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Home My WebLink AboutBROADWATER HEIGHTS TR H LT 7 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-47.44 On-Site Was[ewater Disposal System and/or Well Inspection Report Permit Number: ,~ iA/°l q O ,~ t ';)- PID Number: 0 5" O O c~) 5' / U~: Wastewater System: ~ New ~Upgrade Address: ~7oo 5P~~ . ~'~ r ABSORPTION FIELD A~r~o~IN°'°'~°°~: ~ Deep Trench ~ Shallow Trench ~Bed ~'Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION so, Rating: ~- ~ GPD/Sq, Ft. Lot: ~k: ~ ~ Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe 7 ~ ~0~r~4 ~ ~ ~. ~ ~t. o. ~ ~t. Township: .... ~ Range: ~ Section: Fill added above original~,grade:~. Et, Gravel length: ~ O Et, I I Number of lines: lDistance between lines: WELL: D New ~ Upgrade Gravel width: I ~ Ft. ~ ~ ~-~ Et, Classification (Private, A,B,C): [ X'~ ~ ~. Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: GPM IPump Set at: Ft. 1Oasing Height Ab°ye Gr°und:Ft. TANK SEPARATION DISTANCES ~'Septic D Holding D S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank SewerLines ~0~'~ ~ '~ ~, Number of C~pa~ments: Su,ac. ~ '. - - LIFT STATION Water /0 0 J DO LineL°t ~ ~ / J 0 / ~ ~ ~ Size in gallons:I~ Manufacturer: Foundation ~ C~ , -- -- ~ "Pump on" level at: I "Pump off" level at: I High water alarm at: Cu~ainDrain .~ ~OIJ~ ~. ~ . ~ Pump Make & Model ~ Electrical Inspections pedormed by: Remarks: ~ ~ I~ 5'~ r~o ~ f~ ~ o BENCH MARK Location and Description: I Assumed ~O O, ~ 0 Ft. Elevation: ENGINEER'S SEAL ~ll Inspections performed by: ~.~,~ .~ 2nd q/~/ Department of Healt~ Hu es approval Reviewed and approved b Date:/~/~ ,~,'~a 72-013 (Rev. 9/91) MOA 25 2 2 Permit NOS..w940212 Page of 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 BROADWATER HIEGHTS SUBD.; Legal Description:TRACT H, LOT 7 PID No.: 05008151 r-86.4' / (co~& CO / MT1) MT COl s9 s,c02 Ili/ .................................... .................. II! 86'6/ I 1250 GAL:: ]~86.4' ~ 2~ ; ~1 ~.T.S. :: (CO3& ~ k 8~ O' :~ C04) · FCO' '39:O'i!' 9;0 CO1 29.5i 65.0 C02 37.51 72.0 C03 62.01 96.0 C04 101.8 103.5 MTI 70.51 104.0 MT2 96.5:: 96.5 (MT ~ & MTn) &79.0' WATER FOUND 6/21/94 BED / / / / /. / t 1250 GAL. SEP~rlC TANK N SCALE t" = 40' 72-013 A (1/93) HOUSE WELL EN~ C. COWAN CE -8801 EAL ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 August 23, 1994 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services Attn: Robbie Robinson P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Tract H; Lot 7; Broadwater Heights Dear Robbie, During the installation of the septic system on the referenced property under permit #SW940212, bedrock was encountered in a portion of the area at a depth less than that shown on the soil log. The septic system design has been modified as shown on the attached revised plan dated 8/23/94. If you r~q~ir¢ additional information please contact us. Since~ 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Z ~0 Oz ~0 oz o~ ~0 --z~ ~ 0 WZ ~>~z ~0 o -~ 'NI~ <~ "-"W >' '"uJ u~ < >~ ~ Z ~ -JO -~ ~- uZDO ~ ryZ ~:~ ~o o orn~_O z o z ~4 o 00 z MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION' 2 6 1994 Eli V EI2 September 26, 1994 ROBERTSHAFER, P.E. 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 SOIL 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 P.O. Box 196650 Anchorage, Alaska 99519-6650 Attention: Robert Robinson Reference: Lot 7; Tract H; Broadwater Heights Subdivision Dear Mr. Robinson: In reference to the attached, the conditions mentioned in the "Additional Comments: the existing septic tank and drainfield must be replaced by not later than 7/I/94 with funds escrowed to cover the costs thereof~ have been met. Please lift the conditional approval. If you have any questions, or require additional information for your review, please~, contact us. Sincerely, _ _ Robert C. Cowan, P.E. RCC/cc 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940212 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:HARBOTTLE STEVEN RANDOLPH OWNER ADDRESS:3700 SPRINGER ST. ANCHORAGE, AK99503-5813 DATE ISSUED: 6/28/94 EXPIRATION DATE: 6/28/95 PARCEL ID:05008151 LEGAL DESCRIPTION: BROADWATER HEIGHTS TR 7 H LT LOT SIZE: 23542 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: -~ / ~/. / ~ // .~wy /' ] / -~ .." .dj ,::..- ~y / // 4: DATE: DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. June 22, 1994 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 SOIL 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 P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Broadwater Heights Subdivision; Tract H; Lot 7 Request you issue a permit to upgrade the septic system serving the four bed roadhouse on the referenced property. An adequacy test performed on the existing system for Health Authority Approval purposes found the absorption capacity of the existing system to be inadequate. A conditional Health Authority Approval was issued on February 1, 1994. The conditional approval expires on July 1, 1994. Test holes were excavated and percolation tests performed in the area of the proposed upgrade. The approximate locations of the test holes are located on the attached site plan. At the time of excavation water was encountered at 7 feet in test hole #1 and 8 feet in test hole ~2 and after seven day ground water monitoring water was found at 7 feet in both test holes. Attached is the proposed upgrade design. 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 revie~~2ontact us. RAS/LSU/jk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 0 Z o~O LdO Ez..l,,, -Jz ~ _> .o, '-L...~ E'-, ~ < Z ~ o~ Z / r-~ / oo NVgd 311S , ,0'~' '-- ,,l Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 625 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST SEAL) 4 5 6 7 8 9 DATE Township, Range, Section: SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? / s DEPTH? p I E Depth to Water Alter7 Monitoring? Date: Reading Date Gross Net Depth to Net Time Time Water Drop COMMENTS "-'-7 S & S ENGINEERING PERFORMED BY:£a9le River, Alaska 995?7 /4/.--~'~~RTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDE~~T ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 9 ship, Range, Section: SITE PLAN -~" SLOPE 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? , / IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? '~ Date: Reading Date Gross Net Depth to Net Time Time Water Drop ~ /o~ ~ /~/~' /" (minutes/inch} PERC HOLE DIAMETER TEST RUN BETWEEN ~AND ~---- FT COMMENTS 170,34 Eagle R[ve.r PERFORMED '~:a,,..,..r, ~,.... ;;:.~, ~~,/ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDE~~CT ON THIS DATE, DATE: 72-008 (Rev, 4/85) ON-SITE WASTEWAT~ DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS RE~ENCE: Broadwater Heights Subdivision; Tract H; Lot 7 1. The scope of this project includes the installation of a 1250 gallon septic tank and two five foot wide drainfields to serve the four bedroom residence on the referenced property. The existing 1000 gallon septic tank is to be pumped, crushed and abandoned in place. The existing leachfield is to be abandoned in place. 2. 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. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. 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. 5. 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. 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4' of cover shall be insulated. Page Two Broadwater Heights Subdivision; Tract H; Lot 7 June 22, 1994 5. 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' 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. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCM/DRAll~IELD INSTALLATION: 1. 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 {roughed-up) before gravel ~sewer rock) placement. 2. 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. 3. 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. 4. 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. 5. 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. MINIMUM MAT~AIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page Three Broadwater Heights Subdivision; Tract H; Lot 7 June 22, 1994 2. 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. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ~200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSP~IONS: 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: 1. 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. 2. 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. Page Four Broadwater Heights Subdivision; Tract H; Lot 7 June 22, 1994 3. 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. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. 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 contractor's activities. Final acceptance of the contractor's 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 GREA,,-R ANCHORAGE AREA BOR,..,.GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM -'--"T~_.~ ~,-"' / - ' "hr - L E G AL DE sc R,PT,O N LoT "Z_ .z¢",,¢,~ ~~ f ~. ,,¢'1~ q,/~ LOCATI ON ~'~ J J'J~)~'-. SEPTIC TANK: DISTANCE FROM WELL _ MANUFACTURER ~f,~,,.~'~,T NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH ......... LIQUID DEPTH LIQUID C APAC I TY/"~O~GA L LON$. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE //~)/_ FOUNDATION /'7 / -,,~¢ / NEAREST LOT LINE TOTAL LENGT~::~,~,~ / OF LINES DISTANCE BETWEEN LINES ~'~./~( SQ. FT. LENGTH OF EACH LINE ~'~ / DEPTH OF FILTER MATERIAL BENEATH TILE_~9 IN. ABOVE TILE TRENCH WIDTH~. IN. TOTAL EFFECTIVE WELL: ])CT ;'/")$"/'/~ TYPE_Z~ 't. _&~_. ~-- ~"'~ CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION____ LOT LINE _____, SEWER LINE DEPTH SEPTIC SEEPAGE TANK SYSTEM ' IN. DISTANCE FROM: CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: ~ ~ ~___4.~____ INSTALLED BY: J'~"'~-~'~ SEWER LINE DEPTH: PIPE MATERIAL: LOT S LO PE :'"~!~~ REM^RKS: /.2S DIAGRAM OF SYSTEM Form EQ-O32 "t""rq:::'E (::il;::' SCi I L FIE:$ORBT 1 O1"4 S'¢S'T'EH l E;: TF.".Eit",ICH THE I:~:[.:.'.'QU I REE:, E; I ZE OF THE: 'SO Z L. FtBE;OFE:F'TI ON ::E;'¢STEM I E;: "l"k.ll!i!: L. ENG'T'H [::, I ME:NS 1 O1'.4 I S THE LENGTH ,:: 11'-4 FE:ET ) OF THE TRE:NCH OR [:,RFI I NF ]: EL.E:,. THE E:,EF'TH OF' FI 'T'RE:NE:H OF..' PIT t'_:; THE DIEYFFINCE BETNEEN THE SIJF4:F'FIE:E OF THE GFi:OUN[.':, FIN[)THE: BOTTOH OF THE E','.4C;F:f,,,'FITIOI'4 ,::ZN FEET.':,. 'T'HE:FE:E IS NO SET I,.IIE:,TH F'OF.: TRENCHES. THE GF;i:Ff,,,'EL. E;,EF'I"H I:5 'THE H ZI'.4IMLIM E:,EF'TH OF 6F.'.FIVEL BE'T'NEEN THE; OUTFFIL. L. F'IF"E RN[) "I"HE BOT'T'OM OF: THE: E',:.:',CFIVFIT' 1 O1'.4 ,:: ].' N FEET ::,. ...... F:,~d~:~ FEET F :)F." R F'L BL. I C NELt .... i E: E:I:;i:'T' Z F:'Y "t" H FIT' :L: I I::lI'"l I:::'FtMIL. IFtR NI'I"FI THE F;.:EQUIREHEt",IT$ FOR OI",I-SITE SEI-,.iERS 81"4[:, !.4ELL..S; I::lS E;ET F:'EiF.:'T'H li.:.':"r' THE HUN I C: t F'F:IL t ]"'¢ OF" RNCHORF:tGE. ;.:.'i:: i t.,.i I L.L T NSTF~L.L. T'HE 'Z-';'¢STE:H I N RCE:ORE:,RI",ICE N I TH THE CODES. ::ii:: I UN[.':,EF:'.!';TFIN[)THFff' THE ON-'SITE :.'.-.';ENER S'¢5;TEM I"1R'¢ REt"..:!UIf4.':E EIqLRFi:GEMENT IF' 'THE:. I*i:ESII.)EI'qE:E IS Fi'.EI"'IODIELED TO I I'4CLU[.':,E MORE THRN ~: BE[::,F.':OOHS. I :!i!;Ei;UE[) [., ~ ............... F. H l E SAM COTTE~ DRILLING CO. Box 2~6 £a~'- Rtver, Al¢:ska 99577 SAM CO'I'T~;N DRILLING CO. Bo× 096 Ec~§i:.. ~ivc~, Alca~kct 9~77 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. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING · . .'.' .:, ~ ,~ . ",,..$'.;, Location (site address or directions) 12231 W. Skyline Drive Eagle River, Alaska Property owner Sanda Putnam Mailing address 18515 McCra~'~'_, Eagle River, Lending agency Mailing address Agent Address Day phone 694-4054 Alas]ca 99577 Day phone Day phone Unless otherwise requested, HAA .will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well community well Public water XXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. · 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on;site X~X NOTE: Public sewer 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 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 37034 Eagle River Loop Road No. 204 Phone Eagle River, Alaska 99577 Address Engineer's signature '~Y/'~ 6. DHHS SIGNATURE '~.~ Approved for bedrooms. ,,,'~'" Disapproved. ..'"~'~'~'~ llJ '///~.¢onditional approval for bedrooms, With the follOwing stipulations: 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. -. ~ : ·'~-" ~ '~,:,.~ ..' ~-.;'~7-.:~ .... 72.43125(Rev. 1/91) Back MOA~21 .... ."'?<?:,~.~,~'i "~ ~-~',,,' ':~;~;'.?: ,"; ,-:.?:;:. ,.... ,~,...-~-; ..... ;~: ~ ,~, ~,?,,," .1, · '. ,.~' - ~,..,.,,¥.,~,~.-:,. !~ ..,. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Well type If A, B, or C, attach ADE¢ letter. ADEC water system number Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Date of test FROM WELL LOG Static water level Wires properly protected (Y/N) AT INSPE~TIO~ Well flow g.p.m. Pump level1 L T ~''~ SEPARATION DISTANCES FROM WEL Septic/holding tank on lot ,,~ ; On adjacent lots Absorption field on lot Public sewer main Sewer service line WATER~SULTS: ~n-Date of sa'-'~ple: ; On adjacent lots Public sewer manhole/cleanout g.p.m. Petroleum tank Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts(~) ,.~ water alarm (Y~) High Date of pumping Foundation cleanout~N) Tank size I ~5'-c~ Compartments ~/ Depressio~ (Y~[~ Alarm tested (Y/N) ~,~, Pumper ~J~,~ Well(s) on lot ! / C, To property line '~ Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: I On adjacent lots / o o Absorption field /~ /~0 ~.- Foundation ~-~ 9 ~ Water main/service line 72.026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) .....- SEPARATION DISTA~LIFT STATION TO: On adjacent lots Manufacturer Manhole/Access (Y/N) .,..----~ Surface water D. ABSORPTION FIELD DATA Date installed ? .._,/~ ... ~ ,z// Length O ~3 / Width / ~'~ ' Soil rating (GPD/FF) Total absorption area Date Of adequacy test ~/,,~ '~/~,~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y~) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: After test If yes, give date Gravel thickness Cleanout present Q/N) Results (pass/fail) / ~, .c'" System type 43,~'-' / Total depth Depression overly,eld (Y/~ .'~--~ for /-//~ Bedrooms Well on lot To building foundation On adjacent lots Surface water Curtain drain ///_../r~ ' On adjacent lots / ~ / '~ Property line ~,~ f To e~isting or abandoned system on lot .~o ~ 'P Cutbank "J/,~ Water main/service line /~ ¢ '~ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guideline.$ in effect on the date of this inspecb'on. Signature Engineer's Name Date HM Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number 72-026 (3/93)* Back 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. # 1, GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AU'fHORITY APPROVAL FOR A SINGLE FAMILY DWELLING NAA #. ~,t..,~ ~._~""~ Lot 7; Tra~ H; ' BroaCher H~q~ Sub~v~ion 0 Location (site address or directions) Property owner Mailing address Lending agency Mailing address 18525 M¢¢rary; Eagle River; Alaska Day phone 99577 Day phone /~q4-4054 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: $ ,,,/ XY, X 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 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 inves_ti_gation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING 17034 Eagle River Lof)p~oad~. 204 Address Eagle River, ~~/ Eigineer's signature '~_~~ Phone Date DHHS SIGNATURE Approved for bedrooms. 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. 1/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present.N) ~',~ Total depth \ Sanitary seal (~1) , Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~'l L,, Driller Cased to ~,~ C~c~ Casing height Wires properly protected(~/N) FROM WELL LOG AT INSPECTION Date of test ~ ~ '] L,. \ ~ L~ ~ct ~ Static water level 'z?'Z-'~ E~ '" "~\' Well flow ~c,~.~ (-"17 E'~ ~ \ ."~ g,p.m. Pump level1 0¢"''~ I~¢~ ~ SEPARATION DISTANCE.S~ROM WELL TO: Septic/holding tank on lot I"~ Absorption field on lot Public sewer ma' Sewer service line ,.~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~. OZ Z~ WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate /--~, L,,Cl Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed \ ~ ~ Cleanouts ~_~) High water alarm (Y~,,~ Date of pumping Tank size ~ o,::::,.0. Compartments Foundation cleanout (Y~~-~ De P ressio n ~,tY/~).~ ~'~ Alarm tested (Y/N) ~v~ \'7-'~-5 o ~ Pumper "~"..~ ~t.5/cO ~ SEPARATION [~ISTANCES FROM SEPTIC/HOLDING TANK TO: .I-- Well(s) on Iot-/~ 'TD On adjacent lots t,~ ~ To property line ~.~ ~ x.- Absorption field ~' ~ ~' Surface water/drainage ~. c~ c> Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at Manufacturer High water alarm level ./ Meets MOA electrical codes (Y~ SE~CE FROM LIFT STATION TO: VCell on lot On adjacent lots Cycles tested Manhole/Access (Y/N) ~at Surface water D. ABSORPTION FIELD DATA Date installed /~'1 "J Length ~ '7~-' Width Total absorption area '~ ~' ~ Date of adequacy test \ --' L.~ ~ ~ z~ Water level in absorption field before test Peroxide treatment (past 12 months) L/ Soil rating (GPD/Ft2) Gravel thickness Cleanout present~) Results4~fail) System type Total depth \ ,,/ Depression over field (~.~ ~,~,--~ .... ~-¢.- '~ Bedrooms After test ~ If yes, give date SEPARATIOI~ DISTANCE FROM ABSORPTION FIELD TO: l Well on lot /'~ C~ ~ On adjacent lots To building foundation On adjacent lots "5 ~ ~ ~ Surface water ~ o o ~ ~ Property line To existing or abandoned system on lot Cutbank ~' ~,~ Water main/service line Driveway, parking/vehicle storage area HAA Fee $ ~/~(~ 0 ~ Date of Payment /-~) ,~'- ~' F Receipt Number ~.~,~-~ ~' 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number Curtain drain ~' ~- ' Signatur ' .::? ~:: ''~' ''? ' ' Engineers Nam~ S ~ ENGINEERING ~034 Eag~ Ri~r Loop Road No. 2~ //~ ./ ~,.. '~'-. ~ ' Date e;;7 .-? :, COMMERCIAL TESTING & mI RONMENTAL LABORATORY SERVICES ENGINEERING CO. SINCE t908 PJEPORT of ANALYSIS Chemlab Ref.~ :94.0194-3 Client Sample ID :L7 B H BROADWATER HTS. Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :S & S ENGINEERING Ordered By :R. SHAFER Project Name : Projects : PWSID :UA WORK Order :74905 Report Completed :01/14/94 Collected :01/11/94 @ 13:45 hrs. Received :01/12/94 @ 12:50 hrs. Technical Director:STEPHEN C. ET]E Released By : ~/~~__~ ~ Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY. Parameter QC Results Qual Units Allowable Ext. Anal Method Limits Date Date Init Nitrate-N 4.69 mg/L EPA 353.2/300.0 10 01/12 LLH * See Special Instructions A~ve ** See Sample Remarks Above U = Undetected, Reported value is the practical quantification limit. D = Secondary dilution. Member of the SGS Group (Soci(~tb G0n~rale de Surveillance) UA = Unavailable NA = Not Analyzed LT = Less Than GT = Greater Than ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA /~ ' DA~ ECE VED II.TIME ~' INSPECTION APPOINTMENTS fl~ · ' -- " TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSPECTOB MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L S{reet - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACI LITI ES DIRECTIONS: Complete all parts oil page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER I PHONE MAIL3NG ADDRESS ' PROPERTY R ESI DENT (I f different from above) pHONE MAI LING ADDR ESS ' 3, LENDING INSTITUTION MAILING ADDRESS 4. REALTOR/AGENT [ PHONE' MAILING ADDRESS 5. LF...~,~L DESCRIPTION ' ' ~TREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS ~ SINGLE FAMILY ~ Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six Other 7. WATER SUPPLY [] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give wel depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY [] ONE [] TWO NUMBER OF BEDROOMS [] THREE [] FIVE [] FOUR [] SlX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Sept. icLTaj~l~or [] Holding Tank Size: I ~O)O If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4, DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURER ~ MATERIAL Septic/Holdinfl Tank ~Ab~orption Area ISewer Line Nearest Lot Line 5. COMMENTS DATE [~'"~PPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPP,,OVED. ~- ] BY~~~ 72-010 (Rev. 6/79) DAVID A. SLENKAMP ROBERT A. SHAFER MECHANICAL ENGINEER 694-9055 CIVIL ENGINEER 694-2979 April 5, 1981 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PPOTECTION Debbie Julsen SR 2, Box 231 B Ea~le River, Alaska 99577 APR 6 198t RECEIV .D Dear ~Sss JulSen, Reference: Lot 7; Tract H; Broadwater Heights Subdivision A sewer system adequacy test vms performed at your request on the system located on the referenced property. The septic tank was pumped and verified to have a capacity oC 1000 gallons. The ~bsorption trench ~,~s tested by a continuous flow of an average of 5A5 gallons of wnter ever a 24 hour period with no adverse effect on the system. It can be concluded from this test that the seYmge system (septic tank and absorption trench) is currently functioning adequately for the three bedroom home located on this property. If we may be of further service, please do not hesitate to call. Sincerely,, / I ../ ' ,,R~BERT A. SHAFET /' /P. E. cc: First National Bank Eagle River Branch Municipality of Anchora?e Department of Health and Environmental Heal. th SRB 196X EAGLE RIVER, ALASKA