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CHANDELLE ACRES LT 14
Chandell Acres Lot 14 #051-822-10 Eii � - Permit Number. Municipality of Anchorage ;eta Development Services Department :• `' ' Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page www.cianchorage.ak.us (907) 343-7904 ON-SITE -0WASTE,WAATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 330(:) 3 PID Number: 051 — gOt —' I •err, I'�' / J or3 0 Name' pp olln r�Otnse Wastewater System: ❑New Upgrade eaa P.o, Box 67x577 (In,9,c k, x94567 ABSORPTION FIELD Phone +1 �"')` ge Number W Bedrooms./ f_ it C—J�/ 35 ,,I Waw Trench r] Shallow Trends 0 Bed 0 Mound 0 Other. LEGAL DESCRIPTION SolRating1 D r 0 0,,,,F0FI, Total Depm hon original gradeok Block lot ( / / Subdvision; // n /e// �`rPe L/� L//!S`eectio. /GO Deem to ape bottom from original yre FI. Gravel depth beneath pipe: �FI. Township. Range: Fat added above original grade: I f • FI. Gravel Length: 3 VFI. Well: ['New Upgrade Gravel width' �j ,JC FL Num dMea' Distance between thea: FL j�ClassiRae/on (Private, cy. ,, �" �I 5JT/ ✓l9 �Igi.l r` h' Total Depth: I. Cased to FI Total absorption Gree o 5 e 1 F1s Pi Mate/d�el ��--/s,,� {�.-'+Q �j 41 / D?o3q 1 U I `i Driller tiled. Static Waley Levet FL Installer 0tt1 Kilt" Date Inataaed: / _13 __ D3 16 Yield GPM Pump Set at: Ft. "b0.. Ft. TAN K SEPARATION DISTANCES t4Septic 0 Holding ■ S.T.E.P.IlOther. To From Septic Tank Absorption Field Lift Station Holding Tank PubflclPrtvate SewerUne 't' "t ° ^ 0)G`' Oi C.41)-e,lar / c8Qecity 15.60 Gal. Wall {V•,l'J_r/ 171' �1 ^5I Material �ve Num et of Compartments' �_ Surface water I 1F- l00!+ LIFT STATION LolLne 27' 6, Size Gal. ManhAanuer Foundation /L , /0 'Pump an bvN at. In oH' level al: In Mph water alarm at: In. Curtain Drain �/ / lj1' // -- Pump Make a Electrical Inspections pertained by Remarks. Some mer rock .1! /n � BENCH MARK �% � d u/ 1/19 ;7/544 At 111° 1/. Loxton and besnrplgn: Bal./0m , ...e. s( �d iYl 'til VV415 `7Le We ch ve of +line., d Elevaern. /n ® pvl// y! 'Go FL - o-r s o,-ic 1 vi5?ecf,one I ri/U.Veovs s•EATtc -LANK 6h.4-1 P✓MPtd / C4c-siefh 4 M?�,i� O gLfsfttt c 1' N a. f • E ,4.- � ,'� rpt fff������ •„,,7A , "" """""" ' .....„_; ...............1 �p ROBERT C. CClhts#M e i j �4 .� Cf. -6801 : 4 -4.” 4\ rr-rLJ J1r+'`. yt� AggNaaNeD _ $ & S ENGINEERING 17034 17034 Eagle River Loop Road, No 204 K-12-03 Inspections performed by: Dates: 1' Q ”- i 2 _03 ' zj 6— 13-03 Development Services Department Approval Reviewed and approved by: / lfZ /2(1-4-,•1.-Date: S '%' 3•—•-•--••:.4>„.\•,_ (Rev MOO) PERMIT NO SW030093 PAGE 2 OF 3 Municipalityof Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION PD. Box 196650 *Anchorage, Alaska 99519-6650 •.Tele hon343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 14, CHANDELLE ACRES P.I.D. NO. 051-822-10 LOT 28 LOT 29 10' LIG EASEMENT TH0211C04 CO3 STI ST EX STING A FCO 4 BEDROOM HOUSE B EW TRCHCHUTI 1 02 V (DIVERTER VALVE) DBL1 & 081.2 • C ALTERNATE SITE' c)". N WELL HOUSE // / c:::c / LOT 13 150' RADIUS FROM CLASS 'C' WELL. LOT 15 FP4- �/ JSF / / o� SCALE: 1' - �6 GO�� R LOT 12 • .. ROBERT C. COWAN a? 1 ipx CE -8801 �/ PERMIT NO SW030093 PACE 3 OF 3 Municipalityof Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Teel�ephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 14, CHANDELLE ACRES P.I.D. NO. 051-822-10 ST1 s ST2 / 98.8' FINAL GRADE NEW 1500 GALLON SEPTIC TANK CO1=98.7' CO2=99.3' FINAL GRADE MT1=88.5' C01=95.1' CO2=95.0' NO WATER FOUND 82.5' B.O.H. A 9 FCO 3.0' 25.0' ST1 85.0' 90.5' ST2 95.0' 100.0' DBL1 99.0' 103.5' DBL2 100.0' 105.0' DV 101.5' 106.0' C01 103.0' 107.5' CO2 135.0' 139.0' CO3 80.0' 86.0' C04 103.0' 108.0' MT1 137.0' 141.0' N, T. S. 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 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030093 ILegal Description: CHANDELLE ACRES LT 14 Design Engineer: 0003 S & S Engineering Owner Name: John Rouse Owner Address: PO Box 672577 CHUGIAK , AK 99567-2577 Date Issued: Apr 22, 2003 Expiration Date: Apr 21, 2004 Parcel ID: 051.822-10 Site Address: 023916 CHANDELLE DR Lot Size: 40763 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank [❑ 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. Received By Issued By: --7/11? Date* V4. y l o J �• Date: 4/23/C3 Mmileiptility dt Atit1iui-uge tieVelbpttioll §et-tiltes btpatttnetit building safely bivision on -Site Welet and Waste* ter program 4700 south brags* sl. )`'.o. box 196650 Ahchotage, Ak 99519-6650 unkw.cl.anthotage.ak.us (907) J41-7904 ON-SITL SEWER/WELL PERMIT APPLICATION rola A SINGLt IAMILY bWELLING Parcel I.D. 0 S — ?. a - ( 0 Permit Number SW 06073 Property owner(s) Jo tt n Po“ 5€ bay phone b g g ��D5L7 Mailing address (i) R 0, Bok 67 5-27 Mailing address (2) ( h (49 /a k ,AK / Zip Code I 5-6'7 Legal description (Lot, block i Sub'd.) 1-0-1-11f [� / AA ✓t c lk O�JL res S/D Legal descriiptiott (Section, ToWnship & Range) Lot Size Ll 0/ —163 Acre - Sd.tl Number ot Bedrooms T This AP'LlcAtloN Is poli: SeWer Only Sewer and Well Sewer Upgrade . 'MS PhoP =Rtv bbNTAINS: Not tub (] Jacuzzi 0 Swimming pool ❑ Wafer Softening Uriit ❑ therapy pool (� Well Only ❑ Water Storage G 0 1 I certify that the above Intortrtatioh Is correct. I further cettity that this application Is being Made tor a §fNgle pdttrtly bitelfthd and is in accotdahce Willi applicable Municipal Codes. 5 & S ENGINEERING 17034 Eagle River Loop Road No. 204 ��l✓ i.. Eagle River,Ara.44 99( 77 (SlgnalUre at prapetly bwhet or dlilhotized agent) l'errnil trees: ' Z! 00. " Waivet tees: T / SO• " bale ot Payment: 41/...-/0 3 bate bi 1'aymenl: $ ecelpl Ndmbet: 0 3 tt / 7 ' X Receipt NUtnbet: tRev. 121Oe) eft 3 0 f/ If V)T.,o3oo D \ _ /PAK + ^ L.S & S 4._..: E G1nenung Vii` t4 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANO REPORTS WELL INSPECTION a PLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. April 21,2003 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 14, Chandelle Acres Subdivision CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 It is requested that you issue a permit to install a septic system upgrade to serve the existing 4 bedroom dwelling on the referenced property. A waiver of 5 feet is also requested from the septic trench to the southeast lot line. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation .114/03 no water was found. After monitoring, ground water was not found. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve 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. If you require additional information, please contact us. Sincerely, obert C. Cowan, P.E. RCC/bjj Enclosure 17034 NORTH EAGLE RNER LOOP • SUITE 204 • EAGLE RIVER, ALASKA99577 SITE PLAN sy O RIP Ops 2 Z \ A = N \ Z- 0 Z C /^ N c z 0 FAAQ^^� V, DESIGN 0 \ 0 C-71 D 0 U) xi N D D C7C N m r-0 r 0 ►-3 N ou m C1)(7) 07-1 -4 =0Z m O 0-4Z ZOO 0 a-4 wmra Zom0\ zC v v m n O 3did !O ON] 1" = 40' SCAI _ F 0 v (o - 4 N • 1 0.. 0 1N3W3SV3 on 0 S H) 4_ ols•d•7 :AB 03H]3H os Zz ZP] z zi zy 0 1" = 40' SCAT 0 24 r- < -1r \ Z =,o X O N�-0 C=v� ".1 \ Z \ C • V:K 50= 0 DESIGN 0 H 1 ' \ m r r 0 0 H 1 CAD SITE -PLAN w•NVtO Cr?.ifi o \ \ r0 m O \ t.)-t3 m =CO or N NZ m00 0 \ c, En mmx \ CSN \ V1 -I-•1, \ mac '\ P-1 sxo 1 • \ q—o ,44 \ s00 zmr r o0tt �z zC \ , mr , ov \-- , , t , , \1 >2 0' 1N3113SV3 On rt ti X Z 0 .'9 -1O P1 Z N oH _ :dI2IH.LINJ ma .,_1: XZ� i PI X 10^A O 10• r ..4"i 0'&1414%. 0' 23 b P N 9 ItO AI Nm 10 N r VCR 4.10 0 O0 'W0 23 (5 X XI ZD Z\DV O C 2i l -' Zy `LJ KKN mr O 73 0n y C D m Z O 47, 0 0 1 m r�1 z r rzin cn Jun 12 03 10:40a 688-0377 P•1 DEPT. OF ENVIRONMENTAL CONSERVATION ENVIRONMENTAL HEALTH OFFICE 555 CORDOVA STREET ANCHORAGE, AK 99501 April 18, 1996 Gene Dodd Chandelle Acres P.O. Box 672001 Chugiak; AK 99567 RE: Public Drinking Water System Classification PWSID: 213807 Dear Mr. Dodd: • TONY KNOWLES, GOVERNOR . (907) 269-7500 This letter is to verify the classification status of your drinking water system. Our records indicate that on or about November 1993, your water system was reclassified to a. Class C from a Class A water system. This determination was made based on a letter written on September 23, 1993 by yourself. The letter outlined the residents on the water supply and the population being served. Has this information changed? Please provide an additional letter in writing confirming the present status of your subdivision and the residential count of consumers on the system. Thank you very much for your cooperation. We hope to hear from you soon with this information. Sincerely, M. Johnston Drinking Water Program LMJ:Imj cc: Keven Kleweno, AWPSA f4 * qu1ee zlrig HEALTHAuTNORIn APPROVALS SEWER&WATER MIUN EXTENSIONS SEWER SWATER INSPECTION ENGINEERING STUDIES AND REPORTS WEIL INSPECTION an.OW TEST SITE PLANS ROA/ DESIGN SOIL TEST PERcaAnoN TEST STRUCTURALd INSPECTIONS ON SITE WASTEWATER DISPCSALSYSTEI. DESIGN ROBERT C. COWAN, P.E. CML£NGINEERS (907) 694-2979 FAX (907) 694.1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 14, Chandelle Acres S/D June 12,2003 GENERAL: 1. The scope of this project includes the installation of a 1500 gallon septic tank and a new trench to serve the existing four bedroom residence located on the referenced property. 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. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP I SURE 204 EAGLE RIVER. ALASKA 99577 Page 2 Lot 14, Chandelle Acres SID June 12, 2003 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCIIIDRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalis of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. 6. A subsurface disposal field may not be located on a slope greater than 25 percent unless there is an approved exception documented. Page 3 Lot 14, Chandelle Acres SID June 12, 2003 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, 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 #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement 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: Page 4 Lot 14, Chandelle Acres S/D June 12, 2003 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. . 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / INSTALLER Municipality of Anchorage Development Services Department Building Safety Division a" On -Site Water and Wastewater Program ` 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet WR#: WR030030 PID#: 051-622-10 HA#: HA030160 Permit#: <LA/0300(0 Date Received: 4122/03 Legal Description: Chandelle Acres Lot 14 Engineer: Robert Cowan. PE S & S Enalneering Applicant: John Rouse Waiver Requested: 5 feet from septic trench to southeast lot line Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: Total: Waiver is Granted: X Waiver is not Granted: List Conditions or Reasons for above: 5 F E FV 6'pre( If LE IT f R 0 F Tk 5'7./F/C047io t. DRTE i2 4/2 i/409 »17»C/4F_/9 Date: 4/22/03 By: p/qN Name of Reviewer Rec#: 34178 Amount: 5150.00 Date Paid: 4/22/03 George P. iijzerch. Mayor 4/23/2003 Municipality of Anchorage Building Safety Division Robert Cowan, PE S & S Engineering 17034 Eagle River Loop Rd. Suite 204 Eagle River, AK 99577 Subject: Waiver Request for Chandelle Acres Lot 14 Waiver Request #WR030030 Parcel ID #051-822-10 Permit #SW030093 Dear Mr. Cowan: Anchorage blerd AII•America City 1 1 1 le, 2002 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 5.0 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. erely, ■ CIJAM(/' Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: (907) 343-8301 • Fax: (907) 343-8200 4700 South Bragaw Strcct • Anchorage, Alaska 99507 http://www.ci.anchoragc.alcus • MUNICIPALITY OF ANCHORAGE ,1---- \\ `► , 1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 0 SITE SEWAGE DISPOAL SYSTEM AND/OR WELL INSPECTION REPORT NAcI � /j ID� as/' G CA✓Y v, 6" H❑NEW,[//J ?CrUPGRADE MAILING ADDRESS LEGAL DESCRIPTION( le / ? C 3---yo II Ute'/ 6/`/ LOCATION NO. OF BEDROOM SEPTIC TANK I,Well DISTANCE TO: Absorption area Dwelling PERMIT NO. Manufacturer >) r S 7/4/ % 4 !C-- Material No. of compartments Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth 6 Y JAZ 2 ? Fa- DISTANCE TO: Well Ai Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE TRENCH DISTANCE TO: Well,q,y.) / G(�J Founda 7 / �� Nearest 19 line/ PERMIT N.--0(.4:2 No. of lines Length of�pc link lf�i Total len 6linns Trench 2i [ inches Distance e n es Top of til o finish raple ttl e/p inces Total effec4e absorpti areaNasZe 6 7J SEEPAGE PIT Length Width Depth PERMIT NO. Type of crib Crib diame`ge) p� N / lnp Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line w Class)( ( / $7//v c. Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER N PIPE MATERIALS V C ^� i SOIL TEST RATING 2/2 X - ZZ / 4INSTALLER t I\ REMARKS rye fi 4 4,101.0 C ITS ��, r - 'i'/ 6 0,7 v ' 41 O [,. i i . , t90 1►\IN /o • 'Lois r.,.':tf"i.fz:. rT Rcb-r it A. ,. 40 7. F , ivr, 14 C utt 'y rfli�a _ �. iii .Rid .,. oe /eLeg-1789 'Rd AP' • - � DATE LEGAL; :, 3 s�� itMAW ale z,.,z3_1{2.61~ SUS 3 (Rev. 3/78) Permit # MUNICIPALITY OF ANCHORAGE Department -'-f Health and Environmenta'"`Pr t ctio 825 Street, Anchorage, AK. .,9501 264-4720 HANDWRITTEN PERMIT W OR NN -$ITE SEWER PERMIT Applicant:(j.,;1/.;A l Mailing Address• Location: (Z�%/, Phone Number: Legal Description: /2-i/ (17Aka.G'/C -s/0 Type of Soil Absorption System Is: Trench: Drainfield: Maximum Number of Bedrooms: 5 The Required Size % f DEPTH // LENGTH Seepage Bed: Soil Rating(sq.ft/br) 2/ Z OrkT/r0 /beeW-,— Lot Size: Holding Tank: of the Soil Absorption System Is: GRAVEL DEPTH 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) . 0e lg//1,- * * REQUIRED SEPTIC(WI-N eLDG) TANK SIZE = 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 feel 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 3 3 * * * 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 wi - nstall th system in accordance with codes. (3) I de• - d the on-site sewer system may require enlar.= ent if t • - r= = i� -n• _ �' ' re'• •deled to include more that � • ►9•oms . Signed/k�i 1 %plicant SWP/024(1/81) /Role &I/7 fie// 74 Issued by: Date: r-6,1ele le• � MUNICIPALITY OF ANCHORAGE o , 4 16 �— DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME- V,T725 ('9/JSL �G%a/ NEW UPGRADE MAILING ADD ESS 31 2 <1 3 C4 €/z / 44 99j-/7 LEGAL DESCRIPTION J �"+� L / % 9 C��' /2//e i LOCATION e��� ��/B � 'T � NO. OF BEDROOMS SEPTIC TANK Well �. 1 DISTANCE TO: /d0 Absorption area /.�- Dwelling (./_. - PE T /` C��j(j% Manufacturer /�,�Q� (T 1. Mat e / No. of compaain/ents G' Livbcity ijallons IF HOMEMADE:: Inside length Width Liquid depth Y O z < 2 I— DISTANCE TO: Well /y�T-Dwelling PERMIT NO. Manufacturer �� Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: Well / /�Q �► Foundation�/ (,4 LO Nearest to • e(4 �. PE T �+� % No. of lines / / Length3Le j� Iile . 33 -- Total Ie,_qyf(liner(.. Trer�jh0 i ttir ,,� inches Distanc e n lines Top of tie to finishrade Z nd H✓U(ginches Total of iqJ b�rption area C-.7.‘",, SEEPAGE PIT Length Width Depth / PERMIT NO. Type of crib Crib dia e r A Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J J w Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption areals) OTHER A *- .rJ� �I 467 PIPE MATERIALS , C T SOIL TEST RATING( I Q/J ^oe INSTALLER` aAr- ,4-)s- REMARKS E;i 1_ 1 lit S^'" \ 7 I ++'••.• s •r a e . r •w� ) j,1/ /.• a'S - `� The fly. 4 • / rr 3, .^`Opp' �• } APP V DATE LEGAL 0& S Engineering if 72-Q1(3 (Rev. 3/78) dew RETURN TO: Division of Geological and G+.-vslcal Surveys (DGGS) 9001 Porcupine Drive (Tele, a: 277.6615) Rnchorage, Alaska 99501 WATER �WELL RECORD Drilling Company Name Co.tenn-Ahipasoint Dni LOCATION OF WELL Please complete either la, lb, or Ic. STATE. OF ALASKA DEPARTMENT OF NATURAL RESOURCES U.S.G.S. Local 11o. Drilling Permit No. A.D.L. No. 1a. Borough A,�cle. Subdivision C Lot !k Block ib. Fraction / / / Section No. Township N/S Range E/W Meridian lc. Distance and Direction from Road Intersections C14!44144 ane and Chandelle lata, Street Address and Area of Well Location 3. OWNER OF WELL: C._ - Atuct on Address: 7/.33 &ale 81 # 2 2. WELL LOG Feet Below Surface Material Type Top Bottom Send l Mdia.9.. AA. 99 L. WELL DEPTH: (completed) Surface Elevation Date of 275 ft. 2 �i . riga 5. 0 Cable tool &Watery ❑ Driven 0 Dug 0 Auger ❑Jetted ❑ Bored ❑ Other:_�� 6. USE: @Domestic :Public Supply 0 Irrigat fon ❑Recharge Test Well Other: o Industry GConvert lel 7. CASING: El Threaded Welded in. to 275 ft. Depth Weight 17 lbs/ft. in. to ft. Depth 6. FINISH OF WELL:�,.1 Type: Ohas DImeter:1 ..,,,..� Slot/Mesh Size: Length: Set between ft. and ft. Fittings: 9. STATIC WATER LEVEL: ft. E]Above Elelow land surface Type of Measurement: 10. PUMPING LEVEL below land surface ft. after ft. after hrs. pumplg G.P•m• hrs. pumping 9.9.m. WELL MEAD COMPLETION: O In Approved Pit itless Adapter Inchesabove grade 12. GROUTING: Well Grouted: ❑ Yes t8 Materiel: ❑Nat Cement C:1.01tii HP PUMP: (If available) 19. ., Length �ooff Drop Pipe E O ft. capacity /2 a'. . 'T� Type: SubmersIbte ❑Reciproutlg 0 Jet ❑Other: 1l. REMARKS: gat t `2 wine GEtrirve 4ii.... at 275 4--ww 15. WATER WELL CONTRACTOR'S CERTIFICATION: This ylpilwas_dr lied under my 'ur! Iction end this report is true to the best of my knowledge and belief: • Registered Business Name 1I'/1 SCoonnttrract Lrc.nse Number " eoe a.z 994 Address: v Ak 19� 1Ctr ?1U9. 18 1980 Signed: Date: ''�r:.f.{...t,er`'�.-,�i-z ,l 1 uthori • presentatof e Form 02-WWR Copy DistrlbutionlP WOITE - te'DGGS, PINK - Driller, CANARY - Customer 01P- FM-41173ACIR!FilalE DEPARTMENT [- HEALTH AND ENVIRONMENTAL --OTECTION 825 'L STREET, ANCHORAGE, AK. 99:--1 264-4720 �7.E141aIR IPEF:MIT PERMIT NO. ( 800440 ) APPLICANT YATES CONST LOCATION CHHNDILLE ST LEGAL LOT 14 CHANDILLE SD BOX 243 CHUGIAK LOT SIZE 43000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = SOIL RATING (5Q FT/BR)= 212 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �EF•TH= GR:nvalL__ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. 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). LSEPNTIC: 11-1=04K �IME= 1_1010ID 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 FRORE --- 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. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. EXF'IF:Ef=7. CMEC=EMBE JLIFIeJe I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF HNCHORRGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS 0 SIGNED. APPLICANT YATES CONST ISSUED BY_ ` -� ' _ �__DHTE PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6650, Anchorage, jlaska 99502 2762221 SOILS LOG — PERCOLATION TEST •LEGAL DESCRIPTION: - 2 a pie / chaiS,/k 7Sc(4., SP -Ty :4A-10 0 SOILS Ery"— DATE PERFORMED: c: ire S PERCOLATION TEST 703/-P° SLOPE SITE PLAN 4 8-' 9- 10 - 14 15 16- 17- 18- 19- 20 - b 6 \)()Y 7-5c COMMENTS Robert # Shafer gorrcio c, He L GROUND WATER OUNTERED? ES, AT WHAT TH? /110 S 0 P E i Date Gross Time Net Time Depth to Water Net Drop r - i 1I i i {— l ....-...? ♦ U p 2 Cl F ,t jc% p r 1-- 45 3%1Z ;1 3 r r '' 3c� r Ic . ` if�i ` % '' Y.; ,'op lc 1, 413h; ihL ►, .) t. A 1C,1 It 7 y ii //I, .e k -'11 c r� � i Date Gross Time Net Time Depth to Water Net Drop r - i 1I i i {— l ♦ U p 2 Cl F ,t jc% p r 1-- 45 3%1Z Reading Date Gross Time Net Time Depth to Water Net Drop / *41 '?,'Sc' 31911 2 Cl F ,t jc% p -3r, 1,0 II,, 45 3%1Z ;1 3 r r '' 3c� r Ic . ` if�i ` % '' Y.; ,'op lc 1, 413h; ihL ►, .) t. 3 ;,s-' p 1C,1 It 7 y ii //I, PERCOLATION RATE TEST RUN BETWEEN .yo f ( (1.5 / ,f7 /IC(, or (minutes/inch).„"' � f FT AND v FT t 1/2 • a PERFORMED BY:. 72 003 (7!76) CERTIFIED BY DATE: /?i�7/3'0 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 wwwcianchorage.ak. us (907) 343-7904 Roe ,e)- C. Cra„itN CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-822-10 1. GENERAL INFORMATION Complete legal description Chandell Acres Subdivision: Lot 14 Location (site address or directions) 23916 Chandelle Dr. Current Property owner(s) _ John Rouse Day phone 907-242-3588 Mailing address P. 0. Box 773574 - Eagle River. Alaska 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. HAA# b4O5gA Expiration Date: )'-g„2-c4C:CFJ 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class 'C ' Well Public Water System 4 TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding tank ❑ ❑X 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. 1 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 S & S Engineering Phone 907-694-2979 Address 17034 Eagle River Lp. Rd, - Eagle River, Alaska99577 q/ Engineer's Printed Name Robert C. Cowan Date /0 / II 70y OPA` { 5. DSD SIGNATURE Approved for 11 bedrooms. CE'8801 ` �` At Disapproved. tiauc; cs'stc"Y �w Conditional approval for bedrooms, with the following stip'�'s` 0 ROBERT G COWAN ••I4 f B Additional Comments ,z1/44(imcfrifoic,z r„,Q• 9 o /ONO, Attachments: - HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other (Rev. 01/02) nk.AS)u Original Certificate Date: 10/A.3/00 escnp ion Municipality ofAnchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program " r w �"4'�0�"Souifi"$ragaw St • ox •nhc Drage AK 99& err+rr of anc'horage ak us ; , ...y ;tea "sial.,,. EALTH AUTHORITY APPROVAL CHECKLIST xg:y''�s4aSta°'- o I `{ G rd&E LA_ AS Parcel ID: Or(— S a- — /O e ype 1-44f ate comp eted _ ota _ depth, If A, B, or C provide PWSID # Sanitary seal (Y/N) Vase. o WePI Log (Y/N) Wires pro. I protected (Y/N) asing height (above ground) in. AT INSPECTrOV ate o est e produc roduc ft. 9:p.m. rsenrc Nitrate g• Date of sample j4 G Other bacteria a colonies/100 ml. by Collected by: S 81S ENGINEERING 17034 Eagle River Rp•d No. 244 Eagle River, Alaska 99577 Date installed 6 / / 3 /0 Cleanotitscl) Ye ank ype raters I f'Trc / STE.CG, vr!'°� an size 0 gal ,Number of Compartments oun•a ton c eanou &N) Y45 Depression over tank (Ytf • n' U ate of .urn ing /4 r( 41 ' Pumper J` 3 ate en girl System type tot p r4ENc-H ft: Width ft. Gravel below pipe 7 ft. I ft Eff absorption area Soy ftt Monitoring tube •t Depression over field •__ )- Yeti .c,.,51,-4 Results (Pass/F For bedrooms ate of aitequacy test Water added„_ gal. New depth_ in: apse'me: ny rejuvenation tre fluid depth in. Absorptionrate >= g.p.d. nt (past 12 Pio.) (Y/N "& type) `" `" "" If yes give date LIST STAT(Of::. Date installed Size in gallons Pump on" level at in. "Pump off" level at Datum \c es tested E. SEPARATION DISTANCES' SEPARATION DISTANCE'S FROMM VRL1 O LO Septic tank/lift station on lot' t7-° i' Absorption field on lot S'O rf Pubic sewer; main Sewer /septic service line q Z Holding tank CFPGRATIr1N r)ISTANCESf'FROM SEPTfC%HOLDING TANK ONLOT TO. m level at in. Meets alarm & circuit requirements? On adjacent lots Fro 1 - On adjacent lots / S" d -f- Public Public sewer manhole/cleanout 4 Building foundation S 3 Property line 7 Absorption field Water main 10 -F ' Water service line / 0 t Surface water % 0 b f Wells on adjacent loth ' 00 -t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line a-(, Building foundation /0/ 1 Water main /0 4- Water Service line 10 Surface water / 0 0 , I- Driveway, parking/vehicle storage /0 (- Curtain rain c v svG a Wells on adjacent loots )0© t .10 }�\c. •••••...w.. �((.1 Y/ F/ � � i\ e i " > x z'' JC.d t w, c as Swlc a}, \ G.ENGINEER`S CERTIFICATION ,^ c�:' tet,. .'p %A ' '' r'v . i p': d 4 �a4 jj �;" (, 1 certify that 1 have de'terrr fined through'field mspechons and ` / ... 66 ;•• .A� al records that the above systems are in h MOA HAA guidelines in effect on this date. p t: - ... - a l ROBERY C. COWAN r 'tJ Ii ?_,y review of Municipal conformance with. C Co `��' CE Engineer's Pnnted Name '� $ � _� T ! ,M. sr .. , s Date f0 //q!a� )-Asr i---,-' ,, HAA Fee $Nowa* r0 // /0 `1 Date of •Payment R Date of Payment „y:.r ., .,. ,. `.':, ,. : �ti 'm"c",¢•=E g:;s.. sasn,.a „,,y um ,.,::nw � .a-'^�,.< ... 'k` Receipt Number Z fig' } Receipt Number (Rev. 12/01) Waiver Fee $ 10-18-04; 4:29PM; _Sat SGS Ref.# Client Name Project Name/# Client Sample ID Matrix PWSID 1046616001 S & S Engineering Lot 14; Chandelle Acres Lot 14, Chandelle Acres Drinking Water 213807 Sample Remarks: Total nitrite/nitrate was analyzed by Mat -Su Test Lab of Alaska. ;907 5615301 # 2/ 4 All Dates/Times are Alaska Standard Time Printed Date/Time 10/18/2004 16:19 Collected Date/time 10/06/2004 12:00 Received Date/Time 10/07/200 12:13 Technical Director _ Step Ede Released Parameter Results PQL Microbiology Laboratory Total Coliform 2 08, No Coli Units Method Container ID Allowable Prep Analysis Limits Date Date Ink col/100mL SM20 92228 A (<=j) 10/07/04 DKC 10-18-04; 4:29PM; ;907 5615301 Mat -Su Test Lab of Alaska Water Quality Testing Mile 3.2 Palmer-Wasilla Hwy. Midtown Community Business Park Phone: (907) 745-3005 Email. mat-sutestlabebrooershsa.eom # 4/ 4 P.O. Box 2749 Palmer, Ak. 99045 Fax: (907) 745-3010 Client: SGS Environmental Attn.: Forest Taylor Client ID: 1046616001 LOT 11 C/4-froii;g` Atie Cs" PWSID #: Source: M.S.T.L.#: 2004895 Sample Matrix: Comments: ID Method Date Arrived: 10/12/04 Report Date: 10/12/04 Sample Date: 10/6/04 Sample Time: 1200 Collected By: Parameter Units Results MDL Date Prepared Date Analyzed MCL SM 4500-NO3-E Total NO3/NO2 mg/L 4.08 0.50 10/12/04 10/12/04 10.0 Legend: MRL = Method Report Level MCL = Max. Contaminate Level B = Present In Method Blank E = Estimated Value H = Above MCL D = Lost to Dilution A' Rd By Jon Paul Campbell Lab Supervisor Q1 o• U) w H C m 0- a 7 • e ., •o . a D • t. s• u : 4 Yoe 11 s F Acahcr te. c J N N5344-4 • a 25.00' 0 CLOVERLEAF ROAD N 00°01'19"W N 00°04'31"W 291.87' (M) 291.87' (R) z oo 9,P 0.1 0 z 0 m r r rn o m z co co 0101 W N O mrn cm cm W W WW \ 25 04' 09 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.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 051-822-10 HAA # BA030160 Expiration Date: 4/23/03 GENERAL INFORMATION Complete legal description ,Chandelle Acres Subdivision Lot 14 Location (site address or directions) 23916 Chandelle Drive Current Property owner(s) Gene Dodd Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Mailing Address John Rouse Day phone 242-3588 PO Box 672577 Chugiak, Alaska 99567 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System 2 _ v7) -y/0 3 TYPE OF WASTEWATER DISPOSAL: 0 Individual On-site ❑ Individual Holding tank Community On-site ❑ Public Sewer pE 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 8 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 adequ f•r the number of bedrooms e of structure indicated herein. I further verify that based on the informabfir efrom the Muni chorage files and from my investigation and inspection, the on-site w posal system is(are) in compliance with all applicable Municipal and State codes, o uTations in effect at the time of installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034 North Eagle River Loop, Suite 204, Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date 4/22/03 Conditional HAA requested. Proposed septic system to be installed by June 15, 2003. There is no eminent health hazard, no overf�j;n sewage, or no adverse effect as a result of granting this conditiQtf %.` $# _ a e 5. DSD SIGNATURE Approved for bedrooms. , �s ROBERT C. COWAN 1,,<— c: CE -8801 4711 Disapproved. Disapproved. � F> •:. XX Conditional approval for 4 bedrooms, with the foilowlrt stl 'icefe: Money in the amount of 1.5 times the high bid of a minimum of three bids from approved contractors shall be put in escrow to construct a new wastewater disposal system pursuant to permit number SW030093 attached. Money in escrow shall not be released until this office has given final approval. Construction shall be completed no later than June 15, 2003. Additional Comments Attachments: •'• • • - cam. 0-4-55.) • HAA Checklist 'i�,qs • X „.N`� Septic System Advisd/)))))))))` Well Flow Advisory (Rev. 01(02) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 4/23/03 Legal Description: A. WELL. DATA Well type c`�« Date completed Total depth Date of test Static water level Well production WATER SAMPLE RE - S: Coliform poldniesl100 ml. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST L07 I y N Ad D .4_ f i} GC .S Parcel ID: e S - S l? -/o A If A, B, or C provide PWSID # _ Well Log (YIN) Sanitary seal (Y/N), Wires properly Cased to ft. Cas ed (Y/N) eight (above ground) in. FROM WELL LOG AT INSPECTION ft. g.p.m. ft. g.p.m. Nitrate mg./I. Other bacteria colonies/100 mi. mg./l. Date of sample: Collected by: B. SEPTICIHOL.DtNG TANK DATA C Tv !Jt. p,.,,,.re 'c.4 vs sit , 4 4.,,a 4 4o Date installed ` I ( 8'0 Tank size /Qo o gal. Number of Compartments Z Cleanouts SYN) Y 1 Tank Type/Material , St47-14, Foundation deanout f9N)'„J Date of pumping 'dm /a 3 C. ABSORPTION FIELD DATA Date installed &43 /8`3 Soil Length if$ ft. Depression over tank (Y/0) r o High water alarm (Ye ^' o Pumper 7-4- rating (g.p.d.lft' o�ft2/bdrm4 011 Width ?' ��- ft. z Total depth 11 ft. Eff. absorption area 67S ft2 Monitoring tube Date of adequacy test ''t /is/0 3 Results (Pas Fluid depth in absorption field before test �t i. in. Elapsed Time: "73 min. Final fluid depth 9b in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Gooiat 1144 reEait..ojE System type �'� Gravel below pipe 7 ft. Y41 Depression over field N v 11P - Water added?37 gal. For 3 bedrooms New depth q6 in. Absorption rate >_ 'A- g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off le - - _ in. High water alarm level at Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot °P f * fs On adjacent lots ?c.43 4 Absorption field on lot R -o On adjacent lots a ao �4 Public sewer main %A Public sewer manhole/cleanout i a¢ Sewer /septic service line q0 Holding tank AlA M ss (YIN) Cycles tested Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r r r Building foundation S Property line 3'1 1 Absorption field Water main N 49- Water service line /0 Surface water / D a 14 - Wells Wells on adjacent lots / 00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 Building foundation ) 00 rf Water main Al /4 Water Service line /0 Surface water /oo Driveway, parking/vehicle storage Curtain drain N t N� k #1a..0✓ Wells on adjacent lots /06 14- F. - F. COMMENTS N -'JE Lp irrrC "A•/v.t A FI -.H ADAC G. ENGINEER'S CERTIFICATION I certify that I have determined Through field inspections and review of Municipal records that the above systems am in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name 63 44.; C. Ca wA.i Date J// a a• /0.3 HAA Fee $ 3 76.-'9• -•E i/ co -'1 Date of Payment 4/2.,/o 3 p Receipt Number (Rev. 12/01) 34/ 7`(i to -f MtOF y � ....................... is f•'41 1 _ • Jre,i Waiver Fee $' Date of Payment Receipt Number 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.ancho age.akus (907) 343-7904 • CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING. Parcel I.D. 051-822-10 1. GENERAL' INFORMATION Complete legal description 4 i.. J _ ;Location (site addressor directions) 23916 Chandelle Dr. ..,�. C rt nt PropertrbwneGene Dodd r(s) Day phone Mailing address ,• t' Lending agency 0 HAA # 0 30 /6 o • Expiration Date: / / - G - 0 3 Chandelle Acres.Subdivision; Lot 14 Mailing address Day phone Real Estate Agent Mailing Address PO Box 67257 Unless otherwise requested, HAA will be held by DSD for pickup:' • Day phone 242-3588 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: ' Individual Well • ' Individual Water Storage Community Class C Well Public Water System 4 0 x® e/6 l0 3 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site D 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/dr 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 6 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, 1 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. 1 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. N:mc of Firm S h S Engineeririq "` - Fiiune' 694-2979 Address 17034 N. EagleRiver Loop Ste. 204 Eagle River, AK 99577 Date 1/9 /03 Engineer's Printed Name Robert C. Cowan Release of conditional H.A.A. 5. DSD SIGNATURE Approved for T bedrooms. Disapproved. Conditional approval for /„ WANT C, COWAN , 12.6901 �� ��jF•...„„.••••• t'rv. bedrooms, with the following stipulations: Additional Comments (WO �YfOF Alii re :• � � -: ON-SITE . WAIEKAND : m= WASTEWATER PROGRAM : • Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other (Rev. 01102) Original Certificate Date: 8 - 6 - 0 3 Municipality of Anchorage 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: Lor /4; Ci -t-74-4 A. WELL DATATA/�� '`Z /380.i' Well type ISM I-1 t_4n/1T1 If A, B, or C provide PWSID # - Well Log (Y/N) Sanitary - :I (Y/N) , Wires properly protecte Case • to ft. Parcel ID: Qs! Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100 mi. Arsenic: r' mg./... Date of sample:5 B. SEPTIC/HOLDING TANK DATA r & TIL/moi._ Tank size .?) gal. Number of Compartments Z-- Foundation rFoundation cleanout (YIN) Depression over tank (YIN) FROM WEL LOG ft. g.p.m. Nitrate _/y_% mg.n. lat./03 Tank Type/Material 41' YIN) Casing height (abov •round) in. AT INSPECTION g.p.m. Other bacteria (/ colonies/100 ml. 6r3 Collected byS S ENGINEERING 17034 Eagte River Loop Road No. 204 Eagle Rive , Alaska 99577 Date installed ri J 12./03 Cleanouts (Y/N) High water alarm (Y/N) 4•1 Date of pumping N L^ej Pumper . e 'r" C. ABSORPTION FIELD DATA o3 Soil rating (g.p.d.lft2 or ft2/bdrm) 1 I . 2 Date installed i Length 3 C ft. Width Total depth 1 ft. Eff. absorption area Date of adequacy test System type • C- (-f 3 ft. Gravel below pipe ft2 Monitoring tube Y Depression over field Results (Pass/Fail) A -SS Fluid depth in absorption field before test () in. Water added; gal. ft. r-1 For 4 bedrooms New depth / in. g.p.d. Elapsed Tim min. Final fluid dept in. Absorption rate >= Any rejuve tion treatment (past 12 mo.) (Y/N type) If yes, give date D. LIFT STATION Date installed At A' Size in gallons "Pump on" level at in. "Pump ofr level at ___ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: I Septic tank/Iifttion on lot i Sa -# Absorption field on lot J t et - Public sewer main PJ ! {� t S r /septic service line 1-S4- Manhole/Access (Y/N) High water alarm level at Meets alarm 8 circuit requirements? On adjacent Tots 1gb 41 - On On adjacent Tots in. Public sewer manhole/cleanout 1U / ' r Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDWZ TANK ON LOT TO: 1 1 Building foundation s 4- Property line , k Water main 1 0 4- r -n Water service line Wells on adjacent Tots 15 u `'r' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:. Property line 1 0 4 Building foundation f � -1---Water main 10 11- Absorption field Surface water Water Service line Curtain drain F. COMMENTS 1 1L) Surface water i 0 -I- Driveway, parking/vehicle storage tr+J0") Wells on adjacent Tots 1.'.S *- G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Ro a t...7 C • CO h.q.— Date ,4_Date ‘13/1/1/i3 to 74- HAA Fee $ 37.3' Date of Payment Receipt Number (Rev. 12/01) 1/-22-03 3/78 Waiver Fee $ Date of Payment Receipt Number 07-29-03 01:23PM FROM-CT&E ENVIRONMENTAL SRV SCS Ret.# Client Name Project Name!# Client Sample ID Matrix 1034541001 S & S Engineering L14, Chandelle Acres L14, Chandelle Acres Drinking Water 9075615301 T-521 P.02/02 F-174 All Dates/Times are Alaska Standard Time Printed Date Time 07/25/2003 10:52 Collected Date/Time 07/23/2003 15:00 Received Datelrtme 07/23/2003 15:50 Technical Director Steph de Released Sample Remarks: Parameter QualjTicrs Results PQL Allowable prep Units Method Container ID Limits Date Analysis Init Waters Department Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 A (c10) 07/23/03 JIB \DC 8 N MM tei `c) c) 00 8 z (M) ,L8'I6Z M,I£,VOoOO N (V4) ,L8' 16Z M ,61, 10000 M 3VO i AV RI3A01D z(n UJ > LL! -J —J LU C ,00'9Z ( ) 9AW WW o0 m cw zv, z waa' w `e\Q a w 1- -73 t= 1 O U 1lVH ISV ,L9Z N x- 0 N U 'o\ e't N • • • • • \ \ \ \ •\ \ • • D` • 2'OI 4 N =0 CK LLI w CC cy,O U 0 x1=. N Co a \ ♦ • • • • • • \ N r m .00 (907)694-2979 INSPECTION APPOINTMENTS ATE RECEIVED )t TIF, - TIME TIME DATE DATEDATE 1C- :A'1 -(b1 (----\\ i loic__,.. �- }C: - -'�i;- 1 \\QI '� INSPECTOR INSPECTOR INSPECTOR DEPARTMENT MUNICIP' ITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE D T. OF HE -LTH & OF HEALTH & ENVIRONMENTAL PROTECTIVIRONMENTAL P.OfECTION 825 L Street - Anchorage, Alaska 99501 SANITATION DIVISION OCT 1 41 Telephone 264-4720 vv D OF INDIVIDUAL WATER AND SEWER FAcfL�fE i` ENVIRONMENTAL REQUEST FOR APPROVAL DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days fo processing. 1. PryERTY OWNER 0.44.....„ 30N. j7 MAILING DRESS PROPERTY RESIDEN (If different from above) PH E 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION i, Ai 74� P oNE �-Z1 MAILING ADDRESS[//`f 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION % /' le,e_e-J--fit/� �� 00 -Liles/ STREET LOCATION (24_,.7,_ .i, 6. TYPE OF�RESIDENCE NUMBER OF,BEDROOfOV,S- • One " Four • Other I� SINGLE FAMILY D Two • Five 0 MULTIPLE FAMILY ad Three • Six 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled 0 COMMUNITY since June 1975. For wells drilled prior to that date, give well CI PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM p INDIVIDUAL/ON-SITE** /, C% - - THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY ❑ ONE ❑ TWO E OTHER • THREE I FIVE ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED ( '7 C7~G( 7__-(21)21 INSTALLER CI Septi Tank or CI Holding Tank Size: C °v If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL \_-----, 4. DISTANCES WELL TO: Septic/Holding Tank c'J Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS n ----APPROVED FOR D BEDROOMS certificate) (letter must accompany • CONDITIONAL APPROVAL ❑ DISAPPROVED DATE V''q BY a0 Q11 72-010 (Rev. 6/79)