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Home My WebLink AboutKASILOF HILLS BLK 8 LT 7Kasi'01of H1*11s Block 8 Lot 7 #015�132�08 Municipality of Anchorage Page I of ~ 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: _~".-'°q'to;5~ PID Number: Name: -~A~C~A ~. ~H Wastewater System: ~ New ~ Upgrade Address: Io~oo ~o~o~ ABSORPTION FIELD No. of Bedrooms: Ph°ne:A~cAo~¢ ( A~ ~[~ ~ ~DeepTrench Q Shallow Trench ~Bed QMound ~Other, LEGAL DESCRIPTION so, Rating: Total Depth from original grade: O. ~ GPD/Sq. Ft. [~ Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: Range: ~ Section: Fill added above original grade: Gravel length: WELL: ~ New ~ Upgrade Gravel width: Number ol lines: Distance between Pines: Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: F ~ I ~ Driller: Date Drilled: Slatic Water Level: Installer: Date installed: Yield: ~ GPM Pump Set~/~at: Ft. Casing Height Above.Ground:Ft. TANK SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tan~ Sewer Lines ~o~ '~ Number of Compartments: Well' iO~ t [%~1 ~ ~ ~1~ Material: ~%~EL Surface LineL°t L[~ ~ [ ~ I Size in gallons: Manufacturer:~~ ';Pump on" level at: ~ "Pump 9~ J High water alarm Pump Make & ~ Electrical Inspections performed by: Curtain ~ Drain .... ~C ~ KFIO~-~ ~ ~ Remarks: BENCH ~ARK Location and Description: ~ ] Assumed Elevalion: I OO ,O Inspections performed by70;~4--¢ "__-- ' uates: 1st ¢- ~'-flfl ~ Eagle River, Alaska V~z~. 2nd ~ -~b-fl q ~*H ~ '('";'>' ..... """' '"' ':' Department of Health-a'n ~ma , .... . , ervices approval ,, -,' Reviewed and approved b .-¢~x. :~¢ .... Date: '<, ........ ....u,¥..-.'~ 72-013 (Rev. 9/91) MOA 25 Permit No.Sw940233 Page 2 of 2 Municipality of Anchorage 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 Legal Descriptio~ASILOF HILLS SUBD. BLOCK 8, LOT 7 PIDNo.: 015 5208 CO1 C02 FINAL 85.( NEW 1500 GAL 14,8' S.T. N.T.S~ 71.3~ TANK "461.8' 59.1 MI' 1500 GAL. ODL .CO SEPTIC TANK cd5 C08 SCALE 1" = 40' ~¥ELL RO['ERT C. COWAN Ci~ - 8801 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE /%-~_. DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ~.~ ANCHORAGE, ALASKA 99519-6650 , ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940233 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SMITH PATRICIA G OWNER ADDRESS:10700 STROGANOF DR ANCHORAGE, ALASKA 99516 DATE ISSUED: 7/12/94 EXPIRATION DATE: 7/12/95 PARCEL ID:01513208 LEGAL DESCRIPTION: KASILOF HILLS BLK 8 LT 7 LOT SIZE: 29137 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION 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 (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. SPECIAL PROVISIONS: RECEIVED BY: ~"'~ · ISSUED BY: ~ DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAO DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. July 1, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Kasilof Hills Subdivision; Block 8; Lot 7 Request you issue a permit to drill a well and install a septic system to serve the proposed five bedroom house on the referenced property. Test holes were excavated and percolation tests performed. The approximate locations of the test holes are located on the attached site plan. The monitoring tubes within the test holes have been checked and 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 properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Since~reiy~ ~ ~ 17034 NORTH EAGLE RIVER LOOP , SUITE 204 , EAGLE RIVER, ALASKA 99577 m c; 0 o~ om~O ~.) ~-w~_O .tO 3AIEI(J :IONVOO~J.S ~ o 0 o~ NVqd 3lis ,og = wz . Z (D o --J Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:~/-..~- /~' F O RfVLE~ DATE PER LEGAL DESCRIPTION:/--O'S' "~/ ~-'--~,,,~"¢'~,/~/z"/¢~//(-/~tOWnship' Range, Section: SLOPE SITE PLAN WAS GROUND WATER A I 10 ENCOUNTERED? I~') 0 11 iF YES, AT WHAT ~ DEPTH? 12 13 14 15 16 17 18 ---- 19- I N Monitoring? Z'~ Dale: Gross Net Depth to Net Reading Date Time Time Water Drop I~/"'/,Y~ -- 5 %', ~ ;/~ ~o" 5 Y~ ~" ~o /o~ V~/V ', ~ 20- PERCOLATION RATE ~--O (m~nutes/mch) PERC HOLE DIAMETER "t~ TEST RUN BETWEEN -~F~ND ~'--~' FT PERFORMED BY: ....... ~.L.~L.. on~ I / ~ /~ - CERTIFY THAT THiS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPALGUIDELINE~~N'~IS DATE. DATE: 72-008 (Rev. 4/85) v / ON-SITE WASTEWAT~R DISPOSAL SYSTEM 00NSTRUCTION PRACTICES MATERIAL SPECIFICATIONS REFERENCE: Kasilof Hills Subdivision; Block 8; Lot 7 1. The scope of this project includes the installation of a 1500 gallon septic tank and a leachfield 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. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 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 INSTJILLATION: 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. 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' of cover shall be insulated. Page Two Kasilof Hills Subdivision; Block 8; Lot 7 July 1, 1994 o 0 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' 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 (roughed-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. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. 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. 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. MATIZRIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page Three Kasilof Hills Subdivision; Block 8; Lot 7 July 1, 1994 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: o 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 extruded direct: burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the I1200 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. 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. 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. Page Four Kasilof Hills Subdivision; Block 8~ Lot 7 July 1, 1994 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 contractor's 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 contractor's activities. Final acceptance of the contractor's 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 MUMCOG AUTY ®F ANCHORAGE %! 11 r'.// / Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-132-08 1. GENERAL INFORMATION Expiration Date: OV Complete legal description KaSilof Hills, Block 8, Lot 7 Location (site address) 10700 Stroganof Drive Anchorage, AK Current property owner(s) Jeffrey Orcutt Day phone 229-8700 Mailing address 10700 Stroganof Drive, Anchorage, AK 99507 Real estate agent Jeff Schroeder 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 242-3450 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic ED Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ `55D Waiver Fee $ Date of Payment 0 c 1 Date of Payment Receipt Number Pj �(� CJ� Receipt Number COSA # ��JCI� Waiver # 6. 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 Certificate of On -Site Systems 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 8/25/19 6. DSD/ SIGNATURE / System #1 Approved for 5 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: J ON -SIT ATER afro m— J 6z� Original Certificate Date: o �30 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other Ic n ;, n CW i 0 COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Kasilof Hills, Block 8, Lot 7 015-132-08 4.5 8/23/94 N/A 164 20 2.11 45.5 FORGE ENGINEERING 8/19/19 48 8/7/19 25 SEPTIC/STEEL 49 8/23/19 Tank passed leak test. DEEP TRENCH 8/18/94 8/19/19 5 13.2 0 3.7 882 0 60 0 >750 None N/A ✔ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 8/23/19 ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Septic Tank Advisory Certificate of On-Site Systems Approval # OSC191395 Subdivision: Kasilof Hills Block:8, Lot: 7 The septic tank for this property is 25 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St, P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 01 5-132-08 1. GENERAL INF~3RI~IATION'- Co~pletele[~ldescripti0n..` Lot 7: Block Loc.*tion (site address or directions) 10700 Current Properly owner(s) Patricia Veenkant M~ingaddress 3101 Penland Pkwy Anchorage, Lending agency Homestate..Mortgage HAA# Expiration Date: {?/~-/o~-. 8: Kasilof Hills S?roFanof Dr. Day phone 346-8044 AK 99508 Day phone 762-5890 Mailing address 3201 'C' St Anchorage, AK 99503 Real Estate Agent Mailing Address Unless olhervvise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 Day phone 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class.. Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site ~'~ Individual Holding lank Community On-site [] Public Sewer The Municipality of Anchorage Developmen{ Services Departmenl (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representafions 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 Iranster et title (except between spouses) for propedies 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 propedies served by a private or Class C well and may be reissued wilh new water sample results less than 30 days old. (Cedi~cates 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 wails or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the prolessional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as et the validation date shown below, I veri~y II'lat my Investlgalion, based on procedures outlined In the Health Aulhortty Approval Guidelines for Ihis application, shows Ihal Ihe 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 ~urther verify tha~ based on the Informalion oblained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewa[er disposal system Is(are) In compliance wilh all applicable Municipal end State codes, ordinances, and regulations tn effect at lhe time of installation. Name of Firrn S & .q EnE~neorfnE Phone 60/,-2070 Address 17034 ~. EaRle River booo Ea~le River. AK 99577 , II Engineer's Prin[ed Name Robert C. Cowan gale bedrooms. DSD SIGNATURE Approved for -~ Disapproved. Conditional approval for bedrooms, with the following stipulations: Addilional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report O[her Original Certilicale Date: MuniCipality of AnchOrage Development Services Department Bulldlng ,Safety Division On-.Rite Water & Wastewa~r Program' 4700 South Bmg~w SL ' P.O. Box 196650 Anchorage, AK 99519-6650 w~w~,d.anchorage~k~us (9O7) 34a-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal I:tescrlpuon: Lo'/' ? WELL DATA IfA, B, or C provide PW~ID ale ~ FROM Wi=t I LOG Date of ~t StaUc water level Waft production WATER SAMPLE RESULTS: Coliform O colonies/100 mi. ..-fg.A. ~ B. SEPTIC/HOLDING TANK DATA Tank.~atehat - SE) r, c / TS~k size '] ~'o o. 'gal. * '. Number of Compartments 'iOate of pumping lO/ '~- C. ADSORPTION FIELD DATA Nll~ate :;L~3. mg.A. · Date of sample: Depression over tank (Y/~ /v ~ Pumpe[' /1~*~,'= Soil rating j(~r ~/bdrm) Width $,/O Parcel ID: Wa, t~) Wires prope~ protected ~/N) Casing belght (above ground) · ;;;t ¥./. in. ATINSPECTION ,C. 3. g.p.m. Other bacteria ~' colonies/100 mi. Coflected !~ S ENGINEERING I)b.~n~ltl RI,,, L~pRiidNo ~04 System type Length '~ r~r'4~, ff. Gravel below pipeC/',/.a. ~1o ft. Totaldepth ~'- ft. Eff. absorptionamalJ',~ Monltodngtube Date of adequacy test ~'/~'/0 ;3 Resulte~Fall) /°dsJ For -.S"bedrooms Fluid depth in absorption field before test)~'Y in. Water added"/7~ gal. Elapsed Time: ~O min. Final fluid depth '7 *' in. Absorption rate >= Any rejuvenation treatment Coast 12 mo.) CY/N & [ype) New deptY/ S'~' in. "/y"o g.p.d. If yes, give date ~ D. UFT STATION Date instefied 'Pump on' level at Datum Size In gallons in. 'Pump ~ ~evel at CyUeS tested Manhole/Access (Y/N) High ".~ltC, ~l~rm level at in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic lanMilt station on lot ! e '~ ~ Absorption field on lot ] ~' 6 Public sewer main A//~- Sewer/septic aewicellne ~ ~" "~- On adjacent lots / ~ 0 ~" On adjacent lots / o o "f~ Public sewer manhole/cleanout Holding lank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation / 7 Property line J~ ~' Abso~Jon field Water service ilne /0 ~' surl'ace water Water main N/4 Wells on adjacent lots ] O O ~'~- Water main SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line t .,~* ' Building foundation 7(~ ' Water Se~loe line /O /~ Sulfacewater /oo ~- F. COMMEN'r8" ' .... ,' Driveway, pa~,ing/vehlde storage ) OO G. ENGINEER'S CERTIFICATION I cer~ Y~at I have determined through field in~ and mvtew of Municipal moon,s ~hat ~e above systems am in conformance ~ MOA HAA guidelines in effect on ~his date. Engineer's Pdnted Name ~)~- ~'. HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number /,'~t ~ ~ CT&E Environmental Servlces Inc. CT&E Ref.# Client Name Project Name/~ Client Sample ID blatrix Ordered By PWSID Sample Remarks: 1025567001 S & S Engineering Lot 7, Blk 8 Kasilof ilills Lot 7, Blk 8 Kasilof ilills Drinking Water 0 All Dates/Times are Alaska Standard Time Printed Date/Time 09/03/2002 8:39 Collected Date/Time 08/28/2002 12:10 Received DateffTIme 08/28/2002 15:35 Technical Direct o~......~/t'"- .~ .~/]/Stephe~Ede Released By ~ ~:~'"~. Parameter Resulu PQL Units Method Allowable Prep Analysis Limits Date Date Init Nitrate-N 2.32 0.200 mg/L EPA 300.0 (<=101 08/28102 JDT l~l:l, c :r ob :1. o l o~;ry' ~.al~o:r&l:ory' Total Coliform 5 OB, No Coli col/100mL SMI8 9222B (<--1) 05/28/02 KAP MUNICIPALITY Of ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6660 ;;i . 343-4744 ' CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1," GENERAL INFORMATION Complete legal description Location (site address or directions) 10700 Stroganof Driv6 -~,~'"~.,', .... Anchoraq¢,~ AK Pro perry owhei: ........ /, P~tri~a Smit~ Mailing'address. 10700'~rogano~ P£zzee, Ancho~zge. L~nding agency .... '"' Mailing add~oss ~':' :~':'~ Unless otherwise requested, HAA will be held for pickup. Day phone AK 99516 Day phone_' , :... 2. NUMBER OF BEDROOMS: ...... ,~, 5 ........ 3. TYPE OF WATER SUPPLY: ? ~' " : - --: Individual well Public water ?,;..:,... NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of'system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX ,Community on-site ........ ., ...... NOTE: If community wastewater system, provide written confirmation from State ADEC 'attesting to'the legal!ty and status of system.. ' i ~ .' '. 72-025 (Rev. 1/91} Front MOA #21 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 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 date of this inspection. S & S ENGINEERING Name of Firm ~203'; Eagle River Loop I~oa~l NO. 204 PhoneI ~ ~ ~ -- ~ ~ ~ Address Eagle Rivet', Alaska 99577 ~ Engineer's signature .'~/~ ?~.~.-, Date ~7 /~¢'~/~f,? . 6' ~. DHHS.S!GNATURE ~:,. Approved for Disapproved. ,Conditional approval for · Additional Comments bedrooms, with the~ifollowing stipulations: 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. Th~ 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. (Rev. 1/91) Bsck MOA~I Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~/4s-/~-oF /-//c~-.~ / ,~co,-/~ ?¢ ~oT F Parcel I,D. A. Well Data Well type Log present (~N) Total depth /(~, ~-I ' Sanitary seal (~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed P/q ~-/ Driller Cased to 2_¢__.) ' Casing height Wires properly protected (~N) FROM WELL LOG Date of test ¢/~/ Static water level /C) / Well flow ~' Pump level1 U/~-- SEPARATION DISTANCES FROM WELL TO: Septic/ ........ g. tank on lot / 0¢¢ ~ Absorption field on lot /34¢ ' Public sewer main 75- Lh Sewer service line 25- ' ~ g,p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /('jd +- WATER SAMPLE RESULTS: Coliform Date of sample: B, SEPTIO/H{}L--DING TANK DATA Date installed Cleanouts I~N) High water alarm (Y~ Date of pumping &,)/Pr Nitrate Collected by: Other bacteria ---(~}--- ' $ $, S Eagle River, Alaska 99577 Tank size /~:~0 d¢¢~- Compartments Foundation cleanout (~N) _ y=--~ Depression (YI~ /Jo /u/~F- Alarm tested (Y~.__N~) AJo A//~. /d e-~j '-r-~,,g ~ Pumper SEPARATION DISTANCES FROM SEPTIC/H ....... -TANK TO: / Well(s) on lot / o/./ On adjacent lots To properly line __~'~' ~ Absorption field t Surface water/drainage /OO /00 '+- Foundation /~ ' ~/' Water main/service line 72-026(3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer ~ Size in gallons Manhole/Acces_.s-(-Y~) Vent (Y/N) "Pump on" level at ...~"Pump off" Level at High water alarm level ~ycles tested Meets MOA electrical codes (Y/N) ~ SEPARATION DISTANC.~z('O~ LIFT STATION TO: Well on lot ~ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length '7¢*~ Total absorption area /~4-'2 ~ ¢' Date of adequacy test ,,u/~ ,,de'pJ ~yS'T~fk Results (pass/fail) Water level in absorption field before test ~ Peroxide treatment (past 12 months) (~~'~'~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Width After test If yes, give date Soil rating (GPD/Ft2) ~.4~. System type ~'~-~-p · ~- ' Gravel thickness~Ls'' ,¢/o ' Total depth Cleanout present (~N) y~¢ Depression over field (Y(~ Bedrooms Well on lot /?6 ' To building foundation 74¢ ' On adjacent lots ,/~,' c- Surface water /oo ' c- Curtain drain On adjacent lots /oo / ¢- Property line To existing or abandoned system on lot Cutbank ~S-'o ' ~- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to ali MOA and HAA guidelines in effect o_r~c~d~ate of this inspection. Engineer's Name , , ~ ¢ ~ ROBERT C COWAN Z'~ ~ H~Fee$ ~, ~ Waiver FeeS Date of Payment ~~ ~ Date of Payment , oe,ptNumber .ecei,tNumbe. 72-026 (3/93~* Back 07/03/95 17:00 COMMERCIAL TESTING -* 90?6941211 N0,799 [~03 zTF., Client Samp~m ID ~7 B~8 KA$ILOF HILL~ Ordered By R. COWAI~ Project Name ?roJect~ Pw$ID UA CT&E Environmental Services Inc. Laboratory Division ~~ _ 95.~4~_, Laboratory Analysis Report WATSR sample Remarke: ~AMPL~ COLLECTED BY: J.W. WORK O=~er 15880 PDinted Da~e 07/03/95 ~ 16:44 hYs, Collected Date 06/28/95 ~ 11:05 hrs. Received Date 0~/28/9~ ~ 13:]0 hr,. T~chnica~ Directuv STEPHEN C. EDE QC Parameter ............... Method Nl~rat~-~ 3.56 mg/L ~PA 353.2 Allowabl~ ~xt. Anal Limlte Date Date Init Z0. 06/30/95 CMR ~t? See 8amp1~ Remarks A~Ove UA - U~ava~lable ,, - NA . Not ~i Undetected, Reported va~ue 1~ the practical ~a~ti~lcatlon ~>- 8~conda~ dllutio~. LT , ~s 200 W. Potter Orive~ AnChorage, AK 98~18-~605 -- Tel: (907) 582.2343 F~X: (907) 5~1-5301 ENVIRONMENTAL ~aCitlrlES ;N ALASKA, CALIFORNIA, FLORIOA, iLLINOIS. MARY~N0, MiCHiGAN, MISSOuRL NEW JERSEY,