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HomeMy WebLinkAboutWINTER LT 2T15N RIW Sec 9 Lot 46 #051 -105 -OS Municipality of Anchorage Development Services Department °" - �• Building Safety DMsion On -Site Water and Wastevlater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page' of 3 www.clanchorageak.us (907) 343-79D4 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. I. 0-03gd PID Number: 051-165-01 .J H'e" 0000rla ptioh Wastewater System: [INew I4 Upgrade V690 ' IL, Ato W5 ABSORPTION FIELD �1Z'Au °�'.' 8 0x,•15 / �• IA•,E« a 6«Iroan.'. 3 v o� oc O DFep T,.,IJI IgsiW. T,« O 9b O ManE O oem: LEGAL DESCRIPTION SIR", p p. TOMDepFlhandy,rI7a : Ft 91CC1,: La if/ SubdiAY . DepM b pV a Dome Iran wigkW III*&(3-" dWh b•roRR, Pm 170 FI. FI. ToenNp' �� A' Range' W a•dJR[ /1 `•71 Fa FtlC•E tlorF a'PnN VMF O � C."31P0h 6'= //vv I. Well: [I New E] Upgrade G,mIWEn� alMe. oHl«o beh+enlMs q Ft F, cwvm-ew (P,Iv11. 9, Cr -1r' TON D,,pft C• TON 8bWT m V— 5 P ««ur MDN/ �00 I ; ! Ie FI. FL ( FIS W a•r JbA SINK WNM LevN'. ImlNler Twfed ' ON• Ir41Nb0. Ft Yr ""°SNN. "' D,ana TANK GPM Ft. L SEPARATION DISTANCES b(Septie O Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption LM Holding Publk/PrNat M«d «: , P Cw lyy 13�,IpGN. From Tank Field Station Tank Sewerllne /p )C a L W.L OD' 110' a5'f MN«� p P a aCa p•nme xF sNK.WI« ��% loo (� LIFT STATION LW Low L iff ,L•. PRI MYLIKIJM P VC 30 FanONan Ir , I ` Pa1V an 4M N� 'Pu^V dl' M.M aI `/'5 Sp/w�l/a�mwCDy�A. Hgb ". Narm —/o ef+{{ „ in _`J'•,Y.5n. CUai. D,M O� S•.1� Mp Ma4R a MOEN Q/�, Q% ()(/ ENcirY lW YIWeCa/m`. I} t)i _JC•I / W Nr/� BEN H MARK leubpn «le D•v�peon: Bollorn sip T cr in Bj. leo FL En .OF LFq fit S & S ENGINEERING 17034 Eagla Rlver Loop Road, No. 204 N Inspections by: Dates: 1 V-5-632 performed ERgtayttva�tnlc. 99577— ZR4 R p ROBEURT G COWAN `Q Development Services Department Approval oV CE -8801 ��ill ,,� Reviewed and approved by:Aj 1 Dale: (Rev M") ' PERMIT NO. SW020386 PACE 2 OF 3 Municipalit of Anchorage DEPARTMENT OF HEATH 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 LECAL LOT 46, SECTION 9, T15N, R1W P.I.D. N0. 051-10 �Oo ZGRAVEL ORIVEWIY k `S Q J � 4 >- i z $N N AW Wo= FCO NEW TRENCHES w A 2W wo MT! ATH/2 O MT .T M W NEW 1300 GALLON HDPE SEPTIC TA K AND LIFT STATION jINSTALLED MI MTI MT2 10-1-02) HNI SCALE. V - 50' I I 1 F•►ti P a � ,h LOT 47C s I I I 8 /I pF^� ROeHtT C OOIYYI �F JSrf SEPTIC�) it i I I REA X11\• PERMIT NO. SW020386 PACE 3 OF 3 Municipality of Anchora e 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 LECAL LOT 46, SECTION 9, T15N, R1W P.I.O. NO. 051-105-01 FINAL GRADE ST1 ST2 C01 2" INSULATION NEW 94 2' 1300 GALLON POLYETHYLENE SEPTIC TANK MT1 MT2 100.4' h1T1 = 97.9 99.8' 93.9' 101.0' 100.7'- �FINAL GRADE INSULATION-, DISTRIBUTION PIPE SR � MT2 = 97.9' MT3 = 97.9' WATER FOUND @ 93.7 89.9' B.O.H. TOP 2' INSULATED EFFLUENT OUTLET ._ . MT4 = 97.9' N. T.S A 8 C FCO 16.5 — 14.0 ST1 13.5 — 21.5 ST2 15.0 — 24.5 C01 16.5 — 27.0 MT 12.0 — 26.0 MH 18.0 — 29.0 MT1 30.0 7 8.5 — MT2 87.0 107.0 — MT3 52.0 71.0 — MT4 1 82.0 99.8' 93.9' 101.0' 100.7'- �FINAL GRADE INSULATION-, DISTRIBUTION PIPE SR � MT2 = 97.9' MT3 = 97.9' WATER FOUND @ 93.7 89.9' B.O.H. TOP 2' INSULATED EFFLUENT OUTLET ._ . MT4 = 97.9' N. T.S m OF Municipality of Anchorage iC'QNEER'S lAL1;ti;�1�+ Development Services Department �✓,�-;t: ` � b ` Buldng SafetyDMSIon •• •- on -Site Water and wastewater Program �•�, 4700 South Bragaw Sl -•.. >........./...... P.O. Box 196650 Anchorage. AK 99519-6650ell DO W -RT G COWAN J VAr ww wclanchcrneakus �`/ C:-8601 fa - (907)343.7904 V5 ti f�Fo w„ • L• Soils Long -Percolation Test �h1�'�rES PerformedFcr: 1Ll�Y-1 pnJ L� I/u G j .Date Performed: Legal Description: LvT 4(1 �,A� �• (- S M nr..... Rif.. ole. Depth 0«S 0-1 a 15- 16- '17- is - COMLIENTS �j Y:AS o;lW. 0 Y/ATER ✓r E,NCw rE?.E07--L-D-5 S _ 7 L rl IF YES. AT WAY DEPT117 � 0 � �l DePI`r1oYMer Aller i r Ap I.IonilaME g7 �11 E Date: ?/ Rezding pate Gross Time Net Time Depth to Water Ret Drcp 1 r0 0 10 yM 3« 10 10 " r n 10 O IV 1 J015 114+1 S 10 0 23 10 10 + u FERCDLATICIMATE Iraalnrx+) FERCHCLE OIAt.tETER TESTP.I:NEETYTEN'7L FT AND :_FT P=RFORMEO BY: 9 &V6(;jCCXja&, t 'r�-%� L 414— CERTIFY THAT THIS TEST 1A.S PEP.FOR. IED IN ACC DANCE 'ATH At L STATE A`;D I.:U?:ICIPAL GUIDELINES fit EFFECT ON THIS DATE. �At�O Rising Son Electric Inc. 907 622 6777 09/03/03 OSS22P P.001 Rising Son Electric, Inc. '''�' 14916 Woodland Drive 4. Eagle River, AK 99577 .3, (907) 622-6777 1, >1 •fir September 3, 2003 Re: Lot 46 Section 9 TNI 5N RI W To Whom It May Concern: The lift station at the above referenced property has been wired in accordance with NEC and State/Local codes. Thank you. �Si�ncereely, �, cJc,,t1 • WA,,1ie Celle -Q2, ¢D v Kevin S. Hombuckle, Owner Administration License Number 1284 Specialty Contractor License Number 27285 IEALTHAUf/gHTY APPROVALS SEWERS WATER MAINEXTENSIONS SEWER & WATER INSPECTION ENGINEERINGSTUDIES AND REPORTS WELL INSPECTION &ELON TEST SITEPLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTUVL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN S& September 5, 2003 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519-6650 REFERENCE: Lot 46; T15N; RIW; Section 9 20909 Bowery Lane ROBERT C. COWAN. PE. ROBERTA. SHAFER, P.E. CIVILENGINEERS (907)694-2979 FAX(907)694.1211 Request you grant a waiver on the referenced property for the horizontal separation distance between the leachfield and the south property line at 5 foot. We do not anticipate any adverse effect on the adjacent property. If you require additional information, please contact us. Sincerely, Aobertowan, P.E. RCC/ts pR[o $ Is -o.-4 q Is- lo 3 RE4.14- r # 0 14 1 a.7 y 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 9/8/2003 Alunicipality of Anchorage Mark Mylich, Mayor Btti1(IIng Safety Di -s isiotl P.O. Ik)c I(X;CZO • 4700 I3nkgaw Street Anclit)nigc, Alaslcu t)<)810-6Ck5O • (907) 34343301 • rwx (!X)7).4'1-8!_)00 h t i p: // eir x•. n u m i .ori; Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, AK 99577 Subject: Waiver Request for T15N Rl W Sec 9 Lot 46 Waiver Request #WR030080 Parcel ID #051-105-01 SW020386 Dear Robert Cowan: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 5 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, D' h V Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program Municipality of Anchorage 04, Development Services Department *1. Building Safety Division On-SitcW70 BragawStreetnd rProgram 4700 Bragaw Strect P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: 030080 PID#: 051.105.01 HAM Permit#: SW020386 Date Received: 9/8/03 Legal Description: T15N R1 W SEC 9 L46 Engineer: 3 & 3 Engineering 17034 Eagle River Loop Road Applicant: Romona Pugh Waiver Requested: 5 foot horizontal separation distance from the Leachfield and the South Property Line Criteria: Waiver is Granted: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: List Conditions or Reasons for above: Waiver is not Granted: Date: q 03 By: N'j Name of Reviewer ..............................................................................� Rec#: 41274 Amount: $150.00 Date Paid: 9/8/2003 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial / Upgrade Permit Number: SW020386 (Legal Description: T15N R1 W SEC 9 LT 46 Design Engineer: 0003 S & S Engineering Owner Name: Romona Pugh Owner Address: P O BOX 670026 CHUGIAK . AK 99567-0026 �PVkk Date Issued: Oct 04, 2002 Expiration Date: Oct 04, 2003 Parcel ID: 051-105-01 Site Address: 020909 BOWERY LN Lot Size: 108900 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: Q Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. Received By: Date: / A.7 /V 3 Issued By: ��—I�N -- Date: I Z7 c3 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ek.us (907) 343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. O 5-1— I O 5-6 1 Permit Number SW OZO _?& Property Mailing address (1 Mailing address Day phone Zip Code q "I 56 Legal description (Lot, Block & Sub'd.) Lo+ L 6 Legal description (Section, Township & Range) 5eefioe) TI Lot Size 14 _Acre Sq.F Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above Information Is correct. I further certify that this application Is being made for a Single Family Dwelling and is In accordance with applicable Municipal Codes. S & 5 ENGINEERING M 17034 Eagle River Loop Road No. 204 (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12100) Waiver Fees: Date of Payment: Receipt Number: S&S� ;IneeRInG November 22, 2002 ROBERiC. COWAN, P.E. ROBERT& SHAFER P.E. CML ENGINEERS (907) 694.2979 FAX(907)694-1211 AALS MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 SEWER 8 WATER MAINERTENSIONS REFERENCE: Lot 46, Section 9, T15N, RIW, S.M. SEWER& WATER INSPECTION It is requested that you Issue a permit to install a pressurized bed to serve the existing three bedroom dwelling on the referenced property. A test hole was excavated and a percolation test was performed. The approximate location PREP SSTUDIEs of the test hole is located on the attached site plan. At the time of excavation 10/4/02, water was found at 6 feet. After monitoring, ground water was found at 6 feet. We do not anticipate any adverse effects on neighboring wells, septic systems, ieserve TION JI NOWT ST areas or drainage patterns b the installation of the g p y proposed septic system.. The construction of this system will not prevent any future development on any of the adjacent properties. SITEPLANS If you require additional information, please contact us. Sincerely, ROAD DES04 /E� Robert C. Cowan, P.E. SOILTEST RCC/bj j Enclosure PERCOLATION TEST STRUCLIRAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSISTEM DESIGN 17034 NORTH EAGLE RTVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577 O O C� o fN'1 = Z DEO En , ::E mom n O D M m D i 'r s=o SITE -PLAN C w r rl G1 oCs _+Ir ~ T O w v rJ x o F CO m �oHoLlsf I OQvO� .zm X N .�"• ! Ci,o�nn yam lr;nu • � a II O II 3 N2w I 'D rq ,>.. v Lm -0 �O\\ 3 m 0 x ♦bNi p P w 3 No C, J BOWERY LANE Z��a_ <` =era jo n O � A - v M O -OD i r I % S b DESIGN s=o SITE -PLAN C r rl G1 oCs _+Ir ~ A In W C w v rJ x o F CO m �oHoLlsf I OQvO� .zm coOO •-.� .�"• ! Ci,o�nn yam lr;nu • rO�mO a II O II N2w I 'D rq ,>.. v Lm -0 �O\\ vmm/ ♦bNi _ CA No C, J BOWERY LANE Z��a_ <` =era jo n O � v O -OD I N r- Zr1 m m OL7ND - 1...1 I n' o .- N ` pmoo AmO r s ' N xyZ --1 n_p Z ti m n > .'S7 01 D Ti d I' .Oz Tl - �_ '^ ITC) rr y m p ... O N O o i r I % S b s=o C r rl G1 oCs _+Ir ~ A In W C o O f VI Z x o F CO m �oHoLlsf .zm ;EBE Ij •-.� n ! yam lr;nu • n i r I % S b A In W C f cnO o F CO N 0 U •-.� O bo II K m � a II O II W A ^+ (n 01 C) N n O v Lm -0 O N _ CA No C, J ' , J jo n O � v v I N N 1...1 I n' o .- N ` pmoo AmO VJ s ' • xyZ ti OCy n_p Z ti K�� O I' .Oz Tl 0, O D y m p O N O o MmIcIpllfy bf A th&ip bevelopmbhl SbfvlcbS bepallmehl buddlnd Safely blvlslon >� ()n-Slle Water and Waslewaler hlograrri 4700 SouUr bragaw SL h.0. box 196650 Ancholage• Ak 99519 665a www d (907) 343-7904 Solk Lbd - PlAtblaf101i COSI herlorn,edPer: Ramona Pugh Legal Desvlpllon: Lot 46; Sec9; T15N;R1II;SM er.,... (Feel) Organics 3-I I A -I I GM/SM 3 6- 7- io 12 13 fl 15 COMMENTS WAS Gncow WAttR tNCOUNTEREW • Yes BOTi a IEvts.h10wlAtb8 L beplhtoWlluAllH'i o laonnorina) 6' 3" E betel O /15 /02 V� y+�"•# ROBERT C. COWAN I c,.• G:-8801 herfom,ed: 10/6/02 See Site Plan headlno bale Gross tlme Not Vine Depth to Water Net trop Presoak 10/15 0 0 10 10 9.5" 3.5" 10 10 9.25 3.25" 10 10 9.0" 3.0" 10 10 8.3" 2.5" 10 10 8.5" 2.5" 10 10 8.5" 2.5" Pthco(AtlollhAlt 4.0 t j-e~l PERC11OLEOIAAIETER 6" ttsthUNbtt*Et!)—Z--tt ANb 3 tt hthrohl.lEbbv: Michael J Clare I ��j(�it/% �/ .,_ CERTIEvtllAtiNISTEstWAS hEhrORMEb IN ACCORDANCE WITH ALL STATE ANO MUNICIPAL GUIDELINES IN F-iECT ON MIS bAtE. DATE: / 3 a')- ROBERT C. COWAN. P.E. ROBERTA. SHAFER. P.E. CML ENGINEERS (907)694-2979 FAX(907)694.1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES FE&THALITNORTY and APPFIMALS MATERIAL SPECIFICATIONS SEWER& WATER EFERENCE: Lot 46, Section 9, T1 SN, RIW, S.M. LMERTENSKM November 22, 2002 SEWERS WATER INSPECTION 1. The scope of this project includes the installation of a pressurized absorption bed to serve the existing three bedroom residence located on the referenced property. ENCINEERMGSTUDIES ANDREPORTS 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. WELL INSPECTION ,. . SFLOWTEST 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 311E PLANS 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. ROAD DESIGN S. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their SOIL TEST own systems must also receive prior approval from the Municipal health Department. TEST+ LEACIIFIELD BED INSTALLATION: 1. Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the STRUCIVIAL LECHANCAL` excavation becomes smeared, it must be raked or scratched (ruffed -up) before INSPECTIONS gravel or sand placement. CN SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577 Page 2 - S d S Engineering Lot 46, Section 9, T15N, R1W, S.M. November 22, 2002 2. If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. 3. Sewer rock shall be placed uniformly throughout the entire bed. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. Gravel depth below the distribution pipes shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. 4. The distribution piping must be as shown on the design. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. 5. Silt barrier material must be installed between the final gravel layer and the native soil backfill, unless insulation is used, then the silt barrier should be installed over the insulation. Ensure the silt barrier covers the entire gravel surface before placing backfill. 6. Monitor tubes shall be of four (4) inch diameter, installed at 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 depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. The monitoring tube should not extend below the bottom of the gravel surface. 7. 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 finished grade over the bed must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 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: Tyne of Pine 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. Page 9 • S 6 S Engineering Lot 46, Section 9, TISN, R1 W, S.M. November 22, 2002 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, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the 4200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever specifications applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted atter 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 atter 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. Pape I • S d S Engineering Lot 46, See0on 9, T15N, R1 W, S.M. November 2$ 2002 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. CONTRACTORANSTALLER MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW02038G Legal Description: T1 5N R1 W SEC 9 LT 46 Design Engineer. 0003 S & S Engineering Owner Name: Romona Pugh Owner Address: P O BOX 670026 CHUGIAK , AK 99567-0026 This permit is for the construction of. ❑ Disposal Field Q Septic Tank /o/5 @ 1pm Date Issued: Oct 04, 2002 Expiration Date: Oct 04, 2003 Parcel ID: 051-105-01 Site Address: 020909 BOWERY LN Lot Size: 108900 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. At time of tank replacement the absorption field shall be documented; a test hole must be excavated to determine bedrock and water table, 7 day water monitoring and a perk test, size and construction of absorption field to conform with code requirements. Received By: Issued By: Date: !o—'1—vZ Date: / O - y- 0 -Z Municipality of Anchorage • Development Services Department`' Building Safety Division <- On -Site Water and Wastewater Program ; r; 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. O S'f — / 0 S — O ( Permit Number SW Property owner(s) 62 r1 pry 4 A u 4 N Day phone Mailing address (1) P.O. 80K 6 -700 X (G Mailing address (2) 4k Zip Code 9 &f S -E 7 Legal description (Lot, Block & Sub'd.) L o i >/ (o Legal description (Section, Township & Range) Cl , 7 / S - IV, 2 i o✓ Lot Size Acres/Sq.FL THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool I Number of Bedrooms X/ Well Only Water Storage Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application Single Family Dwelling and is in accordance with applicable Municipal Codes. 5 & S ENGINEERING ,�2 17034 Eagle River Loop Road No. 2(a Eagle River, Alaska 99577 (Signature of property owner or authorized agent) Permit Fees: r00. Y= Waiver Fees: Date of Payment: / 0 / 3 to Z- Date of Payment: Receipt Number: r) a- 6 S }7 Receipt Number: (Rev. 12/00) c is being made for a ROBERT C. COWAN, P.E. CMLENGINEERS (907)694-2979 FAX(907)694-1211 October 2, 2002 lEALTHAWHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Development Services Department ►IAINEXTENSIONS P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 46, Section 9, T15N, RI W, S. M. SEWERB WATER INSPECTION It is requested that you Issue an emergency permit to upgrade a septic system to serve the existing four bedroom dwelling on the referenced property. ENGINEERNO$rlAlEs ANDREPOTITS The existing septic tank has imploded, causing raw sewage to back up into the basement of the existing house. This septic tank needs to be replaced immediately to prevent raw sewage from continuing to spill into the basement & onto the ground outside of the WELL INSPECTION S FLOW TEST dwelling. A proposed upgrade design is attached & permit is requested to proceed with installation of SITE PLANS a new septic tank immediately to replace the existing compromise septic tank. This new septic tank will be connected to the existing lift station & leachfield. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve ROAD0E$1GN areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. SOIL TEST If you require additional information, please contact us. Sincerely, PERCOLATION TEST STAMLIFIALa Robert C. Cowan, P.E. MCKA'"CA1. RCC/jhm INSPECTIONS Enclosure ONSITE WASTEWATER DTSPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 1" = 40' DESIGN SITE—PLAN 'CA( mil- xZ^� m30 BOWERY LANE Sx,,y� i'v:i �nu9 b s c � cc X i V1 � ••1 N z r� O a DAA r m m O OOSO Z<mti a SmOz F 0>> x a mzz c m0o0 WE>m : cncn n r zo c EXISTING r o K < BED i 2i cz, m HOUSE GARAGE GARAGE ioa n pp C1 ' GREEN �p HOUSE 5c Y <C:n m O 1 K - z � I C) IV Z neXL'S N 0 O 2 LI) ? m > m > ` v Q ,F n pAmO V[ > r'1xpin N �( O m S r0 > 2tip Z r0 AKN O Jzc 0 nnm O z z v i O O m $1I ten' W � � adC vh Z r. i,y�. I GREATc.R;.ANCIIORAGE ARIA 60ROUGH 1 ' DEPARTMENT �OP ENVItEONMENTAL QUALITY Pcf1mIT NO. _ r • ; � •, -�ieoO n1i1:•,: 1 [iii %' ;. \pucN R.neo T "f A•tl r 011w\.0 At.A ARA 90002 SEWAGE:DISPOSAL SYSTtMwik! :APPLICATION AND PERMIT PHONE Zi AILING Ar16Mf.9611`C _T. �. L/ryt_. •_T .AMt Or APPLICANT N6TALLAT101+ LOCATION _[DAL DESCRIPTION .. :+( T : NSTALLATtON ORS '![►TIC TANKittilAak Pit f.) L� DRAIM ►ICLO OTHER -Y►L A No tItC Or: FACILITY TO B[f[RV[D"� /J n�f yy(••...AS/Mfi•IF"/A•b./4 ,TD 111 iiisf ILL[D GY otl ittr RttuLTt'L'Prt' "' _ r"`�"' '' 'NOTCI THit PERMIT 16 NOT VALID WITHOUT &OIL TIEST ...li � :.t �•{ T da a; 1. . \•F =ONiLCT10N DA Tt .ANTICVAYED r " ' i•' a -C PERMTT V411n 011E YEAR atNAL'FINSh[bT10N1�, II4 ,HOUR' NOTtcz J1[R ou1[DY:bJACK/ILLIN1 K[ O 0ANY tTM WITHOUT FINAL INM[C[ LTION NY TH HEALTH 0►ArifM[NT A61140111TY_waL sc'tUrJecr TO MJlOt[CUTION. YtKi+;; t\.:K:":•M-i Y1p-'F "• Lt'T' k� om Tt{li`t� �+ ^'tA TYrtt; lSP� ` s" tnnt:{Ltl ilk4 k ARCA tilt TveR , If^h�fll'\' .,tr a / , o i:; i 't• '. �„-r r• ♦�� '. - - wTIN1NIU�♦DIiTANC[!, htQUiREM[NTrI-' I i Yr+r'rSt,a•` r If.\J', ' • DIAGRAM OF SYSTEM 1 ✓tist':c2 rYK L.. -a . L X Y a•o..wad' 'r Y .. I : ' �;'p,';r lr;�,r ;r•• S', 1lLi •- tl : ^p2'�'t�1' r�.t\r?'•i! 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"�J�NMiNo Nto" Ru'brosnN2T lir. e.. >I rr,Lt '.• snHl, rn ncA\aua rntn o. aril -i• i yr \v.v � v���r r r\ r• r IIL'M r+ Irf llnC \1 t 0. da T„ s 1• IA.A 111 M ib (t7r ) rH mi .r t r, .•,.# \:., • 1 SEVENut(le a1N, )•N• rn; A dN Pirb od iE►n TANK ANo at Aek Plr t I Vy. .,." rt ',.( S` ... r rnNr rr 1/:'rr lR• tt11rU •uy. « r \ nr, �{. Y. •, ..•! 1 S - ..:mt N' C1f 1. y y' */7 ZI �YSti1 4� i r1.l A!t 11 P N :Dolt 0 11 ( IN. NH11 wj l r�r r v E i SSKY 1 6T ri ,, f11. 119 NO HSN+ r. i I^.bt l °� t ♦ A1%J4 , MtTr Ila( 11 P N• IED w IN. .1 '7 ti • [ty r NN.\r.. ♦;rr M1 �9«i-n Ate. ltrle :. till Ilnrl T slrll( 1 f'r, p t�..:. 'f =. ,y r„ 9 fx f., lu(. • till V lilt 1�[aotAtiO�tt a.,�.ryY S .rTatl;T .:e •vt r, S�lI>"y+•�':'•Pili . +:. Irrclr ) ' �1 INTOROARofTALUtt I to• SVYDY flrfX"', "fiii , , . IW' .T ' � '�1 ♦ l�,ut f.e r' �yr'f �Alya1M il•MlsM• 11 • '\ � �Ittrat t IIT i. lei l TIM tH1 f� tc. tilt'.1 4_Clalfl lA(rllll i?r Ir, �1OTj10RRT -� t a. ♦ AY Ar,' Iltr • - III y� � S Y -rf•. ♦ .rt.`' ilia?? tpl. ��I•� P- Y7t, H DttIONIR [ 19x7 Y fr r SI •'rIHYu► 4 fi 4. I i M•'r � 1 t4}�•�ro��"t`y11}i �.� i y,•ri 9r ¢� tfa �b �•Y ,.rwt�� �il tt z�'��1 _.}-+1. i',u ....-.�=—_.. __.........:. .: t ATt(Ai.l ANILrart,VYiiT1t'rNC N[o UlRf lltNTL'O t�MtAttR ANCNOR Aat' AAG BOROUGH ORDINANCE NO 26.66 AND THAT THE ABOVS 6X67kai ly I AC C O RdA NCF WITH tA1O COD A �i�.[.",.�. �(-� !/• t ( . 1 1�T ) •Xi •" � it Y� , �`tYr'�ka`�'a.� i,�A�/,tFr..•.:t✓ •�:♦ / ./. ..+' . �\,\ APPLICAiITt iIONAjOR[• • - �� .\. 4• \.P> .Se, r rr r. �•V+ ''Savvy •"`3 Y�'�"r ` s' ;°�Ij �1} CIl•,t'�i >iXt�?In `r: Y0r TITh, • � I.NI �. ,1 'i T'{��{'d}� � I;� G,REAT R ANR -60RO G +.',• Q ,, DEP"�TF4ENTdF NTA LI �/ PERniIT NO. 1 L+3 30 C'• 3YRERT" ANCf A0 A AS KA 09001 I TELEPH0N -ASR(" any - yq ^ (J 7 r�r SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT V LAME OF APPLICANT NSTALLATION LOCATION / ::'/2 ". rfl MAILING ADOREI Our v I: 0i: S JT' 'tom PHONE �" J•'• .EGAL DESCRIPTION 1- rI 7- y,K S- r % /.5 ~ / )V' NSTALLATION OF: SEPTIC TANKE/[1PAG! PIT L DRAIN FIELD I'�l OTHER 'YPE AND SIZE OF FACILITY TO BE SERVED - •� INANCED THROUGH TO BE INSTALLED BY :Dll 7[57 RESULTS - _ NOTE, THIS PERMIT 13 NOT VALID.,WITHOUT SOILrST :OMPLlTION DAT[ ANTICIPATED :•� 'INAL INSPECTION: 24 HOUR NOTICE REQUIRED.'BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE IEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. i EPTIC TANK SIZE TYPE 41NIMUM DISTANCES, REQUIREMENTS •OUNDATION TO SEPTIC TANK OUNDATION TO SEEPAGE PIT DRAIN FIELD :EPTIC TANK TO SEEPAGE PIT WALL :EPTIC TANK SEEPAGE PIT DRAIN FIELD TO NEWSY LOT LINE. ' V[LL TO SEPTIC TANK +DRAIN FIELD VA1TER MAIN TO SEPTIC TANK G j RAIN FIELD f: EPTIC TANK. SEEPAGE PIT 'TO RIVER. LAKE. STREAM. SEEPAGE AREA SIZE SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PIT DRAIN FIELD 'AST IRON INTO AMC) OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF %LAVATION B FEET INTO UNDISTURBED SOIL. I INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT 'ITTED WITH AIRTIGHT REMOVABLE CAPS.' rt IWAV L BACKFILL TYPE DIAGRAM E1F EYBTFM 1 I :ONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. ` -low . • _ I• LICENSED DESIGNER i.z 1 • CEIITIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER'ANCIIORAOE AREA BOROUGH ORDINANCE NO. 20.60 AND THAT TH[ABOVE 96CRIBED SYSTEM IS IN ACCORDANCE WITH SAID COOE.' r .1 �TE' `' APPLICANT'S SIGNATURE Municipality of Anchorage `-- Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 S'ry ;4 v; f CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. D5f'- J S'- L, COSA# 1Xn04y5(p Expiration Date: — �-� — do 1. GENERAL INFORMATION Xorw.�,rt Complete legal description [AMA%l-�2S S �d L �T Z �77,f,y Heir � s�G q GaTcF6. Location (site address) Z09,01 C trcu Current Property owner(s) /4? lf2K w/,7E/L3' Day phone '741-16 ' 1 Mailing address Lending agency Mailing address C Day phone Real Estate AgentZft,*Z,* f�,4j41LTo te- Day phone _ oC T4 03 S-7 Mailing Address 10244f�, a % 6; F 4>/V&e Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Wellt7j Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil pngineersegisteredlaShe.State ofAtaska—Certificates of -On -Site Systems Approval are -required for -the transfer -0f 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for prbperties 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 seat affixed hereto and as of the validation dale shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm B r- l A"I _ Phone gOV— eLP Address/ %,,� 3 % B64A ozoec4a Engineer's Printed Name S f 6_141C Date/fiArC FOOA1,4 0.) t is i : [. pop ..�••• � :',kyyr �0 9�t, S�ercR Vl. 1" 5. DSD SIGNATURE t� s• PE 6256 :rV� Approved for -03 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report — NitraWAdviso the By. e Original Certificate Date: 1.7-2 00 — 0 6 (Ra. 11105) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsde (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: J J /AAr4 ,[ S/0 Lara Parcel A. WELL DATA Well type If A, B, or C provide PWSID # _ Well Log (Y/N) Date completed J�dk Sanitary seal (YIN) Wires properly protected (Y/N) V Total depth I—Sit. Cased to Casing height (above ground) /do in. FROM WELL LOG AT INSPECTION Date of test _ 2! Static water level ft. Well production g.p.m. Jr. S g.p.m. WATER SAMPLE RESULTS: Coliform �colonies/100 mL Nitrate Q k mg1L<M,e4- Other bacteria 0 colonies/100 mL Arsenic: ,Z.,C mgA Date of sample: p E 9j6if Collected by. B. SEPTIC/HOLDING TANK DATA Tank Type/Materiai )�Re4i 6C�& "L r7n e J Date installed Tank size 13LIO gal. Number of Compartments z Cleanouts (Y/N) Foundation cleanout (Y/N) _Y _ Depression over tank (Y/N) !j/ High water alarm (YIN) Date of pumping i Pumper .5 4df T,4A!4 ?Zj*tA?6e x C. ABSORPTION FIELD DATA Date installed s O� Soil rating (g.p.d./ft2 or ft2/bdnn) Z System type 73raic a Length 106 ft. Width S ft. Gravel below pipe �I ft. Total depth .3 ft. Eff. absorption areaf& Monitoring tube Depression over field Date of adequacy test 1 0C Results (Pass/Fa0)_4 JJ For bedrooms Fluid depth in absorption field before test -0- in. Water added gal. New depth_Z in. Elapsed Time: min. Final fluid depth 6 in. Absorption rate >= ys o g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) UdIK If yes, give date D. LIFT STATION Date installed 03 'Pump on' level at in. Datum MICA Zar- E. SEPARATION DISTANCES Size In gallons ZJ'O `Pump offlevel at,- in. Cycles tested 3 SEPARATION DISTANCES FROM WELL ON LOT TO: r� Septic tank/lift station on lot 14Q Absorption field on lot Public sewer main r Sewer /septic service line Z s -e- Animal Animal containment areas WA Manhole/Access (Y/N) High water alarm level at � in. Meets alarm & circuit requirements? On adjacent lots Id d r f On adjacent lots /QQ'& Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas A4a SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r Building foundation s fi Property line Absorption field 14 Water main V A Water service line Al r'r Surface water Weiss on adjacent lots 10441r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Propline s r Building foundation / erty _ Water main _y.1' Water Service line Surface water ��a r� Driveway. parking/vehicle storage y�k Wells on ad �t Curtain drain adjacent lots 44 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and of 491"_ review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. O�p�an,vc�e�.s, Engineer's Printed Name .5T-,xAr%E t� 6 ��sl:, iE 6256 Date q�/�/a t�\ �FRCFESS--rP COSA Fee $ Lf --50 Date of Payment Receipt Number 8l0�3� (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number ,A ANALY'riCA GRot p Analytica International, Inc. 5761 Silverado Way, Unit N Anchorage, AK 99518 Phone: 907-258-2155 Fax: 907-258-6634 Northrim Eng Report Date: 9/12/2006 Attn: Steve Eng Receipt Date: 8/29/2006 17237 Bear Paw Circle Sample Date: 8/292006 Eagle River, AK 99577 Samplc Time: 12:00:OOPM 907-694-7028 Collected By: IE Fax: 907-694-7026 Flag Definitions: Client Sample ID: 20909 Bowery MRL = Method Reporting Limit MCL = Maximum Contaminant Limit Sampling Location: B = Present also in Method Blank Client Project: Northrim Eng 11= Exceeds Regulatory Limit Sample Matrix: Aqueous M = Matrix Interference COC #: 1= Estimated Value PWS#: D = Lost to Dilution Residual Chlorine: •• = RL higher than MCL; target not detected Comments Lab#: A0608351-OIA Analysis Method Pre s MRL MCL Method Prep Analysis Parameter Result Units Flags Date Date Analyst 4500-NO3E (Aqueous),- Nitrate Test was conducted by: Analytica -Anchorage Nitrate as N <MRL mg(L 0.10 10 922006 922006 Al Lab#: A0608351-OIB Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst Test was Bacteria, Other <MRL CFU/IOOmL 1.0 Total Coliform <MRL CFU/IOOmL 1.0 Lab#: A0608331 -01C 82920068292006 PL 8292006 8292006 PL Analysis Method Y Pref Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 200.8200.8 (Aqueous) - Family Well Water 1 Test was conducted by: Analytica - Thornton Arsenic 2.60 ug/L 0.15 10 200.8 9/62006 9/112006 K STONE Reported by: Claire Toon, Page 1 of I Laboratory Project Manager a, fe-, ewr s>ti•� a a to 1 �I ! ti 6'D S7 417 h i ,8 I ti o ea Dof v � , � 6 4i�A•'fr �Yj' � ryr y� • //7C�e • . i N • f� • f89's7J9"w z9Y.9/ ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE` FOLLOWING DESCRIBED PROPERTY Y~ Sd • pfq "%% wwrr~P .ram <orY/ a z DATE] Q� C 950 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS B�o/o6 r ` INDICATED. IT IS THE RESPONSIBILITY OF THE TH 0 OWNER TO DETERMINE THZ EXISTENCE OF ANY GRID: ` �•• '• ••• •• EASEMENTS, COVENANTS, OR RESTRICTIONS �✓w��sB i ,p •� WHICH DO NOT APPEAR ON THE RECORDED SUBDI- �� o�s�* Merk S.wsrd VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB` /�'•. l5 9 •� ANY DATA HEREON BE USED FOR CONSTRUCTION iiz y/ If Y��i OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN: \0.*q�wT.• v�•r >aug� Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program s �' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ei.anchorage.ek.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 05-1' 11)5-01 HAA 3h f�i���'' •� Expiration Date:- 1. GENERALjNF0RMAT.ION � `, Complete legal dAciiption%""%1SN /e1 W SCC q 4 or 41 Location (site -address or directions) ZO 90 `j B0w6/2 y �' *m5. (' Nv6'�g l� y... ...........,.....:. �-- Current.'Propeit ,660(s, _; fC J pucW Day phone SK2-2L2 Z Mailing address,.:;a s r Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or 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 Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and Slate codes, ordinances, and regulations in effect at the time of installation. Name of Firm Win y-7'�ICI..i Ena. / Address /%a-�7 Aper- Ar_ n + coir /P Engineer's Printed Name C'TEcJF C S. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Phone Date o? CLQ ti��.O� .At.gS ,1 r49T �, X11 .. �1 ... 51sre . EM : atm✓ t•�•,_ PE 6456 Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory ON-SITE ••:.4i WATER AND A 111I^^ �fS^T�L%A IAinT PROGRAM X Maintenance Agreements Supplemental Engineer's Report Other By: Al Original Certificate Date: �" � ' OS (Rw 01102) Municipality of Anchorage e Development Services Department � Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: r1,5V R1V1 Sec 9 L Or 416 Parcel ID:_ Q_C1- OS— 0/ A. WELL DATA Well type R If A, B, or C provide PWSID p _ Well Log (Y/N) Al Date completed&4�C Sanitary seal (YIN) Wires properly protected (YIN) Total depth 1—Is—ft. Cased to Oft.* Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test —— Static water level ft. Well production — g.p.m. S g.p.m. WATER SAMPLE RESULTS: Coliform _colonies/100 ml. Nitrate Q•S mg./I. Other bacteria colonies/100 ml. Arsenic: mg./l. Date of sample: d�lelax Collected by: 116%ri4ia. E�J �. B. SEPTIC/HOLDING TANK DATA T'' Tank Type/Material l �C �.�1 �FjQ�_�,�T(C !, Date Installed _03 Tank size LiQo gal. Number of Compartments '• Z Cleanouts (YIN) '10 Foundation cleanout (YIN) Depression over tank (YIN) A( High water alarm (YIN) r � Date of pumping .T Pumper C. ABSORPTION FIELD DATA Date installed gi' 3 Soil rating (g.p.d./ft2 or ft2/1>drm) _2 System type_ Z6K4e Cka ?7WVCfi Length /in CA ft. Width S ft. Gravel below pipe Z ft. Total depth 3 ft. Eff. absorption areaS�ft, Monitoaing tube _X__ Depression over field K( Date of adequacy test a/ -Os Results (Pass/Fail) i .; j For _ ? bedrooms Fluid depth in absorption field before test_0 in. Water added gal.t New depth 2 in. Elapsed Time: 6G min. Final fluid depth C in. Absorption rate >= vs o g.p.d.y- Any rejuvenation treatment (past 12 mo.) (YIN & type) f-WX If yes, give date D. LIFT STATION Date installed'.S o3 Size in gallons L 60 Manhole/Access (Y/N) `1 "Pump on' level atin. 'Pump off level atSn. High water alarm level at n. Datum RiJ 1 a Cycles tested s Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /4040' / Absorption field on lot /G O it Public sewer main AJ14 Sewer /septic service line Z 5 r 'f On adjacent lots / 00 '* On adjacent lots /d G � Public sewer manholelcleanout 410 Holding tank A i . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S fi Property line 1��t Absorption field .S -� r Water main dhl f _ Water service line /Q Surface water /J a rF Wells on adjacent lots IL04' f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: f Property ling JJ s Building foundation /Q f Water main .0 Water Service line /O f' Surface water G'r Driveway, porkingIvehicle storage Z S Curtain drain &N#4 Wells on adjacent lots 6'r F. COMMENTS G. ENGINEER'S CERTIFICATION OF 44 '• 1 1 certify that I have determined through field inspections and o r, ' % -V +� review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name S%fi�L� ENw >♦, ci_ Sn•en w. En7 ' /27�s �J`.'.• PE 6755 Date HAA Fee 5 N3;o • o Waiver Fee $ _ Date of Payment 7I 30 to 5 Date of Payment Receipt Number 1304 Receipt Number (Rev. 12/01) GRAPHIC SCALE... 1 lAch - M Fast 15 is 30 60 FOR: Ken LanMark msen"rlag a suvayng, fae. 9330 Vanguard Drive. Suite 203 Anchorage. Alaska 99507 (907) 562-0050 ENLARGED HOUSE SCALE: 1• = 30' NOTE: THE 50' ROW WAS TAKEN OFF OF HOA GRD) SHEET 1358 Date 8/26/05 1" = 30' id Plot Plan > ,.::. •`::,::•� 2500680 awn by 174. . sr7��?(�� :•s F.ONC. * . DRIVEWAY Wood WNRWAT U PAO� W'� i v l7j SHED CHAIN LINK rc&RA ft FENCE U u2sa a �� Li r GMT VI ti 0 0 OO 1 8 sEPnc 0 0 S89a57125i'W 329.96 GRAPHIC SCALE... 1 lAch - M Fast 15 is 30 60 FOR: Ken LanMark msen"rlag a suvayng, fae. 9330 Vanguard Drive. Suite 203 Anchorage. Alaska 99507 (907) 562-0050 ENLARGED HOUSE SCALE: 1• = 30' NOTE: THE 50' ROW WAS TAKEN OFF OF HOA GRD) SHEET 1358 Date 8/26/05 1" = 30' id Plot Plan 1358 2500680 awn by Field Book DLM 215 I hereby certify that the property described hereon has been surveyed by me, or at my direction, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto unless otherwise shown. That no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other easements on said property except as shown. It is the responsibility of the owner or builder, prior to construction, to verify proposed building grade relative to finish grade and utility connections and to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Listed distances prevail over scaling. Reproduction may cause distortion. I Lot HLM 46 1 SECTION 9 T15N, R11P, S.M. Alaska __ea1 ....GA - 4918 CHARLES E. FORBES y.. LS -7326 pit A. ..... • aoD POWER BLM LOT 48 HAS 108,978 SQ.FT. OF AREA 13 50' ROW RESERVE WEU. � DUSITING U SHED .•2 j OUANSET NUT&—ii O ' CHAIN LINK � Z FENCE e o 0 0 NN eQ p� —SEPTIC o O o S89-57'25"Wt 329.96 AS -BUILT SCALE: 1' = 50' rn ci N M rn O O O O N Mat -6u Teat Lob 90774GaOt2 09t10:06 27r24pm P. 002 L �a.Su Test Lab of Alaska -�- tow 3.2 PalmartY Bt MB BuFMry. / IAIdlown Community ainasa Park l/ P.O. Boa 2749 Palmer, Alaska 99646 Phone: 7463006 Fax' 746-3010 Drinking Water Analysis Report Total Coliform Baetena Client: NORTHRIM ENGINEERING Address: PWSID M N/A Phone #: 694-7028 694-7026 Paid: This Section to bo completed by Sampler Legal Description of Property: 20909 ROWERY LANE. CHUGIAK Sample Site Location: Delivered to Lab By: NORTHRIM P E.: ""hon Bink. Eatvoom eiok. outside hose b*o Time Sampled. 12:30 Date Sampled .818/05 Sampled by: NORTHRIM Sample Type: Routine: © Treated: ❑ Untreated: ❑ Repeat Sample #. This Section to Ba Completed by Lab Analysis Results: E]Satisfactory Unsatisfactory Sample too long in transit (greater than 30 hrs.) •Requost loearnpkr. Coo rLSent to State: Yes : No Chromogenic/Fluorogenic Method Results: A Total Coliform Present (P)/Absent (A) B J Lab I.D. # 51991 / E. Coli Present (P)/Absent (A) Date Received: 8/9/05 Time Received: 11:00 Received by. M. Tyson Date Test Begun: 819/05 Time Test Begun: 13:00 Ana!yst M. Tyson Date Completed: 8110105 — Time Completed: 13:00 Analyst: M. Tyson _ Mat -9u Tort Lab 9077463012 08!11/06 11L37am P. 003 Mat -Su Test Lab of Alaska Water Quality Tasting Mile 7.2 Pslmer-WasUla H". Midtown Community Busin"s Park Phom: (907) 7a5-7005 Client: Northrim Engineering 17237 Bear Paw Eagle Rivcr. Ak. 00577 Attn.: Clont ID: 20009 Bowery Lane Chugisk PWS!D0. Source: M.STIA 61610 Sampia Matrix. Comments: Method Parameter Units S%14500-NO3-E Wnte-N mg/L Legend: MRL= Metllmt Reoort Level MCL a ktax. Contam.nste levet B a Present In Method B ark E-Es6motod Valus 1t -A!) v MCL D - Lost to D lution RepcxVxrRy Jon Paul Campbell Lab Manage, Email: mat-sutestlatr®rouerstrsa.cont Roculs MDL Date Pre <6ADL 0.50 81,10/05 P.O. Boz 2740 Palmer. Ak. 99646 Fox: 1907) 745-3010 Date ATlved 8/&105 Rcport Date: 811=5 Sample Date. 8/8/05 Sample Time: 1230 Colkcted By: Teresu Eng 8/10/05 10.0