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HomeMy WebLinkAboutBERNARD BLK 2 LT 16Bernard Block 2 Lot 16 #060-321-12 SULLIVANWATER WELLS Walnut-Ce.aawrctar-Gnnenuat Nor fe7Jee-27ae Well Log Permit Number. #SW Date of Issue Date Started: 41712009 Date Completed: 4172009 Is well located at approved permit location? Property Description Qrl rw4 L1% a Lo 1 I Property timer Name & Address: MICHAEL Wt31R PO BOX 102954 ANCHORAGE, AK 99510 Parcel Identification Number. Yes ❑No Borehole Data: Soil Type, Thickness & Water Strata Casing Stickup Overburden Hardpan Brown Bedrock Decomposed Drown Bedrock Gray Bedrock Browns Bedrock Gray Bedrock Gray & White Bedrock Water Sample Results: Arsenic: Nitrates Total Coliform Bacteria Other bacteria: From 0 4 8 uwl Depth To 4 8 53 ba 62 62 102 102 127 127 142 142 151 151 204 mg/1 colonies/ICOnd, coVIOOml. Method of Drdliag Ix ] air rotary 11 cable tool Casing type: Wan thickness 025 Mates Diameter 6 fiches Total: 64 feet Liner typo Diameter 4.5 inches Depth: 204 feet Casing stlek-up above ground: 4 feet Static Water Level(fom top of casing) 18 feet Pumping Level: feet alter hours pooping gpm Recovery Rate 15 gpm Method of Testing: Air Well Intake Opening Type U Open End El Open Hole ❑ Screened Start_ feet Stopped _feet n Perforations Start feet Stoppcd fcet Grout Type: Bentonite dry granular Volume: 1 Sack Depth 44 Start o feet Stopped 44 feet Pump Intake Depth: feet Pump sine: 11P brand name Well disinfected upon Completion? U Yes U No Method of disinfection CHLORINE do PPM Comments: WELL IS LINED FROM 64 TO 204. Well Driller: Cole sullhran Sullivan Water Wens P.O. Sox 670272 Chugiak, AK 99567„ , (907) 688.2759 - f % r Attention: The property owner shall provide a well log to DSD within 30 (1335 of completion. vet 6SLZ 889 LO6 sO°M relent uenlllnS eE0:60 60 SZ tiny ARCTIC PUMP & WELL INC. Jim Sullivan, CPI PO fax 770197 Eagle River, AK 99577 (907) 688-2510 (907) 258-2510 (907) 745-2510 pwOrgci.nct Pump Installation Log Well Drilling Permit Number: SW080190 Parcel Identification Number: 060-321-12 Date of Issue: 9-11-08 Legal Description:Bemard Lot:16 Block:2 Property Owner Name & Address: Connie Lisenby 8057 Stewart Mt Dr Paolo. Rivrr ATC QQS77 Pump Installation Date: 6-9-09 Pump Intake Depth Below Top of Well Casing:178 Fect Pump Manufacturer's Name: Dempster Pump Mode1:18-295 Pump Size:11/2 hp Pitless Adapter Burial Depth:10 feet Pitless Adapter Manufacturer's Name: Baker Pitless Adapter Installer: U/K. Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Well, Inc. Page/oft 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 Renewal Date Issued: Sep 11, 2008 Expiration Date: Sep 11, 2009 Permit Number: SW080190 Parcel ID: 060-321-12 Legal Description: BERNARD SUBDIVISION BLOCK 2 LOT 16 Design Engineer: 0003 S & S ENGINEERING Site Address: 8057 STEWART MOUNTAIN DRIVE Owner Name: CONNIE LISENBY Lot Size: 32558 SO. FT. Owner Address: 8057 STEWART MOUNTAIN DRIVE Total Bedrooms: 3 Permit Bedrooms: 3 EAGLE RIVER . AK 99577 - This permit is for the construction of: Disposal Field ❑ Septic Tank ❑ Holding Tank D Privy 0 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 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. Received By:Date. Issued By:,Z2 Date: 0//der Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.orglonsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. D1Di;- 3a I- t o Property owner(s) Ofl tin U&Q_ flh! 1 Day phone ted q ' S 6/4 Mailing address $051 S1EuY1A Mk Dr. &/R Zip Code 9615174 Site address Zip Code Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section)Bta'Yllrci (-bp. Lilo Lot Size S2, 551P Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR (® all that apply): Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage 0 0 0 0 THIS APPLICATION IS AN: Initial Upgrade Renewal 0 I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. v ) phi (Signature f property owner or authorized agent) PermiURush Fees: j 15- Waiver Fees: Date of Payment: t/D/49& Date of Payment: Receipt Number: b 10G Li% Receipt Number. (Rev. 11/05) 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 Date Issued: Sep 11, 2007 Expiration Date: Sep 10, 2008 Permit Number: SW070239 Parcel ID: 060-321-12 Legal Description: BERNARD SUBDIVISION BLOCK 2 LOT 16 Design Engineer: 0003 S & S ENGINEERING Site Address: 8057 STEART MOUNTAIN DRIVE Owner Name: CONNIE LISENBY Lot Size: 32556 SQ. FT. Owner Address: 8057 STEWART MOUNTAIN DRIVE Total Bedrooms: 3 Permit Bedrooms: 3 EAGLE RIVER , AK 99577 - This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑Q Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked 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. Received By: Issued By: vibe z Date: Date: Y1 /r/07 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 SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. no0- 30 1- l `oti Propertyowners) • (?pnit/ e.5-em�rbr,/' Day phone (p,td2t/V ((// Zip Code Mailing address � Se2M1-ei O0 Site address S7 *fewarf /?oU a;n Dr;UP_ Zip Code Legal description (Sub'd, Block & Lot) (- Legal description (Township, Section & Range) Lot Size 3"1-. 5540 Sq. Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR (®all that apply): tit Absorption Field0 Septic Tank Holding Tank Privy Private Well Water Storage THIS APPLICATION 1S AN: Initial Upgrade Renewal I certify that the above information is = ect. 1 furth r certify that this application is being made for a Single Family Dwelling and is i cordance with . plicable Municipal Codes. (Signature of property o Permit/Rush Fees: Date of Payment: Receipt Number. (Rev. 11/05) oriz- • agent) Waiver Fees: Date of Payment: Receipt Number: ,11 1 r* I.A.$&$ gineeRing HEALTH ALIT /CRTY APPROVALS SEWER&WATER MAIN UTENSIOTS SEWER WATER INSPECTION ENGINEERING STUDIES AND REPORTS nu INSPECTION &FLONTEST SITE FILMS ROAD DESIGN SOIL TEST PERCOLATION TEST STR CTUMLS MECHANIC/J. INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN. P.E. September 5, 2007 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 16; Block 2; Bernard Stewart Subdivision CML ENGINEERS (907) 6942979 FAX (907) 694-1211 It is requested that you issue a permit to install a new well to serve the existing three bedroom dwelling on the referenced property. This residence is served by the Bernard Stewart Water System, which was scheduled to be decommissioned 8/31/07. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve � areas or drainage patterns by the installation of the proposed sie"'in t. The construction of this system will not prevent any future development on any of the adjacent properties. If you require A' Tonal information, please contact us. Enclosure r, P.E. NV1d-311S 1 NDIS30 . Permit Municipality of Anchorage Development Services Department till :' ) Building Safety Division _.. On-Site Water and Wastewater Program, 4700 S. Bragaw Si P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 www ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Number: 5W050 33% PID Number: OtiO — 3d 1 'I - . !Vi o13 7 Name iz/ A lid Kier y Wastewater System: ❑ New Upgrade Aad..., /� I1E.3ga11t,U//�%��/I 441.49e, /1 143QI ABSORPTION FIELD Plherh. 0� — iw iha 6 Number a Bedroom.3 ..... D..D Trench 0 Shallow Trench 0 BM 0 Mound ❑ Oew LEGAL DESCRIPTION saR.bng I. p{ Gpoire ToWDepth honerlpnepwade 4 0 FL BIeA ^ la 16 SuedN.on: (� atria rd O(/ 6 UK Depth b pipe eedarn hen caret weds n. Gravel depth beneath pipe r Fr Tamely Range' Section. Fa added Wove odpnr vedrL ` 0.71. Gravel Length w 38 Ft Well: 0 New ❑ Upgrade Greve( Wah Number YMe D�.I.nc. Swoon IM. _Ft_ r/r{y�f/, O {S- /� DI(4611eMM' 4 ii er (A-Ate Total D.De: Fl ��wry w.DTe/pn}�eu 3SOFe '�j�7 i�Mr4isesylpgo Omer t` Dee Dn Static Water Leer Installer -pact Dee Instated s_iT FL IIAk�a G((�t%(i f'I('l� S ©s_ ems GPM rip Set al Ft. Hinged AGMs Ground FL TANK SEPARATION DISTANCES ca Septic ■ Holding ❑ S.T.E.P. ❑ Other: To From Septic Absorption Lilt S�ttaT'tiioo�n/ Holding Tank ublkJPdvata Sewer Line adee. . React:, CF4'1 f el s c.p.cl cel /T�a/n�k� 11 Mees ' I /� /T r Hi", acdrrVelmenl. WM i- - �/ �/F�'1k'/ldJ ieo IW/� r a 5{- 'H1 r1/1 Y((/- Surfauw.W I it cut. !. 1/ ► _jS7JI[/ LIFT STATION LaLIn. 640( l/ lJ U ` &,. ;TO Gr Mater PUC 30ttin Foundation CrV L I bC/ I 'Pump on 1err.l �{ 8 In 'Pump of level al Si. S In High valor Winn al gig. S Curtain am '/ P yM.. Mod.l E,......,Inpecbon, (*loaned by pine F NOLO✓. Yeia lw5 t ; s inJ 56r7 m Reeh. BENCH MARK TACK PONPCbr c a0e44f t C. Location and D..a pIon n / bettor'', Of s;d;00( ��.tciks ell •5a.ThC torIS r /\ /rpt LI Assumed oration. /\(��1 ()oarf /� 10ti Ft a-Act+Fats +s D,sccz 7rc-t/) a-- rt y,4 boNrio Engineer's Stamp .:.:. 44\ a'�t _ 70...\ 5 a 5 ENGINEERING 17014 Eapb Rhin Loop Road, No. 204 at Inspections performed by: Dates: 1 9-11/ —05 i :P141°. f i... t) 0/' ., ree ' °ti 7 a , or ; c:I ytr es i. L:r 2nd 8_15-05 s' �.�.._.., . • Development Services ��'�Department Approval Reviewed and approved by: ��� Lt/. O—Ct ( Date: 9 -a l -�O,S I A. arse., ,(t 'r •ie red �' 1'�-0 �., f ) (Revie t tel _b+,;xiwTZ�:ji PERMIT NO SW050337 PAGE 2 OF 3 They of' Anchora e DEPARTMENTFpHaEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.0. Box 196650 *Anchorage, Alaska 99519-6650 • Te3Lephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 16, BLOCK 2, BERNARD S/D P.I.D. N0. 060-321-12 POWER POLE 1 20' ALL FCO SMr�T1 T2 01 MH / TBM NEW 1000 GALLON / HDPE SEPTIC TANK NEW PUMP BASIN 6" INSULATION 15' ter STEWART DRIVE Y NEW TRENCH TH MTI POWER POLE LOT 15A SEPTIC S AREA ✓ ttROX locoYoh, b W.r(y IMIC SCALE: 1' - 40' EN 1,1)01_TAMP of • e*AIi 4 VI`.. 0 �' • . '•�4i•i , 0,-;:,? e 2 n .+ ,..,•• • • • ..S•" • c :L: a� - n.{ A ;Cid f': • .4 J PERMIT NO SW050337 PAGE 3 OF 3 Municipality of' Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION PO. Box 196650 •Anchorage, Alaska 99519-6650 • Te'tephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 16, BLOCK 2, BERNARD S/D P.I.D. NO. 060-321-12 FINAL GRADE 6" INSULATION 94.0' ST1 ST2 C01 NEW 1000 GALLON POLYETHYLENE SEPTIC TANK FINAL GRADE NO WATER FOUND 91.4' B.O.H. 93.7' TOP 2' INSULATED -o- EFFLUENT OUTLET A B FCO 17.0' 15.5' ST1 26.0' 15.5' ST2 29.0' 16.5' TMT 24.5' 14.0' C01 31.5' 17.5' MH 34.5' 19.0' MT1 86.5' 64.0' N. T. S. 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 WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 07, 2005 Expiration Date: Sep 07, 2006 Permit Number: SW050337 Parcel ID: 060-321-12 Legal Description: BERNARD SUBDIVISION BLOCK 2 LOT 16 Design Engineer: 0003 S & S Engineering Site Address: 8057 STEART MOUNTAIN DRIVE Owner Name: RANDY KAER Lot Size: 32556 SO. FT. Owner Address: 115 E. 3RD Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE , AK 99501 - This permit is for the construction of: 0 Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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. Received By: a Date. Issued B((� Date: 111 /'r Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. (JD- Permit Number SW Property owner(s) i ftADy Yt t icc Day phone Z- CC Mailing address l l S F-, 13 ka f Se4+eC4,r- 4t. Zip Code 'HS© Site address RD5 1- SkeuxiLA rn"c trY / Zip Code Legal description (Lot, Block & Sub'd.) 1-0 1- (� R jntE R B, ✓I at of $t " Legal description (Section, Township & Range) Lot Size 39- 5o1 Acre q.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Well Only 0 Water Storage ❑ Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. 7 "/ lyyZ• 5&3ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 (Signature of property owner or authorized agent) Permit/Rush Fees: y e B Waiver Fees: Date of Payment:(( -9 -or 7 9-z '-OSDate of Payment: Receipt Number: 6 90 5 7 Receipt Number: (Rev. 09/04) = e•,:t•&S Ineemng HEALTH AUTHORITY APPROVALS SEWER*, WATER ATAN E%TEICONS SEWER/ WATER NSPECRON ENGI EERRCSTI.ES MISREPORTS WELLNSPECTICN S FLOW TEST SITE PUNS ROAODESON SOIL TEST PERCOIATWN TEST STRUCTURAL*, MECHANICAL INSPECTIONS ONSITE WASTEWATER 06PoskreSTEAI CESON ROBERT C. COWAN. P.E. ROBERTA. SHAFER, P.E. CML ENGINEERS (907)694.2979 FAX (907) 694.1211 September I, 2005 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 16, Block 2, Bernard Stewart Subdivision It is requested that you issue a permit to install a septic system upgrade to serve the existing three bedroom dwelling on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation (8-10-05), water was not found. Atter monitoring, ground water was not found. 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 properties. If you require additional information; please contact us. Sincerely, 2. L -- Robert C. Cowan, P.E. RCC/bjj Enclosure 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER. ALASKA 99577 = D. 0 0 ro c.,= a G pc OUO c mSo c i IC oi SCA. 3lod a3MOd DESIGN 310d a3MOd I no A -•O ])y trio Zvi on ft 15-20%xo O 75-20x r 0 O 1 SITE -PLAN C.•1 w Ul CO 0 o m zp-nm t-1 �mm-0 C7 y < f) 0 (i1 =toX CO cl) Nom- rnOZ 00 • n G o o XISTI/� o -0-0 TENCH so o13o C mN = yv-iO 2 m NN C-1 zz N0 m r) -)N yco- 0 nxio 0> ZOO AO i i 0 air "Not. m 1t,` r'., d r O v • tri N 7 Performed For, Legal Description: 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS 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.munl.org/onsite (907) 343-7904 Soils Log - Percolation Test ti:11VA`+ Y-ty-Eia_ it( ZBr4243.442tii 5104TowinshiY7t;nge, Section: 0. :fr(l \ It03ERT C. COWAN eel iVC) CE -8801 ±• Ci�11" Date Performed: -oecvstutLs yqr - Gm toicoDeAtS (5(Jeri .5444by\ 4 Q -*vet. 11 Slope WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monftoring? ��f e L O _—f_ �Q P T Date: 411915 84o/os Site Plan SEE r1 tnt int std te— FZ 1< Reading Date Gross Time Net Time Depth to Water Net Drop P2fSog1C 43/It/OS i0 - z'` 0 ICS 10 toll,' 83// t5 2r' O 70 l0 10 f3" ZU - Zr' o -5o 10 IDr" 811 (mYweWrA) PERC HOLE DIAMETER TEST RUN BETWEEN a{ FT AND S FT $ & 5 ENGINEERING PERFORMED BY: 7034I AgLs River Loop Road No. 20}, .t'2< CERTIFY THAT THIS TEST WAS PERFORMED IN AQC C t QFr'o{5fl i*aI AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: �i Or t„ye1/4 BdcS Ineening HEALTH MRI TY APPROVALS SEWER £ WATER SHIN EXTENSIONS SEWER a WATER ScPECTfoN ENCONEERING STUDIES AND REPORTS WELLNSPECHON a NAW TEST SITE PLANS ROAD DESIGN SOIL EMT PERCOTATICN TEST STRUCTURAL MECHANICAL ScPEcNOH9 ONSITE WASTEWATER [MAMA. EMMA DESIGN ROBERT C. COWAN. P.E. ROBERTA. SHAFER P.E. CML ENGINEERS (907) 694-2979 FAX(907)694.1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 16, Block 2, Bernard Stewart Subdivision September 1, 2005 GENERAL: 1. The scope of this project includes the installation of a pump basin and a pressurized drainfield to serve the existing three bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOPSUITE 204 a EAGLE RIVER ALASKA 99377 Page 2 Lo116, Bbdc 2, Bernard Stewart Subdivisim September 1, 2005 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the holes faced downward. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, 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. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 lot 16, Blod 2. Bernard Stewart SubdWision September 1, 2005 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tyne of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever specifications applies. Page 4 Lot 16. Bbck 2, Bernard Stewart SubdNabn September 1, 2005 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: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 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 perforin 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 inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / INSTALLER 4UNICIPALTTY OF ANCHORAGE HeE and Environmental Prote. )n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 ;\, _'-,, INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME-�i "'l S41" MAILING ADDRESS `j� 2 LOCATION � C'1, \ '.vn1 LEGAL DESCRIPTION L t to "Z naxa 51 SEPTIC TANK: DISTANCE C_00"'_ FROM WLLL -`Not-4 MANUFACTURER MATERIAL -"`� 0-S.S INSIDE LENGTH INSIDE WIDTH NUMBER OF COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY L)S°GALLONS. TILE DRAIN FIELD CAav,( TOTAL LENGTH DISTANCE FROM WELL .1-00 4- FOUNDATION_30 4 NEAREST LOT LINE 140 -4" OF LINE V # of Lines — DISTANCE BETWEEN LINES _NA_ TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA 1 (@O SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER Sr MATERIAL BENEATH TILE C. IN. ABOVE TILE 2_ IN SEEPAGE PIT: DIAMETER OR WIDTH _._-__, LENGTH_, DEPTH Log Crib Rings Crib Size:' DIAMETER __DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) BUILDING FOUNDATION NEAREST LOT LINE SQ. FT. Well Class : Q ' "" Depth: Well Distance To: Lot Bldg: Sewer Pipe Materials: # of Bedrooms: Installer: Remarks: Line Line: DATE tOi i 71 ' 1APPROVED • 1 I j r4'T f It __ 1 _.. __ R�_.— ; .— -__,._ — . _ I �p� f_ .1 _� _.._. _ ___r_. DATE tOi i 71 ' 1APPROVED • �li r-4 1 lc I F* Fi I__ -1 -1" '-r" C11 F- ���1.-11 CI) F: Fi C3 EE \C)% DEPARTMENT HEALTH AND ENVIRONMENTAL JTECT 'ON lL 251" E. ."""" .`".' ,"""""""E' AK. 9,.07 �r / 0�m/) 276-2221 n� / XL8��^ K]/r4--��][�-�� �� � E2 ���� ^��][ -1 ' E"''^ ' NO. ` 77077 ' ' /6-1-1..5- / / |/ ` �1^ �L3(-�^ 5 '/w �-` / � 0m� .} �� C.36 -14. - APPLICANT DUANE PEPPER, -�'--�������'`E ^'�~ 77]-6889 ' .^' - LOCATION HILAND'ROAD LEGAL L 16 E3:RD ---- ��(7 ��p- TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 120 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �EEP°11-1-1= W LEENICA-11-1-1= �163 IDE.EFM-1= LOT SIZE 38791 SQUARE FEET � ^/ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F4rEIDIAIFnec. 7su:F-ric: 11-nr4K -VW° FiRla FE:11741.JIIR!laID BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PRO5ECUTIM MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. VF711L..i CirCEE N-1EARIR. I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS RIDELED TO 1 DE MORE THAN 3 BEDROOMS. SIGNED:_ ��.��*�' 44,4,- •,l'ER--__-�__ PP CANT DUANE P ISSUED BY_ c,rtAIL k n[J'i;II ;Lnr! r,P;- r. [;0[0 JcpartmcnL of Lnvironmenr,al Quo , rty 3330 "C" ; trcn t Anchorage, a,{:a Performed for _Mr. Bernard SStewart;).1te Pc rioT� Legal Description Lot_.f6, Block 2, Bernard Sully., F.ac;Ic River This form reports: Soils log _„ Percolation Lest Depth Feet 1 e,,; (85) 2 - 3 - 1:• (35) 4 - (35) 5 - (55 ) 6 - GW (85) 7 - . `i, ( 75) 8- GW(10) 9 - (12 0) 10 - (120) 11 - (120,) 12 - 13 - 14 - Fit Was ground water encountered? (leading Date 0 Gross Tirne s i°')0 r- - -- t- f tine 23, If yes , at wiry t deka t:h? Net Time Depth to Water Percolation rate minute. •Proposed installation: Seepage Pit Drain Field Depth of Inlet Depth to -bottom uF pi t or trench CO '1MLFJTS : Net iirop Performed (3 � - �; ?_ = t- , ::_ Certified By-�1 .�` �_.�aLe: i �,-77 EQ -040 (6/74) GREATER ANCHLkAGL MLA WPC. Department of EnvironmenLal Qu ity 3330 "L" 14reet Anchorage, Alaska 995(13 ' SOILS EOG - PEROEATION TEST Performed fori:r.1. )ate Performed 12,5_176 Legal Description:_ 3,3rnar (3. -31).by This form reports: Solis fog x Percolation test Depth Feet 1 - sw (125) 2 - sw (125) 3 - GW (100 4 - of (100) 5 -J'TW (102) 6 - (100) • 7 - o' (loo) 8- GW (90) q4) 9 - 0t (90) 10 - GW (90.) ..*Na 11 - G(90.) 12 - GW (85) ^ 13 - GW (85) 14 - GW (85) 15 G!:! ( 85 ) 16 •-• ci(85) / "oo Flat Was ground water encountered? si — Date Gross Time Net Time Dep th to Water Net Drop •......o ..... --------------------------------- .., .......-- ,-. . —4. 4'— If yes, yes, at what depth? Reading Date Gross Time Net Time Dep th to Water Net Drop --------------------------------- Percolation rate minute. •Proposed ins ta 1 1 See -page Pi tDrain Field Depth of Inlet . Depth to bottom of pi t or trench _ CONNENTS : Performed Certified By By : . EQ -040 (6/74) ?ichard A. Orahn, P.. J.044, :ate 7.ichard A. Drahn, MUNICIPALITY OF ANCHORAGE Development Services Department ` chi Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 060-321-12 Expiration Date: —7-2,7 -z- 1. GENERAL INFORMATION Complete legal description BERNARD BLOCK 2, LOT 16 Location (site address) 8057 STEWART MOUNTAIN DRIVE, EAGLE RIVER AK 99577 Current property owner(s) MICHAEL WEHR Day phone Mailing address Real estate agent PO BOX 670836, CHUGIAK, AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 55 0 Waiver Fee $ Date of Payment Y��j�� 2 Date of Payment Receipt Number 50919 2 Receipt Number COSA# OSCE 1 I Waiver# 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, based on procedures outlined in the Certificate of On -Site Systems 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 4/18/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any estimate of how long a system will function satisfactory ��Q: •' .. for current or future occupants or guarantee that no unseen encroachments, deficiencies or ��g•' '.� �rJJ discrepancies exist can be given by First Water Consulting & FWr.50 *' � TH ........... I 6. DSD SIGNATURE • Curtis Huffman System #1 Approved for --� bedrooms r�� �F��'•, CE t2ssst • 7 'aw Y pP �� srFyFo-4/18/Z2��. System #2 Approved for bedrooms 11i PROFESSO0 Disapproved Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date:q-z7— 27 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: BERNARD BLOCK 2, LOT 16 Parcel ID: 060-321-12 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 4/7/2009 Total depth 204 ft Cased to 64 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 4/16/22 Static water level at beginning of test 38 ft. Comments B. TANK DATA Age of tank(s) 17 years Tank.type/material SEPTIC / HDPE Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping 7/19/21 - JRS D. ABSORPTION FIELD DATA Which system tested (date installed) 8/15/2005 ® ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade ft (min) ® N/A — pressurized field Well production at time of test 5+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 0.274 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by NES Date of Sample 4/7/2022 C. LIFT STATION ® Required maintenance completed Age of lift station 17 years Lift station material PLASTIC / HDPE Comments: *PUMP FLOATS & PER JRS & MOA IR Adequacy test date 4/15/22 Results Z Pass For 3 bedrooms Fluid depth prior to test 40 in Water added 600 gal New depth 47 in ® Monitor tubes go to bottom of effective. If not, state depth into effective MOA IR SHOWS 5' ED Elapsed time 1200 min ® fluid depth 35 in Code -required soil cover over field Final System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: MT AT GRADE. 0 STICK UP. SIMILAR TO MOA IR DOCS. OPERATING IN TOP HALF OF 5' ED FWH(; j E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ® Yes if No ft Septic Tank/Lift Station on Lot > 100' Absorption Field > 5' ® Yes Community Sewer Manhole/Cleanout > 100' Private Wells > 100' ® Yes if No ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _. Water Main >.10' Igl Yes if No, ft Community Wells > 200' Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below PFoper�ty Line >. 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. ,®.-.,, TH !d• .. ...... ...... ....�...... Curtis Huffman 0 FYI ��� •. CE 128991 •• �� �� ��lF�• • .1J20/2;. •'Fad 1, ft 19.1 Enc. N 86°25'40" W (R&M)`\ _ 136.54' (R&M) Q� OF A�,45��"� L=62.31' (R&M) � _ _S R R=703.43' (R&M) *..'49ll-I —------- E 0=5°04'30" (R&M) Surveying • Engineering 2525 Gambell Street, Suite 200, Anchorage, Alaska 99503 Tele: (907) 563-3835 Fax: (907) 563-3817 AS BUILT OF: LEGAL DESCRIPTION Lot 16, Block 2, Bernard Subdivision, Eagle River, Alaska. WGRKDRDERNUMBEA DATE: SCAlE: E14WL May 8 2009 "-40' sentec@eeiteam.n 09-5179 DRAWNBY: HECKEDBY: GRIDNUNMER BOMPAGE: JAH MJH 255 1 592141.43 o SEPTIC VENT SURVEY CERTIFICATION: SENTEC has conducted Q CLEANOUT `�---_ TRACT E-1 drawing and that the improvements situated thereon are `TL ELEC POLE ALC FOUND PROPERTY COR. other than noted. 0 Well FOR RECR DEDICATED EATIONAI PURPOSES RP to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded S 80°15'00" E (R) subdivision plat. NOTE: Under no circumstances 60 ro S80°29'57"E for the establishing of property lines. r r 195.30' 195.00' (R) i. 18.7' i' Gravel _ Q 13.5: 10.5' Driveway �47.5'v` ,.aUt a; 19.0' }�v canfatever Lot 17 \ `31 7 tt i \ Existing 2 i Story Nouse v23.3' \ 0 0 O MH w -" ui —'� _ o s` � �� ' 33.6 317.5- v o" � 15.6' ti Loi, 1. �� w ? ° Lot 15A <O N 16.3' (e I `u� Shed 19.1 Enc. N 86°25'40" W (R&M)`\ _ 136.54' (R&M) Q� OF A�,45��"� L=62.31' (R&M) � _ _S R R=703.43' (R&M) *..'49ll-I —------- E 0=5°04'30" (R&M) Surveying • Engineering 2525 Gambell Street, Suite 200, Anchorage, Alaska 99503 Tele: (907) 563-3835 Fax: (907) 563-3817 AS BUILT OF: LEGAL DESCRIPTION Lot 16, Block 2, Bernard Subdivision, Eagle River, Alaska. WGRKDRDERNUMBEA DATE: SCAlE: E14WL May 8 2009 "-40' sentec@eeiteam.n 09-5179 DRAWNBY: HECKEDBY: GRIDNUNMER BOMPAGE: JAH MJH 255 1 592141.43 o SEPTIC VENT SURVEY CERTIFICATION: SENTEC has conducted Q CLEANOUT a physical survey of this property as shown on this drawing and that the improvements situated thereon are `TL ELEC POLE within the property lines and no encroachments exist FOUND PROPERTY COR. other than noted. 0 Well EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. NOTE: Under no circumstances should any data hereon be used -for the construction or for the establishing of property lines. Lift Station/Pump Vault Maintenance Owner /mI i Street Address o l tlGti Septic Tank: -Sludge level inches -Pumping: required es no -Pumping completedes no � Lift station: -Pump basket cleaned e no -Effluent filter cleaned es! no -Control floats cleaned 'es no -Proper float settings confirmed✓ es no -Operation satisfactory es no Alarm System: Dedicated electrical alarm circuie -- no -Audible and visual alarm inside dwellincr' es` no ®Alarm system operation satisfacto of satisfacto Manhole Riser -Ground water intrusion at riser to tank connection des no` -Ground water intrusion around pipe penetrations es n' -Weep hole functional , -s no -Manhole lid: Functional e no Insulate e'er no Properly Secured e no Other -All manufacturer required inspections and maintenance completed e no Comments: axace roviaer: �J Date of maintenance Signature Date MUNICIPALITY CF ANC:1-10„qGE ENVIP<UNMENTAL SE;V;`L, MUNICIPALITY OF ANCHORAGE 0 5 / p �N1,ICV DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES 1 t;li CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY �- 264-4744 !' '-ccIRF C !r / VET) T) Application Date a-- — « - fa,-/ 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) l to i — 2 G �G��L3ter) Location (address or directions) • (b) Property Owner G�\C--k(--Lo"-`"? Telephone: Home Business Mailing Address (c) Lending Institution pin fl p -rZ . Telephone Mailing Address (d) Real Estate Company and Agent (—,--\T-vtzy 21 - Pi�t�� `�1�CGAf�JIr P Address -1,4 0j2 -y lei eD._)1'it. Zoe '995\sj - 1444 Telephone (e) Mail the HAA to the followina address: or: Check here -if hold for pick up. List contact person and day phone number below. S & S ENGINEERING 17034 Eagle River Lap Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well 0 Community 0 Public* 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 Public 0 Community 0 Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 i Rev 8,861 Front 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 S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Date Eagle River, Alaska 99577 6. DHHS APPROVAL Approved for 77;)1-11(3) bedrooms by Approved Disapproved Conditional Date „sebcx"t A. 53o,rty 7:.4 Mo. 1467-'1' 1 � (1�q CC, C•,��i i^ 434' Terms of Conditional Approval i albs CAUTION 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. Page 2 of 2 72-025 (Rev 8/861 Back A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OFA 1� AUTHORITY APPROVAL (HAA) DEPT. OF HEAL ECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECi"ICb 264-4744 JAN 1 3 198cl Legal Description. L i' l VA --14-. 2. RECEIVED Well Classification ` ' If A, B, C, D.E.C. ApprovedON) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to t— Depth of Grouting Static Water Level /6\ Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/44eWing Tank on Lot '�� " ; On Adjoining Lots i To Nearest Edge of Absorption Field on Lot Zoe -4 ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments 1:2% r--- (7-47 S'1 .J/S?�t' �� l� S. k 0, 2-k Z� B. SEPTIC/H91DING TANK DATA Date Installed \c)-11 -11 Size \2S0 No. of Compartments Z" Standpipes ON) Air -tight Caps(X N) Foundation Cleanout(PN) Depression over Tank (Y6:1 Date Last Pumped 11- 7 7 8% Pumping/Maintenance Contract on File (Y/N) / --1/A; for Holding Tank High -Water Alarm (Y/N) I Temporary Holding Tank Permit (Y/N) /p' Separation Distances from Septic/Heidi-Fig Tank: I To Water -Supply Well 2.--t-�O -kms To Building Foundation i To Disposal Field 1 140 To Property Line 10`+ To Water Main/Service Line Course \S Comments � To Stream, Pond, Lake, or Major Drainage c, 4e —01-2 Page 1 of 2 72-026 (Rev 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ItoX�nr. Type of System Design' Date Installed t "'- \ 1 — 71 Length of Field L490 j Width of Field 11' 1 Depth of Field S, - Gravel Bed Thickness, Square Feet of Absorption Area '..--?(v,04::. Standpipes Present ON) Depression over Field (Y/7 Date of Last Adequacy Test 1-2- —?ICJ — e7 Results of Last Adequacy Test /%'fl /1b6z - -( C20. - Separation Distance from Absorption Field: I To Water -Supply Well 7�0 + To Property Line To Building Foundation -2'?2 To Existing or Abandoned System on Lot ; On Adjoining Lots 3Q �k To Water Main/Service Line 1 t:;,Ik To Cutbank (if present) 4\ To Stream/Pond/Lake/or Major Drainage Course \ c::› c, -4- 1 To Driveway, Parking Area, or Vehicle Storage Area O Comments D. LIFT STATION Date _ -d Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pu . • Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MO No 27 2- X0-3 A.-►vv1 aD/ 00/ l <an� dQ4Q ., Receipt No. 6 „v tl.,. �r Date of Payment Amount: $ Page 2 of 2 72-026 (Rev 8/861 Back /—/i—eFer ?d o41 . a 1..:11.iii•\1.-_, ..1 . orb / giTill Orl.Er. [A\ 11 /6 \ ' 1 DEPT. OF ENVIRONMENTAL CONSERVATION / / ANCHORAGF. ALASKA 99503 1-1.2-88DATE/ 212754 Tn Whom It May Concern: STEVE COWPER, GOVERNOR 563-6775 According tn the records on f1|e in this office. the BERNARD STEWART SUBDIVISION Water System is in compliance with the State of Alaska Drinking Wafer Requletinn,;, Sincerely. Rnoald S. Klein Fnxirnnmentul Field Officer APP/L�I NT FILLS OUT UPPER HAI ONLY n /)/ r iU '' Property Owner�� � Mailing Address —0 CAir1A/C� (66/e/ / Phone �C% hC/��50,, Zip Code �r Buyer CgG , ,e;',<: 7 %r//:::_x,4,-----„gr �i-477--/.c. Address ,6..?U/jc.--,,� .E9r,�O/f% 71ye , Zip Code Lending Institution Address 5/7 C!,� y,(;," ,4 ",./.4' C 7/-e/. �,,,,,,-0,47,..4/4- ,,,Ljj/� !/ / ,g/ �/%y�S' "� // /%//. �jl,�/.� Zip Code��j 3 ` Phone /,—;t ! / 3/. Realty Co. & Agent Address / /e Zip Code Phone Legal Description Street Location # ,C.. ,4 13,CV-~ 41c/ 70'Z-A.G ,C0A13 rte" ,[�j(J�(-tel %(wee -94 Type of esidence VW -Single Family ❑ Multiple Family ❑ Other No. of Bedrooms ( 1 APPROVED ( ) DISAPPROVED ( ) CO BYTEBY: Water Supply ❑ I4vidual LYCommunity ❑ Public Utility •12"44-g 7&dr.e/lw ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available). Sewer posal Individual ❑ Public Utility ❑ ,Hording Tank /977 , r� Year Individual Installed: �97 When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. l�119t 1- Time Time Time Time I • 4 4 (titiQ Date Date Date Date` 11� 2 l^1, i `- �,1 , 1 -9 1 Li Z. Inspector Inspector Inspector Inspector Field Notes:`Z.f..At, p..7.1., _ / /,% , MUNICIPALITY OF ANCHORAGE ���y K DM'C- : I) ' P. 1 i! ENVIRu d;, _r,,?.. u ",TION 12-22-82: conditional approval if monies are Escrowed ('UV' 1 9 1982 to have an adequacy test performed and also to have the r system upgraded in he event the test fails. This workp p C I i V�E D must be completed byJune 1,1983. The 1,250 c_-allon se tl'1 C tank is approved for a four(4) bedroom home. er Robcrt C. Pratt, R.S. ( 1 APPROVED ( ) DISAPPROVED ( ) CO BYTEBY: BEDROOMS ITIONAL APPROVAL* •12"44-g 7&dr.e/lw 'CONDITIONS OF APPROVAL ` ? ( .4 '—'14.4dr /411144.1449 --T1424* • piJ/ iJ' J ifiai,, /q? ttA: 04)7 (.° ii)‘411V44 IJW4,10 / (V Soils Rating Date Sewer Installed )4' ?I Well To Absorption Area Well to Tank Well Log Received Septic Tank Size 11 72023 (3I82) Tiara Time Date Inspector Comments .1149 ' 6-$ C.4 CrY". 5 a 13se-ie Inspector Conditional Approval Date C1 tie at r .2 a-sQ. ( js 5 Inspector LL v v'S MUNICIPALITY OF ANCHORAGE D T r,,,�.i ENVIK „ rrr: _r A . 1 .o r rL A -3?=1 e-rGcnJ Date Sewer Installed Solis Rating Permit No. Well To Absorption Area Well to Tank Septic Tank Size Holding Tank Size Well Log Received APPLICANT FILLS OUT LOWER HALF ONLY Property Owner t•. ! i t L Ce C r--7 c2 3 CK Buyer ett7-00 k�' /-, /6p).� 6 Address Wit' ,� i P Mailing Address -_ending Institution Address Realty Co. & Agent Address g9.5-0 (erL,>i Legal Description6,1 t)4190 Street,Locatlond 1, Type& Residence ni Single Family ❑ Multiple Family ❑ Other Water Supply jir Individual El Community ❑ Public Utility Sewege Disposal Arli Individual ❑ Public Utility ❑ Holding Tank 440 -Bedrooms �. J ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log If available.) Year Individual Installed: 831 When Connected to Public Utility. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. �z. it hA \\\,,,.... %#'''. kin A ,' i EXCAVATION ROBERT A. SHAFER WORK CIVIL ENGINEER 694-2979 Area Realty ATTENTION: Quacky Tucker 4794 Business Park Boulevard Anchorage, Alaska 99503 Dear Ms. Tucker, July 10, 1983 17{EOEHHE -it/ JUL 131983 "Municipality of Anchorage" "Dept of Health & Environmental Protection" Reference: Lot 16; Block 2; Bernard Stewart Subdivision A sewer system adequacy test was performed on the system located on the referenced property, at your request. The septic tank was pumped and verified to have a capacity of 1250 gallons. The absorption trench was tested by a continuous flow of water through the system for a period of 48 hours without any adverse effect. It can be concluded from this test that the waste water disposal system serving the four bedroom residence located on this property is currently functioning adequately. However, this system cannot be guaranteed against subsequent failure. If we may be of further service, please do not hesitate to contact us. cc: Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA