HomeMy WebLinkAboutFOSTERS LT 62AFosters
Lot 62A
#051-282-43
Municipality of Anchorage Page I of 2
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: 5\A1%0193 PID Number: o51 -282 -o9
"°m°
DALE FOSTER
Wastewater System: 9 N ❑ rade
Y New Upgrade
swip0cli
Address. Be 7?2 A6Lt Rt.re1L A �
ABSORPTION FIELD
Phone: No. of Bedrooms:
6144 -41158
Deep Trench )((hallow Trenc ❑ sed ❑ Mound E3 Other
LEGAL DESCRIPTION
Soil Rating:
1 • %Z GPD/S Ft
Total Depth from original grade:
S
Lot: 62 Block: _ Subdivision:
Depth to pipe bottom h'm original grade:
Gravel depth penes Ih pipe
aI Ft
Ft.
Township:�l
Range: RZ W
Section: Z5
Fill added above original grade:
Gravel length: 50 e
O- 0.5e Ft
Ft
IR
WELL O Upgrade
Gravel width: r
52
Number of lines:
t
DatanctE=ween fres:
Ft
Ft.
Classification (Private. A.B.C):
(>A
Total Depth:
Cased To:
Te
Total absorption area:
Pipe material:
\DATE
i3O' Ft.
soai
500 O Ft.
ASTM O• 34
Driller. �
6Va.L/JA/.1 1/JA k1uLs
Date Dad:
-7r),,,,
Static water Level.
2Z Ft.
Installer.
'ia1Ee.0 E'LG.
Date Installed:
- -23-9 G
yield:Pump
I
set al: casing Height Above Ground:
al':
-act"+
TANK
GPM
Ft. Ft.
SEPARATION
DISTANCES
Septic ❑Holding 0S.T.E.P.
To
septic
Absorption
Lift
Hdding
Public/Private
Manufacturer.
Capacity In gallons:
From
Tank
Field
station
Tank
Saver Lina
ac ORAfaC TikA
%7_ p
weir
100`+
too `
--
—
25 ` +
Material:
STeEL.
Number of Compartments:
;It
watCB
Water
too'•1
t
too+-
—
—
--
LIFT STATION
Lot
Line
e
/
--
Size in gallons:
Manufacturer.
Foundation
•
$
\
23
�.
•�.
�
" Pump on" level at:
*Pump el at:
High water alarm at:
g
Curtain
NONEpyJ
Pump Makes
Electrical Inspections performed by:
Drain
Remarks: l"r.2m.7ma WCLL Le cAr/eN
BENCH MARK
kv R 1 D/t / L L C O A.
t./ E v l A-rsinli
D Ldr nR.y
Location and Descriptio 1 M F Se Or
60 fit
No Lf A- MA tiC at W 4 . OR ICLdO
Pa lar
A • n w n A n R y N Lf 3R° wrL LL
Assumed Elevation:
►QD:O
Fo.+rA AofQ..R1f L..RaKvt reRaAvai/d AJ.
E 0 A(
t '•.9
X
A
Inspections performed by: S 8L S ENGINEERING Daates:1st 7-22-alL
�" ...
f
Eagle River p oe o. 2.4
a 95 J 2nd 7 -23-1L
Department of H and Ices approve
: -
` *. ........... .»..
Tr" \ ROBERT C. COWAN
'+ce.esoiReviewed
J61tivor,illi
m
and approved b Date
��..
72-00 In..",)Mv^z* t/
Permit No.
SW960193
Page 2 of
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:
LOT 62, SEC. 25, T15N, R2W
05128209
PID No.:
72-010 A 04".891) MOA 25
10
WELL RADIUS
NE LL
A
C
ALT. SITE
14.0'
22.5'
20.0'
27.5'
NEW
TR C
3
22.0'
J2DL
29.5'
22.5'
30.0'
w
>
26.5' 4
.0' —
roe
1 1TPA1
1
CC
2 70.5' 6
2 68.5' 6
.5' —
j
i
M
I I
I
I
II 11
1 I 1
I I I
1
1
(�
ML1
LU I
1
A
BEDROOM
BBL
Bell
c
NEW
1250 GAL.
N
SEP
IC TANK_/
FCO
SCALE
- 40'
5-8-97
UTI
11•rz
= 09 0'
STI
STM
fl 98
8'
FiNM
INS
TIONNEW
WS
,
95.2' 1250
CAL 95.0'f7,wd
494.7*
,t�S.T.
; �C01
ROBERT C. COWANCE•8801IrrlIi
r2
—
NO WAT1
FOUND
84.5'
C.H.
,E.w ED S'/IS/q7
72-010 A 04".891) MOA 25
AT
by
talc CO. "'
SULLIVAN WATER WELLS
P.O. BOX 670272,CHUOIAK,ALASKA 99567 • TELEPHONE 688-2759
n
OWNER OF LAND!)t
Il) �- G
i C i,= ti
UEl'iH OFWELL
/
li t:)
ADDRESS
From Ft. to_�_Ft.
-j
LEVEL OF
WATER FI.
LEGAL DESCRIPTION
77
7 'T L-) K • 1 a.t) }^.�
_STATIC
S 11t '1 V t
DRAW DOWN FT.
From
DATE -Started
Ended
���
GALS. PER IIR
/•.Kii JC�t-
PERMIT NUMBER
to
Ft
KIND OF CASI\C.
rr
From
F1. to
FI
From Ft. '-/)
KIND OF FORMATION:
From t1 FI.to.) FL
(•/ISr OC,
S r.1c, d
From
Ft. to
Ft.
From Ft. to_�_Ft.
-j
Front
Ft. to
Ft.
FromFl. to—LL—Ft.
From
F1. to
F1.
From�Ft. to �,,> Ft.
/- 7`? r ;
/•.Kii JC�t-
Froin—Ft.
to
Ft
From i!) Ft. to FL
: -QV,_)
From
F1. to
FI
From Ft. '-/)
A:*, )F !•
%-),?_From
to Ft.
..:e
F1. to
Ft.
From4LFI. to—LLL—Ft.
= i s : f A
Froty
Ft. to
FI.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft
From
Fl. to
Ft.
From Ft. to Fl.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to) Ft.
'
4.Fro.{nt:lo "v
.
Ft. )
t,4.
r
t
From—Ft. Ft. to F1.
From
F1. to
Ft.
From Ft. to Ft.
From
F1. to
Ft.
From Ft. to Ft.
From
Fl. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
FI
MISCL. INFORMATION:
3o I V)/-4
G " C,-jFiAjV
DRILLERS NAME /, ..-A / '• `"'�
& S1 ROBERT C.COWAN, PE.
!TeIZING ROBERTA.SHAFER P.E.
Date: 7-211 -1(.
CML ENGINEERS
(907)694.2979
FAX (907) 694-1211
HEALTHASITHOR TY
APPROVALS
Municipality of Anchorage
SEWERIWATER
DEPARTMENT OF HEALTH AND HUMAN SERVICES
WIHIXTENSKM
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
SEWERS WATER
MPECT04
REFERENCE: L. -f GZ .5re_ Z5�-ri,;14 S A7-Lj
MWERNCSTLOES
00 REPORTS
The septic inspections for the referenced property were
performed on -7-2%-9c and -7-23-% . Prior to submitting
the On-site Wastewater Disposal System and/or Well Inspection
WELLNSPECNON
Report we are waiting for the Fo„aoArwo*) to be
SRdW TEST
completed.
If we may be of further service please contact us.
SITEPIAHS
Sincerely,
ROAOCEMN
Robert C. Cowan, P.E.
SOCTEST
-
PERCCEATION
TEST
STRUCTURALS
MECK."C&
NSPECTgH5
CNSITE
WASTEWATER
06PCSALSYSTEM
DESIC"
1
17014 W)ATH FArI F RIVFR 1 M)P • SI IITF?04 • FArl F RIVFn At AIVA nn,77
��e#ifi�e 4riiiinag i[np
Mc CO. ODa
SULLIVAN WATER WELLS
P.O. BOX 870272, CHUGIAK, ALASKA 98587 • TELEPHONE 8882759
KIND OF FORMATION:
From Ft. to Ft. C,4 S i,JC. Vit, Cr_. r
From -' Ft. to_�__Ft. n c 1 h.0 l5 112,17=.-1
FromFt. to—L,5-
Ft. 71-1a4 i (?A!I1J-L
From s Ft. to Ft. 't q,u A
From cola Ft. to_L"Ft. �t71%?11)C-e
From
Ft.
From_
/
/OWNER OF LAND ��A� =
0,n� # S C
FS C � _/�
DEPTII OF WELL
ADDRESS
F%:
LEVEL OF WATER FF.
DESCRIPTION I /
�� J S -)S
f_Jt `I
(STATIC
o7
LEGAL
1 )RAW DOWN FT.
DATE -Started
Ended77/
�>
GALS. PER HR
PERMIT NUMBER
KIND OF CASINO.
KIND OF FORMATION:
From Ft. to Ft. C,4 S i,JC. Vit, Cr_. r
From -' Ft. to_�__Ft. n c 1 h.0 l5 112,17=.-1
FromFt. to—L,5-
Ft. 71-1a4 i (?A!I1J-L
From s Ft. to Ft. 't q,u A
From cola Ft. to_L"Ft. �t71%?11)C-e
From
Ft.
From_
Ft.
From
Ft.
From
Ft.
From
F%:
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
LJFn i Ft. 1,,—Fl,
From FI. to Ft
From Ft. to Ft.
From Ft. to, ,Ft.
tt ! �
From Ft. to Ft.
From Ft.
From Ft.
From Ft. to Ft.
From Ft. to Ft
MISCL. INFORMATION:
From Ft. to Ft.
From
—Ft `Ft.
From Ft. to Ft.
From Ft. to
From Ft. to
From Ft. to—
From—Ft.
o
From Ft. to
DRILLER'S NAME " �—
Tntifirb Drilling i[aag
by
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 870272, CHUGIAK, ALASKA 99587 • TELEPHONE 8882759
r
OWNER OF LAND J41,FoST•=/r DEPTH OF WELL V
ADDRESS STATIC LEVEL OF WATER Fr
LEGAL DESCRIPTION/5-111 t .l D,7' /tl t `1i 4 7 DRAW DOWN FT.
DATE • Started Ended 1� GALS. PER HR
PERMIT NUMBER
KIND OF FORMATION:
From n Ft. to 7 Ft.
From �I Ft. toy Ft. i1 .J ,� Rd EnJ
From Ft. to 1,P Ft. 114•-0 t /411 ✓=
From Ft. to4_Ft. C L #4 (,,-1 r4 j c L
From 2 Ft. tohl-1 Ft. '61 O,z �j e. L
From
Ft.
From_
Ft.
From
Ft.
From
Ft.
From
Ft.
(� //
KIND OF CASING
From Ft.
to
Ft.
From Ft.
to
Ft.
From Ft.
to
Ft.
From Ft.
to
Ft
From Ft.
to
Ft
_ From ¢\�Ff�tu Ft.
rom Ft. to Ft.
L�
From
Ft. to
Ft.
From
Ft. to
Ft.
r �
From
Ft. to
Ft.
From
Ft. to
Ft. '
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From Ft. to Ft.
• From .i Ft.�o�_Ft.
y
From Ft. to Ft.
From Ft. to Ft.
From Ft.
From Ft. to Ft.
From Ft. to Ft.
MISC .INFORMATION/
DRILLER'SNAME
6-21 -C/,:Y-
Lrf
�5A1; A2 it)- ,5
Ctj� WC6L&L.�)
Stu c�-n, c.�a6l a� c s c -� tatlf l
299.14 (SLM REC)
A v '
1+ /NN
8 cb
0
o ~Cb
.o•
P_ Yal
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w cQ,l oQfve , 0
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m
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4 vL
299.17 (BLM AEC)
----- X40
30
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m A0<,G OI W
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All o o s � o• o' n. ' 3 ` r
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nG
Date: '7-Zk-'IL
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CML ENGINEERS
(907)694-2979
FAX(907)694-1211
ROVA�PLRN°WPY
PP
RECEIVED
JUL 29 1996
Municipality of Anchorage
SEWER&WATER
DEPARTMENT OF HEALTH AND HUMAN SERVICES Municipality of Anchorage
LI E%TENSKM
025 L Street
Dept. Health & Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
SEWER & WATER
SSPECT*N
REFERENCE: L.r CZE Soc. Zs, Trots
Rz.EJ
ENWNEERW4STL*ES
ANDREPORTS
The septic inspections for the referenced
p p property were
performed on -7-27.-9c and '7-211-11: .
Prior to submitting
the On-site Wastewater Disposal System and/or Well Inspection
Report we are waiting for the
FoudOATLe*) to be
WELLMPECTION
&FWWTEST
completed.
If we may be of further service please
contact us.
SITEPLANS
Sincerely,
70z IrW11--1
RDAD DESIGN
Robert C. Cowan, P.E.
SOIL TEST
PERCOLATION
TEST
&IRUCTLR&&
WCMAWAL
HSPECTION4
ONSITE
WASTEWATER
06POSALSYSTEM
OESIGN
17034 NORTH EAGLE RIVER LOOP -SUITE 204 -EAGLE RIVER, ALASKA 99577
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
ate,
-az-Cu
�w�fd
L Cu "
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960193
DESIGN ENGINEERS & S ENGINEERING ` //-� ``
OWNER NAME S ►_ clu.
OWNER ADDRESS:P.O. BOX 772483
EAGLE RIVER, ALASKA 99577
PARCEL ID:05128209
LEGAL DESCRIPTION:
T15N R2W SEC 25 LT 62
LOT SIZE: 108900 (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:
DATE ISSUED: 7/12/96
EXPIRATION DATE: 7/12/97
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: DATE: 7
ISSUED BY
: L / / DATE:
H EALTNAMMORITY
APPROVALS
SEWER & WATER
MAIN EMENSDNS
SEWER& WATER
INSPECTION
ENGINEERINGST DIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PIANS
ROAD DESIGN
SO&TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
ROBERT C. COWAN. P.E.
ROBERTA. SHAFER, P.E.
CML ENGINEERS
June 26, 1996 (907)694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
: Lot 62, Sec. 25, T15N, R2W, SM, AK.
Request you issue a permit to drill a well and install a
septic system to serve the proposed four bedroom house on
the referenced property.
A test hole was excavated and percolation test performed.
The approximate location of the test hole is located on the
attached site plan.
At the time of excavation water no was encountered in the
test hole and after seven day ground water monitoring, the
monitoring tube was 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 information, please contact us.
Sincerely,
Rfberg.�Cowan, P.E.
RCC/gk
Enclosure
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577
rn
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N
co
CO
P
PT1
m
rn
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577
1" =. 60' SITE PLAN DESIGN
SCALE
�4
C9
0
1n
rDO f R�
c
:a o NO WELLS O� �-' O N Zp
W
SEPTIC W/IN 100'+ Do 1 + I: 2JEN.7 I o r
c az t Ef O I x��00 "3 00 d >
I go, Q0 D
M%0 \ D c ----------
t"
_ o wIn0 � \�-.o in z r
yWN 4 rU___1Yt"MM'Oz
o+ois o COO ' a 0008 r
o po
C:o I 0 p\8
m i ocl PROPOSED DRIVEWAY I y�
m0 ll
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II i aft'
e .r Municipality of Anchorage
DEPARTMENT OF HEALTH 8 HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: oALE f7o"TEK DATE
LEGAL DESCRIPTION: LOT G2- Township, Range, Section: -nSn1 , P 7-w I SE.t, 25
SLOPE SITE PLAN
1 ^"
N
2-
3-
4-
5 34 5
6-
7 7
8 J
9-
10-
11 10it
v �
12-
13
2 13
14 ls.olr(
15-
16-
17-
18-
"
516171819
20
COMMENTS
WAS GROUND WATER ,10
ENCOUNTERED? N
IF YES, AT WHAT /
DEPTH?
Dept to Water After o�xl-9t.
Monitoring? 'DIL4 Bate:
■■■■..■■■■
.■■■■..■■■
�l
Reading Date
Gross
Time
Net Depth to Net
Time Water Drop
JG
A L
4- at V,
PAS5.144 S u
t4e
Ado ro
00 . u
1.14 1.7-
Grp
M y
PERCOLATION RATE ' 25 (minutes/inch) PERC HOLE DIAMETER C -a
TEST RUN BETWEEN 6 FT AND 7 FT
S 3 S ENGINEERING
PERFORMED BY: Eagle17034 CERTIFY THAT T IS TEST WAS PERFORMED IN
ACCORDANCE WIT)EAgtas *wAAb ff4X GUIDELINES IN EFFECT ON THIS DATE DATE G �7 7 A L
72-008 (Rev. 4/85)
0
r
A
Percent Passing by Weight _
-+ N W A to M V 00 O O
O O O O O O O O O O
O e O O O O O O O
3-
2.1
112"
1"
3/4"
121'
3.9"
io. 4
NS
No. 10
N16
No. 20
N 30
No. 40
N 50
No. 60
N so
No.10
No.200
D.02mm
3
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S&
ROBERTC.COWAN, P.E.
ROBERTA. SHAFER, P.E.
ON-SITE WASTEWATER DISPOSAL SYSTEM CIVIL ENGINEERS
CONSTRUCTION PRACTICES (907)694-2979
and FAX(907)694-1211
MATERIAL SPECIFICATIONS
WALTHAIAHOATTY
APPACNA1.3 �tEFERENCE: Lot 62, Sec. 25, T15N, R2W, SM, AK.
June 26, 1996
SEWER &WATER
ENERAL :
MVNMENSIONB
1. 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
SEWER&WATER
the referenced property.
FSPEcnON
2. Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with.
any special provisions or conditions, and all
ENGTNEERINGSTMES
applicable State and Municipal Wastewater Disposal
ANDREPORTS
Regulations.
3. The contractor shall be responsible for obtaining any
necessary underground utility locates.
WELLR+SPECIION
&FLOW TEST
4. Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling.
SITEPLANS
5. Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
ROAD DESIGN
systems must also receive prior approval from the
Municipal Health Department.
EPTIC TANK INSTALLATION:
SMTEST
1. A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
PERCOLATION
TEST
2. The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
srmcTuui&
3. All standpipes on the septic tank shall extend a
I.ccNANICAE
INSPECiTXM
minimum of 12 inches above final grade.
CN SITE
WASTEWATER
DISPCSKSISTEIA
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577
Page Two
Lot 62, Sec. 25, T15N, R2W, SM, AR.
June 26, 1996
4. Septic tanks installed with less than 4 ft. of cover shall
be insulated.
5. A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the tank
and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
6. Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed -up) before
gravel (sewer rock) placement.
2. Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
4. Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
Page Three
Lot 62, Sec. 25, T15N, R2W, SM, AK.
June 26, 1996
5. Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
MINIMUM MATERIAL
1. Any septic tank proposed for installation 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:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 38 passing the $200 sieve.
7. When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements.
Page Four
Lot 62, Sec. 25, T15N, R2W, SM, AIC.
June 26, 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:
1. The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic tank
may be set in place, but may not be backfilled before
this inspection.
2. The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
3. The final inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre -construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S
Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
'I
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Municipality ot Anchorage—
_ -
Dept. Health & Human Services
1
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Page Five
Lot 62, Sec. 25, T15N, R2W, SM, AK.
June 26, 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 performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/INSTALLER
Municipality of Anchorage
' Development Services Department G
Building Safety Division
On -Site Water & Wastewater Program
flStreet
P.O. Box 196650
Anchoraora gee,, AK AK 9 99519-6650
www.muni.org/onsile
(907) 343-7904 VIA
CERTIFICATE OF ON-SITE SYSTEMS APPRL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. QQ ^X2- 43 COSA# UOS
1. GENERAL INFORMATION Expiration Date: _ 9' % - O 6
Complete legal description FOSTERS SUBDIVISION: LOT 62A.
Location (site address) 17620 PIONEER DRIVE • EAGLE RIVER, AK 99577
Current Property owner(s) THOMAS & TERI ZUPANCICH Day phone 301-7080
Mailing address 17620 PIONEER DRIVE • EAGLE RIVER, AK 99577
Lending agency Day phone
Mailing address
Real Estate Agent JIM STANDIFORD w/ DYNAMIC PROPERTIES Day phone 244-3940
Mailing address 3111 'C' STREET * ANCHORAGE. AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
E
Individual Water Storage
❑
Community Class Weil
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply andlor wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of Installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS. P.E. Date rf3 ob
Engineer's Comments:
In conducting this evaluation, GEG, LID. attempted to provide a thorough,
conscientious engineering analysis of the system to accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Idontitiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benerit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for L� bedrooms.
Disapproved.
Conditional approval for
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
bedrooms, with the fllowing stipulations:
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Reort
Other
ON-SITE .'- o
ATERANU m=
,STEWATER
rtcwrv+m ;
:4
By:� u/ / Original Certificate Date: 7_ d
IRr 11I S1
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Boot 196650
Anchorage, AK 995196850
www.muni.orglonsits
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: FOSTERS SUBDIVISION: LOT 62A, Parcel ID: 0 ✓-I -a $ 2-1/3
A. WELL DATA *CASED TO BEDROCK
Well type P WAIF If A, B, or C provide PWSID# N/A
Data completed 7/1996 Sanitary seal (Y/N) YES
Total depth 60 ft. Cased to '30.5 ft.
FROM WELL LOG
Date of test 7/1996
static water level 22 ft.
Well production 1.0 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0— colonies/t00 ml. Nitrate _5M_mgJL.
Well Log (YIN) YES
Wires properly protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
5/9/2006
23 ft.
1.0 g.p.m.
Other bacteria 0 colonies/100 ml.
Arsenic: _&Qug.JL. Date of sample: 5/9/2006 Collected by: GEG, Ltd.
B. SEPTICIHOLDING TANK DATA
Tank TypetMaterial STEEL Date installed 7/22-23/1996
Tank size 1250 gal. Number of Compartments E Cleanouts (YIN) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alar (Y/N) N/A
Date of pumping 9/15/2005 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 7/22-23/1998 Sob rating Ed. r ft'Ibdr) 1_2 System type TRENCH
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 08.811 ft. Elf. absorption area 500 fe Monitoring tube YES Depression over field NO
Date of adequacy test 5/9/2006 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test DRY in. Water added 1000 gal. New depth DE" in.
Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >- 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at _in.
Datu
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at in.
Cycles tested Meets alar 8 circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/deanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 100'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
10'+
Building foundation
10'+
Water main N/A
Water service line
100+
Surface water
100'+
Driveway, parldng/vehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and f�•
review of Municipal records that the above systems are in •' • •"' • . • •' •'. ............
conformance with MOA COSH guidelines in effect on this
date. f e rness.:
Engineers Printed Name JEFFREY A. GARNESS �A 7 53`
Date /1 .; .4Y,-,o7P
4��pter...bnd
COSA Fee 430 Waiver Fee $
Date of Payment 6-1 6 Date of Payment
Receipt Number &5W I Receipt Number
(wv. 11ros)
\ Municipality of Anchorage _
• Development Services Department
Building Safety Division 'rte
On -Site Water & Wastewater Program
4700 South Bragaw SL
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. 051-282 91i3 HAA#_ D21—'19—'1`l((��
1. GENERAL INFORMATION Expiration Date: I I — .F_ D 3
Complete legal description FOSTERS SUBDIVISION: LOT 62A:
Location (site address or directions) 17620 PIONEER DRIVE • CHUGIAK. AK
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
GREG
HENDESRON
Individual Water Storage
Day phone 622-9909
Community Class Well
❑
Public Water System
c/o
LINDA BANNER
w/
COLDWELL BANKER FORTUNE
Day phone
LINDA BANNER w/COLDWELL BANKER FORTUNE Day phone
2525 C STREET • ANCHORAGE. AK. 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
265-9109
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of
up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B
wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate
for the number of bedrooms and typo of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER do WASTEWATER CONSULTANTS, INC. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all welts and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year; and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will It confer any legal right whatsoever.
5. DSD SIGNATURE
V/ Approved for L_ bedrooms.
Disapproved.
337-6179
Date__2251_03_
Conditional approval for bedrooms, with the filowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manhenance Agreements
Supplemental Engineer's Reort
Other
ON-SITE.•m
" Wl1TER AND
WASTEWATER
PROGRAM
By; t400—t,'�r Original Certificate Date: 8 —S 03
(R.. IMI)
Municipality of Anchorage
• Development Services Department
Building Safety Division
OnSke Water 6 Wastewater Program
4700 South Bragaw, St.
P.O. Box 190850 Anchorage, AK 99519-6650
www.d.anchorage.sk.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: FOSTER SUBDIVISION; LOT 82; Parcel ID: 051-282 u3
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 7/1996 Sanitary seal (Y/N)'SES
Total depth 60 ft. Cased 3D.5ft.
FROM WELL LOG
Date of test 7/1996
Static water level 22 ft.
Well production 1.0 —
g -p.m -WATER SAMPLE RESULTS:
Coliform 0_ colonies/100 ml. Nitrate d-WritgA.
Well Log (YIN) YES
Wires property protected (Y/N) YES
Casing height (above ground) 18+ in.
AT INSPECTION
8/3/2001
24 ft.
1.0+ g.p.m.
Other bacteria 6 coloniesl100 ml.
Arsenic: N/A mgA. Date of sample: 7/23/2003 Collected by: AKWWC, INC.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Matertal STEEL Date installed 7/23/1996
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation deanout (YM) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A
Date of pumping 8/28/2002 Pumper DENALI PUMPING
C. ABSORPTION FIELD DATA
Date Installed 7/23/1996 Soil rating .p.d. ft%bdnn) 1_2 System type SHALLOW TRENCH
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 'all ft. Eff. absorption area 500 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 8/2/2001 Results (PasslFail) PASS For 4 bedrooms
Fluid depth in absorption field before test "0 in. Water added 1200gal.' New depth 11.5 in.
Elapsed Time: 115 min. Final fluid depth 2_5 in. Absorption rate >= 600+ g.p,d,
Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date —
00 MONITORING TUBES DRY ON 7/23/2003
D. LIFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons Manhole/Access Y/
"Pump off" High water alarm level at
Cydes tested Meets alarm & circuit requirements?.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankflifi station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/deanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water t 00'+
Wells on adjacent W t 00'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 cerfHy that I have determined through field inspections and tip
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed N me JEFFREY A GARNESS Y —7953
Date 75'a� '•.
�djDror••do^d 6
HAA Fee E '3-15-�
Data of Payment -7' 51'0-3
Q
Receipt Number �q 2q
(Rw. 12m)
Waiver Fee $
Date of Payment
Receipt Number
'03 07/19 FRI 13:25 ! 907 2764507
Sent By: RE/HWX OF EAO:E INC.;
b�
FORTUNT PROP.
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Municipality of Anchorage
Development Services Department - e
Building Safety Division .
OnSite Water & Wastewater Program
4700 South Bragaw, SL
P.O. Box 196650 Anchorage, AK 99519.6650
www.d.anchomge.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
a SI — 29,2—L13
Parcel I.D. HAA#_
1. GENERAL INFORMATION Expiration Date:_
Complete legal description LOT
62: T15N.
R2W, SEC.
25
Individual Water Storage
❑
Individual Holding tank
q
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Location (site address or directions)
17620
PIONEER
DRIVE •
EAGLE
RIVER
AK
Current Property owners)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
KIM do AUDRY THEILE Day phone
c/o CINDY WILSON w/ REMAX OF E.R.
Day phone
CINDY WILSON w/ REMAX OF E.R. Day phone
694-4200
16600 CENTERFIELD STREET, SURE 201 * EAGLE RIVER, AK 99577
Unless otherwise requested, HAA will behold by DSD forp/ckup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
ill
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the data of issue for properties served by a private or Class C well and may
be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of
up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B
welts or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Note. -Alaska Water and Wastewater Consultants, Inc. shall bo paid $1235.00 at, or prior
to dosing for the engineering services provided 11 1
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, I verity that my
Investigation, based on procedures outlined In the Health AuthorityApproval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system ls(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 Munidpality of Anchorage files and from my Investigation and Inspection, the
on-sRe water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal
and State codes, ordinances, and regulations In affect at the time of installation.
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179
Address 6901 DEBARR ROAD, SUITE 213 • ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date $
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provfdo a thorough,
conscientious englneedng analysis of the system In accordance with ADEC and MOA
DSD Guidelines 6 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test and separation
distances measured to readily kdentifrable fee turos. The opera tionallife of an wells and
septic systems depend on the I=/ soils condition, groundwater AeWs that may
fluctuate during the year, and the watw usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory last
results do not guarantee future performance of the system, nor do toy that
there are no hidden defects or encroachments. AMW, Inc. can therefore not provide
any warranty or future estimate of how Jong the system will continue to moot the
operational requirements of the ADEC orMOA DSD. The content of this report Is for
Me sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or parry is not authorized, nor w7l it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for Lbedrooms.
Disapproved.
Conditional approval for bedrooms, with the filowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
I OFAN,
AQP••'•• yon'
ON-SITE •�c+=
WATER AND •: T°'=
WASTEWATER
PROGRAM
By: Original Certificate Date: $
(ave. Iver)
Municipality of Anchorage
Development Services Department
on-snetProgram
4700 South Brapew SL
PA. 8ozlMW Anchorage. AK9W19-WW
W%WXLanclrorope.akus
(907) 343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LOT 62: T15N. R2W. SEC. 25 Parcel ID: 051-282-09
A. WELLDATA
Wen type PRIVATE Ba S. or C provide PWSID# N/A
Date Completed /1996 Sanitary seal (Y/N) YES
Total depth60 R C u ad to 30.5 fL -m
FROM WELL LOCI
Date of test 7/1996
Staficwaterlevel 22 tt
Well production 1.0 g.p.m.
WATER SAMPLE RESULTS:
Well Lop (YIN) YES
Wires properly protected (Y/N) YES
Casing height (above Wound) 18+ In.
AT INSPECTION
8/3/2001
24 1L
1.0+ g.pJn.
Coliform - ig
ccloMea/100 ml.
Nitrate j • e- mgJL.
Other bacteria .2 colonles/100 ml.
Date of sample:
8/7/2001
Collected by:
AWWC. INC.
8. SEPTIC IHOLDINO TANK DATA
Tank Type/Material STEEL Date kwtaned 7/23/1996
Tank size 1250 gat, Number of Compartments 2 C2eamufa (Y/N) `ES
Foundation cleanout (Y/N)`ES Depression over tank (YIN)No High water alarm (Y/N) N/A
Date of pumping 8/2/2001 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Dete installed 7/m/1996 Son rating.pJf 1t'/bdmr) 1_2 System%" SHALLOW TRENCH
Length _ 50 1L Width5 1< Gravel below ape 4 -ft.
Total depth s•s h Eff: absorption area500 ft' Monimrtng tube YES Depreaalon over fletd NO
Data Oi edequacy teat 8/2/2001 Results (Pass/Fag) PASS For 4 bedrooms
Fluid depth In absorption field before test—O in. Water added 1200gai. New depth11.5In.
Elapsed Time: 15 min. Final fluid depth 2_5 kr. Absorption rate am 600+ g.p d.
Any rejuvenaion treatment (past 12 mo.) (Y/N & type) NONE KNOWN N yes, give date -
0. LIFT STATION
Date installed Size In pallona
'Pump on' levet at ---In.
E. SEPARATION DISTANCES
High water alarm level at in.
Cycles Nested Mesta alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tenkAiR station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service One 25'+
On adjacent lots 100'+
On adjacent tots 100'+
Public sewer manhola/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIGHOLDING TANK ON LOT TO:
Building foundation 5'+ Property One 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One 10'+ BuOding foundation 10'+ Water main N/A
Water service line 10,+ Surface water 100'+ Driveway paddrrglvehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
i cerV& that 1 have determined through fled kWecifons and -V,
review of Mrml W records that Bra above systems are lo ....
conformance with MOA HAA gu/de0nes in effect on this date.
Engineers Printed Narna JEFFREY A. GARNE55(•, i
Data g O/ mob' •....
�o►o
HAA Fee $ -5(= . o
Date of Payment 9 101
Receipt Number 8 W Ba
1W1?leet
Waiver Fee
Date of Payment
Receipt Number
O MUNICIPALITYANCHORAGE
• DEPARTMENT OFFHEALTH
&8 HUMAN SERVICES ARM
Division 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
Parcel I.D. s 051-282-09 HAA # _AA Qqf� n
1. GENERAL INFORMATION
Complete legal description _ Lot 62; T1 5N; R2w; Sec 25
2.
3.
4.
Location (site address or directions) _ 17620 Pioneer Drive
Eagle River AK
Propertyowner _nalo X nani GP Fnafcr
Day phone 694-9158
Mailing address P.O- Box 772483 Eaale River AK 99577
Lending agency
Mailing address
Day phone
Agent Brian Broderick/Prudential Vista Day phone
Address
Unless otherwise requested. HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual well XX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest -
Ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site XX
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-M(14v.1/91) From MOAF21
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.
ALASKA WATER i WASTEWATER
Name of Firm CONS$it TMIT`ii, Phone 337 G 17�
Engineer's signature
Alaska Water &
Wastewater Consultants, Im
Shall be PAID
or prior to, closing for the
Engineering Servic?s Provided.
6. DHH6 SIGNATURE
0
Approved for E0 t'R bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date
bedrooms, with the following stipulations:
Date '? -q-11
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 purchasersof homes
and their lending institutions in orderto 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.
n-=0Wc+s1) B. uwm
Municipality of Anchorage AUG U 6 1999
DEPARTMENT OF HEALTH & HUMAN SERV406SPALiTy of ANCHO �o
Environmental Services Division "Nv'WNWEN►ALSEWlaSDlvISt
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: LOT 62; T15N; R2W; SEC 25 Parcell.D.: 051-282-09
A. WELL DATA
Well type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Date completed 7/96
Cased to 30.5' (To 8 ) Casing height (above ground) 2'+
YES
FROM WELL LOG
7/96
22'
Well production 1.0 g.p.m.
Wires property protected (YM) YES
AT INSPECTION
.7/29/99
24'
1.4+/— 9—
p.m-
WATER SAMPLE RESULTS: 0
Coliform Nitrate 1-49 41 Other bacteria_
Date of sample: 7/29/99 Collected by: _ A.W.W.C., INC.
B. SEPTICMOLDING TANK DATA
Data installed 7/23/96 Tank size 1250 Number of Compartments 2 Cleanouts (YM) YES
Foundation cleanout (YM) YES Depression (Y/N) NO High water alarm (YM) NO
Date of Pumping 7/28/ q9 per JR PUMPING
C. ABSORPTION FIELD DATA
Date installed 7/23/96 Soll rating (g.p.dJft' or ftM)dnn) 1.2 System type SHALLOW TRENCH
Length 50' Wkhh 5' Gravel thickness below pipe 4' Total depth 8'
Effective absorption area 500 SO FT Monitoring Tube present (YM) YES Depression over field (YM) NO
Date of adequacy test 7/29/99 Results (Pass/FaIQ PASS For 4 bedrooms
Fluid depth to absorption field before test (In.);
0
Immediately after 1?0%al. water added
On.): 1
Fluid depth 0* (ins) Minutes later.
205
Absorption rate : 600+
e,p.d.
Peroxide treatment (past 12 months) (Y" NONE KNOWN if yes, give date
72-028 (Rev. 3196)•
D. UFT STATION
Date installed
Manhole/Access (YM) _
High water alarm level at*
°
Size'in gallons
aY "Pump otr level at'
*Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 100 + On acQacerrt lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main NSA Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Litt station N/A
SEPARATION DISTANCES FROM SEPTICMOLDING TANK ON LOTTO:
Foundation 5'+ Property line 5'+ Absorption field 5'+
Water maiNservice line 10 + Surface water/drainage 100'+ Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water mairdservice line 10'+
Surface water 100'+ Driveway, parldnghmhide storage area 20'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. ENGINEER'S CERTIFICATION
I tartly that I he to Id Jnspectlons and review of Munhh ipal
F ms are
in conic witlr 'de nes in effect an this date.
Signature j i • —
Engineer's Name JEff GARNESS ,.. ....:
y ....
g —7953
Data ��'
HAA Fee $36D.Waterer Fee $
Date of Payment � Date of Payment
LI
Receipt Number 7 ` E. (� Receipt Number
72.026 (Rev. MM-
• MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services low
On -Site Services Section'
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744 FNVIRO IGp" OF Agip
CERTIFICATE OF HEALTH AUTHORITY M SER VICE$DIVSIOfY
APPROVALFOR A SINGLE FAMILY DWELLING MAY O
Parcel I.D. M
OSI—LB�-oq ✓ 8 1997 .
HAA q'
1. GENERAL INFORMATION
jtCEIVED
Complete legal description Lot 62; sec 25; T15N; R2W
Location (site address or directions) NHN Pioneer Drive
Chugiak, AK
e Dale end Denise !'ester
Property owner Day phone
P:O. Box 772483 Eagle River, AK 99577
Mailing address.
agency Day phone
Mailing'address
Agent Day phone
Address
694-9158
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
RECEIVED
3. TYPE OF WATER SUPPLY:
MAY o 8 1957
Individual well xxx
Municipality of Anchorage
Dept Health & Human Serylces
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADECattest-
frig to the legality and status of system.
4. 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.
72-0=(A .1/Yt) Front MOA121
-
S.' 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
S B S ENGINEERING Phone 6`l H- a 97 c/1Address Eagle River, Alaska 99577
Engineers signature Date r SlT 7
6. DHHS SIGNATURE
Approved for �uf� 4 bedrooms.
Disapproved.
:Conditional approval for
L7 �
Additional Comments
i.
'By-
The
y
bedrooms, with the following 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.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.
1. 72-025 nw. uvir Swk uw M
a Municipality of Anchorage NICICALl1v OF Arac"o
DEPARTMENT OF HEALTH & HUMAN SERVICE p�M,usERVICES
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (90) 34*Ay4B 1997
Health Authority Approval Checklist RECEIVED
Legal Description: Ler L2 Sac. 25 -17154 . 92L..1 Parcel I.D.: 051-262 -454,
A. WELL DATA
Well type pokwAns If A, B, or C, attach ADEC letter. ADEC water system number r.) A
Log present (VN) Yes Date completed -7 I9 L
Total depth Lo' Cased to 30 (r. E.ss.aci Casing height (above ground)
Sanitary seal 4DN)
FROM WELL LOG
Date of test
Static water level 2
Well production I
WATER SAMPLE RESULTS:
Coliform 0
Wires property protected (77N) Yas
9—
p.m-
Nitrate 0.160
AT INSPECTION
n
C- r< Z
hl o A-AwrF,�y,
Other bacteria
Date of sample: `+ A, L, Collected by: S & S ENGINEERING
17034 Eagle Rlwr Loop Road No. 204
B. SEPTI OLDING TANK DATA Eagle River, Alaska "S"
Date Installed 7-23-161 Tank size 1250 Number of Compartments 2 Cleanouts (®N) YES
("s N
Foundation cleanout �N) �� s-• Depression (Yl ' High water alarm (Y4M 0e
Date of Pumping' ' ' ��� ', .'Pgmper
i'
C. ABSORPTION FIELD DATA ..
Date Installed '7-23-9(- Soilrating �orft'/bdrm) I.2 Systemtype PKA14F14ti0
Length ` 50 Width 5 Gravel thickness below pipe Q Total depth 8 11,11'
Effective absorption area 60olo Monitoring Tube present (DN) Yes Depression over field (Yq t� o
Date of adequacy test IJE ✓o Results (Pass/Fail) — For `I bedrooms
Fluid depth in absorption field before test (in.); Immediately attar = gal. water added (in.): —
Fluid depth (ins) Minutes later: Absorption rate =
Peroxide treatment (past 12 months) (YM) If yes, give date
72-026 (Rev. 3/96)'
D. LIFT STATION
Date installed
Manhole/Aocess (Y/N)
High water alarm level at'
E. SEPARATION DISTANCES
Size in gallons
"Pump on"
"Pump off" level at'
'Datum RECEIVED
SEPARATION DISTANCES FROM WELL ON LOT TO:
Jljjpt olding tank on lot
1001+
MAY 0 8 1957
Municipality of Anchorage
Dept Health & Human Services
On adjacent lots too 1
Absorption field on lot too 14- On adjacent lots
Public sewer main 14 �A
too I+
Public sewer manhole/cleanout N /A
Sewer /septic service line 251 + Lift station 0 /A,
SEPARATION DISTANCES FRO �HOLDING TANK ON LOT TO:
Foundation 8� Property line (eo 1f Absorption field Z6,
Water main/service linel0 1+ Surface water/drainage too + Wells on adjacent lots 160 '+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line God+ Building foundation 23� Water maintservice line lot +
Surface water 10014. Driveway, parking/vehicle storage area q.0,_+
Curtain drain Wells on adjacent lots 1001 +
F. ENGINEER'S CERTIFICATION
I oerMfy that I have determined OW Meld Inspections and review of Municipal systems are
in conformance with MPA HAA 'dellnes�'�effecct on Mus date. C!
Signature -Y�•4/cijf L/'^ * 91
Engineer's Name 8684 t r C
ROBERT G COWAN
Date s�g�'017 CE -8901 J
HAA Fee $ C* " /
Date of Payment
Receipt Number /^
� � l � �p,�7
72-026 (Rev. 3/96)•
Waiver Fee $
Date of Payment
Receipt Number