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HomeMy WebLinkAboutSOUTHFORK WEST BLK 4 LT 9Southfork West Block 4 Lot 9 #078-031-21 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Permit Number: SW020210 Legal Description: SOUTHFORK WEST BLK 4 LT 9 Design Engineer: 0003 S & S Engineering Owner Name: Alan Miller Owner Address: 11740 Shetland Heights Cir Anchorage , AK 99516-0000 Date Issued: Jul 03, 2002 Expiration Date: Jul 03, 2003 Parcel ID: 078-031-21 Site Address: Lot Size: 91474 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: Disposal Field Septic Tank Holding Tank I Privy j✓ Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: c a-7/ Date: 7161 la L Date: 7/3/02 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anch orag e. a k. u s (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. .78 a 03/- 2 / Permit Number SW0202/O Property owner(s) ALM! Cm' I iL G ^ Day phone 6 7 7 7960 ��7 Mailing address (1)' 1 7 Sh f1Rb/D »4, hfs CSR Mailing address (2) J Zip Code 7 7 f74 Legal description (Lot, Block & Sub'd.) Ler alt Q1OLI: 4 SOVThTOck WepSV Legal description (Section, Township & Range) Lot Size 311 Acres/ q.Ft. Number of Bedrooms 3 c1, wig THIS APPLICATION 1S FOR: Sewer Only ❑ Well Only Sewer and Well n Water Storage Sewer Upgrade n THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool C C Jacuzzi Water Softening Unit C I certify tt the above information is correct. I further certify that this application is being made for a Sing! F ily Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: 150. "' Date of Payment: (a (78/02. Date of Payment: Waiver Fees: Receipt Number: OZZO (q d 0 r (Rev. 12/00) Receipt Number: PERMIT NO SW930350 PAGE 2 OF 3 Municipalityof Anchorage DEPARTMENT OF HEATH 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 LOT 9, BLOCK 4, SOUTHFORK WEST S/D P.I.D. No. 078-031-21 B HOUSE NOT IN s A1T1• MH A B ST1 159.0' 166.0' ST2 155.5' 172.0' MH 155.0' 173.5' MT1 95.5' 176.0' MT2 105.0' 178.0' MT3 134.5' 132.0' MT4 140.5' 138.0' SCALE. 1' • 40' .P*OF#4l LEGAL Ler 1 it:L1C 4, DRAWN -17— S5 -snorts PAWT--,< \aE'sT CKG. -10-n2 SHT. r I.... i M� PGdE SHAFER }}7j� S erp:s NG St1S toe ,,«Q r r Municipality of Anchorage 'E�. (•r y; ill Development Services Department :, 'VP -- Building Safety Division �-- On -Site Water and Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 Page www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. S w 4130 3 So PID Number. 07K— 0 31— ? / .Jia / 1 of 3 Name 4 L PM- cE Wastewater System: rill New ■ Upgrade MS." p p. Qox '1.410-9T2 ABSORPTION FIELD Bedrooms: oIS.*1" phyy. ICII4144a1.L4. TTX i�o>9 000) Ct- •f—i)-i7 DDeepTrench 0ShalowTrandl 0 Bed RM A4 Mac 0 LEGAL DESCRIPTIONL Soi Raba. aigGPDIFI• Taal Depth Ram anginal grade: FI. /��J BhaA: // Ld'. / f OL Subdivilimt �O/IC W�iSt 1-' •7 /1 Dep/1�/jo UP V i Z �V P,J -il. rade Gravel dean beneath PM- D.5 FI. Township. Ranger Section Fa added abete original wad. gra a...JR Garet Length. 57 Fl. Well: ❑ New% Upgrade Gravel wart \ a p� FI. Number el line's Distance WlrnlMe' + FL Cbaa�ftil�t b. A. n ! +I N _•F{�_ L_-�Vi/ a1N D // FI. Cased m: Taal abaonPbOn area. 1 a 5ct Flr 7 ASTM D3'3 yf Fel0 Gila • Dab DroI. ....Mc Wall/ LM I: rt Insiaser Sa4rh4 Fa ermsfr true De.hnadad �_"` Yield. . P FI. awrwd TANK SEPARATION DISTANCES ❑ Septic ■ Holding laS.T.E.P. 0 Other. To From Septic Tank Absorption FieldTStation Lift Holding Tank Public/Private Sewer Line Ma"«a`R`an ANCH4 f4G-� Ti9NK CwaoIy (o't$QDa,. WN /9 /� o f J/ n �{ 57 Maleul:.fiee I Nun�,gf a CanWrlmear �O(] sw,.a.Wab, ow. 1p0;. 100'+ STATION l01` 1{` 106'1SOr LLIFT .M4acRaer Pump olevettP.^p aM MNet 3aNowater as mN ontu)1_• Punp Make b Model 05X 05NN ElacNti i n.pecban. pe,amad by Wer CJNn44r C4 R•A1ed' BENCH ..... - IMARK LafJlpn aro Ww'aiarc �• nada At rFpe rly • url El non. turner• inf A" 1O0 FL E_ aatets tF`p OF ..-1: PERMIT NO SW930350 PAGE 2 of 3 Municipalityof' Anchorage DEPARTMENT OF HEATH 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 LOT 9, BLOCK 4, SOUTHFORK WEST S/D P.I.D. NO. 078-031-21 B HOUSE NOT IN \d A IBM MH A B ST 1 159.0' 166.0' ST2 155.5' 172.0' MH 155.0' 173.5' MT1 95.5' 176.0' MT2 105.0' 178.0' MT3 134.5' 132.0' MT4 140.5' 138.0' d SCALE. 1' A. 40' PERMIT NO SW930350 PAGE 3 of 3 Municipalityof' Anchorage DEPARTMENT OF HEATH 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 LOT 9, BLOCK 4, SOUTHFORK WEST S/D P.I.D. NO. 078-031-21 FINAL GRADE ST1 ST2 MT1=93.0' MT3=91.31.1 'T3 INSULATION MT2=92.4' MT4 MT4=91.4' FINAL GRADE 2" INSULATION ?mrawn. e ' JII-1I1—lI —11 88.2' 88.2' 1.11 1=87.7' MT3=87.6' MT3=87.7' MT4=87.5' • WATER FOUND ® 82.5' 73.5' B.O.H. 8/5/93 ORIGINAL GRADE N. T. 3. fl CE -8801 r rA 44 lF; ` . </..0 k%tciuert 1i47+T`'kt� y%(ti ROBERT C. COWAN \'. 114 * �A'S&S "EngineeRtng tv HEALTH ALITHIORTY APPROVALS SEWER& WATER MAIN EXTENSIONS SEWERWATER INSPECTION ENCINEERNGSTUDIES AND REPORTS WELLNSPECTION & RON TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL NSPEC11C S ON SITE WASTEWATER CISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERTA. SHAFER P.E. Date: -7-1t, Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 CML ENGINEERS (907) 694.2979 FAX (907) 694.1211 RECEIVED� 'tub 12. n, Aid 91996 Municipality of Anchorage Dept. Health & Human Services REFERENCE: �T 41 (�i. 1L ti Sa oca�oR %'- W(v5T The septic inspectjons for the referenced property were performed on $-tt-c and 6 -It -94 . Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the F15,5,3b o.J to be completed. L L If we may be of further service please contact us. Sincerely, ilie v" - Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA99577 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON—SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930350 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:NORTH LAKE INVESTMENTS INC OWNER ADDRESS:7312 HUNTSMAN CR. #C ANCHORAGE, ALASKA 99518 PARCEL ID:07803121 LEGAL DESCRIPTION: SOUTHFORK WEST BLK 4 LT 9 LOT SIZE: 91474 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 9/07/93 EXPIRATION DATE: 9/07/94 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: DATE: ISSUED BY: 0a-us-ta2C /7(f DATE: 9 ` 7 9 3 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 4 LEGAL DESCRIPTION:L ((t, DEPJJ FFEEre ) 1 to 2 $ 1( L 3 _ G u//min 5 * /% 4 CF 4, r 4. (ENGINEERS SEAL) DATE PERFO r(/{Township, Range, Section: 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 rG o 0 0 at cc Cla C r COMMENTS i SLOPE SITE PLAN 1- N WAS GROUND WATER ENCOUNTERED? IF VES, AT WHAT DEPTH? Depth to Water Atie ' pp Moeiyping) Datrp -771 F c( `n Reading S Date - - rots Time — - Net Time Depth to Water Net Drop 1 p/2'In 7vYI j" �— 2 / 2•,.�0 3.O Mau q a 2" 2 /z -C it 6 /-t d 1F9.95 -- 7' S. 7:.5-0 (s- B ` /' c ,c-e.F(/(.e J - 7 2:55- 7'¢ `' 7 / 1 tiop(S 8'!f" /11 7!/i -e / /0 3ilrla '— 7 / / 2,70 l 1� K(� / PERCOLATION RATE / (minutes/inch) PERC HOLE DIAMETER t6 TEST RUN BETWEEN ( ND FT 5 & 5 ENGINEERING PERFORMED BY s7U]ti Eagic Rtrcr Luup Frac No, 204 ACCORDANCE WI$ -P &4R'PRVEAIigt$BIA UP7AL GUIDELINE 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE HEALTH AUTHORITY APPROVALS SEWER 4 WATER MAIN EXTENSIONS SEWER 8 WATER INSPECTION ENGINEERING STUDIES AND REPORTS WEU. INSPECTION & ROW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. August 16, 1993 CIVIL ENGINEERS (907)694-2979 FAX 694-1211 'ECEIVED MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES AUG 18 1993 Attn: Susan Oswald P.O. Box 196650 .I,Iy of Anchorage Anchortage, AK 99519 Uri.. h„attfl & Human Services REFERENCE: Lot 9; Block 4; South Fork West Subdivision Dean. Suzan, This tette& is .Ln reaponae to yours concern with issuing a permit Lo& an on-site waste wcte& disposal system bot the referenced p&opetty. As you had p&eviousty requested ground wtcten monitoring was pe&6o4med at the ptopoaed construction 4Lte dwuing May 06 1993. At that time it was bound that the wand urate& had &wised within the mon.iton.i.ng tube to a Level app&ox.imately 11 beet below the established ground aungace. This is an indicated mise .in the water table 06 app&oximatety 3 beet £&om those measurements taken during November o6 1992. As a neautt o6 the water levet measurements taken dating May, an additional 3 Leet o6 compacted silty, sandy gravel mater-i.at uas ptaced on the construction site. This mateni.al taxis compacted in place and continued ground water monitoring was maintained. Ground watet mon.i toning dating July o f this yea& indicated a separation 06 5 beet. There£o&e it is ours opinion that this 4Lte has been adequately developed in accordance with the o&ig.Lna-t plana and that a petm.t t should now be .issued. The design bot this system has been modib.ied to allow bor the additional £itl that was placed on the construction site this Spiting. Also a soil log showing the percolation tate within the existing compacted 6-Itt material .i.a attached. 16 we may be 06 £anther aetv.ice, please contact us. Stnc---' a t ROB RT A. SHAFER, P.E. /Gk . LOSURES 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 -1047 O" s f // kwe kCves- C)k7 P1 rar no oCr CCl�it. how /.CJ <rt Wintd GUe .Q.n9 ead "ac7W S4 Ake airs 0911 411 feu it/ w` e-7-e-7" s r -r..- --- - -�j AE. cep -It Mo -s INv -��' M `___.Cus-r SOIL TEST PERCOLATION TEST n oana tcea wu .t c. oe .nuu c oea oven dioctated by the high gnounduatet Levet system can be completed as pnoposed by IS you have any questions o2 2egaAe. your review, please contact as. SLncetely, • Hlland Road Area Reference Map -1E 162 A. -4®-164 Y 165 SW 1059 163 ® COPYRIGHT 1999 JMR 1_01 q, 64- V- Sr ittrt tte41 Pet rItAL tit Cat' HEALTH AUTHORITY APPROVALS SEWER 1 WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION d FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL 1 MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, PE ROGER SHAFER. P.E. September 11, 1992 CIVIL ENGINEERS (907) 6942979 FAX 694.1211 Municipality o6 Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 9; Block 4; South Fonk (Vest Subdivision; Requeet you £.asue a pe/unit to £natalt a septic system and d J2t a welt to aenve the ne6erenced pnopenty. Attached ptease 'Sind a site ptan showing the proposed welt and septic Locations., Also attached .14 a pno6.cte o6 the pnopoaed Leach6<etd with the pneeaure diatn.i,6uti.on ayatem detai.ta.l I6 you have any queettona on negiine additional in6ovnatton bon your review, please contact U.S.. Sincenety, ROGER J. SHAFER, P.E. RJS/gm ' 17034 EAGLE RIVER LOOP, SUITE 204. EAGLE RIVER, ALASKA 99577 LEGAL 1 eALi&. 4 /7 oJ" it Po z $- \Jen_ DRAWN 'V-4-5 CKO. DATA - 10-`i2 SHT. i /� D N W J 3 LEGAL c e%2 4 lS .r n.4 DRAWN s SHT. DATE, Ao-,92 SRC-+-rc.. o2&A-rS1cA TiAt4 1,eVC-�1, B0CCbr1 or rt1+ eic %eon.14 SOILS. I.1STS'L.. f• 6 ft: SANDy G1Qr-11--r5t-. Att'Lsro 8/10/93 e••...sews ?F `c�'is . cG l'et '0 * �9'e '*• 491.4ti .k ./ • ••••••• .• ••• • . 110 it • �Z RO& ERSHAFER . . i� Ji % NO. 215 �: �.• 4 ". a I 'toil? OFESS O' .7_� 3 .1 It �¢ Souo 4.1M4 %Fct-o rizo•A .4 tV... I 454 Mr -r -i0 4 f•Yeti LEAtt. tea "'/ Irl-sat1 4 ca l ph -GT y�l r I)• Gen \..4Agit c1244 1c of 4M to i S.>\L L.8y� "LT %et /aC CPI • .•• „••ts� r��s _T ••.7 i • . • ..•.•.•or„ rC AA, a �tid Na 1157-E PROFESeVtl- RE-n73/0#)s 9/10/97 •.;.rd••- ,•ONHM•• 0A, ✓ falx, a gran 4' *4-nitt) 5c C 1l - wiz 1 \ 0.6. - A o list 1. /SNL . - S0 1%oLLeJ. '1i fl t L1F1 err''. ..»- ' z 20 051 ocHN - 4s ',Tn4e.. t-rf. - ' 4114 er. r1faw & t-tot-t,s. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: rL �4%n [-"O A&N ,r4->NGI5SRQt % 4972 .one •N• •M • ••, ••✓�jl ./ S ROG1:R J. SHAFER t $ I 9410%. No. 215 rt 4,piOFESS` DATE PERFORMED: 1 '1"'j'L LEGAL DESCRIPTION: Li 1* 9:=..Yrit Township, Range, Section: E PTH -WE ET) 1 O12-. ae 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 '• O : O' � T 131O.I4i SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? epih lo Water Atter -It Monitoring? SITE PLAN t N 114- 1 SePri C4- PS - 6J Reading Date Gross Time Ne Time Depth to Water Net Drop • 'X a' C pli 1 7-21-n 2 t ZZ — S', '. --*sf '4` _' . Z :32 1o..-.sa. La`Jq-" -7 2-ttkt .. (p�it3� Z/ PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER L TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY' I A/34 Eagle RI Vet Loup Rost No. 2011 $ & 5 ENGINEERING CERTIFY CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITFEa efithiLrAis(91 81 {a GUIDELINES IN EFFECT ON THIS DATE. DATE- �� 11 j I 2 - 72-008 (Rev. 4i85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: eF I Nis, DATE PERFORMED:tillfrEsso weVe 1 LEGAL DESCRIPTION: L 1 614 TIS f ,,.r_ownship, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH ") — 1 • • ei ML (M/1} Wceir- SLOPE WAS WATER ENCOUNTERED? S L SP IF YES, AT WHAT DEPTH? E Depth to Water Alter St Monitoring? Otte:7?J1= �Z SITE PLAN 4- N Reading Date Gross Time Ne Time Depth to Water Net Drop �� e bc,.4 c . erR...s •s9 1 •1 -2T -M- 2:2t. — 41%.` — - 2– 2%3(• tort IA iS/1 ` 1I le" 3 2: Ht- g'; " �' 4 2 : St- 5g" S 3t.os. - 5.5/Q- e "Ii '•l 1• s 1/e" V:" PERCOLATION RATE _1..L'_ (m.nutevtnch) PERC HOLE DIAMETER TEST RUN BETWEEN 4 FT AND 5 FT COMMENTS Lc" PERFORMED BY. S & S ENGINEERING ACCORDANCE WIT/%� 17JI34 Ei�J,E�n agle River$ka-9977 L�QQ LtallMS IN EFFECT ON THIS DATE. DATE �L� 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN "1-Ilsi�- • Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: / \t•-•• 7 lit. •• •• .•4•a� •If ROG 3J.13HAFER W .• tio.88215 : ESP Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �b<4✓ Ars `jtP![AGINEE•S�lr.., yi • ... 9Qnit . R ER 8HAFER � t� . % No. 8215 d 4a hs Ctae••.......eee TyEt I,'h'OFESSIO��+ DATE PERFORMED: ✓`ite LEGAL DESCRIPTION: L-1 V4 4871 F+ Township, Range, Section: vferr 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH Ar. CttI I� ~ ',O EF -t: �NI SLOPE WAS GROUND WATER ENCOUNTERED? IF VES, AT WHAT DEPTH? 1a s L 0 P E Depth to Water Atter s Monitoring? S Dalt 5.44112. SITE PLAN G t N Reading Dale Gross Time Ne Time Depth to Water Net Drop y —42- 7vni C.j 'L, eV) 1 8-I4 9L 1='K G. to le t "Z- t :3s Ior-Li..a. t.' C " 3 1: As — `7`3r, A 1:55 ••• 54' -eA • 5 2..t.s `.. 13/4" 3/0 - PERCOLATION RATE (minutes/inch( PERC HOLE DIAMETER t0 TEST RUN BETWEEN FT AND 3 FT COMMENTS PERFORMED BY S & S ENGINEERING 17334 Eagle River Loo Road No. 204 ACCORDANCE WITH ij`LtiT jMee ki�911 GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Rev. 485) Y CERTIFY THAT THIS TEST WAS PERFORMED IN Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.clanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# j4f/6 67c Expiration Date: Parcel I.D. 07R -03f-? f 1. GENERAL INFORMATION Complete legal description r z -o r q QLo crc H Soo .mire 4 c l.✓ i£ S Location (site address or directions) NM-, lev es?'" RI vk 4 AN r of 4"AC v4C Awes(' Property owner(s) !1 L P 4 6 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Dayphone(S3o) 1-g• ;17 P.O. ADX agio-5T2. IKEFAv,«E YX ltoa9 Day phone E JA Lo (c » -132,f3tianAr. /vf5M /663r Ck,MT44Pi4r.O Unless otherwise requested, HAA will be held by DSO for pickup. 3 2. NUMBER OF BEDROOMS: Day phone G vq- Ch 7G DRrv€ 44c.t-t A'ivq-E Ar Acts -77 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well N.: If') 0 Individual On-site 10 Individual Water Storage 0 Individual Holding tank 0 Community Class Well 0 Community On-site 0 Public Water System 0 Public Sewer 0 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 Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for cne year fcr properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and es of the validation date shown below, 1 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. 1 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 5 & S ENGINEERING 17034 Eagle River Lcop Road No. 264 Address Ea}le River Ata+h 44577 Engineer's Printed Name it t 942 r C. Cr Phone 69 y- aa79' Date /0/13A/ ac -kc CI . .jt .t •• '',.TS:<�•t + 1f1 J GINEER' %Y I i ROaERT C. COWAN /It -4 , 5. DSD /SIGNATURE rrj<<�;y� CE -8E01 :;w� , Approved for bedrooms. t►ti•�� ' t` .. Disapproved. Conditional approval for bedrooms, with the following stipulations: `_•• • ON-S(FE •,— Additional Comments Z -le : WATER AND • M— t. WASTEWATER : - PROGRAM : �Q•••• Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other (Re'.. 12C0( Original Certificate Date: /0 - 2 41 0 / Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 9 et OCK H SO v TH fd,4k W S s r Parcel ID: 0/ '8 -$9 3/ I A. WELL DATA W4 -'-L Nor 1P) Well type _ If A, B, or C provide PWSID # Well Log (YM) Date completed _ Sanitary seal (Y/N) _ Wires grope., • • - - - • (Y/N) Total depth ft. Cased to ft. ng height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE - ,1 LTS: Coliform colonies/100 ml. Nitrate mg./I. Other bacteria colonies/100 mi. sample: Collected by: Date B. SEPTIC/HOLDING TANK DATA TankType/Material 5• •E.A/SrE4 Tank size I a -YO gal. : Number of Compartments a matt Foundation cleanout (Y0 '"_C Depression over tank (Y6 No Date of pumping N/R — ^'44414- ePer"' rt,c v� 4 -4 - Date installed S1///of Cieanoutse(N) Yt J High water alarm (Y® /+o - Ago 1^47-441,4I C. ABSORPTION FIELD DATA Date installed 9l hi let Y Soil rating (g.p.dJft2 or ft2/bdrm) ©• H System type Length S 7 ft. Width a a_ ft. Gravel below pipe O • S ft. Total depth S, C. ft. Eff. absorption area a S 2 Monitoring tube `14./ Depression over field n0 r/A - NSv4 Date of adequacy test �'u• .a Results (Pass/Fail) PA -1 f For 3 bedrooms { *Av.ct. Fluid depth in absorption field before test PRY, in. /4, Water added= gal. New depth= in. Elapsed Time: = min. Final fluid depth _ in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO if yes, give date g.p.d. D. LIFT STATION Date installed Size in gallons I a s O Manhole/Access ON) Y4 J `Pump on level at _ in. `Pump off` level at _ in. High wa Datum Meets alarm & circuit requirements? No 1°)rr A Net r. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic se tj4.r.L no 7— II-) On adjacent lots 0 In. ots Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation N o T Property line' ° I Absorption field 3r • Water main N / A Water service line l'/•"% / "' Surface water / o o t Wells on adjacent lots / 0 0 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Li i Building foundation Nor 1 ^I Water main N A i Water Service line No +` 1"' Surface water / 00 Driveway, parking/vehide storage N0 % r Curtain drain NC.v !r. *Cedars Wells on adjacent lots / 0 0 4 F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. /e0/244r C. Col..•/. 10 /x-3/6/ Engineer's Printed Name Date c secAmpcovari +e.` CE -8801 HAA Fee $ 3 o o. Date of Payment Receipt Number (Rev. 12/00) /0%3/0/ Waiver Fee $ Date of Payment O II s/0 Receipt Number