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Home My WebLink AboutKENO HILLS #6 BLK 2 LT 9 '- Municipality of Anchorage Page 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: ~Y'~," ~'~0~0-0 PIDNumber: o~o-/~'/-'~(~ Name: r ~ ~ ~~C~ ~ Wastewater System: ~New ~ Upgrade Address: ~/O '~O~ C(~CZ~ ABSORPTIONFIELD Phone: No. of ~rooms: ~'~O .( ~ DeepTrench ~ShallowTrench D Bed D Mound D Other Total Depth from original grade: LEGAL DESCRIPTION so, Rating:/. O GPD/Sq. Ft. Subdiv~ion: ~ Depth to pipe bosom from odginal grade: Gravel depth beneath p~pe Lot: ? Block: ~ ~ ~,U~ ~a Ft. 0.~ Ft. Township: ~ Range: Section: Fill added above original grade: Gravel length: Number of lines: Distance be~een lines: WELL: ~ New ~ Upgrade Gravel width: ~ Ft. / ~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Tota~ absorption area: Pipe materi~l: Driller: Date ~rillcd: Static Water Level: In,taller: Date installed: Yield: ~ eP..IPu~p set at: ~0¢ / ' I Ca'i"g HeiCt A"°ve Gr°u"d:Ft./ ~ Ft. TANK SEPARATION DISTANCES ~Septic D Holding U S.T.E.P. To S~ptic Absorption Lift Holding Public/Private Manufaqturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines j~O~ C %~ We'~ /00~ /O0~ -- -- ~5~ Material: S~CCL Number °' C°mpa"ments: Sudace W.te, /O¢'~ /O0'~ ~ -- ~ LIFT STATION Lot ~ Line //0/ ~0/ Size in gallons: M ou a,,on ~0~ ~e~ ~ Pump M~ke & Model ~ Ele~rical Inspections pedormed by: Cu~ain Drain Remarks: BENCH MARK Location and Description: ~ I Assumed Elevation: Depadment of Health and Human Se~iceS approvm ~'~'""" " · ..~....:~..: ;..~ Reviewed and approved by: ~. ~ Date: ~-/~' ~ ~ '*:' ~' ' ' .... 72-01 $ {Rev. 9/9'1 ) MOA 25 PERIiI? NO, SW970350 PAGE 2 OF ~ 3 Municip. o, Li-t oF Anchor'o, ae DEPARTMENT OF HEA~THAND HUM'AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. ]~ox 196650 e Anchor~ge, At~sk~ 99519-6650 · Telephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 9, BLOCK 2, KENO HILLS S/D #6 P.LD. NO. 020--171--,39 NEW 1250 GAL. SEPTIC TANK C02 DEL I OBL CO1 MT1 NEW TRENCH WELL P~.R~? No. SW970550 PA~E ~ 0F ~ Mun[cip~[i~c oF Ancho~c~e DEP~RTMENT OF HE~_TH~ND HUNT~N SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. ]]ox 1966~0 ~Anchor~oe, A~sk~ 99~19'66~0 · Te~e~hone~ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOT 9, BLOCK 2, KENO HILLS S/D P.I.D. NO. 020-171-59 ST1 ST2 6.7'~ NEW ~96.~ 9 1250 GAL ~, GRADE A B FCO 6.5' 40.5' ST1 15.5' 45.5' ST2 26.0' 48.0' DBL1 28.5' 49.0' DBL2 $0.0' 49.5' C01 70.5' 84.0' MT1 69.0' 82.0' C02 155.5' 128.5' MT2 154.0' 127.5' FD1 65.5' 59.5' FD2 76.5' 71.0' FD5 125.0' 99.5' COl MT2 ,CnO2r, MT1 IC01 = 85.6' /H II/qc°2 = 65.~,' ~/-FINAL I '"-+p,._lCOl: 83.i' IC02 = 83.1' MT2 = 82.6' MT1 = 82,6' A~'7.6' WATER FOUND "~]. 6' B.0.H. M-W DRILLING: Inc. I P.O, Box 110378 · 10330 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 TIME : 07/[3/1998 10:54 NAME : S AND S ENGINEERING FAX : 9076941211 TEL : 9876942979 DATE,TIME FAX NO./NAME DRILLING LOG 07/13 18:54 80:00:88 ell Owner t~,~N, TV~ c,n~c.q.'P~rW'mTnN PAGE(S) oo RESULT BUSY Location M(ill[iiress of: Township, Range, S~ction, if ~own~ce main road Use of Well DOMESTIC Size of casing 6" Depth of Hole 200 feet Casedto 25.90 feet ft. ~)~1~,~. ibelow) land surface. Finish of well (check one) open end ( Static water level Screen ( ); Perforated ( . ,. ),.. Describe screen or perforation . [~/A Well pumping test at 5 gall~a pel~ (~[~)X (minute) for_ I hours with 100% of drawdown from static level. Date of completio~ 08 OCTOBER, t:'~'9,7 . . ".~ , WELL LOG GiVe ~ails of formations penetrated, size of material, color and hardness NOTES: WELL DRY GROUTED WITH 2 SACKS OF BENTONITE GRAN~DES x ); Depth in feet from ground surface ~.__TO__ 2 ., 2 TO. 6 · 6 TO 8 ~ .TO 1 9 - ~_TO 9 4 9 4__TO 9 '~ 9 '/--TO 1 7 ~% 178 TO 121 DAR}{ G E¥ W.~TH WMI?E LENSES 151 TO__ 2O0 TO ~RDROCK: __ BEDROCK ~ 'FRACTUJt~ID BEDROCK: GREY W/ITIt WHITE LENSES ft. TO. .TO, ..... TO~., _TO. ELi JUL 1 6 1998 Municipality of Ancr~orage Dept. Health & Human Services CONTRACTOR ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WA?ER INSPECTION ENGINEERING SIUDIES AND REPORTS WELL INSPECTION & FLOW TEST SfTE pLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER OiSPOSALS~TEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 4 RECEIVED NOV 1 8 1997 Municipality ot Anchorage Dept. Health & Human Services REFERENCE: The septic in§pec~ions for~he. referenced property were performed on {1/,~;97 and ~ f~?~7 . Prior to submitting the On-site Wastewater Disposal System and/or~ell In~,pection Report we are waiting for the~,~~ c~¢/~8~0~r to be completed. If we may be of further service please contact us. Sincerely, Robert C. E. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 PAGE 1 OF 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:SW970350 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MOEN JANE MAUREEN OWNER ADDRESS:17800 SPAIN DR ANCHORAGE, AK 99502 PARCEL ID:02017139 DATE ISSUED:10/03/97 EXPIRATION DATE:10/03/98 LEGAL DESCRIPTION: KENO HILLS #6 BLK 2 LT 9 LOT SIZE: 114955 (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 (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 U. NDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED i~ND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~~ ~--~ DATE: ROBERT C. COWAN, P.E. September 24, 1997 CIVIL ENGINEERS (907) 694,2979 FAX (907) 694-1211 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 ONSITE WASTEWATER DISPOSALSYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 9, Block 2, Keno Hills Subdivision No. 6 Request you issue a permit to drill a well and install a septic sYstem to serve the proposed four bedroom house on the referenced property. Test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation no water was encOuntered in test hole #1, and was found at 9.5 feet in test hole #2, and after seven day ground water monitoring water was found at 5 fect in both test holes. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, Please contact us. Sincerely, Robert C. Cowan, P.E. RCC/mg Enclosure 17034 NORTH EAGLE RIVER LOOP ° SUITE 204 o EAGLE RIVER, ALASKA99577 · 1" ,-- 60' SITE-PLAN DESIGN 10' UTILITY EASEMENT ~°~z ~mzm ~-m --q Z"o ~ ~) II z' WITHIN 150'+ OF PROPOSED WELL/SEPTIC~ ~ ~m.~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: I 2 5 6 7 8 9 10- 11 12 13- 14~ 15- 16- 17 18 19- 20- DATE PERFORMED: Township, Range, Section: SLOPE ~°3 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ ~) DEPTH7 p Oepth to Water Alter ~ ~ W[._i~-I~1/ Monitoring? Date: SITE PLAN Gross Net Depth to Net Reading Date ' Time Time Water Drop ~ '. ~3 I ~'~ ~ ~'~ '1~" PERCOLATION RATE ~ I m~nutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '~ '/~ FT AND ~J_ ~/~'' F'~ COMMENTS PERFORMED BY: iZ~34 i.~i. Aiver Loop .*-d No. '/~ .... ~J/~' Y/~/7 ACCORDANCE WITH ~a~'I~I~I~II~!.~i~I~[I~FGUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE SITE PLAN 10 11 12 13~ 14- 15- 16- 17- 18- 19- 20- G .0,#. WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Oepth to Water Alter Monitoring? S /, ! L Dote: Gross Net Depth to Net Reading Date Time Time Water Drop ~/'~/~7 a,. ~ ~ - ¢" - ~', .~ / ~'~ 6 '/~" ,/~ ~'.~ ~ %" PERCOLATION RATE TEST RUN BETWEEN [m~nuteshnct~l PERC HOLE DIAMETER __ FTAND U '/'~- FT COMMENTS PERFORMED BY' -- CERTIFY THAT THIS TEST WAS PERFORMED IN ' ACCORDANCE WITI-~ANi~M' INl~k[~ GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) SEWER&WATER MAIN EXTENSIONS SEWER& WATER INSPECTION ENGINEERING STUDIES AN D REPORTS WELL INSPECTION & FLOW T EST SiTE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECH~ICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 9, Block 2, Keno Hills Subdivision No. 6 September 24, 1997 GENERAL: The scope of this project includes the installation of a 1250 gallon septic tank and two drainfield trenches to serve the proposed four bedroom residence located on 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 responsibl~ for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater dispoSal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. ConstructiOn shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes On the septic tank shall extend a minimum of 12 inches above fmal grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. 17034 NORTH EAGLE RIVER LOOP ° SUITE 204 o EAGLE RIVER, ALASKA 99577 Page Two Lot 9, Block 2, Keno Hills Subdivision No. 6 September 24, 1997 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 holes faced downward. The distribution piping is to be OfPVC (ASTM D3034 or equal). AIl joints are to be solvent cemented. 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, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated fi.om the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the bacldill 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. MOUND SYSTEM INSTALLATION: 1. Any peat or organic matter must be removed from the elevated mound site. The bottom of the basal bed area as well as the top of the sand falter is to be within two inches of level. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. Page Three Lot 9, Block 2, Keno Hills Subdivision No. 6 September 24, 1997 4. The side slopes of the top layer of the mound system must not be Steeper than 33% (3:1). The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion. The distribution pipes are to be embedded in sewer rock. Care should be taken to backfill in such a way as to prevent damage to the piping system. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entke gravel surface before placing backfill. 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. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constrUcted by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, 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. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. Page Four Lot 9, Block 2, Keno Hills Subdivision No. 6 September 24, 1997 When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, deanouts, and insulation, but before the placement of any other backfill 3. The final inspection is to occur upon final grading of the property. Ot~en there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached MOA. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER unicipm .7 y ANCHORAGE, ALASKA 99502-0650 O~ (907) 264-4111 A chora e MA Y OR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit 9: 840324 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 9 Block 2 Keno Hills Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely t Keith E o Bandt, SupeYvisor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 M'UN'I [:.I FT, :L I T"r' OF RNCHOERGE DEPRRTMENT'OF HERLTH RND ENVIRONMENTRL PROTECTION B25 L STREET, RNCHORRGE, RK 9950i 264-4720 Oi~.i--S I TE SEI~.IER & I-~IELL PER. I'll I T PERMIT NO: DRTE ISSUED: RPPLICRNT: RDDRESS: CONTRCT PHONE: LEGRL DESCRIP: LOT SIZE: MRX BEDROOMS: R.M.C.. INC. P.O. BOX 4-2882 RNCHORRGE~ RK 9~509 ~45-581~ SUBDIVISION: KENO HILLS SECTION: ii TOWNSHIP: 2. 58 ($Q. FT. OR 8CRES) 5 LOT: RRNGE: BLOCK: LISTED BELOW ARE THE OPTIONS RVAILRBLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THRT BEST FITS YOUR SITE. TRE~ICH BEE, DEPTH TO PIPE BOTTOM (FT. > 4.0 4.0 GRRVEL DEPTH (FT. > 5.0 0. 5 TOTRL DEPTH (FT. > 9.0 4.5 GRRVEL WIDTH (FT. > 2.5 24.0 GRRVEL LENGTH (FT. > 75.0 47.0 GRRVEL VOLUME (CU. YDS. ) ~8. i 41.7 TRNK SIZE (GRLS> t, 500.0 ~ i, 500.0 SOIL RBTING (SQ. FT.?BR) i50 150 . ~: GRRVEL LENGTH > 75 FT. 4.0 ~.5 7.5 5.0 60. 0 i., 500, 0 ~ REQUIRES MULTIPEE RUNS <NOT E~EEDINU'~ ~ 75 FT. ERCH> · ~ TRNK MUST HRVE RT LERST TWO COMPRRTMENTS I CERTIFY THRT: i. I RM FBMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE <MOR> 8ND THE STRTE OF RLRSKR. 2. I WILL INSTRLL THE SYSTEM IN 8CCORDRNCE WITH RLL MOR CODES RND REGULRTIONS~ RND IN COMPLIRNCE WITH THE DESIGN CRITERIR OF THIS PERMIT. 2. I WILL RDHERE TO RLL MOR RND STRTE OF RLRSKR REQUIREMENTS FOR THE SET BRCK DISTRNCES FROM RNY EXISTING WELL~ WRSTEWBTER D!SPOSRL SYSTEM OR PUBLIC SEWERRGE SYSTEM ON THIS OR RNY 8DJRCENT OR NERRBV LOT. 4. I UNDERSTRND THRT THIS'PERMIT IS VBLID FOR 8 MRXIMUM OF 5 BEDROOMS RND 8N¥ ENLRRGEMENT WILL REQUIRE RN RDDITIONRL PERMIT. IF ~ LIFT STRTION IS INSTRLLED IN RN 8RE8 COVERED BY MO8 BUILDING CODES, THEN <i) RN ELECTRICRL PERMIT RND INSPECTION MUST BE OBTRINED~ (2> 8$-BUILTS WILL NOT BE RPPROVED WITHOUT RN ELECTRICRL INSPECTION REPORT~ .8ND ~) THE ELECTRICRL WORK HUSTLE DONE BY 8 LICENSED ELECTRICIRN. // SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST [] PERCOLATION TEST PE.FORMEO EOR: t~ro~J bn~n, c~-' 1 3 4 8 SLOPE 10 WAS GROUND WATER ~l~&l~'~ S 11 ENCOUNTERED? ~ P 12 IF YES, AT WHAT E DEPTH? 13 14 15 16 17 18 19¸ 20- DATE PERFO.,ED: ~/ --/0--~V SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE COMMENTS UJSU~ I!~ n~+~_~_ ~{ PERFORMED BY: 72-008 (6/79) {minutes/inch) TEST RUN BETWEEN . FT AND CERTIFIED BY: '.~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAL;FH & HUMAN SERVICES Divisionofl:nvironmental s~rvices ' , 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. # 020-171-39 1. GENERAL INFORMATION Complete legal description Lot 9t Block 2, Keno Hills S/D #6 ~ Location (site address or directions) 17800.~_pain.,Dr~ve , Anchorage 995/~ Prop(~rty owner .... Mailing address, r., RnnR]~ V~cera Day phone 7710 McHenrv Circle, Anchorage, AK 99502 248-4560 Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE'OF WATER SUPPLY: Individual well xx× 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 WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX 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 o 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 Address Engineer's signature S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River~ Alaska 99577 Phone Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. 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 purchasem 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 ) ~ack MOA ~'21 RECEIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVI~II~JB 1 6 1998 ~ Environmental Services Division MUINIr. jIp^LITy O1: ANCHORAGE 825 L Street, Room 502 · Anchorage, Alaska Legal Description: LoT ~J A. WELL DATA Well type 13 R ~ ~/ 4 7 ~' Log present (~/N) ~ ~--~ Total depth ;;). o (.3 Sanitary seal (.~/N) k//Z-j Date of test Static water level Well production Health Authority Approval Checklist If A, B, or C, attach ADEC letter. ADEC water system number Casing 'height (above ground) Wires properly protected Date completed Cased to ~ ~'' '~ FROM WELL LOG WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: '7 / '~ /~1 ~ B. SEPTIC/HOLDING TANK DATA Date installed tj/~ 7/~t-/ Tanksize g.p.m. AT INSPECTION Foundation cleano.u.~ ~1) ')' ~ ~_ Depression (Y/f~ Date o.f~Purflpmg ~{~,,.:~ ;: ,~.~ Pumper C. ABJ~,O. hPTION FIELD DATA:~, ~ D~l{).irist~iled i,~'"/~ '7 / q Lequ th~ ':/3.0 WjcJth ,; g.p.m. Collected by: Other bacteria $ & S ENGINEERINO Eagle River, Alaska 99577 Number of Compartments ~ Cleanouts ~N]. /v O High water alarm (Y/~ Soil rating ~r fF/bdrm) ). 0 System type Gravel thickness below pipe (~ ' $~ Total depth ,,3 '/~. Effectve'absorption area .~ ~'o o ~ Monitoring Tube present~/N) ¥~J' Depression over field (Y(~ Date of adequacy test /v/,4- - ~' i~,,x Results (Pass/Fail) For Fluid depth in absorption field before test (in.); ~): Fluid depth ~~ Absorption iate.~- .g.p.d. Peroxide trea st 12 months) (Y/N) If yes, give date bedrooms 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) Size in gallons-------'"'~ "Pump off" level at* High water alarm level at* ....- *Datum E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation / o Water main/service line Property line !O ~ '~- Surface water/drainage /00 ~L SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ; O ~- Building foundation ,~, ~'o / Absorption field. Wells on adjacent lots Water main/service line Surface water ]. o d + . Driveway, parking/vehicle storage area (0 0 .,z Curtain drain r,, o ~ ~. ~ ,~ o ~ ~ Wells on adjacent lots. / o o F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records in conformance with J~fO~A HAA guidelij3es in effect on this date. Signature ~Z ' ~'~ Engineer's Name Date HAA Fee $ ~0~, Date o, Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ~1~ nment8l 9~rvlces Ino. &E Envlfo __ CT _ .__ Client pot/ CT&E Bef.# 983388001 Printed Date/Time 07109/95 09:25 Client Name S & S l~ngiaeering CoBeeted Date/Time 07/07/98 13:30 ~oj~ N~e/g L 9 B 2 K~no Hills ~o, 6 S/D R~dv~ Date/Time 07/07/98 14:00 Client S~ple ~ L 9 B 2 Keno Hills No. 6 S/D T~ical Dlr~or: ~eph~ C. gde Matr~ Drinkin~ Wa~er B~ O~e~ed By 0 Rel~ed PWS~. _ - ' ResUlts PGL __ uni~ Nethod_. Perameter 0 coL/1OOmL $M18 922~B CoLiform 0.100 U 0.100 m$/L EPA ~00.0 Nitrate-N ALLo~ab:e Prep Anotys~s Limits oate Oete lnlt 07/07/98 TMU 07/07/98 07/07/98 RMV