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HomeMy WebLinkAboutTANAINA VALLEY LT 17 Municipality of Anchorage Page / . of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES [~lVlSlON P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ._KMqqd0q'~ PIDNumber: Wastewater System: [] New' I~ Upgrade Address: Phcr, e? No. of Bedrooms: LEGAL DESCRIPTION Lot: ~leok+ Subdivision: Township: Range: Section: WELL: [] New [] Upgrade Classification (Private, A,B,C): Total Depth: Date Drilled: Cased To: Ft. Ft. Static Water Level: Ft. Driller: Pump Set at: Ft. Casing Height Above Ground: GPM Ft. SEPARATION DISTANCES Yield: TO Septic Absorption From Tank Field we,' ~2Z/ ' Surface Water Lot Line Foundation Curtain Drain A./Jot, Remarks: ~ ~%c ~.o(_/~'T~p O/J ADT~-Ce~"F ABSORPTION FIELD J~ Deep Trench [] Shallow Trench [] Bed [] Mound [] Other Boil Rating: GPD/Sq. Ft. Total Depth from original//~grade: 0.6 ]epth to pips bottom from original grsde: I Gravel depth beneath pipe /-J,2FI~I 7 Ft. Fill added above original grade: Gravel length: O_o ~.~Ft ~4¢ ft. Gravel width: 2 ,~' Ft. Total absorption area: 75'¢ SQ. Ft. Installer: Number of lines: Distance between lines: ~ /c/ Ft. Pipe material: Date installed: TANK ,~Septic(E'..~/~'~'/..u~..)[] Holding [] S.T,E,P. Manufacturer: ~'A&-~-(;L- Capacityin gallons: Material: Number of Compartments: LIFT STATION Size in gallons: J Manufacturer: "P,mp on"¢~ lev , at: ,~ "Pum.~o; ,~, "': High Electrical Ins ections pedormed by : BENCH MARK Location and Description; 17034 Eagle River Loop Road, No. 204 Inspections performed by: Eagle River, Alaska 99577 Dates: 1st W -~7-q~ 2nd ~ -/~-?q Department of Healtl'~i~ad Humt~orvices approval j Reviewed and approved b.y~~~:~-~ Date:<Y'/¢/c/ 72-013 (Rev. 9/gt)MOA 2S Assumed Elevation: ENGINEER'S SEAL 2 2 Permit No..SW.~40044 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 Legal Description:TANAINA VALLEY SUBDIVISION, LOT 17 PID No.:01105192 COt MT3 104,9' MT1 A B C D 301 22,0 62.~ N.H. 23,5 83.( ~T1 86.5 87.0 ~T2 66,0 79.5 ~T3 76.5 71.0 ~T4 53.0 63.5 9~.? 93,7' · 84.7' NO WATER FOUND DRIVE 3 BDRM HOUSE TRENCH~ 500 GAL, S.T.E.P. EXIST. tO00 GAL; SEPTIC TANK INTEGRITY VERIFIED SCALE i" = 40' ENGINEER'S SEAL 72-013 A (2/91) MOA 25 ,-'. · "" :[ Iq .gBl.l .C T I 0 N S A B~:~Iq };li;S: 7011 I f.i S P E C '.~ :[ 0 N: · ,j 0 0 0 0 I.:?rJ' NO NOi',I.,U,'I}LI. Af,IC~, t:: ~l WILL PLI,XiSi' ~.NI'-; iht N}(X'f .FIc, I:M.. [{ iq · Ii' k.R[.. r :1 C(Jl,{['(b..,.~:()i')S l,o'>l~,r,~] :,.;[, AS l'-,XI 1, .th~'.I I~FI.,C)W I: ] DO i'l(3.~. CONC,t3AI, IJ,~3.<I, 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 WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940044 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WHITMORE EDWARD A & OWNER ADDRESS:7011 LOWELL CIRCLE ANCHORAGE, AK 99502-1868 DATE ISSUED: 3/03/94 EXPIRATION DATE: 3/03/95 PARCEL ID:01105192 LEGAL DESCRIPTION: TANAINA VALLEY LT 17 LOT SIZE: 38863 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 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: CONSIDERATION SHOULD BE GIVEN TO INSTALLING A DIVERSION VALVE SO AS TO ALLOW THE EXISTING TRENCH TO BE ISOLATED AND TO REGENERATE. / ROBERT SHAFER, P.E. ROGER SHAFER, P.E. February 17, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTHAUTHORITY APPROVALS SEWER&WATER MAINEXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 P~FERENCE: Tanaina Valley Subdivision; Lot 17 Request you issue a permit to upgrade the septic syste~ serving the t~ee bedroom ho~se on the referenced property and issue a conditional Health Authority Approval. An adequacy test performed on the existing system for Health Authority Approval purposes found the absorption capacity of the existing system to be inadequate. A conditional Health Authority Approval is requested until the system can be upgraded in Spring, 1994. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the test hole has been checked and found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review,~ntact us. Sin~~ ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ~ ~llCO ~J~JO // // // N¥]d HIIS (ENGINEER'S SEAL) Municipality of Anchorage ,' .~ 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST SLOPE SITE PLAN PERFORMED FOR: LEGAL DESCR IPTIO N:~J~' 1 5- 7- 8- 9- 10 - WAS GROUND WATER ENCOUNTERED7 11 s IF YES, AT WHAT DEPTH? p E 13 - Moniloring? . Reading Date Gross Net Depth to Net Time Time Water Drop l :0~ 10~ 5VP-" SI'l" :~ IO~ ,~/l~ ~ ~h" 14- 15- 16- 17- iS - ~C~, 19- PERCOLATION RATE ~"'~ tminutes/inch) PERC HOLE DIAMETER TEST RUN SETWEEN --~,~AND ~'~'~'- FT A / u .~ ~p .o.. ~o, ~ //~/ _ WAS ACCORDANCE ~A~¢[~AL GUIDELINE~E~ ON THIS DATE OATh: 72-008 (Rev, 4/85) Y / ON-SI~E WAST~AT~{ DISPOSAL S~ST~ CONSTRUCTION PRACTICES and MAT~a{IAL SPECIFICATIONS REFACE: Tanaina Valley Subdivision; Lot 17 The scope of this project includes the installation of a 500 gallon septic tank effluent pumping (S.T.E.P.) system and a leachfield trench to serve the three bedroom residence located on the referenced property and excavation of the existing 1000 gallon septic tank to verify its integrity. If the integrity of the existing septic tank is poor the existing septic tank is to be excavated, pumped, crushed, and abandoned in place and a new 1250 gallon septic tank installed. 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. 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. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail 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. 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' 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. Page Two Tanaina Valley Subdivision; Lot 17 February 17, 1994 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TR~qCH/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 (roughed-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 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. 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 MAT~a{IAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally 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 FS10 (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. Page Three Tanaina Valley Subdivision; Lot 17 February 17, 1994 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, Fernco, or equal). o A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. Ail 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. 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. 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 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 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 contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. Page Four Tanaina Valley Subdivision; Lot 17 February 17, 1994 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 DE ~TMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Nm,le DISTANCES Address TANK FIELD WELL LEGAL D~SCRIPTION AS-BUILT DIAGRAM (Show Iocahon of well, septm system, property lines, Ioundat~om TANKS ~ SEPTIC ~ HOLDING ~TRENCH [~ BED ~ W, DRAIN ~OTHER ~ PRIVATE ~ OTHER (Identify) REMARKS: I ~ J ~P;:(] ~' (~a ', ~__J '~ cedily II,al this inspection was ped~rmed ~ccordino to all 72 013 (3/85) FYi Z i)l,J I ~ I l',li~IAl.l.[:i) t:N ~'N.I Al::~!:h'~ i:)[)VI:FRIi:I.) BY l'-IliA BI! [I..[) Iix!i; ~.~F;'V'F.'.i)'di:!,) 1,4] iil!:l!!i ~:ff, l :i:l",l~}!;::'l:i]i)!:!ii)l'l U'Ei::;'EiFN'i b.,i:]F-I;: ll!J',~ i u!: ~)i:)i",ll: ~' ~q I. :l:i. it :l',!iil:i:i:) I:I..I:E', I F,~:[i]]],U~l,l,, A&unicipa ty Anchorage P.O. ,. ~X 196650 ANCHORAGE, ALASKA 99519~6650 (907) 264-4~t2k 4 7 4 4 TONY KNOWLES. MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 9, 1987 Design In Wood 7021 Driftwood Drive Anchorage, Alaska 99518 Subject: Lot 17 Tanaina Valley Subdivision On-site Sewer Permit #860424 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1986. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well this Department for documentation of close the permit. log needs to be sent to the installation and to If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report (three part form) must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4744. Program Manager On-site Services RWR/ljw enc: copy of permit ,':'.,S 4... 4 7 2', 0 PERFORMED FOR: SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [~ PERCOLATION TEST 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST Frank Koolin & Associate~ DATE PERFORMED: 10/24/85 & 10/27/85 LEGALDESCRtPTION: Lots 1 through 22 Tanaina Valley Subd. E½, NE~, S~,~, Sec 4, T12r~, R4W, S,F. 1 2 3 4 5 7 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS .3 Humus SILTY SAND (SH) brown, moist some Organics to 3 feet ,,~o,e Silt at , SANDY SILT (ML) brown, moist SLOPE SITE PLAN Se_~ Site Plan Te~t Hole Very moist to wet WAS GROUND WATER S ENCOUNTERED? NO ° Dry 11/7/85 .. IF YES, AT WHAT E DEPTH? Gross Net Depl~l~t~,.~ ~ ~ ,~,, ...~et Reading Date Time Time PERCOLATION RATE 8 (minutes/inch) TEST RUN BETWEEN 4~ FT AND 5 ET Reconlmend adjusted rate of 150 square feet per bedroom due to HL soil~ protect ,.system from surface water infii~.a,,o,' - PEREORMEDBY: Allan W. Hurfitt CERTIFIED BY: Allan W. ~urf]tt, PE DATE: 11/7/85 MOA ST85-015 6 /Vtunicipa.ty o~ Anchorage P.O. b,JX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWL£S, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES ' ,?',~ ,, ,/ / ~_.~ .... ,, .... ~./~ .- '. / ,.." '~~ Monitoring Tube Cleanouts PERFORMED FOR: SOILS LOG JNiCIPALITY OF ANCHORAGE DEPARTMENT ~F HEALTH AND ENVIRONMENTAL PROTECTION []~ PERCOLATION TEST 825 L. Street, Anchorage, Al~ka 99501 264-4720 SOILS LOG - PERCOLATION TEST J~OiSe.. ~ ' ~ I Ol~¢~c~ Frank Hoolin & Associates DATE PERFORMED: 10/24/85 & 10/27/85 LEGALDESCmPT~ON: Lots 1 through 22 Tanaina Valley Subd. E½, r~E¼, S~,"~, Sec 4, T12ri, R4W, S.H. 1 2 3 4 5- 6- 7- 8- 9- 10- 11- 12 13 14 15 16 17 18 19. 20- COMMENTS .3w Humus SILTY SAND (Sl;) brown, moist some Organics to 3 feet more S~l,. at 7 feet SLOPE SITE PLAN Se Site Plan Te;t SANDY SILT (HL) brown, moist "'~'Jl~' WAS GROUND WATER ENCOUNTERED? NO ~L Dry 11/7/85 .. pO Very moist to ~.,et mF~S. AT~.A~ E DEPTH~ Allan W. ~urfitl No. 4977.E PERCOLATION RATE 8 (minutestinchl TEST RUN BE'P~VEEN FT AND 5 FT Recon~mend adjusted rate of 150 square feet per bedroom due to HL soil~ protect Gross Net Dep1~e~%~'~-'~ ~..,~\,. I~et b ~¢edino~, D~te Time Time ~' ~-~ .syster,~ froin surface water lnf~lL.a~,o PERFORMEDSY. Allan W. ~,;urfitt CERTIFIED ~v:Allan W. Eurfitt, PE DATE' 11/7/85 H0A ST85-015 6 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 011 -051 92 NAA # ~~C~'c''~O 1. GENERAL INFORMATION Complete legal description Lot 17; Tanaina Valley Location (site address or directions) 7011 Lowell Circle Anchorage, AK Propedyowner Bob & Mary Arts Mai]ingaddress 7011 Lowell Circle Day p~one 248-8264 Anchorage, AK Lending agency Mailing address Day phone Agent John Buchannen/Prudential Vista Address Day phone 250-2299 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well ×× Public water 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: xx 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 dispo.~L,.~eF~.j~.jp .6ompliance with all Municipal and State codes, ordinances, and regulations i.n e~%to~..~ th'~%'te'~ ¢~{~is inspection. was~ewarer uonsulran~, ; /nc, Name of Firm ~an4..~n '~^~.-~,,~ ~ Phone ~3 EngineeCs signature Date Alaska Water & '~ Wastewater Consultants, Inc. · Shall be PAID ~ I~ or prior to, closing for the Engineering Services Provided. w DHHS SIGNATURE / Approved for Disapproved. ~--/-,/~ ,c' E bedrooms. __ Conditional approval for 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 pu mhasers 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. · t OV · Municipality of Anchorage 0 DEPARTMENT OF HEALTH & HUMAN SERVIC~*8~c,',~L~r~ o, ..... ~NVll~o Environmental Services DlvlsiOR 825 L Street, Room 502 · Anchorage, Alaska 99501 Health Authority Approval Checklist Legal Description: TANAINA VALLEY s./o: IOT 17 Parcel I.D.: A. WELL DATA Well type CI Ag.~ "A" Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number 2!4706 Date of test Static water level Date completed e~ Cased to Casing height (abov Wires proper~ (Y/NI FROM WELL LOG AT I,J~ECTION / g.p.m, g.p,m. Nitrate Other bacteria Well production WATER SAMPLE RESUL~ Coliform J D a.a.a.a.a.a.a.a.a.a~s a m p I e: B, SEPTIC/HOLDING TANK DATA Collected by: Date installed 5/5/_~7 Tank size !000 Numberof Compartments ? Cleanouts(Y/N).YES Foundation cleanout (Y/N) YFS Depression (Y/N) NO High water alarm (Y/N) NO Dateof Pumping ~ Pumper A* NOMF gFRVICES C. ABSORPTION FIELD DATA Date installed 4,/! Length 54' Width [UPPER TRENCH/LOWER TRENCH] Soil rating (g.p.d./fF or fF/bdrm) 0.6 2.5' Gravel thickness below pipe 7' PRESSURIZED System type TRENCHES Total depth 10' - 11' Effective absorption area 756" Monitoring Tube present (Y/N) YFS Depression over field (Y/N) NO ' Date of adequacy test I n/~.~/~ Results (Pass/Fail) PASS For 3 bedrooms 3 3o/535 . . . Fluid depth in absorption field before test (in.);6'5''/31 '5'Immediately a~er gal, wa~er adden (in.): 46"/40.5" Fluid depth 35"/31" (ins) Minutes later: 1518/1~-24 Absorption rate = 450+ q.p.d. Peroxide treatment (past 12 months) (Y/N) NnN~' ~nw~ If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed 4/14/94 Manhole/Access (Y/N) YES 34" High water alarm level at* Size in gallons "Pump on" level at*. 28" *Datum Bo'FrOM OF TANK Cycles tested 5OO "Pump off" level at* 18" 3 (*FLOATS WORK PROPERLY PER A+ HOME SERVICES - 10/25/99) E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main COMMUNITY WELL On adjacent lots Se~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 5'+ Property line 5'+ Absorl~tion field Water main/service line 10'+ Surlace water/drainage 100'+ Wells on adjacent lots 5'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 10'+ Building foundation 10' Water main/service line 10% Sudace water Driveway, parking/vehicle storage area 50'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F, ENGINEER'S CERTIFICATION Icertifythatl~e~t~nf/~f inspections andreview~ in conforrna~ce~/it~j/~icl( ~sineffectonthisdate. Signature '~--~ ,~///'?/j ~ Engineer'sNam(~ ~'~J~EFFRE~"~A. GARNESS Date [, ~,/~ ~' HAA Fee $ Date of Payment Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* OFH rA~F 011-051'-92 ;:,GENERAL INFORMA,T ON ;,..r Complete legal description Lot 17 Location (site addressordirectionsl 7010 L:owe,tl Street Property 'owner Mailing address Lending agency Ed Whi'tmore Dayphone24'8-4196 56 701'1 Lowell Street, Anchorage, Alaska 99502 Dayphone · Mailing address Agent Day phone Add¢ess Unless otherwise requested HAA will be held for pickup, . NUMBER OF BEDROOMS: three (3): TYPE OF WATER SUPPLY: Individual well Community well Public water XXXXXX NOTE: If community well system~ pr°vide written confirmation lng to the legafity'and'status of Sy~tb'm. ' TYPE OF WASTEWATER DISPOSAL: from State ADEC attest- · ~. "~. NOTE: Individual om~ite, Hdldigg,tank ; . , . Community'on-site,,,-: , - Publids~wer tf commumty wastewater system~, prowde written conhrmat~on frOm'Sta't~ attesting to the legahty andstatus of'system, 72-025,Rev, l/91) Front MOA#21 STATEMENT OF INSPECTION ,BY.: ENGINEER* *~ As certified by,i'n~%ea "afl xe'd' he~:~t,6~nd as~ 6f ti~ Va id~tio~ ;date ShoWn!be ow verify that my investigation"of'this H, ealth 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 Munici polity of Anchorgge files and from my investigation and inspection, the on-site water supply and/or Wastewaterdi~'po~al s~,~i~rh 'i~'in compliapc~ With rOI! Municipal and State,cod~s, ordinances, and regulations in effect o'n the ~Jate of this.inspection. Name Of Firm $ & Address 3.?034 ~,~9'le River 'T,oop Engineer's'signature Phbne 694- 979 so-ire ~,,~ 0 ~ ,' :Eagle% RiV~ :,':', AK '99 ~DHHS'SIGNATURE .... , .... · Approv~l '.~br ':":;" :~ bedro0'ms. Disapproved. Conditional approval for ..... bedrooms, i~vith: {h~: following st i Ui t One: Additional Comments ,'~": :' :The~Municipality of Anchorage Department,6f Health and.Human.: Services (DHHS):issues Health A~th0rity )r0val Certificates based on y 'upon the representat onS:,g van; n;.ParagrpPh 5 ab6~,e ~y an independ~nt :,:: :~ ;' : '~ pr0fe§sibnal engineer registered ir! the state of!Alaska, The DFIHs d~es this aS a cOurtesy to purchasers of homes i· i~ :',? ~ L :land their iending institutions in 0rder to satiSfy:C~dain fedex;al ~n~ state requirementA. Employees of DHHS d0 not: : : i ;~; ;Condubt Jnsp, ections or.,analyze .data'befom.,,a,certificate,,islissued, ;,The MUnicipality of AnChorage.!s not ,: ~, res~bh~ible for' errors or 6rnissi°ns i'n'the ~bi~S{i0n~lr ~gi~e~ils work:;: i ' ' r a : : J: ;: ' Municipality of Anchorage Department of Health and Human Services HEALTH AuTH~RiT¥ .APPROVAL CHECKLIST Legal Description: '~'--,~/'''~ ~,1 r--]~, ~//~z~cL'-L-~' ¢ Parcel I.D. A. Well Data Well type ~ ~ · If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) L_~/~,, Date completed Driller Total depth Cased to J Casing height Sanitary seal (Y/N) Wiresj3r popo~erly protected (Y/N) FROM WELL LOG~ AT INSPECTION Date of test ~ Static water level Well flow Pump level1 SEPARATION~DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main g;p.m. .g.p.m. ; On adjacent lots /~/~-' '/'~' ; On adjacent lots ~.~/~' . Public sewer manhole/cleanout cd O~ t~ Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOI;DIN~F'rANK DATA Date installed High water alarm (Y Date of pumping Petroleum tank Collected by: Other bacteria Tank size /~ ~,'~'/~" Compartments "~ . Foundation cleano~N)~ Depression (Y~'~ Alarm te' sted (Y~.~ /'-///Z~' "~ L / ~,~dy Pumper --~5,/~ ''~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface wateddrainage On adjacent lots -~ Absorption field Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons VenCN) / High water alarm level Meets MOA electrical code~",l) Manufacturer Manhole/Access(~N) ~ ~-~ ~/ "Pump off" Level at Cycles tested ~2 SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot /.-),/~ On adjacent lots Sudace water / ~ / D. ABSORPTION FIELD DATA Date installed Length ~'%'/' ' Width Total absorption area Date of adequacy test k_P//~. Water level in absorption field before test~ Perox de treatment (past 12 months) (YN~. Soil rating (GPD/FF) ~" '~ / Gravel thickness ~tea/~ present ~N) '"-7/ Results (pass/fail) System type 772~--/-~¢~7/ Total depth // / Depression over field (Y~ for .~ Bedrooms After test ,~)/ If yes, give date To building foundation On adjacent lots Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /"~/¢~ On adjacent lots ~:P / ~ Cutbank /O~L / Property line /O / To existing or abandoned system on lot /,..Jo ~.3 ¢ Water main/service line Curtain drain Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certi~/that I have checked, verified, or con~d~ all MOA and HAA Date ,_ ~ ¢ $ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back ROBERT SHAFER, P.E. ROGER SHAFER, P.E. April 30, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORIZe APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST ROAD DESIGN SOIL TEST PERCOLATION TEST Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Tanaina Valley Subdivision; Lot 17 RECEIVED MAY 2 1994, Munic!~ality of Anchorage Dept, Health & Human Services A Conditional Health Authority Approval 1994, for the referenced property. Conditional HAA has been completed. (HAA) was issued on March, 3, Ail work required for the Attached is the On-Site Wastewater Disposal System and/or Well Inspection Report for your approval. We request you issue a Final Health Authority Approval for the referenced property. If you have any questions or require any additional information, please T/LSU/jk STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM OESIGN 17034 NORTH EAGLE RIVER LOOP ° SUITE 204 o EAGLE RIVER, ALASKA 99577 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1, GENERAL INFORIVIATION Complete legal description Lot 17: ~a~ a q Location (site address or directions) 7010 Lowell Cir~ Property owner Mailing address Ed Whi~or~ Anchorage, AK 7010 Lowell C~cle Anchorage, Day phone AK 99502 248-4196 (h) 564-2729 (w) Lending agency Mailing address Day phone Agent Address · Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOIVIS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water XXX If community well system, provide written confirmation from State ADE~,,a,ttest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 724)25 (Rev. 1/91 Front MOA #21 STATEMENT OF INSPECTION :" Eib: ..;~ER As certified by my seal affixed hereto and as of the validation date shown below, I verify tha'~'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 EngineeFs signature ' ///~~ DHNS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for-~ / ~'-Additional Comments bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and'Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description'. /_o'T Parcel I.D. A, Well Data Well type /~ If A, ~attach ADEC letter. ADEC water system number Log present (Y/N) Date e~ ete~ Driller Total depth ¢¢"~0 '"~'~ Casing height Sanitary seal~__~_(Y/N)~ ~ Wires pro~) ' FROM WELL LOG AT INSPECTION'"--........ Date of test Static water level Well flow Pump level1 SEPARATION WELL TO: lot Absorption field on lot ; On adjacent lots __ Public sewer main Sewer service line lhole/cleanout Petroleum tank WATER S~.~/~ RESULTS: Coliform Date of sample: B, SEPTIC/HerDING TANK DATA Date installed ~-¢-~,- \- ~"~ Tank size Cleanouts ~,N) Y High water alarm (Y/~) Date of pumping Other bacteria co-Sirecte~_. I0¢--,~ ¢J~- Compartments Foundation cleanout ~N) ~/ .Depress on (Y/I~¢ /~)//~ Alarm tested (Y/I~ /'')///4L / /~1/~ Pumper SEPARATION DISTANCES FROM SEPTIC/H~t~r,~i~ TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots ~ L'zL Foundation Absorption field / ~ t Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION ~ Vent (Y/N)__ __ "Pump on" level at-'~"---,~ ../~u'Pump off" Level at. High water alarm level f/~-~,te,~ted Meets MOA electrical codes (Y/N) / ~ SEPARATION DIST~ANG~T STATION TO: ~ WeJl-e~ On adjacent IoL Surface water -'----. ~, D. ABSORPTION FIELD DATA Date installed '~-~- Length ~/~),~ ~ ~,S Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/[~ Soil rating (GPD/Ft2) ]~© gF/~ Systemtype ~Pd~¢ 7~'%'~u! Gravel thickness ~ / ~ Total depth ~ ', ~ ¢ Cleanout present ~) ~ Depression over field (Y/~ ~ Results (pass/fail) ~1 b for ~ Bedrooms ~G~&" / ~" Aftertest ~0~/~/' ~, ~" ~o If yes, give date ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /'"J//J¢ On adjacent lots ~-OO ' ¢- Property line To building foundation 50 '4- To existing or abandoned system on lot On adjacent lots c~co'+ Cutbank ~/~ Water main/service line Surface water /O',',','~t4- Driveway, parking/vehicle storage area [~ Curtain drain ~O~J~,................~ ~-~',.~. E. ENGINEER'S CERTIFICATION I cerfify that I have checked, verified, er conformed to all MOA and HAA guidelines in effect on the date of HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number inspection. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON~SITE SEWER AND WATER FACILITY 264-4744 Applicetion Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, bJock, subdivision,section, township, range) Location addre~s.br, dire,ction~ 1,¢ /r - (b) Property Owner~ ~_~'r'~--~,:~5 *,'D-~Z ~A~eiephone: Heme Business (c, Le;dingl,stitution~ ~~ ~'Telephone ~ . ' ~Z . ~ ', Mailingfddres~/ ~~,. ~~ (d) Real Estatb'Company and'Agent Address .'~'~ Telephone (e) Mail the HAA to the followine address: or: Check here [], if hold for pick up. List contact p~rson and day ph/:xne n~mber belpw. TYPE OF RESIDENCE Single- Family"fi~ Number ot Bedrooms WATER SUPPLY Individual Well [] Community~ Public [] Note: if community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/861 Fronl ieuo!ssajoJd aq~ u! aUOISS!LUO Jo sJoJJa JoJ alqlsuodsaJ iou s! abeJoqauv lo X)!led!o!unR aLU. 'panss! B! eleo!llJJao e aJojaq eJep azXleue Jo suo!jaadsu! ~anpuo3 lou ap SHHC] Ia aaa/,oldLU3 'aiUeLUeJ!nbaJ ejels pub IBJapal uiepaa ,~Js!ies al Jap Jo u! suo!jmjlsu! 6u!pual J!eLI~ pub BaLUOLI tO sJaseqoJnd oi,~sapnoo e se s!qi esop SHHC] aLI.L 'B~selv JO ale,S aqj u! paJela!aaJ Jaeu!aua leuo!ssajoJd luapuadapu! uB ,~q e^oqe ~ LIdeJ6eJed u! USA!8 suo!leluesaJdaJ aq] uodn ,quo paseq seleog!pea leAOJddv ,q!JoLIln¥ LIlleal-I senss! (SHHO) seo!^JeS UBLUnH pub qlleeH ,to luaLupedec] aSeJoqauv jo /q!led!a!unlN eLI/ NOI.Lrl¥c) leAoJdd¥ leUO!!.!puoo J.o suJJe.L leuo!l!puoo pa^oJddesK] " /' ale ,(¢'//)~) .///?..~? Aq StUOOJpaq '~ paAoJdd¥ O~ ~ 401 paAoJddv 'l'¢AOUdd~ SHHQ '9 · uo!l. oadsu! S!LI1 JO m. ep aLI~ ua loajja u! suo!lelnSaJ pub 'seauBu!pJo 'sepoo elels pub led!olunw lie q~!M aoUe!ldLUoO Jo/pu~ Xlddns JeieM ails-ua aql 'uo!loedsu! pub uo!lea~lseAu! A~ ~oJ~ pub Sel!J eaeJoqouv pau!elqo uo!lemJoju! sql ua paseq leql XJ!JeA JaqpnJ I 'u!aJaq peleo!pu~ aJnjonJjg lo edX1 pub 9mooJpaq elenbepe pub leUO!~oun~ 'ales s~ ~elSXS lesods!p ~eleMa~SeM Jo/puB Xlddns ~aleM al!s-ua aql l~ql SMOqS leAoJddV ~lpoq~nv NOILV~BOJNI aN~ v~va 'NOU~BS ]~1~ 'SZS~& 'SNOI~O~8~NI 9NlalAOMd BMIJ 9NIB~]NISNB .g MUNICIPALITY OF ANCHORAGE (MO, MUNICIPALITY OF ANCItORAG'~EALTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Jt. IN g 6 1987 WELL DATA RECEIVED CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~ Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) I~13, C, D.E.C. Approved Date Completed -Yield Cased to Depth of Grouting / ~~At __ ~..8'anitary Seal on Casing (Y/N) /' Depression Around Wellhead (Y/N) Separation Distances from Well: / To Septic/Holding Tank on Lot ~ ; On Adjoining Lots Edge of Absorption F/~ on Lot ; On Adjoining Lots To Nearest To Nearest Public Sewer Li/r~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot Cleanout/Mani~/~ Water Sample~.Lt~cted by Water Sa,~Dle" Test Results Co m,,~ts ; Date B. SEPTIC/HOLDING TANK DATA Date installed ~.,2,,)_//.~7 Size .?¢ ¢,'~ c'~ No. of Compartments Standpipes CN) Air-tight CopseS)N) Foundation Cleanout L~N) Depression over Tank (Y~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) /'~.//~. ; for Holding Tank High-Water Alarm (Y/N) ,¢J-//,4 Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To ProPerty Line -"~ co To Water Main/Service Line Course Comments To Building Foundation /Z. To Disposal Field /E'- ' To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / Date Installed ,'3~/~-//'~ ,'P Width of Field ,~0. Square Feet of Absorption Area Depression over Field (Y/~/) Results of Last Adequacy Test Type of System Design Length of Field ?~" Depth of Field Gravel Bed Thickness 0¢~ ZTM.,:~ / Standpipes Present (_(~N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation "¢~ / Lot To Water Main/Service Line ///" To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~'~-! To Existing or Abandoned System on ; On Adjoining Lots -~ ~-~ To Cutbank (if present) /'L-'z,,,,.¢_ /,.J¢ ~- ~ ./(~/ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments ~ Dimensions Manhole/Access (Y/N)..~ "Pump ~ at /Vent (Y/N)  Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verifie¢, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 bi'EVE COWPER~ GOVERNOR Telephone: (907) Address: 274-2533 DATE' PWS I.D.# To Whom it May Concern: According to records on file in t~is office the Water Regulations. Water System is in compliance with the State Drinking