~~_SiiBDiVT~-rOi%: ~. 13?Nh AVV.. ANCHORAGE ~ ALASKA Size of casing--i//--- Depth of Hole~,!::~.0 feet Cased to--feet Static water level 7~6 ,,.ft. (~J0~)~:i (below) land surface. Finish of well (check one) open end ( X ); Screen ( ); Perforated ( Describe screen or perforation-~ Well pumping test at._1-0 _ga[/~:p~!..(~X (minute) for____l~urs with -. 1~% .ft. 09 JULY ~i~9~..?~; Date o~ completion ~ < : ~epth in feet from ~: ~:-':u;~f~<~ 'df.f6rmations penetrated, size of material, color and hardness 0 __TO. 2 C~S~NG/STIC UP 2 TO 5 5 .TO__23 BROWN, SILTY 23 .TO_ 26 26' TO 39 SILTY ___%9___TO--5-1- - _ 51 TO 7n 70 _TO 79 79 .TO 87 _j7 TO. 122 ~ 22 TO_J 30 GRAVEL: 'G~E~;,"'SiL-TY, SANDY, DAMP GRAVEL: SILTY WITH CLAY LENSES WATERGRAVEL: SANDY TO TO .... TO__ - .... TO [TWWA Certified Con%ractor Ce. rtfificate No's. 814 & 973 1 -- CUSTOMER I 'd ~9~LO~ '0H XV3 N01~0fl~SN00 ~AI~VAONNI ~V ~'0[ N0~ 8~-Z -~V~ .... :3,.)5;4. March 23, i998 Robert C. Cowan, P.E, S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 4 Block 3 Rabbit Creek Subdivision Waiver Request #WR980007, PID #017-063-19, HA980039, SW970038 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 is the property line to the absorption field of 5 feet. 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, Civil Engineer On-site Services ljw #7 MUNICIPALITy OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~%c~f%~ PID# 017-063-19 HA# HA980039 Date Received: March 5, 1998 Permit ~ SW970038 Legal Description: Lot 4 Block 3 Rabbit Creek Subdivision Engineer: Robert C. Cowan, P.E., S & S Engineering 17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska 99577 Applicant: Innovative Construction Waiver Requested: Absorption field to the property line of 5 feet. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. ]Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: ~ Waiver is NOT Granted: List Conditions or Reasons for above: Name of Reviewer Rec #: #03519/7506 Amount: $ 115.00 Date Paid: 3-5-98 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTEF,~IO NS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TES¥ PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSffE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. March 5. 1998 MUNICIPALITY OF ANCHORAGE Departlnent of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 4; Block 3; Rabbit Creek Subdivision CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 :;'FiVED R L. ~.. MAR 6 1998 D Municipality ct A:'<;ho~ age ept, Health & Human Services Request you issue a Health Authority Approval on the referenced l)rOpcEty and grant a waiver roi' the horizontal separation distance between the leachfield and the property line at 5 feet. We do not anticipate any adverse effect on the adjacent properties. The property linc is adjacent to a road right of way, sce attached inspection report. If you require additional i~fformation, please contact ns. Sincerely, Robert C. Cox~an, P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 HEALTH AUTHORITY APPROVALS SEWER &WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING SIUDIES ANDREPORTS WELL INSPECIION & FLOWTEST SITE PLANS ROAD DESIGN SO~L TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL ,~Y~ [ E M DESIGN ROBERT C. COWAN. RE. ROBERT A. SHAFER, RE, Date: CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 RECEIVED AUG 18 1997 Municipal,ty ol Anchorage Dept. Health & Human Services REFERENCE: Tile septic inspections for the .referenced property were performed on '~/~/~ and ~/~¢~ Prior to submitting the On-site Wastewater Disposal Syst%m and/o~ Well Inspection Report we are waiting for the __~,~ ~~ to be completed. 5 c~ ~¥ 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 HUNLAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970038 DESIGN ENGINEER:S & S ENGINEERING OWNER NANE:MCBURNEY MARK & MARY OWNER ADDRESS:1919 SPENARD ROAD #1 ANCHORAGE, ALASKA 99503 DATE ISSUED: 3/18/97 EXPIRATION DATE: 3/18/98 PARCEL ID:01706319 LEGAL DESCRIPTION: RABBIT CREEK BLK 3 LT 4 LOT SIZE: 43700 (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 ALASICA WASTEWATER DISPOSAL REGULATIONS {18AAC72) AND DRINKING WATER REGULATIONS (18A3~C80) . 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: ~/Y ROBERT C. COWAN, P.E. ROBERT A. SHAFER, RE. February 27, 1997 HEALTHAUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING SI'UDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOiL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 4, Block 3, Rabbit Creek Subdivision CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 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. Test holes were excavated and percolation tests performed. The approximate locations of the test holes are located on the attached site plan. At the time of excavation water was encountered at 14.5 feet in test hole Itl and at 17 feet in test hole #2. After seven day ground water monitoring, water was found at 14 feet in test hole ~tl and at 17 feet in test hole ~2. 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 require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/mg Enclosure 7034 NORTH EAGLE RIVER LOOP ' SUITE 204 · EAGLE RIVER, ALASKA 99577 1"=50' SCALE SITE PLAN Z COO i~Frl --Im PEDESTI~IAN WAY DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~ LE-GAL DESCRIPTION: Township, Range, Section: 1 2 4 5 6 7 ~/t V 8 10 11 12 13 14- 15- 16 17 18 Go,H, 19 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? ~ , sE DEPTH?IF YES' AT WHAT )/~/ /~. pOi Ei D,plhloWaterAller t¥ ' Monitoring? Dale: Gross Net Depth to Net Reading Date Time Time Water Drop ~0 ' )~'- ~ ~1~ ~ o ':.57 G ~1~ PERCOLATION RATE '~' (.m~nutesnnch) PERC HOLE DIAMETER ~'" TEST RUN BETWEEN 7 ~/~' FT AND ~ `/~' FT $&$ENGINEERING I "~'~ ¢~'~'. /~¢ ~'"'"~u-"~ C E R T I F Y PERFORMED BY: ~70~4 F. agie i-6ver Loop Road No. 204 ACCORDANCE WITI~iI~I'~,4~I~f~III~I~It~,~L GUIDELINES IN EFFECT ON TRIS DATE. DATE: THAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0850 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: /~1'~ R~( ,~ /~/~',;,, LEGAL DESCRIPTION:LO (EN GI~,,~A~L) ~ · -~ ~ ~ ~ r:' DATE PERFORMED~[ Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ~7 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Oeplh to Waler After Monitoring? Gross Net Depth to Net Reading Date Time Time Water Drop - s.- ,, _ I~ '. I ~ i i~ ~ " t" ) 0'. ~o ~,, /o , ~l ~ c~" PERCOLATION RATE TEST RUN BETWEEN __ ] [minutes/tach) PERC HOLE DIAMETER __ C~ FTAND ¢~' FT S & $ ENGINEERING ,---) .,,~.~-.~ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: ---170"g4 Eagle River Loop Road No. 204 ~ ' ~ '" ACCORDANCE WITI'-~J~/MII~I~I~7. GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWE ft & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECNANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAl SYSTEM DESIGN REFERENCE: Lot 4, Block 3, Rabbit Creek Subdivision February 27, 1997 GENERAL: t. 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. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. A].i 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 4, Block 3, Rabbit Creek Subdivision February 27, 1997 e 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 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 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 4, Block 3, Rabbit Creek Subdivision February 27, 1997 MINIMUM ~ATERIAL 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: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (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 slit 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 #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever applies. Page Four Lot 4, Block 3, Rabbit Creek Subdivision February 27, 1997 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 document 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 & 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 AUTHORI!Y APPROVAL FOR A SINGLE FAMILY DWELLING 01706319 ~, HAA # ~p~ ~,O~'"~(-~,c-~ 1. GENERAL INFORMATION Complete legal description Lot 4.; Block 3: Rabbit Creek Subdivision Location (site address or directions) Bast 132nd Avenue ~ Property owner -. Mailing address <' Lending agency .... Mailing address Agent Innovative Construction P.O. Box 113689 Anchoraget Day phone AK 99511 Day phone Day phone 348-8366 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEr)ROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: xxx Public water 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 NOTE: XXX Public sewer If community wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72-025 (Rev. 1tgl) Front MOA ti21 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 reg~1 ~t'~)k~f~e' t on the date of this inspection. 17034 Eagle River keop Road No. 204 Phone f~ Name of Firm EagJe J~|ver, Alaska 99577 Address Engineer's signature ~/~'~ ~.~ Date DHHS SIGNATURE Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date ,~ -2, ,~ - ¢~ The Municipality of Adchorage 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 DH HS 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 engineer's work. 72-025 (Rev. 1/91) Back MOA~r21 Legal Description: A, WELL DATA Well type ~¢. ~J~l' ~- Log present (~/N) Total depth ~ '~ ~) ~ Sanitary seal (Y/N) : FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: 2- B. SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout ((~N) Date of Pumping _ ~ ¢¢ C. ABSORPTION FIELD DATA Date installed Length ~z,~rl Width Effective absorption area Date of adequacy test Municipality of Anchorage DEPARTMEN-r' OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343'4744r,~ Health Authority Approval Checklist L,o.r L} ~ ~l~ao~ '~ .~ Parcel I.D.: Ct'"/ If A, B, or C, attach ADEC letter. ADEC water system number '~E~ Date completed --7 - ¢]-~'i '1 Cased to I '2.~4 · ~, Casing height (above ground) g.p.m. Tank size jooo Depression (Y(~ Pumper Wires properly protected (Y/N) AT INSPECTION §.p~m. ~. j~o m,.~ / ~ Other bacteria Collected by: $ & $ I~N(HNEERING 11034 Eagle River Loop IZoad~ No. 204 Eagle P. iver, Alaska Number of Compartments 'Z_ Cleanouts ~/N) I'~ e . High water alarm (Y/~i Soil rating (~r fF/bdrm) j,, '7_. System type ~¢,h~lF~-O_ I Gravel thickness below pipe /-~, _ Total depth ¢/I,~ ~;~. 51 Monitoring Tube present(~N) Y'E,-¢ Depression over field (Y/~) t,J o Results (Pass/Fail) ~ For ,~ bedrooms Fluid depth in absorption field before test (in.); Fluid depth ~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Immediately after '-'-'gal. water added (in.): Absorption rate = ~ - .g,p,d, If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Size in gallons ~ Manhole/Access (Y/N) ~at* "Pump off" level at* High~ *Datum P.~s tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main I,J Sewer/septic service line On adjacent lots Iodl'/' On adjacent lots I o O I + Public sewer manhole/cleanout ~/~ Lift station ~/'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation I ~, Property line t Water main/service line 1~2 Surface water/drainage SEPARATION DIsTANcE FROM ABSORPTION FIELD ON LOTTO: .~ ..~ I Building foundation Property line Surface water Curtain drain joeI .¥ ENGINEER'S CERTIFICATION HAA Fee $ '~ Absorption field Wells on adjacent lots j OOI ~ Water main/service line I0 Jr+ Driveway, parking/vehicle storage area '3~ i'~-- Wells on adjacent lots ) 00I ~' I certi that/have determined thru field inspections and review of Municipal records tO~t~F.~. ~ems are in conformance with MOA ktAA guideline.~ In effect on this date. Signature .... ~~ Engineer's Name /~0 ~ __ ~ L a~"~ Date 5 ~'~/~ ~ Waiver Fee $ Date of Payment Receipt Number Date of Payment Receipt Number 72-026 (Rev, 3/96)* ,~'~ CT&E Environmental Services Inc. CT&E Rcf.# Client Name Project Nnme/# Client Sample ID Matrix 0rdercd By PW$ID ~atera Department AnaLyses Total CoLiform 980849001 S & S Engineering Lot 4 Block 3 Rabbit Creek Lot 4 Block 3 Rabbit Creek Drinking Water ResuLts POL units 0.t00 u O,lOO mg/L 2 o~/ 100 mL/ No ceti Client PO# Printed Date/Time 02/27/98 16:45 Collected Date/Time 02/25/98 09:30 Received Date/Time 02/25/98 12:40 Technical Director: Stephen C. Ede AtLowabte Prep AnaLysis Method Limits Date Date init EPA 300,0 10 mag 02/25/98 DCP SM18 92228 02/25/98 THW £O/EO'd '[0£S1;c2SL06 3~U~OHDN~ IS3 3~1D SS:OE