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Home My WebLink AboutT15N R1W SEC 9 LT 59 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: ~c'Jci'~°°~ ~ PID Number: o'~1 lo5 I ~ Name: ~/,z/.~li~L~.~ .-~. ~ Wastewater System: ~New ~ Upgrade , ~ ABSORPTION FIELD Phone: ~ .~]~ No. of Bedrooms: ~ ~ Deep Trench D Shallow Trench ~ed ~ Mound ~ Other LEGAL DESCRIPTION so, Rating: Total Depth~ original grade: Lot; ~ Block: Subdiv~ion: Depth t0 pipe bottom from original grade: Gravel depth beneath pipe Township: /~ IRange: , ~ ISection: ~ Fill added above original grade: Gravel length: WELL: ~New ~ Upgrade Gravel width: t5 I Ft. Number of lines:~ ~Distance between lines:~. G Ft. Classification (Private. A.B.C): Total Depth: Cased TO: Total absorption area: Pipe material: ~ ~T ~ Orgler:~ ~ ~ Date Drilled: ~51 ~ StatioWater Level:~5~ Et, Installer: ~ {~*~ Oateinstalled: ~ Yield: Casing Height Above Ground: SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gaPo~s: Well' IO~ ~ / O~ ~ ~ ~ ~ r~ Material: ~T~EL Number of Compartments: Water Lot ~, Size in gallons: I Manufacturer: Drain Remarks: ~( ~ ~ ~3~ BENCH MARK Location and Description: Assumed Elevation: I00,0 Eagle River, Alaska Department of He H rvices ap ~. ~4'. ....... c~- Reviewed and approved b Date:~'~ '~x~-~'~'~ -~- 72-013 (Rev 9/91) MOA 25 SW950075 2 Permit No. Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SEFIVICE$ ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report T15N E1W SEC 9, LOT 59 05110314 Legal Description: PID No.: 2 ~.o~ W~TE~ rou~5 -r~~ / WELL LOT 59?: NEW A~SORBTION SCALE 1" = 40'[ 72-013 A (1/93) 1.~ GAL !!~ N___ SEPTIC TA~ ROBERT C. COWAN CE - 8801 STATE OF ALASKA OEPAR1 MENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL ~EGORD LOCATION OP WE~L LoCATtONISKETCH~ WELL OWneR= DEPTHS MEASURED FROM:~¢eslng ~c~PXffirourld surfl~oe BoREHOLE DATA: Depth Materiel Type an~ Color From To WELL DEPTH; DATI~ 01; COMPLETION Depth Of DI~PTH_TO STATIC WATER LEVEL~ ._..~__..ft below ~'too of gash%0 0 a,ound M~HOD OF DttlLLINO~ ~8i, rotary 0 ~ble ~001 ~ other USE OF WELL;~domBstI~ ~ irrigation ~ monitor ~l public sy~O1v ~ other., CA~ING,STICK.UF~ fl, DEem: ~tn, to~ft Casing ly ~ln. WELL INYAKE OPENINg TYPE; ~ open end ~ Dorforated ~ open hole Depths: Ot OpeningS; ~.~ to _ ~ ft IVE, JUL 1995 atth & Human, SCREEN TYPE: Oiam: .,.-~. In, Slot/MesI~ Size; It GP~O, VEL PACK TYPE; ..~/~' . Volume used: -- ' Depth tO top; ........ GROUT TYPE: m?~_ Volumm Depth: Iron1 t¢ I__ __ it PUMPINQ LEVEL AND ~LD~ 8her hfs pumpln ~ ~ PUMP INTAK~ DE'TH= Ho¢~e~ower: WELL DISINFECteD UPON ~PL~HON~ ~ Y CONTRACTOR INFORMATION: PLEASE[ MAIL WHIIE COPY OF LOG TO: DNR/DIvI$ION OF MINING & WAYER MOM't' ANOHORAGE AK MARK HANSEN P.E. HC02 BOX 7387, PALMER, AK 99§45 (907) 745-4721 FAX (907) 746-4721 Quality Sand and Gravel P.O. Box 1456 Palmer, AK 99845 May 20, 1995 Project No: 9524 Fax:373-7979 Project: 1995 aggregate testing Subject: Sieve Analysis, Hyer Road Gentlemen: The following is the sieve analysis of the sand sampled on 5/18/95 Sieve % Passing % Required for DEC Septic Filter Sand Group A Group B 1 1/2" 100% 1" 99% 3/4" 98% 3/8" 96% #4 95% #10 93% #20 84% #40 33% #.60 8% #100 1% #200 0.3% 85-100 60-90 25-50 0-15 0-5 0-5 85-100 Coefficient. of Uniformity Cu 2.2 Coefficient. of Curvature Cc 0.99 4 max 1 Max The sample conforms to group A and B specifications. If you have any questions, please do not hesitate to call. Sincerely, Mark Hanson 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:SW950073 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WARNER CHARLES D OWNER ADDRESS:8460 ROVENA DRIVE ANCHORAGE, ALASKA 99518 PAGE 1 OF 1 DATE ISSUED: 5/09/95 EXPIRATION DATE: 5/09/96 PARCEL ID:05110314 LEGAL DESCRIPTION: T15N R1W SEC 9 LT 59 LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PER~4IT: 4 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 (18AACS0). 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 AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~/: DATE: DATE: I0 ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. HEATH 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 ONSITE WASTEWATER DISPO~ALSYSTEM DESIGN May 5, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Depar~ent of H~alth and H~man Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 59; T15N; RIW; Sec. 9 Serve ~h¢ proposed ~ou~ bec~oom house on ~he re~e~e~ prop~.~t Test holes approxd~ate site plan. were excavated and percolation tests performed. The locations of the test holes ~e located on the attached At the time of excavation water was encountered at 14 fe~t in t~t hole ~I and dry in test hole #2. After ground water monitoring water ms found at 10 feet and dry respectively. This property has enough ar~a for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on n~ghboring properti~ by the installation of the proposed septic syst~. The proposed 1250 gallon septic tank is to be placed outside the protective radius. Attached ~s a site plan which depicts the location of the proposed tank. If you req~re additional inform~ion please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577 SCALE SITF PI A~ N.T.$. om~ XO~ ~m~ PROFILE DEEP 0 Wright-Alaska Engineering Services 6004 Glenkerry Dr. · Anchorage, AK 99504 · Telephone: (907) 338-6230 Fax: (907) 337-5182 Percolation Log Report/ Soils Log Performed for: Charles Warner Hole No:l Date: 1/21/95 Legal Description: Lot 5~Block NA Trcct NA Subdivision: NA Township, Ranqe~ Section: T15N, RIW, Sec. 9 Sheet: 1 of 1 Groundwater Gross Net Depth tl~ Net Adiusted Encountered? No Reading Date Time Time (lin,) Water ,) Drop (in.) Rate (min./in,~ 1 1/21/95 1225 0.83 1 12 At what depth? NA 12 Incl iS of wate flows out of hole In Ulld~ 1 lin, [Takee >2.5 Gals to fill hole) Water level after 1 1/21/95 1227 0.53 5 6 Monitoring? 1 4.12' 1 1721795 9 0,57 5 6 0,67 From dtlal 12" flllnq, two 6tests and e~amlnatlon ~f soil, It is obvh,us that rate Dat~: 1/28/95 ~= < 1mln./In, Percolation Rate 0.~7 rain/in. Comments: ~ ~ - /~/ /~/ - Performed by: Bob Wrighf I, ~J~ ~/ effect CertifYonthatthisthiSdote.test Dote: was perfpr~e,d~in~ce//~/~¢/~g with oil store & Municipal guidelines in '/ 0-1 Root Matl,2,?ack Organics F--]---l---F--] '--'---'--'--'---'--'--'---'--'--'---'--i 3 ~."'0~ 1-0'5 Darkoraded Gravol w/Sand ~ ~ ~ ~ ~ IGrey' Dry. Poorly~r--~ -F--r--n~ ~ ~ ~r ...... ,--,--,---,__,__,___,__,t~ ~ ...... .--' -r61-+-~--~--+-~, , u - -+---~ Grovol Hno to Coor*~ ~--~- 1---~-J c ...... u__~__~___u__x~ ~___~__x ...... 5_ ;' ~Po'~ Cobbles ~ Boulders ,IF--=--' [---r--q ,' ,I ,I ,Ir ......~ ._~: '--'---'--'--'---'--' II II Il ,' Ii ,' ...... ,' .- 20~ ~__~ ...... ~__~ ~ ...... ,~___~__+_~___~_ _+ ...... ~__~ 5 , , ,x, , , , , 7 fo 5 ~-~---,---~--~ ~--- 8 , , ~___~__~ !i ! ~ ! ! ' m m m m i i i i i i i m m---~--~ 9 ~ Slope Site Plan .:0;, S,'--%--'--'--'---'--'--'---'-, , ~ , , , ,R~__._ ,T--%--F--'~ , 9.5-15 Dark Brown, Moist to Wet IIL--J---L--Z--J-I I _L__Zi I .......... m I I J___L__i I 10 ':" "~':' Poorly Graded orovom w/Sand o ' , O~ ,--~~ 11 ' " Gravel Fine to Coarse P [-- mm )l [ '---'--'--'---'--'--'---'--'m I I I m I m I · ,__,___,__,__,___,__,__,___,__,__,___,__, ~"9: :( Sand Coarse, 12 _,.;Op'~ Cobblee ~ Boulders . OF4 ~a~ROBERT W. WRfGHT to 20~ Silt appears to be lO:b~ 16_ 15 End Hole 17_ 18 c~.. F,..0=. PERFORMED FOR: LEGAL DESCRIPTION: 5 6 7 8 9 I0 11 12 13 14 15 16 17 18 19 2O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST · SLOPE SIT~ PLAN ' WAS GROUND WATER ENCOUNTERED? E Depth to Waler Alter ~ ~"'--.~'1"5" Monitoring?' ~'~-'~/ Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE . TEST RUN BETWEEN ~¢ {m~nutes/mch) PERC HOLE DIAMETER ~ FTAND .~.~--.-~ ft COMMENTS PERFORMED BY: S & $ ENGINEERING , ~-~1/~,~,~1[~* CERTIFY THAT THIS TEST WAS PERFORMED in 17034 Eagle River Loop Road No. 204 ~ ACCORDANCE WITH .~I~ir~TI~]',~?,I~I~Ig~TGUIDELINES IN EFFECT ON THIS DATE. DATE: ~"'~'~'-~'~ 5'~ 72-008 (Rev. 4/85) ~00 gO 8O 7O LL ~: 50 13_ 3O 2O lO 0 ~00 GRAIN SIZE DISTRIBUTION TEST REPORT lO0 10.0 ~ .0 O. I 0.0~ 0 .O0l GRAIN SIZE - mm %+75m~ % GRAVEL % SAND % FINES 0.0 70.3 2g.1 0.6 LL PI 085 D60 D50 D30 0~0 Cc Cu 53.03 26.58 ~6.g6 4.836 0.7577 ~.~6 35.~ D~5 ~.3788 MATERIAL DESCRIPTION USCS AASHTO · BROWN WELL GRADED GRAVEL WITH SAND GW Pro)ect No.: 130~ Peoject: S g S ENGINEERING · Location: LOT 59, SEC. 9, Ti5N, R~W Date: 4-28-95 SAMPLE DELIVERED TO RPKA OFFIOE BY S g S ENGINEERING GRAIN SIZE DISTRIBUTION TEST REPORT RODNEY P. KINNEY ASSOCIATES Figure NO. ~ GRAIN SIZE DISTRIBUTION TEST DATA Test No.: 1 Date: 4-28-95 Project No.: 1301 Project: S & S ENGINEERING Sample Data Location of Sample: LOT 59, SEC. 9, T15N, R1W Sample Description: BROWN WELL GRADED GRAVEL WITH SAND USCS Class: GW Liquid limit: AASHTO Class: Plasticity index: Notes Remarks: SAMPLE DELIVERED TO RPKA OFFICE BY S & S ENGINEERING Fig. No.: 1 Mechanical Analysis Data Initial Dry sample and tare= 1016.70 Tare = 163.10 Dry sample weight = 853.60 Tare for cumulative weight retained= 163.1 Sieve Cumul. Wt. Percent retained finer 3 inches 163.10 100.0 1.5 inches 402.00 72.0 1 inches 516.60 58.6 0.5 inches 628.40 45.5 0.375 inches 663.50 41.4 # 4 763.00 29.7 # 10 857.60 18.6 # 20 925.10 10.7 # 40 966.70 5.9 # 100 1005.20 1.3 # 200 1011.30 0.6 % FINES = 0.6 ~// D85= 53.03 D60= 26.577 D50= 16.963 D30TM 4.8362 D15= 1.37880 D10= 0.75770 CC = 1.1614 Cu = 35.0752 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXEENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE pLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE W/~TEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS ~EFERENCE: Lot 59, T15N R1W SEC May 4, 1995 ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. GENERAL: CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 me e e Be The scope of this project includes the installation of a 1250 gallon septic tank and absorption bed 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 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: 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. 17034 NORTH EAGLE RIVER LOOP SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 59, T15N R1W SEC 9 May 4, 1995 Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leaehfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These oleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first oleanout, 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. LEACHFIELD BED INSTALLATION= Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed-up) before gravel or sand placement. If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. The perforated distribution pipes must be no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. Page Three Lot 59, T15N R1W SEC 9 May 4, 1995 Silt barrier material 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 at 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 depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. The monitoring tube should not extend below the bottom of the gravel surface. 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 finished grade over the bed must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: me 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 burial polystyrene (Dow Chemical Company equal)· extruded direct Styrofoam HI or Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Page Four Lot 59, T15N R1W SEC May 4, 1995 Be 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. 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. 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. e 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. 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 M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. Page Five Lot 59, T15N R1W SEC May 4, 1995 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 & $ 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 171'11 RECEIVED dUN ? 6 1995 Mun/c~P~a/'zY oi 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 Complete legal description Lot 59; TISNi R/Wi Se, c. 9 z Location (site address or directions) NHN P~ters Cr~,~k Drive Chagiak, AK Property owner · Mailing address Lending agency Mailing address Charles D. Warner 8460 Rov~na Drive Day phone 349-7~14 Anchora~e~ AK 99518 Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 4 NOTE: 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: Individual on-site XXX Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. (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. $ & s ENGINEERING Phone Eagle River, Alaska 99577 Address ¢ ~t¢/~/_~... ,~ Engineer's signature ' ~-~/-?~,------ Date /4 /¢1 /¢/~'-' 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 DH HS 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 engineeCs work. 72-0'25 (Rev, 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage. Alaska 99501· (907) 343-4744 Health Authority Approval Checklist Legal Parcel I.D.: A. WELL DATA Well type [?~-~,,l..,,.n-r,.. If A, B, or C. attach ADEC letter ADEC water system number Log present(12~)N) \[ Date completed Total depth ~, ~ Cased to /..ag' Sanitau seal (~q'q) x~ FROM WELL LOG Date of test ~'- Static water level Well production \ID , o g.p.m Casing height (above ground) Wires properly protected(~N i ,,~ AT INSPECTION WATER SAMPLE RESULTS: Coliform ~;> Nitrate Date o£ sample: ~O ~ Q.- B. SEPTIC/HOL'IMin~ TANK DATA C> ,~-Lo" Other bacteria Collected by: 7034 Eagle River Loop Road No. 204 d:v,:,lo ¢,iwr, A!aska 99S77 Tank size 1'l-~5"C> Depression ( Yd~I~ Pumper r& I A Date installed,. [O '7. \ cX-°l~' Foundation'cle~flout ~l~) ..~ ~ Dat~ OfPumpit;g ~ '~ c. A~e~to~ ~m~n ~AT~ Date iostalled. ~ ~ ~ ~ -~ ~/ Soil rating (g.p.d./fl or W~drm) Length ~ width [~ Gravel thickness below p~pe. Effective abso~tion area g 7~ ~ . Monitoring Tube present~) Date of adequacy test ~-~[~ Results (Pass.ail) _ Number of Compartments ~ Cleanouts (~xl) ~/ High water alarm (Y~) r~ System type ?>(=.42, O,S" ~ Total depth ~,,q r Depression over field rY~ tJ For ~ bedrooms Fluid depth in absorption field before test tm.t: -"'-- hnmediately after "~al. water added (in.): Fluid depth ------ .(las.) Minutes later: Peroxide treatment (past 12 mouths) ('Y~j> Absorpuon rate = g.p.d If yes, give date ~.A D. LIFT STATION Date mstulled Manhole/Access (Y/N) High water alarm level at* Size m gallons "Pump on" level ut* ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/hcl~ing 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 SEPTICgIGLDIN6 TANK ON LOT TO: Building foundation ~ ~ ~ Property line tl~- ' Absorption field Water main/service line \ c>~ ,k Surface water/drainage \ C::o~ -v- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation \ i:~x Water main/service line Surface water '\ ~ t-k Curtain drain ~/~- Receipt Number ~O'~ / Oh~-)~~' Rev. 8/95 OSS: haa.wk.doc Driveway, parking/vehicle storage area '2.~' Wells on adjacent lots \c>O \ 4' Property line F. ENGINEER'S CERTIFICATION l certi~ that l have determ#~ed thru field inspections and review ofMunicipal recr~'~, in co~brmance with ~/lO~HAfi~,t6tdelinfdrin effect on this date. Signature / ~/ -- ........................................................................................... HAA Fee $ ~ Wawer Date of Payment Receipt Number CT&E Environmental Services Inc. Laboratory Diviaion Laboratory Analysis Report 200 W. PotTer Drive, Anchorage. AK 99518-1605 --. Tel: {907) 662-2343 Fax: (907) ~61~5~01 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURi, NEW J~RSEY, OHIO, wEST VIRGINIA ~0~ 6Pg'ON ~I~P69406 ~ 9N[ISBI qUID~BWWO3 P0:60 S6/90/0I DEPT. OF ENVIRONMENTAL CONSERVATION WALTER J. HIOKEL, GOVERNOR MAT-SU DISTRICT OFFICE P.O. Box 871064 Wasilla, Alaska 99687 (907) 376-$038 (907) 376-2382 Fax June 2, 1995 Mr. John Waters Quality Sand and Gravel P.O. Box 1456 Palmer, Alaska 99645 RE: Sieve Analysis for Sand Filter Material; Specification Review Dear Mr. Waters: This letter is in response to your letter, received in this office by facsimile on May 22, 1995, which enclosed the results of a sieve analysis The analysis was done by Mr. Mark Hansen, P.E.. Based upon your letter, the analysis is 1hr sands from your pit, that are to be used for sand filters for soil absorption systems (SAS). After review of the required specification for filter sand, issued by the Department and the results of your sieve analysis, I find that the sample :If sand meets the requirements of the Department. Therefore, the Department has no objection to the use of this sand as material for SAS. In order to retain the Department's non-objection, a sieve analysis on a representative sample, taken from your stockpile will need to be submitted to this office for every 1000 cubic yards stockpiled. A similar submittal will need to be made next year, by May 1, 1996, if you intend to obtain the Department's non-objection on your sand. This non-objection is for use in sand Iiners, which are constructed in the Mat-Su Borough. It is emphasized that this letter of non-objection is for sand used in wastewater disposal systems, which are less then or equal to 1000 square feet in size. Systems larger than 1000 square feet may require a separate sieve analysis, every 1000 square feet; however, this is the concern of the owner/deve! ;')er,. not the supplier/source of the material. Thank you for you cooperation wi:h this "~epartment. If you have any questions, please do not hesitate to contact me. Sincerely, Robert A. Fultz (~ Environmental Specialist RAF:gp cc: Mark Hansen, P.E.