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HomeMy WebLinkAboutCURRIN LT 6Currin Lot 6 #017-341-21 MUNICIPALITY OF ANCHORAGE –' Iw DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM INSPECTION REPORT NAME IPHONE NEW - ❑ UPGRADE MAILING ADDRESS P.Q. LEGAL DESCRIPTION 116t• 1 ��. W LOCATION NO. OF BEDROOMS z&9kiim— -it DISTANCE TO: Well Absorption area welling PERMITgO`! �ry2 -T 0 U Y t �,'se 6 . n~ ZQ Manufacturer Materia f No. ofcompartments W r f� Liq. capacity in allons IF HOMEMADE: Inside length Width Liquid depth 0 Y DISTANCE TO: Well Dwelling PERMIT NO. �_ Jaz = z H Manufacturer Material Liquid capacity in gallons w = DISTANCE TO: A) Well r 1 /,`� * Fo d n Nearest lot line/ PERMIT NO. `!^� Z IAO'9 LL Z No. of lines Length of each line Total length of�nes Trench width Distance between lines ` �Zw OH Top of tile to finish grade I+ Material beneath tile ! Total effective absorption are Length Width Depth PERMIT NQ_ w a ._ Q 1- Type of crib Crib diameter Crib depth Total effective absorption area LU a -� W Well Building foundation Nearest lot line DISTANCE TO:— ._ Class Depth Driller Distance to I91,line PERMIT NO. �— W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOI L TEST RATING INSTALLER TC Ey. 04 — 06 1• REMARKS 1 , �f�.t7t • la�Mti cunt WOLA e -L 'r vwft 8,i 0 s' APPROVED LEGAL / ��/ / 1-:7DA�TE E,� '71�/�cf dLo -f-G . Z 72-013 (Rev. 3/78) fid?' 7-6 ) , . . . 1-1 LJ f%-11 I C_ I F=�"FA L_ I -T"V �:3 F=' ����A C1 F:Z trN C-3 I-=--- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~ ' ' 825 L STREET, ANCHORAGE, AK 99501 264-4720 PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: 840972 12/03/84 E3 En bO E" FR CLARK CONSTRUCTION P O BOX 110741 ANCHORAGE, AK 99511 344-7223 80 V4 E=_ L_ L_ F--" 1-1-' � LEGAL DESCRIP: SUBDIVISION: CURRIN SECTION: 27 TOWNSHIP: 12N LOT SIZE: 2A (SQ.FT. OR ACRES) MAX BEDROOMS: 4 ' LOT: 6 BLOCK: NA RANGE: 3W ' Listed below are the options available to you in designing your septic system. Choose the option that best {its your site. J-K0FE7 01 C0 041 0, W ~ 13 F';-.rN ][U,,U DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 , GRAVEL DEPTH (FT.) 7.0 0.5 3.5 TOTAL DEPTH (FT.) -'11.0 4.5 7.5 GRAVEL WIDTH (FT.) 2.5 28.0 5.0 GRAVEL LENGTH WT.) 60.0 56.0 129.0 ** GRAVEL VOLUME (CU.YDS.) 41.7 58.1 95.6 TANK SIZE(GALS) 1,250.0 ** 1,250.0 ** 1,250.0 ** SOIL RATING (SQ.FT./BR) 208 257 299 ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST ________________________________________ TWO COMPARTMENTS ^ certify that: 1. I am familiar with the requirements for on-site sewers and wells 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. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater 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 4 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 (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED DATE- ----------------------------------------- APPLICANT: ATE:_____________________________________APPLICANT: CLARK CONSTRUCTION ISSUED BY DATE: _____________________________________ MUNICIPALITY OF ANCHORAGE Department "f Health and Environmentz Protection 825 ---L Street, Anchorage, AK. `"39501 264-4720 Permit # �� # * # HANDWRITTEN PERMIT # # # WE L ANII/-Mt ON-SITE SEWER PERMIT Applicant: / Mailing Address: d L 1.0 Location: Ph ne Number: Legal Description: Size: Type of Soil Absorption System Is. Trench: 'Drainfield:y Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System it r. / DEPTH � LENGTH --#-I_ GRAVEL DEPTH 31 K: __7"_ Is : %ct 7 a '/- W I DTH o WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC TANK SIZE _ S _ GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other -requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 PW -_AT * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the es'dence r odele to include more that bedrooms. Signed: Issued by: A icant Date: T SWP/024(1/81) //y v_41 MTIVIIT, "w —r - UNICIPALITY OF ANCHORAGE r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATtpN S' 825 1- Street, Anchorage, Alaska 99501 264-4720 TEST SOILS LOG — PERCOLATION TEST- PERFORMED FOR: DATE. PERFORMED: 2-6 LEGAL DESCRIPTION:, Cyrr n S,•,6 L I;-a� TM $3 - 3 n1C A D PT SLOPE SITE PLAN t �F FY I 1,(OL> era, 9t -61o, Grgant ;i11 wid vt��nc 2 /. (G /5W) 5,liy' song, o-nd, grave\) w;tl, 3- 4- 5 45 e 6 12 13 14 15 16 17 (C,YJ) WEI%_gT -A' Oro�� i and Sa^� r.0 S . I } a,i Eolo-S 18 I♦ 19 ♦�+` 0-50 WAS GROUND WATER No L ENCOUNTERED? Si it and $iHl5n. - ,ro"c\ P IF YES, AT WHAT E DEPTH? 6''z" jia• Pek4- 18 c Reading Date Gross Net Depth to Net Time Time Water Drop � {- 12 12:00 - 3, 5 9 — 1 2' 33 33 3. li•a /q 3.6'} 30 ». /:06 — 3.63 — :: 31 30 . oo 20«a�.�- 83-3 PERCOLATION RATE �� (minutes/inch) 'TEST RUN BETWEEN Q 3 FT AND .3 YZ FT r COMMENTS S.:I rwRP �t Z.J�Q/�rn M i'fZ '�D 8Robed V _ .Ily �i 85 1]'��rm -PT )M & 10 �I PERFORMED BY: Beyc^5 CERTIFIED BY: DATE: 72-006 (6/79) ALASKA ENVIRONMENTAL JOB CONTROL SERVICFc INC. SHEET NO. OF 1200 West 33rd Avenues, suite B ANCHORAGE, ALASKA 99503 CALCULATED 0Y �' r DATE ' l (907) 561-5040 CHECKED 0Y. DATE -- i SALE 1//= y0 Lf '- f'- i' =- (-)' Ml000Cf iM-1 hr:'a j UK Grow. Mm, 01471 M -W DRILLING, Inc. 85-12k P.O. Box 10.378 • 10300 Old Seward Highway (907) 349.8536 ANCHORAGE, ALASKA 99511 DRILLING; LOG Well Owner J004 Q1NMCLARK of Welt otic Location (address of: Township, Range, Section, if known; or distance main road 7Ae 6 0= 1n SUM. - Anchorage Size of casing-----6H--Depth of Hole 242 feet Cased to 241.50 feet Static water level 210ft. X� elow) land surface. Finish of well (check one) open end ( a>b Screen . ( ) ; Perforated Describe screen or perforation. Well pumping test at 10 galftotis' ped VOW (minute) for -1 --hours with :a of drawdown from static Date of completio , WELL LOG Depth in feet from ground surface 0 TO 2 e 2 TO 120 120 TO 150 150 TO 160 160 TO 180 180 TO 235 235 242 TO TO TO TO TO TO TO TO . a. ; GiVt r�ei2s offormations penetrated, size of material, color and hardness lieiltZ gravel drives hard avel ��,�.bravel Q G (G 1 I C n NWWA Coet>1#iod CmifUlff 3 --CONTRACTOR 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 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 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Date a If -71P i Engineers Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readily Identifiable 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 bonefit 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 _1Z Approved for bedrooms. Disapproved. c Je (%yC rnessr �il: '•3, •117 t7•/coQv� Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory y Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Other (tUa)1„v, ANr, v,. ••. tie., ON-SITE WATER AND rK WASTEWATER PROGRAM By: yr v Original Certificate Date: �-' 3 0.7 (Rw. 71105) Municipality of Anchorage • '' Development Services Department Building Safety Division On -Site Water 6 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: CURRIN S/D; LOT 6 Parcel ID:0[73W-z/ A. WELL DATA Well type PRNATE If A. B, or C provide PWSID# N/A Date completed 12/21/1984 Sanitary seal (YIN) YES Total depth 242 ft. Date of test Static water level Cased to 241.5 ft. FROM WELL LOG 12/21/1984 210 ft , Well Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 2/6/2009 204 ft, Well production 10 g.p.m. 4.4 g.p.m• WATER SAMPLE RESULTS: Coliform Q_ colonies/100 ml. Nitrate l 4 mg./L. Other bacteria colonies/100 ml. Arsenic: 4UOug./L Date of sample: 2/2/2009 Collected by: GEC Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 12/17/1984 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 6/12/2008 Pumper ' ISAACS PUMPING SERVICE C. ABSORPTION FIELD DATA To BOTTOM Or STEEL MT DRIVEN BY CREY CONSTRUCTION Date installed 12/17/1984 Soil rating .p.d./ or ft'/bdrm) 208 System type TRENCH Length 69 ft. Width 2.5 ft. Gravel below pipe 8 ft. Total depth 0 10.25 ft. Eff. absorption area 1104 ft' Monitoring tube YES Depression over field NO Date of adequacy test 2/6/2009 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test41 in. Water added 660 gal. New depth 66 in. Elapsed Time: 120 min. Final fluid depth 61 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 me.) (YIN & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" level High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '7' Property line 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 line 10'+ Building foundation 10'+N/A Water main Water service line 106+ Surface water 100'+ Driveway, parking/vehicle storage 11 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *7.0 FEET FROM PRIMARY TANK STANDPIPE TO FOUNDATION EXACT DISTANCE UNDETERMINED. G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines In effect on this date. Engineer's Printed Name JEFFREY A. CARNESS Date a117 IV 9 COSA Fee S !1q0 Date of Payment a I I Y I o`{ Receipt Number OOOU%% (Rev. 11105) Waiver Fee Date of Receipt Number SGS Rcf.R 1090402001 Client Name Garness Engineering Group, Ltd. Project Name/# Currin L6 Client Sample ID Currin L6 Matrix Drinking Water Sample Remarks: Printed DateMme Collected Dateffime Recehed Datelfime Technical Director 02/17/2009 13:56 02/022009 14:20 02/022009 15:35 Stephen C. Ede Paramcicr Results PQL Units Method Container ID Allowable Limits Prep Analysis Date Date [nit Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.9 C (<10) 02/09/09 02/16/09 SCL Waters Department Total Nitratc/Nitrite-N 124 0.100 mg/L Sh120 4500NO3-F D (<10) 02/04/09 JDZ Microbiology Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 coVl00mL Sht20 92226 coVl00mL Sh12092220 cOVl00mL SN1209222B A (<200) A (<I) A (<I) 02/02/09 DLC 02/02/09 DLC 02/02/09 DLC CU. V'^ C"C'C 0 :: d1 r, ! 111.5Pa: PIAT I hereby certify trial a survey of lot—!�.-. Block_—_-----. Suodivision was made on _ZL'att<''=� and that the Improvements situated thereon are within the property lines and do not overlap or encroach on the properly lying adjacent thereto, that no Improvements on property lying adjacent thereto encroach on the premises In Question and that there are no roadways. transmission lines Or other vis:ble easements On said property except as Indicated hereon. It is the responsibility of the owner to determine the existence of any easements. covenants. Or restrictions which do not appear on the recorded subdivision plat. Under no circumstances should any data hereon be used for construction Or for establishing boundary or fence lines. ii r tin Dated at Anchorage. Alaska. this day of CONSTRUCTING ENGINEERS.VC. 9001 Buddy Werner Dr. Anchorapa, Alaska 346-2000 tea^ S ,j i.♦t� .'a UPDATED FBG`, Zov9 40 MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. # 12-11 - Q 1 HAA # hA 1. GENERAL INFORMATION Complete legal description Lot 6; Cunni.n subdi.vi-6ion; Location (site address or directions) 5121 Cunn i,n Ci tate Property owner Max R Manc,.a Lowe p y phone 345-6140 LO: 243-2 Mailing address 5121 CuA)Lin Ci4ce.e Anchohage, A.i'_"ka. 99516 Lending agency Seaxtte Moatgage Co. Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 'N 3. TYPE OF WATER SUPPLY: XX Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. 72-025 (Rev. 1/91) Front MOA 821 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 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone S & S ENGINEERING Address 17MA Eagla River Loon Road No. 2Q4 Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for By: A.& N cr Additional Comments Date OF- ACAt-lu 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. 72-M (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:,_>—t �' �J��I'� Parcel LD A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present 67N) Date completed �Z_'L - g4" Driller r&/ � k Total depth Z�Z Cased to • S Casing height L2 4— Sanitary seal (L7N) Wires properly protected (7N) `4 Public sewer main jv pt'k- Public sewer manhole/cleanout Sewer service line S 4- Petroleum tank Otx_� WATER SAMPLE RESULTS: Coliform O Nitrate Other bacteria Date of sample: o.&& �2 Collected by: A 5 fa_-n�- B. SEPTIC/HOLDING TANK DATA 0 Date installed �2 " i1 " 154' Tank size VZ6y Compartments 2- Cleanouts&N) � Foundation cleanout &N) Depression (Y46 0 High water alarm (Y/N) Alarm tested (Y/N) Date of pumping - �- 2 Pumper 1 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ' I � Well(s) on lot 00On adjacent lots QO Foundation To property line � 0 k Absorption field � �� Water main/service line 1n � Surface water/drainage 1 oc?4- r.e.p. w,-n+i rj 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION «' 2 (" ti '13 - �2 Z Date of test 1 1�r1 (� Z Static water level Z l LoS r'r'1 ry Well flow j 9.p -m. �•g.p.m. C 0 < a r ,� Pump level U1_- - v SEPARATION DISTANCES FROM WELL TO: z Septic/holding tank on lot k ()E> ; On. adjacent lots Absorption field on lot c7c�,, ; On adjacent lots t o "F Public sewer main jv pt'k- Public sewer manhole/cleanout Sewer service line S 4- Petroleum tank Otx_� WATER SAMPLE RESULTS: Coliform O Nitrate Other bacteria Date of sample: o.&& �2 Collected by: A 5 fa_-n�- B. SEPTIC/HOLDING TANK DATA 0 Date installed �2 " i1 " 154' Tank size VZ6y Compartments 2- Cleanouts&N) � Foundation cleanout &N) Depression (Y46 0 High water alarm (Y/N) Alarm tested (Y/N) Date of pumping - �- 2 Pumper 1 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ' I � Well(s) on lot 00On adjacent lots QO Foundation To property line � 0 k Absorption field � �� Water main/service line 1n � Surface water/drainage 1 oc?4- r.e.p. w,-n+i rj 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA "Pump off' level at Cycles tested Surface water _ Date installed \2" k-1 - e, Soil rating `oa �l�- System type�"F:!Gh�GJA Length Len Width 2 �� 1 Gravel thickness 8 Total depth �2- Total absorption area l k C>A-� Cleanouts presentd 7N) V Depression over field (YAV N Date of adequacy test 3- o - 12 - Results ass%fail) �S \\ for Peroxide treatment (past 12 months) (W ti.Yg:r�flV11" If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1 �� 4- On adjacent lots i C:>=� 4- Property line bedrooms To building foundation S-.— To existing or abandoned system on lot V- 1 r -3c On adjacent lots 12?C;;1� 4. Cutbank 10 0, Water main/service line ( c:> r Surface water �. C;>�.Driveway, parking/vehicle storage area � o � -t- Curtain = Curtain drain 1J3 E. ENGINEER'S CERTIFICATION i certify that I have checked, verified, or conformed to all MOA and HAA guide) S & S ENGINEERING Signature 17034 Eagle River Loop Road No. 20A Eagle River, Alaska 99577 Engineer's Name Date :!2 °,%pROFESS3©�'A.�v® 1o�e��s C� HAA Fee $ O Waiver Fee: $ Date of Payment �c�-3[J'-� Date of Payment Receipt Number -2-3S 7 Receipt Number 72-026 (Rev. 3/91) Beck MOA 21 sction. CHEMICAL & GEOLOGICAL LABORATORY =c°g A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. LwwwArowr f 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 51977 Chemlab Ref.# 92.1034 Sample # 1 Matrix: WATER Client Sample ID : DRINKING WATER L6 CURRIN Client Nacre :S & S ENGINEERING PWSID UA Client Acct :SNSENGP Collected MAR 17 92 1 16:40 hrs. BPO# PO# :NONE RECEIVED Received MAR 19 92 ! 11:50 hre. Req# Preserved With AS REQUIRED Ordered By A. SHAFER Analysis Completed MAR 19 92 Laboratory Supervisor STEPHEN C. EDE Released By : Send Reports to: 1)S & S ENGINEERING 2) .................................................................................................................................... Parameter Results Units Method Allowable Limits ------------------------------------------------------------------------------------------------------------------------------------ NITRATE-N 0.66 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: R.J.S. Remarks: .................................................................................................................................... 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Leas Than, GT -Greater Than ,MBS Member of the SGS Group (Socidtd Gdndrale de Surveillance) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date Z" — 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) _LOT C C09RIA1 s10 1712-N 63w Location (address or directions) S-12-1 CORRIN CIR Aiyo AK (b) Applicant Name p �.1odN CORK Tele hone: Home 3(14-7223 Business 3! 5--0q2- Applicant Address Po. BOX 1167111 ArqC#4' AK g91,57/ — (c) Applicant is (check one): Lending Institution D ; Owner/builder I$; Buyer[]; Other D (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family,' Multi -Family O Other Number of Bedrooms q 3. WATER SUPPLY Individual Well 0 Community D Public D Telephone Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite K Public D Community D Holding Tank D Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 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 is E C 5 1 N C, Telephone S-6 / ^-2S0 ya r1 Addre Date ♦gr C.r'�vw� Q t:ZOF A4"'Will, i *-0 "I ibe, eal %...:...... 666 0006: .. ,` • C. REID, J . • •. CE -2251 : �,-'� A" f600,08 IT 1� i; p�leniona� ��+ 6. DHEP APPROVAL (40/ for Ado— bedrooms y a ' "^ Date Approved Ok Disapproved Conditional Terms of Conditional Approval 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 issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OFANCHORA HEALTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 MAY 15 � Legal Description: 1; 6 CORRIN 510 Tt2N Raw sEC 27 ` A. WELL DATAR E C E I V E D Well Classification I IJ 01 V1 CuftL If A, B, C, D.E.C. Approved (Y/N) Nf Well Log Present (ON) Date Completed 21 OFC g Yield t0 GPM Total Depth ?q2/ Cased to 2. 4Y / Depth of Grouting _ Al Static Water Level 210 ( Pump Set At UN &OU.)1/ Casing Height Above Ground 1,s Sanitary Seal on Casing ON) Electrical Wiring in Conduit ON) Depression Around Wellhead (Y49 Separation Distances from Well: To Septic/Holding Tank on Lot 01? / ;On Adjoining Lots 06 "4 - To Nearest Edge of Absorption Field on Lot 1 /+ ; On Adjoining Lots To Nearest Public Sewer Line NJA To Nearest Public Sewer Cleanout/Manhole NA To Nearest Sewer Service Line on Lot 0 Water Sample Collected by , + A-1 [04UCS ; Date 17 6 Water Sample Test Results Ls SAfL — 5 EF 4TTi+CHFD R 66 UZ .S Comments B. SEPTIC/HOLDING TANK DATA Date Installed q Size 12-5-0 No. of Compartments 2 - Standpipes Standpipes &N) Air -tight Caps (9N) Foundation Cleanout ( N) 4TDepression over Tank (YA Date Last Pumped Pumping/Maintenance Contract on File (Y/N) A ; for N�%? Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well X01? To Building Foundation 6+5 To Property Line S-0 To Disposal Field 077 To Water Main/Service Line NVA To Stream, Pond, Lake, or Major Drainage Course l o B f + Comments SEF C ERTIF J CArE OF © C CU,641VGli Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2Q9 Type of System Design L6CA/Cr1 Date Installed j�1_7/fq Length of Field 691 i i Width of Field 2,15 Depth of Field 1? Gravel Bed Thickness Square Feet of Absorption Area 110 Standpipes Present (9/N) Depression over Field (Y(9) Date of Last Adequacy Test Results of Last Adequacy Test t /7 Separation Distance from Absorption Field: Z To Water -Supply Well 100 fi To Property Line r To Building Foundation 2©O f To Existing or Abandoned System on Lot N� ; On Adjoining Lots To Water Main/Service Line Nift To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments 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 ) "Pu ff" Level at Vent(Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I haveecke=verifi,or conformed to all MPA and HAA guidelines in effect on the date of this inspection. Signed ��// Date Z Comoanv AF-C,/Y -S I Gr MOA No. Receipt No. 3d 50 Date of Payment (moo Amount: $ - `6 � �E, Page 2 of 2 72-028 (11/84) t 'tE OF At Will, CO)' p j /*LER C. REID,AT �'„ CE - 2251%