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HomeMy WebLinkAboutDUKE & DUCHESS BLK 2 LT 2Duke & Duchess Block 2 Lot 2 #051-221-55 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: S wO0©O a PID Number: 0 Name: p^� d i-1 �Ytl—C Wastewater System: U New 9 Upgrade Addreaa: �BpyC.7-71Q ABSORPTION FIELD Phone:No. of Bedrooms: / � 9 �_ y 5 y� '••, O Deep Trench I7(Shallow Trench ❑Bed L7 Mound U Other LEGAL DESCRIPTION Soil Rating Lp Total Depth from original grade` IJ•S" GPU/S .Fl. s"t ,vA a Lnl: Block: Su division: ��% 7�v Depth to pipe bottom from original glade Gravel depth heneath pipe G o�O�SLC 3 e Ft 016 FI. township: I �• , 1 N Range I Section: I� Pill added above original grade: 317 FI. Gravel length: \ l ISO eLiGln. • WELL: O New U Upgrade Gravel width: FI Number of lines' � Distance between lin as I.J FI. Classll calico (private, A.B.C)jr� k. 5 v/% 1 ✓��t.2i T'olal Depth: FL Cased To: rL Total absor Iim1 mea: p Soo SG. FL Pi mateMria S I/ 1 36 Q Driller: Dale Drilled: Static Water Level: Fl. Inslaller: [[ 96KC i/0 Dale Installed`VV //��0n) Yield: Pump Set at Casing Height Above Ground: TANK GPM Ft. I Ft. SEPARATION DISTANCES jiSeptic UHolding Us.T.E.P. TO From Septic Took Absomlion Field LII( Station Holding Tank Public/Prlvale Sewer Lines Manufaclurer: (\� 9 ys 2�Cdj lY/ V//r{^I Ci Capacity In gallons:' /h U Well W4 IQOI {- `..� _��� Material: Y (,� Number of Compartoonds: 0� Water I011 (001t LIFT STATION Lot\ IIS: 5 3\ Size In gallons: Mnnu er Llne Foundation S 1 �( C) V "Pump on" level at:"P c 1"leve lilgh water alarm at Curtain Drain 1 �,\ voe jy�t/v1 Pl wnp Mak de Electrical Inspections performed by: Remarks: c1, / 0 /= v1_0.4. f}AMO^ Of BENCH MARK .56jr/IJ 1NJi-F)LL✓L 1! V,V !)°i `�s? Location and Description: Y_oq4,kyri s� w r�,Z- A, d C 4 5-lab 1 bejod •T M Assumed Elevation: I O gO EN�I�`t.E�ifS Sri. i1i .,� tai •�• .: .., .gs�ttt If S & S ENGINEERING 17034 Eagfe River Loop Road, No. 2,0a Inspections performed by: Eagto-Rive"Ifirska 995TH 114t-es: 1sl�f �� �% .;... _....-,..,. 6,i..':�—.,., a 211dC� •� 8 `�� , �% ROBERT C. COWANCE eI 0 - 8801 Department of Health and Human Servics approval tt <<, •. -. .,. • � ,rY Reviewed and approved by; .Date:..._ ,,, 72-0131nev. 9/91) MOA 25 PERMIT No. SW000032 PAGE 2 OP 3 Municipalit of Anchora e DEPARTMENT OF HEATH AND HUKAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL NE%4 of SE%4 of SE%4, SEC. 17, T15N, R1W P.I.D. NO. 051-221-19 10' GAS EASEMENT BIRCH DR I I 03 MT3 COf 1300 GALLON MT1 POLYETHYLENE N SEPTIC TANK 1 OUT k OBL2 IYII 2 Sil T ST ECG PS (PLOW SPLITTER) B N 2 I M A vJ C04 MTTOM Ctji. /1W\ O Z W W N WSCALE: 1" = 60' Q A\CY .o j ROBERT C. COWAN�2 oO�c�l. C(:-8801 4"•'d PERMIT No. SW000032 PAGE 3 OF 3 Municipalit 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 NE% of SE% of SE%4, SEC. 17, T15N, R1W P.I.D. N0. 051-221-19 CO1 MT1 CO2 MT2 CO1 = 66.9' CO2 = 66.9' MT3 FINAL GRADE 2" INSULATION COI = 64.5' r SR CO2 = 64.5' I MTl = 63.9' I\- MT2 = 63.9' MT3 = 58.7' _ 1 Y' M.vA S19A,/3 FINAL GRADE , i-100.5' 96.8'—/ NEW 1300 GAL. POLY. TANK CO3 C04MT4 CO3 = 61.6 n n C04 = 63.3 01A NSULATION 96.5' WATER FOUND ®5"/, 1' H 9.2' B.O.H. CO3 = 59.3 C04 = 59.3 MT4 = 58.7 N. T. S. i MUNICIPALITY OF ANCHORAGE v Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 15// M/. ` a: -W Py,_11 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT f MVC�1 J� t Upgrade Date Issued: Mar 15, 2000 Expiration Date: Mar 15, 2001 Permit Number: SW000032 Parcel ID: 051-221-19 Legal Description: T15N R1W SEC 17 NE4SE4SE4 Design Engineer: 0003 S & S Engineering Site Address: 018232 BENDING BIRCH DR Owner Name: Bette K. MacClelland Lot Size: 435600 SQ. FT. Owner Address: 18232 Bending Birch Dr. Total Bedrooms: 4 Permit Bedrooms: 4 Chugiak , AK 99567 - This permit is for the construction of: n Disposal Field E Septic Tank n Holding Tank ❑ Privy n Private Well ❑ Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: 3 �) B O Date: 3 — /S ^60 nG March 16, 2000 ROBERTC. COWAN, P.E.. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694.2979 FAX (907) 694-1211 HEALTHAUTHOflITY APPROVALS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 SEWER & WATER MAINENTENSIONS REFERENCE: NEI/4; SEI/y; SEI/4; Sec, 17; T15N; RIW, SM SEWER&WATER INSPECTION It is requested that you issue a permit to upgrade the septic system to serve the existing four bedroom dwelling on the referenced property. A test hole was excavated and percolation test was performed by K&D Engineering, The approximate location of the test hole is located on the attached site plane. At the time of the EERINGSTUDIES A AND REPORTS NDR excavation, May 1996 Water Was found at 101/z ft. After seven days of ground water monitoring the monitoring tube showed Water still at 10'/2 ft. The existing septic system 1T'as permitted for 5 bedrooms, however; it appears to be WELL INSPECTION undocumented. & FLOW TEST We tto not anticipate any adverse effects on neighboring wells, septic systems, reserve areas, or drainage patterns by the installation of the proposed septic system. The construction of this System Will not prevent any future development on ally of the adjacent properties. The SITE PLANS lot is approximately 10 acres and play be ftLrther subdivided in the future. If ,you require additional information, please contact us. ROADDESIGN Sincerely, SOILTEST Robert C. Cowan, P.E. RCC/glc PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE204 • EAGLE RIVER, ALASKA99577 I " = 100' DESIGN SITE—PLAN -- --�---------------- 20' NATURAL GAS SCALL0 d $ f r ----PETERSON a � N OO OtN 4A O r \CA -- m9w lo O O Z Tl m mmsv 30' ROAD EASEMENTI I D "N.0 S n r pVD z m x m b ;10 — _______ 30' R.O.W. ROAD EASEMENT -- --�---------------- 20' NATURAL GAS 0--- EASEMENT °� N d $ f r ----PETERSON WAY-----' O r \CA -- m 30' ROAD EASEMENTI I � �j o II O d I o O \ O O \ p\ \ m m n N �p x � m \• m o C) V1 N \t7i 0 tp ~ ONS m I 3 I�r �I O 'J opo c i SA i�IR �I kf�l� m4 mo 99 I� KGs A. b� O 0 �I F 00 mo n 8 I ] n y 00 y rA V, y O I> o A I � yo N c F ---I 'X w A N m I o O `C— -------------------- --J-- ------__----- — m cue .� F mom£ �j1�c;i 2b y _mem i�{i Z Q I� I� I� I� u his W < G A vi U I, i� rzw 4 ¢ O r,J Es CL as"� • c tip,. w0EL w O Awa > N ata O z w OU (n Or U >- N p F a . Z N UDO — O p zoo W O i;oa I� >Fw-Z O¢o (y l U>m O \ / U ¢ oV , x m I � rnw¢ o 44 U U 6 CD o' O U ilk E ' C CL o\ 0 O LO 0 o O m II 7 r mJZ w g Q V UI Ki=� NVId-3115 I N`JISM Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: /c'l. �� h��� �f�' �- DATE PER �/ LEGAL DESCRIPTION: '��'L'�E �/Gt /i<Ea5 ydTOWnshlp, Range, Section: 2 �?Y/UGI% Ge»3/dLt%3 7U 3 /� �llr.�Sc/ GcL ditJ F7 4 M .-E/15raJG� �alSvrt/� 10 12 /KO/S rte 2E 15 16 17 18 19 SLOPE WAS GROUND WATER J J cnirni inmcoero SITE �11 20 L� PERCOLATION RATE �^-� (minutes/inch) PERC HOLE DIAMETER V TEST RUN BETWEEN a' s FT AND 3 FT COMMENTS �'� T7� �//-=- pErC- �Aol_'Va , s Sic PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72 -BOB (Rev. 4/85) ■■.■■■■■■■ .■■■■■■■■■ 20 L� PERCOLATION RATE �^-� (minutes/inch) PERC HOLE DIAMETER V TEST RUN BETWEEN a' s FT AND 3 FT COMMENTS �'� T7� �//-=- pErC- �Aol_'Va , s Sic PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72 -BOB (Rev. 4/85) . _. •.. .6 .1 ✓MSI .J .i a s January 10, 1986 TO: Permit Applicant P.O. SOK 6650 ANCHORAGE, ALASKA 99502-OG50- (907) 264-4111 J... AIO SVLFS � DEPARTMENT OF HEALTH & HUMAN SERVICES Subject: Permit # 850667 T15N R1W Section 17 NE -4 SE -4 SE -4 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as -built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, A �' Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit ` ' ,9 !E- H1. ovall oil N Y DEPARTMENT []I HEAL||1 AND ENVIRONMFNlAL PR[)T|�L�[I N~~'x^�~x 82h L 13 111410 ANCHORAGE, AK 9,)501 - LIM_1FT 0: 9 UZ b1pon W VA HAI FIPORM T: If 'EKMIl NO� �50&67 )A|E [SSUEG: 10/07/85 \PPLIC�N[: D�� WALKER )DUR�SS: P.O. MOX 670317 EABLE RIVER, AK 97567 WNTACT PHONE: 27b-1072 JEG(,L DESCRlP: SUBDloIJION: NF1/4S[1/SSE1/4 LOT: NA BLOCK: NA FIRM Cold: 17 TOWNSHIP: 15N RANOW 1W OT SIZE: 10A (SQ.FT. OR ACRES) |A� ��DRODMS: 5 is!ed he]ow are the options available to you in designing your septic �ysiem, C�oose tho option Lhat best fits your site, ------------------- 1-1 Q Q 1%H 11:U-0 APT SAY x? bi~ K 1 WA e A AL All! )E1,111 Tq 001 ION (I T.) 4,0 1,9 4"0 )RAVEL DBPTH (FT,) . 3^O 0"5 .OTAL DEPTH (F| ") "5 jRAVEL WlDTH (FT.) 2.5 21.0 5.C) }RAVEL LENG[H (FT^.0 65"0 jRA;EL VDLAME (CV,YDS31.2 42"2 ANK 3IZE (GAL�} 1,000.0 ** |,500"0 ** 1,500.0 ** 0lL RATTND (3Q.FT./8R) 102 11O 1!O LENGTH FT, RBPUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. MCH) jyT LEAST TWO COMPARmMENTS curtif`V that;: ihat: 1. l am familiar with the re4uirements for on-site sewers and wells an set forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2. I will install the system in accc,dance with all MOA codes and regulations, and in compliance wiLh Lhe design criteria of this permit" 3" I will adhsre to all MOA and State of Alaska requiremznts for the not back distances from any existing well, wastewater disposal system or public se��prage systom on this or any adjacent or nearby lot" 4 l understaHCI that this permit is valid Mr a maximum of 5 bedrooms anU any enlargempnt will require an additional permit. [ A LIF[ STATION IS INSTAiLED IN AN AREA CVVERED BY MOA 81jILDING CODES, |/[H (1) AN ELECTRlCAL PBIMIT AND 7NSPECTION MUST DE OBTAINED; (2) AS-9UILTG /Ii1. NOl B, AF'PROVED WITHyIJT AN ELECTRICAL INSWECTlON REPORT; AND (3) THE 11 [GTR1C01 10110 MUST DE OONE BY A LICIN5ED ELECTRIClAN^ �lGNED DATE: / ,|` VIA. CANT: Dul 1,1ALME,' SSU[D BY DMTL�: 77'------^-'—�r-----------' ----- --�p`-/------_- PERFORMED LEGAL DESCRIPTION: 2 3 O 4 o, 5 ---- 6 CJ U 7 d u - a .� u 0 9 l 10 Q G 11 12 31415 13- 14- 15 16- 17 6 r�- {i 19- 20 A SOILS LOG ❑ PERCOLATION TEST SOILS LOG — PERCOLATION TEST Imp �.il "— LVg/!y-r�.�gcC O �^I� d t a p u Lr; A. Sutora w4 0-6736 a.\� 'ger Qo a°�`ab�J r. so�rss�oNw:� DATE PERFORMED: 1cg/ ,f WAS GROUND WATER S ENCOUNTERED? y" L D P IF YES, AT WHAT E DEPTH? PLAN Reading Date Gross Time Net Time Depth to Water Net Drop I Now E mom Reading Date Gross Time Net Time Depth to Water Net Drop I u s.ATI / RERCOLATION RATE SS J l / -S 65 �/r 11minutes/inch) ,✓�J TEST RUN BETWEEN FT AND FT COMMENTS_q�c'�co.-.��,;( /11 -' 0_ r PERFORMED BY:J ac'Le �'/ ✓'E'-9 i- si., CERTIFIEDBY: '--�---- - DATE: /c>/9/y5._ 72008 (6/79) 1J Municipality of Anchorage • Department of Health and Human Services Division of Environmental Services Mlj On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. 051-221-19 HAA#(_� iO Expiration Date: 1. GENERAL INFORMATION Complete legal description_ NE 1/4 of SE 1/4, of SE 1/4, Section 17, T15N, Rli Location (site address or directions) NHN Bending Birch Drive Current Property owner(s) Dan CIaugus Mailing address Lending agency Mailing address Real Estate Age Day phone PO Box 771971, Eagle River, AIK 99577 Day phone Day phone 694-4540 Mailing Address Unless otherwise requested. HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Fn Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. _v-925.Rev 01-001' 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone y - .)L 11 7 r% Eag — Address Engineer's Printed Name P 0 13 %.t i C . C v a„ i, Please release Conditional Health Authority. The items on the Conditional Health Authority have been satisfactorily completed. 6. DHHS SIGNATURE �/ Approved for 4 bedrooms. Disapproved. Conditional approval for Additional Comments Date y approves bedrooms, with the following stipule Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other LE ER'S 2G2Si' C. COV:?N - y .0 By: Original Certificate Date: G - d - c O Expiration Date: `/ - � -C ° 5 )25 Ree )l oot Reissue Date: Municipality of Anchorage • '� Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: NE 'ryi S E '/w ) S �, '/y S+c c-, /od ,1 ? i T 1 S -IJ , k It,/ Parcel I.D.: 0S-/-aaf._ ) 9 A. WELL DATA Well type R+,411r+i If A, B, or C provide PWSID # — Date completed �D�`L� Sanitary seal 'V k 5. Total depth �oo f ft Cased to 1 a r ft FROM WELL LOG Date of test 1,5 r a 6 �- Static water level I ° o + ' ft Well production i -'- /0'x-2 2k.'c:tr Flaw WATER SAMPLE RESULTS: 11, 9 -p.m 9-icAA4 S4 Well Log 00 Wires properly protected Yc J Casing height (above ground) -30 in. AT INSPECTION 3 < ft 0 g.p.m Coliform 0 colonies/100 ml Nitrate :3 . K Z mg/I Other bacteria colonies/100 ml Date of sample: '3 / I o Collected by: S & S ENGINEERING B. SEPTIC/HOLDING TANK DATA 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Tank Type/Material 54,°T. c- / Pt I-/ 4t7 -14y1,0. -V- Date installed 01000 Tank size 13 oy gal Number of Compartments DL Cleanouts Y �, J Foundation cleanout yf S Depression over tank NO High water alarm Nc' Date of pumping N / 4 - N r -1 Pumper C. ABSORPTION FIELD DATA I.0 Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) qwa F1�ro�ystem type S /Frt,-u - ) A'4;vCtj Length 0-0 ft Width S ft Gravel below pipe 6) • S ft Torn Total depth 3 ft Effective absorption areaC00 ft2 Monitoring tube YE1 Depression over field YV 0 Date of adequacy test N /A Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test inVater added— gal. New depth in. Elapsed Time: Final fluid depth in Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date 72-026 (Rev. 01/00)' D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in "Pump -Of -level aT in High water alarm level at in Cycles tested Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot loci '•+- On adjacent lots lbo /0of Absorption field on lot /00 /+ On adjacent lots loo Public sewer main Iv 1,4 Public sewer manhole/cleanout N% Sewer /septic service line a S Holding tank N /a SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S Property line Us- Absorption field zpS Water main A05 /4 Water service line /a '4 Surface water Drainage N i4 Wells on adjacent lots /00 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3 Building foundation Water main r / Water Service line /e -fi Surface water / oo Driveway, parking/vehicle storage a 0 f f Curtain drain NoN/f Wells on adjacent lots /0 + M�6161MTIF* t G. ENGINEER'S CERTIFICATIONa � Y; .."" s�"tt I certify that I have determined through field inspections and review of Municipal records that the above systems are in o...,.:.... ,. r conformance with MOA HAA guidelines in effect on this date. %•• :•• • MP ._ Z✓.... Engineer's �0/3,-,Ar �wArJ 1, 4 RORERT C. Pd`g;'.� CF. COWAN i � fl Printed Name -8801 °•:� l fps%:;,•-, : ;' Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00)' 3 v o ° "j/ (r/oo ,Y, '7 6 S' 8.7 Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 1" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci. anchorage. ak.us (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. D<S/ZZ HAA# 4n -O I Expiration Date: 1.. GENERAL INFORMATION Complete legal description /VE ! i ,� E Iz_ ; 31' �Ac-C. / 7-AfA-, ," ti /IQ Location (site address or directions) /r� Z -:75 Z�l e C H 0 /'• Current Property owner(s) 13eIlLz %f, 14hqC Cl//F11z'l ill'/ Day phone Mailing address Lendingagency S T c- Day phone Mailing address Real Estate Agent A/'c'%' /X-, E Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well Public Water System ❑ Community On-site ❑ Public Sewer ❑■ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 01/00)' 5,.110 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone 6 91/— a `9 Address Eagle River, Alaska 99577 Engineer's Printed Name Date C.DHHS SIGNATURE 1����J4aoaCE 8801 COWAN ?`c c - Approved for bedrooms. •.•...... Disapproved. Conditional approval for �_ bedrooms, with the following stipulations. �P/99cuP /7r /XIr /��z/ii h r r- //��� ), of r /`� �� l 2n l( k.-/,�,i� ru"// z. �Addton`al o meents� A TO Tat OP 012 000 00 stl)9tt 6 PUT IN FsifA?ow TO ACGOMPLug THE C014/STRUC'TION OF THE SNBJE T wf15T ivATr1f DISPOSAL $Y TFM PIARSUAd/T TO PEIPHIT 5W000032 MONEY /N ESCROW SHALL &or BE fflglmrw UNT/t THIP OFitICf HAY GIVEN FINAL APPROVAL Attachments: HAA Checklist �_ Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other PE141417* Yw0000?2 By/ Original Certificate Date: .3 Expiration Date:_tp _U — 00 Reissue Date: 75025 (Rev. 01/00)' Municipality of Anchorage 1< DEPARTMENT OF HEALTH & HUMAN SERVICES C r V Environmental Services Division 44AR LA 825 L Street, Room 502 • Anchorage, Alaska 99501 • (9,Q7Q,43-4744ft0 A"it yOF AN MfI�Tq� Health Authority Approval Checklist SfkV/CF.,S UkAGE Legal Description:X�' �U ;< � ; S % PbM ellel Parcel I. D.: 49', A. WELL DATA Well type L/lG��' If A, B, or C, attach ADEC letter. ADEC water system number b�ate l-` Log present (1 /N) ; NL7 • completed 6C. — 1? %� . /cOf-0 rCl! % TFICA f s:14 -Gl Total depth Cased to /Z/ .S L't<Casing height (above ground) 30�! Sanitary seal (Y/N) Wires properly protected (Y/N) 111 FROjvI WELL LOG AT INSPECTION �y Tsr� Date of test Static water level Well production Ot (/ q jM ��� %/?ll/���r g.p.m. 4 0 g,p,m, 2 �i�i fc r gh�tersl WATER SAMPLE RESULTS: Coliform - (J — Nitrate 1- Other bacteria U Date of sample: 3— f2 [ Z Collected by: A/G- 1 B. SEPTIC/HOLDING TANK DATA Date installed �-__ Tank size Number of Compartments Clea_nouts (Y/N) Foundation cleanout (Y/N) �gepression-(Y/N) High water alarm (Y/N) Date of Pumping Pumper C. ABSORPTION FIELD DATA.S �,SL.!_(l Date installed— Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length Width -� Gravel thickness below pipe Total depth _ Effective absorption area Monitorjng Tube present (Y/N)— Depression over field (Y/N) Date of adequacy test Results (Pa�s7Fatl For bedrooms i Fluid depth in absorption field bef��st-(In.); Immediately aft T—_ gal. water added (in.): Fluid depth — pasrMinutes later: Absorption rate = g.p.d. Peroxidq-treatment (past 12 months) (Y/N) If yes, giv"ate 72-026 (Rev. 3/96)` D. LIFT STATION Date installed A Size in gallons Manhole/Access (Y/N) - — .P-ump on" level at. High water alarm level at' Cycles E. SEPARATION DISTANCES 'Datum mp off" level at' SEPARATION DISTANCES FROM WELL ON LOT TO: / Septic/holding tank on lot <C>`%liv/<�7/ct On adjacent lots Absorption field on lot /11- `, l<.%<l/'/<�<�<I n On adjacent lots Public sewer main / / Public sewer manhole/cleanout Sewer /septic service line /Dz r /— Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: (--5FP'7—( C. Foundation Property -line Abs rption field__ Water main/service line Surface water/drainage Wells onadjacentlots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Surface water Curtain drain F. ENGINEER'S CERTIFICATION i%e)f7/1/p Water main/service line ---------- Driveway, parking/vehicle storage -area Wells on adjacent lots 1 certify that I have determined thru field inspections and review of Municipal recon in conform777Z A /H'AA guV lines in effect on this date. Signature 1 Engineer's Name 6�3 fie. % C' (' i�9 Date HAA Fee $ 6-b Date of Payment / l Receipt Number 72-026 (Rev. 3/96)" Waiver Fee $ Date of Payment Receipt Number T� ROBERT C. COWAN i 42 CE -8801 tta:' ?nt....... are January 10, 1986 TO: Permit Applicant P.O. BOX 6650 ANCHORAGE, ALASKA 99502-065C 1907) 264-4111 n . wow�es a DEPARTMENT OF HEALTH & HUMAN SERVICES Subject: Permit # 850667 T15N R1W Section 17 NE4 SE14 SE4 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as -built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit ** GRAVEL LENGTH > 75 FT" REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS certify that: 1" I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2, I will install the system in accordance with all MOA codes and regulations, anin compliance with the design criteria of this permit. 3" I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4" I understand that this permit is valid for a maximum of 5 bedrooms and any enlargement will require an additional permit. :F A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, 'HEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2Y AS~BUILTS JILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT;,AND (3) THE :LECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. ���� ��� � ?IGNED �~�~~°..�_.~~,`�-~-^_-__~��~~���~~�~~^'-�~ ,PPLlCANT: DOE WAL :GGUED BY .................... ----- -_ DATE: DATE:V17 ` ^ �F- ��VA 1['.3 Fz. &2'-h��� p ~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTI I\T~+~r~ 825 L STREET, ANCHORAGE, AK 99501 264-4720 � 1ZJ1%J_1E1 2: -T-EE E3 EE VJ F-"* F-"� �F� 1'.1 1 7^ "ERMIT NO: 850667 )ATE ISSUED: 10/09/85 \PPLICANT: �� D�� WALKER \DDRESB: P.O. BOX 670317 EAGLE RIVER, AK 99567 ;DNTACT PHONE: 276-1072 ` ,EGAL DESCRIP: SUBDIVISION: NE1/48E1/48E1/4 LOT: NA BLOCK: NA SECTION: 17 TOWNSHIP: 15N RANGE: 1W , .OT SIZE: 10A (SQ.FT" OR ACRES) |AX BEDROOMS: 5 ,isted below are the options available to you in designing your septic iystem. Choose the option that best fits your ... ... ..... ���� site. ... � ... ...^�����-` 1=: 1%J1 E-1 F-1 ETEEED 5J 13 FZ A% 3: E-11 )EPTH TO PIPE BOTTOM (FT.) 4"0 4.0 4"0 3RAVEL DEPTH (FT") 3,0 0"5 3.0 'OTAL DEPTH (FT") 7^0 4"5 7^0 !RAVEL WIDTH (FT") 2°5 21"0 5"0 )RAVEL LENGTH (FT") 85"0 ** 46"0 65,0 )RAVEL VOLUME (CU"YDS,) 27"6 31.2 42,2 "ANK SIZE (GALS) 1v500"0 ** 1,500^0 ?OIL RATING (SQ^FT./BR) 102 110 110 ** GRAVEL LENGTH > 75 FT" REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS certify that: 1" I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2, I will install the system in accordance with all MOA codes and regulations, anin compliance with the design criteria of this permit. 3" I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4" I understand that this permit is valid for a maximum of 5 bedrooms and any enlargement will require an additional permit. :F A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, 'HEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2Y AS~BUILTS JILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT;,AND (3) THE :LECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. ���� ��� � ?IGNED �~�~~°..�_.~~,`�-~-^_-__~��~~���~~�~~^'-�~ ,PPLlCANT: DOE WAL :GGUED BY .................... ----- -_ DATE: DATE:V17 x SOILS LOG ❑ PERCOLATION TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: Vee- ��` �k�r DATE PERFORMED: ^ I SCic 17, '>9 l / LEGAL DESCRIPTION: E X// 'S L //y G' �/7 T lS J�u �/�1 /G 19cv pso APIrm SLOPE SITE PLAN NTs 2��� WB/l yraaQy C� 6•u�G 3- 4 4 `� G 5 �G P) /01/, �IOZ < /a Y} -v. ,,r 12 )w/e 13 14 r. 16 ,e .°mine. s .e.•° 17 .... p,•^ Y La'. /A. P:uterq : r.p Ck573d°°��a 18 19- 3 jORGFESu�ON�® ■■■■ Date Gross Time Net Time ■■■■ Net Drop I�1�■■■■■■■N1 ■■■ 111111 ■■1`i1■ ■■i1■i MEN NEI IN WAS GROUND WATER S ENCOUNTERED? L G O P IF YES, AT WHAT E DEPTH? �- — — Reading Date Gross Time Net Time Depth to Water Net Drop I�1�■■■■■■■N1 111111 MEN NEI IN INN ®■Kill 11■. li l ►wl�;, �ll�l�N � WAS GROUND WATER S ENCOUNTERED? L G O P IF YES, AT WHAT E DEPTH? �- — — Reading Date Gross Time Net Time Depth to Water Net Drop 20 � -0t* REf2C6i-AI FION RATE TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: %'4.5'LG Ir, w1 CERTIFIED BY:DATE: 72.008 (6/79) jC 7n a. it .., •/„, ir,r�. {tiC Q.a .^r,'¢c ��aC.�'/k'..rr, ]Rs . /�"L. C-rr%-�/, r�... �:c:. /� w r- -.f'? w%.�•.^r_, �`jsL�Z.-C---.-.b r /�j//f ry�..,;,151 .(., /, r_✓cx.(.C.-t. +r,.� .-z-...+. ��t,'..w. 't��a.dG. G+-�' 7�1.,/F. %..✓G ,`o•,rF_.�„ ca-,.�. TLs. f' CPd-r,.'f't�,c..�,.Ft r+-a�-r.�'.�' Fay. �',1.:,!T•br'r',��Y-ev�� �m�y a.-��. we_//�. L✓.� /�.yGp o...r ....e z-..� `%7,...a.-/ �l.r_t � :v j%j"t^i s+� e^�..k-a K'.�.. GJG- ✓�G/ ”" ✓H-�.1� %�L-% `f �(,r u- .Q aa_S' i r r K? �-'...-a_. �. �a.n lr ✓ 9�-�2. t. l i�£'�'-�C �1 r- G �- A..Y-1r-- . 1— al � /✓,T l'l� d /-C:"... ,e..:c.r'/�G'..J .�6n X. f .f.. C.. � 9"77 R �^...e -��v.. A.' JJam. n a 'Q..G-e-(� 'In.. /die.. '157�r'. l?r-1 �e �}"C.. !�'.e i •'[s- �..... �,T N..,-....� . jj77 / / ta W im,. �'0 H.- +,,. e l t"y�^r' K.^.!' TDr (�✓Lti. �.f 1 C /'L C44 71-014 (Rev. 5/83) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 1 Irl +� Environmental Health Division CASE REVIEW WORKSHEET ��- ✓ k '� CASE NUMBS --;72 o c� DATE RECEIVED: COMMENTS DUE BY: S-8281 August 21, 1985 September 16, 1985 SUBDIVISION OR PROJECT TITLE: Lot 1-2 Block 1, Lot 1-2 Block 2 Bending Birch Estates Subdivision ( ) PUBLIC WATER AVAILABLE ( ) PUBLIC SEWER AVAILABLE ( ) COMMUNITY WATER AVAILABLE COMMENTS: Cii �/� 'Ic✓ A n�'.=-a 7n ,c-,3 �el. �a.n lr ✓ 9�-�2. t. l i�£'�'-�C �1 r- G �- A..Y-1r-- . 1— al � /✓,T l'l� d /-C:"... ,e..:c.r'/�G'..J .�6n X. f .f.. C.. � 9"77 R �^...e -��v.. A.' JJam. n a 'Q..G-e-(� 'In.. /die.. '157�r'. l?r-1 �e �}"C.. !�'.e i •'[s- �..... �,T N..,-....� . jj77 / / ta W im,. �'0 H.- +,,. e l t"y�^r' K.^.!' TDr (�✓Lti. �.f 1 C /'L C44 71-014 (Rev. 5/83) Ted Forsi and Associates, Inc. (- 124 East Seventh Avenue • Anchorage, Alaska 99501 • (907) 274-9517 P.O. Box 2470 • Soldotna, Alaska 99669 • (907) 262-5531 'lay 27, 1933 Mr. Dee Walker SRA 290-1.Y Eagle River, Alaska 93577 Subject: Soils Investigation Rending Birch Estates NE 1/4, SE 1/4, SE 1/4, Section 17, T154, R1W, SM, ,klaska Dear bir. Walker: On "Lay 2r), 1983 a soils investigation was conducted on your property. Four test holes were dug with a backhoe. Soils were visually analyzed and samples were taken for laboratory sieve analysis. The soils encountered were prinmrily silt -gravel and gravelly sarxl. Copies of the soil logs a -re attached. The locations of the borings are note on the site plan as well as the location of the existing house. The inhabitants of this; house inlicated they have had no problems with their on-site well ani wastewater system. The sobdivision's vegetation is characterized by climax growth of 13irch trees interspersed with Spruce trees. The soils encountered iniicated that this subdivision is developable with properly designed and constructed on-site wastewater disposal. If you have any nuestions concerning the above investigations, please feel free to contact this office. 3incerPly, TED MRSI AND ASSOCIATES, INC. John T. I-f)vett, P.B. Civil BnP_ineer JTL:dh Enclosures S` 72 CEP 0 7 T93 �$1 HCl p 2 'GBS Engineering 0 Planning 0 Surueying '_l SOILS LUG �Q MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION ..,r, TEST Pouch 6650, Anchorage, Alaska 99502 276-2221 �f SOILS LOG — PERCOLATION TEST —`.(��G%_ DATE PERFORMED: 11 L� PERFORMED FOR: \�f LEGAL D ESCR I PTI O N: KI (F—: 114 7G (��- '-i5 j/Li- Net Time Depth to Water _ Ll 11 A... SLOPE SITE PLAN r�.•..f' DEPTH. .1_ r�-._ __._ .__' .... _ S 114 16 �j• •• J011N T. LCVETi 17 No. 9512-E ' ti 16 e �� P_sU�_1_P> r` C I_�-v__�� �•...� 19 3 L i, I L_ I_ II � i - — :_ I 5 s r 7 i a / Gl o�v- 10 \ — � �1 11 WAS GROUND WATER ENCOUNTERED? 12 13 Date 4A Net Time Depth to Water _ Ll 11 A... is „ r�.•..f' S 114 16 �j• •• J011N T. LCVETi 17 No. 9512-E ' ti 16 e 19 20 COMMENTS IF VES, AT WHAT DEPTH? E' Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) FT AND FT i PERFORMED BY: PlI II_ VIL77 llci✓1 — CERTIFIED BY: ? ' �� DATE: rz ona (717617209SEP 071933 MUNICIPALITY OF ANCHORAGE ,.,. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION Pouch 6.650. Anchorage, Alaska 99502 276.2221 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: TI -C ��,/DATE PERFORMED: I�E--AIOI 14 LEGAL DESCRIPTION:�Sc / -5h TN. S ENCOUNTERED? SLOPE Depth to '.Yater SITE PLAN DEPTH- IFEETI� E' IF YES, AT WHAT DEPTH?-, I - , 4 4 Q p SG GM E/✓1l Y- ry- 4M✓6G. 1 4 T61 o - - - 5 I C?„1 Cry`- ��Y 7 6-' ML s IE 13- 14 3 to '„ P�•,,.... ...,,� 'r 16 ....... r, �f •� ,•JOHN T. LO`lETT 17 9 No. 5512E •V` 0 18 ay,�saa�-�s'Q 19 20 COMMENTS WAS GROUND' WATER S ENCOUNTERED? L Depth to '.Yater O. P — E' IF YES, AT WHAT DEPTH?-, Reading Date Gross Time Net Tim. Depth to '.Yater Net Drop PERCOLATION RATE (minutes, TEST RUN BETWEEN FT AND FT PERFORMED BY: B)LL AATH/-'r/ CERTIFIED BY: V . G,- DATE: v ln^ 17 nn6171761 ^ ��� S 7`• 1y� { y 12 1.3 1 / / / 385.2 1"In 3913 385.2 - 389 5- ��`. / .f-3452 % • 3895 1^ .i / �76 t l� ao 497i )y 5690. /• 90 r 5-4 5- 2 1 I'll 02