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HomeMy WebLinkAboutSEIDLER #1 BLK 2 LT 5''DSS- ���- S� 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: OSP231301 Effective Date: Work Type: Septic Upgrade Expiration Date: Tax Code Number: 05013153000 Site Legal Address: SEIDLER #1 BLK 2 LT 5 G:0253 Site Mailing Address: 11811 LAURIE CIR, Eagle River Owner: BUCHHEIM LORI & STEVEN Lot Size in Sq Ft: Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: This permit is for the construction of: ,Live nt �° S<�. I t)Cpartill e11t 10/2/2023 10/1/2024 23972 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 may= �S 5 U��� -�o Ac / Crr Issued By: Date: Date: 101-17 4 MUNICIPALITY OF ANCHORAGE c Development Services Departments Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 050-131-53 Property owner(s) Steven & Lori Buchheim Mailing address Site address 11811 Laurie Circle, Eagle River Day phone Legal description (Sub'd., Block & Lot) Seidler #1 Blk 2 Lot 5 Legal description (Township, Range & Section) Lot Size 23,972 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: t® all that apply) Absorption Field X❑ Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank N]Upgrade nX Duplex Duplex (D) El Tank El Renewal F-1 Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: y Date of Payment: ZJ Z 3 Receipt Number: Permit No. S P Z OI Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231301, Deb Wockenfuss, 09/29/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231301, Deb Wockenfuss, 09/29/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231301, Deb Wockenfuss, 09/29/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231301, Deb Wockenfuss, 09/29/23 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this q Day of � br of 20a� by and between 0 d4)J yy,\ herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advantex located at (legal description) Seidler #1 Blk 2 Lot 5 - 11811 Laurie Circle, Eagle River 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) y_ Throughout the term of this Agreement, the Owner shall enter into a service agreement (� with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. Q� It shall be the responsibility of the Owner during the term of this Agreement to pay for all U repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This 4 includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 ��/ i Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Alb Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be t/4-IX assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the ,gV/ AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the v AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. S. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: o A Ae4r - By: IE" 6XIAIJCLI-4---� (signature) Date: - I (� laq -t> 0 chi earn 21 � •?)uChNn e -vv,, ­\(print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me thisaq L bY',r"'iyr� NOTARY PUBLIC FOR ALA ' KA 1 My Commission expires: l 12 S hx?a MUNIC LITY: By: (signature) (print name) day of , 20Q3 4ffrcial Seal" f Notary Public Rebecca Cary State Of Alaska mM-51on # 230125012 E3fP:01120!2027 Date: % a IZ- � Title: (rev. 05/18/2018) Page 3 of 3 Municipality of Anchorage Page --Z—of z— DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S K/ !? �, 17 PID Number: OSp' /3�� Name: Wastewater System: ❑ New ❑ Upgrade Address: ABSORPTION FIELD cK.as _ Phone: No. of Bedrooms: CJ Deep Trench ❑Shallow Trench ❑ Bed ❑ Mound Wother LEGAL DESCRIPTION Soil Rating: 1 Z Total Depth from original grade: ✓� s GPD/Sq. Ft. Lot: Block: Subdivision: � / Depth lo-ptpebott m om original grade: •.� w Gravel depth beneath pipe .-'S- 0- /GL'.rS/L AOP tel`' _ Ft. Ft. Township: f Range: �J - zy Section: Fill added above original grade FL Gravel length: /C3 Ft. WELL �,Y/SP9ew ❑ Upgrade Gravel dopihw�Qri► Number of Distance between lines: 8 Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: - Pipe material: 6 r� f 2/ 1141 -r -57' --Ft. 4,0f- Ft. ,'`a Z7 SC. Ft. �0a'� Driller: Date Drilled: Static Water Level: Installer. Date installed: Ct L -1 A---- )q,;,3±_21 Ft. I 3 Yield:Pump Set at; Casing Height Above Ground: K TAN `'��-0 3-/�• / GPM / �1 �L Ft. Z. Ft. 0_0 'i ro NST SEPARATION DISTANCES Xseptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines r--. &C.T / Z Jr Well /o Z /00 5 o r- Material: Number of Com anmenls: e LIFT STATION Water Water / ot, /oc�t- �^ ----- LOtr Size in gallons: Manufacturer. � Line /� �5^^ _N T7 "Pump on" level at: "Pump off' level at: High water alarm at: Foundation Curtain _---- .____, Pump Make & Model Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: �J G Imt AJ CX Z-742 U�7. Ouz oP- ?�1od56 Assumed Eley/ation: o ENGINEER'S SEAL �• •.fY r`T� •9 kL EYo�y �,i us's V4y' '4. Y David R. Dayton P•�. Inspections performed by:-maID-Do—lar St. bates: 1stsL�� �7;y « <r �'• Chuink���y}} Alaska 9956]2nd-- - 9 2nd , uy. n<eaoCs aO eaou=e•ue •'° Department of Health and uman Services approval ``�'°� j�" szoe � Dater ,�a"r R01 r 5i0 Reviewed and approved by: 72-013 (1/91) MCA 25 _ _ _ a)4 aF4 Permit No. _751/v 9Cj4C>'_-?17 Page Z of Z Municipality of /Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES - ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 995'19-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report a _egal Description: La 61-4 Z. ��i� 2 Sub /&o PID No.: O -�3/ S3-caoo C, P" w IP w�' I L" i ►JSN r a�-io i ENGINEER'S SEAL n 114 cor�n.sa' xti �j ei7 j =)ts' Alm SCA-.,, .} i�'02.. •. .. I /-_....._. _ p •e 44 001.9 C5 G wsc+W coo •r eo o .• )e.. ,r ��� Dos f4 X Do/74 tntf �.. ew.- �sr •rto��.-izs �t�'j�•saH+��)�rt�, 7 0 e E, ri 5 fi 72-013 A (2/91) MOA 25 _ - �•'� _ i 3 1±/�O' IP w�' I L" i ►JSN r a�-io i ENGINEER'S SEAL n 114 cor�n.sa' xti �j ei7 j =)ts' Alm SCA-.,, .} i�'02.. •. .. I /-_....._. _ p •e 44 001.9 C5 G wsc+W coo •r eo o .• )e.. ,r ��� Dos f4 X Do/74 tntf �.. ew.- �sr •rto��.-izs �t�'j�•saH+��)�rt�, 7 0 e E, ri 5 fi 72-013 A (2/91) MOA 25 _ - �•'� _ PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940217 DESIGN ENGINEER:DAVID R. DAYTON, P.E. OWNER NAME:ROBBINS DOUGLAS S & OWNER ADDRESS:11811 LAURIE CIR EAGLE RIVER, AK 99577 PARCEL ID:05013153 LEGAL DESCRIPTION: SEIDLER #1 BLK 2 LT 5 LOT SIZE: 23972 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 6/30/94 EXPIRATION DATE: 6/30/95 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 RRC1TLZ\rPTODTS�1 ZACU,L-ANI1 II2=NC, _WLTE.R _FF.GUT ATIM4 O R-A.LQ9L1_, 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: . / z 6L__ ,/ v__P'(_1nzllnl( DATE: ISSUED BY: c LJI vvv( I l //(Il41111 DATE: L ,r,�c.5'--5f-- Soo, r-;,. 445 ,t= 12- b -tom 4-Ar"K- 1'ST Lz-�e.,nZ-k j` y- E5 �' r�13 ' 5urrov�vo.•vzi (:7oA! Rr.-v R.hvcrt��, Row CT'UA-1- >-t�ai4 J4 D�v&C4 'FZt -V- loot/ y&1// sirs �a- �91 — —� ¢ a ✓is R ��R•a ?1 171 I cR� mss- 13UIL-T— 3av - yf• .�'� w Jb •..ii.npe . � ^•' t•!a!t•on awwn•• SaP nPFwi .• � b v WJC V /L7/9•p w/L s/ 9'-I 5/i-ew9'f :David R. Dayton P.E. F 20210 Donalar St. �Itugi�%te Al'uhA MOT d, i la Municipality of Anchorage + f . „ ` ',kY ^� ° DEPARTMENT OF HEALTH R HUMAN SERVICES rfl^� ;J, G''' .a oe � .iyr .y F RaM 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG —PERCOLATION TEST -;w _v,. yf %ti�0 PERFORMED FOR: ^ IGFFP�Cun7S DATE PERFORM. C LEGAL DESCRIPTION:_ L`�[e Z 5E1Dcl� Township, Range, Section: Sar—) ' /¢,U 2 DEPTH SLOPE SITE PLAN @,a Date Gross Time Net Time Depth to Water 2 ► s xc 9 Z12j7 -1 1 R—r 70' — / 3" 7- r -IU - 3 — / i" ', 4- Pvy-rm%A VIP- P10 t,,S 5 6 a - yn' 6 " _ 1 3" 19 Cc � or+a 'lam/ nrJ` 7P, .�.D 3r/Ywo 3'cY-3 `v f 8 (01' 9- 10- WAS GROUND WATER YGs ENCOUNTERED? 11 s IF YES, AT WHAT L DEPTH7 _/moi p 12 E 13 Depth to Water Atter iG Monitoring? /�� Date: � z1 X11 14- Date Gross Time Net Time Depth to Water 16 ► s xc 9 Z12j7 -1 70' — / 3" 7- 213/1a 2.37`No 16 — / i" ', 17 Pvy-rm%A VIP- P10 t,,S 7" - r 3'r 6 a 18- yn' 30" " _ 1 3" 19 Reading Date Gross Time Net Time Depth to Water Net Drop ► s xc 9 Z12j7 -1 70' — / 3" 7- 213/1a 2.37`No 4,' 3c" — / i" ', 2'4:1r z1sv: y-'�,. 7" - r 3'r 6 a yn' 30" " _ 1 3" C ° 3r/Ywo 3'cY-3 6 `- 3o" 71' _ /3" (01' 13 6 20 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ' 6- FT AND 7 FT COMMENTS 20210 Donalar { :. � PERFORMED BY: ERTIFY THAT THIS TEST WAS PERFORMED IN I U'rfzr Chugjarc, Alaska 99567 ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: - 72 -008 (Rev. 4/85) - ` D. R. DAYTON, P.E., R.L.S. 20210 Donalar Chugiak, Alaska 99567 (907) 696-2417 June 27, 1994 Lot 51 B1k 2, Seidler Subdivision septic System Up -grade The proposed up -grade is to replace a failed septic tank on a previously un -documented septic system. The system consists of a tank and a log seepage crib. An adequacy test on the seepage pit shows the pit to be capable of handling the flaw from a 4 Bedroom home. The'. log crib'is.8_ft sq with 5 ft. of very coarse gravel surrounding. A test hole near the pit shows the ground water to be 4.3 ft. below th crib bottom. There was no bedrock or impermeable soils at 6 ft. below the crib bottom. The system will have no measurable impact on wells or wastewater systems on adjacent properties. There will be no adverse impact on reserved areas o on drainage. as © 41 Nt_ MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY . APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 050-131-53-000 v HAA # — ')R C-) �-�R -- 1. GENERAL INFORMATION Complete legal description Lot 5; Block 2; Seidler .mss )' 1 Location (site address or directions) 11,911 Laurie Circle Eagle River, AK 99577 Property owner Cherly Lintz Day phone 694-6120 Mailing address _17.811 Laurie Circle Eagle River, AK 99577 Lending agency Mailing address Agent . Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 y 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXXX Holding tank — Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-M (Re .1/91) Front MOA 021 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S& S ENGINEERING Phone Q 3- q 7 9 17034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 99577, Engineer's signature 6. DHHS SIGNATURE Approved for 4 Disapproved. Conditional approval for Additional Comments By: bedrooms. Date C l t l a r OF q M �... ...... 7. A ROBERT C. COWAN Q CE -8801 114, bedrooms, with the following stipulations: Date l — /5_1 CIE The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rw. 1/91) Back MOA #21 RECEIVED e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES MUNICIPALITY OF AN Environmental Services Division ENVIR®NMENTALSERVIA 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist At Legal Description: Lor tiJ Boa- 2. St;ioa--Q {6#(P,,5 Parcel I.D.:_015p - /3 00 A. WELL DATA Well type P12 -0,69S If A, B, or C, attach ADEC letter. ADEC water system number Log present l'fo NDN' °" ' _ Date completed _^ a 7 3 _ Total depth 1 / t + Cased to 4f u Casing height (above ground) 12- Sanitary 2Sanitary seal (DN) —mkt' Wires properly protected C/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 1=ROM WELL LOG Nitrate p.m. AT INSPECTION dg& a a' Other bacteria t Date of sample: �y d Collected by: C> Ewa NLt<(e: M iri B. SEPTIC/HOLDING TANK DATA Date installed6�_ Tank size I '0 Number of Compartments a —Clean outs vn'V6v_ PEc.K Foundation cleanout ®N) —VL -e, Depression (Y/@I O �_ High water alarm (Yk� �o Date of Pumping _.Pumper JR-� C. ABSORPTION FIELD DATA Date installed �� 3 _ Soil rating g.p.d,/ or ft2/bdrm) 1,2- _ System type Length _Width 8 Gravel thickness below pipe _�' Total depth ) Iam' �` Effective absorption area 04� Monitoring Tube present(DN)�� Depression over field (YO_ l_ Date of adequacy test _5! 1 1'f�_ Results Pas ail) _ _ For Fr u tz. bedrooms Fluid depth in absorption field before test (in.); gq3 Immediately after gal. water added (in.):_ Fluid depth 35 11 (ins) Minutes later: ) 2-4 r^1 Absorption rate = _�00 + _g.p.d. Peroxide treatment (past 12 months) (Y/N) - �d�AIQ If yes; give date 72-026 (Rev, 3/96)` D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septic/holding tank on lot lb j + On adjacent lots lop? Absorption field on lot too r On adjacent lots 100 + Public sewer main 5 I fi Public sewer manhole/cleanout I GO f Sewer /septic service line 25 Lift station 160 % SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Id + Property line ID Absorption field 5 Water main/service line lb Surface water/drainage IDD Wells on adjacent lots j00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Ib'4- Building foundation lbWater main/service line 161 Surface water lcc) Driveway, parking/vehicle storage area IDS Curtain drain iJeNE, i`;ricLot1 Wells on adjacent lots IbD -+ F. ENGINEER'S CERTIFICATION l certify that / have determined thru field inspections and review of Municipal in conformance with OA HAA guide Ines in effect on this date. Signature ^� Engineer's Name ddl3�,Zr` C C©W'JJ y/r, � II Date G / HAA Fee $✓� ' Date of Payment 6 151&11%& Receipt Number 3 L7 S t F-2 72-026 (Rev. 3/96)* Waiver Fee $ Rl, ystems are A AJ -Pr, V ROBERT C. COWAN P�,'•� CE - 8801 r Date of Payment Receipt Number 06/12/1998 08:34 9076941211 S AND S ENGINEERING PAGE 04 JUN -12-1998 08:J8 ME ESI ANCHORAGE 907561,5301 P.02.105 AOlk t IAE Onvircinmomal ""h"s Inc. (:'P&E Rerx 982796001 Client pOp Client Name S & 5 Engitlecring Printed DateMme 06/11/98 22:19 Project Narne/N Lt 5 Blk 2 Seidler 13st. Collected Date/Time 06/08/98 14:30 Client Sample ED Lt S Blk 2 Seidler Pat. Received Date/'Cime 06/09/98 11:10 Matrix Drinking Water Technical Director: Stephen C. Ede Ordered By MED 0 Relmed By allowable Prep Analysis Paramecer AoeutCa PqL Un(ts method Limits Dote Dote snit Nitrote•N 4.87 0,100 m9/L EPA 300.0 10 max 06109M 06/09/98 ccP r - i .. MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. tf OS _eD -/3/- S 3 HAA ft 1. GENERAL INFORMATION Complete legal description°� S �yclro�2 S�r6 '4yO f 2. 3. 4. Location (site address or directions) //�'// 4#6 -JR -145 G•�y Gcs'- Property owner-ZLEFE`Eo r3& s Day phone Mailing address I S I l I (— c, G�4 L_ c e-1 : AIS al 7 Lending agency Day phone Mailing address_ Agent ��i�/i1x of d Day phone e- Address�,/r�nn J YJji^cif '„'J✓ — Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water K NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA N21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 David R. Dayton P.E. Phone 20210 ona ar t. Address Chugiak Alaska 99567 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Date �'9 PQ'; ✓.. tmi^ 4Ld' .. .>IS 10' gYw2 f . •T 90 e��s0 oc neee��o0 nr�'.. 1,� 1 t) D ovlil .R. Dnytun f tP i M 'na err bedrooms, with the following stipulations: Date e? - 3 - U The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon tho roprosontations 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 not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, 72-025 (Rev. "l) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _561oe� 5,Ve-0 Parcel I.D. OSO ` /-.3/- 5_6 ^ 000 A. Well Data Well type P1P1W4r't If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed I om -6 iL Driller Total depth Cased to VO t Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump levell SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot AT INSPECTION 2.� Uri 2 r AZ lid C: m Y r Z r .p.m. �.—9.p.m. � ry m O N � < z M 49 tmi, S O p On adjacent lots 0C) F77 ---mm Z ; On adjacent lots /oo Public sewer mainPublic sewer manhole/cleanout ��i5t Sewer service line Petroleum tank AoN-,? WATER SAMPLE RESULTS: Coliform 0 Nitrate _-3, Ca Other bacteria Date of sample: 716A9e,6 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed � `� Tank size 2— Compartments Cleanouts (Y/N) High water alarm (Y/N) Foundation cleanout (Y/N) C Z Depression (Y/N) arm tested (Y/N) Date of pumping /lG�� ��,L Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /a 2-- On adjacent lots /pO p` Foundation /0 f' To property line Absorption field Water main/service lineSrL _ Surface water/drainage / o o -74- 72-026(3/93)`Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed A4 Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Date installed Soil rating (GPD/Ft2) Z System type _ Length L J_ Width /��Gravel thickness 7 Total absorption area S0 Cleanout present (Y/N) Date of adequacy test .5- Z9s� Results (pass/fail) �gs� Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Total depth Lac C,e.a �z`�"PaJ6 Gt �T Depression over field (Y/N) IV for e/ Bedrooms test 1,171 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / o / On adjacent lots Property line /S To building foundation Zo f To existing or abandoned system on lot On adjacent lots / o o f Cutbank /f9 Water main/service line Z,57 7Z Surface water /0 0 Driveway, parking/vehicle storage area Curtain drain /C> w6 E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in David R. Dayton P.E. Signature 20210 Donalar St. Chugiak, Alaska 99567 Engineer's Name / Date HAA Fee $ � DG 0(0 Date of Payment / z—?V- 1 Receipt Number �? 72-026 (3193)' Back <, e,!�:.. .•:ill Waiver Fee $ Date of Payment Receipt Number ZSR of this inspection. f..;--., 5. LEGAL DESCRIPTION --^ DAl RECEIVED INSPECTION APPOINTMENTS Subdivision TIME TIME TIME ^J i DATE DATE i - qn1u.,/1s DATE - - ) INSPECTOR INSPECTP INSPECT 7. WATER SUPPLY Kk INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF 1:-A ji & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTMMONM,E ,1,11L i--.---'iF-CTION 825 L Street - Anchorage, Alaska 99501 ❑ PUBLIC UTILITY A h R 2 9 1980 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REC kI kQ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FA L IT DIRECTIONS: Complete all parts on page 1. Incomplete requests will not he processed. Please allow ten (10) days for processing. - 1. PROPERTY OWNER PHONE - James/Judith I3ouston 694-9809 MAILING ADDRESS -- PROPERTY RESIDENT (If different from above) - _ - PHONE 2. BUYER - -- PHONE - Frank/Christine Papasauas 694-3246 MAILING ADDRESS 3. LENDING INSTITUTION PHONE Alaska USA Federal Credit Union MAILING ADDRESS 2600 De Barr Road 99504 4. REALTOR/AGENT - PHONE Terry Beal/Virginia Kolfield o Area Inc. Realtors 694-9555 MAILING ADDRESS Post Office Box 249 99577 5. LEGAL DESCRIPTION --^ Lot 5 Block 2 Seidler Subdivision STREET LOCATION See attached map. 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other x® SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY )29 Three ❑ Six 7. WATER SUPPLY Kk INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - 93< INDIVIDUAL/ON-SITE** 72/73 _YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS EQ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE p� BY e- (I vlt4y 72-010 (Rev. 6/79) 5. LEGAL DESCRIPTION (S 1,6 �. i�a _� 8_\ DEPARTMENE MUNICIPALITY OF ANCHORAGE OF FIEALTII & ENV I RONNIFNT AL PROTECTION , �( �, __ _ STRFET LOCATION 825 L Street - Anchora(e, Alaska 99501 MUNICIPALITY OF AN ORAGE DEPT. OF "'•`h a k! ENVIRONMENTAL ENGINEERING DIVISION ENVIRON1WEi,1,',_'„'- 1 -TION � ^ � Telephone 264.4720 1t,PR � 9 'I��i��J REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILIT��II/ES -Ihre,e D S,x 7. WATER SUPPLY �------ ��J! . DI RFCTIONS: Complete all parts on page I. Incomplete requests will not be processecl, Please allow len If 0) clays for processing, 1. I' R O P E f r Y OWNER ")�M0� k �I.,j IAI�--� ---------- �&.C. HONE — — ------_— PHONE") MAILING ADDHESS ------ �-- �-----_.�� INDIVIDUAL/ONSITE” PROPERTY RESIDENT III different from above) PHONE S A IVs e, by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCE=SSING CAN BE INITIATED. _ 2. BUYER '�NaN C�rIS� ltiJ e UA� PHONE --—°e�l�-3a_�lh _ MAILING ADDRESS 3. LENDING INSTITUTIONc uSA �0d Cve(1(t r/- UOIv�) ,—� PHONE MAILING ADDRESS - R0 �tic�a qq Sc�� :;Ic0oC) !D 0�6RY'v� (A r 4. REALTOR/AGENT ,,( (� PHONE �AlI G ! ( 9 9S-( �S MAIL�INGADDRE(S�Sn 5. LEGAL DESCRIPTION (S 1,6 �. i�a I- a 4 s c. I __ _ STRFET LOCATION (� /�U4 � l s, �- l •Q , �:Y'V"�`!�' ,(�I v(,' t�1 l°-� t 1_ .:J ✓' c U i G. TYPE OF RESIDENCE -- NUNIULH OF BEDROOMS — 0 One- D Four D Other SINGLE FAMILY Ll 1-wo D Five D MULTIPLE FAMILY -Ihre,e D S,x 7. WATER SUPPLY �------ ---- — A ---- — m INDIVIDUAL' *ATTACH WELL LOG. A well log is required for all wells drilled F] COMMUNITY since June 1975. For wells drilled prior to than date, give well D PUBLIC UTILITY depth (attach log if available,) B. SEWAGE DISPOSAL SYSTEM ------ �-- �-----_.�� INDIVIDUAL/ONSITE” SII individual/on-site, give installation date%2.= �3 If system is Over mo (2) years Old an adequacy test Is required D PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCE=SSING CAN BE INITIATED. L6