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HomeMy WebLinkAboutSAND LAKE #2 BLK 4 LT 41OI 1 135 12 o0p Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221349 PID Number: 011-135-12 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New■❑ Upgrade Name Orville Shefelbine A RPTION FIELD ❑ De Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 8140 Seacliff St Other Phone Number of Bedrooms Soil Rating NtVQISF depth from original grade 3 JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original g e Gravel depth beneath pipe Subdivision Block Lot SAND LAKE #2 4 41 Ft. Fill added above original grade Gr length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distbetween lines Ft. SEPARATION DISTANCES 0 Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between t hes From Tank Field Tank Line Ft2 Well >100' >1 00' N/A N/A >25 TANK ❑p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Infiltrator Capacity 1060 Gal. Surface Water >100' >100' N/A N/A Material Plastic Number of compartments 2 Lot Line *5.6' >10' N/A N/A NA Foundation *4.5' >10' N/A N/A L ATION Manufacturer Capacity Remarks *See waiver OSV221063 Gal. Alarm location Electn Iled by Installer PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Precision General Contractors Drainfield D3034 CO/MT D3034 Inspector M. Jakubisin BENCH MARK (Assumed elevation) 100 ft Inspdection 151 9/19/2022 9/19/022 Location and description 2 d 3b Bottom of siding 41h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF A Conditional Approval: Date loAMW w, /*: 49TH � •* i . . .�. i Se tic S ,Std Approved % �,. I_�i Date 12-2 Z `z % Benda nsschiller / �$���'slF •�������// . ,X10 11%22', . l pROFESSIONA� Note: this approval does not include well permit requirements. 1\�ROFiS 4'�- - -A PERMIT # OSP221349 PID # 011-135-12 E N Gk.. IN. I r HOT 40It j PLAN AS -BUILT 0 20 40 FEET 111=20' A B FCO 3.4 34.9 MH1 6.1 35.7 SV1 11.0 37.2 2C0 15.6 36.9 C01 19.6 29.8 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEAN( FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE PERMIT # OSP201325 PID # 051-492-39 0 3 6 WE M 100 00 FEET 111=3' ENGINEERING October 11, 2022 PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) FORGECIVIL.COM MOA Development Services, On -Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Sand Lake #2, Block 4 Lot 41— 8140 Seaeliff St Septic tank waivers Dear On -Site Services Engineer: Due to the very tiny size of this lot, several waivers were needed for the septic tank permit. The permit provided for a 6' separation to the foundation, and 1' separation to the side lot line and the existing trench. During installation, due to a change in the tank manufacturer, the installer was able to maintain 5.6' from the lot line and 3.8' separation to the existing trench. However, the end of the tank was measured at 4.5' from the foundation. Shots were taken at the bottom of the foundation as well as the bottom of the tank, and the elevations showed that the tank was outside the bearing prism of the foundation. We have documented the as -built conditions in the final profile drawing. We request that the waiver be updated to approve this closer distance. Sincerely, Benjamin Schiller, PE Municipality of Anchorage .�_�� I)epartmcn[ P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 a Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV 221063 Permit#: OSP221349 PID#: 011-135-12 Legal Description: Sand Lake #2 Block 4 lot 41 Engineer: Forge Applicant: Shefelbine Your request for a waiver of the required 5 feet horizontal separation from the tank to lot line and tank to field has been pr *ed. The approved separation distance is Hoot for each. You are also approved fo - bot eparation tank to foundation This waiver approval applies to the Existing tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department ❑The affected adjacent property owner(s) have been given a 7 -day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: ` —' ` Z Z Approved ' Na of evj ver **** VARIANCE/WAIVER REVIEW **** 1-73YIS JJ17JV-7S 1Q, 1 16.1 LIJ GO LL - Q LS cn LLI F- 0 >Z w uj 4im M ca N C, ZLWOO Wi Wo v� ZW< ----------------------- ------------ 120, LIJ GO LL - Q LS cn LLI F- 0 >Z w uj M N S Iz Im LU ZW< LU �e Uj Lu C3 ni W Q ui uj w LLJ -i 11 ui r Lu a_ LU rZI :;> > < Ld = ui Of n 0 W U) ZW < < r1i uj SZ) CD 0 fj M M LU C) Lu Lu L9 ro M: 2: z < K W " -cc cr O> _j -> 0 m 0 WW >- tj Lij -j � IL F- 0 V3 M: a' LLI < -0 LU - W= c LD OL F co -C uj00 < w W0:: -1 cr w S O m iL LU Ld W Lu Q> I-- U n GO LL - Q LS MUNICIPALITY OF ANCHORAGE On -Site Water& Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221349 Work Type: SepticTank Upgrade Tax Code Number: 01113512000 Site Legal Address: SAND LAKE #2 BLK 4 LT 41 G:2224 Site Mailing Address: 8140 SEACLIFF ST, Anchorage Owner: SHEFELBINE ORVILLE L & NANCY S Design Engineer: FORGE ENGINEERING This permit is for the construction of: ❑ Disposal Field 21 Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: �ll�ent �`'� Sof. v Dehartinent 9/14/2022 9/14/2023 6750 ❑ Private Well ❑ 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 Received By: Issued By: Date: Date: [ —I l —ZZ 3 MUMUPAUTl Y OF ° IMC HO RG C Community Development Department `` - �l-% Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 011-135-12 Property owner(s) Orville & Nancy Shefelbine Day phone Mailing address 8140 Seacliff St, Anchorage, AK 99502 Site address Same Legal description (Sub's., Block & Lot) Sand Lake #2, Block 4 Lot 41 Legal description (Township, Range & Section) Lot Size 6,750 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: & 2 "), S Waiver Fees: aa57- Date of Payment: Cl /l /'2a Date of Payment: R I 11 :2 Receipt Number: O ULIV-7 D Receipt Number: Q } 9(9'-,t ) Permit No. Q S P,29 1349 Waiver No. 05V991Q&3 Permit App_'- : c Municipality ®f Anchorage �� Ue partment P.O. Box 196650 ® 4700 Elmore Road Anchorage. Alaska 99519-6650 ® (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV 221063 Permit#: OSP221349 PID#: 011-135-12 Legal Description: Sand Lake #2 Block 4 lot 41 Engineer: Forge Applicant: Shefelbine Your request for a waiver of the required 5 feet horizontal separation from the tank to lot line and tank to field has been approved. The approved separation distance is 1 foot for each. You are also approved for 6 -foot separation tank to foundation This waiver approval applies to the Existing tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department ❑The affected adjacent property owner(s) have been given a 7 -day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. Adjacent properties are not affected by this waiver. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: � � � -1 � Z Z-- Approved Na of evj wer ..................................................... 0 ...� ................... . **** VARIAN C E/WAIVER REVIEW **** September 13, 2022 CYE E E R I N G Municipality of Anchorage On-site water and Wastewater REVIEWED FOR CODE COMPLIANC OSP221349, Tim Eddund, 09/14/22 PO BOX 244773 ANCHORAGE, AK 99524 522-7773 677.7766 (FAX) FORGECIVIL.COM MOA Development Services, On -Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Sand Lake #2, Block 4 Lot 41— 8140 Seacliff St Septic tank replacement permit Dear On -Site Services Engineer: The owner of the above lot wants to replace their septic tank, so we are submitting this pen -nit application. The attached site plan identifies the location of the home as well as the well, septic location and proposed tank location. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. Due to the very tiny lot, we are requesting several waivers for separation distance. The existing septic tank does not meet 10' separation from the foundation or 5' from the existing trench. There is no possibility of placing a new tank to meet these separation distances. We are proposing placing the new tank closer to the property line to increase the separation from the foundation, and requesting waivers for 1' separation to both the property line and existing trench. These waivers do make installation and maintenance difficult, but will not have adverse impacts on the septic system. We are also requesting a 6' waiver to the foundation. As the attached profile indicates, the septic tank will be outside the line of influence of the home foundation at that distance. There will be no adverse impact to the foundation or to the tank with this installation. Wells on this and adjacent lots are shown. The new tank will be a minimum of 100' from all wells and surface water. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, !k Benjamin Schiller, PE 1� LOT 131 1 1 1 1 I I 1 I NEW 1000 -GAL TANK W/ 20" MANWAY MAINTAIN 1 00'FROM ALL WELLS DECOMMISSION EXISTING TANK PER UPC & REMOV.E'= 10' ELECTRIC EASEMENT AS RECORDED IN BOOK -1480 -PG 293 LOT 41 SHED I p I WATER VALVE "CLASS C" SHARED WELL s E NGIN E E ft I NG _� o ` t '4s: • :9 I ' 49 TH •.fir .. Benja i Schiller ' 6' • s P o 2 oz9z2 • •��C�® PRO FESSIONP��` t 6.4 t I 3-BDRM HOME I i On-site Water and Wastewater REVIEWED FOR CODE COMPLIANp OSP221349, Tim Ecklund, 09/14/22 10' ELECTRIC EASEMENT AS 1 ' ;ORDED IN BOOK 1129 PG 385 . I � 1 111 4 f I I 1 i ( l I j-1.3 -(--i ---- CONNECT TO EXISTING TRENCH LOT 40 NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. 0 20 40 FEET 1"=20' LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE A 4 LOT i On-site Water and Wastewater REVIEWED FOR CODE COIVPUANC OSP221349, Tim Ecklund, 09/14/22 IVILVV VL(- I IV 1/'11Vr\ FOUNDATION TO TANK SLOPE PROFILE 0 3 6 FEET 1 "=3' ENGINEERING 0 ..:. ... Benja i Schiller `�'Fc• CE 2592 • *e �o. �on• •��t�G�o PROFESSIONt' s MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL 0*0 ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE TANOT��.N '= .1�'}'1�G �1f" Z6"7!� ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION i-6— I -5. 49,-2- .t/. S LOCATION - NO. OF BEDROOMS Well ) Absorption area ! Dwelling PERMIT NO. O Y DISTANCE TO: ,Q- ,1,. 2„j"t5� - 4' S E _ PZ Manufacturer Material No. of comp tments wF C'#Q m Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth z DISTANCE TO: Well Dwelling PERMIT NO. 0 z F Manufacturer Material Liquid capacity in gallons O LU = DISTANCE TO: Well % �., Foundation i 1-r Nearest lot linef(� / PERMIT NO. J w Z No. of lines Length of each line Total lenQth of lines Trench width) Distance betty en lines H Z w I I- 36 inchesAeIA cc H Top of tile to finish grade I Material beneath tile y Total effective absorptipn area 0 'f Length Width Depth PERMIT NO. w C9 Q F Type of crib Crib diameter Crib depth Total effective absorption area wa LU Well Building foundation Nearest lot line DISTANCE TO: lass K Depth Driller Distance to lot line PERMIT NO. J w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS r CAS-)- (9A-) N D,363 41 - SOIL TEST RATING 1 16-6 INSTALLER ..�� rA PAC EX e q-124 ►3 REMARKS -2, -/ :XS0,L A)ST. r) C)1JLsP I 'T c' C t 1 1- SiOE g 0 < c,9 rO {�k/' '.Su D aL APPROVED DATE LEGAL 'I S ZC p L 6 72-013 (Rev. 3/78) 11 0 ��D ��)IRO��������^�����T7�fl r STRE�T/ HNCHORHGE/ HK 99501 264~4720 PERMIT NO: DATE ISSUED� HPPLICHNT� HDDRPS, S� COV-A THCT PHONE LEGHL DESCRIP LOT SIZE MHX BEDROOMS 840229 G4/2]/84 T&T CONST 2]20 DENNIS WHY HNCHORHGE, HK 99517 ]45~2670 SUBDIFYI ISION� SECTION� 10 6700 (SQFT 2 ' m SHNDLHKE #2 LOT: 41 TOWNSHIPNGE: 41,1 OR HCRE5) BLOCK: 4 LISTED BELOW HRE THE �PT'IONS 1`11-1`111 ABL!:TO YOU IN DESIGNING YOUR SEPTIC SYSTEMCHOOSE THE OPTION THHT BEST FITS YOUR SITE ` �������������������������������� �����» ��. -»L���][�� DEPTH TO PIPE BOTTOM (FT. "i40 4�0 4�0 GRHVEL DEPTH (FT) 11 0 0� 5 I 5 TOTHL DEPTH (FT� ) 15�0 45 7.5 GRHVEL kill) TH� (FT 15.0 50 GRHVEL LENGTH (FT ) 140 ]0.0 ]I0 GRHYEL YOLUME (CU.YDS) 14.9 16.6 244 THNK SIZE (GHLS) 1,000�0 ** 1/000.0 ** 1/000�0 ** SOIL RHTING FT/BR) 150 150 150 ** THNK MUST HHVE HT ..... ... ..... �..... LEHST TWO COMPHRTMENTS . .....����������.��������������� I CERTIFY THHT� 1. I HH FRMILIAR WITH THE REQUIREMENTS FOR ON -:-SITE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE (MOH) HND THE STHTE OF HLHSKH. WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH HLL MOH CODES AND REGULHTIONS/ HND IN COMPLIHNCE WITH THE DESIGN CRITER IH OF THIS PERMIT ]I WILL HDHERETO AL) MOH HND STHT� OF HLHSKA REQUIREMENTS� FOR THE SET BAD" DISTHNCES FROM 1:::N1 1 EXISTING WELL, WASTEWATER DISPOSHL SYSTEM OR PUBLIC SEWERHGE SYSTEM ON THIS OR HNY ADJACENT OR It-IEHRBY LOT. 4.I UNDERSTHND THHT THIS PERMIT IS VHLID FOR H M8XIMUM OF 2 BEDROOMS AND HNY ENLHRGEMENT WILL REQUIRE HN HDDITIONHL PERMIT_ IF � LIFT STHTION IS INSTHLLED IN HN HREH COVERED BY MOH BUILDING CODES, THEN (1) HN ELECTRICHL PERMIT RND INSPECTION MUST BE OBTHINED/ (2) HS~BUILTS WILL NOT BE HPPROVED WITHOUT HN ECTRICHL INSPECTTON. REPORT/ AND (3) THE ELECTP: ICHL WORK MUST BE DONE BY H'LICENSED ELECTRICIHN. � SIGNED DHTE� ���� ����- �����~^�� ������`��~����� HPPLICHNT� NS ISSOED BY DHTE� �� .r w MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: ! C�YI�C��n C jiC?ii DATE PERFORMED: LEGAL DESCRIPTION: sju r) (A t\(A J5 C' -f4 --z7% C DEPTH ll (FEET) 1 � � •-J J ' S es Y\d C' ('20 h 2 3- 4- 5 4 5 6- 7 7 / 8 it 9 / 10 / 11 WAS GROUND W d / ` ENCOUNTERED? 12 t�1 GrQU�'I)({ ^ j J IF YES, AT WHAT �-DEPTH? i dean 14 , I IYiuIbt 15 �/ 16 j 17 ii / t ti 18 � 19 GA%l� WA 20 R11 COMMENTS PERFORMED BY: 72-008 (6/79) J< SOILS LOG Ll PERCOLATION TEST SLOPE SITE PLAN ,4 E Gig S L O P E — Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE UVR III-(minutes/inch) TEST yyRUN (�BETWEEN FT AND FT CERTIFIED BY: DATE:�- ALASKA OUIROWnTAL CONROL S�'UICCS, InC. Engineerinq & Enutronmental Studies MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & June 20, 1984 ENVIRONMENTAL PROTECTION Department of Health and Eivironmental Protection I JUL 2 41984 825 L Steet Anchorage, Alaska RECEIVED Attn: K. Bandt Subject: Lots 11, 12, 13, 40, 41 and 42; Block 4 Sand lake #2 Dear Keith: The above mentioned lots are to be served by a class 'A' well, and separation distances were waivered (attached sheet). The residences and foundation were under construction at the time of installation of the on-site septic. The permits were issued by your department, for single family dwellings. The permits were designed, for the most part, at depths of 10 to 15 feet (total depth). In the soils rated for this area, this presented problems -in that with the depth, the excavations tended to enlarge greatly. In an attempt to circumvent this, the excavator had our office on location during the actual excavation. The lots are extremely small, generally about 6,700 square feet in size. With the class 'A' well restrictions, and the prior establishment of the foundations, the available space for on-site septic was limited. The proximity of neighboring private wells also influenced the establishment of the septic systems. In all cases, the absorption areas and septic tanks adhered to the 100 feet separation from adjacent private wells. Also separation distance (waivered) to the class 'A' well were enforced. Absorptions were confined to 10 feet within the property lines. As the absorption areas were excavated, the trench would widen -due to caving in of the sidewalls. Gravel had to be placed in the trench immediately upon verification of the proper depth. During the excavation, the area separating the septic tank and absorption area also collapsed in. The permits were issued in probably the only configuration that would fit the lots. The only connpromising distances are: 1) Separation distance between septic tank and absorption area. 2) Septic tank distance from lot line. 1200 West 33rd Avenue. Suite B • Anchorage. Alaska 99503 • (907) 561-5040 The above mentioned compromising distances occurred during the excavation of the septic systems. It was felt that if a compromise had to occur, then the tank would be the exception. If you have any questions please do not hesitate to contact our office at 561-5040. [� Sincerely, Larry Montgomery Environmental Engineer I STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE A. APPROVAL TO CONSTRUCT for PUBLIC WATER SYSTEMS gy21--t= A - 33(0 Plans for the construction or modification of k/kFFI► WELL 1I S(,(STE)!j It- ©TS 1�I 1I AM1 14442- &OC(c SANp 1AKE � wt_rsse 1 _�� `f pu�c water system located In 0C NG191+6-t Alaska, submitted in accordance with 18 AAC 80.100 by NL/1-S !CA ENUT 1(Q?U11 F41T& C6WC6C -C 6have been reviewed and are approved. ❑ conditionally approved (see attached conditions). BY TITLE 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. B. APPROVED CHANGE ORDERS Change (contract order no. or dsecrlpthe reference) To SE Y91 M s CO & fit, c S-25:�— Approved by C. APPROVAL TO OPERATE Flo S a I j 3 f Z)Ly M Date WL -SCPAR4T7d$) -2n-py �I bc,l&OQwoklo w o w ixft urerL The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water Is made available to the public. The construction of the GL&M R S �T� LDTS 11 12 1?j % q (`�42 (?LOCk Q putlllc i water system was completed on 7 J 1— ! (date). The system is hereby granted interim approval to operate for 90 days following the completion date. TITLE 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 final approval to ope e. crrEf11_� BY .��Q TILE � DA DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2 YELLOW - WATER SYSTEM FILE (Complete Section C) -3- PINK - ENGINEERiMUNI-BOROUGH (Complete Section Q MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) ?- 6r q-/ 44 I( 4-- 54 4)h /-A h E wz L 21U_' g4 C�_j se_16 Location (address or directions) Se -A c L r- r 2 T— (b) Applicants NameA t e0"L)5tga: r-io ti Telephone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer E:7 ; Other E:7 (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Other (describe Number of Bedrooms 3. Water Supply Individual Well 1=1 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 El 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] 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 regula- tions in effect on the date of this inspection. Name of Firm -Arc -5 !N c Telephone Address Date 6. DHEP Approval r� ® 1049 (ENGINEER SEAL) (io•c••0gav Approved for 6:A bedrooms Approved _1�/_ Disapproved Terms of Conditional Approval Qu Leroy, C. Rrid, Jr, li 22;1-1 r< < BY at 6' Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 (Page 2 of 21 7-19-84 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PRCTECTION MUNICIPALITY OF ANCHORAGE (MOA) SEP 14 1964 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 REE ,1 U E D A. WELL DATA Legal Description: I -o -r t{-/ /34 1-5 4 Well Classificationifc) /m&u, ` t If A, B. or C. D.E.C. Approvecy6N) Well Log Present (Y/N) ,t �'}} Date Completed ,� Yield—d /a Total Depth/� Cased to Depth of Grouting `�— Static Water Level Pump Set At Casing Height Above Ground y / Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N)_f.1,1A Depression Around kkellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Q /p 7!0- On Adjoining Lots & /Oa( To Nearest Edge of Absorption Field on LOtO /6701 } ; On Adjoining Lots® /pC / To Nearest Public Seer Line y77/ To Nearest Public Sewer � Cleanout/Manholeyz To Nearest Sewer Service Line on Lot/A Water Sample Collected By �Jya Date��y �7 Water Sample Test Results Conyrents 14,56 + 'c-r� C35 fl c tuA J uce r? B. SEPTIC/HOLDING TANK DATA Date Installed 22 Size /� ��� No. of Compartments 2, Standpipes I) Air -tight Caps_ Foundation Cleanout 6D ) Depression over Tank (Y Date Last Pumped ,U%y� Pumping/Maintenanoe Contract on File (Y/N) for' / Holding Tank High -Water Alarm (Y/N)/yam Temporary Holding Tank Permit (YM) Separation Distances from Septic/Holding Tank: To Water -Supply Vb11 ® /6-7 `t To Building Foundation 4,r, To Property Line 9" To Disposal Field 6,<-1 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course .! l /i.+ Comments Pt�Mnu+ AsAolcT n,CIL &)141Q1:P Receipt # � F-att.3 Date Paid: 0-./9_OP-c/ Amount: �' v [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA i Soils Rating in Absorption Strata/.,t a Type of System Design 'i"ReXc j Date Installed 6�L2V 4, Length of Field %8 Width of Field 30 Depth of Field )S' Gravel Bed Thickness )I� Square Feet of Absorption Area 39veZ/ Standpipes Present 1) - Depression over Field (YAO Date of Last Adequacy Test Results of Last Adequacy gbst Separation Distance from Absorption Field: To Water -Supply TAb11 O 1 p 71- To Property Line To Building Foundation 16:-( To Existing or Abandoned System on Lot A.)& ; On Adjoining Lots _ > 3(3' To Water Main/Service Line _A�& To Cutbank(if_ present)t) ,, To Stream/Pond/Lake/or Major, '� - Drainage Course 'T- To Driveway, Parking Area, or Vehicle Storage Area �? Comments peg mo,4 n tpE c L,uAt'ytg D. LIFT STATION Date Installed AJ Zg Dimensions Size in Gallons _ J �^ Manhole/Access (YIN) _ "Pump On" Level at iv"Pump Off" Level at High Water Alarm Level at y%� Vent (Y/N) ,J/ _ Tested for _ �/ Pumping Cycles during Adequacy Test. Mp-ets MOA Electrical Codes(Y/N)Aj _ Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelires in effect on the date of this inspection. Signed �- Data Compan C_ „�, �_ MOA No. S t 64-o z KB1/d5/s [Page 2 of 21 Ur 4,C�JaN 1644064 0 •a0o �, t�� 00 s Ooapa Bn b is I C. Reid, Jr. 0. 2257-14 2-15-84