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Home My WebLink AboutT12N R3W SEC 24 W2W2SW4SE4SW4 N PTN Municipality of Anchorage Page } of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater DiSposal System and/or Well Inspection Report Permit Number: .~ LO ~0OO~ PID Number: C~)I~"*~,,~ ' ~ Nam.e~ ~e~cT~ Wastewater System: ~ New ~ Upgrade Address: w~ e~ %~ ~ ~,~ ~ ABSORPTION FIELD Phone: ~. ~ I No. ofBe~oms: ~ Deep Trench XShallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION so~, Rating: ~* ~ GPD/Sq. Ft. Total Depth from O~al grade: ~..~: ~ ~ ,I ~.on: ~ ~ Fill added above original grade: Grave, length: G ravel width: Distance baleen ]in~: WELL: ~New ~ Upgrade 5 Ft. Numbero~lines: I ~ Ft. Cia~ification~ · ~(Private' A,B,C): Total~Depth: Ft. Cased~jTo: Ft. Total absorption area:~ SQ. Ft. ~T~P'pe material:o.~O~. Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: Casing Height Above Ground: SEPARATION DISTANCES ~Septic ~ Holding O S.T.E.P. To Septic Absorption LiE Holding Public/Private Manufacturer: Capacityin gallons: From Tank Field Station Tan~ Sewer Lines ~ ~ ~ ~ ~ Sudace Lot Size in gallons: I Manufacturer:~ "Pump on' level~mp off" level at: ~ High water alarm at: Foundation lO J~ [01 ~ Cu~ainDrain -- -~0~. ~Ob ~ _ P~de[ ]Electrical Inspections pedormed by: Remarks: BENCH MARK Location and Description: Clo To Assumed Elevation: 100 ENG~N[~'~AL Inspections pedormed by: ~ s s ~lN~mNm Dates: 1st ~'~ ~~':~; ...... ~ .... Eagle River, Alaska 995~ ~, a '~ ,~7 ~i ~, CE- 8801 Department of Health and Human Se~ices approval ~,~, .... 72-013 (Rev. 9/91) MOA 25 Permit No. SW970003 Page 2 of 2 Municipality of Anchorage 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 NORTHERN PORTION OF 015--242--78 Legal Description.w. i/2, w 1/2, sw 1/4, sE 1/4, sw 1/4, SEC 24, T12N, RSW PID NO.: 0 WELL NEW TRENC TH#3 / 1250 / GAL. SITE ST1 ST2 MTI = MT2 = MT1 -- 91.0' MT1 CO1 MT2 CO2 96.4' 96.1' WATER FOUND 8;3. B.0.H. = 94.0' = 93.9' ROBERT CE-8801 72-O13 A (Rev, 9/91) MOA 25 , From : aLPINE DRILL 90? 345 0202 Mar, 19,1997 12:51 RM .... . '..'.'. '....,:' ' : "' "."":.'..'} ".,::/'..:.'...'"'":'" '.~ : "' "' ..'. '.'"...,i'.':.." ' .~, LOCATION OF WELL ~-' ~,, BOROI~OH · St~BOIVISfON LOT BLOCK I I S~CTIONQTR~, " ' I ~EPTHS. MEASURED.. FROM. . ~l[,ca sing., top E]oround. surlace '80REHOLE DATA: Depth .Mat,(iai Type and Color' From TO P01 · STAYE OF.ALASKA 'DEPARTMENI~;0F"NATUR~L RE~;OURCE$ . DIVISION OF'MI~JJNG & WATER MGMT WATER'WELL 'I(E(~ORD : 1;IN O~ · · ' WELL OWNER: . WELL DEPTH: Depth of easing: .~/ . ,," tt DATE OF COMPLETION' TD STATIC WATER LEVEL:'. ft below ~ t(~p of easing Date: ..a~,~/.. ~ / ?~ [] grOuhd sudaos Municipality CONTRACTOR INFORMATION: F~i~t~ist~red Business Name Si{i/l~i~re' 0t A~tho~zeU Re~pceS~ative L~ate METHOD OF DRILLING: ~'ai~' rotary' E] e~ble tool .0 other USE OF WELL: ~omeati0 [] irrigation. ~ monitor ~]'pvblic supbly [-] other CASING lt. Diem: ~, Casing WELL INTAKE OPENING TYPE;' [] open end l"'1 screah.sd':' E] perforated [~open h01e DePths of openings: .to ft . SCREEN TYPE: ' DiarO .. in. Slot/Mesh Size: ft GRAVEL PACK TYPE: '. ) , Volurno used: Depth'to top:' (3ROUT TYPE: Depth; from ft DEVELOPM C'~,4~ .... Duration: PUMPING LEVEL'AND YIELD: PUMP INTAKE DEPTH: , it Ho'rsepower~ , WELL DISINFECTED UPON. COMPLETION?. ~YE~. '[-I NO REMARKS: ' PLEASE .MAIL WHITE· COPY OF LOG TO:' DNR/D'IVISION OF MINING &..WATER MOMT · : 3601 .C St,.SuRe'.800. ANCHORAGE AK 99503-5935 Phdno .(9. O7)~68.8639,Fa~ '(907)56Z.~384. PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section:"71'3-~/ ~ 3 ~ $¢C. ~. ~/ SLOPE SITE PLAN ~;~Y 13- 14- 15~ 16- 17- 18- 19- 20- WAS GROUND WATER ~ & ENCOUNTERED? IF YES. AT WHAT -- DEPTH? pO E Monitoring? Dote: Gross Net Depth to Net Reading Date Time Time Water Drop ~/15/¢17 '7 ;o04,-, -- $-'/~'" - 7: ~ 6" 6 PERCOLATION RATE (~ 0 (minutes/inch) PERC HOLE DIAMETER -- TEST RUN BETWEEN ''~ '/'~ FT AND O~ ~/~ FT COMMENTS d ?? //"? ,~' S &$ ENGINEERING ¢-~____~/ ~7.v~..--~ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: ~, 70=4 ,~,,,g~, .~v~i- L~;~ .~;~ .'~;. 30~ ~ ACCORDANCEWIT~X~~ZLGUIDELINESINEFFECTONTHISDATE. DATE: i /J ~ /~ 7 72-008 (Rev. 4185) ROBERTC. COWAN, EE. ROBERTA. SHAFER, RE. ENGINEERING SIUDIES AND REPORTS WELL INSPEC]'ION & ELOWT£S]r ROAD DESIGN SO)LTEST PERCOLATION 1EST STRUCTURAL& MECHANICAL INSPECIIONS Date: Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 CIVIL ENGINEERS (g07) 694-2979 FAX (907) 694-1211 RECEIVED MAR 1 2 1997 Munic)pality of Anchorage Dept, Health & Human Services The septic inspections for the referenced property were performed on %-AA~9~ and l-a~-~ % ~%~Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the ~.~% ~-~+ ~ 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 PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUM-AN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL A/~D WASTEWATER DISPOSAL SYSTEM PEP, MIT PERMIT NUMBER:SW970003 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:VILNA REIJO & MARGARETA OWNER ADDRESS:8321 RAGGED TOP CIRCLE ANCHORAGE, ALASKA 99504 DATE ISSUED: 1/08/97 EXPIRATION DATE: 1/08/98 PARCEL ID:01524278 LEGAL DESCRIPTION: T12N R3W SEC 24 W2W2SW4SE4SW4 N PTN LOT SIZE: 26400 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 A~ND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18A3~C72) AND DRINKING WATER REGULATIONS (18/LAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS } (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS ISSUED BY :h~~ DATE:l--8--?? ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. January 7, 199~.~' SEWER&WATER MAIN EXTENSIONLq SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST ROAO DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS 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: Northern protion of W 1/2, W 1/2, SW 1/4, SE 1/4, SW 1/4, SEC. 24, T12N, R3W Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on the referenced property. Two test hole~ were excavated and a percolation test performed. The approximate location of the test holes are located .On the attached site plan. At the time of excavation no water was encountered in test holes and after seven day ground water monitoring, the monitoring tubes were found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 l" = 60' SITE PLAN DESIGN Z PROPOSED 5 BDRM HOUSE -<0 ddI~IVD m ooZ~Zo z~ ~ z~ o~ HEALTH AUTHORITY APPROVALS SEWER&WATER INSPECTION ENGINEERINGSTUDIES ANDREPORTS WELL INSPECTION & FLOWTEST SITE pLANS ROADDESIGN PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON-SITE WASTEWATER DISPOSAL SYSTEM CON$~RUCriON ~u~z=~ and MATERIAL SPECIFICATIONS ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Northern portion of W 1/2, W 1/2, SW 1/4, SE 1/4, SW 1/4, SEC. 24, T12N, R3W January 7, 199~- GENERAL: The scope of this project includes the installation of a 1250 gallon S.T.E.P. system and Ofive foot wide drainfieldv to serve the proposed three bedroom residence for the referenced property. 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 Wast·water 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. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 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. e The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP ' SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Northern portion of W 1/2, W 1/2, SW 1/4, SE 1/4, SW 1/4, SEC. 24, T12N, R3W January 7, 199~ e Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout 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. Final 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 final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. e 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 grave], 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 Three Northern portion of W 1/2, W 1/2, SW 1/2, SE 1/4,' SW 1/4, SEC. 24, T12N, R3W January 7, 199~ MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type 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. 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, Fernco, or equal). 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. Ail 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. Page Four Northern portion of W 1/2, W 1/2, SW 1/4, SE 1/4, SW 1/4. SEC. 24, T12N, R3W January 7, 1997 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: 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 barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 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 inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/OWNER ' L Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~J.~ L~ ~ b, J yT..i ~ l..,j~/~ l ,~' ~, l/~c., ~CTownship, Range, Section: LEGAL DESCRIPTION: ~ 2 3 4 5 6 ? (FEET) SLOPE SIT~' PLAN 10 11 12 14 15 16 17 18 19 2O O0..~NTS ~S''E' I ~ WAS GROUND WATER ENCOU.TERED~ IF YES, AT WHAT DEPTH? Depth to Water Alter. e iA Monilering? ~ Ir~ Date: Gross Net Reading Oate Time Time d,~'o l//t4~ll ~5~ t~ S E PERCOLATION RATE ~ ~ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWE~:N ~" ~ FT AND '~ ~'' FT , PERFORMED BY: ~'"'~ ~'~1~~'1'~'~'~' ' ~'' ~'~ ['~'"c'(M~ CERTIFY THAT THIS TEST WAS PERFORMED IN AOOOROANOE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEOT ON THIS DATE' DATE: I '~* /4 '"~ I 72-008 (Rev. 4/85) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 , www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. 1. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR SINGLEFAMILY DWELLING Expiration Date: / 0 GENERAL INFORMATION Complete legal description BQ~I~-.~ L~ '1~ Location '(site address or directions) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent 2. NUMBEROFBEDROOMS: ~--~.~J~ ~'~-..~",-% Day phone Day phone Mailing Address "'3~f,,~ ("~o ~c/~,,/,~I Un/ess otherwise requested, HAA will be held by DSD for pickup. 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage . Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: :ndividual On-site · ~ Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Deve!opment Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except be,h~veen spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C we!l and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality cf AnchoraGe is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(aro) 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 inspect[on, 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. Engineers Printed Name ~~ ~ bedrooms. Disapproved.. Conditional approval for 5. DSD SIGNATURE J Approved for bedrooms, with the following stipulations: Additional Comments 5 : WASTEWATER : -- p p. OC-'~-~M .:' :'-'.,jj Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: "~ - ,,'g--(.. - C3 / Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 .Nx:homge, AK 99519-6650 www.d.anchomge.ak.us (S07) 343-?go4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ,~ ' Parcel ID: O ~'~ "~- - 7~ A. WELL DATA Well type ~ Date completed Total depth Dateoftest Static water level Well production If A, B, or C provide PWSID # ~_~ · Sanlte~ seal (Y/N) y cased to ~_L~. FROM WELL LOG Well Log (Y/N) \/ W~res properly protected (Y/N) l Casing height (above ground) .~._.in. AT INSP~:~TION p.m. ~ g.p.m. WATER SAMPLE RESULTS: B. SEPTIC/HOLDING TANK DATA Nitrate l~J ~) mg./I. Other bacteria .~ colonies/100 mi. C.~d by: Tank Type/Material Tanksize J~.'~{::) gal. Number of Compartments .~ Date installed cl nout (Y/N) High water alarm (Y/N) Depression over tank (Y/N) I~ ': Foundation cte~ ~/N) 7 Date of pumping ~/"//~.0'~:~ C. ABSORPTION FIELD DATA Date insteJled I-.~;~' (r~ Soil rating (g.o.d.lt~' ~ O, ~ Total depth ~ ff. Eft. ~fion ~a ~ M~oring tube D=~ of ad.uaw ~t ~/n/~ / R.ul~ (P~Fait) ~ ' Fluid dep~ in abs~fion ~ld ~fora ~t ~ ~. Wa~r add~ ~al. Elaps~ Time: ~ m~. F~l fluid de~ ~. ~y rejuvenati~ ~t (past 12 ~.) ~/N & ~) Absorption rate >= System type '~'4,4~,~,~/~ Gravel below pipe ,~ f. Depression over field /~ For -'~ bedrooms New depth ~ in. /'/~' ~ g.p.d. If yes, give date / D. UFT STATION Data installed 'Pump on" level at · Datum E. Size in gallons ./" in. 'Pump o~at in. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift staUon on lot Absoxption field on lot Public sewer main J~/~ Sewer/septic eentice line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line ~..al~ ~ Absorption field Water service line ~ ~ Surface water Building foundation Water main ~1/,~ Wells on adjacent lots ~'~) ' Manhole/Access (Y/N) High watar alarm level at Meets alaml & circuit requirements? On adjacent lois On adjacent lots Public sewer manhole/cleanout Holding lank SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Il~ Watar Service line ) ~ ~ Curtain drain I~t~ O F. COMMENTS Building foundation Id Sudace watar ~ I DO Wells on adjacent lots ~ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA HAA guidelines in effect on this date. Engineer's Printad Name To ~o~o~ ~ ~.~ ~- ~4~t ~, ~ Date "~--/7- O I ' ' Water main Iq/~r Driveway, pa~ngh, ehicte slorage HAA Fee $ Date of Payment Receipt Number (Rev. 12700) Iq' Waiver Fee $ Date of Payment Receipt Number XX # XXXO[O/~$ # lIWN]d lOOg'Og ,(7111' IO£~G '~Y 'HONY $BNSAV 'HI£I ~ £0~ ~ ~'d ONVT~BdS N]8801 0£ = .~ N JUL-~'4-§I r,g:2T FR0tF-CTgE Eli',qE~I~NTAL SRV a~lt~aa& CT&E Environmental ~ervlce~ Inc. 9CT5E15301 T-4S6 P.02/£3 r-'"813 CTAI~ RefJ~ 1014413C01 Clieat PO~ Pre-PaJ,~ Colts/~O3 Clknf Hame ToSbcn SpmMand P.~. Fl'Jnte~l De te~'Jm e 07~3~1 20:49 P~Jeet Nam~ S~4 TI2 ~ ~l~t~ Da~lme 07/17~] 13:15 Clknt ~mpk ID WI~ ~'l~ awl/4 SEI/4 awl/4 ~c~ed Dat~lme 07/17~1 16:53 ~btri~ ~g Wetcr Technical Di~or__ Stephen ~ ~o O~e~ By ~lcl~d Oy~ ~SID 0 ~ $~.mplc Rcmmk~: AJlowable Prep Rney~s Para~qtr P~sula PQL Un~a },{,rJ~od Limbs Dine Dale Init Nitrate-~l 0.500U 0.500 m~/L EpA 300.0 (<10) 07/11'01 SCL Tolal Coli£arm $ OD, I'~o Coli gol/10flmL SMIS ~.220 (<1) 07/17101 KAP MUNICIPALITY OF ANCHORAGE ./~-~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 1. GENERAL INFORI~ATION Complete legal description C,~RTIF,.¢ATc OF HEALTH/~.UTHC PJTY APPROVAL FOR A SINGLE FAMILY DWELLING Location (site address or directions) ~P~d. perty owner ~5_ ~i~¢ilir)g addresS.'--~. ~' Lending agency ..... 'Mailing address Day phone $ ] ~' ¢ 2-0 ~/ ~'- Day phone '- {~g~¢¢,~ ~4R/4~-)~ -- ~lb,,~/t.x Agent Address 'D~ o o Day phone ;3 '7 6 - ,~ '7 6 ) Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide Written confirm, ation from State ADEC attest- ing to the legality and status of system. TYPB OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide Written confirmation from State ADEC attesting t~ the leg~d;ty and status of sys,'em. 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 Munici ~)al and State codes, ordinances, and regulations in effect on the date of this inspection. $ & s ENGINEERING Phone Name''~v, Firm Eagle River, Alaska ~9577 Address Engineers signature /r~ .. Date DHHS SIGNATURE __ APproved for 3 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments '¢he MunMp~lity of AhCb6rage Department of Health and Human SerVices.(DHHS) i~ues Health Authority Approval Ca~ificai~!ba~ed only upon the rePres*ntations Cron in paragraph 5 a~ovo by an independent profoss~0nal on~ m~r ro~tster~ m tho 8tato of ~laska. The DH H8 doos th~s as a coudo~y to put,ha*om of hom~ and lhoir I~ndin~ institutions in order to ~tis~ ca~ain ~ederal and stat~ roquirom~nts. ~mploy~ of ~HH8 0o not conduct inspections or anal~e data b~foro a ce~ificato is i~suod. Tho ~unMpali~ ~ ~nchora~ i~ not rosponsi~lo for orro~ or oral,ions in ~he profo~ional en~n~S Work: Municipality of Anchorage APR 1 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Settees Division R E C E 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription: ~.ecr-.,,..,~u 3-~ 7"- i',~ /,.. ,.C~l-,~ ParcelI.D.: A. WELL DATA Well type Log present (~N) Total depth Sanitary seal IfA, B, or C, attach ADEC letter. ADEC water system number Date completed ~'/'~ /~ ';'- Cased to '~ t ~' o ~J'-'~ Casing height (above ground) Wires properly protected (~N) )/~ J' Date of test Static water level Well production FROM WELL LOG c 1'/ g.p.m. AT INSPECTION · g.p.m. WATER SAMPLE RESULTS: Coliform 0 Date of sample: ~/)0 / ~ '7 B.~HOLDING TANK DATA Nitrate 0 , / COllected by: Other bacteria O S & $ ENGINEERING I:i~ ~:agle ~iver LOOp ROil~J ~:agle Eive~, Alaska 99577 Date installed t/~'}/~/? Tanksize J~$'-o Number of Compartments ~-~ Cleanouts(~N), Foundation cleanout ~/N) ~ ~-~ ~ Depression (Y/(~ /u O High water alarm (Y/{~. ~' Date of P, ump~r~g?~/~' ~,,._~" '¢ '~ Pumper -- ABSORPTION FIELD DATAF ~:. Dale'installed '/ ~ 3 .....,,,.~,~ Soil rating r ff~/bdrm) O, ~ System type Length' ~ ~ WJd~' '? ~ Gravel thickness below pipe 3 Total depth EffeCtive absorptiOn area / 7 ~ ~r~onitoring Tube present ~N) ~¢~ Depression over field (Y~ Date of adequacy test ~ - ~ ~ Results (Pass/Fail) For ~ bedrooms Fluid depth in absorption field before test (in~er added (~n.): Peru ' atment (past 12 months) (WN) If y~, giv~ d~t~ ' .'" ": 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons _..~--,~"~- "Pump on" level at* °ir' %el at* ._.------ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line /00 '-¢- On adjacent lots / OO -/ On adjacent lots / Public sewer manhole/cleanout '"" Lift station ,'~ SEPARATION DISTANCES FROMLSEPT~HOLDING TANK ON LOTTO: Foundation / o/4,- Property line / o ' -/- Absorption field / 0 ' ~ Water main/service line /o /-,~ Surface water/drainage / Oo ~¢- Wells on adjacent lots / O O '--/- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line Surfaoe water Curtain drain / 0 Building foundation /o Water main/service line / oo -/- Driveway, parking/vehicle storage area /v 0 ~ ~L Wells on adjacent lots HAAFee $_ 7~ ' ~ Date of Payment ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records tha,,~.~st, ems are in conformance with MO,¢ ~ guidelines in effect on this date. Waiver Fee $ 72-026 (Rev. 3/96)* Date of Payment Receipt Number AP~-l$-lgg? 14:4Z CT&E ESI ANCNORAGE CT&E Environment.al.Services Inc. Laboraton/ Divisfor; ~ Analysts Report for Total Coliform Bacteria 200 w. ,ott.r or,., · Anchocage. AK 8951 8-1505 VEt~E SIDE BEFORE COL£ECThYG SAMPLE Tel: (@07) 562-2343 {2 $¢~d Restdt$ (~ Se"d Im'oice Month Day Year SAMPLE TYPE: ,~[ Routine fl Treated Water 13 Repeat Sample flor routine sample .~ Untreated Water with lab ret. nO. ) 0 Special Purpose Fax; (907) 561-5301 TO BE COMPLETED BY LABOB_ATOKY Analysis shmvs this Water SAMPLE to be: Satisfactory , , Unsatisfactory ~ Sample over .~0 hours o d. resutm may be Sampl~ too long in ~ran3i~; sampl* should not be over 48 hours old at egaminafion to ifidlcate r~Eable resulm. Please send new sample via special d~flveu mail, Date Received Time Received Analvtleal Method: ~ Membrane Filter ' MMO-MUG Number of colonies/100 mL Lab Ret'. No, Result~ Analyst $¢n~ to ;CD,*~.C. Anch Fbks Jun ~ Client notified er unsatisfactory results; Phoned Sooke with Dam: Time: Time Collected 5AbiPLE LOCATION Collected By BACTERiOLOGICAL WATER ANALYSIS RECORD MMO-MUG Rcsu[t: Total C~liform £. Colt Membrane Filter: Direct Count ~ Colonies/100 mi , "~'~ Verification: LTB BGB Fecal Coliform Confirmation · ' Final Membrane Filter Results ~ Rcpo~te~~T COLIFiRSl ONE OF Coliferm/lO0 mi hfs CT&E cefE~:flcation status is prov~Rional as of 4/8/97. ~mber of the $G$ Grouo {SocietY' G~n~rale de Sutveillan¢~l TOT~L P. 85 CT~E ES1 ANCNORAGE ' ~t~k ;CT&E Eno ronmental Services Inc. CT&E Ref.# . 971731001 Client Name : $ & $ Engineering Pr.oject Name//~ ;:,i N/A Chant Sample 1[~!! W2,$W4 Sec 7.4 T12N P,3W Matrix (! Drinking Water Ordered By PWSID 0 Client PO# Printed Date/Time 04/15/97 10:38 Collected Date/Time 04/10/97 18:00 Received Date/Time 04/11/97 09;,45 Technical Director: Stephen C. Ede Sample Remarks: CT&E certification status is provisiona/a.$ of 4/8/97, Nitrate-g 0.100 U Total Coliform 0 Units Method ALLowable prep AnatyM~ Limits Date Date Init 0.100 mg/L $M18 4500-i103F qO mox cot/lOOmL $M18 9222B 04/16/97 dBL 04/11/97 RMV