HomeMy WebLinkAboutPROSPECT HEIGHTS #2 BLK 8 LT 1pisf os p It'i 4�c,�rds "a 'I'' 0 14s I 3L1 -1u MAY -1-2007 02:26A FROM: beYdt ftw ba-mas bwrlwat/ kaft ad" Omani an -Alto Watir i Weds mw PtsrA Aeckons, AX 2111"630 Marfaasm� Pump 1 stsilstio Loy wall Dru ti Fwmdt Nwmbw, ____�__--- "x-sy3- 997 Petud Ideadtkttlaa mtlmbtm TO:3437997 Dow At Ingot L t+(el Demrlptlea y� /bel fat `dR 1 A" wont � 5 f5 � � Ipuot S�ussD� pump IMIM94ft Dabs PUMP tatoke DOOM sdew 2* 9f WiA Ca1bW t g,2,t alt PrrltO Ptugfitttttet'f ttotittllrtn�vv-�� � PgmpMadel: T6 a� Ale' PWeetAss�tltrftotidDgrllr in, fw PldoetAdeyhr]doranhelatae oNegst-•4 AZA PltlenAAo�talmlapvt WoD DhbdMbd TPP C4WOUba7 A Yet 0 No IMelbodatbbb4stffirn rr �;rr C'ttatrnttt CALL FOR SERVICE —Complala Walar Byetam BoMao— AAROW PUMP & Will SERVICE, LLC ANCHORAGE SRUN WLLE (007) 34"366 EAGLE RIVER (007) e22-8380 Afetatln/t Tka PER* Iea9a',tte11 petift a peep ku1A>leNea IAA 16 UM wWa l0loam afpmp bMWId," 5'-)fiL.-ALq9 P.2/3 J -fid Municipality of Anchorage Page 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: 513D3'I PID Number: No0: 12 ?kohl s Wastewater System: New Upgrade El Address: S Goss. — ABSORPTION FIELD Phone:No. of Bed oms: Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: t �s LO GPD/Sq. Ft. ` :5 Lot: Block: Subdivision , i Ia�� 4s Z Depth to pipe bottom from original grade: l Ft. Gravel depth beneath pipe U 1 Ft. Township: Range: Section: Fill added above original grade: t Gravel length: Cl) Ft. S Ft. WELL: 'New ❑ Upgrade Gravel width: t Number of lines: Distance between lines: 1 2.S Ft. � 1T7 t Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Y\� �b Ft. 0 Ft. ly,� p(. y SQ. FL �•y�_ 1' ipV � Driller: iP•�!� ��w�h! Dae Dril ed: 2!0 93 Static Water Level: r Installer: cx. Date installed 53 Ft. Yield: Pump Set at: Iii i_ Casing Height Aboye Ground: 17-'4- TANK GPM Ft. Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To From Septic Absorption Lift Holding Public/Private Manufact re'r:,\ /A'\\' A 111'— Capacity in gallons: Tank Field Station Tank Sewer Lines _\ k Well �'� i'F' _ i•f Material: Number of Compartments: Surface Water \bp\ `��\k ` -- LIFT STATION Lot �4, Size in gallons: Manufacturer: Line L7 — Foundation ' t "Pump on" level at: "Pu off' level at: High water alarm at: CurtainO 1© Iv Pump Make & el Electrical Inspections performed by: Drain V Remarks: BENCH MARK Location and Description: 1 Z> V�_bV tJl�. �.s•lkl�t • Assumed Elevation: o FtENGINEER'S SEAL �fq�nlnBS�'� SH� S & S ENGINEERING Inspections performed by: 17034 Eagle River Loop Road, %%,41st ` ,1AA*3 IWe Eagle River, Alaska 99577 2nd -20k-95 :. . Department of Health and Human Services approval Reviewed by: and approved Date: 72-013 (Rev. 9/91) MOA 25 ,Permit No. SW930379 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PROSPECT HIEGHTS #2, BLOCK 8,LOT 1 PID No.01513476 9J A (Z/Yl) MUA 20 98' CO1 CO 97 C MT 99' C05 MT2 NEW �26' 9271500 GAL 9 . S.T. 90.3'N.T.S. JR 84.3 83' A 79' NO WATER FOUND A B FCO 28 13 COI 26.5 19.5 CO2 41 40.5 CO3 66.5 78 Mn coa C04 29 43 AI C05 MT2 C05 67 84 MT1 68.5 78 MT2 66 83 NEW TRENCHES / 10% CO2 CO CO DBL CO ... ENGINFfiR;$ SEAL ATH NEW 1500 GAL. SEPTIC TANK F fY co FCO A .B HOUSE Y. DRIVE SCALE 1" _ 40' u ''• p' _ 9J A (Z/Yl) MUA 20 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE N� zy DEPARTMENT OF HEALTH AND HUMAN SERVICES J-1om P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930379 DATE ISSUED: 9/21/93 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 9/21/94 OWNER NAME:VOZAR PAUL M & SANDRA J OWNER ADDRESS:10401 SCHUSS RD ANCHORAGE, AK 99516 PARCEL ID:01513476 LEGAL DESCRIPTION: PROSPECT HEIGHTS #2 BLK 8 LT 1 LOT SIZE: 102754 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION 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 OR 343-4681 AFTER BUSINESS HOURS 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: h. 14; HEALTHAUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN September 13, 1993 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 ROBERT SHAFER, P.E. ROGER SHAFER. P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 REFERENCE: Prospect Heights Subdivision Addition #1, Block 8, Lot 1 We request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced property. A test hole was performed on the property. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the hole has been checked and found to be dry. This property has enough area for a future septic upgrade, which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your resew, please contact us. Sinc fer, P.E. /LSU/lsu 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 e Municipality of Anchorage' , R t DEPARTMENT OF HEALTH & HUMAN SERVICES s' 825 "L" Street, Anchorage, Alaska 99502-0650 ° SOILS LOG — PERCOLATION TEST PERFORMED FOR: (�;� 1 ') °` C C AIZL�N �1C��z'/-�12 DATE PE FO ED LEGAL DESCRIPTION: L UM 1'FTC_ Township, Range, Section: SLOPE SITE PLAN E1111111111 2 �) T'6ff7 S 1(-7 3 �I N6 6RAVSc . 4 5 6 7 8 F-1 N �• p(. Sw 14 10 ML `��Y I 16 1<6.1 I1 11 CA 17 12 18 li r, IV L 13 F-1 M � 14 c 15 `��Y I 16 1<6.1 I1 c ��I 17 18 li r, 19 20 �tl o COMMENTS SO/M L (.�)dt CTGtA�ED SAI�o I,,' S(cT L£nNG WAS GROUND WATER (� \/\ ENCOUNTERED? I )o s IF YES, AT WHAT L 0 DEPTH? P E Depth to Water After Monitoring? 7��,2V� Date: mmmmm�W0113 M � PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 6.U.lt. TEST RUN BETWEEN'—L=,,--F7 AND ! 3 FT PERFORMED B�1:7034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELI IN 72nna in.,, A,aci / CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: > 9N k4 MI i v ♦ Crl a - I uo��F � 4 1 'o 0 �b�as I F I U) 1 � 1 w 1 O F- O O Z E Z ~ Z O o < Q Or 22 Of CL t= 0ON OWE O� of W a}Qwp V1 ®Z r� wmXLLIZ bd 1 Oz�JOOr z ,- 1 c0 g G r af F- O O w id U rn Zao Jvi�¢ j tib LU wwrpm_ho c > O uw(1) 1,L`'° �pc) a aal b7 O Z p A Oa QN(n CLL�ii0 �JW rzwl w — Vl wwZ m P.31 N J a 0 - LdZ� > �v p� Z 'D LL, `'p o bJb G I-- Z I F-KZ� Q F ij O u) :3a N><v~ �QOY a H N1--a rn 1 Z_ z � Z uj (f) W¢ �� o 0 0 0 CL 6 a NOTI A t o_ 1 GO o--� —- — z W A O QQ i Qa W O 0`n 4 W 0 I o o U�1 Y ^ MIp1. v _ 1 C.D 0 h L O o� 1 _I MgN' O•�� v z to Or � F N CL O v j 00 p I a LO O w (n W F 1 p V) 11 OI I Z S F E i LO E-+ W O U 1 P4 w�Jw ao wn aOcl:� x a 3 n m =J O Lit Lr) I-- a d W LO t4) ¢ W d•V) LOO Co J CO� I p `to N s w 11" n ` J WU - SlO NV d 311S 09 = „! ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Prospect Heights Subdivision Addn. #1, Block 8, Lot 1 GENERAL: 1. The scope of this project includes the installation of a 1250 gallon septic tank and two leachfield trenches to serve the proposed four bedroom residence on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. Page Two Prospect Heights Subdivision Addn. #1, Block 8, Lot 1 September 13, 1993 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (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 and installed approximately in the locations shown on the design. 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. 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. Page Three Prospect Heights Subdivision Addn. #1, Block 8, Lot 1 September 13, 1993 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 21, 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, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. 1) Page Four Prospect Heights Subdivision Addn. #1, Block 8, Lot 1 September 13, 1993 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. Paul M. and Sandra J. Vozar P.O. Box 111269 Anchorage, Alaska 99511-1269 (907) 246-1333 September 28, 1993 seOIAJeS uewnH V 41Mf9H'jd90 GbUJ040uy JO d}ijedioiunVq Department of Health & Human Services £66t 8 Z d38 On Site Well and Septic Department 825 "L" Street, Suite 502 (� /� Anchorage, Alaska 99501 0 A3 '1 Re: On Site Well and Septic Permit Lot 1, Block 8, Prospect Heights Sub. No. 2 Paul and Sandra Vozar Gentlemen: This letter will serve to advise you of the following: 1. The well will be drilled by Alpine Drilling Enterprises; and 2. The owners, Paul and Sandra Vozar will install the septic system pursuant to the design and inspections of S & S Engineering, and according to municipal regulations. If you have any questions, please feel free to contact me. —Q� Municipality of Anchorage .0, o �) Development Services Department* p P •� -, 6 ?t • Building Safety Division -*45 ,�,' `c ` _= On -Site Water and Wastewater Program 4700 South Bragaw St. `_ ❑ P.O. Box 196650 Anchorage, AK 99519.6650 ❑ Community Class Well www.ci.anchorage.ek.us Community On-site ❑ (907) 343-7904 ❑ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAwLY DWELLING Parcel I.D. 0 13'1 - 7 C HAA # Expiration Date: - 2.7 - 0.2- 1. Z1.. GENERAL INFORMATION Complete legal description )-07- 1 at -cc -1< HEj4Ni3 tt,Z ! Location (site address or directions) 1 D `/ 0 1 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent CHAALE,;:,4F_ )0031 5c-tia5S S C-l/u S1 DR . � 9 .r N . V O Z A R Day phone _3'/ 6 -- -1 6 r DR. y .4 . c.rf s< 010)S-0 7 Day phone Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. �� $ /o 2- 2. 2. NUMBER OF BEDROOMS:_ 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ 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 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 welts or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional eraineees work. 4. STATEMENT OF INSPECTI04t 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. S 3 S ENGINEERING Name of Firm 17024 Ewe yt,,,r r ,,,,p-2=91 No. 204 Phone Address Eagle River, Alaska 99577 Engineer's Printed Name 1P 0.3 P147— e • Co w a ,J Date E Af„` ROBERT C COWAN ,4Q- 5. DSD SIGNATURE fo�sr�h CE -8801 ✓ Approved for _� bedrooms. f�f'F� ......... Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory (Rw 01Na YIOF q/A�,y�� :. ON-SITE X: WATER AND : r" WASTEWATER •••rROGRAh1 A,. ; 0 -E-N X Maintenance Agreements Supplemental Engineer's Report Other 1 eL�� Original Certificate Date: 9. 27— O '1— i I 0 Municipality of Anchorage e , , 4(( • Development Services Department ' Building Safety Division Onsite Water & Wastewater Program •' "` `" 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ek.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo -r / SLoc a i (o R aSPs c r H r-.$ it Z Parcel ID: O 1,f - 13 y- T (s A. WELL DATA Wenlype GAN4Til. Date completed9�ac%3 Total depth Le -9 --ft. If A, B, or C provide PWSID E Sanitary seat @N) —4-3 Cased to R FROM WELL LOG Date of test R /a.043 Static water level S• 3 R Well production 3 g.p.m. WATER SAMPLE RESULTS: Coliform Q wlonies1100 mi. Nitrate 6-1 mg.A. i Well Log &N) YX s VNres properly protected &N) Vt-$ Casing height (above ground) _L>.: _+ —in. AT INSPECTION 68 R 3,s' g.p.m. Other bacteria O colonies/100 mi. Arsenim rng.A. - Date of sample: Q r 3 o s Collected byt t 5 par:rNEER1NG B. SEPTICJFIOLDING TANK DATA 17074 Eagle Rim Loop Rad No. 204 Eagle Rlwr, Alaska 99577 Tank Type/lAiteBal~ fE P r a c/ S r 4 i L Data Installed °l 3.1 i `U Tanklize l S ov gal. • , Number of Compartments 2- Cleanouts ft yE- Fc�4ation cleanout & _A i Depression over tank (Y© !! 44 High water alarm (YATt A, 0 F Date of pumping 11/ 160 2 Pumper O L D w1 r, Do c q i C. ABSORPTION FIELD DATA..' Date imaged q a9 93 "!Soil rating ypjgor 1t?Axirm) 0.6 System type Length T4 rvmo R Width "a . S- R Gravel below pipe b ft. Total depth 1 r fL Elfabsorption area 10 ft' Monitoring tube y 4S Depression over field W o Date of adequacy test i �> u ° 7- Resultsas ail) �' *s S For 9 bedrooms Fluid depth in absorption field before test May in. Water added 610 gal. New depth 4_h in. Elapsed Tune: A° min. Final fluid depth L in. Absorption rate >= 6 O O g.p.d. Any rejuvenation treatment (past 12 mo.) (YAV & type) N"ti "0"0 If yes, give date ` D. LIFT STATION Date Installed Size to gallons 'Pump on" level at _ in. 'Pump ofr level at _ In. Datum _ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot / 0 u '+ r Absorption field on lot /00 t Public sewer main ^i �A i Manhole/Access (Y/N) High wb1w alarm level at Meets alarm b circuit requirements? On adjacent kits /00 r4 - On adjacent lots 100,+ Public sewer manholeldeanout 14 Sewer /septic service line a S f Holding tank ' N f 4 SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation S r f Property line S f Absorption field S r , Water main H /f} Water service line /Ci * Surface water /00 h r Wells on adjacent lots / 0 ° SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /n +- Building foundation 10 ; Water main N A in. Water Service line IO !10, Surface water °Q * Driveway, parking/vehide storage a o -/- Curtain draln Welts on adjacent lots oo J F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems ale in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name R B B4 R T C. �e r.,f •✓ Date $/ / �0 -z- HAA HAA Fee $ 3 7 f- > o Waiver Fee $ Date of Payment /;L, /,V Date of Payment Receipt Number O a w N T' 3 �iL� Receipt Number (Rev. 12101) Ll R Jk'C'C0WAN e AUG -15-02 10:30AM FROM-CHE ENVIRONMENTAL SRV G CUE Environmental Services Inc. L `. ►rrrrrrrirrrr�.rrrr� Cr&E Resp 1025207001 Clleat Name S & S Engineering Proles Name/# Prospect Heights #2 LI; B8 Client Sample ID Prospect Heights #2 LI; B8 Marta Drinking Water Ordered By PWSID 0 Sample Remarks Parameter Results Waters Department Nitrate -N 0.200 U Nicrobiology Laboratory Total Coliform 0 b 4 9075515301 T-848 P.02/03 F-263 All Detesfrimes are Aloka Standard Time Printed Datefrime 08/1612002 8:49 Collected Datefrlme 08/1312002 11:00 Received Datefrime 08/1312002 16:40 Technical Director Stephen C. Ede Released By Allowable hep Analysis PQL Units Mediad Limits Due Date Init 0.200 mg/L EPA 300.0 (<=10) 08/13/02 IDT col/IOOmL SM18 92229 (<-1) 08/13/02 SDH 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and n c pal and State codesion, the on-site , " supply and/or wastewater disposal system s n compliance with all Mu ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Phone Name of Firm' aye rver cop Road No.204 Eagle River, A es a Address / � Date Engineer's signature - ©rte ALM' .............. ~cam • MT CCWAN siti 6� n 3 A CA $$Oi SJ• 6. DHHS SIGNATURE bedrooms. — , z, _ - Approved for - ;, Disapproved. l for " bedrooms, with the following stipulations: Conditional approva "Additional Comments Date es (DHHS) issues Hlth Authority th and an Servic The Municipalityaof Anchoragetes based onlyD uponntheepartent representations of lgiven n paragraph 5 above by an independent Approval Certific professional engineer tut gistered in t 's i ordeht satisfy cetateof lrtain federal and state reqa.The DHHS does uirements. Employ ees of DHHS do not and their lending ins „ ....conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in7.the professional engineers work. }' k MOA #2172.025 (RW -1A") Bac � - - - . Municipality of Anchorage AaL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT/, �PR68/ �7 Ag' Parcel I.D. ()/_; %3y �7K A. Well Data ADEC letter.DEC water system number 114 Well type t IZIUAFTE I/ If A, B, or C, attach 72,6 Log present (Y/N) YDS Date completed 9 3 Driller Cfi//�lE J/�1LUNG Total depth Cased to 160'-6 EF_D2ocic_ Casing height Sanitary seal ION) )5 Wires properly protected (9/N) %S FROM WELL LOG AT INSPECTION Date of test 2146 %' 3 0J1,4 tvl?S Static level o z C) water Well flow 3 g.p.m. g.p.m. _, 5 K Pump levell �� � o SEPARATION DISTANCES FROM WELL TO: Z Septic/holding tank on lot 1064 ; On adjacent lots 1 W 4 ,— n Absorption field on lot 166 V ; On adjacent lots IW z Public sewer main N114 Public sewer manhole/cleanout Se line o25 � Petroleum tank ewer rvic se WATER SAMPLE RESULTS: Coliform �6 Nitrate O • /D Other bacteria Date of sample: I IC' q5 Collected by: S S EN&INK N& B. SEPTIC/HOLDING TANK DATA Date installed '�:J lay I93 Tank size I5>00 Compartments Cleanouts411) e Foundation cleanout SSI) X Depression (Y/19 t� High water alarm (Y/ _IJ/A Alarm tested (Y/& II f-% Date of pumping Pumper A-/- 4144E J�il1/7C � SEPARATION DISTANCES FROM SEPTIC/TANK TO: Well(s) on lot 100 On adjacent lots 1004 Foundation 10 ,4 r To property line 10 Absorption field I O Water main/service line 10 Surface water/drainage /06 72•026(3W)•Front CONTINUED ON BACK PAGE LIFT STATION�� Date install Size in gallons Vent (Y/N) "Pump High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DIST FROM LIFT STATION TO: Manhole/Access "Pump off" Level at tested On adjacent lots Surface water D. ABSORPTION FIELD DATA /aq /y 3 Soil rating (GPD/Ft) (� 6 System type Date installed 6 Total depth /s AJ Length �q To�FlL Width Gravel thickness Total absorption area I o 0 `d Cleanout present `7 N) _! _Depression over field (YI I ass/fail >\1 A- for Bedrooms Date of adequacy test ��f� - Wt w Sys _Results (p ) II Water level in absorption field before test IJ AftertestN 1� Peroxide treatment (past 12 months) (Y/10 � If yes, give date / SEPARATION DISTANCE FROM ABSORPTION FIELD TO: l � Well on lot l o v � On adjacent lots j pp 14 Property line 4- To building foundation 14 4 To existing or abandoned system on lot On adjacent lots �-S 'I"- Cutbank LJZA Water main/service line Surface water 106 k Driveway, parking/vehicle storage area Curtain drain SLA E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and NAA guidelines in effe_c �.l S Signature Engineer's Name 15- Date l F. Date " HAA Fee $ t w Waiver Fee $ '� D�s Date of Payment Date of Payment Receipt Number Z % Receipt Number ,-f CE -8301 this inspection. 01/12/95 15:39 COMMERCIAL TESTING y 9076941211 NO.510 002 ME Environmental Services Inc. ,ztiL Laboratory Division CT&E Ref.# 95.0113-1 hgkgyptory Analysis Report Client Sample lb L1 BLK8 PROSPECT HE Y Matrix WATER 31- 2 - Client Client Name 8 & $ ENOINEERING WORK Order 11896 Ordered By RAY Printed Date 01/12/95 ap 16:33 hre. Project Name Collected Date 01/09/95 q 11:30 hra. Project# Received Date 02/09/95 0 15:35 hra. PWSID VA Technical Director STEPHEN C. EVE Released Sample Remarks: ROUTINE SAMPLE COLLECTED BY: J.W. qa, Parameter Results Qual Unite Nitrate -N 0.10 U mg/l, Allowable Ext, Anal Method Limits Date Date init EPA 353.2 10. 01/10/95 CMR acazzaarrrr-rwaaacr_z-err----wra----a--ra w rraaaacr r..>zzeazaawrrr-.-vaazvaar-���Raazzcaasrwr-w-rzz_vzawrar�a�azz_ar- • See Special Instructions Above UA - unavailable -" See Sample Remarks Above NA R Not Analyzed I - Undetected, Reported value is the practical quantification limit. LT - Lose Than q:�,r Secondary dilution. OT - treater Than io C, U, 1AA w Pn}Tor nrive 6nr_hnrann_ AK 99515-1605 — Tel:(907) 562-2343 Fax: (907) 561-5301