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HomeMy WebLinkAboutDENALY BLK 1 LT 13benaly Block 1 Lot 13 #067-041-19 ___ - - •9 Municipality Anchorage a Permit e of -��'1 ;c 1_ Development Services Department i ' ri /% Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. 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 Number: SW030070 PID Number. t7 —091 , of3 1/ / r ApPpV�Harries. Wastewater System: 1:14 New UpgradeName: AMres p 170i./�(1. ,49/,,,,,uez_t pPoaci f-�91,,e✓el',IK 9g -s 7 ABSORPTION FIELD P11011e. 6a- ��/ �_/ NuMer of B.Goamr / f `� illtDeep Trerwh 0 Shallow Trench ODed 0 Motnd 0 Other: LEGAL DESCRIPTION Soil Rating: GPofFis Total Depth from Original grade' 1(1 Ft, Stock: Lot:1 3 Subdivision: / IX {�eel /� Depth to pipe bottom bom original grade:Gravel FI. depth beneath pipe: FI. Township: Range: Section. Fie added above original grade: 13}. Ft. Gravel Length: .50 FI. Well: IV New • Upgrade Grated width: 3 Ft. Numberof fins: Distance Dalween linea: ' FL Crasuriutt (Private, A. B. C): 1 r I VAte Total Depth: 7�Ft. Cased lo: / FI, Total absorption ares: Fls P' lMaleriMal: /T/- ( P3_03q/r00 piper: MAA) pril(r`i1 Int. Dale Drilled: 5-ILf �03 Static Water Level: 37 FL ;Viler. vee��.ictarinT/,,� Date Installed: —7-63 Yield:54-I/ � GPM Pump Set .t: kipM Above., Grand: bin in./ ✓I FLI Casing fFL TANK SEPARATION DISTANCES vi Septic ❑ Holding ■ S.T.E.P. ❑ Other. To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer line hL" la`t"ef - I i P(eiy)JPr Pi Capacity. 1300 "- Well Well OC/ /y,/t % l//JL/�� ,r'•15 Q—r/ Material: F ^ /IE U Y Number or Compartments: er-x) Surface Water (CY*: I W 1we LIFT STATION lot Line D L VT 604 I /►r L �/( Size: �. Manufacturer: Foundation 7•^ .a�J 0 1 •Pump on level et: in • r . ' vat at' Nigh water alarm at: h Curtain Drain ••••••••••••• 4)o4e ttt y rale' rale' W1 �� Pump Make d Mode Electrical Inspections performed br Remarks: BENCH MARK Location and DesanpaorcO LLG s/ �,u �a lied Elevation: n �1 R m ® PO/! e /ri/ sl '©O FI. Engineer's Stamp •'�' �� • „.._1_,."..:;.--, �d) ';' ' • `)( ' 1 :x: `d r "11 S & S ENGINEERING .17034 Eagle River Loop Road, No 204 sI r !; Inspections performed by 9 Dates: 1 �3 t.,1-/../ teagte River, Alaska 49577 r 2nd 7- 03�• 03'.:: Lv- � ROBERT C.COWAN GO4,(71. �1)+f..••'• C - 8ao t y ••• ••�, v1 tkzl4.. 1,4~ Development Services Department Approval � Reviewed and approved by: r/ Gil tf Date: 9 -/5 -' 0_3 (Rev. Imom �/ PERMIT NO SW030070 PAGE 2 OF 3 Municipalityof Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 •Anchorage, Alaska 99519-6650 • Tele hone; 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 13, BLOCK 1, DENALY S/D P.I.D. NO. 067-041-19 18' MIN. c01 ATH//2 V•1i G i DBL1& DBL2 NEW 1300 CALLON HDPE SEPTIC TANK PERMIT NO SW030070 PAGE 3 OF' Municipalityof Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 •Anchorage, Alaska 99519-6650 • Teel�ephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL. LOT 13, BLOCK 1, DENALY S/D P.I.D. NO. 067-041-19 ST1 ST2 97.0' FINAL GRADE 1 1 2" INSULATION 92.3' NEW 1300 GALLON POLYETHYLENE SEPTIC TANK 92.0' C01=97.5' CO2=95.6' FINAL GRADE MT1=84.3' MT2=84.3' C01=92.3' CO2=92.4' N. T. S. NO WATER FOUND • 7 7.3' B.0 .H. 5,...G+e,, .. .. : "Tn.=..,...� I6 11 ROBERT C. COWAN / s•- ; lc', CE -8801 , „! A B C FCO 26.5' 10.5' - ST1 20.0' 11.5' - ST2 22.0' 10.5' - TMT 17.0' 13.5' - DBL1 25.0' 9.0' - DBL2 26.0' 8.0' - C01 31.5' 8.0' - MT1 31.5' 10.0' CO2 79.5' - 56.5' MT2 77.0' - 57.0' C01=92.3' CO2=92.4' N. T. S. NO WATER FOUND • 7 7.3' B.0 .H. 5,...G+e,, .. .. : "Tn.=..,...� I6 11 ROBERT C. COWAN / s•- ; lc', CE -8801 , „! Performed For: Legal Description: 1- 2- 3- 4- 5- Depth (Feet) 6- 7- 8- e - a" Municipality of Anchorage Development Services department Building Safety Division On•Site Water and Wastewater Program 4700 South Bragaw SI. P.O. Box 196650 Anchorage, AK 59519-66.50 wwH.ci anchorace.ak.us (507) 343.7904 Soils Log - Percolation Test t</ -}-Pe i.) 6'6 Slope 10- 11- 12- 13- 14- 15- 16- 17 1 A- 19- 20- 0 . a 0 0 COMMENTS W;.S GROUND WATER MCLINTE7-'.E.07 IF YES. AT MAT DEPTH? Depth to Water After Monitoring? 4;";'..."'47-. OF tk :. Ott Date Performed: 417A/6-3 Site Plan Reading Dale Gross Time Net Time Depth to Water Net Drcp Pi. - ,// Wit'( Zg�n3 Y1 vV 0 67 �Zt u t r ff I 00 __/Zy 0 ( . I 11.0 "fl 1 , 4' 1 - 1/4--" /_ N 1re3 1/4'r 7.-4 PE COLATICII PATE ! 6. 3 • (rrixtesrcl) P_RC HOLE DIAMETER TEST RUN EETPrE=H �. F7 P IO 45, F7 PEPFOR2.IED f3Y: p % J j' j ii .�1� 1-1,62 �'1(r -� CERTIFY THAT THIS TEST 4%' AS PERFOR?.IED IN ACCORDANCE WITH Al L STATE PND MUNICIPAL GUIDELINES PI EFFECT ON THIS DATE. DATE: Ste/ b/0 3 M -W Drilling, Inc. ♦ P.O. Box 110378 • Anchorage, AK 99511 • ♦907-345-4000 • 907-345-3287 Fax* MAY 2 8 RECD Job No.: 03-132 Project No.: N/A Permit No. SW030070 Groundwater Well As -Built & LoR • Wel! Owner: Kappen Homes • Use of Well.: Domestic • Legal Description: Denaly Subdivision, Block 1, Lot 13 Eagle River, Alaska Construction ♦ Hole Depth: 75' ♦ Casing Size: 6" ♦ Cased To: 74.42' ♦ Drill Method: Air Rotary ♦Material: A 53 Steel Perf • Well Completion- Open end X Screen Perforated _ Method: *Screen/ Perforation description: None • Grout Notes: (5) Sacks- No. 8 bentonite granules • Notes: Well capped & ID tag installed ♦ Well Development: Method: Air surge Notes: *Static water leve! (SWL) 37.02' (above) (below) top of casing (TOC). • Well yield test at 5+ gallons per minute (GPM)/ ) for 1 hours with 100% of drawdown (DD) from static level (SWL). *Method: Air lift • Dale of completion: 14 May 2003 ♦ Pump Install: Well Lo Depth in feet from top of casing. Details of formations penetrated, size of material, color and hardness. 0 TO 3 Casing stickup 3 TO 45 Boulder gravel: cobbley 45 TO 62 Cobbley gravel: damp 62 TO 75 Water gravel TO TO TO TO TO TO TO TO TO TO C7 TO TO NwI A—Cerlificd-Contractor Certificate No'e. 814 & 973 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 S-1)03 c To Sj11(Y) (� 2_: 00 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW030070 Legal Description:. Denaly Block 1 Lot 13 Design Engineer: 0003 S & S Engineering Owner Name: Kappen Homes Owner Address: 17034 N Eagle River Loop Rd Eagle River , AK 99577 - Date Issued: Apr 09, 2003 Expiration Date: Apr 08, 2004 Parcel ID: 067-041-19 Site Address: 17034 N Eagle River Loop Road Lot Size: 48388 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ 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. 5. The following special provisions. prior to constructing the water well, the well driller shall submit a drilling plan to this office. this plan shall show how the well construction will prevent all leaking through the casing annulus from the confined aquifer _ l 1 (15.) I 5 7 0� fl ouse. t „ty Govt t�'�vc7 (trlti•cr� S�/1�C+.� Lvas p(eClyy, f'Yt vtry S �'�� c, d „,,c d- 1 • a n. (tD con 2Cfret w, li... nC.tyti bor,Ns r7.sta,.,s Received By: Date 't/o/o 3 Issued By: / f " Date: KIc•'US r • Mttiiticiptllty at Aitcharagc beVelophrietit SeFliices bepattmetit 13uitding Safety bivision On -Site Water and Wastewater Program 4700 South 13raga* Sl. P.O. Pox 196650 Anchorage, Ak 99519-6650 www.cLanchorage.ak.Us (907) X43-7904 ON-SITE SEWER/WELL PERMIT APPLICATION POR A SINGLE IAMILY DWELLING Parcel I.D. b( 7- Oaf- /9 Property owner(s) k'ck ppen Hon1e5 Permit Number SW03 cbl-o Recto/ phone 6,201 '-S 53 Mailing address (1) ) 703'- A) E, 99/& ;ver Loop Rectd 5u;4 -e O 1 Mailing address (2) .ag le P, s' ver, 4K Zip Code C//Ii -�77 Legal description (Lot, Block & Sub'd.) LO -t- 13„.8/06k- 1, DeWitt 1 y Sl Legal descriptiion Section, Township & Range) Lot Size "'''14-55-3-911/Acre •1Sq.Pt. Number of Bedrooms "T THIS APPLICATION IS BOR: Sewer Only ❑ Well Only 0 Sewer and Well IA Water Storage 0 Sewer Upgrade . 0 THIS PROPBRTY CONTAINS: Not Tub ❑ Jacuzzi 0 Swimming Pool ❑ Water Softening Unit 0 Therapy Pool ❑ I certify (hat the above Information is correct. I further certify that this application is being made for a Single Family bwelling and is In accordance With applicable Municipal Codes. (Signature of properly owner or authorized agent) S & S ENGINEERING 17034 Eagle River Loop Rod No. 204 tagte River, Alaska 99577 Permit pees: / SS 0 • , Waiver Pees: bate of Payment: '1 / `3 /0 3 Receipt Number: 0 3 3 Cooler (Rev. (2/00) Date of Payment: Receipt Number: • "i`ii :�� •. 'T ♦_n 1717 Gi elttflg IEALTHAUT HOI TY APPROVALS SEWER WATER AWN EXTENSIONS SEWER 8 WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION I FLOW TEST SITE PUNS ROAD DESIGN SOIL TEST VERcouncN TEST STRUCTURki AECNAMCAL INSPECTIONS ONSITE WASTEWATER OISPO6ALSISTEM COIGN ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CML ENGINEERS (907) 694-2979 FAX (907) 694-1211 April 4, 2003 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 13, Block 1, Denaly Subdivision It is requested that you issue a permit to install a well and septic system to serve the proposed four bedroom dwelling on the 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 3/24/03 no water was found. After monitoring, ground water was not found. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/bjj Enclosure 17034 NORTH EAGLE RIVER Loo SUITE 204 EAGLE RIVER, ALASKA 99577 cl A 0 a 0 in m v -4 A rn Z n l') 0 Performed For. Legal Description: 1 2- 3- 4- 5- 6- 7- 8- n- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19 - Depth (Feet) 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 wwwd.anchcraee. ak,us (907)343.7904 Soils Log - Percolation Test /L ►p --7.r Lor /3; 4/42 . K / i Slope O. . • 20- e =0 • .. -0 0 • • • 0 .a COMMENTS WAS CPOUND WATER AI E`COUYEpo7 S IF YES, AT WHAT DEPTH? Depth to Water After 0 Monitoring? E Date: 4 - Dale Performed: 3/m403 Site Plan Reading 4 i L si . Dale /%3 i Gross Time Net Time Depth to Water Net Drop ' D 30 0 30 /44 Y4-. 6 5 b 0 -- 3o 30 '" z" I Ztfc D o 0 3 0 S e/Zv g tg: FE COLATICH PATE eO (rsnctrss4C.) FERC ECU 0:2.1=TER TEST PUN BETWEEN 45 FT P:IO 6 F7 6 re PERFORM.MEO BY: N'1(,14 -04G(.. J CLJA-elE 1 �f�i CERTIFY THAT THIS TEST WAS PERFORMED 1;1 ACCORDANCE WITH A! ! STATE AND MUNICIPAL GUI LIMES IN EFFECT ON THIS DATE. DATE: i /?- Id 3 �� ♦ °S&S G[eniriG HEALTH AUTHORITY APPROVALS SEWER WATER IAAIN E%TENSIONS SEWER 8 WATER INSPECTION ENGINEERING STUDIES AHO REPORTS WELL INSPECTION 6 FLVHTEST SITE PLANS ROA- DESIGN SOIL TEST PERCOLATION TEST STRUCTURALa MECHIANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694.1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 13, Block 1, Denaly Subdivision April 4,2003 GENERAL: 1. The scope of this project includes the installation of a 1300 gallon HDPE septic tank and a new trench to serve the proposed four bedroom residence located on the referenced property. 2. 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. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORM EAGLE RNER LOOP SUITE 204 • EAGLE RIVER, ALASKA 99577 Page 2 Lot 13, Block 1, Denaly Subdivision April 4, 2003 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. 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. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. 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. 2. 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. 3. 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. 4. 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. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 13, Block 1, Denaly Subdivision April 4, 2003 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. 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. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. 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. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. Page 4 Lot 13, Block 1, Denaly Subdivision AprII 4, 2003 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: 1. 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. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / INSTALLER Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. ' v P.O. Box 196650 Anchorage, AK 99519-6650 wwvi.ci.anchcrage.ak. us (907) 343-7904 CERTIFICATE OF HEALTH AU T HORI T i .APPRO\JAL FOR A SINGLE FAMILY L)WELLING HAA # 030 Lict) Expiration Date: /" — / 8 — 0 3 Parcel I.D. 067-041-19 1. GENERAL INFORMATION Complete legal description Lot 13: Block 1: Denaly SU vision Location (site address or directions) Kulchay Cir. Current Property owner(s)fKappan Homes Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 17034 N. Day phone 622-5585 . Eagle River Loop Eagle River, AK 99577 Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. ' NUMBER OF BEDROOMS: • 3. TYPE OF WATER SUPPLY: • Individual Well Individual Water Storage Community Class Well Public Water System 0 0 Day phone 9/i /o3 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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 8 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, 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm` S & S Engineering Address 17034 'N. Eagle River Loop Ste. Engineer's Printed Name Robert C. Cowan 204 Eagle Piwile 694-2979 River,'AK 99577 Date 6114.10,3 E � ‘.4 At,�skat' / ENGINE �� f(I ROBERT C. COWAN' ilk- f 5. DSD SIGNATURE S Ce -880I .Z• f.' Approved for 14- bedrooms.t cp ., -•.' �• d Disapproved.'ozy► Conditional approval for bedrooms, with the following stipulations: Additional Comments 4417 ON-SITE n+ • WATER AND . WASTEWATER PROGRAM : O)Ill!)))»>%ENT' Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory •Supplemental Engineer's Report Well Flow Advisory Other (Rev. o1A2) Original Certificate Date: 7 / g- 0 3 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: (,OT 13 i &o C-34 1 ; .&Ai Parcel ID: fro 9 '04/ / I' A. WELL DATA Well type Date completed Total depth 75- ft. Date of test Static water level Well production 1f A, B, or C provide PWSID # 4IZQ?3Sanitary seal (Y/N).._ Cased to 412 R FROM WELL LOG 5�I 4 03 3I- ft. S g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 19, 5-mg./1. Arsenic: — mg./I. Date of sample: 8/Ar X03 B. SEPTIC/HOLDING TANK DATA, / Tank Type/Material % 'i,ii ('7 H 0 Pr Date installed 7 / L� 3 Tank size 1 50 7) gal. Number of Compartments 7i Cleanouts (YIN) r 1 Foundation cleanout (Y/N) YDepression over tank (Y/N) !_ High water alarm (YIN) N Date of pumping AI CZ&) Pumper C. ABSORPTION FIEELDfDATA Date installed 5/ 9/(�3 Soil rating (g.p.d./ft or ft2/bdrm) _0 Length 5 + ft 1N1dth 3 ft. Gravel below pipe Well Log (Y/N) Wires properly protected (Y/N) (7' Casing height (above ground) ID in. AT INSPECTION Jj ft. g.p.m. Other bacteria , colonies/100 mi. Collected by:IM.;– System type d 7 F;4Ic4 6 ft. Total depth ) • 3 ft. Eff. absorption area (3%b ft2 Monitoring tube V Depression over field A Date of adequacy test ,t) (14 Results (Pass/Fail) P455 For -4 bedrcoms Fluid depth in absorption field before test / in. Water added, gal. Elapsed Time: min. Final uid depth _ in. • Absorption rat Any re;uvenation treatment (past 12 mo.) (YIN & type) /V New depth___ in. c.p.d. if .'es. c:ve care D. LIFT STATION Date installed J1/ Size in gallons Manhole/Access (Y/N) "Pump on" level at in. 'Pump off* level at _ in. High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATIO1+i DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/tia.stet on on lot l 00 I+ Absorption field on lot 100 r•f- Public sewer main z§ehvgleseptic service fine 't" On adjacent lots On adjacent Tots in. 1(0014— I no + (()Q Public sewer manhole/cleanout N/A - Holding tank 1/�}- SEPARATION DISTANCES FROM SEPTIC/I jPBfl TANK ON LOT TO: Building foundation 5 f- Property line Absorption field 1— Water main N/ A Water service Zine 1 Surface water / 00 ► +- Wells on adjacent lots 1 Q0 t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1 1 1 Property line I t� i- Building foundation 1 O Water main =/V /,¢ Water Service line l'� + Surface water 00 11 Driveway, parking/vehicle storage Curtain drain/Jo/0- �t� o�lri Wells on adjacent lots 1 '+ F. COMMENTS G. ENGINEER'S CERTIACATION I certify that I have determined through field inspections and review of Municipal recants that the above systems are in conformance with MOA M.4guidelines in effect on this date. Engineer's Printed Name ee 0 6 *42- • C.6 kJ dies Date VA /03 O HAA Fee S 3 Date of Payment 9 /} /0 3 Receipt Number y 0 a 95•--- (Rev. 5 (Rev. 12'01) Waiver Fee $ Date of Payment Receipt Number "0 0 (Y) D o zO rG co 0 0 0 z NOildI21OS30 1V031 m INOH N3ddV71 m O coN O � N o Q N n. 0 0 D. 7 to o N O 3 aW as (a O O 7 o W N -i O �y • 7 aW 0, O o � V N < W 0 7 X W O f 0 0 O N O 3 b O O 3- O • ^ O 7 3 5. ow o 0 3 N Q. *7 r‘) N \ O O O — 0 (J k Cti .1, r- 0 0 -1 2 Oa N m -4 T 0 0 co C 8-29-03; 6:424M; SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1035377001 S & S Engineering Denaly S/D L13, BI Denaly S/D L13, B1 Drinking Water ;907 5615301 # 2/ 3 All Dates/Times are Alaska Standard Time Printed Date/Time Collected Date/Time Received Date/Time Technical Director Released 08/26/2003 14:27 08/21/2003 15:30 08/21/2003 17:10 Stephed C. Ede Sample Remarks: 9222B - Non -coliform growth detected on Blank; sample results are not affected. Parameter Qualifiers Results PQL Units Method Allowable prep Analysis Container ID Limits Date Date, Inn Waters Department Nitrate -N Microbiology Laboratory Total Coliform 0.534 0.100 mg/L EPA 300.0 B (<=10) co1/100mL SM189222B A (<=1) 08/22/03 JJB 08/21/03 JS