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Home My WebLink AboutWOODBOURNE BLK 1 LT 14 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: ..~1~$ (,o (:)6~ PID Number: ~2 I~ - ~.-';i - gO Name: ~*, A~(;~s t~, ¢/~-~,~-A¢-- Wastewater System: [~/New [] Upgrade Address: rjrt ~'0 J ~oo= c. Je~f I&'rH A~. &,o,.~ ¢~ ABSORPTION FIELD I No. of Bedrooms: ~ Trencl~ ~ Shallow Trench O Bed B Mound B Other Deep Total Depth from orlgi al grade: LEGAL DESCRIPTION Soil Rating: ~)~8 GPD/Sq. Ft. I ~ Lot: Block: Subdiv~ion: Depth to pipe bottom from ~riginal grade: Gravel depth beneath pipe Township: IR~ng,:-- ISection: .-- Fil]addedabovo,riginal,grado: Gravellength:. , - WELL: ffi New D Upgrade 3ravelwidth: ~*Ft. Number of lines:z Oislancebetweenlines:j~l Ft. Classification (Private, A,B,C): Total Depth: Cased TO: Total absorption area: Pipe material: ~¢~ Driller: Date Drilled: Static Water Leveh Installer: Date installed: Yield; Pump Set at: Oasing Height ~bove Ground: SEPARATION DIS'rANCES ~ septic u Holding U S.T.E.P. TO Septic Absorption Lift Holding )ubilc/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~0~ ~ J ~5~ Well- i00~~ jO~) j~ ~ Material: ~'r~ ~ Number of Compa~ments: Sudace . Water 10O~ IO~'+ --' ,-- ~ LIF'f STATION Lot Size in gallons: Manufacturer: Line ICOI.'~ eS I,~ .... ~ Foundation i ~ t ,~r~ I ~ ,~ ~ 'Pump on" level at: J~vel at: High water alarm at: Curtain Inspections pedormed by: Drain ' ' Remarks: BENCH MARl( Location and Description: Assumed Elevation: J Inspections performed by: s & s ENGINBERIN8 Dates: 1st ~- I~ -~ ' .......... I¢_t ROBERT C. COWAN Department of Heal,and. Human Ser~ces approval ~ ~),~ ....,;~ Reviewed and approved by: ate:/¢ -//- ¢~ '"~;,*~'o~s~5~" 72-013 (Rev. 9/91) MOA 25 SW960064 2 2 . Permii No. Page of Municipality of Anchorage OEPARTMENT 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 14, BLOCK 1, WOODBOURNE S/D 015-351-20 Legal Description: PID I~ o.: A B C D Ko ~.o' 6.6 - ~-ALF. SITE )BL1 29.5' 29.[ -__ / / / )BL2 ~8.0' 82.[ - - ;oz_- - 52.5' 6o.o' ~NEW TF ENCHES~///¢ Jog - 62.0' 49.5' ~ 204 - 48.0' 32.~ co2 ~ NE~ 1250 GAL SEPTIC TANK~ C02 88.8' z C04 = 92.6~ ~ z col / co~ RAVEL M~ 1C02 / Mr2C CO1 = 85.4' 3 87.9 COg '4.4' ~MT~ 78.4' '['2 = 80.7' ~>r 9 . 1250 GAL ..~=, 72-013 A (Rev. 9/91) MOA 29 Aug-09-96 11:55A P.01 M-~/DRILLING, Inc. P.O. Box 110378 · 10330 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DI(ILLING LOG, Well Owner--BETHARD CONSTRUCTION _Use of WellDOMESTIC Location (address of: Town~hip, Range, Section, if known; or distance main road LOT 14 BLOCK 1, WOODBOURNE ANCHORAGE, ALASKA Size of casing 6, Depth of Hole_ 103 feet Casedto 102.49 feet Static water leveL_ 2 ft. (above)· ~ land surface. Finish of well (check one) open end Screen ( ); Perforated ( ,- ). Describe screen or perforation ,, ~ N,/A, Well pumping test at--lO+ gallo?s pe~ ~I~Yd~) (mina!e) for 1 houm with 100% of drawdown from static ~%,e]. NOTES. WELL DRY GROUTED WITH 1 SACK BENTON ITE Data otcompletioru 20 MAY 1996;' WELL LOG Give de;ta~ of formations penetrated, size of material, color and hardness CASING STICK UP TOP.SO!L: BROWN, CLAYEY, ORGANICS ~L~.~.~,. ,GR~Y, STICKY G'/~:.. COBBLEY, SILTY Depth in feet from ground surface 0 .TO 2__ 2 TO. 8__ 8 TO_ 12 12 , TO. 49 49 ' TO 52 52 T0 64 64 TO 80 80 TO 84 84 .TO 88 86 .TO ].02 CLAY: GREY, SILTY~ STICKY WATERBEARING GRAVEL.' SAND CLAY: BROWN x ) ft. 102 To__lOB ~O .2'0. ~WWA Certified Contractor ...... w~,,~ El4 & 9'13 I -- CUSTOMER ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. SEWER&WATER INSPECTION WELL INSPECTION & FLOWTEST SITE pLANS 801LTEST STRUCTURAL& MECHANICAL INSPECTIONS Date: CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O0 Box 196650 Anchorage, Alaska 99519-6650 RECEIVED AUG 1 9 1996 MURicipality of Ar cr~orage Dept. Health & HumaR Services REFERENCE: L. OT I ~ ~boC~c / b~00D 8~om,~ The septic ins, peqtions for t~e ~eferenced property were performed on 7//7/ ~6 and ~///~/~ . Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the ~~ ,~, ~C to be completed. If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 . EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960064 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MLAKAR FRANCES B OWNER ADDRESS:1002 WEST 15TH AVENUE ANCHORAGE, ALASKA 99501 DATE ISSUED: 5/02/96 EXPIRATION DATE: 5/02/97 PARCEL ID:01535120 LEGAL DESCRIPTION: WOODBOURNE BLK 1 LT 14 LOT SIZE: 84206 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) . 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: DATE: ISSUED BY: ~J ~' W~ HEALTH AUTHORI~ A~PROVALS SEWER&WATER iNSPECTION ENGINEERING S?UD]ES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. CIVIL ENGINEERS April 15, 1996 (907)694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 14, Block 1, Woodbourne Subdivision Request you issue a permit to drill a well and install a sep%io system to serve the proposed four bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole and after seven day g~ound water monitoring, the monitoring tube within the test hole was found to be dry. This proper'fy has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. If you require additional information, please contact us. Sincerely, Robert C. Cowan, RCC/gk Enclosure MUNICIPALITY' OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION RECEIVED 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ~OALE SITE PLAN DESIGN q I NC, WELLS wl'r HIN 100'+ ~ ,( Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: '~'~'~ '~ ~J ~ DATE PERFORMED~ LEGAL DESCRIPTION:)'0~- 15/ .~£l¢ / C'2o0o~',~WErownship, Range, Section: 1 2 3- 4- 5- 6- 7- 8- 9- ~o-- 13- 14- 15 16 17 18 19 2O COMMENTS SLOPE WASGROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~- ~ DEPTH? p E Del)Ih Io Water Alter Date' Mogitorin[l? D/~ ~ . . SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ~/cl~ ~; ~ - ~"//" - ~ '. ~1 ~ ~ ~, ~ ~ ~/¢" ~1~. ,. ~ ¢ ¢ '/~ ,, ¢, ', PERCOLATION RATE (m~nutes/~nch} PERC HOLE DIAMETER TEST RUN BETWEEN ~ '/;~' FT AND 7 Y~- FT PERFORMED BY; 17(~34 Eagle River Coop Road No. 204 ACCORDANCE WITI~&~I[~,/~I~f~ GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) ROBERT C. COWAN, P.E. ROBERTA. SHAFER, RE. HEALTH AU7 HORII~' APPROVALS SEWER&WATER INSPECTION ENGrNEECENG STUDIES AND REPORTS WELL INSPECTION & FLOW TEST ROAD DESIGN SOJLTEST PERCOLATION TEST STRUCTURAl & MECHANICAL INSPECTIONS REFERENCE GENERAL: 1. e De ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Lot 14, Block 1, Woodbourne Subdivision April 15, 1996 The scope of this project includes the installation o~ a 1250 gallon septic tank and leachfield trench 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. 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 14, Block April 15, 1996 1, Woodbourne Subdivision 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 leachfieldo The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the 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. A silt barrier must be installed between the final gravel layer and the native soil backfJ_ll. 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 14, Block 1, Woodbourne Subdivision April 15, 1996 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. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ti200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.Co requirements. Page Four Lot 14, Block 1, Woodbourne Subdivision April 15, 1996 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. 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 14, Block 1, April 15, 1996 Woodbourne Subdivision 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 · ~t~ CT&E Environmental Services Inc. CT&E Ref,# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 966359O02 S & S Engineering L14 131 Woodboume S/D Crawlspace Hose Bib Drinking Water 0 Client PO# Printed Date/Time 12/18/96 16:16 Collected Date/Time 12/03/96 13:15 Received Date/Time 12/03/96 14:45 Technical Director: Stephen C. Erie Sample Remarks: Nitrate-N Total Coliform Results 0.800 0 PQL Units Hethod 0.100 mg/L SH18 4500-NO3F 0 col/lOOmL Sg18 9222B Allowable Prep Analysfs Limits Date Date Init 10 max 12/04/96 EMB 12/03/96 TMW CT&E Environmental Services Inc. Laboratory Division Drinking Water Analysis Report for Total Coliform Bacteria 200 w. Po.er Dr~ve Anchorage, AK 9951 8-1 605 READ LYSTRU'CTIO,VS O.Y REVERSE SIDE BEFORE COLLECTI:YG SA3IPLE Tel: (907) 562-2343 Fax: (907) 561-5301 .".lUST BE COMPLETED BY WATER SUPPLIER PUBLICWATERSYSTEiMI,D.# [ I I I I I I PRIVATE WATER SYSTEbl . SAMPLE DATE: ?,Ionth SAMPLE I'YPE: Rouline I)-epenl Sample (fur routine sample ~silh lab ref. no, ) D Special Purpose SAMPLE LOCATION TO BE COMPLETED BY LABOKATORY Anah'sis .;hows this Water SAMPLE to be: .,~ Satisfactory Unsatisfacto~' a Sample over 30 hours old, results may be unreliable a Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send ne,~ sample via special deliv~.~ ma~ ~ Date Received / '~ ~ Ti,lie Recei,'ed ~, t~. t~ ~..~'~' ,~.am:'s~s Beg..,.1,5 ~ 0 Analytical blethod: Jsi~'Membrane Filter [] MMO-MUG * Number ofcolonies/100 mi. P,.es ult* Analyst D~:' Vee. 96. 6359 Treated Wa/er Untreated Water Thne Collected Collected By BACTE~OLOGICAL WATER ~N~YSIS RECO~ ,ch Fbks Jun Client notified of unsatisfactoD' results: Phoned Spoke wilh Faxed MMO-MUG Result: Tote! Coliform E. Coil .Membrane Filter: Direct Count ~ Colonies/100 m[ Verification: LTB BGB COLIFIRM Fecal Coliform Confirmalion Final Membrane Filler Results ~ Coliform/lO0 mi I'~ e p o r I e d B.v ~", {/"~ ' c'~ ~a t e L~_~.(.~ Tinle ~ hfs ~'~. ~G~ Membe, of the SGS Group (Soci~tO aOn~ro)e de Sur,,eillanee) ENVIRONMENTAL FACILITIES IN A'~,SKA. CALIFORNIA. FLORIDA. ILLINOIS, MARYLAND. MICHIGAN. !A[SSOtJRI, NE~,¥ JERSEY. OHIO, WEST VIRGINIA 6� g970 T, • f7 ��p ISS e, •4 � Municipality of Anchor. I.: � ` On-Site Water and Wastewater Progra �� 907 343-7904 (� SA, ETY . w Certificate of On-Site Systems App: 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, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address PO Box 240773, Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 6/17/2017 OF �_,`P• ' A ••.•sem 9—z\ *. 6. DSD SIGNATURE L, 511 °'71/ �: ••>?••••• System #1 Approved for - bedrooms ��, :I�ICciAEL C.`ANDERSON : System #2 Approved for bedrooms ,••• C• E-4381 ,•\`�` Disapproved , F� p ***** * R r ESSIO* �@ Conditional approval for bedrooms, with the following stipulations °� ��. l 'G .a ON-S1TE WATAND m WASTEREWATER � : PROGRAM 6 By: vt.+s, Original Certificate Date: (0-1 2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. • 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory~' Septic System Advisory Arsenic Advisory'. Well Flow Advisory Other ' • • • • . . cOSA blue sheet S c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Woodbourne, Block 1 , Lot 14 Parcel ID:015-351-20 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 5/20/96 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 103 ft. Cased to 102'49 ft. Casing height(above ground) >18 in. FROM WELL LOG AT INSPECTION Date of test 5/20/96 5/24/17 Static water level 2 ft. Artesian ft. Well production 10 g.p.m. 6.5 9-10-r11- WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 1 -4 mg/L Arsenic NDug/L Date of sample: 5/4/17 Collected by: Anderson Engrg. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/SteelDate installed 7/1 8/96 Tank size 1 '250 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (YIN) N Date of pumping 6/7/2017pumper Around the Clock Pumping C. ABSORPTION FIELD DATA Date installed 7/18/96 Soil rating (g.p.d./ft2 or ft2/bdrm) .8 GPD/SF System type Deep Trench Length 2 @ 30 ft. Width 3 ft. Gravel below pipe 7 ft. Total depth 11-12 ft. Eff. absorption area 750 ft2 Monitoring tube Y Depression over field Y Date of adequacy test 5/24/1 7 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0/54 in. Water added 601 gal. New depth 0/66 in. Elapsed Time: 1 ,440 min. Final fluid depth 0/54 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) "Pump on" level at in. "Pump off'level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100 On adjacent lots >10 Absorption field on lot 100' On adjacent lots 100' Public sewer main >75' Public sewer manhole/cleanout X100' Sewer/septic service line >25' _ Holding tank >75' >100' Animal containment areas X50 Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field >10'Water main Water service line >1 Surface water >1 00 Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: >10'Property line Building foundation > Water main >10 >10' >100' >10' Water Service line Surface water Driveway, parking/vehicle storage Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION .."'"..00.0 till F44/ certify that t have determined through field inspections and 4<Q- '' S+ review of Municipal records that the above systems are in d Uj.` - =..� •*-y�Q .� 0 0 conformance with MOA COSA guidelines in effect on this date. � ,� 49=- ;,�� • ,"r 0 Michael E. Anderson, P.E. " • Engineer's Printed Name " . ..•.. 6/7/2017 t4 ,, . .MICHAEL E. A 4DERSON : � Date 10 •J�.. •CE-4381 ..1...- . 0 •...... COSA brown sheet 10-10-12.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.# 0(~'-.~ 5'~/ -- '~ 0 HAA# /7/'~ GENERAL INFORMATION Complete legal description Lot 14; Block 1; Woodbourne Subdivision Location (site address or directions) NHN Woodbourne Drive Anchorage, AK Prope. rty owner Mailing address L~n'ding agency Mailing address Agent AddreSs Bet~ard Construction 12801 Reata Drive Anchorage, Day phone AE 99.5.16 Day phone 345-] 61 ~ Day phone Unless otherwise requested, HAA will be held for pickup, NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individuel on-site Holding tank Community on-site Public sewer xxx NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-O25 (Rev, 11131) 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 investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances,~a.nd regula_'d.ons in effect on the date of this inspection. Name of Firm s & S ENGINEERING 17U;;Iq Eagle I~iver I.oop I~oad No. 2~ Phone G ~/z-/ Address Eagle River, A~[as .ka 99577 Engineer's signature ~~. ~----~ Date DHH~.~IGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality o~,..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 courtesyto 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. ENVIRONMENT^I, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIGES Environmental Services Division 825 L Street, Room 502. Anchorage, Alaska 99501° (907) Health Authority Approval Checklist Legal Description: A. WELL DATA Well type Log present (~) Total depth J 0 .~1 Sanitary seal ON) ~E~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to _10~.. ~'1' ~ Casing height (above ground) Wires properly protected ¢~/N]. Y~$ Date of test Static water level Well production FROM WELL LOG AT INSPECTIO~ ~ O'~- g,p.m. g.p.m. WATER SAMPLE RESULTS: Coliform I]) Nitrate Date of sample: B.~HOLDING TANK DATA Date installed "~ - ~8..-- ~1 ¢, Tank size Foundation cleanout {~/N) _ Date of Pumping I~P--,cJ Pumper Collected by; Other bacteria S & -~; ENGINEERING 12'654 Eagle RNer L~up Eagle River, Alaska {20577 1'7-~O Number of Compartments '),. Cleanouts (~N) r'{~5 Depression (YA~J ~o High water alarm (Y~ f~o C. ABSORPTION FIELD DATA Date installed Length _~ ~_~_Width __ Effective absorption area Date of adequacy test '? ~1%- ~,t,, Soil rating ~r ft2/bdrm) O. ¢ System type T¢4r'~,i¢ F[ Gravel thickness below pipe '7 ~ Total depth J I ~-.I-z t Monitoring Tube present (~/N) 7't5.¢_ Depression over field (Y/~ ~ Results CPass/Fail) '-- For ~ .bedrooms Fluid depth in absorption field before test (in.); Fluid depth ~-- (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Immediately after ~'gal. water added (in.): Absorption rate = _g.p.e. If yes, g~ve date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons ~ Manhole/Access (Y/N) ~"Pump" off" level at* High water alarm level at* / *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~olding 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 FRO~HOLDING TANK ON LOTTO: Foundation Iff~ Property line Ioo I~._~ Absorption field jj I Water main/service line Iol4'' Surface water/drainage Ioet+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Ef~' I;~ Building foundation ~$1 Water main/service line Surface water ) <3 o ~.~" Driveway, parking/vehicle storage area Curtain drain 14,/A Wells on adjacent lets ICct 4- F, ENGINEER'S CERTIFICATION I cerfi~ that I have determined thru field inspections and review of Municipal recor~.~, t~a~tems._ -,~.,- are in conformance with MOA~AA guidelines in effect on this date. Signature ~Z ~ ~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number