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HomeMy WebLinkAboutHERITAGE HEIGHTS LT 15Her'il'oge Height Lot I 015-361 -34 Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181315 PID Number: 015-361-34 ❑ New ✓❑ Upgrade Name: TRAVIS & MEGAN PELTIER ABSORPTION FIELD ❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 5831 CHISANA WAY ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SF 12.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.0 Ft. Gravel depth beneath pipe 7.0 Ft. Subdivision Block Lot HERITAGE HEIGHTS 15 Fill added above original grade 0.0 Ft. Gravel length 45 FL Township Range Section Gravel width 3.0 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station I Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 630 Ft2 1 N/A Ft. Well N/A N/A N/A N/A N/A TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity I Surface Water N/A 100+ N/A N/A Gal. Material Number of compartments I Lot Line N/A 13.6 N/A N/A NA Foundation N/A 47.6N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain N/A I 50+ N/A N/A Gal. Remarks DRAIN FIELD UPGRADE ONLY Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank Tank to 3034 drainfield A+ HOME SERVICES Drainfield 3034 CO/MT 3034 Inspector PANNONE ENGINNERING SERIVCES BENCH MARK (Assumed elevation) 102.0 ft Inspection10/11/18 �s' dates: 2"' 10/11/18 Location and description 3d 12/19/18 4'h O.G. AT DOUBLE CLEAN OUT COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional �G Approval: Date .� . t Steven . 'Pa' nonW 19CE 8149 ���D�• Approved Date (0 9 p\� DESIGN PARAMETERS I UPGRADE SEPTIC SYSTEM L T 15 NO. BEDROOM: 4(600 gpd) TANK SIZE: 1250g (E) PERC RATE: <1 MPI SOIL RATING: 1.2 GPD/SF AREA RQD: 500 SF SYS. TYPE: DEEP TRENCH 7.0' ED MIN LENGTH: 35.7 LF USED: I 45LFx3.0'Wx7.0' E.D., 12' TD TOTAL AREA: 630 SF w i I U io 1 I= viz 1 mw m 00 m Of O 00 i 15' x 15' x 6.0'ED CRIB COMPLETELY REMOVED ANY PART OF CRIB AND BIOMAT W/1 14' OF THE DRAIN FIELD AND REPLACED W/ CLEAN FILL 13.6 DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 4(600 gpd) TANK SIZE: 1500g ADVANTEX W/ AX20 POD PERC RATE: <1 MPI SOIL RATING: 6 GPD/SF AREA RQD: 100 SF SYS. TYPE: DEEP TRENCH 5.0' ED MIN LENGTH: 10 LF USE: 1OLFx3.0'Wx5.0' E.D., 10' TD TOTAL AREA: 600 SF DRIVEWAY v 1250g SEPTIC TANK (E) 0 4BR HOUSE INSTALLED 2012 TO REMAIN (E) � W �Q B DECK RESERVE DRAIN FIELD (FUTURE 1 OLF x 3'W x 5.OED x 10.O'TD _ BASED ON CAT III ATH -1 z Q M2 ss ?� 10' UTILITY EASEMENT SEPTIC AREA / W INSTALLED DRAIN FIELD 45LF x 3.0'W x 7.OED x 12.OTD INSTALLED CO AND MT AT EACH END CONNECTED TO DCO(E) I w w m m z o o Z ABBREVIATIONS 'F1' ,2 73 TH TEST HOLE to (P) PROPOSED t5 76 131.0 (E) EXISTING 17 CO CLEAN OUT NO. 18 TOH MT MONITOR TUBE NO. a�z /20188RMEo. TYP TYPICAL NOTES: P� ONE ENG 99 L0 PHONE (907) 272-8218 FAX (907) 272-8211 „��►�� \® OF A/-,gslt� �"''�P• • • � t c.� / y j *. 49*I/� Steven R. Pannone ���F CE 8149 SOP Date 2/28/2018 RECORD DRAWING Scale DRAWN BY: HERITAGE HEIGHTS, LOT 15 TRAVIS & MEGAN PELTIER ACP P.I.D."NO -361-34 PERMIT NO. 5831 CHISANA ANCHORAGE, AK WAY 99507 1111F�fROfESS10NP�� OSP181315 PLAN sheet \ 2 OF 2 Lot 14 50 N89057'20"W 100,00 51 Utility _E�asement 1 S", CD 0 50 SCALE: 1"= 30' 01 Frame 0 < 0 L6 � Nt LLI O CID tv CD 0 50 SCALE: 1"= 30' cu E U) LOT 15 M Uj Septic Vent (typ)-16 — — — — — — — — — — 10' Utility Easement N89 -^57'20"W 125.00 Lot 16 "Nx NX 4%` ff Aw ,ow C).* Aoth ...... 00 01 : N "a"''0, MUNICIPALITY OF ANCHORAGE • On-Site Water&Wastewater Program N° . ,5ri. 4 ° c`� PO Box 196650 4700 Elmore Road •— � Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,� r. `� " i httpa/www.muni.org/onsite '"6 I :. .\ J/ _ Dt.parttn( nt 4"CHOPA(,' On-Site Wastewater Disposal System Permit Permit Number: OSP181315 Effective Date: 9/19/2018 Work Type: Septic Upgrade Expiration Date: 9/19/2019 Tax Code Number: 01536134000 Site Legal Address: HERITAGE HEIGHTS LT 15 G:2438 Site Mailing Address: 5831 CHISANA WAY, Anchorage Owner: PELTIER TRAVIS M & MEGAN K Lot Size in Sq Ft: 17307 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4 This permit is for the construction of: 0 Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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) 343-7904 (24/7). 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 Received By: A/AA��A L L , A ` Date: 9/ –b7/5 U Issued By: ��. ,W— '7lf L Date: 17 fr i EOJ3 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-361-34 Property owner(s) Travis & Megan Peltier Day phone Mailing address 5831 Chisana Way, Anchorage, AK 99507 Site address 5831 Chisana Way Legal description (Sub'd., Block & Lot) Heritage Heights, Lot 15 Legal description (Township, Range & Section) Lot Size 17,307 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field n Initial U Single Family (SF) (X (w/wo ADU) Septic Tank U Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings Privy ❑ (SF and/or D) Private Well ❑ Water Storage n THIS APPLICATION INCLUDES A VARIANCE I 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/Rush Fees: 5-0 Waiver Fees: Date of Payment: q` 118 Date of Payment: Receipt Number: 670 C/Cj Receipt Number: Permit No. QS P1 (3)5 Waiver No. Permit App_:-:• c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181315, Deb Wockenfuss, 09/19/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181315, Deb Wockenfuss, 09/19/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181315, Deb Wockenfuss, 09/19/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181315, Deb Wockenfuss, 09/19/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181315, Deb Wockenfuss, 09/19/18 Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE NUMBER OF FROM WELL~?,/~t MANUFACTURER ~-)'~ ~^~ MATERIAL ~-~-/' COMPARTMENTS / INSIDE LENGTH '~ INSIDE WIDTH -- LIQUID DEPTH ~ LIQUID CAPACITY /~0¢~ GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER / ~)~ OR WIDTH__, LINING MATERIAL )~C~-~' CRIB SIZE: DIAMETER BUILDING FOUNDATION ~C~,'~'~>NEAREST LOT LINE ADDITIONAL ABSORPTION ) LENGTH__, DEPTH ~' DEPTH ~-~ DISTANCE FROM: WELL~'~"~'a"~ ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~--r--/~9 ~/ SQ. FT. WELL: TYPE~'~/~q/''/¥ , 7'''~ CONSTRUCTION BUILDING / NEAREST FOUNDATION __, LOT LINE CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE DEPTH DISTANCE FROM: SEPTIC SEEPAGE , TANK __ , SYSTEM REMARKS DISTANCES: DIAGRAM OF SYSTEM PIPE MATERIAL: ~/// LOT SLOPE: REMARKS: Form No. LQ-031 DATE /~DO/r~ :~ APPROVED GREATEr ANCHORAGE AReA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT PERMIT NO. .~, _ *~ ~ . ~ · MAILING ADDRESS tYpe anD siZe of fac,l~y to bESErVED ~~ ,~'~ SOil TEST RESULTS /, ~ NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE Pit SEPTIC TANK TO SEEPAGE PIt WAll SEPTIC TANK '~ / · SEEPAGE Pit TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAin TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, , SEEPAGE Pit DRAIN FIELD ! ., DRAIN FIELD SEEPAGE Pit ALSO CONSIDER AREA WE~LS. ! . SEEPAGE PIT ! , DRAIN FIELD TO RIVER, LAKE, STREAM. CA~4- iEON irqlU~-~-E7 OUT of-SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET I__~LTJ:~JJ~LD~J~D_..~OIL. 4 INC.H DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT rEMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING iNSTALLATION. i I I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGF-~A BOROUGH ORDINANCE N~). 28-~i8 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE FORM 6 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road 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 Parcell.D. .015-361,-34 C 0 S A -4— 'l. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HERITAGE HEIGHTS LOT 15 5831 CHISANA WAY *ANCHORAGE, AK. 99507 JOE WEINBERGER ... Day phone 5831 CHISANA WAY *ANCHORAGE, AK 99507 ... Day phone BOB BEAR WZ DYNAMIC PROPERTIES Day phone 3111 C STREET *ANCHORAGE, AK .99503 Unless otherWise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 229-1939 261-7600 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community ClassWellCommunity 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 samples. (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 engineers work. As certified by my seal affixed hereto and as of the validation date shown below, 1 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. t 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 andlor 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD, attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. _ can therefore. not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 337-6179 Date OF A q�� ffr �/ A Garn!ess: P E-79 r@� Z,P,ofessi0 a Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory 0 Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report ON-SITE 'CATER AND "~ a WASTEWATER PROGRAM •" Nitrate Advisory Other By: Original Certificate Date: -- (Rev,11105j r4lun^c~paRty of Anchorage Deveiop.m. er.f. Sierv^ces Department Building Safety Division On -Site ���&�e��t����� ~�L� 470UElmore Road PD.Box 1g0050 Anchorage, AK80510'6850 vmwwmuniorg/onnihe (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST HERITAGE HEIGHTS LOT 15 Legal Description: A. WELL DATA PUBLIC WATER Well type _____- |fA.B.orCprovide PVVS|D# Date completed ______ Sanitary seal (Y/N)__- Total depth_____ -ft. Cased to_____'ft. FROM WELL LOG Date of test � Static water level _ Well production _ WATER SAMPLE RESU ft. g.p.m. Parcel \D: 015-361-34 Well Log (Y0N) Wires properly protected (Y/N) Casing height (abo round) AT IN CTION Coiiform 100 noi Nitrate _mg./L. Collected by: -ug./L. Date ufsample: _________. B. SEPDCHHOL[>\0G TANK DATA TankType/K8ateha| SEPTIC/STEEL Date installed y /10/73 Tank size 1000 gal. Number ofCompartments 1 C|eannuts(YYN) YES Foundation cleanout (Y/N) YES Depression over tank (Y7N) NO High water alarm (Y/N) m A Date nfpumping Pumper ROUND THE CLOCK PUMPING C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ftbr 114 System type CRIB Length 17 ft. Width 17 ft. Gravel below pipe R ft. Total depth *10.5 ft. Eff. absorption area 404 +2 Monitoring tube **YES Depression over field NO Date ofadequacy test Reou|ts(Paes/Fai}) PASS For 3 bedrooms Fluid depth in absorption field before test 19 in. Water added 719 gal. New depth 58 in. Elapsed Time: 122 min. Final fluid depth 42 in. Absorption rate >= 450+ g.P.d. Any rejuvenation treatment (past 12mo.)(Y/N&type) NONE KNOWN \fyes, give date - **COULD NOT VERIFY 6 FEET OF EFFECTIVE. CRIB DEPTH MEASURED THROUGH MT WAS 4.41 FEET. Vate installed Size in gallons "Pump on" level at —in. "Pump off" Cycles tested RFD TF"TVaW 0=1 . - t�*# I Sewer /septic service line Manhole/Access h water alarm level at in. Meets alarm & circuit requirements? PUBLIC WATER On adjacent lots On adjacent lots 120=1 manhole/cleanout Anom ent areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ — Absorption field 5'+ Water main 10'+ Water service fine -,� i D'i Surface water 100'+ Wells on adjacent lots 100'+ PVT/200'+ PUBLIC 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 1 00'+PVT/200'+PUBLIC F. COMMENTS DURING INSPECTION IT WAS NOTED THAT THE SYSTEM IS <50' FROM A SLOPE >25%. G. ENGINEER'S CERTIFICATION o6 OF A I certify that I have determined through field inspections andH ....... review of Municipal records that the above systems are in ... ...... conformance with MOA COSA guidelines in effect on this date. fft Engineer's Printed Name JEFFREY A. GARNESS E-7953 Date r/it ro f e S S10n111\�_� 0� COSA Fee t 0 Waiver Fee $ [U1 Date of Pamenta — 0 y� Date of Payment 6"! 0,Q, I Receipt Number Receipt Number (Rev. 11/05) 8350M / Lot 14 / 50 N89057'20"W 100.00 5' Utility Easement — — — — — 2. o WPP 1 .�•: _ P © I c E Wood $' ra�1e fence 2 story C) C) I 0) w (typ) v L6 asI ( 1.0 O `25 3.0 _17 U 42.0 ck <>; W m � o I C Septic vents�� co ¢ I r z E � Q E 0 C' LOT 15 I n W z I zWoad w ret.wall (typ) o I ` U Septic vents ( — tN Wire fencea I = O o Z Wood fence I 50 10' Utility Easement 25 N89057'20"W 125.00 Found 5/8" rebar with Yellow Plastic Cap I ound 3" Aluminum Cap Monument Lot 16 RECERTIFIED 8-16-10 AS -BUILT hereby that I have Mortgagee's inspection 0 j" , I certify perfomned a �„ ' `" . • "^-^�, i of the following described property: LOT 15 HERITAGE HEIGHTS SUBDIVISION 49 TH d' Tt Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines i� ............ and do not overlap or encroach on the property lying Fred lying d tNalatka fs adjacent thereto, that no improvements on the property ,✓ adjacent thereto encroach on the premises in question and '• No. 3255-S transmission lines or other � that there are no roadways, t � Q � visible easements on said property except as indicated SCALE: 1 "= 30' t' , • ,• • , .� `$�'��FFSSIOM-_ Z' hereon. •� °� Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN this 3rd day of JUNE 12010 THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES PLAT ARE NOT SHOWN HEREON. Fb 10-3, pg 12-13 BE(907-248-1666) Engineers and Surveyors MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of EnvirOnmental Services ' On-Site Services Section' P.O. Box 196650 Anchorage, Alaska 995196650 - 34,3-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O/~'--~/-3~ 1. GENERAL INFORMATION Corn plete legal description Lot 15; Hc,t.Z~ge HcZgl, u~ ._ Location (site address or directions) 5831Ch~sana Way Anchorage, AK Property owner Mailing address Lending agency Mailing address Randy and CharleneBrush 5831Chisana Way Anchorage, Day phone AK 99516 Day phone Agent- Jack Blair/ REMAX PROPERTIES ' Day pho.ne Address 2600 Cordova 'S~t, '.~.. S~".7.~i~~0 .'~.. Anchorage, AK otherwise 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: 346-5499 :-" ' Individual well - - ............. Community well Public water Y, XX ............ If.community well system, provide written confirmation from ~. ',te ~DEC ing to the legality and status of system. -'~ . 4. TYPE OF WASTEWATER DISPOSAL:-:': Community on-site . .. Public sewer If community wasteWater system, provide 'written confirmation from State ADEC attesting to the legality and status of SyStem. NOTE: 72-025 (Re~. 1/91) Front MOA#21 5. STATEMENTOF..INSPECTION BY ENGINEER S & S ENGINEERING Address 17034 Eaale Riv,~ L,~.-'~_---__~ ~=. 29_*/ signature ....... / ,/ / Engin~fs ~ . . 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, functio hal 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 compli'ance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm · ,~,,,, ~ -~ ,,. , ?~ ,.: .,. ....... d . ~* :~A* :*. .~::~. Approve... ...... .::- ...... .... · cOnditional approval for'- b~rooms,' with the following stipulations: Additional Comments \,\ t Th~MtJnicipality 0~ 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 DHH$ 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 p~ofessional engineer;s work. 72-025 (Rev. 1./91) Bacl~ MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAl. CHECKLIST Well Log If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Total depth Sanitary seal (Y/N) Cased to Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 WELL LOG AT SEPARATION DISTANCES FROM Septic/holding tank on lot Absorption field on Public ;On adj On adjacent lots Public sewer manhole/cleanout line Petroleum tank WATER SAMPLE RESULTS: Coliform 4~f- Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts ((~/N) High water alarm (Y/~ Date of pumping Tank size /(_.b~ (~¢ Compartments / Foundation cleanout (~N) Y~ Depression (Y/I~ ~ , )~)/~ Alarm tested (Y/~D~ /,,3/~-) I I /l~ /?~ Pumper ~_~AAC.~' '~:' SEPARATION DISTANCES FROM SEPTIC/~G TANK TO: Well(s) on lot ~)/~ On adjacent lots To property line I(~ 4 Absorption field I..~ Surface water/drainage lO0 '/ Foundation ~ Water main/service line /(_.) ~ 72-026 (3/93)* Front CONTINUED ON BACK PAGE Date installed "~.., ~ Manufacturer ., Size in gallons '~. Manhole/Access ~ Vent(Y/N)__ __"Pump on" leave 'at. ~..-~'~"Pump 0fi" Level at High water alarm level .~~Cycles tested __ Meets MOA electrical codes (Y/N) J SEPARATI~IFT STATION TO: ~- On adjacent lots _ Surface w~_ FIELD DATA D. ABSORPTION Date installed 4/,0 )'~..~ Soil rating (GPD/FF) [] ~ $~/~1?-- Systemr- ~type Length I ~'' Width ~' ' Gravel thickness -~ Total depth /0 Total absorption area /-/0~ ,~ Date of adequacy test ~/~, I~ 5 Water level in absorption field before test Peroxide treatment (past 12 months) (Y/~)) Cleanout present (~1) Results (pass/fail) t//£s Depression over field (Y/I~ ?~D~, for ~-~ After test If yes, give date ~,-JG Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain /66 On adjacent lots ¢-/q-C~ '¥ Property line /0 ~ ! 0 To existing or abandoned system on lot /~/~ Cutbank /,J~ Water main/service line /0 ~/ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION Si nature _ /; Eagle River, Alaslca~g577 HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number APPLI~NT FILLS OUT UPPER HAI~ ONLY Property O~ner Phone Mailing Addre~ Zip Code Buyer Address Zip Code Lending Institution Phone Address Zip Code , ~.~C , C ~ ~ t:~ ~ ~ ~. Phone Address ;~ C'.~ '7 / Legal Descript~n ~ Street Locati~ ¥*:?. Type of Resi~nce ~, Single Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply ' Individ~t A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.  ~m~i~ For wells drilled prior to that date, give well depth (attach log if available). Public Utility Sewer Disposal ~ Individual Year Individual Installed: ~ Public ~ility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: -'~ ~ (~&.~dz..k.~.~,c,.~ MUNICIPALITY OF AMCHOP. AGE D~DT C'~ ,,-'~';' ! ~ ENVIF-.-J, ,it. :[', ,~-- ...,~ RECEIVED ( ~-~'~PPROVED BEDROOMS 'CONDmONS OF *PPROVAL ( I D~SAPmOVED ( ~ COND~T~ONALAPPROVAL' Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size Date Date Date Inspector Inspector Inspector Comments ~-\ / Conditional Approval Date Sewer Installed '~ Permit No, Septic Tank Size ~ '~ 3 Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ~~/~' Mailing Address ~ Buyer ~ ~ Address Phone Address Type~f Residence ~ Single Family : Multiple Family No. of Bedrooms : Other Water Supply : Individual A~ACH WELL LOG. A well log is required for all wells drilled since June  Community 1975· For wells drilled prior to that date, give well depth (attach log if Public Utility available.~ Sew~e Disposal ~ ~.~i~idua~ Yea~ ~.di~idua~ ~.sta,e~: : Public Utility When Connected to Public Utility: : Holdin~ Tank "~- THE INSPECTION FEE ~UST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ALASKA enuiBonm nTAL CO[1T[ OL $ itUIC $, I[1C. ~n~jineerint~ 8 ~uironmentel Stuclics 3/12/82 MUNICiP.AL1TY OF ANCHORAGE ECE! E DON KEENE SRA BOX 62-X ANCHORAGE AK 99510 SELLER - DON KEENE BUYER- SUBDIV]BION-HERITA G E HEIGHTS BLOCK- L 0 T-15 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM ]B A PIT WITH AN AREA OF 404 SQFT. THE SYSTEM ]B CAPABLE OF ACCEPTING 700 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM ]B 473 GALLONS. BASED UPON THE TEST DATA THE SYSTEM ]B ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 3/12/82 . SEPTIC TANK ADEQUACY THE EXIS'ITNG SEPTIC TANK VOLUME OF TH/B 3 BEDROOM HOUSE. 1000 ]B ADEQUATE FOR 1220 UJes! 25th Auenue · Anchoracle, Alaska 99503 · {907) 276-1361 MUNICIPALITY OF ANCHORAGE //>:;>-~--~--~.~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~ICIPALITY ?_~.~~'~ ? 825 L Street- Anchor;,§e. Alaska 99501 DEPT. ' ENVIRON],' ;':,~1.! :. :' : CTION .~. ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 U E b ic::c': ~(~ REQUEST FOR .APPROVAL OF IND,VIDUAL WATER AND SEWI~RI~I.I~TJl~ DIRECTIONS: Complete all parts on page 1. incomplete requests will not be processed. Please allow ten (10) days for processing, . PROPERTY OWNER ADDRESS PROPERTY RESIDENT (If different from above) 2, BUYER MAILING ADDRESS T PHONE PHONE --~- , ~ 1 PHONE ~~ 4. REALTOR/AGENT MAILING ADDRESS L- c -f lA STREET LOCATION .~, ¢ _5'/ 6. TYPE OF RESIDENCE ~' SINGLE FAM LY ?~ MULTIPLE FAMILY NUMBER OF BEDROOMS ~ One [] Four ~ Two ~ Five ~ Three F-__I Six Other 7. WATER SUPPLY ~.--- INDIVIDUAL'* OO M M U N I TY PUBLIC UTt LI-FY * ATTACH WELL LOG. A well iog is requh'ed for ail wells drilled since June 1975. For wells drilled prior to that date, give well depth (ettach log if available,) 8. SEWAGE DISPOSAl.. SYSTEM DUAL/ON-bITE F'~j PUBLIC UTILITY m~.wdual/on-s~te give installation If system is over two (2) years old ~n adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-0i 0(3/78} THIS SIDE FOR OFFICIAL USE ONLY ' DATE RECEIVED INSPECTION APPOINTMENTS TIME ITIME TIME DATE I DATE DATE t NSPECTOR Jr INSPECTOR ~ NSP ECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE ~__.F-: SINGLE FAMILY MULTIPLE FAMILY [] ONE [] THREEL~ FIVE [] TWO ~ FOUR [] SIX OTHER 2. WATER SUPPLY [7 INDIVIDUAL r:~'j CO M M U hi I TY [] PUBLIC UTILITY Connection Verified PERMIT NUMBER 3, SEWAGE DISPOSAL SYSTEM ~ INDIVfDUAL/ON -SITE L~PUBL!CUTiLITY DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED Connection Verifieci INSTALLER [---~Septic Tank or [~ Holding Tank t Size: /l~__OO If Tank ishomemade ~'0-T'~-~'~-~I give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: MATERIAL Septic/Holding Ta Area ISewer Line Neares~ Lot Line Absorption Area to nearest Lot LSne 5. COMMENTS DATE APPROVED FOR _-~). BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) DISAPPROVED ' L E Gt;~,E~-E-~:C R I P T 10 N (Rev. 3/78) JML John M. Lambe, P.E. PERFORMED FOR: 4303 North Star Street Anchorage, Alaska, 99503 907-279-8056 ~.~.~,, PHO~'~ Nb~4BER 276-~t 13 SOIL ~BSORP~IO~T ~ Z,ST~4 TEST NO. OF BEDROOMS: ~ RECORDS ON FILE: o /~ CRIB, ~, DRAINFIELD /------OT~ ~~ ~ TEST PER~RMED IN AC~ORDAJC~ WITH JML STANDARD PROCEDURE ACCEPTED BY MUNICIPALITY OF ~CHORAGE, DEPT. OF ENVIRO~,~ENTAL QUALITY ON ~ WI~ THE ~LLOWING MODIFICATIONS: TELEPHONE: DATE OF TESTS: SURGE CAPACITY: SEPTIC TA~ PLUS SAS ABSO~TION RATE ~~ A~RAGE 24 hrs ~~~ STEADY STATE RISE JML / OF '~. John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907-279-8056 DEPTH BELOW METER READING GALLONS PUMPED TIME ~REF~ENCE ( GA~.TONS ) ( NE~ ) , ~, /~;,~ /~ '. ,.' ~C] /-3 · ,,, ., ' v ~ 7 ~ " ,~x."~ ~'~0 / o .'/ 7.//Y/ //;la John M, Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907-279-8056 ,:LEGAL DESCRIPTION: /_z'_~'"'/'~/' /~-/~z., , ' ~,:,D]CPTE :B2Z,,OW .ME~ER READING GALLONS PUMPED - TIME GREATE GE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Date Received ? Time of Inspection Date of Inspection 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: A. Type ~Z..~.~ ' B. Depth C. Construction Sewage Disposal System~ A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: D. Bacterial Analysis Total length of lines 8. Distances: A. Well to: Septic tank , Absorption ar~ea , Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page ~2 of two pages - Re st Legal Description for Approval of Individual & Water Facilities Comments Approved ~ ~. ~ Disapproved Date ~ Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Type of Inspection: Property Owner: Mailing Address: Name of Buyer: ~m ~ Mailing Address: Name of Lending Institution: Mailing Address: Name of Realtor or Agent: Mailing Address: CMRO VA FHA CONV /~ Day Phone Day Phone Phone .. ~:?- ~- ~. Phone ~_~ Legal Description: Location: ~/~. /'-& / o Type of Facility to be inspected: Water Supply Type of Supply: Public Utility _~ Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation No. Bdrms. Individual (on-site) EQ-037 (1/74)