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HomeMy WebLinkAboutSKYLINE VIEW BLK 1 LT 20Skyline Vi W Block Lot 20 #051 - 192- 35 : 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: -'~,~'i GolN ¢1 PID Number: 0',~i =-. iq'Z. - ~- Name: ~O'~ ~H~I~ Wastewater System: ~ New D Upgrade Address: ¢ o~ ~,~ '7'7-~ ~L~,~W~, A~ ABSORPTION FIELD Phone: ~ ~ 6~ ~ NO. of Bedrooms: _ ~ D Deep Trench ~ShallowTrench D Bed DMound ~Other LEGAL DESCRIPTION SoilRating: I' 2 GPD/Sq, Ft. Total Depth fro~o~iginal grade: Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe ~0 j ~j ~ ~f~ ~ I Ft. Ft. Township: .... Range: Section: Fill added aboveo I'"°riginalj J grade: Ft. Gravel length: ~ ~ Ft. WELL: ~ New ~ Upgrade Gravel width: ~ J Number of lines: Distance belween lines: Ft. J ~ Ft. I Classification (Private, A,B,C): Total Depth: Cased To: Total absorption ares: Pipe material: ~-~ Driller:t Date Drilled: Static Water Levei: Installer: Date installed: Yield: JPump Set at: Casing Height Above Ground: SEPARATION DISTANCES W Septic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding =ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~NcRO¢-~ ~NK / CO O Number of Compa~ments: Well' j OoJ~ Jo0~ ~ ~ ~ l~ Material: ~ L Sudace Water JOol~ ~oo~ ~ -- LIFT STATION Lot I t ,-- Size in gallons: Manufacturer: Line Z~ J'~ ~ ~ I Foundation ~ ,~1 ~ ~ ~ ~ ~ "Pump on" level at; ~~ at: High water alarm at: Remarks: BENCH ~ARK Location and Description: Assumed Elevation: ~1~:,.' ,., %'.',.;,.'~ Inspections performed bys & s ~7034 Eagle River Leop Read, N., ~es: 1St ~'- I l-lit; .ep.,,men, Hea. h app...va ",, "-,..:. · Reviewed and approved by ~,'~¢ /~/~.,~ . . ""'" ' '*<'- :~-':"" 72-013 (Rev. 9/91) MOA 25 SW960149 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 20, BLOCK 1, SKYLINE VIEW S/D 051-192-.35 Legal Description: PID No,: FCO 8.( 26.5' ST1 46. i' 74.0, ST2 50. ~' 76.5' DBL1 52. ~' 78.5' UI::JLZ D..3,~' I'J,U' / C01 47. ~' 72.0' ~ C02 44. P_ 52.5'/~LOT MT1 42. I' 35.0' --~ ' 2O I ~NEW 100 GAL ' ~'~ .~u i ~ SEPTIC lANK ~ I co~ ~1 -ALT. SIT~ I ~ ~ I ~ , ~ NEW TRE NCH~ SCAB~ f' ~ 40' MTI ~'1'1 ST2 , FINAL GRADE N / ~ NEW ~ COl C02 ,ou, S~P' 'lC ~98.4' ~M': 1 = 91.1' NO GROUND W ~'i'ER ...... '"" 85.1' }LO.H. ',' ..' ........ .~ 72-013 A (Rev. 9/91) MOA 25 Z "d ROBERT C. COWAN, R E. ROBERTA. SHAFER, P.E. HEALTI~ AUT HORIF,' APPROVALS SEWER&WATER MAIN EXIENSIOHS SEWEFt &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER CISPOS~L SYSTEM DESIGN Date CIVIL ENGINEEFIS (907) 694-2979 FAX (907) 694-1211 RECEIVED Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 JUL 1 9 199 MunicipaliTy ol Anchorage Dept. Health & Human Services The septic inspections for the referenced property were performed on 7-~1-~ and w-l~-~ . Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the ~ B~ to be completed. If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP . SUITE 204 . EAGLE RIVER, ALASKA 99577 PAGE 1 OF 1 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 PERMIT NUMBER:SW960149 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SCHRECKHISE, ROY OWNER ADDRESS:P.O. BOX 772062 EAGLE RIVER AK 99577 DATE ISSUED: 6/26/96 EXPIRATION DATE: 6/26/97 PARCEL ID:05119235 LEGAL DESCRIPTION: SKYLINE VIEW BLK 1 LT 20 LOT SIZE: 19080 (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 RECEIVED BY: / ROBERT C. COWAN, RE. ROBERT A. SFIAFER, RE. May 30, 1996 CIVIL. ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN E~TENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND F~EPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 20, Block 1, Skyline View Subdivision Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the 'test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole. The monitoring tube within the test hole has been checked and found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 © o 0 069 > o ~So ~ 0 ~ ~::~© / I~ ~ ~o o 10' UTIL. ESMT. r~UO 06:(9 © PERFORMED FOR: LEGAL DESCRIPTION: 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: ~C,~,j ~<~,/~) SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? *"~----' P E Beplh to Water After M0nilaring? O ~L't' Dale: ~'~ ' ~ '''~ ('-- SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop .:..~ - 'Z'~' "l.(, 'Z', iS' 'Z: ~ ~' t~/z~' 'Z '.Z~ ,, i~t~' - PERCOLATION RATE J (minule$/mch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND (~o FT COMMENTS $ & $ £NGINEERING I ~--~, ~_/~.A"~ .~ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: i1034 Eagle klver Loop Road No. 204 '" .... ' ACCORDANCE WITFIF-c~;~,,J~'~I]"/~II~[II~ GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS 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 INSPECTIONS ONSITE WAs'r EWAT E R DISPOSAL SYSTEM DESIGN REFERENCE: Lot 20, Block 1, Skyline View S/D May 30, 1996 GENERAL: 1. The scope of this project includes the installation of a 1000 gallon septic tank and a five foot wide drainfield to serve the proposed three bedroom residence located on the referenced property. 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. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 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: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 o EAGLE RIVER, ALASKA 99577 Page Two Lot 20, Block 1, Skyline View S/D May 30, 1996 Septic tanks installed with less than 4 ft. of cover shall be insulated. 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. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 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 (ruffed-up) before gravel (sewer rock) placement. 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. 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. 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. Page Three Lot 20, Block 1, Skyline View S/D May 30, 1996 5e 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. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than lJ. sted above must be approved by the inspecting engineer. e Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield grave], layer and the native soil backfill. Alii leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 20, Block 1, Skyline View S/D May 30, 1996 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted 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. 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. 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.0.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. Page Five Lot 20, Block 1, Skyline View S/D May 30, 1996 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 De aHmen[ Building Safely Division On-Site Wa~er and Waslewaler Program · ,~700 Soulh Bragaw SI. P.O. Box t96650 Anchorage, AK 995t9-6650 www.cl.anchorage.ak.tJs (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-192-35 1. GENERAL INFORMATION Co~plete legal d.es6ril~.[.i~.n, Lo t 20; L0calion (site addre§s'6i'c~jrections) 19 3 5 5 I r i s S t r e e t Cdrrent Property owner'(s)~ Mark Ragsdale Day phone =.~aiiingaddress ,Po Box 6179 Elmendor£ Air Force Base, Lending-a{iency ' Day phone Block 1; Skyline View Subdivision 688-1014 AK 99506 e Mailing address Real EstaIe Agen| Mailing Address Unless otherwise requesfed, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 Day phone 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual. Holding tank Commundy On-site [] Public Sewer The Municipality of Anchorage Development Services Departmenl (DSD) Issues Certificates of Health Authorily Approval (HAA) based only Upon Ihe representations given In paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificales of Heallh Authority Approval are required for the transfer of title (except between spouses) for propedies 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 Aulhorily Approval are valid for gO days from the date of issue for propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Cedil~cales may be reissued [or a period of Up Io one year with valid water samples.) Cedific'~tCs are valid roi' one year for propedies 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 englneer's work. 4. STATEMENT OF INSPECTION By ENGINEER As certilied by my seal affixed hereto and as oJ' the validation date shown below, I veriJy Ihat my tnvesflgalion, based on procedures outlined In the Heallh Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) sale, functional and adequate for the number of bedrooms and lype of struclure indicated herein. I further verify that based on the information obtained from Ihe Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewa[er disposal system Is(are) In compliance Wilh all applicable Munlcipal and Stale codes, ordinances, and regulations in effect at tile time of installation. NameofFirm S & S En~ineerin~ Address 17034 N. Eagle River Loop Ste. Engineer's Printed Name Robert C. Cowan DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for Phone 694-2979 204 EaRle River, AK 99577 bedrooms. '~ ~ ""r:="'" bedrooms, with Ihe following slipulalions: Additional Comments By: Attachments: HAA Checklist Septic System Advisow Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Olher Original Cedificate Date: ~/~/~' '7_. Municipality of Anchorage ,o 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) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST WELL DATA We, type 5 f~ Date completed ~.L~'/~ j~, Total depth ~.._~_ft. If A, B, or C provide PWSlD # *'*""' SanitaTseal (Y/N) ~/ Casedte ~0/fl~ Well Log (Y/N) )/ wires properly protected (Y/N) '~/ Casing height (above ground) /,~ '/-In. FROM WELL LOG AT INSPECTION Static water level / ,~ '~ It. '//q~,-,' lt. Well production [ ~ g.p.m. 3, ~ g.p.m. WATER SAMPLE RESULTS: Coliform (~ colonies/100 mi. Nitrate ~,~ mg./t. Other bacteria ~.__ colonies/100 mi. Date of sample: ~*'/'~/~rg~/"COllectedby: '~,~ ~6~-/,'~/'~'~-'~-/~,,,/~,?--- B. SEPTIC/HOLDInG TANK DATA p,q~ks,ze /~_,/~ gal, ;(..:, Number of Compartments ~ Cleanouts(Y/N) · ~.o~J. ndatlon'clea"°~t (Y/N)"~ Depression over tank (Y/N) AJ' High water alarm (Y/N) .,-'-~ t I I f L--' Length ~ O fi. W*Mth ~ ft. Gravel below pipe ~ fl. Fluid depth in absorption filetd befor% test 0 in. Water added4~ggal. Elapsed Time:~,~ C) min. Final fluid depth,~ in. Absorption rate >= Any rejuvenation treatment (pest 12 mo.) (Y/N & type) '~ Depression over field ,A,./ For ~ bedrooms New depth {'~ in. If yes, give date D. UFT STATION Datum / EL SEPARATION DISTANCES Size in gallons 'Pump off level at Cydes tested Manhole/A_~__~ (Y/N) In. High water alarm level at in. Meets almm & cimuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanldlitt.~d~'n on lot Absomtion field on lot ((~7~) /'P' Public sewer main ~//~__. ! Se,~septlc service lIne ( ~' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~'..~'- Property line .~'" ~t. Absorption field Water main /~J//~r- Water service lIne /O '~ Sudace water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property lIne / O I ~' BuildIng founclaflon /0 ~ Water main water sauce ilr / CurtaIn drain /~/~R/~ ,~-4//9~/Weils on adjacent lots ~)~ ~'~' On adjacent lots / O0 / ~- On adjacent lots /00 / .1.- / Public sewer manhoteJdeanout ~'//o/-- ! / /00 HAA Fee $ Date of Payment Receipt Number (~. 12/oo) Waiver Fee $ Date of Payment Receipt Number F. COMMENTS I ~ ~at I ha~ dete~l~ ~m~h fle~ i~pe~ and m~w ~ Mull ~s ~ ~e a~ s~e~ am ~ ~an~ ~ M~ ~ gu~llnes ~ eff~ ~ ~ date. ,~I~K CT&E Environmental Services Inc. Project Name~# C~ient Sample 1D Ord~ By PWS~ Sample Rcm~rkt: 1024500003 S & S F..~e~ring NA Sky Linc View Lot 20 Block 1 Drinking Water 0 All Dateu'l'ime. s are Alaek~ Standard Time Printed Date/Time 07~22/2002 15'.39 Collect~ Date/Time 07/19/2002 15:35 Received DatdTimo 07/19/2002 16:50 Technical Director Rcleazed By (~~ Allowable Prep Analysis LimlU D~g D~g Init Watere D~,~ar ~.eni: Nittat~N Microbiolo~iv Laboratory To~l CoIif~ 2,96 0100 ~ EPA 300.0 (<10) 07/20/02 6 OB, No Coti coVl00ml. Slvil ~ 9222B JDT (<I) 07119/02 mAP A$-~UrLT I'\l Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl. TH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING -- AN Z 1998 RECEIVED 1. GENERAL INFORMATION Complete legal description Lot 20; Block 1; Skyline View Subdivision Location (site address or directions Property owner Maiii'ng address Roy Seh~e~h4~¢ P.O. BOX 772062 19355 Irls Str~t Eaqle Rivert AK Day phone Eaqle River, AK 99577 Lending agency Premier Mortgage Mailing address 3000 "A" Street Suite 102 Agent Caroline Greiner/ Remax of Eagle River Address Day phone Anchoraqe, AK Day phone 563-7736 99503 694-4200 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 ~ TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xxx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Re','. 1191) Fronl MOA ~t21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that rny 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. S & S ENGINEERING ~ ~ ~ ~ ~- ~ '7 ¢] Name of Firm 1703-~ m?~ ......... ~---~ e~. ~ Phone Eagle River, Alaska ~95~ Address ,;~2/ ~~ Engineer's signature _ . _ Date / /'~ ~ /~ ~ DHHySIGNATURE Approved for (t Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfl/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. 724325 (Rev. 1/91) Back MOA Legal Description: Municipality of Anchorage J;)l~ ~ DEPARTMENT OF HEALTH & HUMAN SERVICE'St; C E IV E D Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)¢'~4'~-~794z~998 Municipaiity of AnChorage Health Authority Approval Checklis apt, Health & Human Services A. WELL DATA Well type Parcel I.D.: ~Ot'.,iq'Aq'l~, If A, B, or C, attach ADEC letter, ADEC water system number /'J ~k, LOg present ((~N) Total depth Date completed ~, -- I ff- - tl G.- Cased to ~-'-~, Casing height (above ground) Sanitary seal (~JN) ~g' ~ Wires properly protected FROM WELL LOG AT INSPECTION Date of test Static water level Well production I g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Other bacteria ColleCted by: $ & $ ENGINEERING 17034 Eagle River Loop Road~ No. 204t Ea~le River, Alaska 99577 Date installed -/,- I(.-'~IG Tank size I co o Number of Compartments ~ Cleanouts L~'N) Foundation cleanout ~)N) YE.g Depression (Y~) t~ c, High water alarm (Y~.~ Date of Pumping I/3.~/c'}~ Pumper .7' /~ C. ABSORPTION FIELD DATA Date installed Length 5;?, Width Effective absorption area ~J~ Date of adequacy test _ '-/'° '~.-I ~ "~] (, Soil rating ~or fF/bdrm) j', 'Z. System type Gravel thickness below pipe Total depth Monitoring Tube present (~) ?~ Depression over field (Y~ ~' Results (Pass/Fail) ~ For ?] bedrOoms Fluid depth in absorption field before test (in.); ~ Immediately after ~ gal. water added (in.): Fluid depth ~ (ins) Minutes later: Absorption rate = --- .g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3~96)* LIFT STATION Date installed Size in gCllons Manhole/Access (Y/N) ~_--.~J~ level at* "Pump off" level at* E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Ioo~ On adjacent lots On adjacent lots Public sewer manhole/cleanout Public sewer main Sewer/septic service line :~; I~. Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ ,&l Property line ~-q i Absorption field Water main/service line ~ o ¢-.i- Surface wateddrainage IooIf¢ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /'7 Building foundation ~q ~ Water main/service line Surface water ~ Oc)'F' Driveway, parking/vehicle storage area Curtain drain I~ ,: 5~ I/-~,1c¢,~ Wells on adjacent lots I o o~ 4- ENGINEER'S CERTIFICATION I certify that I have determined th?u field inspections and review of Municipal recor.~t4tfe abotCb"~y,¢$~¢ are in conform elines in effect on this date. ~k~ / ~;;: ( ~'~4. ", 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc. Laboratory Division Drinking Water Analysis Report for Total Coliform Bacteria 200 w. ~ot,,r o,i,, Anchorage, AK 995!8-1605 READ INSTRUCTIONS ON REI/ER~E SIDE BEFORE COLLECTING SAMPLE Tel: (907) 562-2343 C3 ,ge?nd g,nult~ 0 Send invotcf Month Day SAMPLE ?YPE; Routhte ~ Relent Sample (f~ murine sampler- c~ with lab ref. ne. ~'~.~. I ) Treated Water Untru~es&Waeenr,: Fax: (907) 561.5301 TO BE COMPLETED BY LABOR~TORY Analysis shows this Water SAMPLE to be:. Satisfactory O Unsatls~actory C] Sample over 30 hours old, results may be unreliable Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable m~ults. Please send new sample via special .deli,very mail. Time ReceivedA 0 ?,z~ Analytical Methodt ,~' Membrane Filte~ a MMO. MUG * Numbetofcolonies/lO0 mi. S804912 t' libel: Ancb Fbk~ Ju~ [] Fa~ed 0 Special Purpo~e Time Collected SAMPLE LOCATION~ '~'' Coll~.ea~ ifF- Time: CHeat notified of unsetbfactory r~ulls: Phee~ Spoke wi(b ~ _ ~mc BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MIJG Membrane lqlte~: ~rect Coaee Vertlhmtio.: L~ IIGa, Emi Coli~ Commen~: ~ ¢olonie~ I00 mir COLIFII~ Tine ¢oli~nrmZl~ raj t5<' _ Fixed if~ll~ ~. Memt~r of the SG$ Group tSo~i~bt* G~n~ale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASIG~, CALIFORNIA, FLORIOA. ILUNOI$o MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA ~t~m~, CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Sample Remarks: 980421001 S & S Engineering Lot 20, Blk 1 Skyline View S/D Bathroom Sink Drinking Water 0 Client PO# Printed Date/Time 02/05/98 17:10 Collected Date/Time 01/28/98 11:10 Received Date/Time 01/29/98 13:10 Technical Director: Stephen C. Ede Released By ,~ ~J~ Parameter Results PQL Units Allowable Prep Analysis Method Limits Date Date Init Nitrate-N Waters Department Analyses Total Coliform 2.17 -7X~-ob/ lOO-ml/ ne-eoCi 0,100 mg/L EPA 300.0 10 max 01/29/98 RMV SM18 9222B 01/29/98 TMW