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Home My WebLink AboutDALZELL-SCHNEITER BLK 2 LT 18 Municipality of Anchorage Page ' ~/' o! ~" · 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: 5/J ;~/-/O/~ PID Number: ~/~ "~"'Waslewaler System: O New ~ Upgrade ~'"':' ~/.~ ~, ABSORPTION FIELD Phone: Jgr-- ?r ~ ~ ¢ ¢ a Shallow Trench D Bed O Mound a Oiher LEGAL DESCRIPTION a. e ~.o/sq ~, /~ WELL: D New ~y/~?/H~Q Upgrade ~,~ W'eid ~umps.,.,: F,. TAN K SEPARATION DISTANCES ~p.c U Holding U S.T.E.P. ~lom lank ~ietd Sl~li~ Tenk 5~e~ Ll~s ~ w.,~, /,~/~ JlJ~ f//~ ~1/~ IdA LIFT STATION " ', BENCH MARK Remarks: ~;~ ~ ENGINEER'8 SEAl.. · - ~ .'~j ".~. ~:-:., .:.,....~.,;.~.~). Inspections performed by: C/I&/H~ Dates: 1st O&/d5/~ 2.0 Department of Healt nd Hum~ervices apprCva~ Reviewed and approved by: .... Date: Permit No. of 2 SW 94-0163 ~ Page Municipality o! Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Waslewater Disposal System and/or Well Inspection Report Dalzell-Schneiter Lot 18, Blk 2 PID No.: 015-29-130 Legal Uescrlptlon: A-C ll.~ ~ EXISTING 35' TRENCH I ( A-H=30.3 15' DRAINAGE EASEMENT . ~.-}.- { ~-J=77.0 LOT ~7 SCALE' : ; ~ ~ TEST HOLE ~ ~ s ~ MONITOR TUBE ,, : o ? S~ER CL~O~ I~ I I -' ~ + - WELL ~ ~ EXISTING LEACHFIELO ~ ' PROPOSED L~CHFIELD -ELEVATIBNS .. m J .... ! ' ENGINEER'S SEAL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE I OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940163 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:BOS GREGORY N & OWNER ADDRESS:10151 EVERGREEN ST ANCHORAGE, ALASKA 99516 DATE ISSUED: 6/02/94 EXPIRATION DATE: 6/02/95 PARCEL ID:01529130 LEGAL DESCRIPTION: DALZELL-SCHNEITER BLK 18 2 LT LOT SIZE: 49294 (SQ. FT.) NUMBER OF BEDROOMS: .-~3'THIS PERMIT: .-% THIS PERMIT IS FOR TH-~ CON'kRUCTION OF: DISPOSAL FIELD 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 (24 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. 1 SPECIAL PROVISIONS: ISSUED BY:,~', ~ ~ DATE: Louis Butera, P.E. Registered Civil Engineer May 25, 1994 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Dalzell-Schneiter, Lot 18 Block 2 Narrative Dear Mr. Cross: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to soil absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. ~C:\WPWIN60\WPDOC$~1994\94-019A.NAR P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone {907} 69.1-5195 · Fax {907) 69.1-3297 V~,L ~ ' '~ ~. LOT 13 ~. EXIST. 1250 TANK~ I ~'~'' ' TH ~ ~ VACANT ' LBT 18 , ' ' 15' DRAINAGE EASEHENT . e~,'~.' [ ~~ '' ~DIVERSION VALVE ~EXIST. TRE~H ~ - TEST HOLE ~ · - MONITOR TUBE DETA[L o - sewer cutout + - WELL ~- EXISTING L~CHFIELD - PROPOSED L~CHFIELD NO SURFACE WATER .... ~S[M[NT NO KNOWN CURTAIN DRAINS ~EPTIO ~ITE PLaN OWNER: DOS / SEE ~......~ CONtRACTOr: N/A ~2.¢~ ".~'~ ~o. ~ ~4-o~1 ~Ate: 0~/~4/~1 SCAUe ~" = eO' ~'"'"~~~ ............ j' '~ ".. c~-e~ .." ~. P.O. Bo~ ~73294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTE31 LEGAL: DalzelI-Schneiter, Lot 18 Block 2 ~;1ENERAL 1. The septic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. The excavation is to be exactly in the area shown on tile site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate tile nearest lot line position and the location of any easements. TANK 1, The existing hank is to be uncovered to assess structural integrity and replaced with a new 1,250 gallon steel tank to MOA requirements if necessary. If existing tank is utilized, provide lid with pomp-out for second compartment. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed I0' at any point. 4. The effluent line is to be connected to the existing and new trench by means of a Bull Run diversion valve. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface g~ter runoff. 8. Tile septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class 'C' well, or 200 feet to any community well. RECQMMENDED LEACIIFIELD DIMENSIONS: TOTAL DEPTtt = I0' GRAVEL DEPTtl = 7' TRENCH LENGTH -- 53' TRENCII WIDTH = 3' SOIL RATING = 0.8 GPD/ft: BEDROOM CAPACITY = 4 SEPTIC TANK = 1,250 gallons Twe,fly-four (24) hours notice reql,ired for all Inspections. C:gWPWIN60\WPDOCS~I994\94-019A.$PC Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEERS SEAL) DATE PERFORMED, LEGAL DESCRIPTION:..J~/~ ¢l/'~'e//~- L/.~'/~'.,~ Township. Range, Section: D'E.P T'H~ ~'//,d ~ ~" ''/ ,c;~ ~;l& ~,.,,,./ ,....,,, ~,,,.,~/ ~,'/t.,..Ft..,,,./ _~.'1~';. ~....,. ,,.,~,~ WAS GROUND ENCOUNTEREt M0nil0dng? -~%..........q~ ~, ~' , .." ~.~.~ · . ! 2 3 4 5 6 7 8 9 ~0 - UNO WATER ~2- 13- SLOPE II II SITE PLAN 14 - Reading Dale Cross Nel Depth to Net ..~-~ ~ Time Time Water Drop 7 " ~ ~.'~ ~o.,. ~ ~" ~., ~6- ~ ,, /~.,~ 7~...' ~ ~.. ~ ,~.. 18- 19- 20- 1~ [' P~ Iminule~i~h) PERC HOLE DIA~ETE~ ~ ~ TEST RUN BETWEEN . ~ FTAND ~ FT COMMENTS BY; ,~''''''~'''~'/'. I'"~-~~~"~ CERIlFY THA1 1HIS 1EST WAS PERFORMED IN PERFORMED ACCORDANCE WITH ALL STA~E AND MUNICIPAL CUIDELINES IN EFFECT ON 1HIS DAI E. EAGLE RIVER ENGINEERING SERVICES P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 Dalzell-Schneiter Lot 18, Blk 2 / 94-019 SHEET NO OF CALCULA,ED s¥ L.B. DATE 05/14/94 C.~C~ED s*. L.B. DATE 05/14/94 :.....:...._../__-_ ........ I..., ! ': , ence ~ ~ ~ ~. ~ ~ : , ~ : :, ,. . .: . : . .... ~......~4b~r~m~ =..~g~lon~r~y~) : :: · ~So~l ~ench a~hm~on m~ = .0.8 g~/ft .... :-..--.-~R~ui~ abm~tion ~m = · ~.*~ · ,0.8 = 750 ft ~ ~R~ommend~ ~ench dimension~: ......... ~.....~ .:Gmveldep~: ~.7'. . : ................................... . : ~-:~ ~ - ' MUNICI.AUTVOFANCHO.AGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 '"~' ~ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE MAILING ADDRESS LOCATION . ~ ~ NO' OF BEDROOMS DISTANCE TO: IW~l~r /~ IAbsorp"O~e~ D~lling~,~ ~ PERMIT NO. E ~ ----__~-- DI~AN~ ~0; ~--~ NO' of lines i Length °f each~;tlin' Total leng~l?es Trench width,7~ inches k ~op of tile Jo finish grade / / Material beneath tile Total eff~ti~ absorppon area Length W~dt~ Depth PERMIT NO. ~ Ty~ of crib Crib diameter Crib depth Total eRecti~ absorption area m Well 8uildlng foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth DriUer Dastance to lot line PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(si ~ DISTANCE TO: OTHER PiPE MATERIALS REMARKS ' ' ' ~APP"OVED~z~[I~ ~ >~ ~DATE LEGAL 72-013 {Rev. 3~78) PERMIT MO. MUI'-I 1' C T PFtL 1' T"~ OF "./~-' DEPARTMENT ~ HEALTH R,ND ENVIRONMENTAL/--:OTECTION~.~-~I'. ~7-/ 2~4-4720 WELL AND ON--S ITE SEWER PeR~T ~.~ INC. ~TRR ROUTE R BOX 4~4E ~50~ ~44-i~ APPLICANT SUN COHSTRUCTION, LOCATION HILLSIDE RREA TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH LOT S~E 40000 SQUARE FEET MAXIMUM NUMBER Of BEDROOMS = 4 SOIL RATING THE REQUIRED SIZE Of THE SOIL RBSORPTIOH SYSTEM IS: DEPTH= :I_O LENGTH= ----~-4 GRFIYEL DEPTH= ~: THE LENGTH DIMENSION IS THE LENGTH <IN FEET~ OF T~E TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GR0U,~D AND THE BOTTOM OF THE EXCAVATION ¢IN FEET>. ~ THERE IS N0 SET WIDTH FOP, TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH Of GP,AYEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM Of THE EXCAVBTZON (IN FEET>. REQU lr RED SEPT I C TRt~I~.. S I ZE= 12-=;O GALLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF RHY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO (2~' II'-iSPECTIONS ARE REQUIRED BACKFILLING Of RNY SYSTEM WITHOUT FINAL INSPECTION RND APPROVAL BY THIS DEPRRTHENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEH R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS IQ0 FEET FOR R PRIVATE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PP, IVRTE HELL TO R PRIVATE SEWEP` LINE IS 25 FEET AND TO R COMMUNITY SEHER LINE IS 75 FEET. HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF THE ~,'ELL COMPLETIOH. OTHER REOUIREMEHTS MAY RPPLY. SPECIFICRTIONS AND CONSTRUCTION DIRGP`AMS RP,E RVRILABLE TO INSUP,E PROPER INSTRLLRTION. PERM I T e~:P I RES DECEMBER I CERTIFY THAT l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEHERS AHD WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: i UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. V4. 0 ~IUr~ICIPRLIT~r' OF RNCHORR8E DEPARTME~T,~"'~ HERLTH BND ENVIRONMENTRL ~OTECTION 82~' ~ STREET, ANCHORAGE, AK. ~5 ~l . . 264-472e LdELL Rt4D Ot4--_~ I TE SEi4ER PERM I T LOCRT%ON ........................... /. .................. . LEGRL ;~-~" ~ ~ .... ~:~t.f/-~c~(7~...~'LOT SIZE~;~°~ SQUARE FEET TYPE OF SOIL RBSORBTION 5~STEN IS: ~r~ ~RXIMUN HUMBER OF BEDROOM~ = ~ SOIL RATING (5Q FT/BR)= /00 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTE~ IS; DEPTH= ~ 0 LEt~GTH= ~ GRRVEL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT I5 THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOI1 OF THE EXCAVRTION (IN FEET). THERE IS HO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH ~ THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REQUIRED SEPTIC TANK SIZE= }~ GALLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TI,~O ( 2 ) I r~ISPECT I Or.IS ARE RE(;]U I RED BRCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND RPPROVRL BY THIS DEPBRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL AND RNV ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL; OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS OF THE WELL COMPLETION, OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE RVRILRBLE TO INSURE PROPER INSTALLATION. PERM I T E:'{P I RE--'5 DECEMBER :3:'t.. '1 ~"3 80 I CERTIFY THRT l: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLIT¥ OF RNCHORRQE. 2: I WILL INSTRLL THE SYSTEM IN BCCORDRNCE WITH THE CODES. 3: I UNDER~TRND THRT THE ON-~ITE ~EWER SVSTEH HRV REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. December 29, 1978 ~780928 J. Bumgardner Star P~ute A Box 474-E Anchorage, Alaska 99507 SubJeet~ Lot 18 Block 2 Dalzell-Schneiter Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar y6ar basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Specialist ~m/ljw enc: copy of permit PERMIT NO. .... ~M..U....N~ I.C ! p~L I TY O~'--f~-~ E' EP~TMENT O! .ZRLTH 'RND' ENVIRON,ENTRL 825 'L' STREET, RNCHORRG~ ~4-4~ WELL 8~D ON--SITE SEWER PER~IIT ( 788928 ) 'RPPLICRNT J. BUI~R (DB8 SUN C BOX 474 E SRA ~LOCRTION ILEGRL I-t8 B2 DRI. ZELL-SCHNEITER TYPE OF SOIL RBSORBTION SYSTEM IS: iMRXIMUM NUMBER OF BEDROOMS = 4 iTHE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM LOT SIZE 244 i~ 49294 SQURRE FEET TRENCH SOIL RATING (SQ FT/BR)= DEPTH= :1.0 LENGTH= 2~4 GRRVEL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DIST~4CE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). REQUIRED SEPTIC TRf4K SIZE= ~1.250 GRLLOr~$ :PERMIT RPPLICRNT HR~ THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF 8NY WELLS RDJRCENT TO THIS PROPERTY RND THE --~ NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. .*=.. TWO (2 ;) INSPECT IONS FIRE REQU I RED BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND APPROVRL BY THIS :DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINII~ DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS il~8 FEET FOR R PRIVRTE WELL~ OR ,,, ii58 TO 2B8 FEET FROM R PUBLIC ~LL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ~E ~I~D R~ ~T BE RET~NED TO THE ~P~T~ WITHIN 30 DAYS ~OF ~ ~LL C~ETI~ OTHER ~IRE~$ ~ R~LY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRIL~LE TO I~ PROPER INSTALLRTI~. " PERMIT E}<PIRES DECEMBER ii CERTIFY THRT I: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET iFORTH BY THE MUNICIPRLITY OF ANCHORAGE :2: I WILL INSTRLL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. V3. 2 PROJECT ' CLIENT W.O. SOILS TEST HOLE NO. ELEV. TOP OF HOLE DATE. 11/3/76 SHEET '12 2-19 443 4: OF 14 12" Forest Duff 18" Damp~ Yellow-Brown, Orqanic Silt (OL) Damp, Yellow-Brown, Silty Sandy Gravel 2-19 Cobbles DAmp, Brown Sandy.~ravelly Silt (GM) Damp, Brown, Silty S~nd (SM/SP) Damp, Brown, Sandy Gravelly Silt (GM)' Bottom, Dry Hole t [ ~1 .........,,T,-,L ,c ,0,~.,..,~ .ti DEC 8 1§7~ RECEIVED 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 Parcel I.D. # 015-29-130 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# ~ ~Ach'L~ 1"~ ~0~ ~ 1. GENERAL INFORMATION Complete legal description Dalzell Schneiter Lot 18, Blk 2 Location (site address or directions) 10151 Evergreen, Anchorage Property owner Greqory Dos & Marianne See Day phone 345-6526 Mailing address 4200 Southpark Bluff D=ive, Anchorage, AK 99516 Lending agency(]v~'C/Henri P~3os Day phone 562-2181 Mailing address 701E. ~udor Rd.. Suite I07, Anchoraqe, AK 99503 Agent N/~ Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: X Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: X If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. Se STATEMENT OF INSPECTION BY ~ENGINEER As certified by my seal affixed hereto and aSof 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 dat.e of this inspection. Phone 694 -5 ] 95 9957 Name of Firm Eaqle River Enqineerinq Services Address P.O. Mw 77~q4: v~l~ ~t~. h]~ Engineer's signature ~ bedrooms. DHHS SIGNATURE / Approved for Disapproved. __ Conditional approval for bedrooms, with the following stipulations:' By: 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· Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) Total depth I~,~LZE/-L: ~C~,,V~/77~,E. Parcel I.D. &¢'[ /~' ,'5~-/" Z If A, B, or C, attach ADEC letter. ADEC water system number ¥d$ Date completed ¢'7/~'D Driller 5<] ~ Cased to ~, 9 / Casing height Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level ,~5// Well llow /.'~ Pump level1 Wires properly protected (Y/N) AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holdieg tank on lot /¢'~'/~ ' Absorption lield on lot /z/g/ Public sewer main /~//~ Sewer service line g.p.m. · /',,13 · ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: Nitrate ~-- 1~/~- Other bacteria Collected by: B. SEPTIC~,|CLOING TANK DATA Date Installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size / ~. ,~. Q Compartments Foundation cleanout (Y/N) ~C .~ Depression (Y/N) Alarm tested (Y/N) ,A//~ -' /%//E/,'~ Pumper. / SEPARATION DISTANCES FROM SEPTIC/t:IOL,DtNG TANK TO: Well(s) on lot /~-/'¢ ~ ¢ On adjacent lots To property line ~,~7 ~" Absorption field Surface water/drainage Foundation ~ j Water main/service line Z./~ ' ~.o~ (~)' F~ CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Size in gallons Vent (Y/N) , 'Pump on' level at High water alarm level ~ ~..~ J Meets MOA electrical cod..~~ SEPARAT~...~STANCE FROM LIFT STATION TO: Well o.~Hof- On adjacent lots Manufacturer ~. ~ Manhole/~Acc ~) ~ 'Pump off" Level at Cycles tested Surface water. D. ABSORPTION FIELD DATA ~IVE~-EIo/JJ/E~U~ Oateinstalled ~b/~./?~/ I ~'7/$DSoilrating(GPDIFF) ~.~ &?42 / ~ Systemtype · /v~,. Total absoq:~ion area ~4 ~ Date ~ adequacy lest /'///~ . Water level In absorpllon field before test I · . -~ / ~ ..T,O ~' Gravelthidmess Cleanout present (Y/N) Results (pas.~la~) Peroxide treatment (past 12 months) (y/N) b//~ Depression over field IY/N) for ~/7" Bedrooms ~er test yes, gWe date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //~'(~ ' On adjacent lots ?~/D~ ~ Property line To building foundation ..~ ~ .To existing or abandoned system on lot On adjacent lots ~ ,~ 0 ~ Cutbank /"///~ Water mai~service line Sudace water /,//~ Driveway, parldng/vehicle storage area " Curtain drain ~ /~//~ " E. ENGINEER'S CERTIFICATION I certi[y ~at I have checked, verified, or confon'ned to all MOA and HAA guidelines in effect or~ the date of this inspection. Signature Engineer's Name Date HAA Fee $ Date of Payment Receip~ Number 72-026 (3/93)* BacX CT& ERcf.# Clieut Sample ID Malrix Clictlt Naule Ordered Ily Project Name Project# I'WSID Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 94.2347-1 DALZELL-SCl INEIFER WATER 'EAGI.E RIVER ENGINEERING JlA WORK Order 78518 l'rintcd Date 05/20/94 @ 16:57 hrs. Collected L~fle 05117194 (~ 10:00 hrs. Rccciv cd Date 05/17/94 @15:40 hrs. Technical Director STEPI IEN C. EDE Rclcascd By: Smnple Rcnnarks: ROIJ'I'INE SAMI'I.I~COI.I.I".Cll~I) IIY: hi. NORI)INI. WI'I~IIkSSEI) BY I..B. QC Allowable Ext. Anal I'aramctcr Results Qual Units Method Limits Dale Date hill Nilratc-N 2.1 mg/L EPA 353.2/300.0 10 05/I 8/94 CMR * Sc',: Special luslnlctions Above UA = Unavailable * * See Sample Remark s Above HA = Not Analyzed :~ U = Undetecled, Rcpoi, led value is the practical qmntificalion limit. LT= Less'lhan .' I) = Scconchry dilulion. GF= Greater 1hah 5633 B Street, Anchorage, AK 99518-1600 ~ Tel: (907) 562-2343 Fax: (907! 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA. COLORADO. FLORIDA. ILLINOIS, MARYLAND. NEW JERSEY. OHIO. UTAH. WEST VIRGINIA CATE RECEIVED -~ INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE IO'.3o ~,.~..~¥ ~.o-~3-~ INSPECTOR INSPECTOR INSPECTOR~, uN,aPAu oF MUNICIPALITY OF ANCHORAGE D~PT. OF HEALTH & ENVIRONMENTAL SANITATION DIVISION SEP Telephone ~7~ DECE/t/E~ MAILING ADDRESS TREET LOCATION TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One I--1 Four [~SINGLE FAMILY [] Two r'] Five [] MULTIPLE FAMILY [Z~hree [] Six [] Other 7. WATER SUPPLY ~,-'"~NDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) S. SEWAGE DISPOSAl. SYSTEM {~.'~NDiViDUAL/ON.SITE'O t/'¥ (¥"U YEAR ON'SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY I-'1 ONE D THREE [--I FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX 2. WATER SUPPLY PERMIT NUMBER I'--1 INDIVIDUA~L ' DEPTH OF WELL I--'1 . COMMUNITY ' DATE DRILLED I-'1 PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER I-'lIN DIVIDUAL/0N -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER I--ISepticTanl< or I-'lHoldingTank /A.~. ~--_~. , Size: !-~-~"~ If Tank is homemade ' SOILS RATING give dimensions: 1 (~ TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Absorption Area to nearest Lot Line 5. COMMENTS [~APPROVED FOR .~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72.010 (Rev. 6/79)