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HomeMy WebLinkAboutCOTTONWOOD HEIGHTS BLK 1 LT 5Cottonwood Heights Block 1 Lot 5 #051-431-19 MunicipalityofAnchorage :''s'>;'• Development Services Department p `~- Buliding Safely Division " On -Site Water and Wastewater Program, 4700 S. Bragaw Sl. P.O. Box 196650 Anchorage, AK 995196650 Page C)"3www.ci.anchorage. ak.us (907)343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 51AJ 000 (F5 S PID Number: 05( -1+31-1 R.m. 1 AmLlofy Wastewater System: b(New ❑ Upgrade ail BBq *v%Ve i "19977 ABSORPTION FIELD P,— i 7— p T1/ w.•c« a e.s.. 3 1(°°ep Trwrh t] Blugvw Trwcn ❑Bed 0 1,4.nE o DIM1.r LEGAL DESCRIPTION SO4R.M1q Tar D.Ph aae agrw paM' P �1• FI lr c to 5Dl D"p bPAF. W" k" Woq gr C.v depn b.Mh p"C Oh ! 7 Fl. FI. Toe+rr.p Rrgs Secaan 41 Fa.dded rim. oip.•r yM 0.7 +F1. 0"Llm"' 50 FI. Well: $New ❑Upgrade Ghr+MT M.rWwal 1 Di,t. b.M.n" �-- Fl. FI CM.P;lr(Prbi .A a. cr TOMD"M i C..w Iwie) �3 /✓wV"/ I{yaya...OP .o / C)FI' P M.h•W' O` 5 R. F, Dr3 -3 � slrc w,x� L••r `K ligo DneSMTi.,.d �3-� 0 - Fl Q VQ[ Vh 5 Pr.ro So C. Ihy1x A c ev a TANK CMI to FI. FL SEPARATION DISTANCES %Septic ❑ holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding PubBUPrtvat //-- i^ crnr•' From Tank Fietd Station Tank Sewer Line y1G►70r aI% Gal. woo 187' !I!d ` --- as:t•• rlr..r Sfiee I FO ,.re.ra •.nprlmerxr SwWew.l« 1064 too+ LIFT STATION LO LM D' 161 `o Fandm. O, ' � R 'Porro m ver r 'Pvro ar h+.� Ilgl. wrx r.m r ti h „ Cl.lrn drn Nv V F► PurrO M.+. A 1. ENdrkr h,mer�.rl, WIamM DF BENCH MARK Lxaeo•r me D.wp�m -er-O /� f Joon D of .1 0444 AtY/� • t t `Q /� Emil ' SJVnp ,Zor- AL h, r�\ r,.... ••., si tit S i E ENGINEERING 3E fe River LeeP Road r -- 4 Inspections performed by: 170� Ft'tOt:�s: 1 6 %�U'� r•• —� ••,�- •••� •^" '"' �� Sagle ver, Alaska r/ C. COWAN f Development Services Department Approval !r ROBERT �V /j rc� CE -8801 Reviewed and approved by: Date:��• 3 0� r � It e" (Re. Erol t1• L F'.. -- •.•,S• y PERMIT No. SW000455 PACE 2 OF 3 Municipalityof Anchoraqe 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 1, COTTONWOOD HEIGHTS S/DP.I.D. NO. 051-431-19 I I LOT 4 100' WELL RADIUS YTi COI I ~ Z W// I LJ RADIUS y// i= oau LJ V) / •¢ oe� .: NEW 1000 GALLON I w 3 sTT SEPTIC TANK cos A _ V un J TH rco i... col A TBM I D to 4j Oro DRIVEWAY M I� I� 100' WELL RADIUS I I SCALE: V - 4040' p LOT 6 ;n ROBERT C. COWAN 40eC,,, CE -8801 e it rf s •w.. PERMIT No. SW000455 PACE 3 OF 3 Municipalit of Anchoraqe 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 1, COTTONWOOD HEIGHTS S/D P.I.O. NO. 051-431-1 ST1 ST2 98.6' FINAL GRADE 94.5' NEW 1000 94.3' GALLON]Z�7 SEPTIC TANK A B COI =97.7' FCO 5.0 49.0 ST 1 17.5 53.0 CO2=97.8' '§T _2 -T4—.O'-55.0 DBL1 26.0 55.5 DBL2 47.5 53.5 CO1 47.0 18.5 5 MT1 48.0 23Rff5 FINAL GRADE7 CO2 56.0 MT2 57.0 COI=93.1' CO3 16.0 SR CO2=93.1' N. T. S. MTI =87.0' ���`� ... .iDj� MT2=87.1 �•....' NO WATER FOUND .... ......•.. 79.0' E.O.H.j, ROBERT C. COWAN ,? �lrg,�tE-8801 �,It f-.-�.+-�-.:.........a,,�...e,.-..w•-'^T. �.�'Tvr.,-«eew.: �......._�.. .., ,»��:w.x...�..y..v.+..�,.r�. w•r�w ...�.�--.-�..�» Certf f f eb �rftling log by DOC CO. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2750 OWNEROFLAND: 1314.1. /'I700 -I1640, J ADDRESS: 1z 21I 13t4 orrrn3 S i� F t2— LEGAL LEGAL DESCRIPTION: C0 i T u CJ W p o D He DATE: 3/3J/ L1 PERMIT NUMBER:an Date of Issue�� TAX IDENTIFICATION NUMBER: DC 931 gAr'R:vt�10 LAY ou f �oTpi i- - Is well located at approved permit location? _jYes _J No Method9f'Drilling:it rotary �-J cable triol Depth of well:-/ Casing Type C rLFe Wall Thickness n� Ste` inches i Diameter. C inches, depth feet Liner Type: .0 vj 17 v Casing Stickup Above Ground: feet Static Water Level: d I feet Recover Rate: qpm Method of Testing: /41 /2� Well Intake Opening Type::) open end J open hole J Screened: Startfeet Stopped—feet feet �i _. rforations Start _r _ T (feet ?pped� feet Grqut Type: T_2 c�%�'' 'r volume Jy L C Depth: from feet, to feet Well Disinfected Upon Completion? 5 5'es J No Method of Disinfection: CNc °.t—r- s`o PPre Comments: DEPTH C� 1.;2 14oxv- tr+-A72-- q-V4,t' iC A. J f 0 u t e S'j 0C,Or iJ , S4.j4 6a4J,-e_ .S4.:,/7 o,Z4J�c, e.A7 /*1��1.. SAAJt? 6.(.4-jcL c&04 .S or;,j i? () e1 %9 Jr? L. — W E i Driller's Name I?, -;j til •-�`-� ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health 8 Human Services and/or Department of Environmental Conservation. Matsu Borough: Department of Environmental Conservation. MUNICIPALITY OFANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW000455 Legal Description: COTTONWOOD HEIGHTS BLK 1 LT 5 Design Engineer: 0003 S & S Engineering Owner Name: Bill Momblow Owner Address: 10211 Baffin St. Eagle River , AK 99577 - Date Issued: Oct 26, 2000 Expiration Date: Oct 26, 2001 Parcel ID: 051-431-19 Site Address: 016039 DIVISION ST Lot Size: 44550 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: 0 Disposal Field Q 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 DHHS at least 2 hours prior to each Inspection. Provide notification by calling (907) 3434744 ( 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. 2-27-01 5 #VIE Received By: Issued By: 5TILL'✓/9A1 wroTBR WELLS woe rjr OF rI4F, VRIvr ww Y. 1-0 PC"'E 4E a6_L Td sow7-rf Date: /0 — 30 — o 0 Date: la _ 26 -CYC October 18, 2000 ROBERT C. COWAN, P.E. CMLENGINEERS (907) 694-2979 FAX(907)694-1211 TEALTHAUTH0FM MUJNICIPALITY OF ANCHORAGE APPWNALS Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 SEWER&wATEn 1MMOMNSE]1S REFERENCE: Lot 5, Block 1, Cottonwood Heights S/D SEWERSwATEn It is requested that you Issue a permit to Install a well and septic system to serve the PSPECTION proposed three bedroom dwelling on the referenced property. A test hole was excavated and a percolation test was performed. The approximate location ENMKENNGSTULMES of the test hole is located on the attached site plan. At the time of excavation 9/27/00 water ANGREPORTS was not found. After ground water monitoring the excavation was found to be dry. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve WELL"PECTION areas or drainage patterns by the installation of the proposed septic system. The &FWWTEST construction of this system will not prevent any future development on any of the adjacent properties. SREPLAM If you require additional information, please contact us. Sincerely, RGAGGESrcrT Z. I Robert C. Cowan, P.E. SGILTEST RCC/jhm Enclosure PERCOLATION TEST STAWTLAAL♦ MECKINCAL NSPECTIONS ONSITE WASTEWATER WPOSALSYSTEM OESKW 17034 NORTH EAGLE RIVER LOOP i SUITE 204 • EAGLE RIVER ALASKA 99577 SITE PLAN DESIGN 1" = 50' A QO�M on• � lr>, �nx SVI (VISION STREET _ _2 _ ___— —_—_ -„fig b — p-' a -. o � � N � lid A d En ca00 y f C) f e- 11 oil a 'Y Ln z� n ANA O O W lu O'er OHO C a' O` JO =N o `� �C Amo 0 o Nu O m T/••� O CNK CCA AD o l z .-i O \\ I7 K N_ m " 3 Y ro M O= "< ALTERNATE SITE = icy z o m m z O Ei�� _" o x o O- -__; m C I CD O O 7o 1 o d n o O NOT = m w� OOxE o 3snOH L 9�f M_ C C=] xx>-Z. WOOa038 , O3soaoaa=S Ory T y0 a s JCTC� ns _ oym d — — — .4 ---------- — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — �1 O ------------------------------ - I !,r-E-------- 0' Util Esrlt //I' I 0 1 I �,DL10a 1 I o PERFORMED LEGAL 1 2- U 34 3- 4- 6 7 8 9- 10- 11 10 11 ; 12- 13- 14- 15- 16- 17- 18- 19- 20-1 2 13 14151617 19192D COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST �owme 01�6AN I (Is � ><(Ts 6M DATE PE Range. Section: //VVV/✓�I. II 1 1 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT ROOM FNAFA©o©ZWAv DEPTH? 1' Depth to Water Inter Monitoring? be—V 0>IIe: ■■■■■■■■■■ ■.■.■■■■■■ ■■■■.■■■■■ EMEMENEENE =®mm ROOM FNAFA©o©ZWAv Y PERCOLATION RATE P. (5 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 5 • S FT AND 6 "57 FT 5&3 ENGINEERtN� ,/ //� / /-IIG PERFORMED Bv:1+8;4ppiagta•66ohI00,,,.��sLna55n77Road No. 204 I �-(�� C,_/ CERTIFY THAT THI3 TEST WAS PERFORMED IN ACCORDANCE 1'A?AtALL'MrATE0RM9UNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (A". 4185) ROBERT C. COWAN, P.E. CML ENGINEERS (907)694.2979 FAX(907)694-1211 ON-SITE WASTEWATER DISPOSAL SYSTEM 1NO1°" PTIOJ APP" APKS CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS SEWERSWATER AWNE%TENSIONS REFERENCE: Lot 5, Block 1, Cottonwood Heights Subdivision October 3, 2000 SEWERAWATER NSPECTpN GENERAL: 1. The scope of this project includes the installation of a 1000 gallon Premier polyethylene septic tank and a new trench to serve the proposed three ENGINEERNGSTlA1ES bedroom residence located on the referenced property. ANDREPOITTS 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all WELL INSPECTION applicable State and Municipal Wastewater Disposal Regulations. S FLOW TEST 3. The contractor shall be responsible for obtaining any necessary underground utility locates. SITE PLANS 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. ROAD DESIGN 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 SOIL TEST Department. SEPTIC TANK INSTALLATION: PERCOLATION TEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. WSTP�IL 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of "SPEOTIONS the tank. ONSITE WASTEWATER DISPOSALSISTEM DESIGN 17034 NORTH EAGLE RNER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 Page 2 Lot S, Block 1, Cottonwood Heights SID October 3, 2000 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: 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. Paye 3 Lot S, Block 1, Cottonwood Heights SID October 3, 2000 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 52U 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, Femco, 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. 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: Page 4 Lot S, Block 1, Cottonwood Heights 3/13 October 3, 2000 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 Parcell.D. 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-431-19 1. GENERAL INFORMATION Complete legal description Ln t, Location (site address or directions) HAA # ()6053i' Expiration Date: ! / 1 .5/ a=k-o. Current Property owner(s)William Homblow Day phone 272-4495 Mailing address same Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage to A Community Class Well ❑ Public Water System V i t �t CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-431-19 1. GENERAL INFORMATION Complete legal description Ln t, Location (site address or directions) HAA # ()6053i' Expiration Date: ! / 1 .5/ a=k-o. Current Property owner(s)William Homblow Day phone 272-4495 Mailing address same Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site }fX� Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Clyrtli�iil :i�•ISP.b�01il•I.1zY&Q 3[.fttgl� 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 riles 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 Engineers Printed Name Robert C. Conan Date ^zz/0_5— S 7 5. DSD SIGNATURE ! - �M` Approved for �_ bedrooms. F+ �.-•�.,,,,,_ �' J Xr Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: A" .M L r 1 l 4+ QA Original Certificate Date: i� r�/apo5 (Re, 01002) Municipality of Anchorage • Development Services Department Building Safety Division ' On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: %T G F 5L&C- (; (2-07�WeX% 1117,. Parcel ID:_Q51 1 -19 A. WELL DATA Well type L 111AFM If A, B, or C provide PWSID # _ Date completed A ( Sanitary seat &N) �tV> Total depth ILYtft. Cased to IPLft. ft. FROM WELL LOG Date of testf== 1 Static water level s 1 t ft. Well production S g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: mg.A. Nitrate 2.11 mg.A. Date of sample: 43 f 0 S B. SEPTIC/HOLDING TANK DATA Tank Type/Material `5-&P -Ic / gT6-6L Tank size 10M gal. Number of Compartments 2 - Well LogQYIN) \IV5 Wires properly protectedON) -S Casing height (above ground) ► S 111- in. AT INSPECTION R z'q/o5 79 r ft. '3�7 g.p.m. Other bacteria _� colonies/100 ml. Collected by: 54-5 �w4xIK f�r2lnOCo Date installed 4,111- o I Cleanouts 6�N) `IES Foundation cleanouloN) 7 Depression over tank (YAW W High water alarm (YO) N0 Date of pumping q Pumper �Q�S-PVt-nPr'Q- C. ABSORPTION FIELD DATA Date installed 01 Soil rating (g.p.d./ft= or f?/bdrm) -L--6 System type Dt�P TIe��C 4{ Length 60' ft. Width 3 I ft. Gravel below pipe Total depth 16-IT! ft. Eff. absorption area 6Co ft2 Monitoring tube *5 Depression over field 4-0_ Date of adequacy test —1124105 Result as / il)� S For 2-1- bedrooms n Fluid depth in absorption field before lest P -ay in. Water added S6 gal. New depth in. Elapsed Time: W min. Final fluid depthD„ in. Absorption rate >= L-iSo+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y& type) NO If yes, give date — D. LIFT STATION Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES 1 Size in gallons 'Pump off" level at Manhole/Access (Y/N) level at in. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: 1 Septic lank/lift station on lot 1 M,4- On adjacent lots IOC' Absorption field on lot t bO I+ On adjacent lots 1004 Public sewer main ►J l`} Public sewer manhole/cleanout AM Sewer /septic service line 2 t5 + Holding tank N N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 1 r Building foundation jib Property line Absorption field S r4 1 Water main AS A Water service line 10 Surface water Wells on adjacent lots iC0I4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line 1 Building foundation 16Water main f-! iR Water Service line 1014 Surface water 100 1+. I Driveway, parking/vehicle storage 10 + Curtain drain 00VC f-A-ttCk) Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and I review of Municipal records th,4~ove systems afe in x d conformance with MOA H�✓/Lltis dat ........... .......... Engineer's Pri7// NaZo DateD S HAA ."?�. � Fee $ y 40 Waiver Fee $ Date of Payment 'w I r�%1 Date of Payment Receipt Number 752 r h Ar - Receipt Number (Rev. 12/01) AUG -24-01 FRI 01:43 PM ROTH CONSTRUCTION FAX:907 745 0892 PAGE 2 'a.✓ LEGEND • ... FOUND 5/8' RESAR (R)... RECORD VALUE PER PLAT /71-291 (M)... MEASURED VALUE THIS SURVEY LOT 4 SCALE 1'-50' LOT 5 SPE BLK 1 `C�Al7� � r _ CANT., DECK ✓ham `POWER POLE W/ STEPS UNE DIRECTION AND PHONE PED. l� WELL --- 298.58'(1d N 89'59'38" w BASIS OF BEI LOT 6 10' U11uTr I F EASEMENT I S ONE STORY e o HOUSE W/ IcictI V GARAGE I II £I II l ENT NOTES: ONLY READILY VISIBLE ENCROACHMENTS. AT THE TIME OF FIELD SURVEY, ARE SHOWN HEREON. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE UNES. A COMPLETE TITLE SEARCH WAS NOT PERFORMED FOR THIS ASBUILT SURVEY, OTHER RECORD TITLE INTERESTS MAY AFFECT THIS PROPERTY. �o��OF s-euiLT COTTINI LAND SURVEYING ��� 4j•• SURVEY P.O. BOX 2748. PALUER ALASKA 99645 745-1188 OR 745-3658 V 49th �W,,t� I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION ON THE —� FOLLOWING PROPERTY: LOT 5, BLOCK 1. COTTONWOOD HEIGHTS (PLAT #71-291) o ; PIOv. COTTINI ff ANCHORAGE RECORDING DISTRICT. ALASKA. EASEMENTS OF RECORD OTHER THAN r No. 7074-S b THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON. DATED AT �•,�„ v'f'.••• PALMER. ALASKA. THIS 24th. DAY OF JULY, 2001. ~ba a W.O. 01-154 F.B. 01-07 DATE. 7/24/01 SCALE 1'-50' Municipality of Anchorage pp1 "O. • �� 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.enchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. OS/ -'`/3/-19 HAA #_ P7/ y4DId o Expiration Date: / / - 9 O - O 1. GENERAL INFORMATION Complete legal description L07- S BLo c K / C o r ro N two o d H E /(1NTl Location (site address or directions) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address f3 )Lt.- MprtDL D t l Day phone Gc7y-5y /02-11 13AFFr.J ST1?44T, EA,FI,E 4q/%jee AK 9g5-77 /.ksIDlNrihc- 1`610 Ar. Day phone ,C/y,L" kj%/6a Day phone Unless otherwise requested, HAA will be held by DSD /or pickup. 2. NUMBER OF BEDROOMS: -3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well�1X 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 5 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 rew water sample results less than 30 days old. (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 regulations In effect at the time of installation. Name of Firm S& S ENGINEERING Phone 69'1—;k -Q'79 0 age Iyer Loop Road No. 204 Address Eacle Ri cr Alaska 99577 / Engineer's Printed Name RnQdRi C. CDt-JA-� Date b6 -b (° � ENGI 'i ROEERT C. COWAN 4 e. •DSD SIGNATURE CE -8801 J Approved for, 3 bedrooms. ++to-(; �? Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By; (,,/. Original Certificate Date: (Rev. 12:L0( Municipality of Anchorage • Development Services Department Building Safety Division On -Site water 6 Wastewater Program 4700 South Bragaw St. P.O. Box 198650 Anchorage, AK 99519-6850 www.d.anchorage.ek.us (907)943-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT S 8L.)CK ) C.)7 Too+ t,wpa Nlsr(�/$7J A. WELL DATA wen type P/RrE Date completed 3110% 1 Total depth L14D ft. If A, B, or C provide PWSID # Sanitary seal ®/N) -Y . Cased to ±11-1—ft- FROM 111ft. FROM WELL LOG Date of test Static water level Well production S g.p.m. Parcel ID: OS- / -y3/ / 9 Well Log (SAN) Y'F J Wires property pro) Y4 1 Casing height (above ground) 19"' in. AT INSPECTION i ft. 9— p.m- WATER SAMPLE RESULTS: Coliform O colonies/100 m1. Nitrate ;I •-)3mg.A. Other bacteria C colonies/100 mi. Date of sample: I ly t/o / Collected by: S A S ENGINEERING B. SEPTIC/HOLDINO TANK DATA 17030 E9k RNar LOOP flood N0.204 Espy River, Alaska 99577 Tank Type/Material 54-4 T' S T 4 E Date installed fe /7 /0 / Tank size / 0o 0 gal. Number of Compartments Cleanouts&N) Y4' J Foundation cieanoui &N) Yt) Depression over tank (Y41 &0 High water alarm (Yo O Date of pumping 0104 —^°E w Pumper C. ABSORPTION FIELD DATA Date installed 6 7 �o/ Soil rating ft2ibdrm) 0• System type *tai . c„ ti/ Length SO ft. Width –7 ft. Gravel below pipe ft. Total depth 10 �k ft. Eft. absorption area 60 0 ft2 Monitoring tube yes Depression over field N 0 Date of adequacy test 44 - Nt r✓ Results (Pass/Fail) For 3 bedrooms Fluid depth in absorption field batons test _ instar added_ gal. New depth_ in. Elapsed Time: _ min. ufd depth _ in. Absorption rate >= g.p.d. Any rejuvenation (past 12 mo.) (Y/N 8 type) If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at _ in. -Pump oft Datum Cycles tested . E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot P? 7 Absorption held on lot 16th Public sewer main N /A i Sewer /septic service line r?• r 4— High water alar level at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots /00 � /Ov �4 Public sewer manhole/deanout Holding tank N /A' SEPARATION DISTANCES FROM SEPTICMOLDING TANK ON LOT TO: ,VA Building foundation /0 Property line A$ 0 Absorption field ;k.3 Water main N iii Water service line / 0 Surface water / 0 O Wells on adjacent lots /00 r -OL SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation )S, , Water main A)/'a i Water Service line /D ; Surface water 100 4 Driveway, parkingivehide storage ) 0 t Curtain drain Ei i kAlowpi Wells on adjacent lots 00 t F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field lnspecdm and review of Municipal records that the above systems are in r"' � conformance with MOA HAA guidelines in effect on this date. -000f FiS; AN Engineer's Printed Name RilhAr C. Cot,4rd /foIt ...- ,.«-\Data F^ n HAA Fee $ 3o0- o c Date of Payment 87 / a a / 0 / Receipt Number 00 11310 (Rev. 12100) Waiver Fee $ Date of Payment Receipt Number