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HomeMy WebLinkAboutSAND LAKE #2 BLK 2 LT 7and Lake #2 Block 2 Lot 7 #011-133-42 Municipality of Anchorage On -Site Water and Wastewater Program - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSPI81170 PID Number: 011-133-42 Dwelling: W Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: M New FIR Upgrade Name: Craig & Vanessa Hassinger ABSORPTION FIELD FE -1 Deep Trench F-1 Shallow Trench R Bed ❑ Mound Address 8101 Seaview Street Anchorage AK 99502 El Other Phone Number of Bedrooms Soil Rating depth from original grade 3 2.0 GPD/SF JTotal 10.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6.0 Ft. Gravel depth beneath pipe 5.0 Ft, Subdivision Block Lot Sand Lake No. 2 2 7 Fill added above original grade 0 Ft. Gravel length 23 Ft. Township Range Section Gravel width 3 Ft. Beds: Number of Lines Distance between Tines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 230 Ft2 1 Ft. Well >100' >100' N/A N/A >25, TANK El Septic A S.T.E.P, E] Holding N Other Manufacturer FAP Advantex/Orenco Capacity 1 1,500 Gal. Surface Water >100' >100' N/A N/A Material Number of compartments Lot Line >5' >10' N/A N/A Fiberglass 2 NA Foundation >10' >10' N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Cirenco 1500 Gal. Remarks Existing Septic Tank Decommissioned Pump on level at 25 in. Pump off level at 13 in. High water alarm at 11 in. in Accordance with MOA Code. Exisitng Absorption Trench Abandoned in Place. Pump make and model PF2005 Electrical Inspections per -formed by MOA Installer PIPE MATERIAL House to tank D3034 drainfield Tankto D3034 Affordable Septic Drainfield D3034____ CO/MT Q3034 inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspectes:tion is' 7/09/18 2 nd 7/10/18 da Location and description 3`d 7/10/18 4th 7/13/18 Garage Slab (Back Door) COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL F A4 qsAw� Conditional Approval: Date ,q) 49 TH .................. • Michael E. Anderson Approve Date 63% 4381-E 0, i... law 111tipvLalurl mupuli_a- j -! Z.doc SAND LAKE #2 BLOCK 2 LOT 7 PERMIT # OSP181170 PID # 011-133-42 SEAVIEW STREET LOT 7 A BEXISTING CLASS C WELL FCO 21.5 5.2 ,. MH1 21.3 15.0 \ so'RADIUS MH2 28.9 24.3 2C01 28.2 25.2 / 2CO2 30.3 26.6 LOT 8 CO1 30.0 13.3 \' LOT 6 MT 44.5 36.0 3-BDRM HOME .. CO2 44.6 35.8 NEW 1500 GAL.FAP ADVANTEX O 23'LONG x 3'WIDE x 5'EFF. TREATMENT TANK w/AX-20 POD •• FCO • DEPTH ABSORPTION TRENCH • _ ''-01 EXISTING SEPTIC TANK DECOMMISSIONED ONSITE IN = ACCORDANCE WITH MOA CODE. 2001 N , 2CO2 e � 2000 TH FROM MOA FILES • PT1 m-ri-0O2 • • • I-1 .. • U �� ---- EXISTING ABSORPTION 1982 TH LOCATION ��• • TRENCH FROM MOA FILES ABANDONED ABSORPTION "E— / TRENCH I I 10 ELECTRICAL EASEMENT EXISTING ABSORPTION TRENCH ABANDONED IN PLACE illiktGE EMOINEENI146 NOTE: ....����x\x NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND .'4. .....L,q����`� PROPOSED SEPTIC SYSTEM CO-CLEANOUT Am • �)�' tI ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2C0 DOUBLE CLEANOUT />ft:•�TH /\ .* / FCO-FOUNDATION CLEANOUT SYSTEMS.EMS. ARE SHOWN.NO CONFLICTS WITH WELLS OR SEPTIC FS-FLOW SPUTTER VALVE �F • Michael E.Anderson : # 0 30 60 MH-MANHOLE f+fo.• CE-44381 </ MT-MONITORING TUBE ms's•• 9 -i-0-* t="1 im um mi NM FEET 11 F��O$- ��� v SV-SEPTIC VENT �1,'�\"`o\O"- 1"=30' TH-TEST HOLE SAND LAKE #2 B2 L7 PERMIT # OSP181170 PID # 011-133-42 o = = o 02u_ 2 g N — , 98.8 — — AX-20 POD AND I- - MANHOLES r____I v A \ N— 96.0 95.0 -71 1500 GAL F.A.P.TANK J / -.1'.'— 91.0 0 02 98.7 ORIGINAL/FINAL GRADE 0 —, ,miiim,„ L , 93.7 93.7 DRAINFIELD ROCK -."------ 88.7 23' 88.7 79.7 O `— NO GROUNDWATER 6/01/00 J ± r, .............. :I k, 41 *•49 TM /, �9*+�/ �f- .l- -, F : Michael E.Anderson : f Ns.� PROFILE AS—BUILT 1fc".•.. 4831-E .:`�i ) GE (NO SCALE) `ili(\\\\L. ~ MUNICIPALITY OF ANCHORAGE ~.� !�;q�p‘jl DEVELOPMENT SERVICES DEPARTMENT /� P�••••• �1,—. •9tI 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 'iitc.9TH.. . ; . SOILS LOG AND PERCOLATION TEST •. Michael E.Anderson .' j �� I+�c�'• 4831-E LEGAL DESCRIPTION: SAND LAKE #2 B2 L7 �l�\��\"``��� PERFORMED FOR: CRAIG 8, VANESSA HASSINGER ProfessionalEngineersEngineers Stamp: DATE: 7/07/18 PROJECT No.: PARCEL ID#: 011-133-42 TECHNICIAN: N. SHAFER DEPTH PERK TEST 1 (feet) 1 SLOPE SITE PLAN 2 3 4 5 SEE SITE PLAN 6 7 8 9 WAS GROUND WATER ENCOUNTERED? NO S 1 O IF YES(n WHAT DEPTH? - L DEPTH OF WATER AFTER MONITORING: - 0 1 1 DATE OF MONITORING: - 12 E DEPTH TO DATE READING GROSS TIME NET TIME WATER NET DROP 13 (MINUTES) (MINUTES) (INCHES) (INCHES) 14 7/07 TEST HOLE PRESOAKED PRIOR TO TESTING: 15 1 13:20 4 2 13:50 30 91- 516 16 3 13:52 4 17 4 14:22 30 8 s 416 18 5 14:24 4 19 6 14:54 30 816 4 Is 20 PERCOLATION RATE: 6.2 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 4.5 FT. and 5.5 FT. COMMENTS: Note: This lot is served byaClass Ccmnmunity well. 0 "P, *.OElizabeth L. Walatka AO 8036 - LS SCALE: 30' EASEMENTS OFRECORD, OTHER THAN THOSE SHOWN ONTHE RECORDED PLAT ARE NOT SHOWN HEREON UNLESS DTHEF�V|SENOTED. Ho|�.FB1�O. pg 25 BE AS -BUILT NOCORNERS SET THIS DATE | hereby certify that I have performed a Mortga ee's Inspection of the following described property: LOT 7, 19LOCK 2. SAND LAKE SUBDIVISION No. 2 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated Dated at Anchorage, Alaska this I 6th —day of_JULY .208. FnEovW^LATKA & ASSOCIATES, Luc. En 907-248-1666 Sun��� 907-248-1666 | |nf /� | ��`� | | �t 19 . . �— N89055' 13500 / �| ~ C) St 0 She C) Coo hain link fence < 17.7 8.3 Septic system W 1 Story Frame House |mf 16CD C14 04 LOT 7 GJ 0 46.0 Z fence (typ) ,food --_- Wire fen: N89055'00"W 135.00 | 30 Lot o ! | Lot 1� ~^ '^ Note: This lot is served byaClass Ccmnmunity well. 0 "P, *.OElizabeth L. Walatka AO 8036 - LS SCALE: 30' EASEMENTS OFRECORD, OTHER THAN THOSE SHOWN ONTHE RECORDED PLAT ARE NOT SHOWN HEREON UNLESS DTHEF�V|SENOTED. Ho|�.FB1�O. pg 25 BE AS -BUILT NOCORNERS SET THIS DATE | hereby certify that I have performed a Mortga ee's Inspection of the following described property: LOT 7, 19LOCK 2. SAND LAKE SUBDIVISION No. 2 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated Dated at Anchorage, Alaska this I 6th —day of_JULY .208. FnEovW^LATKA & ASSOCIATES, Luc. En 907-248-1666 Sun��� 907-248-1666 TY OF ANCHORAGE C----,NJN' v1,rrr _ MUNICIPALI `�""c S'On-Site Water 8 Wastewater Program s° �';;PO Box 196650 4700 Elmore Road .� Anchorage,Alaska 99519-6650 Phone:(907)343 7904 Fax:(907)343-7997 ,q http://www.muni.org/onsite ehartment On-Site Wastewater Disposal System Permit Permit Number: OSP181170 Effective Date: 7/2/2018 Work Type: Septic Upgrade Expiration Date: 7/212019 Tax Code Number: 01113342000 Site Legal Address: SAND LAKE #2 BLK 2 LT 7 G:2224 Site Mailing Address: 8101 SEAVIEW ST, Anchorage Owner: HASSINGER CRAIG &VANESSA J Lot Size in Sq Ft: 6750 Design Engineer: FORGE ENGINEERING Total Bedrooms: 3 This permit is for the construction of: 0 Disposal Field 2 Septic Tank 0 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 Special Provisions: A percolation test shall be completed at time of construction at the location identified on the site plan. If results require a design change, construction of the system shall stop pending On-site review and approval of a change order. Please submit stamped and signed results with the inspection report. Received By: /� Date: / t I ir Issued By: (LlULI-+ Date: 7e18 X61 8 9 �� MUNICIPALITY OF ANCHORAGE ry v f Phone: 7 343-79U4 - 3 Community Development Department Fax: -343-7997 Development Services Division ti On Site Water & Wastewater Program <<a r 6 8 9 c,h ON-SITE SEWER/WELL PERMIT APPLICATION M Parcel I.D. 011-133-42 Property owner(s) g Crai & Vanessa Hassinger Day phone 830-3228 Mailing address 8101 Seaview Street Anchorage, AK 99502 Site address Same Legal description (Sub'd., Block & Lot) Sand Lake #2, Block 2, Lot 7 Legal description (Township, Range & Section) Three (3) Lot Size 6,750 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Single Family (SF) 0 Absorption Field 0Initial n (w/wo ADU) Septic Tank n Upgrade El Duplex (D) ❑ Holding Tank ❑ Renewal I I Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: -L-et-EirternaiveffAlas a , _ • - - - - - J.; Distance:2/10 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. D (Signature of property owner or authorized agent) Permit/Rush Fees: II il°.4D Waiver Fees: ' 00 I Date of Payment: 1 E q. Date of Payment: Receipt Number: Q) q61/D Receipt Number: 02-C172D QC v l�O 2 Permit No. OSS $1 h 0 Waiver No. S J Permit App_i-: ._...:c: GE ENGINEER 1 N G PO BOX 240773 ANCHORAGE,AK 99524 522-7773 677-7766(FAX) July 2, 2018 Municipality of Anchorage Development Services Dept- On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Sand Lake#2 Block 2 Lot 7—8101 Seaview Street Septic System Design and Permit Application Dear On-Site Services Engineer: The septic system on the subject lot has failed and must be replaced before a COSA can be issued for the 3-bedroom home on the property. We are submitting this permit application for the construction of a new septic system. The attached site plan identifies the location of the home as well and the existing and proposed septic locations. The property is served by a private well on the adjacent lot to the north. No conflicts exist between this proposed system and any other well or septic system,whether on this lot or adjacent lots. The ground surface on the lot is flat allowing placement of the absorption system in any alignment. There are no slopes greater than 25%within 50 feet downslope of the absorption system site.Storm water drainage will not impact this septic system. The new trench will be constructed parallel to any slope as much as possible. The well on the adjacent lot is shown. The new system will be a minimum of 50' from all wells and surface water as allowed in the MOA Code, and more than 5' away from the septic tank. The existing septic tank on the lot will be decommissioned in accordance with MOA Code. The new system will be an Advantex Treatment System with an AX-20 Pod due to the limited area available on the lot and the location of the existing septic system. The absorption trench will be 3' wide by 23' long with a 5' effective depth. The application rate based on the test hole placed in 1982 is 2.0 gpd/sf. We request a condition be added to the permit for the completion of a new percolation test prior to the construction of the absorption trench. Please refer to the attached test hole log,plan and profile pages for the septic design. If this design is followed,there will be no adverse impacts to adjacent properties. Sincerely, �•���pF al* 49?H • Michael E. Anderson,P.E. h �I •MICHAEL E. ANDERSON . - Attachments s'•• CE-4381 ;�`�.: SAND LAKE #2 BLOCK 2 LOT 7 _ , _ - SEAVIEW STREET \\ / i LOT • W EXISTING PRIVATE ELD t / LOT 8 LOT 6 3_BDRM HOME / i NEW 1500 GAL.FAP ADVANTEXI'' ,J••- FCO 23'LONG x 3'WIDE x 5'EFF. TREATMENT TANK w/AX-20 POD •• 10' J— MH DEPTH ABSORPTION TRENCH FLAT CO PROPOSED TH 7 MH Mr • 2C0 NOTE: 0 • DECOMMISSION EXISTING 1000 GALLON SEPTIC •• TANK IN ACCORDANCE WITH MOA CODE. LFLAT7 • ABANDON EXISTING ABSORPTION TRENCH IN SE �— EXISTING ABSORPTION PLACE. 1982 TH LOCATION 0 .. ` EXISTING • SEPTIC ••�• TRENCH FROM MOA FILES �� TANK i--- ABANDONED ABSORPTION TN . / TRENCH I IELECTRICAL EMENT EXISTING ABSORPTION TRENCH illiifGE [NGIN[10.1NG NOTE: ������� NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND QF'�`‘il PROPOSED SEPTIC SYSTEM CO—CLEANOUT A P••• • •.' ��� ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2CO DOUBLE CLEANOUT *:•�7H �••* FCO-FOUNDATION CLEANOUT .. PROPERTY ARE SHOWN.NO CONFLICTS WITH WELLS OR SEPTIC FS—FLOW SPLITTER VALVE d SYSTEMS. MH—MANHOLE Michael E.Anderson :�/ 0 30 60 MT MONITORING TUBE ��T V.•• �E-4381 ��/ FEET SV-SEPTIC VENT flF• 44 0.-` � TH—TEST HOLE �AgDPROFESSIc0•� 1°=30' SAND LAKE SUBDIVISION #2 BLOCK 2, LOT 7 DESIGN FACTORS: SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW 3' WIDE DEEP TRENCH SYSTEM PERK RATE: 56 MIN/IN 1,500-GAL FAP ADVANTEX TREATMENT TANK APPLICATION RATE: 2 GPD/SF AX-20 FILTER POD 450 GPD / 2 GPD/SF / 5' DEEP /2 SIDES = 22.5 LF TRENCH REQUIRED (23 LF SPECIFIED) BOTTOM OF TRENCH: 9' BELOW GRADE FLOW LINE ELEVATION: 4.0' BELOW GRADE TOP OF TRENCH: 0.5' ABOVE GRADE 6" „a g 1VTIIAI111 _ - IallmI 1E 11 r: I1I 1*_ J, 111==*1 ' 1111-I 1 I Imt: q11 I�ll�7 I 0,11= 11=11=11-IC*11:11' = 111IC111=11=1 6" ;,.,..•:::::•;: •;.:i.:• 4" PERFORATED PVC (HOLES DOWN) t::;::::::�:.:•::::::; __::;9;; 0,.::::::::::::::;.i„:-::::i.,:::::.;':::..:: DRAINFIELD ROCK P...::::::.:::•:•:%;•;•:%;9:%:::. P.;.::;::::::.:::::#_9:!;9 :; I:::::::::::::::.;:::::::::.I:, 5' is :;:::;: Mike Anderson From: Claudia Roberts <Claudia_Roberts@chugachelectric.com> Sent: Wednesday,June 27, 2018 3:34 PM To: andengr@gci.net Subject: Sand Lake Sub#2 B2 L7 septic system Hello Mike: Chugach has a two (2)General Easements that affect this parcel. Chugach will claim the East Ten Feet(E 10') under the General Easements for the existing overhead power line located on Lot 7, Block 2, Sand Lake Subdivision No. 2. Chugach will grant an Encroachment Permit for a shed, deck, structure, septic system,well, etc.,that intrudes the easement area and does not limit any future Chugach usage. Atadia CLAUDIA ROBERTS Right of Way Agent III Chugach Electric Association,m Inc. 5601 Electron Drive P.O. Box 196300 Anchorage,Alaska 99519-6300 (907)762-4646 or fax(907)762-4852 claudia roberts@chugachelectric.com 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE 0 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMr PHONE ElNEW r MAILING ADD SS 0--913)(UPGRADE f 47 1 f 1 vP LEGAL DESCRIPTION #2 1 Loi'l � � � LOCATION NO. OF BEDROOMS Well i - Absorption area i Dwelling PERM v Y DISTANCE T0: aQ Manufacturer Material No. of comp ments F � - r i� N Liq. caTi ty in ions IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PER _j 0z ❑ Z Q — Manufacturer Material Liquid c pacity in g Ilons 2 IP- I Well i Foundation d Nearest lot line.� d PER ew w= DISTANCE TO: L �_ J w zNo. Z w ~ of lines Length of each line P Total length of lines (� f 7— f Trench width inches Distance betwe n Ines ' a H Top finish Material beneath tile Total effective absorption area p of tile to grade ^��� � inches 11170- ' Length Width Depth PERMIT NO. Lu QF Type of crib Crib diameter Crib depth Total effective absorption area as w y Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J w Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER F PIPE MATERIALS �VIC, o SOI L TEST RATING 11 '3 ` INSTALLER REMARKS 0 F I L-A 5 el o f d APPROVED DATE LEGAL r 72-013 (Rev. 3/78) C: 1 NO, M Q. 1 C"D MET DEPHRTMENT,''O HEALTH HID �NY�RONMENTHL/�ROT�CTIGN 825 STREET01 ^ 264~472@ / 1,XWE M KEE W M 1=4 M Fz- n PERMIT foO. ( ;�L:`,2Cj499 ) HPPLICHNT HULTQUIST CONST INC 4767 MARS: DR ]44-911] LOCHTION L7 113*2SHND LHKE #2 SIZE 8700 S8UARE FEET LEGHL L7 B2 SHND LHKE #2 LOT TYPE OF SOIL HBSORPTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF 8E1f7`-R00M5 SOIL RHTING (SQ THE REQUIRED SIZE OF THE SOIL HB�ORPTION SYSTEM IS: REA EEL Q -71- Of — 11. up) L, Q BY 171 -f- 1-1 === "YN Q% V ---i F-!! �=� UVO FEE.: L- E> EEEP2 1- k=E-EI-1 THE LENGTH DIMENSION IS THE LENGTH (I04 FEET) OF THE TRENCH OR DRHINFIELD, THE DEPTH OF H TREWCH OR PIT IS THE DISTHNCE BETWEEN THE -C.:URFHCE OF THE GROUND HND THE BOTTOM OF THE FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRHVEL DEPTH IS THE MINIMUM DEPTH 8F GRAVEL BETWEEN THE OUTFI�-ILL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET). 05"FRE: (It U X I " THE! EE'. ��L- P-1� PERMIT HPPLICHNT HAS THE RESPONSIBILITY 1'8 INFORM THIS E)EPHRTMENT DURING THE INSTHLLHTION INSPECT�ONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE NUME5ER OF RESIDENCES THHT THE WELL WILL SERVE. �������� BACKFILLING OF HNY SYSTEM NITHOUT FINHL INSPECTION HND APPROVAL BY THI,"S DEPARTMENT WILL BE SUBJECT TC PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL HND ANY ON-SITE �EWHGE DISPOSHL SYSTIE:M IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FFe.(DM H PRIVATE WELL TC) H PRIVH'M LINE IS 25 FEET HND TO H COMMUNITY SEWER LIVIE IS 75 FEET. OTHER REQUIREMENTS MHY APPLY. SPECIFICATIONS HND CONMRUCTION DIAGRAMS AF -`.E HVHILHBLE TO INSURE PROPER INSTHLLHTION. VIER7 lot M I W- �M" 'K- 131 NET CI 1=2 to! ED KEE W ���; A'-, I CERTIFY THHT U I HM FAMILIAR WITH THE REQUIREMENTS FOR ON --SITE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPRLITY OF HHCHORHGE. 2 I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITH THE COOPS. ]' I UNDERSTHND THHT THE ON�SITE SEWER S95TEM MHY REQUIRE ENLHRGEMENT IF THE . RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDIROMS SIGNED�~__._ HP �CHNT HUL�oUIST CONST IMC /^ / / � ^� 'l DHT �m'�/�^ / SOILS LOG l01UNiCIPALETY OF ANCHORAGE DEPARTMENT Ot HEALTH AND ENVWONi0EN TAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SCOIL.S LOG — PERCOLATION TEST PERFORMED FOR: -S�i — ^ k--.r'lteo DATE PERFORMED:_ INAS GROUNID WATER LEGAL DESCRIPTION: 1-- 0-t t 610C K SLOPE ENCOUNTERED? L OF P aim ecJi: Ame96n. Win&€ .4 'L 9% €, B g �o aem�o�,e eaa ne aog o f�i ENo. dd51 •g n.. IO ;i DateGross 'rune INAS GROUNID WATER f SLOPE ENCOUNTERED? L TEST RUN BETAIEEN t�._.-_..... _ iJfj qq e l_._") Fr P IF YES, ATWHAT 2 i(� � to P DEPTH? lei —/ — , z•�ns4r — ITu't- — jA—_— %�1 i� f'l- a "f�, ? DATE: 7T 5Z5 Q, --�%`Y1 —f — ¢— 0 �F �e /I I'RdeczIf A-C'E 4s-�rc-�s?1r/ A.fvf ryc/ /_0_ ..% (AT! -,:''j sl Jr OF P aim ecJi: Ame96n. Win&€ .4 'L 9% €, B g �o aem�o�,e eaa ne aog o f�i ENo. dd51 •g n.. IO ;i SITE.. PLAN DateGross 'rune INAS GROUNID WATER f �j S ENCOUNTERED? L TEST RUN BETAIEEN t�._.-_..... _ iJfj qq e l_._") Fr P IF YES, ATWHAT _r-'ve.; /vf i(� � to P DEPTH? c,? 0", —/ — , SITE.. PLAN Reading _ DateGross 'rune Net j Time Depth to Water N ei Drop --� t 0 5 00 TEST RUN BETAIEEN t�._.-_..... r iJfj qq e l_._") Fr � _r-'ve.; /vf i:�5 f1, z.. i 1_-., 1-ff�� f <"�• S- f_., c,? 0", z•�ns4r tj ITu't- 17 jA—_— %�1 i� f'l- CF riTI FI ED BY: "f�, ? DATE: 7T 5Z5 Q, --�%`Y1 —f — ¢— 0 �F �e /I I'RdeczIf A-C'E 4s-�rc-�s?1r/ A.fvf ryc/ /_0_ ..% Reading _ DateGross 'rune Net j Time Depth to Water N ei Drop --� t 0 5 00 TEST RUN BETAIEEN t�._.-_..... r iJfj qq e l_._") Fr � _r-'ve.; /vf i:�5 f1, z.. i 1_-., 1-ff�� f <"�• S- f_., c,? 0", tj 17 PERFORMED BY: �,�-�("i.'.Y�. %�1 i� f'l- CF riTI FI ED BY: "f�, ? DATE: 7T 5Z5 Q, --�%`Y1 —f — ¢— 0 I I PERCOLATION RATE ,_—'=� !minutes/inch) TEST RUN BETAIEEN t�._.-_..... r FT AND Fr COMMENTS lfr��%C gvt _r-'ve.; /vf i:�5 f1, z.. i 1_-., 1-ff�� f <"�• S- f_., c,? 0", PERFORMED BY: �,�-�("i.'.Y�. %�1 i� f'l- CF riTI FI ED BY: "f�, ? DATE: 7T �F �e /I I'RdeczIf A-C'E 4s-�rc-�s?1r/ A.fvf ryc/ /_0_ 72-008 (G/79) CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of ✓4:! 6 Stl !7, 0 MILS ioro A2, (Or. LofS 7-11 JA (1Ici6S' Hn I -F24- public water system located in/7�z =a r�T{ T'C Alaska, submitted in accordance with 18 AAC 80.100 by e _ have been reviewed and are X approved. ❑ conditionally app oved (see attached �conditions). 'iTTL€4)1�cih r-vE&l —��L1y L�E'Y f DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date or descriptive reference) The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the 5k=Lbtc-t Cc( ik:e, 0-0t Ag kC (r— �tJ< 7- l Z- public water system was completed on -Is- Z71 ti e= Pi M� (date). The system is hereby gra fed interim appal too erate for 90 days following the completion date. �j —7 4 -Y J jy 6jY1,i P LI C(1 l� 31 Li 1 h t (' v / �' / �t'rLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted f al approval to operate. /� e c. L `�®'''" �Lv1vu,.YA4T—CI u.Z�t��IM��'O BY TITLE �— DATE COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Sand Lake #2, Block 2, Lot 7 011-133-42 FORGE ENGINEERING 10/14/20 Class C Well on Lot 6 to the East. Arsenic retested 10/28/20 2 STEP/Advantex/Fiberglass 2 Fiberglass See Maintenance Report See Maintenance Report Deep Trench 07/13/20 10/19/20 3 9.3 0 4.5 514 34 1440 0 >450 No ✔ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 11/11/20 Community Well adjacent lot. ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ >50 >50 ✔ Lot is served by Class C Well on Lot 6 to the East. • • Gt 8V Municipality of Anchorage On-Site Water and Wastewater Program i (907) 343-7904 SAFETY Certificate of On-Site Systems Approval Parcel I.D. 011-133-42 Expiration Date: / t " 6:1"- 1. '1. GENERAL INFORMATION Complete legal description Sand Lake #2, Block 2, Lot 7 Location (site address) 8101 Seaview Street Anchorage, AK 99502 Current Property owner(s) Craig & Vanessa Hassinger Day phone Mailing address 8101 Seaview Street Anchorage, AK 99502 Real Estate Agent Carmi Gubser Day phone (907) 830-3228 2. TYPE OF DWELLING: El 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 Individual El Individual Water Storage El Holding Tank El Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: (1&/f J 4. Date: g(q`/ COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 7:3( -i 0 Date of Payment Receipt Number ( �X/C 03 - Receipt Number COSA# Q C- I $I 3 7�5� 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 Forge Engineering Phone (907) 522-7773 Address PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 8/09/18 r�Q�EOF Ak ••.0 40 d * 49 TH " * f i7 r 6. DSD SIGNATURE System #1 Approved for —3 bedrooms �r . Michael E.Anderson � �'F • 438 -E. •�`� System #2 Approved for bedrooms , %TF. �;•-�,� • :.���� lil9FopROFESS\C3 - • Disapproved 1\\ �� Conditional approval for bedrooms, with the following stipulations: `\ Ui- ,.. •vu„,. L ON-SITE G, WATER AND o WASTEWATER a- '77), 'n PROGRAM cy—nk 11r Original Certificate Date: 0-c?"-/W By: J The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r c . Ifmore than 1septic system iaonthe lot: CDSAChecklist #o___ Structure served by this system ���D�|����� A{Or�� k�7 Lego|D�achodon� Sand `-=`" ""-` Block ^-' `-"� ' A-WELLOATA r'lnec r, 01i-1��.�_�� Parcel |D�" ' ' '~'� `'� Well type If A,B.orCprovide PWS|D# Well Log (YIN)____ Date completed Sanitary seal MYN\Wires properly protected 08N\________ Total depth ft. Cased to Casing height (above ground) ________n. FROM WELL LOG AT INSPECTION Date of test Static water level ft. Well production g.pJn. VVATERSAMPLERE8ULTS: Coliform Ned oobniee/100mL NitrateND mo0- Arsenic 55.0 ug/L Date of sample: 7/11/18 Collected by. Forge Engineering ft. B.SEPTIC/HOLDING TANK DATA TankTmo/@ateha/ F.A.P./ Fiber Glass Tank size 1500 e gei Number ofCompartments 9�� Foundation cleanout (//N) V Date ofpumping Date installed 7/1q/1A Cleonouts (YIN) \/ Depression over tank (YIN) W High water alarm (YIN) ' N�� Construction __ rumpor'' ~ ~^'�~^' Date installed 7/10/18 Soil rating (o.p,dm2or*u*dnn) 2.0GpD/SF System type Deep Trench �� � 0 5 L�Q��" ft. Width"'" ft. �u�|b�o��m..M ft. Total depth 10 ft. Eff.absorption area 230 ft2 Monitoring tube \/ Depression over field N �VV Date ofadaquaoytest New Reau|ta(Paaa/Fai|) For ____bedrooms Fluid depth inabsorption field before test in. Water added_ gal. New depth______in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenationtreatment (past 12mo.)(YIN &type) |fyes, give date________� D. LIFT STATION 4'12444 1500 Date installed — Size in gallons "Pump on" level at 25 in. "Pump off' level at 13 Datum Top of pump Cage Cycles tested New in Manhole/Access (Y/N) Y High water alarm level at 1 1 in. Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: >50' > 100' Septic tank/lift station on lot On adjacent lots Absorption field on lot >50' 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' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >1 0, Property line >51 Water main >1 0, Water service line >10' Wells on adjacent lots >50' ABSORPTION FIELD ON LOT TO: Property line >1 0, Building foundation >1 0, Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >50' F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, PE Date 8/09/18 COSA brown sheet 10-10-12.doc Absorption field >5 Surface water >100' Water main > 10' Driveway, parking/vehicle storage >10' 4�t\\\fit kl O�� AC,gsllt j*. 49 TH .. . Michael E. Anderson �,/•. „4381-E .•��`�� �111��PR0.SS &, �' MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT . 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Arsenic Advisory Certificate of On-Site Systems Approval # OSC181378 Subdivision: Sand Lake #2 ,Block, 2 Lot 7 A water sample revealed an arsenic concentration of 55.0 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org Municipality of Anchorage , Development Services Department -r''` Building Safety Division `t! +. On -Site Water and Wastewater Program $ A 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 + www.ci.anchorage.ak.us ^ (907) 343-7904 �( Q CERTIFICATE OF HEALTH AUTHORITY APPROVAL�s FOR A SINGLE FAMILY DWELLING Parcel l.D. 011 -133 -1151 - 1. GENERAL INFORMATION HAA # 050 OId Expiration Date: / O - 29 - O S Complete legal description Loi I Block 2 Maxt- 11Z Location (site address or directions) %lot Sexy;eu3 Current Property owner(s) Choi; San1tA5on Day phone 2L43 — 146 -- Mailing address Lending agency Mailing address Real Estate Agent Mailing Address slot Scno(w ,Ane�r AK `nSo2 Day phone FF5013 Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class C Well K Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verity that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verity 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 Address Engineer 5. DSD SI( Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: - D �� Original Certificate Date:_ a g ^ U S (Rev O1102) Municipality of Anchorage Development Services Department •�s•. Building Safety Division • • , , , on -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Loi -1 Slock 2 So—Auks..'-2 Parcel 10: :93 -1/ 2— A. WELL DATA Well type oinhKn��Y Date completed = Total depth � ft. Date of test Static water level Well production If A. B, or C provide PWSID # = Well Log (YIN) Sanitary seal (YIN)= Cased to — ft. FROM WELL LOG ft. Wires properly protected (YIN) _ Casing height (above ground) — in. AT INSPECTION WATER SAMPLE RESULTS: o.to L.S. Coliform —.0--colonies/100 mi. Nitrate 6+B mg./l. Arsenic: — mg./l. Date of sample: 15 MS B. SEPTICIHOLDING TANK DATA Tank Type/MaterialGtn� S4c{d Tank size 1000 gal. Number of Compartments 2 ft. Other bacteria —,�— colonies/100 ml. Collected by: "_Snurkk00%a Date installed 6�28�Q2 Cleanouts (YIN) r�o!{ndation cleari6ut ('iNN) Y Depression over tank (YIN) 14 High water alarm (YIN) Date of pumping / Pumper � o C. ABSORPTION FIELD DATA ��Q1"1- Date installed -4 W4 Soil rating (g.p.d./ftZ or ft2/bdrm), (a System type i%een 1.5 Length �8i ft. Width 3-10 ft. Gravel below pipe ft. Total depth 19_25 ft. Eff. absorption arealift' Monitoring tube Y Depression over field e� _ Date of adequacy test All to S Results (Pass/Fail) Pass For bedrooms Fluid depth in absorption field before test -40 in. Water added!ta gal. New depth_g_% % in. Elapsed Time: {IM min. Final fluid depth kb_ in. Absorption rate >= 1W g•p.d• Any rejuvenation treatment (past 12 mo.) (YIN & type) Alone, krowe% If yes, give date D. LIFT STATION Date installed mons anhole/Access (Y/N) "Pump on" level a _ in. 'Pump off" level at in. High water alarm level in, Datu Cycles to Meetsalar circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot -- Absorption field on lot Public sewer main ._ Sewer /septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout — Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation > lo' Property line > lo' Absorption field to' Water main _ N,A Water service line 72 S' Surface water 1 too' Wells on adjacent lots 10014 L.f' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I L.S. Property line 'r S Building foundation 1101 Water main > 2S' Water Service line )"LS Surface water 7lee' Driveway, parking/vehicle storage '12S' Curtain drain N/� A Wells on adjacent lots JOo * F. COMMENTS 1# M.A... G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Te66c.. Date '*I%5% ZoaS HAA Fee $ �-3 0 /7S 9Ur4 Date of Payment —2 ' a % - Q .7 Receipt Number .r 4na (Rev. 12/01) Waiver Fee $ _ Date of Payment Receipt Number, •'i 6 &+rte C"M y CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of�us'riciu�.!%1C� Scf /x art1�5ldn7 Z- Islet 2 / -•+s n / (f f aS �(Y a (VI -1 1 - Fs4- if 4P public water system located in Ryyae_ •,vu 9;9 y�} �C Alaska, submitted in accordance with 18 AAC 80.100 byw 11 M CJ �e Fd r , r rvs have been reviewed and are K approved. O conditionally app oved (see attached conditions). 1 ht t ,r4� /�rPPv GATE By 146� If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contact ordw ma Approved by Date or Murlpt" "'I"MI) The "APPROVAL TO OPERATE" section must be completed before any water Is made available to the public. APPROVAL TO OPERATE ��� The construction of the �u u t., I:,,- L dua e k L �.+f� �% r Z public water system was completed onl e,- 4-T Nr /Cl r--iL (date). The system is hereby graotod interim apprgyal to operate for 90 days following the completion date. ` 2 �• �.,.r r...nMN.e milt ( l�, h �l 1 hPrl -/ � /� b E DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted f al approval to operata. r LN lilvt'�JUY'ct BV TITLE �— DATE N to 1+1 0 7>7nn zN z tryo0 " rn9 00 M+ H y 7. H H O N M R7 n o C' n n n CL 1 9 e p 1•+ o :' o "cr tr tro 6 17 H trµi ."I n M O C ='• x •�v n 'b• aro ° n .°..°. e n V ^ o' l� A n M° o m goo. t•• `C �0. Ie m < re o 0 0 C y n : r C 70 0 R C] n n 0 M b r m0 O h yy N O" n v n n ( M n H d b O C n 0 G. M n M x°9tr 0 °�H tn r k ::r 1r+1g+ n y M N N <G t] •O O N CD aM ^ O 6+ t57 �• tr O 1Y0 M O M t F' n qyq tr t�•7 \, Np " 0 6 O N` In 09 CC .! n 9 N W C E \ R b •�Op vµi N O n 9 o n M i1 b A O o Mb R N O m n n n fb o I W q n�C n M W IDO N C O O 1-• b tr m C I h~ O fb n M n R A V F' A A 0.n �410 6 C, R M A A b Nlb n 1 1 C3 7 t7 0 N 1 td a H H z O 0 1�j�t�01 til Hy H N a H M v li t� O V !1 e MUNICIPALITY OF ANCHORAGE • t Department of Health & Human Services y i DIVISION OF ENVIRONMENTAL SERVICES �= 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel l.D.# r"5S'" 4-z HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lo 7 -1 C3 K 2gz, ► _6L Id 2 S.*. < < x 12 n i E 12 4 1'�/ Location (address or directions) (b) Property ownerTelephone: (home) Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here 7!; if hold_ for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family 3. WATER SUPPLY Business .I- Ll £3 -45 02 S- Number of bedrooms at - Individual Well 9 Communityx Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: I community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. vae) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. —� Name of Firm ���''► �Or/✓lt�c�uOL: Telephone – Address Date !lo ✓ /fl 20 �f .rte n...r 'fir ."• ��� r. M ly qq.y%e •_�l i•�� �f4s 6. DHHS APPROVAL Approved for /U b Date Approved Disapproved,,, Conditional Terms of Conditional Approval lye CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze 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. 7/88) Back Page 2 of 2 A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 i 343-4744 Leg"escription: �- Date Completed Electrical Wiring in Conduit (Y/N) Depth of Grouting SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by S ; Date / 't L) Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 6. 9?— Size I V-0,0 No. of Compartments Z. Standpipes(Y/N) :1 Air -tight Caps (Y/N)%Foundation Cleanout (Y/N) Depression over Tank (Y/N) ly Date Last Pumped-7.7,0- Pumping/Maintenance umped 7•ZU- Pumping/Maintenance Contact on File (Y/N) Holding Tank High -Water Alarm (Y/N) ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well I dt� To Building Foundation To Property Line '[ To Disposal Field s / To Water Main/Service Line 7 .GJ To Stream, Pond, Lake or Major Drainage Course /`f o &4 �— Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design 1zt NcH Date Installed 6-S Z Length of Field 783 J Width of Field - 4, Depth of Field �l ✓� Gravel Bed Thickness 7 J� Square Feet of Absortion Area //70 Statndpipes Present (Y/N) 3 Depression over Field (Y/N) �Y Date of Last Adequacy Test 7,/60,9 Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well I O-ta To Building Foundation Lot To Property Line ; On Adjoining Lots To Existing or Abandoned System on /Df, To Water Main/Service Line >.2 a To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Areay Comments D. LIFT STATION L Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) _ Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HI` guidelings in effect on the date of this inspection. Signed r { V rA _ m 6J Company � i 4 (�� Engineer's Seal � Date U ✓ 1 MOA No. ac 6�3 g&� Receipt No. Receipt No s- _ ct d Date of Payment Waiver Fee: $ Amount: $ /70Gb Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES �` 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # (")t ` - 1 -,- I_I Z HAA# 001 1/-i-, L1'!'�-1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 7• B2uck 2• Sand Lake #2 Location (address or directions) 8101 Sea View (b) Property owner H.U.D.037934-203 Telephone: (home) Business Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent ROGER'S REALTY ATTN: Lyman Meacham Telephone 344-8492 (e) Mail the HAA to the following address: (or check here df hold for pick up.) List contact person and day phone number below: S & S ENGINEERi NG 117034-rGae l Riyv r Loop Road IRin 2414 Eagle River, Alaska 99.577 2. TYPE OF RESIDENCE Single -Family W Number of bedrooms 3. WATER SUPPLY Individual Well ❑ Community Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site 6X 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. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone 5 & 5 ENGINEERING Address 17034 Eagle River Loop Roar{ No. $ Eagle River, Alaska 99577 Date WA Na. 1467-a s s' 6. DHHS APPROVAL Approved for __bedrooms by Date Approved �� Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 orderto satisfy certain federal and state requirements. Employees of DHHS do notconduct 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. nae) Back Page 2 of 2 SPG 9�p� p�G�oO�J� MUNICIPALITY OF ANCHORAGE (MOA) pF �¢,�� • Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 Jc'`G�Q���,t 343-4744 \�C ` Legal Description: Lot %��c_.=s 2 A. WELL�,A�A Well Classification LOAAM I A) %u If A, B, C, D.E.C. Approved (Y/N) t - Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Z -4 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ZC90 r+ ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments P Li 5 1 N Z 16 15-0 B. SEPTIC/HOLDING TANK DATA Date Installed ( Size iQco No. of Compartments 2 Standpipes (Y/N) _Air -tight Caps (Y/N) Foundation Cleanout (Y/N) til Depression over Tank (Y/N) A% Date Last Pumped 't �7 — Z O — 8 y Pumping/Maintenance Contact on File (Y/N) t'JIyi ; for 6U 1114 Holding Tank High -Water Alarm (Y/N) AJ.16 Temporary Holding Tank Permit (Y/N) NL SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well / od To Building Foundation To Property Line - To Water Main/Service Line To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments 14Dnn.� L)Ac_AAt 72-026 (Rev. 7/88) Front Page.1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata (5 %4r_:j'Type of System Design :7 ) h Date Installed Length of Field `a Width of Field Depth of Field (� S Gravel Bed Thickness S Square Feet of Absortion Area / 1 :jo Statndpipes Present/N) Depression over Field (Y/N) tJ Date of Last Adequacy Test Results of Last Adequacy Test �� +s f✓!C-toer4 - Z 8eo(vo0nn SEPARATION DISTANCE FROM ABSORPTION FIELD To Water -Supply Well ( on To Building Foundation _11,S To Property Line To Existing or Abandoned System on Lot A)/tA ; On Adjoining Lots o To Water Main/Service Line / tp 7t To Cutback (if present) N%W To Stream, Pond, Lake, or Major Drainage Course 00 t i To Driveway, Parking Area, or Vehicle Storage Area to t Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) _ "Pump Off' Level at "Check Permitted Bedroom Rating Against HAA Request" Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effeZt.,6Mtbiey ate of this inspection. Signed S & S ENGINEERING Eagle RiverLoop Road No . 204 Company Eae Ra;,_orR ,Alaska 99577 y!F r51� JF'3`.1.Yfn�lll . Rl.i (-i Date �� Y� ¢, :,,.J.v,,.... MOA No, C= 9 — O o s,.•..f� 4 a� No I 74i P Receipt No. O S — -2- S ( Date of Payment /b _ g 0 Amount: $ 1749, Receipt No Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE • -� Department of Health & Human Services p DIVISION OF ENVIRONMENTAL SERVICES dj 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # i711 - I'� -)-1 HAA # 0 Q2 J2) l `l 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (addressor directions) 5.cgtIA5 J (b) Propertyowner Mailing-Address (c) Lending Institution _ D Telephone: (home) Business Telephone Mailing Address (d) Real Estate Company and Agent fIAMPW 1%190TiEi Address Telephone (e) Mail the HAA to the following address: (or check hereK if hold for pick up.) List contact person and day phone number below: AEcs 161eX 0 2. TYPE OF RESIDENCE Single-Family'gL Number of bedrooms z- 3. WATER SUPPLY Individual Well ❑ Communityx Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site'K Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 Z ;o Z abed Hoeg (991L 'A98) 9ZO-ZL •i!aorn s,aaau!6ua jLuoissa;oid ay} u, suo!ss!wo ao saoaaaao; alq!suodsa.( jou sl a6eaoyouy;o Aj!!Ldio!unlN a141'panss! si a}eo!;p}iao a aao;aq L}Lp azAleueao oldw3 -s}uaimbei a}e}s pue leaapa; u!eaao A;s!}es o}aa aao su jsui suoi}oadsui }onpuoo}ou op SHHa;osaala}L}S y}a p aaa}s!6a 6u!pual a!ay} pue sawoy ;o s.oseo.nd o} (sa}.noo L se sly} saop SHHQ ayl eiSely1 Jaau!6uaieuo!ssa;oid }uapuadopu! ue Aq anoge g gdea6eaed ul uan!6 suoeuasaidaa ay} uodn Sluo paseq pa}Lo!;!aao aS uewnH pue 14}le9H10 }uaw}aedaa a6eaoyouy;o /}!led!o!unW 9141 !enoaddy (}uoy}ny 14111139H sanss! (SHHa) sao!nJ lenoaddy 113U01}IP00010 swial leuoi}!puoO panoiddes!Q x panoaddy a}ep !q swooapaq Z Q'qjao} panoaddy 1VAOaddV SHHQ '9 16u3 auoydalal — SSS "bL2 -/1'Q ale(] M � ssaJppy wild 10 OWEN •uo!}oodsul sly} ;0 a}ep ay} uo 109;19 ui suo!}LlnBei pue 'saoueu!pio 'sapoo a}e}S pue led!ownlN !le y}irn aoue!idwoo ui sl wa}sAs lesods!p ja}erna}sEm Jo/pue Alddns as}ern a}is-uo ay}'uo!}oadsu! pue u0i}e6!}sanu! Aw woa; pue sal!; a6eaoyouy ;o �(}!led!oiuniN ay} woa; pau!L}qo uoi}ewao;u! ay} uo paseq }ey} A;uan.(ay}an; l •u!aaay pa1e01pu! aan}onj}s;o adAl pue swooapaq;o aagwnu ay} ao; a}Lnbepe pue !Luo!}oun; aj}! ,ales si wa}s(s lesods!p Ja}ena}sLm ao/pue Alddns aaium a}!s-uoo S1141 10 uol}L6l}sanuAw }ey} Aj!Jan I molaq umoys a}ep uoi}ep!len 9144 10 puL o}away paxb;ees lw(q pa�ao sy NOIlVWi!OdNI aNV V1Va `HOUV3S 3114 `S1.S31 `SNOI103dSNI ONIaIAOdd WNid JNIH33NIJN3 '9 --Z r~ -7x frYNs '7P L –/ A. WELL DATA Well Classification II Log Present (Y/N) Total h Cased to Static Water Casing Height Above Gold Electrical Wiring in Conduit (Y• 0"-X0� 0` bNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 P 343-4744 C�HN Date Completed SEPARATION DISTANCES FROM To Septic/Holding Tank on Lot Legal Description: L 7 15Z L040E ad- T/x l fEe /o Depth of Grouting To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA If A, B/;:Z\ D.E.C. Approved (YY N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wallhonei W/Ml ;On To Nearest Pu Z,, Z` /9oCS Date Installed le r,BY Size 1o'tlD No. of Compartments y Standpipes&N) - Air -tight Caps&N) Foundation Cleanout(Y)N) Depression over Tank (Y6)Date Last Pumped 7'2'0-,c1 11"Ae-5 Pumping/Maintenance Contact on File (Y/N) WA ; for Holding Tarek $Ii lat ,Alarm (Y/N) �A Temporary Holding Tank Permit (Y/N) �A 1, „o+e J ram SEPAR,A.,LAtl9tAN13 SEPTIC/HOLDING TANK: To W,atupply`(e)Iss' _ °' �� To Building Foundation Y'4 -° To Property Line To Disposal Field To Water Maih/Service Llne To Str0i.-n;,Pond, Lake or Major Drainage Course �� t Comments` 72-026 (Rev. 7/88) Front Page 1 Of 2- 7 0 z- sa✓d vt>r�y C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 3/S Type of System Design 77eE�ell Date Installed —z�-8y Length of Field -7k Width of Field 3 �'' Depth of Field �� ;5r- 01 ' Gravel Bed Thickness %:!�' Square Feet of Absortion Area Statndpipes Present (1 N) Depression over Field (Y, f9V Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: i To Water -Supply Well /OV To Property Line To Building Foundation 33 To Existing or Abandoned System on Lot 4114 ; On Adjoining Lots lD�t To Water Main/Service Line /o f To Cutback (if present) i To Stream, Pond, Lake, or Major Drainage Course /� f To Driveway, Parking Area, or Vehicle Storage Area X01 Comments D. LIFT STATION nstaIled Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "`Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines i inspection. �� � Signed �" � a ` Company ��Gf Date MOA No. dZ Receipt No. c21,3 / / l 7 7 Date of Payment_Z'\�z Amount: $ 42y . RC1 Receipt No Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 wt or O•: the date of this IF - - .. .•••.R • ROY C. REID, JR. �• r '. CE -2251 : 4- i is Seal MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. ;/GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision section, township, ran e) Lrs7< 7 i3lec� Z S lee Su/�/, ��Ieil/d, z TIZN 4YW sQe io Location (address or directions) (b) Applicant Name � 64t Telephone: Home Business Applicant Address (c) Applicant is (check'one): Lendirigr Institution[]; Owner/builder[]; Buyer[]; Other (explain); (d) Lending Institution ' Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: Onsite `Public ❑ , CcmmunityJ Holding Tank ❑ �, ommunityv✓ellsystem rpust have written confirmation from the State Department of Environmental Conservation I to the gally an stat�sr� y✓t r C e � � E -. 72-025 (11/84) - MLfNICIPALTIY OF CZ MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALRA HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 1 4 1986 264-4720 Legal Description: Z 7' T/Z/Y e4 W A. WELL DATA Well Classification e�o_G/i" If A, BQ D.E.C. Approved (Y/N) Y Well Log Present (Y/N) � Date Completed /Y/A Yield IVA Total Depth N 1A Casedt AYA Depth of Grouting IVIA Static Water Level Pump Set At N�� Casing Height Above Ground NI Sanitary Seal on Casing (Y/N) /111A Electrical Wiring in Conduit (Y/N) NIA Depression Around Wellhead (Y/N) IV 14 Separation Distances from Well: O N�To Septic/Holding Tank on Lot On Adjoining Lots 7Q ` To Nearest Edge of Absorption Field on Lot MO ; On Adjoining Lots To Nearest Public Sewer Line NI To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 11q Water Sample Collected by L f ly f /1 CG Afc, ; Date Water Sample Test Results �DccC! C Comments Gllllil/llG ��/ XDSC B. SEPTIC/HOLDING TANK DATA Date Installed Z�2 Size No. of Compartments Z Standpipes (Y/N) ! Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) y / Depression over Tank (Y/N) Date Last Pumped Z1/7/Ts Pumping/Maintenance Contract on File (Y/N) NI ; for /Y� Holding Tank High -Water Alarm (Y/N) N A Temporary Holding Tank Permit (Y/N) A Separation Distances from Septic/Holding Tank: To Water -Supply Well X00 / e To Property Line /1 i To Water Main/Service Line 3874 Course Comments Page 1 of 2 72-026(11/84) i To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Z -or 7 f3LP1CrC Z s6rNDG �rE ? � T AF !z ¢ W S¢c, /0 ' C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata a/gl� Type of System Design Date Installed Z& Z Length of Field �� > Width of Field 3 �� r Depth of Field �� r Square Feet of Absorption Area 1176 Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well /00 Gravel Bed Thickness 7!5- 1 15- Standpipes Present (Y/N) of Last Adequacy//Test Y .� �QGI!'b�3LJ (�Ip2LS� r To Property Line S To Building Foundation 3S r To Existing or Abandoned System on Lot NIA On Adjoining Lots ;> To Water Main/Service Line r To Cutbank (if present) _A/ To Stream/Pond/Lake/or Major Drainage Course �(}U To Driveway, Parking Area, or Vehicle Storage Area Comments 7�f'iWa-51_ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Dimensions nhole/Access "Pu Off" Level at Vent(Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed L476 Date �Z/� Company 146 /arc. MOA No. BS- aZIf 5� Of aAC,q��g Receipt No. 3JrJ �$ ••' •� Date of Payment bI '� a1� •• oafsit •+••••" ' � H Amount:$ ^ 1` •• �••�♦w e• • S� Page 2 of 2 72-026 (11/84) i C. Reid, Jr. ?w No. 2251-E pROFESS����� z ALASKA ENVIRONMENTAL CONTROL SERVIC'�`, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 ,, G 7 B Z 5��la 4- - 4; � F z SHEET NO. OF G/ CALCULATED BY .sF 4f//�©S DATE CHECKED BY DATE wee nQonE39c G //A/E ....1. I- L� PFOVA.2C41..� 1.: 000 Fpm 0147 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION 2. (a) Legal Description (include lot, block, subdivision, section, township, range) v,— /�ocK �js,d �� /fie 71, Location (address or directions) (b) Applicant Name I` �� / ®` Telephone: Homee� Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; ne builder PC, Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) pAail tha HAA to tha fnllnwina address: TYPE OF RESIDENCE Single -Family K Multi -Family ❑ Number of Bedrooms 3. WATER SUPPLY Other r � Individual Well ❑ Community Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: ff 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 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address Date ee®°Y eao xnnn••o Kn sa °a0�� L y C. Reid, 0 2251•E a FESS4IPC�� 6. DHEP APPROVAL ft Approved for ,--6E �' bedrooms by �" `� `� �6 f�%`��`C— Date X Approved Disapproved Conditional Terms of ,Conditional Approval CAUTION Engineer's Seal The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) ! CHECKLIST - FEBRUARY 1964 U L i 8 264-4720 RE C E I V E® Legal Description: Bi-ecg a Sa�rLc/ �& fin 4*7- A. WELL DATA Well Classification 06ultmvl y 1 Tt If A, B/C,JD.E.C. Approved&, Well Log Present (Y/N) VIADate Completed ��IVIA- Yield Total Depth 1J(A Cased to r' Depth of Grouting Static Water Level �� Pump Set At Nr` Casing Height Above Ground Sanitary Seal on Casing (Y/N) IUTA �� u1 Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot /fin / O ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /©O ; On Adjoining Lots w ,f' To Nearest Public Sewer Line ii To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot N� Water Sample Collected by ni �� ra4P e4Adtd ; Date w/7+ Water Sample Test Results _ )J 1A_ Comments B. SEPTIC/HOLDING TANK DATA Date Installed2c� c�o2 Size /000 No. of Compartments Standpipes (Y N) Air -tight CapsYfi�V) Foundation Cleanoutg N) %f' Depression over Tank (Y/jN),� Date Last Pumped / J� -iI s Pumping/Maintenance Clonntract on File (Y/N) for All 111 -7 - Holding 11 -7 -Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) ✓V n Separation Distances from Septic/Holding Tank: To Water -Supply Well ��D� To Building Foundation To Property Line I- M- To Disposal Field �6 i To Water Main/Service Line 4- g To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 v� 72-026(11/84) ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hv�checked, v rifled, or co formed to all M A an HAA guidelines in effect on the date of this inspection. Signed Date �3 Company C MOA No. �'j OF Receipt No.e �1 9J o Date of Payment `'�� •�°° ` M• Amount: $ H•• •• e e q •° s0 �°¢ .p e QZ Ler C. Reid, Jr. a �� i� °°•• o. 2251-E- eeL 60 Page 2 of 2 �Q�F9�;0B••ee°,ee..pB,E �e c 72-026 (11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strat f Type of System Design��� Date Installed dig Length of Field $� 1. Width of Field J Depth of Field �� S Gravel Bed Thickness,S Square Feet of Absorption Area %� D't Standpipes Present � N) Depression over Field (Yf 4) 1) Date of Last Adequacy Test Results of Last Adequacy TTest✓�� �� GDS t3��f On m^ Separation Distance from Absorption Field: d, To Water -Supply Well MID 7 J(-- To Property Line h r To Building Foundation 3S/ To Existing or Abandoned System on Lot On Adjoining Lots 4' r9-0 To Water Main/Service Line + 35 To Cutbank (if present) ��r`fi To Stream/Pond/Lake/or Major Drainage Course `i -I OUB To Driveway, Parking Area, or Vehicle Storage Area Comments I t�PLv;wt2{ D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (YY "Pump On" Level at l "Pilm ff" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hv�checked, v rifled, or co formed to all M A an HAA guidelines in effect on the date of this inspection. Signed Date �3 Company C MOA No. �'j OF Receipt No.e �1 9J o Date of Payment `'�� •�°° ` M• Amount: $ H•• •• e e q •° s0 �°¢ .p e QZ Ler C. Reid, Jr. a �� i� °°•• o. 2251-E- eeL 60 Page 2 of 2 �Q�F9�;0B••ee°,ee..pB,E �e c 72-026 (11/84) Time Time .e Date Date Date Inspector Inspector Inspector Comments _ t/4-&W-10�Q Conditional Approval Q f9 f.4- I C 0�f Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner a 1� P,3 Phone Mailing Address 11761 1 �U[7 Vi.^ !' j5ti7 Molt Buyer Address Lending Institution Phone Address v Realty Co. &Agent RPOTN Pry er Phone Address 9301 Legal Description 7v✓r Street Location✓I U TypeResidence &f i5 Single Family j ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply J7 Individual ATTACH WELL LOG. A well log is required for all wells drillsd since June �9 Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. Sewage Disposal ICI Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.