HomeMy WebLinkAboutBIG DIPPER LT 2 Onsite File
big Dipper
Lot 2
#050 - 201 - 57
Municipality of Anchorage
Community Development Department Page 1 of 3
On-Site Water&Wastewater Program
4700 Elmore St. •P.O. Box 196650 Anchorage, AK 99519-6650•http://www.muni.org/onsite•(907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181037 PID Number: 050-201-57 ❑ New ■Upgrade
Name:
KEITH HAMMER ABSORPTION FIELD
Address: ■ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
21630 PRICE DRIVE, EAGLE RIVER, AK 99577 ❑ Other
Phone: No.of Bedrooms: Soil Rating. Total Depth from original grade:
952-5098 3 0.8 GPD/Sq.Ft. 9 (MAX.) Ft.
Depth to pipe invert from original grade- Gravel depth beneath pipe.
LEGAL DESCRIPTION SEE DWG. 6
Ft. Ft
Subdivision: Block: Lot: Fill added above original grade Gravel length:
BIG DIPPER - 2 SEE DWG. Ft 48 Ft
Township: Range: Section: Gravel width Beds Number of lines: Distance between lines:
-
2.5 Ft. - - Ft.
SEPARATIONDISTANCES Total absorption area: Number of trenches: Dist.between trenches:
To Septic Absorption Lift Holding PublicrPr vate
From Tank Field Station Tank Sewer Lines 576 So.FL 1 12+ Ft.
Well 100'+ 100'+ - - 25'+ TANK ■ Septic ❑ S.T.E.P. ❑Holding ❑Other
Manufacturer Capacity:
Surface Water 100'+ 100'+ - - ANCHORAGE TANK 1000 Gal.
Material. Number of compartments:
Lot Line 5'+ 10'+ - - N/A
STEEL 2
Foundation 10'+ 10'+ LIFT STATION
Curtain Drain NONE KNOWN Manufacturer C..
I
Gal.
Remarks: TIM EKLUND WITH THE MOA ONSITE DEPARTMENT WAS •Pumpori level at: "Pump off level at: High water alarm at:
PRESENT DURING 1ST INSPECTION.
Pump Make& ••• Electrical Inspections performed by.
PIPE MATERIAL
House to tank EXISTING Tank to D3034
drainfield
Installer
WILCO EXCAVATING Drainfield D3034 CO/MT D3034
Inspector GEG, Ltd. BENCH MARK (Assumed elevation)
Inspection 105.07 F-
Dates: 1st 4/10/2018 2nd 4/10/2018 Location and Description.
3rd 4/11/2018 4th - BOTTOM OF DOOR THRESHOLD I
ENGINEER'S SEAL
Community Development Department Approval ��.•'": `�"4
.,` -. ...
.•4-\F- ♦♦,
Conditional approval: Date: r a i1,
.‘
ii: i ...:I.. • - 0
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♦•<,• ,; CE -7953 .icTa
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Approved: '^�- 7 Date: LICENSE♦b. �;`S`��.••4
#AECC884
Inspection Report_1-1-12.dac
•
i PERMIT NUMBER: RECORD DRAWING PARCEL ID NUMBER:
OSP 181037 050-201-57
PRICE DRIVE
-
•
\ ", "
I
�
\ NOTE:THE OLD SEPTIC TANK WAS .•:
1 \ COMPLETELY REMOVED AND DISPOSED ••.i. ,.. r /
IOF OFFSITE PER THE CONTRACTOR.
-0141 ` ` ,: !. 't,:; '•
y•
F�Ox�� 1 NEW 1000 GALLON : ',' OR/YF1'41)-43.4„••"'
q
tPs I SEPTIC TANK / •. ''.� y/p • •.:�•••.'' j.: ••.
•
J F I • • r'I :. .:':.
z z INSTALLED FLOW �,�;` '.'".•:;•
O I I SPLITTER(FS) FCO ` / y.'r •..0(0 / • , '
`'' APPROXIMATE LOCATION OF co, “'104-j')� ��
1995 TESTHOLE BY ROBERT C. BO `````` /
COWAN,P.E.PER MOA RECORDS- A
/ C. Coy
AHi
EXISTING WELL /
/
M'` 01 I LL RADIUS /
--/.4_
�.......
100'wE ��,
/ )/
✓
----- / \\ NEW DRAINFIELD 1 Ov%
/ // N\ \ ,��
/ N \ 7�.
.r - �/ A B C \\ \ O-1,
FCO - 18.8 21.2 \ \
ST1 47.7 22.4 45.0 \ /
ST2 53.2 28.1 52.8 \ \ •
DBL1 54.2 29.1 54.1 \ /
N
DBL2 54.9 29.9 54.9 \ '
FS 55.5 30.7 56.4
\ • \
CO1 47.0 24.2 57.8 \ / SCALE:
CO2 98.0 73.6 94.0 •
MT1 97.9 73.6 94.4 \ / 1'=40'
CO3 46.2 31.3 70.4 1
MT2 48.2 33.2 72.0 _
CO4 89.8 67.4 95.0 WELL RADIUS BIG DIPPER;LOT 1
MT3 87.8 65.7 94.0 (AppROX.LOCATION)
. *SIM 11
.44 ,h
••,P.••.., IA.
♦
••• ..
GARNESS ENGINEERING GROUP, Ltd : •4�'
-
. CIVIL&ENVIRONMENTAL ENGINEERS ..I Iti ••�;
3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE,AK 99507•PHONE(907)337.6179•FAX(907)338.3246'WEBSITE:www.gemessengineehig.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: •t^= e ; Ga' ess i W■
KEITH HAMMER 952-5098 2 OF 3 • 0 '• C -7913 ° �
PROJECT/LEGAL DESCRIPTION: DRAWN BY: • 4 I bI ••••
BIG DIPPER S/D; LOT 2 J.L.M. �.•c�Q PROF.'... • ••........'P�,�••
TYPE OF WORK: DATE: LICENSE, 1 ESS` �••
RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 4/13/2018 #AECC884 , ����� J
PERMIT NUMBER: PARCEL ID NUMBER:
OSP181037 RECORD DRAWING 050-201-57
FINAL GRADE=104.03-105.35
ST1 ST2
TOP OF TANK TOP OF TANK
AT INLET=97.93 AT OUTLET=97.86
■ U
NEW 1000 GALLON
INVERT OF BUNG SEPTIC TANK
AT INLET=97.48 (RATED FOR INVERT OF BUNG
10'BURIAL) AT OUTLET=97.18
ROBERT CHOLE
COWAN,P.E.
MT2 CO3 1995 TEST HOL
FINAL GRADE MT C04
=98.48-99.03 = = ORIGINAL GRADE B
=97.20-97.60
FILTER FABRIC
7:•_I
INVERT OF PIPE
=94.60
BOTTOM OF TRENCH=88.60
RELATIVE ELEVATION OF BOTTOM OF TEST HOLE =82.60
(NO GROUNDWATER ENCOUNTERED ON 9/1/1995 PER MR.COWAN
OF
GARNESS ENGINEERING GROUP, Ltd • g '' •
~`�� ••
CIVIL& ENVIRONMENTAL ENGINEERS m m- 0 •
•
3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE,AK 99507 PHONE(907)337-6179'FAX(907)336-3246'WEBSITE:%ww.gamessengineenng.00m
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 ''';••• 'yA. G. •: s
�■
KEITH HAMMER 952-5098 3 OF 3 •jam-J'• CE-793 ��
PROJECT/LEGAL DESCRIPTION: DRAWN BY: •�1/4'e:61
� 1 3 •' •
BIG DIPPER S/D; LOT 2 J.L.M. 1 FD.• p•'V•�f/JJJ•.....((("' �� ��
TYPE OF WORK: DATE: LICENSE Il j ESS L•7‘.4:4,•4•
RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 4/13/2018 #AECC884
1cipAt,r, MUNICIPALITY OF ANCHORAGE
11\i 171
On-Site Water&Wastewater Program •°\ S ;
Aral', PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.org/onsite11E11111 %
1)(•pa LTI II
4';c; PGE
On-Site Wastewater Disposal System Permit
Permit Number: OSP181037 Effective Date: 4/5/2018
Work Type: Septic Upgrade Expiration Date: 4/5/2019
Tax Code Number: 05020157000 yb0/I S Go k
Site Legal Address: BIG DIPPER LT 2 G:0058
Site Mailing Address: 21630 PRICE DR, Eagle River
Owner: HAMMER KEITH S Lot Size in Sq Ft: 49577
Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3
This permit is for the construction of:
II Disposal Field RI Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
\lis () •
Received By: — J Date:
, GGV
Issued By: ,t.? lAp, COU(JYQ9
Date: )D i
MUNICIPALITY OF ANCHORAGE
Community Development Department s'i1_ Phone: 907-343-7904
Development Services — Fax: 907- 343-7997
On-Site Water & Wastewater Program
Mayor Dan Sullivan
On-Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 050-201-57
Property owner(s) KEITH HAMMER Day phone 907-952-5098
Mailing address 21630 PRICE DRIVE*EAGLE RIVER AK
Site address 21630 PRICE DRIVE*EAGLE RIVER,AK
Legal description (Sub'd, Block& Lot) BIG DIPPER: LOT 2
Legal description (Township, Section & Range)
Lot Size Sq.Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING:
(®all that apply) Initial ❑ Single Family (SF)
Absorption Field ® (w/wo ADU)
Septic Tank ® Upgrade Duplex (D) ❑
Renewal ❑
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: (Log Waiver Fees:
Date of Payment: � -I Date of Payment:
Receipt Number: OOP,
COAG Receipt Number:
Permit No. 04J` 1 U I o%1 Waiver No.
(Rev.01/11)
_, !iI'an!c!.
... t.GARNESS ENGINEERING GROUP, Ltd AdvsxcdTreatrr4 Vstc"
C.rrht:
CIVIL&ENVIRONMENTAL ENGINEERS Dealer
March 29th, 2018
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic System Upgrade for Big Dipper; Lot 2
To whom it may concern:
The existing 3-bedroom house is served by a private well and septic system. The
drainfield is in a state of failure and needs to be upgraded. We are proposing to utilize the
existing 1995 test hole by Robert C. Cowan, P.E. and install a new 1000-gallon steel
septic tank and deep trench type drainfield. Comments regarding the design are
summarized as follows:
1. SOILS: See the attached 1995 soil log by Robert C. Cowan, P.E. which shows 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 topography drawing, the topography
around the drainfield is less than 25%.
We are unaware of any adverse impacts this installation would have on adjacent wells or
septic systems. If you have any questions, please contact us at 337-6179. Thank you
for your assistan e.
S cer-ly,
fill°
Jeffrey+ . :rness, ".E., M.S.
Preside t
3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259
Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com
/� /
'EPT/C AREA
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100 WE I
HYLEN CREST/3: I MILE FM;BLOCK 2,LOT 2 I \ /
BLOCK 4.LOT 9 \ / I MILE HI;BLOCK 2,LOT 4 I
I►'� \\ I MILE HI:BLOCK 2.LOT 3 I /
\ / IVACANT I
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r I \\\ PRICE DRIVE
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-- \\
■ . o I F i I BIG DIPPER;LOT 1 I ♦\\``
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♦ sti — / I
ROAD EASEMENT SCALE:
1"=100'
il'41,1VIMS iii,
.4' ' �4♦
GARNESS ENGINEERING GROUP, Ltd i' 4' •• *�•'•
CIVIL&ENVIRONMENTAL ENGINEERS ••
3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE.AK 99507•PH0}iE(907)337-6179•FAX(907)338-3246•WEBSITE:www.gemessenpineeting.com • •• •• ,
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: c^L• e : •. Gam-ss :
KEITH HAMMER 952-5098 1 OF 2 ♦.J,' C -795
PROJECT/LEGAL DESCRIPTION: DRAWN BY: ♦'.I.
1. . •••?�l, J. .
BIG DIPPER; LOT 2 D.J.G./L.K.B. ♦ ♦ ,, ••
TYPE OF WORK: DATE: LICENSE♦4�',%"SS\'4 •
SEPTIC SYSTEM DESIGN UPGRADE 3/29/2018 #AECC884 3??4J/$ I
t __——
DESIGN CRITERIA: GEG,Ltd.HAS A 8 PAGE SPECIFICATION
NUMBER OF BEDROOMS:3 LETTER THAT PERTAINS TO THS DESIGN.TO NOTE:THE CONTRACTOR SHALL HAVE THE
GALLONS PER DAY(GPD):450 GPD OBTAIN A COPY OF THE LETTER CONTACT
PERCOLATION RATE/S:'8 MIN/INCH GEG.BY PROCEEDING FORWARD WITH THIS SOUTH LOT LINE,AND ALL WELL RADII
PROPOSEDCCGPDlFT' INSTALLATION,THE ENGINEER.WELL DRILLER, SHOWN FLAGGED BY A REGISTERED LAND
PDRAINFIELDAPPLICATIONS RATE:0.8 FT' CONTRACTOR AND PROPERTY OWNER AGREE SURVEYOR PRIOR TO CONSTRUCTION.
THAT THEY HAVE READ THESE
'PER ROBERT C.COWAN,P.E.T.H.(ATTACHED)
SPECIFICATIONS AND AGREE TO ACCEPT THE
DRAINFIELD DESIGN: TERMS AND CONDITIONS OUTLINED.
MAXIMUM DEPTH:9 FEET
WIDTH:2.5 FEET
LENGTH:48 FEET
EFFECTIVE:6 FEET PRICE ID R I V E
ACTUAL SO.FT.:624 FT'
4
•.••..
. - 1.:•!..;•
EXISTING FCO PER SURVEY;INTEGRITY TO BE .
CONFIRMED BY CONTRACTOR DURING INSTALLATION
PROPOSED 1000 GALLON STEEL SEPTIC TANK;INSTALL •?.:......,•:.; ' '4'.
DOUBLE CLEANOUT AND FLOW DIVERTER AFTER TANK
APPROXIMATE LOCATION OF EXISTING SEPTIC :. OR/�.'
TANK;TO BE DECOMMISSIONED PER UPC Fw"• •':-
Z APPROXIMATE LOCATION OF 1995 TESTHOLE BY • .a gY4q ••:. i•: ..
Z z ROBERT C.COWAN,P.E.PER MOA RECORDS : : •Rk/SVG ;•{;: .':
O w APPROXIMATE LOCATION OF EXISTING :''•( : q. A :•'. .:5•'
U 1n TRENCH PER CLEANOUT LOCATIONS • • ;,,,:;:.17:;.:,,
wa oa I •
••'. ,••. .
COw
'in
c� �ry ' EXISTING 3
/
S *it T1 BEDROOM
\�- M. HOME i
/ Ci. _\�
- 0
/ ho 100.VJEIL RADIUS
i•--— /—-- PROPOSED DRAINFIELD �
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GARNESS ENGINEERING GROUP, Ltd ;• . .. ,
Mai CIVIL&ENVIRONMENTAL ENGINEERS �� ••
3701 E.TUDOR ROAD.SUITE 101'ANCHORAGE,AK 99507•PHONE(907)337-6179•FAX(907)3383246'WEBSITE:www.gemessengineenng.com 1:r .
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 L ��?!!!: A. -- •'ss . 4/
KEITH HAMMER 952-5098 2 OF 2 0 0 -7 3 ;°: a
PROJECT/LEGAL DESCRIPTION: DRAWN BY: •. u
• BIG DIPPER; LOT 2 D.J.G. �•• ��� , 2 P\., :•'
TYPE OF WORK: DATE: 1 ill'OFESS1 4
SEPTIC SYSTEM DESIGN UPGRADE 3/29/2018 #AECC884 11������'
• f r Municipality of Anchoragelit
`9
4:7 DEPARTMENT OF HEALTH & HUMAN SERVICES ".. 4 9b
It 111141110:14•11,
825"L" Street, Anchorage, Alaska 99502-0650 �r / ' - r
SOILS LOG — PERCOLATION TEST ��,k ROBERT C. COWAN -
c :\ CE-8801 '..
K-� 'C l�MM+ t• -•
PERFORMED FOR: 1 ___-_ DATE PERFORMED: ��.''ZS ��'�'
LEGAL DESCRIPTION: 1A1 Z 1�tt.4 t/tPp✓i.-- 1r? Township, Range, Section:
SLOPE SITE PLAN
E PTA.,
L(FEET) OV
1
1)- , N
2 - ,,
0
3 - . • _
1 yoxll•
,/ ` T/7?
II t"�1�-
6 ,
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10 — WAS GROUND WATER /LD
< ENCOUNTERED?
11 — ° �I
V'•r
` IF YES,AT WHAT I0
DEPTH? P
12 — . ', E
Depth to Water Alter
13 — i I Monitoring? _ —Dale: �'1 `1s
14 — • : Gross Net Depth to Net
Reading Date Time Time Water Drop
15 6.0.A ii7, po.,t, Pe.w t) ,
16 - 1 c1-1-`1S- t ;_, 3.1St " _—
z 3 0,,a 4./as ' .375 "
17 - i LI„co,,) r 73'
• 3N
.
L
y —_ - 1 -_-_ __ ,/.07s ,d7s'"
18 - r
19 - --
20 -
PERCOLATION RATE �g (minutes/inch))PERC HOLE DIAMETER el
(
TEST RUN BETWEEN / FT AND 5 FT
COMMENTS
S&S ENGINEERING \ o
PERFORMED BY. _._ t Lm CERTIFY THAT THIS9TEST WAS PERFORMED IN
ACCORDANCE WITH AI EMINPR INNIA Ic 9A7 UIDELINES IN EFFECTON THIS DATE. DATE. /--/'7rss—. —
OMB(Rev_4/85)
N 89 56' 55" E 330.10
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NO CORNERS SET THIS DATE
0000�0p�4 I HEREBY CERTIFY THA
o��OF .'�'-'1d16
d1 OF THE FOLLOWING DES
"4'7".. '. sV LOT 2, BIG DIPPER SU
v,* . 49 — %\ * ANCHORAGE RECORDING
•sis/ �a , 't' VISIBLE IMPROVEMENTS
tu( THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY THE PROPERTY LINES A
We • _ 0 CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS EXIST OTHER THAN NOT
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL'SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~vJ'f.~o_~'~ PID Number: ~Sb - ~ - ~'7
Name: J4:~aE,-r, )-{^,~,~. Wastewater System: ~ New D Upgrade
Address: ~O. ~=~ O~. A~,., ~= w~,~ ABSORPTION FIELD ..
l No. of Bedrooms:
~hone: ~ ~ ~ .. j~ ~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION so, Rating: ~. ~ GPD/Sq. Ft. Total Depth from original~, grade:
Lot: ~ Block: ~ Subdiv~ion:~t ~ 01 ~ Depth to pipe bottom from~,original~ grade: Ft. Gravel depth beneath pipe~. ~ Ft.
Township: ~ Range: ~ Section: Fill added above original grade: Gravel length:
~I ~~ ~ ~ - ~ Ft. ~ Ft.
Gravel width: Number of lines: I Distance between lines:
WELL:
New
Upgrade
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
' Driller: Date Drilled: Static Water Level: Installer: Date installed:
SEPARATION DISTANCES ~ Septic D Holding ~ S.T.E.P.
To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~C¢O~ ~ ~ ~¢ /
Number of Compartments:
Sudace
Wat.~ ~oo~+ /o~ -- -- ~ LIFT STATION
Lot 50'~ ~o'~ -- size in gall°ns: I U"nufacturor:
Line ~
Foundation ~l' ~3~ - -- -- "Pump °n" level at:~l at: I High water alarm at:
Cu~ain Pump M~ ~ Electrical Inspections pe~ormed by:
I
Remarks: BENCH MARK
Location and Description:
I Assumed Elevation:
Inspections performed b~:7034~: R~-::r L~ ~.N~.~tes: 1st ~z/I.~/~s ~'~~~'~ '-P ~/~'¢~
Department of Heal h and ~a ~ices approval '~.t~; ........
Reviewed and approved by:~~ ~&~"'~ Date: ~ ~ ~/~ ~:~'~'"'~"
72-013 (Rev. 9/91) MOA 25
SW950304 2 2
Permit No. Page of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
LOT 2, BIG DIPPER SUBDIVISION 050-201-57
Legal Description: PID No.:
IEW TRENCH
ST1
SIX
NEW 1000 GAt
B
19,5'
24.5'
29'
.31.5'
32.5'
25'
74'
74'
SCALE 1" 40'
ST1
NEW
TAN~
ST2
CAI. ~989
IC
FINAL
C01 =
C02 = 89.1'
NO
72-013 A (Rev. 9/91) MOA 25
C01
:02
~, 79.7'
FOUND
9-1-95
~EAL
~ .':z.~, ROB,,, c..':do~ ~. j.~'
-~. ,,.,,..., ..,,;.,r..~
,, ..~..... .... %? .~
.: .,.':' ......,.q:., ~
· ' "·: ..... ";-.,47
COMMUNITY CO~$TRUCTIO~ 90724~0164 P. 01
Date Drilled: Dec. 1~ 1995
Static Water Level 27'
Draw DoWn_N/A __feet
feet
WELL LOG
Debbie Rd.
Gallons Per Minute '_B ....
lotal Feet of Casi.ng~
T__~.pe Material Drilled:
0 fee% to 12 ft. ~ril~y,w-_.~Gravel'& 1%ock
12 ft. to 20ft. Sand & Clay
20 ft. to 78 ft. Gravel & clay
_7.g fi-__'_ to 112 ft.- R~-]~-_r~.k ....
112 ft. to 122 ft. B.e~.rock wlfractor-es H2Q_
to LiB_ed.w~ll. w{+h. 4%'~ p!aFtiC
to
tO
HEF'I'%' DRILLING
3540 AKULA ORIV~
ANCHOI~AGE, AK 99516
(907) 345-0593
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PAGE 1 OF 1
:% ',
PERMIT NUMBER:SW950304
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:HAMMER KEITH STUART
OWNER ADDRESS:4304 FOREST RD.
ANCHORAGE, AK 99517
DATE ISSUED:10/02/95
EXPIRATION DATE:10/02/96
PARCEL ID:05020157
LEGAL DESCRIPTION:
BIG DIPPER LT 2
LOT SIZE: 49577 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT:
3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
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 (iSAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, RE.
September 15, 1995
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
~NSPECTiONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 2; Big Dipper Subdivision
Requ. eat yo- ,t~6u.e a ~ to ~ a me..it ami ,tnata,~ a
6¢¢uing the tJ,~e.e bed,'toom hou,6e on tJ~.e re~erene, ed p,'cope,~t.
A t~st hole was excavated and a percolation test performed. The
approximate location of the t~st hole is located on the attached site
plan.
At the time of excavation no water was encountered and after seven day
ground water monitoring, the monitoring tube was found to be dry.
This property has enough area for a f~ture septic upgrade which can be
seen on the attached site plan.
We do not anticipate any adverse effects on n~ighboring wells, septic
systems or drainage patterns by the installation of the proposed
septic system.
There are no points of contamination within the proposed well radi~s
which can be seen on the attached site plan.
The proposed 1000 gallon septic tank is to be placed o~t~ide the well
protective radius. Attached is a site plan which depicts the
locations of the proposed tank.
If you require additional information, please contact u6.
Sincerely,
Robzrt C. Cowan, P.E.
RCC/gk
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
ROBERT C. COWAN, RE.
ROBERT A. SHAFER, RE.
October 13, 1995
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SO~LTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
RECE/VED
825 L Street
P.O. 19665o 00T "/6 1995
Anchorage, Alaska 99519-6650
'-')ept, Health & H....,n~c_h,..°rag. e
,,,,,a,, ~erv/ces
REFERENCE: Lot 2 Big Dipper Subdivision
Permit Number: SW950304
Dear Robbie,
This is to inform you that a permit was issued on the
referenced property on 10-2-95 by the DHHS. Due to a note on
the plat, "All wells shall be located a minimum of 100 feet
from any right-of-way", we have relocated the proposed well.
The DHHS also had questioned the classification of the
proposed structure. The purpose for not having an interior
access from the upstairs to the basement is because the
basement will be an unfinished basement. It is the intent of
the homeowner to install an interior access from the upstairs
to the basement once the basement is finished. This is not
to be used as a multi-family structure.
If we may be of further service please contact us.
Sincerely,
Robert C. Cowan
Professional Engineer
Keith Hammer
Homeowner
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
SITE PLAN
NEW SYSTEM
33' SEC2 ·,LINE EASE
0
OO3
03 11
II 0
H
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION: ~ 'Z.-- ~'~'H-,~ '~.~O,0~.~'L Township, Range, Section:
SLOPE
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED?
k
IF YES, AT WHAT O
DEPTH?
P
E
Depth Io Water Alter
Monitoring? ~ Date: c['~c1~'
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
/
PERCOLATION RATE '~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ¢ FT AND ~ FT
COMMENTS
S & S ENGINEERING
ACCORDANCE WITH A~0~III,z~J~NI~II~I~Ii~/:~LT~uIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CER"I'IFY THAT THIS TEST WAS PERFORMED IN
DATE: ¢-'/¢'%' f~""
;tneee nq
ROBERT C. COWAN, RE.
ROBERT A. SHAFER, RE.
ON-SITE ~ASTE~IATER DISPOSAL S¥STEU
CONSTRUCTION FP, ACTICES
UATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
,N:~PROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
REFERENCE= Lot 2; Big Dipper
;E NEP, A L :
I. The Scope of this project includes the installation of a 1000
gallon septic tank and a leachfi~ld trench to serve the
proposed three bedroom residence located on the referenced
property.
2. Construction shall be in accordance with the approved site plan
and design drawings, Municipal p~rmit with any special
provisions or conditions, and all applicable State and
Municipal Wastcwat~r Disposal Regulations.
3. The contractor shall be r~sponsible for obtaining any necessary
underground utility locates.
4. Unless specifically agreed otherwise, the property owner sha2Z
be r~sponsible for final grading areas subsequently depressed
from soil s~ng. On all leachfi~ld mound syst~s, the
property owner shall be responsible for ensuring a satisfactory
vegetation growth over the mounded area.
5. Contractors installing wastcwater disposal systems m~st be
certified by the Municipal Health Department for system
installations. Owners installing their own systems must also
receive prior approval from the Municipal H~alth Department.
~EFTIC TANK INSTALLATION'.
I. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for
pumprng access.
2. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
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' of cover shall be
insulated.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Page Two
Lot 2; Big Dipper Subdivision
5. A foundation ~leanout shall be installed one to four fe~t from the
building foundation. In the line b~tween the tank and the leachfi~ld
there shall be two adjacent cl~anouts (unless an effluent pumping system
exist~ within the septic tank). These cl~anouts shall be located on
undisturbed soil not more than 10' from the tank. The first cleanout,
in line, shall be to clean toward the l~achfi~ld. The second eleanout
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.
ABSOI~PTXOH TRF. HCH/1)P, AXHFXELP XI~STALLATXOH:
I. Excavate the proposed trench to the dimensions shown on the design. The
bottom of the excavation shall be within 2 inches of level. If the
sidewalls of the excavation become smeared, they must be raked or
scratched (roughed-up) before gravel (sewer rock) placement.
2. 0ncc the grav~ is installed, the distribution pipe is to be installed
level with the perforations faced downward. Grav~ 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 b~tween the final gravel layer and the
native soil backfill. Ensure the silt barrier covers the en~re gravel
surface before pla~ing backfill.
4. Monitor tubes shall be of four (4) inch diameter and installed
approximately in the locations shown on the design. 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 grav~ 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 se~ling.
UIt~IUUU UATEI~IAL SPECIFICATIOI, i$ :
I. Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
Page Three
Lot 2; Big Dipper Subdivision
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
T~pe of Pipe Perforated
Solid
Cast Iron Yes Yes
ASTM D$034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Y~s Yes
Use of a type of pipe other than listed above must be approved by the
inspecting engineer.
3. Insulation shall be ~t least 2" thick extruded direct burial polystyrene
(Dow Chemical Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal)
must be installed between the final l~achfield gravel layer and the
native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel
with less than 3% passing the #200 sieve.
7. When sand is being used as a filter material, its gradation
specifications must conform to current M.0.A. or D.E.C. requirements.
INSPECTIO~ :
Typicat~y there will be a minimum of three ($) inspections required during the
installation of the waste~ter disposal system. These inspec£ions will occur as
follows:
I. 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.
Page Four
Lot 2; Big Dipper Subdivision
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 trench~s, sand fi~ters, pressurized distribution
systems, ~tc. Thu~, the inspecting engineer is to be contacted at least 24
hours prior to the start of construction. If necessary, a pre-construction
me,ting will take plac~ on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractor's 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 wi~ be no contractual arrangement existing b~ween 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
contractor's a~ivit~es. Final acceptance of the contractor's 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 p~rsons p~rforming work on this project
or the failure of the contractor to carry out the work in accordance with these
construction documents. S & S Engine~ring's inspecting engineer will not be
responsible for the construction m~ans, m~thods, techniques, sequence,
procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
•
Municipality of Anchorage
:II i_ On-Site Water&Wastewater Programt7,'.31�
<
(907)343-7904 1., ,.
«A
t' T-Inlai.VC4f.;
1111.
r�
Art( 1 I LuI8
Q 3
CERTIFICATE OF ON-SITE SYSTEMS APPROVA�t`
c.
0016. 6 9 "3
Parcel I.D. 050-201-57 Expiration Date: -7- ! Q •
1. GENERAL INFORMATION
Complete legal description BIG DIPPER S/D; LOT 2
Location (site address) 21630 PRICE DRIVE, EAGLE RIVER,AK 99577
Current Property owner(s) KEITH HAMMER Day phone 952-5098
Mailing address 21630 PRICE DRIVE, EAGLE RIVER,AK 99577
Real Estate Agent DAR WALDEN W/KELLER WILLIAMS Day phone 865-6406
2. TYPE OF DWELLING:
• Single Family (w/wo ADU)
Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well II Individual On-site Ill
Individual Water Storage I I Individual Holding tank ❑
Community Class Well 7 Community On-site
Public Water System I I Public Sewer ❑
WaiverNariancerequest for/4h') Distance: -
Received by: Date: Y/(9//(i
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 4R Waiver Fee$
Date of Payment Li— 1? l o Date of Payment
Receipt Number b.-3Slyo�i� Receipt Number
COSA# 0, -)C-13 <<L o Waiver#
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, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are)safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are)in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP,Ltd. Phone 337-6179
Address 3701 E.TUDOR ROAD,SUITE 101 *ANCHORAGE,AK,99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date //I
/f'/r3
Engineer's Comments:
In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system in accordance with the ��,,���1
guidelines and regulations established by the Municipality of Anchorage and industry practices.The reported results describe the .�4•, OF•.44 44♦
condition of the system/s on the dates of the evaluation.Separation distances were measured to readilyidentfiable features. .' P�*,,.••••"" *.
Hidden defects or encroachments may exist that were not identified during the evaluafion.The operational life of all wells and septic i ..
systems depend on a variety of variables including,but not limited to,soil conditions,groundwater levels(that may fluctuate during ti •••'
the year),quality of construction(materials and workmanship),and the water usage of the family utilizing the system's.These - *;•• 9 ,4\ 4-#0
0
conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee future performance of the I
systems;therefore,GEG makes no warranty(express or implied)regarding the future performance of the well or septic system. �/ 0
GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the i! - 1 ,
current systems fail.The content of this report is for the sole benefit of the person/patty who retained GEG.Reliance upon the 0 J A.G m- s .Ltdi
information provided in this report by any other person or party,including but not limited to subsequent property purchasers,is not ♦ G�% ;4 N
%authorized.In short,GEG disavows any legal duty to anyone other than the person/party who paid for this report. 00 S %/ CE 79 3• ,
6. DSD SIGNATURE '** PROFESS\��4
LICENSE 1�1�""��
X' System#1 Approved for 3 bedrooms. #LICENS a
System#2 Approved for bedrooms. . .c.\ OF i j,i
Disapproved. �.Q U'Q9
ON-SITE
Conditional approval for bedrooms, with the following sti�tt, IatismTER AND .
vt. WASTOGRAMEWATER o
` ` PR
stn grp\I\C'
By: ("^--- 1 ,I Original Certificate Date: Li'1 —i
The Municipality or Anchorage Develop,emt Services Division(DSD)issues Certificates of On-Site Systems Approval(COSA)based only
upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist 7 Nitrate Advisory
•
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev.10/12/12)
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: BIG DIPPER S/D; LOT 2 Parcel ID: 050-201-57
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 12/1/1995 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 122 ft. Cased to 78 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 12/1/1995 3/21/2018
Static water level 27 ft. 29 ft.
Well production 8.0 g.p.m. 3.8+
g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 ml. Nitrate 1.26 mg./L. Collected by: GEG, Ltd.
Arsenic: <5 ug./L. Date of sample: 3/21/2018
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date installed 4/10-11/2018
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout(Y/N) YES Depression over tank(Y/N) NO High water alarm (Y/N) N/A
Date of pumping NEW Pumper -
C. ABSORPTION FIELD DATA I *BELOW FINAL GRADE
Date installed 4/10-11/2018 Soil ratings p.d.yorft2/bdrm) 0.8 System type DEEP TRENCH
Length 48 ft. Width 2.5 ft. Gravel below pipe 6 ft.
Total depth *9.9-10.4 ft. Eff. absorption area 576 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fail) - For 3 bedrooms
Fluid depth in absorption field before test - in. Water added - gal. New depth - in.
Elapsed Time: - min. Final fluid depth - in. Absorption rate >= - g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) NEW If yes, give date -
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at •• .• a er alarm level at in.
_ . •• 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 75+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
44 OF , I•
G. ENGINEER'S CERTIFICATION 0., P�E••••. .,.�' 4 fit,
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in • I ••
conformance with MOA COSA guidelines in effect on this • •
date. o0 J•" -' A. Gornss kll:
Engineer's Printed Name JEFFREY A. GARNESS •1 Ste•' — WS �5.
9 r 6 ��♦:'0P ..
•
Date f l��i LICENSE 4t��FESS ��4
(Rev.10/12/12)
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AS—BUILT SURVEY 1 ” = 3 0 '
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OFA
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 2,BIG DIPPER SUB.(PLAT 87-9)
49 III ''' )',Q)
0- ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
gs-Atft di, g VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
v' r THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
6))'• -• • ' ;• / CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS EXIST OTHER THAN NOTED.
. SHANE 6 A. .. ,N,:,. . HOLT. NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. DATED AT ANCHORAGE,ALASKA THIS 13th DAY OF
, Oh?: •
LS,6914,•' ,A, EASEMENTS OF RECORD, OTHER THAW THOSE APPEARING ON THE RECORD PLAT , ARE NOT STOW
.
•• O., HEREON(UNLESS INDICATED) APRIL 2018
ktb4,0, ,,.......":4=' NOTE: FENCELINES TNA,MAY APPEAR ON THIS DRAWING ARE TOT TO BE USED TO DETER
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND suoveim
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9)09 GROVER DRIVE
ANCHDRAGE,AK 99507
1 • 13841.FB 187-37.63 1454513
-..•
t
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
Parcel I.D. # O .¢-O
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
-5-7
GENERAL INFORMATION
Complete legal description
Lot 2: Big Dipper Subdivision
Location (site address or directions)
N[~ Price Drive
ProPerty owner
Mailing address
-'~e~'th Hammer
4304. ,~Forest Drive
Eac!e River, AK
Day phone 223-1044
Anchorite, AK 99517
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
Public water
MUNICIPALITY OF ANCH(...)t~UI:
ENVIRONMENTAL SERVICES DIVISION
RECEIVED
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site -' ;::i:
Holding tank
Community on-site
Public sewer
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 #21
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
Address
Engineer's signature .
S & S ENGINEERING
Eagle River, Alaska 99577
Phone
Date
DHHS SIGNATURE
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
. ' L' .'~ j ~ ~./4.~,
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 Alaskal 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.
72-025 (Rev, 1/91) I~c~ MOA
Legal Description:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES _
Environmental Services Division R E C }~ I V E
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744' "'
UA¥ 21 ]996
Health Authority Approval Checklist
Z t~c.. P~f'e~ ,~/1:> Parcel I.D.:
t
MUnicipality of Anchorage
Dept. Health & Human Servloea
~ 5o - Za I 'S~
A. WELL DATA
Well type
Log present (~N)
Total depth
Sanitary seal {~:~N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
t
Cased to
Casing height (above ground)
Wires properly protected~q)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
FROM WELL LOG
AT INSPECTION
./
Coliform
Nitrate
Date of sample: ~ - I q'- q
B. ~OLDING TANK DATA
O. gl~_~ Other bacteria
Collected by: ~ o on fi) ~ v.r
Date installed
fi-lo-qt. Tank size Iooo
Pumper ~ /~e~ -
__ Soil rating (g.p.d./ft2 or ft2/bdrm)
Number of Compartments ~ Cleanouts {~rN) Y
Depression (Yt~ t~ High water alarm (YI~) rl
System type
l_~.ngth ~ 2 t Width '~, ~ Gravel thickness below pipe ff. 5 Total depth la. ¢ ~
EffeCiive absorption area ~(.2 gt Monitoring Tube present{~Oq'q) Y Depression over field (Yt~) gl 1
Date of adequacy test 4/k- - J ~,~1 Results (Pass/Fail) ~or ~ bedrooms
Fluid depth in absorption field before test (in.);
Fhdd depth (ins.) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
.~..---4mmediately aftet"'--"-~, water added (ira):
Absorption rate = .....~ g.p.d.
If yes, give date
Foundation cleanout ~N)
Bate of Pumping ~ 'i'lat4 ':,,'"
ABSO,..RPTION FIELD DATA
Dat~'installed 0;. : .~ ? 2
De
LIFF STATION
Dale installed Size i~~
Manhole/Access (Y/N) . ~t* "Pump oW' level at*
, High water alarm 'lev, gl,at-*~
*Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
~holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
I oo 14,- · On adjacent lots
I oo I ar ' On adjacent lots
~ oo~ ar Public sewer manhole/cleanout
I O o ' 4- Lift station
SEPARATION DISTANCES FROM~OLDING TANK ON LOT TO:
Building foundation 'Z~ Property. line .GO ~-I- Absorption field
Water main/service line Z~ ~+ surface water/drainage loo ~e- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water
Curtain drain
Water main/service line 'Z ~'
Driveway, parking/vehicle storage area
,
Wells on adjacent lots /o o -b- Property. line
F. ENGINEER'S CERTIFICATION
I certifv that I have determined thrufield inspections and review of Municipal recor ,~ are
in con/brmance with MOA H~ gmdeline8 in effect on this date. ~ ............ a ~'~T2~
Signature . t¢~~ ,~~,
- ~ ~, _ ~ ':~
Engineer's Na,ne ~o~,4 ~ C. C°~'~' ~'~~4 Sea~ig2;__~:
.......................................................................................... ---
HAA Fee $ ~ ' ~ Waiver Fee $
Date of Payment ~~ Date of Payment
Receipt Number / ~ F~ C~ Receipt Number
Rev. 8/95 OSS: haa.wk.doc