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HomeMy WebLinkAboutCHANDELLE ACRES LT 20AChandelle Acres Lot 20A #051-063-92 �1 Municipality of Anchorage < '':•, _ Development Services Department Building Safety Division Onsite Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www d.anchorage.sk.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. Ott/ 06015%2- PID Number. 0 E I - 0 e 3 RrR. q✓1 t 4�40I 1114rStV4 Wastewater System: ❑ New Upgrade Ad&"• �3G/ ChancitlCe. TT�,��ct� ABSORPTION FIELD Pe N1•Ibf of BMegna p. VTevrIIOSMIb•rTmrll❑BW ❑141 tl ❑0ow LEGAL DESCRIPTION sw Re" O.5/S" Tar D.an Ball""" 6•o C'c"e Fl. 20.4 cNe�/v �2rs DapelbP"erbin ewll09N WWI* Dias mpm owp"wl P /Oro O Fl. FI To•nNp / � Rarpe ♦ � Samwt � Fr a00ee tleM erpw QaOa GtM Ullplll •J1•- .0 FI. iii FI. We ❑ New ❑ Upgrade c . r • am raaror a Mw / arrR. MR .r a w• . Q FI. R GMaRM1ulan (PRMM.A Tar Doral DaNab Irr aoaapom arM PaM M•Ieny �/ w'/0 FI. FI Fe If poor Cra Dn $AnOC WOW Le FI iMWW Vim DaM MMWee ."I' wI,P S.I.I GWb1�xA� TANK ISPM FI. Ft SEPARATION DISTANCES &r) ❑SepUc ❑yHoldingg RS.T.E.P. ❑Other: TO From Septic Tank Holding Absorption 011 Station Field Station Tank Udlr/Prwale Sewer uBe I AAla / A lk- 9 uAF-&VI� /V0Oda1 wa /OS SIO P �� !/,S l/� Mr CodTLD STEEt, r«a�.r 2ae•IIPrbM•aa suraoa wrw x1pAl LIFT STATION LoUw 7& f CRY Ce 72. 5'SO dr ySdH� FaneMbn 3 p� �^ ! y 4Cr� �� PY Vq MM M Lfs PY VOrYM M 5Q Y�I w•Iw/r•nmN M b J G Irt Cnw Dram �0� ROO MM•! Maeel 67sr— E,rr'aI Il.leIpacegla OMpnlaea%� .a�� Kl7tN� SOf.D IY.i/C��I�.1e+ ReA4•`F 2o5a��o� BENCH MARK TEP 5 %TIFF i 5 Age,14 T" V- LauMn rq Da•ygwl 964&A9 Go:le- F400,1C _ /mo. Ct7 * A,7-160051 o �ereWn Ar N W VoCACI ji,4co a Ft V44 (,4e5o.1 4wL 1Ahr'Ai44re .r A44i 46 CO040SE. SY NOdP g)ryy}rudL7QltifNFl6lbfa7utrc I co e� ��5t OF ajPea ��>1, *•T performedby:'JJA7rs; )W Dates: 1' G /!o o-O..:4 Inspections �X-err 2ndk-i2 —46 ... Development Services Department Approval G ; So3tt L Hr.3rlbug : ••., Conditional Approval by: FI1��D••.,,,,.•`s<�+� Date: Reviewed and Approved by: f� Date: - f �- D ` (Rw I].(e) V V/ v Ln ul 1 L -t2 -ora Lor 20 A cgA.NAr-u-r.. SWINGTIETAeLE I 1 Dh1onC. from VONT A e C D pilon I 35.6 US 1c.O. z 24S 740 C.o. Q3 3e.0 36.6 CC.O. 60.3 747 Clam CO. O6 .67 19.7 CT..k C.O. e 61.0 18.6 18'889.1.. Q 69.6 31.6' C.O. 7T la.s MY 11 of C.O. ll b 9 e7.7 1 61.0 JMT. 1 n.s 18e.z JMT. 1 nOr 171.6 I1/C C.O. elnw A. NW c.mw NpnQOr e . NE cams N.1po lz I L20 11 Q d� ® C� :J r PvC CD iD 15CO GALLON STATION 'S;C D �l HANGAR DEC 3 FF . ICpCO' CNEW 4" G A ASTM4303 NEW MOA-APPR SEPTIC TANK / L ANC64 TANK -AT]! / h OO / DIVERSION VALVE / IN LIFT STATION EXISTING LEACH Z„ FIELD TO REMAI 1 1/4" WD p AS BLCKIUP PRESSUR_ EWER 140 LF. CF 6' GRAVEL R NWAY ' 49 .0 •�:, ; Salt L H�snCtr9 : i� SEQn sYsT�M .a5- $UIt�T dt, ;a ., CE 7ig : '.•�`'� //-9-Olo s!�[.B: �u=3o' `aZ� pB�r�r�%yl��%►� i f�ov sE �ov,.toannrJ "C� uPP6 ro i i nW �Flr�p g . nW �Flr�p i a voZ 'Lep-1 _ ._ rLeonl UP Z12e-0Aiet4A&9JCa6ryP) TYPi END C1LP IM PAF WG f %y "� �iDPr: 'TO L. S. -2 it )<41 Qr&ID Ir15UL . -Cx>:oT�XT"1 t� -z�X2�(�rL-�rD I►1`�UL - I%. xt(�10 PVcw p�eF pr Pr= 0. L) _ 1.IdLLGj �L/ EZ] ,aB-�ORPV0 `1 TPMC14 64S 8 WL.;7') 564Lr:: 4!pp2oX I"- 2' OF A j. •. No. CE6739 • •� Scott Hattenburg, PE Loris Dilley, PE/CPG Dennis Unnell, PE David Lundin, PE HATTENBURG DILLEY & LINNELL Engineering Consultants November 9, 2006 Municipality of Anchorage Department of Health and Human Services 4700 South Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: INSPECTION REPORT AND ASBUILT LOT 20A CHANDELLE ACRES SUBDIVISION Gentlemen: Attached for your review and approval are the inspection report and asbuilts for the upgraded septic system for Lot 20, Chandelle Acres Subdivision, Chugiak, Alaska. The following is submitted for your consideration. o- ➢ MOA Inspection Report, ➢ July 13, 2006 Letter from Rising Son Electric, ➢ As -built Plan with Swing Tie Data (1' = 30'), ➢ Site Plan —Area Wells (1" =100'), ➢ Septic System Profile —As Built ➢ Profile of Disposal Field — As Built, and ➢ Absorption Trench — As Built. If you have any questions, please contact me at 564-2120, or at shattenburg@hdlalaksa.com Sincerely, HATTENBURG Scott Hattenburg, P Cc. Dan Larson attachments: as stated & LINNELL, LLC H:Nobs106-022 Chugiak Larson Septic (File Only)tLot 20A Inspection Report Cover Letter 9 Nov 06.doc 3335 Arctic Boulevard Suite 100 • Anchorage Alaska 99503 • Phone: 907.564.2120 • Fax: 907.564.2122 808 South Bailey Street Suite 102 • Palmer Alaska 99645 • Phone: 907.746.5230 • Fax: 907.746.5231 Nov 15 2006 10:07nN HRTTENBURG DILLEY LINNEL 9075642122 P.1 Scott Hettenburg, PE Lori+ Dllley, PMPG Dennie Unnell, PE David Lundin, PE HATTENBURG DILLEY 8 LINNELL tom Engineering Consultants November 15, 2006 Municipality of Anchorage Department of Health and Human Services 4700 South Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: SEPTIC SYSTEM LOT 20A CHANDELLE ACRES SUBDIVISION Gentlemen: Per your request, we are providing the following Information: 1. The lest holes were dug to a bottom -of -hole elevation of 87 feet. 2. The existing steel septic:'1 failk:iilias ,ped, limed, crushed and abandoned a. mors? v.,-4• on-site. If you have any questions, please contact me at 564-2120, or at shattentwrg@hdialaksa.com Sincerely, HATTENBURG D LEY & LINNELL, LLC Scott Hattenburg, P.EJPrinc I CC. Dan Larson H:Noba%D"22 ChKiak Larson Septic (File Only" 20A Additional Info 13 Nov 06.doc 3335 Arctic Boulevard Suite 1C0 • Anchorage Alaska 99803 • Phone: 907.554.2120 a Fax: 907.684.2122 808 South Bailey Street Suite 102 • Palmer Alaska 09646 • Phone: 907.746.5230 • Fax: 907.745.5231 July 13, 2006 Hattenburg, Dilley and Linnell Attn: Scott 3335 Arctic Blvd., Ste. #100 Anchorage, AK 99503 Rising.5on Electric. Inc. 14916 \VooAand Drive Eagle River, AIC 99577 (907) 622-6777 HATTENBURG DILLEY & LINNELL Re: Lot 20A Chandelle Acres - 23612 Chandelle Drive - Chugiak, AK 99567 Dear Scott: JUL 14 2006 RECEIVED The lift station at the above referenced property has been wired in accordance with NEC and State/Local codes. Thank you. Sincerely, Kevin S. Hornbuckle, Owner Administrator License Number 1284 Specialty Contractor License Number 27285 MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 13, 2006 Expiration Date: Jun 13, 2007 Permit Number: SW060152 Parcel ID: 051-063-92 Legal Description: CHANDELLE ACRES LOT 20A Design Engineer: 0842 Hattenburg, Dilley & Linnell Enginee Site Address: 23612 CHANDELLE DRIVE Owner Name: DAN & KIM LARSON Lot Size: 48740 SO. FT. Owner Address: 23612 CHANDELLE DRIVE Total Bedrooms: 5 Permit Bedrooms: 5 CHUGIAK , A 99567 - This permit is for the construction of: ❑✓ 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 (18AA080 ). 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. 5. The following special provisions. Existing tank must be pumped, crushed and buried or removed from site. Received By. Issued By O—d Date:,/3 Date: 6 3 O (o Municipality of Anchorage --�1 Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.orglonsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel l.D._OS/-063-92-,- ZD 63--92•- Property owner(s) DAPI £ k-Im 1-4(Z50KI Day phone G99-- G 9 7 7 Maili Site ngaddress -:1302 C,AAICEffF JAR. UOrJc,k zip Code 99SG,7 address�36/.R l "�AJDE[Lf �% �, f I le Zip Code 99,5_6 7 Legal description (Sub'd., Block & Lot) L.-c)T 20th, C94,ktDf=t.LF AGR.a✓5 Legal description (Township, Range & Section) T(S Irl Q 1 W '53 Lot Size 48,'740 ) Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field El Septic Tank ER Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms S THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ 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 owFer or authorized agent) Permit/Rush Fees: n Waiver Fees: Date of Payment: 4 - l 3 - o G Date of Payment: Receipt Number. Q '79 Receipt Number: (Rev. 11105) HATTENBURG DILLEY & LINNEL_L_ Engineering Consultants June 12, 2006 Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Application for Construction of On-site Wastewater System Lot 20A Chandelle Acres Subdivision Chugiak, Alaska Dear Sirs: We have prepared and submit herewith an application for a permit to construct a septic system on the above -referenced property. The application is for wastewater only. This application is replace the existing wastewater system with new piping, a new septic tank and lift station, and a new deep trench disposal field. The property is currently served by a private residential well that is located on the property. A site plan (1' = 100'), a septic system layout plan (1' = 40'), and a disposal field profile and cross-section were prepared and are attached to show the new systems layout and it's relation to the existing wells in the area. The site is generally described as an approximate 1.1 acre developed residential lot. The lot is gently sloped at approximately 8% to 14% from back of the lot near the Hilltop Runway on the east to the front of the lot which is bounded by Chandelle Drive. Two soil percolation tests were performed on May 15, 2006 (Testholes 1 and 2). Two 14 - foot deep perforated monitor tubes were installed on May 15, 2006 and were monitored until May 24, 2006. Groundwater was encountered in TH1 at a depth of 12 feet and No groundwater was encountered in TH2. Soils encountered in the desired percolation zone between a depth of about 6.5 feet and the bottom of the hole are described as a uniform, homogeneous layer of dry, hard silty -sandy -gravel (GM). The desired percolation layer appears to be uniform across the site. The calculated percolation rate is 48 minutes per Inch for TH1 and TH2. This lot has available space for a new disposal field. The owner proposes to replace the entire septic system, but leave the existing disposal field intact as a backup in the future. The old and new disposal field systems would be connected with a diversion valve. The grade is uphill from septic tank to the new disposal field site so a septic tank/lift station and pressure piping will be installed. A new pre-engineered MOA -approved 1,500 -gallon septic tank/lift station (Anchorage Tank Model AT1500Ll0) will be installed per the manufacturer's instructions. Buried gravity piping between the house and septic tank will be replaced with 4 -inch diameter ASTM 3034 PVC gravity piping and 1-1/4 inch HDPE pressure piping Scott Hattenburg, PE between the lift station and disposal field. Loris Dilley, PE/CPG Based on a need for 5 bedrooms and an effective depth of 6 feet and a required application Dennis Linnell, PE rate of 0.45 GPD/SF, the required trench length is 138.9 feet. In order to maintain 4 feet David Lundin, PE separation above the observed groundwater, we recommend that the deep trench bottom be 3335 Arctic Boulevard Suite 100 • Anchorage Alaska 99503 • Phone: 907.564.2120 • Fax: 907.564.2122 808 South Bailey Street Suite 102 • Palmer Alaska 99645 • Phone: 907.746.5230 0 Fax: 907.746.5231 RE: Lot 20A Chandelle Acres Septic June 12, 2006 Page 2 of 2 installed at a depth of 8 feet with 2 feet of cover to the ground surface. The disposal field will be insulated with 2 inches of rigid insulation board 4 feet in width centered over the disposal field for frost protection. Insulation board will have a minimum compressive strength of 35 psi and be rated for burial applications. The probable impacts to adjacent properties are as follows: Wells. Six private residential wells are located in the vicinity on lots 6, 7, and 19 of Chandelle Acres, and lot 6 block 2 and lot 3A block 1 of Voyles Subdivision. The proposed location of the septic system is in compliance with current MOA and ADEC regulations for setbacks between wells and septic systems. Wastewater Systems. Because the proposed septic system location is already bounded on all sides by existing water wells, this project will have no impact on adjacent properties wastewater systems. Reserved Space. The existing disposal field will be used as a backup to the proposed new disposal field. There is also additional space for another disposal field if necessary. Drainage. The probable impacts to adjacent properties drainage will not be affected by the proposed improvements. The proposed septic system improvements will not change existing drainage patterns. Please also note that Dan Larson, the Owner, has requested approval to construct the improvements. He has completed the MONS septic installer program. If you need any additional information, you may contact me at (907)564-2120, or at shattenburq CDhdlala ska.com. Sincerely, _` t%F'-M HATTENBURG DILLEY & LINNELL, LLC / y�P�O.OF �Q��s�++,t • •9 /, (� i *: Scott Hattenburg, P. ./Principal I� ;•Soot L Hatt ;r AW Attachments: Percolation test results (2 pages) Ot��`"`=��� Septic System Sketches (4 pages) K: obs\06-022 Chugiak Larson Septic (File Only)\Lot 20A Permit Application Letter.doc Mu1 RATTENBURG DUEY 9 LNNELL Enomeermy conewlenl• L21 ! L„ ----------- -- T- I �O I Le I r BOAT. AILEA TOAZ MT A 77, C I L L — — I T-- _ 1 I MMY. W / I GRAD. I M�•maau rRECORD � K•rZ�IR !RD RMlEr � Y TC NO SELLS 1 16 LOT Roux Lb E OF tAAAA.. 49* wl� �`� ... . AAAA ....� , u r SITE PLm • SCM L Hattendry ;r • No. CE6739 �� 6-12—Deo GRAVEL Y DR�VC retic Waw 45m MNMmn MPE — —1 _ PSF.Of gt4s �1 Alan:: A" eaoe,- :SgAu. 80- 70 POA SYAvcAet;s * 49T��� . ...:..., 51=Pnc.SY5nC:1.4 LA-toc3r PLA4 Saan L 'rl •• No. CE6739 �l\\�:FfSS10M��� lo-12-O(o Lt 4 El 1 t li��l•_ �' ti : s?i i J 7a T-YPJCAU Ap5DcFnop1 TR"c" 11 Z1 *14TL ; k �, _ G�o7i�l�tlt.f, 'Pete PIPs Cc.Nc N T►.ni �) — 'D 2M ►J , Qw G.G. ; No. CE6739 �, _ G�o7i�l�tlt.f, 'Pete PIPs Cc.Nc N T►.ni �) — 'D 2M ►J , Qw G.G. ; Municipality of Anchorage Development Services Department Building Safety Division OnSile Water and Wastewater Program 47DO South Brag" Sl. P.O. Boz 196650 Anchorage, AK 995IM50 www cl anchorame ak us (907) 343-7904 ".'(ENGIN9LTARft3EALj.j e�.rra vasa •�!•.•• •.•• �•�' SMUL,rH��nivii ' ir10 jV : \�'� , /Soils Log - Percolation Test I `��������� Performed For: {� VAN Iia VIrA O Date Performed: S I I S• I n to ! Legal Description: L AD T 20 A, "b K10Eu.1E $C4 -S Township, Range, Section: TIS N Q I W 53 T141 - Depth (Feet) 1- ToQSoIL— 2- 3- G M n 51� caiRALIE, re a- s 6- :•::•; SnrtoY EsaavEl. Pcv� D . e • o (yM- Sa�iDY s- 5)L.rY 10- 6Pgtlrct. D t�GQ r 11- w.T: 13- BoT .J Floc E WAS GROUND WATER ENCOUNTERED? Ye.s 6 IF YES. AT WHAT DEPTH? i rLl L Depth to Water Amer alonitorhq? IZr E Date: S12K o(c Reading Date Gross Time Net Time Depth to Water Net Drop SIIs ol0 11:05•e, Fe r--!5 Ak- I 3:'I5*P 5 3/8" 2 " 4: IS P % '7/t3 If 3 " �1S 3o HtAI to 7/6 s S rr S:LiSSin mW 8 & s 8 PERCOLATION RATE �(ftM*.M M) PERC HOLE DIAMETER TEST RUN BETWEEN e FT chiAND!SFrTC TI--eCOMMENTS F,2 5BP/by7/ Gpe•e�o 7;!C-qt:Z PERFORMEDBY:��o77-F-i41T1�(�thtf? ) CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EF ECT ON THIS DATE. DATE: I/Z O Performed For: Legal Description: ruz Oepth 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 d anchoring ak us (907) 3437904 Soils Log - Percolation Test DA1.l Date Performed: U(p 2 LmT 2oa GI bn! 0EL-I-G AtPEr7ownship. Range, Section: TIS N R I w 5 ✓ �, ToPso1L.. GrYI - Snnto`r Cz QAOEL - 0 - 5A1JDY C�R4ur� G H - Sa�1oY 51L.ry GQWMs ph.a.0 -h---F— per 16- 17- 18 - WAS GROUND WATER ' IO OF At IN rhe ••9 * T ( Y�r S .a. ..e•: .^ • Scat L Depth to Water After NonIG O E C 6739 W •, 5- Soils Log - Percolation Test DA1.l Date Performed: U(p 2 LmT 2oa GI bn! 0EL-I-G AtPEr7ownship. Range, Section: TIS N R I w 5 ✓ �, ToPso1L.. GrYI - Snnto`r Cz QAOEL - 0 - 5A1JDY C�R4ur� G H - Sa�1oY 51L.ry GQWMs ph.a.0 -h---F— per 16- 17- 18 - WAS GROUND WATER ' IO Date ENCOUNTERED? IV Net Time Depth to Water Net Drop S IF YES. AT WHAT DEPTH? L Depth to Water After NonIG O E MttiiMd"g? Dale: 5124IV(, Reading Date Gross Time Net Time Depth to Water Net Drop 511571olP II;09A P2� 4K 3:FIs 5- 7- q,.15- 30 "(.1 9 -T/ a 0 ''45, 30tnv) toZz y2a `f S•I 80 X41"7 /!5e S/qtr S g:45- 3O A4111 -7 3/`I a a Nth 'B 3/ga 5/g N PERCOLATION RATE — /8 (ewulsvN ) PERC HOLE DIAMETER (o " TESTRUNBETWEEN 4.0 FT AND 6•5- FT COMMENTS OS4 57BPo41?,W'NS P/'v✓/Oe /99 to)= e,• �fFPc nµe VPpP TTPH c%-. PERFORMED BY: 5S�977- lit 7TF,JBt s,2 1-=54 -' r'A CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EF ECT ON THIS DATE. DATE: / D �Anl 407-Ir�d 7� / c -o � C), h- /~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ,A/d~-~.,,~:,,~/ ~.x'~,,~.,,'~~ it.~,~-z_~?~ ~ UPGRADE LEGAL DESCRI~PT]ON ~ ~ ~~~ ~ ~ LOCATION NO, OF BEDROOMS ~' DiSTANCE TO: I /~ f~ IAbsorPtionarea/~ ~ Dwelling ~2- ~ ~ Z Manufacturer~ · · 7 ~z~~~~7~" Mat~__~ ~- No. of compartments~ I . . IF HOMEMADE: Inside length ~ Width Liquid dep~ ~ -- ~ Manufacturer /~ Material Liquid capacity in gallons DISTANCE TO: Well //~ ~ Foundation~ /~ Nearest lot ~ /~ P ERMI~ ~ No. oflines~ ~ ~~ ~ inches Distance ~ Len~ ~a~ /-:~lin~ Total length~ Trench w,~ Total effec i~e ab~pti~ea ~ ~ Top of t,le to finish .rado ~ Materialbenoathtilo ~ inches Een~th ~ ~idth ~opth ~MIT ~0.  Tg~e of crib Crib diameter Crib Total effective absorption area m Well Building ~oundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE~ ~ ~O:~ ~u~d~o~ation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS~ SOl L TEST RATING ~/~ INSTALLER ~ ~ ~ REMARKS I ~ ~ ', X "' " APPROVED ~/~ 72-013 (Rev. 3/7~1 ~I_l~ ] C:IP~]LIT'T' LnF A~'4mZ:H.f~-,AGE DEPARTMENT Ot IEALTH AND ENVIRONMENTAL F. ,TECTION 825 L STREET~ ANCHORAGE., AK 9958i 264-4?20 I_-il'-J--~ I TE SEL~IER ._~: L-JELL PERr'I I T PERMIT NO: DATE ISSUED: 840~97 05?29?84 APPLICANT: ADDRESS: CONTACT PHONE: C?O S & S ENG~G. SRB 196X EAGLE RIVER, RK 294-29?9 AMERICAN EXCAVATING 995??. LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS: Sb~DI¥ISION: CHANDELLE ACRES SECTION: ~ TOWNSHIP: iSN 4~000 (SQ. FT. OR ACRES) LOT: 20 RANGE: BLOCK: LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THRT BEST FITS YOUR SITE. DEPTH TO PIPE BOTTOM (FT.> GRAVEL DEPTH (FT.) TOTAL DEPTH (FT.) GRAVEL WIDTH (FT.) GRAVEL LENGTH (FT.) GRAVEL VOLUME (CU. YDS. ) TANK SIZE (GALS) SOIL RATING (SQ. FT. ZBR> TREI'-.ICH BED I~1. DRF:t I N 4.0 4.0 4.0 6.0 0.5 g. 5 10.0 4.5 7.5 2.5 26.0 5.0 88. 0 ** 50. 0 11_~. 0 ** 52. 9 48. 1 87~. ,'-' i., 000. 0 ** l., 000. 0 ** 1.. 000. 0 _?-49 284 GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS <NOT EXCEEDING 75 FT. TANK MUST HAVE AT LEAST TWO COMPARTMENTS EACH) I CERTIFY THAT: i. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 2. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF ~ BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. IF~ A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES., THEN (1> AN ELECTRIC..8~ERMIT AND INSPECTION MUST BE OBTAINED~ (2> 8S-BUILTS WILL NOT BE 8PPROME~" WITHOUT 8N ELECTRICAL INSPECTION REPORT.~ 8ND (g) THE =, I GNED "r;" ~ ~ DSTE' -- LECTRICSL~BY 8 LICENSED ELECTRICISN. 8PPL I CSNT ~~~NG ~ ~ 8MER I E:SN EXC~VST I NG ISSUED DSTE' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] SOl LS LOG PERCOLATION TEST PERFORMED FOR: SLOPE LEGAL DESCRIPTION: 7 g DATE PERFORMED: '--~---- SITE PLAN 10 11 12 13 14 15 16 17 18 WAS GROUND WATER N S ENCOUNTERED? C) ~3 P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop I ~-z~--'o(.//:~,o, - ~7-~~' '---'- 'z.. , z .' , ~ ? 30 ,~ / ,,/. ~ ~ / PERCOLATION RATE TEST RUN BETWEEN 72-008 (6/79) (~ninutes/inch) (~ FT AND 7 t FT by OOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started ' Ended PERMIT NUMBER DEPTH OF WELL STATIC LEVEL OF WATER FT. '? ':'~" ':'d DRAW DOWN FT. GALS. PER HR ; ~' - ' KIND OF CASING · "~" KIND OF FORMATION: From From From ' Ft. to From__Ft. to From__.Ft. to . From __ Ft. to . From ~ Ft. to From : Ft. to From Ft. to Ft. to " Ft. Ft. to Ft ,~--'4 ,: /'~ % d From__ .... ~; From Ft. ~ ,.- :'. ~ ~'"" -~ ~:~ ''~ From__ Ft. -' ~¢' ,,.t i' ,<,-~ ,..C'~ From Ft. ~.~,~ ,~t . ,c :' , ~'-' ?, From~ 'Ft. ; f~";*': ¥:~"" From ' ' ~ ~ From ~ Ft : :". ~.; ,' ~ ~-'~ :'~- ; From From Ft. to Ft. From__ From Ft. to Ft From From__Ft. to Ft From From__Ft. to Ft From From Ft. to Ft. From From Ft. to__Ft. From__ From Ft. to Ft. From DEPT. OF HEALTH Ft. to ~N~I~N~NTAL Ft. to Ft. Ft. to Ft to Ft. to Ft, Ft. to Ft. Ft. to .Ft, Ft. to Ft. .Ft. to.~Ft, Ft. to Ft Ft. to.~Ft Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. MISCL. INFORMATION: DRILLER'S NAME • • .--6:7 Municipality of Anchorage .... ,1;.:%-,!:,, On-Site Water and Wastewater Program < ®ham 1...Er, - (907) 343-7904 SA <[TV Certificate of On-Site Systems Approval •,� 6 7 8 g�o. >, Parcel I.D. 051-063-92 Expiration Date: i :/��ir — ir- JULI22018 3 1. GENERAL INFORMATION 4t. c>Complete legal description Lot 20A, Chandelle Acres w 01 9 Location (site address) 23612 Chandelle Drive, Chugiak, Alaska Current Property owner(s) Danny & Angela Larson Day phone (907) 688-6877 Mailing address 23612 Chandelle Drive, Chugiak, Alaska 99567 Real Estate Agent Shanna Bloom/Core RE Group Day phone(907) 231-5656 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex - ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well K1 Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance:_ Received by: Date: 1/24// COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ / Wit, Waiver Fee $ Date of Payment 7,-1)--'/Y Date of Payment Receipt Number A')--7)-� Receipt Number COSA# 12 1 3 I Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems 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 Pinard Engineering Phone On) 232-1347 Address PO Box 871347, Wasilla, Alaska 99687 Engineer's Printed Name Paul E. Pinard Date 7/12/18 �d/®Boei�®� 04jdA.�®F A�S 6. DSD SIGNATURE Si . :49th "' ° � a I6 System#1 Approved for bedrooms .rr,-. -. —1 ----��, System#2 Approved for bedrooms c:°Paul E. Pinard / �` Disapproved "74 `��F°.`OE -4793,0 ..,I,� m dooms+ Conditional approval for bedrooms, with the followingstipulate/Wm",� FESg1�Q �dt� ` .\\:; OFi;,',/ �hG . ON-SITE y�\II . WATER P\1\1° 0 WASTEWATER 0 .c2. pROGRAM ,c. �. tj) By �—t Original Certificate Date: 2- •6 l The Municipality of Anchorage Development Services Division (DSO) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet: c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On Site Systems Approval Checklist Legal Description: Lot 20A, Chandelle Acres Parcel ID:051-063-92 A. WELL DATA Well type pvt. If A, B, or C provide PWSID# Well Log (Y/N) y Date completed 10/7/83 Sanitary seal (Y/N) y Wires properly protected (Y/N) y Total depth 236 ft. Cased to 235 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test. 10/7/83 6/29/18 Static water level 192 ft. 200+ ft. Well production 20 g.p.m. 4.0 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample:6/25/18 Collected by:Pinard Engineering B. SEPTIC/HOLDING TANK DAT STEP Tank Type/Material -34T /Steel Date installed 6/12/06 Tank size 1 500 gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (YIN) Y Date of pumping 7/2/18 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 6/12/06 Soil rating (g.p.d./ft2 ontediaohnix.45 System type Deep Trench Length 140 ft. Width 2 ft. Gravel below pipe 6.0 ft. Total depth 8 ft. Eff. absorption area 1680 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/29/18 Results (Pass/Fail)Pass For 5 bedrooms Fluid depth in absorption field before test 12 in. Water added 900 gal. New depth 24 in. '7 o Elapsed Time: 1350 min. Final fluid depth 13 in. Absorption rate >= 720 I g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) None Known If yes, give date D. LIFT STATION Date installed 6/12/06 Size in gallons Manhole/Access (Y/N) Y "Pump on" level at 21 in. "Pump off' level at 1R in. High water alarm level at 23 in. Datum Bottom of LS Cycles tested 2 Meets alarm&circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100 + On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 25 + Public sewer manhole/cleanout • 100 + Sewer/septic service line 101+ Holding tank 75 + Animal containment areas 50'+ Manure/animal excrete storage areas 100' + SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 5 '+ Absorption field 5 '+ Water main 10' + Water service line 10'+ Surface water 1001 + Wells on adjacent lots 1 00'+ ABSORPTION FIELD ON LOT TO: Property line 10' + Building foundation 10'+ Water main 10' + Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain None Known Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION OF Ate'-M I certify that I have determined through field inspections and 1 g��• t, •'•.T review of Municipal records that the above systems are in ** th % .100,1 conformance with MOA COSA guidelines in effect on this date. ; • 49t ='- • Engineer's Printed Name Paul E. Pi nard ♦ r° Paul E. Pinard :W Date 7/12/18 •'a;••.• CE -4793 &' % ��'•........••* 4& sil.PROFESS0,1411 COSA yellow sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE f Development Services Department �i On-Site Water 8, Wastewater Section Fax: 907Phone:907-343.7pp4 43-7997 Lift Station/Pump Vault Maintenance Log Owner- C- 7 Street Address a3 Sem Tank -Sludge level r' inches 'Pumping: required #4:_ng -Pumping completed •Pump basket cleaned '' nQ *Effluent filter cleaned Ala.gg *Control floats cleaned *Operation aatisfactnry 'Proper float settings cxxdirnw►d �� 4m ser -Dedicated electrical alarm circuit �r -Audible and visual alarm Inside dwelling 'Alarm system operationtF a eLpstatidazuy Manhole RF,..r -Ground water intrusion at riser to tank connection A -Ground water Intrusion around pipe penetrations ALA 'Weep hole functional •Menhde tid: Functional Gr-"" �(y no gnint Insulated no_ Properly Secured * -All manufacturer required inspections and maintenance carnpieted (4 no omen, 11 • • ce ' •_;. Techni ': y Date of niaintenenre 7.,�'f j Company S i Signgtui>9 - Data 7 ( Z / /' Z sc' �k/Y q4 .// LEGEND: � �Pg j (C)=CALCULATED DATA 0 •ck , (M)=MEASURED DATA I[jyeJ'C\j/ LOT 19U.G.UNDERGROUND=RECORD DATA PER PLAT �O UGE T&E=TELECOMMUNI CATION & / / ELECTRIC NAT.=NATURAL i / �4a,, PED=PEDESTAL / te. . 00N/11 LOT 20A ;Y��s (TYP.)=TYPICAL \ \ 'e 10,' �/ 48,740 S.F. �J� �os, \ '/ / i'� / UGNAGAS BUILDING r7/\ ` v NO FND. / -* pi aiIrri 0.5' ' �o 1(c.i> 2.3' c--- y :EIE:LLz., �_ REBAR1z• O b'. COVERED' , , , 04iia 4.2'6, �_ AREA S- �� `. ��.. SS ��4�"/ /��c, / A. se ''''.....1, 4.).--. .. G sj.' / yL.' - S � . • ,Jam\\ ,3' / Z r ./ : .I.. „ . k Y. \ /. Q / 1:6. CAP ekz �,© .�� \\,�<30 .7/ / " s 6 ¶,,HANGER -4 ... i 1 NAT GAS .` zS 1 - • : 49�± •y 4” PLASTIC — — / ., �, ' _ - RISER (TYP.) / oi ,v2, rj3 :A.:: LIG E--"*.' • s•: -." ,:• -.' * -S- _.. Z o _ : 0 I�" p 44 K O aI / — --. , :. �-:.:�::::•v .~' TRACT B-1 // / 77/ ,, / , // 1" = JV 50' NOTES: 1. EXCEPTING FOR GROSS NEGLIGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY. 2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY. 3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. 4. THIS SURVEY PERFORMED FOR DANNY & KIM LARSON, IT SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. REUSE OF THIS DRAWING FOR ANY PURPOSE NOT STATED ABOVE WITHOUT THE EXPRESS WRITTEN CONSENT OF FARMER SURVEYING LLC IS A VIOLATION OF FEDERAL COPYRIGHT LAW. EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. SURVEYED BY: FARMER SURVEYING LLC. MAILING ADDRESS: 6183 N. STEEN RD. WASILLA, ALASKA 99654. OFFICE: 9131 E. FRONTAGE RD. SUITE #21, PALMER, ALASKA 99645. PHONE: (907) 355-0620 EMAIL FARMERSURVEYINGLLCOGMAIL.COM 18-245FSLLC LLC#126467 ���N1ttt RJF ALASKA RIM N‘ �j 9131 E. FRONTAGE RD. `_``iP-\�o�F• A�1fff,, AS—BUILT PALMER, ALASKA 99645 . 6-0222 '+ 5.• • o . I �'9,��j� `doa Pdmer EMAIL: aPH: krriim®ala kanm.om : WEB: ww07)745-0222 : FAX: w alaskarim com 49TH i .* i ARE s WO: 1800334 FB: 18-052 •v/16......--_—___. • PAGE: 1 of 1 • ,�, a • SCALE: 1 " = 50' FILE. 1800334AS S `,a Robert J. Farmer .�o � '�...:". 10615-S Atte I HEREBY CERTIFY THAT A MORTGAGE INSPECTION WAS PERFORMED I��d fROF......'`:Pa9 pial+ CHANDFIUNDER M F ACRESY ION ON THE SUBDMSIONFOOT20A,ING DESCRIBED PROPERTY: •II fill.f ffttttff,�••• 7-,-/ll SURVEYED ON 70�EA29thOFGE UNEGOR018G DISTRICT, ALASKA. ©2018 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 20; Chandelle Acres Subdivision Location (site address or directions) ~.~7 Property owner Mailing'address HOMEOUITY File #2097-265865 Day phone Lending agency Mailing address Day phone Agent Jean Hohnst~in/MARSTON REAL ESTATE Address ?/ifl4 W~x~ Nn~.¢b~n L2gb~*.~; A~ohn~ag~_; A~'a~z Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well XX× Community well Public water NOTE: Day phone 248-2804 99577 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: XXX Public sewer If community wastewater system, prov!de written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address 17o34 Eagle River Loop Road No. 204 Earl. ~,;ver, A;aska Engineer's signature Phone Date '7-'~-~''~ DHHS SIGNATURE /~ Approved for ~"~ _(/'~)bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Bacl( MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST -~ Legal Description: ~:~'[' ~''~ ~-~t~4.~.-LJ.-F~ ~"~a'~el I.D. A. WELL DATA Well type ["~¢-~J~'t'¢ If A, B, or C, attach ADEC letter. Log p resent ~.~N) Total depth Sanitary seal ~/N) ADEC water system number '~'/,~ Date completed Lc::, - '~- ~5'5 Driller ~,J ~ 'J ~ Cased to ,~ c> Casing height Wires properly protected ~N) ~/ Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION ~ ~-z-' ~c~, ~,,'O. c~ g.p.m. ~"' ~ ~ 0 V--.- SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ~1 Sewer service line ,~.~-~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform C> ~'" ~/t0 O ~. Nitrate Date of sample: ~ -"Z-~ ~- ~--~'7.-- Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts ~f-~N) High water alarm Date of pumping Other bacteria I,.~c:) ~ ~ S & S ENGINEERING 17034 ~.ag;,u ~V-.;' ~---'?r~ ~aa-I NO. 204 Eagle River, Alaska 99577 Tank size \ c~.~/.~ Compartments Foundation cleanout ~(~N) '~ Depression (Y~_.~ /'~ Alarm tested (Y/N) ~'"'(/~' Pumper "~.~¢-~, /---.~l~f',",~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot to~ On adjacent lots To property line \ 0 *' Surface water/drainage Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level 'at High water alarm level Meets MOA electrical codes~(Y/~--~'~. '~ SE~ROM LIFT STATION TO: Well on lot On adjacent lots Manhole/Access (Y/N) Surface water D. ABSORPTION FIELD DATA Date installed ~' '~>'~f Length ~' ~ Width Total absorption area Depression over field Result~_____~ail) ~;;?/~5 ~ Peroxide treatment (past 12 months) (YN~/dpex- Soil rating --z~,~o[ ~/~.~.'/ Gravel thickness ~" Cleanouts present Date of adequacy test ~o ,J ~ If yes, give date System type ~"~1~ '''[ ~ Total depth C~ t bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~, c>C> t 4.- On adjacent lots ~ ~ C> ~ ~' Property line To building foundati.on ~'~ t To existing or abandoned system on lot On adjacent lots "~ ~ J~ Cutbank ~) t~ Water main/service line Surface water \ Curtain drain E. ENGINEER'S CERTIFICATIQN Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. $ & S ENGINEERING Sinnature 17034 Eagle River Loop Read Ne. = Eagle River, Alaska 99577 ~'~' Engineer s Name ~__ Date '~-'~ ~--'~'Z,- R J. HAA Fee $ //' ~) ~'~ ¢ Waiver Fee: $ Date of Payment ¢'-'¢"Z- Date of Payment ReoeiptNumber C~ ~J~>9~ ~°~,~_~ Receipt NumBer 72-026 (Rev. 3/91) Back MOA 21 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONM~ENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONI~ENTAL PROTECTION APPLICATION FOR H~ALTH AUTHORITY A~PROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot,jblock, sub~iviston, section, township, range) Location (a~dress or directions) (b) Applicants Name ~CP~'~/~ /~46 ~/JTelephone - Home Applicants Address ./O (c) Applicant is (check one) Lending Institution ~-~ ; O~r~er/builder~ ; Buyer ~--~ ; Other ~-~ (explain); Bus ines s (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) _Maj~ t~e HAA to the following address: 2. Type of Residence Single-Family,~, Number of Bedrooms blultJ,-Family! Other (describe) 3. Water Supply Individual Well~ Community ~-~ Public ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal i Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineerin$ Firm Providin~ Inspections, Tests~ File Search~ Data and Information 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Address Date DHEP Approval Approved for Approved Telephone (ENGINEER S~L)j ./ ..... ~' ........... ., '. bedrooms By ~,~ ~ ~~'.~ Disapproved Condi~ion~ ~ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY LkM INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN TItE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. F~[PLOYEES OF DHEP DO NOT CONDUCT iNSPECTIONS OR ANALYZE DATA BEFORE A . CERTIFICATE IS ISSUED. TIlE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERROk~{ OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] A® MUNICIPALITY OF ANCHORAGE (MOA) HEAL~ AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT ! O Well Classificatio~qn ~/~ ~ Total Depth ';~ 6' Cased to Static Water Level /_~ Casing Height Above Ground Electrical Wiring in Conduit~ Separation Distances f~cm WeIl: To Septic/q~~g~3--Tank on Lot To Nea~st Edge of Absck~ption Field on Lot To Nearest ~9~-ic-Sewe~ Line Pump Set At .RECEIVED ; On Adjoining Lots /d)~ ; On Adjoining Lots To Nearest Public Se,~er Cleancut/Manhole /~ / ~ ~ Nearest Se~r Service Line on Lot Wate~ Sample Collected By J'~.'_~ ~.g//~Y//~ ; Date Water Sample Test Results ~/~ 'FI $ 7~' ~ ~ 7 CcJm~ nts Date Installed/,% ~/~ ~ Size / ~ ~ No. of Cc~pa~tw~nts ~-~ Standpipe s (Y~) Air-tight Caps~ Foundation. Cleanou (~~) Depression over Tank (~)~ Date Last .Pumped Pumping/Maintenance Contract on File (Y/N)/'//~ ; for Holding Tank High-Water Alarm (Y/N)/~i~-~ Temporaz~y Holding Tank Permit (Y/N~ Separation Distances f~cm Septic/Holding Tank: To Water-Supply W~ll j/~ F To Building Foundation _~ ~ / To P~operty Line /~ To Water MaiP~Service Line Course /~ ~ Conm~nts ~ 0 ~ ~ To Disposal Field /C~ ' To Stream, Pond, Lake, ar Major D~ainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD E~TA Soils Rating in Absorption Strata Date Installed ~//~ .~ Width of Field ~ ~ Square Feet of AbsQrption A~ea Depression over Field (¥~.~ Results of Last Adequacy Test ~ ~-~ ~ Separation Distance f~cm Absc~ption Field: To Water-Supply Well ///~> ' To P~operty Line ~ f//~ Type of System Design of Field _~ t Depth of Field ~ ~ Grave 1 Bed Thickness 7 ~ Standpipes P~esent ~ Date of Last Adequacy Test /%~ To Building Foundation Lot /~/~ ~'J ~ ; On Adjoining Lots To Water--Service Line ~ ~- To Cutbank(if To Stream/Pond/Lake/c~ Majo~ Deainage Course To D~iveway, PalTking Area, c~ Vehicle StQrage Area Cca~Tents /~ ~ ,.r ~ TO Existing c~ Abandoned System cn D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Wate~ Alarm Level at Tested fo~ Electrical Codes (Y/N) Dimensions ~anhole/Access (Y/N) ['~Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets ~gA Cca~ents ** Check Pez~itted Bed~ocm Rating Against HAA Request I certify that I have checked, verified, o~ confc~m~d to all MOA HAA Guidelines on the date of this inspection. SRB 196~ Signed Company KB1/d5/s [Page 2 of 2] in effect Date/0/~ ~ -~ MOA No. 2-15-84 Whom It May Concer Susa' )swalt, Acting ~4anager R Envi~ ,~ental Engineering 0 Dept. of Health & Env. Prot. M Municipality of Anchorage SUBJECT i{ei%~th Au_4~horif_y for Lot_ 2,q.. £!~and~.l]~_ ~nr,.~ ~/n DATE T have ~l~o confir?._e~_ [~T~. 4S 472 SIGNED DATE SEND PARTS I AND 3 WITH CARBON INTACT - PART 3 WILL BE RETURNED WITH REPLY. DETACH AND FILE FOR FOLLOW-UP