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HomeMy WebLinkAboutHUNDRED HILLS 1ST ADDITION BLK 4 LT 3Onsite File ' k Ff � a� z, t x YP. oi {�1 078aml9i Od The 1996 trench cannot be tested f or a 5 bedroom MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211351 Work Type: Septic Upgrade Effective Date: Expiration Date Tax Code Number: 07819106000 Site Legal Address: HUNDRED HILLS 1 ST ADDITION BLK 4 LT 3 GA 160 Site Mailing Address: 430 WOLF DR, Eagle River Owner: MINSHEW MARY F Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy l„cnt c o� `S`'r• Department 8/20/2021 8/20/2022 Lot Size in Sq Ft: 195158 Total Bedrooms: 5 ❑ Private Well ❑ 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: Issued By: Date: Date: O Z- OAl MUNICIPALITY NC AGE -147 G �tNh 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. 078-191-06 Property owner(s) MARY F. MINSHEW Day phone _ Mailing address 430 WOLF DRIVE, EAGLE RIVER, AK 99577 Site address 430 WOLF DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) HUNDRED HILLS 1 ST ADD. B4, L3 Legal description (Township, Range & Section) Lot Size 195,158 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 7 Initial F-] SingleFamily (SF) 0 i (w/wo ADU) Septic Tank 0 Upgrade Duplex (D) El Holding Tank El 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. (Signature of property owner or authorized agent) Permit/Rush Fees: $_65�Waiver Fees: Date of Payment: -S 1 /,2021 Date of Payment: Receipt Number: go g 1 (0 3 Receipt Number: Permit No. O.SPZI 1351 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com August 18, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: HUNDRED HILLS 1ST ADDITION, BLOCK 4, LOT 3 The property owner has requested we obtain a permit to upgrade the 3-bedroom septic system to a 5-bedroom system to serve the 4-bedroom house and 1-bedroom ADU of the above referenced lot. We propose to install one deep trench and 1500-gallon tank to serve these structures. The design is based on the recent test hole conducted on August 9, 2021. No groundwater was observed at test hole excavation or monitoring. The slopes are moderate at 3-7% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211351, Deb Wockenfuss, 08/20/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211351, Deb Wockenfuss, 08/20/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211351, Deb Wockenfuss, 08/20/21 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL : HUNDRED HILLS 1ST ADD. B4, L3 PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 8/13/2021 DEPTH FEET OG SOILS 1 2 ORG/OL 3 4 5 6 7 8 9 10 GM/sp-gp 11 12 13 14 15 16 17 18 19 20 BOH Reading Date Gross Time Net Time Depth to Water Net Drop 8/13/21 10 min 6” 5 3/16” “ 6” 5 3/16” “ 6” 5 2/16” “ 6” 5 1/16” “ 6” 5 2/16” “ 6” 5 2/16” PERCOLATION RATE 2 (MIN / INCH) TEST RUN BEWTWEEN 5 & 6 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 8/16/2021 TESTHOLE # 21-1 DATE PERFORMED: 8/9/2021 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: S&S 1994 PERC WAS 10 MIN/ “ – USE 0.8 GPD/SF VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: MARY MINSHEW 8/18/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211351, Deb Wockenfuss, 08/20/21 1\' I ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: HUNDRED HILLS SUBD. FIRST ADD. LOT 2&3 BLOCK 4 PLAT 90-11 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. 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. WORK ORDER NUMBER: DATE: SCALE: E—MAIL- JULY 2, 2021 1"=80' schullerOok.net 21-092 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE JLS SW1160 210214 Q = FND 5/8" REBAR �v.•©4 Aw •. j L LAN11 p r' 49TH- ..................... . . . . . . . . . / PA 6 •.JOHN L. SCHULLER.• c LS -10408 ��, "`• ` �1831 Talkeetna Street • • : �..'.�• • 6 ? Anchorage, Alaska 99508 j"�v p� o fe a� �. (907) 227-1455 office sslon •a. �►'���®��e,°�► (907) 274--4992 fax Municipality of Anchorage Page 1 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: Sul 91x0060 PID Number. Ole - I`11 -• t7t, Name: DA.lg JIII.LE:R Wastewater System: A New ❑ Upgrade Address: Na4,00 015 Lan1G DIL, AOLU, 1 A //sea. ABSORPTION FIELD Phone:No. .Z N 2. O 0 1 of Bedrooms: 3 [Deep Trench 0 Shallow Trench 0 Bed 0 Mound 0 Other LEGAL DESCRIPTION Soil Rating: o • GPD/Sq. Ft. Total Depth from original grade: 1 �, Lot: Block: Subdivision: ' • Li {%MORE() NtLI„5 Depth to pipe bottom from original grade: Ft. Fill added above original grade: 11' 1.5' Ft. Gravel depth beneath pipe 9 Ft. Gravel length: .31.5 Ft. Township: Range: lI Section: WELL: Tg New ❑ Upgrade pg Gravel width: 2.5 t Ft. Number of lines: 1 Distance between lines: 1 .....—.. Ft. Classification (Private, A,B,C): PRI4ATB Total Depth: I Ft. j Cased To:Total /ILI Ft. absorption area: 5 7 SQ. Ft. Pipe material: AS Oio K i aio DrillerrC j ''', IJ / ' ji 1Iii0AA (Aktteti .0Clic Dater Iled: rl cf 0 Static Water Level: Ft. Installer: A tug escAJAi$6 Date installed: 6-24-94 Yield: 1 GPM 'SEPARATION , Ft Pump Set a Casing H ight Above Ground:.TANK rl DISTANCES ttif Septic 0 Holding 0 S.T.E.P. To From Septic Tank io0 + Absorption Field )001 - Litt Station Holding Tank Public/Private Sewer Lines t 25+ Manufacturer:A��.rte Alec }{GM1 pc„c- r /-K. Material: 5TaEs. Capacity in gallons: 1000 Number of Compartments: Z.surfac Well- Water 1o0t46 1001.E —• LIFT STATION Lotr,l, Line 105.-^' 701:-1: „e, Size in gallons: Manufacturer: Foundation Pump on" level at: "Pump off" ley High water alarm at: Curtainse Drain _ v� F o�� e Pump Make & M �/ lec rical Inspections performed by: /V1a4 Remarks: BENCH MARK Location and Description: 1e et a Toe ®F 0t rcu, AT Polpr '1A" Assumed Elevation: i ca O Ft. EN 0..j te� WI ""'t /%` ;:•: ••"•, t .7o ROBERT C. COWAN 4 4 (``cam •y CE - 3801 �`v °pit 1:P/N. •.-��� InspectionsperformedS&S Noin�(l"Dates: lst 6-zN'`rb P by:17034 Eaglo Eivcr Loop Eoad, No. 20th Lnd to -Z...,- — Eagle River, Alaska 99477 !1 3rd„JI..-2_,,,......^1$. Department of Heal and H man Services approval Reviewed and approved by: /.I' � Date: 2 -2‘ - 72-013 (Rev. 9/91) MOA 25 Permit No. SW960060 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 Legal Description: LOT 3. BLOCK 4, HUNDRED HILLS S/D 1/1 PID No • 078-191-06 WELL 1e0' WELL RA IUS A B FCO 21.5' 10.0' 601 22.0' 23.5' ST1 22.5' 24.0' 3BDRM HOUSE FCO GARAGE ST2 29.5' 30.5' N IBL1 31.0' 32.0' IBL2 32.0' 33.0' 102 39.5' 37.5' 103 67.5' 63.5' 14T1 65.0' 60.5' C01. ST1 ST2. O©L 00L2 CO2 \\ \ NEW 6,6 Iv' 1000 GAL. \ • NEV. . \, TRENCH \_' \\ \ \`y\MT1 \ \ATH U \\ C0` ALT. SITE SCALE 1" = 40' ST1 96 J' ST2 - ®/FINAL GRADE- CO2 CO3 MT1 = 95.2' = 94.7' ^03 405)„.., ................... or C i i 1 A9 hnn /... ... ..4.,/..S j/�j�%p1�.M 1 °'• a i \ ..fYh.MI j...... / 91.1' NEW 1000 S.T. GAL ` 90.9' = 90.8' es, = 90.61 CO?, CO3 M J. 1 = 81.8' NO WATER 75.8' FOUND B.O.H. ROBERT C. COWAN +r <a''�. r`$�i r . _ , `3i�;, 4;41144WW. 72-013 A (Rev. 9/91) MOA 25 grrttfigi rtLLtn OOC CO. aoa SULLIVAN WATER WELLS P,O. BOX 670272, CHUGIAK, ALASKA 99667 • TELEPHONE 668.2759 OWNER OF LANG) DEPTH OF WELL ADDRESS 44 Oma' /2/2-2 4, aft ,Qr,J ?g5-1'STATIC LEVEL OF WATF,R FT 31C - LEGAL DESCRIPTIO i1�C Ammo /7I DRAW DOWN FT DATE • Started Ended GALS. PER HR /1� / PERMIT NUMBER KIND OF CASING KIND OF FORMATION; From 0 Ft t From a. Ft to From Pt to FromFt t From.f// �•Ft. to From '7 t_ FL to From.7S Ft. t From/). _ _Ft. to Prom Ft. to From Ft to From Ft. to From Pt. to From rt. to From Ft. to From Ft. to From Ft to Prom rt to Ft. Q.1'/� �' (lCK(JP From Ft to Ft /S Ft S a i i ErR,0 °tiJFroo, Ft. to rt 31 Ft j`jFP��QA��� From Ft. to Ft of Ft. �C,�' 4/4 g lol'tiJ1 �. From 1 Ft ,j/CL/ 664,44 L= 1 Froth Ft. �I'4T k�$(4\-413.1...d , m Fro oL2__Ft. A�.(�Ct'%!K1(o rCD�/r" //5FtS'6f,ta.J (,c.) <4 i 7E ft_ Ft Ft. Ft rt. Ft Ft Ft Ft Ft Ft. to F( Ft to Ft Ft to Ft. Froin Ft. to Ft From Ft, ro Ft. Front Ft. to Ft From rt to Ft. From Ft to Ft From Ft to Ft. From Ft. to Ft From Ft to Ft From Ft. to Ft. From Ft, to Ft. From Ft to Ft MISCL. INFORMATION. lommle T0•d 4444444444446S4.Z 889 DRILLER'S NAME /34 -Li S113M I31tyM H AI-I"1tlS 41V 80:0T 3rl1 L6 -17,0-83.I S&S EngineexinG 116.. EAGLE ANEEri SI A HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. Date: 6,- 26 -9C Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECEIVED JUN 28 1996 Municipality of Anchorage Dept. Health & Human Services Lo -r 3 r HurJo,een NrE.E.s The septic inspections for the referenced property were performed on 6 -2q --R4 and 6 -26 -IL . Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the F'oarlOPCno,3 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 El' f Acyl, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960060 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:CAIN CECILY A OWNER ADDRESS:P.O. BOX 231673 ANCHORAGE, ALASKA 99523-1673 PARCEL ID:07819106 LEGAL DESCRIPTION: HUNDRED HILLS 1ST ADDITION BLK 4 LT 3 LOT SIZE: 195158 (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: PAGE 1 OF 1 fpm (() - Lo -A(.0 -CALL DATE ISSUED: 4/24/96 EXPIRATION DATE: 4/24/97 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 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: RECEIVED BY: ' "ms`s DATE: /13-- C ISSUED BY: „-)6(44 DATE:1 24 .)' Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 October 2, 1995 Cecily A Cain PO Box 231673 Anchorage, Alaska 99523 1673 Subject: Lot 3 Block 4 Hundred Hills 1st Addition Permit #SW940373, PID #078-191-06 The subject permit, issued September 30, 1994 by this office for a single family well and/or on-site wastewater system, has expired as of September 30, 1995. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as -built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. erely, Jmes Cross, .E. rogram Manager On-site Services enc: Copy of Permit cc: S & S Engineering MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE,' ALASKA 99519-6650 PAGE 1 OF 1 /03- /‹ ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940373 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:CAIN CECILY A OWNER ADDRESS: PARCEL ID:07819106 LEGAL DESCRIPTION: HUNDRED HILLS 1ST ADDITION BLK 4 LT 3 LOT SIZE: 195158 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 9/30/94 EXPIRATION DATE: 9/30/95 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 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: RECEIVED BY: ISSUED BY: DATE: %1.35›,/,!;,f/ DATE:, V!5!/ HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. September 19, 1994 MunicLpatL y ob Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Aka6fza 99519-6650 REFERENCE: Lot 3; Bkoefz 4; Hundred ULU. Subdt.vi6.ion CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Request you issue a permit to &till a weft and in4ta t a septic system to serve the proposed thaee bed'toom house on the reSeneneed p'topenty. A test hoke was excavated and pe4co.2ati.on test pergormed. The approximate £ocatLon (56 the test hake i4 kocated on the attached site peon. The monitoring tube within the test hoke has been checked and 4aund to be dry. ThL6 property ha6 enough area bon a butane septic upgrade which can be been on the attached 6.ite pkan. We do not anticipate any advek6e ebbeets on neighboring properties by the in6tattatian ob the proposed septic 6y.tem. There are not points o6 contamination within the proposed wett nadL.u6 which can be been on the attached bite pkan. The proposed 1000 gatton septic tank -L6 to be pkaced outside the wet protective rad.iu6. Attached ,is a 6 -cite pkan which dep-.cam the Location ob the proposed tank. 14 you have any quest -Lovas, or requ-uee addi.t iona2 inionmation bar your review, pkea6e contact u6. S.incerety,, Robert C. Cowan, P.E. RCC/7A/gfz 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 2 = 50' NO ) e 20)0 .~/ 0 / 0 \\ CfrO ® ZO / 0 010 0 co m &„< 11 \ ,� �.m \c{ q \\)\ rli ®/% g 7 §\~ q 0jam c §w / 0 y® Pco 0.m 0 2 » G yme b G \700 3» Z e9<°=/z \\��/$\m CO 9®m=zj e 0 §\Qm,�g© 0 e®eeam --t; }\\/\e[ w 33@e«42 e \j//(/ 1 I— T, 0ox)< o , _g oZ>m z g a m m \\\ �\\ ? 0 \\ �\ y4 - m � G3 GNny1e,3, r 0±§ oW0 ))hiff{3 /\\ G\\ /ED 0 ZEg CHZ <9e '53\0 tn \§R w >>/ \\\ \% C.?! m \7\°\ 0 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ✓ (4ko �.- AA ` i LEGAL DESCRIPTION: D PIH (F .0 Nllft7 61ZC&Pci c ' G rot row" I- 5 oqr 6- 7- 8 �le t 9 - , D ter' 17- 18- 19- 20 - 'l.O.l-4 • DATE PERFORMED: 1 -pr L Township, Range, Section: SIL7f/ CRA/IDV GRAuEL wl7U Q6Af Q SAND Lis- 77-fcWUG SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Atter Monitoring? S L 0 P D ;� q1 LY Dat t/9�i SITE PLAN N Reading Date Gross Time Net Time Depth to Water Net Drop 3: OcV41 r- 2-Y3 " — .,lo 16/.41N 3I& " I is :pc) 14 " 4,I� 1„ - 36 !a G3/3 1Ys" A)9QEo H6,0 -- a Ys' i•(3 lUmmo 3" a-4, : 53 t 0 - (I" 11 t I, PERCOLATION RATE I° (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN .1L__ FT AND LI, S FT 7:11' RYL- C�u�rvlt . COMMENTS t 2- txc A* iNe- tXCR-t)R7 PERFORMED BY CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 3; B2ocfz 4; Hundred Hitt4 Subdi-v.i4ion GENERAL: CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 1. The 4eope ob thi4 project ine2ude4 the .Ln ta22atLon ob a 1000 ga22on 4ep.,ic tank and a 2each6.Le2d :trench to 4enve the pnopo4ed three bedroom ne4Ldenee Located on the nebenenced pnapenty. 2. Construction 4ha22 be .in accordance with the approved 4ite plan and deo Lgn dnawLng4, MunLcLpa2 penm,i t with any 4pecia , pnouLi -Lavas on condi tLaru4, and a22 app2.icab2e State and Mun c.Lpa2 Wa4-ewa-en Dizpo4a2 Regueat,%an4. 3. The eontnaeton 4ha22 be ne4pan4.ib2e bon obtaining any nece44any undengnound u J.ity tocate4. 4. Unte44 4pecitiica22y agreed o.thenw.i4e, .the pnopenty owner 4ha22 be re4pon4.Lb&e ban bLna2 grading anea4 4ub6equentey depne44ed bnom 40)1 4e-tLng. On a22 2eaehb.%e2d mound 4y4tem4, the pnopen.ty owvivt 4haU be nespon ibte ban enhun.ing a 4ati.4bactony vegetation gnaw.th ovek the mounded area. 5. Con.inacton4 .Lno.afLLng wa4tewaten dLi po4a2 4 y4tem4 must be een.tib,ied by the Mun,%ci-pa-. Health Depantmevtt on. 4y4.tem .in4.ta.2/.at ono . Ownen4 inztaiting .thaLJL own 4 y4tem4 mu4t x240 neeeive pn-Lon appnova2 beam the MunLcLpa2 Health Department. SEPTIC TANK INSTALLATION: 1. A 4eptic tank .i4 to be coutnucted by a cen,tiiii d 4eptic tank manubaetunen. CoutnuctLon 4ha22 ..nc&ude two 4" c2eanout/6 ban pumping acce44. 2. The 4eptic tank 4ha22 be 4u66ic ientty bedded to prevent 4ett.e ng on 4hL tLng ob .the tank. 3. A22 42andp,ipe4 on the 4ept.ie tank. 4ha22 extend a minimum 0.6 12 .ineh.e4 above 4.ina2 grade. 4. Septic tank4 .in,tatted with 2e44 .than 4' ob coven 4ha22 be in4utated. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 3; Btoefz 4; Hundred Hitbs Subdiv..ion September 19, 1994 5. A 4oundat.Lon cleanout 6ha& be .in.tatted one to bows fleet 4nom the bu tdLng 4oundation. In .the tine between the tank and the teach{.Letd there 6ha2t be two adjacent cteanout6 (ante.& an eb4tuent pumping &ystem ex.i6t6 within the 6ept.i,c tank) . The cteanout)s &hart be Located on undisturbed soLP not mane than 10' nom the tank. The 4.ir&t e2eanaut, .in tine, .halt be to clean toward .the teach4.Le2d. The second cleanout Ghat be to clean toward the sept e tank. 6. F.Lnat gnadtng oven the 6epttc tank .hatt be such that a po6.iti,ve &tope ex-L.t4 away {nam the 6eptt.c .tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the pnopo6ed tkench to the dtmevot.on4 shown on .the de..ign. The bottom o4 the excavation shalt be within 2 .inches o4 Levet. 14 the 6Ldewatt6 o4 the excavation become smeared, .they must be naked or scratched (toughed -up) be4one gravel (&ewer wocFz) ptacement. 2. Once the graver .L4 .in4tatted, the diztn.ibut.ion pipe .C6 to be .Lrutatted Levet with the per4oratt.on. {aced downward. Gta.vet tis then to be ptaced over the diat't.bution pipe to provide a minimum o4 2 .inches o4 coven over the pipe. 3. A oat bartt.er must be .iv4tal2ed between the 4.inat graver toyer and the native 6oit bacfz4. U. Ensure the zitt bawn Let cover& the entire gravel 6ur4ace be4ote prating bacfz4Lll. 4. Mon.iton tuba &halt be o4 flour (4) .inch dLametet and .ivztatted apptoximate2y in the toeations shown on the de6.ign. The portion o4 the mon toning tube extending through the gnavet .haft be pet{onated {rom the bottom o4 the trench to the Invent o4 the dL tt.ibutton pipe. Th.ii eguivatevit to the e44ective depth o4 the gravel a6 noted on the de6.ign. 5. Baefz4.-tt over the 4,Lnat gnavet tayen mu,st not be te66 than twenty-4owc (24) .Lnchu. In&utation mcut be .inutatted when the bacfz{.%l2 depth .is te66 than th.vety-6.Lx (36) J.nehez. The 4.ivush grade oven the trench mint be mounded to prevent the 4ormat.ion o4 a depne66.ion a4ten 6ettttng. MINIMUM MATERIAL SPECIFICATIONS: 1. Any 6epti.c tank. proposed 4on in6tattation mint be canztuueted by a MunLcLpa2ty approved septic tank manu4actwcer. Page Three Lot 3; Mock 4; Hundred H.LU4 Subd-iviz ion September 19, 1994 2. The 6ottowdng pipe mateniat.4 ane approved son, uoe -Ln 6eptLc ayatem inztattation6 .in .the Mun.icipati y os Anchorage: Type as Pipe Pen6ona.ed SotLd Caa. Ikon Ye -s Ye6 ASTM D3034 (PVC) Ye6 Yea ASTM F810 (HDPE) Yea No ASTM D2662 (ABS) Yea Yea Ube os a type os pipe o.then than lusted above mtust be appnaved by the ..napect%ng eng.ineek. 3. InauJatian aha t be at £ea6.t 2" thick ex kuded dtinect bukiat poly6.iynene (Dow Chem.icat Company S.yko6oam HI an equal). 4. Septic tank .roles and outlets 4ha2l be 6Ltted with watentJght couplings (Cautden, Fenneo, an equal). 5. A permeable nontoxic 6LU bann.ien (Typan 3401, M.ina6.i 140/N, an equal) muat be .inu.talted between the 6.ina2 leach6.ield gravel layer and the native 6oit bacfzs.iXX. 6. AIt leach6.ield gravel (6ewen nock) shalt be 0.5"-2.5" acneened gravel with less .than 3% paasl.ng the #200 a.ieve. 7. When nand 416 being used a6 a 6L ten maten.ial, -%t6 gradation 6peci6.icati.on4 must con6onm to cunnent M.U.A. an D.E.C. kequikementz. INSPECTIONS: Typ.ica ty there wLU be a minimum o6 -three (3) .inspections nequined during the in6taltation o6 .the wa6tewateek di6pa4a2 system. Thebe inspections wiJ ocean a6 6oltow6: 1. The 6.in.t .inapection must be conducted aster the excavation o6 ditches, pit, trenches, on beds and be6one the .instaltation o6 any gravel. A septic tank may be 6e -t .in place, but may not be bacfzsitted be6one this in6pecti.on. 2. The second .inspection must be conducted aster the placement o6 .the zitt bann.ien, gravel, d.i4tn.ibution li.ne6, 6tandp.Lpea, cteanoutz, and lnsutatian, but be6one the placement o6 any °then back4it .. Page Eoun Lot 3; & ace 4; Hundred HiLe/5 SubdivJ .ion Septembers 19, 1994 3. The 4.Lnae .i i4pect%on Li to occurs upon 4.inae gnad-i.ng o4 the pnopenty. 04ten there wLt2 be more than .theae 3 .napeetiona nequ,ined, eapeci.aZ2y with the .i.nsta22atian a6 mu,Zti.p!e tkenehea, sand 4itten4, pneaaun.ized d.iatn.ibut%on a yatema, etc. Thug, the .inspecting eng..neen .is to be contacted at £ea&i 24 hauna pn.,on to the a.tan.t o4 cou.tnuct%on. I4 neeeaaany, a pre-cona-tnuct%an meeting wJJ.2 take peace on-a.%te. The in4pecting eng.Lneen wilt not coond.ivute, dt.nect an cantkoe .in any way the cantnactat'a activLtiea. The ownen ahae2 contkact with the con kacton to pen4wun the worth ou tined in these 4peci.4icatian4 and p.an4 and .in aceondance with .the attached M.U.A. penm.it. There wLU be no covr nactua2 akkangement exating between the contnaeton and S & S Engtineek.ing. S & S Eng.ineen.%ng shah be the owners" nepneaentative and w.itt .inspect .the worth as stated above to document the eont)ulc tan' a activities. E.inat acceptance o4 the contntacton' a wonfz nea,ta with .the owners and .the M.U.A. S & S Eng.ineen..ng 4ha2e have no £Lzbiti y to the owners an to a.thena 4o11. Recd on om.iaa.iona o4 .the contnactan an any others penaona pen4onm.ing wonfz on eha project an the 4aitune o4 .the con nacton to canny out the wonfz .Ln aceondance with these canatnuction documents. S & S Eng.ineen..ng'a .%vwpecting eng.ineen wilt not be neapons.ibee liars .the covutnuctLon means, method', teehn.iquea, sequence, pnoceduneJ on the 44ety pnecawt-Lon4 incident to thv prsoJec . CONTRACTOR/INSTALLER PARCEL: 078-191-06-000-95 CARD: 01 OF 01 RESIDENTIAL VACANT LAND STATUS: RENUMBERED TO/FROM: - - 1 CAIN CECILY A PO BOX 231673 ANCHORAGE AK 99523 1673 SITE HUNDRED HILLS 1aT,,,cAnDTT�ION_ 13� 4 LT 3 0 LOT SIZE: ZONE TAX DIST: GRID NOTES . 195,158 R10SL 010 1160 ---DATE CHANGED --- OWNER : 09/23/93 ADDRESS: / / HRA # : 000000 REF 050-421-13,14 PLAT 90-11 SSMENT HISTORY FINAL VALUE 1992: FINAL VALUE 1993: FINAL VALUE 1994: EXEMPT VALUE 1994: STATE EXEMPT 1994: FINAL VALUE 1994: ---LAND-- 0 0 0 0 -BUILDING- 0 0 0 0 ----DEED CHANGED ---- BOOK : 2497 PAGE: 0773 DATE : 09/20/93 PLAT : 900011 ---TOTAL--- 0 0 --EXEMPTION--- 0 TYPE 0 0 -COMM COUNCIL - 0 SOUTH FORK E. R trstk /..1' -1-11:. 41-14,1ut veA 43/1 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 81-1 el / — D (o cosA # 14A 0 GO i 10 Expiration Date: $ — % % - O 9 1. GENERAL INFORMATION Complete legal description Lot 3; Block 4; Hundred Hills Subdivision #1 Location (site address) 430 Wolf Dr. Eagle River, AK 99577 Current Property owner(s) David Miller & Cecily Cain -Miller Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Eva Loken Day phone 689-6476 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. ' TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site (] ❑ Individual Holding Tank ❑ ❑ Community On-site 0 ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 1 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. Name of Firm s a s Engineering Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Robert A Sharer 5. DSD SIGNATURE iZ. Approved for 3 bedrooms. Disapproved. Conditional approval for Phone 6942979 bedrooms, with the following stipulations: ,k .OF ecy. •• ON-SITE • %ma Lam• WA1ERAND ; m= •• WASTEWATER . 4. PROGRAM • ,% �817moo,`111 Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �h/ jo"c 1 Original Certificate Date: 5 —/ 1 — 0 9 e- 1rusr Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST LCI 3; "gin 4) thaert Mus/ParceIID:7g - I9 ( - 06 Well LoON) CS Legal Description: A. WELL DATA t Well type r2illfrie Date completed If A, B, or C provide PWSID # Sanitary seali/N) iCS Wires properly protected r 119 ft. Casing height (above ground) /22 '24- + in. AT INSPECTION abbite 351 (s' ft. 'f •� g.p.m. No Total depth 1Ij ' ft Cased to FROM WELL LOG Date of test Static water level Well production 1;2 ft. g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 0•21 mg/L zr c�7 Arsenic: 10/D ug/L date of sample: q B. SEPTIC/HOLDING TANK DATA Tank Type/Material SC PTC- 3TrEC Tank size gtO gal. /2Number of Compartments `/ Foundation cleanout�l) l'fS Depression over tank (Ye k Date of pumping 66/10`% Pumper S4ANM , y C. ABSORPTION FIELD DATA Date installed e/abf it. Length 3 1 I S r ft. 13, Total depth /3.5 ft. Eff. absorption area 66'3ft2 Monitorin Date of adequacy test I 4/ 9109) Resu Fail) ttt II Fluid depth in absorption field before test in.Water added I- POgal. 2 rI Elapsed Time: 1q ✓ min. Final fluid depth /Sin. Soil rating Width Other bacteria n colonies/100 mL Collected by: Sc --S e41X-IVECeJ4D Date installed /07el9lp Cleanoutsc N) YCS High water alarm (1� a00 ft2/bdrm) D1 R (915 I ft. System type 1 Rocnif /Gravel below pipe 7 r ft. tube VP'S Depression over field IVO For bedrooms Ir New dept h3Q in. ^ Absorption rate >_ 'fG0't g.p.d. Any rejuvenation treatment (past 12 mo.) (Y j type) ' &/ 0 If yes, give date • D. LIFT STATION NI ft Date installed 'Pump on level at _ in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off" - - _in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /CO Public sewer main Il-Dll+ 1 Sewer /septic service line ,9rJ ÷ Holding tank AV A Animal containment areas 50 !} Manure/animal excrete storage areas KO 1+ Manhole High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots /CC) + I Absorption field on lot /l� 'i On adjacent lots /CO + Public sewer manhole/cleanout X7/4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r 1 / Building foundation S 't Property line S a Absorption field S 't- i / Water main n Water service line (D + Surface water /CO 11- Wells on adjacent lots /09 '- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 + Building foundation (0 ->< Water main R Water Service line (a 1 1- Surface water /00 f+- Driveway, parkinglvehicle storage /0 + Curtain drain !(9t9& & &MX tX) Wells on adjacent lots /CO Li F. COMMENTS K Flab P€6712-cr J 5 Pump e- Punnis/&x. 50735(04x -4x Vn-0.1/ 'flOVS cnru Gacue , G.' ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and I review of Municipal records • - the above systems are in conformance with MOA COS guld, ones h gffe • • his • = e. Engineer's Printed Name Date Pinto e/H& is icor acfltibcfl tfl- es iklp to 4 •'4,b ti . t' A. IA ate 11 en :4.7; COSA Fee $ Y 7 I) Date of Payment F CAA) Receipt Number Qa 4 -CO C (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SCS Rea Client Name Project Name/N Client Sample 1D Matrix 1091539001 S & S Engineering L3;114;I lundreds dills S/D NI L3;B4;Ilundreds hills S/D NI Drinking Water Printed Date/Time Collected Date/Time Retched Date/Time Technical Director 05/04/2009 16:51 04/21/2009 13:51 04/21/2009 14:35 • Stephen C. Ede Sample Remarks: Parameter Results POL Units Method Allowable Prep Analysis Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 04/28/09 05/01/09 NRB Waters Department Total Nitrate/Nitritc-N 0.214 0.100 mg/L SM204500NO3-F B (<10) 04/23/09 JDZ SGS SGS Ref) Client Name Project Namd# Client Sample ID Matrix 1091612001 S 8 S Engineering L3;134 Hundred 1E11 S/D #1 L3;134 Hundred 11111 S/D #1 Drinking Water Printed Date/time Collected Date/Time Received Date/Time Technical Director 04/29/2009 14:44 0427/2009 11:50 04/27/2009 14:05 Stephen C. Ede Samplc Remarks: Parameter Results PQL Allowable Prep Analysis Units Method Contamcr ID Limits Date Date Ind Microbiology Laboratory Colony Count Total Coliform Fecal Coliform 0 0 0 col/100mL SM20 92220 col/I00mL 5%120 922213 co1/100mL SM20922213 A A A (<200) (<1) (<1) 04/27/09 DLC 0427/09 DLC 0427/09 DLC i` -s• l i o ...�o. -ate /•=✓G9�lat//,j940% ASBUILT I HEREBY CERTIFY :THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: r: trectfrxeZefVd; 49":041f6 Siar;a r AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCE SHOULD ANY DATA OF FENCE LINES, OR FOR ESTABBE USED FORLIOSHS NG BOUND- ARY LINES. DRAWN: SEWARD & ASSOCIATES LAND SURVEYING 694-082 SCALE: DATE: 1,4/7 GRID: t r."0".0 FB: j.S-7'o `E �F.. r ;kyri t"4 .. i• - $4 r }. �• ; Ovin. Mirk Lnrd 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# U - 1. GENERAL INFORMATION HAA# Complete legal description Lot 3; Block 4: Hundred Hi 1 1 s Suhr1; v; F;i on #1 Location (site address or directions) _ Wolf Drive Eag1 Riy AK 'Property owner nave Miller Day phone Mailing address 4600 De]ang nrivP Anchorage, AK 9950 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 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 Approvalapplication 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 S 8 S ENGINEERING Phone c y- 7 C1 17034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 99577 Engineer's signature 7' 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. By: Date 7/)- /c1 7 I A ROBERT C. COWAN Q rc CE -8801 `4 Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 1 r// 92 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. 72-025 (Rev. 1/91) Back MOA N21 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage JUL 2 8 199 DEPARTMENT OF HEALTH & HUMAN SERVICES j �� V Environmental Services Division l� 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Qi-ocr 4, 1-lutwkao Parcel I.D.: Oi s3 191 - oro NILL5. S/0 A. WELL DATA Well type PRIJr-TE If A, B, or C, attach ADEC letter. ADEC water system number Log present (4YN) YCS Date completed 9/1i, Total depth 11 ff Cased to 119-1 Casing height (above ground) 21 + Sanitary seal ON) YES Wires propbrly protected ON) YES FROM WELL LOG AT INSPECTION Date of test a /9fo Static water level 3S Well production ) a g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate 0 . 1 G Other bacteria 0 Date of sample:S & S ENGINEERING p 7-,) / " G% 7 Collected by: 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed " 26 -94 Tank size !b oo Number of Compartments a. Cieanouts ON) YES Foundation cleanout CVN) YES Depression (Y4 7 O High water alarm (WED_ NIT, SyS"7"- bT PJ Y /A.105 UJL U") 77 (.4_ 5-/- 97 Date of PL)mping E Pumper rte. C. ABSORPTION FIELD DATA Date installed x'26'414 Soil rating g.p.d./ft 'rft2/bdrm) 6.8 System type I RE.nfci4 Length 31.51 1 Width x.51 Gravel thickness below pipe q1 Total depth i2!" 13i Effective absorption area b. r Monitoring Tube present Q'aY N) YES Depression over field (Y/N) Date of adequacy test NE J Results (Pass/Fail) ---- For 3 bedrooms Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.): Fluid depth -- (ins) Minutes later: Absorption rate = i g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" High water alarm level - *Datum s tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot 10o1 -f - loos+ Public sewer main ni �A- "Pump off" level at* On adjacent lots On adjacent lots Public sewer manhole/cleanout Sewer /septic service line ZstLift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: 1001+ til NIA I Foundation I S Property line 1051+ Absorption field to Water main/service line 101.1- Surface water/drainage 10011 Wells on adjacent lots loot + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: 1 Property line —10 + Building foundation 39Water main/service line !c 1 Surface water 1°01+ Driveway, parking/vehicle storage area SI + Curtain drain 4.94E •kr,towlJ F. ENGINEER'S CERTIFICATION Wells on adjacent lots I o o t + - I certify that I have determined thru field inspections and review of Municipal in conformance with MOA HAA uidelines in effect on this date. Signature Engineer's Name Date kaQc CoIs/ //� /a 7 *90 S ms are ?.1kt ROBERT C, COWAN �,% CE=8801 0\�,4 HAA Fee $ Gro Date of Payment 7 I 0-3 l G 7 36/� Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number JUL-25-1997 14:43 CTSE ESI ANCHORAGE LTE 9075615301 P.05/05 CT&E Environmental_Services Inc. Laboratory Division n rrAe�„roitria-ssslr,,r�,tyirarar� rAinssr:Atrdirr��.rrisT•0:os,dye'.rrr'e4 Drinking Nater Analysis Report for Total Coliform Bacteria 200 tIV. Potter n99v� Anchorage. AKD518.1 605 Re,4D INSTRUCTIONS ON RE'YER$4' SIDE BEFORE COLLECTING SArtfPLR' Tel (907) 552.2343 Fax: (907) 561-5301 MUST BE COMPLETED BY SVATER SUPPLIER o "" PUBLIC WATER SYSTE`f LD. A �`c laPRIVATE 'WATER SYSTEM O Send Results , teamJynem.s vn��y pylrl,.4me - 0 ..Tend Invoice CJmr.nr • MMI t.JMatt Meme Aline Annum. .s\umber . IMin t AdJ,eta Liu C.,ua c'7 )late m l ,Wa O Send Rt1ftla 0 Send lnvoicc CJmr.nr • MMI LOLL! n,mr dlulrq ...1 cif 1..'7 seat, Liu C.,ua SAMPLE DATE: SAMPLE TYPE: .›¢C: Routine 0 Treated 'Vater Sent in,1-O.E.C. ,tncn Fhla Jun ❑ O Repeat Sample (for routine sample 0 Untreated Water Faxed with lab ref. no. ) Dare: `^— Time; o Special Purpose TinteCollected Client noliried 0 -unsatisfactory results: SAMPLE LOCATION Collected By O ❑ /,3 et guru tjllls 5/D % `y'� V Phoned Spoke with Eased 2 :20v�is"d-e- -6..r PlenePriM� WV Time: _ 0 :Mon th 1 Fr 7J Day Year TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory Unsatisfactory Sample over 30 hours old, results may be unreliable Sample too long in transit: sample should not be over 43 hours old at examination to indicate reliable results- Please send new sample via spat delivery mil. Date Received Time Received Analysis Began Analytical Method: eJ` Membrane Filter ti- iN(MQ-NIUG • Number of colonies/I00 ml• 1.nh Ref. No. Result' Analyst .oz 913976 , EUCD Comments: BACTERIOLOGICAL WATER ANALYSIS RECORD .. d1\TO-'IUC Result: Total Coliform E. Coll Irlembrnnc filter: Direct Ceunt Colonies/100 nil Verification: LTH Fecal Coliform Confirmation Finals Reporrc 8C8 COLIFIRNI It Coliform/100 mi Time\1 hes rvre. - rmr Numen,u.r r•, c ,,,t (11 - liter Hucteriu SGS Member of the SGS Group ($0eiete Generale de Surveillance) TOTAL P.05 JUL-25-1997 14:43 CT&E Refit Client Natne Project NameN/ Client Sample ID Matrix Ordered By PWSID Sample Remarks: Parameter Nitrate -N Total Coliform CT&E ESI ANCHORAGE CT&E Environmental Services Inc. roxiwarolgswoirunewargiromora 973976002 S & S Engineering N/A L 3, B4 Hundred Hills S/D #1 Drinking Water 9075615301 P.03/05 Client PO# Printed Date/Tinge 07/25/97 08:22 Collected Date/Time 07/21/97 14:25 Received Date/Time 07/22/97 12:45 Technical Director: Stephen C. Ede 0 Released By Allowable Prep Analysis Results PQL Units Method Limits pate Dote !nit 0.186 0.100 mg/L SM18 4500-IJ03r 10 max 0 cot/10011L SM19 92228 07/22/97 JRJ 07/22/97 TMW