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HomeMy WebLinkAboutVOYLES BLK 2 LT 7 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~cOq~OOS~L PIDNumber: Name: ~fle~ ~H~O~ Wastewater System: ~New ~ Upgrade Address: /~/'I'-S %O.~,~cN¢°O~ C~. ~r~ ABSORPTION FIELD Phone: ~0~ ~lN°'°fBedr°°ms:~ D Deep Trench ~ShallowTrench DBed DMound nether LEGAL DESCRIPTION so, Rating: , ~/~ GPD/Sq, Ft, Total Depth from original~, grade: Lot: Block: Subdiv~ion: Depth to pipe bottom from odgin~l grade: Gravel deplh beneath pipe Township: I Range: I Section: Pill added above original grade: Gravel lan th: WELL: ~New D Upgrade ~ravel width:~ Number of ,nas: Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe materi~; Driller: Date Drilled: StaticWater Level: Installer: Date instaged: Yield: Casing HeigM Above Ground: SEPARATION DISTANCES ~Septic ~ Holding O S.T.E.P. To Septic Absorption Lilt H~lding ~ublic/Pdvate Manufacturer: Capacity in g~llons: From Tank Field Stabon Tank Sewer Lines ~O~A~ Number of Compartments: Sur~.c~ ~ LIFT STAT~~ Water ~ Oo'+ ~ co ~ -~ Remarks: %V~T~ ~s16~ ~f/A~ BENCH MARK ID0, O ENGINF~'S SEAL inspections performed by:lIOa4 Enolo Rivar Loon Road. No.~es: 1st. ~-/~-9~ Department of Heal um n ces approyal Reviewed and approved b Date: 72-013 (Rev. 9/91) MOA 25 Permit No.SW95°°52 Page 2 of 2 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 LOT 7, BLOCK 2, VOYLEB S/D 05106469 Legal Description: PID No.: ST [ SI'2 ;: FINAL GRADE--: ~INSULATION 94,6~ MT5 M"I'2 co4 00.4' ~A'I'ER FOUND COB SCALB 1' = 40' 000 GAL TANK' ....... WELL 92.4'....I MT3 C07 · FCO i39' 39' ST1 i38' 44' ST2 i40' 47' C01 i41' 48' C02 i42' 49' .C.0.5 i~5.! 29! C04 i26' 8O' C05 i38' 91' C06 i56' 64' C07 i55' 00' C08 i64' 76' ..~.T!... .i.n.r.i...7.~.L MT2 i$9' 89' MT5 54' 99' iRT C. COWAN CE - 8801 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:SW950052 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:GRAYBILL JOHN & DOLORES M OWNER ADDRESS:P.O. BOX 670350 CHUGIAK AK 99567 DATE ISSUED: 4/19/95 EXPIRATION DATE: 4/19/96 PARCEL ID:05106469 LEGAL DESCRIPTION: VOYLES BLK 2 LT 7 LOT SIZE: 43700 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 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 (18A3~C72) 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 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: RECEIV DBY' ISSUED BY: ,/C~ ~~ ~:~ .... DATE: HEALTH AUTHORITY APPROVALS SEWER&WATER iNSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD OESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL ~NSPECTIONS ONSITE WASTEWATER CISPOSAL SYSTEM CESIGN ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. Ap~ 7, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 7; Block 2; Voylzs R~e~t ~o~ i~6~ a ~e~ot to ~ a~tlandin6ta~la 6~ptie 6~6t~ to 6o~v~ th~ propo6ed th~e bedroom bowie on the r~f~eneed property. Test holes we,re excavated and percolation tests performed. The approxd~ate location of the. test holes ~Le located on the attached site plan. At the time of excavation water ~s zncounte,red at I0~ feet in test hole. #I and 10 fe~t in test hole #2 and aft~ seven day ground water monitoring water was found at 10~ feet and 10 feet respectively.. T[~ property has enough ar~a for a future septic upgrade which can be seen on the attached site plan. We do not anti,pate any adverse effects on neighboring prop~rti~ by the, installation of the proposed septic system. If you have any questions, or re, quire addd~onal information for your review, please contact us. Sinc~Lo~y, Robert C. Cowan, P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP o SUITE 204 · EAGLE RIVER, ALASKA 99577 ']']]AA AIINnBI~OO A8 (]3AUqS OS-1¥ HI~tON 3FII Ol Xl~3dO~d IN3OVf'(]V 'R31SAS 31183S JO ,00~ NIHII~ Sq-13M ON 'P~31S),S ~J31¥~ XIINn~FIOD Aa 03AUIS A.L~3dOad NVId 311S [ (.9 [ o / O0 0 o~ )[:DOi3 d33(] '/~ .... ,,9 3AI±O3333 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: L--'O"~'~ d ~t-'~" "-~ t~/l~%-[l~'~',~ Township, Range, Section: oF..- 5 6 7 8 9 10- 11 13- 14 15 16 17 18 19 2O SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTR? ~'-~ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE . TEST RUN BETWEEN __ tm~nutes/mch) PERC HOLE FT AND q FT DIAMETER __ COMMENTS 72-008 (Rev. 4/85) Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST CE - 8801 LEGAL DESCRIPTION: ~--C"f-'~ ~'PL.~' '~ qO~,{L.~¢.S ~'~ Township, Range, Section: SLOPE 1 4 7 8 9 10 11 12 13- 14- 15- 16- 17- 18- 19- 20- WAS GROUND WATE. ENCOUNTERED? IF YES. AT WHAT DEPTH? OepLi~ to Water Menilorir~g? ~ SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~'Z.¢~ (m~nutes/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND t-~ FT COMMENTS PERFORMED BY: ~ ~'~ ~-'~ ~"~ '~"~ ¢~--~'["~ , F~'~V~'-~ ~'C> ~'~c~--' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTA'rEANDMUNICIPALGUIDELINESINEFFECTON THiS DATE. DATE: 72-008 (Rev. 4/85) ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. HEALTH AUTHORITY A~PROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST ROAD DESIGN SOIL TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE ~A~TE~ATER ~ZSPOSAL SYSTEM CONSTRUCTION PRACTICES MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 GENERAL: The, scope, of this project includes the installation of a 1000 gabon septic tank and five foot wide, drainfield to serve the proposed three bedroom r~sidence for the referenced property. Construction shall be in accordance with the approved site plan and design drawings, MunieipcZ pe~it with any special provisions or conditions, and ~ applicable State and Municipal Wastewate~ Disposcl Regu~tions. 3. The, contractor shall be responsible for obtai~ng any necessary underground ut~y locate~. Unless spe~ifieally agreed otherw~e, the property owner sha~ be responsible for fin~ grading are¢~ subsequently depressed from soil set~eing. On a~ lcaehfie£d mound systems, the, prope¢~y owne~ shall be responsible for ensuring a satisfactory vegetation growth over the, mounded area. Contractors instating wastewater d~posal systems must be certified by the Municipal Health Department for system instal~ztions. Owners installing their own systems must also receive prior approval from the Muhicipal Health Department. SEPTIC T/~K INSTALLATION: A septic tank is to be, constructed by a certified septic tank manufacturer. Construction shall in~ude two 4" cleanout~ for pumping access. 2. The septic tank shall be sufficiently bedded to prevent setting or shifting of the tank. 3. All standpipe~ on the septic tank sh~ extend a min~m of 12 inehe~ above final grade,. 4. Septic tanks installed with l~ss than 4' of cove~ sha~ be. ins ulated. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page, Two Lot 7; Block 2; Voyles Subdivision Ap~ 7, 1995 A foundation cle~nout sha~ be installed one to four feet from the building foundation. In the line beXween the~ tank and the leachfield there shall be two adjacent eleanouts (unless an effluent pumping syst¢~ 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 l~achfield. The, second elcanout shall be to clean toward the, septic tank. 6. Fina~ grading ove~ the, septic tank shall be, such that a positive slope. exists away from the septic tank. ABSORFJ'ION TRENC, tt/1)RAINFIELD INSTALLATION: Excavate, the proposed trench to the dimensions shown on the design. The, bottom of the, excavation shall be within 2 inche~ of level. If the, sidewalls of the, excavation become, smeared, they must be, raked or scratche,d (roughed-up) before gravel (sewer rock) plac~ent. Once the gravel is instated, the d~tribution pipe, ~ to be, installed level with the, p~rforations faced downward. 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 instated b~tween the, final gravel layer and the, native, so~l backfill. Ensue the silt barrie~t covers the entire, graveZ surfac~ before placing backfx~. Monitor tubes shall be, of four (4) inch dia~r and instated approximately in the locations shown on the design. The, portion of the monitoring tube, ~xtending through the gravel shall be. pe~forated 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 d~sign. Backfill over the final gravel layer must not be less than twenty-four ~24) inches. Insulation m~t be, insta~led whe~ the, backfill depth is less than thirty-six (36) inch~s. The, finish grade over the, trench must be mounded to prevent the, formation of a depression after se~ng. ~I~I~UM I~TERIAL SPECIFICATIONS: I. Any septic tank proposed for installation must be, constructed by a Municipally approved septic tank manufact~er. Page Three Lot 7; Block 2; Voyles Subdivision April 7, 1995 2. The fo2~owing pipe mat~a2~ are, approved for usc in septic system installations in the Municipally of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Y~s ASTM D3034 (PVC) Y~s Yes ASTM F810 (HDPE) Ye~ No ASTM D2662 (ABS) Yes Yes Use of a type of pipe othe~ than listed above mu~t be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Ch~icol Company Styrofoam HI or equal). 4. Septic tank iml~s and outl~¢~ shall be fit~ted with watertight couplings (Caulde~, F~nco, or e~qual). A pemmeable nontoxic silt baraAer (Typar 3401, Mirafi 140/N, or equo~) mu~t be im~talled b~we~n the finol leachfield gravel layer and the native, soil backfi2~. 6. A2~ lcackfi~ld gravel (s~wer rock) sh~2~l 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, it~ gradation specifications must conform to c~rent M.0.A. or D.E.C. requirementS. INSPECTIONS: Typically there wi2~ be a minimum of three (3) inspe~ons required du~ng the installation of the waste~ater disposal system. These inspections will occur as follows: I. Th~ first inspecX~Lon must be conducted after the excavation of ditches, pit~, trenches, or bed~ 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, sX~t barrier, ~rave£, distribution lines, standpipes, cl~anou~, and insulation, but before the. placement of any other backfill. Page Four Lot 7; Block 2; Voyle~ Subdivision April 7, 1995 The final inspec~sion is to occur upon final grading of the property. 0fte,n there wi~ be, more. than the~e 3 inspections required, e~pedially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Th~, the. inspecting engine~L is to be contacted at least 24 hours p~or to thc start of construction. If necessary, a pre~construction meeting will take place on-site. The inspecting enginee~ wi~ not coordinate, direct or control in any way the contractor's activiti~. The own~ shall contract with the contractor to perform the work outlined in th~se spe~fications and plans and in accordance, with the, attached M.O,A. permit. Thence will be, no contractu~ arrangement e, xisting between the contractor and S & S Engineering. S & S Engineering shall be, the. owner's representative and wi~ i~pect the, work as stated above, to document the contractor's activities. Final acceptance of the co,factor's work rest~ with the, owne~ and the M.0.A. S & S Enginee~ng shall have. no liability to the, owner or to others for acts or omissions of the co,actor or any other persons performing work on t.~is project or the failure, of the contractor to carry out the, work in accordance with these, construction documents. S & S En~ineerin~'s inspecting engineer will not be responsible, for the construction m¢~ns, methods, tech,iques, sequence, procedures or the, safe~y precautions incident to th~ project. CONTRACTOR/INSTALLER JUN-21-95 WED 06:16 PM SULLIVAN WATER WELLS 688 2?59444444444444 P. 01 (ger ifiell rilltng by SULLIVAN WATER WELLS P,O. BOXSZ0272, OHUGIAK, ALASKR99557 , TELEPHONEO~8,275g ADDRESS DA~f E - Started Ended PERMIT NUMBER DEl'TH OF WELL STATIC LEVEL OF ~¥ATER DRAW DO'NN FT. GALS- PEP, HR ~ KIND OF FORMATION: Froro~Ft. to.~- Fi. to Ft. Ft to__Fi Ft, to _Et. Ft. Io Fi, From ..... FI, to ~Ft, From ..Ft. to.__Ft.. From Fl. to FI,__ From .... FI, lo~Ft __ l:tObl .~Ft. to _Ft. FtODX~ ~FI, to.__Ft From ,,. Ft-to .~Ft From FI, to ,_FI Prom Fi. to. Ft,__ From Ft. to~F! ............. Flom___ Fi, (o~, FI,~. Fror~ FI. ~O__rt. From .... Fi, to FI,__ .... From.__.Ft. to__Ft. ... From.___.FI. Io Ft Frot~ ...... Ft. to Ft ldI§CL, iNFORMATION: ,,: ....... ~-' ' ~ MUNICIPALITY OF ANCHORAGE ~: "..'. ?' = ~ .... "_~._:'~ ' DEPARTMENT OF HEALTH & HUMAN SERVICES . %?.' '. :~.,?~r. D v s on ~of Environmental Se~/ices · ' '" ' "'~ '~ On-Site Services Section "' ' " "~P.O. Box lg6650 Anchorage, Alaska 99519-6650 343-4744 · " CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel!l:,D.# (9 &. / -(9 (0%' - c~c) ~,.. :~ .HAA#.:' :~ (~°t~L/~);:~,'~ GENERAL INFORMATION ' ~: ..... Lot 7; B£oc~ 2; Voyl~S S~bdivisio~ Complete legal, description Location .(site address or directions) ~.. Chand~ll~ Circle Chuqiak, AK ~' ;$;?r~perty owner*"'":' C/t~.~.s Joh~on Dayphone 688-7095 '~ ~:Mailingaddress 18~17-3 So, Birc~ood Loop Chu~x~k, AK 99567 -.:,';¢ ~ending agency 2__ -, .. Day ph ........... ...... one~ ~' "~"" ' ;- ,: -. :'.. u ':'; . , , .~ . , ' ~,-.~. ;!;;~ i.,,.~ .~ . .... , ..... nd v dua well ....................... ~--~,. - ,,. ' , · . ,.,-,~.~,~.~ ......... 0 - __ ~iNOTE: .Jf commo~v~ell system, provide_yvdtten con~(rmation f~o~7.~tate ADE.~;at{est' "~,: '~-. +lng to tl~e'legality and status of system. -- 'i ' "" :'~' '-" " [:':.~-i ii.. 4. T~PE OFWASTEWATER DISPOSAL: Holding tank .... site ' ' ....... · ' · Community on- ' .... -- """ .....' ....... e NOTE: If community wastewater system, provido writt n confirmation ~rom State ADEC attesting to tl~e legality and status of system. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAl. CHECKLIST Legal Description: L~.'~ -7, ~_.c~. ~ k/~,yL~-~ 4/0 Parcel I.D. A. Well Data Well type Log present if A, B, or C, attach ADEC letter. ADEC water system number Date completed ¢'~-~' 5" Driller Cased to ~ q' Casing height Total depth 7_C,,-~ Sanitary seal ~(~N) '.7/ FROM WELL LOG Wires properly protected (~N) Date of test Static water level I ,~O ' Well flow ~ Z-. O Pump level1 .OI/-~ SEPARATION DISTANCES FROM WELL TO: Septic/holding-tank on lot J 67 Absorption field on lot [ H q ~ Public sewer main -~ '+ Sewer service line ~ ~ '+ g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (~ , Nitrate Date of sample: ~ -,% ,~ -~¢$' ,/(" ~ 1~ ' 95' B. SEPTIC/HQI.~IN6 TANK DATA Date installed (~ -/9 - 9~'~ Tank size Z. 6, Other bacteria Collected by: S 8,~--N ~ ! 1703~ [;~91e River Loop Road No. 204 Eagle River, Alaska 99577 I ooo -~- Compartments Cleanouts (-~N) ~./EE, Foundation cleanout ~N) k/~% Depression (Y,~ High water ,alarm (Y/t~) h/o -- N/"A Alarm tested (Y/~ I',/o -- ,%-/"A Date of pud~ping ~'/A- ~-.~ ~y~q'~'~. Pumper /v/A- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot }t~"7 ' ioo' + Foundation To property line -/'~ ' 5 ' Water main/service line Surface water/drainage On adjacent lots Absorption field IoO ~ CONTINUED ON BACK PAGE 72-026 (3/93)* Front 06×30×95 10:05 COMMERCIAL TESTING ~ 90?6941211 N0.782 Q05 CTS/E Environmental Serv ce~ Inc. ~boratory Division Drinking Water Analysis Report for Total Coliform Bacteria 200 w, ~o.~, or~v, Anchorage, AK 9~518-1605 READ LNSTRb'CTIOA,'S ON REVERSE SfDE,~EFORJz' COLLECTZt",'G SA.,g?LE ' Tel: 1907) 502-2343 MUST BE Colvr. PLETISD BY WATER SUPPLIER O PUBLICWATERSYST£Mi.D.e- ,: ~ · ;~[ PRITVATE 'WATER SYSTEM SAMPLE DATE: hlonth SAMPLE ~ Routl.e 0 Repe~t Sample (for routine sample with lab rcf. no. __ o Special Purpose Year O Treated W'n t et' rn Un,reared Water s.~,~va,~E ~.OCA'rzoM Time Collected Collected lB)' · -:: ',~" Fax: {907) 561-5301 TO B~ COMPbETED BY LABOIL~,TOR\' Pmalxais simws Q~is Water S,~x, fPLE Lo be: Safisfacto~' c* Unsatisf~mor)' a Sample over aO hours olo, ,esu,~s · be unreliable r] Sample too long Jn transit: sample should not bc over 48 hour~ old to indlc~_te reliable resulu. Pl¢~s= scad new sample vl~ special delive~ m~il, Date R~ceived ~~ Analysis Began Analytical 5tethod: It( Membrane Fiber MMO-M'Uo Number of colonies/100 mi, Lab Re[ No. Result~ Anah'~t ,~ Sont Io A.D ~.C. /'~n-~h% Fbk~ Jun ~ Dele: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD .Membrane Filter; Dire~t Count 0 Coloniesll00 mi , Veri final;ion: LTB. BGB COLIFIRbl Comments: Final Membran~ Filter }~eported By - pAR~OF o~ Two ToQJ f Low ~;~ Member of lhe $G$ Group [So,iht6 Gt~n~r*le de Surveillance] zTF CT&E Ref,$ Matrix CTStE Environmental Services Inc, Laboratory Division ~ s~.~ Laboratory Analysis Report L9 BLK2 VOYSB~ 8/D Ordered By R. COW;UN P~inted Date ProJec~ Received Date 06/20/9~ ~ 10:30 hrs. Sample Remarks= SAMPLE COLLECT~D BY: 8 & $ ~NGINEBBING, NA - Not A~aly~ed 200 W. ~o{ter Or{ye, A.ehorage, AK 99~18-160~ -- Tel: (907) 562-2343 Fa~: {~07) 5~1-5301 SNVIRONM~NtAL FACIUTIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND. MICHIGAN, MISSOURI. NEW JERSEY, OHI0. W~$T VIRGINIA C0~ 8~L'ON EI~]P69L06 ~ DNIISBI q~ID~BWWOD £S:9I 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 D~~N TO'. Well o~d~'~ On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump~at .Cycles~teste-8'''''~ Surface water D. ABSORPTION FIELD DATA Date installed G- [~- ~- Soil rating (GPD/Ft Length IH~ ~ror^c Width 5 Gravelthickness. ~2 ' Total absorption area/~ %,~ ¢~ Cleanout presentON) ¥6% Date of adequacy test ~,/A- ,-~-*~ s¥5'r~,,,,s Results (pass/fail) f for Water level in absorption field before test ~ After test Peroxide treatment (past 12 months) (Y/N) / If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: System type 5 HALLOUa Total depth H.6 - Depression over field (Y~) ,,-' Bedrooms Well on lot J't~' On adjacent lots I oo ~+ Property line To building foundation ~'8 To existing or abandoned system on lot On adjacent lots ~o'~- Cutbank ~5o' + Water main/service line lo Surface water I oo + Driveway. parking/vehicle storage area Curtain drain ~ o ~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to al~ MOA and HAA guidelines in effect c date of this inspection. Signature Engineer's Name Date HAA Fee $ ~:~v-.,'0, ,/D Date of Payment ('/~/~J/,~,~ ~ Receipt Number /~ ~"~ ("//"~"~/ 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number CE ~8801 As certified i~;/my se~l'~fflx~'h~'r'et(~ ~.n~l:as'bf!{l~'valldati0n date shown below, I veri~ that my . investigation of this Health 'AU~hori~ A'~pmvai application shows that the on-site water supply and/or wastewater disposal system is ~fe, functional and adequate for the number of bedrooms and ~pe of structure indicated heroin, I fu~her verify that based on the information obtained from the Municipali~ of Anchorage files and from my ~nves~ation and insp~tion, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal an~ State codes, ordinances, and regulations in eff~t on the date of this inspection. · S&S ENGINEERING ..... Phone ~ ~- ~ .7.~ Name'0f Firm 17c;~ EagJe ~lver L~p Road NO. 2~ Addre~ Eagle River, Alaska 995~ ~ Date ~/~/~ - 6. DHHS~ SIGNATURE .~1. .... ~ "?:~'~,!"':':':": ..... Disapproved;*::':~:-'."l'!'""*'~?.:~'::~'?-?:~'::"~ ::'~'"':'"~:~:'~-'" " Cond tional aDprov~ ~ for;~,- ~*'"'~'*'"~' '~*: '- 'bedrooms, wlth..the following Date The Municipality of Anchorage Department of Health ano Human Services (DHHS) ssues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above Dy an independent professional engineer registered n the State of Alaska. The DHHS d°es this as a c°urtesy t° purchasers °f h°mes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DH HS do not .conduct inspections or analyze data before a cert f cate is issued/The Municipality of Anchorage is not responsible for errors or omissions in tl~e professi0nal':~ngineer's ~orl~.' '