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HomeMy WebLinkAboutSCIMITAR #1 BLK 1 LT 64k�o k�=� \Sa4wb4a Municipality of Anchorage Page 1 of_3__~. DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVlSIO~N P.O. Box 196650 · Anchorage, ALaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S,ln/ .~E~C~/~.~.~ PID Number: ~.~113 Name: ~a~ela S. Sloa~ Wastewater System: D New ~pgrade Addre~: 20314 Chugach Park Drive ABSORPTION FIELD ~ ep Trench D Shallow Trench D Bed ~ Mound ~ Other LEGAL DESCRIPTION so, Rating: Total Depth from original grade: -~ GPD/Sq. Ft. ~, // ~Lot: 6 BIoCk:l ~C~Subdiv~i°n:~l ~p~ to pipe bo~om~,lmm originsl ~. ° Ft.grads; Gravel depth beneath pipe 7 Ft. Township: Range: Section: Fill added above original grade:~ Gravel length; Ft. [/ Ft. WELL: ~.~ New C U pg rade Gravel width: ~'~ Ft. Number of lines:/J Dist~ be~n lin~: Classification Total absorption arem Pi~e materi~[: ~ ~ ~ ~Ft. (P~vate. A,B,C): Total Depth: Cased To: ddllea ~/[g./~ Date D¢lled: Static Water Lsvel: InsUlter: / Date inst~lled: / Yield: J Purnp Set at: ~ing Height Above Ground: > ~ ~ ~. ~ ~. TANK SEPARATION DISTANCES ~i, ~ Holding ~ S.T.E.P. T° [ ~otic Ab~tion LI~ Holding ~d~te Manufacturen Capaci~ in gallons: Fromr Tank Field Ststion Tank ~wer M~ ~~ / WaIF /~01 /~Z' ~/~ ~/~ >/~1 [M~7~ Number of Companmen,s: Sudace W~ter ~/~/ ~/~' ~/~ ~ >/~*' LIFT S'TATION~ Lot r Cu~ainDrain ~/~ ~ ~ Pump Make/ Electri~llnspections pedormed by: Remarks: ~/~ X~/~ ~ BENCH MARK , L~tion and Description: / Assumed Elevation: E ~IN~'ER'8 .SEAL Inspections performed by: -- Dates: ls ~2~t,.-/',.,-~ S2 "~ ......... Department of Hea~ ~an S~ice ~*':*'~' ' ,.' ':~*' Reviewed and approved by: Date: ,Z-~-~ 72~13 (Rev. 9/91) MOA 25 Permit No. SW980124 Page 2 .of 3 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. Description:~ LT 6, BLK 1, Scimitar #1 PID No.: 05113203 ,250 G  SP1 Septic Pump, compa,r, tment 1 SP2 " " 2 'C Clean Out MT Mon~ ~.or Tube rock · ; ELEVATION AS -BLT 1" = 10' 2" insul. Permit No.SWg801 24 Page 3 of 3 _ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ® Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ®n -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LT 6, BLB 1 , Scimitar #1 I -' PID No.: 0 51 13203 LEGEND --------- - -- - - -- - -- - - - - -- - -- - -- - SP1 Septic Pump, compartment 1 - - - ------__-_ _-----------_ __ - SP2 n n u 2 _ .- - C Clean out ---- — —-------- --. _ .�-- -- ---- ----- ---- -- MT Monitor Tube a 04 �17 _. MT --- - - 1y Ori_ incl V i I ., . •� u o 2 S P -- ------ -- --- -------- 3 BR house J Kr O I —Jj -- -- ._ — PLAN AS -BLT - --- J 201 MEMORANDUM DATE: July 8, 1998 TO: Dan Roth FROM: Mike Anderson, P.E. SUBJECT: Lot 6, Block 1, Scimitar No. 1 Permit No. SW980124 The original absorption trench was not accurately drawn on the as -built recently submitted. We have revised the drawing showning the original trench more than 10' away from the new trench. The area for the replacement system was limited by the location of the driveway and the location of the old trench. Every effort was made to maintain the separation distance required between the two trenches. No cleanout was placed at the northwest end of the trench because it was felt the two post tank cleanouts and the diversion valve were close enough to that end to allow cleaning or thawing of the trench if it becomes necessary. The Municipal Ordinance on Page 18, Section 12 states that cleanouts must be placed near each end of the field. We feel we have met the requirements of the ordinance. Thank you for your consideration concerning these matters. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 / .L'N �,pCC viv 5--27- ?6 PAGE 1 OF 1 2 57_Z0-9co;5 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW980124 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:SLOAN PAMEULA S OWNER ADDRESS:20314 CHUGACH PARK DR CHUGIAK, ALASKA 99567 PARCEL ID:05113203 LEGAL DESCRIPTION: SCIMITAR #1 BLK 1 LT 6 LOT SIZE: 39488 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 5/19/98 EXPIRATION DATE: 5/19/99 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: (J�J c%; " RECEIVED BY: _1VI LC "j, ` ' DATE: ISSUED BY: /, DATE:, May 10, 1998 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lots 6, Block 1, Scimitar Subdivision Addn. No. 1 Septic System Design Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption trench on Lot 6, Block 1, Scimitar Subdivision has failed and must be replaced. We are therefore applying for a permit to upgrade the system. The attached site plan and backup documentation identify the size and location of the new septic system to serve the three bedroom home currently on the lot. The well location is also identified and the 100' protective radius is shown. A waiver is currently in place allowing the septic tank to be 90' from the neighboring well. The existing tank will be uncovered and inspected for continued use. If it is found unsuitable a new septic tank will be placed outside the radius if possible. Another waiver may be required if space for the new tank is not available outside the radius. A testhole placed on the property revealed silty gravel which percolated between 10 and 15 minutes per inch. We have designed a deep trench absorption system with 7' of effective depth. The trench will be placed parallel to the slope due to the area constraints on the property. The existing trench was also placed parallel to the slope and has operated effectively for more than 15 years. We are confident the new trench w i I I also operate efficiently in this alignment. The surface of the lot slopes from south to north at shallow grades approximating 2.%. The lot also slopes from west to east at much steeper grades. The area designated for the system slopes at a rate between 8 and 10%. A flow diversion valve will be placed to connect the existing system Lot 6, Block 1, Scimitar No. 1 May 10, 1998 Page Two for possible future use. The driveway will be regraded so no portion falls over the new trench. If the system is constructed as designed the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern w i I I be maintained. Sincerely, Michael E. Anderson, P.E. Attachments I > I� I� WAN, ry � >h��ti• QP�� Well I pip �tn/1 ,,d:.^�� ., �I�, N ^,� _ •`o� / \\� !01 1 i1i\'l)tli 11 l, 2 FS ' I p 5 Gaya �% : so }o AREA MAP. / SCALE V, - 100' 155 JI / I 568at lJi.9S o I I N69•!9'00"w !67.90 I I —i027.67 30 ) - - n I I .!o I I /7 _� I i THIS PROJECT � 9'.59'00-w 266.55 ?I HI to) I bl o� SII I p • We 11 p 2 p O We 11 // e Nes ,7 v A�. ,SZW Proposed Well I > I� I� WAN, ry � >h��ti• QP�� Well I pip �tn/1 ,,d:.^�� ., �I�, N ^,� _ •`o� / \\� !01 1 i1i\'l)tli 11 l, 2 FS ' I p 5 Gaya �% : so }o AREA MAP. / SCALE V, - 100' i toE off, Wel]_ S 0 ti O�G� PARK DRIVE SITE PLA( SCALE 1" = 40' Well 0 0 Diverter valy Existing Absorptio Trench L- QRE OF WORK 1. 2. 3, 4. 5. 6, Three Ho ew 41' Long 7' Effecti bsorption T 4J 3 ov zz >, -a U ro 41 c N 14 E� -H 4J �4 U C Q O •H rooA 4 U 0 N 04 Z E� < oom Depth nch SYSTEM PLAN SCALE 1" = 20' Place Foundation Cleanout (If Necessary). Verify Integrity of Existing Tank. If Tank Cannot Be Reused Place New Tank Outside 100' Radius. Place After Tank Cleanouts and Diverter Valve. Tie In Existing System. Construct New Absorption Trench. LOT 6, BLOCK 1, SCIMITAR NO. 1 DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home Deep Trench System Perc. Rate: 13 Min./Inch Verify Existing Septic Tank Application Rate: .8 GPD/SF 7' Drainfield Rock 3 Bedrooms X 150 GPD / ..8 GPD/SF = 562.5 SF of Absorption Area 562.5 SF/14 SF/ LF of Trench = 41 LF 'french Length Therefore: Construct a Deep Absorption Trench System With One Laterals 41' in Length with 7' of Drainfield Rock Beneath the Lateral. Distribution Pipe in Trench Placed at 3.0' Below the Original Ground Surface. Flow Diverter Required to Tie in Old Trench for Possible Future Use. 3' Geotextile Fabric 4" Perforated PVC (Slots Down) TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away, Minimum 3' of Cover over Septic System. Minimum 4' Separation From Groundwater. Minimum 10' Separation From Lot Line. MunicipaUty of Anchorage 0* DEPARTMENT OF HEALTH $ HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: M[VI 4- M W tjT-U L71 N DATE LEGAL DESCRIPTION: L'T Gi �jtAmA+ Township, Range, Section: 2 0 3 0, 4 5 ' •�c 6 o' 7 .. a o 9 •d 10 1' 4 0 •o 12 6 13 U 14- 15- 16- 17 41516 17 9 1s 19 bP-1vGWAy (�rL4 QL-1, G �- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? /11/O S L 0 ® PE MWAMM?/�On/lr LU-- `[ I S �,' . U PERCOLATION RATE_ Itrunutwmcttl PC HOLE DIAMETER 7 TEST RUN BETWEEN —S;$. FT AND FT COMMENTS TSTFFQ (� / �/L6'Sp MC.t,'79 �/2.� D /L TF 7'c 5 i , PERFORMED BY: / I 1 T "�CEA71F�T FIAT -IIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE., 5[l -E PLAN X Reeding Dan Grow Time Net Time Depth to Water Not Drop rel s 9b 4tos P7,7.t r:7g 47 3 " 7S� ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL_ SPECIFICATIONS SUBJECT: LOT 6, BLOCK 1, SCIMITAR SUBDIVISION NO. 1 GENERAL: 1. The scope of this project includes the exposing a verifying for continued use the exisiting 1,000 gallon septic tank. It also includes the construction of a new 41' long by 3' wide by 7' effective depth absorption trench. The distribution piping must be placed at 2.5' below the ground surface. Direct bury insulation may be required to provide protective cover from freezing. A flow diverter valve will be required to tie in the existing absorption trench for possible future use. 2. Construction shall be in accordance with the approved site plan, 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 a I I underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. If the existing septic tank is found unsuitable for continued use a new 1,000 gallon septic tank must be procured from an approved source and installed outside the 100' protective radius from the neighboring well. Lot 6, Block 1, Scimitar No. 1 May 8, 1998 Page Two 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Flock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Lot 6, Block 1, Scimitar No. 1 May 8, 1998 Page Three 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2.662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted w i t h watertight couplings (Caulder, Fernco, or equal). Lot 6, Block 1, Scimitar No. 1 May 8, 1998 Page Four 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. 72-013 (Rev. 3/78)1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 — ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME���� �/f l/ ` PHONE ANEW 1 ��1� L��/ ❑ UPGRADE MAI LING ADDRESS /j o x LEGAL DESCRIPTION /V/ T NO . to LOCATION �^ ( NO. OF BEDROOMS — Won ell i Absoiptiarea Dwelling I DISTANCE TO: /(6i2 4- ._`- �y PERMIT NO. / % () & ,-q Manufacturer Material & kq �: � 2 5'T2. No. of compartments 2 LU E_ Liq. capacity in gallons Inside length Width ©a IF HOMEMADE: ,�, �-.-- Liquid depth --�--- O z DISTANCE TO: Well Dwelling PERMIT NO. Q O Z Manufacturer Material T�F Liquid capacity in gallons DISTANCE TO: Well / Y� / 17 ,.,, Foundation p /*, Nearest lot line l� ¢ PERMIT NO. _ / /�/v ��6( t zNo. w of lines Length of each line /� Lf/ Total length o lint's Trench width f" �% inches Distance betwe lines / N Fes-- Top of tile to finish grade Material beneath tile � Total effectiveab1sor h area inches '5 211 Length Width Depth PERMIT NO. �u C7 Q F Type of crib Crib diameter Crib depth Total effective absorption area LU w w Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot lineEAbsorption IT NO. r < ✓�- W � DISTANCE TO: Building foundation Sewer line Septic tank area(s) OTHER PIPE_ MATERIALS SOIL TEST RATING INS'iALLIER S ✓Iii/G- ��r_'f%V. 2�� � -� REMARKS �i -�•lti f n� J p _ ^Robert A. 110fer c Stf`+•h� � No. 14 57-L ,� fir. �F "• I r f' AVOV DATE feC---� r7LEGAL Ietl 72-013 (Rev. 3/78)1 tl RJ t -A 1: s T: C-1 L._ I -T- N-" RD I"' 9==1 I" -"I C_- & -•o _.Q ip' E=1 M.. -.i EES" 1 DEPARTMEkIT HEAL-TH AND EhIlVIRONMENdTAL. „d("iTEC:TIONd 825 L ` _STREET � AN C-HORACAE, Ak::. 99501 1:L / I -°-I I I_... L__ F9 II° -.I f -a RD :IC -..N... PERMIT NO. 821106 ) APPLIC:Ar•dT MYERS CCit•.IST P:; BC1;>.; :51 C:III_I1; :[AI:: '-r."i!-6-7 6:a4-:1,414 LOC:AT I ON LE13FIL L681 SOI M I TAR �' ` LOT SIZE :_+'_ 99:-1.9 SQUARE FEET r TYPE: OF .:OIL_ ABSORPTIONd SYSTEM IS: TRENdC:FI IvIAX I r'1UM N UME'sER OF BEDROOMS _ SOIL. RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SY'':TEM I S : IF. -a EE F::" -IF"—; :._ �Jl_ L.._ U_ I° -°I ern _F I -I = r 7- a_:® F,' f -i "°°°a F_- L_ I' -a E- F=° -I- F --I THE LENGTH H D111EN S I C;rd IS THE LENGTFI (It -1 FEET) OF' THE TF:Eh•,IC*I OR DDA I hIF I E Ll". THE DEPTH OF H TRF_tdC:H OR. PIT' IS THE DISTANC:E: BETWEEN THE SI_RFACIE OF' THE GROLINL) AND THE BOTTOM OF THE E;,-MAVATIOIl i' IN FEET'). THERE IS NO SET WIDTH FOR 'TRENCHES. THE GR.AVE:.L DEPTH IS THE MINIMUM DEPTH OF GRAVEL.. BETWEEN THE Cil_ITf=AL-L.. PIPE AND THE BOTTOM OF THE EXOff wr I ONd (IN FEET). Fes' Ea: n_-! U T I::' E__ E--- a" F_ IF:" '-" I f_- - -1'" F -i P -a P-_- =::I -;' E--- =: ft 10 a = a cz-1 9--H- F=l L.__ I...._ Ce 8 ,•@ °= ; PER11 T'T APPLICANT HAS THE RES•PON S I B I1....7. TY TO INFORM TrF E S C?EPAR.TrIENdT D1_IF.::E -413 'THE I hISTAL.LAT I ONd I NdSPEU I ONdS OF ANY kIELLS ADJACENT TO THIS PROPERTY AND THE NaUVIBER OF RES I GENC:ES THAT THE WELL- W I I._L 'SERVE. �. -- _r R °..I w_'w a=: _2 I I° -°I -. F=" I-- 1=-_- -r 1: 110 h -°I'_" r=l FR' IFd:' Ems:: a= e U0 :L BACKFILLING OF' ANY 6 SYSTEM WITHOUT FINAE_ INSPECTION AND APPROVAL. BY THIS DEPARTMENT WILL BE S I_ BJEE::T TO PROSECUTION. MINIMUM D I STANCE BETI...IEENd A WELL i'It'dD ANY Ord ... SITE SEWAGE DISPOSAL SYSTEM :I: lC10 FEET FOR A PRI'V'ATE 14EL.L. OR 150 TCI 200 FEET FROM A E='i_BL.IC' WELL. DEPEI%IDING UPON THE TYPE OF PUBLIC: WELL... MINIMUM f,I_:TANJC:E FROM H PRIVATE WELL TO A PRIVATE SEWER I...INdE I'S 25 FEET AND TO i A COMMUNITY SEWER UNE I'_; 75 FEET. I. -JELL I._Cn3'S ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 2-:0 I)h-I''rS OF THE WEL.L C:OMPL.ETIONd. OTHER RE1-UIREIIENdTS MAY APDL','. SPEC: IFI1_:ATIONS AND C,.ONdSTRUC,TIONd ClIAGRAMS ARE AVAII_FIBLE TO IN•IS_IRE PROPER IN,:::TAE_LATIONd. F=" E:; I-°--' 8 °'1 T<: '-I- E=_:--. IF-" I IF°' 0`:_ E, F -a E-: dZ�' F_= M Ew E: F"'-' 1 = :..I_'_:4 m I CERTIFY THAT 1: I All FAMILIAR WITH THE REQUIREMENTS FOR ON -•_-;ITE : -'EWER:_ At -11) IdELL:_. AS SE"T. FORTH BY THE MUNI Cl F'AL I TY OF ANCHORAGE. I W I LI... INSTALL STALL THE SYS.TEM IN AC:1m ORDAN GE WITH THE CODEC.. _ : I i,ltdC:ERSTANdC: TI IFIT THE C1ta SITE SEI.IEF: 'wY=TE:M MAY REQUIRE ENLAROEffIEr••IT IF THC-: RESIDENCE I' f;:Erq(jDE:l_.ED TO INCLUDE MORE THAN = BEDROOMS. SIGNED APPLIC.ANdT f ISSUED E;Ye_��� V„ 1.. 0 O SOILS LOG MUNICIPALITY OF ANCHORAGE ..■` DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 \ _ SOILS LOG - PERCOLATION TEST PERFORMED FOR: �� \.-�-�1�5 �� DATE PERFORMED:, f✓��" LEGAL DESCRIPTION: 4 6-� -� C'� ✓ % /-)- A SLOPE SITE PLANA D E �7rL.� •� l �� I I __ _A 1 2 3 e 4 5 6 7 8 9 ;10�) fir.. �.. r'r `�•I��� o �- (J (�rav �;. L_ 10 MIMI Gross is fCt " Net 1 0 0 0 Time Time t3 Drop 12 13 14 15 F+ v ooae 00 17 I' i 18 19- 1h5j-l: 20-1 COMME 10 MIMI Gross is 011 Nis NJ Net 1 0 0 0 Time Time Water Drop 55 WAS GROUND WATER_ �A /C) L ENCOUNTERED? �Y 0 �r P E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop I' i PERCOLATION RATE —(minutes/inch) TEST RUN BETWEEN - FT AND FT PERFORMED BY:CERTIFIED BLY:. e ��- DATE - !f 72-008 (6/791 - - 15j June 14, 1991 C)epf. tie_ai;ii u f-�i.n-nan 5er��;ces Laura Montgomery MOA, DHHS On -Site Services P.O. Box 1966650 Anchorage, AIC 99519 Dear Laura: Enclosed is a copy of my well report for Lot 6, Block I, Scimitar Unit #1 per our conversation June 12th. If you have any questions please call me at 745-•0135 or 688-6080. Sincerely, Catherine Bennett rSTATE' 'OF ALAS'c.: - r` 4 _AETVRM TO0lvlslon of Geol oy lcal and Geophyslcll Surveys (DGGS) 7 - DEPARTMENT OF HATUML RESOUKCES l'sn'��sr ; %]� _ .a- i >• a 3001 Poreupina Drive (Telephone: 77-6615) �4 -.�-/tai'+ ^dr F�.. Anchorage, Alaslu °9501 pp �'ti'se7rJ a. �s2�.:Fg7nYi"i+ c•r V 0 E P T E 0. V E L C R D 2l.�+�t iy,� }yell LAS �p*44 f t r+ .. U.S.G.S, Local No- cn+Vfa, �' Lb}'• kl T`l8 TlUf3on DriJ_lin."'. Drilling Permit No. Dr�ll lnp Coapan)kNaara, 4 h'dvn r M t A.D.L. No.... :..y,cYs; Rtt.sr®T�`$�tr,• '4yE P LOCATION`OF LLcj Plaase complete either la, It, or Ic. y b - --Township Range Meridien•' f-.p la oBDrougha `s j Subd Ivision Lot B1ocR 16. Fraction I Section ho. .-`� i s ✓i' �jl. -:. s H/S�lt r a .Itinch?�" ctar t sr'Ms�S vy 3. OWNER OF WELL: ,r'iX�a PaUl Myer. les lc sDlStance. g roetibn fron Road Intersections r i 2p 16� 1,r - Address: .Pa G.BOX 371 3. a Chugiakf Ak. �ils i Y r� Streets Address and Area of Well Location tiA { Feet Bela.+ 4. WELL DEPTH: (eompl etad) Surfaea Elevatl ��� ��� � 2 HELL L00. - s�- Surface 1::.` ft. tis t{ Bot Eam , '•`s.s Material Type Top f p }s�t's{F,' 40 ay f - etc -D�i"1'. .Olid Cobbles r 10 5. []Cable tool_ x' Rotary ❑Driva_f l�'f;yr,Bry' gravel :C �� ❑Auger ❑Jetted Bored 1' pL.Mr •r""r'4� •ru,r-��"'_us 1 .boulders 1 c ? - C 7 WE, ,lu, 4 +Mry I 6. USE: ❑Dourest lc ❑ Public lc Suppl yYs� � ,'Z73f j`5e b4ulde� rin e` rt trr. ' 11 irrigation ❑Reeha rgevy"�ttmafC ��'. boulders c x J- B3 -b0111C -.ir6 []Test Well ❑other - T'`,{'x ' a,Rwi p - _ 4 3 "lSI'Ave1 with oculdf'r:' ��= i�c : su "ski r+.- 7. CASING: ®Threaded �1lelded '�_`vaf''F`�s�ri.�{'T��' in. to ���—ft:i DePch We lghtl""i bflr4 - in. to ft. 0 Pth v ,'yip r* A`"R•, rtit .. { T— 8, F I H I SH OF WELL: i r r^ Type: � .",n 11010 Diameter f SIoE/Mesh Size: Length ..a' "y�.h� Q fv ? _-.^< ;.ra•— - ( Sat betwaen _ ft. and t y +'_ Fittings: STATIC WATER LEVEL �yy 'jt 9. Iidl{'t i� r +"Yi:a`" hDtr -r '•(]eCJI• i-� 'iu ' ❑ Above. �Belox..l�nd surfa`0 } - R y't i k r"5 s2ay 9 ` r n: Type of Measurement: 10. PUMPING LEVEL below land surface ft. after - ,hrs. pump rip as r' —mss. 1 r ft. after _ hrs. pump n _ �rj.`.i'f!!}► �f' IL WELL HEAD COMPLETION: ❑ In Appre P vt _. ❑Pl tl ess Adapter in half - I 12. GROUTING: Wall Grou.ed:. ❑ yes ;y08 � ra. Material: ❑Heat Cement-- -❑ Othef'i ZUT 13. PUMP: (If available) HP - s Length of Drop Pipe _ ft. capacity" s2aMr�9aa1 ))1 f I - Type: ❑Submersible ❑Rae proUL(nQ�'yq r Jet ❑Other: 14. REMARKS: P tested't 5 6PMs� *' Water Temperature: � `- � {u tA c. 15, WATER.VELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdiction and this report is :run to the best of my knowledge and belief: .!`'t,^��; .'lJy-j,• cl , a l iaPnuson bJ„ � r Registered Bus mess Name Contract License Numoer a t i. Address: ?.C. Boa: ' Signed: :.ai. r r ati;t Yom' thorized Rapresentat,ve r �. Q•� Rick Mystrom, Mayor Municipality of Anchorage u, Department of Health and Human Services t 625 1" Street 1 P.O. Box 196650 Anchorage, Alaska 99519-6650 November 6, 1994 S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, AK 99,577 Subject: Waiver Request for: Lot 6, Block 1, Scimitar Subdivision #1 Waiver Approval: # WR940060 Dear Mr. Cowan: Your application for waiver(s) from the required separation distances is approved as follows: Well to Tank 90 feet This waiver approval applies to the existing septic system only. Any future upgrades will require all separation distances be met or another approval be obtained from this department. Sincere) Robert W. Robinson Civil Engineer On-site Services 207 MUNICIPALITY OF ANCHORAGL Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR940060 PID# 051-132-03 HA# NA Permit # NA Date Received: 11/8/94 Legal Description: .Lt 61 Blk 1, Scimitar Subdivision #1 Engineer: S & S Engineering _ 17034 Eagle River Loop Road, Suite 204 Eagle River, AK 99577 Applicant: S & S Engineering Waiver Requested: _ Request 90' waiver between septic tank on Lot 6 to well on Lot 5. _ Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for. above: Date: ame of Reviewer Rec #: 00479 (7744) Amount: $ 625.00 Date Paid: 11/8/94 s&S� �rn��RinC HEALTH AUTHORITY APPROVALS SEWER& WATER MAIN EXTENSIONS SEWER& WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN November. 1, 1994 MUNICIPALITY OF ANCHORAGE Department o{ Heat th and Human SeAviees P.O. Pox 196610 Anchorage, AK 99519 REFERENCE: Lot 5; Bloch. 1; Scimitar Subdivision #1 Request you grant a wa.iveA Uor between .the septic tank on Lot 6; serving this property at 90 Ut. ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. the hor,izontat separation di,6tanee Bto ck 1; S c m,i tar 171 and the we P 2 A risk analysis was pe)t6mmed using the State o6 Ata,6ka, Department o6 Enviunmenta2 Conservation's sepakat.i.on di-6tanee waiver gu,idetinn. Our resu,P s are as �oP,2ows: A. WATER TABLE From the weU tog we can see that the weft depth iz 172 Deet. From the Heatth Authority Approvat pe 6ormed by David R. Dayton, P.E. on 8/30/94 we see the static water Levet to be 162 Ut. Using 162 6t. as the aqui6en wateA tabte: =7.4 pts. B. SOIL SORPTION: From the soils .Log used .in the design oU the septic system the neceiv.ing 6oia 6or the septic system ane sUAy sandy gravel. From the wW tog there appears to be hard pan at 50 Ut. and clay at 120-125 Ut. =2.5 pts. C. PERMEABILITY: With the soils as desc)Libed above use I's.i ety gravet with stay" =2.0 pts. D. WATER TABLE GRADIENT: with the static water Levet .in the weU at 162 6t. and with the wet approximatety 10 st. up kitt Urom the septic tank the hydrautic gradient tis toward,5 the wee. =o.o pts. E. HORIZONTAL SEPARATION: The horizontat separation distance between the septic tank and the weU .is at 90 4t. =2.6 pts TOTAL POINTS = 14.5 PTS. .. C• (-171N i`( (J ` 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 CIVIL ENGINEERS (907)694-2979 T FAX (907) 694-1211 AI 0 r � > Q J w 7 V Q � C71) lL yam' a LU J zC' e 0. 1 LIU z q � PL W the hor,izontat separation di,6tanee Bto ck 1; S c m,i tar 171 and the we P 2 A risk analysis was pe)t6mmed using the State o6 Ata,6ka, Department o6 Enviunmenta2 Conservation's sepakat.i.on di-6tanee waiver gu,idetinn. Our resu,P s are as �oP,2ows: A. WATER TABLE From the weU tog we can see that the weft depth iz 172 Deet. From the Heatth Authority Approvat pe 6ormed by David R. Dayton, P.E. on 8/30/94 we see the static water Levet to be 162 Ut. Using 162 6t. as the aqui6en wateA tabte: =7.4 pts. B. SOIL SORPTION: From the soils .Log used .in the design oU the septic system the neceiv.ing 6oia 6or the septic system ane sUAy sandy gravel. From the wW tog there appears to be hard pan at 50 Ut. and clay at 120-125 Ut. =2.5 pts. C. PERMEABILITY: With the soils as desc)Libed above use I's.i ety gravet with stay" =2.0 pts. D. WATER TABLE GRADIENT: with the static water Levet .in the weU at 162 6t. and with the wet approximatety 10 st. up kitt Urom the septic tank the hydrautic gradient tis toward,5 the wee. =o.o pts. E. HORIZONTAL SEPARATION: The horizontat separation distance between the septic tank and the weU .is at 90 4t. =2.6 pts TOTAL POINTS = 14.5 PTS. .. C• (-171N i`( (J ` 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 5; Bloch. 1; Sci.mitah Subdivision 01 November 1, 1994 Since the septic tank does not nonmatty allow e44tuent to reach the soitz pn.ion to peach i.ng the absorption axea, the pkobabi.P-i.ty oU contaminating the so.iP6 at Tess than 100 Ut. .to .the weU .is mitigated by the s.teet tank. In going Unom the well to the septic .tank the ground Stopes away Unom the we -U. In ouA opinion, the sepahation distance kequ-inements pnuen.tbed by 18AAC.021 is not neeessaky ,in this case. 15 we may be o 6unthe4 seu ice pte" e contact us. S.incen y, ER A. HAFER, P.E. RAS qk LUSURE \/ - . \x- \ .. } LLI / \ -- »66�_ . � 3 ~ e 7 ®O \ \ § � - / 23 /_ ®/ x u �/ )3P ~ 0 7} e»/ ® e, may« / }/\- c U< �(//w» w » 0\//Ko' j 2 of V) � e& o / 2z-i 3 w LL, w / \CD 26 \®EE \®o3c \��§�w�- �« 3 m }°)\\((j ® `ez� 2 = y*yzg»/% a °S s o �? w@§\ / /2 \ / V) V) _ e 2 7 < \ r 7 0 3 2 ®z w Z -j 0 �� u 3 c vc © � \#§ § ) ~ Ax\ # m_ � f ¥ TIVa NV� d :ts 0s = J u M _W DRILLING, P, O. Box 4.1224 4 1310C Internati (907) 274.4611 ANCHORAGE, ALASKA Post -1, grand fax transn;ittal memo 7671 a o! pages / To From . —5111 Phone 16 - --'-- Fax h � _E z l Fax d 5 _ 7 r� _TO DRILLING LOG 7 hr's /s v_ � T ZZ C2�-" /W r?k',/ /'t •C 0 , i , se of WeIL-LI .m Location (address of: Township, Flange, Section, if known; or distance main road—_...-.--.------------ - <, meek Size of casing -6 --Depth of bole_____ _5 "feet Cased to_17__C�___feet Static water level.—ILA--ft, (Rbo(below) land surface. Finish of well (check one) open end { x � — v* ); Screen ( ) ; Perforated ( ) Describe screen or 1nG -ft?, Well pumping test at__?_.__gallons per (hour) (minute) for -----hours witla�--- of drawdown from static level. 25 dticov_ 74 Date of completion__ --- - WELL LOG - Depth in feet from ground surface .5 ._TO._"— 16 - 507 5T0 7 5 _ 7 r� _TO E� — 102 TO 107 107 TO— 11-0_ 1.2r -- -12.Q_T0.__. L25 - __12r, TO_- -j27 --122_`1'0---._12 _.1''nn TO --_1211L ).P' 0 IL70_T0--..-..--. Give details of formation -s penetrated, size of material. color and hardness Sandi wet l i yli t 1 y Silty vrayr l Haps- cobhl), Boulder Gravelly I�-- _'Ar11 111 % OASE (-,ravel-- V Graven Hard ant Cabbl-y �_.__ �. C;ravell�' Fl�rr n n: i C r i\ V E' r'1 t E? - �— -- 3 — CONTRACTO Municipality of Anchorage o,wJ,.� DEPARTMENT OF HEALTH fig HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650JL ,011.8 LOG, PERCOLATION Tt� d' ��a.ry", �1IN ° •oa coa>o Ze PERI-ORMED FOR:_"-- -�� ��-__`�-�� ' -���____.___ __ DATE PERFORMED:" . fir' 7ownshi Range, Section: ! c'- 1 �_,�- LEGAI_ DESCRIPTION:.1,G:?__L. �_":- lr�-��-�-- ------ �� ---g----�-- 1 a T --t ���� I--.:.�t��-"_�) -9 SLOPE SITE PLAN 1 � � 2 - 101 3 4- l 7(®rl � CL 6 J 6/ i� 7 .✓ ti{n a / 9`/I✓ 12 -ewe 13 fa 14 -� 17 18- .19- 20- COMMENTS 8-.1920COMMENTS WAS GROUND WAT ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to WaterFill Q ') Monilorif Data RearlimDate Oji Gross Net lime Depth to Water Not Drop fiTl�, _~ I u� Depth to WaterFill Q ') Monilorif Data RearlimDate Gross Net lime Depth to Water Not Drop _Time _~ I II PERCOLATION RATE It(2— (rn nute,'n,ch) PE:RC HOLE DIAMETER TESL RUN BL-TWEEN _ __, -' �F I AMD -IL- FT PERFORMED 6Y: j7c)3,s teaulo River Loop WNW No. 20. ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEI_I 72-008 (Rev. 4/85) I- CERTIFYI A"f Trits T WAS PERFORMED IN EFFECI ON 1 HIS DATE. DATE: MUNICIPALITY OF ANCHORAGE I�tA • 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 HAA # Parcel l.D.# I'F2'40 - T 1. GENERAL INFORMATION Lot 6; Block 1; scimitar subdivision Unit #1 Complete legal description Location (site address or directions) 20314 Chugach Park Drive, Chugiak, Alaska Property owner John ,lav and Catherine Bennett Day phone 745--0135 Mailing address HC 79 Box 4499, Chugiak, Alaska 99567 Lending agency City Mortgage Day phone Anchorage, Alaska Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 `-- 3. TYPE OF WATER SUPPLY: Individual well xxx Community 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 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. 72-025 Rev. 1/91) Front MOA N21 5. 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 furtherverify 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 Phone Jwa-f t Address 111024 Eagle River Loop Road jV Engineer's signature 6. DHHS SIGNATURE Approved for /bedrooms. Disapproved. Conditional approval for Additional Comments Date � 1 ••r YCYpo v�'� � �I aoanon�" rA �, Rb ii L4YffY 9 14 i �• .�J 1.1 it , af.:)� •'* .:nom bedrooms, with the following stipulations: Date �� �— �Z The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91( Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: � L, �'A-+L \ �c v-NkrPV'6 Parcel LD A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number f�� Log present (SN) Date completed 10 U" 8Z Driller HA L-'i4uS0r1 DZ -i r -t -r ^I U Total depth 1 VI Cased to 1 U 2. Casing height \7 Sanitary seal &N) Date of test Static water level Well flow Pump level Wires properly protected (SeYN) FROM WELL LOG ern- LP -132- 0 5-C, g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot toc 1" Absorption field on lot lQc' ; On adjacent lots — —I �2o'X Public sewer main I °- Public sewer manhole/cleanout t3 Ip� Public sewer service line 1-1 IAC Petroleum tank t3 IA WATER SAMPLE RESULTS: GaL r Coliform (S2r /100 M�^ Nitrate 3•� M� � Other bacteria e' " I3 `� 1 Collected b Date of sample: y: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed 0 �Z Tank size loco Compartments 2 Cleanouts &N) Foundation cleanout/N) Depression (Ya High water alarm (YO �y Alarm tested (Y/N) _ �/A Date of pumping L-- ( 3 -5 ( .72. Lr'-5SPvu � PL) wl'-7r/(? SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 1 On adjacent lots l ��r t Foundation tpr To property line 6 —Absorption field 5 i� Water main/service line 101 4 -- Surface water/drainage _ 1 ab '' 72-026 (Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE AT INSPECTION z � c (v -ICA -`11 M `7 z r M I 45' 6\ g.p.n<Lo n ,r J V_ O Z On adjacent lots too Absorption field on lot lQc' ; On adjacent lots — —I �2o'X Public sewer main I °- Public sewer manhole/cleanout t3 Ip� Public sewer service line 1-1 IAC Petroleum tank t3 IA WATER SAMPLE RESULTS: GaL r Coliform (S2r /100 M�^ Nitrate 3•� M� � Other bacteria e' " I3 `� 1 Collected b Date of sample: y: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed 0 �Z Tank size loco Compartments 2 Cleanouts &N) Foundation cleanout/N) Depression (Ya High water alarm (YO �y Alarm tested (Y/N) _ �/A Date of pumping L-- ( 3 -5 ( .72. Lr'-5SPvu � PL) wl'-7r/(? SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 1 On adjacent lots l ��r t Foundation tpr To property line 6 —Absorption field 5 i� Water main/service line 101 4 -- Surface water/drainage _ 1 ab '' 72-026 (Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N)_ High water alarm level Manufacturer Manhole/Access (Y/N) "Pump on" level at _ / "Pump off' level at Meets MOA =STANCE _ SEPARATIOLIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Surface water Date installed i0'Soil rating )`��g� System type _'CV29AL-A — Length Width �1 Gravel thickness —Total depth ) r Total absorption area Cleanouts present dYN) —� Depression over field (YO Date of adequacy test I. _L1 - i ) — Results as ail) Ppm for -rPee"'r, 3) bedrooms Peroxide treatment (past 12 months) (Y& I)P- If yes, give date \ ._ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1 p�> 14 - To a..To building foundation — 1 t-1 On adjacent lots On adjacent lots \ .�_ Property line G5 I -k M Ir�-;P• 1�0?oK'r To existing or abandoned system on lot ti Cutbank °'}I,4, —Water main/service line --l_a` Surface water lc>n Driv way, parking/vehicle-storage area a� Curtain drain � � E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in S & S E NGINEI RING Signature 17034 River R.eola Road N9, ;04 F,aglo River, Alaska 99577 Engineer's Name Date 6 this inspection. HAA Fee $ 4_,7 Date of Payment �S ^ -W Receipt Number � Y 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number Time eAPPLIC JT PILLS OUT UPPER HAL 7NLY Property Owner Myers Construction, inc. Phone Mailing Address 9ZipCode gg577 694 96 Fac-1pRiver . John J., & Catherine M. Bennett Address 2131 Tudor lulls Court Zip Code 99504 Lending Institution First Federal Savings & Loan Phone Address 813 West Northern Lights Blvd.274 Zip Code -6565 Realty Co. & Agent Commonwealth Totem Realty, lnc.Phone (�'im Montague) Inspector Address PO BOX 911, Eagle River, AK Zip Code Inspector X99577 4 Legal Description Lot 6, Block 1, Scimitar #1 Street Location NHN Pionard Drive Type of Residence 0 fk Single Family U Multiple Family ❑ Other No. of Bedrooms ,3 Water Supply (K Individual LJ Community ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Public Utility ( AP�J3OVED - ' For wells drilled prior to that date, give well depth (attach log if available). Sewer Disposal ( ) DISAPPROVED Individual ❑ Public Utility Year Individual Installed: _ JIM ❑ Holding Tank When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: 0 /) / U A -f. f.a G C'/' ( AP�J3OVED - ' ` 'CONDITIONS OF APPROVAL ( ) DISAPPROVED _ L (✓ CONDITIONAL APPROVAL' DATE I'— " Sr- 3— BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size ]2023 (3k --