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HomeMy WebLinkAboutCANDLELIGHT (JOHNSON ADDN) LT 8ACandlelight (Johnson Addn) Lot 8A #051 - 065 - 04 Municipality of Anchorage Community Development Department 3 Onsite Water & Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsits "(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP151112 PID Number. 051-065-04 ❑ New I�Upgrade Name GALE JOHNSON ABSORPTION FIELD ® Deep Trench [I Shallow Trench ❑ Bad ❑ Mound Address: 21920 OLD GLENN HWY, CHUGIAK, AK 99567 ❑ Other Phone: No. of Bedrooms: Sop aYYlp: TOW Dept somagFW yatlx (907) 686-9042 3 0.6 GpDft a 10 MAX. R LEGAL DESCRIPTION oep apba MaHmm aryYW aatla: cmw aagn earappx SEE DWG. R 6 a subdivbbn: swat: Lot Fu rtlaO me+eagNalpaea: claw Wpaa CANDLELIGHT (JOHNSON ADDN) 8A SEE DWG. "63+ a R. Township: Range: Section: emmawab: NuroarW sec Obmnu eaaaan bet SEPARATION DISTANCES Toad Wwro as aL 75B+ aW Mea: oW e.anma.We.: To Septic Absorption Holding Fran Tank Field station Tank 5900CUM Well 100'+ 100'+ - - 25+ TANK ® Septic ❑ S.T.E.P. ❑Holding ❑ Other aMebob.r: ANCHORAGETANK C.P.W. 1000 ew. Surface water 100'+ 100'+ - - users: w OfcxlgelMea,: Lot Line 51+ 101+ - - N/A STEEL 2 LIFT STATION Foundation 51+ 101+ Curtain Drain NONE KNOWN trnubeann: oe Re,pwivm at 'Moog Mae 1phwW aWme Remarks: "JAY CREWDSON VERBALLY APPROVED TO ALLOW CONNECTION AT END OF DRAINFIELD ON 6/18/15. peap NYea eaNb b,petlMepebmeE y ""ALL CONTAMINATED MATERIAL REMOVED PRIOR TO PIPE MATERIAL INSTALLATION OF NEW DRAINROCK. House to tank D3034 Tankto D3034 drainfiekl Installer NORTHERN EXCAVATION Drainfiekt D3034 CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.33 a Inspection�llaxw tplmrx Dates: let 8/12@015 2nd 611612015 3rd 6/16/2015 4th BOTTOM OF VINYL SIDING AT POINT "B" Community Development Department Approval ENMEEM SEAL oop�4 _ooOF Conditional approval: Date: '•fid :• _ ....... ................... . r a.P ._ Ga:. ss:. C 7953 vO � ��l.J:.••'�o°+o Approved:0p"f's00000 InurMn Yarvv! 1.1.19 Nr. �y OSPI51112 RECORD PARCEL ID DRAWING 05106504 BER. TOP OF TANK AT INLET =98.5 INVERT OF BUNG AT INLET= 95.91 NOTE: ALL CONTAMINATED MATERIAL WAS REMOVED WITH REBUILDING OF EXISTING PORTION OF DRAINFIELD EXCEPT FOR TRENCH BOTTOM. INVERT OF NEW 4" PERFORATED PIPE WAS AT APPROXIMATELY THE SAME ELEVATION AS THE OLD DRAINFIELD PER THE CONTRACTOR. FINAL GRADE = FINAL GRADE = 104.77-104.87 NEW 1000 GALLON SEPTIC TANK ORIGINAL GRADE = 98.73 (HIGH) TER FABRIC INVERT OF PIPE _ 94.73 — BOTTOM OF TRENCH = 88.73 RELATIVE ELEVATION OF BOTTOM OF TH#1 = 82.23 (NO —TOP OF TANK AT OUTLET = 96.54 INVERT OF BUNG AT OUTLET = 95.74 GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3701E. TUWR RWM. SURE 101•ANCHGR/.GE M 99507•PMNE(W) 3378178' PAX W7)M& 46•MS.IM:w Wm.vnpmemn m PREPARED FOR: PHONENUMBER: PAGE NUMBER: GALE JOHNSON (907)688-9042 3 OF 3 ���f_% LEGAL DESCRIPTION: DRAWN BY: �♦a) CANDLELIGHT (JOHNSON ADDITION)S/D; LOT SA J.L.M. TYPE OF WORK: DATE: � RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 8/3/2015 PROFESSM�i MATANUSKA ELECTRIC ASSOCIATION, INC. LETTER OF NON -OBJECTION July 29, 2015 Gale and Janet Johnson Living Trust P.O. Box 670126 Chugiak, AK 99567 Re: Lot 8A, Candlelight Subdivision Johnson Addition (Plat 2006-1, Anchorage Recording District) Dear Gale and Janet Johnson Living Trust: MEA has no objection to the encroachment of a Septic System located in the utility easement as depicted on the attached as -built survey drawing, subject to the following conditions: 1. The improvement will in no way restrict or limit the current or future ability of MEA to fully enjoy the benefits of the easement for any and all utility purposes that it presently enjoys under the easement. 2. MEA will be held harmless by the landowner from liability for any and all damages or injury to any person or property that may result from the existing and future use of the easement by MEA, its contractors, or assigns. 3. MEA will be held harmless by the landowner for any and all liability arising out of or relating to any use of the easement by others under a Letter of Non -Objection. 4. The landowner will be liable for any damages caused to MEA facilities by the improvement in the easement. 5. The landowner will be responsible for any special construction costs incurred by MEA due to the improvement in the easement. 6. The landowner will assure compliance with all applicable safety codes relating to the improvement in the easement. 7. Use of this letter by the landowner, their successors or assigns will constitute acceptance of these conditions. 8. Alteration of these conditions shall invalidate this letter. 9. This letter is not effective unless it is recorded in the Anchorage Recording District before ownership of the referenced property is changed from the above named landowner. Sincerely, ' C Keith Quintavell Right -of -Way Administrator STATE OF ALASKA)SS- THIS IS TO CERTIFY that on this 29 day of July, 2015 before me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared Keith Quintavell Known to me and to me known to be the individual(s) named in and who executed thep1N9 "' and acknowledged to me that he/she/they signed and sealed the same as a volunta� t,and deetVq uses and purposes therein mentioned. �Q '~ IN WITNESS WHEREOF, I have hereunto set my hand an icial s al the day aq dWeiar first above SEAL Notary Public in and of Alaska My commission expires3TgrF -p4 ••Opm,xnnm,mmn Return to: MEA, PO Box 2929, Palmer, AK 99645 Permit Number: OSP151112 Tax Code Number: 05106504000 Work Type: Septic Permit Effective Dates: May 21, 2015 On-Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade to May20, 2016 Departraent Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: CANDLELIGHT (JOHNSON ADDN) Site Legal Address: CANDLELIGHT (JOHNSON ADDN) LT 8A G:1460 Owner/Address: JOHNSON GALE & JANET LIVING TRUST JOHNSON G R & J I/TRUSTEES PO BOX 670126 CHUGIAK AK 995670126 Site Mailing Address: 21920 OLD GLENN HWY, Chugiak Lot Size in Sq Ft: 33279 Total Bedrooms: This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~/)~ i~ Issued By: ~-~_~ MUNICIPALITY OF ANCHORAGE Community Development Department Development Services On-Site Water & Wastewater Program Mayor Dan Sullivan Phone: 907-343-7904 Fax: 907- 343-7997 On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. O,~' )-- ~..~ O~-'1 Property owner(s) GALE JOHNSON Mailing address 2'1920 OLD GLENN HIGHWAY, OHUGIAK, AK99567 Day phone 688-9042 Site address 21920 OLD GLENN HIGHWAY, CHUGIAK, AK 99567 Legal description (Sub'd, Block & Lot ) CANDLELIGHT (JOHNSON ADDITION) S/D; LOT 8A Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (~allthatapply) Initial [] Single Family (SF) [] Absorption Field [] (w/wo ADU) Septic Tank [] Upgrade [] Renewal [] Duplex (D) [] Holding Tank [] Multiple Dwellings [] Privy [] (SF and/or D) Private Well [] Water Storage [] THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. Waiver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 01/1t) GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTALENGINEERS II I I I May 20, 2015 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System Upgrade for Candlelight (Johnson Addition) S/D; Lot 8A To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The drainfield did not pass a septic adequacy test and needs to be upgraded. The existing septic system consist of a 1000 gallon septic tank and a 52 foot long by 2.5 foot wide trench which has 6 foot of effective. There is very limited area for a proposed septic upgrade due to steeps slope west of the existing trench, the location of the driveway, and the location of underground and overhead utilities. We are proposing to re-build the existing drainfield in the same location by excavating out all contaminated material (widening the existing trench) and building to the same elevations. During the re-build we are proposing to extend the drainfield an additional 11+ feet on the south end of the trench in order to meet the minimum square footage requirements. We are also proposing that a new 100 gallon septic tank be installed in the area shown on the design drawing. Since the 1986 test hole was only 14 feet deep, we excavated a new test hole in the same general area to a depth of 16.5 feet and allow us to rebuild the trench to the same elevations and still meet current MOA requirements (6' separation to impermeable soils or bedrock). Comments regarding the design are summarized as follows: 1. SOILS: See the attached soil Icg which show the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface water concerns. 4, TOPOGRAPHY: As can be seen on the attached design drawing, the existing drainfield is installed at the base of a 15 to 25% slope and the trench is curved around this slope. The area below the drainfield ranges from 1 to 10 percent slope until the east side of the driveway where the slopes range from 15 to 25%. In short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have an.y questions, please contact us at 337-6179. Thank you for your assistance. Presi ~a eY, O,~,~FLE., M.S. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com SAMPSON ESTATES; BLOCK 1, LOT 18 TO BE REBUILT, CANDLELIGHT; LOT GA --L. ?--- :~"- -'---= //~ " ; -.fi .... ;. r-_._ .. ,/ ,' IICA, N~3LELIGHT;/ LOT 4 CANDLELIGHT;LoT 1 II , /,,7' EKLUTNA HEIGHTS; BLOCK 1, LOT 5 GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS I I PREPARED FOR: ~ PHONE NUMBER: PAGE NUMBER: GALE JOHNSONI 688-9042 1 OF 2 LEGAL DESCRIPTION: DRAWN BY: CANDLELIGHT (JOHNSON ADDITION) S/D; LOT 8A J.LM. TYPE OF WORK: DATE: k,. SITE PLAN FOR SEPTIC SYSTEM UPGRADE 5/1/2015 / /'~ CANDLELIGHT' ,' ~ DIE ' , , M RROR R V , ,,44'~ , ,4 ' ...... ~___. ............... ..~ ............ ",, _/ ./- ,/ ~ / · ~ / / ,,' / ,,,;,,' ..... ._... I GEG, Ltd. HAS A 8 PAGE SPECIFICATION DESIGN CRITERIA: DRAINFIELD DESIGN: LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT NUMBER OF BEDROOMS: 3 MAXIMUM DEPTH: l0 FEET FROM ORIGINAL GRADE ( PER 1986 I,R,) GEG. BY PROCEEDING FORWARD WITH THIS GALLONS PER DAY (GPD) : 450 WIDTH: 3+ FEET ( REMOVE ALL CONTAMINATED MATERIAL) INSTALLATION, THE ENGINEER, WELL DRILLER, PERCOLATION RATE/S: 18,5M~N,IINCH LENGTH: 63 FEET LONG (REBUILD52'SECTIONOFOLDDRNNFIELD) CONTRACTORANDPROPERTYOWNERAGREE PROPOSED APPLICATION RATE: 0.6 GPD/SQ.FT. EFFECTIVE: 0 FEET THAT THEY HAVE READ THESE MINIMUM DRAINFIELD SQ,FT.: 75D ACTUAL SQ.FT.: 756 SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. EXISTING WELL , / ........ ~ NOTE: THE CONTRACTOR '~o~~- / ' I}~,~ ..., ,~ ~ :o.... ~ ~..- ~ : X / J / ,.x>"'.,: ]- ....... ~N~ ~~~~~,N~:/FEET TO END OF TRENCH ! ! ! GARNESS ENGINEERING GROUP, Ltd ~.--q ff.,...~...,. :~ r/-~,...: ............ ,..~..~ o,v,.. PREPARED FOR: I PHONE NUMBER: PAGE NUMBER: G^LE ~OHNSO. < ~0~ ~0~ ~ 0~ ~ ,;,~y.. ' ~ .....2~,~ ~EGAL OEBGR,PT,ON: O~WN EY: *.~e~'.-.5'/~ o/,~...'"'~.~ CANDLELIGHT (JOHNSONADDITION) S/D;LOT8A J.L.M. DESIGN OF SEPTIC SYSTEM UPGRADE 5/1/2015 GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS ISOIL LOG - PERCOlaTION TEST~ LEGAL DESCRIPTION: CANDLELIGHT {JOHNSON ADDmON) S/D; LOT 8A PERFORMED FOR: GALE JOHNSON DATE: 4/2412015 ORGANICS ITEST HOLE #1 I SOIL CLASSIFICATIONS GM (DISTURBED) GM ORG ML CL OL MH CH OH SC DEPTH TO DATE GROUNDWATER DRY 4/24/2015 DRY 5/1/2015 SITE PLAN SCALE: DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 4/24/2015 I 4:20 6" 2 4:50 30 4-1/2" 1-3/4" 3 4:50 6" 4 5:20 30 4-3/8" 1-5/8" 5 5:20 6" 6 5:50 30 4-3~8" 1-518" SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED By: COMMENTS: PERCOLATION READINGS ARE WITHIN t/16 OF INCH. PERCOLATION RATE 18.5 (MIN./INCH) PERC. HOLE DIA. S TEST RUN BETWEEN 5.5 FT. AND 8.5 FT. A FOUR HOUR PRESOAK WAS PERFORMED YES l NO[--I JODYMAUS __ (INCHES) PERFORMED BY GEG, .Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P~./:~FO~M~ED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: ~['~ /~ ,,.~'~' Environmental Health Division · "' .- 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Na,~, DISTANCES )~'1-1~ '~/L~/_.'~:~ F R 0 M~"~...~ SEPTIC ABSORPTION Aee,e~ TANK FIELO WELL P~onel$1 IPe, m,t No "o o e~a oo.~ WELL l u,~ ~u~,~,s,on ~EPTIC D HOLDING TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~ OTHER ~t 0 ET FT WELLS ~PRIVATE D OTHER (Identifvl REMARKS: " ' Insect'°ns Ped°~ed'~Y' '' ~ , , ~,. ~.-...... ~,~'~ 72-013 (3,85) MUN I C I PAL I TY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 ON--SITE SEWER & WELL PERMIT PERMIT HO: DATE ISSUED: 860092 04/21/86 APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: KEITH BAKER P.O. BOX &70442 CHUGIAK, A~4 99567 688-2062 LOT SIZE: MAX BEDROOMS: Listed below are the options available to you in designing system. Choose the option that best fits your site. SUBDIVISION: CANDLELIGHT LOT: 8&12 SECTION: 5 TOWNSHIP: 15N RANGE: 1W 14400 (SQ.FT. OR ACRES) BLOCK: NA your septic TRENCH [RED W. DRAIN DEPTH TO PIPE BOTTOM (FT.) 4.0 . 4.0 4.0 GRAVEL DEPTH (PT.) 6.0 0.5 5.5 TOTAL DEPTH (FT.) 10.0. 4.5 7.5 GRAVEL WIDTH (FT.) 2.5 -~1.0 5.0 GRAVEL LENGTH (FT.) 49.0 42.0 65.0 GRAVEL VOLUME (CU.YDS.) 29.5 52.7 46.7 TANK SIZE (GALS) 1~000.0 ** 1,000.0 ** 1,000.0 ** SOIL RATING (SQ. FT./BR) 194 195 194 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: · 1. I am familiar with the requirements for on-site sewers and well~ as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 5. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewatep disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 5 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SI GNED ~_ _~_~_~___~ DATE: __~_~__/_~_~ APPL I CANT: ISSUED ~~. ~z~~· DATE: ~ ..... ~- ~ PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN 825 "L" Street, Anchorage, Alaska LEGAL DESCRIPTION: ~-c~r'~['~- ~D~[I-I~.~T ~{~Township, Range, Section: ~ J'~ · /Z.4~ sLoPE S#E PLAN 5 6 7 8 9 10 11 13- 14- 15- 16- 17- 18- 19- 20- 'ER i,~o WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop ~~ ..~o~(~. I" PERCOLATION RATE /~-- {m,nuteshnch) PERC HOLE DIAMETER ~ ti 'rEST RUN SETWEEN g F'rAND ~ · FT r~O' S / C, 17 4c. V ~' c~JT ) ,x.i il c. 12 ! · S & S Englr',e~ln~ SRB 19~x SR~ 196x ~ C~MPUTATION SHED' DA~E: SHEET BY CKD OF GRANT OF EASEMENT FOR WASTE DISPOSAL S~STEM Grantors, GALE RUSSELL JOHNSON and JANET IRENE JOHNSON owners of land described husband and wife, of Anchorage, Alaska, as Lot 12, Candlelight Subdtvis~0n, Anchorage Recording District, _ _ Third Judicial District, State of Alaska, In consideration of Ten Dollars ($10.~0), receipt of which is acknowledged, hereby grant, bargain, sell and convey to Grantees, GALE RUSSELL JOHNSON and : JANET IRENE JOHNSOn;, of Anchorage, Alaska, owners of adjacent land described as Lot.~, Candlelight Subdivision, Anchorage Recording District, Third Judicial District, State of Alaska, .an easement and the right of way for a waste disposal system, over and across' the above described Lot 12 owned by Grantors and sit- uated in the Candlelight Subdivision District. The easement and right of released is for the sole purpose of of the Anchorage Recording way hereby conveyed and locating, establishing, constructing 'and maintaining over and across the above described land an appropriate waste disposal system serving Lot 8 in accordance with the specifications and requirements of the Municipality of Anchorage Health and }{uman Services Department o right away shall terminate immediately upon the availability and connection of public waste disposal or sewer system to the above described Lot 8. IN WITNESS WHEREOF, we have hereunto set our hands this GALE RUSSELL/~OHNSON SUBSCRIBED AND SWORN~to before me this ~+'3~day of NoTary Public in and ~or Alas%a My Commission JANET IRENE JOHNSON SUBSCRIBED AND SWORN to before me this ~'~day of Ndtary Public in an~'~or Alaska My Commission Expires:/~_/~_~_~8 WATER WELL RECORD STATE OF ALASKA OEPARTMENT OF NATURAL RESOURES Division of GeologicQI 8, Geophy$icQI Surveys ~J"o..-"(: s."'.*.'o" Lo, .,o.. ~ '/.q',.. s..,o..o. To....,..O ~ch ~e~ ~ --of--of--of-- ~JDISTANCE ANO DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF Chuffiak, ~. 99567 Dirt mhd silt 0 10 e. ~c~,, ~ ~v 150 165 ~ '~r~ 16~ 175 ~ Tel, Wet, ~ Other: 8. CASING: Type: ~~ ~ ~ -' .,.... ,,..., ,,. ,,. ,~,,~,o~.~,.~ io ~ /,~¢'~ "'"""' '"': ~ _ - ~oduction of 2 Per for~.tions M:~'nu~on Drillin;. Z~E 5~5 .....' ..... ' ' MUNICIp.~UTY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTI~ON FOR HEALTH AUTHORITY APPROVAL .... i ; .~.. ' OF.ON-SITESEWER ANDWATER FACILITY ......... 264-4720 . : 1. GENERAL INFORMATION ' '" ; · (a) Legal Description (include lot, bl°C~ subdivision, seC.~on, iownship, r~nge) "'{b) Applican~ Nam~~ ~elephone: Home (c) Applicant is (check one): Lending Institution []; Owner/builder,,~'; Buyer~[], O~ther [] (explain); .,. (d)AddressLending Institution~ (e) Real Estate Company and Agent Address (f) '-Marl' the HAA to the following .address: 2. TYPE OI~ RESIDENCE . Single-Family,,~ Multi-Family [] Page 1 of 2 Other * ' "- Number of Bedrooms ~ ~.' ' ~ ~ '" ' ' WATER SUPPLY Individual Well.,~' Community [] Public [] Note: If community well system, must have writte~ confir~ati0n from the State Department of Environmental Conservation attesting lo the legality and status. ' . . -,-~ , ~,. -:t; ~ ,~,~'~ , * . SEWAGE DISPOSAL ' " ~' : . *., · · Onsite"J~ Public [] CommUnity [] Holding Tank [] Note: If communtty'well system, must have whiten confirmation from tho State Department of Environmental Conservation g tO th Iity a ":' attestin e lega nd status. , ..... .~. .~,, .; .. .... -.:: · 5. i; ENGINE.ERING FIRM PRO,VlDIN"~NSPECT, IONS 'TESTS; FILE SEARCH,rD.a""%AND INFORMATION"* ~!:~, -~;"i~,',.~ · . · . ,' ~, · . .: . ,. · .,r., !'"-.'*';'.?':~..~:5;~v~ -,:"~,';,~.~' ,- ? .... i.' · :~ ,, '., '. ~- :. As certified by my seal affixed hereto and as of the validation da!e ~hown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate . for the number of bedrooms and type of structure indicated herein: I further verify that based on Ihe information obtained from the Municipality of Anchorage liles and from my investigation end 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 Telephone the date of this inspection. Name of Firm. S & S ENGINEERING Address SRB J96X EAGLE RIVER, AK 99577 · Date .6. DHEPAPPROVAL' ^pproved for (>')_bedrooms Approved ~ '~ Disapproved Terms of CondifionalApproval. Conditional CAUTION . ~ -~ The Muncipality of Anchorage Department of Health and Environmental Protection [DHEP) issues Health Authority Approval certificates based solely upon the representations given In paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or ': ':. ~ ..analyze. data, before a certificate. . ,: Is Is,s.u.e, d.. ~ .,.,'T .h,e?...M.u,~; ,.cipa~ty.°f~ ~ ., ~ -An, -c .h- orage~. ,,~. . ¥'s ,n, ot,.~ responsible~ . for~ ~err°rs or om ss ons. .n. the ,~ . ,professlonalenglneer'swork.,..,:. ~ [,.,, ...:.~ .~..,,,?~ ,-,:. ~-...~,..,~-~.,,,, .,.:.~ ...... ~:-.,,~..~,-.,¥ .. , ..,< ~, , ..-,,, :. ' ''' ...... ' ' "'"" ' "::"~ "~ ''J' '" ' ' : "'" : ' ' ' ~ '~ WELL DATA Well Classification_,t~/U4:z"Y'~ Il A, B, C, D.F-C. Approved (Y/N) Well Log Presen~'(Y]N). ~ Date Completed Total Depth /~,~.~.. I Cased to /75 Static Water Level -,~ ~) · Casing Height Above Ground Electrical Wiring in Conduit ,~)N) Separation Distances from Well: To SepticJI I~,;,.;;,,~ Tank on Lot Depth of Grouting ~ ~ Pump Set At ~ ~ Sanitary Seal on Casing~Y~N) Depression Around Wellhead~ (Y(~ ,/OO ' ; On Adjoining Lots /(.,~0 / To Nearest Edge of Absorption Field on Lot //O ' ; On Adjoining Lots To Nearest Public Sewer Line /J //:~ To Nearest Public sewer CleanouVManhole ~ /R To Nearest sewer Service Line on Lot Water Sample Collected by '"~".(,~' ~'"~',/f'/~'J~J"~,/~ ;Date Water Sample Test Results ,,~,~ '"~'/"~'~'~)¢~'~'7 Comments ~./e B. SEPTIC/PI~BIN~ TANK DATA Date Installed Standpipes ~VN) Depression over Tank (Y,~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/service Line Course Size / o~.~::) No. of Compartments ~-- Air-tight Caps (~N) Foundation Cleanout ~YN) Date Last Pumped ~J'w /,,4/~ ;for - Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream. Pond, Lake, or Major Drainage Comments Page I of 2 72-026( 11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Slrata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Type of System Design Length of Field .~' ~- Depth of Field Grave{ Bed Thickness ' Standpipes Present (~N) Cate of Last Adequacy Test To Property Line Lot ; On Adjoining Lots Z.y/ To Existing or Abandoneq System on .~' To Water Main/Service Line To Streem/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutbank (if present) ~/~, D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request '* I certify that I have checked, verified, or conformed to all I~OA and HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEFJ~NG Date SR B 196X ..... Compan _ _ __ ~.AGI,E RIVER, AK Y'~=S/ MOA No. Receipt No, Dale of Payment Amount: Page 2 of 2 72-026 (11,84) ro r,s TELEPHONE (907) 562-2343 Anchorage, Alas? 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER pR BLIC WATER SYSTEM I.D.# IVATE WATER SYSTEM Mailing Address City SAMPLE DATE: Phone NO. Mo, Day Year SAMPLE TYPE: I:Y'Routlne [3 Check Sample (for routine sample with lab ref. no. [3 Special Purpose ) r'l Treated Water [3 Untreated Water 'SAMPLE Time Collected NO. LOCATION Collected By ~1 - I TO Br[ COMPLETED BY LABORATORY Analy[Is shows thls Water SAMPLE to be:. Satisfactory Unsatisfactory [] S~mple too long In transit; sample should not be over 30 hours old at examlnatlon to Indicate reliable results. Please send new sample via special delivery mall. Date!Received '~-/ ?- ~2~ TlmeiRecelved / ~ Analytical Method: Membrane Filter * No. of colonlesll00 mi. Lab Ref. No. Result* Analyst I F~ ,~ 1 ~' I l-F1 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter:.' Direct Count Verificetlon: LTB BGB Date Time: TNTC = Too Numberous To Count OB = Other Bacteria Collform/100ml 0 ~/f/~ilformll0Oml ' / ~,"/0 ..m.