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HomeMy WebLinkAboutFORELAND VIEW BLK 1 LT 1Foreland View Block 1 Lot 1 #017-401 -40 l7 yz 0/7- _ 6 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES SEPTIC ABSORPTION Address FROM TANK FIELD WELL Phone(s) Permit No. No. of Betlrooms WELL LEGAL DESCRIPTION LOT LINE 0-/0 Lot I Block f Subdivision , ei4^� c/,ev FOUNDATION Township, Range, Section N/A AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway. water bodies. etc.1 TANKS C9 SEPTIC ❑ HOLDING Manufacturer I Capacity in gallons /l,t, TaK j rn 74C e / --.)- TYPE TYPE OF SYSTEM_ ❑ TRENCH ❑ BED [X W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade L%S FT g Fill added above original grade I Gravel depth beneath pipe a FT 3.6 �I length Gravel width jao ` FT S absorption area Distance between lines 9_2,4 SO FT a 1 .2-2Y SOFT J�rTrT 3i3y Installer L14 01 _ L—.1 I I I Date Installed WELLS 0 PRIVATE ❑ OTHER (Identifv) S'a //i ra 6 5 a REMARKS: Inspections Performed by: GiPES Date: - O'29/7/9/ certify that this inspection was performed according to all Municipal and State guidelines in ellen on this date: 3 - Health ✓Health Department Approval: a" 'z t2.F� • Louis A. Butes 7 '.®_N,•° CE -6736 a No Wells +100' no structures 200' <59 ®TH 3 200' II ----------------------------- 100' Neighbor's Well 68' Upper DeArmoun Road 1 50 gal tank u distance 100, - TEST HOLE - MONITOR TUBE -. o - SEWER CLEANOUT TH � - WELL NO KNOWN CURTAIN DRAINS HHHi+++t Lac n NO SURFACE WATER - — - - EASEMENT . dralntlelds 10 p Wide p� v o E ® TH 1 O r NOUSe --------- Q- <59 SEPTIC SITE PLAN LEGAL: Lot 1, Block 1, Foreland View Subdv. F.„ OWNER: Scott Peppers CONTRACTOR: chuck Barr JOB # 90-056 DATE: X91 SCALE 1' = 40' EAGLE RIVER ENGINEERING SERVICES e P.O. Box 773294 A—a EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694 3297 no structures 200' II ----------------------------- 10' Easement Upper DeArmoun Road ® • - TEST HOLE - MONITOR TUBE -. o - SEWER CLEANOUT � - WELL NO KNOWN CURTAIN DRAINS HHHi+++t - PROPOSED LEACHf NO SURFACE WATER - — - - EASEMENT . SEPTIC SITE PLAN LEGAL: Lot 1, Block 1, Foreland View Subdv. F.„ OWNER: Scott Peppers CONTRACTOR: chuck Barr JOB # 90-056 DATE: X91 SCALE 1' = 40' EAGLE RIVER ENGINEERING SERVICES e P.O. Box 773294 A—a EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694 3297 EAGLE RIVE ENGINEERING SERvICES P. 0. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 JOB Loy' i Qiki ore/<�m( ✓.ew SHEET NO. OF CALCULATED BY G ✓ DATE CHECKED BY DATE_ — Res /J pro.-, of /ire si mu•�< /•.2 �_.. _. � OXOpt ml LFV �bl.' GM ' Mm 01411. I 1 j�sr yo�F � MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST Er SOILS LOG PERCOLATION TEST PERFORMED FOR: S//C r7% f��/��%G iJ GG DATE PERFORMED: a//6h/ LEGAL DESCRIPTION: hoT / /'rte /cN✓ 611e.,/ SLOPE - SITE PLAN jr/3 . 11/7 2d r 3-1 , . (G�l �✓� s, if 11 D 12- 13- 14- 15- c' 2 1314c 16- 17- 18- 19-1 617 19 mss' WAS GROUND WATER �y ENCOUNTERED? L Depth to O Reading m�....s�.-e.I P IF YES, AT WHAT Time DEPTH? Drop Si�r� 20 PERCOLATION RATE /.?r.? (minutes/inch) ' '57 - TEST RUN BETWEEN FT AND FT COMMENTS -r01 / ✓ i`;� Eagle River Engineering Services �.- 3/ PERFORMED BY: P. 0 Box 77994e CERTIFIED BY: DATE: 691e River, AK 99577 694.5195 72 -DOS (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop Si�r� 2r/ic�/ / y:43 3 1"r5 20 PERCOLATION RATE /.?r.? (minutes/inch) ' '57 - TEST RUN BETWEEN FT AND FT COMMENTS -r01 / ✓ i`;� Eagle River Engineering Services �.- 3/ PERFORMED BY: P. 0 Box 77994e CERTIFIED BY: DATE: 691e River, AK 99577 694.5195 72 -DOS (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650. 825 "L" STREET. ROOM 502 ANCHORAGE. ALASKA 99519-6650 LD �_U� ON-SITE WASTEWATER DISPOSAL SYSTEM () PAGE 1 OF 1 li;l:� PERMIT ERMIT NUMBER:SW910024 DATE ISSUED: 2/16/90 ESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 2/16/91 WNER NAME:MACDONALD STEVEN & WNER ADDRESS:4251 EDINBURGH DR ANCHORAGE, AK 99515 ARCEL ID:01740140 EGAL DESCRIPTION: DT SIZE: 44910 (SO. FT.) UMBER OF BEDROOMS: 4 THIS PERMIT: 4 SIS PERMIT IS FOR THE CONTRUCTION OF: ISPOSAL FIELD SYSTEM _L CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. 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). THE FOLLOWING SPECIAL PROVISIONS. DECIAL PROVISIONS: 1E DRAINFIELD MUST BE INSTALLED AS SHOWN ON THE ENGINEER'S [TE PLAN AND SPECIFICATIONS DATED2/12/91. CEIVED I 3SUED BY DATE: DATE:_ a1z)141- _- Eagle RAWT EUSAM(MUS SeTVIlCI(es Louis Butera, P.E. Registered Civil Engineer February 12,1991 Mr. John Smith P.E. Department of Health & Human Services 825 "Lr' Street Anchorage, Ak 99502 RE: Lot 1 Block 1, Foreland View Dear Mr. Smith, We are requesting approval of the proposed wastewater system plans attached. The plans were previously approved under a 1990 permit and are modified to reflect current regulations. The drainfield location will not effect the neighbors septic replacement area as the neighbors well already eliminates the area adjacent to our septic location. Our well location will not affect replacement area. There are no affected drainage paths or patterns. The ground surface slopes to the South in the drainfield area. There is a large area for a replacement system to the South. If you have any questions or any further concerns please call me at 694-5195. Sincerely, Louis Butera, P.E. P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 • Fax (907) 694-3297 No Wells +100' no structures 200' Neighbor's Well 68' distance loo' 5' wide <5z R so ®TH i House I � � I � <5x a no structures 200' ----- ----------------------- 10' Easement Upper DeArmoun Road ® - TEST HOLE • - MONITOR TUBE o - 'SEWER CLEANOUT NO KNOWN CURTAIN DRAINS Q - WELL ++1+IH+ft+ - PROPOSED LEACHFIELD NO SURFACE WATER - — - - EASEMENT SEPTIC SITE PLAN R LEGAL: Lot 1, Block 1, Foreland View Subdv. �,s4 OWNER: Scott Peppers �d CONTRACTOR: chuck Barr 7ee JOB # 90-056 DATE: 2/T-8/91 SCALE 1" = 40'®Y°°'°'� ,, >,L� EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 !`�4Fz) ° �w��m EAGLE RIVER, AK. 99577 A `�aa�°� (9O7) 694-5195 FAX: (907 694_ 3297 xa,a....u.:.,.., . SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT 1, BLOCK 1, Foreland View A. GENERAL 1. The well and septic plan are 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 and State Department Of Environmental Conservation require- ments. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. S. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi --family well. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. DRAINFIELD 1. The drainfield is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the drainfield shall be level, plus or minus 1.5". 3. The total depth of the drainfield excavation is not to exceed.8'at any point. 4. The sewer line is to gravity feed to the drainfield or a lift station Is required. 5. The drainfield aravel is to be covered with typar or fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 4' or equivalent is to be placed over the drainfield. 7. The area over the drainfield is to be finish graded to prevent ponding of surface water runoff. 8. The 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. RECOMMENDED LEACHFIELD DIMENSIONS WIDE DRAINFIELD TOTAL DEPTH = 8' DRAINFIELD LENGTH = 100' Soil Rating = 228 Bedroom Capacity = 4 Septic Tank Size = 1250 GRAVEL DEPTH = 3.5' DRAINFIELD WIDTH = 5' B D YSTE BED DTH = 30' BED EN H = 45.6' G AVEL D H = 6" ***NOTE: VERIFY DISTANCE TO ONSITE AND NEIGHBORS ACTUAL WELL LOCATION PRIOR TO EXCAVATING LEACH FIELDS 17 :i�4„ !0 =f1��%LFYomFt. to Ft ° r/Y1I3�L=L� From a' Ft to Ft Y!Y f �s r{ 'Fritm F" Ft to �" Ft , _ 4 S \ 1 _ F�rSeom' Ft to fi: 4 Ft ` l/ Sw Ww sSC C ..n iYi s. 3,�. "From t"',� _F F • `: C����tfi�ed ��tllt�t� �r�,� by 00C CO. dba SULLMN WATER WELLS P.O. BOX 070272, CHUG IAK, ALASKA 99567 *TELEPHONE BOB -2750 OWNER OF LAND MTt: L. C t'-Jj j DEPTH OF WELL ADDRESS STAII('LE\'ELOFWATrRi;['. 2 LEGAL DESCRIPTION. L sl I ..e4K -fA&e-a4i0 dIDURAW DOWN FT. DATE - Started Endvd GALS, PGR HR T,2 a PERMIT NUMBER KIND OF CASING KIND OF FORMATION: Front JG A q From.—Pt. t. to— FI. From 2 Ft. to. A— Ft.__.. From Ft. to— Ft. ­­ from-':[—Ft.to_ j FI. to Ft. From --Ft. to -1 Ft. Ffwn—Fl. 111­rl_ From 2• 1. Ft. toa. 7'7' t. to— Ft--, From— _—Ft. o_ Fr(vni_ F1, fu- Ft. From_!._ Ft. to -L2 From— _Ft. to__ Front -—FI, to Ft. From. Ft—... Fruai_Ft. From_. -Ft. to,. --Ft. From Ft. to--Ft,— From ..— Ft. 10-- From ...—Ft.1v—F1 From From—... -FI, to FL Rtk-cl From_ ...—Ft. to. From— Fl. to —,Ft. Fria 20 ASS, From ...—FL to—Ft. From ..-Ft,— �—­ age From From- Ft. to—. %wglpalltv of.p."'T'00, Ices - From- .Ft. to­ t. Health From-- - --Ft. to. ---Ft.. From-.. .—Ft. to-- .-Ft—.. MISCL. INFORMATION: DRILLER'S NAME MVNICIPALITY OF A1\1CHORA�� Department of Health & Human Services �25 L Street, Anchorage, Alaska 995O1 343-4?2� Om-CE�ITE SEPTIC T & WELL 1 1-RMIT Permit Num�er:9()0152 �ate Jssued: 06/14/90 Fngjneer Designed Owner Name: GTEVEH MCDONHLD Owner Pddress: 4251 E.DIN9URGH DR. ANCHORAGE, AK 99515 Parcel Td: 017-401-40 Lot Legal; S�bdivision: ` Section: 25 Lot Sire 44910 Max Dedrooms: This Permit: FORELAND VIEW Lot: 1 Block: 1 Township: 12N Range: 3W or acres) 4 Total Capacity: 4 nay Phone: SEPTIC TANK: Mjnimo�l um +asepiic tank capacity: 1,250 gallons. Each septic tank must have a1 least 2 compartments. Depth to top of septic tank (s) < 4,0 [eeL requires insulation over tan k(s)^ WE 1-1- Log must be submitted to Municipality of Anchorage Department of Health and Human Serxices withjn 30 days oI well completion" lNFORM DHHS PRIOR To IN9PECTIONS BY ENG �NEER. IF AFTER �FFICE HOURS, CALL 343-4681 AND LEAVE A MESSAGE. ALL SYSTEM COMPONETS MUST DE VFRlFIED AS BEING 100 FT. FROM PROPOSED WELL AND ADJACENT WELLS. CONSTRUCT PER ENqlNEER/S ATTACHED DESIqN TH11S PE�MIT EXPIRE -c, 12/3//90 AND IS VALID FOR DNLY A SlNGLE FAMILYHnUSE [ CERTlFY THA7:- 1. I am amiliar with therequirementti, Ior on-site sewers and wells as set [orthby the Municipality of Anchorage (MOA) and the State of Alaska" 2, I wil| insta1l the system in accordance with all MOA codes and ,egulations, and in compl1ance with the design crj. ter ia of this permit" 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4^ I understand that this permit is valid for a maximum of 4 bedrooms. I also understand that te capacitV a the total system is 4, bedrooms and any enlargement will requi,e an additional permit. �igned: «� DATE: (OwnerSTEVEN MCDONALD Issued Gy: �� - ______�________ _-�������_���___ SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT 1, BLOCK 1, Foreland View A. GENERAL 1. The well and septic plan are 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 and State Department Of Environmental Conservation require- ments. 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 or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. S. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family well. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. S. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. DRAINFIELD 1. The drainfield is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the drainfield shall be level, plus or minus 1.5". 3. The total depth of the drainfield excavation is not to exceed 8'at any point. 4. The sewer line is to gravity feed to the drainfield or a lift station Is required. 5. The drainfield gravel is to be covered with typar or fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 4' or equivalent is to be placed over the drainfield. 7. The area over the drainfield is to be finish graded to prevent - ponding of surface water runoff. S. The 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. RECOMMENDED LEACHFIELD DIMENSIONS .E.VOUNUM TOTAL DEPTH = 8' DRAINFIELD LENGTH = 100' Soil Rating = 228 Bedroom Capacity = 4 Septic Tank Size = 1250 GRAVEL DEPTH = 3.5' DRAINFIELD WIDTH = 5' BED SYSTEM BED WIDTH = 30' BED LENGTH = 45.6' GRAVEL DEPTH = 6" ***NOTE: VERIFY DISTANCE TO ONSITE AND NEIGHBORS ACTUAL WELL LOCATION PRIOR TO EXCAVATING LEACH FIELDS Neighbor Well 68 dleionci No Wells +100' N 89' 47' 49" W 22-7. SS Z' Upper DeArmoun Road M — TEST HOLE e — MONITOR TUBE o — SEWER CLEANOUT NO KNOWN CURTAIN DRAINS + — WELL — PROPOSED LEACHFlELD NO SURFACE WATER — EASEMENT SEPTIC SITE PLAN e ` LEGAL: Lot 1, Block 1, Foreland View Subdv. OWNER: Scott Peppers CONTRACTOR: m saaaea y .) t; ° A. a° louU,67Buh erc . e �L 'y JOB # 90-056 DATE: 06/1 1 /90 SCALE 1" = 40' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 A t °•©.° °- �t` EAGLE RIVER, AK. 99577 Ro�css,��'y��� (907) 694-5195 FAX. (907) 694-3297 ` TLS1 I-1DLS 1 ... - BJ SOILS LOG MUNICIPALITY OF ANCHORAGE \ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION TEST �i 825 L. Street, Anchorage, Alaska 99501 264-0720 SOILS LOG — PERCOLATION TEST ,PERFORMED FOR: JCpj %P,1-�De1rtS DATEPERFORMED: 6/30/,90 -f LEGAL 'a 2- 3 - a 4- 5- 6 5 a '� 7 0:a 8- 9 9 0 10- 11 0 11 ' 1 \1 12 „ 13 91 TOP 5o r, I- J'M- srh N;y+' 5...A C 1�-'I, 14 S A)O L ENCOUNTERED? Net Depth to �.y n 9 P IF YES, AT WHAT ,e E DEPTH? Drop �A K 2 aeaaoeemoaa®aeoa.• 17 �`a°®p° 1 �Io x • 6�i; an .............. 10 m.,y R'$= 1,0,.4. Butora 18 b®C ' CE -6736 19 WAS GROUNDWATER S A)O L ENCOUNTERED? Net Depth to O P IF YES, AT WHAT ,e E DEPTH? Drop Reading Date Gross Net Depth to Net Time Time Water Drop �A K 2 y:a3: 3a 5 '/io IYIL 1 �Io 253. S0 10 m.,y ri 2:54 : 0 n `{ I �I 1. tl 2 3:0"% oo cj I�j It( 3: os: ow n 5 y�6 10/1 a/ 3+ISr o.a S It. 3:Iu :oma ., `F Sib 11 /11. 3:2b;co 5 Io/b 20 n t_jPERCOLATION RATE / y' S _ (minutes/inch) TEST RUN BETWEEN S FT AND FT COMMENTS Eagle River Engineering Services PERFORMED BY: p 0 8g%77g99A CERTIFIED BY: DATE:_��/�yr Eagle River, AK 99577 6945195 72-008 (6/79) 7 -EST HOLE # Z HJ SOILS LOG MUNICIPALITY OF ANCHORAGE ��' • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION I TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: UC�T�1 I'P_�n1 iS �r'� '�"'rw/� DATEPERFORMED: J130/-10 LEGAL DESCRIPTION: LO f 1 RIe)Lk ,1 F:)re-1r y -A 1 );t,wFTZ p SLOPE SITE PLAN 3- 45 4- 5 .0- 6-. 6 o. 7 ':p• `0: 8- 0- 10- o-10 0 11 O-- 12 13 Topsot' Lep - br* Lr -sy COMMENTS WAS GROUND WATER Nv ENCOUNTERED? IF YES, AT WHAT DEPTH? 7 Oma. yr Reading Date Gross Net Depth to Net ® "Y Time Water Drop So AK 11P 16 -4 r✓`J B6 &JO LO°°pOOHpOIMIOOG b_� 4 . 17 ......... weav; y a 2 3.2�' Aca �pRO 19 �"Co w Q 3:yl:oa 20 3y%14 7 COMMENTS WAS GROUND WATER Nv ENCOUNTERED? IF YES, AT WHAT DEPTH? 7 Oma. yr Reading Date Gross Net Depth to Net Time Time Water Drop So AK �I�IS� 2 3.2�' 3:yl:oa 3y%14 7 3 -t: LS '. 00 3: C'L,0 3V -7/ PERCOLATION RATE TEST RUN BETWEEN �' a • Q (minutes/inch) S FT AND G FT PERFORMED BY: Eagle River Engineering ServieeS CERTIFIED BY: � -� DATE: IZO-" F� Eagle River, AK 99577 694-5195 72-008 (6/79) Pyur4 I j-_ I iFij I -rkr CIF= Rr4lZ�H FZF=f®3E DEPARTMENT IHEALTH AND ENVIRONMENTAL TECFION 825 L STREET. ANCHORAGE, AK. 99 1 264-4720 WEF.F. F=lr4E-� rpt 1—=ITE '�EWEFR F"F=FZrl I T PERMIT NO. ( 630505 ) APPLICANT CHRIS PUCHNER P.O. BOX3 3942 345-0110 LOCATION LEGAL LOT SIZE 999995 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BR)= 210 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ENE:F:"T F1= -� L_EraG TH= -40 CaF{Fa%-FEL_ E> F= F:zl-r = THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SUtR.FACE OF THE GROUND AND THE BOTTOM OF THE EXC_.AVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). FREU''U I FREE1 EF T I JG 'T F=t "K SS I =E= -1IDa E:RF_I ID 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. --- -rWC3 -_ 22 > I N=F='EiG-r 10"� 5 t��E F:cF=L :I FECr --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. 11 MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. FIEF; PM I _r F=XF=' I FRES. E>E=0EPiEB: EFR 2�1P -1 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3. BEDROOMS. SIGNED APPLICANT CHRIS PUCHNER ISSUED BY V4. 0 &jos ICIPAL� OF ANCHORAGE� RC i DEPAR OFR€ 1�v4itOiN TmAND€ENIALP � PERCOLATION l ® F�•r8 - . AdaTs-i -�7&i YEST LS LOG — PERCOLATION TEST e t€sxFt3tut�a Fof+:_.-,,. %'•tl,"" ssli.� �r'�� n�""re r€art�sasec�: ! _ ��` g �' f� LEGAL DESCRWT ME PLATE A -w, ! 4" W,&S B SLr WATER S P vditft . Ott _ __i TefM Terse Oath to lYats mop /) Z r( i r—t /f. 4 t fe ....,.. u r�€x�Ar atAr� !�'� M�wamtax�E T€Sa' xtmE€TW€E¢d FT AN9 ...... FT vatumun PA7E: hlraE — I MUNICIPALITY OF ANCHORAGE r • T Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# n0 -tliCk - LIQ HAA# �i�ckIncnl4 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Foreland view Subdivision Lot 1 Block 1 Location (address or directions) 8500 Swanson Circle, Anchorage, AK (b) Property owner Steven MacDonald Telephone: (home) N/A Business N/A Mailing Address 4251 Edinburgh Dr., Anchorage AK 99515 (c) Lending Institution KeyBank Telephone 562-6100 Mailing Address P.O. Box 420, Anchorage, AK qq510 (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here, if hold for pick up.) List contact person and day phone number below: Eagle River Engineering Services 694-5195 2. TYPE OF RESIDENCE Single -Family � Number of bedrooms 4 3. WATER SUPPLY Individual Welled Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Kx Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm _Eagle River Engineering Services Telephone 694-5195 Address P.O. Box 773294, Eagle River. AK 99577 Date * S� 3 Engtbpoltl� Seal �/F Cfi 6. DHHS APPROVAL /�/ (/ Approved for bedrooms by A Date Approved � Disapproved Conditional Terms of Conditional Approval CAUTION The Municipalityof Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraphs above byan independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) (`'•!�_��/'J\ Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 �t 343-4744 •v S, y Legal Description: 4o l` / B/!'/ S ----A ,.o( ����` �'L� `0 iJi ems✓ Sh �v , A. WELL D)NA Well Class0lon If A, B, C, D.E.C. Approved (Y/N) '"A Well Log Present (Y/N) Y Date Completed 100 Yield -2-2 6f'm Total Depth oda Cased to �'' Depth of Grouting Al Static Water Level 6° Pump Set At aYD Casing Height Above Ground /V Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL Depression Around Wellhead (Y/N) A) To Septic/Holding Tank on Lot ;Ori Adjoining Lots To Nearest Edge of Absorption Field on Lot +/oma / ; On Adjoining Lots 4-1411 1 To Nearest Public Sewer Line "/,+ To Nearest Public Sewer Cleanout/Manhole 'J1d To Nearest Sewer Service Line on Lot 80 Water Sample Collected by Date Water Sample Test Results '-V 4e Comments B. SEPTIC/HOLDING TANK DATA Date Installed a J 91 Size /-252' No. of Compartments Z Standpipes (Y/N) Y Air -tight Caps (Y/N) X Foundation Cleanout (Y/N) r Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contact on File (Y/N) for Holding Tank High -Water Alarm (Y/N) P-✓% Temporary Holding Tank Permit (Y/N) _V/_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well / "-1- To Building Foundation Y� To -Property -L-ine — do 11 To Disposal Field . !� To Water Main/Service Line 'f -'all To Stream, Pond, Lake or Major Drainage Course ^� Comments _ 72-026 (flee. 7/88) Front Page 1 of 2 C. FIELD DATA SoiIj:%iing Absorption Strata —Type of System Design Lvidi� br"" �P lcf 'te In1st�tl�l= / Length of Field VW �Ru Wid TFie �`�Ss ! / `` Depth of Field � � Gravel Bed Thickness 3. S Squet of Absortion Area Statndpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test Nl`F Ce/ew ) SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well '%oo To Building Foundation Lot A1,44 To Property Line tro To Existing or Abandoned System on On Adjoining Lots ;,I- 3a ' To Water Main/Service Line /o ' To Stream, Pond, Lake, or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION X14 Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments — To Cutback (if present) ^' r✓%f 7'/0 ' Dimensions Manhole/Access (Y/N) **Check Permitted Bedroom Rating Against HAA Request** "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. Signed Company Eagle River Engineering Services P. . Box 773294 Date Eagle River, AK 99577 �® - a 694.5195 MOA No. `f Receipt No. a �S,Z _ f s S Receipt No. _ Date of Payment /3 `r� Waiver Fee: $ UD Amount: $ X70 Date of Payment 72-028 (Rev. 7/88) Back Page 2 of 2 ZZ Louis A. Butera CE -6736 ?ROFESStONP'Z of this