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Home My WebLink AboutCOHOE LT 10ACoho Lot IOA #015-051-23 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ame DISTANCES J ~(, Cci ~[~'~C'~-_~-~ ~ SEPTIC ABSORPTION Address [ TANK FIELD WELL . . ~ I Permit NO. INd. of ~edtoom~s' '' WELL ' ~-~0~1 I~10~I ~ 200 t ~0~ ~.o.~D.sc.,.T,O. LOT LINE / O ~ Township, Range, Section / o / o h - A~-BUILT DIAGRAM (Show location of well, septic system, prope~y lines, foundation, i~ ~ ~ , ~J- ~ : B ~ I ~ driveway, water bodies, otc.) ' TAN~S N ~ SEPTIC ~ HOLDING Manufacturer CapacRy in gallons Ma~er~al ~ No, of Compa~ments TYPE OF SYSTEM - '; ~' TRENCH ~ BED ~ W. DRAIN ~ OTHER Depth to pipe bottom from I Total depth from original grade Fill added above original grade Gravel depth~beneat~ pi~e 0 FT [~ Fi Gravel length Gravel width Total absorption area Distance between lines ~ ~ ~ S~ FT ~ FT Installer ~ ' Date Installed WELLS ~ PRIVATE ~ OTHER Hdentifv) Classification (A,B,C) Total Depth ~ Cased to ~ FTII FT Instalter Date Installed: REMARKS: Inspections Pedor~ '~:' ",'* ~ ::" ~ "~ ~70:~'~' ~le River Loop Koad NO. 204 7/~ .... ~--~a 99.577 ce~ily thais insp~ion was pedormed according to all I Eagle Health Oepa.ment Approval' .' / Date: ' ' -/ ~ 72-013 (3/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744 HAND WRITTEN PERMIT Permit Number: SW Date Issued: //~/~ Design Engineer: S~$~'~~ Owner Name: Owner Address: Parcel ID: Lot Legal: Subdivision: Section: Lot Size:~;~D~ ~ or acres) Max Bedrooms: This Permit: Permit Type: ~yW~ Expiration Date: Day Phone SEPTIC TANK: Minimum septic tank capacity:/~;c; gallons. Each septic tank must have at least 2 compartments, insulation is required if depth to top of septic tank(s) is less than 4.0' Lift stations require an appropriate electrical inspection. WELL LOG: A copy of the well log must be sent to DHHS within 30 days of the well's completion. -;~ ~;~¢~_,~,;;A ~/~¢~) I CERTIFY THAT: 1. I will install the on-site sewer system and/or well in accordance with all codes and regulations of the Municipality of Anchorage (MOA) and State of Alaska , and in compliance with the design criteria of this permit. 2. I will adhere to all MOA and State of Alaska requirements for separation distances from any existing well, septic system, or surface water on this or any adjacent or nearby lot. 3. I understand that this permit is valid for a single family dwelling with a maximum of ~ bedrooms. I also understand that any enlargement will require an additional permit. 4. I understand this permit is issued for 365 days and expires one year from the date of issue. 5. I will notify DHHS prior to all inspections by the e~r or well dril~ / ( ow'"~e~ i g nee )/~/ . db/ll5 unicip lity of nchora e Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. BOX 196650 Anchorage, Alaska 99519-6650 January 8, 1991 Jerry Green 1323 Annapolis Drive Anchorage, Alaska 99508 Subject: Lot 10A Cohoe Subdivision Permit #900359, PID #015-051-23 The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as of December 31, 1990o A new permit must be obtained from this office for a well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Siam_4~er ly, ~ J ith Pyogram Manager On-site Services JW/ljm: 200 enc: Copy of Permit "Kids Are Our Future" 'FI...IE I:~EF'L.ACEI'"'IEI',.IT 'T'I::~:ENCH IvlUS'T' BE :1.2 FT. F:'R:OM THE OLD CR;[E-~ A'f' 'T'HE i,41:;]t;:;:"l'~l,,.I f:~t'.,ID ~!i~l::JI.J"l"l-,I I~Jq:l:)S,, I...Q'T' I....;I;I',IE 1,4~ZVE:RS PlAY BE REG!LJ;1.'I:;~ED., "J'l,,,!J!il; EX ..... (i:;~,:~.?'~¢,:.~"f;!;(;ih.~!!!~ t','i!.,}:!!;']' Edi'.i; [:)i:::']ii!J-.,lliii).)/[;;',i,,,[:):ii!~ii:iI',)'l~'~"-[llii; !i!;¢:'~l"li!ii; i;.:,(.~Y (;:'fi:i'. ~;::di:!; I,,'}liii;f,Vl"l!i!?-[3'v'E:f',?, ..... ........ ;/.:::,lit,,,!:::. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~ OO / ~ .--""--~,~/* ~T' y' LEGAL DESCRIPTION:L..~3?' /O :; ~J't O'~ 2 3 4 5 6 7 8 9 12 13 14 15 16 17 18 19 2O DATE Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? ~ O S L IF YES, AT WHAT 0 DEPTH? p E Depth to Water Altqr Monitoring? C'~_ O"~ Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN -.--""'-'~T AND FT CO~MENTS~'7 ~:~O PERORMED BY;AccFoRDAN/~EWiTH ALL STATE AND MUNICIPAL GUIDELIN~IN ~'FECT ON THIS DATE. DATE: TIFYR THAT THIS TEST WAS PERFORMED iN 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ~.~ ~"~"~ ! _/0 } t~_,',~.~-~ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O DATE Township, Range, Section: SLOPE SITE ~LAN · WAS GROUND WATER ENCOUNTERED? ~ C) s L IF YES, AT WHAT O DEPTH? p E, Depth to Water Attar Monitoring? ~l~ Date'. Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER __ ZZ-- 1~30 ~ TEST RUN BETWEEN ."-""~'~T AND __ FT COMMENTS ' ' ' / PERFORMED BY:Ea~,. ,,~,_., I/~/~~'::"'--/--~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE~CT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ROBERT SHAFER, P.E. ROGER SHAFER November 27, 1990 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & 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 10; Cohoe Subdivision; Permit Number 900359 Request you approve the design change on the referenced permit. During the first portion of the upgrading process the existing septic tank was found to be of poor integrity. The septic tank wil~ need to be replaced. At that time elevation measurements were taken. We found the lot to gently slope uphill to the east. In order to achieve a 6 ft. effective depth the trench m~st be 16 ft. deep at the deepest portion. Two additional test holes were drilled to a depth of 22 ft. each. The soils encountered were consistent with soils found in the original test holes. After seven days of monitoring, the test holes were dry. We request to change the depth of the bottom of the trench from 10 ft. to 16 ft. If you require additional information for your review, please contact Sin(_×~~ /gm MUNICIPALITY OF ANCHOP. A(~ DEPT. OF HEAETH & ENVIRONMENTAL PROTECTION 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 October 30, 1990 ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & 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 10; Cohoe Subdivision PEPJ~ZT REQUEST NAERATI{IE Request you issue a permit to install the proposed septic system on the referenced property. The existing log crib is failing. completed (see attached). Soi~ tests and a design have been The subdivision is served by a Community Water System. The area behind this property is undeveloped and all septic pipes within 200 ft. of the proposed system are shown on drawing 2. We feel the proposed system will be best suited to serve this small lot without adversely impacting any systems on adjacent lots. If you have any questions or require additional information for your review, please contact us. Sinc~ MT A. SHAFER, P.E. gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 · · · U PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SITE PLAN SLOPE _ / WAS GROUND WATER ENCOUNTERED? /k.) C;~ S L IF YES, AT WHAT O DEPTH? p E Depth to Water Alte~l/ Monitoring7 ~/ Date: I tO - I ~ - q0 Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE 2.. 0 (minutes/inch) PERC HOLE DIAMETER TES]' RUN .BETWEEN ~ FTAND ~FT PERFORMED BY: 17034 Eaale River L~D Road kl~ ~~ CERTIFY THaT THIS TEST WAS Eagle Riv;r, Alaska 99577 ..... ~ ~/ /o /~ / ~ ~ PERFORMED IN ;2~;;~,;~;5~,TR ALL STATE AND MUNICIPAL GUIDEL~FFECT ON THIS DATE. DATE: /(~/~o/~ ~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SITE PLAN Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? s L IF YES. AT WHAT O DEPTH? p E Depth to Water AlterI· Monitoring? d[d'~ Date: t Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~_. I~ (minutes/inch) PERC HOLE DIAMETER [,')_ ' ' TEST RUN BETWEEN ~ FTAND ~ FT PERFORMED B77034 Eagle River Loop Road No. ~l'~ /L// ~ CERTIFY THAT TH~ TES:I' WAS PERFORMED IN Eagle River, Alaska 99577 - ACCORDANCE VV]TH ALL STATE AND MUNICIPAL GUIDE I~_.~/FECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE MEMORANDUM Date: November 7, 1990 TO: Accounting & Budget, DHHS Fourth Floor FROM: On-site Services, DHHS Fifth Floor SUBJECT: Request for Refund - Account # 9570-9426 Please make the necessary arrangements for the following refund. This property is serviced by a community water system and there is no well permit required. This was requested in error. Thank you. S & S Engineering 17034 Eagle River Loop Road #204 Eagle River, Alaska 99577 Lot 10A Cohoe Subdivision Well permit portion refunded Receipt #22312/3744 November 1, 1990 Amount: $50.00 Account # 2570-9426 Lau~~tgo[~mery On-site Services cc: File S & S Engineering Legal Description / O i(~t ~ r Lot Block Subdivision Lot Size ~¢ ~ ~Sq. F, Inspections will be conducted by: ~ Number o Bedrooms: ~ ~ L ..... Approved Engineering Firm . ~%..t ..... --~ Municipality (permit fee included) ~(~ L~~..~ Does your house contain any of the following: Hot Tub, Swimming Pool, Therapy Pool Jacuzzi ~ or Water Softener Unit? ~ o If ves. which on~ ' This...,,c.,io. isfor: I cedify that the above information is correct. I fu~c~fify that t~ ~pli~ beina ~e fora Single Family Dwelling and in accordance with applicable Municipal codes. ~ ~ S & S ~NGINEE.,NG ~~ ~~ 17034 Eagle River Loop Road No 2g- ~--~ -~~~. ~C=_~ ,, - . -. --. - ..... ' ~ / ~ ~peny Uwner/well Dri,er 72-012 (fl~v 10/8~) Municipality of Anchorage ~ DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Services Division Telephone: 343-4744 .............................. ON-SITE SERVICES FEE DOCUMENTATION Date Paid://~/-- ~' N,~me of Pa~er;_~ame on Check), Mailing Address: (~ff_of check) . Legal Description(s): Z /¢ ~ Type of Payment: (Indicate Amount Paid) Health Authority: /~ /~/2~ Excavator Permit: Sewer & Well Permit: Well Permit: ~'~) Sewer Permit: ~'~ ? Copy Request: 72-034 (Rev. 10/87) Engineer Permit: Pumper Permit: Well Driller Permit: Tank Manufacturer: (Waste Treatment) DISTRIBUTION: OS- 22312 Permit Number: Receipt #: Check #: WAIVERS: Lot Line: Well to Tank: Well to Field Field to Surface Water Tank to Surface Water WHITE--MASTER FILE CANARY--PROGRAM FILE QGRE/ ~.R ANCHORAGE AREA BOF"JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS/-7/]Z/Z~/ ~-/~~Z~]~'''/i~;~/~ ~/{ PHONE~PT~~/~- //~{~']~-~ t: ~ -~w~ , LEGAL DESCRIPTION /'b [' /'~ (P~-/..(x~. / / SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH NUMBER OF COMPARTMENTS / INSIDE WIDTH LIQUID DEPTH __.LIQUID CAPACITY. /~") GALLONS· SEEPAGE PIT: NUMBER OF PITS / DIAMETER __ LINING MATERIAL B SIZE: · / BUILDING FOUNDATION~' . / ./ OR W~DTH'k~, LENGTH '~,""" DEPTH DIAMETER__DEPTIq DISTANCE FROM: WELl._ /~-~ NEAREST LOT UNE ~ / TOTAL EFFECTIVE · ABSORPTION AREA (WALL AREA) -~"~)'"/. / SQ. FT. ADDITIONAL ABSORPTION 2&~"-/'~-~ -~ WELL: , ' BUILDING NEAREST FOUNDATION __, LOT LINE CESSPOOL , OTHER SOURCES APPROVED ~"'~-~' DISAPPROVED DEPTH DISTANCE FROM: NEAREST SEPTIC .,-~ ~ / SEEPAGE SEWER LINE , TANK ,,z..-~'~';, SYSTEM /"Pg) ~'~' REMARKS PIPE MATERIAL: LOT SLOPE: ~'~'LLE~' REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM G.A.A.B. GReATEr ANChorage AreA BOROUgh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT 'EGAL'DESCR,PT,ON Z_ I0 d___? ti : '+ - INSTALLATION OF: SEPTIC TANK SEEPAGE PIT ~ ' DRAIN.FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED ~'t~'} FINANCED THROUGH TO BE INSTALLED BY '!~'~~ SOIL TEST RESULTS NOTE~ TH~S PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SI~E YPE ~ REA SV~E MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT .TO NEAREST LOT LINE./ ~.L WELL TO~EPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD DRAIN FIELD DRAIN FIELD SEPTIC TANK, TYPE 0 ,/t2, DIAGRAMS* OF SYSTEM SEEPAGE PIT / ~' ~'~ / ALSO CONSIDER AREA WELLS. , SEEPAGE PIT /~) / ., SEEPAGE PIT , DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 fEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REg/~TIONS REGARDING I~?STALLATION. OR I CERTIFY THAT I AM FAMILIAR WiTH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ~ORM N~Q-OI 6 Alaska Mineral & Materials Lab, Inc. 702 W. 32ND AVENUE ~ ANCHORAGE, ALASKA 995~03 TELEPHONe 272-2716 OR 277-7111 June 14, 1973 Greater Anchorage Area Borough Department of Environmental Quality' 3500 Tudor Road Anchorage, Alaska 99502 ATT: Denise Bashaw Gentlemen: The enclosed is an addendum to the soil analysis and recom- mendations regarding seepage for on-site sewer for William Maus, Case 24, performed May 29, 1973, on Lot 10, Cohoe Subdivision. Permeability indicated 228 square feet of drainage area was required per bedroom. This excavation was again inspected on June 13, 1973, after further exposure, and is re-evaluated at 175 square feet per bedroom. This drainage rate is based on the improvement in strata conditions as the pit was enlarged in a northeasterly direction where clean gravel seams and lenses were encountered. Sincerely, Lab Manager, Physical Testing REC:sd ANCHORAGE, ALASKA 99502 Performed For William Maus Legal Descri pti on: Lot 10 B1 ock This Form Reports Soils "L~g xJt Date Performed Su~'division Cohoe ~e-r.c6iation June 13, 1973' Test Depth Feet / 2 ~ 3._. Soil Characteristics G~:avelly silty sand to sandy s£1ty gravel with pockets and 'lenses of medium sand; cobbles to 12" (GM) with clean gravel seams and lenses below 6' W~s Ground Water Encountered? No If Yes, At What Depth? Reading Date Gross Time i, Net time ) Depth. to H 0 I Net Drop !,, PercOlation R'at~ Proposed Installation: Seepage Pit xx Drain Field Depth Of Inlet Depth To Bottom Of Pit ~r Trench COMMENTS: 175 sq.£t Jfdraina~eareaisrequiredper bedroom. - N Test Performed BY_R.E.Carlisle ' ' m Data Certified By: DEPAR,,,ENT OF ENVIRONM 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE # , g4, 'Performed For WilliamMaus Date Performed..May2.9, .1973 Legal Description; Lot 10 Block Subdivision Cohoe This Form Reports Soils--L~g ×× T~l-~t-ion Tes't De 1-- 2~ 3~ 12-- Soil Characteristics 6~ga'nics, roots, moss, etc. s~ilt with gravel, red/brown, some orga,n, ics ML Gra,velly silty sand to sandy silty gravel' With pockets and lenses of medium sandjcobbles to 12" GM W~s Ground Water Encountered.? No If Yes','At What Depth? Reading Date Gross Time j Net T~me i Depth to H20 ' Net Drop, ' , .... ' .... '~ .......... i,' ,.-...:-., ,1,'.' ".i ..... . ,, "'. ", .... Perco 1. a-~i-on Rate Mi'nute .. Proposed Insta¥1ation: Seepage Pit xx Drain Field Depth Of Inlet Depth To Bottom Of Pit Or Trench COMMENTS: The soils characteristics requi.re 2.,28 sq. ft,. per bedroom.. ... . ye'st Perfd'rme'd'""By.. ,W. F'. Atwood ALASKA MINERAL & MATERIALS LAB,' o'at'a Certi-fi"e'd '"By: Date,; Mav 30, 1.973 Municipality of .An. ch?rage D6v~eibpm'ent. se~ices Department '"":.~ On-Site Waier add Wast~,~'ater Pr'ogra'm': '. P.O.' Box 196650'~ch6r~g&?AK 99519-6650 ?'. ' ~,: · ' ' - ..... www ci anchorage ak us, . ·, ' (907) 343-7904: . HEALTH AUTHORITY APPROVAL-' ~:..." - .. . FOR'A', SINGLE FAMILY DWELLING Day phone': 346~.~706 '; · ~9219Str:utz'Av~e:.A~:h~rafl~,'AK99515 ' '" " - Jea'nneBiedien':'.." · '-' ' .DayPhb~e:· "' "' ' ::" · Day phone '244-1921 · ' ~-Complete· lega! description. ' ..... . ' Lot 10A, C0h6e Subd~v~smn ..Locat~(~n (s~te address or directions): 92t9 Strutz Avenue Current Properly owner(s), Betsey Hain~slLizWi Mailing address Lending'age~,ncy Mailing a~dress... Real Estate Agent : Mailing Address .. ' ' - ' 31 t I C Street '.;. An~h0raqe, AK 99503 Unless otherwise reques!ed, HAA will be held by DSD for plckup. 2. NUMBER OF BEDRooMs: Three(3) 0 [] [] [] TYPE OF WASTEWATER DISPOSAL:' Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] 3. T~PE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class _A Well Public Water System The Municipality of Anchorage Development Services Department (DSD) Issues Cedificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in tho State of AJaska. 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 private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up Io one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4: STATEMENT OF INSPECTION BY ENGINEER,', .: ,'- ",:' .- · ' n~ ,;~rtifi~:~:bv'~/se'al ~ffi~&:l I~'~t~ ~'~ of the valida~on date sho~ bel~ I ~i~ t~t my i~v~tig~t~. ',,, ........h' ~-~ 'nn"ni~;l~. ......... ~]fl~n~'""" 'n'~ th~'H&a ~ Au{~ ...... Appro~a GdMelin~s*'fm this ap~ ~t~ s~ ~at the ', ' ~ on:sit~ ~te~ suPPI~ an~6r ~ast~wate~ dis~sa system is(are) ~fe 'functional ahd ad~uate f~. t~ n~m~r'~f b~dr~ms a?d ~pe of s~cture ind~t~ herein: I ~yeri~ that bas~ on the inflation ~tain~ from ~e ' ' - ' Munid~li~ '6f ~ch0~, files '~dd from :my,inv~stigation add insp~tion,* th~'on-~ile ~t~. Supply anWor' ~tewa~er"d spo~ Syste~ s(are) in' ~mp an~' ~th all appli~ble M~ici~al and S~te'c~?~dihances,- and ~eg~tat~ohA i~ ~ff~t at the time of ins~llation. . . .. .... N~me of Fi~ ~de~on En~lneenn~ " .' ' ', Phdhe" 5~-~3 : ' . . Address P Box2~3 ~ch - '" ~._ En*'~ne;;'s ~nted Name' u~aelE.':An~e~o~ 'P.E: .', .'" , Date :~ ~ ~ ".*' ' ' " '"'" """' ' ' """' ' '""' "; ' ' ' '" "'~ ~F'~'"~ ''"' ............ . ..... , ~., ..., . .. ,. ~. . ;:~ - ,.. ..... . ,..~. ,, . , ...~, ,.,.~..~.~...~T~.~/~, 4~"' .. . · , - , , , , . , ~,~.~t~,Et ~ ~O~l~ ~, , . .. ~ . ,. . ., .... . ~., ....... .~ ,, 5.' DSDSGNATURE, , .- .-. ' ' '.- - . ~.~:.., .' . '.'.~. - - ....... ., :. . ~ ,~ .~ .. ~, ~ ~ , , ' · - ' ~' Approved for" ..... ~ ~'~ [~'edrooms.:~:', 2 '" ,.': · "- . .' "., {~[~ ~[*~'.".', .... ,. - · , ", ,:;,'X' ~.' 7.':;~-~"-:" "- '~'," "" ' - '"' '; : ' -~~ "'' ". ~ "- "~ ' '"' fora' "' -"b'd' ' 'th'th ..... "' ' ' Cond t o'na adp for' - ' e rooms w~ e fol owing st~pulat ons.., ,., ,. ,. - .. ; ...... ,,- .:, -, .' .,, ...- - .. , , ; *: '~.;~ . , ,, ,' - ' ........ '- -' · :- ' '. - ,,,¢x~,u~4ew..~....... c-~ ..... . .... ,,.,¢;~e~.. ...... . ¢~. .... .. . . -,~,... ,'. . %.~¢ · .-; ;',~; .~- .v': ~, ..... . .. ,.. ~" ..... . ..... :~¢~ -. -- ,~.: .ON-SITE. ,- , . . ~' .. .' Additional Comm~nt~ ~ . WASTEWATER . Attachments: HAA Checklist Septic System Advisory ' Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Cedificate Date: Legal Description: A. WELL DATA war type A Date completed Total depth Date of test Static water level we~ preduct~n Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewate~ Program 4700 South Brag St. P.O. Box 196650 ~ge, AK 99519-6650 ~v.ci.anchorage:ak.us HEALTH AUTHORITY APPROVAL CHECKLIST Lot tOA, Cohoe Subdivision Parcel ID: 015-0M.23 If A, B, or C p,-ovide PWSID # Cased to lt. FROM W~=l I LOG wa Log (WN) w~s pmpee/m~tad (Y~N) Cas~g height (above ground) AT INSPECTION g.p.m. g.p.m. WATER SAMPLE RESULTS: Coltfoml cokm]esJl00 mi. · Date of sample: e. SEPTIC/HOLDING TANK DATA Tank Type/Matedal supflrJSteel Tank size 1,000 gal. Foundation deanout (Y/N) y. Date of pumping ~/1~01' C. ABSORPTION FIELD DATA Date installed t/12/1991 Total depth 1%13.6 lt. Nitrate mg.~. Numt~r of Compartments Oepre~_~idn ove' tank (Y/N) Pumper Old MacDonald's Pumplnfl Date of adequacy test ~J/2001 Results (Pass/Fall) Pass Fluid depth in absorption fle~d before test 0_ in. Elapsed Time: ~0 min. Final fluid depth ~ in. Any rejuvenation I~eatment (past 12 mo.) (Y/N & type) N 8oll rating (g.p.dJlt2 or fl~/Ixlrm) .$ GPD/SF System ~ Deep Trench fl. Width 3 ft. Gravel below pipe 6 lt. EfT. abso~tlon area 768 (Record) ~ Monitoring tube Y Depression oyes' field N For_3 bedrooms Water added4.~0~ gal. New depq in. Absorption rate >= 450 g.p.d. ff yes, give date N/A D. LIFT STATION Date instailed 'Pump on' level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off' level at __ Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanYulilt station on lot Absorption field on lot Public cewer main Sewer Iseptic ses'vice line Manhele/A ~ _~_ _$ (Y/N) High water alarm level at Meets alarm & cimult requirements? On adjacent lots >200. On adjacent lots >200' Public ~ manhele/deanout N/A Holding ~enk N/A SEPARATION DISTANCES FROM SEFrFICJHOLDING TANK ON LOT TO: Building foundation >5' Water main N/A Wells on adjacent lots >200' Progerty line Water sewice line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation >10' Absmption field >5' Surface water >100' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >200' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal tecerds that the above systems are/n conf~mance with MOA I-IAA guiderlnes in effect on this date. Engineer's Printed Name Michael F_ Anderson, P.E. Date 6/25J01 Date of Payment Waiver Fee $ Date of Payment Receipt Number Property llne >10. Water rain >10. June 25, 2001 Dynamic Properties 3111 C Street Anchorage, AK 99516 Attention: Jeanne Bierlien Subject: Lot 10A, Cohoe Subdivision Septic System Inspection and Certification Dear Jeanne: On June 9, 2001, we inspected the septic system serving the three-bedroom home on Lot 10A, Cohoe Subdivision. Prior to the inspection we researched the information on the system located in files maintained by the Municipality. These files indicate the system was originally constructed in June of 1973 when the house was originally built. The original system apparently failed and was replaced by a new system in January of 1991. The current system consists of a 1,000-gallon septic tank/md an absorption trench with two lateral built along the perimeter of the original absorption crib. The length of the laterals is shown on the as-built drawing prepared in 1991 as 31' and 33' respectively. The actual measured length was found to be 29.5' and 27'. The as-built of the system indicates 2" of insulation has been placed over both the septic tank and the absorption bed. No water was found in the monitor tubes in either lateral prior to the injection of 450 gallons of water. No water was noted after the injection was completed indicating the system absorbed the entire amount during the test. We are confident the system is currently capable of absorbing more than 450 gallons of water per day. We make no guarantees, however, of the ability of the system to sustain this rate in the future. We noted the monitor tubes and cleanouts had been cut off flush with the ground and were slightly buded, The Municipality requires the tubes be accessible for cleaning and monitoring of the system as required. They are currently uncovered and should remain SO. Sincerely, Michael E. Anderson, P.E. 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 AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) 92~9 Stru. tz Auc..n~e. Property owner Bryce and C/~,¢.ot~. Ray Day phone Mailing address p,0. Box 1245 Kod~a/~; AZaska 99615 Lending agency Day phone Mailing address 276-2001 Agent Charle. ne. McLean / 2001 Realty Day phone Address 2600 De. nali, Su. it~ 400 Anchorage. Alaska 99503-2740 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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 XXX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. $ & $ Name of Firm ~Tn:~ ~n-,~, -~i,,~r L~p Road No. ~ Phone Address Engineer's signature Date 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Three (3) bedrooms, with the following stipulations: Escrow funds to cover cost of system upqrade per S&S Enq. l~f~r of 12/29./g2. N~c~mry p~rmit r~quir~ments must be met prio~o construction. ~11 work to be completed by 7/1/93. / Additional Comments ,---? ...? .., , ,,' / By: ~~~"~ ~ .,¢~/~/'~'/'~ Date 12/30/92 The Municipality of Anchorage 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 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. 72-025 (Rev. 1/91) Back MOA #21 D~c~mb6r 29, 1992 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & 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 Anchorag~ DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Str6~t P.O. Box 196650 Anchorage, Alask~ 99519-6650 Attention: Dan Boll~s REFERENCE: Lot IOA; Coho~ Subdivision D~ar Dan~ As w~ hav~ briefly discussed by t~phon6, it has com~ to our attention that a portion of th~ s~ptic l~achfi~ld s~rving th~ r~f6r~nc~d property has b~n ~rron~ously install6d within th~ utility ~as~mznt. W~ propos~ r~locating that portion of th~ s~ptic 16achfi~ld within th~ ~asem~nt as shown on th~ attachzd sit~ plan. S & S Engineering has ¢ommitt6d to p~rforming this work no later than July I, 1993. Thus, w~ r~qu~st you issu~ th~ previously submitted H6a~th Authority Approval with th~ following conditions: I. Th~ cleanouts b~for~ and aft6r th~ s~ptic tank r~pair~d.. 2.. That portion of th~ s~ptic l~achfi~ld within th~ utility 6as~m~nt is relocated outsid~ th~ ~as~m~nt.. If you hay6 any questions, or r~quir~ additional information for your r~vi~w, pl~as~ contact us. Sincerely, ROGER J. SHAFER, P.E.. RJS/tv Attach~6nt 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~,-~<:::~ I ~ ~' ~ [,~ ~ ~ Parcel I.D. /?//~-~/~/~..~-/~-~_~ A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system nUmber Log present (Y/N) Date completed Driller Total depth Sanitary seal (Y/N) Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot '~-'¢--"qc~ Absorption field on lot '~,'q~4-- g.p.m, g.p.m. ; On adjacent lots ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA ,~ Date installed Cleanouts ~:~/N) High water alarm (Y/N) Date of pumping Tank size ~ ~ Compartments 'Z- Foundation cleanout4[,~N) Y Depression (Y~I~ ~-~ '-'-- Alarm tested (Y/N) ~ "~ ~ ~ "' ~'~ Pumper /~ ~ ~t~_~ ~~. Surface water/drainage 72-026 (Rev. 7/91) Front SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ¢ ) j~ On adjacent lots "'~"¢t~1'4~ Foundation ~Jc To property line \~ J¢ Absorption field ~ 1..~ water main/serVice line ~ ~=~ Jr- CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~ Width Total absorption area Depression over field (Y~' Results ~l~/fail) Peroxide treatment (past 12 months) (Y~ Soil rating Gravel thickness ~ ~/ Cleanouts present. N) Date of adequacy test for "~ I---[ If yes, give date System type Total depth ~'~ '~ ¥ bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ /& On adjacent lots '~:~'~ Property line To building foundation I,-~ Jr- To existing or abandoned system on lot On adjacent lots '~ ~ Cutbank rJ, /A Water main/service line Surface water Curtain drain Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on~~~.this inspection. .~. Signature E~ie River, Alaska 995~ Engineer's Name HAA Fee $ ? 7Z)~'~ Date of Payment Receipt Number ~.'.~~ Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 WALTER J. HICKEL, GOVERNOR (907) 349-7755 December 17, 1992 Mr. Roger Shafer S & S Engineering SUBJECT: Cohoe Subdivision - Revised Letter of Compliance Class "A" Public Water System, PWSlD 212924 Dear Mr. Shafer: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on September 16, 1992. This d_oes meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on September 20, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results were submitted to the Department on September 16, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical were submitted to this Department on June 11, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Asst. II ~.~, pr~mcd o~ rccycled paper SCALE MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~'~\ ~:~- ~1- .C~ HAA# ~"~t~C~.[''~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot I0,~' Cohoe Subdivision Location (address or directions) 9219 Strutz Avenue (b) Property owner Mailing Address (c) Lending Institution Jerry Green 1323 Annapolis Drive Telephone'(home) Anchorage, Alaska 99508 Telephone Business Mailing Address (d) Real Estate Company and Agent 2001 Address 2600 Denali Street Telephone 276-200! REALTY ATTN: Nancy Berth-Pollock Anchorage, Alaska 99503 (e) Mail the HAA to the following address: (or check here [~x. if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle RN'er Loop Road No. 204 Eagle River, Alaska TYPE OF RESIDENCE Single-FamilyY2~ Number of bedrooms. WATER SUPPLY Individual Well [] Community'~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site E;~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & $ ENGINF. ERING Telephone 17034 F..agle River Loop Road No. 204 Address ~ac,]e River, Alaska 99577 Date 6. DHHS APPROVAL Approved for Approved Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATA Well Classification Well Log Present (Y/N) MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 __ Date Completed Legal Description: IJ If A, B, C, D.E.C. Approved (Y/N) Yield Total Depth__ Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: / To Septic/Holding Tank on Lot .7___~0 '¢'- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 2- Oo 'p ; On Adjoining Lots I To Nearest Public Sewer Line ~ ~' '/' To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot / O0/-/' Water Sample Collected by ; Date Water Sample Test Results Comments ~) ~ B. SEPTIC/HOLDING TANK DATA Date lnstalled /-/2-~/ Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) / Holding Tank High-Water Alarm (Y/N) No. of Compartments ! Air-tight Caps (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: Foundation Cleanout (Y/N) . Date Last Pumped /~..) .~. ; for ! To Water-Supply Well To Property Line / I To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ./~ 0~,~ ~'~ Q ~ To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /- [ ~- Width of Field 2 Type of System Design ~E.(A Length of Field ~ ~L / Depth of Field ! r~. ?' ' ']Po ~/-'~. G ' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ To Building Foundation / Lot /' 2 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test / To Property Line To Existing or Abandoned System on ; On Adjoining Lots ..'~o To Cutback (if present) / /c~o ¢- ! Comments D. LIFT STATION Date Installed 'X, Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. S & S ENGINEERING Signed 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Company Date MOA NO. C- ~ _~;;>,o - O¢ ReceiptNo. ~__~.,~ ,~;~Lj (.~/ Date of Payment Amount: $ Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR 563-6775 January 15, 1991 FOR: S & S Engineering Attn: Roger PWSID: #212924 My review of the records on file in this office reveals that the Cohoe S/D Class A Public Water System is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, A. Karnowski - Environmental Engineer {~ p,,ote~J on recycled pape~ b y f3J3. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage· Alaska 99507 279-8686 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Aoproval Requested By: Address: 2. Prooertv Owner: 3. Legal Description: 4. Location: 5. Type of Facility to be Inspected: Number of Bedrooms: Depth Bacterial Analysis~ 6. Well Data: ! C. Construction D. 7. Sewage DtsOosal System: ~ C. -Septic Tank: 1, ~ze /oo o 2. Manufacturer / Seepage Pit: 1. Size ~/~ 2. Material .... Disposal Field: Total Length of Lines B. Distances: A. Well To: Septic Tank , Absorption Area · Sewer Lines , Nearest Lot Line · Other Contamination B. Foundation to Septic Tank Absorption Area C. Absorption Area to Nearest Lot Line F(eq~m~t for Approval of Individual Sewer & Water Facilities Page Two 9. Comments: ~_,~ ~ ~. .Annroved Disapproved Date /~/2/ Apgrova] Valid for One Year From Date Signed Greater Anchorage Area Borough, DeF~rtment of ~-nvironmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the sub.iect sewer and wager facilities located at: Signed Date