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HomeMy WebLinkAboutFOX HILL BLK 2 LT 6Onsite File 100% % It JO Unly The 3 be%-droom field may be test -ed for Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SWRg©3g6 PID Number:�� Name: ,t,t IAe/ (and( ,(� rcv rota eX n er Wastewater System: El New ;<upgrade Address: Papa �, �T13az. GtiV ,• k Ak ABSORPTION FIELD Phone:9` r��O� 11 () No. of BZedrooms: ❑ Deep Trench O Shallow Trench >4 Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: � Total Depth from original grade: y/ t/ i GPD/Sq. Ft. 7— Lot: % Block: Subdi is on: ! 2 rO Depth to pipe bottom from original grade: Gravel depth beneath pipe C, i 7 v R/ Ft. 14 Ft. Township: (� /�/ I Range: / r ° 1 Section: 33 Fill added above original grade: z. .1 Gravel length: I A / ' • GC -.�' Ft. /" Ft. WELL: ❑ New ❑ Upgrade Gravel width: ^ N/ 4 Numberoflines: R Distance between lines: Ft. t5E? e WtcYr S Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material— �7 PVC, Ft. Ft. 10 13; SQ. Ft. Driller: Date Drilled: Static Water Level: Inst Iler: � a hge Alex Date installed: - 7-' 6 -' 9 Ft. f ac��'r' Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. s SEPARATION DISTANCES 9septic O Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: G Capacity in gallons: From Tank Field Station Tank Sewer Lines I COO Well' let '-f- lei �W A /[//,4 i 7-51+ z � + Material: s��� 1 Number of Compartments: Z. Ico ico+ LIFT STATION WateSurface r LotIO /� / Size in gallons: Manufacturen r: �/4 Line Foundation i G / 70 "Pump on" level at: _ 'Pump off" level at: High water alarm at: Curtain / / JV Pump Make & Model Pump,t,/ Electrical Inspections performed by: Drain If f} Remarks: /Vew- pecl W0.4 con Xrt i BENCH MARK �&4 Alf-- Location �and) Description: G InVW_r- — — /;7 c r a( /a 7/ P 057`/ ��ecis�a 15; /,x 37 nd IZ/X se r— lcij,{ G.b 37.5 Assumed Elevation: ic1z. ENGINE�,E L ''::. A/ o Inspections performed by: �o r7 �' U/9rre� Dates: 1s Q_-1 -29 F; 2ndtf;a aaa.o rr 9 JOHN ARCH WARREN Department Department of Health and HumanMS�esapproval ,� 03 r `��3 <<�.,.°° ° ,.°°�<�OP Reviewed and approved by: a Date: 72-013 (Rev. 9/91) MOA 25 Rick Mystrom, Mayor lkttuncipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci. anchorage. ak. us October 2.7, 1998 John Arch Warren, P.E. 4201 Viscant Circle Anchorage, Alaska 99502 Subject: Waiver Request for Lot 6 Block 2 Fox Hill Subdivision Waiver Request #WR980082, PID 1051-073-15, HA980248, SW980386 Dear Mr. Warren: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 8 feet from the absorption field to the north property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744. Sincerely, y Daniel J. Roth Civil Engineer On-site Services ljw #7 AS BUILT INFORMATION RECORDED BY MICHAEL ALEXANDER, P.E. LOT 12 I NS 3 I 0 TEST HOLE/PERC e TEST /�1 55% S1OpE ••• ` TEST HOLE/PERC 'r m TEST #2 � I � p , LOT 13 9,k i I x• I v ryoo � I ►�---•ell .OF•A .......... w . JOHN ARCH WARREN •:� � s''• CE -8603 : ��` A 200' + TO NEAREST WELL EXISTING DRAIN FIELD GR 200' + TO 161 EXISTING DRAIN PIPE i WELL C.O. INV. ELEV. 102.5 I o EXISTING y o �� • • DRAIN PIPE I ro If I J x EXISTING 1000 GAL EXISTING I C.O. INV. r STEEL SEPTIC TANK BEDROOM EXISTING 2 WELL ELEV. 102.E C. 0. INV. ELEV. 102.6 HOUSE Z U NEW BULL I a N o RUN VALVE o —EXISTING rn {, WELL 1r. moo' FRENCH DRAIN J lN82 218.39' � 1� PE gs�Oo 15' EASEMENT 11 LOT 7 200' + TO 40,001 S.F. NEAREST WELL DRAWING NAME: DESIGNED BY: MTA SHEET AS—BUILT — DRAINFIELD DESIGN DATE: 10/26/98 LOT 6 BLOCK 2 FOXHILL SUBDIVISION SCALE: i•=ao' 1 of LOT 5 �] 40,000 S.F. NEW DRAIN FIELD BED 37.25' X 15' N BED ELEV. 100.6' s I _ S76.74, ,E 0 o231� 1 NEW DRAIN FIELD BED 25'X12' tBED` BED ELEV. 98.6' NEW DRAIN FIELD 12.5' X 12' S<OpF \ BED ELEV. 99.6' TZEBCO FLOW SPLITTER/C.O. INV. ELEV. 101.6 LOT 6 SHALLOW DITCH 40,001 S.F. NEW PVC DRAIN PIPE PNEP DR1NE EXISTING DRAIN FIELD GR 200' + TO 161 EXISTING DRAIN PIPE i WELL C.O. INV. ELEV. 102.5 I o EXISTING y o �� • • DRAIN PIPE I ro If I J x EXISTING 1000 GAL EXISTING I C.O. INV. r STEEL SEPTIC TANK BEDROOM EXISTING 2 WELL ELEV. 102.E C. 0. INV. ELEV. 102.6 HOUSE Z U NEW BULL I a N o RUN VALVE o —EXISTING rn {, WELL 1r. moo' FRENCH DRAIN J lN82 218.39' � 1� PE gs�Oo 15' EASEMENT 11 LOT 7 200' + TO 40,001 S.F. NEAREST WELL DRAWING NAME: DESIGNED BY: MTA SHEET AS—BUILT — DRAINFIELD DESIGN DATE: 10/26/98 LOT 6 BLOCK 2 FOXHILL SUBDIVISION SCALE: i•=ao' 1 of TEST HOLE #1 �Ji' PERC RATE 48 MIN/INCH 0-12" BROWN a3w ORGANIC SILT [ 1'-2' BROWN �ow SILTY GRAVEL WITH SAND ' WATER AT 5' 8' Q m Z Z 2'-5' BROWN C SILTY SAND WITH L GRAVEL +,. 5'-12'6" GRAY _ ajp SILTY GRAVEL:::::::::{ •;S. A.; WITH SAND J 1 f•'!'^. O a Z z o ov V) o x m M Lu Y =� Jap pa In 0 1i U U O j 3F 3Of az Ow Od Q_ • a L. In IL a CL p w p D ow w° wC'� zo 0 Fz aQ �x w OQ �w U- < J Z 30 m m a m TEST HOLE #2 PERC RATE 40 MIN/INCH 0-'8" BROWN ORGANIC SILT 8"-1' 4" REDISH SILTY GRAVEL WITH SAND WATER AT 5' 6" .. 1' 4" - 7' GRAY SILTY GRAVEL • WITH SAND 12" MAX. .4;� OF'q<9��4 Ooui i p W .. �. u. ••• ..... . • •...........• FJ I i 0. .. pw w I r.I �'� JOHN ARCH WARREN I� x ; ,I .• CE -8603 •: moi A <00 ROFESSO w Q i - J Y U Q m z p' m m a Q p a p p z O w O w Om Om NF tn� � o Loo w O m Lo 24" MIN., ALL INFILTRATORS AND PIPING INSULATED 'NTH 2" RIGID POLYSTYRENE m U Z Q OR, UJ U w zpa 00- z " p - z" zwz Ori DRAWING NAME: AS—BUILT -- DRAIN FIELD DETAILS LOT 6 BLOCK 2 FOXHILL SUBDIVISION I'- �Ji' p liJ 1 a3w o �. Q JQ M , �ow V- z V) U p w ' N Q m Z Z uj O ;! F_ a O N K .;. Z�o� IBJ _ ajp •;S. CQ Q J =d• J 1 f•'!'^. Lz W � ~ J }i J co UQ J 11 Qcr z�i Zp Uw O z O cr Ld w m� I II V) 4' MIN. 10 6> MIN. I I I I I DESIGNED BY: MTA SHEET DATE: 10/26/98 SCALE: NTS 2 OF 0 o �. Q JQ M , V- z V) U p it z p a> ' N uj O ;! F_ a a I I I I I DESIGNED BY: MTA SHEET DATE: 10/26/98 SCALE: NTS 2 OF P.O. Box 671302 Chugiak, AK 99567 October 27, 1998 Attn. Laura Municipality of Anchorage Department of Health and Human Services Environmental Services Division P.O. Box 196650 Anchorage, AK 99519-6659 Re: On -Site Wastewater Disposal System Lot Line Waiver, Lot 6 Block 2 of Foxhill Subdivision isC.fi IVF qCT 2 ( 1993 Municipalityoi Aflcnoiac3e Dept. t-o,11tn & H.iman Services Attached is the As Built for the two bedroom on-site septic system for a single family residence on Lot 6 Block 2 of Foxhill Subdivision. Myself, the property owner under the supervision of a licensed professional engineer, completed the installation. During the installation, an additional row of infiltrator chambers were installed on the western most bed. This was done to utilize better soil conditions and resulted in the corner of the bed being installed 8 feet from the property line (see drawings). There will be no adverse impacts because of this waiver to adjacent Lot 5 with regards to future on-site development. If you have any questions or require any additional information, please contact me at (907) 688-4908. Thank you. 243 X893 Michael Alexander, P.E. Attachments MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# P I D # 051-073-15 HA# HA980248 Permit # SW980386 Date Received: October 26, 1998 Legal Description: Lot 6 Block 2 Fox Hill Subdivision Engineer: John Arch Warren, P.E. 4201 Viscant Circle, Anahcorage, Alaska 99502 Applicant: Michael Alexander, P.E. `\. 2"A Waiver Requested: Lot line waiver of 8 foot from north property line Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: _ List Conditions or Reasons for. above:T ,�i/„7;������,7'S /q 7�j�r L7-1Fic19�7-1niv Date: /6 -�-7-9 By: 04 Al Name of Rev r Rec #: 04254/6514 Amount:: $ 115.00 Date Paid: 10-26-98 MUNICIPALITY OF ANCHORAGE��`� G` Department of Health and Human Services �r❑ 1-;�� �1k On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 25, 1998 Expiration Date: Sep 25, 1999 Permit Number: SW980386 Parcel ID: 051-073-15 Legal Description: FOX HILL BLK 2 LT 6 Design Engineer: 0803 Michael Alexander, P.E. Site Address: 021740 WOODCLIFF DR Owner Name: Michael & Patricia Alexander Lot Size: 40001 SQ. FT. Owner Address: PO BOX 671302 Total Bedrooms: 2 Permit Bedrooms: 2 CHUGIAK , AK 99567-1302 This permit is for the construction of: [✓] Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. THE SAND USED IN THE FILTER LAYER MUST BE A CLEAN COARSE SAND WITH 4% OR LESS PASSING THE #100 SIEVE AND 2% OR LESS PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED ON THE SAND USED OR OBTAINED FROM AN APPROVED SOURCE. Received By: Issued By: O_ q Date: L_6 Date: 7-257-0( 61 I�I�Lt.; 1� L_c\� � TZJu��c'i ^�C�w�e 'p �c�� �G t, S i`�c�,r rc�.vi❑;ten c:� b ec') Michael Alexander, P.E. P.O. Box 671302 Chugiak, Alaska 99567 (907)688-4908 September 21, 1998 Municipality of Anchorage Department of Health and Human Services Environmental Services Division P.O. Box 196650 Anchorage, AK 99518-6659 Re: On -Site Wastewater Disposal System, Lot 6, Block 2, Foxhill Subdivision Attached is a design for a replacement drainage field for a two bedroom house located on Lot 6, Block 2, Foxhill Subdivision. Also included are percolation tests. The property has an existing system that was unable to qualify for a Health Authority. The existing field has been in use for 13 years. The existing system is still functioning, however, a new field is required. There will be no adverse impacts to adjacent properties or neighbors by installing this new field. The new field will be installed next to the existing field in the back of the lot. Adequate separation from other property lines and wells will be maintained. The installation will be by myself, the property owner. I will have the septic tank pumped, and then excavate to an access port. I will inspect the state of the tank to assure that the condition is acceptable. A Bull Run Valve will then be installed after the septic tank. The home owner will be able to use the new field and allow the existing field to "rest". This will possibly allow the existing field to become useful in the future. Because of the location of the field and the ease of installation, an infiltrator system has been used. I will contact your office during the installation of the field for the drainfield inspection. If additional information or material is required, or if you have any questions regarding this design, please contact me at (907) 688-4908. Sincerely Michael Alexander, P. . Attachments NOTE: SEE ATTACHED TEST HOLE LOGS AND PERC TESTS LOT 12 TEST HOLE #2� _o LOT 13 ^ ` / �e OFA 1� 9> � * • q. rH � . d I. of �: JOHN ARCH WARREN CE -8603 �� FyFo ° • •' E� o ESSW ate'• 200' + TO NEAREST WELL LOT 5 40,000 S.F. TEST HOLE #1 / N / 0 s � / 0' o a. S76-14, 33E. l 2311 .19• NEW DRAIN FIELD BED 31.25' X 15' SEE DETAILS NEW DRAIN FIELD BED 37.5' X 15' SEE DETAILS LOT 6 / 4 'Oen 40,001 S.F. 0 • ZEBCO FLOW SPLITTER NEW PVC DRAIN PIPE EXISTING DRAIN FIELD GRPNE� OR1� / I 200' + TO NEAREST (! / EXISTING DRAIN PIPEI I WELL _ I ro o • • I a ro _ 1g0 k EXISTING 1000 GAL EXISTING 2 EWESL NG STEEL SEPTIC TANK BEDROOM I w HOUSE Z NEW BULL N o RUN VALVE I c EXISTING rn A I Ec WELL ? o cn I� s FRENCH DRAIN NBZ - __- — — 2.18.39 1 S�O,a 15' EASEMENT F LOT 7 200' + TO 40,001 S.F. NEAREST WELL DRAWING NAME: DESIGNED BY: MTA SHEET SITE PLAN — DRAINFIELD DESIGN DATE: 9/24/98 LOT 6 BLOCK 2 FOXHILL SUBDIVISION SCALE: i"=40' 1 OF]3 D Ur �m O� 0 mLO oD Z .0nZw =m> �nrD Z OWmp X00 0 A 0 S1N :TIVOS 86/4Z/6 :31v0 V1W -A8 03NDIS30 -00 1 0 NOISIA1a8ns -ITHXOJ Z NOM8 9 iM STVAG C1 IJ NIV8(1 :34VN DNIMV60 M D 9: C -I O Z mZ 00 70 m0z m 0 �m� cDc z C) =m „9£ NVHl SS3l Al NOL1vlflSNI 3N38AlSAl0d OION „Z Him 31vinSNI "NIW „4Z z D m W D n Z r r 0 K Z m m 0 N C 1 D G7 I I I r > IIII/ILII I'S10- � D n r" 0 m I 111 KO 11 0Do �-ic N A Z 1 m o n arLD II o 0 m zDr 11 O -xvW „ZL I -D� 'NIW ,9 XVW „Zl1 11 U -00 L 'NIW ,4 1 0 n �m m� I 0zm I� m o 0r m� OD v J c m� oZ :E \ Zm Coo r Drm0 1 C m� r -{� ��A< m= rDDm CJ 0 D m G morD = AAAA O z Z Lo 0 D C) DDK� Z p m y A r Z mon r n n m 11 ��!yNpISS3lOyd X098-30 #.. N38NVM HOW NHOf 0 ....00 / 01' . ... ... ....... 0 ............30 4w NOISIA1a8ns -ITHXOJ Z NOM8 9 iM STVAG C1 IJ NIV8(1 :34VN DNIMV60 M D 9: C -I O Z mZ 00 70 m0z m 0 �m� cDc z C) =m „9£ NVHl SS3l Al NOL1vlflSNI 3N38AlSAl0d OION „Z Him 31vinSNI "NIW „4Z z D m W D n Z r r 0 K Z m m 0 N C 1 D G7 I I I r > IIII/ILII I'S10- � D n r" 0 m I 111 KO 11 0Do �-ic N A Z 1 m o n arLD II o 0 m zDr 11 O -xvW „ZL I -D� m� �-u < U -00 w0 0 n 0m o �� m o 0r z� OA m Zm ;u W A X C V CJ 0 C O O z Z D Z D C) rm Z SETBACK REQUIREMENTS: Subsurface disposal field: Surface water = 100' 25% change in slope = 50' Another subsurface disposal field = 10' Property line = 10' Building = 10' Water service = 10' Septic tank = 5' Domestic water well = 100' Septic tank: � 1 �l ..19T 1. ........... / JOHN ARCH WARREN : % i Property line = 5' 94j �', CE -8603 ��` Building = 5' Water service = 10' Surface water = 100' Domestic water well = 100' Subsurface disposal field = 5' DESIGN CRITERIA: 2 BEDROOM HOUSE, USE EXISTING 1000 GAL. SEPTIC TANK (VERIFY CONDITION DURING EXCAVATION) SOIL=0.3 GPD/FT2 FLOW=150 GAL/BEDROOM ABSORPTION AREA REQUIRED=1000 FT2 INFILTRATOR DIMENSIONS: WIDTH=3'-0" LENGTH=6'-3" HEIGHT=1'-0" USE A MINIMUM OF 54 INFILTRATOR CHAMBERS IN WIDE TRENCHES, SEE PLAN FOR DETAILS DRAWING NAME: DESIGNED 8Y: MTA SHEET SETBACKS AND DESIGN CRITERIA DATE: - 9/24/98 LOT 6 BLOCK 2 FOXHILL SUBDIVISION SCALE: NTS 30F3_ 0*;� Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST �Sa "4 , Qo-o a ©®oc 000 IO_POf. ../.•-ter S�`E i 0-609 0 A o hit chael i. Hlexandor 0 ` VPe o, CE 781 �;' 9 PERFORMED FOR: .MI F:( cff'7!f r22'Y/C1A' /LI/Lx�V'/Q% // �" L°P� DATE PERFORMED: LEGAL- DESCRIPTION: �O� 6 131 ,Z II�'/j/�f TOWnShlp, Range, Section: SSC', � , DEPTH Te- ',:;7Z �AT/Ay/fR 1#:1 / 1 (FEET)W/1 074-. cm f/ 2 p /Z. 13r9wh lii//:4� G 4 Dr-� C�rialv�� 5 6 7 ` a 9 10 A 11 ` 12 13- 14- 15- 16- 17 314151617 18- 19- Reading 819 .s / z /j� // G,ey Lv✓ r-/ei GPav�/ w/ �Qrro� 6� 5 S ii SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Afters l 6 Monitoring? 5— S L A/0 E gale:. -98 SITE PLAN 0- Tj Reading Date Gross Net Time Time Depth to Net Water Drop 9 -/-c/o ©- 1 1130 z go 9,43 p 20ii PERCOLATION RATE �v (minutes/inch) FERC HOLE DIAMETER 6 - 1 TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: /�-��<�� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOI4DANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: '?-7— q'Lj5 72-008 (Rev. 4/85) Q Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 -L" Street, Anchorage, Alaska 99502-0650 SOILS LOG e PERCOLATION TEST M / ,,/J �ly 00 0 F.iJ PERFORMED FOR: /'It440 Q'rul lAglrf;-. /4( 9r' DATE PERFORMED:uSS LEGAL DESCRIPTION: Z- d 6 Blkz >.eh1 S Township, Range, Section: �.' 4"7- CA/ 0 / I,... DEPTH ^_t't�� YO/a (FEET) II s n (rrgv w� Sonc�� a . 4 i /— // ��• re� �i�ry • 7' 5 u-/ 6 0 7 �-- I�o� � --F llole 7 / 0 E SLOPE 10 Depth to Net Water Drop WAS GROUND WATER //��// rO ENCOUNTERED? /1/© 11 s IF YES, AT WHATL —, 0 12 DEPTH? — P E 13 Depth to Water Aft / a� Monitoring? 6 Date: 14 15 16- 17 81920 18- 19- 20 COMMENTS SITE PLAN Reading Date Gross Net Time Time Depth to Net Water Drop rO Z PERCOLATION RATE -L� (minutes/inch) PERC HOLE DIAMETER o / TEST RUN BETWEEN v T AND ` — FT T lir q is T.,> ( &- 1r -Oct PERFORMED BY: / � CERTIFYTHAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ti..... SEP -18-98 FRI 16:t$l UURL1.1 Y' %:;HNDL HTML UKHYCL rL � N 'L llfwcent PANVing uy Weigllt a m ❑ C3` R rL � N 'L G •P ` C h-1 V l.J Cp 7 JQJ �7 �s 1h FM1 C� � r —�-- i♦ � � � Q1 a I6 G'a rL � N 'L G •P ` C h-1 V l.J Cp 7 JQJ �7 �s 1h FM1 C� N ` C h-1 l.J Cp 7 �7 �s i♦ � � � Q1 a I6 G'a No. 20 J f5i 1/30 i- ii0.'iV a 150 No. 60 uA G; r. AO N0.100 • r 5 V w Np.z90 c'roo fi C', # i M N ` C h-1 l.J Cp 7 �7 MUNICIPALITY OF ANCHORAGE DEC TMENT OF HEALTH AND HUMAN SERO S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/®R WELL INSPECTION REPORT Name DISTANCES Address C �— TO SEPTIC ABSORPTION WELL FROM TANK FIELD �lCtelo Phonels) I Permit No. No of Bedrooms WELL 1. f-3 00-._l.(3 LEGAL DESCRIPTIONv LOT LINE 1'� I.Y L1� 1+ Lol Block Subdivision,,, —-- ®p Le Z- t_ -� FOUNDATION Sri I ownshlp. Range. Section _T-1 es f v t t\hj ` eii 7� AS -BUILT DIAGRAM Show location of wi septic system. property lines. foundation, 7 "I dnveway. ureter bodies. etc.) TANK'S SEPTIC ❑ HOLDING — -- -- - Manulacturer Capacity in gallons Material No. of Companments --- TYPE OF SYSTEM - L-1 TRENCH �rBED ❑ W. DRAIN ❑ OTHER — -- — Depth bo to pipe ttom Irom I Telat depth Irum original grade original grace ___ ,OFT ',SFT � Fdl added above onginal grade Gravel depth beneath pipe _ 1 , OFT S FT-- Gravelleng;h Gravel width — - r – FT �8r lotal absorption area�t , It I Distance between lines /� 1 12- SQ F1 f P FT m — Nubwry Cs Soil rating Plpe malcnal Z4 -- to SO FT Pli ilrf5f6& C73o3q' WELLS � ❑ PRIVATE ❑ OTHER (Identity) — — — -� Classification tA.B.CI total Depth Cased to 1 F 1 FT - -- - - - Insiallel Dale Inslalle — — REMARKS: — — — —_ $Cale:E yA� Inspections�V�Ped by. 'I1I rl Date. �41IAiCt� it 1?hil,�At 0A _Q c lily Ihal This nspeclion w perlornted according to all '"'r' 1' "'ll��'t , ra inn t+'vr Municipal and Slate guidelines ill 01W on-thimdate: .lfs,.v Health Depal1menl Approval:—�_a� ',_:_.,'.'-� Date: s 1 i� k'r-i" ' b•�� 72-M.', 13iFi.51 IS 90 IKH X IT! :1. on? too L. 1: 1 El wo rA U �:� 11 1������� DEPARTMENT OF HEALTH AND ENVIKONMENTAl. PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264^4720 WNSU-AS 11 -1 EE MEMAHENAT too �WOZ.O.. FAFAWRIVA X A PERMIT NO: 850709 DATE ISSUEi 11/05/85 APPLICANT: C/O S & S ENG'G MYERS CDNGTRUCTION ADDRESG: 131 B 1196) EAGLE RIVER, AK 99577 CONTACT PHDNE: 69,4~2979 LEGAL DESCRIP: SUBDIVIQION: FOXHILL LOT: 6 SECTION: 4 TOWNSHIP: 15N RANGE: 1W LOTSIZE: 40001 (SQ,FT. OR ACRES) MAX BEDROOMS: 3 Listed below are the options available to systefl) ^ Choose the option that best fits ... .... ..... ��..... ..... �������� DEPT�| TO PIPE BOTTOM F--- 1'. 3.0 ** GRAVEL DEPTH (FT.) 0"5 TOTAL DEPTH (FT.> 3"5 GRAVEL WIDTH (FT"> 22"0 GRAVEL LENGTH (FT") 44"0 GRAVEL VOLUME (CU.YDS. ) 35"9 TANK SIZE (GALS> 1,000"0 ** SOIL RATING (SQ,FT./BR) 213 you in designing your septic yoursite, m'�mn KIl 11-w/ ^J1 t Visa ** DEPTH TO PIPE BOTTOM < 3"5 FT" REQUIRES INSULATION ** DKPTH TO PIPE BOTTOM < 4.0 IT^ MAY REQUIRE A LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS l ce�It. i<y that: 1. I am [aif] iliar with the requirements for on~site sewers and wells as set forth by the Municipality o< Anchorage (MOA> and Lhe State of Alaska" 2" I will install the system in accordance with all MOA codes and regulaLions, and in compliance with the design criteria'of this permit" 3" I will adhere to all MOA and Stte o4' Alaska pequireIll ents for the set back disLances |rom any existing we119 wastewater disposal system or public sewerage system on Lhis or any adjacent or nearby lot" 4" I understand that this permit is valid f,or a maximum o| 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE DBTAINED; (2) AS--BUILTS WILL NOT BE APPROVED WITHOUT AN,ELECTRICAL AND <3> THE ELECTRICAL WORK MUST 8E DONE BY A LICENSED ELECTRICIAN. ' SIGNED DATE: _,'___ APPLI[�ANT8 MYE4 [%)MiS'|F8}ClI[��/' ISSUED BY Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOO — PERCOLATION TEST PERFORMED FOR: 1`- \LQ�L.�j ( �71� S DATE PERFORMEQr�ia� LEGAL DESCRIPTION: �? �O�' 1.�<. �' Township, Range, Section: a- "V3 .rte p4U f �L r, I-V I I—Ie S E> SLOPE SITE PAN r ran Frl r--r—r.- 2 3• 4 7 r 8 �o 9- 10-- 12 0- 12 13- 14 15- 16 17- 18- 191 20 819- 20 COMMENTS �r'"1 - 21I3�'1E311i WAS GROUND WATER , ENCOUNTERED? ���/�� IF YES, AT WHAT DEPTH? (Z— U�-[at-r'�.1 Depth to Water Aller Monitoring? �C Date: Reading Date Gross Time Net Time Depth to Water Net Drop 1 to -u- e� 3t�5 : –�— K 7(4- 2 5 , t6P Qq�r S 2 v L \ O w ---I--'' `g N PERCOLATION RATE ?"(minutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND S —FT PERFORMED BY:I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STAVE AN MUNICIPAL GUIDELINES I EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & Geophysical Surveys II. PUMPING LEVEL below land surface and YIELD : 1 ft. of ler - hrs. pumping 1•= g.pM. Drilling Permit No. hrs. pumping g.p. m. LOCATION OF WELL (Please complete either to, Ib or Ic.) Material ❑ Neat Cement A.D.L. No. 13. PUMP: (if available) HP la. Borough Subdivision Lot Block Ib. 1/4 qt re. Section No. Town ehipN❑ Range E❑ Meridian ❑ Subm. ❑ Jet .—.ot—or_of— 5❑ WC] I] DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL7J f-,l„r_, Address: i'�r)e t.;�')J{ •'�; !I,;S ).�,, i Street Address and Area of Well Location 2. WELL LOG Feet Surface Below 4. WELL DEPTH: (Ilnal) 5. DATE OF COMPLETION Bottom M atarlal TypeTop Q-? 6• OCable tool C] Rotary E] Driven Auger Jetted ❑ Bored 0 Dug 01 her: P�!at _`:_�s '_^(ti'r':ita.K '`�'•'.!',c �'1'-'' 'ti?:'^.`i:.. ''r 7. USE: Q Domestic Public Supply ❑ Irrigation ❑ Recharge ❑ Test Well � Other: Industry commerical iiI a.`l Paid 1�•j� xa-r! a,I'I. B. CASING E] Threaded ❑ Welded diem. J in. to_''r-� ft. Depth Weight 27 1be./ft. diam. in. to ft. Depth Stickup ft. _ C1.0 .>_%87 ''s;%f� '%'l J 9. FINISH OF WELL: �+ _ Type: Diameter: Slot/Mesh Size: Length: Set between ft. and Backfilling _ Gravel pack ft. MUNICIPALITY OF ENVI SZNM�tdTtet—ijy 10. STATIC WATER LEVEL: ft. _ t,,'.riN ❑ Above or ❑ Bolow land surface Date - rJ Equipment used: - II. PUMPING LEVEL below land surface and YIELD : 1 ft. of ler - hrs. pumping 1•= g.pM. 11. after hrs. pumping g.p. m. 12.GROUTING Well Grouted: ❑ Yes ❑ No Material ❑ Neat Cement ❑ Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. ❑ Subm. ❑ Jet Centrifical Other 14. REMARKS 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; Registered Business Namel Contract License Number Address: Signed Date:' - _ Authorized Representative Form 02-WWR (II/81) Coov Distribution: WHITE -State DGGS. PINK -Driller. CANARY -Customer ❑ F ❑ C 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 Parcell.D. 051-073-15 HAA # D50 34)(f) Expiration Date: / O — ,1 9- 0 1. GENERAL INFORMATION Complete legal descriptio Location (site address or directions) 71740 Woodcutt urtve, LnugiaK, AN yyaer Current Propertyowner(s) Scatt Pickett Dayphone 5883887 Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: _Z 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority 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 private 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 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 engineers work. 4. 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, 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 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. ••• �1• a •.. • .. _� .. Engineer's Printed Name__Kenneth M Duffuc Date R/78/05 Engineer's Comments: This Investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE Approved for -2— bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: PROGRAM Attachments: ��i•�O • •S� HAA Checklist X Maintenance Agreements ��ivj�qjjwffl� Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Zlf, Original Certificate Date: --7— / _q-Lo—c Municipality of Anchorage Development Services Department ' Building Safety Division ' Onsite Water & Wastewater Program 4700 South Bregaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description* Foxhill, Block 2. Lot 6 Parcel ID: 051-073-15 A. WELL DATA Well type Private Date completed 1/30/86 Total depth -2fL_ft. If A, B, or C provide PWSID # Sanitary seal (Y/N)Y_ Cased to -2fL-_ft. FROM WELL LOG Date of test 1130/86 Static water level 65 ft. Well production 10 9 -p.m WATER SAMPLE RESULTS: Well Log (Y/N) Wires properly protected (Y/N) Y__ Casing height (above ground) 2'+ AT INSPECTION 61 ft. 5 g.p.m. Coliform ,_Q_colonies/100 mi. Nitrate 1.33 mall. Other bacteria Q colonies/100 ml. Arsenic: _NA mgA. Date of sample: 6/15/05 Collected by: KND Engineering, Inc B. SEPTICIHOLOING TANK DATA Tank' Type/Materlal- SEPTIC=EL Date installed 11/20 HS Tenk size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y_ Depression over tank (Y/N)&-High water alarm (Y/N) N Date of pumping 6/15 to Pumper J R s C. ABSORPTION FIELD DATA Date installed 9/26/98 Soil rating (g.p.d./fe or fe/bdrn) 0.3/' System type Bed Length 37.5 ft. Width #1 151&#2 12 ft. Gravel below pipe NA ft. Total depth Infll. Chambers ft. Eff. absorption area 9j2 fe Monitoring tube Y Depression over field N Date of adequacy test 6/15/05 Results (Pass/Fall) PASS For 2, bedrooms Fluid depth in absorption field before test" ! 0 in. Water added 449 gal. New depth 0 / 5.4 in. Elapsed Time: IQ min. Final fluid depth 0/ 0 in. Absorption rate >= 300+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at_ in. Size in gallons Manhole/Aaoess (Y/N) 'Pump off" level at in.High water alar level Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout _ 10 0 0 + Sewer /septic service line 25'+ Holding tank 10 0 1 + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5 ' + Absorption field 5 ' + Water main 10'+ Water service line 10'+ Surfaoe water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 8'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 10 0'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ Wells on adjacent lots 10 0'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in �1�"""" conformance with MOA HAA guidelines In effect on this date. ♦ O's %, �,����i it 46 Engineers Printed Name _Kenneth M. Duffus If`i1.Fp i Date 6128/05 4%161 PROF HAA Fee $430.00 Date of Payment Receipt Number (Rev. toot) Waiver Fee $ Date of Payment Receipt Number In. 3 ASBUILT—NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY= For-sem/« .raF� !aT!8�.� j AND THAT NO ENCI�OACHM€NTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR -RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. T. SCALE,� OF. At DATES YS/ r-*7:.'Z'� J. GRID, /yfd° J. A yw ii+moi• Duo'. Mark Se+.ud 4� / FB 4! f` . LS -691B DRAWN, ,psi Municipality of Anchorage Development Services Department Building Safety Division On -She Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET Legal description: Foxhill Block Loth The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on ❑ Calculation error in design. ❑ Additional soils information needed. ❑ Water monitoring results inadequate. ❑ Discrepancy in information submitted. ❑ Topographic information missing or inadequate. _ ® Incomplete; missing Survey ❑ Incomplete; missing ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils Information submitted. _ ❑ Well log required. _ ❑ Omission in narrative. _ ❑ Insufficient fill over tank or field._ ❑ Other. Name of reviewer: W Date: 7/7/2005 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# HAA# Jl_A qg©Z`f8 1. GENERAL INFORMATION I Complete legal description Z -of 6 Rloc.k Z.,, 15–c2X/2tjj_ S�bci���sioh Location (site address or directions) Zl 7-/1D Wc90 Yc1i---!F D r nnAif GaI/ G �� nn1'�i k Property owner L(el 4- Pot4rlc(oj Day phone Mailing address Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF 13EDROOMS: z 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ✓ _ Holding tank --_ Community on-site — Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 5. M 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 ineffecton the date of this inspection. Name of Firm ... 7n 4n We r -r -en Phone 2 -q_3 -e3)1 7 Address gZ01 l/'5 cv� (:A,'r-c1e_ Anc_4oro%!je 1}K gR5DZ -.. Engineer's signature DHHS SIGNATURE /\ Approved for Disapproved. Conditional approval for Additional Comments bedrooms. MITIr, Date 'Oz: t AY V ��t��\'j3T ^ �'f+pi Hie ia. i0moaiQVitiasicwoo F . A _ Pr f JOHN ARCH WARREN e �@ CE • 86038 bedrooms, with the following stipulations: Date ZO -2 7-278 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 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALII Y Uh ANl ry' 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907)113 P6 144sERvicEs Dlvlsln� Health Authority Approval Checklist Legal Description: Lo + 9 131 1©Gk Z. rod r 7 v _ Parcel I.D.: A. WELL DATA Well type N vq _. If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) _ Date completed P-30-86 Total depth C16--_ Cased to _ W Casing height (above ground) 3Z Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well production _ ' 1 0 ' g,p.m. WATER SAMPLE RESULTS: Wires properly protected (Y/N) AT INSPECTION S 111 -C/o 6` 9 - p.m - Coliform O Nitrate I.D(_ Other bacteria Date of sample:! ^ �� Collected by: B. SEPTIC/HOLDING TANK DATA Date installed I I'ZC•"SF_ Tank size 1000Number of Compartments 1 ''Cleanouts (Y/N)-Y—_ Foundation cleanout (Y/N) _ _ Depression (Y/N) /V High water alarm (Y/N) IV _ Date of Pumping i1" 2'c7Pumper S R 5 I ✓M rn C. ABSORPTION FIELD DATA Date installed %-Z6-3--E Soil rating (g.p.d./ftz or ft2/bdrm %3�y�system type Re -0T �) 113 fl i n�anz Length -37r 5 Width x -Q 17- Gravel thickness below pipe Total depthe�- Effective absorption area 1013 •��_ Monitoring Tube present (YM) Depression over field (Y/N) _ Date of adequacy test _ /USW' Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test (in.); — Immediately after= gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) N If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed IV/4 Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic/holding",tank on lot I DO 4- On adjacent lots 100 � Absorption field,on lot IDD 'f"' On adjacent lots CO1+ Public sewer main /V/ Public sewer manhole/cleanout /VIA Sewer /septic service liW Z ✓� 'f- Lift station ' M�>9 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 55 Property line 10 + Absorption field 10 f Water main/service line 10 +- Surface water/drainage 40 + Wells on adjacent lots J 00 + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ® / + Property line �J Building foundation 7© �� Water main/service line i0 / Surface water -- Driveway, parking/vehicle storage area Curtain drain /V/A Wells on_adjacent lots l7-/ / F. ENGINEER'S.CERTIFICATION l certify that i av dete fined thru field inspection and review of Municipal records that the kov , ems are in conforman e w M A AA guidelines in effect on this date. OF Signature Engipeer's Name - 2Ll q imp " Date ��0/ ia(9 EJ JOHN ARCH WARREN 4C CE -8603 oc `9j `, ROFFSSO\ u HAA Fee $ ;Oc-) VC) Waiver Fee $ Date of Payment �S� ��� \ Date of Payment Receipt Number C'� l V '� L tCo l �) Receipt NumberTi 72-026 (Rev. 3/96)* Property owner _ Go -l4 Luedthe Day phone _ 688-5369 Mailing address LL Box 670325 Chugiak, AK 99567 _ S. 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 da of this inspection. Name of Firm S & S ENGINEERING Phone q�'2g7y 17034 Eagle River L Road 0.2 Address Engineer's signature Date tl , n p{ $V - kg � ��rs `',�I✓i i' da . 41 �A4p�1 P!�86H. YlOMWoe� � O er ben + .a••. ee oo off.• it b A enM A. Sha t" ; ti s J°ao in. 1457• a: 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations UITIC 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 wor:<. »mt,ao� iio„ na�� unn ,nl Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:c"o _ l -P (57L 2 q7�, Parcel I.D. rlmlelgIIDTI 7 Well type �-,l Nr -F. If A, B, or C, attach ADEC letter. ADEC water system number Log present &N) Date completed I—,30—BU, Driller La Total depth q Cased to I L'e kCasing height Sanitary sealS� N) Wires properly protected (Y/N) 5/ Date of test Static water level Well flow Pump levell FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot _ Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: Z _ t�� R 2Std— 3--2-CA- 13. SEPTIC/HOLDING TANK DATA AT INSPECTION 4 '2 —Clµ 4- On adjacent lots k On adjacent lots ) o Public sewer manhole/cleanout Petroleum tank Nitrate D,C� �25 Other bacteria Collected by: S d S 6 " Date installed Tank size t o co Compartments Z Cleanouts (VN) Foundation cleanout &N) Depression (Y/ 1a ti High water alarm (Ya r� Alarm tested (Y/N) �IA Date of pumping Pumper Le_SsPoc>y_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10 k On adjacent lots I o To property line I J t Absorption field 10 t Surface water/drainage / o a t Foundation _ ��7 Water main/service line /o' iz-026(3/93)°Front CONTINUED ON BACK PAGE 2 3' 70 C) m D r P 0 1"il in O raa g' u> M T ` Z M `n M _ � o C � �c o" Z On adjacent lots k On adjacent lots ) o Public sewer manhole/cleanout Petroleum tank Nitrate D,C� �25 Other bacteria Collected by: S d S 6 " Date installed Tank size t o co Compartments Z Cleanouts (VN) Foundation cleanout &N) Depression (Y/ 1a ti High water alarm (Ya r� Alarm tested (Y/N) �IA Date of pumping Pumper Le_SsPoc>y_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10 k On adjacent lots I o To property line I J t Absorption field 10 t Surface water/drainage / o a t Foundation _ ��7 Water main/service line /o' iz-026(3/93)°Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons - Vent (Y/N) allonsVent(Y/N) High water alarm level Manufacturer Manhole/Access (Y/N) "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION on lot D. ABSORPTION FIELD DATA Date installed 1I-2;�,—Q, Length 115-4 Width tested LIFT STATION TO: m On adjacent lots Surface water _Soil rating (GPD/Ft') 2t System type i�p 1 �6 ` Gravel thickness o , 5 Total depth I t Total absorption area �-72� Cleanout presentON) Date of adequacy test q - 3 Water level in absorption field before test Depression over field (Y/N) Results (41jj�fail) for 15- u After test Peroxide treatment (past 12 months) (Y& )-1r-(C �LJ° If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: 3 Bedrooms y Well on lot ) oa / On adjacent lots / 00 1 + Property line /0, -1 - To o, -1 - To building foundation T3 ` To existing or abandoned system on lot 'J /A On adjacent lots So / Cutbank Water main/service line 1 0, Surface water l D C> Driveway, parking/vehicle storage area Sd 1 Curtain drain E. ENGINEER'S CERTIFICATION l certify that 1 have checked, verified, or conformed to S & S ENGINEERI Signature HAA guidelines in effect on the date of this inspection. s c.. � U S r os o Rjvur o oad 0.2Q4 Engineer's Name Eagl River AI 8 i x . r r+ r Date Zk N i HAA Fee $ �� U U Waiver Fee $ Date of Payment //_ -5-- 0 r" Date of Payment Receipt Number �R a % 7 5�) l� ��) Receipt Number. 72-026 (3/93)` Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date Z_" 'L66 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 4ecrl Z �GxIIrL[ Location (address or directions) 1 n,t I (b) Applicant Name r v t�� �Sr Telephone. Home —(obb- D q S Business Applicant Address — o _ 3S-1 L. Aut-tAct< 160(- 99SU7 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderO; Buyer ❑ ; Other ❑ (explain); _ (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone 4-0 (f)0 the HAA to the following address: S �, 5 Engin2Ct'IrM 5RB 196,,c epi ev r; malas a 97977 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well a Community ❑ Public ❑ Telephone Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite tfl� 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. Pace 1 of 2 72-025 (iven) C:1 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 Telephone Address SRR 196x Date Eagle River, Alaska 99577 Shah;�r Q, ,P °n� No. 1457.E a o ^ °T DHEP APPROVA C Approved for bedrooms b"L'/ i-� Date Approved Disapproved Conditional _ Terms of Conditional Approval dl't�.p CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOAT MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) MAA 15EN HEALTH & ENVIRONN MENTAL PROTECTION CHECKLIST - FEBRUARY 1984 264.4720 / i- 1- E3 0 998 Legal Description: L -o T- �e I k Z i:: -r, Y t -L I L L_ A. WELL DATA Well Classification IVT If A, B, C, D.E.C. Approved (Y/N) — Well Log Present /DIS Date Completed — �-Y�- 15 6 ( Yield Total Depth 6t _ Cased to Depth of Grouting __S -4o N Static Water Level _ LOS, — Pump Set At tt � Casing Height Above Ground — (Z Sanitar Seal on Casin �1/fd) Electrical Wiring in Conduit (Om Separation Distances from Well: Y 9 Depression Around Wellhead (YO To Septic/Holding Tank on Lot Loo I F ; On Adjoining Lots lob0-- To Nearest Edge of Absorption Field on Lot LDC t ~ _ ; On Adjoining Lots 10 C) ( 4 - To Nearest Public Sewer Line µ�(� To Nearest Public Sewer Cleanout/Manhole N To Nearest Sewer Service Line on Lot Water Sample Collected by `� S EMS n����/M6 ; Date Water Sample Test Resultsi tS F;A e. -M R - S-1 Comments B. SEPTIC/HOLDING TANK DATA Date InstalledSize No. of Compartments — z Standpipes jo/N) Air -tight Caps &K— Foundation Cleanout &NT Depression over Tank KA Date Last Pumped NEW Pumping/Maintenance Contract on File (Y/N) N��- ; for 1 N FY Holding Tank High -Water Alarm (Y/N) _ Temporary Holding Tank Permit (Y/N) -- Separation Distances from Septic/Holding Tank: To Water -Supply Well (O C� t ~ To Building Foundation To Property Line �� / To Disposal Field -- To WaterfAftirt/Service Line Course Comments Page 1 of 2 72-026(11/84) 59 1 I +' C)I To Stream, Pond, Lake, or Major Drainage N C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata z- 13 Type of System Design Date Installed \`` " 6,z�- Length of Field S l u Width of Field Depth of Field Gravel Bed Thickness d1 Square Feet of Absorption Area 9 7ZStandpipes Present Depression over Field,(*/6) Date of Last Adequacy Test N Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 1 �t To Property Line 1C)0c) To Building Foundation l To Existing or Abandoned System on Lot �1� ; On Adjoining Lots t To Water-AUaa4Service Line yd To Cutbank (if preVnt) N� To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed s 8t a Engineering Date SUB Eng Compan)F,r­ lc Qkror, Alaska 99377— MOA No. Receipt No.% �/ L Date of Payment Amount: $ � Page 2 of 2 72-026 (11/84) or E ineers S�baie, a 9 - )ort A. Shnfor kl G�F 41 A s a (ji 4 t1 A(!'/1 d