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Home My WebLink AboutSPRING BROOK VISTA #1 BLK 3 LT 5Spring Brook Vista #1 Block 3 Lot 5 #050-091-06 Municipality of Anchorage° • .�sl . . Development Services Department n Building Safety Division � On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page I of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5wQ303/6 PID Number: 056-0e71-06_ Name' ,,Q /� Lj o %h Sora Wastewater System: 1Z New ❑ Upgrade AA // Address : % 16 ca of R,r✓e,,Ro,, EA r i 7 ABSORPTION FIELD Phone: «-� / L ^ Number et Bedroom.: 5 ® C•/q ❑Deep Trench Shallow Trench I] Bed ❑ Mountl ❑ Other LEGAL DESCRIPTION Soil Rating: I ) a GPD/Ftz Total Depth from original grade: Fl. Block: Lol:5 $ybdiviaion: �'s S Depth to pipe bottom from original graded 5 Gravel depth beneath pipe: 14 rr✓1 /' FL FI. Township: Range: Section: Fill added above original grade: m Fl. Gravel Length: /'p Ft. Well: ❑ New ❑ Upgrade Gravel width: � Numberof lines: Distance between lines: FI. _ Fl. C ssifiyllign,IPrivale, A, B,�: Total Depth: tl G Ct e l - Ft. Cased 10: FL Total absorption area: r—l' j DUOFt' Pipe Meted: Ego /F -8 5 8l Driller Date Dril .. Static water Level: Ft. Installer. ,,,,gg �UGiI'Gi�CC'�'I�?3l`�,CC' Data Installed: �. Yield: Pump SetaF. Casmg �p��: TANK GPM Ft. FL SEPARATION DISTANCES ttseptic ❑ Holding ❑ S.T.E.P. ❑ other: To Septic Absorption Lift Holding RublidPdvat Manufactures ce acCit% From Tank Field Station Tank Sewer Line ✓eei� I JOGal. Well /* �r/�} �—, N /A Material: Nuydber of Compartments: //^r C, e Surface Water I ' 1 I� LIFT STATION Lot Lina 4-f- Size: Manufacturer: Gal. Foundation ^'� , OCJ 'Pump on' level al: in on' le I n. High water alarm at: in. Curtain Drain ,A Pump M 8 ake Electrical Inspections performetl Remarks: BENCH MARK Location and Description. t ` a>�rI Assumed Elevation: o !✓%-IF j06 Fl. En ' F gC1sfi S & 5 ENGINEERING 17034 Eagle River Loop toad, No �4 al Inspections performed by: bates; 1 'J— -. .Alls•.^ ,2nd �'`� /��r/J ( ..w. ,.. -." •."�T":Rz....�. Development Services Department Approval( ar„' ROBERT C f�Q c� CE • y^ -8801 : 2•' ,� Reviewed and approved by: o � Date. - 2-O (Rev. 12/00) �� -'`•• ' E��: �t .•=M1.• • � PERMIT No. SW03031 6 PAGE 2 OF 3 Municipalit o P Anchcra e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 3, SPRING BROOK VISTA #1 P.I.D. NO. 050-091-06 - TH SEPTIC c AREA / T B M MT 1 C01 \rT\ TH#2\F \ ,o, A FCO LOT 6 'o. / / / / / / / / / / NEW 1250 GALLON SEPTIC TANK i BL2& aF S10_l i SEPTIC �REA LOT 4 N / / / N 40' y ♦ ROBERT C. COWAN loot CE-8801 PERMIT No. SWO3031 6 PAGE 3 OF 3 DEPARTMENT pHEALTH ANDhHUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 3 SPRING BROOK VISTA #1 PID. NO. 050-091-06 FINAL GRADE 93.8' NEW 1250 93.6' GALLON SEPTIC TANK C01 CO2 PMT1CO2 CO'=97.6' = 97.9' FINAL GRADE C01 = 92.5' SR CO2 = 92.4' MT1 = 88.6 A NO WATER FOUND 82.6' B.O.H. N. T. 5, A B C FCO 1-3.0' — 34.5' ST1 — 55.5 52.0 ST2 — 57.0 60.0 DBLI — 58.0 62.5 DBL2 — 58.0 64.5 C01 50.5' 33.0' — MT1 51.0' 33.0 CO2 28.0 57.0' — C01 = 92.5' SR CO2 = 92.4' MT1 = 88.6 A NO WATER FOUND 82.6' B.O.H. N. T. 5, Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers (907) 272-8218 Anchorage, Alaska, 99510 March 21, 2007 19071272 8211 Fax Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 5, Block 3 Spring Brook Vista S/D, Addition No. 1 Reserve Septic System Location Ladies and Gentlemen: I am writing at the request of the owner of the above referenced property. He has initiated the process to obtain a building permit to construct an addition on the west side of his house. The proposed addition will be located on the septic systems reserve location. I am writing to advise you that PES has reviewed the proposed addition and the location of the primary field, and finds that there is sufficient room located west of the existing field to install a reserve field. The reserve field will require a waiver to the property line from ten feet to 7.2 feet. The reserve field will meet all other aspects and set backs as required by the code. By placing the reserve field in this location, it will not adversely affect or impact the ability of the lot to the west to upgrade their septic system. See the attached site plan. A Class A water system operated and maintained by AWWU serves these lots. Deck foundations shall be located at least ten feet from the existing tank and septic drain fields. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells within 200 feet of the proposed septic location or septic systems within 20 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: PERMIT NO. SWO3031 6 PACE 2 OF 3 Municipalit of Anchora e DEPARTMENT OF HEATH AND HURXN SERVICES ENVIRONMENTAL SERVICES DIVISION ON—SITE WASTEWATER DISPOS6650 0 AL SYSTEM , AlSaska 995LAND/OR pIWEhonLLe, 343-4744 INSPECTION REPORT LEGAL LOT 5, BLOCK 3 SPRING BROOK VISTA #1 P.I.D. NO. 050-091-06 B Q� c COIF\\,rte TH2\�\ 'o. A FCO SEPT` C AREA LOT 6 FA .2 THp / / / / / / SEPTIC c AREA LOT 4 r / / / / / SCALE: 40' per` ROBERT C. COWAH CE -8801 11 Ff J PERMIT No. SWO30316 PAGE 3 OF 3 Municipaut of Anchora e DEPARTMENT OF HEATH AND HUN�IAN SERVICES ENVIRONMENTAL SERVICES DIVISION e h in: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM e, Ataska LAND/OR 9-6650 0 e1WELLeINSPECTION REPORT LEGAL LOT 5 BLOCK 3 SPRING BROOK'VISTA I ST1 FINAL GRADE 93.8'Z I NEW 1250 GALLON SEPTIC TANK COl SR ST P.I.D. No. 050-091-06 98.0' 93.6' MTI COI = 97.6' CO2 = 97.9' FINAL GRADE COI = 92.5' CO2 = 92.4' MTI = 88.6' NO WATER FOUND 82.6' B.O.H. N. T. S. ROOERr C cc)m 1 ` CE -8801 rig to Date: ) a, / -)- -) /0 3 no6En r c. cowAN, P.E. nOMIT A. SI IAFEn, M. CIVIL ENGINEWS (907)694-2979 FAX(907)694-1211 IrtaitiAmtlohttr ... APPWVALs Municipality of Anchorage DEPARTMENT OF HEALTH AND 11UHAH SERVICES sEwEhdwnien MwflbutmsloNs 925 L Street P:O, Hox 196650 Anchorages Alaska 99519-6650 .StWEnAWAiEn thSPECtKy" Lp i S' (3 Lc c K 3 S }',Rr,vC- a0i'avrc Vt41-4 RE�'HHENCE: ErroiNEfnlnGsilmlEs ANOnOOMS The septio ih¢ppgetions for tie referenced property were Prior to submitting performed on �P/H/ 0 3 and gMlo3 • the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the As`Vv'cT- -�""Y to be wetllusrEctlau completed.. . sFLoWiEst If we may be of further service please contact us. Sincetelyy sIIEPUNs ^/ pGA60E51GN Robert C: Cowan, P:E: SOILiest rEhcoWioW test 9iMkritnALk �• %ieCNANio%L . INsPeoiroNs WFstfl4Ai�h dsrosAlsystel� tzstati 17034 NOhTN eEAGLr: 1iIVEn LOOP t SUIti:204 • FAGLE nIVEh, ALASKA 99577 �jocv\_ MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Aug 19, 2003 Expiration Date: Aug 18, 2004 Permit Number: SWO30316 Parcel ID: 050-091-06 Legal Description: Sp ng� roo i o�ck rC6 Design Engineer: 0003 S & S Engineering Site Address: 12303 E Prince of Peace Drive Owner Name: Brad Johnson Lot Size: 33318 SQ. FT. Owner Address: 20236 Eagle River Road Total Bedrooms: 4 Permit Bedrooms: 4 Eagle River , AK 99577 - This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: _ Issued By: Date:L � a, Date: a l t✓� A ttiAtIP liiY of Atitltofrdge boViDloo i@lit toviGtis boparthitht building Safely blvislon on -Site Water and Waste*ater program 4704 South bragaw St. 0,0.boxi9665o Anchorage,Ak 99519-665o www.ci.anchorage.ak.us (907) J43a904 ON-Sltl= Si=WER/ftLL PrpluIT APPLICATION rbR A SINGLt FAMILY DWELLING i Parcel I.D. IOC7 0 m) permit Number SWn3 42 propertyowner(s) Grad J060500 a Mailing address (i) QN3n6 Erkolei � +ye✓� POad Mailing address (2) &iVe Legal description (Lot, block & Sub'd.) Legal description (Section, Township & Range) Lot THIS APPLICAtION IS pdR: bay phone 5�1�a-1076 Number of t3edrooms Sewer Only W Well Only Fj Sewer and Well ❑ Water Storage ❑ Sewer Upgrade d tH18 aRopl Rtv tONTAW8: Hot tub d Jacuzzi ❑ Swimming pool d Water Softening Unit ❑ therapy pool Ll 3 L Y I certify that the above information Is correct. I further cel-tily that this application is being made for a §liigle Karnlly b*eliing and is In occotdance With applicable Municipal Codes. S & S ENGINEERING Road No. 204 .-. / V034 EaglQ River Loop of property owner or authorized agent) Permit kees: bate of payment: y OP. "' Waiver trees: S / `d /0 ? bate of Payment: hecelpt Number: a 3 '7 9 0 s'< . Recelpt Number: (Rev. 12/00) ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 August 7, 2003 HEALTHAUTHOR" APPROVALS MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 SEWER&WATER Anchorage, AK 99519 MAINE%TENSIONS REFERENCE: Lot 5, Block 3, Springbrook Vista Subdivision SEWER & WATER INSPECTION It is requested that you issue a permit to install a septic system to serve the proposed four bedroom dwelling on the referenced property. ENGINEERING STUDIES Two test holes were excavated and percolation tests performed. The approximate locations AND REPORTS of the test holes are located on the attached site plan. At the time of excavation (7/22/03), no water was found. After seven days of monitoring, ground water was not found. WELLINSPECTION We do not anticipate any adverse effects on neighboring wells, septic systems, reserve &PLOW TEST areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. SITEPLANS If you require additional information, please contact us. Sincerely, ROAD DESIGN SOILTEST Robert C. Cowan, P.E. RCCrojj Enclosure PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 t " = 50' DESIGN SITE -PLAN AL \ .. 9Es -n m mmNv QO qp �om \ G 3 \ m \ \ 00 \ `— / ➢fes 00 � r y / N II �: W It 2� L MO 0-00 l ' N \ Cl \� \ zc0. \Gi \ 1 y \ \Fye OOO 0 00 .o \ / q� v0 r\ ► \ J W Ppygq�e//�/y YO \\\ 'y1 9p p0 _ \ \ O \ TP 1p, \ 1z m �{ ti \\ \ C 0 \ `1N Vl y \ \ O / Dm xoA \ \ o' \ 'i{ off;: Depth (Peet) 1-0. I IT>—T-1 M 11- e 12- 13- 14- 15 2- 13-14-15 J 16- 17- 18 - COMMENTS PERPORMED BY: PERFORMED IN! WAS GROUND WATER /� Muhlelpdiity of Ahtih&A& ENCOUNTERED? A Net Time bevelopmenl Setvlces bepartment s IF YES, AT WHAT bEPtH? Building Safety b(vision Depth to Nater After P p Monitoring? DRY On-Slte Water and Wastewater Program Dale: A(263 lO 0 4700 South bragaw Sl. P.O. Box 196650 Anchorage,AK 99519-6650 d L2 www.cLanchoraoe.ak.us (907) 343-7904 Soils Log - P&Golatioh test j Performed For: q.,i> J Affi+y 5 O� bate Perform Legal Description: % _OF ,^, 5 lj _eD C-.4,<3 sn21 -G I - re -5 T Slope Hoy 2 r— I I IITI— Depth (Peet) 1-0. I IT>—T-1 M 11- e 12- 13- 14- 15 2- 13-14-15 J 16- 17- 18 - COMMENTS PERPORMED BY: PERFORMED IN! WAS GROUND WATER /� Dale ENCOUNTERED? A Net Time Depth to Water s IF YES, AT WHAT bEPtH? L Depth to Nater After P p Monitoring? DRY r-- Dale: A(263 OF ROBERT C. CO% 1"e CE -8801 -�' /Z 2/ D fjff` W Reading Dale Gross Time Net Time Depth to Water Nil brop r-- lO 0 13 V L2 j" j /D L9 PERCOLATION RATE I ' S (minules4nch) PERC HOLE DIAMETER (Q TEST RUN BETWEEN _ A5_ FT AND FT CERTIFY THAT THIS TEST WAS DANCE WITH ALL STATE_ AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 10 j e c Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Bey ej- 1 JGAh So -*7 DATE PERI �y S LEGAL DESCRIPTION' L O')' S .' Black .3 Township, Range, Section: Sr r DEPTH 1FEET) 1 •Q pp' 2 .CJ 3--0 =® 51-0 .-, 6- 7- 8- 9- to- 12- 13 - 14 7 89101213 14 { 15 16 17 18 19 TIL ST t1JL6 9/ WAS GROUND WATER Gross Time ENCOUNTERED? Depth to Water Net Drop S IF YES, AT WHAT q , L O DEPTH? 17 P E Depth to Water After Monitoring? .4� Date: 7-3-7S 7— CE -8801 r._7, Reading Date 20 Gross Time Net Time Depth to Water Net Drop k o -d 4 11 3 ° ' 3 l 3/ / y Al • 33 z 8 y:3.5' Xy :3� zT/--/- v 3 2 1O � 5r 20� - PERCOLATION RATE (minutes inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY. S QN:;IIERIPi'G 1 J-e'=L%» CERTIFY THAT THIS TEST WAS PERFORMED IN s84 6agla Riwr LOpp Ria N, 1 ACCORDANCE WITH ,I$i� �,�,rA at l 2ALWINgb A"IN EFFECT ON. THIS .DATE. DATE: �% '�s 72-008 (Rev. 4/85) S& HEALTHAUTHORITV APPROVALS SEWER&WATER M NE%TENSIONS SEWER& WATER INSPECTION ENGINEERINGSTUDIES AND REPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROADDESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 5, Block 3, Springbrook Vista Subdivision August 7, 2003 GENERAL: 1. The scope of this project includes the installation of a 1300 gallon HDPE septic tank and a new trench to serve the proposed four bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 Page 2 Lot 5, Block 3, Springbrook Vista Subdivision August 7, 2003 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 5, Block 3, Springbrook Vista Subdivision August 7, 2003 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. 9 Page 4 Lot 5, Block 3, Springbrook Vista Subdivision August 7, 2003 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER ipanty ot,Ancuorage , Development Services R®partment °` U Building Safety Division On -Site Water a"nd Wastewater Program 4700 South'Bragaw St,` s`A ..Y P.O. Box 196650 Anchorage, AK 69519-8850 a cFiara e.ak.us Wal esc p on: Wa 'ac a ....paperwork as, eeni rqy, a re ume or. e oWWrng rea Or-iiginal signature or stamp mrssrng Qn `Cculation�errorJn clesrgn: .. Additional soils in armadgn nye eu . — Vt/ater monftonng res is ma l Topogra hic irjfprM on `missing ora equa e. 0 FE N 96996 A '. OTT t " s? e I °� ?, Incoin late; missing 1p Incoin tete; missing;�� Aclditianai adequacy test an orma rqn nee e, ... Water sample unaccep e. Measured/propose dtstarrces rmansto�nsrnissrng. ____ Locatipns.of all spi_s; perdo a rorrarr . ,a er " r gnng es s o, s Own "v Proposed s stem too deep or eCl log"required. _,�„_ Omisston:in ri "five. ___ , Insufficient' Ofher: " z neve r: ae. se upp y e necessa, n oxma ipr1,_an.re" su mi 'Your req :es . Municipality of Anchorage Development Services Department s" Building Safety Division y ' On -Site Water and Wastewater Program s N ` E.. 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 050-091-06 HAA# N04M Expiration Date: — a 0 S Location (sK6 bddres P*urrent Property oditt ,Nailing address„' Lending agency Mailing address Real Estate Agent Mailing Address Lot 5; Block 3; Spring Brook Vista Oil directions) 12303 E. Prince of Peace Dr. Brad Johnson Dayphone 552-8076 20236 Eagle River Rd. Eagle River, AK 99577 Day phone Day phone HAA held by DSD for Unless otherwise requested, will be pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 391 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System 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, l verify 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 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 S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date `V////S`/O-/ 6. DSD SIGNATURE __1z Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: C��4-( — Original Certificate Date: (Rw OV02) �a .. ufu� palit of Angora a Y _$oil stip (g.p•d.lff oreb•:drm) Development Services Department s ;. Building Saf@ty Division' ` ' ` S-A E r, On-Sde Water &Wastewater Program rfmpleted _" Sanitary seal`(M)_ .... Ras�hg height (above ground) in d 4700 South Box9665b Anchorage AK 995196650 P 0�' a "' Lan owdge ak.us �;.. w „ M.... . ^(903-7904 .,..• , , . M a � �, DATA _$oil stip (g.p•d.lff oreb•:drm) V�efog ('IN " or C provide PWS rm colon�es1100 ml _ y, ,• r .. rotected /N Wiresp YP (Y ) rfmpleted _" Sanitary seal`(M)_ .... Ras�hg height (above ground) in fepti'_ft Ceased to M— AT INSN a• FROM CL L G M a � �, bf test y ft ft wafer level _r., g.p.m.n 9 Pro�uchon R SAMPLE SULTS: r ; ._ v _$oil stip (g.p•d.lff oreb•:drm) -4v -�: m 11 Nifrate 9 Other bactena cQlon°es/100. ml , �� =- rm colon�es1100 ml Width JC ° ft Gravel below pipe ft• �iC�1ETbLDING TANK f3{1TA� ` :S�PTfG gT�c, Datemstalled �,� Type��<� /Matenat s¢e �50.ga1 Num�"erofCpmparime'nts �_ � �, _$oil stip (g.p•d.lff oreb•:drm) 1=� System type Y-=-3 ° e Width JC ° ft Gravel below pipe ft• FROM PHONE N0. : 5626040 Aug. 12 2004 04:45PM P3 ti /r 33,316.76 SQ.FP, OF AREA lot s <11 1001, I / / I ' / / tC N FOOT FAMdkIN} Y1MIN reFW Oa \\ NIv OCJ16DEFECTYE YYfr4 ' uw ma.+ OFeFa¢aF+o Asr Fxcnw,trora , ��1, h _ WAPW SOAK£• T bMh 5050 Fee 00 y Z5 1 t ' Date scale Le al Descri tion FOR: BRADLEY JOHNSON 9/26/03 1" = 50' wt S Mock 3 L�Grid A;—Hunt r ase.vaw me NW252 2300940 SFRINGBROOK VISTA on Vanguard Wit. Suite 203 Drawn by Field Hook $tJ$DIVISiON Ancho_raM Alaska 20507 KAUDIX 201 NUMBER i I hereby "(y that that the properV described hereon hes .been surveyed -�I•'� OF A e�� dicectton, and that the improvement® situated thereon +ar,��••......� Z •.5,•� by rue, or at my and do not ovaria or encroach on the are with(* the property lines p s thereto uolees otherwise shows. That IsoAr the .� ,• p• propart9 emeota OR iiia property � thereto encroach on adjacent este transmission ,,,* � •* / premises in Question and that ora are no roadways, tines or other easemeAU on raid property eseept as shown. ...... . •• ..«...«w.«.«/ 10 IC is the owner orbuilder..Prior to cd Utility n. Leh �roAe and utility ...... a � .: CHAkiES E. fOReES : -'Alf I� er y proposed g. to verily proposed bdetermMe ART sawmeAts, covenants. conaeotioas and to determsne the�t7n ice reeesded subdivision plat. j '+ LS -•7326 . a _ g••, ,: 5eW ��+so ar restrictions which do not apps p�••.....•.�ee`j� j\ 1.istod distance* prevail ever waling. Reproduction may cause distortion. _ O/Osf'oo0N �� ,�*jWvr W