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HomeMy WebLinkAboutVALLEY VIEW TERRACE BLK 1 LT 5 MUNIClPALITY OF A NCHORA GE ON-SITE WA TER/WASTEWA TER DISPOSAL SYSTEM FIELD AUDIT Date .~ ~ I ~ -5'/- Document Type Legal Description ~'-~1 ~ L [ (/~/~LLq~/ SiteAddress ~ [~ Engineer/Firm g % ~ Excavator .~ Follow-up Notes Time /463-5-92 AS-BUILT // PROFILE O0 /j Co 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: ~cl~'°'Z(~'l PID Number: Of~-O'~ Name: 14[~ A~ ~ ~ Wastewater System: ~ New ~ Upgrade Phone: ~ ~ Deep Trench ~ShallowTrench D Bed D Mound D Other - - Total Depth from original gr~ ~ GPD/~q. Lc ' e: Gravel depth beneath pipe Gravel lengt · Ft, ~ ~ 0 Ft. ~ (~ TANK LOt I I I t /// ~ Sizein gallons: I Cu~ain I ~ I , // ~ I P~mpM~ Drain I:' /- I- I-- '/ Remarks: g~,~zr~d- /oo~ C.~,~ Location and Desc Inspections pe~ormed by:tltl~lN[[ll[~ _ , I~034 Eagle River Lo~ ~le RNer, Alaska 99577 2nd~ Department of Health and Human Se~ices app: Reviewed and approved by:-'~~ 79-013 (Rev. 9/91) MOA 25 SW960267 2 2 Permit No. 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 Legal Description: LOT 5, BLOCK 1, VALLEY VIEW TERRACE PIDNo.: 050-552-40 / FI1 AL GRADE FIN ~,L GRADE / C01 88.0' --97,6' ~89.1' CO2 88.7~1(~O3 = 85.0; / co, MT1 C02 ~0 ~ EX STING = C AL 85.7' ' COJ = 85,5' SI ',PTIC C02 85.4~ , ~K N.T.S. y C04 ~T1 = MT2 = 81.8'  ~: ~9.7' WATE[ FOUND 74.2 B.0.H. / ~ ~ ~EXISTING RENCH DRAIN D~ 21 4mo', 2~.o' I O.s o.o' CONCRETE ~PTIC TANK-~ LOT 5 k / DE 41 66.0~ 1 7.0' NEW 500 GAL / e~%/~r// ~ / FD I 81.5 1;;2.0' SEFi'IC TAN~ ~~ ' ' ~ / CC [ 79.0' 1;.9.5 iNSTAtLEO FLOW -- /'~J~iiT / // bun I Ub.U' 1,.1.0' DNIDER (FO) ' / / C014 I 69.5' 1(i2.0' ~ ~ ~¢]' ~ ' M J 96.5' 1,-1.5' 72-O13 A (Rev. 9/91) MOA 25 ~ ,~GALE AS-BUILT PROFILE / ©O MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ~ Pr.A7 E 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960267 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:BENNIS ESTHER K OWNER ADDRESS:P.O. BOX 772266 EAGLE RIVER, AK. 99577 DATE ISSUED: 8/26/96 EXPIP~ATION DATE: 8/26/97 PARCEL ID:05035240 LEGAL DESCRIPTION: VALLEY VIEW TERRACE BLK 1 LT 5 LOT SIZE: 23522 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHOP,~GE 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 LrNDER 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: INSTALL GROUNDWATER MONITOR TUBE NEAR. SOUTH TRENCH AND BTWN.~CURTAIN DR~AIN AND FIELD, MONITOR TUBES MUST( EXTEND TO A DEPTH OF FOUR (4) FT. MIN. BELOW THE BOTTOM (LOWEST PORTION) OF THE ABSORPTION FIELD. MONITOR TUBES MUST REMAIN IN PLACE THROUGH UNTIL OCTOBER 15TH, 1996. RECEIVED BY: ISSUED BY: DATE: DATE: Municipatity of Anchorage Department of Health andHUman Services 825 "L" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor October 24, 1996 Bob Cowan, P.E. S & S Engineering 17034 Eagle River Loop Rd. Suite 204 Eagle River, Alaska 99577 REFERENCE: Valley View Terrace, Lot 5, Block 1 Dear Mr. Cowan On August 26, 1996, permit # SW960267 was issued to upgrade the septic system on the referenced property. The special provisions for this permit included the requirement to install two groundwater monitoring tubes during construction of the system upgrade. These monitor tubes were to be installed a minimum of four foot below the lowest portion of the absorption field with monitoring to continue through October 15th, 1996. One monitor tube wasto be installed near the south trench and the other to be installed between the proposed curtain drain and the absorption field. During the past two months I have made numerous inquires and several site visits, and to date this office has no evidence that the monitoring tubes have been installed. We have also not received an as-built drawing/inspection report of the upgraded system, which is in violation of AMC 15.65.150. E. It is now necessary that the monitor tubes be immediately installed as desc¢ibed above with monitoring continued througt?~, e spring of 1997. If the monitor tubes are not installed by November 10, 1996, the septic tank must be plugged off at the discharge and used as a holding tank until satisfactory results are obtained from the spring groundwater monitoring. . S,,.'~incerely' ~ / ¢ t/,~.... ~'~mes P.~IVilliams t~Civil Engineer On-Site Services Aught 21, 1996 ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 SEWER&WATER I~PECTION ENGINEERINGSTUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS MUNICIPALITY OF ANCHORAGE Department of H~alth and Human Szrvic~ P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 5; Block I; Va2~ey View T~race Subdivision ~ fo~ b~oom ho~ on ~ r~{~e~ p~op~. ~o, r~qa~t ~oa ~S~e a I ~oot ~v~ from ~e ~n~i~ ~ ~e ~t ~t ~ne a~ locked on the a~achzd s~e plan. At the ~ of zxcav~on water was ~ncou~zd at 9 ft. and aft~ seven day ground w~ mo~to~ng, wat~ was found ~ 8.5 f~t. Since t~s motoring was i~t~d, a ~ ~n h~ been i~t~d above th~ w~ to catch s~facz w~ run~ng to the t~t hol~ lo--on. Wz ~so propose to i~t~ a second ~rt~n dr~n, as wz ~c~sed, 20 ft. up~ from th~ proposed ~znchzs. Attached d~ the proposedupgrade design. We do not anticipate any adverse effects on n~ighboring wells, septic system or drainage p~rns by the i~tallation of the proposed septic system or by the issuance of the above mentioned waivers. The proposed 500 gallon septic tank is to be placed outside the we~l protective radius. Attached is a site plan which depicts the location of the proposed tank. If you require adddd6ion~ information, please contact uS. Sincerely, Enclosure 17034 NORTH EAGLE RIVER LOOP ° SUITE 204 · EAGLE RIVER, ALASKA 99577 tO0' WELL RADIUS z / / - t Z /i~,~,~ v>f2 IIN/Z W o C~'W[~- rkO_~ C) qlVI3G ZO v N¥]d 3115 Z z 0 W W ,0~ = Z 3ql -IO~ld 0 Z N 'S'J_'N · :3 ~:~ 0--40 o~°~ kd Z 0 3qlJO~d 7l¥13a 'S'I'N PERFORMED FOR: ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 LEGAL DESCRIPTION:L'o1' ~' 1 2 3 4- 5- 6- 7' 8- 9- 10- 11 12 13 14 15 16 17' 18- 19- 20- Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED7 ~'l ~'~p ' IF YES, AT WHAT C~ ~ DEPTH? pO E Depth to Water AIt~ ~' MonitorinD? "' ,~ Dale: ~' ,ct" %k, Gross Net Depth to Net Reading Dete Time Time Water Drop z- 1 PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER -- FT AND ~-'-" FT COMMENTS (Rev 4/851 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST I 2 7 8 9 10 11 12 13 34 15 16 17 18 19 20 .~]~?, ~ ........... --~ ~.~ DATE PERFORMED~'~ b ' l Township, Range, Section: WAS GROUND WATER ENCOUNTERED? iF YES, AT WHAT DEPTH? l]eptb lo Waer Alter ~ ~ Meaitoring? c~ ,,, SLOPE ~ITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop TEST RUN SETWEEN · (minutes/tach) PERC HOLE DIAMETER . _ FTAND ~ ,~"' FT COMMENTS PERFORMED BY: ~'~*')~) I . ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNIC~PAL GUIDELINES IN EFFECT ON THIS DATE. DATE; ~ / ~ /~ 72-008 (Rev. 4/85) HEALTH AUTHORI~' APPROVALS SEWER&WATER INSPECTION ENGINEERINGSTUDIES AND REPORTS WELL INSPECTION & FLOWTEST ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPO,gALSYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 5, Block 1, Valley View S/D August 21, 1996 GENE~%L: ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 The scope of this project includes the installation of two five foot wide drainfields and a new 500 gallon septic tank to serve the four bedroom residence located on the referenced property. The existing 1000 gallon septic is to be excavated to verify its integrity . If of poor integrity, abandoned completely and replace with a new 1250 gallon septic tank outside the well radius. The existing crib is to be excavated, and abandoned: and clean fill brought in. e 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. 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 5, Block 1, Valley View S/D August 21, 1996 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 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. e 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. 3e 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 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. Page Three Lot 5, Block 1, Valley View S/D August 21, 1996 Se Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM I~ATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. me The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pip9 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. 3e 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). Se 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. 7e When sand is being used as a filter material, its gradation specifications ~mst conform to current M.O.A. or D.E.C. requirements. Page Four Lot 5, Block 1, August 21, 1996 Valley View S/D 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, cleanouts, and insulation, but before the placement of any other backfill. e 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. 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. Page Five Lot 5, Block 1, Valley View S/D August 21, 1996 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 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 APPRQVAL FOR A SINGLE FAMILY DWELLING o 50 - Z~. - ~-c} haa # ~. ~'?t~,~ 1. GENERAL INFORMATION Complete legal description Lot 5; Block I; Valley VZewT¢.rrac~ Location (site address or directions) Property owner Mailing address Lending agency Mailing address Esth~ Bend, s P.O. Box 772266 Mile 5 Ea~l~ ~ve~ Road Eagle Riu~.% AK Eaqle Rive% Day phone 694-1575 AK 99577 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: L~ TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water XXX ENVIRONMENTAL SERVICES DIVISION !996 RECEIVED 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. 72-025 (Rev. ~/91) Front MOA 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 vedfythat 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 Eagle River, Alaska 995~ Phone 6'¢J ~' - '~'~ -7~ Date DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for [~) bedrooms, with the following stipulations: Escrow monies to perform all work necessary to upgrade the wastewater disposal system per pending MOA septic permit. Ail work must be completed by June 15, 1996. Additional Comments granted from this department. # Monies to remain in escrow until final approval is '['he 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 D H 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 D HHS 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SE~u'lY Environmental Services Division ENVIRONMENTALSERVICI~$ DIVI$~O 825"L" Street, Room 502 ® Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist J ECE IRED. Legal Description: A. WELL DATA Well type ~, ~ q ,~n-~ Log present (Y/N) Total depth ~[ t~ ~ Sanitary seal (Y/N) "{ES Date completed Cased to ~..~ IfA, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) Date of test Static water level FROM WELL LOG AT INSPECTION % o ~ l ~f'z Well production "~.. O g.p.m. '2 .~ ' g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: B.~OLDING TANK DATA Date installed Foundation cleanout (Y/N) Date of Pumping ~ C. ABSORPTION FIELD DATA Nitrate Collected by: Other bacteria S & S ENGINEERING Eagle River, AlaSka 99577 Tmtk size I 0 oO Number of Compartments ] Cleanouts (Y/N) Depression (Y/N) /~0 High water alarm (Y/N) /~0 Pumper "~ ¢' Qo~Pi ,3 ~ Date installed I ~i-/~ Soil rating (g.p.d./ft2 or R2fodrm) System type Length .Width Gravel ttfickness below pipe ,/-/~1 depth Effective absorption area Monitorin~Depression over field (Y/N) Fluid depth in ~0 n ); lnlm_ech~ttel: after gal. water added (in.): Fluid depth ,/ C~teF~bsorptim~ rate = g.p.d. P~tment (past 12 months) (Y/N) If yes, give date D. LIFI' STATION Date installed Size in gallous Manhole/Access (Y/N) ~'Pulnp on" le..~y, eJ~4¢'~'~ "Pump ofF' level at* High ~sted E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~holding taiflq on lot Absorption field on lot Public sewer main ~ Sewer/septic sen, ice liue [ O~ + ; On adjacent lots Ioo ~ + ; On adjacent lots I o o ~ 4- Public sewer manhole/cleanout ~/.~ Lift station Ioo ~ 4- SEPARATION DISTANCES FROM/S~'~HOLDING TANK ON LOT TO: Buildiug foandation ~ ~ Property line I o ~ 'ff Absorption field Water mai~qservice lille [ O I + Surface water/drainage leo ~ + Wells on adjacent lots SEPARATION DISTANCE FROM ABSOR~ION FIELD ON LOT TO: Building foundation Water lnai~ffse~ice line Surface water ~kin~vehicle storage area ~ Wells on adjacent lots Property line F. ENGINEER'S CERTIFICATION I ce,'t~ that 1 have determined thrufield in6~ections and review of Municwal records t ~}~ ~,s are co ~Jormance w,th MOA H,,M~ del ~s m erect on this date Signature ' ~ ~- ~ Euguleer's Name /[~¢ dX ~ C. ~0 Wd~U , c. cow, ttAAFee $ ~- ~ Waiver FeeS Date of Paymeut ~/~ Date of Payment Receipt Number /~ ~~J Receipt Nmnber Rev. 8/95 eSS: haa.wk.doc · (~ 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O 5'0 -"~-'~/0 1. GENERAL INFORMATION Complete legal description HAA # ~ ~ Lot 5; Block 1; Valley View Terrace Subdivision Location (site address or directions) Eagle River Road Eaqle River, AK Property owner Mailing address Kevin & Kathleen Bragg Day phone. P.O. Box 772266 Eagle River, AK 99577 Lending agency Mailing address. 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 y, xx NOTE: lng to the legality and status of system. If community well system, provide written confirmation from State ADEC attest- TYPE OF WASTEWATER DISPOSAL: Individual 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~)25 (Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER. Address Engineer's signature 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 verifythat 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 Name of Firm 17024 .~..~. m,.~. L~-~p ~.==_.4 .~.'=. =04 Phone ~' ~ ~ ~ ~' ¢/ 7 E Eagle River,~laska 99577 DHHS SIGNATURE /~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Muhicipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificateslbased 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~Y~I 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 Description: A. WELL DATA Well type ~,~ Log present (~N) ~'_~, Total depth Sanitary seal ~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~//~6 (I)~ P'~,~ ~*° Cased to ,~, (~ o ,~l Casing height (above ground) i Wires properly protected {~',1). ¥¢~ Date of test Stati6 water level FROM WELL LOG AT INSPECTION Well production g.p.m. ~. $- g.p.m. WATER SAMPLE RESULTS: Coliform 0 Date of sample: Nitrate O. J Other bacteria 0 B. SEPTIC/HOLDING TANK DATA Iq~l Date installed ~J- [ I-'il; Tank size Foundation cleanout (~/N) ~/~ Date of Pumping ~J~¢ Collected by: $ & $ ENGINEERING 11034 Eagle River Loop Road, NO. 204 Eagle River, AlasEa ~9577 Number of Compartments J Cleanouts Depression (Y~I~) /~o High water alarm (Y/~) Pumper C. ABSORPTION FIELD DATA Date installed q" Length D~'/ Ll(~ q~/Width Effective absorption area Date of adequacy test Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: ' Peroxide treatment (past 12 months) (Y/N) Soil rating (~ or fF/bdrm) ]," ~. Gravel thickness below pipe Monitoring Tube present {~N) ?~-~¢ Depression over field (Y,~') Results (Pass/Fail). ' For ~ Immediately after gal. water added (in.): ~ Absorption rate = g.p.d. If yes, give date System type ~-~c'~ Total depth bedrooms 72-026 (Rev. 3/96)* LIFT STATION -' Date installed Size ~ Manhole/Access (Y/N) ~el at* "Pump off" level at* High wa~~.~'~''~ *Datum CyjTJeS~t e sted E, SEPARATION DISTANCES Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO' ,~ Septic/holding tank on lot 7.5 ~i'~-~lk c'iqT'l)~ |0o "~ On adjacent lots took+ On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~¢~ Prpperty line"' · Absorption field Water main/service line I O!~' Surface water/drainage jeer4' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line i Building foundation ,.,~ I Water main/service line Surface water J o01~ , Driveway, parking/vehicle storage area Curtain drain ~ (.,,~ Wells on adjacent lots iOot p F. ENGINEER'S CERTIFICATION I cert fy that l have determ ned thru field nspect/ons and rev/ew of Mun/c/pal record~t~. .~ lb[~,~. ,,o~ ¢., ~,,;~ ms are in conformance wit~ M¢~HA~uidelines in effect on this date ~¢~,,.,~"" ,~"'..~ {tl.//~/ ~ /-' ~,,, ~ .~, ::,, %'..;. ,& Signature ~ O. ~'~ ~:,']~/>~ ~ HAA Pee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 02/20?96 &8:07 CT&E ES[ RNCHOR~GE ~ 90?6941211 N0,419 005 CT&E Environmental Services lnc, Laboratory Division ~t.~-t.~',~,*'~:~t,,~,~,~',~'~',ar,~r.~'.~r.~ Drinking Water Analysis Report for Total Coliform Bacteria 200 w. Po,,. o.~ve Anchoroga, AK 99~18-1605 READ INSTR UCTIO.YS O.V REYE~E S[DE BEFO~ COLLECTING SA VlPLE Tel; (907} 562-2343 ~ax: (907) 561.5301 PUBLIC WATER SYSTE~I I.D. PRIVATE WATER SYSTEM ~ $~,'Idlnvolfe ~CUST BE COMPLSTI~D BY WATER SUPPLIER .51onfh Day Year SAMPLE TYP£: wlth lab ref. no. ) S,k3IPLE I. OC.:?,TI 0,~ Time Collected Collected IBy BACTERIOLOGICAL WATER ANALYSIS ~CORD ~IMO-3IL;(; Resull: Total Coliform TO BE COMPLETED BY LABOIL~,TORY Analysis sho~vs this Water SAMPLE to be: O Unsatisfactory Sample over 30 heurs old, r;suks may ~e ~nreliable 0 Sampl~ too long in ~ransit; samplc should not be ov*r 48 hours old at ~xaminadon to indicate reliable resuks. Please send new sample via special delivc~ mail, Date Received ~/~ q Time Received ( L ~ ~ Analysis ~egan [ Analytical ~ethod: ~Membranc Fikcr ~ MMO-M~G * Numbel;O¢coloni~/100 mL Lab Reft No. R,suit* Anal);st ~96. 0488 Sent to A.D,E.C. Anfh . Fb~ Jun Dale: Time: Client notified or un~nd~fagto~' resultS: E. Coil . . ISGB COLIFIR~'I ~'axcd Foxed 02/20/96 18:07 CTgE ES[ ANCHORAGE ~ 90?6941211 N0,419 ~03 CT&E ReL# Client Sample ID Matrix PWSID 0 Sample Rem~ks: 960488.2234 L5 B1 VALLEY VIBW[0488-01 Drinking Water .lOO u .1 mg/L Collected Dat~ Te~tmical Director Released By 02/13/96 O0 O0 3~llJO~d / / / / / / / lqlns-s¥ GAAB-HO-I GRf~tER ANCHORAGE AREA BOROU"~",~ §~'. 4FiTMEBIT/ OF EBIVIRONMENTAL 0. UALh , ' 3500 TUDOR ROAD ANC:HORAGE, ALASKA ggS07 27g-8585 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM  ; MAILING NAME ~'~,/'.~//1/ ~>lXL..q,-1./C~.~ ADDRESS SEPTIC TANK: DISTANCE FROM WELL UqU~D CAPAaT¥ / ~ (/~/-~..~ NUMBER OF MATERIAL ~Y-~'J/~ COMPARTMENTS GALLONS. INSIDE LENGTH. -" INSIDE WIDTH LIQUID DEPTH____ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PiTS / OUTSIDE DIAMETER OR WIDTH '~ ~/., LENGTH /~/ , DEPTH ~? LININGMAIERIAL~~ ~ ~ DISIANCE FROM WELL / ~ [ · BUILDING FOUNDATION ~,i NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ, FT. TILE DRAIN FIELD: DISTANCEFRO~ ,FOUNDATION NEAREJTLOT LINE B? F/LIN ~ ETW ~ES TRENCH WIDTH NUM ES NS.T~C E B ABS~)RPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE IN. ABOVE TILE , BUILDING FOUNDATION. SAMPLE NEAREST SEPTIC ~,~ t SEEPAGE ~' LOT LINE , SEWER LINE , TANK· , SYSTEM //'~ ~ , CESSPOOl , NEAREST OTHER , SOURCES.__ DISTANCES: DIAGRAM OF SYSTEM Il' APPROVE G.A.A.B. by DOC Co. aba SULLIVAN WATER WELLS P.O, BOX 670272, CHUGIAK ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND LEc~AL DESCRIPTION ~ DATE- Started PERMIT ~UMBER DEl'TH OF WELL Ended ST&TIC LEVEL OF WATER F'F. "I)RAW DOWN FT. GALS. PER HR ,]c~ O KIND OF-CASING t,-> KIND OF FORMATION:: From (? Ft. toO,?(:a Ft. ' ~ ,..rr,,~ ¢ oot~ From Fro~Cg' Ft. to~~ Ft. ~(~9~Oqt< ?Zd,~ From From Ft. to Ft. J ~g/~'~ ~ ~2~-~ From From Ft. to Ft. (),) 'q ~t ~ .~.4 r, ~' From From~Ft. to Ft. /1 O- ~/~ From.~ Frm~)~ ~ Ft. to~' Ft/~,/~e~ ~ ~ ~< From_ From Ft. to Ft. From.~ Ft. to Ft Ft. to__Ft. Ft. to Ft. Ft. to Fl. Et. to Fl Ft. to__Ft. Ft. to Ft. Ft. to__Ft. .?t. to Ft. Ft. to Ft. From Ft, to__ Ft From ' ' Ft. to~ ' ' Ft. From Ft. to__Ft From Ft. to .Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to __Fi From Ft. to Ft From Ft. to Ft From_ Ft. to Ft. From Ft. to ' oeP'LHealth & Human 8er~ces From Ft. to Fl, MISCL. INFORMATION: DRILLER'S NAME /.~?~..$~t ~.'.-~ ...... -/