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Home My WebLink AboutDENALI HEIGHTS LT 4Onsite File Denali Heights Lot 4 #068-031-04 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 1 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211164 Work Type: SepticTank Upgrade Tax Cod.- nlurnber• nczQn,:zinnnnn Site Legal Address: DENALI HEIGHTS LT 4 G:0759 Site Mailing Address: 3839 COTTON GRASS DR, Eagle River Owner: HAMILTON VIVIAN M & Design Engineer: NORTH RIM ENGINEERING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: 5/26/2021 5/26/2022 302350 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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) Q Tho miss+n We for —An roni sir— inonon+inns r4..rinn the installation. Tho o droll nn+ifv +hn .. i � i� vvao a — v.— "'j—- a ioN�.v uv� io u n i j a io n io �u nu uvi i. The is ciigiiieer o� iau 1 wuly a i� vcvcwNi i ici n Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By� Issued By: l✓ Date: A 6 Date: 5toa� 2 MUNICIPALITY OF ANCHORAGE Development Services Department {' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 068-031-04 Property owner(s) FRERICH DANIEL Flailing address 3839 Cotton Grass Site address same Day phone 696-3267 Legal description (Sub'd., Block & Lot) Denali Hts L4 Legal description (Township, Range & Section) Lot Size 302,350 Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El Upgrade Q Duplex (D) El Holding Tank ❑ Renewal❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: '4 a ri Waiver Fees: Date of Payment:�� - Z j - 2 Date of Payment: Receipt Number: 6037% Receipt Number: Permit No, 0 S P 2 M( y Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 5/21/21 Number of Pages: To: MOA On-Site Services Subject: Denali Heights Lot 4 Septic Tank Failure The subject septic tank has failed- a new tank will replace the old one. The existing seepage trench appears to be working OK. Please issue a permit so the tank can be replaced. Please review as soon as possible. This is a large lot with no nearby neighbor conflicts. Elevations in vicinity flat. If there is need for additional information or clarification please give me a call. Thanks-Steve Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211164, Rebecca Carroll, 05/26/21 SteveEng.com Denali Hts L4 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: The current septic tank has failed- the seepage trench still functions. This lot is large with nearby wells drawn on plan sheet. No adverse impacts are expected from tank replacement. The easements are depicted on the lot. The slope is indicated in the area of the septic system. No conflicts to neighbor properties. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations.  New 2- compartment, 1000 gallon septic tank. Watertight couplings on inlet & outlet.  5 minimum between the tank and trench. 5  to property lines & 10  to house.  4 of cover or insulation is required for tank; an equivalent of 1  insulation for 1 foot soil cover. Tank & solid pipe must be set on well compacted, stable soil.  No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per MOA- sand or pea gravel.  4 diameter cleanouts with airtight caps are required 1  to 4 from foundation wall, prior to any 90 degree bend in 4 inch line, in 2 nd tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10  from the tank positioned to provide cleanout access towards the tank and towards the absorption field. Manhole Riser required in 1 st tank compartment.  All cleanouts must extend to at least ground level.  In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.  Insulation must be placed over any pipe installed under driveways or parking areas.  Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661,  Sewer Service Line is minimum 2% slope.  Septic Tank to be pumped every two years or when required.  Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211164, Rebecca Carroll, 05/26/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211164, Rebecca Carroll, 05/26/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211164, Rebecca Carroll, 05/26/21 2.0' v 4.7' 1 I I I I I 1 I I 10 10 I 10 I 10 D IN I I Im 1:;z1 I I I I I I I I I II I I Lot 5 1 II I X15' T&E EASEMENT N m 0° SEPTIC CLEANOUTS I `-SEE DETAIL 4 161.2' GRID SW 0759 Project 0I Lang & Associates, Inc. 11500 � Alaska 99515-3049 n (907) (907) 522-6476 Phone 522-4625 Fax 000p4p�O kglanglsOolaska.net / jclonglsOalasko.net C o 0 V \ o D � n o I / � o Li I� m D �c 12.0' x 20.3' 2aaius 4 f*1 CARPORT \ o 12.3' x / 20.3' SHED 10' x 25' T&E EASEMENT L� I I I I I 2 STORY WOOD FRAME RESIDENCE DECK House Detail SCALE: 1" = 30' Lot 4 6.941 Acres Lot 3 PLOT PLAN AS BUILT X SCALE 1" = 100' GRID SW 0759 Project No. 08-074 Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Registered Land Surveyors (907) (907) 522-6476 Phone 522-4625 Fax 000p4p�O kglanglsOolaska.net / jclonglsOalasko.net OF A�gOpp I K�•.. I hereby certify that I have surveyed the following described properly: LOT 4, DENALI HEIGHTS SUBDIVISION nd (PLAT No. 85-338) Anchorage Recording District, Alaska, athat the Improvements situated thereon are within the property lines and do not encroach onto the properly adjacent thereto, that no Improvements on the properly lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated this the ZSR' Day of , ?� , at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH ' .................... . ENG. L KNETH AN LS -5202 •:'� 4p�nR��SSI0NA1- � �� Municipality of Anchorage Page ~ of 2_. 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: ~'tNc)q¢?2..~. PlO Number: Name: Wastewater System: .~New__ Q Upgrade Address: -' ,' ABSORPTION FIELD ~0. ~o~ 77~/0 , ~E ~/vc-/~ ~ ~77 ~No. of~BedrooffiS:j ~ Deep Trench B Shallow Trench B Bed B Mound B Other LEGAL DESCRIPTION so,, Rating: Total Depth from original grade: ¢.~ GPO/Sq. Ft. Lot: D',~ck: Subdiv~ion: Depth to pipe ~om from original grade: ,/ Gravel depth beneath pipe ~ ~ ~~/ ~/~ ~ Ft. ~ Ft. Township: ~ I Range:(~ I S.tio.: Fill added above original grade:. ~ Ft. Gravel length: ~/ Ft. ~ Gravel width: / Number of lines: I Distance be~n lin~: WELL: ~ New ~ Upgrade / ~ Ft. /I O Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: F~/O ~' Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: GPM ~ Pump Set at: Ft. ~ Casing Height Above Ground:Ft. TANK I I SEPARATION DISTANCES ~Septic U Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capaci~ in gallons: From Tank Field Station Tank Sewer Lines ~~~ ~ ~ Material: Number of Compa~ments: Sudace Water /~ , /~ ~ _ ~ - LIFT STATION Lot Size in gallons:~ Manufacturer: Line /~ ~ 1~ '~ ~ - -I ~at I High water alarm at: Foundation ~ ~ ~ / "Pump on" level at: .... : Cu~ain ~ ~ ~ ~ ~ ~O ~ - P~p~ Electrical Inspections pedormed by: Drain Remarks: BENCH MARK Location and Description: ] Assumed /~O .~ ~, Elevation: Inspections performed by: 5'~ 5 ~,~,~o Dates: let q-~'qq ~'~'~~'~ ~ ~.,~ cE-88o ~. Department of Healt Hume es approval , ',, ~. -.., ....".,,~,' Reviewed and approved by:,/ Date:,/ '" . ~'~ '' '"'"::,~.- 72-013 (Rev. 9/91) MOA 25 2 2 Permit N o-.S.w940322 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 DescriptionDENALl_: HIEGHTS SUBD. LOT 4 PID No.: 06803104 Legal (Co4& \ DBL 0~02 f~EW 1000 GAL. SEPTIC TANK .FCO -i-2, O 8,5 CO1 41.5 44.5 COg 47.0 51.0 C03 59.0 64.0 C04 98.5 104.5 MT1 95.0 101.5 FCO WELL RADIUS ROBERT C. COWAN CE -8801 72-013 A (1/93) * 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:SW940322 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DISOTELL CARL A OWNER ADDRESS:P.O. BOX 770210 EAGLE RIVER, AK 99577 DATE ISSUED: 8/29/94 EXPIRATION DATE: 8/29/95 PARCEL ID:06803104 LEGAL DESCRIPTION: DENALI HEIGHTS LT 4 LOT SIZE: 302350 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION 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) 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: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. August 12, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SE~NER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 4; Denali Heights Subdivision Request you issue a permit to drill a well and install a septic system to servethep~twobedro~mhouseon the referenced~rty. Test holes were excavated and percolation tests performed. The approximate locations of the test holes are located on the attached site plan. The monitoring tubes within the test holes have been checked and found to be dry. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. This property has enough area for a future septic upgrade. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your ~vi~ontact us. ,R~/LSU/jk / 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ~J Lot 4; Denali Heights Subdivision 1. The scope of this project includes the installation of a 1000 gallon septic tank and a leachfield trench to serve the proposed two bedroom residence for the referenced property. 2. 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. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. 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. 5. 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. 1. A septic tank manufacturer. access. is to be constructed by a certified septic tank Construction shall include two 4" cleanouts for pumping 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4' of cover shall be insulated. Page Two Lot 4; Denali Heights Subdivision August 12, 1994 5. 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' 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. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. 1. 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 (roughed-up) before gravel (sewer rock) placement. 2. 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. 3. 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. 4. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. 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. 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page Three Lot 4; Denali Heights Subdivision August 12, 1994 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes 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. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ~200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. 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: 1. 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. 2. 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. Page Four Lot 4: Denali Heights Subdivision August 12, 1994 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's 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 contractor's activities. Final acceptance of the contractor's 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 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~,(- LEGAL DESCRIPTION: 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS 72-008 (Rev. 4/85) ~ SEAL) DATE Township, Range, Section: WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT ~ O DEPTH? p E SLOPE SITE PLAN Depth to Water After Monitorino? Reading Date Gross Net Depth to Ne,. Time Time Water Drop PERCOLATION RATE~:;./?![!3~|~J ('nutes/inch) PERC HOLE DIAMETER TEST RUN yA BETWEEN .ND .FT CERTIFY THAT THIS TEST WAS PERFORMED IN T ON THIS DATE. DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST /~ SLOPE 1 2 3 4 5 6 7 8 9 10 11 WAS GROUND WATER ENCOUNTERED? 12 13 15 16 17 18 19 20 SITE PLAN I ~ 7;/-/ -I '---'"! S L IF YES, AT WHAT -- O DEPTH7 p E neptll t° Water Altalr"~--/Oale:Monitoring? ~}/'l~'/ Reading Date Gross Net Depth to Ne+, Time Time Water Drop fi:/~e,' " ~'/~" -- '. I-7 ~,~,,. q'fi." I" PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER ~'// COMMENTS(0~/~L' ~_~ (:::~V.~7.~.¢ .~/.])TEST RUN BETWEEN ~ ~ ~ FT S & S ENGINEERI ' / ACCORDANCE WlT~Le~X~'~~ZL GUIDE~ ON THIS DATE, DATE: 72-0~ (Rev. 4/~J by SULLIVAN WATER WELLS P.O. BOx 6}'0272, CHUGIAK, ALASKA gg567 · TELEPHONE 658-2759 OWNER OF LANO /~/5' ,-a .7~ ~"g~ ~'o,.O'~ ) DATE - Sta~ed Ended ~ ~ ~" .el't. oF WELL STATIC LEVEL OF WATER FT. ~:':DRAW DOWN FT. cats. PEr.r., K,n,) OF c KIND OF FORMATION: From,, () Ft. to ~ Ft... From ~ Ft. to..,, ~ Ft.. From 4 Ft. to lDO Ft. From Ft. to Ft. From !O{~ Ft. to]/~, Ft. From I/~_ Ft. to /27 Ft. From. Ft. to Ft. From-/)7 Et. to ~O Ft. From,:~: / 0 Ft. to ~):r~. ~ Ft. From ,:2h,:'} 5 Ft. to From ~" ,~-b Ft. to From_ Ft. to,. Ft.'-- ~/ ~ / From..~Ft. to .~) 5'-D;Ft. FromO~'~ FI. to ,,3OO Ft. From From From I From.. ~,~.~ ~. e--,,J rr,,m From From Ft. to Ft. From,, Ft. to, Ft. From~Ft. to-~ Ft. MISCL. INFORMATION: 1 10~ 6,// 'FoT'qc (~// oPqo ' 4 ~ // Pr <. From From From From ~,om .,om, From From From Ft. to. Ft. Ft. to__Ft..- Ft. to Ft. Ft. to FL Ft. to FI, Ft. to Ft. ~Ft. lo Ft. ~Ft. to,, Ft. __Ft. to FI. Ft. to 'Ft.~ Ft. to Fl Ft. to Ft. Fl. to Ft.- :rrna,ED FLto !:~ L %.. L I V ~Ft. to Ft. ~Ft. to Ft.APR 1 I 1995 From Ft. ,o~l.~l?~'i°alitY O, Anchorage ......................... ~:_,~ uit.__n. ~ ~.~u_?a,_n_.$..,e..rvlces c.',~s' ,.o 6 I! · - MUNICIPALITY OF ANCHO~GE ~ ~"'~ ' '% - ':.- ' ~:~'~'":;~' :"~ ~' ..... ......... P.O. Box 1~50 "Anchomge,~Al~ka:'9~l~O ':';?:~'~'~ :''~ :'~'~: : '~ ....... '~ ..... APPROVAL FOR A SINGLE FAMi~ DWELLING *' ' ........ - ' ~:~'complei~ I~al de~ription LO~ 41 P~ H~M~ .: ........"~ : ...... ~:~Lend~ng age.~ '-' ::" Day phone 4.: ~!;TYPE OF wAsTEWATER DIspOSAl.: '::NOTE: . ~ 'lf communi~ aes~-'ing to me-~ ga~ 'e "- and ~(~. 1~1) F~ MOA~I .STATEMENT OF INSPECTION BY ENGINEER ......... -/ -. :~ {: ~';_ ~:.*i:i.'".~-~':~:~V!~ ' 'r~As-~e~ifi~*bY-~ $'e~[affi~ h~mtO and ~Of the~valid~tion~date shown~low, I ved~ that m~-, inv~ti, ation of this Health Au~od~ Approval applimt~on shows that ~e on-s~te water supply~., and/off~w~tewater d~spo~l system ~s ~fe, fun~onal ~nd ad~uate for the num~r of ~moms~{~ :~.?? and ~ of ~tm~um indi~t~ h~min. I ~u~h~r v~ri~ that b~ on tho information ob~in~ from ~:~{: th~ Muni~ipali~ of ~nehom~ fil~ and lrom my inv~ation and in~ion~'th~ on2~it~ ~at~r :-:C:"~upplV ancot ~a~{~ d~p~ ~{~m i~ iff ~o'~l'~n~ ~ith all Municipal and S~t~'~fi~ ii of Ancho~ e De a.~nt of H~alth and Human ~lca (~HHS) ::'~; ~;':,?.'t::::::::)' APP~ai '~ifl~t~ b~ only "Upon the rep~nations given in paragraph 5 above Dy anmae~naem '=:' ':" =:':r:::: ;: ' , .... : .... ~,, ......... ,~:: '"'"' ' · ; :'~;: ~:~:;:;~,;~':;~; Prof~i0nai~ngin~r ~i~e~ in t?e S~te of Ai~E~ The DENS d~!~:~,,~0 :~; ~:(; ~:~: :;:: and the(r"l~ding in~itUtiOns in ~e~ to ~ ce~in f~eml and ~te.~ui~men~. ~(~.I~1) ~ ~A~I Mu nicipalitY of~iAnchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~---~'T ~ ~)P~"~t Pamel I.D. A. Well Data Well type Log present(~tN) ..~ Total depth Sanitary seal (~N) Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~-q ~ Driller S,3~.~, Cased to ~ o-/.._' u. ~' Casing height FROM WELL LOG .g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/~cl~!n~ tank on lot Absorption field on lot :z_,-{ ~' Public sewer main ~ L Sewer service line 7..~ t ~ Wires properly protected ~N) ,,~ ATINSPEC~ON I'I'! ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ~)~ iP Collected by: Other bacteria B. SEPTIC/;;CLD:.~:C TANK DATA Date installed Cleanouts High water alarm Date of pumping Tank size \~ ~c~ ~ ~ Compartments --z_ Foundation cleanout ~1) ,,~ Depression (Y~ Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/H(~-BtN~ TANK TO: Well(s) on lot To property line Sudace water/drainage On adjacent lots Absorption field Foundation Water main/service line ~ t3' '~' 72-026 (3/93)' From CONTINUED ON BACK PAGE C. UFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ Manufacturer Manhole/Access (Y/N) Surface water D. ABSORPTION FIELD DATA Date installed ~ _ ~ ~ _ c~ ~ Soil rating (GPD/FF) o. Length ~ [ ~ Width '7..5" ' Gravel thickness Total absoq:)tion area '//o ~ Cleanout present (~N) ~ Date of adequacy test ~,,- - I~¢_~.~ Results (pass/fail) Water level in absorp{ion field before test~- Peroxide treatment (past 12 months) (Y~ After test If yes, give date System type T~---~ c ~ Total depth ~.~ Depression over field (Y/{~ ,~ for A~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ To building foundation On adjacent lots Surface water ~ ~c) '~' Curtain drain On adjacent lots ~ o c> ~ + Property line To existing or abandoned system on lot Cutbank ~-~ ~ ~' Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I cern'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect OQ~this inspection. Signa~m . _ . ; ........ HM Fee $ Date of Payment Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back 04×03×95 12:52 COMMERCIAL TESTING ~ 90?6941211 N0.123 Q02 CT&E Ref.~ Matrix CT&E Environmental Services Inc. Laboratory DiviJion __ _ . ............. Laboratory Analysis Report L4 D~-NALI HGT$ $/D Client Same S & S ~'~GINEERING WORK order 11501 0rde~ed By RAY S}IAF~R Printed Date 04/03/9S ® 13:S3 hrs. Project Name Collected Date 03/29/95 ~ 1%:30 hrz_ Project~ Received Dale 03/29/9~ · 16;15 hr;. PWSID UA Technical Director STEPHEN C. EDE Relea,ed By ~~.' ~.. Sample Remarks: SAMPLE COLLEu'r=u BY: S & 8 ENGINEERINg. WITNESSED BY JACK. QC Allowable Ext. A~lal Parameter Result, Qua1 Unitm Method Limits Date Da~ Init Nitrate-N 0.10 U ln~/L EPA 353.2 10. 03/31/~5 CMR U~ - Unavailable Undetected, Repo~tea valu~ is the pra~tical gUantif, icaticn limit.. LT - Le~ Thax1 Secondary dilution. GT = ~reater Than 200 ~A/, Po~er Dr;ye. Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 ;ax: {907) 551-5301 ENV~RON~5NYAL FaCIUTIES ~N ALASKA, CALIFORNIA, FLOR;DA. ~LLI~OIS. MARYLAND, ~ICHI~AN, M;$SOURI. N;W JERSEY, CHI0, WEST