Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
SUN VALLEY NORTH BLK 6 LT 6
Sun Valley North Block 6 Lot 6 #050-662-06 Municipality of Anchorage -, Development Services Department'°' f Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page / of 3 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 500040 / ZS PID Number: _QSO-- 662'66 Name'. 1014a rffomesw Wastewater System: ;9 New ❑ Upgrade Adtlress „r e, le, �,l CoriIrriiC rC3,k/ ABSORPTION FIELD Phone 9 c Number of Bedrooms > �_ J El Deep Trench D Shallow Trench ❑ Bed ElMound 5'- Ujd jE it Other. LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: GPD/Ft' Ft. Block. / Lot: Subdivision : b 5Z � Depth to pipe bottom from original grade' Gravel depth beneath pipe: "I CLCi 2 -0 Ft. z Ft. Township. Range: Section: Fill added above original grade', FL Gravel width: Gravel Length: / SO Ft. Number of lines: Distance between lines: Well: New ❑Upgrade FL Ft. Classification (private, A, S. C) I>/l' (C Vtd Total Depth: Ft. Cased to: /4!�G Ft. Total absorption area. 44l Fl? Pipe Material: PVC YZO .SCK. ill Driller r ' /�� CLL- I Date Dnl tl: 6 a3 0 Static Water Leevvel'. ! FL Installer .50c1`%I RlG Crf�cJ Date Installed' 8��O O Yield: Pump 'Be,at: / S Casing Height Above Ground: TANK GPM Ft. r? FL SEPARATION DISTANCES ❑ Septic ❑ Holding T.E.P. ❑ Other: To From Septic Tank Absorption Field Lift Station Holding Tank ublic/Private Sewer Line Manufacturer I(tc gclli4166 IyK Capacity: �ZS Q' Gal. Well U rf QQ ,rt /60 ", — /GO rf Material: S`%F6L Number of Compadments. Z Surface water oalin' /66't /OGlr ,... LIFT STATION Lot Lina Sa ''{„ /Q /r 0r,F — : 7 Size Manufacturer: 1G So Gal. A� '%ft•rc 60oR,¢GF J Foundation Sa t� S rt "Pump on' level at: "Pump off level at �'7 in. Z in. High water alarm at . in. Curtain Drain u �/. VIVA'- Pump Make &�/M�odel wecV9icel inspect je rme(d(y '��r�!/r� µ{�• ig; Yg C50&( Remarks. BENCH MARK Location and Description: Assumed Elevation: �0o Ft. •�� w•s ' * r • e 'Fk / a�sxs=••a..:.,. �,/ st Inspections performed by: /lior/h Dates: 1 P o nd z �' DeveloWit° me t Services Department Approval P p • ••.•• .�.. ate�eR �I s'•• Reviewed and approved by: Date: j 1 {ji 12/00) -_AL1 P� b ..'°a� 9 +•++ ��� O�Qll'�;,.�u•.> (Rev. AS 13U,5 EASURE NTS A: B Tan C.O. 1 15 30 C.O. 2 19 30.5 Trench 116 M.T. Trenc 2 3.5116 .0. 10.5 31 _ ... , IN 11 e �y +d`rF . . 4 4 A . I B Welt Septi nk/Lift St tion Tes� Hole Absorption Trench ~4t'B i eeee�+� =P�``.4s''� N OR THRI M a��: 't0 SUN VALLEY NORTH ENGINEERING .. *`; 17237 Bear Paw Circle LOT 6, BLOCK 6 S/D LAY ❑ U T AS -BUILT DIMENSIONS £0910 River, Alaska. 99577 ce> s 10/1/04 To 3 .z |m |§w ® ®�G w. �qwLjm V. y § d<a::� 2wZ� � wS -j2 ® < LLJ |eA . D / »y +|A ' yu 2c = ( if � Q \ / \ \) . } ° 0 0 > ) �� \ \ j > )» o u ! C� Q) Me ¥ G t / 00 k L� CIL >K .a- 0 ®_0 < -Y e % �Q) c \ / j u>U d \ Q r.� 2( 3E 6 /� /C wf \ }} .6! < 28 �° `-6 °' t <_ /§ \/ y �\}. f �\ o §ems« £- )![E\ �- {kA § \ q/\5 \@,(U G o ® ��� )>CG ��2�Q \/R/c f)\\ Z o & a )a � , o -0 , (, >, � 4' / ou = 6 &EX - //\: *�22\/E))S e *§ § e< 2Z(�Q) LCL C G ®' �0-S%C�®2! d :2 » ° 0 u L 22§�0c E.6~M°{°®+L G „ r .�z=i�2o{zCL < 5�����Q e�eee,c 9 ° E b o ° ® % Q) Q) ) d \ � ai 6 3 > ) -C \I.-: +> §/ E j 22�w� / % w¥aa w .z |m |§w ® ®�G w. �qwLjm y § .z |§w ® ®�G w. �qwLjm d<a::� 2wZ� � wS -j2 ® < LLJ |eA 4 < D / »y S 2c � � Q ,\ y 2 � j ® ®�G w. �qwLjm d<a::� 2wZ� -j2 ® < zj tt�ert�` tea writung Vkuu by DOC Co. ma SULLIVAN WATER WELLS P.O. BOX 67027% CHLMAK• ALASKA 99567 ON"oF�nn�r ADDPEss tl rmTF 6•��a �I PEMff-MIAMt 0401nZroele(Afssm-J� SL7 TM IDEN MICA iON Oso -sem- iswilbeaked ataPPmed PelwA bcaftm? Method of txlkKS k • r mWy €:r rye toa DePM Gf wet J da CaslMTrpe-9ML6t_v"m.cxress �? inches t b �� inches• ate, / � � LWWType ' Qx6gs6aW AbMe QM, a shm water Lemmet » feet Recover Ftatm–. �—We Method of Tesling A A- we9 opsmv TYPE end u open note ::i sok Start feet SthPPad feet u PerforAbOM SW feet Stopped feet t�outType /3Ss•�i7r1: i G K Et1E1 [. Depft horn V" pbkbUpon Gonq)e6on? ia m Method of Diskdac§m C Ma s d+�� PP✓w - Commantm 0 • � i o _, •♦. ...♦ . ♦' i - r • • > • > • � ♦, err •� - • • • i - n e • > 1 •_ i ' �:r ., 14916 Uoodland Drive Eagle (liver. 44 99577 (907) 622-6777 October 11, 2004 C&T John Thomson 17343 Santa Maria Eagle River, AK 99577 Re: Lot 6 Block 6 Sun Valley Dear John: The lift station at the above referenced property has been wired in accordance with NEC and State/Local codes. Thank you. Sincerely, iC ec�z IL• 5��zl�c�LoQe� Kevin 9. Hombuckie, Owner Administration License Number 1284 Specialty Contractor License Number 27285 V sh �o MUNICIPALITYOFANCHORAGE 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/ WATER SUPPLY PERMIT Initial Date Issued: May 18, 2004 Expiration Date: May 18, 2005 Permit Number: SW040126 Legal Description: Sun VatCey'Norfh BOei 6 Lot`fi' Design Engineer: 0838 North Rim Engineering Owner Name: John Thompson Owner Address: Hiland Rd Eagle River , A 99515 - Parcel ID: 050-662-06 Site Address: Hiland Rd Lot Size: 90284 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 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 Issued By: Date: c5-/OPO Date: at 8/0V Municipality of Anchorage • '� Development Services Department Building Safety Division On -Site Water and Wastewater Program ` 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. iso— Cp(p2- 06 Permit Number SW Property owner(s) _ �%� /� T�� uF� ,tiJ C y % Ui�Ju P` Day phone G-2 2 Mailing address (1) Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) S�c1�� V®9LL 6ri2 ((-t Legal description (Section, Township &Range) O% 6 1 c'- C. ({, Lot Size—'i:2 . S Ac� /Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or Permit Fees: agent) Waiver Fees: Date of Payment: i t 10�? Date of Payment: Receipt Number: Receipt Number: (Rev. 12/00) Northitim Engineering 17237 Bear Paw Circle Eagle River, AK 99577 907-694.7028 907-830-4186 May 11, 2004 Dan Roth MOA On -Site Water & Wastewater Program 4700 Bragaw St Anchorage, AK 99519 RE: Sun Valley North, Lot 6, Block 6 Dear Dan, Please review the submittal for the water & sewer design for the proposed single family home. The area has large lots & this lot is about 2.5 acres. The land drainage is toward the west to the South Fork of Eagle River. The highest soil on the lot is being utilized through the use of a S.T.E.P. tank. No adverse impacts are expected from development. have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Sincerely, NorthRim Engineering Steven W. Eng, PH Design Enclosures ESIG,,,- -NOTES: 1. T al Depth of Trenc surface at south tr n 2 is 4' fm ch linelerrain is Sewer Se Li minimum Trench is Mini u 10' from 4. 'Lots Served /by P vote Water Septic Doe-,oq Lotski - F w 0 ater Well Absorption NOR THRIM ENGINEERING 17237 Gear Pow Circle Eagle RAW. Alaska 99577 1_3 Te 6 slope. Line. -Ills. ;tem Construction Pr6ctude Acijoining t,,, Sanitation I Site aC&C- 1ft=L_1() SUN VALLEY NORTH LOT 6, BLOCK 6 S/D LAYOUT =1 tion g p I` 9-n 2 \� & \ 2 � � ■ ��$ ) :2 � Fj� . s I|� ' . § »< ,/ Vol qi , ,i ,4 , f� � • - - _ : :' - �t 99 . -V:ol 0 Vol is� : | � ,i �,o _ , \� i _ KA ONI i ifi - g p I` 9-n 2 \� & \ 2 o V v 9� CA J> W N [- ty _ CD I p Z N tn�-£�� S SSS A IYi f*7 7C -I O -i a F -0 � -i 'h� '3 O 3 �n ti Z-�?.. U h hO n .+--^�'S P V, n M -9 R° : V 0 7 Q, o O N S A ' S 44, 0 r 0 0 N= N O� N _cru Q N N 3 :37 Z O � O r0 -h h O N N 3-0 « 3 CA �l O N O h3`-+ �M �O 0 n o S 0 0 O Q 3 3 O O O A h 7� ! a. ro O N n in 3� S Q C7 Q tn .D N -i N U1 (PO N � < N (� VI h O `-� Ul �" -I0 -3 3 30 �n �m n� m z 3 n hW nP 3 ;7 D 3 N S S fo 0 S 3 V1 ro Z 3 w O P cn T� mn � s � f7 n ,- , d h rD -r� Q O D O 3 3 .n.. n P TI O TI H T r0 3 _ r M 3 P 3 n N m -h 3 -t)N O ro n �' 3 i sM r-. C7 O z � N :5` O h z Z Z W 0 U 9 M n =� C> F- C OZ ro A 0 ro 3 O a ( ) o S Z O oX C Z �< I Q Q e3 r 0 0 3 m r N o h mm rM <AD > 0 - Z 0 3 D S z O� D M ED U1 - 3 C7 O Z u 3 0 P h S D r p = h O S iou 0 W rn 1-0 o C N N O r0 tj O b N � D W m X Lots 4 & 5 to the north are undeveloped, South Fork Eagle River ties to the west & drainage is toward the river, No conflicts existeastor south a OF 4� NORTHRIM .. ....... . ENGINEERING 17237 Bear Pow Circle &70, R,'w. Alasko 99577 R4TH SUN VALLEY NORTH SSB LAYOUT LOT 6, BLOCK 6 5/1/04 n SUN VALLEY NORTH, Block 6, Lot 6 NorthRim Engineering SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is a single family home projected at 3 bedrooms. The best placement for an absorption trench is upslope, which will require a S.T.E.P. tank (lift station). This requires a 1250 gallon S.T.E.P. tank, manufactured by Anchorage Tank & Welding per Orenco Systems specifications. This lot is about 2.5 acres in size and no adverse impacts are expected from development. The neighboring lots range similarly in size. The adjacent lot to the south is a single family home with septic system and private well; large lot and no conflicts. The lot to the north is undeveloped. South Fork of Eagle River borders the west, with no conflicts. No conflicts to any neighbor lots is anticipated. Soil tests found typical soil for this area; a silty sandy gravel. The system utilized a 5' wide trench with allowable reduction factor. An application rate of 1.2 GPD/FT2 with 0.7 reduction factor for utilizing a 5' wide trench. Monitoring revealed groundwater at 8' depth. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment, 1250 gallon S.T.E.P. tank, conforming to Anchorage Tank & Welding/Orenco Systems Specifications. • Watertight couplings on inlet &outlet • 5 foot minimum between the tank and bed. 10 foot to property lines. • 2 feet of cover and 1" insulation is required for trench. • Tank & solid pipe must be set on well compacted, stable soil • 4 inch diameter cleanouts with airtight caps are required 1 to 4 feet from foundation wall, prior to any 90 degree bend in 4 inch line. • All cleanouts must extend to at least ground level • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron • Trench to be placed level, minimum of 4 feet to groundwater, 6 feet to bedrock from drain -rock • Drain rock to be'/z inch to 2'/Z inch screened. Drain rock to be distributed uniformly throughout the trench. • Distribution pipe shall be 1.25" Schedule 40 PVC w/ 1/8" orifices @ 27" on center w/ Flushing Valve Box at end of pipe on both ends. • Force main shall be 1.25" Schedule 40 PVC, conforming to Anchorage Tank & Welding/Orenco Systems specifications. Force main burial to be 4' minimum. • Silt barrier (filter fabric) to be installed above the drain rock • Smeared trench sides must be raked or scarified before drain rock placement • Backfill over drain rock must not be less than 24" & 1" insulation. • The finish grade must be mounded to promote drainage over the bed • Insulation must be placed over any pipe installed under driveways or parking areas • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, PVC Schedule 40. • Sewer Service Line is minimum 21/o slope • Septic Tank to be pumped every two years or when required • Insulation board shall be extruded direct burial polystyrene (Dow Styrofoam HI or equal) 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 - 11 - 12 - 13 - 14 - 15 - 16 - 17 - 18 - 19 - 20 - 21 - 8 F�jl Nt DEPTH (FEET) Q" 0 Silty Sandy Gravel Q GM w/ Sand S❑ILS LOG — PERC❑LATI❑N TEST Performed For: Kaanda LLC Groundwater Observed: None Depth To Water After Monitoring: 97" BGL Slope 2 5-10% Date of Monitor: 5/1/04 Test Hole located 1/2 down Cat -Trail # - Date Gross Time Net Time Depth Net Drop 1 12/26 0 -- 8' -- 2 12/26 5 5 min 7' 1" 3 12/26 35 -- 8.5' -- 4 12/26 40 5 min 7.5' 5 12/26 70 -- 8' -- 6 12/26 75 5 min 7' 1' Percolation Rate: 5 min./inch Pre -Soaked Test Hole Perc Hole Diameter = 6" Test Run Between 5' and 6' Performed in Accordance with All State/Municipal Guidelines in Effect 4�. NORTHRIM ENGINEERING *,�s 17237 Bear Paw Circle my Eagle River, Alaska 99577M � .,,,,,,..` SUN VALLEY S/D BL❑CK 6, LOT 6 T, H. 3 GE❑TECHNICAL Datc PM. 12/26/03 3 of 3 I'll ti O CA rn rn �� C) C7 r— P— (D O (V) CD W O tB ♦n o il V � NQN Li. O Z V Z LL 01 J Q/•�0•o I..I.n O CE U) V L L - Q Z o� D(1) Ucp L CDC�6 co L c M O_ O � > U) 00 ca O iZ 0- U) U) a) En rra) VJ C O 4- 0 a) U W N N d O 6 cu C: O m .Q X W O O O I O O i N (D O LO O U ci7 a. 20 W z Q 06 J W 2 Q LU W O m N CD c O Q) O_ O Q Q) U U) 0 O 70 N .O C) 0 a ° O Q OL m CD L ca N O C O H KI 0 O L O_ m C6 c O c O O N LC N C 0 as O a M %U O E o a) 12 O a) Q Q U cB m � T O (n E E T N in U) co U) o cn Q U U) a) O Crn a i E d � L a) N U > a) co 6 L C O }c/% r C � � U E E U Q \I Al 0 0 0 a� 0 a OO N 'Q 'a Q 3 � 'C) t�6 C C U L O p 0 C N V a •� N C2 o 0 C +j 'vO CL > 0° . _ V O 3 -0 Q ,fA N C O .. N U Q 0) N = m coa) "J ch U) O +'C_+ 3 C a o .N z Q U > C Q. 'a O O wN .Q C Q L Q N Q O aNi r m x x N +r CD O 0 U) A _N O N r .Q to N E 'a O Q i C O s Q. O° > Q N m N a o> O D 4-O O O > Q L +' U o IL "O Q N N O o 0 M U N O N H Q CL Q L "- -- � rte-+ � W O � C: O c6�--• E CD cLa = U Q F- O U O N O a O O CD CY) W TMI C O Q U v7 a) rn aD Q) 0 U w T N C O Q 0 O. C O A a� a) LL a� > C Q) ca IL 0 a) cu w a� U � � 7 7 a) (D LO C a) N _ C/) (0 a) U) =0) N U Q_. C O C O L O ❑ (0 C) E _ E N Q _ U U U) I— ❑ O N C _0 O C cn E V ® (On > IL O U N ca N c — c ❑ ❑ m a) c w, Q) "O U `1 IL V ❑ NCO CO a, cu a� °' ' vI V O a) O U L W O o ❑ U cu O m QO Q. a� .2 � ElL L El°- O cu O MI i > m cn U O N a a O n a) � E U. ❑ Q N W J � L, Ea. Q>a) .,.. cn c U) cu -1 a) d� W W © W c N M 1W- O LL a) L t i U U) Q Q Y Z o � a ° � �° M >ID W LL LL F- p~„ � d H O O v w 1 _ m (q W W O °' a a cn Lm Z W rn m m -0 a ca N M �! L6 CO > W m r a� a) LL a� > C Q) ca IL 0 a) cu w a� Sun Valley North Block 6 Lot 6 050-662-06 6/23/04 160 160 27 9/16/24 * *Artesian well 4.8+ None 42” 8/7/24 20 Steel 8/10/04 7 9/16/24 6 450 8 30 6 450+ 24 6 18 9/10/24 Arcterra Consulting STEP tank 0.767 6/14/24 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. Arcterra Consulting Kenneth Duffus (907)-696-6111 5+** ** Meet code at time of install. MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Lift Station/Pump Vault Maintenance Log Owner Street Address Septic Tank: •Sludge level inches •Pumping: required yes no •Pumping completed yes no Lift station: •Pump basket cleaned yes no •Effluent filter cleaned yes no •Control floats cleaned yes no •Proper float settings confirmed yes no •Operation satisfactory yes no Alarm System: •Dedicated electrical alarm circuit yes no •Audible and visual alarm inside dwelling yes no •Alarm system operation satisfactory not satisfactory Manhole Riser •Ground water intrusion at riser to tank connection yes no •Ground water intrusion around pipe penetrations yes no •Weep hole functional yes no •Manhole lid: Functional yes no Insulated yes no Properly Secured yes no Other •All manufacturer required inspections and maintenance completed yes no Comments: Qualified Maintenance Provider: Technician Date of maintenance Company Signature Date LANCE BODEEN 3650 HILAND ROAD PUMPING COMPLETED 6/14/24 SEAN DOLAN 8/7/24 Sanitary Pumpers 8/12/24 Invoice Item Description Quantity Rate Amount other LIFT STATION CLEANING AND INSPECTION 8/7/24 175.00 175.00 $175.00 Date 08/07/24 Sanitary Pumpers 17545 Kahiltna dr Eagle River, AK 99577 Invoice No. 24637 P.O. Number Terms Due on receipt Total Subtotal $175.00 Sales Tax $0.00 Bill To LANCE BODEEN PO BOX 770887 EAGLE RIVER, AK 99577 907-688-4602 sanitarypumpers@gmail.com www.sanitarypumpers.com Gallons Pumped 1250 Balance Due $175.00 Location LANCE BODEEN 3650 HILAND EAGLE RIVER, AK 99577 Please make payment to SANITARY PUMPERS by Cash, Check or Credit Card. Cash or Checks can be dropped off at 17545 Kahiltna dr. Eagle River Alaska or sent by USPS to 17545 Kahiltna dr Eagle River, Alaska 99577. Credit card payments can be done by phone or online at sanitarypumpers.com. Balance Due $175.00 Online payment use QR code or sanitarypumpers.com Sanitary Pumpers 17545 Kahiltna Dr Eagle River, ak 99577 907-688-4602 sanitarypumpers@gmail.com $175.00 W a O V z a LL g 4' M O a) ~ s Q N CO !73 O E L O C: O f>3 L cn O O CU' J O N 4-j m a ¢ a Z W ° U � V � V I- v N a, t10 fD L v N � O C:) N >- L 0 LY -CL L o � z � L . n41 U u N a, 4-J �O O +, m a) N OY O f0 V W f6 r 0 3 +' c) Q a) N v N N -0 N W 41 U � y E L O Ln > C6 N U LLJ i-- Ou V) O F- L Z L W 41 ° (6 a � � 0 E 1 41 W �, 3 o O 3 4' M a; L a) ~ s Q N CO !73 O E L O C: O f>3 L cn O O Q O N O N 4-j m -i U Lr)M r -I-0 N Ou Qo Q a) N A N c/) m 4%- O Z >- () ro > a, t10 fD L v N � O C:) N >- L 0 LY -CL L o � M N O � ua) m a L H OJ C)y ° u a) !:! N L O � E 1- G 4A 5;. �^4-1 s= v Q) U u N a, 4-J �O O +, m a) N OY O f0 V C: O VI — � +' c) Q a) N v N N -0 v C: 'a _� V S✓ E L O Ln > C6 N U V) i-- Ou c F- Municipality of Anchorage APS @U Development Services Department s Building Safety Division <" On -Site Water and Wastewater Program s a g, Y 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 A0 I NULL FAMILY DWELLING Parcel I.D. tjE_�ID122'CAD s• 1. G14NERAL INFORMATION C©mpiete legal dessriP Location (site address HAA #� Expiration Date:1 1 1A_11�1 Current Property owners) e ` T CJNd7— Mailing address a Lending agency Day phone Day phone Mailing address Real Estate Agent 45AIr4 Lo IeEn( Day phone O� ns,.'.ai/iri�l ter' f4Cl.<_ EiL Mailing Addressi2(tl . fK� u� r _ � Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 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, I 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 regulationsin effect at the time of installation. Name of Firm /VQZ /e/L'U Ftill' Phone 6ilr- 7O1z2 Address 1%oZ37 fi4Rfr2(`_L Engineer's Printed Name ,5 % GJ1f G Date loe (2-110 5. DSD SIGNATURE 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: W \ w o�, Q_ Original Certificate Date:Ica (Rev. 01102) lvluniclpality of Anchorage Development Services Department Budding Safety Division' On Site Water & Wastewater Program $A ETY ,x �O Boz86�0 Anchorage; AK 99519-6650 �� �� ,� �R ^: r'a 7 RH`.-AzW^'.'': aw:i'�,`'..mrt i"§"'S�Vvrvv�'''T}-" a'T" `7 rk1�'aX- �. /, +r� t'0 '. `+.-°"w.(.v. w'x%M=�'a•!` tiarvi J,�?- x �' d.ix. b` nvJ`" v L✓kP l�i, .. Y.. ', Y �. Ls, �. ..... . If A B, or C provide PWSID # Well Log (Y/N) 3 3�n7 Sanitary seal (Y/N) Wires properly protected (Y/N) 6 ft. Cased to /Oft. Casing height (above ground)_in. �TN^"'a^Pa'•�'r.'„k.'7'G'i"asPE,''zd*' r yi�a".3i"�*?e .�sr 'Ro�r"LL Lac A�r"I�Tro ." vel Q ft ft �asx r .t° ,,.v -"i ... i f, .wr,. s4 �.6€.read n` g.p.m. g.p.m. ',.r }, kIDy .,, usp :.-?)x�4na,�x �''-m�,:;e�rw,�-.» ^-.- ,..a".., n,. ,mom✓. ,Fd�`"���",',m s � �''kn�r F % '. w LE RESULTS. ` tr4 m'"•"y �' > colonies/100 ml Nitrate 2 g./l. Other bacteria �_ colonies/100 ml. r mg /I Date ofsample 9F Collected by A,(0M4Itn /c,U C i trTANX�(3�TA' .. _. . �s �z ail S P4 /Z ESL _ Date installed gal. Number of Compartments, Z Cleanouts (Y/N) anoutY/7J) Depression over tank, (Y/N) /A� High water alarm (Y/N) g' Pumper .= N r � IF ELDb�TA , .. .. 0 0 Soil rating (g p.dAe or#fbdrm) -,System, type L� /DE %hEaJG'F sft. Width S ft. Gavel below pipe Z ft. .S ft. Effabsorption area �O ft2 Monitoring tube Depression over field acytest" Ic.�S Results (Pa_ss/Fail)` /� 1 T For bedrooms j 3 3Y IIhX S ..,�.,. .^,.;�.,b'. �,r� dm,�atii"?.; ✓✓d+.r.3$. ,..�irti to 2,.. .vii,+." v ri�P,,: iar,..a. �6sorption f eTd before test_ ln. Water a�ec�"'`— gal Kle"w depth_ in min. Final fluid depth _in_. Absorption rafe >`= �- "TPA n 5+ r -r r fes„"^x�rtt�'k"rr9� w:'" y."'..L.✓ '.� o F. a },' `° ,4.- e •Hvi . e,.H r :..h '"h�n,_'w..,'�.»r"',zs -v.. ,..,aa...r ..<,> rms _�.�.,.., t.,,.A:>�� in treatment (oasf 12 ino.l (Y%I�� � "("voel If ves. oive�date All on t; Ott. A . . f inspeorions and "' »491 systems are in >ffect on this date AO* sv, a /2t�y Ay pyYb�%rY ASBUILT SEWARD & I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE FOLLOWING DESCRIBED PROPERTY: /"SG �. AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. DATE: ' IT IS THE RESPONSIBILITY OF THEOWNER TO DETERMINE THE 9�3/oy EASEMENTS, OF Y . RISTENCE RESTRICTIONS WHICH D0 NOT APPEAR ON THE RECORDED GRID: SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB - ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN: • Duane Merl Seward fl 40 l A AX4 v .