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Home My WebLink AboutNAVROT LT 3Navrot Lot 3 #015-271-60 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program Po Box 196654 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax (907) 343-7997 .- http:llwww.rnuni.orglonsite i On -Site Wastewater Disposal System Permit Permit Number: OSP221239 Work `type: Septic Upgrade Tax Code Number: 01527160000 Site Legal Address: NAVROT LT 3 G:2634 Site Mailing Address: 11101 NAVROT CIR, Anchorage Owner: SILL LINDA S 50% & Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date: G'CVL cnr o....S � ,mac. r_ Q n v DL'partrneiit Lot Size in Sq pt: Total Bedrooms: 8/3012022 8/3012023 53270 Q Disposal Field 0 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) 343-79044 (2417). 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 Special Provisions: I. The bollards to protect the tank are to be in place prior to IR approval. 2. The Engineer isrequired to do an additional percolation test prior to construction of theseptic field. Please submit stamped andsigned results with the As -built Inspection Report. If the results require a design change,construction of the system will stop pending On -Site review and approval. Received By: Issued By: IZZ Date: 813012022 Date: F /z�'/Z -Z__ 4 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-271-60 Property owner(s) LINDA SILL & ROBERT TURKINGTON Day phone Mailing address 11101 NAVROT CIR, ANCHORAGE, AK 99516 Site address 11101 NAVROT CIR, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) NAVROT LT 3 Legal description (Township, Range & Section) Lot Size 53,270 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field 0 Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank 0 Upgrade ❑ X (D) ❑ Holding Tank El Renewal Renewal ❑ Multiple 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. (Signature of property owner or authorized agent) Permit/RushFees: t5%5 Waiver Fees: Date of Payment: %z�li Z Date of Payment: Receipt Number: 116016 Receipt Number: Permit No. OSP Q 1 -2.3 % Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com July 1, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: NAVROT LOT 3 The property owner has requested we obtain a permit to upgrade the aged septic system of the above referenced lot. We propose to install two deep trenches and 1250-gallon tank to serve the existing 4-bedroom residence and leave or abandon the existing trench that can be used in the future with a lift station. The design is based on the site test hole and area soils. No groundwater was observed at test hole excavation or monitoring. The slopes are moderate at 8-13% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221239, Deb Wockenfuss, 08/30/22 38.8 5 8 .2 3 3. 2 4 0 .9 34.7 37.11 2 .0 2 3.7FIRST WATER CONSULTING DESIGN CALCS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC SYSTEM. VERIFY PRIOR TO CONSTRUCTION. THE SLOPES ARE >25% WITHIN 50' OF PROPOSED FIELD & MEETS AMC 15.65.210 STEEP SLOPE SECTION DRAINAGE FIELDS. NAVROT LT 3 CLASS "C" PRVT. WELL ON FIREWEED HILLS B2, L2. SEPTIC AREA SEPTIC AREA VERIFY EXISTING WELLS & OTHER REQUIRED SEPARATIONS PRIOR TO CONSTRUCTION. SEPTIC FIELDS HAVE BEEN IN OPERATION SINCE 1977 WITH NO EVIDENCE OF EFFLUENT DAY LIGHTING. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221239, Deb Wockenfuss, 08/30/22 FIRST WATER CONSULTING NAVROT LT 3 DESIGN DETAILS: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221239, Deb Wockenfuss, 08/30/22 MUNICIPALITY OF ANCHORAGE w Development Services Department % Phone: 907-343-7904 On -Site Water & Wastewater -� Section Fax: 907-343-7997 Septic System Owner -installer Agreement The On-site Water and Wastewater Section (On-site) may issue an approval for a homeowner to perform work on an on-site wastewater disposal system to serve that individual's owner - occupied, single-family or duplex home if the homeowner meets and agrees to the following requirements: 1. The property owner and excavation equipment operator may perform work on no more than one owner -installation project in a 12 -month period. 2. Owner's projected active involvement with the installation: LueA co" _ LI.✓ &- To 7-A�/t- . Tit •✓A! v- 41NAL Ta 4M 44 r-cELa l-1 141U" 1c;1 V- i.J!CrAjL_ 169rl,6_ 1Z4'gdC. neL !91,47—W/774- 4(sf.�C 3. The name of the excavation equipment operator: go 0"-7- Tu A,,,we -rzy 4. 1 agree that there will be no monetary compensation for installation services rendered. 5. The name of the inspecting engineer: FIRST WATER CONSULTING 6. 1 agree to discuss the following items with the inspecting engineer: a. Permit design criteria and specifications. b. Inspection requirements set forth in AMC 15.65.070. c. Advance notice given to the On-site Water & Wastewater Section for all required municipal inspections (AMC 15.65.070A). 7. 1 agree to have the project -specific On-site Wastewater Disposal System Permit available at the construction site for the duration of all related work. 8. 1 agree that if the system is an advanced wastewater treatment system (AWWTS), I will�Q obtain additional installation instructions and approval from the equipment distributor. As owner of (legal description) ///4/ NXJR-t 7-(_NA26r agree that the information above is true and accurate. Owner's printed name: ww__ lnl Owner's signature: Date: 9 -Z9 -ZZ Mailing Address: P. o. Box 196650 * Anchorage, Alaska 99519-6650 ' www.muni.org 113-&, Municipality of Anchorage Page I of 2 - DEPARTMENT OF HEALTH 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 Permit Number: 5W9403S9 PID Number: OAS -27/6(0 NBme Wastewater System: 13 New ❑ Upgrade f GOJL E-FFCRIE'S Addr//,OJ ABSORPTION FIELD 1 Ror 619, fNona: /�lUCNORgGE I/iK O%95/G No. of Bedrooms: ' P(Deep Trench ❑ Shallow Trench ❑ Bed O Mound C3Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: O.8 GPO�S Ft. !11 Lot: Block: Subdivitil Depth to pipe bottom from original grade: Gravel depth beneath pipe 3 Avxor 9 Ft. 6 k Ft. Township: Range: section: Fill added above original grade: Gravel length: �• —� . S_ Ft. Ft. • WELL: ❑New E3 Upgrade Gravel width: X Numbe� flines: Detencebthitio(lines 2 Ft. Ft. Classification (Private, A,B,C): CXIS T. Total Depth: Cased To: Total absorption area: Pipe material: Ff/O ?IFEF- PR/v?I-ar Ft. Ft. PHY O Ft. lqrrot DT034 P•KC. Orilter: Date Drilled: Static Water Level: Installer. AJ` Date Installed: /0-P-99' FL .«Q-SL-/2V/CB Yield:Pump Set at: Casing Height Above Ground: TANK GPM FI. Ft. SEPARATION DISTANCES ypSeptic 0Holding 0S.T.E.P. To Sapllc Absorption Lift Holding PubuctPrivate Manufacturer. Capacity In gallons: From Tank Haid station Tank Satyr Lines p E / T UK im T`0 /07r /30J 7-S-1+Well'7-S-1+Material: S7-ccL Number of Compartments: 2 Watery /oo'+ ioa !r LIFT STATION LotSixs in gallons: Manufacturer. Line /O 't /O �!- -- Foundation Po J 'Pump on" level at: 'Pum eveI at: High water alarm at: Curtain NON KN Wn1 Pump Maks Electrical Inspections performed by. Drain BENCH MARK Remarks: Location and Description: 9101- rOP 0.0 FPaArl' act. Assumed Elevation: /00.x Ft . EN- $EAL OF ADZ :. s ..»..,,...,.S�l14 A~•• • ` ti + +� S d S ENGINEERING 17034 Eagle River Loop Road, No. 204 .... Inspections performed by: Irani. Witter Alaska 99577 Dates: 10 /o -a-94 2nd /0-4-9y it'd R02ERT c COWAN iV r Department of Healt and Human Services approval y`--Cc-8901 ... v.. tl(t''r 2 Reviewed and approved by: Date: � 72-013 (Rov. 11MI) MOA 25 Permit NoSW940359 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH 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 DescriptiolVAVROT SUBDIVISION, LOT 3 PID No.: 01527160 cos: n ;100.7' 98.1' 1 1250 GAL 4 Na TANK' C -I0' 72-012 A (IM) - co GRADE MT 80.1 v A83.1' NO WATER AND FENCE ......................................... ...... ___.._.._.___.__._. I NEW 1250 GAL. SEPTI E •1 / • f ........................................:......................................... fE :WALL k • 1 l; .1 REQUIRED SEPARATION iTY LINES PRIOR TO TANK kOBERT C. COWAN CE - 8801 ............ PAGE 1 OF 1 'Z MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES O�P h• ib'r-y¢ P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE. ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940359 DATE ISSUED: 9/22/94 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 9/22/95 OWNER NAME:JEFFERIES GREGORY J & OWNER ADDRESS:11101 NAVROT IR ANCHORAGE, ALASKA 99516 PARCEL ID:01527160 LEGAL DESCRIPTION: NAVROT IT 3 LOT SIZE: 53270 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 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 B ISSUED BY: DATE: el/�3/qy DATE:! -22- /`f- ROBERT SHAFER, P.E. CIVIL ENGINEERS �!(907) 694-2979 A?*FAX 694-1211 HEALTHAUTHORMY APPROVALS Municipatfty o6 Anchouge DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 ' L' Street SEWERLWATER P.O. Box 196650 MAIN EXTENSIONS Anchorage, AR.a6ka 99519-6650 SEWER & WATER REFERENCE: Lot 3; Nav,%ot Subdivision INSPECTION ,.-J ♦� 011 Request you .issue a peamct to upgrade e septic system zeAv.ing .the ENGINEERINGSTUDIES AND REPORTS 6oux bedroom house on the aeftunced p4opeaty. A test hole tau excavated and a peacotation test pen6avned .in .the area o6 the p4opo6ed upgrade. The approximate .Location o6 the teat hole 4.s WELLINSPECTION .Located on the attached site pian. The mon.i torti.ng tube within the test &ROW TEST hole has been checked and bound to be dry. Attached .i.6 the proposed upgrade design. We do not anticipate any adverse e66eets on neighboaing propeniies by SRE PLANS the 4.nstaUation o6 the proposed septic system. The proposed 1250 gatton septic tank .i.6 to be placed outside the weft protective radius. Attached is a site pP-an which depicts the .Location ROADDESIGN o6 the p4opo6ed tank. 16 you have any questions, on requin.e addi tionat .in6olLmati-on 6or yout review, pLea6e contact us. soLTEsr Since e-ty, PERCOLATION ,EST / R3 A. Sha6er, P.E. STRUCTURAL& MECHANICAL INSPECTIONS ON SUE WASTEWATER DISPOSALSYSTEM DESIGN 'ja/gk 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 c :. N d O Y U Z O N w W O Z Q 2 Q 2 O = It FO O= 1- QZF ' I� H�/ p W W In;WII��!IaN WZ O2O HQ�Y I W32 al �p00a5 20 mar- Om�O It aN Za2O c�0a3 Wm00. > AVNtONO O MISS IWdI AI W�mZF�Z __ __ _ Li Caz ZZ14jJ co OZ3 OO O a F F+ Q W Ng 94 WFW=mIN-O a WN>NNWa a. W�1=/1ZdNZ U —62.5 aNa z W � V1~Wz003 17 V1~J�KWap M3pa �_^>�ZMZ �OON� J �•� OTO Ir o I F== ZLL W ' I� H�/ p W W In;WII��!IaN � Y a I W32 al o I H�/ p W W In;WII��!IaN d' a 6L:zo2 p'FW WOGN SI~/1 al �p00a5 pl 1D ap _ W �IIOII Jf It c O In J m W - Wm00. > AVNtONO o o wN 7 0 �) N 0 0 W �l ___._..________________ .LWSa ']I.L[1 .OI E?% z p{W pN w� w"x 0I M nv�s 3OV80dn .Os a ,r Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 ; �` � SOILS LOG — PERCOLATION TEST //� PERFORMED FOR:�1_Ee,, V PI.'•F' ?-5111 .. CS DATE PE LEGAL DESCRIPTION: LOT J / PAtbT SlQ Township, Range, Section: I iNgL SA1W0 wf Sir AAE Suzy SAr'D Laf-SaC. No UuvA-L.. • • ■■.■■■■■■■ .■■■■■■■■■ ■■■■.■■■■■ i EMENNEEMEN 0 c "JLNUIlSILLM - JtAL) . �:".•• �P•4 Jr 7t •~` •.5• •e .„.V ._ ! bmi A. Shafv 10, No. 1457.1 � IF YES, A 112—'••l' DEPTH? 13- r C.A1 SsL4 V �/ ' Depth to Wete Monitoring? 14 15 17- 18- 19- 20 7181920 COMMENTS PERFORMEtZR.4 E: Eagle Rh ACCORDANCE WITH 72.008 (Rev. 4185) Reading Date Gross Time Net Time Depth to Water Net Drop I 2- 3- 34 1 .. OA.sw g� 4- :I& o 11/5 2L 5 5 �. 35 6 • li ,:r •1 St o -y-.. s %s 6 V •• J 10 ,51• 11 I iNgL SA1W0 wf Sir AAE Suzy SAr'D Laf-SaC. No UuvA-L.. • • ■■.■■■■■■■ .■■■■■■■■■ ■■■■.■■■■■ i EMENNEEMEN 0 c "JLNUIlSILLM - JtAL) . �:".•• �P•4 Jr 7t •~` •.5• •e .„.V ._ ! bmi A. Shafv 10, No. 1457.1 � IF YES, A 112—'••l' DEPTH? 13- r C.A1 SsL4 V �/ ' Depth to Wete Monitoring? 14 15 17- 18- 19- 20 7181920 COMMENTS PERFORMEtZR.4 E: Eagle Rh ACCORDANCE WITH 72.008 (Rev. 4185) Reading Date Gross Time Net Time Depth to Water Net Drop I _ 1 .. OA.sw g� a/ :I& o 11/5 2L to 35 41 •1 St o 690 %s ;d L p V •• PERCOLATION RATE _[1._ (minutes/inch) PERC MOLE DIAMETER 6 n TEST RUNBETWF�EN �� LTAND -4-S FT %N. — trl2r/tS.�,E 11..a•2Po 26, ribrnµ CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: Municipal ty P.O. rX 196650 ANCHORAGE, ALASKA 99519-6650 of a�! f' (907)26"X= 4744 Anchorages TONYKNOWLES. MAYOR DEPARTMENT OF HEALTH 8 HUMAN SERVICES December 11, 1986 Mr. Greg Jefferies 11101 Navort Circle Anchorage, Alaska 99516 Subject: Lot 3 Navort Subdivision Dear Mr. Jefferies: On July 22, 1986 you submitted an application to this office for the purpose of obtaining a sewer upgrade permit. On July 29, 1986, this office requested additional soils, percolation and water monitoring data. As no further information has been obtained, we are hereby informing you that the application you submitted is considered expired. The information package you submitted with the application is being returned to you with this letter, copies will be retained in our files for future use. If you should have any questions, please call this office at 264-4744. SZ7 Daniel N. Bolles Engineering Tech On-site Services DNB/ljw ALASKA U1R0nM6nTAL WOOL S� DICES, U. Enqinetrinq 6 Enuironmenial $ladies May 13, 1986 Municipality of Anchorage 825 L Street Anchorage, Alaska 99501 Attn: Susan Oswald Dear Susan: MbNIDEPT OF t, CRAG; ENVIRONMENTAI PROTECTION .qAY I [E RECEIVED This is in regards to Navrot Subdivision, Lot 3. Presently, this house is served by a septic system designed for 3 bedrooms. The owner wishes to upgrade the septic system to 4 bedrooms, by adding on a 500 -gallon septic tank to the exising 1000 -gallon tank, and extending the leach field. In order to demonstrate that such improvements would not infringe upon the neighbors' ability to install wells or septic systems, AECS conducted a survey on May 9, 1986, in which septic systems and wells on all lots bordering the subject lot were surveyed. This information has been carefully compiled on a scale drawing which is attached. As you can see, due to the large size of most of the lots in the area, there will be no chance that any adjacent lots might be harmed by the upgrade of Lot 3. According to the original inspection report, the present 3 -bedroom leach field is 9.5 feet deep with 6 foot of rock, and is 33 feet long with an absorption area of 396 feet. The soils were rated at 125 sq.ft.lbd. Assuming continuity of soils, in upgrading the system, another 11 feet of trench could be built, also 9.5 feet deep and with 6 foot of rock, for an additional 132 square feet of absorption area. Thus there would be a total of 528 square feet of absorption area, more than adequate for a 4 -bedroom house in such soil. We hope that this is sufficient information for you to issue on upgrade permit. If not please feel free to call at 561-5040. Sincerely, ��% Darey vans Engineering Geologist 12M West 33rd Auenue. Suitt B • Anchoroge. Alaska 99503 • (907) 5615040 oet eerie/ Oy o torn:- P.O. W.n ori../ 1 ri 14.01 oet 7.14 /.Is h..e ro/:r r A.c be(r. _ ,r .n •{..71 tic ,J/ A. •r. y4c n(.✓ d•I f`� �sy' R.• f.- N.+r.r csf s W q ba im'...,y. RLOCK 2 FIREWEED HILL Le -r y I LOT 2 F.P 1.0 �UTIP •'a E/.ST 112**" AVE EA. -r 330 u t•.� ^' WMT SWIVISIQI LOT 3 4OF• A4'9:r'Foi '4�%�49TH .p e �..� ... ........ •.:.• LVE C KID, 1 . CE - 2251 a� f• ......•• •�o� . 0 �EOfd� 4p vcfk O�•�' I i Io LcT 3 .lv.fe - L.7s 3 .-,o 4 n/kn S wer. net S.•r.(y(1 6e. rAe % "e/ m.. /c..l. ave.. too re.? {(.« ANV Lo -r 4 r«nY en 4• H.e..f 'I..µ. h wl 5l..dfl /.0 fit VKM�. /Vevrof Lsf j w, s..p dei Pr.�uTren. ilio so..(yfJ by b --•r. r. Q l -I•,y t rAP4 I I UvI o _ 1 • 1 I r 1 r1 )` k) I I ti• 1 '�:� ii.• ,I 1 I 1 I-"TH4 'e 11 I 1 C.."i ':..zo r Ifl E/.ST 112**" AVE EA. -r 330 u t•.� ^' WMT SWIVISIQI LOT 3 4OF• A4'9:r'Foi '4�%�49TH .p e �..� ... ........ •.:.• LVE C KID, 1 . CE - 2251 a� f• ......•• •�o� . 0 �EOfd� 4p vcfk O�•�' I i Io LcT 3 .lv.fe - L.7s 3 .-,o 4 n/kn S wer. net S.•r.(y(1 6e. rAe % "e/ m.. /c..l. ave.. too re.? {(.« ANV Lo -r 4 r«nY en 4• H.e..f 'I..µ. h wl 5l..dfl /.0 fit VKM�. /Vevrof Lsf j w, s..p dei Pr.�uTren. ilio so..(yfJ by b --•r. r. v M L.i r -j 11� I Fr•t� L I T v I1 F F=+r4I� a 1C�o to rr DEPARTMENT O. iEALTH AND ENVIRONMENTAL I TECTION 825 'L' STREET, ANCHORAGE, AK. 99501 i 279-2511 WELL_ AtJl7 ��t+l—� I TE EWEFZ F� Ef2M I 3V ry� PERMIT NO. ( 77891 ) _ APPLICANT ROBERT NAVROT SRR BOX 1779 X 344 5950 CUD LOCATION OHIO-S-ITTREET1 LEGAL LOT 23 SEC 21 T 12 N R 3W LOT SIZE 85000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: d1=FaTH= 1F.+ t_Et+IGTH= S;2 GFZ*f=fwEL dt=F'TH= ►-=; THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). FQFrCA J ]1 FZEd 03EF•T I C TRtlFC b• I LE= ZCtCACD �FiLLOr 1 F1FicsF<Hl'it= F}L1=1"-r OF•T I ClrA A PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1. EITHER A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2. A CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM AND/OR YOU MAY BE SUBJECT TO PROSECUTION. ---------------------------------------- --- TLJCJ C 2 ] I NS~F=�EC:T I IDr4_=; F=1FR! E F= IF(7!U I [--z I=- --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION-' MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. FIEFZM I T EXF=' I: F?E'S dECEI 7F3EFt :3:1_s 1 1_-+ 9 r I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IPJ ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEPIEHT T RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDFOQMS�(), L SIGNED: ------ �h! �- L -----=--- =--=------ APPLICANT �� ROBERT�NAVROT �% Q� ISSUED BY_jCA�=-=-- " v- l' ' --- DATE--!_ --4 i7_ --.S�% 7 V3. 0 1.11_1 N 11:7- I F~ A L_ I T Y 1=1 F= H t+l 1::� H (--I x:1=113 F_. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 279-2511 WEI_1_ AN17 1 -Jt l—S I TE L4 I= F='FERN 3: T PERMIT NO. ( 77891 ) APPLICANT ROBERT NAVROT SRA BOX 1779 X 344 5960 LOCATION OHIO STREET LEGAL LOT 23 SEC 21 T 12 N R 3W LOT SIZE 85000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/SR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: F7F=1=TH= �N LENGTH= :9:2 GFRAkoEI_ OF=F1TH= r. THE LENGTH DIMENSION IS THE LENGTH (IFJ FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IFJ FEET). FZIEC' 1U I F!FEE G QEF T I C TAMC !E> 312! = 14x4_11=, 2-3AL_1 (71r4E> PACFCAGE F'L_FIt-IT OF -1T I (3 t4 A PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1. EITHER A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2. A CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM AND/OR YOU MAY BE SUBJECT TO PROSECUTION. ---------------------------------------- --- TWO C 2 ? I t-453F-E17,T I Ot-JFRE FR- -U I SEC} --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMEFJTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION- F>ErFQP 1 I T Ezxr" I FZES 17ECTErflE:EF-d 11s SL"Q w- r I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMEFJTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IFJ ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: -------i`o APPLICAfJT ROBEP,T NAROT 4� All g � ISSUrD BY49'✓F= ✓LT= iLs l�'1=1'=----DATE- " -I --------- V3. 0 ?-,�1UNICIPALITY OF ANCHORAGE^ Hea a and Environmental Prote, on Fourth Floor West 825 L Street Anchorage Alaska 99501 r 264-4720 T J INSPECTION REPORT ON-SITE SEWAGE /D DISPOSAL SYSTEM NAME( •�fl� N�y"4 MAILING ADDRESS S PJ6 ©a'Y 11 J" PHONE 4µ4-596 LOCATION C� S LEGAL DESCRIPTION Ls3 �� J i Tt N 'C 3 u SEPTIC TANK- . DISTANCE {(( (' L_ 1^J NUMBER OF �L FROMWCL 00 MANUFACTURER Gem'- MATERIAL S56j COMPARTMENTS INSIDE LENGTH INSIDE WIDTH ' LIQUID DEPTH LIQUID CAPACITY LSV GALLONS. TILE DRAIN FIELD: wt 1 ( TOTAL LENGTH 1 DISTANCE FROM WELL FOUNDATION 130 NEAREST LOT LINE - f` OF LINE 33 # of Lines I DISTANCE BETWEEN LINES N 16 TRENC14 WIDTHIZ IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE '� 1 DEPTH OF FILTER OEPTII: TOP OF TILE TO FINISH GRADE S' 2_MATERIAL BENEATH TILE IN. ABOVE TILE IN. SEEPAGE PIT: DIAMETER_ORWIDTH_, LENGTH_, DEPTH Log Crib.—Rings_ Crib Size:I DIAMETER —DEPTH— DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. Well°P Class: 1-,3. Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: ham, # of Bedrooms: Installer: Remarks: DATE -aLW-JAPPROVED . fN 3. - J-J--�- �U- -T— Lv f c5t DATE -aLW-JAPPROVED . fN SOILS LOG MUNICIPALITY OF ANCHORAGE \ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION s Pouch 6850, Anchorage. Alaska 99602 276-2221 SOILS LOG - PERCOLATION TEST PERFORMED FOR: n(.1tZ/J .,Ve-f— f-- /I/wV �1.LL0-7— �7 LEGAL DESCRIPTION: Z7 .� S&C ca7l DEPTH (FEET) shy 2 3 4 • ,,///AA 5(� 6 7 6 , 10 11WAS GROUND WATER 12 ENCOUNTERED? V .(i IF YES, AT WHAT 13 DEPTH? 14 too* 15 BO a' 617i616- 17- 181 19 20 PERFORMED BY: 72008 (7/76) DATE PERFORMED: Reading Data Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT ..�7 G CERTIFIEDBY: / DAt 3L 1 rN �Lj.303 Municipality of Anchorage -- Development Services Department Building Safety Division On -Site Water and wastewater Program 4700 Bregaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015.271!0 COSA # Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 3; Navrot Subdivision Location (site address) 11101 Navrot Cir. Current Property owners) Tara Benin Day phone 339-8847 Mailing address 4040 Winchester Loop Anchorage. AK 99507 Lending agency Day phone Mailing address Real Estate Agent Sk p Mendor/ Prudential Day phone 441-1872 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site ❑Q 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 On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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,tion, based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this app' 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 a s engineering Address 15861 S. Birchwood Loop Rd Chugiak, AK 99567 Engineer's Printed Name Robert A. snorer 5. DSD SIGNATURE—._.__.--_-- .----.....----------- -- �� Approved for �� bedrooms. Phone 694-2979 Date / 1I N.N• M� - Disapproved. ' lJ` Conditional approval for bedrooms, with the following IL MAW 14"4 Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: ecu ve Original Certificate Date: m" wo5i Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw, Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: 161 �'r ��1/�OT Parcel ID: DIJ`��'taV A. WELL DATA Well type VP)TEE If A, B, or C provide PWSID # = Well Log (Ye Date completed =19'7 7 Sanitary seak:TN) Wires property protected l) '&S ' YY n Total depth `'Js ft. Cased to �ft. Casing height (above ground) _L n. FROM WELL LOG AT INSPFrCTi N Date of test y L� `! Static water level fL IS ft. Well production g.p.m. �J. /� g.p.m. WATER SAMPLE RESULTS: Coliform /2 colonies/100 mL Nitrate mg/L Other bacteria 10colonies/100 mL Arsenic: l U mgA Date of sample: �0'� Collected by: Sag I•it�6//U£�/2l C7Gp B. SEPTICIHOLDING TANK DATA Tank Type/Material G Date installed —it) Le Tank size Z gal. Number of Compartments 2 Cleanou (!) As Foundation Clea (Y ) OAX- Depression over tank (Y® k1l High water alarm (Y/tg) ' Date of pumping Pumper�� aFxVICg C. ABSORPTION FIE D T Date installed /� 8 Soil ratin(g.p.d.e r fe/bdrm) �u System type �;p _l 45.4XJI / ' / gl(I Length ft. Width c�. 5 ft. Gravel below pipe 6-q ft. t Total depth 0 ft. E .absorption area Ott= Mond'orin tube LS Depression over field Date of adequacy test Z D Resu (Pass/F il) For 4 bedrooms '1 ,I Fluid depth In absorption field before test in. Water added gal. New depth � in. Elapsed Time: min. Final fluid depth in. Absorption rate >= cco 9.p.d. Any rejuvenation treatment (past 12 mo.) ( type) f��C� If yes, give date D. LIFT STATION Date installed Size in gallons 'Pump on' level at —in. 'Pump off Later Datum _ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: I Septic tank/lift station on lot eU f Absorption field on lot / Public sewer main Sewer /septic service line �s I Animal containment areas SO % High water alarm level at in. Meets alarm & circuit requirements? 1 On adjacent lots len 4 - On adjacent lots / cc � Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas gz- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I r Building foundation 5 a Property line �'t' Absorption field 64- I Water main A 7 /i? Water service tine /0 I f- Surface water /00 -t I Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: It Property line /D 'f Building foundation Water main i� I Water Service line Io I+ Surface water too 4 Driveway, parkingtvehide storage 11)-4 r� Curtain drain Il,'aCyl,'6 K��Nells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA g6alnes in eflegNp this pVe. Engineer's Printed Name Date COSA Fee $ -7p Waiver Fee $ _ Date of Payment e4 .3 Date of Payment Receipt Number / " J Receipt Number (Rev. 11/05) 1 L,:Zp S 13 Municipality of Anchorage 1zl5 05 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 Parcel I.D. O I S X'7J G lD HAA # 05fXP"Z Expiration Date: :1 &101ir 1. GENERAL INFORMATION Complete legal description rot I- N4kvrc)t Suhd i vi ai nn Location (site address or directions) 11101 Nnvrnt r1 ,- nachorage, AK 9951A Current Propertyowner(s) Grep, Jefferies Day phone 360-3733 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address sane Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: `( 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site a 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. 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 6 S Engineering, Phone 694-2979 Address 17034 N. Eaele River Loon Ste. 204 F.aale River, AK 99577 Engineer's Printed Name Rohert C. Cownn Date ///a-9 /oj— S 5. DSD SIGNATURE 'i'/' q, RoeCE NNOTra� �e Approved for bedrooms. ttt� XPi ....... ` �s Disapproved. �%�k__ -� Conditional approval for bedrooms, with the following stipulations: Qrr Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: U U ��_ (Rev. 01103) Municipality of Anchorage *S", Development Services DepartmentBuilding Safety DivisionOn-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: Lcrr 3; 0ow 511b Parcel ID: 0115-271-40 A. WELL DATA Well type--atv A'TE If A, B, or C provide PWSID # = Well Log (Y®3 n� O Date completed 2:177-7 Sanitary seal(6N) ` ES Wires properly protecte (c�1J) \1&101_ Total depth +5 ft. Cased to r?0+ ft. Casing height (above ground) 12"4 in. FROM WELL LOG Date of lest Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate 0"255 mg.11. Arsenic: mg./I. Date of sample: t 1 r �05 B. SEPTICIHOLDING TANK DATA TankType/Material SFPfIG >/SrEr<L- Tank size 12-'510 gal. Number of Compartments AT INSPECTION 11 161-05 7 ft. l�o3 g.p.m. Other bacteria o colonies/100 mi. Collected by: S)S-c�h�>yiR%Cr Date installed to IS111i Cleanouts (YON) \(65 !d Foundation cleanout N) LK Depression over tank C(n Nn High water alarm (YA4 PO Date of pumping It 5 Pumper A t Ncrtitc Ssev1CCq C. ABSORPTION FIELD DATA Date installed to Lbbjq Soil rating (g.p.d.W or teibdrm) L System type C)F�f' -174CA t-4 Length ft. 10&th 2.5 ft. Gravel below pipe b • �� ft. Total depth Jf ,."ft. Elf. absorption area 41 _ft2 Monitoring tube cif`'- Depression over field+36 Date of adequacy lest 11 LT o Results (Pass/Fail) s1 For 41 bedrooms Fluid depth in absorption field before test JL in. Water added4a gal. New depth in. Elapsed Time:P oo min. Final fluid depth to In. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/M& type) W 0 If yes, give date D. LIFT STATION JJ (A Date installed Size in gallons 'Pump on' level at _ in. `Pump off" Iev Datum Cvcles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot I & `� r Absorption field on lot I ul I Public sewer main PA Sewer/septic service line a5'+ water alarm level at Meets alarm & circuit requirements? On adjacent lots 1 oo /+ On adjacent lots 10014 Public sewer manhole/cleanout U14 Holding tank Nil SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 56' Property line I014 Absorption field S 1+ Water main IJ N Water service line 10 '+ Surface water t oe /f Wells on adjacent lots loo �f in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line IV 14 Building foundation $O ' Water main k.1A Water Service line 10 1a Surface water /Cie) Driveway. parking/vehicle storage 1 '� Curtain drain rac &)e wuOLO Wells on adjacent lots r oo '4 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name U 13 f it_i C Co wq,.i Date 11 a"? / os - HAA Fee $ 30. "° Date of Payment ) / �,,, 9 k ° S Receipt Number 07 19 6 (Rev. 12/01) Waiver Fee $ T •� RCSERT C. COWAN moo'• CE - 8801 t121,' Date of Payment Receipt Number Municipality of Anchorage • -� Development Services Department Building Safety Division i 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 Parcel l.D.0/S—d-7 —GO HAA# �_/!f 0/1-/L� Expiration Date: "7 - 2 3 - 02- .1. 2.1. GENERAL INFORMATION Complete legal description LOT 3 fi.4 q X0S ID Location (site address or directions) / 11 O / N A vR c T Gt /e c Le r1.�+cNo�4.f E Current Property owner(s) GREG 7 k F F 6R / E S Day phone 3 6 0— 3 3 3 Mailing address Lending agency 1 Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. �D�% 'Ile 4;'" � y/z vo t 2. NUMBER OF BEDROOMS: H 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 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 we!I and may be reissued with new 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 encineer'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 8 S ENGINEERING Phone �' °) y- a-9 7 1?034 Evgk Rim L.1, Road No. 204 Address Eagle River, Alaska 99377 Engineer's Printed Name /L o 8 t2T C. Ce wn, i Date 'div/0-2. e ow 5. DSD SIGNATURE ry "a,4 ROSSRT C. COWAN Approved for bedrooms. .,, ,.• `e= ll ' :;1�• S Disapproved. ;��_ ��.•.. AP, Conditional approval for bedrooms, with the following stipulations: .• p N -SITE •: Additional Comments WATFq,ANE r. . WASTEWATFa . Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: j l�/, Original Certificate Date: 4 -2,3 -0�;2— (Rev. 12=) Municipality of Anchorage •� Development Services Department Building Safety Division OnSfte Water & Wastewater Program 4700 South Bragew St. P.O. Box 19WW Anchorage. AK 99519.6650 www.cLanchorage.ak.us (907)943-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1-0 1 3 N 4 Y R o 7 15/a Parcel ID: 01 S— a 71 - 6 0 A. WELL DATA Well type PA 1 SAT # Date completed" f 4 7 7 It A, B. or C provide PWSID # — Well Log (Y/® Sanitary seal &/N) Y41 Total depth of $S" ft t F 14J Cased to y D* ft. FROM WELL LOG Date of test Static water level ft. Well production g•p•m- WATER SAMPLE RESULTS: N 0 Wires property protecteddr/N) Y11 1 Casing height (above ground) l d`f in. AT INSPECTION q a./0 � , y g.p.m. Coltform ! colonies/100ml. Nitrate B.342mg.A. Other bacteria o ootonies/100 ml. Date of sample:. '4 0 2 Collected by: S a S ENGINEERING 17024 Eagle Riwr Loop Rad Ne. 201 B. SEPTIC/HOLDING TANK DATA Eagle Rte, Aloka 119577 Tank Type/Matertal SiP rr.c, s i E E Date installed / 0 $ �4 y Tank size I a SO gal. Number of Compartments Cleanouts(&N) y L S Foundation cleanout ®/N) Q_TA'D 'Depression over tank (Y& NQ High water alarm (Y/& O Date of pumping' Ai1 i I 0;L Pumper 4 f 94 M 4 S 4 R V4 C-4 J C. ABSORPTION FIELD DATA Date installed 10 A141 Solt rating ..d./ft2 ft Atdrm) 0 f Length (0 G ft. Width a . S' ft. System type U4A 744f, c.q Gravel below pipe 6 , y ft. Total depth IO_S ft. Eff. absorption area 5 ±tft' Monitoring tube 4 S Depression over field d) 0 Date of adequacy test `�/� y� o -x ResultsJ!/Fail) PASS For 14 bedrooms Fluid depth In absorption field before testa g yin. Water added gal. New depth - n. Elapsed Time: 60 min. Final fluid depth i/06n. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N ° r"E Absorption rate >= G 0 ID g.p.d. K,ao If yes. give date — D. UFT STATION Date installed Size in gallons "Pump oW level at _ in. "Pump off" I t� Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankliift station on lot /0 7 Absorption field on lot i 3 O Public sewer main N / A Sewer /septic service line :157 f High water alarm level at Meats alarm 8 ciradt requirements? On adjacent lots On adjacent lots 1 0 f Public sewer manhole/clearxxA N �A Folding tank V 14 SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation S $ ' Property line/ 0 �"f' Absorption fie! I Water main V Water service line 104 Surface water Wells on adjacent lob /O O r in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line to rf Building foundation TO Water main PIA Water Service line % O r4 Surface water ) 0 D /+ Driveway psrkingNehide storage a 0 't i Curtain drain N law./ Wells on adjacent totsF. COMMENTS G. ENGINEER'S CERTIFICATION 1 C;+" o� I certify that I have detemmed through field inspections and : q ` •�� review of Municipal records that the above systems are in • - ^ ^ Of conformance with MOA HAA guidelines In effect on this date /nL 6AX Engineer's Printed Name 08 C. CtlaA.y •%a R� PCOWAN �C c��y Date �f / I B 0 Z 111 y^ • ^`�`�t HAA Fee $ 3 7 S ° Waiver Fee 8 Date of Payment Y / q /o i Date of Payment Receipt Number 0 + $ STY Receipt Number (Rev. 12/00) P, F 3 I --- ;x •' 3 cr✓G R Jam' C r-1 ES t C 14 S E/'✓ �� > ArJT. ��j P�-=a FUEL R15EP-5 r / m�H5E ` � 4 10114191 I %� / L 7 - DATE FLO. BK. � OF X4,4 4 T H* r1�e••e e•• S'�� • 0./O•III•• sKI •• • O ��i�• LS -5713 Ar e ee NOTES : Easements not appearing on record subdivision', plat ore not shown unless description of easement is provided by client. It is the responsibility of the owner or builder, prior lo construction, to verify proposed building 9rode"relative to finish grade and utilities connections, and to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. Elevations based on assumed datum unless otherwise indicated, and bearings and disionces are record date. � aunt, 15- Enginrcring �= 17034 EAGLE RIVER LOOP ROAD A EAGLE RIVER. ALASKA 99577 (907) 694-2979 4, LEGAL DESCRIPTION LOT Ay;�O i 15- 80/V/S/O _PLAT P10. I SCALE GRID 71-51-/C2 11'1=.401 Z� �� MUNICIPALITY OF ANCHORAGE ' • DEPARTMENT OF HEALTH 8 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. # Of S -� -1 t I, O HAA # HiA q µ p(,( t 1. GENERAL INFORMATION Complete legal description Lot 3; Navaot Subdiv:c3.E0n ' Location (site address or directions) 11101 Nav4ot /19 -A- - AnnHnxngn AK Property owner Gaeg Je66erti•ed Day phone 344-9857 Mailing address 11101 Navnot Cdlr.et:e Anchoaage, AK 99516 Lending agency Day phone Mailing address Agent - Day phone`..... _ _ Address Unless otherwise requested, HAA will be held for pickup r 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX - Community well Public water NOTE: If community well system, provide written confirmation from State A `EC attest- i Ing to the legality and status of system - , �, tip• ) ' ' ,. ��'•. �li. ifs• 4. TYPE OF WASTEWATER DISPOSAL. %,� F� •. , �� . Individual_on-site . �.,'n I �C Holding tank i. . `Community on-site a .,: ,•.-r.;,•?�slT Public sewer..,,, •....:..,,, •.'. ',_ i ,NOTE;4.,If community wastewater system; provide written confirmation from State'ADEC attesting to 1he legality and status of system 1 . F 4 1 72•a+S PM'•1N7) Jmn MOA Qt�• c ��, ' ., , , Y w, a S. 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 i 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 a s Etuc►NOForruG Phone Gey-a9-�79 17034 Eag Address to River Loop Read N0. Engineer's signature Date °f _ - �� •� EOFgr a7... i;S``t;. ._ .: ."N � _ •;,7111 _ r _ ................ v O� f,*s •ROBERT C. COWAN !I!- 100 - i P CE -8301 6. DHHS SIGNATURE Approved for bedrooms r y- _ _Disapproved Conditional approval for bedrooms, with the following -stipulations: t Additional Comments Date 2 \ 1•, 111111 - CAUTION 1 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 in'Independent professional engineer registered in the State ofAlaska.The DHHS does thisas 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 analyie data before a certificate is Issued.,The Municlpality of Anchorap Is:not i ,_ __.. k •' responarble for errors or omissions in thej. professional engineer s work << c ,r Municipality of Anchorage AL I Ail= Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:Z1n7 MAII N'T Parcel I.D. A. Well Data Well type URZt7- If A, B, or C, attach ADEC letter. ADEC water system number Los present (Y 1 Date completed c Driller UNKJuowN Total depth � l Cased to q() Casing height Sanitary seal) _Wires properly protected (3'/N) IGS FROM WELL LOG AT INSPECTION /vl,tAJ Date of test ��1NFk1F}lc I1�3 /9y o 7p v Static water level m ^� ro Well flow g.p.m. y� g.p.m. o t Pump levell acr SEPARATION DISTANCES FROM WELL TO: 5 Septic/I+olding tank on lot I 16}I ; On adjacent lots /� z Absorption field on lot I-2in, t ; On adjacent lots Public sewer main N /!} Public sewer manhole/cleanout !J!� r t Sewer service line as Petroleum tank 1 uOMIF- I�f�owr t WATER SAMPLE RESULTS: Coliform d Nitrate 0,14 ni / Otherbacteria 6 Date of sample: 1\pact `°IH Collected by: S � S EKYJIM 21Pj& SRN`)xr TAr.&J c ttjilty B. SEPTICMCESFR&TANKDA7A Date Installed 16 -0 -qty Tank size la Sly Compartments Cleanouts (&N) _Foundation cleanout (Y© * NO Depression (Y/6 No High water alarm (4) li//4- Alarm tested (Y. fJ(f� fV/A Date of pumping NJA - /1JF-i, 7A,- r Pumper LV/ SEPARATION DISTANCES FROM SEPTIC/46H"QG TANK TO: Weil(s) on lot 10-3 On adjacent lots LUOr� Foundation Ss To property line 10 Absorption field 10 Water main/service line Surface water/drainage /06 1.4 72-026(599)•F=t CUEAN-OLLT INST,+C4,F_J PRIWL CONTINUED ON BACK PAGE To ScPTtc-r4"r-, ,SWECPwc( RXr- 'TolrArtos NSE. LIFT STATION YVIA Date (nsta Size in gallons Vent (YIN) "Pu High water alarm level Meets MOA electrical codes (YIN) SEPARATION DIS FROM D. ABSORPTION FIELD DATA at LIFT STATION TO: On adjacent lots tested (YIN) off" Level at Date installed IU'g-A'� Soil rating (GPD/Ft) 6's 8 / System type /Zy Length Width a 5 Gravel thickness 6 T Total depth II r Total absorption area gNN Cleanout present &N) Y Depression over field me Date of adequacy test AK IUi tai Syc Results (passtfail) /J/,4 for 4— Bedrooms Water level in absorption field before test OJfA After test Peroxide treatment (past 12 months) (YAN) /�/ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1 2(j ( On adjacent lots 166 (-k Property line if U I ' ' To building foundation 8aTo existing or abandoned system on lot /A- •- On adjacent lots 1 56 '-4-Cutbank N�/� Water maintservice line �1Q II Surface water 1 lSd "tDriveway, parking/vehicle storage area eU Curtain drain LOP -JE LNo o r✓ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified or conformed to alf MOA and HAA guidelhes in effect on the date of this inspection. c�'• �JL"-: -" Signature %f \ Engineers Name /` a s, -1C,— C, Co✓A.• �,,. /eov//�✓ RO?ERT C. CC'::AN I� Date ► a �i 19 S' C_ • t o t r z �• ;tt : P. HAA Fee $ Waiver Fee $ Date of Payment /n% 4 / l Date of Payment Receipt Number ✓�3 t �'O� �/ Receipt Number 72-026 (399)• Back 5. LEGAL DESCRIPTION DATE RECEIVED STREET LOCATION INSPECTION APPOINTMENTS NAyrnt rirrlp- nnrth of 112th Avenue. west f Cange Road and east of Hane St. TIME TIME TIME \ O One O Four E3 Other SINGLE SINGLE FAMILY — Two O Five 13 MULTIPLE FAMILY Three O Six DATE DATE DATE ATTACH WELL LOG. A well log is required for all wells drilled O COMMUNITY since June 1975. For wells drilled prior to that date, give well O PUBLIC UTILITY depth (attach log if available.) INSPECTOR INSPECTOR INSPEC '!Ci-ZV YEAR ON-SITE SYSTEM WAS INSTALLED. O PUBLICUTILITY MUNICIPALITY OF ANCHORAGE NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH d \ DEPARTMENT OF HEALTH 6 ENVIRONMENTAL PROTECT:NWONMENTAL PROTECTION 1 826 L Street • Anchorage, Alaska 88601 � SEP 17 1980 ENVIRONMENTAL SANITATION DIVISION Telephone 2644720 RE W Vm REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER L DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten 1101 days for processing. 1. PROPERTYOWNER PHONE 745-5146 MAILING ADDRESS SRA Box 1779X Anchorage, Ak. 99502 PROPERTY RESIDENT lit different from above) PHONE Navrot Circle 2. BUYER PHONE Greg Jefferies 344-9857 MAILING ADDRESS 1200 Uest Dimond Blvd. #148II Anchorage, Ak. 99502 3. LENDING INSTITUTION PHONE Rainier Mortgage, Attn. Karla or Judy Voss 279-0665 MAILING ADDRESS 4797 Business Park Blvd. Anchorage, Ak. 99503 4. REALTOR/AGENT PHONE Sidsel Bergmann, RE MAX PROPERTIES INC. 276-2761, 344 - MAILING ADDRESS 2702 Gambell St. Anchorage, Ak. 99503 5. LEGAL DESCRIPTION ' STREET LOCATION ' NAyrnt rirrlp- nnrth of 112th Avenue. west f Cange Road and east of Hane St. 6. TYPE OF RESIDENCE NUMBER OFsBEDROOMS O One O Four E3 Other SINGLE SINGLE FAMILY — Two O Five 13 MULTIPLE FAMILY Three O Six 7. WATR SUPPLY INDIVIDUAL'S � ATTACH WELL LOG. A well log is required for all wells drilled O COMMUNITY since June 1975. For wells drilled prior to that date, give well O PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM ._ INDIVIDUAL/ON-SITE" YEAR ON-SITE SYSTEM WAS INSTALLED. O PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) f arc 150 IN 72010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLICUTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank /io�r ❑ Holding Tank Size: -Qum 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 (�PPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 1 i - -3,-IS6 BY IN 72010 (Rev. 6/79)