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Home My WebLink AboutATELIER #1 TR 2AAtelier #1 Tract 2A #041-031-37 Municipality of Anchorage P~ee I ef Or DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater DiSposal System and/or Well Inspection Report Permit Number: ~'~J~OIqS' PID Number: O~ I--¢~l--'~ ~'~'~":/~OO ~y~4~ ~'~ ~ ~1~ ABSORPTION FIELD Phone:, 3~ 5~ ~ Deep Trench .ShaHowTrench ~Bed ~Mound ~Olher Total Deplh from original grade: LEGAL DESCRIPTION so,,.,.,: 0e~ GPD/Sq. Ft. ~.~ ~/~loc~: S~bd~v~io.: Deplh,opipeb0[to~fromodgf.algrade: Orave]depthbenoatbpipe ~ Ft. Township: Range: Fill added above original grade:j¢~.Ft' Gravel lengt h: WELL: ~.ew ~ Upgrade eravelwlmh: S Ft. .umb~flines: ~Oistani~lweenlin;;:' Driller: , Date Drilled: S,atic Water Level: Installer: . . Date installed: ~._~ 1 __ ~ ~ YJ~d: ~ I Pump Se a Cas ng ~ e gh Above G ound: ~GPMI ~/~ ~,.J ~ .t. TANK SEPARATION DISTANCES ~s~pti~ u Ho~ai.g u M .fac ure.: k Capac'l' in gall°ns: I ~ 50 From Tank Field Slation Tank Sewer Lines O¢~ s~ [00~+ ~0'+ ~ ~ LIFT STATION ~ Foundation ~% /7' "Pump on" ,eve, at~le~water alarm at: :Remarks: BENCH MARK i : 1oo EN~L S & S ENGINEERING ~r ?' %~-~ ~. / 17034 Eagle River Loop Road, No. 2~ ~.~ ~q~ Inspections performed by:E.~e ~!ver, ~-.~ e~sT7 Dates: lst~-~ ~,~~" .... ~ ~ ~ ROSE~ C. COWAN ~ Department of Health and Human Services approval ~, ~"-. .'¢,~ ~ Reviewed and approved by: ~¢~ ~ Date: /¢'ZZ' ¢~ ~._ 0,~,¢ 72 013 (Rev. 9191) MOA 25 PERMIT NO SW990195 PAGE 2 OF 4 IVlunicip. oti~ oP Anchoreqe DEPARTMENT OF HEAl. THAND HUH'AN SERVICES ENVIRONMENTAL SERVICES DIVISION P,B, Box 196650 ·Anchorage, Atcska 99519-6650·Telephone: 343-4744 ON-S[TE WASTEWATER D[SPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL TRACT 2A, ATELIER #1 P.I.D. NO. 041--031--37 .......................~ jill ~ ~~ ~" " - ~ACT~A~ , , -. , ', ~ ', s' , t~ ,, , -~_ TRACT ~ ~ , ~ , - , ~ , , T~ACT ' ', ' '" " " ' ' k ~'% ? / ,,- ......................... , , ...~. I I PERMIT NO. SW990195 P^aE 3 0P 4 Municip. a[i~y oF Anchoraqe DEPARTMENT OF HEALTH AND HUIVFAN SERVICES ENVIRONMENTAl SERVICES DIVISION P,B, Box 196650 SAnchorcge, Alaska 99519-6650 e TeLephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEC^L TRACT 2A, ATELIER #1 P.I.D. NO. 041--031--37 ~ EXISTING DRAINAGE DITCH SEPTIC TANK co I N PERMIT NO SW990195 PAGE 4 OF 4 Municip. oti~ oF Anchoroqe DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,B, Box 196650 ®Anchorcge, ALaska 99519-66500TeLephone; 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL TRACT 2A, ATELIER #1 P.I.D. NO. 041--031--37 " NEW i ' 92.8~ 13S;E~i~i?L "~92.6' CO1 CO1 = 95.4[_ CO~ C02 95.4'1 x~ C01 = C02 = 92.2'1I s~ MT1 = 88.3'~/~ A 8 FCO 21.0' 34.5' ST1 15.0' 45.5' ST2 17.5' 46.0' DBL1 23.0' 47.5' DBL2 24.0' 47.0' FS 25.0' 47.0' C01 28.0' 45.5' MT1 28.0' 44.5' C02 75.0' 44.0' ~/o3 39.0' 58.5' MT~ 39.5' 59.0' ~04l 80.0' 58.0' C03 MT1 C04 ~ i1MT3.~JC03 = 91.9' I1~ lC04 = 92.0' ~H4~c0s - 89.1' [lC04 = 89.1' "-MT2 = 84.8' · WATER FOUND ® 77.3' B.O.H. ?8.3' 09/20/3.997 22:28 9075629228 :'My~rom · silt '.:'.',.'. - "'::'" ". &ilt' ".. ' ... . '" ~ ;~.'.. .' . '.. .... :.. .~ -=... .:... ~ ..:,.. :. PAGE OG erVices. 'ldentifi=a.tion Number: 0~1-03'/-37' :25 in~h~': . :' :. "..' "".:' '. '..'. ''" ~'t'. '" .inches. . Dept) . .." t~et · C8 t~e:t ~r :' ' ...... '.' ~Pm".' ' ' " " ~: 30'spm .': .. :. : .'..., . ¢ir //ft " '". ~,i.g.T2pe:.'' .. '.'-: '.'.. ~ Qp63. FM'I~./ ' ';. '1 " 5ur~.~.'~6~ '$[;~¢p~d" ' '" ~ - St'ad' 0'Ibc( . Stopp6d.: l~el . - 't~et' ·..'..' hp,:B~M:'N~..':'.' · ' ..... · Upon co~p~e/:~(m.t ~-y'e~ o.;-~... -. · ~.'0. B~x'"~.'fO~96 '.'" Anchorage, .A~ 9951 ~ ' ' pletJo'n and Ihe'propbrlv ~:.: .. .... .... .:..... . ~}~?'.': .'.... -, . ..... ..... ...... ?.:...'..: .. ' m Plat· 17. :..'(he . ~: .'.':-..":: .". Fi-'¢~ Feet.:, .'...'."'. ':. Distfi~i" ?,..'. ' .': ~5 ": ~.... fot~ · .:;5:;.'~ .... · "-' ' · ' ~..,...... :Traqt2A, ..~.;. .. - ~a d ' ~;;.:: ...':- . ... 23'.. .. ~'~; .. · .:. ........ ..... . .....,: ~'~!~;': ~.': ..::.::.. '(~ein:~r~r~r' ' ..... ~;~:~'~':::'~.;." '.~. :.:',.'~.. ~ .~¢~,:....... . PAGE 02 120~;6U . .'' .,'. .0-21.4~ . :': · EN9904'0" .-' .Alaska'non:PrOfit' .:.... ! 1.963.0,0', A_qeh0fhge~ '. (~+/o~e aadr~si' iS:2:3.~0 ' for .the .Construction .' ,.ofNovemb~."- ... · 1, a~o?ding' '..- . , '.' ' on'file, in ~e 0ffi6e" '"" .. ; AI~ · i'~i~8~dred"T~en¢5~."" "...'.' }'.)..o~Tract 2~' :Se 23? day. "~ .,:-. ',..: ' !asemeflt. and:~e'.· .... O*nt'::' .' ".:.'.L .7"" '." '. ' .'" ." 795 l'07'mgorded 6~ 'the. ':' ' .R~co~der,-.~Lhom. g~ · ." ' ' · .' ~ --.'.. -.'.- ... ... '.". ":~ ..'. .'.'. :? : .: ~'.".,'. .. ~.." . ..".....' .".'... · .. '.' '. ' '. '7..':..' '...::'.' :.' :', '... 22:28 9675629228 ~.~":.. '. - ~. . ~',t~'~.f::' ' · ' · ' · '. ' .':.:. "..(~;~.".." ... "'.'" ' .~ t~Sf'~: '"... '~.....' ~.~;:~'"" . .. ........::: '. ..,..'~ 4; '.'"('. :.; :; .. .... ..... · · '..:..:,. "":' "' ' .... :'6..~..5'. ~5....'- .acco~o~atmgcr ~ ..~f;:.' , . . . .. . .,... ~ .~5". ('. '-. ' '.'.. · ' ' ., ~.~'(."~ .'-. · .,'.. ..', '..... ., .'. ...- -.. ... ..,: ~.~,,.....' .' .. :..., .., ...'. ~;;, '. ,' ". 4' ..' . ".' ': .' ',.'-. · .'.',;.. ~&~3C.'-'' '. ' :' · '.. · '. :.: '.v ~..~.:,.. .. .... -. .. .... .. :".)..)(: .. '.'.' .> ':,,... PAGE 03 · existence of ecu'~0:said Easement: ' "i y:525::i;e~t pr0Pel?y, line-. ... · glNCLIJDED'.IN~_ ' ' : ';."" ".-. , ,~..~S/~D. ' '...:..~'. ?::.':::.'..: ..' ::'::.:: :..:('.' '.:' ".:.."....' 0nfinue-'th~'..'.:. '~ '~ ~o'the30vm~'S~'fo~h ~. ' ' · ('..,..'..;: -)....: .:.: ." . .' .: .'.'.). ':'..'. :~ .' , : ~om' ' '. :' 'ih~y~y:~om'~ "'' ;?.'...'..,' ... '.'..... _ :~',,:,. . . ... · . . . · . ... ncre~e" '. · . ~y-.%..: · h~. no ·obligation. t0 " :' · ' ' 2 ' ..~ '. -/.% . .' .' ~C~6wledges~at.~.':: '.' .. ' ~s nbt md.s~n"/' 'E~t... th6 'foreg0Jng,: Peru[nee '-' gaeh :~d...i~" . ofthe'.eOmmon, law' ':- ,....- .' ..:.'.:....: .. ..,' ../'. Ffae[lifies'loeated wi~' . - '-. -P~ine~.'sb~ll pay'that · .'. ' [.'" ~ s r6asona'bly "a~bmabl~ 'to · ..- . ~,snot made ~in thi~ : · burden ~e:P~cel'and.. L~h~ffb~ndfit' the'Easemefit '. ' ..,~..' . '~':'.'.': - ...; ~--:;...: · ..:':.. :.-.... · :... . . ....:...........' ...:~ ,. ':..... ;'.:: ...:.( ':. ~ .: (..., :. ~..; ....' ..~ '. 09/20/1997 22:28 9075529228 · ', giving-or, thirty'(30).' withifi .the're :all. other.'ptior" · .'.- ., .~Nb' m6difi~at!ons; be' effective .unless .in OB/20/19B? 2~:2B 9075629228 '.Th~ PAGE 05 [a?.o.f · · ~"::- : ' · ' . '.' .'.i ".:. !.: ~i~..:~..'..'.'. . ::' '"': "... ': : ' ~. ~,:., ..-. ' ... ~:., ..0,h. 8 2,0 0. .ABC, ,,~.gAGc .. .... :.':! DING [iI~;TRICT." '."." ~.,~,~i~:: .';.," :':' :'" .': ,':. ' .' :q?.,.:.-',' ',.. · ... ' . · .. ,.. ,.' ~. ~!,':?, .,. .- . . .: .- . .... , !~:, q:.. · .. . · ., .. .. ': :' :i:'ii:..::::'.'. ...... :':";" ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. Date: CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 SEWER&WATER INSPECTION ENGINEERINGSTUDIES ANC REPORTS ',%'ELL INSPECTION & FLOWTEST ROAD DESIGN SOiLTEST PERCOLATION TEST Municipality of Anchorage DEP~LRTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 ~nchorage, Alaska 99519-6650 RECEIVED AUG 20 1999 Municipality of Anchorage Dept. Health & Human Services The septic inspections for the referenced property were ~rf~orme~ on V-ROb ~ ~nd ~-~J-~ . Prior to submitting ne un-si~e Wastewat.er. Dlsposal System and/gr Well Inspection Report we are waltlng for the ~~~,/~ E,fv¢y to be completed. If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 PJck Mystrom Mayor Municipali of Anchorage Department of Health and Human Services 825 "L" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 ~0~5 http:llvcww.cLanchorage.ak.us Permit Number: #SW__ Date of Issue: 7-14-99 Date Stm~ed: 7-19 99 Date Completed: 7-19 99 Legal Descdpfio~n;' Atlier # 1 Tradt 2 A Property O~vner Name & Address: Telemark ConsL 14500 Rocky Road Anchorage Ak. 99516 Parcel Identification Number: 041-031-37 w ...... amd .~ app~ o...,, p,.~ m,, I~+' 9 ...... ion, [] Yes [] ~" Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To Stick-up 0 2 organic & silt 2 7 sandy silt 7 11 Gravelly silt 11 35 silty sandy gravel h2o 35 53 gravelly silt 53 71 silty sandy gravel 71 80 water sand & gravel 80 88 RECEIVED AUG 27 1999 Muificipality et Anchorage Dept. Health & Human Services Method of Drilling [] air rotary [] cable tool Casing type: Steel Wall Thickness: .2~5 inches Diameter: _6 inches Depth: 8~8 feet Liner Type: Diameter: __ inches Depth: __ Casing stickup above ground: _2 feet feet Static water level (from ground level): 61 feet Pumping level: 88 feet after _2 hours pumping 30 gpm Recovery Rate: 30 gpm Method of Testing: air lift Well Intake Opening Type: [] Open End [] Open Hole [] Screened Start__ feet Stopped __ feet [] Perforations Start feet Stopped__ feet Grout Type: Bentonite # 8 Volume: ! bag Depth: Start_0 feet Stopped: feet Pump: Intake Depth feet Pump size __ hp Brand Name Well Disinfected Upon Completion? [] Yes [] No Method of Disinfection: clorox Comments: Well Driller: Alpine Drilling & Enterprises P.O. Box 110496 Anchorages AK 99511 Attention: The we~-~ .....s,,..~,,,~,,ac a *~,eu log tol-~eproperiy~w~r-wt ...... 3Od~ys of compietion and the property MUNICIPALITY OF ANCHORAGE Department of Health and Human Services 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 /WATER SUPPLY PERMIT ~ -'~ ' ~ t'~. Initial Date Issued: Jul 14, 1999 Expiration Date: Jul 13, 2000 Permit Number: SW990195 Legal Description: ATELIER #1 TR 2A Design Engineer: 0003 S & S Engineering Owner Name: Telemark Construction Owner Address: 14500 Rocky Road Anchorage, AK 99516- Parcel ID: 041-031-37 Site Address: Lot Size: 293159 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 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. SEWER&WATER }JAIN EXTENSIONS 80ILTEST ONSITE W,'k~TEWATER DESIGN ROBERT C. COWAN, P.E. June 15, 1999 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Tract 2A, Atelier Subdivision It is requested that you issue a permit to drill a well and install a septic system to serve the four bedroom dwelling on the referenced property. Two test holes were excavated and percolation tests was performed. The approximate location of the test holes are located on the attached site plan. Ground water was monitored as shown on the attached soils logs. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent prop ertles. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. cc/j m Enclosure 17034 NORTH EAGLE RIVER LOOP * SUITE 204 · EAGLE RIVER, ALASKA 99577 1"'-- 60' SITE PLAN DESIGN SCALE )~ ~ ~ ~E ~ I / ~ ~ / ~h~ ~ / , / XX ~ I / ~/ ~ , : I Municipality o! Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTrON: DATE PERFORMED: . ~"~ ,'~:~ I"t'~ J'" Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16- 17- 18- 19- 20- COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? %)f~'~ ~' S IF YES, AT WHAT ~ ! OL DEPTH? p E Depth 1o Water After Monitoring? .O(&~' Dale: G ]q/~[~ Reading Date Gross Net Depth to Net Time Time Water Drop ~ ::)0 r~,~, 11~/~'' I ~I~ o ,- ~&" ~ 0 ~ ~ ~/~" ~ PERCOLATION RATE __ TEST RUN BETWEEN . (minutes/inch) PERC HOLE DIAMETER FTAND ~ FT ACCORDANCE W,T~A. Le~X~,~i~ZL GUIDELINES iN EFFECT ON THIS DATE, DATE: 72-008 (Rev. 4/85) Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL D ESCR IPTION:'T f~¢~ 1 2 3 4 5- 7- 8- 9- 10 11 12 13 14 15 16 17 18 19 20- Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? L IF YES, AT WHAT O Depth to Water After '7 ' Monitoring;' 't,,~ 0ate: ~/~ /c~ SITE PLAN [ Reading Date Gross Net Depth to Net Time Time Water Drop ?~ '~ ~'/~//,~ o - ~ ~/,/" - ~o ,~,~ ~.o ,,,~ c)-,l~,, i r/~,, '~o ]o ~,,~ ~ ?1~'/ I '/~" O ~ .~ V4" _ ~0 30 ~,N ¢ ~1~a I '1~" PERCOLATION RATE '~) ~' 7 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 3 ~/;2-- FT AND ~/ '/~- FT COMMENTS PERFORMED BY: 17624 ~.~ ~:V~i Lc~p ,~;ad N;. 2~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WIT~A~ GUIDELINES IN EFFECT ON THIS DATE. DATE; 72-008 (Rev. 4/85) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Tract 2A, Atelier Subdivision June 15, 1999 GENERAL: The scope of this project includes the installation of a 1250 gallon septic tank and leachfield trench for the proposed four bedroom house located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal perrrfit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page 2 Tract 2A, Atelier Subdivision June 15, 1999 Septic tanks installed with less than 4 fl. of cover shall be insulated. A foundation eleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Finai grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the £mal gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Tract 2A, Atelier Subdivision June 15, 1999 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Mnnicipality of Anchorage: T_vpe of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must he approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt banfer (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Tract 2A, Atelier Subdivision June 15, 1999 The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt bander, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspect'rog engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 ParcelI.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description -~fi/) c. 7- ,~. A Location (site address or directions) /v E ,.~ /~r 7 £ ~- ~ ~' .-'~ P /~ ,,/'~ W,~ c [~ Property owner Mailing address Lending agency Mailin. g address Agent Address Dayphone ~G¢) - Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well ~ Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/9~) Front MOA #21 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, ] further verify that based on the information obtained from the Municipality of Anchorage files and from my invest[gat[on 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 $ & $ ENGINEERING Phone ~ ~ '7" - ~ ~'~ ? ~ 17034 Eagle I~Jver Loop Road NO, 204 Address Eagle River, Alaska 9~577 Date DHHS SIGNATURE v'/ Approved for "~'U i~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division /~u~c~^L~-~ o~^~ 825 L Street, Room 502. Anchorage, Alaska 99501 · Health Authority Approval Checklist LegalDescription: TR~c-T 3.~ /~r~.,..~.~- ~ [ ParcelI.D.: 0~f/- o~ / -.3'7 A. WELL DATA Well type PR Log present ~/N) ¥~-~ Date completed Total depth Sanitary seal ON) '"/ FROM WELL LOG Date of test Static water level ~ ! Well production ~ O g.p.m. If A, B, or C, attach ADEC letter. ADEC water system number ! Casing'height (above ground) ~' Wires properly protected {~/N) ¥~ J AT INSPECTION WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed '7/Al/~J ~ Tank size Foundation cleanout ~/N) Date of Pumping ~/41 ~ ~ ~ Pumper Nitrate ]. 7 G Other bacteria Collected by: $ & S ENGINEERING 17034 Eagle River Loop Road :~le River, Alaska 99577 };~ ,f- 0 Number of Compartments__ ~' Cleanouts (~N) Depression (Y/~ /,~0 High wateralarm (Y~). ~ C. ABSORPTION FIELD DATA Date installed -7' / ~,I/ / ~' ~' Soil rating g~..p.d.-~r ff=/bdrm) ~) ~' (~ System type Length Jg~ Width .~- Gravel thickness below pipe ~ Total depth Effective absorption area/0 ~o /~r z. Monitoring Tube present (~/N) V~J Depress on over field (Y/~). ~' o Date of adequacy test ''J//) ~ /v ,~ ~, Results (Pass/Fail) For 2_/ bedrooms Fluid depth __ (i~: Absorption~rate = _' g.p.d. Peroxide tr~paSt~12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on' ev~L~ High water alarm level at* ~Datum Cycles tested ~ _ SEPARATION DISTANCES "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~ (2 0 4- On adjacent lots ,/0 0 "J- Absorption field on lot ? 0 0 -F On adjacent lots Public sewer main h//~ Public sewer manhole/cleanout / Sewer/septic service line / 0 0 -/- Lift station ,'t.//,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~ Properly line ) DO Absorption field Water main/service line ) O /- Surface water/drainage ? OO '+" Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: , , Property line "-] c7 Building foundation ) '7 Water main/service line Surface water / (2 0 '¢-' Driveway, parking/vehicle storage area / Curtain drain M ~ ,.,4_ ~'.~0 ~¢ ¢,." WeLls on adjacent lots / O O Y' F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of in conformance with MOA HAA auidelines in effect on this date. Signature r~--C¢/Z ~ Engineer's Name /~),'3~-/L,z ~.. Cof.~//~¢ Date ) %//~' / ~' ~ HAAFee $. ~ ~;~dP, Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 12-14-gg 07:57 FRO~I-CTE EI~VIROI~b!TAL ~tK CT&E EnvkonmenmlServiceslnc. 56l§301 T-~Z8 P.03/05 F-~43 CT&E Ref.# g9661900R Client Name S & S E~eermg Project Name/O Client Sample ID 7~r2A Atehar Matrix Drinking Watcr Ordered By PWSID 0 Sar~pl¢~crmtrks, Client PO~ Printed Date/Time 12/13/1999 15:52 Collected Date/Time 12/08/1999 14:00 Received Date/Time 12/09/1999 10:45 Technical Director Stephen Ede Relea~e~ ~ uA?ERS DEPT Units Hetnoa 1,7o 0.500 m~/L EPA 300,0 Prep Analysis Date Date Init (<10,1 1~/09/1999 12/09/1999 TOtaL CoLiform coL/1O0rm. SR18 922~ 12/09/1~99 dDT