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HomeMy WebLinkAboutWHALEY #5 BLK 1B LT 3Whaley #5 Block 1 B Lot 3 #051-111-21 Municipality of Anchorage Page 1 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: PID Number: 051 - I II'c;A Name: JrUAAa- No e alnsoA Wastewater System: )KNew ❑ Upgrade AddfeSS,0ehk 951oN`11 Po 6 ABSORPTION FIELD Phone: 35Q _ O 'r V No. of Bedrooms: p Deep Trench Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: + ] '1 Total Depth fromm o�inal grade: e Y r GPD/Sq. Ft. Lot: Z Block: Su ' division: pp r /IW h le j W9 *1 Depth to pipe bottom f ompriginal grade: Gravel depth been/ea h pipe �J J Ft. Township: _ Range: Section: Fill added above original grade: 0 Gravel length: �D ' G Ft. Ft. WELL: .New ❑Upgrade Gravel width: �1 Numberof lines: Distancebe epgn lines: Ft. /1 Ft. Classifi�j�tion (Private, A,B,C): Total Depth: Q Cased To: as Total absorption a®rea: �% Pipeym�aterial: �p '-3a'6� P' n`ll)A� FL Ft. 3 O SQ. Ft. 1 pl() Driller: LTC44 nll cC Date Drilled: -1�1-qio Static Water Level: 1 %® Ft. Installer: L l'X irk AS, Date installe fit/ //nn (�kP AW Yield: Pump SetAt: Casing Height Above Ground: TANK (/II l0 P �hI�O LO AFt. � Ft. SEPARATION DISTANCES yeeptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manu cturer: Capacity in {g{a��llo�,n�`s^�y f From Tank Field Station Tank Sewer Lines rCt e. I t 4 Welly `I✓Ol+ I �l •,t, Material: .1 ` Number of Compartments: Surface 100— WWolt �� .�— LIFT STATION Water V Lot 15D' +- J 501.-t' ,� _-� Size in gallons: Manufacturer: - Line V Foundation "Pump on" level at: "Pum a at: High water alarm at: Curtain ,�— VOAe K� Pump ode( Electrical Inspections performed by: Drain /1/ Remarks: i F s NoL.oaAr/u/.. f V, 14/1 BENCH MARK G}5 J/VOW A) T657- )Vo L&- Loc 47/; ,) Location and Description: Do c,L�✓if L. Assumed Elevation: 10©t Ft E Inspections performed by:9 ENGINEERtRriNG Dates: ls� I.- ., �. .S 17034 Eagle River Loa Road, No. 204 M�u��q g p 2nd-M$ f' t � ROBERT C. COWAN y� `f'i Eagle River, Alaska 99577 F) N9 L _ J/6'. � q'7 CE-8801 Department of Health and Huinan Services approval's^.'a.e�`' Reviewed and approved by: Date: -24 �`a'>•> <vaw"� 72-013 (Bev. 9/91) MOA 25 SW960232 Permit No Page 2 2 of — Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report LOT 3, BLOCK 1B, WHALEY S/D #5 Legal Description: 051-111-21 PID No.: 10' MIN. \ NEW 1000 GAL. oe�z SEPTI TANKMT \\ \ A r col oeu 1.5' 29.0' FCO ST2 Fco sT' ST1 12.5' 31.0' ® \ ST2 18.5' 33. 0' A NEW DBL1 21.5' 34.0' DBL2 22.5' 35.0' TH' 3 EDROOM c02 J HOUSE C01 31.5' B MT1 31.5' ALT. SITEJ 1 _ WATER PPROX. LINE LOC.) 1 1 i Im as TRENCH gp yT 1 W � q� WELL i i i N 1 Y UTIL. ESMT. STI FINAL GRADE Col MT1 CO2 S'P2 99.1' 1 SR'jM 95.1' 1000 SE GAL TIC 94.9 CO1 = 95.0' CO2 = 94.9' /FM.-•' Y0 MT1 = 90.6'. ROBERT C. Cc (� CE- 8801 t� SCALE i" = ao' NO WATER F B.O.H. 966'' fjl, ••� `�Ci YZa� R03""' 72-013 A (Rev. 9191) MOA 25 WE SERVE, 44 116414 ALL ALASKA **V*;RILLING C0.1 CHUGIAK, AK P.O. BOX 670042 — CHUGIAr, ALASKA99 587 WAS ILLA, AK 688-3199 376-3199 OWNER OF LAND .... ............................... DEPTH OF WELL ......................... I ................... . ........................ ADDRESS ...... STATIC LEVEL OF WATER FT...!A§J:t& .............................................. WELL - SITE .... Whal-ey .. 15-lilk-111-U-3 ... Cbugiak .. ikk,, ............ DATE - STARTED ........38 a:% ............................................................... DATE - ENDED .............E. -.14m%................................... KIND OF FORMATION: FROM ...................0. FT. TO .................. 9.. FT... tMh ..UP................. FROM ...................2. FT. TO ................... 6.. FROM ...................6. Fr. TO ................U. Ff...Z.Quldex ................ FROM ................1k. FF. TO ............... 31.. FT—Sand..&Jfxamel. .... FROM ................31. FT. TO ................A. Fr..3.9M;L4fm ................ FROM ................39. Fr. TO ................83.. FT.—Sanji-h ... Cohlea.. FROM .................U. Fr. TO .............1.42.. FT—Rea...Gravel ......... FROM .............. LAU. FT. TO .............. Uk. FT...AmadgX ................ FROM ..............156. IT, TO ..............17.5.. 177-5.ilt..4 .. UU ....... FROM ..............1.7.9. FT. TO ..............203.. FT. Jiar.dpim ................ FROM ..............2.0. FT. TO ..............22.4.. rr—AitAr ... Q. r Fiv. al..... FROM...................... Fr. TO ...................... FT.................................... MISCL. INFORMATION: No warranty or no warranties implied DRAW DOWN FT . .... 22.9 .. ft..»........................................................ GALS. PER HR.AQQA;LAU1..F,§,6.......................................................... KIND OF ...................... FROM....................... FT. TO ....................... FT . ................................. FROM ....................... FT. TO ...................... . M.C.EIVED JAN 211997 Municipality of Anchorage QePt- Health & Human Services Permit NO, SW 960232 DRILLER'S NAME ...... Jay .. Mil I I ama .......... FROM....................... FT. TO ........................ FT................................. FROM....................... 1". TO ........................ 17 . ................................ FROM....................... FT. TO ........................ FT............:.................... FROM.... : ................. FT. TO ........................ FT . ................................ FROM ....................... FT. TO ........................ FT................................. FROM....................... FT. TO ........................ FT............................::... FROM ....................... FT. TO ........................ FT..............................:.. FROM....................... FT. TO ........................ FT......:.......................... FROM....................... FT. TO ........................ FT . ................................ FROM....................... FT. TO ....................... FT.................................. FROM ....................... FT. TO ...................... . M.C.EIVED JAN 211997 Municipality of Anchorage QePt- Health & Human Services Permit NO, SW 960232 DRILLER'S NAME ...... Jay .. Mil I I ama .......... PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT � PERMIT NUMBER:SW960232 DATE ISSUED: 8/05/96 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 8/05/97 OWNER NAME:HANSON DARWIN & NADINE OWNER ADDRESS:P.O. BOX 210491 ANCHORAGE, ALASKA 99521-0491 PARCEL ID:05111121 LEGAL DESCRIPTION: WHALEY #5 BLK 1B LT 3 LOT SIZE: 57935 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY ISSUED BY: DATE• DATE• 61-S`_ / 6 J-24'96 ,E.vb/AiiFE/i wRNTJ io cH�P/UdE DFS/Ga %0 � S �wiA,� Dn1AYNF/6L/% X 9Ff �GovG s wF/? RocK. 390 ft% S&S nq July 25, 1996 ROBERTO. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 HEALTHAUTHORITY MUNICIPALITY OF ANCHORAGE APPROVALS Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 SEWER&WATER MAIN EXTENSIONS REFERENCE: Lot 3, Block lei, Whaley S/D Addn. #5 Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on SEWER&WATER the referenced property. INSPECTION A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. ENGINEERING STUDIES ANDREPORTS At the time of excavation no water was encountered in the test hole and after seven day ground water monitoring, the monitoring tube was found to be dry. WELLINSPECTION This property has enough area for a future septic upgrade &PLOWTEST which can be seen on the attached site plan. SITE PLANS We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. ROADDESIGN If you require additional information, please contact us. Sincerely, SOILTEST aW Robert C. Cowan, P.E. RCC/gk PERCOLATION TEST Enclosure STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 V., = 50' DESIGN SITE PLAN SCALE o2d M c t�3 r r m LzJ W" cn R' �m IrTj r o zdMro to I N W wN� 0Or c�i�bo Ciro tC.y r M m rC • JOO. r�i p\'tl 0 D r f o z t O y C 7/1 ty � xl Z y yY�l LTJ o (A o S xy c y f C 1 0• - I �'� k7 M Z O f" O IgSS lL ern > d C D W S I�<l� o F- O0 Z O O D 0 7-\r m r O I N \9 ,N9 W I m ZOC o�$Fm 3AI210 43SOd02id2g /�mAmWzc g �9 A01 OFc A in < ��� Z m N p OZ z D ��y-ri m0 oma` In=m W m6ogf'l m z Z A N fN•1 I �N zC) �A� A� ' cNn O �i C a T.o <Oo�::EzO Z rc zm�my4Z mm 0) C I / r ➢ = mm O m m N O H< Z r .. D CJ OM,nx NO 2 m 0(7) D D O O>M x r 00 O 6n Z m mo rro z0/ m / A z N O A m O Z�D> D 3 - of Dz�A \S•�i SJR I L-------------- iws3 gun j t XGA � . O ice'" T DnO f3 U7 Cp n �i NF � e LEGAL DESCRIPTION:, 9' Fr r�- 1 r� 2 D' 3-- 4 4 5- 6- 6 . 7 8 ( 6` r 9- 12 - 12 d, 13 -5a� 14 15- 5161718 16- 17- 181 19 20 T DATE ), Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water 1 y�Aftpe�r � Monitoring? '� Dale: It A ». •rte„ ? { ROBLE—R COWAN 1i� �cfe�� CE -8801 61M FLAN PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND t' FT COMMENTS If 1z S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: 9 Loop Road No. 104 / Eagle Iver �( 3t 194 ACCORDANCE WITF611IgWaSRbWAAIbMj f VW GUIDELINES IN EFFECT ON THIS DATE. DATE: 7? -008 (fay. 4/65) 1 ROBERTC. COWAN, P.E. EnGineeRinGON-SITE ROBERTA. SHAFER, P.E. MR CIVIL ENGINEERS CONSTRUCTION PRACTICES and (sol) 694-2979 FAX(907)694-4- 1211 MATERIAL SPECIFICATIONS REFERENCE: Lot 3, Block 16, Whaley S/D Addn. 05 HEALTHAUTHORITY APPROVALS July 25, 1996 GENERAL: SEWER & WATER MAIN EXTENSIONS 1. The scope of this project includes the installation of a 1000 gallon septic tank and a leachfield trench to serve the proposed three bedroom residence located on the referenced property. SEWER & WATER INSPECTION 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal ENGINEERINGSTUDIES Regulations. AND REPORTS 3. The contractor shall be responsible for obtaining any necessary underground utility locates. WELLINSPECTION 4. Unless specifically agreed otherwise, theproperty &PLowresT owner shall be responsible for final grading areas subsequently depressed from soil settling. SITE PLANS 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the ROADDESIGN Municipal Health Department. SEPTIC TANK INSTALLATION: SOILTEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. TEST PERCOLATION 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a STRUCTURAL& minimum of 12 inches above final grade. MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSA.SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 3, Block 10,Whaley S/D Addn. #5 July 25, 1996 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 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. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 3, Block 1$ Whaley S/D Addn. #5 July 25, 1996 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All. leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 3, Block 10 Whaley SID Addn. #5 July 25, 1996 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 3, Block 16.Whaley S/D Addn. #5 July 25, 1996 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage • Development Services b6peittment Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ct.anchorage.sk.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-11-121 GENERAL' INFORMATION Complete legal description Lot 3, HAA # L40ol- 01V Expiration Date: S -.2 2- O 2- 415 - Block #s - Block 1B, Ilhaley-'Subdivision'.. Locatia"n'(siteaddressordirections) 24245 Temple Drive — Chugiak, Ak. 99567 Current Propertyowner(s) '.;Darwin & Nadine Hanson Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone 907-263-5475 24245 Temple Drive — Chugiak, Ak. 99567 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. '/� ! t�✓;— S" ��7 t/° . 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site 171 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 5 by an Independent professional civil engineer registered in the Stale 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certifietates 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. 4. STATEMENT OF INSPECTION by ENGINEER As certified by my seal affixed hereto and as of the validation dale 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 Willi all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S tngineer Phone -694-2979 Address 17034 Eagle River Loop Rd. - Eagle River, Ak. 99577 Engineer's Printed Name Robert C. Cowan Date _rj-,0 /a z ro P,%.. ROBERT c COWAN ! 5. DSD SIGNATURE oo CE -8801 Approved for 3 bedrooms. .•• "`t`' Disapproved. ,•'`ZC\ti7y►���� Conditional approval for bedrooms, with (he following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Z�• ct/( Original Certificate Date: -S- •z 2-O.2_ (Po 13100) Municipality of Anchorage •� • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.cLanchorege.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST si S Legal Description: LoT 3 13 wit*#-ty n S/D ParcellD: Orr -SII 1 A. WELL DATA Well type /R'Vd>r If A, B, or C provide PWSID # = Well Log &N) YE -j Date completed Sanitary Sanitary seal&?/N)-k-,#l Wires properly protectedo/N) Y41 Total depth 71 R Cased to 2 a ft. Casing height (above ground) a y4 in. Date of test Static water level Well production FROM WELL LOG 4/itl/qb ►g6- WATER SAMPLE RESULTS: 10 Coliform 0 colonies►100 mi. Arsenic mg71"- B. SEPTICAiOLDING TANK DATA AT INSPECTION s --/a/,) s ft. y8B ft. g.p.m. s •,f .S t g.p.m. 4 L.M'r#o Ay Ponr .4 /•�..n+Q�...4 Nitrate `1.01 mg.A. Date of sample: S/ -y/" i Tank Type/Materlal S j -P' r C- / STET 4 Tank size ► 0 o o gal. Number of Compartments Other bacteria 0 colonies/100 ml. Conectedll*3 ENGINEERING 17034 Ep • a 204 E"% Rim, Als*s 99377 Date installed 41b (0 Iq Cleanouts (ON) y4 Foundation cleanout&N) !#—J Depression over tank (Y&j E v High water alarm (YAO v Date of pumping r/31/02- Pumper C. ABSORPTION FIELD DATA Date installed 9 /;L I Length 3 Q fL Soil ratingg..d.Al= r feAxinn) La Width S R. f ygL&6w System type -,,I 4N c N Gravel below pipe 9_ ft. Total depth 0i ft. Eft. absorption area 29-0 fe Monitoring tube Yt Ss Depression over field Jv 0 Date of adequacy test S i a -x ResuRs Pa all) Pis S For 3 bedrooms 0 11 Fluid depth in absorption field before test I in. Water added �e gal. New depths c in Elapsed Time: a 0 min. Final fluid depth i� In. Absorption rate >= Lf $-0 g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) '44'"L K Aoo "w If yes, give date - D. LIFT STATION Date Installed `Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off" level tested water alarm level at Meets alarm 6 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankNft station on lot ) 0 D ; On adjacent lots Absorption field on lot ) Da -y- Public sewer main Sewer /septic service Anel On adjacent lots /00 + Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation / l) f Property line /o � Absorption fief Water main H /A Water service line / 0 �� Surface water Wells on adjacent lots o B i✓IA ,W/,4 in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3 * Building foundation 1 S �' Water main %A Water Service line Surfacewater /00 + Driveway, parkingtvehlde storage Curtain drain POA& W,Oev,0 Wells on adjacent lots /60 F. COMMENTS G. ENGINEER'S CERTIFICATION 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. ., ` �lgWl4iirNNu I�! Engineer's Printed Name /' gee Data f //a J0 i �attaiit' HAA Fee $ 3 7 S Walver Fee S Date of Payment a A Date of Payment Receipt Number n 1 9 S-5 Z _ Receipt Number (Rev. 12/04) e- 7-02; 3:27PM; ALCT&E Environmental Services Inc. CT&E ReLM 1022325001 Client Name S & S Engineering Project Name/# Lot 3 Block 1B Whaley N5 Clientsamplem Lot 3 Block I B Whaley #5 Matrix Drinking Water Ordered By IUP PWSM 0 ;907 Ser 5301 0 2/ 3 All Dstes/rimes are Alaska Standard Time Printed Date/rime 05/07/2002 14:10 Collected Date/time 05/02/2002 17:30 Received Date/time 05/(}1(2002 1235 TecbnkcalDirrSdnr; S 6 C. Ede Allowable Prep Analysis parameter Results PQL Unita Method Limits Date Date Init Natera Department Nitrate -N 4.09 0.200 mg/L EPA 300.0 (<10) 05/03/02 IDT Microbiology Laboratory Total Coliform 0 col/100mL SM189222B (<1) 05/03/02 IUP N 30 m N mo g� m A � au / m (038) sa•a5a 3.90,so,00 s (SV3W) .60793 3.0£.9400 S Z7 1 ? I o O � I c 2Gi O' �n - m O c S9• o O 1 � N 1 i 84.5 ?a.°. .714. ey°' ' 1 � 104.9 0 y m $ m3s•' 0G q s� f -v Z 1 3y a1 n mu O1 I A m u -mi m O(') mO 0` O` r N OW m Vt 1 Oh wv 1 •/ - n v WV; I R � - gym A1 I 1 � C P i ' pl I �I P N 1 rnl ZIm _ ------------- 0 - 1kS Z ,1 .I 'o SI O no c3(JJo�coc� L \ N Sm aJ OJ Wn m O (0 N { Wm p N J u b O' J pT ~ C/ r 0I O C N • S/® ♦p t�i� F Cl) 400 z p y Nas <u mN'-oWu /g CIA 0• :'no 7 m .ZCSno i ?� 0 3•#<0�0 •• �a , •• O m �� s ••. _� i Z � �• O .�� /��Y� W N O �j J a•�•e W O I � *�I Ai W N � 0 r•, v �. N a ,,,, •+� _ •_� o W J.O m u W W n r W W W 0 V o m u m (O W x MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0 S-1 ' I I I — a 1 HAA # W 091 C0a6 1. GENERAL INFORMATION Complete legal description Lot 3; Block IS -Whaley 5th Addition Location (site address or directions) Temple Drive Chugiak, AK Property owner " 'Darwin & Nadine Hanson Day phone 41 Mailing address P.O.Box 210491 Anchorage, AK 99521 Lending agency Seattle Mortgage Day phone Mailing address Aggnt Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If.community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1191) Front MOA#21 s 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 & 5 ENGINEERING Phone 6 q y ^ a1 % % 17034 Eagle River Loop Road No. 204 Address Faalp R'yar.4Iq4 4957V Engineers signature 6. DHHS SIGNATURE X Approved for Disapproved. 3 Conditional approval for Date ( /,AO/ -17 M ROBERT C. COWAN c/ CE -8801 2e bedrooms. bedrooms, with the following stipulations: Additional Comments By: Date —�¢ —717 CAUTION The Municipplity 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 couitesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M(RW.1i91) Beck MOA#21 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage JAN 2 [ 19g DEPARTMENT OF HEALTH & HUMAN SERVICES r Environmental Services Division R & E I V f'l5 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-47 4 Health Authority Approval Checklist Legal Description: LeT �_ IsLo r -K 181 0 HA+.e7 Parcel 1. D.: s Trk A ooi7ioa A. WELL DATA Well type Vg,.j o,^rF If A, B, or C, attach ADEC letter. ADEC water system number Log present (DN) "i ES Date completed ig _ Total depth 224124I Cased to 224 Casing height (above ground) :2I Sanitary seal (ON) FROM WELL LOG Date of test 8- 14 --14 Static water level Well production 10 611sox� £sr. 1 g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate 3.S-7 Wires properly protected (ON) Va�s AT INSPECTION Other bacteria E g.p.m. Date of sample: t /I y /17 Collected by: S & S ENGINEERING 17034 Eagle River Loop Road, No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed 9 Zrm b Tank size /ooa Number of Compartments _�_> Cleanouts J) lje Foundation cleanoutON) YES Depression (Y/Q NO High water alarm (Y NO "a Date of Pumping' Pumper C. ABSORPTION FIELD DATA Date installed F Soil rating 093Yor ft2/bdrm) 1.-4 System type 'F2etJ44.1 Length ` 3B I Width I i Gravel thickness below pipe _� Total depth Effective absorption area 319 Monitoring Tube present<j5%)yrr Depression.over field (Q nl n Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)' If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES "Pump *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot )Dot* Absorption field on lot Public sewer main Sewer /septic service line Size in gallons On adjacent lots "Pump off" level at* loop On adjacent lots lac51 Public sewer manhole/cleanout Of A t F Lift station _ _ tS /A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: f� r Foundation /8 > ;Property line 5a Absorption field $ Water main/service line 1© 1-t Surface water/drainage !aa't Wells on adjacent lots too 1 - SEPARATION SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: I Property line so h Building foundation Is + Surface water Curtain drain o Id - F. ENGINEER'S CERTIFICATION Water main/service line Driveway, parking/vehicle storage area —Wells on adjacent lots f 6 ° 1 t 1 certify that I have determined thru field inspections and review of Municipal records in conformance with MOA AA gy'defines effect on this date. � Signature s/ov (% Engineer's Name Date % /a o HAA Fee $ � Date of Payment / Receipt Number Z_,z l Z/2 9� 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number CE -8801 are CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID CT&E Environmental Services Inc. Laboratory Division �ori'fi®�ooesoiesiiei®i Laboratory Analysis Report 970258002 S & S Engineering N/A L 3,B 1B Whaley Addn #5 P. Tk Drinking Water A Parameter Results Nitrate -N 3.57 Total Coliform 0 Client PO# Printed Date/Time 01/16/97 16:17 Collected Date/Time 01/14/97 11:50 Received Date/Time 01/14/97 15:10 Technical Director: Stephen C. Ede Released By Allowable Prep PDL Units Method Limits Date 0.200 mg/L SM18 4500-I403F 10 max col/100ml- SM18 92228 _ 200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562-2343 Fax: (907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 — Tel: (907) 474-8656 Fax: (907) 474-9685 Analysis Date Init 01/15/97 JBL 01/14/97 TAV ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA I