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HomeMy WebLinkAboutKASILOF HILLS BLK 6 LT 5 Municipality of AnchoragePage 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: ,~'/'¢/ ~d'O,2,,,'). ~ PID Number: O/.5~- /3.2.--:~ "~ _ Name: /,~,,~. F'~'¢¢~--'< WastewaterSystem: ~;¢'New [] Upgrade Address:~'~'/~:~.r~(:~f'/~,,4?/¢,.,,_>,,~...~,~,~ .4/< ¢.%'~ ABSORPTION FIELD Phone: t,~/,,~ -- ~ I¢,/~ ~// [~ Deep Trench ~"Shallow Trench [] Bed [] Mound E] Other LEGAL DESCRIPTION so, Rating: Total Depth from original grade: ~::" ~ GPDtSq. Ft. I_,)1: Block: Subdivision: Deplh to pipe bollom horn original grade: Gravel depth beneath pipe township: Range: Seclion: Fill added above original grade: Gravel length: .3-5-" Ft. WELL: [] New [] Upgrade Graveld~,~ ~4'~ ~:¢~/' Ft. _~ /dP FL Classification (Private, A,B,C): Total Deplh: Cased To: Total absor,~tion area: Pipe material: .~,'/~,~-< ~ ~ ,¢ .t. ~ o pt. %F',p SQ. Ft. Yield: -- Pump Set at: Casing Heighl Above Ground: SEPARATION DISTANCES m septic ~ Holding O S.T E.P. Well ]~S' ]¢% /~, /J~ lf/%/ Material:~ / Number of Compartments: ~ Surface Water ~t¢¢ ...... > LIFT STATION Line ~ ~rD ~ ~ ~' /~O/2 ~c~ ~,~,~ ~.~ Foundation ~--~ /~ ~ /J/ /~ ~ ~ q ~ ~, Curtain Pump Make & Model ~ Electrical Inspections performed by~ Drain ~/~ ............... ~ ~ 2¢NPF Remarks: ¢~,'¢];/~</¢ /',~¢%* :~ Z ¢~.....? BENCH MARK / ' ENGINEER'S SEAL Inspections performed by: ~ Dates: 1st ~-/%-~ ¢~ 2nd. ~-/¢- ¢ 4 ~._~~.~ ...... Department of Hea~and Hyman Services approval '&~ Reviewed and approved by: Date: 4- 27-¢~ Permit No. SW96-220 Page 2 of 3 ...'V, unicipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 34-3-47¢4 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Descriation: KASILOF HILLS LOT 5, BLK 6 PID No.: 01§-132-37 O0'OFi5" E 8.63' c ,.~ THREE 5X50' ~ TRENCHES PROP HOUSE / / / / / / / / / / / / / / / / / o / o / / / / / / 49.o' / / / / / / / / / / / - TEST HOLE - MONITOR TUBE - SEWER CLEANOUT WELL EASEMENT LEACHFIELD SWING TIES: A-C = 127,1 B-C : 162 I A-D : 1,44.4 B-D : 154.5 A-E = 1618 B-E = 148,9 A-F = 171.3 B-F = 219.4 SCALE 1":60' 4/16/98 ENGINEER'S SEAL Oh ~.' 49m~ '.~ 20~". LOUIS A. BUTERA ."~ ............. Permit No. swgt3-220 Page 3 of Municipolif. y of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: .543-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal DescripUon: KASILOF HILLS LOT 5, BLK 6 PID No.: 015-132-37 ELEVATIONS (NOT TO SCALE) NE LOT COR ASSUMED ELEV = 119,46 89.4 TANK W/LIFT ORIGINAL OROUND LEVEL AT: / TR1 96.0 ADDED FILL /~ TR2 91.7 TR2 91:2 II TR2 91:2 TR3 88.0 ~. 'FR3 88.0 TR1 95.0 TR2 90.7 TR3 87.4 FrI NO GWT TR3 81.4 4/16/98 I~g~NI~IP~I~TY OF Ai,~CHDRAG~;. i~UIL[.)INL~ SAF-E-,''y DIVI~I~ STATE OF ALASKA DEPARTMENT OF NATURAL RESGURCES DIVISION OF MINING & WATER MGMT ', LOCATION OF WELL WATER WELL RECORD ~s ~w LOCATION/SK~CH: , "" DEPTHS M~SURED FROM:~casing top ~ground surface WELL D~H/ DATE OF Depth of hoIe:~ft BOREHOLE DATA: Depth Depth of casing:~ ft ~/ Material Type a~ Color From To  M~HOD OF DRILLING: ~sir rotary ~ cable tool USE OF WEL~: ~domestic [~ irrigation ~ monitor ~ public supply ~ other, CASING STICK.UP: ~ ft. Diam:~ in, Casing type~ ~" in, to~ ft WELL INTAKE OPENING TYPE: ~ open end ~ screened ~ ~ pedorated ~open hole Dept~ of openings: _ to. ft SCREEN TYPE: Diem: in. Slot/Mesh Size: Length: ft GRAVEL PACK TYPE: Volume used: Depth to top: Depth: fram f~ to ft APR 2 0 D~ELOPMENT ~HO~= Duration: ,~ ~' Municipality of An~ ~orage PU~PING L~EL AND YIELD; _ Dept. Health & Hume Service: ~ ~ ft after ~ hrs pumpJng~gpm PUMP INTAKE DEPTH: ~ - ft Horsepower: ,,, WELL DISINFECTED UPON COMPL~I~YES ~] NO CONTRACTOR [NFORMATIpN: REMARKS: ~ , ame ,/ .~- ~ ~.~'t./'.~'~ ~'--/~'--/~ PLEASE MAIL WHITE COPY OF LOG TO' Sighature of Authorized Respre~,i~.tt'a~?'er-- ~ DNR/DlVlSIO31~oOlr'~M~tN, I~u~t~ ~O~TER MGMT ' ANCHORAGE AK 99503-5935 Phone (907)269-8639, Fax (907)5624384 MLrNICIPALITY 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:SW960220 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:FOUTS MARK & MELISSA OWNER ADDRESS:3422 ORION CIR. ANCHOI~AGE, AK. 99517 PARCEL ID:01513237 PAGE 1 OF DATE ISSUED: 7/30/96 EXPIRATION DATE: 7/30/97 ]LEGAL DESCRIPTION: KASILOF HILLS BLK 6 LT 5 ]LOT SIZE: 60202 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 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 343-4744 ( 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 AI~D CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1.)ENSURE A 6 FT. VERTICAL SEPARATION BETWEEN BOTTOM OF SEWER ROCK AND BEDROCK. 2.) INSTALL IMPERMEABLE MEMBRANE AROUND PERIMETER OF EACH TRENCH TO ENSURE T~{E DOWNWARD MOVEMENT DATE: DATE: Eagle River Engineering Louis Butera, P.E. P.O. Bo× 773294 Ea~le River, AK 99577-3294 ervices (907) 694-5195 tel (907) 69,~-3297 fax July 16, 1996 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Kasiloff Hills Lot 5, Block 6 Narrative & Permit Application Dear Mr. Cross: The proposed well and septic system will have very limited impact on adjacent properties for the following reasons: The surrounding lots are large, allowing sufficient room for septic sites despite the presence of bedrock. Immediate neighboring septic systems are all +30' distance. Our well protective radius lies almost entirely on our lot and in the right-of-way. 3. Reserve space is adequate, due to absorption capacity and lot size. 4. Drainage will not be affected and is not a major consideration in our design. Construction of this leachfield requires installation of the leachfield on a slope of approximately 30%, slightly exceeding the 25 % maximum. After excavating nine test holes to bedrock level, we have selected the most favorable area, and located the leachfield appropriately. We do not believe the slope aspect will be detrimental to the leachfield performance. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \1996\96-044^-N^R.DOC SPECIFICATIONS FOR ON-SITE SYSTEM LEGAL: KasiloffHills Lot 5, Block 6 07/16/96 A. GENERAL 1. The septic and well plan is for a single family residence only. 2. The drawing and/or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health (MOA- DHHS requirements. 4. All soil tests are advisory to the design and are to verified or modified in the field by the Engineer. 5. All excavations and depths are advisory and are to be verified in the :field by the Contractor to meet MOA-DHHS requirements. 6. It is the responsibility of the Owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. It is the responsibility of the Contractor to secure all utility locates prior to construction. 8. The excavation is to be exactly in the area shown on the site plan, any deviation requires Engineer approval. 9. Any remaining open test hole excavations shall be filled. B. SEPTIC TANK/LIFT STATION 1. Septic tank and lift station shall be 1,500 gallon Orenco/Anchorage Tank model OSI 05- 20-HHF. 2. Receipt from Building Code inspection stating the lift station was wired to applicable codes to be supplied to Engineer. C. LEACHFIELD 1. The leachfields are to follow the natural contour to maintain uniform total depth of the drainfield bottom. 2. The bottom of the 5' wide field excavation shall be into the native sandy gravel material beneath the topsoil 3. Lake Otis Gravel fill material shall be placed to an elevation of 1' below ground surface at deepest point, and leveled to within 1.5". 4. A 1' gravel bed is to be placed over the sand with the effluent line placed within the top 5" of the gravel. 5. Effluent line is to be 1-1/4" PVC with 1/8" holes drilled 2.5' OC, oriented face up with orifice shields in place. Holes are to be drilled at the ends and middle of the pipe on bottom of effluent pipe for freeze drainage. 6. The leach gravel is to be covered with typar fabric material. 7. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield and all sewer lines 8. The area over the trench is to be finish graded to prevent ponding of surface water runoff between trenches 9. The septic tank and leachfield must not be closer than 100' to any existing private well, 150~ to any Class "C" well, or 200' to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH: 1' GRAVEL DEPTH = 6" under pipe, 2" over pipe GRAVEL LENGTH = 150~ GRAVEL WIDTH = 5' SOIL RATING = 0.8 gpd/ft2 BEDROOM CAPACITY = 4 SEPTIC TANK SIZE = 1,500 gallons with lift station. Twenty-four (24) hours notice required for all inspections \1996\96-044a-spc.doc 07/16/96 Page 1 of 1 LOT 8 m[] NOT DEVELOPED TEST HOLE iN PLACE , ~ASIS oF BF_,ARI~G f S 89' 59'00" ~' 238.96 ~ ~. ~/ /~ - M?~o~ Eu~ _ ~ / o - SEWE~L~NOUT NO SURFACE WATER < ~% ~" ~~ ~%L~MENT NO KNOWN CURTAIN DRAINS 28.?~ PROPOSED L~CHFIEL0 ~- EXlSTINO L~CHFIELD W E L L / S E P T I C S ~ T E P LA N _ LEO*L: KASILOFF HILLS LOT ~ BLK 6 - CONTRACTOR: N~A, ~;.LOUIS A, BUTERA."~ ~ EAGLE RIVER ENGINEERING SERVICES ~'... CE-6756 ...'~ ~ EAGLE RIVER, AN. 99577 (907) 694-5195 FAX: (907) 694-3297 'MUNICII~AI,.ITY ©1~ ANCHORAGE EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 96-044 Calculated By: I_B Date: 7/16/96 Legal: KASILOFF HILLS Single Family 4 Bedroom Dwelling Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 600 gallons Percolation rate = 2.3 minutes per inch Wastewater application rate = 0.8 gallons per day per square foot Required absorption area = 750 square feet Trench width (W) = 5 feet Gravel depth (D) = 1 foot (6" Below pipe) Total Depth of Field = 1.0 feet Required length = 150 feet Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~7' 5' LEGAL OE$CRIPTION:__ OATE PERFORMED: Township, Range, Section: I 3 4 5 7 ~3 ~6- ]7 COMMENTS OH SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED;' IF YES, ATWHAT DEPTH? Oeplll lo Wata' Alter, Mortising? ~ Reading Date Gross Net De,th to Net ._.~),~ ~_. T~me Time Water Drop ~ ' 7;~u .~ "//~" ~ ~ ?: ~ ~ ~5 ~1/~' ~ ~//~" PERCOLATION RATE TEST RUN BETWEEN ~" ~ (mmutesnnci~} PERC HOLE DIAMETER ~,~ ** ~"' CERTIFY THAT THiS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 '1." Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL D ESCR I PTIO N: ~ ~t,.~ ~.-~'~',~ 2-- 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S I_ IF YES, ATWHAT O DEPTH? p E Gross Net Oeoth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~'/¢,'~ (mmutes,',nch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT 7% ,'¢ Z2e~-,~,.~/ ,~¢r .~'¢cF42 PERFORMED BY: I ~ /~' ~ ~ ~)¢~ERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, Murttcipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "!_' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMEO FOR: LEGAl.. [:~ATE PERFORMED: Township, Range. Section: 0/-/ SLOPE SITE PLAN 10 11 12 13- 14- 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E ~7 OaLe: Reading Data Time T~me Water Drop PERCOLATION RATE z~"/'~;t (mmutes~LnCh) PERC HOLE DIAMETER ~ TEST RUN BETWEEN __ FT AND COMMENTS ~__FT ~:' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOROANCEWtTHALLSTATEANO MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. DATE: PERFORMED FOR: LEGAL DESCRIPTION: 1 3 4 5 6 7 8 10 11 12 13 14 15 16 17 18 19 20 COMMENTS Municipallly el Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L YES, AT WHAT O DEPTH? p E After Gross Net Depth to Net --Reeding Data Time Time Water Drop PERCOLATION RATE __ (mmutes~,ncn) PERCHOLEOIAMETER TEST RUN BETWEEN _ FT AND FT PE.FORMED..: ?~I , E /~-- ~'~¢';~-ERT,.. T.A. TH,S TEST WAS.ERFORMEO 'N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13- 14- 15- 16- 17 18 19- 20 DATE PERFORMED: Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT'WHAT DEPTH;' Oeplll LO Water Alter..,~_t,~ Gross Net Oel~t h to Net Reading Date 3qme 'lime Water OrOD ~- ~,,~/~ ~? '~" PERCOLATION RATE TEST RUN BETWEEN COMMENTS A,/~' ,~.'Tf ..,',~,cr.~./,4~-.( ,..[~E. ~-/'t' ~ ,.~ t __ (m,nutes,,,nch) PERC HOLE DIAMETER __ FTAND ACCOROANC/WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE. ~'~'-,/"'~ '-- ~'- ¢ Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: Township, Range, Section: 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS SLOPE WAS GROUNO WATER ENCOUNTERED? /~,,/O SITE PLAN Gro$s Net O~th to Net ,.~eading Date ~/~. Time ~me Water Orop / ~/~7~ /;// ~ ?//~" PERCOLATION RATE // (m.nules/incn) PERC HOLE DIAMETER TEST RUN EETWEEN ~ FTANO .3 __FT PERFORMED .~: /y/Vi , '5 '~- E Z ~ ' ,.~;RT]FY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AN[3 MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. OAT~ ~" ~,//z¢"- '¢ ,~'4;" Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PER.ORMED FOR: ~'O~7 TS LEGAL DESCRIPTION:__ 2 3 7 8 10 12 13 14 15 17 19 20 COMMENTS DATE PERFORMED: Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT 0 DEPTH? F E Oepll~ Io Walet A~r ~ Mondm'ing? d:t,-~ (]aim SITE PLAN .~..~ Oate Gross Not O~l~th to Ne, Time Time Water Orop ~ ~/~7~ ,,~ ~ /~ ~,~ ~ ~'~" " ~ ~ ~',o~ IQ .~ /~//~,, ~ Io///~" ~[~ ~ /~ ~ ~,'/IPJ, n ~//~ .I ~ I~ I ~ ~ ~ I~',~ z~ ~/1~" /~ ~ /~;~7 ,~ ~//~ " ,-- I~ ~7 /a 3~ (//IL," 3 '//~" PERCOLATION RATE ~. ~L. (minutes/tacit) PERC HOLE DIAMETER TEST RUN BETWEEN ..~'/~ FTANO _~__FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GL)IOELINES IN EFFECT ON THIS DATE. DATE. Municipality el Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 625 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: Township. Range, Section: l 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS OH SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, ATWHAT 0 DEPTH? p E Oe~ Lo WaIer Alter Monitm'ing? / / / Reading Data .~,.~ .~ j/_.... Time Time Water Drop /. ~,?.'7/~(~ I~; 7-q ~/ /,~flu" Z ~ //:IS 1~ I~ /~h~~' ~ /~ll~ I0 ~ // ; ~ I0 ~7 ~)1o" d /~//u PERCOLATION RATE /. '7 (mlnuLesy,ncn) PERC HOLE DIAMETER ~-~/I ~'~'.~ERTIFY THAT THIS TEST WAS PERFORMED IN ACCOROANCE WITH ALL STATE ANO MUNICIPAL GUiDELINES IN EFFECTON THISDATE. DATE; ' ~"-'//~ ~ ~'J'~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCR P.r ON=_ 2 7 ~2 14 17 2O DATE PERFORMED: Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUN.rER ED? S L IF YES, AT WHAT O DEPTH? p Bel~tl~ t(~ Wala' A~r '"'"~ /~' Gross Net Oef~th to Nee Reading Date Time T~me Water Orol~ PERCOLATION RATE __ (mmutes,qncn) PERC HOLE DIAMETER TEST RUN BETWEEN __ FT ANO FT COMMENTS PERFORMED BY: I ~ //~ Z~ ..~ ~ IFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE ANO MUNICIPAL GUIDELINES IN EFFECT ON TI-IlS DATE. OATE; ,,~ ~-~ f"~'.~ ,5~',¢' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAt.TH & 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 d')J.J~ ~/.~ -~? HAA # ~'~:~ ('~ ~r-,~ 1. GENERAL INFORMATION Complete legaldescription k.¢;"'//¢T'/4 / //lls L.,:r Location (site address or directions) Proper[y owner /."/;i~/~ ' ,v, ,,, ~'*a'"n- a'~"2ess'uu, ' Lending agency Mailing address - Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WAS.TEWATER DISPOSAL: In,dividual on-site Holding tank Community on-site Public sewer 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 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. Name of Firm Phone Eagle River Engineerin Services Address P.O. ~ox 2~23z,,~, t~agl, e ~ver,.C~K 99577-3294 Engineer's signature DHHS SIGNATURE ' X Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: .... / Date ~f -2 7- ¢~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval CertJfioates 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~)25(Rev. 1/91) Back MOA#21 ECEIVED Municipality of Anchorage 98 ~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 ~ Environmental Services Division '~v/c~ oJvl~l Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Health Authority Approval Checklist /¢/~/~j~ ~__~,5- /¢~,,/¢~ ~ Parcel I.D.: ~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to Casing height (above ground) Wires Properly protected (Y/N) _ FROM WELL LOG ~'--/¢_ Nitrate Date of test Static water level ~ Well production ~- WATER SAMPLE RESULTS: Coliform Date of sample: ~ - 2, B. SEPTIC/HOLDING TANK DATA Date installed '-~ - ?~ Tank size FoundatiOn cleanout (Y/N) _ Date of pumicing /¢/~ ~' C. ABSORPTION FIELD DATA Date installed ~,L./¢, Length 1.~-o ' Width ,~ ' Effective absorption area Date of adequacY test _ /V'~-,-~, Fluid depth in absorption field before test (in.); Fluid depth ///) (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) AT INSPECTION g.p.m. '~ g.p.m. ¢,/, ~4'.~ ~./,/'~. Other bacteria Collected by: ~-~'-~.:~/~ /~/v~r Number of Compartments ~'~ Cleanouts (Y/N). /P High water alarm (Y/N). Depression (Y/N) Pumper /¢?~ ' Soil rating (g.p.d./fF or fF/bdrm) Gravel thickness below pipe Monitoring Tube present (Y/N) Results (Pass/Fail)_ ,I,// ¢' ~ System type ,4'/-¢..~//¢,¢,.- /_.5', ~-- ~ Total depth /,~ · Depression over field (Y/N) For /-/ bedrooms Immediately after ,,¢~ gal. water added (in.): ,///'/ Absorption rate = /¢//'~ g.p.d. If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested Size in gallons "Pump on" level at* *Datum "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot On adjacent lots On adjacent lots Public sewer main -"[,'/~ Public sewer manhole/cleanout Sewer/septic service line //-¢- / Lift station ! ~, ~ SEPARATION DISTANCES FROM SEPT-IC/H~EBINC~T--ANK ON LOTTO: Foundation ~-¢' / Property line J-J- ~ Absorption field Water main/service line + q¢' ' Surface water/drainage */~ / Wells on adjacent lots ~-/'~¢~ ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water ¢-/(~¢ / Curtain drain Building foundation /.F / Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review in conformance with MOA HAA guidelines in effect on this date. Signature ':~--~ ~-~%' ';-~"~"~"~"~"~"~"~ Engineer's Name , "~¢¢¢ "-'; ~" '~';'~'* Date ~ ¢~'//~'/~'"J: of Municipal record~t~at~ ~i~v, stems are .¢;5%." ~a ~ Louis A, Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ~Nm~mlm' CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Saznple Remarks: 981257001 Eagle River Engineering Kasiloff Hills L5 B6 Kasiloff Hills L5 B6 Drinking Water 0 Client PO# Printed Date/Time 03/25/98 08:32 Collected Date/Time 03/20/98 14:25 Received Date/Time 03/20/98 14:30 Technical Director: Stephen C. Ede Released By~/Q~ ~t,/~ ~//t~.~ Parameter Results PQL Units Method Allowable Prep Analysis Limits Date Date Init Nitrate-N 4.68 0.100 mg/L EPA 300.0 10 max 03/20/98 RMV Total Coliform 0 col/lOOmL SM18 9222B 03/20/98 TMW