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Home My WebLink AboutPATNODE BLK 1 LT 1Patnode Block 1 Lot 1 #050-671-07 W- 5 Municipality of Anchorage Page ► of 2 - 72-013 DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT 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: 5-k)9zf009y Pit) Number: 060(p7/07 Name: Wastewater System: ;Er New F1 Upgrade L �, so SLG. Address: ABSORPTION FIELD IP61-26- m/E v8. Ppene. 5,46-1.6- var4 flk 98577 o. of Bedrooms:.eme! s:. T ❑ Deep Trench .Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: O• P"GPD/S . Ft. Total Depth from original grade: S •S' Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe , U 0X)6 5/,P 1-411:11 Ft. 3.7 3 .9 Ft. Township: Range: Section: Fill added above original grade: 11 Gravel length: 7 Z , S Ft. t0q Ft. WELL: ONew ❑ Upgrade Gravel width: Number Z•of lines: Distance between linFt • S- Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ;glD P6R-F fA/VRTE 5'00 Ft. 20 Ft. 9(03 SQ. Ft. 14.5 7—M Dgo? Li P V. C. Driller: S6,41-/V,4,u k), TFT_ y)ECL Date Drilled: 4 /qy Static Water Level: ►S Ft. Installer: Ptso7'c=c.i- QA)sr. Date installed: I 2.! -9y Yield: Pump Set at: I I Casing Height Above Ground: TANK 2- GPM U K Ft. I Ft. SEPARATION DISTANCES iXseptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines 4A)cH GE NK /GOO Welt' /00 �F /00 /.,L2S i + Material: S� EEG Number of Compartments: Z SurfaceLIFT STATION Water 100,4- 10614- Lot Line /0 , /O *- !=I�� "Pump on" level at: "Pump off" lev High water alarm at: Foundation p3 f 12.1 1 Curtain Pump Make & Model Electrical Inspections performed by: Drain NON KN WN BENCH MARK Remarks: Location and Description: TOP OF PORCHS E,uTr;tcit 13ETW EN UCTU lZ ES Assumed Elevation: /DO" O Ft- ENGINEW,S SEAL ' S & S ENGINEERING` 17034 Eagle River Loop Road, No. 204 Inspections performed by: Enalle Rover, Alaska 99577 Dates: lst s -13 -94 2nd s- f7 -941 Department of Health and Human Services approval Iti Cl �W.�a''` -?4- y¢ Reviewed and approved by: % Date: - 26 72-013 (Rev. 9/91) MOA 25 Permit No. SW940094 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description rATNODE SUBDIVISION, BLOCK 1, LOT 1 PID No.: 05067107 C04 C05 MT1 C07 GRADE71.0 MT2 C09 -FINAL 70.7' 70.3' ........................ ... . .............. ............ .. ........................... .................................... ... 67.87 NEW 67.6 1500 GAL 67.5: R 27.1111 S.T. 1 �*63. 66.8' 63.6" ....................... .. .... ......................................................................... TANK FROM TANK ............ .......................................... 1, 63.1' ........... ......................................................................... A i B FCO 25.5: 5.5 COI 58.5:: 48.0 CO2 101.5 86.0 CO3 113.6 97.5 ....... ...... ..... . ... . . ......... . ... ...... ............ ........... . ......... .......... ......... ............... ... ...... ........... C05 110.0 97.0 C06 134.0 124.0 C07 172.6 168.5 C08 147.5 135.0 v C09 182.0 175.0 MT1 168.6 163.0 MT2,148.$ _136.5 ............. .......................... .................................................................. .................................... .............................. ......... .......... ......................... ... ............ ....................... :A 5 BDRM.:HOUSE NEW TRENCHES .............. ........................ ..................................... ... .......................................... ...... Fco' ...................................................... ............... . .. ...... col TBM :M C07 T1 DOL 0 cog C06 C 05: .................................... .......... ........... .......................... C04 .... ...... . 0 CQ2 ......................... ....................... MT2:: co3 ENGINEER'S SEAL 10o + cob . . . . . . . . . . . NEW 1500: GAL. SEPTIC TANK ................ ........... ........... SCALE 1" = 40, 72-013 A (1/93)' by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND orEG, 4 Ca.v S ADDRESS O 1 a LEGAL DESCRIPTIO o r 1 N Oxy " DATE -.Started Ended PERMIT NUMBER DEPTH OF WELL sa0 i STATIC LEVEL OF WATER FT. DRAW DOWN FT GALS. PER HR /0110_ KIND OF CASING 6� KIND OF FORMATION: From Ft. to__C�—Ft. - e,'s/,-JA S 7-ir itJ From Ft. to Ft. From Ft. to__J_Ft. _ From Ft. to Ft. From _Ft. to -S --Ft. S14 t r iiL From Ft. to Ft. From _Ft. to_rX--Ft. c p e.K 641 T From Ft. to Ft, From Ft. to4-5_'_Ft. From Ft. to/ 6 U Ft. From_/6© Ft. to 0 Ft. AAE", -AC 6,F40J t�/� /� c.�'7G/C J%l � � 3 c eC From , Ft. to )Vr �' WET rom Ft. to Froin Ft. to Ft Ft. Ft. Fro as Ft. to,?9S" Ft.d_r-&,( Fro Ft. to 30r Ft C 6At--- �'J From Ft. to Q�&,je le 6Q wl jF' �_� 1��+�'� � rom F $0 Ft. Ft. From - Ft. tol 7 Ft. _ From�_Ft. to 3�rv7z�r Ft.,A r From.3 Ft. to say Ft. 4,60R a GIC 6RtF(_-^J From ((Ft. to W_L KAELI 1 h-�,�cTF m� Ft. o� ~� c_ic A A�/: C From Ft. to Ft. Ft. 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 Ft. From Ft. to Ft. From Ft, to Ft MISCL. INFORMATION: DRILLER'SNAME it -"� 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:SW940094 DESIGN ENGINEERS & S ENGINEERING OWNER NAME:DISOTELL CARL A OWNER ADDRESS:18525 JAMIE DR PARCEL ID:05067107 LEGAL DESCRIPTION: PATNODE BLK 1 LT 1 LOT SIZE: 71733 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 3/01/94 EXPIRATION DATE: 3/01/95 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: THIS IS A REVISION TO THE ORIGINAL PERMIT DATED 030194. THE REVISION IS FOR A FOUR BEDROOM RESIDENCE BASED OF THE DESIGN DATED 04/22/94. RECEIVED ISSUED BY: BY : I DATE: e_ o - f`-2.' DATE : Z G G NI nom\ April 22, 1994 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street RECEIVED P.O. Box 196650 SEWER & WATER Anchorage, Alaska 99519-6650 APR 2 51994 MAIN EXTENSIONS ivIuniclpality of Anchorage Dept. Health & Human Services SEWER & WATER REFERENCE. Patnode Subdivision, Block 1, Lot 1 INSPECTION ENGINEERING STUDIES Request you re -issue permit #SW940038 to drill a well and install a septic AND REPORTS system to serve the proposed five bedroom house on the referenced property. WELL INSPECTION The original permit was for a four bedroom house. The well has been drilled with & FLOW TEST existing permit #SW940038, attached is the well log. Test holes were excavated and percolation tests performed. The approximate SITE PLANS location of the test holes are located on the attached site plan. The monitoring tubes within the test holes have been checked and found to be dry. This property has enough area for a future septic upgrade which can be seen on ROAD DESIGN the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. SOIL TEST If you have any questions, or require additional information for your review, please contact us. , PERCOLATION Sincer TEST STRUCTURAL& R rt A. Shafer, P.E. MECHANICAL INSPECTIONS RASIL SU/Isu ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 F - Z La U W U) O x ko /o l y / U /o / aF E d V) 33 SECTION LINE ESMT. / I� O Z O O Z �z Qao W� 5 = 1 t [ � d Owe Cr T r: of zwj O=oN L`'LJ°n(f) O o S4. I �z d Q a<z Z LdNO F - Z La U W U) O x ko /o l y / U /o / aF E d V) 33 SECTION LINE ESMT. / I� O Z O O Z �z Qao W� 5 = o V) Zoo U) U) d Owe of zwj O=oN L`'LJ°n(f) O o d I �z d Q a<z Z LdNO / L�DJ A 0Z3:O0�> �a N pq VT: � � �Q-f CF < ^ F --I I S zn.o i- w woo _jw N W ww>-Um�O / H a wo�F-Nw� Nr> H P W o Wa l,J 0 0 F a O = mOrnwaz F- F- w O C) F- WZ�D:f fnU Dom www Z�Y Zaoix / o u H 1 t=-�v� Om�O Y Z) N><V) c�oa3 O vi �O F -Z V)< F-ooary ' J Q i Ld O Va L,J zO � Y 000 U) z0 0, -,Ln N o Z E-+ O °�- �> Q W p w H U M �� F-- U Z E� � UZ O CY o 11 C) II _j 04O WWw�E- F- QS II o0 ��W� <� �pv�\ Q 3 Lf) M J 0Lo t1) M d C7 Q w Io ON r Q J p Q F - Z La U W U) O x ko /o l y / U /o / aF E d V) 33 SECTION LINE ESMT. / W� 5 / W o / 0 o A LoLo x Q I Lo ^ F --I / J Q W E- " 0 U) U / oH/ P W o N / J / o u d w z . / - .. Ndld ITIS 31doS '05 = j ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Patnode Subdivision, Block 1, Lot 1 GENERAL: 1. The scope of this project includes the installation of a 1500 gallon septic tank and five foot wide drainfields to serve the proposed five bedroom residence for 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. Page Two Patnode Subdivision, Block 1, Lot 1 April 22, 1994 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: 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 Patnode Subdivision, Block 1, Lot 1 April 22, 1994 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, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Patnode Subdivision, April 22, 1994 INSPECTIONS: Block 1, Lot 1 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, cieanouts, 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 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/OWNER 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 WAS PERMIT NUMBER:SW940038 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DISJOTELL JANET L OWNER ADDRESS:PQ BOX 770213R EAGLE RIVER, AK 99567 PARCEL ID:0506710 LEGAL DESCRIPTION: TNODE BLK LT LOT SIZE: 71733 (SQ.\4HIS .) NUMBER OF BEDROOMS: PE MIT: 4 TER DISPOSAL SYSTEM PERMIT 1 THIS PERMIT IS FOR THE CO TRU TION OF: DISPOSAL FIELD /SEPTIC TAN //WELL SYSTEM ALL CONSTRUCTION MUST BE IN CCORDANCE WITH: 1. THE ATTACHED APPROVED D S N. 2. ALL REQUIREMENTS SPEC ED N 15.55 AND 15.65 AND TH STAT REGULATIONS (18AAC72) ND DRI 3. THE ENGINEER MUST NOT Y DHHS PRIOR TO EACH INSPECT ON. PFA CALLING 343-4744 OR 343-4681 4. FROM OCTOBER 15 TO A RIL 15 A ABSORPTION SYSTEM UN ER.CONSTR WEATHER MUST BE EIT ER: PAGE 1 OF 1 DATE ISSUED: 3/01/94 EXPIRATION DATE: 3/01/95 ANCHORAGE NIC AL C OF ALASKA W TE" ER GER R GULA IOr EAST H RS NOTI ICA ION R BUS NE HOUR SU FACE SOI UCT DUR NG FREEZI A. OPENED AND CLOSE ON HE SAME B. COVERED, SEALED ND H ATED TO 5. THE FOLLOWING SPEC AL PRO ISION . SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: �Y v :EVEN FREEZIN E CHAPTERS SPOSAL (18AAC80). nein\ February 13, 1994 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 SEWER & WATER Anchorage, Alaska 99519-6650 MAIN EXTENSIONS SEWER & WATER REFERENCE. Patnode Subdivision, Block 1, Lot 1 INSPECTION ENGINEERING STUDIES Request you issue a permit to drill a well and install a septic system to AND REPORTS serve the proposed four bedroom house on the referenced property. Test holes were excavated and percolation tests performed. The approximate WELL INSPECTION location of the test holes are located on the attached site plan. The monitoring & FLOW TEST tubes within the test holes have been checked and found to be dry. This property has enough area for a future septic upgrade which can be seen on SITE PLANS 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 review, ROAD DESIGN please contact us. Sincerely, SOIL TEST � /�'/ A. Shafer, P.E. PERCOLATION TEST 6 RAS/LSU/Isu STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 I Z 1--O O Z w Z U O O 30 Q ~ __ aN zCo �a Z�� zw00O=00 W ~ Z J a z l, 1) J S ozaooOr>- � (L H w wwUm�O F- w wvi>l-Zw� Llj Ljjwp Nz V) -j Of LU W Z - � }-I i- � U �3a N>QV) NV)Q �000 `way. Y•j' , e� —o l I � ; 0 p a w... wa a ~Ua • Lo a' OJ X */ .+�,.... w Ur I Z 1--O O Z w Z U O O 30 Q ~ __ aN zCo �a Z�� zw00O=00 W ~ Z J a z l, 1) J S ozaooOr>- � (L H w wwUm�O F- w wvi>l-Zw� Llj Ljjwp Nz V) -j Of LU W Z - � }-I i- � U �3a N>QV) NV)Q �000 o I� , e� —o O ; 0 p a w... wa a ~Ua • Lo a' OJ X */ .+�,.... w Ur I- z 0O J< C N� W _ F- a� X Z o� Om EEO �w� (.)0 a. 3 o , e� —o Q C N� W U- r�� w� V) 0 C Q �� C4p o ofO � CLL, ww�z w E"C/�� n 004 J \ moo aZ 3 �i�rnbo ago W �r�� LU J p Q z�ffi Na O 33 SECTION LINE ESMT. r w� �a>8 31VOS NVId 31lS 'OS = AG e Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: '/ t S nTi►�t.�.. �►�s� DATE PER RM I l -1 ' LEGAL DESCRIPTION: �o•r gjyYi 1 I�DA+� a�4.s�v Township, Range, Section: DEPTH SLOPE SITE PLAN 14 15 16 17 18 19 20 COMMENTS S /-,\I /Sa Lit Lr A < S► L'j- Mix WAS GROUND WATER ` ENCOUNTERED? O S IF YES, AT WHAT 111 L 0 DEPTH? P E Depth to Water After Monitoring? vfd4— Date: 2, 1bh4 Reading Date Gross Time Net Time Depth to Water Net Drop 'So eA Z S Ifl HI•S ,�~ � 4N 3 ' 5s;- to W►. .5 4.. A Z:os Lo *A.j PERCOLATION RATE •3 (minutes/inch) PERC HOLE DIAMETER V TEST RUN BETWEEN • A' F�AND -4,0 FT PERFORMED BY: i" agle River Loop Road No. 2Qd 1 r-agle River, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELItd9 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN r ON THIS DATE. DATE: (ENGINEER'S SEAL) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 S. SOILS LOG — PERCOLATION TEST PERFORMED FOR: V/ Sore- . �DATE PERFO 1 1 Township, Range, Section: LEGAL DESCRIPTION: l-'bi � �lL � ��i'''m'��SCJ p' g ' ??T SLOPE SITE PLAN ER 1 ✓ opN N A,� r N 2 v 3 4 /o 5 ( O %1'� I! s� L-►L'a-r stLsr 8- 9- 10- 11 9 1011 12- 13 � P 14 7 15 16- 17 18- 19- 20- COMMENTS 81920COMMENTS WAS GROUND WATER ENCOUNTERED?� S IF YES, AT WHAT L 0 DEPTH? ~ A P E Depth to Water After Monitoring? 2E4 Date:b��L� Reading Date Gross Time Net Time Depth to Water Net Drop p.pCIL I b 3% Z s- � HA -z 7 ` l o D Wl "L L{ " PERCOLATION RATE )3o$ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN -511r' • FT)AND *•5— FT S & S ENGINEERING PERFORMED BIZ age River toop Road No. 2W I ACCORDANCE Milt /tf3bwrAAl§axkw9 bPAL GUIDELINES 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN THIS DATE. DATE: ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Patnode Subdivision, Block 1, Lot 1 GENERAL: The scope of this project includes the installation of a 1250 gallon septic tank and five foot wide drainfields to serve the proposed four bedroom residence for 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. Page Two Patnode Subdivision, Block 1, Lot 1 February 13, 1994 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: 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 Patnode Subdivision, Block 1, Lot 1 February 13, 1994 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, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Patnode Subdivision, February 13, 1994 INSPECTIONS: Block 1, Lot 1 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. 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 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/OWNER Municipality of Anchorage • e.c =_ Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-671-07 HAA# 4&-)Ca/7 1. GENERAL INFORMATION Expiration Date: 2,3 1 1 OS' Complete legal description PATNODE SUBDIVISION; LOT 1 BLOCK 1, Community Class Well ❑ Public Water System Location (site address or directions) 1805 JAMIE DRIVE * EAGLE RIVER, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address DAN & BOBBIE WEIGMAN Day phone 694-5015 1805 JAMIE DRIVE * EAGLE RIVER, AK 99577 Day phone Real Estate Agent SHAYLENE ERNISSE w/ PRUDENTIAL VISTA Day phone Mailing address 4241 "B" STREET * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well E Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 351-9916 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ I,Qg5at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 28 * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for - bedrooms. Disapproved. Phone 337-6179 Date 1 l[07— Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Jti(t �Y0PA�r�� WATER AND m' (n/� AS E%kT CR PROGRAM (/111111 i� _� gy. /D Original Certificate Date: J �� (Rev. 12/0 _W 1) Municipality of Anchorage Development Services Department �J Building safety Division On4b Ws%rS WaatewawProgram 4700 South Bragew SL P.O. Boa 798850 Anchorage, AK 6951118650 www.dAndwmge akus (907) 943.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: PATNODE SUBDIVISION: LOT 1, BLOCK 1, Parcel ID: 050-671-07 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YM) YES Date completed 4/1994 Sanitary seat (YIN) YES Wires property protected (YM) YES Total depth 500 ft. Cased to "20.3 ft. Casing height (above ground) 12 in. FROM WELL LOG AT INSPECTION Date of test 4/1994 4/17/2002 Static water level 15 ft. 42 ft. Well production 2.0 g,p,m, ••0.35 — g -p.m -WATER SAMP E RESULTS: ••500 GALLONS OF STORAGE INSTALLED Coliform colonies/100 ml. Nitrate ' 3(0-1 g./L. Other bacteria -4— colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 4/18/2002 Collected by: AWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 5/13-17/1994 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 4/23/2002 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 5/13-17/1994 Soil rating OE> ft'/bdrm) 0_8 System type TRENCH Length 104 ft. Width 5 ft. Gravel below pipe 3.7/3.9 ft_ Total depth 7.5 ft. Eff. absorption area963 ft' Monitoring tube YES Depression over field NO Date of adequacy test 4/17/2002 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 0 In. Water added 765 gal. New depth 3 in. Elapsed Time: 54 min. Final fluid depth 0 In. Absorption rate >= 750+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YM 8 type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES High water alarm level at Cycles tested Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAiR station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 58+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 109+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 1009+ Driveway, parking/vehicle storage 25'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and a ye review of Municipal records that Me above systems are in conformance with MOA IAA guidelines in effect on this date. Q ' Je a A... ... se: Engineer's Printed Name JEFFREY A. GARNESS `0 7953 Datea�1)2 �r•^�d Drof�si:00. v .... HAA Fee $ 375 ,00 Data of Payment rJ a3 -aa Receipt Number ©a (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number •• 05/21/02 14:32 $9072737250 PRUDENTIAL VISTA 0002 I y f V 1 a Y, .... , y.. y Sj'3 wia N `Y4 liltls 1 ' dm .. .,'-+' ., J/ Iv,.JI>•�rl- :="iii —'r4- 1A rw 94:wj/iI ' Sse ft%w Llq t' F7enY'•1 AS -BURT • . 1 herebL othat haveryeyed Bowing described Dcpropert ,a OF-.qL t►y1 "Anchorage Recording Precinct, Aiaska; �#nd thabthe improve•', L q n ments situated theredn ire within the Proper' lines and do not �"�� "ti " f� overlap or encroach ort the ro I m adjacent thereto; that . i �Q ,•' •.'i r tr P P PertY' Y g J #e a 9 Z.---- no improvements bn property lying adjacent thereto enaoalch r t�1 on•the premises In question and that there creno roadways, 1 • ..... transmission lines or other visible easements on said property except as Indicated hereon. • `••••' Dated at $agle River; Alaska 4 Robot C. Jc n «? iJ,L . ; NO. 88D.5 �y� .. .tli� jb say of ROBERT C. JOHNSON '7pL'10' '•`t/� �'r..�•w�,,.!''�`S!� .SCAF.E:.'•e^,Ire�t eredLand-SunrfyorNo. 1S'' 1" " 6O Boz h-04%'Eagle River', Alaska 99577 .:Phone (907) 694-7543, ; MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services /C/,p On -Site Services Section kyjF IY pF P.O. Box 196650 Anchorage, Alaska 99519-6650 Jo� 343-4744 U� %8 �s'0 SON CERTIFICATE OF HEALTH AUTHORITY APPROVAL.FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0 Co .. 671 -07 HAA # 1a1 i�, ci �] 1. GENERAL INFORMATION Complete legal description Lot 1; Block l'= Patnode subdivision Location (site address or directions) 18525 Jamie Drive Eagle River, AK P,rope, rty,ownerRobert Steiner Day phone 694-7778 - Mailing `aCldress Box 771168 Earle River AK 99577 Lending agency Day phone >, Mailing address f �` Agent GaryRich% Polar Realty Day phone 242-0069 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 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 021 � C 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 S & S ENGINURINGPhone a 2 Z 17034 Eagle River Loop Road No. 204 Address Ea _ - D . r _A6.1-9577 ` Engineer's signature Date q 7 p ROBERT C. COWAN� �G,A CE-8ao1 • 6. DHHS SIG ATURE �.t ��'�''••`.....,.,«••'•'f �� Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Y Date CAUTION 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 courtesy to purchasers of homes and their lending institutions in orderto satisfy certainfederal 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. .72.025 (Rev. 1/91) Beck MOA M21 y/ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICESI� Environmental Services Division 0 49.9825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-V�/ �Fa Health Authority Approval Checklist - Legal Description: t_C)T- A1 jVL-- � �p�t-�ot�f�s�j Parcel 1. D.: O rO "G -7t -0 7 A. WELL DATA Well type Iako I �1 I ,, U W'_' If A, B, or C, attach ADEC letter. ADEC water system number `)/ Log present(rWN) Date completed 4 - 1 Total depth Cased to °�� `/" Casing height (above ground) 12 l Sanitary seal&) FROM W' (ELL LOG Date of test i —j17 Static water level /S Well production �. WATER SAMPLE RESULTS: Coliform C. Wires properly protected &) \' AT INSPECTION ('-/.t-9 f,/ g.p.m. / g.p.m. Nitrate 6.1 3-.). Other bacteria 0 Date of sample: i 3 °t 7 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed (v—d I � 5 Tank size /SOo Number of Compartments 2— CleanoutsON) _ Foundation cleanout &N) Depression (Y&QP High water alarm (Y/N) /j4 Date of,0gmping �f� � � 7' :. Pumper die • PPAIY'/W � C. ABSORPTION FIELD DATA Date. installed Zi —`lei Soil rating (g.p.d.ff or ftz/bdrm) System type `DAn-Lo\J T�-& e� Length. 1.0'-A Width Gravel thickness below pipe3 7' , 3,S' Total depth 7. S' Effective absorption area _ alL Monitoring Tube present &N) -y - Depression over field (Y4 J Date of adequacy test _ _( - /a - S Results ff ail) of rS ,> For S- bedrooms Fluid depth in absorption field before test (in.); fl N Immediately afterP-70 gal. water added (in.): -7 5 " Fluid depth 12- " (ins) Minutes later: 14- Absorption rate = 75'za f g.p.d. Peroxide treatment. (past 12 months) (Ya /a'dK �� If yes, give date �G d 72-026 (Rev. 3/96)" „ D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES "Pump on" *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons off' level at* Septic/holding tank on lot /oc> F On adjacent lots /00 14 Absorption field on lot /b o t + On adjacent lots /00 1 Public sewer main _ J IA Public sewer manhole/cleanout �/ Sewer /septic service line 2 S I+ Lift station IJ 1A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 3 Property line /0 14- Absorption field Water main/service line 14) t Surface water/drainage Ire t> t k Wells on adjacent lots 1 t } SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 1p 1 Building foundation I Z 1 ' Water main/service line I (> I �- Surface water 1L --D I �- Driveway, parking/vehicle storage area 5-0 1 Curtain drain tjo^1l< I4^10hlPJ Wells on adjacent lots 1194) 1 4- F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance wit O Mdes in effect on this date. Signature Engineer's Name c7Q�'t f �° co Date HAA Fee $ C��D, 41L) Date of Payment ��%/ C f// Receipt Number/ / da 72-026 (Rev. 3/96)* Waiver Fee $ recorQtlp�i�t� s are Date of Payment Receipt Number ROPEgT C CpWM 1, CE - 8801` 'rf`;v < .. •' AV 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. # �a4 -��7/ �' 7 HAA # P for d 1. GENERAL INFORMATION Complete legal description Lot 1; Btock 1; Patnode Sudivi cion Location (site address or directions) 18525 Jamie Dkive Eag.Ze RiveA, AK Property owner Cant DiAote.Z.Z Day phone Mailing address 18525 Jamie Dn i.ve Eagte Riven, AK 99577 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual well XXX f. Community well Public water NOTE: If community well system, provide written confirmation from State?- ADEC attesf " ing to the legality and status of system. 72-025 (Rev. 1/91' F,ont MOA 1,21 1 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 S & S ENGINEERING Phone 17034 Eagle River Loop oad No. 204 Address Eagle River, Alaska $77 Engineer's signature Date l3 �f � a �•., ,;• � " ";, a til ' 6 64. $ is UevY.aO Y �i d b o Yl Eelam VA"Ptim-ts J. 6. DHHS SIGNATURE Approved for S bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments / f By _ 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 courtesy to purchasers of homes and their lending institutions in order to 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: , 72-025 (Rev. 1/91) Back MOA 021 Municipality of Anchorage MqM Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �—T \ C5ue- \ ��,�onc S�a Parcel I.D. A. Well Data Well type ?R_\.kT-rz- If A, B, or C, attach ADEC letter. ADEC water system number A Log present ON) �1 Date completed -1-7 1 Driller .So t -t-, uk,,/ Total depth S-Dtj' Cased to '2- c> `f w Casing height I - 1+ Sanitary seal 6( N) yl Wires properly protected 0) S./ WATER SAMPLE RESULTS: Coliform D Nitrate A .9 Other bacteria Date of sample: —43 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed (-, - 21 `1 `{ Tank size 1 15-00 Compartments 0 Z CleanoutsO I) si Foundation cleanout &N) J Depres ion (Yo tA —T High water alarm (Y l Alarm tested (Y/NI" Date of pumping ', —e_ Pumper 'S A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10 z> \a- On adjacent lots t 4- Foundation to I +_ To property line 83' Absorption field Gb' Water main/service line _ I b L �- Surface water/drainage \ b n & 72-026(3=)•Front CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION rn Date of test Static water level m -O Z r Well flow Z• o g,p,m, M g,p,r n m o Pump levell tJ /L d•CM r'I D K o0 SEPARATION DISTANCES FROM WELL TO: �_ c o rr Septic/holding tank on lot lvo `� ; On adjacent lots 4- Z Absorption field on lot 1 b ut1 ; On adjacent lots o `� j Public sewer main I a Public sewer manhole/cleanout A r. Sewer service line 25- Petroleum tank 2 s- `} WATER SAMPLE RESULTS: Coliform D Nitrate A .9 Other bacteria Date of sample: —43 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed (-, - 21 `1 `{ Tank size 1 15-00 Compartments 0 Z CleanoutsO I) si Foundation cleanout &N) J Depres ion (Yo tA —T High water alarm (Y l Alarm tested (Y/NI" Date of pumping ', —e_ Pumper 'S A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10 z> \a- On adjacent lots t 4- Foundation to I +_ To property line 83' Absorption field Gb' Water main/service line _ I b L �- Surface water/drainage \ b n & 72-026(3=)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DIST D. ABSORPTION FIELD DATA FT STATION TO: On adjacent lots Cycles "Pump off" Surface water Date installed Ci -2\ - `l 4 Soil rating (GPD/Ft2) O,`3 System type Length 1a4' Width S' Gravel thickness 3,1, 3,9 Total depth 7, s" Total absorption area .3 Cleanout present(N __Depression over field (Y(@ _ Date of adequacy test -- awl Results (pass/fail) —" for S' Bedrooms Water level in absorption field before test After test Peroxide treatment (past 12 months) ( A If yes, give date '� A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I -oc> On adjacent lots / co (+ Property line / a /+ To building foundation /,21) To existing or abandoned system on lot ''f' On adjacent lots '30 14- Cutbank Al' Water main/service line 1c), 4- Surface water 100 Driveway, parking/vehicle storage area So � Curtain drain "Jo,,l�_: /� do a,,( E. ENGINEER'S CERTIFICATION l certify that l have checked, verified, Signature Engineer's Date all MOA and HAA guidelines in effect do=xhe d ,p,,1 s inspection. d_ HAA Fee $ X00 , Waiver Fee $ Date of Payment r/5` y7`/ Date of Payment Receipt Number D o a V C 8/1 Receipt Number 72-026 (3/93)' Back