No preview available
HomeMy WebLinkAboutBERNARD BLK 2 LT 14ABernard Block 2 Lot 14A #060-321-10 sutsml o A wL SEP 3 2019 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191215 PID Number: 060-321-10 Dwelling: Q Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New N Upgrade Name David and Kathy Laymon ABSORPTION FIELD �r ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ M LrFid Site Address 18901 Elnora Lane Eagle River El Other Phone Number of Bedrooms Soil Rating Total depth from • iginal grade 907.242.2436 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. ravel depth beneath pipe Ft. Subdivision Block Lot Bernard 2 14A Fill added above o t ✓ Ft. Gravel length Ft. Township Range Section Gravel wi Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer To a rption area Number of trenches Dist. between trenches From Tank Field i Tank Line Ftz Ft. Well >100' TANK ❑Q Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water >100, Material Number of compartments Lot Line >10' NA plastic 2 Foundation >10' I LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by . PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Installer JRS Septic Drainfield CO/MTD3034 Inspector Curtis Townsend, PE BENCH MARK (Assumed elevation) 100 ft Inspe 15 7/18/19 7/19/2019. Location and description tion 2�a 3°' 7/31/19 e bottom of house siding ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: DateQ'C • •� .� J{ TH Curtis L. Towns nd • j �: Date •�;` �Y� `% . No, CC i—� Septic System fi&�X Approved l Date PROFESSX� Note: this approval does not include well permit requirements. trcev uoluzri u) MARK A 8 SVl SV2 DC1 21'-5" 28'-4» DC2 22,-4„ „ 100' Qv ) WELL NEIGHBORING WELLS ARE ALL AT LEAST 100' FROM PROPERTY LINE EXISTING 38' x 7' ED TRENCH MT DECK HEIGHT `, < 30" DEC O \ 100' X12 ,D r— �rTl 0 !�! !moi ;`L rn ! f D � �z! i ! f ! t NEIGHBORING WELL IS AT LEAST 100' FROM PROPERTY LINE i f 1 -i- C- — INSTALLED DOUBLE CLEANOUTS NEW 1250 GAL ,GREER PLASTIC SEPTIC TANK GRAVEL k SURFACE PAVED DRIVEV`1AY T \3 BEDROOM HOME F- 0 t 1 NEIGHBORING WEL IS f � \ AT LEAST 130' FR M PROPERTY LINE Ct !\ NEIG BORING WELL 1S AT LST 75' FRO �RROPER`T`Y LINE SCOPE OF WORK 1. REMOVED EXISTING SEPTIC TANK. 2. PLACED NEW 1,250 GALLON PLASTIC SEPTIC TANK AND / TIED INTO EXISTING ABSORPTION SYSTEM. THE TANK WAS PROVIDED WITH MINIMUM 20" A MANWAY RISER SERVING / THE FIRST COMPARTMENT. MONITORING TUBE WAS PLACED NEXT TO THE TANK. 3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE / CHAPTERS 15.55 AND 15.65. Tank Replacement As Built Prepared for David & Kathryn Laymon 18901 Elnora Lane Eagle River, Alaska 99577 BERNARD BLOCK 2 LOT 14A EKLUTNA ENCINEERING, LLC 19162 MOUNTAIN ROAD CHU;IAK, ALASKA 99567 (907) 355-9820 OSP191215 DATE: 9/3/2019 DRAWN: CLT SCALE: 1" = 30' PID: 060-321-10 SHEET 1 OF 2 0 Z'- 0 LU < -j w 0 0 0 0 m Z M Uj Uj < -i 0 < z Li m Tank Replacement As Built Prepared for David & Kathryn Laymon 18901 Elnora Lane Eagle River, Alaska 99577 BERNARD BLOCK 2 LOT 14A OSP191215 EKLUTNA ENGINEERING, LLC DATE: 9/3/2019 19162 MOUNTAIN ROAD DRAWN: CLT CHUGJIAK, ALASKA 99567 (9 0 7) 355-9820 SCALE: 1" 10'1 PID: 060-321-10 SHEET'3 OF 2 EXISTING 38' x 7' ED TRENCH '0i L . DL- CaL ot UR, w�112 01 CA Is sula CA cj L=U cr "Ots S) (AVA 01 JAW s) ----------- A 0 p is O<<Z < < . DL- CaL ot UR, w�112 01 CA Is sula CA I of 04— (w 0 p is O<<Z < < LO Do Z < iE 1--: CA OR MAd m9R1<->-w zo- M w � Ljj Ln 4 LU Do Lwj C1 On gggy C W Gil wo� Q C) ; 'i qp CA cs < m to IC04 > 0 ull C5 Z oil UJ P as p pla. i 01 Z V OV) VQ P= 01 p < 'y �j -- CA Do CA 03 ()o 1, 0 01 z Ud Lr) ZcAS CA K OZ OZzrj Do bw I—A O_: z cV cnIsp zi N _j CQ 75.6 L 19.01 . . . . . . . . (J) (D 0 1#1 Z 1.21 57. ±1051 uj X Rq S� CA :H uj io r7 V7 j)X CFA �O 10 DRAINAGE EASEMENT (.99U0 (3 Oi'.9LZ S) �Ej E '0Z uj ;w,'• oj cr_ CR OAK 12 cv) ZE DL- CaL ot UR, w�112 01 CA Is sula CA I of 04— (w 0 p is O<<Z < < LO Do Z < iE 1--: CA OR MAd m9R1<->-w zo- M w � Ljj Ln 4 LU Do Lwj C1 On gggy C W Gil wo� Q C) ; 'i qp CA cs < m to IC04 > 0 ull C5 Z oil UJ P as p pla. i 01 Z V OV) VQ P= 01 p < 'y �j -- CA Do CA 03 ()o 1, 0 01 z Ud Lr) ZcAS CA K OZ OZzrj Do bw I—A O_: z cV �b II w z 0 WO 2K S2F z W 0 Lf C) W V Z z 0 Is mCA c= CA as Do 0 to CL 03 LU to it 00 WDo < w Li F- OC LJ Ul Do AS 01 < 0,0 cr < I CD < U)Do co LL, woo T On Do 0 U<, F I ') C, Do Li Oil nj IZ Cal00 mc 15 to cc E CA K < F CLLL' 0 a LJ Do F 0: CA c 2: CC CA CA W Do — 00- Dow 0 5E Lil < C)ww(.)00 0 -j z ui i�� w < < -, 2 Es < . Do wi� cr '0, �,""""'� MUNICIPALITY OF ANCHORAGE a c-n� , i # ',, On-Site Water& Wastewater Program �-el; 6' PO Box 196650 4700 Elmore Road '��, Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 \� ; _I http://www.muni.orgionsite , 5-=' � liretjan ' c-� Department '4cNoapo` On-Site Wastewater Disposal System Permit Permit Number: OSP191215 Effective Date: 6/18/2019 Work Type: SepticTank Upgrade Expiration Date: 6/17/2020 Tax Code Number: 06032110000 Site Legal Address: BERNARD BLK 2 LT 14A G:0254 Site Mailing Address: 18901 ELNORA LN, Eagle River Owner: LAYMON DAVID H & KATHRYN R Lot Size in Sq Ft: 34020 Design Engineer: EKLUTNA ENGINEERING, LLC* Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field CEJ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907)343-7904 (24)7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: ( C1 Issued By: gd /jug �� Date: 6 /6 /' EPL-/9NS MUNICIPALITY OF ANCHORAGE Development Services Department ; Phone: 907-343-7904 On-Site Water & Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 060-321-10 Property owner(s) David & Kathryn Laymon Day phone 907.242.2436 Mailing address PO BOX 770127 Site address 18901 Elnora Lane Eagle River Legal description (Sub'd., Block & Lot) Bernard Block 2 Lot 14A Legal description (Township, Range & Section) Lot Size 34,020 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field Li Initial ❑ Single Family(SF) El (w/wo ADU) Septic Tank ❑ Upgrade C Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ‘///15 (Signature ofyroperty owner or authorized agent) 1 Permit/Rush Fees: aa5 Waiver Fees: Date of Payment: (101.5)L Date of Payment: Receipt Number: ot/Q Sq.v Receipt Number: Permit No. OSP 14IzIS Waiver No. G:1Development Services\Building Satety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191215, Deb Wockenfuss, 06/18/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191215, Deb Wockenfuss, 06/18/19 Certtf teiy fit tilting tog by DOC CO. aba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 •TELEPHONE 688-2759 OWNER OF LAND: 44)14 1j}/,f�,sf 6 J9 ADDRESS: LEGAL DESCRIPTION' DATE: 5-71/ * 6 PERMIT NUMBER:0400 454 Date of Issue 3 _'3_c>5, TAX IDENTIFICATION NUMBER: 06C? _ _32L- _ /0 Is well located at approved permit location? i 0 No Method of Drilling: r rotary 0 cable tool Depth of well: at Casing Type Srcar... Wall Thickness Diameter 6 " Inches, depth 6¢ Liner Type: 0?6cJ 4 S ,, t f% Pcxx inches feet Casing Stickup Above Ground. v?' Static Water Level: a D Recover Rate:, 3 gpm Method of Testing: Ashm feet feet Well Intake Opening Type: 0 open end l] open hole o Screened: Start OPerforations Start Grout Type: /3&aiarri _ feet Stopped _feet Stopped Volume /0(14/51 feet feet Depth: from 0 feet, to O feet Well Disinfected Upon Completion? fairs0 No Method of Disinfection: C M.0 scr..c ro fr, Comments BORE HOLE DATA C•47,.0G Pr, c .c✓A n J e e6 DDc.0 e.-.) hiekD/ %1 / 3u.A,i',r� fEC(acit 6•Ctf 6eFt..J /3r OA c,c, &W et) 2./ u3 -v Ser ,rani 131:4(4cK 6w,,-) Re -argot ,RAY 2'45-4 "'cc Com Y -434'444.1 QM.c it S'erf.acs 3 -C tnn L S 4(ocic (,,4iK7' Driller's Name Co4‘ J'44L,J�f...3 ATTENTION: It Is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality at Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. TO/i0 3Vd NVAITflS 6SZZ869 ZO:Li L00Z/S0/E0 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Permit Number: SW060044 Legal Description: BERNARD BLK 2 LT 14A Design Engineer: 0000 None Required Owner Name: DAVID H & KATHRYN R. LAYMON Owner Address: PO BOX 770127 EAGLE RIVER , AK 99577-3344 Date Issued: Mar 23, 2006 Expiration Date: Mar 23, 2007 Parcel ID: 060-321-10 Site Address: 018901 ELNORA LN Lot Size: 34020 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy E Private Well 9 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 DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 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 INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55. PLEASE SEE THE ATTACHED SHEET 'PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM". IT IS THE BURDEN OF THE PROPERTY OWNER TO DETERMINE THAT THE PROPOSED WELL WILL NOT HAVE ANY ADVERSE IMPACTS ON ADJASCENT WELLS OR SEPTIC SYSTEMS AND DETERMINE ANY EXISTING WASTEWATER PERMITS EFFECT THE LOCATION OF THE PROPOSED WELL. IF THERE ARE ANY QUESTIONS PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER PROGRAM AT 907-343-7904. Received By: Issued By: Date: ?--23- t'6 Date: 3/7/04 Parcel I.D. Property owner(s) Mailing address Site address Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEPTICIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 321- (o m aL Day phone Zip Code Zip Code 9.9s2__7 99577 41147 Legal description (Sub'd, Block & Lot) Legal description (Township, Section & Range) Lot Size 2 ' ' O2 D Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage ❑ 0 0 Number of Bedrooms s THIS APPLICATION IS AN: Initial Upgrade Renewal I certify that the above information is correct. I further Ica certify Munic pal Copliication is being made for a Single Family Dwelling and is in accordance with app' (Signature of property owner or authorized agent) Permit/Rush Fees: J 7 Waiver Fees: _ Date of Payment: o ��_ Date of Payment: Receipt Number: 2 6' 3 & Receipt Number: (Rev. 11/05) ,1 E MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME z., eO(ar DIn S -V'NG/ 01/ PHONE 2 �$-311 aj7 IA NEW CD UPGRADE MAILING ADDRESS P. ©..Box 771301, Ea j le /liver-, AK 995`77 LEGAL DESCRIPTION Lor / Li- A 81 k a Bernard 5//7 Se_cIq,7-,i,✓, .e LOCATION,NO. 11IGI/ld Rid, OF BEDROOMS SEPTIC TANK DISTANCE TO: Well w Absorption area Dwelling ! ei PERMIT N% '3/035- D 35' Manufacturer„ rL�t° r Material e../No. greLiq. of compartments a capacity in gallons room IF HOMEMADE: Inside length Width Liquid depth O Y —i 2Z S Z 4 DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: Well w Foundation �l / Nearest lot line2O/ PERMIT NO. 3 / 0 - 7� No. of lines, Length of each 1line Total length of Iines 3 $ Trench width 3© inches Distance between lines Top of tile to fini�st,gra 3 PINS CF�'1iadIe�� a Material beneath tile 7 - Total effective absor tion area 1"32 z SEEPAGE 1 PIT Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J lj /'' Class, ,; i 'Vi �. Depth Driller Distance to lot line PERMIT NO. N.' DISTAI'(CE TO: Building foundation Sewer line Septic tank Absorption areals) OTHER PIPE MATERIALS A-77'1 D 303Y - SOIL TEST RATING /'J / ler2 it s'eepzge � e-44 !_ 3'31 -,1�1 '�PT;Fc T k INSTALLER/` aO57i4 ?M G6elr CU - - - REMARKS S/freWl has been hezIS 4-'; fled, 9 railed ami -1-,154T .de— Cleau ouT Tittx ea s arc ;tisr ilecf ®H all s7dNdpiPest‹.Q.}, L // OF ) .'9 •a •lin • V*: • T axh z,., 1 • T, James L Thode • \Ilks ••ti CE 5035 '� - r(4 or” �a111 .. �e,,p '••••••••1 �.F. pgOFESSIOWII E 1 n>� 1v:7$. APPROVED flail LEGAL j/14/01‘,7AL.,�.oT ;*A ,�Ik e, 8cr►fatrc VD 72-0t (Rev. 3/78) rLAz-ex ii- ,-„ 7/f t 1 2 °"1 M It -.1 T: C: I: k d p L._ 17- "V CIF- Fu 1°-4 (7:1- 4� _� ;, : 9=1 C F" DEPARTMENT OF HEALTH FINN:' ENVI F:ONMENTAL - PF:OTECT I ON 5 'L' STREET, ANCHORAGE, AK 9950:1" 264-4720 : ANCHORAGE 694-2131 : EAGLE RIVER a.µat — EE EE 14EEF : F"E F:111 1 "r PERMIT NO. 831035 APPLICANT: OEOLF-IF: C:CIN5T ADDRESS PO BOX , 1 :130 2 EAGLE RIVER, AK 99577 LEGAL DESCRIPTION - SUBDIVISION: BERNARD BLOCK.: 2 LOT: 14A LOT SIZE iii SQ. FT. TOWNSHIP -- /SI RANGE: -14) SECTION : 191 MAXIMUM NUMBER OF BEDROOMS = 3 SOIL F:ATING = 177 177 177 (SQ. FT. BR: LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM.' CHOOSE THE OPTION THAT BEST FITS YOUR SITE. PHONE: 688-3437 EE 1" -CII -1 C:d E -._. I 4,te (3 P7iO i WIDTH = 2.5 FT. _ LENGTH .= 54.0 FT.. �D TOTAL DEPTH •-- 9 0 FT. 38 GF:AVEL.. DEPTH = 5.0 FT. AGF.:FiVEL. VOLUME = 27. 5 CI_E. TANK SIZE = :1, 000. 0 0 GALLONS(TWO C:Or1F`FIF:TN'1EN•T TANK) ) WIDTH : 2n. 0 FT. LENGTH = 40. 13 FT. TOTAL DEPTH = 5..0 FT. GRAVEL DEPTH = 0. `7.5 FT. GRAVEL VOLUME = .7?!::41.6 CU. 'r'D`. . TANK SIZE = 1,000. 0 GALLONS ': TNO CCIFIPARTN'1ENT TFiM:::::' 1-" 1 . I E £: 1 : .: PA F.7 CB Cu _ a 1"-.1 WIDTH = 5. 0 FT. LENGTH -- r,'2. '3 FT. TOTAL. DEPTH = 7. 0 FT. GRA'rEL. DEPTH = w:. 0 FT. GIF:AVEL. VOLUME •- 40.1 CtI. 'Y'DS. TANK SIZE = 1,00a 0 GALLONS (TWO COMPARTMENT TANK) I CERTIFY THAT: AM FAMILIAR WITH THE REQUIREMENTS FOR ON --SITE SENERS AND WELLS AS SET FORTH. E:Y THE MUNICIPALITY OF ANCHORAGE 1E ANN THE STATE OF ALASKA. WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE C:ODES AND HAVE RECEIVED A COPY AF• THE CODE . Ut1N'1AF:'Y' AN•tD DIAGRAM ATTACHMENTS WHICH 1.E F'AF'T OF THIS PERMIT . I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE .ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3: BEDROOMS PERMIT APPLICANT HAS THE RESPONSIBILITY Ti:' INFORM PERSONNEL ON•NNEL C:'LIRING • THE I N. TALLAT I oN I N SPECTI ON, S OF ANY HELLS ADJACENT TO TH I w,•F'F:OF'EF:'' Y AND THE NUMBER OF RESIDENCES THFIT THE WELL WILL =,EF:'','E. IF A LIFT STATION I E, INSTALLED, FIN ELECTRICAL PERMIT ANC' INSPECTION 11I._i' T BE OBTAINED. A'S-- JILTS CANNOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION.. REPORT. THE E .: I C AL WORK MUSTiy .. DONE BY •A L. I IIENSED EL.ECTR I C: I ANN SIGNED: APPLICANT: ISSUED BY: DATE : 12/02/83 Russell Oyster 694-2774 0 & E ENC,INJEERING & DEVELO1 1 1ENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Earl Ellis 688-2280 Performed for: Name• L . ,L/. _60/e, 4.) Tel. No 69JY " Z 3gi Mailing Address. r^ ® /db,L 2Z �,�1. e�.�.o�° f '7 9 5-7;p 7 Legal Description. Depth (feet) Soil Characteristics 0 ►--' 1 /V+L- GfL^r fpP6L.-. 2 3 4 f ee_ 5 TES ' C�/ " 4 .,1A ty 7 C=o,3.g ZT s i c--.dc_-;Q s 8 T f $ i AJLOrs 10 75 ,ep, �/ s' 11 12 13 `c7 w A 7-- 7e T� LE - 14 15 C -rr-r) rtn 1— 15 •FbA D Nth .a 11-41.- e•r PLOT PLAN PERC. TEST l��,Pt dr /e o41,AJ/n/2 y Ground Water Encountered: Yes ✓ No If yes, what depth 13 Proposed Installation: Seepage Pit_ Drain Field / Comments. 1 ) t..1` 4 9 �T6i t; ' Q v3 i%r e`a onotIn000eea000a� it , Russell L Oyste? ,° 44 P ^),.; No. 4286-E ,° 1§)oif yu °"0.• .5 •?'' Performed by:. -•1A Date. e, fc7 82 Parcel I.D. # 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 :' G- 53.( - ) v 1. GENERAL INFORMATION Complete legal description HAA # Lot 14A; Block 2; Bernard Subdivision Location (site address or directions) NHN Elanora Lane Eagle River, AK Property owner Bill Clark Day phone 694-6873 Mailing address P.O. Box 3344 Eagle River, AK 99577 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 v xxx 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 xxx NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 Address S & S ENGINEERING 1/t134 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Engineer's signature Phone yi y - �-�i 7 l '(�,�I C —✓' Date l 7 `r ,, :OF . f��..........'`� ,'-: ffr C7 •ti:S� y9t,tt '. Ps ii 3 l y�if , RO6 RT . COWAN " I Q c�.. CE -8801 /4;'/ 6. DHHS SIGNATURE t�+`vr:::'' J�' Approved for i,ki�1 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By' �� c /a6(4 CAUTION Date �g The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Author Approval Certificates based only upon the representations given in paragraph 5 above by an independer professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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 SERVICESMUNICIPALITY OFA '8.11111': "'',I Environmental Services Division ENVIRONMENT NCHO ,,r jL-1 ALs 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 ERVICEs DIVISION Health Authority Approval Checklist Legal Description: L (+A ' $Z '� Rb sip Parcel I.D.: RECEIVFO J Q Coo— 3a1-10 A. WELL DA Well type A If A, B, or C, attach ADEC letter.ADEC water system number a 1 'a 7 S L/ Log present (Y/N) Date completed Total depth =sed to Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Other bacte g.p.m. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 1 9 S 4 Tank size ltx'n ouil Number of Compartments X Cleanouts QN) y Foundation cleanout IN) r'%S Depression (Y0 ND High water alarm (Y/N) 4/A Date of Pumping. C. ABSORPTION FIELD DATA Date installed 'C e.+ - Soil rating g.p.d./ft2) r ft2/bdrm S rs1 System type TIZ1=r' C �1 f 111 Lengthy Width 30 Gravel thickness below pipe } Total depth {i%_ Effective absorption area 532- 1T Monitoring Tube present f l) (/i%5 Depression over field (ye, ,J© Date of adequacy test i' J 1 J CIO Results `i ail) P,c66 For TH2f.0 bedrooms it Fluid depth in absorption field before test (in.); 2 Immediately after 539 gal water added (in.): 2.5" u Fluid depth /7 (ins) Minutes later: 2.2. w'f.i, Absorption rate = tf 50 f g.p.d. Peroxide treatment (past 12 months) (Y/N) /JON E 44'14t If yes, give date 72-026 (Rev. 3/96)` D. LIFT STATION Date installed _ 4 Size in gallons Manhole/Access (Y/N) - . s p on" level at* "Pump off" level at* High water alarm level at* *Datu Cycles tested E. SEPARAT N DISTANCES SEPARATION DISTA FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot On adjacent Tots Public sewer main Public sewer - • ole/cleanout Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation t 5 + Property line Absorption field . I+ Water main/service line lb Surface water/drainage ADD Wells on adjacent lots 2150 '+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 -4-Building foundation lb { Water main/service line Surface water 100 Driveway, parking/vehicle storage area Curtain drain feJOreJ E KJav Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal rec in conformance with Jylgj4 HA/�,guide Jines in effect on this date. Signature Engineer's Name Date !GO%jfft T q 72- / 10�� ZOO'� Q ms are *l 10 R `OBERT C COW...'. II+c� :\ CE - 8801 .....V :i11ut.IRO ESS\ HAA Fee $ Date of Payment Receipt Number.3b3a 2!J,?2 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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 Parcel I.D. # ()(on -'2\-1n 1. GENERAL INFORMATION Complete legal description 2. HAA # II�il�-1 no -\TS Lot 14A: ' 1 r rk 2 Rprnard Guhrli vi Ginn Location (site address or directions) NISI Elnora Lane Property owner Bill Clark Day phone 786-4821 (w) 694-6873 (h) Mailing address P.O. Box 3344, Eagle River, AK 99577 Lending agency Day phone Mailing address Agent Day phone • Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS:' 3 \I TYPE OF WATER SUPPLY: Individual well Community well Public water x 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 x NOTE: If community wastewater system, provide written confirmation from State ADEC*. attesting to the legality and status of system. 72-025 (Rev, 1/91) 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. 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 th' 'nspection. Name of Firms s ENG"'aa'""`� Phone a�' X979 Address 17034 Eagle River Loop Road Eagle River Alaska 9957/ Engineer's signature Date 04 age Ada 2. f' DHHS SIGNATURE Approved for J bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments CAUTION The'Mrnicipality 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 professionPl 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 and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: U4tt C'�t,v-2 sh Parcel I.D. A. Well Data Well type Log present (Y/N) Date completed Driller Total depth Cased to Ca • : eight If A, B, or C, attach ADEC letter. ADEC water system number Sanitary seal (Y/N) Wires prope • otected (Y/N) Date of test Static water level Well flow g.p.m. g.p.m. FROM WELL LOG AT INSPECTION P evell SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ ; On adjacent lots Absorption field on lot Zoo ; On adjacent lots Public sewer main Public sewer manhole/cl Sewer service line Petrole - nk WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria ample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed \ 18 di Tank size 1 o Compartments -z- Cleanouts ON) Foundation cleanout oN) Depression (Y0 n1 High water alarm (Y0 Alarm tested (Y/N) Date of pumping Pumper 5 r 57k1-1 IP Orta PL /s SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 11-6 tk On adjacent lots 4Foundation 5 I To property line 1 b Surface water/drainage 72-026 (3/93)* Front Absorption field \eot� Water main/service line I o i)- CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level ycles tested "Pump on" level at "P Meets MOA electrical codes (Y/N) SEPARATIO NCE FROM LIFT STATION TO: evel at Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA /e,e___ Date installed � 3 4 Soil rating (GPD/Ft2) 111 4 System type T ,S(..A Length e) Width 3 O Gravel thickness 1 Total depth t Total absorption area ' 4 Cleanout present ON) Depression over field (Y/64) Date of adequacy test 2-1► 4 Results ,Vail) Pd,, --_,s for 3 Bedrooms Water level in absorption field before test / 0 After test 0 / A Peroxide treatment (past 12 months) (Y & ° - /LAI r r iti-� If yes, give date 4- SEPARATION DISTANCE FROM ABSORPTION FIELD TO: l Well on lot 2�b 0. --On adjacent lots '� y Property line \ 0 �� To building foundation o, To existing or abandoned system on lot On adjacent lots 3 a Cutbank.6 Water main/service line �� Surface water 1 D r Driveway, parking/vehicle storage area /fr Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verif d, o conformed to all MOA and HAA guidelines in effect on -the d'= to of this inspection. Signature Engineer's Namd 703 Eagle Ri Date 01 HAA Fee $ :c dvo Waiver Fee $ Date of Payment a— /b �/T Date of Payment Receipt Number 6-6 T ( g77?) Receipt Number 72-026 (3/93)` Back