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HomeMy WebLinkAboutROEHL LT 2 Jul 06 22 06:42p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Parcel Identification Number- 020_09276 Date of Issue: - - Legal Description ROEHL Block Lot 2 11 Property- Owner Name & Address: SNOW KEVIN E & SUSAN C PO BOX 111668 ANCHORAGE, AK 99511 Pump Installation Date: 06 - 29 - 2022 7640 KING STREET 200 ANCHORAGE, AK 99518 Pump Intake Depth Below Top of Well Casing: feet GRUNDFOS State: Zip: Pump Manufacturer's Name: SQ07-320 Pump Model: Pump Size: '75 hp 10 Pitless Adapter Burial Depth: feet MARTINSON Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Completion? X Yes ❑ No Method of Disinfection: PELLETS Comments: Pump Installer Name: ANCHORAGE WELL & PUMP SERVICE Company: 7640 KING STREET ANCHORAGE, AK 99518 Mailing Address: _ 907-243-0740 City: State: Zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Page I 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: L-~Lc~,_,,~ L:~7/~/L PID Number: Name: ~ D Upgrade ~y~o~,) ~ ~. ~ ~,~ ~, ~Y'~ WastewaterSystem:__ew Address: ABSORPTION FIELD -, ~,~,~: No. of Bedrooms: ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION s°" Rating: ~. ~ GPD/Sq. Ft. Total Depth from original grade: Lot: 5~cck~ Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe ~ ~ ~ Ft. ~ Ft. Township: I Range: ~ Section: Fill added above original grade: Gravel length: I I WELL: ~ New D Upgrade Gravel width: Number of lines: Distance betweenlines: ~ Ft. ~ /~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~PZO ~V~ ~ Ft. ~ Ft. /)~7.~ SQ. Ft. ~ ~ ~ Driller:~ ~/L~I~ Date~/~/~Drilled: Static Water~Level:Ft. nstaller: ~~ Date, inst~'~' Yield: ~ Pump Set at: Casing Height Above Ground: ~.~ GPMI ~ Ft. ~ Ft. TANK SEPARATION DISTANCES ~septic D Holding D S.T.E.P. To Septic Absorption Lift Holding 3ublic/Private M~ufacturer: Capacity in gallons: From Tank Field Station Tank SewerLines ~~ ~ Number of Compa~ments: we,r .... Su,.ce '. '. LIFT STATION Water /O0 /~ ~ ~~ ~,___. I,,__~~=ufacturer: Lot Line /~ ~ 4 Foundation /~'~ ~2'~' ....... ,,Pump on" level at: ~~ [ High water alarm at: Remarks: BENCH MARK Location and Description: I Assumed /~0. O0 Elevation: ENGINEER'S SEAL S & S ENGINEERING ~w '~ · ~ ~'~%-~ 17034 Eagle River Lo~ R~d, No. 2~ ~ ~~v~ ~ ~ Inspections performed by: ~.:,. Givar.. Alnc~a W577 Dates: 1st ~ '~ '~ '~ ~~1¢¢' "~ :':*~ '~ Department of Health and Human Se~ices approval Reviewed and approved by: ~ gate: ~-~-~ ~"~'~ ~"~~ ,;' Permit No. SW930214 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:ROEHL SUBDIVISION, LOT 2 PID No.: 02009276 C01{ iNEW ..... A B FC0 12.0 15.£ C01 i21.0 19.£ ~O2' 30:0- 2%¢ C03 42.0 42.£ C04 44.5 67,¢ C05 56.0 56.C C06 57.0 77.C C07 72.0 72.C C08 170.0 86.C MT1 ::44.5 67.¢ MFS2. i..5.7+0. ~7.C MT3 i70.0 86.C SCALE 1" = 40'I CO2 C05 / / ORADE--~ i CO4 MT 1 1500 GAL SEPTIC 5 BDRM HOUSE ~84.0' NO WATER ~NK APPRO k. DRIVE WAY iLOCATI~ WELL C0 MT3 FOUND EN( x~zx Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 13, 1994 Raymond P Davis, Jr. Anita M Davis 3416 Orin Circle Anchorage, Alaska 99517 1651 Subject: Lot 2 Roehl Subdivision Permit #SW930214, PID #020-092-76'i The subject permit, issued July 13, 1993 by this office for a single family well and/or on-site wastewater system, has expired as of July 13, 1994. 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. raom~cerely' ~ ~aCmr~aSnS~geP;E' On-site Services cc: S & S Engineering Robert Shafer, P.E. 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 2 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMB~R:SW930214 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DAVIS RAYMOND P JR & ANITA M OWNER ADDRESS:3416 ORION CR. ANCHORAGE AK 99517-1651 DATE ISSUED: 7/13/93 EXPIRATION DATE: 7/13/94 PARCEL ID:02009276 LEGAL DESCRIPTION: ROEHL LT 2 LOT SIZE: 49500 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION 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 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS 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: A PORTION OF THIS PROPERTY HAS RECEIVED UNCLASSIFIED FILL MATERIAL. THIS PERMIT IS ISSUED BASED ON THE ENGINEER'S ASSERTION THAT THE PROPOSED WASTEWATER SYSTEM AND PROPOSED REPLACEMENT SITE ARE LOCATED OUTSIDE THE FILL AREA. IF PAGE 2 OF 2 MuNIcIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 FILL MATERIAL IS ENCOUNTERED DURING CONSTRUCTION THE ENGINEER MUST NOTIFY DHHS. ~fF~ca~q> ~ O~-W. {~T~r~O~ RECEIVED BY: ISSUED BY: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. June 4, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOII~TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 REFERENCE: Roehl Subdivision,~--~, Lot 2 We request you issue a permit to drill a well and install a septic system to serve the proposed five bedroom house onthe referenced property. Two test holes were excavated and percolation tests performed on the referenced property. The approximate location of the test holes are located on the attached site plan. The monitoring tubes within the holes have been checked and 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 properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. A. Shafer, P.E. / RAS/LSU/lsu 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 o~o N¥ld 311S 133WIS Nv'~r 11138 ON-S~TE ~ASTE#ATER DISPOSAL SYSTE~ CONSTRUCTION PI~.CTICES and NATERIAL SPECIFICATIONS REFERENCE: Roehl Subdivision, ~Lot 2 GENEP~L: 1. 4o The scope of this project includes the installation of a 1500 gallon septic tank and five foot wide drainfields to serve the proposed five 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 Wastewater 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: me A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. Page Two Roehl Subdivision, ~a~, Lot 2 June 4, 1993 Se 6e 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. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. 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. Se Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Roehl Subdivision, ~ Lot 2 June 4, 1993 MINIMUM M~TERIAL 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 ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No 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. 6e 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, it's gradation specifications must conform to AMC 15.65.060D. Page Four Roehl Subdivision, ~ Lot 2 June 4, 1993 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: me 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. * *l Z, s DATE PERFORMED: Township, Range, Section: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST · EG^, DESOR,P*,ON:/~;t,, ~----"~. · ,;, ~ SLOPE SITE PLAN DEPTH (FEET) 2 , 3 §- 7 8 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth t0 Water After Monitoring? ]0/ Date: Gross Net Depth to Net Reading Date Time Time Water Drop ~-/~ "~z. '~'.o~, '-*- ~ y~." - :Io ~o ~ V~" ~', : ~ ~o q" '1~" PERCOLATION RATE ~,O (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~'~ FT AND. + FT COMMENTS $ & S ENGINEERING PERFORMED BY: I 17034 Eagle River Loop Road NO. 2~,0~. CERTIFY THAT THIS TEST WAS PERFORMED IN ..... 1~-'5~ .,, PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION:/..-OT ~ ( .-'~~[~' .~E:~C ~Ownship' Range' sectj°n: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 1 2 3 4 5 6 7 8 9 10 11 12 13- 14- 15- 16- 17- 18- 19- 20- Depth to Waler After Moniloring? [:::f""~ Date: ~o Gross Net Depth to Net Reading Date Time Time Water Drop c/:~5 I~ ~" /" ,, ff.~ ~ ~/~" s/~', '. ~ S to 7 Va V~" PERCOLATION RATE ~:'~0 (minutes/inch) PERC HOLE DIAMETER .. TEST RUN BETWEEN ~'~ FT AND '~ FT COMMENTS PERFORMED BY; S & S ENGINEERING ~ '~ < CERTIFY THAT THiS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No. 2~0~. ~ c>- "~-~w~l'~-- - "LIWS 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Gamess Engineering Group Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date:; 2 l In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells * q T and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and D workmanship), and the water usage of the family utilizing the system/s.. These conditions can vary, and • • • • • • • • • • • • • are outside the control of GEG. Satisfactory test results do not guarantee future performance of the e f A. F ess. system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of�O CE -79 3 �� the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in 04 erP �•... •°�� the future. The content of this report is for the sole benefit of the person/party that retained GEG to aProfesstc�oo� perform the evaluation. Reliance upon the information provided in this report by any other person or D�O�000" party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE � is System #1 Approved for bedrooms ``�\G�Qpa-�T OF4 • r, System #2 Approved for bedrooms� �N�SiTE O� Disapproved o CATER AND m VVgS� — Conditional approval for bedrooms, with th f wi S i i%R O ®,o RAM Sy: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other CL1,> P 9_C,-ZVS COSA blue sheet 10-10-12.doc Legal Description: ROEHL; LOT 2 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA Parcel ID: 020-092-76 Structure served by this system ❑® Well log is filed with Onsite (or attached) Well production at time of test 2+ gpm Date drilled 8/3/93 Water storage tank volume N/A gallons Total depth *225 ft AVell disinfected for coliform test? ❑ Yes ON No Cased to *80 ft ❑ Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate mg/L [Nitrate less than MRL (ND) W Wires are properly protected Arsenic ug/L �rsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by GEG, LTD Date of flow test for COSA 8/13/19 Date of Sample 8/13/19 Static water level at beginning of test 83.8 ft. Comments *PER 1993 INSPECTION REPORT. WELL LOG IN MOA ONLINE RECORDS IS ILLEGIBLE /�. TANK DATA Age of tank(s) 26 years Tank type/material STEEL Measured operating fluid level in septic tank 52 0 Standpipes/foundal0 t tion cleanout per record drawing I Date of pumping el 5 116 D. ABSORPTION FIELD DATA x3 TRENCHES Which system tested (date installed) $17193 © ALL standpipes present per record drawing Total measured depth from grade 7+ ft (max) Measured depth to pipe invert from grade 4+ ft (min) ❑ NIA — pressurized field ❑E Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: N/A Adequacy test date 8/13/19 Results IDPass For 5 bedrooms Fluid depth prior to test 6 in Water added 823 gal New depth 7 in Elapsed time 45 min A-1 Code -required soil cover over field Final fluid depth 6 in Absorption rate 750+ gpd E] System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) N/A If yes, enter date N/A Gallons introduced gallons Comments/Deficiencies: TESTED MIDDLE TRENCH ONLY, EAST TRENCH WAS FULL UPON ARRIVAL, WEST TRENCH DRY UPON ARRIVAL AND STAYED DRY THROUGHOUT TEST COSA Checklist yellow sheet OA E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ❑ Yes if No _Septic Tank/Lift Station on Lot > 100' Surface Water > 100' [M Yes if No ft Community Sewer Manhole/Cleanout > 100' ❑M Yes MQ Yes if No ft Q Yes if No ft Neighboring Tank > 100' v Yes if No ft Private Sewer/Septic Line > 25' 7M Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' 0M Yes if No ft Neighboring Absorption Fields > 100' ft If septic tank is under driveway comment below Animal Containment > 50' ] Yes if No ft ❑M Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MD Yes if No It M❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *51+ ft Surface Water > 100' [M Yes if No ft Property Line > 5' ❑M Yes if No ft Wells on Adjacent Lots: Yes Absorption Field > 5' QM Yes if No ft Private Wells > 100'✓Q Yes if No ft Water Main > 10' OM Yes if No ft Community Wells > 200'MQ Yes if No ft Water Service Line > 10' 7 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 121 Yes if No ft If absorption field is under driveway comment below Property Line > 10' M Yes if No ft Wells on Adjacent Lots: Water Main > 10'M[] Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' F71 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECC884 f� m r is r ^ �rr'• 1 (� n ir^� a y�� Zq'�'fi�` � � oncw Q :k Ca? M !~+ O R w tih . 67'e;5 cn °ti Zi— N� A r ~ Ra►ty 1dummw ► EC Aj EG Ec• ESM 7- c W 5 O M W, R t� . ��rn _ a r m La n o w rn ms ftO�w � 0 "� 1 � C w w ® � d 9 S + ® y a q o a = �: � �"'� AA n•.��� • ,a,B \ �'. D M D� 0 rip rn4� to b\\,IA � rano v O• G R K t, o i :� a 40 , �rr twNn O E O R a < � •� � I- ''35 � r so x RK ? N E/t co w F,a �r V 0 tD rt o �( nn, U, W n• H • ..• .. /t? � Q N ZVI a. a O "'Sart o, f� m r is r ^ �rr'• 1 (� n ir^� a y�� Zq'�'fi�` � � yr Cl Y tb Q �aS,� ,-o tih cn °ti Zi— N� A r ~ 1dummw EC Aj EG Ec• ESM 7- c O M W, le .4 n. r m La � 0 "� 1 �y r is r ^ �rr'• 1 (� a: .00 20"a a _. pp pMp P = .'• d � b 71 ' • 4 < 9 N V 0 :°^ c o m 'q ir^� a y�� Zq'�'fi�` � � yr Cl Y tb Q ,-o A r ~ �w O M ; to y r m La � 0 "� 1 � C w w ® � d 9 S + ® y a q o a = �: � �"'� AA n•.��� • ,a,B \ �'. _c m H •.D iii �i x jT) o i ��r• �`®��� a < • _ o a ? X K Septic 'Wank advisory Certificate of On -Site Systems Approval #OSC191408 Subdivision: Roehl Lot 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 26 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Corn plete legal description Lot 2~ Rochl SUbdivision Location. (site' address or directions) B~ti~an Str~t Anchora~ AK Anchorage, Property owner RaFmond and Anita Davi~ Mailing address , 3416 Orion CZAe.~ Lending agency Mailing address. Day phone 345-7444 AK 99517 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: XY, X Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: XXX Individual on-site Holding tank Co mmunity on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legafity and status of system. 72-025 [Rev. 1/91) Front MOAii21 Engineer's signature '~x~/, _~, ~,.//~. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disPosal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm ~' ~' -~ E./vC,~v~.v~/~,~/C Phone Address 17 0'3~t 7 Date bedrooms. DHHS SIGNATURE Approved for Disapproved, Conditional approval for bedrooms, with the following stipulations: Additional Comments 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, I/91) Back MOA#21 ~ Municipality of Anchorage //~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. Well Data Well type Log present ~/N) If A, B, or C, attach ADEC letter. ADEC water system number '"//~' Date completed ~-~-~ ~ Driller ~'~F-'-'( / Total depth c~ 0 ~' Cased to Sanitary seal ~/N) FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding-tank on lot Absorption field on lot / "~ ' Public sewer main Sewer service line ~_~(~ r Casing height ~' ~ 0 Wires properly protected ~)N) ~'~_..C g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Z ~u O WATER SAMPLE RESULTS: Coliform O Nitrate ~2 ~ / O Date of sample: / O t~t <~z7//O q~ ~,~r~/~,A/v "r A'~r~' C°llected bY: B. SEPTIC/I~ TANK DATA Date installed /:~-/~ ~ ~'~ Tank size Cleanouts (~_~) F Foundation cleanout (Y/N) High water alarm (Y/~NNNNNNN~ Date of pumping /0./~ ~ ~J~__~J Other bacteria ~/334 Eagle Rivsr Loop Road No. 2~04 ~:~1~ River, Alaska 99577 CompaAments Depression (Y/~ Pumper SEPARATION DISTANCES FROM SEPTIC/H~TANK TO: Well(s) on lot To property line Surface wateddrainage On adjacent lots Absorption field Foundation Water main/service line CONTINUED ON BACK PAGE 72-026 (3/93)* Front Manufacturer / Manhole/Ac~N) Vent (Y/N) __ ~ ~at ~.//~'"~ "Pump off" Level at High water alarm level ~ Cycles tested Meets MOA electrical ~ SEPA~CE FROM LIFT STATION T0: ~ ~on lot On adjacent lots Surface wate'7'-~. D. ABSORPTION FIELD DATA ~~' / Date installed ~ _ ! ~ _ c~ ~ Soil rating (GPD/Ft2) ~), Length I~H T~S~L Width ~ / ' Gravel thickness System type Total depth Total absorption area l.~,,~.~,~ ~ Cleanout present~/~l) Date of adequacy test A)//~ /~E ~ - .~y$, Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/~ Depression over field (Y/~) for ~ Bedrooms After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water adjacent lots Property line ~ To existing or abandoned system on lot Cutbank fJ//g-- Water main/service line Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effecj,~i~date of this inspection. Engineer's Name H~ Fee $ ~OO, Waiver Fee $ Date of Payment (0 ¢~[ - ~ Date of Payment Receipt Number 00~% (7~¢) Receipt Number HEFTY DRILLING 3540 AKULA Di{IVE I EI,EPHO~E: ....... ..... ~ ..... 3], 345,0593 3540 ^KULA Di~VE (gO?) $45~0595 RECEIVED .,JUL 2 0 1994 Municipa{ity ol Anchorage Dept, Hea th & Human Services 10x18/94 09:3? CT&E ENVIRONMENTAL LAB SERVICES ~ 907~941811 N0.951 ~08 Commercial Testing & Engineeri.[ Environmental L~boratory Services c?~; R,=.# ~,~=~-3 LABORATORY ANALYSIS REPORT Cllen~ s~m~le ID ~2 ROWEL $/D Matrix WATER Client Name S & 8 ENGINEERING WORK Order Ordered By R,J.S. Prim:ed Date Project Name Collected Date project# Received Date PW$ID UA 10024 ~0/12/94 Sample Remarke: ROUTIN~ SAMPLE COLlECTeD BY: J,W. Par&meter Re~ult~ Qual Units ~ethod Limits Date Date Inl= ~ltrate-N 0J!~0 U m~/L ~PA 353.2/300.0 l0 ~0,/14/9% MCE ** See Sat~ple RemarR~ Above NA . Not Analy~ed U - Un4eteo~ed, Reporte~ val~e is the p~actical ~an~lfio~t~on llmi~. LT ~ Lee~ Than 5633 B Street, Ancho~age, AK 99518.1500 -- Teh (907) S62-2345 Fax: {907) 561-5301 ENVIRONMENTAL FACILITIES iN ALASKA. COEORADO. FLOR}DA. ILLINOIS, MARYLAND, N~W JERSEY, OHIO, UTAH, ~VEST VIRGINIA