HomeMy WebLinkAboutT13N R1W SEC 4 E2SE4SE4SW4T13N, R1 W,
Section 4
E2, SE4, SE4, SW4
#050-412-24
-, 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: ~L~ ~/,.OC:)~' PID Number:
Name: ~-~'"/~/~'~)A ~JALL I Wastewater System: ~New D Upgrade
Address~j~ ~ ~ ~ ~ ~a ABSORPTION FIELD
Phone: ~ _~ No. of Bed~ms: ~ Deep Trench ~ShallowTrench ~Bed ~Mound ~Other
LEGAL DESCRIPTION SoJlRating: ~.~ GPD/Sq. Ft TotalOepthfrom~igjnalgrade:
Townsh¢ [~ ~ IRaage~ ~ ~ I 4 Fill added above original grade: Gravellength:
WELL: ~New ~ Upgrade Gravelwidth: ~ ~ Numberoflines: ~gistancebe~eenlines:
Clsssification~Private, A,B,C):~ TotalDepth:~ I Ft. CasedTo:~ I Ft. Totalabsorptio~ ~ SQ. Ft. ~
~i""a~ ~ O~'~r.~riJled: Static~tWater Level:Fi ' ~ st~r;~__~ ~T. Date installed:
SEPARATION DISTANCES ~Septi~ ~ Ho~i.g ~
Uanuf cturer: Capacity in gallons~
TO Septic Absorption Lift Holding Public/Pdvat( ~
From Tank Field Station Ta~k Sewer Lines , I ~
Cu.ainDrain ' ~ ~ '- k~ ~_ ~de, l a,ectrica,,nspectionspedormedby:
Remarks: BENCH MARK
Locatio~ Descriotion'
Assumed Elevation:
[~L
Inspections pe,ormed by: ................. Dates: 1st S-19'~7 :,~y~
Department of Heal~ and Human SeNices approval '~ (~kN.., ~:~ .... ,.,,
Reviewed and approved by: Date: ~- / 2 -? ~ ~' '- ~>~:-~:~" ~' "~
/
72~)13 (Rev. 9/91) MOA 25
PERMIT NO SW960059 PAG]~ 2 O? 2
Munlclpo. Lit:y o~' Anchoro, ge
DEPARTHENT OF HEALTH AND HUMAN SERVICES
ENVIRONHENTAL SERVICES DOVISION
P,D, Box 196650~Ancho~'age, Alaska 99519-6650®Telephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEH AND/OR WELL INSPECTION REPORT
LIiIGAL E1/2, SE1/4, SE1/4, SW1/4, SEC 4, T13N, RlW P.I.D. NO.
ST1
xxxx MT~X /-- NEW TRENCH
SEPTIC TAN K~ ~~~o~
WELL
GRADE~ MT CO
~ ~C03 78.9'
MT1 = 74.T~
NEW
1000 GAL
SEPTIC
TANK
·
NO WATER FOUND
68.7' B.0.H,
CALCULATED
HORIZONTAL MEASUREMENTS
A B
IFC( - _
CO' 37.5' 10.0'
ST1 50.5' 23.5'
ST2 57.5' 30.5'
DBL 60.0' 33.5'
DBL 61.0' 35.0'
CO: 65.5' 49.5'
[MT1 65.5' 49.0'
C~ 118.0' 93.5'
IMT~ 115.0' 90.0'
MEASUREMENTS
ALONG THE SLOPE
A B
43.5' 24.0'
55.0' 32.0'
61.5' 37.5'
64.0' 40.0'
65.0' 41.0'
67,5' 53.0'
69.0' 53.5'
121.5' 97.5'
117,0' 92,5'
by
SULLIVAN WATER WELLS
P.O. 80X 6702?2, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2159
OWNER OF LAND Ztt,~J~{9/:] /7/ilL/... DEPTH OF WELt
ADDRESS fl~ ~0~ - . ~ ~ S~TIC C~V[C 0F
LEGAL D~CRI~IO~~IJ~ ~ ~ ~,) 5 E 45ff~S'~ ~atw oow~ ~T.
DATE - Stalled Ended ~/~ GALS PERHR
PERMIT NUMBER ~ KIND OF CASING
KIND OF FORMATION:
From__Ft. to Ft.
From__ . Ft. to__FI.
From.__ Ft. to Ft
Ftom~Ft. to Ft.
Fr0m__Fr. to .Ft,
From__Ft. to__Ft.
From .Ft. to__Ft.
From FI. to__Ft.
From Ft. to Ft.
From Ft. to Ft..
From__Ft. to Ft..
F~om~.Ft, to
From ~Ft, to__Ft..
From __
F[om __
From __
From__
From
From
From,-
From
From~
From.__
Ft, to__Ft.__
Ft. to ,Ft. .
.._Ft. to ~Ft.~
FI. to __FI, .,~
Ft. to Ft.
FI. to Ft __
Ft. to___Ft. :-.-
Fi. to_ Ft._ ,-
_FI, to_Ft. ._
FI. to ,FI.,
Ft. to Ft.
FI. to . Ft
FI. to__FI
FI. ID__FI
FI, to .Ft.
,FI. to Ft.
.Ft. to Ft.
MISCL. INFORMATION:
RECEIVED
JUN 1 2 1997
Mun cipality of Anchoreoe
Dept. Health & Human Services
DRILLER'S NAME
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
PERMIT NUMBER:SW960059
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:HALL LINDA J
OWNER ADDRESS:HC85 BOX 9802
EAGLE RIVER, ALASKA 99577
DATE ISSUED: 4/24/96
EXPIRATION DATE: 4/24/97
PARCEL ID:05041224
LEGAL DESCRIPTION:
T13M R1W SEC 4 E2SE4SE4SW4
LOT SIZE: 217800 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS°
SPECIAL PROVISIONS:
SL°WER & WATER
~NSPECTION
WELL INSPECTION
&FLOW'rEST
ROADDESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ROBERTC. COWAN, RE.
ROBERTA. SHAFER, RE.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
AAR 18 1997
Mueicipality of Anchorage
Dept. Health & Human Services
The septic inspections for the referenced property were
performed on ~j~ and $'1-~-~-~ . Prior to submitting
the On-site Wastewater Disposal System and/or Well Inspection
Report we are waiting for the ~ Sc~ ~ to be
If we may be of further service please contact us.
Sincerely,
Robert C~ Cowan, P.E.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
ROBERTC. COWAN, RE.
ROBERTA. SHAFER, RE.
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL tNSPECTION
& FLOWTEST
SITE pLAN, S
ROAD DESIGN
$OILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAl_SYSTEM
DESIGN
CIVIL ENGINEERS
April 8, 1995 (907)694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: E 1/2, SE 1/4, SE 1/4, SW 1/4, Sec. 4, T13N, R1W
Request you issue a permit to drill a well and install a
septic system to serve the proposed three bedroom house on
%he referenced property.
A test hole was excavated and a percolation test performed.
The approximate location of the test hole is located on the
attached site plan.
At the time of excavation no water was encountered in the
test hole and after seven day ground water monitoring, the
monitoring tube was found to be dry.
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
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
There are no points of contamination within the proposed
well radius which can be seen on the attached site plan.
If you require additional information,
Sincerely,
RCC/gk
Enclosure
please contact us.
MUNICIPALII¥ ~ .
cNVm'ON/HENi-A£ ~'~ANCHo/.~GE
~c~VIcEs DIWSION
RECEIVED
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR; L I I'~r ~ ~1~ ~¢J~ A ~'l'~
LEGAL DESCRIPTION:
1
4-
5-
6-
7
8
9-
10-
11
13-
14-
15-
16-
17
18
19-
20-
DATE PERFORMED; . ' D
Township, Range, Section:
E,,O,H. tS/
COMMENTS
SLOPE SITE PLAN
II H.
IIIf-
Ii '1
III
III
I'1
WAS GROUND WATER kJ
O
ENCOUNTERED;)
IF YES, AT WHAT / SL
DEPTH7 pO
E
Ooplh tO Water Alter D./Ry
Monitoring? Date:
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE [(~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 5,5 FT AND ~ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
q neemnq
SEWER&WATER
INSPECTION
ENGINEERINGSTUDIES
AND REPORTS
WELL INSPECTION
& FLOWTEST
SITE PLANS
ROADDESIGN
PERCOLATION
TEST
STRUCTUI:~.L&
MECHANICAL
INSPECTIONS
'~EFERENCE: E
GENEIL%L:
1.
ROBERTC. COWAN, RE.
ROBERTA. SHAFER, RE.
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
1/2, SE 1/4, SE 1/4, SW 1/4, Sec. 4, T13N, R1W
April 8, 1996
The scope of this project includes the installation of
a 1000 gallon septic tank and a five foot wide
drainfield to serve the proposed three bedroom
residence located 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.
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.
~EPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
e
The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
e
Ail standpipes on the septic tank shall extend a
minimum of 12 inches above final grade.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Page Two
E 1/2, SE 1/4,
April 8, 1996
SE 1/4, SW 1/4, Sec. 4, T13N, R1W
4e
e
Septic tanks installed with less than 4 ft. of cover shall
be insulated.
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.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed-up) before
gravel (sewer rock) placement.
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 soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
4e
Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
Page Three
E 1/2, SE 1/4, SE 1/4, SW 1/4, Sec.
April 8, 1996
4, T13N, R1W
Se
Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
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.
Insulation shall be at least 2" thick
burial polystyrene (Dow Chemical Company
equal).
extruded direct
Styrofoam HI or
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, 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 soil backfill.
6. Ail 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, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements.
Page Four
E 1/2, SE 1/4, SE 1/4, SW 1/4, Sec.
April 8, 1996
4, T13N, R1W
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.
e
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.
e
The final inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S
Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
Page Five
~ 1/2, s~ 1/4, s~ 1/4, sw 1/4, seo. 4, ~13N, RlW
April 8, 1996
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/INSTALLER
Municipality of Anchorage
Development Services Department"
Building Safety Division
On-Site Water and 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.050-41-224 -
· ExpiratiOn Date:
GENERAL INFORMATION
Complete legal des'cfiption E2; SE4; SR4; SW4; T13N; R1W; Sec4; SM
Location (site'addressor directions) 2020West River])Dr., Eagle
River, AK
Current Property OWner(s)
Mailing address '
Day phone
Lending agency
Mailing address
Day phone
m
Real Estate Agent Barbara Crittenden
Mailing Address
Un/ess othen~,ise requested, HAA will be hem by DSD for pickup.
NUMBER OF BEDROOMS: 3
Day phone. 689-4000
TYPE 'OF WATER SUPPLY: '
Individual Well [~
Individual Water Storage [--i
Community Class ~ Well [--I
Public Water System I'-I
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
I
The Municipality of Anchorage Development ServiCes Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska;' Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties 'served :by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY 'ENGINEER
As certified by my seal affixed hereto and as of the validation 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, funEti(~nal and adequate for the number of
bedrooms and type of structure indicated herein. I further vedfy 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 $ & $ RnRineez~inR
Address 17034 N. ]3a~;le River Rd, Ragle
Engineer's Pdnted NameRobert. C. Co,,zan
River, AK
Phone 694-2979
99577
Date' '-Y"/
DSD SIGNATURE
V'"' Approved for
Disapproved.
Conditional approval for
.....
bedrooms. ' ' 'l~:~;;- ...... .,..'"~ ~
bedrooms, ~th the [ollo~ng stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
SupPlementai Engineer's RePort
Other ·
Original Certificate Date:
(Rev. 01/02)
MuniCipality of Anchorage
Development. Services DePartment
Build!ng Safety Division
.. ..... ' On-Siie Water.& Wastewater Program'
'- ;'~'~" . 4700 South Bragaw St.
~','- P.O. Box ?96650, Anchorage, AK 99519-6650 :
' ' i www.ci.anchorage.ak;us ·
· -, ~ ' - i(907) 343-7904 i :
HEALTH A0;-rHbRIT¥ APPROVAL CHECKL~iS'T
olmp~Jrtr:n e/its 'j ~. !i '
)ression Over t~
. . :. ? C eanouts'(Y/N) '
Poundaton cleanout YIN ~"' De :, · ,, ~,.. . :L . ·
(). ~ . ~., ank(WN . H hwat ,
. . · ,. , ...... ) g e alarm (YIN
I ' '~[ ..~ ~ td :. '' . .: ~ ~ . ,. ........ ' ....
C. ABSORPTION FIELD DATA " .......... '- ~
Date~nstalled.~J)~ ~Soi ratin':/--~'/,,~2:';,~,L'`~; i~ '~ ~ _ . ~: :.:'~ ~ _
Length ~ 'ft, ' ~ ~ .... ' ~" . '
.. , ~ · ;W,dth .f,.~. 5~ , -,, ~ ~ .... G~:,,- ~, ..... ,-~~ -.
I , ' , - F- , t~ , ~ ,r ...... ~1 ,I ....... ' i? ~, ,: '
Total depth ~':ft -. Eft abs-r-,,~:'J--- ~ 0-'.~ Ii .Ij.~, :..[:.. ;u ,. ;:.._ I. h t,~.,,. ·
. .. . ,. ... ..,~ . , ..... ~. ~ ~. epress, onoverfeld
Fluid depth[~n absorpbon f eld before test ~ in .... i ~,~;t_~ ~1 ~: u :i;. ., .
, ~ / , ~ .;,, ....~ .... epth~ n.
. ;, . , ~ ~ , ~.. ~] ~ .. ..
ElapsedTme ~O mn , Fn ' · . ': ." ;- ;
· . alfludde thw~ n ,~ ......
Any rejuvenat on treatment (Bast 12 mn'~iv/~',J ,,,";~ .~iJ'/ ~ ? I: .
t I ~
' . ' ' ' '1 ' · ~ ~ .' , " ' I .
. _
O. LIFT sTATIoN
Date instalied : ·
'"Pump on. Jevel,at / .~n.
Datum :':, ',/
E,
Size in gallons
"Pump off" level at .
cycles tested
.in.
SEPARATION DISTANCES .,
SEPARA'i-,ION DISTANCES FROM WELL. ON LOT TO:
Septic tank/~on on lot /OO' I .'.' '
Manhole/Access (Y/N)
High water alarm level at
· Meets alarm & circuit requirements?
On adjacent lots
Absorptioi~ iielJ' jn lot /{~C): '~- 0n adjacent lots
~/t~pd6 .se~ioe 1,ne ' ~ .
':,'? J :J:',;:i'l ' ~ ' ':
O. LOT TO:
Building~fodn'8ation. ~. + ' Prope~ line ~ ~ Absorpt,on field
": ' ~ Surface water I
Water m~in, L'.
'Wells o'fi'~f]ac'~ntlots ! OO ~ -" ,
sEpARATION'DISTANCE FROM, ABSORPTION FIELD ON LOT TO:
Prope~,l,~e :[ Building foundation ~ Water main
Water'Se~lce hne ' · / ~ ~ Surface water / O~-'1¢ Driveway, parking/vehicle storage ,
' :' ' i~ll':' ~]~ ~ ' ' adja~entlots /~ O f~
CuKain dra n~~ Wells on .: ~ .
F. COMMENTS; . ',
];111 i','':~
G. ENGINEER'S CERTIFICATION ~'
,cert, t;'~! .
ve determined throUgh'field inspections and
revieW;o,f, ',.M,.Snic, ipal records that the above systems are ,n
confoi'~ab'ce "i~ith MOA HAA guidelines in effect on' this date.
Eng, n,e? r', ,,,s,i p,, r,,? ..
r,i
HAA Fee'
Date of, F
Receipt N
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
· 05/12/04 WED 11:54 FA]~ 6896499 VISTA REAL ESTATE ER
/ - - ~ ...... o,-~n~(u ~ A~$O~IAIES LAND SURVEYING 694-0829
I HEREBY CERTIFY .THAT I HAVE SURVEYED THE SCALEs
FOLLOWING DESCRIBED PROPERTY= /~'~
' DA~ -
/~...-'
INDrCA~. IT IS T~ RES~SrBILI~ OF THE
E==.~=. cov=.~.~=, o..~s~.,=,o.= ~~
WHI~ DO NOT ~EAR O~ THE RE~D~
~.'._
~Y DATA H~N BE US~ F~ CONS~U~ION ~¢'~
OF FENCE LIN~, OR FOR E~LISHING ~ND- DRAWN:
ARY LINES.
SGS Ref.#
Client Name
Project Name///
Client Sample ID
Matrix
1041841001
S & S Engineering
E2;SE4;SE4;SW4;T 13N;RI W;Se¢ 4
E2;SE4;SE4;SW4;TI 3N;R I W;Sec 4
Drinking Water
Sample Remarks:
All Dates/Times are Alaska Standard Time
Printed Date/Time 04/26/2004 8:.32
Collected Date/Time 04/i 9/2004 ! 3:00
Received Date/Time 04/19/2004 16:33
Technical Directs...... Ste.?~ C. Ede
Released~J~-~
Allowable Prep Analysis
Parameter Results . PQL Units Method Container ID Limits Date Date Init
Metals Department
Arsenic
0.00200 U 0.00200 mg/L EP200.9 C (<=0.01') 04/20/04 04/23/04 IMP
Waters Department
Nitrate-N 0.156 0.100 mg/L EPA 300.0 B (<=10) 04/I 9104 JIB
Microbiology Laboratory
Total Coliform
0 coFI00mL SMI8 9222B A (<=1) 04/19/04 DKC
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 'L" Street Room 502
P,O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak,us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A S~NGLE FAMILY DWELLING
Parcel I.D. 050-41-224
1. GENERAL INFORMATION
Complete legal description E
Expiration Date:
1/2, SE 1/4. SE 1/4. SW 1/4. T13N, R1W. Section
Location (site address or directions) NHN ~;est River. Ea~le River
Current Property owner(s)
Mailing address
Lending agency
Linda Garten
Partners Real Estate
Day phone 230-5624
Day phone
Mailing address
Real EstateAgent Partners/ C Rolf Milton Day phone 694-4994
Mailing Address 11940 Business Blvd,, Ste 100. Ea~_le Rive~. AK 99577
Unless otherwise requested, HAA will be held by DHHS for pickup, HAA picked up by: -)/'~/¢~
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
[] Individual Holding Tank
[] Community On-site
[] Public Sewer
[]
[]
[]
[]
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates c:
Health Authority Approval (HAA) based only upcn 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) on properties served by a single family on-site
wastewater disposal and:or water supply system. DHHS also issues HAAs upcn request to home owners
Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served b>
a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificate.,
are valid for one year for properties served by Class A or B wells cra public water system. The Municipality,
of Anchcrage is not responsible for errcrs or omissicns in the professional engineer's work.
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
based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval
application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm $ & S ENGINEERING
17034 ~-.5:~ ~,;,~=r
Address E;3(~le River. AIas~<a
Engineer's Printed Name Robe,-t: C. Cowan
DHHS SIGNATURE
t,,'"'. Approved for
Disapproved.
..~ bedrooms.
Conditional approval for
bedrooms, with the following stipulations.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplementa Engineer's Report
Other
Expiration Date: ~.. - ~ ~ -.~ c
Original Certificate Date:
Reissue Date:
Municipality of Anchorage ~
Department of Health and Human Servl~j:= CE I V E
Division of Environmental Services ~ · t,
On-Site Services Section 825 '1." Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650 NOV 2 8 2000
w~nv.ci.anchorege.ak.us
(907) 343-4744
HEALTH AUTHORITY APPROVAL CHEbE~iIMENTN' Si~VlCE$ DlVlSl0N
A. WELL DATA
Weft tl~pe ~'~ V~ ~
Date completed 4/q¢'
Totaldepth ¢¢! ft
If A, B, or C provide PWSID #
Sanitary seal ¢~
Casedto z~:~ .
FROM WELL LOG
/~' g.p.m
Nitrate ~5)~¢ mg/I
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~ colonies/100 mi
Date of sample: ' ~) / / O/~Z3
Parcel I.D.: 4;~-O --
Well Log
Wires properly protected
Casing height (above ground) ~'/ in.
AT INSPECTION
,¢.5- g.p..
Other bacteria q colonies/tOO mi
S & $ ENGINE{;RING
17034 Eagle E|¥er Loop Roa~ Ne. 204
B. SEPTIC/HOLDING TANK DATA. ;aele R;ver, Alaska 9;$77
Tank Type/Material ~.~c~r, C / ~
Date installed ~ ' Tank size / ~ gal Number of Compartments
C,eanou / Fou. ation c,aanout De.re.ion over =nk .igh water alum
Date of pumping /I/~ o Pumper ~ A- -J
c. AeSORm~O..EtD DATA
Date instated _~ / I.~/~ ~- So, rating (g.p.d./,2 or,'Z~odrm) ~- ~ System type ~
Length ~ ~ ft Width &; ft Gravel below pipe ~' ft
Total depth ? '~" ft E,ect~e ab.orption afeard,= Mon,to~ng tu~, '~< Depression over tiald
F,uid dep~ ,n ;=~o~on tie~d before tea: !:// in Water added/~/~gal. New depth in.
Elapsed Time: /~'~ min Final fluid depth. ~ ' ~ ' in Absorption rate >= '52'0'~ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)/V'~/~E /~/~/u,~/ If yes, give date
724)26 (Rev. 01/00)'
D. LIFT STATION
F.
Date installed I~~n
'Pump on" lave .
Datum
//-
SEPARATION DISTANCES
Size in gallons __
"Pump off' level at __
Cycles tested
in
Manhole/Access
High water alarm level at in
Meets alarm & circuit requirements
Sewer/septic service line
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot / Z~/4-
Absorption field on lot /~
Public sewer main
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
/
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation <~ ~ Property line ~ /
Water main A//A Water service line / ~ ~ Surface water /~-z) /~-
Drainage "'- ~/~.:~. Wells on adjacent lots / O o /~-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line / O/-+- Building foundation / (:~ Water main ~./,/~-
Water Service line /~/+- Surface water / O o /~-- Driveway, parkingh/ehicle storage ~- /
Curtain drain A//~/v~-~A/rz,J~ Wells on adjacent lots
COMMENTS
ENGINEER'S CERTIFICATION
',~! /~ ,, \,'.,
I certify that I have determined through field inspections and 2."~'Z'/"'~-*"'~"~ _-!~[]1~ ~R'S'"'""
review of Municipal records that the above systems are in
conformance with MOA HAA~uidelines
Engineer's Printed Name /
Date I, ! ~.-, JO0
HM Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-0~6 (Rev. 01~00)'
11-15-00 10:14 FROM-CTE ENVIRON~ENTU.
ztK CT&E Environmental Services Inc.
5615301
T-626 P.02/03 F-014
CT&E ReC~
Client Name
Prolect Name/~
CUent Sample ID
Matrix
Ordered By
1007150001
S & S E~L~eerCng
E1/2,S£I/4,SEI/4.SW 1/4.
T13N~IW,Sec4 (~[**~ W. RiveO
Dfi~d~x~g Wate~
Sample Remarks:
RIW,Sec4 ~ W. Rivet).
P.~s~lts
PQL Units McO~xl
Olen! PO~
Printt'd Date/Time 11115/2000 8:54
Collecled UltUTlme 11110/2000 13:30
R~elved D.sttffTImt 11110/2000 17:30
Ni~aTe-N
0500 U 0.500 mg/L EPA 300.0 10 max I II10/00 SCL
N~croblology Labora~or~
To~l C~liform
9 OD, No Coli
col/100mC SMI8 9222~