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Home My WebLink AboutSPRING BROOK VISTA #1 BLK 3 LT 9Springbrook Vista Block 3 Lot 9 #050-09 ! - ! 0 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 PermitNumber: ~'~/ ~ C) 5/¢20 PIDNumber: 050~0~/'-/0 Name: ~E~ u~/¢~'oW Wastewater System: D New ~ Upgrade Address: /~/~// C U¢'~/~ ~'/P~c ABSORPTION FIELD No. of Bedrooms: Phone: ~¢¢. /~.¢~ ~ ~DeepTre.ch ~ Shallow Trench ~Bed UMound ~Other LEGAL DESCRIPTION so, Rati.g: O. ~ GPD/Sq. Ft. Total Depth fr~riginal grade: Subdiv~ion: Lot: ~ Block: ~ ~o/[/~' ~¢¢~ ~/~ Depth to pipe bo~om from original grade: Grave] depth beneath pipe Township: ......I~ Range: Section: Fill added above original~ grade: Ft. Gravel length: ~ Ft, Gravel width: Number of lines: Distance be~een lines: WELL: D New ~ Upgrade ,~ /.~ Ft. ~ ~ ¢' ~ Ft. Classification (Private, A,B,C): To~l Depth:/ ~d To: Total absorption area: ~) Pipe material: Driller: ~ Date Drilled: Static Water Level: Installer: . ~ Datelnstalled: Yield: ~ I Pump Set at: Casing Height Above Ground: TANK ~ GPM I Ft. Fl. SEPARATION DISTANCES ~ Septic U Holding U S.T.E.P. To Septic Absorption Lift Holding Public/PrivateManufacturer: Cap~cityin gallons: Wel~ /¢07 r --- 2~.1 Material: Number of Compa.ments: su~c~ ' LIFT STATION Water /00 '¢ /00/¢ LineL°t ~ / ~ / Size in gallons: Manufacturer:~ "Pump on" level at~m~" level at: / D~ /~ I I High water alarm at: Foundation / 0 Cu~ain Pu~l Electrical Inspections pedormed by: Drain Remarks: BENCH MARK Location and Description: 17034 Eagle River Loop Road, No. 204 ~"'"';~/"lY"~'"% ..... ~, inspections pedormed by: ~gle River, Alaska 99577 Dates: 1 st/~ ~ ~ Y~ ~,.~.,.~ Bepad~ent ~f Heal~ and Human Sewioes approval ~'~¢*" Reviewed and approved by: . _ Date://-/~' ~ 72=O13 (Rev. 9/91) MOA 25 P~R~? NO. SW980420 p^~ 2 o~ 3 Ivlunicip, (1Li-t.. _¥_..oF Anchon~oe DEPARTMENT OF HEALTHAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O, Box 196650 ~Anchor~ge, Atosk~ 99519-6650 ~ TeLephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT [.BGAL LOT 9, BLOCK .3, SPRING BROOK VISTA ~ I P.LD. NO. CURTIS CIRCLE / PRINCE OP--~C1Z DR. B~X ~/L LOT 10 NEW BE]) DBLI / / NEW i300 GAL, POLYETHYLENE SEPTIC TANK 050-091-10 LOT 8 8CALE ROBERT C. COWAN CE - 3301 PERMIT ~0 SW980420 PAOE ,.5 OF .5 rvlumicip, alit oF Anchoraae DEPARTMENT OF HEA~_THAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196658 ~Anchora§e, A. Laska 99519-6650·Tetephone, 343-4744 ON-SITE WASTEWATER DISPOSAL :SYSTEM AND/OR WELL NSPECTION REPORT LEOAL LOT 9, BLOCK 3, SPRING BROOK VISTA #-/ P.].D. NO. 050-091-10 STt ST2 NEW 1300 GAL , S.T, A B C FCO 9.0' 50,0' - ST1 23,0' 45.0' - ST2 26.0' 42.5' - DBL1 31,0' $8.5' - DBL2 52.0' 57,5' - C01 - 42.0' 62.0' MT1 - 29,0' 51,0' C02 - 49.5' 58.0' ~T2 - 55,0' 47,0' C01 C02 /-FINAL GRADE MT8 ~] ~¢,. , n / /-FROM SEPTIC TANK o~ c~,7 8,, ,j/ "~ 16 ~87 ' 87,7 ~89 5' ~ ,8 '89.5,J/ 83.?' WATER FOUND 79.7' BOH N. T. S, MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 995'19-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 26, 1998 Expiration Date: Oct 26, 1999 Permit Number: SW980420 Legal Description: SPRING BROOK VISTA#1 BLK 3 LT 9 Design Engineer: 0003 S & S Engineering Owner Name: Gregory J Johnson Owner Address: 12141 CURTIS ClR Total Bedrooms: 3 EAGLE RIVER , AK 99577-7542 Parcel ID: 050-091-10 Site Address: Lot Size: 33598 SQ. FT. Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] 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 ( 18AAO72 ) and Drinking Water Regulations ( 18AACS0 ). 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: Date: Rick MFstrom, Mayor Mini ' t c pan of Anchorag'c Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage. Alaska 99519-6650 http: www.ci.anchorage.ak. L~S October 26, 1998 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 9 Block 3 Spring Brook Vista Waiver Request #WR980080, PID #050-091-10, SW980420 Dear Mr. Cowan: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 2 feet from the proposed leachfield to the south property line and waiver of the separation from the leachfield to the cutbank of 35 feet. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744. Sincerely, DaY'th Civil Engineer On-site Services ljw #7 MUNICIPALITY OF ANCHORAGE Department Of Health and Human Services On-site Services Section Waiver Review Worksheet WR#[~Oq~.-~O~/~PID# 050-091-10 HA# Date Received: October 21, 1998 Permit Legal Description: Lot 9 Block 3 Spring Brook Vista #1 Engineer: Robert C. Cowan, P.E., S & S Engineering 17034 Eagle River Loop Road, Suite 204~ Eagle River, Alaska 99577 Applicant: Gregory J Johnson Waiver Requested: Lot line waiver of 2 feet from the proposed leachfield to the south property line; and waiver the separation from the leachfield to the cutback a~ 35 feet. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: _ .~ Waiver is NOT Granted: List Conditions or Reasons for above: ~£~ ~/~/~£~ ~' Rec ~: 04278/6378 Amount: $ 115.00 Name of Reviewer Date Paid: October 21, 1998 RECEIVED MUNICIPALI"IY OF ANLH~GJE: ENVIRONMENTAL SERVICES glVI~JON ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLA~S ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN October 20, 1998 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECEIVED MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 OCT 21 1998 Municipality of Auchorage Dept. Health & Human Services REFERENCE: Lot 9, Block 3, Spring Brook Vista #1 Subdivision Request you issue a permit to install a septic system to serve the three bedroom dwelling on the referenced property and grant a waiver for 2' horizontal separation distance between the proposed leaehfield and the property line to the south. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 09/23/98 water was not encountered in the test hole. After seven days of ground water monitoring the monitoring tube showed water at 8'. We do 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 fmure development on any of the adjacent properties. If you require additional info~nation, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/rdp Enclosm'e 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 1" -- 50' SCALE ~-~> DESIGN DETAIl_ ~ o~n~, "~ [.nO ~ o \0 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ¢~nship, Range, Section: SLOPE SITE PLAN WAS GROUNO WATER ~ ENCOUNTERED?~ IF YES, AT WHAT DEPTH? Deplh Io Waler Alter, j Monitoring? [O Dale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE J "7.-'" (mmutes/~nch) PERC HOLE DIAMETER ~ ' TEST RUN BETWEEN '~.'~'" FTAND &']'~'* FT COMMENTS :/:d/:' 4' PERFORMED BY: ~0~4 ~gl~ ~iv~P I ~op ~A~ No. ~ ~'~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WlT~~"~[ GUIDELINES IN EFFECT ON THIS DATE. DATE: ' O /', / ~ ~ 72-008 (Rev. 4185) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: bO~r ~ ~.,~L. '~ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O ,~ ~ ,r ' /~, ',.o'1..~'~ ~,~ ROBERT C. COWAN ~,~ DATE PERFORMEb~i,'.I , ~'.'.,~'g.- ..;:¢ -- nshjp' Range, Section: SLOPE SITE PLAN WAS GROUND WATER ~ ENCOUNTERED? ~'& ~ IF YES, AT WHAT ~-~/ DEPTH? ~g- Depth t0 Water Alter, ~ Monitoring? [O Dale: ~C,-\ ~c~ ~' ¢- Gross Net Depth to Net Reading Date Time Time Water Drop ~ · ~ ~ ~/~ ~ .s~" PERCOLATION RATE I ~ (m~nutes/,nch) PERC HOLE DIAMETER TEST RLJN BETWEEN '~.:~ FT AND b/. ~ FT COMMENTS PERFORMED BY; ~.?034E~l~iv-rl~pr~a,~ctN~,20A /r/'/'~fJft// ~-' (~"~-'-~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITP~AaL~eS[~,~V'~CA~ba~Ji~?~TA~L GUIDELINES IN EFFECT ON THIS DATE. DATE: I fO / 1,~ / ~ ~ 72-008 (Rev. 4/85) ROBERT C. COWAN, RE. ROBERT A. SHAFER, P.E. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGrNEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOiL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 9, Block 3, Spring Brook Vista #1 Subdivision October 8, 1998 GENERAL: The scope of this project includes installing a leachfield to serve the three bedroom residence, verifying the integrity and replace the 1000 gallon septic tank if necessary with 1300 gallon polyethylene septic tank. Also verify existing leachfield so that it does not have ground water encroachment and if not install diverter. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval fi'om the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page 2 Lot 9, Block 3, Spring Brook Vista #1 October 8, 1998 All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Two flow dividers shall be installed sending 3/4 flow to longer trench and remaining 1/4 flow to shorter trench. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt ban'ier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page 3 Lot 9, Block 3, Spring Brook Vista #1 October 8, 1998 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: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforat~ Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. Page 4 Lot 9, Block 3, Spring Brook Vista #1 October 8, 1998 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt bamer, 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. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons perfoirning 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 ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGfNEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST S~TE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL fNSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN October 8, 1998 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 9, Block 3, Spring Brook Vista #1 Subdivision Request yon issue a permit to install a septic system to serve the three bedroom dwelling on the referenced property and grant a waiver for 5' horizontal separation distance between the proposed leacbfield and the cutbank to the south. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 09/23/98 water was not encountered in the test hole. After seven days of ground water monitoring the test hole showed water at 10'. We do 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 any of the adjacent properties. If you require additional information, please contact us. Sincerely, - ert C. Cowan, P.E. RCC/rdp Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ~" = 50' SCALE DESIGN O ,-3 O [',3 DETAIL ~ulm Z O MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES E.v,ro...~.,a, Hea,,h D,.,s,o. ~ FO ~ q~ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT /O TYPE OF SYSTEM /~'TRENCH ~ BE[) [] W, DRAIN OTHER REMARKS: DISTANCES WELL SEPTIC TANK AB$Ot:IPTION FIELD WELL LOT LINE /o .-~ __ FOUNDATION .,/,.5"" / [ 7 AS-BUILT DIAGRAM tSnow local:on el well, septic system, properly lines, Iourldabon, driveway, waler bodies, etc) , ~'~:. ~ I _.~_,_ ~ ,er~ No. ~04. cedilyJJ~at this inspection was pedormed accordinfi lo ail : Health DepadmenlApprova,: _~~//z. ~- Date:,,~ ~:~ 72-013 (3/85) *,~.~:~.I ~ i~'~:~l.,:t:l..t, t.l"~':~ ~',,,'~'~:.~..z, li~ :i~ atc;:c:c)r.d,:~v'~c:~:, ~,~:i.'Lh ~':~:I. 1 IvlC)(::) ~:::~::~::1(.~ ,t~d'"~d i"(.:,)~t]~..~:i.,::~.'~.:i.(::~i'"~,~, ~,,~ ~t ~',~. Lo ,::~.1:1. M(::)(:~ .:.ti'id ~l'..,:~';'v~:.~;~ ~::~ (.~:l,:~d~il.~:~:~t i"(.'~ec~L~:i.l'-(.~.:,l[le.)r'l'l:.s~ fop 'Lh(.:.z, ~e:,'l:. :;.~:~'~:::~::~ ~'~::)~'['~ ,';:tri'y' o~.~:i.~;F,'l'..:i, nq ~,'~(.:.):1.:1.~, ~,,,n?~.~Co~.~,:~t't..~,~,P d:i.?q:)c:)~o.:l. ~y~;t..e~m c)r' ~(.,]ow.'l'60.:~:' ::,/~I:.Oi[i "' ~'.:: C)I" i~d~~ .~::'[C[.'j.StC:(?~I'~. 01" I"IC~P~:)'~ ;~.~t. 'LIt(.:~ c:,';:H::~atc::i.'L'y (:)f 't.l'~e~, 'l'..c)'t'.a]. ~i;'y~i'('.(~::,m :i.t~; :/~; I:)~.:.:.)clr'(::)()m~;~; and Municipality oi Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:,¢~, ~'~/ ~¢-J,~ 7~, Township, Range, Section: z//-/¢ SLOPE SITEPLAN ' 10 11 12 13 14 15 16 17 18 19 2O ENCOUNTERED? Depth Io Water AlleE .... Monitorino? /~y Date: ~_~ S IF YES, AT WHAT O DEPTH? p Gross Net Depth to Net Reading Date Time Time Water Drop , ¥;* ,o ,, I~" ///1'¢" PERCOLATION RATE~ ~ (m,nutes/mch)PERC HOLE DIAMETER TEST RUN BETWEE T AND ~ FT COMMENTS S & S ENGINEERING ~ ~ PERFORMEDBY~~[ .... .// /~~ CERTIFY THAT THI~TEST WA~ PERFORMED IN Muldcipality of Anchorage Development: Services Depadment ' Building Safety Divlslon On-Site Wa~er and Wastewa~er Program 4700 South ~ragaw St. ~ P.O. Box 196650 Anchorage, AK 995t9-6650 www.ct.anchorage.ak.lls (907) 34;J-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING RUS Parcel I.D. 050-091-10 1. GENERAL, INFORMATION Compl~.t9 legal description. Lot 9; Expiration Date: Block 3; Springbrook Vista #1 Loc~ti~Jr~ (~te address or c~irections)12141 Curtis Circle, EaRle River, AK Cu~.r.e. nt Property owner(s) G.k'eg Johnson Day phone 622-2543 ~Vl.~ili"ngaddress 11'910 t,ugene LR, l~agle River, AK 99577 Lendir~ agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Slorage Community Class __ Public Water System Well TYPE OF WASTEWATER DISPOSAL: Indivi. dual On-site ~ ~] Indiv,dual, 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 Ihe 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 lille (except between spouses) for propedies served by a single family on-site wastewater disposal ahd/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Heallh Authorily Approval are vnlid for 90 d.nys from lhe date of issue for properties served by a private or Class C well and may be reissued wilh .ow water sample results less than 30 days old. (Cedificates may be reissued for a period or up to one year with valid water samples.) Certifio~]les are valid for one year for propeflies served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible [or errors or omissions In the professional e.gineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as o{' the validafion da(e shown below, I verify It,at my Invesllga(ion, based on procedures outlined In lhe Health Authorily Approval Guidelines far this application, shows that Ihe on-site water supply and/or wastewaler disposal system is(are) safe, functional and adequate for Ihe number of bedrooms and type of slructure Indicated herein. I further Verify Iha[ based bn Ihe Information obtalned from the Municipality of Anchorage files and from my Invesllgation and Inspection, Ihe on-sile waler supply and/or wast,ewater._di~posal system Is(are) In compliance With all applicable Municipal and Slate codes, ordinances, · and~;e~_'hJt~ neffectatthelmeoflnsla a on Nameo[FlrmS & S Engineering Phone 694-2979 Address17034 N. EaRle River Loom RD.. E.R.. AW Engineer's Printed Name Robert C. Cowan Dale ~"/21/o ''/''- 5. Dsm SIGNATURE [,"'"/ Approved for Disapproved. Conditional approval for , E.r c ca,,,,,. bedrooms. · . ',~,~;¢.,... ¢~~8.0! .,~.'~' ~,I, -; ...'~'"'" .,.', ~ ~' bedrooms, wflh the follow~ng shpul.~'fi'~-~:~''~ . Additional Comments Attachments:. HAA Checklist Septic Sys{em Advisory Well. Flow Advisory X Maintenance Agreements Supplemenlal Engineer's Report Other Original Cedificale Date: ~'-'o ~ ~ -' ~.~ .'2_ Municipality of Anchorage Development Services Department Building Safety Div~Jon On-Site Water & Wastewater Program 4700 South Bragew St. P.O. Box 196650 Anchorage. AK 99519-6650 www.cLonchorage.ek.us (~07) HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type Date completed Total depth :' Data of test Static water level * / / Well production / WATER SAMPL~I;~SULTS: Coliform .~_colonios/100 mi. Date of sam,[;le: ----- pc/,Gc-l~- ~ If A, B, or C provide PWSID # Sanitary se~/N) lt. C~d'to ft. FRO~,~L LOG B. SEPTIC/HOLDING TANK DATA g.p.m. Nib'ate Collected by: Tank Type/Material ~ Tank size ),,- gal. Number of Compmlments Well Log (Y/N). mg./t. AT INSPECTION ff~. g.p.m. r bacteria colonies/100 mi. Data Installed / O/~,//'~ Cleanouts (Y/N) Co Foundat~n cteanout (Y/N) ~ Depression ova' tank (Y/N) ,~/ High water alarm (Y/N) ,'~ Dat.e? Pumping Pumper ABSORPTION FIELD DATA Date;"talied,_ ~__(~_~..C~ Soil rating (g.p.d./ft~ or ~/lxtrm)~. Length ('~ ~ ff. Width !.~"/ lt. Gravel below pipe /, ~ lt. Totaldepth ~' lt. Eff. absorptionama/~'~f~ Monitoring tube Data of adequacy test ~"/~4.~/~ Z.-- Results (P=__~_,flFail) ,~[~A.~ ' For ~ bedrooms I[ J~/~ Wateradded~f/'/ I Newdepth/~Z/~/n.~' Fluid depth in absorption field before test .L~ in. Elapsed Time:.:2~'/'~ min. Final nuid depth a' Absorption rata >= ~ O.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) e,./ If yes, give date D. UFT STATION Date installed A// ~ / "Pump on" level at.~ in. / SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tenldlift station on lot Absorption field on lot Public sewer main Sewer/septic service line Manhole/Access (Y/N) in. High water alarm level at. in. Meets alarm & circuit requirements? Size in gallons 'Pump off" level at Cycles tested __ On adjacent lots On adjacent lots Public sewer manhole/cleenout Holding tank SEPARATION DISTANCES FROM SEPTIC/~G TANK ON LOT TO: Building foundation ~' ~ .4-- Pmpen'y line ~- t j_ Absorption field ~ t Watermain (~) -~- Waterserviceline I 0 ,4-- Surface water Wells on adjacent lots ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Propertyline ;~ '~. Buildlngfoundaflon ,J{~ .",- Watermain [ O I.~ I ~ Driveway, panking/vehicle storage Water Ser~/ice line ~ O ,f- Surface water 14~(~) t Curtain drain ~ Wells on adjacent lots ~f~.P/! F. COMMENTS G. ENGINEER'S CE~.CA~ON I ~1~ that I have dete~ ~h field mview of Muni~pel ~s that ~e a~ s~e~ am ~ ~n~ance ~h M~ H~ au~e~s in e~ on this ~[~ lO ~ H~Fee $ 37~ ~ I~O (~) Date of Payment Receipt Number (Rev. 12/00) Date of Payment Receipt Number MAY-=~-=O02 10:5-'J S&S ENGINEERING 90? 694 1211 P.O~/OJ ~.~:~;~i.~ '.~".': .'-.. ." ~ . ... ~:t .. · . , ,.. . ~ ,.. .. ~ . .~ . ,. . ,.~ . . . ~ ~ ~.. · : ..~ t . . .~...~.. . ~ . ,~ .... . .. - ~ , ~ .. , ~ .... ..~ ... t ~. · .... ~ .... · . ~. .. . . ... .~ . .' · .. ~. · . ; ~.~. ' ... . .... ,... . . .,. ~. · . . ...... ~ .... =~, ...~.~,~ ~ ..- ': "' : · .. ~¢'~ ~ .~'/ ' ' ".' ,'~.-' / '.: · ." :,., . ~ " , '"::.' ': -' ' '.x .... ,. ~ ., ~ ... .. .. . .. . -~,. . .-, . · '. · ,.; ' '. ~/.- ..... · · c;'~*..r. .... ,*, . .'~ .. . . - :: . , . · . ..~...., .. ~ . . · · . ~,.~.:;~:.,. '/.....'~. '. · 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-091-10 HAA # 1. GENERAL INFORMATION Complete'legal description Location (site address or directions) 12141 Curtis Circle Property owner Mailing address Lending agency Mailin. g address Agent Address Greg Johnson Day phone 12141 Curtis Circle¢ Eaqle River, AK 99577 Credit Union One/Kathy Day phone 16635 Centerdfield Drive, Eagle River, AK 99577 Day phone 696-1639 786-2222 ext. 317 Unless otherwise requested, HAA will be held for pickup. 3 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: individual well Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWA'I'ER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: XXX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 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 i7034 ~.agle klver Loop Eoad No. 204 Phone ('2¢/~'/- ~.c~ '7 ~l Address Eagle River~ Alasl(a 9~577 Engineer's signature Date DHH8 SIGNATURE AV Approved for 2 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date ////-/"~- ~'4:¢ 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 State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907')~3~744 Health Authority Approval Checklist A, WELL DATA Well type ;~'-' Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production Date s~ample: If A, B, or C, attach ADEC letter, ADEC water system number Date completed /.~. J'"'~ Cased to Casi~jp~eight (above ground) _..,-~,/ires properly protected (Y/N) FROM WELL LOG /~-~ AT INSPECTION Nitrate Other bacteria g.p.m. Collected by: B. SEPTIC/HOLDING TANK DATA Date installed /() -'~ 1- '~' Tank size /,~oO Number of Compartments ~ Cleanouts L~/N) ,~',S'_ Foundation cleanout (-~N) V'd ~ Depression (Y~) /-(f~ High water alarm (Y/N) /-///~ Date of Pumping h',~ Pumper ~/'~ C. ABSORPTION FIELD DATA Date installed t() - ~t- ¢/o~ Soil rating (g.p.d./ft~ or fF/bdrm) O, ~' System type ~"~ Length ~o ~ / Width /.5" / Gravel thickness below pipe /, ~ / Total depth ~ '" Effective absorption area /O~ O ¢ Monitoring Tube present (~/N) y~'.5' Depression over field (YL/N~ //'¢, . Date of adequacy test #/~ - ~ ~- ~'/ Results (Pass/Fail) For ~' Fluid depth in absorption field before test (in.); 2 Immediately~_..__~ add_.___ed (in.): ~..----- Absorption rate = Fluid depth (ins) Minutes later._~.~_ g,p.d. Pero~erCC(~2 months) (Y/N) if yes, give date bedrooms 72-026 (Rev. 3/96)* LIFT STATION Date installed //,//~ Manhole/Access (Y/N) High water alarm level at* Size in gallons ~ "Pump level at* off" *Datum Cycles tested E, SEPARA~STANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ,,'¢O /.,,L Absorption field on lot /dO/¢- On adjacent lots /4)0 ¢'/- On adjacent lots /oo //- Public sewer main .~,/~ Public sewer manhole/cleanout Sewer/septic service line o.~.5'// Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /~ / Prope~y line ~' / Absorption field ~¢ / Water main/se~ice line /O (~ Sudace water/drainage /¢(~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON'LOT TO: Properly line ~ / Building foundation ~ / Water main/se~ice line Sudace water /00 (/ Driveway, parking/vehicle storage area Oudain drain ~ ~o~.¢M Wells on adjacent lots ENGINEER'S CERTIFICATION I ce~ify that l have determined thru field inspections and review of Municipal recor~~q~s are in conformance with MOA HAA guidelines in effect on this date. Signatur Engineer s Name ~0¢~,4 ~ C_ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number