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Home My WebLink AboutJOHN WELLS 1952 ADDITION BLK 5 LT 9 THRU 12 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: _~u3~ o:z~o PID Number: O1'4 -'z.~,[ - '~o Name: ~)t~¢.,.l~ ¥.¥ jNf.¢,,,O~ Wastewater System: ~ New ~ Upgrade Address: ~o~ ~z~ ~. ~c~" ~ 4~.~, ~ ABSORPTION FIELD Phone: NO. of Be~ooms: ~ - ~ ~ Deep Trench ~ Shallow Trench ~Bed ~ Mound ~ Other LEGAL DESCRIPTION Soil Rating: O.~ (~NCGPD/Sq.P'~e~Ft. Total Depth from origip.l~rade:~, / ~'(A~o,Y,o¢~ Depth to pipe bottom from original grade: Gravel depth beneath pipe Lot: ~ ~ Block: ~ ~oR~Subdiv~i°n:~ ~.1~[ ~- ~ Ft. O · ~ Ft. Township: Range: Section: Fill added above original grade: Gravel length: ~ ~ ~ O,~ I.~ Ft. ~ Ft. Number of lines: Distance between lines: WELL: Ex~r~ ~ New ~ Upgrade Gravel width: ] ~ Ft. ~ ~' ~ Ft. Classification (Private, A,B,C): Total Depth: ~ Total absorption area: Pipe material: Driller: ~ed: Static Water Level: Installer: Date installed: ~i~Pump Set at: Ft. Casing Height Above Grou;;: TANK SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~ ~ .~ ~ C~ ~ '7 ~ ~ ~ Number of Compartments: Well- loci+ /oo1~ ~ ~ Mated"l: ~G~ Surf~c. ~ -- -- LIFT STATION Water /oo1~ Iool~, ~ LineL°t ~ff~ ~O ~ ~ ~ ~ Size in gallons:I~ Manufacturer:~ Foundation ~ ~ ~" ~ /I ¢ ~ ~ ~ "Pump on' level at: ~level~ I at: High water alarm at: Curtain - ~o¢ . ~Me~ ~P _ ~ ~deJ Electrical Inspections performed by: Drain - Remarks: ~ 'T6 ~.~.,-.¢~ ¢.~,,~F~,~ BENCH MARK Location and Description; J 0~. 0 ~, Assumed Elevation: InSpections performed by: S&SEN6~N~E,I~G .... .2~: 1st ~-z¢-,~ ~;~=,, ~ . Department of Healtha~d Reviewed and approved by~~-~c ~;Z''''~r;'c "- '~ ..... Date: Z-~~' "t~"L'~"SS¥~"~'''~'~ 72-013 (Rev. 9/911 MOA 25 Permit No. SW960210 Page 2 of 2 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 LOT 12, BLOCK 5, JOHN WELLS S/D (1952) 014-261-50 Legal Description: PID No.: LOT 10 NEW 1 O( GA ,0' WELL )IUS~ LOT i2 ~ELL SCALE 1" = ST1 NEW ]000 SEPTIC TANK 40' G~ c° 72-013 A (Rev. 9/91) MOA 25 · ATER~['i'~ ~1, t~.O.H,FOUND'~ ;~'~ MT2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960210 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WARBURTON MICHAEL OWNER ADDRESS:3500 CRITTENDON DRIVE HOMER, AK 99603 PARCEL ID:01426130 DATE ISSUED: 7/18/96 EXPIRATION DATE: 2/i8/97 LEGAL DESCRIPTION: JOHN WELLS BLK 5 LT 12 LOT SIZE: 8550 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 (iSAACS0) . 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: THE SAND USED IN THE FILTER LAYER MUST BE A CLEAN SAND WITH 4% OR LESS PASSING A #100 SIEVE AND 2% OR LESS PASSING A #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED ON THE SAND USED.~/,j RECEIVED BY: DATE: DATE: ROBERT Co COWAN, [¢![~, ROBERT A, SHAFER, P.E. June 26, 1996 CIVIL ENGINEERS (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 ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 12, Block 5, John Wells S/D (1952 Addn.) Request you issue a permit %0 upgrade a septic system %0 serve the 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 no water was encountered in test holes and after seven day ground water monitoring, the monitoring tubes were found to be dry. Attached is proposed upgrade design. 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~ PoEo Enclosure 17034 NORTH EAGLE RIVER LOOP SUITE 204 · EAGLE RIVER, ALASKA 99577 , 1'~ ~ 60' I ,~C:ALE SITE PLAN TOLOFF STREET 0o0~° DESIGN ,-Ch Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: LCJ'J- ¢1 T~'~/~V i,~ ~,L,~,~C ,~'- DATE Township, Range, Section: 1 2 3 4 5 6 7 8 9 10- 11 12 13- 14 -- 15- 16- 17- 18- 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED? S IF YES; AT WHAT DEPTH? p E 0epth to Watnr After O/~ )/ 7/i ~/'~ Monitoring? Date: SLOPE SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN __ __ (minutes/inch) PERC HOLE DIAMETER __ FT AND __ FT ~, ¢ P6~ ~ ~.+ ~) ~ ,L. PERFORMED BY: S & S ENGINEER NG ~ '.,~,..-~'~ERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No. 20~ "- c- ~,-- - -- ACCORDANCE WlTi'E~i~le,.~i~f~,~,/~,ll~s'~l~J~.- GUIDELINES IN EFFECT 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 I~ ~ t'~ ¢~ ~:~ ~J~ 4,¢ l}'~q/~ DATE PERFORMbD: PERFORMED FOR: LEGAL DESCRIPTION: Township, Range, Section: SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS WAS GROUND WATER ~,¢C~. ENCOUNTERED? S L IF YES, AT WHAT '" O DEPTH? P E Depth to Water After O~;;t ,7' Date Monitoring? ' ; Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE '~ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN __ FTAND .~: C. /?/!',L ~:~ ~ ~ ~' ~)~ ~;'' PERFORMED BY; S & $ ENGINEERING ~ CERTIFY THAT T~IIS TEST WAS PERFORMED tN 17034 Eagle River Loop Road No. 204 ACCORDANCE W~T~A~i~.~s~Jg~ ~U~DEL,.ES ~. EFFECT O. TH~S ~ATE. DA~E: 72-008 (Rev. 4/85) HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER iNSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERT A. SHAFER, RE. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 ~EFERENCE: Lot 12, Block 5, John Wells S/D (1952 Addn.) June 26, 1996 ~ENERAL: 1. 5e The scope of this project includes the installation of a 1000 gallon septic tank and an absorption bed to serve the three bedroom residence located on the referenced property. The existing septic tank is to be excavated, pumped, crushed, and abandoned in place. The existing leachfield is to be abandoned in place. ~ 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. ;EPTIC TANK INSTAL~TION: 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. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 12, Block 5, John Wells S/D (1952 Addn.) June 26, 1996 3e Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 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. LEACHFIELD BED INST~LLATION: Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed-up) before gravel or sand placement. 2e If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. The perforated distribution pipes must be as shown on the design but, no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. Page Three Lot 12, Block 5~ John Wells S/D (1952 Addn.) June 26, 1996 6e Silt barrier material must be installed between the final gravel layer and the native soil backfill, unless insulation is used, then the silt barrier should be installed over the insulation. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed at 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 depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. The monitoring tube should not extend below the bottom of the gravel surface. 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 finished grade over the bed must be mounded to prevent the formation of a depression after settling. 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: 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). Page Four Lot 12, Block 5, John Wells S/D (1952 Addn.) June 26, 1996 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 ~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. 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: me 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. Page Five Lot 12, Block 5, John Wells S/D (1952 Addn.) June 26, 1996 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/INSTALLER GSBD CICSPROD CURRENT LEGAL ~HOWSE - ~E~UM%I~ ~Omv~'f pE6=~TN, TO MAIN MENU PF09=SHORT PF10=REGLR JOH8 WELLS BLK 5 LT C 014-261-13-000 SMITH JOHN C & RD 01 SMITH JOAN NADINE C 014-261-16-000 SMITH JOHN C & J NADINE CV O1 C 014-261-17-000 H 2 W CONSTRUCTORS INC CO 01 C 014-261-20-000 PAHLKE DAVID H RD 01 C 014-261-21-000 ANDERSON JANICE L RD 01 C 014-261-24-000 SPRINKLE DAVID & RV 01 DELIGHT C 014-261-25-000 JOHNSTON CRAIG & JUDY RV 01 C 014-261-28-000 SEIDLER RICHARD H 1991 TRUST RD 01 HARJORIE J SEIDLER/TRUSTEE C 014-261-29-0001WARBURTON MICHAEL RV O~ C 014-261-32-00~ WARBURTON MICHAEL RO CURRENT PARCEL y S: 051-042-76-000-97 u//u//~o 1 JOHN WELLS BLK 5 LT 1 JOHN WELLS BLK 5 LT 2 JOHN WELLS BLK 5 LT 3 JOHN WELLS BLK 5 LT 4 JOHN WELLS BLK 5 LT 5 JOHN WELLS BLK 5 LT 6 JOHN WELLS BLK 5 LT 7 JOHN WELLS BLK 5 LT 8 JOHN WELLS BLK 5 LT 9 JOHN WELLS BLK 5 LT 10 HELP==> X EASEMENT AGREEMENT The undersigned,, in consideration of mutual agreement set forth below,i grant, convey and affirm the following easement, effective t~is ~ ~ day of July~ 1996, and agree to the conditions and restrictions as follows, i I, Michael J. Warburton, hereinafter referred to as grantor, owner of' certain real property herein after referred to as "Lot 9 &lO; Block 5; John Wells (1952 Addition) Subdivision". According to the official plat thereof filed in the records of ANCHORAGE RECORDING DISTRICT, Third Judicial District, State of Alaska, do hereby grant to Michael J. Warburton, hereinafter referred to as the grantee, as owner of certain real property hereinafter referred to as "Lot 12: Block 5; John Wells (1952 Addition) Subdivision" according to the official plat thereof filed in the records of ANCHORAGE RECORDING DISTRICT, Third Judicial District, State of Alaska, An easement for an on-site wastewater disposal system to be placed partially on~ Lot 9 and on Lot 10; Block 5; John Wells (1952 Addition) Subdivision, together with right to maintain the on-site wastewater disposal system to include reasonable egress and ingress for pumping the septic tank and maintenance of the absorption area. The easement to be effective upon the signing of this' agreement by the parties. : It is understood and agreed that sewer service to Lot 12; Block 5; John Wells (1952 Addition) Subdivision is to be provided by connection beginning on Lot 12 and extending across Lot 9 and onto Lot !O~ Block' 5; John Wells (1952 Addition) Subdivision. It is further agreed that the cost of maintenance of the in place sewer lines shall be born by~ the grantee. There shall be no charge for the use of the on-site wastewater disposal facilities so long as this easement is in affect unless a charge is arranged between the parties of their heirs or assigns or successors in interest by separate written agreement. 'gG JUL 19 tlq 11 86 Grantor makes no warranty as to the adequacy of the wastewater disposal system and shall not be liable for any damages caused by the system failing to work adequately. 4. The grantor further covenant and agrees that the grantee shall have full, free and uninterrupted use of said easement for reasonable domestic use as long as such use does not create an unreasonable, adverse impact upon the grantor. 5. Failure to make use of the on-site wastewater disposal system herein described shall not be deemed abandonment of the said easement. The grantee further agree to bear all cost, if any, for the operation, maintenance and/or abandonment of the on-site wastewater disposal system and/or easement. e This easement from grantor to grantee shall be binding upon the inure to the benefit of the parties hereto, their heirs, legal representative, successors and assigns, and shall run with the land. ]rantor: l~/[cha~f ~ Warburton Lots 9 & 10; Block 5; John Wells (1952 Addition) Subdivision Grantee: /Micha~i'J. Warburton Lot 12; Block 5; John Wells (1952 Addition) Subdivision Subscribed and sworn to before me this l~ .day of ~J,~t~ 1996 for ' My co.~,ision expires Notary Public __ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program .. 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www. ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 014-261-30 GENERAL INFORMATION Complete legal description L o t Location (site address or directions) · .AA 0400 2 Expiration Date:. -7- 12; Block 5; John Wells 1952 tddttion 2237 E 86th Ct. Anchorage, AK 99507 Scott Byron Dayphone 522-5274 same Current Property owner(s) Mailing address Lending agency Mailing address ~esidential Mort~aFe Day phone_ 223-8R3§ Real Estate Agent 'Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 Day phone TYPE OF WATER SUPPLY: ' Individual Well :[~- Individual Water Storage I--I Community c'IaSS. Well r'-I Public Water System r"] TYPE OF WASTEWATER DISPOSAL: 'Individual On-site [~ Individual Holding tank ['-i . Community On-site ...r-] Public Sewer r'-I The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authod~ Approval (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water sample .results. (Certificates may be reissued for a period of up to one year with valid water sample,,~'~,; Certificates are valid for one year for properties served by Class A or B wells or a public water system. T~e Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. sTATEMENT OF INSPECTION BY 'ENGINEER .As ceitified 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 this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate fo~ 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(are) in compliance with all applicable Municipal and State codes, ordinances, an'd regulations in effect at the time of installation. NameofFi~n S & S ~.ngineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name ·Robert C. Cowan Date ,~/!o/°~' DSD SIGNATURE ~ Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist .. X Septic System Advisory , . Well Flow Advisory (Rev. 01/02) Maintenance Agreements '-: ...... Supplemental Engineer's Report Other Original Certificate Date: Z/_ ~ J - 0/-1/. MuniCipality of Anchorage ' Development Services Department ~Building Safety' Division On-site Water & Wastewater' Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www. ci.anchorage.ak.us (907) 343-7904 HEALTH 'AUTHORITY APPROVAL CHECKLIST · Legal Description: '~0 Fe,~ ~: A. WELL'DATA {~ ~¢~ ~ ~ ~ Wellt~p~e~. , ' IfA B, orCprovidePWSIO~ ~ : :,~ ,~];, ..~ , Well Log (WN) :Date C6~Pl6ted ~: ,,. ' sanita~ seal : ~ ,, ?:... . . (WN).~/ Wires properly protected (Y/N), Total depth [J~ff. Cased to ~ ft. ~l ' Casing height (above ground) ~ i~: 'FROM,WELL LOG ' ~ ~ AT INSPECTION Date 6f test: -' ~I~ i Static ,ater level ff. ~' . ~ ~ ' ft. Well ~'r "t: / ~duction ~' ~ ~ 0 i~,~ / g.p.m. ~ g.p.m. WATER SAMPLE RESULTS: . : ~ ...~ ~[: . ColifOrm ,~O colonies/100 mi. Nitrate O, I B. SEPTIC/HOLDING TANK DATA - Tank. T p L ateri, . ..: . Datein,ta,ea Tank size.~ .!.~¢. . gaL. Number. _ of Compadment{ ~/ Cleanouts (Y/N). Founda~ion:'cleahout., i, - {Y/N) '...Y . Depression over tank (Y/N) . ~ . H gh water alarm (Y/N) uate o~ ~u~ping I~1 D ' / O ~ PUmper ~~ ~ · ' :~ ' iii,: "/ , '/ ~ : C. ABSORPTION FIELD DATA riI ~,I' · /' / ~O Date in, tailed ~ ~/~/~ Soil rating r ff~/bdrm) ~ S~stem type. ~ Length.~t .~3 E ' Width I ~ '~ ~ · ' ft. Gravel below pipe. O, ~ - ft. ~I ~1~' ~- : .: . :~ . Total depth ~'ft. - Eft. absorption area :~ ~ fl~ :~Monitoring tube ~/ Depression over field Results (pads/Fail) ~ ~. For ~ bedrooms "' Date of adequacY test ~//'/~,~ ; :: ' " ' ' ' luid de~th in absorption.field before test. O' im ~Water added~ gal. New depth~Fin. ' Elapse~,' 'e~O min. Final fluid dept~ ..' O inJ Absorption rate >: ~ g.p.d. Any reju~enabon, treatment (past 12 mo.) (YIN & type) ~/~,'W If yes, give date Parcel ID: in. Other bacteria O .colonies/100 mi. Collected by: ,<J' ~ ~o · ~ C,- c~ ~'-"~-~t / LIFT STATION Date installed Size in gallons "Pump off" level at Cycles tested ' ' ,I, / "Pump on" leVel at in. Datun~ :' ~ SEPARATION DISTANCES SEPARATi6N D STANCES FROM WELL ON LOT TO: Septic tank/lift.~t~n on lot Abso/'ption field on lot '.~ ~i . Public sewer main '~./ 'in. Manhole/Access (Y/N) ,- 'High water ala~'m level Meets alarm & circuit requirementS? On adjacent lots · .. / O On adjacent lots Public sewer manhole/cleanout ~sePlic service line '"~- ~"~ ' * "Holding tank SEPARATION DISTANCES FROM SEPTIC/HOEDtl~G TANK ON LOT TO: Building foundation ~ / .,- ...Property line ~- .-'- Water main f.~ '/,A- . Water service line ! (..,~- I Wells~. on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Propi~rty line ! 0 Building foundation ! C2 .~- Water' Service line !~ . Surface water ~/¢") (/') .Absorption field ' ~ri~eway, parkin~Nehicle ~tora~e ~ 4 Wells adjacent lots Curtain dra~n on COMMENTS 1o0 W ENGINEER'S' CERTIFICATION I Certifythat I have determined through field inspections and re~/i~w o~ ,Municipal records that the above systems are in conf6rma[~e with MOA HAA guidelines in effect on this date.. Name ~ ~ ~..,4 7" C. HAAFee $~:,J "7"3 0 Date of Payment ~ /L~/o fi' / Receipt N, umber 0 5-4) 5- '~ (~ (Rev. 12/01): .Waiver Fee $ Date of Payment Receipt NUmber APR-1G-200~ 12:18 S&S ENGINEERING SG$ ReK# 11~1760001 Client Name S Project Nam~ Lot ]2, ~ 5 Joh~ ~lls 1952 CUent Sample ~ Lot 1 ~ B~ 5 Jo~ Wil~ 1952 Matr~ ~ ~atet ~mplc l~'merks: Nit~atc.N O.IOOU 0.1{30 t~d.v-~ob£ology I~bo~at o~, Total ColLt'orm 907 694 1211 P.02/02 mm, All Datet/T~mes are Alaska Standard Time Printed Date/Time 04/16/2004 1 ] :0g Collected Date/Time 04/14/2004 17:00 ~eeelved Date/Time 04114/2004 17:20 Technical Dir ~e~/ Stephen C. Ede Con~ainer ID Allowable Prcp Anslys~s Init 300.0 coVl00mL SMI8 9222B A (~-1) 04114104 DKC TOTAL P.02 ~~00 ~0 · ~ · ~0~ Z ~o~ ~ 133BIS N~OIN~$ ' r % ;/ ~.~_ % '71/~_" 8 ~ ~ '" L~ 8~ I 0 , ~- ~ ~ . 0 I ~ r ...................... , I I i NOIIVONnOJ 'NgB '3N03 .g I I d: I I I I , , :--X' X--X X X X X 'X "X X ~ 133BIS JJO901 B31N33 ONO~IO '~-B 'BI ' 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. # 1..: GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY' APPROVAL FOR A SINGLE FAMILY DWELLING · Complete legal description Lot 12; Block 5; John well~. 1952 Addition Location (site address or directions) 2237 E. 86th' Court ·: .. Anchorage, ~ ·; "~' Pronely owner',." Michael J. Warburton Dav nhone · : Ma ing addressC/O r~bra Hardman 2228 D. 86th Court Anchoraqe, I~endi,ng agency AK '99507 Day phone i ~ '-, ' 'r'ingtO the legalit]iandstatUs ' , 4. TYPE OF WASTEWATER DISPOSAL: ,,~: . ~ al on-s~te ~ iol'ding attesting to the legality and status of systeml " ' ;r ' 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. $& $ ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone Eagle River~ Alaska 99577 Address .~j~ ~ Engineer's signature . Date DHHS SIGNATURE ,~ Approved for _~'~ Disapproved. ./Conditional approval for bedrooms. ROBERT C. COWAN t ~ ~ bedrooms, with the followin~ stipulations: Add t ona!;Comments ' B,Y: The Mdnlclpahty of Anchorage Department of Health and Human Serv,ces (DHHS) issues Health Authority Approval Certificates based only upon the representabons given in paragraph 5 above by an ,ndependent 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 engineer's work. 72-~25(Re~.1,'91) Ba~k MOA~2t Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: A. WELL DATA Parcel I.D.: Well type Log present (Yt~I ,~v Total depth Sanitary seal L(?N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed v' / ~ Cased to ~;~ o ~ Casing height (above ground) Wires properly protected((~/N) %¢ ¢' J Date of test Static water level Well production WATER SAMPLE RESULTS: FROM WELL LOG g.p.m. AT INSPECTION Coliform Date of sample: 7 B. SEPTIC/HOLDING TANK DATA Nitrate Collected by: Other bacteria o ENGiNEErING ....... ~,~ ~,;w~' Loop ~oad ~o. 204 Date installed -7 ~ Zq- ~c Tank size /ooo Number of Compartments. %~ Cleanouts ((~) . Foundation cleanout ~). Y Depression (Y._~ /~ High water alarm (Y/~)) ~J Date of Pumping r-[ ~-~ Pumper C. ABSORPTION FIELD DATA Soil rating (g.p.d./fF or fF/bdrm) Gravel thickness below pipe Monitoring Tube present (¢~1) Y' Results (Pass/Fail) Date installed Length q~%' Width_ EffectiVe absorption area (~w5 Date of adequacy test /'~ Fluid depth in absorption field before test (in.); (ins) Minutes later: Fluid depth Peroxide treatment (past 12 months) (Y/N) (~ ¢¢"/,~ystem type r~,p~o Total depth '4/~,. ~/"2'r:,,~ ¢,~¢0'~ __ Depression over field (Y~) fi For _ ~-, bedrooms Immediately after ~- gal. water added (in.): .... Absorption rate = ~ ...... .g.p.d. If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm3evel-~t¢ _~_~Cycl~s tested E. SEPARATION DISTANCES Size in ga! ons ............ on" level at* "Pump off" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: LS_~_~holding tank on lot / ¢ O/ '~¢'' Absorption field on lot /o ¢ 4- Public sewer main rd /A- Sewer/septic service line ~-z.~j 4 On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM/_~'~'I~_~HOLDING TANK ON LOTTO: Foundation "] o Property line ,V¢i Absorption field Water main/service line Io c % Surface wateddrainage / ~° 'L~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ~ O Building foundation I ~ Water main/service line Surface water ! u o --~ Driveway, parking/vehicle storage area Curtain drain f'' ~.~'z ~:"~ ~ ~ "~ Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that, have de,ermined thru field inspections and review of Municipal records in conformance with MOA HAA ~uideline¢ in effect on this date. Signature /~ ~.¢ ~ ~ ..... Engineer's Name ¢ [ ¢ ~-4'1 ( - (8~-~4...~ Date ~ IS / ~ (. HAA Fee $ Date of Payment Receipt Number c~?._~,'~- U/~O / 72-026 (Rev. 3/96)* Waiver Fee $ _ Date of Payment R ec e i pt N u m b e r ~'~-~' ¢;?-U/~'/~/~ CT&E EnVironmental Services Inc, Drinking Water Analysis Repo~ for Total Coliform Bacteria ~oo w. ~AD IN~TR~CTION~ ON R~VE~E ~IDE ~EFO~ COLL~CTIN~A~L~ roi: (9071 562.2343 Anchor,~e. AK 99518-1 605 PUBLIC WATER 5Y$TI~b! LD. # PRIVATE WATZR SYSTEM Fax: {9071 561-5301 Analysis show~ this Wa~:cr SAMPLE to be: JS~' S~tisflcmry o Unsatisfactory 0 Sample over 30 hour~ old, resulB may be unret~able Sampt~ too long in transit; sampJe ~hould no~ be over 48 hour~ old at examination to Mdicatc reliable resulB. Please scad new Sample via *pecial de]ive~ mail_ _. Date Received Tim e Received t~l'o n th Day Year SAMPLE T'Y~E: O Routine //~ Repeat Sample (for routine sample 0 Treated Water with lab ref, no. _c~/;. 3 Z ~g . ) ~ Untreated Water O Spec/al Purpose Time Collected $ A/~I2>LE LOCATION Collect,d By Yom'meritS: Analysis Began Analytical Method: ,..~-' Membrane Filter o MMO-MUO "Number of colonies~lO0 mL Lab Re~ No. Result* Analyst 5e~t to A-0. E C Anch eb~ Jun ~ Faxcd Dare: __ Time: _- Client notlHed of Unsatisfact0ry results: BACTERIOLOGICAL WATER ANALYSIS P. ECORD Phoned Spoke with Dale; ~ Time: ~MO-MuG Result: ~otal Coliform Membrane Ftlter: Direc! Count Verification: LTB Fecal Coliform Confirmation Coif ~ Coloniel/100 mi COLIFIR~M U Faxed CT&E Environmental Services Inc. Laboratory Division 200 w, Potter Drive Anchorage, AK 99518-1605 Tel: (907) 562-2343 Fax: (907) 561-5301 CT&E Ref.# Client Name Project Name/# Client Smnple ID Matrix Ordered By PWSID 963283001 S & S Engiaeeriag L12 B5 JOhn W¢ll~ 1952 Add, L12 B5 Jolm Wells 1952 Add. Drinking Water PWSI'D 0 Smnp[~ Rem~rks: Client PO// Printed Date/Time Collected Date/Time Received Date/Time Technical Director 07/30/96 07:59 07/26/96 12:30 07/26/96 12:40 Nitrate~N Tote[ coliform Results PQL Unlts Method 0.100U 0.100 m~/L EPA 353.2 0 0 co[/lOOmL SM18 922~B Altoweble Prep AnatYsiS Limits Date Date Init 07126196 USC 07126/96 TAV ~~ Member 0f the $G8 Group ($oei~t~ G~mlrsle de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA. FLORIDA. ILLINOIS, MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA