Press Alt + R to read the document text or Alt + P to download or print.

No preview available

The URL can be used to link to this page

Home My WebLink AboutGROLL BLK 2 LT 6&roll Block 2 Lot 6 #050-521-35 Inspection Rep&r�1-1-12.doc Municipality of Anchorage Community Development Department Pagel of 3 On -Site Water & Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:llwww.muni.org/onsite • (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP121005 PID Number: 050-521-35 ❑ New N Upgrade Name: TONY GONGLIEWSKI ABSORPTION FIELD ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address; 25427 BLACK PINE CIR. *EAGLE RIVER, AK ❑ Other Soil Rating: Total Depth from original geode: Phone: No. of Bedrooms: 907-694-8669 4 0.6 GPD/Sq. Ft. 11 MAX Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade: Grovel depth beneath pipe: SEE DWG. Fl. 5.03 & 5.02 Ft. Subdivision: Block: Lot: Fill added above origiml geode: Gravel length: GROLL S/D 2 6 SEE DWG. Ft. 50 + 50 = 100 township: anger ec ion: - Gravel width: Beds Number of lines: Distance between linew - - 2.5 FL N/A N/A Ft. SEPARATION DISTANCES Total absorption area:Number 1000+ Ft. of trenches: 2 Dist. between trenches: 10+ To Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines So. Ft. Well too'+ 100'+ - - 25'+ TANK ®Septic ❑S.T.E.P. 01-lolding ❑Other Manufacturer. Capocity: Surface water 100'+ 100'+ - - ANCHORAGE TANK 1250 G.J. Lot Line 5'+ 10'+ - - NA Material: Number of comportments: STEEL 2 Foundation 5'+ 10'+ — — LIFT STATION Curtain Drain NONE KNOWN Manufacturer: Capocity: - Got. 'Pump or, level at: lump off Isvel o(: Ni or alarm at: Remarks: OLD SEPTIC TANK WAS DECOMMISSIONED PER UPC. Pump Make & Moder teicol Inspections performed by: PIPE MATERIAL House to tank D-3034 Tank to D-3034 drainfield Installer WHITTERS EXCAVATION Drainfield D-3034 CO/MT D-3034 Inspector GEG, Ltd. BE MARK (Assumed elevation) 100.00 FI. Inspection Dates: 1st 5/14/12 2nd 5/14/12 I.ocobon and Dascriplion: 3rd - 4th - TOP OF CONCRETE SLAB Q GARAGE ENGINEER'S SlA Community Development Department Approval00 o p poi F �F Conditional approval: Date: :9 v0 .............. .......... p. .... ........ p QO P Gar ess•- E vp Q�4pPPa••b.�d�la�';�000 iill�l�,,� Date:�f�7" 4QQ Profession Approve o Inspection Rep&r�1-1-12.doc PERMIT NUMBER: AS BUILT DRAWING PARCEL ID NUMBER: I OSP121005 050-521-35 TESTHOLE LOCATIONS WERE APPROXIMATE ON THE DESIGN. LOCATIONS SHOWN ON AS -BUILT DRAWING ARE CORRECT. / OLD DRAINFIELD CONNECTED AS A RESERVE SITE--( TH#i 1&2 — NEW 1250 GALLON DEEP BURIAL SEPTIC TANK i / / y Fki f yOG� �b c SF. 4 HNSULATED SEWER LINE v EXISTING UNDER DRIVEWAY WELL , Y ( THICK, 4 WIDE) PER CONTRACTOR 100' WELL RADIUS -- NEW DRAINFIELDS I 1 1 1 OF SLOPE (APPROX.) OF SLOPE (APPROX.) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 3701 E. N1 FMO. Wn 101 • aucxOwGE. M N W] • FNONE (9071337-61N • 9M (907)336-3346 • MM": �w.9ommengina•ring.cam PREPARED FOR: PHONE NUMBER: PAGE NUMBER: TONY GONGLIEWSKI 907-694-8669 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: GROLL SUBDIVISION; BLOCK 2, LOT 6 1 PNB/JLM TYPE OF WORK: AS -BUILT DRAWING (Rev.01105) 6/6/2012 PERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: OSP 121005 050-521-35 /rr FINAL GRADE = 99.63-100.47 ST1 / ST2 TOP OF TANK j TOP OF TANK AT INLET= 92.16 AT OUTLET = 92.15 NEW 1250 GALLON INVERT OF BUNG SEPTIC TANK INVERT OF BUNG AT INLET = 91.54 AT OUTLET = 91.42 FINAL GRADE jft rORIGINAL GRADE = 93'17-93'34 ORIGINAL GRADE = 93.45 FINAL GRADE MT I = 90.65 ® HIGHEST POINT = 9n 77-99.84_ B ® HIGHEST POINT FABRIC FABRIC INVERT OF PIPE = 87.47 :RT OF PIPE = 84.68 0+ BOTTOM OF TRENCH = 82.45 BOTTOM OF TRENCH = 79.65 RELATIVE ELEVATION OF BOTTOM OF TESTHOLE = 73.45 (GW ® 75.45)-sILL RELATIVE ELEVATION OF BOTTOM OF TESTHOLE 7386 (DRY) 00600 �� GARNESS ENGINEERING GROUP, Ltd. p * 4 `• CONSULTANTS& GENERAL CONTRACTORS """ "' • •••"• "" .. 37D1 E. 79C9R RM. SURE IDI • ANlW C. M 996D7 • MW (907)337-6179 • FM (9D7)336 M" • wE9a a —9.m range imq .m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: •• •. ...•••• ......•• TONY GONGLIEWSKI 907-694-8669 3 OF 3 O e f ey Go ess; LEGAL DESCRIPTION: DRAWN BY: Oo9 CE 79 3O GROLL SUBDIVISION; BLOCK 2, LOT 6 PNB JL QQ'e ''•(R4F c°d TYPE OF WORK: DATE: 4�OPloOOOofess!0 PROFILE AS—BUILT DRAWING 6/6/2012 (Rev. 01/05) On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP121005 Tax Code Number: 05052135000 Work Type: Septic Upgrade Permit Effective Dates: January 19, 2012 to January 18, 2013 Design Engineer: GARNESS Subdivision: GROLL GROUP. LTD. Site Legal Address: GROLL BLK 2 LT 6 G:0262 ,tr-1`/-t2 57-14-12 Owner/Address: GARNESS ENGINEERING GROUP, LTD. 3701 EAST TUDOR ROAD, STE#101 JENS JENSEN ANCHORAGE AK Site Mailing Address: 25427 BLACK PINE CIR, Eagle River Lot Size in Sq Ft: 126168 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage C 4)_ * 3 0 r 3;0 All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: PRIOR TO CONSTRUCTION: Verify the trench design with another percolation test at the location, 'Proposed Confirmation Test Hole", as shown on page 2/3 of the design. Special Provisions: The permit includes waiver OSP121008, allowing the drainfield to be 35 feet minimum from a slope that is 25% or greater. C 01 ►^e U seS �I�e arra `� �''�! d �.(� Received By: Issued By: �!—hC kllyw X __k� Dater Municipality of Anchorage P.O. Box 196650 9 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://Www.muni.orn/Onsite Development Services Division On -Site Water and Wastewater Proaram n.ent SPS S L n v. Department **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP121008 COSA#: Permit#:OSP121005 PID#: 050-521-35 Legal Description: Grolt, Block 2. Lot 6 Engineer: Garness Engineering Group Applicant: Tony Gonaliewski Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the 25% or greater slope has been approved. The approved separation distance is 35 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: x Waiver is not Granted: Date: Approved by 1, Name of Reviewer .............................................................................. Rec#: 0179OG Amount: $200.00 Date Paid: 1/19/12 **** VARIANCEIWAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I. D. Property owner(s) TONY GONGLIEWSKI Day phone 907-229-5314 Mailing address 25427 BLACK PINE CIRCLE * EAGLE RIVER AK * 99577 Site address 25427 BLACK PINE CIRCLE * EAGLE RIVER, AK * 99577 Legal description (Sub'd, Block & Lot) GROLL S/D; BLOCK 2, LOT 6 Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (E all that apply) Initial ❑ Absorption Field ® Upgrade Septic Tank ❑ Renewal ❑ Holding Tank Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: s3 L 00 Waiver Fees: '�y0 `:-o Date of Payment: l Ila 11), Date of Payment: 1 1 q /1 a Receipt Number: (12qG7 Receipt Number: O )''�01)0 C�j Permit No. OSQ1,21005 Waiver No. 02 Q/,) 1 a69 (Rev. 01/11) a i i. GROUP,, i `. ! CONTRACTORS January 2012 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic System Upgrade for Groll S/D; Block 2, Lot 6 To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The septic system is in a state of failure and needs to be upgraded. We are proposing to install the alternate site identified on the original 1995 design an Sol I wmummzzffip� or the original 1995 Robert C. Cowan, P. E. design, two test holes were excavated on the property. The alternate drainfield will be designed around the 30 foot radius of the test hole #1. A confirmation testhole was excavated by Whitters Construction on December 29, 2011, and logged by GEG, Ltd. to confirm groundwater separation. This test hole was excavated directly next to the original test hole #1. We are proposing that a confirmation test hole be excavated as shown on the design drawing to confirm soil condition are the same on the east of the proposed drainfields. Comments regarding the design are summarized as follows: 1. SOILS: Since the 1995 test holes were dug, approximately 5 feet of fill has been added in the area. We are basing our design therefore on the original test hole depth, adjusting 5 feet to remain true to the original soil elevations. See the attached log which shows the soil classifications and groundwater monitoring. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATER: There is no surface water within 100 feet of the proposed upgrade. 4. TOPOGRAPHY AND SLOPE WAIVER REQUEST: As can be seen on the attached design, the slopes below the drainfield are approximately 10-15% running northeast to southwest. Approximately 35 feet downhill from the lowest trench, there is a slope that ranges from 35 to 50 percent slope. Attached is a profile drawing showing the worst case scenario in regards to the slope. As you can see, the 25 percent slope 2 feet above the top of the drainrock (2.5' above the invert of the pipe) daylights approximately 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessenginecring.com 44.5 feet downhill from the lowest trench. The steep slope is heavily vegetated and is believed to consist of fill that was created at the time of the construction of the house. We request that a 35 foot waiver be granted to a slope greater than 25 percent slope. It is our opinion that there is minimal concern with the granting of this waiver. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. , P. E., M. S. NO TE.- Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for this septic system. (Contact G. E. G. Ltd. for 7 page construction specification letter) 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * website: www.gamessengincering.com \ GROLL S/D; \ BLOCK 2, LOT 4 \ HIDEAWAY S/D; LOT 5B,, \ \ DAMMAN CIRCLE N E: 1 • = 100' 1 LOYE S/D; BLOCK 3B, LOT 2 \ c�F .9� :XISTING SEPTIC SYSTEM \, EXISTING \ 4 BEDROOM HOUSE \ a � EXISTING WELL 100' WELL RADIUS I 1 1 \ SEPTIC UPGRADE _ _ i T74N, R1W, SEC 23; NE4 NE4 NE4 SW4 C2 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS • • • 3701 E. NOOK ROM. 5U 101 • Il1CXORAOE. M 98507 • PHO 90))337-6179 • FM (OrAM-3 S ieEEbRE:.e�.99rnannginashp.c O PREPARED FOR: PHONE NUMBER: PAGENUMBER: •• •••• •••••• •••••••• TONY GONGLIEWSKI 907-694-8669 1 OF 3y f y GOrn sS:' LEGAL DESCRIPTION: DRAWN BY: oOO 9� GE— ct'G GROLL S/D; BLOCK 2, LOT 6 J.L.M. TYPE OF WORK: DATE: �QOO4 fe slo �o CITE PI AN rnP SEPTIC SYSTFM I IPr PAT)F 1 2012 1nev. uvw) Lot / NOTE: THE CONTRACTOR SHALL HAVE THE SOUTH LOT UNE FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO ANY CONSTRUCTION. EXISTING DRAINFlELD TO BE CONNECTED AS RESERVE SITE ':9.. m m OF BEDROOMS: 4 PER DAY (GPD): 600 PION RATE/S: 32 k 8.5 MIN/IN (20.25 AVG) D APPLICATION RATE: 0.6 GPD/FT' DRAINFlELD SO.FT.: 1000 MAXIMUM DEPTH: 11 FEET WIDTH: 2.5FEET LENGTH: 100 FEET (2 O 50 FEET LONG EA.) EFFECTIVE: 5 FEET ACTUAL SO.FT.: 1000 PROPOSED ZABEL FLOW DNERTER INSTALL DOUBLE CLEANOUTS —EXISTING SEPTIC TANK TO BE REMOVED AND REPLACED WITH A NEW 1250 GALLON DEEP BURIAL SEPTIC TANK —PROPOSED DRAINFlELDS. ALTERNATE SITE FROM 1995 ROBERT C. COWAN DESIGN -TOP OF SLOPE (APPROX.) OF SLOPE (APPROX.) i IN / �--INSULATE SEWER UNE UNDER DRIVEWAY (4" THICK, 4' WIDE) PROPOSED ZABEL FLOW SPUTTER TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND OF GARNESS ENGINEERING GROUP, :Ltd. * 4T �* CONSUILTANTS & GENERAL CONTRACTORS .......... . ....... ........ 3]01 E TUWR M . SME 101 w MlCHUR C M 9950] r p E (907]33]-61]9 • W (907)336-3246 • WE M- www.gormaa,n9>n"0n9 �n PREPARED FOR: PHONE NUMBER: PAGE NUMBER: .•. . . ... •••••••• TONY GONGLIEWSKI 907-694-8669 2 of 3B G ess•- LEGAL DESCRIPTION: DRAWN BY: Q4 9, CE-79�� GROLL S/D; BLOCK 2, LOT 6 A.J.G. O�Q @ e '�!`I Fe2'' FpAd� TYPE OF WORK: DATE: 40Qapro f sslona\ DESIGN OF PROPOSED SEPTIC UPGRADE REV. 5/14/12 (Rw. U1N5) GARNESS ENGINEERING GROUP, Ltd. �rr�r CONSULTANTS & GENERAL CONTRACTORS E. R610R FOU). SUITE 101 • MCXOPME. m 99507 • R E (90)73])-6119 • FM (9(Y1)336-3246 • MEBS rrrAa^6999M�^6ef^9.9� EPAREDFOR:. PHONE NUMBER: PAGE NUMBER: TONY GONGLIEWSKI 907-694-8669 3 OF 3 ;AL DESCRIPTION: DRAWN BY: GROLL S/D; BLOCK 2, LOT 6 J.L.M. 1E OF WORK: DATE: DETAIL OF PROPOSED DRAINFIELD 1/6/2012 I` A. Ga*r essi Coi GARNESS ENGINEERING GROUP, CONSULTANTS & GENERAL CONTRACTOR$ 101 E NOOK ROAD, 81ME 101 • ANq RkM W. 99307 • PHONE (907)337 -GIM • PAX: (90)3W-320 WEBBOE: W..91, mq. SOIL LOG — PERCOLATION TEST ... ... .. ............. . LEGAL DESCRIPTION: GROLL S D; BLOCK 2, LOT 6 '.J r A. Garn ss.: �r PERFORMED FOR: TONY GONGUEWSKI DATE: 5/10/2012'Os ^P ••/I1t 17,•.DEH��Avv4 (f e Q �oO41Ofesskoo0 TEST HOLE #2 (CONFIRMATION TH) 1 2 5 6 7 8 9 10 11 12 13 14 15 16 17 18 SOIL CLASSIFICATIONS "i DATE DRY 5/10/2012 DRY 5/11/2012 ILI shtt I 1?. 6" - 2 GP 30 ML 3.5" 3 3:44 - 6" - 4 4:14 30 2.5" 3.5" GM 4:14 CL 6" - 6 4:34 30 2.5" 3.5" GC OL 9°9 o SW MH •' ' •••.• t SP CH SM OH SC DEPTH TO GROUNDWATER DATE DRY 5/10/2012 DRY 5/11/2012 ILI shtt I 1?. 6" - OSP O r = loo, DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 5/11/2012 1 3:14 - 6" - 2 3:44 30 2.5" 3.5" 3 3:44 - 6" - 4 4:14 30 2.5" 3.5" 5 4:14 - 6" - 6 4:34 30 2.5" 3.5" 19� PERCOLATION RATE 8.5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 7.5 FT. AND 8.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: E YES ❑ NO SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: ROB CAMPBELL COMMENTS: -m -(-Ur= CLoSsj I%/L PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PFtRFQRMFD IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: GARNESS ENGINEERING GROUP, Ltd CONSULTANTS & GENERAL CONTRACTORS - 101 E. NDOR ROAD, SORE 101 • ANCHORAGE, M. 8950 • NONE. (907)337-61]9 • FM: (907)336-3246 • WOSRE: g9meeeengineaNnq.con SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: GROLL S/D; BLOCK 2, LOT 6 PERFORMED FOR: TONY GONGLIEWSKI DATE: 12/29/2011 DEPTH (feet) TEST HOLE #1 1 SOIL CLASSIFICATIONS 2 3 — ORGANICS/FILL x�°' GP 11111111 ML = GM CL 4 GC OL °° 0 0 o SW MH 5 '��.:: . SP CH J rA. G rness;' C — 3 Qs W\1?r°fasslDn°\ o SM off SEE ATTACHED 6 SC SITE PLAN 7 8 9 10 11 12---]1I"II'^:''I GW TO GM 13 14 15 16 17 18 DEPTH TO GROUNDWATER DATE DRY 1?/2/11 I I� 19� PERCOLATION RATE _ (MIN./INCH) PERC. HOLE DIA. _ TEST RUN BETWEEN FT. AND FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ❑ NO SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: — COMMENTS — (INCHES) PERFORMED e5T ttU, LLa. I, JtrrrctT A. UAKNt55, GLKIIhY IHAI THIS WAS PjERF/ORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: I /Q /1 2, a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 7;��.J 1.�1u AG1.. f G kl S1L ( LEGAL DESCRIPTION:1/o DgPTY nET) C>R-- 1 2 S 3- 0/1 0/ r 4 / 5 / 7 n 8 / . 9 r�i 10 ,• r 11 12 - 0. 13- 14- 15- 16- 17 314151617 18 19 20 COMMENTS 5 5wrt WAS GROUND WATER ENCOUNTER ED? S IF YES, AT WHAT t L 0 DEPTH? 117 P E Depth to Water Atter Monitoring? np�aale: °0�1�'�S DATE PERFOR Section: ROBERT C. COWAN SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop 1 S -1 `•1.95 ' cs " — 'L Mli.l �gL t N PERCOLATION RATE 3Z' tminuteslinch) PERC HOLE DIAMETER G TEST RUN BETWEEN FT AND FT PERFORMED BY: a R C r: CINEERING I LA'L1 D CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ,�`t I RIYBLI�'I.WS*G dNo.2Q�F g,Zt _q5- ��gle ��Ver, as a 9//GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) s C PE LE TEST RUN BETWEEN . I FT AND 's FT PERFORMED BY: S $ S ENGINEERING1 Andyh.u.� D _ 17334 Eagle R ver Loop OO e. 2 TEST WA5 RMED IN ACCORDANCE WITH *.Wo %$NRIW0)VfXr.UIDELINES IN EFFECT ON THIS DATE. DATE: g'� z')' `r 72-M (Rev. 4/85) Municipality of Anchorage Page 1 of 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: _05(3'-.5zi -" 35 Name: Wastewater System: 1 New 11 Upgrade %1r�swtd .�� Ga�� Address: 1•/106 GcS,v1o5 nu_ r1cN• I K `i`r61 ABSORPTION FIELD Phone: � ..Z � � �,i r No. of Bedrooms: _ 0 Deep Trench fiS.Shallow Trench O Bed O Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth fro�o�iginal grade: GPD/Sq. FL {c Lot: e Block: 7 Subdivision: pj Depth to pipe bottom frpm original grade: Gravel depth beneath 1 pipe Vs G�(Geal L Ft. Ft. Township: Range: �d Section: ,.. Fill added aboIe original grade: Gravel length: 1 �' � + FL Ft. WELL: New ❑ Upgrade Gravel width: 1 2 ,�5 Number of lines: t Distance between lines: _ Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To1i Total absorption area: Pipe material: AS;T1rN n 303 i1e1 ATE 1 Ft. 1%p+ Ft. `l SQ. Ft. / Flat D Driller: a ^ p JhtV / (4,L& Date Drilled: 9 — li' "qG Static Water Level: 71f Ft. Installer: WEf-0 G-x�kvvtTla� Date installed: , -• Yield: Pump Set at: Casing Height Above Ground: "�� TANK a GPM li• FL Ft. SEPARATION DISTANCES _ %Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Litt Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines polel.RoOrAGE TAtAr- 110 Well- F l�df f -- � ,1 Material: Tf-EL Number of C apartments: IwI Surface Water Papt# Icet-F "" w — LIFT STATION Lot 1 t _ Size in gallons: Manufacturer: s Line �1$ ; 6c) Foundation 1 g„ ,s, "Pump on" level at: "Pump o at: High water alarm at: �F. Curtain_ 1 a� Jay Veldt Pump Make Electrical Inspections performed by: Drain 14 Remarks: �PTtc, "TAf-1k BENCH MARK Location and Description: J CAC. _1600. V'urL Oa6p=/L T m =- aar ov 000f, Vurc, L JnA Cbo P0, VAT 1119,1 Assumed Elevation: IG —S & S ENGINEERING Inspections performed by:D4'Tt�QS4• I"I 17034 Eagle—R—wer LOOP ROM, Eagle River, Alaska 99577 2nd R�O7 ERT C. COWAN C- CE -8801 Z 1% Department of Heal and Human Services approva Reviewed and approved by: Date: -2/ -9 72-013 (Rev. 9/91) MOA 25 SW950268 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 6, BLOCK 2, GROLL SUBDIVISION PID No.: 050-521-35 IA zmll PCS ' 1 _!!!- 3 2 19.Q' 39,0' DBL1 19 .0' DBL2 19.5' 42.0' CO 22.5' 65.5' CO2_ 74.0' 02.0' MT1 73.5' 02.5' SEPTIC YANK DRQ i ALT. SITE °r1 /� 99.4''ST2 —FINAL GRADE TH{/1 /-4 / NEW — / 91.5 1250 GALr, 002 MT,� An ST FINAL GRADE MT1„CO1CO2 CO? _ — 9 .0' 85. J Z4 B NO WATER FOUND 77.8' B.O.H. e SCALE 1" — .w 4Q9 �� P.,".� CE • 8801 o 1� 72-013 A (Rev. 0/91) MOA 25 Tprtlffirb Brining llxg bN DOC Co. tlba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND ADDRESSST,\TIC LEGAL DESCRIPTION DATE - Started PERMIT NUMBER __ Ended DEI'"iH OF WELL LEVEL OF WATER FI - DRAM' DOWN FT. m GALS. PER HR KIND OF CASING _ KIND OF FORMATION: 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 Ft.;'_________ From Ft. to--F(-- oFt. From—Ft. From Ft. to —Ft. __ - - From Ft. to—Ft— o FtFrom FromFt. to Ft.___ - - From Ft. to Ft. From Ft. to i Ft. _ From Ft. to_ Ft. From + "> Ft. to Ft. ____ From Ft. to _Ft. From Ft. to Ft. —. __ From Ft. to--F(.— oFt.FromFt. 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 Ft. From Ft. to –Ft. From Ft. to Ft. From Ft. t t From Ft. to Ft. From Ft. to_ _Ft._ From Ft. to Ft. From Ft. to i Ft. From Ft. to Ft. Frmn FiP f Ey%� Ghc aqB MISCL. INFORMATION DRILLER'S NAME .__ HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN S&S nc, Date: ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECEIVED JUN "191996 Municipality of Anchorage Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES Npt. Health & Human Services 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Z_ o. (!I/000 The septic inspections for the referenced property were performed onG/� '& and _ 6_113,1eila. Prior to submitting the On --site Wastewater Disposal and/or Well Inspection Report we are waiting for the u a�� 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 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE k DEPARTMENT OF HEALTH AND HUMAN SERVICES n P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650--�`)L' ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT LD PERMIT NUMBER:SW950268 DATE ISSUED: 9/08/95 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 9/08/96 OWNER NAME:GONGLIEWSKI ANTHONY & TAMMY OWNER ADDRESS:4106 COSMOS DR. ANCHORAGE, ALASKA 99517 PARCEL ID:05052135 LEGAL DESCRIPTION: GROLL BLK 2 LT 6 LOT SIZE: 132727 (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 (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: RECEIVED BY: ISSUED BY: DATE: DATE: /" `�2 S&S1 din epunG August 24, 1995 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 SEWER & WATER MAIN EXTENSIONS REFERENCE: Lot 6, Block 2, Groll S/D Request you issue a permit to drill a well and install a SEWER&WATER septic system to serve the proposed four bedroom house on INSPECTION the referenced property. Test holes were excavated and percolation tests performed. The approximate locations of: the test holes are located on ENGINEERING STUDIES the attached site plan. AND REPORTS At the time of excavation water was encountered at 10 feet in test hole #1 and no water was encountered in test hole #2 and after seven day ground water monitoring, the WELL INSPECTION &FLOWTEST monitoring tubes were found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. SITE PLANS We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. ROAD DESIGN There are no points of contamination within the proposed well radius which can be seen on the attached site plan. SOIL TEST The proposed 1250 gallon septic tank is to be placed outside the protective well radius. Attached is a site plan which depicts the location of the proposed tank. PERCOLATION If you require additional information, please contact us. TEST Sincerely, STRUCTURAL& MECHANICAL Robert C. Cowan, P.E. INSPECTIONS RCC/gk Enclosure ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1 ' = 60' SITE PLAN DESIGN SCALE ro myz --1 A 0,c zo W Zt o r NWN�3OO P > D 7• cn "� 0 — co Z r @ M 0 t�tj F ® F- ''I fl >i i0 b 0 \, wzmnv�N II _ m cn trJCD o�o o C) �pN- 00 Ln F- m e 7j N P O G ps m ➢N vn ONO ZSA C7 �m �m�,W 050 �� rq;U�CZri Z 7n (Ah -1 =m z - 0 m (n D .Zl .TJ rR� N of M (n 1-- < m m O mQ �, � ")�a ?9 0 .P Ohm m-f� y Z --p on�G�� CCiP "�m�� -0nA mZ, m m Nm V�� J� Ci�� j0O�ZO� I U zvn rC-,� 7zyA N -'l m vM?Ly9WmM I o z U y i, -i • • CAO CD o� mm \ 70v0�l �0 W O _ °� \ O oDZ _C) :n o= 2 n0 IIS,-� >n �m - O00 zz '0� / zA 0� O s °' 2s r [i PU A D 71 z 1 m C) r/ a zea fl nzp-1 z onzm J f on Ion / SNF; �• // DOS < D ,yF�n V11 71n LEGAL DESCRIPTION: L/DT L�, 1,J 'OLtr`SLTownship, Range, Section: SLOPE 7— SITE PLAN VC)(L.-- F I ( , 1 / 2 s 3 4 v 5 / 6 7 n ; 8 / 9 r�1 , 10 ° 11 12 Rj 0. 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT I L O DEPTH? �t7 P E Depth to Water After Monitoring? V V Date: Reading Date Gross Time Net Time Depth to Water Net Drop Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 - "; 4. x SOILS LOG —PERCOLATION TEST a r•51. :1?^!�?",x...�:,�� Ir ;� ROBERT C. COWAN PERFORMED FOR: p ��. �u 1 L.l.r I %w� SIL 1 DATE PERFORM1x:)':. „9"5 w LEGAL DESCRIPTION: L/DT L�, 1,J 'OLtr`SLTownship, Range, Section: SLOPE 7— SITE PLAN VC)(L.-- F I ( , 1 / 2 s 3 4 v 5 / 6 7 n ; 8 / 9 r�1 , 10 ° 11 12 Rj 0. 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT I L O DEPTH? �t7 P E Depth to Water After Monitoring? V V Date: Reading Date Gross Time Net Time Depth to Water Net Drop 2 MI.� VI N 20I PERCOLATION RATE �� (minutes/inch) FERC HOLE DIAMETER II � TEST RUN BETWEEN FT AND .5 ---FT COMMENTS �� PERFORMED BY: 5 & G y: GINEERING I .n� D CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH )yZ k le River Loop ad No. 204 21 Atgle EA. MSN GUIDELINES IN EFFECT ON THIS DATE. DATE: Eagle IErver, as a 72-008 (Rev. 4/85) or � 01.(�.........ON s " Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG —PERCOLATION TEST C. COWANr CE -8801 u� PERFORMED FOR: +�P`� �(6p)L1E StL( DATE PERFORM�Ip t 5-7p. a. LEGAL. DESCRIPTION: VO't"Io �J�h-��Z- 61PiO"Township, Range, Section: FDEPTH7 SLOPE SITE PLAN C] 2 � 3 / G j 4 f! 5 6 7 B P 9 G� 10 11 12 13 /. ` i 14 '/ 16.-D,A 15 16 17 18 19 20 COMMENTS ry Z WAS GROUND WATER O ENCOUNTERED? T _ S NIF YES, AT WHAT L O DEPTH? p E Depth to Waterer Monitoring. Monitoring? 1- Date: _ Reading Date Gross Net Depth to Time Time Water Net Drop V-- P k -a -I o 0 Ali 'A3 t til / l 5 - PERCOLATION PERCOLATION RATE 3i (minules/inch) PERC HOLE DIAMETER ZO TEST RUN BETWEEN FT AND ` -- FT PERFORMED BY: S & S ENGINISERING I F4,-, VN uv� D _ CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Roado. 204 9 - 21 - q. -ACCORDANCE WITH F ,T/Yj,N�IA,I} (;�Y957r-UIDELINES IN EFFECT ON THIS DATE. DATE: _ 72-008 (Rev. 4/85) HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROADDESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN s&S� �tne punq ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 6, Block 2, Groll S/D August 24, 1995 GENERAL: ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 1. The scope of this project includes the installation of a 1250 gallon septic tank and leachfield trench to serve the proposed four bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include: two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on -the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 6, Block 2, Groll SID August 24, 1995 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 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. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruff -ed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel. is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, 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 6, Block 2, Groll S/D August 24, 1995 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer.. 3. Insulation shall be at least 2" thick extruded direct burial. polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #7.00 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. Page Four Lot 6, Block 2, Groll S/D August 24, 1995 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: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at :Least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the 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 6, Block 2, Groll S/D August 24, 1995 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0 So - Sa, I - 3 s" HAA# 92,4e1DCOO 1. GENERAL INFORMATION Complete legal description Lot 6; Block 2; Groll Subdivision Location (site address or directions) NHN Damman Circle Eagle River, AK Property owner Tony Gongliewski Day phone 242-5815 Mailing address 4106 Cosmos Drive Anchorage, AK 99517 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual,well XXX Community well _ Public water NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 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. 72-025 (Rev. 1/01) 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, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone '� _ a °► 7 17034 Eagle River Loop Road No. 204 Address Eaale River. Alaeka 998=7 Engineer's signature ; Wz 4�-A _ Date ) / a % R 7 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date 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 Stateof Alaska. The DHHS does this as acourtesyto purchasers of homes and their lending institutions in orderto 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-M (Rev. 1/91) Back MOA N21 *eMunicipality 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: Lar iv% , 6LUCK Z 1 6f-ol.i. //0 Parcel I.D.:_ oa v SZI -35 A. WELL DATA Well type 67%0Pl-fes If A, B, or C, attach ADEC letter. ADEC water system number N + Log present (ON) Date completed q -1 `i 17.5 Total depth 11f Cased to 10 -f Casing height (above ground) 2 f Sanitary seal ((VN) YFIs Wires properly protected PN) Y&s FROM WELL LOG AT INSPECTION y Date of test _ " 19 " `1l + ji —�- ; r• 2 Static water level ?'f Well production iia g.p.m.m. WATER SAMPLE RESULTS: Coliform V Nitrate O. f®o E' Other bacteria Date of sample: 12 ! I 1°Ib 1�I��y Collected by: S & S ENGINEERING 1/034 Eagle pop Road, ft B. SEPTIC]HOLDING TANK DATA Eagla River, Alaska 99$77 Date installed 4am-13•-44 Tank size I Z50 Number of Compartments Z_ Cleanouts0/N) Yc.S _ Foundation cleanout (VN) `(E -z Depression Q0 Iv U High water alarm (Y/M tJv Date of Pumping Rao C. ABSORPTION FIELD DATA Pumper Date installed (c> I:3j`I6 _ Soil ratingp,d./ orftz/bclrm) I > System type r(ZaA�+F Length e Width Z •Si' Gravel thickness below pipe H. t _ Total depth Effective absorption area _�° Monitoring Tube present (q�1V) '>Es Depression over field (Y(j %I o _ Date of adequacy test _ R X05 Results (Pass/Fail) For _ l bedrooms Fluid depth in absorption field before test (in.); Immediately after� gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate =—g.p.d. Peroxide treatment (past 12 months) (Y/N) _ If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off' level at* High water al evel at* *Datum Cy6les tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ptic holding tank on lot 1001 + On adjacent lots too t Absorption field on lot 100 ` ' E On adjacent lots ( 00 Public sewer main /� Public sewer manhole/cleanout p IV t/ t$ Sewer /septic service line + Lift station rl SEPARATION DISTANCES FROM SC HOLDING TANK ON LOTTO: Foundation 0 t Property line 1 i6I t Absorption field Z8 , Water main/service line loft Surface water/drainage I net fi Wells on adjacent lots )no 0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water 6p` + Building foundation Water main/service line Driveway, parking/vehicle storage area Curtain drain p�f4 Wells on adjacent lots foo If * /V- 5 P e, &70 A( Li k r, IJ S LSI ,� v vN A- �,3 A F. ENGINEER'S CERTIFICATION trtr� S <-�` n T•c ( w �s ��r 1-0 t; FL -ow, c) � 1 certify that f have determined thru field inspections and review of Municipal records that the,' 46 ky�rem`s are � vo pf in conformance with OA A guieynes in effect on this date. r w e Signature 14 irk Engineer's Name 1 �z� yih,! Date h ROBERT C. COWAN w V"-%, CE -8801 HAA Fee $DC7 Date of Payment — " / 7 Receipt Number 5/ 72-026 (Rev. 3/96)* `�3g Waiver Fee $ Date of Payment Receipt Number 12/21/96 13:24 CT&E ESI ANCHORAGE � 9076941211 NO. 796 D02 CT&E Environmental Services Inc. Laboratory Division rer�.rairaiviirs�.oirwia-�+r��.r�".r�rrrrrrrrrer.►sos Dunking Water r'�nalySls Rnport for Total Coliform Bacteria 200 VV. 9e, AK 99516-1605 READ lr\'STRUMONSONREfIERSESIDE BE,ti'ORECOLLECTLYGSAYPLE Tel: (907)562.2343 Fox; (907) 361-5301 MUST PE CO'NIP4E-I'E.D BY WATER SUPPLIER © PUBLIC WATER SYSTEM I.D. q �_ IS( PRIVATZ WATER SYSTEM r0 '7end lnvulee S�"' Collected Q...r a�nam nunulomwnv �C �;�—i '.`."f to �0�t, vMOa/ Nl �umoer NWIr1( I,MW u�l•T�� lir! )Ulr Zia VW. 0 Send Routu O Send lrrvoke LIMO)'?"ti. I 4110%AGCItr —1 �-- — SAMPLE DATE:./J I Month Day Year SAMPLE TYPE: Routine 0 Treated \Yater q Repeat Sample (for routine Sample 0 Untreated Water with lab ref, no. � ) * Special Purpose SA:NIPLE LOCATION /_01-6 6 t✓,C Z Time Collected Collected By L Pica,. T'0 BE CONSPLETFD BY LABORZ-�TOKY Analysis shows this \Fater S.k'04E to be; Salisfactary d Unsatisractory 4 Staple over 30 hours old, results may be unreliable o Sample too long in transit; sample should no( be over 43 hours old at examination to indicat, reliable resulu. Please send new sample via special do .very mail. Date Received 2 Time Received Analysis Began Analvti(;al IiMc(hod; W Membrane Filter 0 IVIMO•1\tUO ' dumber of c010nie5/100 ml. Result' Analyst (96.6 05 - Anch Fbls Jun El Far% ogre: -- Tine: Client notified of unsntisfaelory results: 0 T ❑ Phenol Spoke 'Aith Faxc Dutc: Tin,.: I3ACTEPIOLOGICAL WATER ANALYSIS RECORD 1INI1N10.1%M; Reful(: Total Coliform g', C0/i Mcrnm rano Filter: Oireel Count _ _ Q Co19nie3/100 ml Verification; LTB BGB __^ �COLIFIV-h�_ - Ys'rC•tw.r'. r,C"o" Fecal Coliform Confirmation °" Final I\tcmbranc Filter Results Coliro mf100 ml Reported By /`f t V bate f2 �'C1G Time t hrs r ---� Comments: r©1_SGS M@r*+ber of the SCS Group (50eiCI6 GCn Qrd IE de Surveillance) 12/1b/`J6 11:155 1;166 t5l HMLHUKHbt - yb'lby611211 NU.755 We? ME Environmental Services Inc. AL u ME Ref.N 966504001 Client Name S & S Engineering Project Name/# L6 B2 Groll Client Sample ID L6 H2 Groll Matrix Drinking Water Client POl/ Printed Date/Time 12/13/96 17:01 Collected Date/Tune 12/10/96 11;00 Received DatelTline 12/10/96 13:00 Technical Director: Stephen C. Ede Ortleced By PWSID a� Released By 4 -C f Sample ReOuurks: Sample collected by: Ray Parameter Nitrate -N total Coliform Allowable Prep Analysis Results POL Units Method Limits Date Date Init 0.605 0.100 mg/L SM18 4500-NO3F 10 max 12/13/96 WEP 0 0 col/100mL SM16 922Z0 12/10/96 WEP -43-ob we ooH' 1\�L SNMPL-�L L>