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Home My WebLink AboutGARDENIA LT 168AGardenia 168A #051-232-78 Municipality of Anchorage:,~,~...'-- ,,.'-:' Development Services Depadment Building Safety DMsion ' On-Site Water; and Wastewater Program, 4700 S. Bragaw St. '~ ~' P.O. Box 196650 Anchorage, AK 99519-6650 Page www. ci. anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ~'~f/D~ ~ 50 ~ PID Number:, lb 5 i -~.~r~-- "7~ Name: V'~'/~./VI:T ~T'A-T~' ~ Wastewater System: [] New ~Upgrade ,~dre,,: ~.~_~o~< ~' 7;Z. Io~ ABSORPTION FIELD Phone: ~1--~.~--~1~) Numbero~.~edmem~. rqD.pTrenctt ~ShallowTrench I-IBed l'lMound r'lOther. Tot~ Depth from original grade~:~ LEGAL DESCRIPTION s°""'"~' I. ~ ~.p,~r, ~, Block: Lot: Subd'Msio~l: Depth lo pipe bottom from odg~al grade: Gravel deplh beneath pipe: Township: Range: Se~o~: Fill added above edgtna~ grade: Gravel Leng~ '~ - / ~,. £,~ 5_5 ~,. Well: [] New [] Upgrade o~,,,~,~ Classification (Private, A, B, C): ~'~ ~ Total DepI~ Cased to: Tolal absorption ,ma: I Pipe Mattel: "'- ~ 5 ¥/,, ~,' '~o~ ,-/ Driller. ~,,-~ Date D~led: Static Wate~ Level: Installec Date I~laltap: Yield: Pump Set at: I C&sii'~ Height Above ~ (:;P~I F,.I r~ TANK SEPARATION DISTANCES II*/septic [] Holding [] S.T.E.P. [] Other. From~.~ Septic Absorption Lift Holding Public/Private Manufacturer. Capacity: Tank Field Station Tank Sewer Line ~NrH '7"ANI/,. lP-5o Da,. Soda. Water "lo r~J'/0 ' ~ ~/ LIFT STATION '-/O ,,' C .a,.ora,. ,'//o , '"/\ Remarks: O/a/ "/'n~/~ ot~r,t4r~,/ BENCH MARK Assumed Elavabon; Inspections performed by: '~, ~ Dates: 1st I Developmen, t~Services Department Approval *. ~- Reviewed and approved by:. (J'~' ~'"l~ {~ - Date: $C~'LE, 1' = 50 f 168A 169 ROAD 100 1c~5 150 7', INST,4U. EO REV/SYSTEW: 1250 STEEL SEPTIC TANK ~ 11~0 5-1~1D£ TRENCHES r.4¢H 35 FI' LON~ ~ FEET DEEP ~.$ rLrET OF SE)FER R~K ~1~ AT $ FEET ,O ~ WARK SlVIN8 TIFS: AC $I, BC 40 AD 41oBD 55 TOBBEN SPURKI..4NO P.E. II 20:,T Pt' 15TH. AVENUE ANCH. AK. 99501 (90Z) :zg-.T916 LOT 16flA GARflENI~I II SEPTIC SY$i-EM AS eu/Lr VERNE STATER [I DATE: JAN. 5, 2004 19040 RICHNER, CHUG/AK SHEET: 2/3 GRID:Ni/FI054 PERHIT #$~/050502 Piti # 051-222-78 GARI68A2.D~/G Monlfor Clean Ou Standard Trenches~ 5' Wide 35' Long 6' Deep 45' Sewer rock 3' Cover Monitor Clean Out 0 0 1B50 gal Sepfic lank Z £80 FLOW SPLITTER 0 NO SCALE / FLOIf' SPUTITR NO SCALE 1£50 SEPTIC TANK ASSUMED ELEV. 100.00 TDBBEN SPURKLAND P,E. 203 ~15th Ave Anchorage Ak 99501 LOT 16DA GARDENIA VERNE STATER 19040 RICHNER RDAD, CHUGIAK OSEPTIC SYSTEM SCHEMATIC DATE, JAN. 5, £004 SHEET, 3/3 GRID, NWiO54 PERMIT # SWd3050£ PID # 051-232-78 GAR16BA3BWG MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Dec 16, 2003 Expiration Date: Dec 15, 2004 Permit Number: SW030502 Legal Description: ~~i'6~ Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Verne Stater Owner Address: 19041 Richner Rd. Chugiak, AK 99567- Parcel ID: 051-232-78 Site Address: 019041 RICHNER RD Lot Size: 49596 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: J'~ Disposal Field r~ Septic Tank [--] Holding Tank [] Privy 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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: ~///~,,~~"~/~,~__j _ _ ~. Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P,O, Box 196650 Anchorage, AK 99519-6650 www,ci,anchorage,ak,us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D, Permit Number.SW O ~'O,~"'O~ Property owner(s) Mailing address (1) ~address (2) Day phone Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size~Acres~___~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Number of Bedrooms /7/ I--I Well Only I-"1 I-"l Water Storage [--I Jacuzzi [] Water Softening Unit [] 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. (Signature of property owner or authorized a~ent) - Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 168a GARDENIA VERNON STATER Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 December 11, 2003 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and .the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable test holes are also enclosed. The septic system design is based on the following: Ground Water at 12 ft. on December 11, 2003 Assume at 10 ft at breakup Use Standard 5 Wide Trench Soil Rating. From Test hole 12/04/03 >lmin/in = 1.2 gal per sq.flIday No. of Bedroorns 4 Required Area per Bedroom: 150/1.2 = 125 sq.ft. Total ama required: 125 x 4 = 500 sq~ Bottom Rock At 6 feet Top Rock At 3.5 feet Rock Depth 2.5 feet Reduction Factor .64 Minimum Trench Length 500 x .64 / 5 = 64 ft. Use twop trenches each 40 feet. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 80 FT TOTAL WIDTH 5 FT TOTAL DEPTH 6 FT ROCK DEPTH 2.5 FT COVER 3 FT SEPTIC TANK 1250 GAL The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoffwill not result from this installation. 1595 167 181 0 ~0 $£~£E~ ~' = ~00 FT. I __ 169 TOBBEN SPURKIAND P.E. '-T-[ 205 Pt 15TH. AVENUE ANCH. AK. 99501 LOT 168A GARDENIA VERNON $TATER 19040 RICHNER, CHUG/AK SEPTIC SYSTEM DESIGN DATE: DEC. 11, 2003 SHEET: 1/3 GRIO: NWl054 ,PERMIT #$~I030XXX PIB # 051-232-75 GAR16OA1,DWG 160B 168A sCALE, 1' = 75 100 50 FT. INYrAIA I250 GAL $.T. 1WO 5-WID£ I~CHES EACtl 40 FT LON~ 2.5 FEET OF S~'R ROCK QGW AT 5 b'EET fi.ell ~/..//RICHNER REAfl ~ SPURKLAND P.E 205 H~ 15TH. AVENUE ANcH. AK. 99501 ~-sgm LOT 1flSA 169 PooP. CRUSI'I, I ANo BUR)' I VERNON STA TER 19040 RICHTER, CHUG/AK GARDENIA ~ sEPTIc sYsrEu DES/GN DATE: BEC. 11, 2003 SHEET: 2/,$ GRID: NH/lO54 PERHIT #$~/030XXX Piti # 051-2,92-70 GAR168A£.BWG Monitor Clean Out Stondorcl Trenches, Monitor Clean Out 5' Vide 48' Long 6' ~eep £.5' Sewer rock 3' Cover Clean 0 ND SCALE NO SCALE 1250 SEPTIC TANK ASSUMED ELEY. 1~.00 TDBBEN SPURKLAN9 P.E. "FI 203 ~15~h Ave Anchorage Ak 99501 LOT 168A GARDENIA VERNON STATER 19040 RICHNER ROAD, CHUGIAK SEPTIC SYSTEH SCHEMATIC I)^T£, DEC. II, 2005 SHEET, 3/3 GRI]), NVlO54 PERMIT # SVO3OXXX PID # 051-232-78 GAR16BAB. DVG Soils Log - Percolation Test Fe."formed Fcr: Legal Description: ~ 'T I~, ~/~ 5- 6- 7. 8- ~c. 10. 11- 12- 13- 1;- i 15- 17- ~'[ 20- Municipality of Anchorage Developmenl Services Department Building Safely Division On. Silo Waler and Waslew'aler Program 4700 South Bragaw SL P.O, Box 196650 Anchorage, AK 99519-6650 www.ci.anchoraqe.ak.us (~7) 343-7904 ~ AI~.'D ~ t',-! I/-~-" Township, Range, Section: Slope Site Plan III I I COMMENTS HoLE WAS GROUND WATER E.";CCU;:TER*-'D? IF YES. AT VC,,-IAT DEPTH? Depth Io Water Alter Monitoring? Date: · I I I I ~ I ~r-/,.J~, I I I I I I I I I <. [ I.-,.~,.:tes.'~.c:~) F[RC HCLE DIAMETER FERCOLATIOt'I PATE TEST RUN EtE'P;IEFJ'I PERFORMED BY: ~ ~ I ~,., ~ CERTIFY THAT THiS T-iST ~,':.":~ PERFORMED IN ACCORDANCE WiTH ALL STATE AND ,MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE' l 'Z'/I I/{) :~ GREI !R ANCHORAGE AREA BOR Department of Environment Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: FROM WEL' MANUFACTURER __ NUMBER OF MATERIAL ~)q/-~(~ ~_, COMPARTMENTS LIQUID DEPTH L~ ~ LIQUID CAPACITY/~~ ~) GALLONS. TILE DRAIN FIELD= DISTANCE FROM WELL /_~ ~ /FOUNDATION ~//O / I TOTAL LENGTH / NEAREST LOT LiNE ~ O OF LINES ~/~ O NUMBER OF LINES -'~ DISTANCE BETWEEN LINES TRENCH WIDTH/~- IN. TOTAL EFFECTIVE ABSORPTION AREA_ SQ, FT. LENGTH OF EACH LINE ~_'"~ ,"Z.~ /~ / / ~ /%'~' f' DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE IN. ABOVE TILE IN. WELL: tYPE //2 /f CONSTRUCTION /~-~-~ / ,? DISTANCE FROM: ~ ~.~'! ¢,] DEPTH .'~-'~-~ / BUILDING NEAREST ! NEAREST SEPTICs] ~- [ SEEPAGE FOUNDATION ~)F l, LOT LINE /(~ SEWER LINE_ ~C) , TANK , SYSTEM /C~ CESSPOOL OTHER SOURCES -- APPROVED DISAPPROVED. REMARKS DISTANCES: INSTALLED BY: SEWER LINE DEPTH: REMARKS: DIAGRAM OF SYSTEM t Form PW,027 O[-~E.~ ;R ANCHORAGE AREA ~O~ JGH DEPARTMENT OF ENVIRONMENTAL QUALITY' 3330.'!C" STREET ANEHORAGE, ALASKA 99503 TELEPHONE 274-45§1 PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLiCATiON AND ?E[I,M~T INSTALLATION LO6ATION ,, '~//~ ~' ~'~ , INSTALLATION OF: SEPTIC TANK ~ , SEEPAge PITi ~ , · FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTAI~IGES, REQUIREMENTS FOUNDATION TO SePTiC TANK FOUNDATION TO SEEPAGE PIT SEPTI(: TANK TO SEEPAGE PiT WALL WATER MAIN TO SePTiC TANK DRAIN FIELD SEPTIC TANK, SEEPAGE PIT TO RIVER, LAKE, STREAM. // t DIAGRAM OF SY$STEIV~ /Y20 , SEEPAGE PIT GRAVEL BACKFILL CONFORM TO BOROUG OULATIONS REGARDING INSTALLATION. Box 90, Davis St., Eagle Rivet, Alaska 99577 694-2774 or 333-5240 Russell Oyster Earl Ellis 694-2774 333-5240 Civil Engineering Surveying Soils 8- Foundations Land Development SOIL LOG Performed for: Name: ~Z~ ~O,~x%,kx~ ~c'~\,~'xxt>w Tel. No.~~c~ Mailing ~Address: ~ ~,~ ~G~ ~ Legal Description ~ X~ ~c ~ ~ ~X~ ~~~, Depth (feet) 0 1 2 3 4 5 6 7 8 9' Soil Characteristics 10 ll 12 Ground Water Encountered: Yes No ~m. , If yes, what depth Proposed Installation: Seepage Pit__ Drain Field v/~ Comments: Performed by.' Date: Municipality of Anchorage Development Services Department Building Safety Division ' On-Site Water and Wastewater Program: 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 ' v,~wv, ci.anchorage.ak.us (907) 343-7904 · CERTIFICATE OF HEA. L...T_H AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~ Parcel I.D. _o51 - GENERAL INFORMATION Complete legal descr!lJ!io'n /--07" Location (site address or directions) Current Property owner(s) Mailing address.. Lending agency Mailing address Real Estate Agent · Mailing Address Expiration Date:_ ,y,/.;z/~.,./ Day phone · ~.m!r~Dayphone. 777-. Day phone ' Ur~l~ss otherwise requested, HAA will be held by DSD forpickup. 2.' NUMBER OF BEDROOMS: /"[ 3. TYPE OF WATER SUPPLY: ' IndividUal Well E~ _ · Individual Water Storage [] Cornmunity Class __ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners· 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. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. MunicipalitY Of Anchorage - DeVelopment Services. Department ::,i: : "%' .. Building Safety Division i.. ' ' ! omSite Water & Wastewate~ Program ' ' I :~ r ~ '' : ~ , :p.O. BOX 196650 Anchorage, AK 99519-6650 : : i ; , ~: www. ci.anchorag&ak:us . 'i ': ii;l: ' ' - - . i (907) 343;7904 i; ': !:' !. :.l : . i,i HEALTH AUTHORITY APPROVAL CHECKLIST;i' .,Lega!,Descn, pbon., L.o I I/o~A- t~/~P_.,lj)F__lql A- ~ > "~ Parcel ID" O.~l-eO..~ -'7~__~ A. WELL DATA" i-.'-., . .. i " ;' ! ' ' ': '~ ' : ;i':i ~.!:... . :Weli~pe ~,: : ' . :~ ffA, B,.orCprovidepws~)#~' ..: : ..WeiiL~g(Y/N)_ . ..Date ~ompl ted J~'7~ '. : Sanitary seal (Y/N) ~-/ : Wires properly, protected fY/N~ · I~ ! ~- ' ' ",: , ' ; ." ,, : f ; : ' . ~I : :,. . " ' / _Total~lePth .q0 -r ft. ' . ii Casedto L~O4' ft. 'I ';': ;'! ' ' , Casing height (above ground) ~ 'Z. ' in. " .... ; ' FROM WELL LOG ,'.l:' - AT,INSPECTION ~ 'Date' "~ ' ' III %1:5 '!' ': Ioftesl~>":" '; ~ '"-':" ~ ' ' ! 6 ~':i. r' ~:, :c , I" ~ · Stai water'l~vel , ~.. : ' i i j~o ~ '. iff. Wellproduct,on g.p.m. , : :: ":'.. I. ~ II! ' r " ' '~ ~ =[" g.p.m. ' ,Coliform O'i '; colonies/100ml. -Nitrate .~'~;) ~g./i...;¢ ;Otherbact~fia'.'?" ' ' ~.': ~ .: i IL' ~ ' ';'--: :.. ' ... ,i~ ':,i '" '..:... ' '.i.'' ;~ "colonies/100ml. : ,:Amenic: V-. ; mg./I. ' ' :.' Date 0f Sample: ? ~tI~ 'coilected b~ ':'..~ ~ ~':B':~SEPTICIHO~DING TANK DATA ...,' ., .. ' .:: .;' . :~. Tanksize: I~o.' gal. Number Ofc0mpadments ~ .' Clsan0Uts (WN)' :. ~ '~ , , . · ,, . ; ; =,- ] , ;.,. ..... '. Fou,dation ~l~an0,t ~/N) DepreSsion over tank ~/N) ' ~igh'water ~Ia~r'(WN) :' 'Dateo~pumpihg~ :~/A' pumper':'; ' ~ ~"::: ~/A it;":.'[::: ': C.:ABSORPTION FIELD DATA [[ - ' ': ' * ":'" 'Date i~stalle ~ ~ - S0i'l rating (g.p.~./E~ or~:/bdrm)_"/' '~ .. System ~pe '. ,~ ~ ~ . :Leng ~;~ "" .. , ...... ~, .... " Gravel below pipe ~ ~. ~ :'ff. ~otal:depth. [ "' ;~' : ''; ' ' ' ";' "~' ":': ~' ~ ::;~'' ~ ' ' ~ ff.: ~:Eff. ab~orption ' ' "- ' ~ ' area'b~ff= .', Monitoring tube .~.. D'epressionoverfield. ' ' I ~" ':' : ' '~R~sUlts(P&sS/FaJl)' ~ ..... ",~': ~[~ For '~ .:Dateofadecjac~test . ...... . ; ;i,' '; . . . 'bedrooms .; Fluid'd~pth ir :?b~orption field be'~oretest ~i~: ' Wateradded :~ ~al:' ~ ~:.:'~: ~: :~Newdepth ' ~n..; ~ Absorption,rate~>~ :" :-~ .;'ElapSed Tim,,;::~'. ~ mim Final fldid depth ' ~ ': '"[ "' ': '" ''~ , , ..... : ~ : ~. ' g.p.d. ,'! .Any re uvenation treatment (pasi;12 mo.);(Y/N &'~pe) '] ': :' ~ : '~!~ ' yyes;.'~giVe date "~ ~i/0S/200~ 17:25 9B727S7B0~ ROBERT E JOHNS JR P~GE Bi *~ ~ ~ ~% R~bert E Johns, Jr. ~ Assoc. ~r ~ . ~; ~.~ ........... ~ ~ - PLOT P~S ~ LO~,~R~ NO~ - - Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. ' · P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak, us (907) 343-7904 CERTiFiCATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING L. oT GENERAL INFORMATION Complete legal description · Location (site address or directions) Current Property owner(s) Mailing address Lending agency Mailing address Day phone Day phone, e Real Estate Agent Mailing Address Un/ess otherwise requested, HAA will be he/d by DSD for pickup. NUMBER OF BEDROOMS: ~ Day phone 3.. -.TYPE OF WATER SUPPLY: ' Individual Well [~' Individual Water Storage [] Community Class ~ Well I--] Public Water System [] TYPE OF WASTEVVATER DISPOSAL: Individual On-site E~ Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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. (CertifiCates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or'B weils or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 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. NameofFirm I'-"~'~" '-~'u~'~'''-ta-~-~' ~ ~- Phone Address ~_0 "~ ~ I .~' ~ /~ Zo "~ Engineer's Printed Name. '~ ~Jab-~,.~ <:~'~u,-P'.J~,~,~_ Date DSD SIGNATURE Approved for Disapproved. XX Conditional approval for bedrooms. [;_-' ' 'l 4 bedrooms, with the fc~lio~ng stipulations: Money in the amount of 1.5 times the high bid of a minimum of. three bids from approved contractors shall be put in escrow to construct o new wastewater disposal system pursuant to perh~dt number 5WO3050Z attached. Money in escrow shall not be released until this off,c'e has g~ven final approval. Cons?ruction shall be completed no later Than 3une 15, 2004: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report . Other .MnnicipaHty of 3nchorage Development Services Department ,Building Safety Division On-Site Water & Wastewater Program 470'0 South Bragaw SL P.O.'Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Legal Description: A. WELL DATA Well type ~'~ '~ Date completed t Total depth t-/O+ HEALTH AUTHORITY APPROVAL CHECKLIST · . ParcellD: If A, B, or C provide PWSID # ~_~ Sanitary seal (Y/N) ~ · Cased to ~o + ff. FROM WELL LOG .; ...:~Well Log (Y/N) Wi[es properly protected (Y/N) Casing height (above ground) I ~-' in. AT INSPECTION · ,' :'~,' 16 ft. I. ~ g.p.m. Date of test ' Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 mi, t,{.O mg./i. Arsenic: u/ mg./I. · Nitrate Other bacteria ~, . colonies/lO0 mi. Date of sample: UI:ZI/~ Collected by: ~4.'D I~ B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~'~,~ ~..'r/~-., * Tanksize / ~-O'~gal. Number of Compartments Foundation cleanout (Y/N) ~ Date of pumping ' I ~1 I'~ } o ;5 C. ABSORPTION FIELD DATA · . , ' Date installed. / ~ 7'5 Cleanouts (Y/N) ~// Depression over tank (Y/N) I"~ High water alarm (Y/N) Date installed Length ~ ~'~ Total depth ~ ft. Date of adequacy test Fluid depth in absorption field before test I in. Water added ,,,x' gal. Elapsed Time: ~' min. Final fluid depth ~'l{n. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~ Soil rating (g.p.d./~ or ft~/bdrm) ~ System type' 1~ ~' P ff. Width I ~ ft. Gravel below pipe Lo ~ I ff. Eft. absorption area "~Vfft' Monitoring tube '/ , Dep~ression overfleld I--I I~l~Lil~..~ Results (Pass/Fail) ~-- S~¢¢~For ? ,bedrooms New dep~ ¢ in. Absorp~on rate >= ~ g.p.d. / If yes, give date ~ D. LIFT STATION ' ~Size Date installed in gallons "Pump on" level at.__.~ 'Pump off' level at Datum ,// CYcles tested _. E, SEPARATION DISTANCES High water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ~ c3 Absorption field on lot ./~ Public sewer main I'-//,,~_ .. ', Sewer/septic service line _ ~' .P-~'": .' 'O~'adja'cent lots:, ~' ~o--~ On adjacent lots _ Public sewer manhole/cleanout Holding tank /"///,A, ' SEPARATION DISTANC. ES FROM SE~PTIC/HOLDING TANK ON LOT TO: Fe Building foundation I D '/' '" P?operty line ! b 'p" Water main Wells on adjacent lots. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I L3 'lc Water Service line '~ ~L ~' Curtain drain COMMENTS ... ENGINEER'S cERTIFICATION I certify that I have determined through fie/d'inspections and review of Municipal records that the above systems are in conformance with'MOA'HAA guid. e/inb's Tr~ effect on this date. Engineer's Printed Name '"~ J~ ~ Date ' '-' ' ~ HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) Absorption field Surface water, Date of Payment Receipt Number Building foundation 'J Surface water ~'J/O Driveway, parkingNehicle storage Wells on adjacent lots '~. Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 RO. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Paroel I.D. (~x~-/- c~ ~-~ -- ~ Z 1. GENERAL INFORMATION Complete legal description Lot 168A, Expiration Date: Gardenia Subdivision Location (site address or directions) 19041 Richner Road Current Property owner(s) Tim Scott Day phone Mailing address 19041 Richner Road, Chugaik, AK 99567 688-5458 Lending agency Mailing address Day phone Real EstateAgent Della Thomas/Prudential Vista Dayphone 689-6464 Mailing Address 16635 Centerfield Dr., Eagle River, AK 99577 Unless otherwise requested. HAA will be held by DHHS for pickup. HAA picked up by:'~-. Z NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding Tank [] [] 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 Aor 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, STATEMENT OF INSPECTION BY ENGINEER As ce~ifieo oy my se~ a~x:-o hereto and as of ;he validation date shown below, i verify that my investrgation based on proceoures cullinet in :ne Health Authon~. Approval Guidelines for the Health Authority Approval applicmion erc',v :hat :-e sr.-s;~e ,va[er supply and or wastewater disposal system fs safe. ~J~C; 2~al arc ~ceouate for :he numoer of bedrooms and type of s;ructure indicated herein. I further verify :"a~ sase: cr~ :re information cetalneo from the Municipality of Anc~'orage files and from nves;:,gaticr' s?c rs:~c:~cr. :re cn-s;[e water supoy and;or wastewater dispose: system ~s in compliar~ce with ail apolicaD,e Mu¢~c:2,_=. ~rc S:a:e CCCeS. orcinar~css, and regula[ions in effect at :::e time of installation'. Name 3f F!r- S & S ENGINEERING i7054 F. aBI. R;,~r L~'V ......... Adoress ~.1~ River. Alaska 99577 --nglt*eer's F--:ec %a-e -**--'-~ ~.. ~ BHHS SIGNATURE X Ar'orcve: ;st 4 oecrooms. D..~uor Ccncitic"=, aDcrcvai fcr __ bedrooms, with the following sSoulations. Additional Cc-,mme";s Attachme?:s: HAA Septic Sys:em Well Flow Advisor/ Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: //2 -/~-- ~ Original Certificate Date: Reissue Date: RECEIVED Municipality of Anchorage ~ Department of Health and Human Services Division of Environmental Services SEP 0 5 ZOO0 On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650MUNiOiPALiTYOFANCHORAGE www. ci.anchorage.ak.us ENVIRONMENTAL SEEVICES DIVISION (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type /~/I/.4~7"~- Date completed Total depth-,/- ¢~¢- / ft Cased to FROM WELL LOG Date of test Static water level J,'/¢3 ft Well production /' g.p.m / WATER SAMPLE RESULTS: If A, B, or C provide PWSID # __ Sanitary seal ~ Coliform o colonies/lO0 mi o, B. SEPTIC(..,..~ TANK DATA Ta .,nt~i ,T~,~ ~?M ~_t e r iai D~_i(~' installed / ¢ 7~-3 Tank size Nitrate Collected by: Parcel I.D.: Well Log ~V'.41 Wires properly protected ~ Casing height (above ground) /~ in. AT INSPECTION ~' / g.p.m __ mg/I Other bacteria o colonies/lO0 mi S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle Ri'car, Alaska 995?7 /5-727--) gal Number of Compartments / Cleanouts ~"~5 Foundation cleanout/,d,'$'/~Depressionovertank ,,~ High water alarm Date of pumping ~/~1/~ Pumper L.~¢''¢ C. ABSORPTION FIELD DATA 4~,~.~_~S Date installed //~7~-%~ Soil rating ~ ft2/bdrm) ystem type Lengt~-~ ft Widt'~. ~/~z'- ft Gravel below pipe ~'n '~ft Total depth z¢ / ft Effective absorption area,-~5"'fF Monitoring tube/¢~-¢'- Depression over field Date of adequacy test ~//~/~"~ Results(Pass/Fail)r/~,¢~ For z:¢ bedrooms Fluid depth in absorption field before test / / ' in Water added ~'¢'~ gal. New depth ~z~,~¢ In. Elapsed Time: ~ men Final fluid depth / /d;/,~ "in Absorption rate >='-*-¢~ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type)--A/p,V¢ /~,k,~,cz, j¢,/ If yes, give date 72-026 (Rev. 01/00)* D, LIFT STATION Date installed "Pump on" level at Datum ~,.~e in gallons ¢ ~ in "Pump off" level at __ Cycles tested E. SEPARATION DISTANCES in Manhole/Access High water alarm level at in Meets alarm & circuit requiremenls SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot~ On adjacent lots Absorption field on lot /d~ ! -¢~ On adjacent lots Public sewer main /v' /,,¢~ Sewer/septic service line ~/¢''- Holding tank SEPARATION DISTANCES FROM SEPTIC/I'4C4..-D4..NG TANK ON LOT TO: Building foundation ~-/4-- Water main /0~ /,'~ Drainage ~ / ,¢-'- Public sewer manhole/cleanout Property line Water service line . ,/~ Wells on adjacent lots ,,/d'~/~- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ('~ ~ Building foundation //'~ ~ Water main Water Service line ~,"~ Curtain drain COMMENTS G. ENGINEER'S CERTIFICATION Absorption field '!~- /'c- Surface water //~;~ /'¢-- Surface water ,,"¢'~ Wells on adjacent lots I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date ¢4 / ( ./~ o HAA Fee $ ~ Date of Payment Receipt Number 72-026 (Rev. 01/00)~ Waiver Fee $ Date of Payment Receipt Number Rick Mystrom, Mayor Mtmicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci anchorage.ak.us September 15, 2000 Robert Cowan S & S Engineering 17034 Eagle River Loop Rd., #204 Eagle River, AK 99577 Subject: Waiver Request for Gardenia, Lot 168A Waiver Request #WR000072 Parcel ID #051-232-78 HA000435 Dear Mr. Cowan: Your request for a waiver of the required 100 feet horizontal separation from the septic tank to private well has been approved. The approved separation distance is 80.0 feet. This waiver approval applies to the existing septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system will require ail separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Services Waiver Review Worksheet WR#: WR000072 PID#: 051-232-78 Date Received: September 7, 2000 Legal Description: Gardenia, Lot 168A HA#: HA000435 Permit/C: Engineer: S & S Engineering 17034 Eagle River Loop Rd., #204, Eagle River, AK 99577 Applicant: Tim Scott Waiver Requested: 80 foot waiver from well to septic tank. Criteria: 1. Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2. Special Conditions: 3. Other: Total: Waiver is Granted: X, waiver is not G~'anted: List Conditions or Reasons for above: ,~'E~ Date: ?--/~- 0 0 Rec#: 06320 ~ Amount: $625.00 Name of Reviewer Date Paid: 9~7~00 '7'7'7 ~re~,o rom~ 2.2 (O/reel. ~ ,~ / ow September 6, 2000 ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 ENGINEERING STUDIES ANDREPORTS WELL INSPECTION &FLOWTEST SITE PLANS SOILTEST MUNICIPALITY OF ANCHORAGE Department of Human and Health Services P.O. Box 196650 Auchorage, Alaska 99519 REFERENCE: Lot 168A; Gardenia Subdivision We request you grant the following waiver for the referenced property: 1. Waiver the horizontal separation distance between the private well on Lot 168A, and the septic tank to 80 feet. A risk analysis was performed using the State of Alaska, Department of Environmental Conservation's Separation Distance Waiver Guidelines. Our results are as follows: a. WATER TABLE: At present time no historical information is available for the onsite well, (including a search of municipal records). The static water level was measured at 31 feet. The pump appears to be set at -42 feet. Per a conversation with the current owner, the well was drilled at 55 feet. From the well logs of the surrounding properties and taking into account the elevation differences between the wells we can see that the water table slopes to the north. This slope is in excess of 3% from the referenced onsite well towards the onsite septic tank. From this we expect that any leaking sewage from the septic tank would not flow towards the well. b. SOIL ABSORPTION: From the soils log used in the design of the Lot 168A; Gardenia existing septic system, the receiving soils for the septic system have gravel with some sand, which should provide excellent septic effluent treatment. From the surrounding well logs there appears to be layers of silt with some sand, clay and gravel mixes. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 c. PERMEABILITY: The hardpan with silt layers and blue clay at the 20' to 30' depth should provide a confining layer, providing a good barrier, isolating the onsite well from contamination. d. HORIZONTAL SEPARATION: The horizontal separation distances between the well and the tank location is 80 feet. e. ADDITIONAL CONSIDERATIONS: 1. The existing system has been in service for twenty-six years with no apparent adverse effects to the onsite well, or surrounding properties. Per our inspection (and during a repair to the system) of the onsite system the system appears to be functioning adequately. Past water samples indicate satisfactory results. The current water samples from Lot 168A well am ~' : Coliform: o colonies/100ml Other Bacteria: d) colonies/100mi Nitrate: c~, 5' mg/L As shown on the attached as-built, the topography is such that surfacing effluent from the septic tank would flow away from the Lot 168A onsite well. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas, by the granting of the requested waiver. If we may be of further service, please contact us. Sincerely, RCC/mjc (b) (c) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVIS!ON OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date, ~AL INFORMATION Leg~al ~)escription (include lot, block, subdivision, section, township, range) Location (address or directions) , Applicant Nam~//,~.~--~ ~.-~'~ ./Z~--~-~ _-~etephone: H~ome ~2- -- . Business Applicant Address g~/'~ ~ ~) ~' ~ ~ ~"'~-',~-~-J Y-~'~'~ Applicant is (check one): Lending Institution []; Owner/builder Buyer []; Other [] (explain); I nstit utiol~ - ~--~/..~?~,'~_~_ ~, Telephone (d) Lenalng ~ ~ Address ~ / __ (el Real Estate Company and Agent Address ~ c~ /...J ~ T.eJephone (f) '9~,fl~l. the HAA to the following address: TYPE OF RESIDENCE Single-Family~/ MultNFamHy Number of Bedrooms Other WATER SUPPLY Individual WellA Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite'~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-02.5 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date show n below, I verify that my investigation of this1 Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe for the number of bedrooms and type of structure indicated herein. I further verify that based on the i~ 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 Telephone Address ~R~ tgB~ Date DHEP APPROVAL~ ~ Approved for ~ bedrooms by "~j~Date Approved ~" Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Cl~ssification ~,~. Well Log Present (Y~) Total Depth., ~,K, , Cased to Static Water Level ~ ~ A4UNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAY 8 lg85 RECEIVED Legal Description: ~e ~e~ed ~ 7~7 Casing Height Above Ground JZ '~ -iA/ %A/~;- /$D~$~ Sanitary Seal on Casing Electrical Wiring in Conduit (¥~. /~/ ~./~-A /~.(~6Dep=ession A~ound Wellhead (Y~ Separation Distances fTcm Well: To Septic/~ Tank on Lot ~" , ; On Adjoining Lots ..... z'~ To Near~st Edge of Absorption Field on Lot /Z~D' ; On Adjoining Lots .../~ To Nearest Public Sewer ~e To Nearest Public Sewer Cleanout/Manhole. /R To Nearest Sewer Service Line on Lot '~O Wate~ Sample Collected By ~ a% ~ ~_.. ; Date ~'~-~- ~ Water Sample Test Rssults Be ,SEPTIC~ TANK DATA Date Installe~d~ Size !~-~_~ No. cf C~a~U~nts Standpipes ~t---' ~// Air-tight Caps ~/N) Foundation Cleanout (Yf~ Dep~ession ove~ Tank (Y~ Date Last ~P~ed ~-~ S~ Pumping/Maintenance Contract on File (~Y~)~3/~A ; for Holding Tank High-Water Alarm (Y/N) ~/~ Temporary Holding-~ Tank Permit (Y/N) Separation Distances from Septic/H~l~Tank= To Water-Supply Well ~ ' ' To Property Line I c~ ~ ~c , TO Water M~Se~vice Line ~-6) ~- Course TO Building Foundation ~ To Disposal Field To Stream, Pond, Lake, c~ Major D~ainage Comments Receipt # Date Paid: Amount: [Page 1 of 2] 2-15-84 DATE F(/EC LIVED ! INSPECTION APPOINTMENTS TiME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR /~ --'GE MUNICipALITY DFPT ', ~)~": ,'¢~f ~'~" MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL i',r;O'rECTtgJm ( DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION S2S,St,..*-A..,o,.g.,A..,k, EgSO, SEP ,5 1981 ENVIRONMENTAL SANITATION DIVISION R E C E IV E D Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing, 1, PROPEL I~T~Y O~/N E R ~ PHONE' MAIl'lNG ADDRESS ' ' PROPERTY'RESIDENT (If different from above) PHONE 2, BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION 1 PHONE At( MAI LING~ 3DRESS 4, REALT~ R/AGENT r ~' - PHONE~ MAI LIN G ADDR ESS 5, LEGAL DESCRIPTION STREET LOOATI'ON ..... 6. TYPE OF RESIDENCE ~ SINGLE FAMILY ~ MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* COMMUNITY PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY NUMBER OF~BEDROOMS [] One [] Four [] Two [~ Five [] Three [] Six [] O~ner ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well deoth (attach log if ay?liable.) //'~ 7~ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) CHEMICAL & G~JLOGICAL LABORATORIES ~F ALASKA, INC. TELEPHONE (907)-279,4014 'ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 S Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Mailing Address I.D. NO. Phone No. City State Zio Code SAMPLE DATE: Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose - Treated Water ; Untreated Water SAMPLE ~10, 1 3 I 4 5 I LOCATION Time Collected Colleete(I By TO BE COMPLETED BY LABORATORY Analysis snows mis Water SAMPLE to be [~] Satisfactory [] Unsatisfactory [] Same~etoo ongmtransm sample should not De over 48 hours old at exammauon to indicate reliable results Please send new sample Date Received Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No, Result* Analyst , I--i-] *NO of colon es/100 mr or No of Pos t Ye READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 {b) .ReV, X978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collect ea Source ved Time ReCelvod p.m, Lit), No. Pte~umpt lye. 10mi 10mi /0mi Z0ml Z0ml Z.0ml 0.1mi 24 Hours Conflrmat?ry Mu icipa itYof A cho 'age 825 "L" STREET A,ASXA (907) 264-4111 []EP/\R]MENTOF HEALTH AND ENVI[IONM[NTA[ Pl:tOlECllOIXl September 9, 1981 William A. Schmidt Star Route 1 Box 2247 Birchwood Chugiak, Alaska 99567 Subject.: T15N R1W Section 18 Lot 168 Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: 41) The water analysis report needs to be submitted to '- this office from the Chem Lab, 5633 B Street, for our review. The stand pipes to the septic tank and the seepage area need to be located and expose(] for our inspection. The septic tank pumped with a receipt submitted to this office. Please notify this office for a re-inspection when the noted descrepancy has been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, James S. Roberts Associate Environmental Specialist JSR/ljw cc: Alaska USA Federal Credit Union Pouch 6613 99502 r THIS SIDE FOR OFFICIAL USE ONLY · 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [~ FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~NDIVIDUAL/ON -SITE DATE INSTALLED f//~ ~PUBLIC UTILITY Connection Verified INSTALLER [~l~'ptic ~'ank or [] Holding Tank Size: ~ ~ ~ If Tank is homemade SOILS RATING give dimensions'. TYPE OF TANK / ~-~,-,-, ~'~ MANUFACTURER ~.~ 'OTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Hol~tng, Tank~ ~ [Abs°rpti°n Areaj ~'~ , Sewer LineIIf I Near~s~L°t ~rine Absorption Area to nearest Lot Line 5. COMMENTS / ~/~' APPROVED FOR ~/~ BEDROOMS [] CONDITIONAL APPROVAL (letter mast accompany certificate) [] DISAPPROVED 72-010 (Rev, 6/79)