Loading...
HomeMy WebLinkAboutLAKEWOOD HILLS #3 LT 33Lokcwood Hills Lot 33 #015-134-12 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw Bt. P.O. Box 196650 Anchorage, AK 99519-6650 ~vww.c[anchorag e.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-134-12 1. GENERAL INFORMATION Expiration Date: Completelegaldescdption LAKEWOOD HILLS SUBDIVISION #3; LOT 33, Location (site address or directions) 7560 UPPER O'k{ALLEY DRIVE ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOHN & SHELBY BLOUFIELD Dayphone 892-9011 7560 UPPER O'MALLEY DRIVE ANCHORAGE, AK 99516 Day phone KE[TH FACER W/ PRUDENTIAL JACK WHffE Day phone 727-5851 3201 'C" STREET SUrE 200 ANCHORAGE, AK 99503 Unless otherwise requested, HAA ~411 be held by DSD for plckup. 2, NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank [] Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an independent professional civil engineer registered In the State of AJaska. Certificates of HeaIth Authority Approval are required for the transfer of ti*Je (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. Certiticates of Health Authority Approval are valid for 90 days from the date cf Issue for properties served by a pdvata or Class C well and may be reissued with new water sample results less than 30 days old.~,'.;ertlficates may be reissued for a pedod of up to one year with valid water samples.) Certiticates are valid for one year for properties sewed by Class A or B wells or a public water system. The MunicipaIity of Anchorage Is not responsible for errors or omissions in the professional engineer's work. Note:Alaska Water and Wastewater Consultants, Inc. shall be pald $1,110. OO at, or prlor to closing for the engineering sa/vices provided. 4. STATEMENT OF INSPECTION BY ENGINEER As ce~'fied by my seal affixed hereto and as of the validation date shown below, I varify that my investigation, based on procedures outlined in the Health Authodty Approval Guidelines for this appticab'on, shows that the on-site water supp~' and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vadfy that based on the Informab'on obtained from the Municipality of Anchorage §les and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with a~l applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm ALASKA WATER & WASTE'WATER CONSULTANTS, INC. Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504- Engineer's Printed Name JEFFREY A. CARNESS, P.E. Phone 337-6179 Engineer's Comments: In conducting this evaluation, AWWCo Inc. attempted to provfde a thorough, conscientious engineering ana~/sis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The repertsd results described the performance of 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 lewis that may fluctuate during the year, and the vtater usage of the famliy being sen/ed by the system. These conditions are outs/de the control of the e~aluator of the system. Satisfactory test results do not guarantce future performance of the system, nor do they guarantee that there are no hidden def~.-ts or encroachments. AWWC, Inc. can therefore not pro~fde any warranly or futoro 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 lhe owner listed abev~. Any reliance upen or use of this report by any other person or pady Is not authotfzed, nor wfll it confer any legal fight whatsoever. DSD SIGNATURE Approved for '~ Disapproved. Conditional approval for bedrooms. · . bedrooms, with the fllowtng stipulations: . WATERAN9 .-' ,. ,. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manttenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: 2 "2 2 - e/ Municipality of Anchorage Development Sewices Department 8ulldlng Safety DMslon Orr-Site Water & Waateaatet I:~ 4700 South Bm{paw St. P.O. Box 196650 Anchorage. AK 99519-6650 Legal Dascdptlon: A. WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST LAKEWOOD HILLS S/O l~3; LOT 33, Parcel ID: 015-134-12 WelltTPe PmVA~[ IfA, B, orCpmvtdePWSlD# N/A Data completed 10/6/94 Sanlta~/seal (Y/N) YES Totaldep~ 121 It. Casndto 120 It. FROM WELL LOG Data of test 10/6/94 Static v~Rer level 75 .lt. Well prnduclk)n 9 WATER 8AMPLE RESULTS: Collfom~ ~ colonles~100 mi. Date of sample: 2/6/01 SEPTIC/HOLDING TANK DATA g.p.m. Well Log (Y/N), Wires properly pmtactnd (Y/N) Casing he,bt (above ground) AT INSPECTION 2/6/Ol 75' ft. 3.0 +/- g.p.m. YES YES 12+ in. Nitrate ~;;, q~ mgA.. Otberbecterla -~ colonles/100ml. AWWC, INC. Tank Type/Material STEEL Tankelze 1500 gal. Number of Comparlmenls 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date Installed 8/17/94. Cleanouta (Y/N). YES High water elam~ (y/N) N/A Date of pump~ AB$OPJ~noN FIELD DATA Data Installed 8//17/g4 Length 77 lt. 2/2/01 Pumper DENAU SEWER &: DRAIN ~nTHS~O WESt mENCH. PRESOAKED Oe~NnELDI 1320 C. AI. LON$ ON 2/5//01. ,Soil rating (~or ~/bdtm) 1.2 System type TRENCH Width 2.5 .It. Grovel below pipe 4.5 Total depth 8 It Eft. absoq~on ~ 693 It= Moflltaring tube YES DaM of adequacy test 2/6/01 Results (Pass/Fall). PASS Fluid deplh In absofl3Uon field before test 0" In. Water added 869 gal. Elapsed Time: 15 min. I=inal fluid depth 12" In. Any reJuvenafion treatment (past 12 mo.) (Y/N & type) Depression over field NO For 5 bedrooms New depth 19" in. 750+ .g.p.d. If yes, ghm data - Absorption rate >=. NONE KNOWN D. UFT STATION Date instellad, Size in gallons ~ a ~?~a~z-~-fi~ ~ "Pump on" level at in. "Pump n. High water alarm level at __ in. ~ Cycles tested Meets alarm & circuit requlremente1! E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septlo tank/lilt elation on lot 10o'+ Absorption field on lot. 100'+ Public ~ewer main N/A Sewer/sepUc service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Pubflc sewer manhole/cieanout Hcidlng tank N/A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Bulldlng foundation 5'+ Property line 5'+ Water main 10'+ Water eswlce line. 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field. 5'+ Surface water. 100'+ Prope~y line 10'+ Water esndce line 10'+ Curtelndraln. NONE KNOWN F. COMMENTS Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 100'+ Water main 10'+ Driveway, parldng/vehlcie storage 5o'+ G. ENGINEERS CERTIFICATION I certify that I have determined flm~ugh field inspec~ns end review of Municipal records that the above systems em In conformance wfth MOA HAA guidelines in eFect on this date. Engineer's Pdnted Name JE~-rt<EY A. GARNESS oO Date of Payment m ./ , Receipt Number 0 7 Waiver Fee $ Date of Payment Receipt Number. · 0Zol4-01 11:08 FROV,-CTE EKVIROfli, ENTAL ,~TK CT&E Environmental Service. Inc. 5615101 T-851 P.02/O] F-276 CT&£ Ref. g Client Name Project Na mrd# Client Sample ID Matrix Ordered By PWSID Sample Remarks: 1010627001 AK Water & Wastewater Consultants Inc. Lake Wood Hil~s Lot 33 Lake wood Hills S/D Drinking Water Client Prlnted Date/'rlme 02/13/2001 16:31 Collected DateJTlme 02/06/2001 16:00 Received Datc/'flme 02/07/2001 15:30 Technical Director Stephen C. Erie Rasults PQL Units Method Limits Date Date Inlt Wat'era Department. Nitrate-N 5.48 0.500 mg/L £PA 300.0 10 raax 02/07/01 SCL ~[:Lc rob:Lolo!T,/ T-abora~.ory ?oral Coliform co~lOOmL SM1S 9222B 02/07/01 KAP E · 02-14-01 11:08 FROU-CTE ENVIRONI/ENTAL 5615301 T-86] P.03/03 Fo276 CT&E Environmental Services Inc. Labor-tow Division m~,~,,~,~,' 200 W. Pot~er Drive Drinking Water Analysis Report for Total Coliform Bacteria A. rao,. AK Q$61.-1606 Tel: {90?) 562-2343 READ INSTRUCTIONS ON REVERY:E SIDE BEFORE COLLECT'lNG SAMPLE Fax: ~907) 561-5:301 TO BE COMPLETED BY LABORATORY MUST Bi& COMPLETED BY WATER SUPPLIER .PUBLICWAT£RSY%~T£MJJ1-L .... I ~--I" I--'[ 4 I p~VATE WATER SYS~ ~end Re~ltl ~ ~end gn~e ~Ot DcDarr Roe, d, Sui~ Anch¢': ,;:~, Al( Month ... D. ny Year SAMPLE TYPE: ~ Roullne 1:3 Treated Water a Repeat Sample (for routine saml~le I~ Untreated Water with lab ref, no. O Spatial Purpose Time Collected SAMPLE LOCATION Collected By ~ ~,~alysis shows this Water SAMPLE m be: ~ Satis~tory ...... O Unsatis faclory OSample over 30 hours old, results may be unreliable n Sample ~oo lung in m~nsit; sample should not be over 48 bouts old at examina6on m indicale't~liablc results. Pleue se~d · new senile via special ~liv7 mail. Amapyll~.l Method:~4ernbrane Filth' * Number ofcolonies/100 mi. ..... t..~. nd.ufo . q~.ult* Analyst Fbks .Jun . Foxed TWit: Client notified or unsedsi'actory results: fho~f Sf~ae vdt# Foxed Dale: Time; BACTERXOLOGICAL WATER ANALYSIS RECORD MMO-MUG Ittml~. Total Coliform blembrane Fltte~. [Nrt~ Count ~ Verification: LT8 , IJCB Fecal Coliform Confirmation Final Membrane Filler Re~lt~ '~-~ ~. C~ Colonlff/lO~ mi COLIFIRM . .. Coliform/lO~ mi Time /~) has -- t ~MJmblf o| me SGI Grouo (Socml G~Wile m Suweillmflce) ENVIRONMENTAL FACIUTIES IN A~.S~ CAUFORNL~ FLORIDA. ILLINOIS. MARYLAND, MICHIGAN. MISSOURI. NEVi/ JERSEYt OHIO. WEST VIRGINIA Municipality of Anchorage Page 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: ~c~0077 PID Number: ~/ Name: ' ' Wastewater System: ,~New [] Upgrade Address: /o~-o o~- /~,~ ABSORPTION FIELD Nc. of Bedrooms: J~Deep Trench [] Shallow Trench [] B~d [] Mound [] Other LEGAL DESCRIPTION sci, Rating: /.~GPD/Sq. Ft, Total Depth fromploriginal grade: Lot: ~,~: Subdiv~ion: Depth to pipe boffom from original grade: Gravel depth beneath pipe ~ ~~ ~/~ ~,~ ~.~Ft. ~,~Ft. Township: --I~ Range:I~ Section:~ Fill added above original grade:~ -~.~ Et. Gravel length: ~ Et. WELL: ~New ~ Upgrade Gravel width: Number of lines: Distance baleen lines: ~ ,~ Ft. ~ ~ ~ Ft. Class~tion (Private, A,B,C): Total Depth: Cssed To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: nstaller: Date installed: Yield: ~ Pump Set at: Casing..i,~*~ove ~rou.,: TAN K GPM~ Ft. Ft. SEPARATION DISTANCES ~septic D Ho~ing ~ S.T,E.P. To Septic Absorption Lift Ho~ding =ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~ ~ Welk //~ / / ~ ~ ~ ~ ~ Material: Number of Compa~ments: s~.~c~ ,~ ,+ ~ LIFT STATION Water /Od /Od - LineL°t /O ~ ~ /~ ~ ~ ~ Size in gallons: Manufacturer: I m.o~',~~ "Pump on" level at: Foundation /~, ~-I I"Pu~h water alarm at: CudainDrain ~O~(~ ~( ~ ~~~cal Inspections pedormed by: Remarks: BENCH MARK Location and Description: I Assumed Elevation: S & $ ENGINEERING ,~' ~ :.~ 17034 Eagle River Loop Read, No. 204 :~ Inspections performed by: ~,~ m,,,. ~,~ ~s~ Dates: 1st ~-//-~ Department of Health and Human Services approval ,.~.-,~. .~., . . .,, ~ ~. ~~ Date: ?-~ / Reviewed and approved by: ~. Permit No.Sw94°°87 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.~KEWO°D HILLS SUBD.#$; LOT 33 PID No.: 01515412 CO1 COZ NEW 1500 GAL S.T. A B FCO 5,0 42.0 ~"01 15.5:. 56.0 ~02 24.0 64.0 ~"03 34.5:. ?1.0 ~O4 25.5] 21.0 ~05 47.5i 80,0 ~T1 26.0:: 20.0 ~IT2 35.0i 62.0 100.0' (CO (C04) 90.0'~ (MT1) (C06) 90.0' (MT2) i A~79.0' NO WATER FOUND TRENCHES i0i.7' C06~ N LOT 53 SCALE f' = ~0' NEW 5 BDRM HOUSE 1500 GA1 j Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES ~.~ 825 "L" Street, Anchorage, Alaska 99502-0650 ~? ~DESCRI...:~~ ~5~.~ Township, Range, Section7 SLOPE SITE PLAN t 7 8 9 10 WAS GROUND WATER J~'~ ENCOUNTERED? 11 s IF YES, AT WHAT ~ ~ 1 2 DEPTH? . p E 13 Depth to Water After Monitoring? Date: Reading Date Gross Net Depth to Net Time Time Water Drop : 0£ .f ,~,~, ---7'" 3" :t~ ~ ~ ?" /" :~1 5 ~" /" 14 15 16 17, 18- 19 20- PERCOLATION RATE S & S ENGINEERING ~~ ~RTIFY THAT PERFORMED BY:1~034 Eag;e River,L~p ~oa~ NO, ~ I/~ ~/ ~ THIS TEST WAS PERFORMED I~' *cco.o,,c~ ~~T~~,L GU~D~U.E~ 72~ (Rev. 4/~) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT ~ERMIT NUMBER:SW940087 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:BLOMFIELD JOHN F & SHELBY C OWNER ADDRESS:10850 OUR ROAD ANCHORAGE AK 99516 DATE ISSUED: 4/22/94 EXPIRATION DATE: 4/22/95 PARCEL ID:01513412 LEGAL DESCRIPTION: LAKEW00D HILLS #3 LT 33 LOT SIZE: 24000 (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: 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: SYSTEM MUST BE CONSTRUCTED BY DHHS PERMITTED EXCAVATOR. ENGINEER MUST PERFORM ADDITIONAL SOIL PERCOLATION TEST ADJACENT TO PROPOSED RESERV~SITE[ RECEIVED BY: ~J~A~. ~ ISSUED BY: DATE: DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. April5, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOI[~TEST TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEAL TH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lakewoods Hills No. 3, Lot 33 Request you issue a permit to drill a well and install a septic system to serve the proposed five bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the test 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 review, ~lease contact us. ~AS/LSU/Isu 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 z or,,.) :r1¥08 NWId 311S ,Og : .I.' PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST SLOPE '~-~-':,. '~ :~"-'"" ~ WA~:G'ROuND WATER E'N~)U NTER ED? IF YES, AT WHAT DEPTH? SITE PLAN 5 6 7 8- 9 10 11 12 13 14 15- 16- 17- 18 19 2O Depth to Water After ~-~. //L$1~/~/ Monitoring? ].,,/c}/ Date: Gross Net Depth to Net Reading Date Time Time Water Drop 1.'0~,~ ~ ~%" : ~ o S,',~,~ ¢'/'~ " I ~" PERCOLATION RATE ~ {m~nutes/~nch) PERC HOLE DIAMETER 1~ c i TEST RUNBETWEEN ~'~' E-T---A~ND ~'[' FT [~"~ --~ "-. ON-SITE WASTEWA TER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MA TERIAL SPECIFICATION$ REFERENCE: Lakewoods Hills No. ~7, Lot 33 GENERAL: 1. 3. The scope of this project includes the installation of a 1500 gallon septic tank and two leachfield trenches to serve the proposed five bedroom residence on the referenced property. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 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 Lakewoods Hills No. Z, Lot 33 April 5, 1994 Septic tanks installed with less than 4 ft. of cover shaft be insulated. A foundation cleanout shaft be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shaft be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shaft be located on undisturbed soft not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shaft be to clean toward the septic tank. Final grading over the septic tank shaft 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 shaft be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soft backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shaft 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 shaft 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. 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 Lakewoods Hills No. _~, Lot 33 April 5, 1994 MINIMUM MA TERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must Municipally approved septic tank manufacturer. The following pipe materials are approved for 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 be constructed by a use in septic system Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soft backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Use of a type of pipe other than listed above must be approved by the inspecting engineer. Page Four Lakewoods Hills No. 3; Lot 33 April 5, 1994 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt 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. -:.U~: .',;- ,~;:~ :':"--' '':~ "- ' -' "CERTIFICATE OF H~LTH AUTHORI~ · Location (site address or directions) 7560 Upper O'Malle¥ Road, Anchoraqe, AK. 99516 Property owner John & Shelby Blo'mfield Day phone ~46-1444 Mailing addreSs ' Mobile 229-1191 .-. Address ' ' Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5· TYPE OF WATER SUPPLY: Individual well community well Public Water xxx 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:. 72-025(Rev. 1/91) Front MOA#21 - ' As certified by m~/seal affixed hereto'and asof the validation date shoWn beloW, I verify that my .. ''" ' . ' investigationr "'~ of this Health Authority Approval applicati0n'shows that' the on-site water supply., · ~ - and/o~' Wastewater disposal S~/Stem' is ~afei'fUhcti0nal 'e~d ~deq'uate for the number of bedrooms and type of structure indicated herein. I farther verify that based on the information obtained from the Municipality of Anchorage files and from .my investigation and inspection, the on-site water - supply'~nd/°r wastewater disposal system is in compliance .with all Munici pal and State codes, ordinances, and'regulations in effect on the date of this inspection. ' Name of Firm Address ; .... ~: Engin~r's signature S & S ENGINEERING 17034 Eagle River Loop Road No. ~4 Ea~le River, Al~ska.~5?7 ./ - Phone · 6.,, DHHS SIGNATURE : t~.~ ~tt~ ~ ~ ' ..~: , ,. ' ~ " ' ~. '~uFESS~ ~ , ', , ' Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 (Re~. 1/91) Back MOA~¢21 A. Well Data Well type Log present ~N) Total depth Sanitary seal (~N) Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ~;~arcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number ~/,,~' Date completed Driller t Cased to f~,O Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/hektmg tank on lot //,,~- Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTION 131 ; On adjacent lots ; On adjacent lots / CO ~¥ Public sewer manhole/cleanout /LJh Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate '~'~ /~/.~. Other bacteria B. SEPTIC/HGLD;NG TANK DATA Date installed ~- l ~ - ~ ~/ Tank size ],,~(-30 ~_.,.~(... Compartments ~ Cleanouts (~_~) / Foundation cleanout ~i) ,~,,/ Depression (Y/~ High water alarm (Y/{~) /"J//~ Alarm tested (Y/~ /'J//~ Date of pumping ~k.)//9 -- ~ '--[,~r'hJ/c Pumper /~/J)~ ~ ~,~'~b-o -7-~h3'~ SEPARATION DISTANCES FROM SEPTIC/,HO'~,_Dh%'C TANK TO: Well(s) on lot [~L~ ' On adjacent lots To property line / O Absorption field Surface water/drainage ~/© C~ ' 4- Foundation Water main/service line c~S '4~ 72-026 (3/93)* Front CONTINUED ON BACK PAGE Date installed Manufacturer Size in gallons ~ Manhole/Access (Y/~--'"""~ Vent (Y/N) "Pump on" level a~ off" Level at High water alarm level ~""'""~ Cycles teste~'d""--~ . Meets MOA electrical codes (Y/N) ~ SEPARA~FI' STATION TO: Jot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Soil rating (GPD/FF) l, ¢0~ , Gravel thickness System type Length Width Total absorption area (~ cf '~ ¢-r~- Cleanout present ~/N) Date of adequacy test ,/k)~-- -'~)-~FJ '-~ Res. Its (pass/fail) Water level in absorption field before test /~/./4- Peroxide treatment (past 12 months) (Y/~. c/';, ~ ' Total depth ~ ' Depression over field (Y/~ for-% After test ~/~ If yes, give date /")/.~' Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on 1ct /~ To building foundation On adjacent lots ~ Surface water /O(~ i./_ Curtain drain On adjacent lots /06 t. Property line To existing or abandoned system on lot I Cutbank /-~/.4 Water main/service line Driveway, parking/vehicle storage area / (-) E. ENGINEER'S CERTIFICATION I certify that ! have checked, verified, or conformed to all MOA and HAA gu/defines in e~.'.~-~f th/s/nspection. ,~-~' ~ V~ ..... F' /t/ ognature -~-v ~ ~ - HAA Fee $ ~' ~ Re,:e bt Number Waiver Fee $ Date of Payment Receipt Number ztk 08:54 COMMERCIAL TESTING -~ 907G941211 N0.273 Commerclal~Te~ing & Engineering Co. Anchorage, AK $9518-1600 Drkddng Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS oar ,RE'FE,~,gE $1D~ BEFOI~, COLLECTING SetJ'IPLE Tel: (9071 582.2343 Fax: (907) 551-5301 SAMPLE DATE: Mouth SAM2LE TY'FE'x 0 Repeat Sample (for routine sample with lab ret, no, ) 0 Special Purpo$~ Day Year Treated Water Untreated Water Time CoUeeted Collected By TO BE COMPLETED BY LABORATORY Analysis show$ ~s Waler SAMPLE to be; .la'"/Sa~sfactot7. 0 Uasatisfactory Sample o,'er 30 hours old. rcsul~ may b~ ufa'eligible Sample too lon$ i~.translt; sample should not be over 45 hours old at exam~ation to indicate r*lieblc re, ult,. Plea,e send new sample via ~cci6 delivery mail, Date Received --~/-/-~-/~ T~a Received Analy, i, A~allxicaI Me~hod: ~mbr~e Filter a ~O-~O * Number of colon/es/100 mi. Client uotifled of uosattsfaetory ruult$; Phone(l Spoke with Date; Tune: ___. BACTERIOLOGICAL WATER A/VALYSIS RECORD 3 \'4~MMO'lVI'UG Resuk: Total Coliform M~mbraue Filter: Direct Count 0 ColonlerdlO0 mi Fa;ced Yettficatton: LTB Fvcal Coliform Con ruination BG B COLIFIRM. T~Tc- r,, ~'~-~t r. Co,,~ Final M~mbran~. Filter Results Coll[omdlO0 mi ENVIF~ONMENTAL FACILITIES IN ALASKA. COLORADO F/OR DA LL NOI$, MARYLAND. N='I/V J~RSEY, ONIO. UTAH. WEST VIRGINIA 21:02 COMMERCIAL TESTING ~ 90?6941211 NO.O?i Q02 CT&E Ref-# Client ~ample ID Matrl~ Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 94.5~-1 D33 5AK~WOOD HILLS Ordered By RAY $}I/%PER Printed Date 1~/29/94 ~ 16~2~ hrs. Project Name Collected DaCe X1/23/94 ~ 16~10 hr~ project# Received Date 11/23/94 ~ ~6~$0 hfs Technical Direotor STEPHEN C. EDE Sample Remarks: ROUTINE SAMPLE COLLEOTEDB¥~ J.W. QC Allowable EXt, A~al Parameter R~mul~ ~u.1 Uni~e Method Limits ~a%e Date Init Nitrate-N 3.90 D mg/L EPA 300,0 IO~ 11/28/94 MC~ ~ See SF=~Iel In~tructlons Abov~ UA = U~avallable ~* See ~ample Remarks Above ~A - NO~ ADalyzed ~U - Utldetecte~ R~po~d val~e 1¢ ~he practical 9~a~tl[1Oa~lo]% limit, bT a Z.~SS Tha~ ~D - Secondary ~ilucloD- GT = Greater Tha~! 5633 B Street, Anchorage. AK 99518.1600 -- Tel: (907) 5§2-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACIUTIE~ IN ALASKA. COL08ADO, ;LORIDA. ILLINOIS, MARYLAND, NEW J~RSEY. OHIO. UTAH, WEST VIRGINIA