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HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES #1 BLK 5 LT 4Mountain Valley Estates #1 Block 5 Lot 4 #050-651-16 wm* 0 �s � �� I t AA A, OPOV) ON! o cc I,Z/ g 1ACUry 61 K lm f 70, Vlt-(-6,sr Municipality of Anchorage U 4/04 - On -Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: Q $ P/cfl�tl/[��_ PID Number: Q 50 455116 Dwelling: 0 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New X Upgrade Name: .�c�f-bagOn/ ABSORPTION FIELD eZDeep Trench EJ Shallow Trench ❑Bed [:]Mound Address L/119- 1319bSOv6 -6/2 ❑Other Phone Number of Bedrooms 3 Soil Rating Total depth from original grade GPD/SF 7 Ft. LEGAL DESCRIPTION Depth to pipe Invert from original Gravel depth beneath pipe Subdivision� / � r� Block Lot � �'S / / S `7"/ tgr�ade G . 7 Ft, y S FL Township Range Section Fill added above original grade Gravel length 0% Jrt FL 41Z Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 3 Ft. To Septic Tank Absorption Field Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches Tank Line From 3 75 Fe _ Ft. Well/OQ , /A /V �j,�. Zsr�„ TANK eptic ❑ S.T.E.P. ❑ Holding EJOther Manufactur r Capacity 410ANe ����� T4A/% /OOQ Gal. Surface Water iav f /�Q `t /VA Material Number of compartments N4 114 NA LIFT STATION N4 Lot Line �r7 Id r Nq Foundation S /D 4 NSP Manufacturer Capacity Curtain Drain A14 N/( NA 1/4 Gal. Remarks Pump on level at Pump off level at High water alarm at in.1 in. in. maKe ana mooei (Electrical Inspections performed by i• Installer ,[PIP MATERIAL House to tank /PVC,draain•"fi•ke'•[da r Drainfield 30,.?tl CO/MT_7O Inspector /0 �/ F/r� BENCHMARK (Assumed elevation) l 00 g InspectionV Yttt-l/�O--ez3 Location and description dates: 3w/0 ._ Vim. O z; FRONT COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Approval: Date I -//// y Approved�� Date r Neighbor IWell Birdsong Drive Eosem%Ho Well 100 New Trenchdroom New 1000 Gal Tank- / Decommissioned Ol No Septic Tank onflict Per Uniform Plumbing Code hbor Septic ++ SJoPe 11p 1. I AS -BUILT MEASUREMENTS FCU A 31 B 6 STI 16 26 ST2 14 31 DCO 13 34 col 26 51 MT/CO 65 81 NOR THRIM ENGINEERING PO Box 770724 'Eagle River, Alaska 99577 907.694.7028 .°F.� MOUNTAIN VALLEY EST 1" = 40' .. ... #1 BLOCK 5 LOT 4 RECORD SEPTIC SYSTEM DRAWING rrF�y. UPGRADE '11/1/14 2' of 3 H^� F7 Z D = z FTS z d 70 9 ~ F7 F F9 i \ \ C of a � mj z i sl Lq < n i T\ F wl F9 z S m N P _h O m II Q co h W 0 CP T I I �D 0 CA m H M F 3 F < + < P G P (_+ _,F O O 3 R' 3 II � II 3 lD P ID CJl � V Vi Z (0 N f <+ n 0 0 �o P 3 P O 3 O p m Q < P P < h h P 0 o + O C7 II 3 N P CJ3 (CJI c h C7 � O N 3 P T P 3 X_ � c-1 T P N Q P N 3 O O �\ UI m ro P h 0 3 if 0 UI CP On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141441 Tax Code Number: 05065116000 Work Type: Septic Upgrade Permit Effective Dates: October 17, 2014 to October 17. 2015 Design Engineer: NORTH RIM ENGINEERING Subdivision: MOUNTAIN VALLEY ESTATES #1 Site Legal Address: MOUNTAIN VALLEY ESTATES #1 BLK 5 LT 4 G:0758 Owner/Address: DUSTON JOHN D 4118 BIRDSONG DR EAGLE RIVER AK 995770000 Site Mailing Address: 4118 BIRDSONG DR, Eagle River This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 70020 Total Bedrooms: 3 N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By. MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERNVELL PERMIT APPLICATION Parcel I. D. () SO — 1� S/ — / Property owner(s) T O6W 6 US TO n! Day phone Mailing address / //ZQ S Q ri Atz Site address S''&4j Legal description (Sub'd., Block & Lot) /22 &41jr, 4in/ fI L Lf ej 7 / Legal description (Township, Range & Section) Lot Size 74 )2a Sq. Ft. Number of Bedrooms _ APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field Initial ❑ Single Family (SF) Septic Tank Upgrade ► (w/wo ADU) Holding Tank ❑ RenewalDuplex ❑Multiple (D) Privy ❑ Dwellings Private Well ❑ SUBMITTAL (SF and/or D) Water Storage El OCT 0 1 2014 THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 146 of property owner or Permit/Rush Fees: 50— Waiver Fees: _ Date of Payment: _ 1o/ / hq & Date of Payment: Receipt Number: OfA!5? 1 tJ Receipt Number. Permit No. Waiver No. Permit App_9-1-12.doc h Date: 10/17/14 To: MOA On -Site Services Steve Eng, PE, PH P.O. Box 770724, Eagle River AK 99577 (907) 694-7028 SteveEngPE@gmail.com Subject: Mountain Valley Estates #1, Block 5 Lot 4 Upgrade Septic System Design Number of Pages: An existing trench has failed on the subject lot. A new soil test was completed, SM soil and groundwater at depth. The design calls for a deep trench and new septic tank. The neighboring lots are on private wells and septic systems. A diverter valve is to be installed to utilize the old trench. The lot was searched and no surface water or creek is present on the property. Please review the wastewater system design for the single family home. I have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Th / 0/r 7//C-( �� THS Imo_ ENGINEERING -, MEMO Steve Eng, PE, PH P.O. Box 770724, Eagle River AK 99577 (907) 694-7028 SteveEngPE@gmail.com Date: 10/17/14 Number of Pages: 3 To: MOA On -Site Services I Crewdson, PE Subject: Mountain Valley Estates #1, Block 5 Lot 4 Upgrade Septic System Design Your Comments, 10/16/14 This is in reply to the subject comment sheet, dated 10/16/14: 1. We measured the slope directly downgradient of the proposed trench site. The slope falls within 10-15% within the 50' of the trench. This has been noted on sheet 2/3. 2. A distance has been included for the drawing separation between tank and foundation @ 5' A note has also been added. 3. THl was identified on sheet 2/3. 4. Rebar was driven to 14'; no bedrock is present within 6' of the drainfield bottom. 5. The typo was corrected to read 375 FTI. 6. The well radius to the east was located on drawing. 7. The property was walked and no creek found. /3 (( 7/f Y Mountain Valley Estates #1 Block 5, Lot 4 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 3 -bedroom, single family home. The existing trench has failed. A new trench has been designed. The existing trench will be connected via a diverter valve. Neighbor lots are served by septic systems/private wells and there are no conflicts. A new 1000 gallon septic tank will be installed and the old tank decommissioned. The topography slopes to the east at about 10% slope at the trench site. A new soil test indicated a SM soil at the trench. Groundwater was encountered and reported. An application rate of 1.2 GPD/FTI will be used for the trench. Trench length = 375 FTI/4.5' x 2 = 42'. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • New 1000 gallon septic tank. Install diverter valve after the double cleanouts. Connect to new trench and existing trench. "On" to new trench. • 5' minimum between the tank and house foundation, tank and trench. 10' to property lines. 10' minimum between trench and existing trench. • 3' of cover or insulation is required for bed; an equivalent of 1" insulation for F soil cover may be used. 2" Minimum thickness for insulation. • Tank & solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required F to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain - rock. • Drain rock to be %I" to 2 ''/2' screened. Drain rock to be distributed uniformly. • Perforated pipe to be installed level with perforations down. • Silt barrier (filter fabric) to be installed above the drain rock. • Smeared bed must be raked or scarified before drain rock placement. • The finish grade must be mounded to promote drainage away from trench. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Decommission old septic tank per the uniform plumbing code. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) Neighbor (Well Birdsong Drive Easem t 10' Utility 4 SvoPay W e l p.15 e� 1 New Trench CO MT/CO 3 Broom S`;1 `dco ort Fva�' Vo,lve 'D %niltrd UQIVe—n�nn To New Trench New 1000 Gal Tank Decommission Septic Tank Per Uniform Plumbing Code ,Neighbor Septic Slope 11pl. DESIGN NOTES: 1. Trench Depth At 8'. 2. Sewer Service Line minimum 2% slope. 3. Connect Existing Trench Via Diverter Valve. 4. Lots Served by Private Water Wells. 5. No Conflicts Within 200'. 6. Decommission Old Septic Tank. 7. New Septic Tank To House Foundation Minimum 5' Sepa No onftict (� �ry 1 °F. MOUNTAIN VALLEY EST — 1� 40' NORTHRIM y�P' * :49UL ENGINEERING #1 BLOCK 5 LOT 4 PLAN PO Box 770724 xw. e LAYOUT Engle R7ver, Alcskc 977 /� SEPTIC SYSTEM S T E M 907.694.7028 UPGRADE 10/17/14 2 of 3 � ° LLI °; c g I �. ! 0 ( W c [ { \ /I . .. .. 2 , / \ Qj u D \ > 5 / /I } } J 3 / \ \ \ / fi % ) ° ) > / \ 2 m LLJ y ® u ± ® w � \ LLJ / 2� C5 \ , EL -Ul E . w / a; \ c d\6 2&7 G 2� 2e ® _]{ El-- �, ® 2� , ± g Q� z \ ± mo om-F; o ° CD F- G$§£,! -0a- u� lit7 \§ \ )g a{E2e$'' .0/\�~\�� "r -� )2 _ `006. ■� d j•\ §j u0) -QL`/ -- o \ 'U {{}/ ° §\{\/Ju IL E \ \�\±\\\\}/[ /$)(, c g zf»)/f��&)° �-4— ai boa, ƒ Q �7NR § mA/®I>mJ�E= _2 RQ ƒ §gig e¥aa 2 ;32 »�m■§ Ka czEF 2Q m � S❑ILS THRIM N jNEERING LOG - PERC❑LATI❑N TEST Performed For: John Duston Date Performed: 9/28/14 Legal Descriptions Mountain Valley Estates #1 B5 L4 1 - DEPTH (FEET) Organic Net Time 2 Net Drop 1 3 - 0 -- 4 - -- SM Silty Sand 5 _ ,' . w/ Gravel 10.5" 3,5" 3 9/28 12 -- 7� -- 4 9/28 22 10 min, 10 - 3,5' 5 11 - 25 -- 12 - -- 6 13 - 35 10 min. 14 - 3,5" Rebar Driven 15 - 37 To 14' 16 - -- 8 17 - 47 10 min. 18 - 3.5' 9 19 - 50 -- 20 - -- 10 T,H, Location: See Attached Design Groundwater? No Depth -- Water Depth After Monitorinq,12' Date: 10/6/14 # Date Gross Time Net Time Depth Net Drop 1 9/28 0 -- 7' -- 2 9/28 10 10 min. 10.5" 3,5" 3 9/28 12 -- 7� -- 4 9/28 22 10 min, 10.5" 3,5' 5 9/28 25 -- 7� -- 6 9/28 35 10 min. 10.5" 3,5" 7 9/28 37 -- 7' -- 8 9/28 47 10 min. 10.5' 3.5' 9 9/28 50 -- 7' -- 10 9/28 60 10 min. 10.5' 3.5' 21 - Percolation Rate 3 min,/inch Perc Hole Diameter 6' Test Run Between 2' and 3' Comments: Presoaked. Measured to nearest 1/1(;th inch. Performed By NorthRim Eng, I -:::275' CERTIFY THAT THIS TEST WAS Performed in Accordance with All State/Municipal Guidelines in Effect ❑N THIS DATE, DATE: 9/28/14 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME , PiONC UPGRADE MAILING ADDRESS O / I , O LEGALDESCRIPTION Ay LOCATION'S f� NO. OF BEDROOMS L L U Y 1— z Well Absorption arya )L DISTANCE T0: ✓ Manufacturer Dwelling 4-- � _ 'al PERMIT NO. �� 2 Mat No, of com artments N� Liq. p'1ty in gallons (JUS IF HOMEMADE: Inside length Width Liquid depth Z DISTANCE TO: Well Dwelling PERMIT NO. Z F Manufacturer Material Liquid capacity in gallons W = LU a Z = Well 2�� / DISTANCE TO: No. of lines Length o acl�iryC Foundation /a Nearest to �n� „ fs - Total len h L / Trenc �th PERAQ M `7 Distance etween ins N � nches F Top of file to finish rad Mate i be eath tI'1 ��' /' 02,Z i $Ye641C1 ��Ge Totalal eve abso.�l I n area 0 inches �/ W Length Width D th PERMIT NO. aa~—. W Type of crib Crib diameter its depth Total effective absorption area W V) DISTANCE TO: Well Building foundation Nearest lot line a Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tankAbsorption area(s) OTHER PIPE MATERIALS ,©v c SOIL TEST RATING' INSTALLER ,� / B `V lei V C/v /e, REMARKS _ O. NO r Fy9e 'R L2 I �• . r �04 �I e APP E DATE LEGAL ry Com.' y� o LIM7 M". os iol 0 z I m oil m m (D VP 1-3 m pil 04 oil ,33H3 q 1-3 H H H H or] m R to (D VP 1-3 0 Z 1-3 H H H H k.A ;-,3 41 Fj q tj 1-3 i(D po C+ ic+ SC :(D Jj :42r icn i trio !04 0 Ili Iq 11, iFl pa, (1) (D O -q 04 m oil pi �t �o io i. ic+ i . qj H 1-3 H H i 4 R to (D VP 1-3 0 Z :48 41 Fj q 1-3 H po 0 :42r trio !04 0 Ili iFl pa, R (D Z 0 Z > Z :I- c) r;l T n 5"o 0 g 0 Z (7) Z :48 Fj po iFl m tq i�j i �o io i. ic+ i > Z :I- c) r;l T n 5"o 0 g 0 Z (7) %�/af ��GrV �4 • n`C / %✓lurot'c.i/�ra� Roan! Gur�-iwi.0 O/iAt�i^'Y 004 113 I We � y0� o\ o HItHNif ll1*1 11+4 'r ' redk N - 0� 70/ 492 0, 90 Sq, 0 Qixs - Fnd S "C. bur Oos14 �-, zol � '4' <o7'- I9 / -;g O -►�gt ��oU/v -rQ/� Y� c�Er srArEs .d' 0 F , A L X11 pp - /lOD / T/ON No, / SU4 D/d/S/O/V ff l�7 �� ' Con 7�0: if i/JV /, lv O % O C. 9.+_ '� yk. loe.rfed i'.4.l/%z see 3'S rMOYRlwttrz E�G/NEjz/,fYEyiiYtr .. Y ;f z ' SER Y /CC'S ..`'�.1�� 4y , r�Q �~ �sar`/icr/edFp�',ve, Wi7si//o, AIC 99497 ,.,:: r'�1i1'L%Va••w J -J -FTD i•'sC .-JiA6 Lit i,.,: •;r�; Seo {ir , .cise,er�'.•d 4y .. Mo G. r! _ . Cr -2 -go TYPE OF SOlL H8SOR8TlON TRENCH MHXIMUM NUM8ER OF BEDROOMS SOlL hot! TING (SQ F171310i48 T|lb: REQUIRED ST OF THE SOIL RHSORPTION SYSlEM IS. THE LENGTH DIMENSIUH IS THE LENGTH (IN FEET) OF THE lHFNCH OR DRRIHFiEiA THE DEPTH OF H TRENCH OR PIT IS THISTHNCE RE[NEEN TH[ SURFHCE 0F THE GROUND HND THE BOTTOM UF THE EXCHVHTI0N (IN FEET) THERE IS NO SET WIDlH FOR TRENCHES. THE GRHVB. DEPTH IS THE MINIMUM 0EPTH OF 6RHVEL 8ETWaN mE OU[FHLL PIPE HND THE BOTTUM OF THE EXCHYHTION (IN FEET) I V Ail &A 4. A W RK" V TA �SVH"U^:07 C 1�pl-hp< ���U��� �!:�i )! � �: r ����--�::,:: PERMlT HPPLICHNT HHS THE RESPONSI8ILIFY TO lNFORM THIS DEPMTMENT RING THE INST�LLHTION INSPECTIONS OF RNY NB.LS HDJHCENT r0 1111 1010010TY HND THE NUMBER OF RESIDENCES THHT THE NEL( NILL SERVE 4 T.PQ Q IT A 1: INA 77; to, U V � T 1: -1 NY? n: V w A Ron 40 - �0 17 :jil [i i��� BHCKFILLING OF HNY SYSTEM NITIOU T 1lNHL IidSPECTI0N HHD HPPRnVHL RY THI� DEPHRTMEHT 14ILL 8E SUBJECT TO PR0SECUT[UN 1 " KH Q PH V-9 - 40 K" 1: TQIE�K �> WE C, bl 1-1 NO K f d, �R -� ���1� ] CERTIFY THHT 1 l HM FRMILIHR NITH THE REQUI10MENTS FOR ON�S}TE SEWERn WD NEL1 S SFT FORTH 8Y THE NUNICIP9LITY OF HNCHORHGE 2� I Ill ILL lNSTHLi, THE SYSTEM IN RCCURDHHCE WlTH THE CODE� ]� I UN0E[In [HND THHT THE CN~SITE SEWER SYSTEM HHY REQUIRE ENLRRGEMEN[ IF THE RESTDENCE lS REMUDELED lD INCLUDE MORE lHHN 7 BEDRUOMS PERFORMED FOR: LEGAL DESCRIPTION: DEPTH (FEET) 1 2 �� 4 , 3 ` 0 V �U r -v SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION Pouch 6650, Anchorage, Alaska 99502 276.2221 TEST SOILS LOG - PERCOLATION TEST T7 s 6/ Z- yle- 5- �/QN 7 -,FY 7' 6 d � 8 9 2S 10 11 w0 WAS GROUND WATER A fD ENCOUNTERED? Al "D i 13 y ,( 14 I �a %G�6C'i 49 !� 15� F 16 17 18- 19- 20- COMMENTS 81920 SLOPE COMMENTS � A PERFORMED BY:'--�, 72-008 (7/76) IF YES, AT WHAT DEPTH? / 16 /f491- o y� 0 �- E j Reading Date Gross Time Net Time Depth to Water Net Drop 170e -T S/'/S -- ye rr / 0 V[/1'1/ 13 PERCOLATION RATE_ (minutes/inch) J y RUN E ,,,ea.✓/ l Z l0 —7 z, F-- AND FT / CERTIFIED DATE: / 7Mr 7 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL �} L L)– I OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date October 15, 1986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4 Block 5 Mountain Valley Estates #1 T1.4N R1W Sec. 33 Location (address or directions) Eagle River (b) Applicant Name John Dustom Telephone: Home 694--6427 Business ILA Applicant Address SR Box 9305 Eagle River, Alaska 99577 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Centrust Mortgage Telephone —561=19_3 Address 4000 Old Seward #103 Anchorage, Alaska 99503 (e) Real Estate Company and Agent Address Telephone (f) Mail the MAA to the following address: 2.. TYPE OF RESIDENCE Single -Family ® Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well ® Community EI 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 0 Public ❑ Community ❑ 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(11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 0 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 Address EACIE RIVER FNGINFFRING SIRVICES Date 1W-2 EAGLE RIVER, AK 99577 P: 0.-8IIX-773'L94- 694-5195 Telephone ,( �ngihbb r's Seal ��pCO �'�•os a,-ca,.\.,rte 6. DHEP APPROVAL (.3 Approved for , �" ` bedrooms by Approved Disapproved _Conditional �. Terms of CondiApproval CAUTION 'The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. Thb'DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 (11/84) MUNICIPALITY OF ANCHORAGE (MO.,) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 1 Legal Description: Z o -'�Vc r 71VIv /C / w A. WELL DATA Well Classification ✓A 7.1F If A, B, C, D.E.C. Approved (Y/N) — 1"v4 Well Log Present (Y/N) _Y Date Completed — /°lay%7 5 Yield 3 �r ph 7ediP� Total Depth CS Cased to k / Depth of Grouting y� Static Water Level 3.2� 4-1i,� hcc r, i5 Pump Set At e Casing Height Above Ground :2Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (YIN) N Separation Distances from Well: To Septic/Holding Tank on Lot 1_25— On Adjoining Lots To Nearest Edge of Absorption Field on Lot _ ; On Adjoining Lots To Nearest Public Sewer Line _ y�t To Nearest Public Sewer Cleanout/Manhole N/� _ To Nearest Sewer Service Line on Lot Water Sample Collected by G4 s� iii e , %� .N�e Date /0 ' Water Sample Test Results -S4 Comments. B. SEPTIC/MOLDING TANK DATA Date Installed / 77 5 Size /61—�4 No. of Compartments "2 Standpipes (Y/N) Air -tight Caps (Y/N) �y Foundation Cleanout (Y/N) Depression over Tank (Y/N) irJ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) N ; for ly's Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) N Separation Distances from Septic/Holding Tank: To Water -Supply Well / To Property Line To Water Main/Service Line —?,5— i Course Comments Page 1 of 2 72-026(11/84) To Building Foundation To Disposal Field SS To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /9 75 Width of Field 36) Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test * �Ze - 'So 104 Type of System Design Tr��✓G� Length of Field '4K�- / Depth of Field /L Gravel Bed Thickness S Standpipes Present(Y/N) ifs Date of Last Adequacy Test Sri f iS C qc 7DrS i ur 6 ties �CG?� 7g'- Separation Distance from Absorption Field: To Water -Supply Well /'-74) To Building Foundation Lot yea To Water Main/Service Line C;2d To Stream/Pond/Lake/or Major Drainage Course To Property Line e� 6 To Existing or Abandoned System on On Adjoining Lots 7C :3e, To Cutbank (if present) To Driveway, Parking Area, or Vehicle Storage Area -' 1� Comments So/%i /N fD rr tiv� �iJe� �) ?25;5 , Y �J if� l �.vri vice NS a /I%uN.e �G f Yo4�Ct s Gccr7`ai.� 6(Y41w/ /0ca7"e4 �05- c�uc�..s/one 7� +, 5ept.� /r c l Wvsi.lherd pori" '>'i+ 7',Me /S' c,>oCc , Sec �o/ate �o/y.v q'JYc �.Sa.p( D. LIFT STATION e Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that II have chocked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed y Date see co.. e,.,Ar tee, e. Company /�✓�ES, MOA No. ST -d6J Receipt No. �U U / d Date of Payment q Amount: $ Page 2 of 2 72-026 (11/84) ' Eriginebr;s Seal a \V , INSPECTION APPOINTMENTS DATE RE EIVED STREET LOCATION TIME TIME TIME 'fir (a M DATE DATE DATE C1� �� �— ��— ri 1` 1 AA INSPECTOR INSPECTOR I PECTOR { MUNICIPALITY OF ANCHORAGE [� 1 - ----- MUNICIPALITY OF ANCHORAGE ENVIRONMEf'T,',- I,:;I_CTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION - - - 825 L Street . Anchorage, Alaska 99501 MAIZ 1 0 1.,980 J ENVIRONMENTAL SANITATION DIVISION [� E C E I 0* Telephone Telephone 264.4720 1� y REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (101 days for processing. 1. PROPERTY OWNER . ❑ PUBLIC UTILITY PHONE D/�/ /tom MAILING ADDRESS 4-�O-1/64- PROPERTY RESIDENT (If different from above) - PHONE 2. BUYER/ _ _ PHONE _. C/ d f , ,l) MAILING ADDRESS 3. LENDING INSTITUTION MAI ING ADDRESS —HONE 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION o 7-c�6G�iUT�/� STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF�BEDROOMS 6?r ❑ One ❑ Four ❑ Other _ SINGLE FAMILY I�r Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ® INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - Ezr INDIVIDUAL/ON-SITE** f_YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) I �J v THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED f^� 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED \t INSTALLER ❑SepticT�nak or ❑ Holding Tank r )� SizeIf Tank is homemade give dimensions:` SOILS RATING TYPE OF TANK MANUFACTURE TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 19--APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE -' VA— 1; r) BY vwl- 72-010 (Rev. 6/79)