Loading...
HomeMy WebLinkAboutTUXEDNI PARK BLK 2 LT 2Tu dni Pork lock 2 Lot 2 041-022 -25 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~,ol~-~ PID Number: Name: ~"~,'~'~1,3 ~O/~5"J"~.q-i~ ('pA,{ H^~-r=a~ Wastewater System: .~ew [3 Upgrade Address: ~o~,. i',l,:,,: ~,o A,~-,~o~.,~.~: k~- '~ ABSORPTION FIELD Pho.e: '5't'~- ~,~o I"°'°'B~r°°ms: rlBed []Mound ri Other ,~Deep Trench i-I Shallow Trench LEGAL DESCRIPTION Soil Rating: Total Depth Irom original grede: O. ~ GPD/Sq Ft. q I Lot: Block: Subdivision: Oepth to pip~ bottom from original grade: Gravel depth beneath pipe Township:~ I Range: Section: _ o Fill added aboveoriginalc:)grade:~_ I Ft. Gravellength: ~oL)'J Ft Number Of lines: I Dista.e~ ~_ ~.~e~. li~s: WELL: .1~New Cl Upgrade Gravel wld [ . : g ~ F, . I F t l Classification {Private, A,B.C): Total Depth: Cased TO: Total absorption area: Pipe material: ~,1%v~ O'~ o"~ ~{ Date Drilled: Static Water Level: Installer: Date installed: Yield: I Pump Set at: I Casing Height A~bove Ground: 3- O GPU I U/,< Ft. I I '+ Ft. SEPARATION DISTANCES ~it' Septic TO Septic Absorption Lift Holding Public/Private Manufacturer; From Tank F~eld Station Tank ~ewe~ Lines J~ I~.~ TANK n Holding [3 S.T.E.P. Capacity in gallons: "/-~ F.- m'z~o Wel[~ IDol+ ioc, l.j.. ~ ..Z~t~' Material: ~'r'm~L. NumberofCompartments: - SurfaCewater ! ~'+ ~:+ ~ .... LIFT STATION Lo~ _- I Line ,~ t ,~.~ 1 ~ Size In gallons: Manufacturer. Foundation L~' ~,.~,' -- -- "Pump °n"level at:~vel at: I High water alarm et: Curtain ~ I -- ~. ~ Pump M~&-IW'6~ I Electrical Inspections performed by: Drain i~jo~ ~ 0~,31~t -- ~ I " Remarks: '3~,¢/V O~:~,.,~,~ r:o,,, e~,~,-(-~o ". BENCH MARK · ~ Location and Description: I ~sumed Elevation: I I00. 0 ENGIN~ SEAL ~. -. 1'',"°: , ' Inspections pedormed Y~4 =.~, ~l~e~ Leap gaas. Ne.$~ates: 1st ~ .2z-wz _~ 'l Department of Health~dHumEnSe~mces. approyal. 't,~, ~ ~ Reviewed and approved by' ~ Date: 'tt~. 12~13 (Rev. 9/91) MOA 25 P,ermit No. SW960157 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report LOT 2, BLOCK 2, TUXEDNI PARK S/D Legal Description: NrW 1250 (:;AL SEPTIC T,~ NK NEW TRI LOT 2 ALT. SCAL~ 1" - 4C' ST 1 ST2 -/97.~' - .~../-FIUAL GRADE"~ CO1 ~ 96.6' C02 = 97.2~ 1250 GAL S.T. co~: 93,3'/~s3 C02 93,3'--/l ~T1 - 07.4' /' I, iT2 87.3'---/ * · 83.3' NO WATER FOUND 81.3' E .O.H. 72-013 A IRev. ~'91) MOA 25 PID No.: 041-022-25 A FCO 25.0' ST1 53.5' ST2 60.5' DBL1 65.5' DBL2 69.0' C01 110.0' MT1 105.5' C02 57,0' l~12 b i.5' 62.0' 65.0' 106,0' 101.5' 42.1' 4/.D' 9075625228 LO~ATION OF W~__t :' ',~ LOCAI'10N/~: PAGE 02 STATE OF AI,.A~KA .DEPARTMENT OF ~T~L DIVISION OF MINING & WATER.MGMT ~.~ WAT~ ~ BOREHOI,E bATA: De0th :' Ool~th of casing: C~r "~ · tt Mat. rlal Ty~e ami C~or From' .To' ' D~r~ TO STATIC WA~ER METHOD OF DRILLING: ~"~;¢ rotary ! I-I. oroufld.: surface.. cable tool US~ OF WEIJ.: ~ domestic I-1 Irrigm, io~ I-I mo6~tor t-I I~Ublic supply ~ other : .... Casing. ty~e: In. to ft .~,~.WEU. INTAKE OPENING TYPE: [] ope~ end ~] ~creenecl"-. ~perfomtKI [~) open hole ' '. OeDth$ Of open;rigs: SCREEN TYPE: Oiam: in. $1odMesh Size: ' Length: ~ GRAVEL PACK TYPE: Volume u~d: ' Depth* to top: GROUT TYPE: Volume: Depth: ,from It to tt 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:SW960157 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:HOOD DORIS MULKY OWNER ADDRESS:5722 NE 56TH STREET SEATTLE, WA 98105 PARCEL ID:04102225 PAGE 1 OF 1 '%- DATE ISSUED: 6/27/96 EXPIRATION DATE: 6/27/97 LEGAL DESCRIPTION: TUXEDNI PARK BLK 2 LT 2 LOT SIZE: 70089 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY - May 29, 1996 ROBERT C. COWAN, RE. ROBERTA. SHAFER. RE. ClV1L ENGINEERS (907) 694-2979 FAX (907) 694-1211 SEWER&WATER MAiN EXTENSIONS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 2, Block 2, Tuxedni Park S/D SEWER&WATER INSPECTIC~ ENGINEERING STUDIES ANDREPORTS WELl. INSPECTION & FLOW'IEST SITE Pt. AN~ ROAD D~SIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPEOTIOfIS Request you issue a permit to drill a well and install a leachfield trench to serve the proposed four bedroom house on the referenced property. Two test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation no water was encountered in the test holes and after seven day ground water monitoring, the monitoring tubes were found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional infozmation, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure ,~v~r..r~ ~ dUN 0 7' 199; RECEIVED ON SITE WA~TEWATER DISPOSAL S~TEM DESIGN 17034 NORTH EAGLE RIVER LOOP · surrE204 · EAGLE RIVER. ALASKA 99577 1': = 60' SITE PLAN DESIGN 0 100' WELL RADIUS 1~' = 60' SITE PLAN ~0 O~ m z -13 o ;:~ 100' · ~ ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. CI~L ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUT HORI"I~ APPROVN. S ~EFERENCE: Lot 2, Block 2, Tuxedni Park S/D May 29, 1996 SEWER&WATER MAJN EXTENSIONS SEWER&WATER INSPECTION ENGINEER~NG STUDIES AND REPORTS WELL INSPECTION &FLOWTEST mANS 3ENERAL: 1. ® Se The scope of this project includes the installation of a 1250 gallon septic tank and a leachfield trench to serve the proposed four bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wast.water Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wast.water 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. SOILTEST TEST STRUCTURAL & MECI-IAN~CAL INSPECTIONS SEPTIC TANK INST~LL%TION: 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. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP * SUITE 204 - EAGLE RIVER, ALASKA 99577 Page Two Lot 2, Block 2, Tuxedni Park S/D May 29, 1996 Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INST~T~,~TION: e Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire g~avel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 2, Block 2, Tuxedni Park S/D May 29, 1996 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 fozmation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: ® ® Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No 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 140N, 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 %200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 2, Block 2, Tuxedni Park S/D May 29, 1996 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. o 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. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 2, Block 2, Tuxedni Park S/D May 29, 1996 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons perfo£ming 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 o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: L'~ ,'~[, '~r'o)~..bF4 [ "'~AG:V~. Township, Range, Section: , SLOPE SITE PLAN 7 d 9 10 _i 12- WAS GROUND WATER ENCOUNTERED? 14 - ~t L,'F'//~,AI.I~ I Reading Date 15 15.o .~. - 16- I 17- L IF YES. AT WHAT ~ O DEPTH? p Depth a Waer After _. ~.~,-6~b,,__ Gross Time Net Depth to Net Time Water Drop 19- 20- COMMENTS PERCOLATION RATE 'L'~/ (minuteS/inch) PERC HOLE DIAMETER ~'~O~ TEST RUN BETWEEN (J~ FT AND "~ FT PERFORMED B~034 ~le RI~ L~ R~d No. 2~ i CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ /~ 3 / ~ { 72-008 (Rev. 4/85} Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: L'~. ,"~,.."~u~.m-~t. lt 'PA{z.F-, 1 3 - ~o,t.'~l r~.c~/~1~-~ 4 Township. Range. Section: SLOPE 5 6 ~0 ~2 ~6 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplh ~o WMer Alte~e~ Monitoring? Reading Date ~-I~-~ I Gross Time ~ ~ .O~E~T c cow^. /.~ , 't, ~ "-. . ."i'~?.. ~ · ,t,~,~=,.. ~..., .A',,. ,.. DATE PERFORMED: ~{~"~.~'~'.' SITE PLAN S L O P E Net Depth to Net Time Water Drop 19- 20- PERCOLATION RATE (~ (m,nutes/mch) PERC HOLE DIAMETER ~:~ "~ TEST RUN BETWEEN ~ FT AND COMMENTS '~"~° ~ ~' '~['%CA~*ATIEC> ,[~L/ ~A~ ~0~. S & S ~GINEERIN6 PERFORMED e~gle R~, ~a~ ~5~ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ / ~ ~ / ~ ~ 72-008(Rev. 4/85) CERTIFICATE OF Legal Description: WELL DATA Well type PRIVATE MuniCipality of Anchorage Development Services Department Building Safety Division ,,..._'/. On-Site Water & Wastewater Program 4700 Bragaw Street '~'/ P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 oN-SITE SYSTEMS APPROVAL CHECKLIST TUXEDNI PARK S/D; BLOCK 2, LOT 2 If A, B, or C provide PWSID# N/A Date completed 7/22/1996 Sanitary seal (Y/N) YES Total depth 105 ft. Cased to 92 ft. Date installed Length Total depth FROM WELL LOG 7/22/1996 26 Date of test Static water level ft. Well production 20 g.p.m. WATER SAMPLE RESULTS: Coliform ¢ colonies/100 mi. Arsenic: i'Jp ug./L. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments__ Foundation cleanout (Y/N) YES Date of pumping 10/5/2010 ABSORPTION FIELD DATA 7/22-24-96 64 ft. Nitrate ~- ' 2> ~g./L. Date of sample: 2/3/2011 2 Depression over tank (Y/N) NO Pumper [*BELOW EXISTING GRADE] Soil rating ~or ft2/bdrm) 0.8 Width 5 ft. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 2/5/201 J 32 7.22 Other bacteria Collected by: YES YES 24+ in. g.p.m. ~) colonies/lO0 mi. GEG Ltd. Date installed 7/22-24/1996 Cleanouts (Y/N) YES High water alarm (Y/N) N/A MCDONALDS PUMPING *9.8 ft. Eft. absorption area 768 ft2 Monitoring tube YES Date of adequacy test 2/,3/2011 Results (Pass/Fail) PASS Fluid depth in absorption field before test 29 in. Water added 840 gal. Elapsed Time: 130 min. Final fluid depth 4-2 in. Absorption rate >= Any rejuvenation tre~tniedt (pabst 12 mo:)'(Y/N & type) NONE KNOWN System type TRENCH Gravel below pipe 6 ft. Depression over field NO For 4 bedrooms New depth 45 in. 600+ g.p.d. If yes, give date - D. LIFT STATION Date installed "Pump on" level at__ in. Datum J Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons Manhole/Access ~ "Pump off" level~ water alarm level at 100'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ Meets alarm & circuit requirements.'?. On adjacent lots 100'+ On adjacent 10ts 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ Building foundation Water main Wells on adjacent lots SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5'+ Property line 5'+ N/A Water service line. 10'4. 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ Absorption field 5'+ Surface water 100'+ Building foundation 10'4- Water main N/A Driveway, parking/vehicle storage in. 10'+ F. 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. Engineer's Printed Name JEFFREY A. GARNESS Date ~z./li /tl COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number MuniCipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF 0N-SITE SYSTEMS APPROVAL Legal Description: WELL DATA Well type PRIVATE TUXEDNI PARK S/D; BLOCK 2, LOT 2 If A, B, or C provide PWSID# N/A Date completed 7/22/1996 Total depth 105 ft. Date of test Static water level Well production 20 WATER SAMPLE RESULTS: Colifom~l~olonies/lO0 mi. Sanitary seal (Y/N) YES Cased to 92 ft. FROM WELL LOG 7/22/1996 26 .ft. g.p.m. Nitr~g./L. Date of sample: 2/3/2011 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size, 1250 gal. Number of Compartments Foundation cleanout (Y/N) YES Date of pumping 10/5/2010 C. ABSORPTION FIELD DATA Date installed 7/22-24-96 Length 64 ft. 2 Depression over tank (Y/N) NO Pumper, I'BELOW EXISTING GRADEJ Soil rating ~or ft2/bdrm) 0.8 Width 5 ft. CHECKLIST Parcel ID: 0///'"//' 0 2 ~,-- ~,,,.~ Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 24+ in. AT INSPECTION 2/.3/2011 32 ff. 7.22 g.p.m. Other bacteriJ~~lonies/100 mi. Collected by: 'GEG Ltd. Date installed 7/22-24/1996 Cleanouts (Y/N) YES High water alarm (Y/N) N/A MCDONALDS PUMPING Total depth *9.8 ft. Eft. absorption area 768 ft2 Monitoring tube YES Date of adequacy test 2/.3/2011 Results (Pass/Fail) PASS Fluid depth in absorption field before test 29 in. Water added 840 .gal. Elapsed Time: 1.30 min. Final fluid depth 42 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) KNOWN System type TRENCH Gravel below pipe 6 ft. Depression over field NO For 4 bedrooms New depth 45 in. 600+ g.p.d. If yes, give date - Absorption rate >= NONE D. LIFT STATION Date installed "Pump on" level at in. Size in gallons Manhole/Access ~ ~ "Pump off" leve~gh water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ Septic tank/lift station on lot Absorption field on lot, 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ .in. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A N/A Manure/animal excrete storage areas 100'+ Building foundation Water main Wells on adjacent lots SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5'+ Property line 5'+ N/A Water service line, 10'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots. 100'+ Absorption field 5'+ Surface water. 100'+ Building foundation 10'+ Water main N/A Driveway, parking/vehicle storage 10'+ F. 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. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SG.S SGS Ref.# I 110377001 Client Name Garness Engineering Group, Ltd Printed Date/Time 02/10/2011 16:02 Project Name/# Tuxedo Park B2,L2 Collected Date/Time 02/03/2011 10:30 Client Sample ID Tuxedo Park B2,L2 Received Date/Time 02/03/201 I 11:20 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 02/07/11 02/10/I 1 NRB Waters Department Total Nitrate/Nitrite-N 2.56 0. I 00 mg/L SM20 4500NO3-F B (<10) 02/03/11 AYC Microbiolog~ Laboratory E. Coli Negative I 100mL SM20 9223B A 02/03/11 SDP Total Coliform Ne~.ative I 100mL SM20 9223B A 02/03/1 I SDP o o 2.0' X 13.5' --~ x 7os' X 21.0' CANT POECH CANT 41.0' TWO STORY WOOD F'P,A~E EI~DI~ICE 2.0' PEOW CANT LOT 3 / / / / CLEANOUTS o LOT 2 70,089 s.fo / / / X 5.0' U.G. TEL. & POWER EASEMENT LOT 1 / / / LOT 2 / / / / / / LOT 4. LOT 2 70,089 / / / / / // // LOT 2 / / PLOT PLAN __ AS BUILT ~ SCALE 1" = 40' GRID SW 2043 Project No. 08-015 Lo n g (907) 5=-e475 Registered Lond Surveyors (907) 5=-~525 kglanglsOalaska,net / JclanglsOalaska.nef & Associates, inc. ~5o0 Daryl Avenue, Anchorage, Alaska 99515-5049 Phone Fax I hereby certify that I have surveyed the following described properly:. LOT 2, BLOCK 2, TUXEDNI PARK (:PLAT No, 67-105) Anchorage Recording Dls4Tlcf, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the properly adjacent thereto, that no Improvements on the propert7 lying adjacent thereto encroach on the surveyed premises and fhaf there are no madw~3,s, frunsmleslon lines or other visible easements on said property except as Indicated hereon. Dated fhls the ~.T+~ Day of Z--~~..~ , ~-o~ , af Anchorage, Alaska If Is the responsiblllfy of the owner fo determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision ~)lcrf. ,4-_ 5432 ~. Northen~ Lights Blvd, Suite g466 Anchorage, Alaska 99508 (907) 338-4476 ~nwi¢, # 6 6 4 4 Date: · Phone: [Customer P. O. Number: Contact Person: Description Septic tank pumped Prico per urdt Sludge in tank Leach lT'eatment Bio-mat in leach Water level in leach Cap on Stand Other.. Recommendations: Amount 1.5% inXter~ext w-~ be 'charged _monthly on unpaid bills until paid~ 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1, GENERAL INFORMATION Complete legal description Lot 2~ St. oc/z '2; Tux~dn~ Park · Location (site address or directions) NHN dopp~.r DrZv~. ,.~. . . -.. Anchorage, AK ,~_ :,..~' .... ...: ..,: ~;.. . ~.-Propert¥ owner '-~ .-T~.ma~k Con~tr~¢.tZon Day phone' 242-8945 t .~,~'f' -.. - \ ,... ~ ',*"/Mailing address .:.. ~000A E. 72nd Av~.nue Ane. Aora0e, AK ¢9507 · .;'.Lending agency ........ ~: Day phone'": ~.': Mailing address'"" ,~ ':' ' i';[Uhless othe:rWise requested, HAA will be held for pickup. '.' .;.:,~, ~;~., :. -....:. . [..;_. ~:~*: - Day phone 2.;:~':.'NUMBER OF BEDROOMS: :.L. 3. e:.;TYPE OF WATER SUPPLY:?" .' '.":?Z';D:' *:: Ir~dividual well: ' · . NOTE: ,, ' Community well P~l~lic water *'' '**' If community well system, provide Written confirmation from Sta~e ADEC ~tteSt'-: ; ing to the legality and status of system. .. ~ ,* ,, TYPE OF WASTEWATER DISPOSAL: ": .' ,". Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMENT OF INSPECTION BY. ENGINEER *~i :i!'"'~i':~i:; '?~' !"/~'**;~;" :*' , , ..**~' . . ~ - .,~.*,~,L.,,:~,*'!-~: .: ~, ,!, P*''~' , '.' ~':~'hr'*%:'~? ' ~:~*'~.'~': * :.. As certlfieo by my sam affixed hereto an, d as of the validation date shown below, I verify that my · .~' investigation of thls Health Authority Appro,vai application sh~w?, that the on-slte water supply and/or wastewater d~sposal system is safe, functional and adequate for the number of bedrooms and type bf structure Indicated herein. I furthe[verify..that based On the Information obtained from the Municipality of Anchorage files and from ~y.investigation and Inspection, the on-site water supply and/or wastewate~' disp~Sa!*syst~l~ I~"i~'~n~liance".W.' Ith'=~ll MuniCipal and State codes, ordinances, and regulations in effect on the date of this Inspection. Name of Firm s & s ENGINEERING :. i,:' · 17034 Eagle River Loop Road No. 204 Engineer's signature .. Phone ¢ c/¥ _~ ?~ DHHS SIGNATURE ~.. ... ;:.. : .,*'..':";; .,,.,, .' 'i"/.' ';:, " : Approved for .... bedrooms."~, ... }., : : · '"' :": .... *":li~ "V :..."~':. Disapproved '- Conditional approval for bedrooms. ~tlth the following stipulations: ; ~,~.~ ,,.~', ~dditional ~mmont~ '-' ~' ~. :? '?' ." ~' ~'~' ~'.~?.': ' ' . . . . . , ...... ........., ,, . .- :, .,,. .,..,. , , bate '.:. ':2', '.-The ~un[,elp~hty. o! Anchorage Dep~rtment o! Hoalth and H.,uman ,~rvl~'(OHH$) i~ues H~lth Authority · . "~';^0.p. ro~al~.~diflcat~ t~ only upon th~ r~pr~ont~tlons'givon In I~ragmph Sabo~ by an indepondent '" professl6h~l englnee!: re{llstered In the stat&"of Alaska. The DHHS d~es thig ~S ~'i:ou~te~¥t° pumhasers of homes and their lending in~tutions In orderto,~ti~t certain f~leml a~d st~t~ r0quimment~. Emplo~ of DHHS do not conduct Inspections oranalyze:da~ be,f.o,,re a certificate. Is issuedi-.The Municipa Ity of Anchorage is not responsible for errors or omissions In the professional engineer's work.:: ~.~:, .:? !. ,.. -, .-M'UNICIP"~tTy O~ Aluc,.,.._ _ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 7 6 79~ Environmental Services Division 825 L Street, Room 502. Anchorage, Alaska 99501. (907) 343~El VED Legal Description:LoT ,~. 8Le¢~c 2 Health Authority ApProval Checklist '7'ux~,o~v/ P~t.<~ ~Opameli. D,: 0~t-0;~ A. WELL DATA Well type Log present (~tN) Total depth /O If A, B, or C, attach ADEC letter, ADEC water system number Date completed '7 / ~. ~ / ¢~ (~ Cased to q ~' Casing height (above ground) Sanitary seal Date of test Static water level Well production FROM WELL'L°G · g.p.m. Wires pmpedy protected (~N) ¥ ¢ 5 AT INSPEC'FION g.p.m. WATER SAMPLE RESULTS: Coliform ~) Nitrate Data of sam,,m: / /U OLO=O TA. DATA Oateinstalled T/~./qG Tankslze la. re ). '7 ¢~ Other bacteria Collected by: S & S ENGINEERING 17034 Eagle River Loep Road No. 204 Eagle Ri~er, Alaska 99577 r-e~.Number of Compartments ~ Cleanouts ~N), Y~ 5 Foundation cleanout (Z~IN) Date~of~umPlng., ... , ,'-b~"/.~ C. AB$ORPT~NiqELD D Effe~ve.ab$orption a~a :")'~ $ ''?' Date of adeclua~'y test L~ .,~ u High water alarm Of~ A, 0 Soft rating ~..~_~r fff/bdrm) ¢~. g Syetemtype / Gravel thiclmess below pipe (= Total depth q ' / o Monitoring Tube present (i~tN) ¥~-$ Depression over field (Y~ ,'~ o Results (Pass/Fall) For bedrooms Fluid depth in absorption field before test (in.); Immediately ~er gal. water added (In.): Fluid depth (ins) Minutes Im,~n Absorption rate = g.p.d. Peroxide tre.tme,, tpest 12 months) (Y/N) 72-026 (Rev. 3/96)' If yes, give date LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycle~ E. SEPARATION DISTANCES Size in gallon.~ _ 'Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: [~holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM~'~"C'C~HOLDING TANK ON LOT TO: Foundation ~ ~ Property line 3 ~ Absorption field Watermain/servicellne ~'0 ¥-Surfacewa. ter/drainage )~0 -W Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface'water Curtain drain / / ~ 5" ' Building foundation ~ I Water main/service line ~'-O "~ '! 0 0 ~f-'. Driveway, parkingNehicle storage area ~vo,~ ¢ ~c ,~o ~/,'~ Wells on adjacent lots /0o /'~ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records Signature ' ///,~(,,~v/' /--. ~/~,"~'~."-"~ Engineers Name ~J ~ ~-'t )-- C. ~/"o ~'4 Dato / "./", r.. HAA Fee $ ~_z'~. ~,0 Date of Payment ~//~/,,~' Receipt Number c~_ ~j:~',.~"~~:~ 72-o26 (Rev. 3/~S)* Waiver Fee $ Date of Payment Receipt Number 9076941211 S AND S ENGINEERING PAGE 03 ·, ~.~ ~&E En~~~l 8~1~ Ino. ~m~ O~;f~"_ '" ~ ............ . .... ; · ~ W. ~r D~ ' ' l~rele. AK~Ble.le08 : Tel: (907} ..., ProJ~t Na~I ~ ~ ~ ~':""'.c, C0~ h~ ~117/96 Cli~ $~le ~ ~ ~ ~ ~.. · q., ~!~ D~ ~118/~ 09:~ . ..%..~'~ Par~ter ,.:~ tl~¢:~ : q,. ~l:e Xeth~ Llelte . .. ,.~,~,.,;~. · ..