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Home My WebLink AboutWYNTER PARK #1 BLK 1 LT 11Onsite File W ynt��r P rk.. Lot 10 Lot 23 l - UTILITY _ � 1 EASEMENTS Lot 12 iRa i L=1j0.06' 'R,=30 @ 1@ 2@ IN PARK DRI v E Lang & Associates, ince Pro`iesslonal Land Surveyors NOTE! THE L97 Is SERVED BY A COMMUNITY WATER MUM b,22-1;476 Phan@ 592-4625 Fqx I h@r@by @@r#ffy thgt i hgv@ §Ljr-v@y@d th@ following d@@@ribod e@fty= LOT 11, BLOCK 1. WYNTER PARK NODIYIMON NQ- 1 7,,.149) Angherga@ Alm -kLa, @nd th@t th@ I-rl'►.er@v@m@nts mit@gt@d th@reen gr@ within th@ pr-@p@rty line@ end ds net @n@rg@@h enie ih@ prgp@r3y Qdja@@nt th@r-@t@, thgt no lmprgv@Monts @n th@ pr@P@rly lying Bolo nt th@r@to m6min-0 on ih@ gmry@y@d pr@mlg@* qnd that th@r@ gr@ ne r@adw@m tr-mmi@el@n lfn@@ or eth@F vi@lhi@ @gsem@nt@ on sgid prop@rfy m mpt as INIpmtmd h@rg@n= ItoW thim th@ ==A' BM of f—MVV-3L94- 1-722 , gt An@horfla@. AlggM It I@ th@ rapongibllihr gf th@ ewn@r t@ d@t@rmin@ th@ @Klgt@ng@ of gnY e@g@ment@, @Qv@nentm, @r remtrietlens whish do net @pp@gr @n th@ r@Gard@d m@bdivi@isn plgt, MUIMICIPALITY OF ANCHORAGE DEPARTMENT QF HEALTH & ENVIRONMENTAl_ PROTECTION ENWRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT PHONE ~ E ~'-'-- c/ LEGA,L DESCRIPTION I Liq. capacity in 9aliens DISTANCE TO: DISTANCE TO: L,O~IDly/ __ _ Length of eac~ !I.~0 / NO. of lines / Type of crib Crib diameter Well DISTANCE TO: Total 19~.~.~o f, lin es Material beneath die Oopth Nearest lot line ' P IT NO. .- No, of compartments Liquid depth PERMIT NO, Liquid capacity in gallons Total eff~tiCe absorption area PERMIT NO. q eta1 effective absorption area Nearest lot line Distance to lot line OTHER PiPE MATERIALS INSTALLER REMARKS APPROVED% DATE L GAL 72-013 {~ 3178) 4 ~ QGRE ,ER ANCHORAGE AREA BOR ,JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~ (~I, LA~__(¢~,, _ MAILING 2~ -- ADDRESS~F ~/~ ~ ¢~_~ PHONE~"'~ SEPTIC TANK: DISTANCE FROM WELL '~:~2- INSIDE LENGTFI _MANUFA£TURER,'-~-',~,,~ MATERIAL INSIDE WIDTH NUMBER OF COMPARTMENTS __LIQUID DEPTFI .... LIQUID CAPACITY /¢)-,~-'/.;i _GALLONS. SF-EPAGE PiT: NUMBER OF PITS LINING MATERIAL BUILDING FOUNDATION____ ADDITIONAL ABSORPTION DIAMETER ____ OR WIBTH CRIB SIZE: DIAMETER NEAREST LOT LINE'~~ LENGTN I~"J,~DEPTH TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) '-'"~'~ f SQ. FT. WELL~ BUILDING FOUNDATION CESSPOOl APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES _ DISAPPROVE[) NEAREST SEWER LINE REMARKS DEPTH__ DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES:~'¢) 1~, DIAGRAM OF SYSTEM INSTALLED BY; _L) PiPE MATERIAL: (~,...~O C_~'~L'___ LOT St_OP~i~ REMARKS: Form No. EQ-031 G.A.A.B. L.i:I, t3:1_ I,,lrl',fL.L. FhM,.. I::/i':'t:::'1.,, :[ CFII'.,!T L 0 C R T :[ 0 t",t L ~YC'iF:!I 'T"/F'E OF SOL£1... HE ......... M !L[l"~l'.l .... IE.!I ,[.=,. tkt=l,,t, ll F.f ) 1 .[ big ( SQ r::'~'., :,,=,. .... .. THE: F;:E:g!I..I]:P;:E:D :,.[ZE Eft:: THE SEC[I,. i~E..,...,...IF.F []~_t,f .... Ell .... : THE/ t..ENI3"FH D :[i"IENS I Oi',1 !' ?.; THIE L..ENGUlH ( .l_'l'.J. FEET ) OF '1 HE TI:;~:IEI'.rlCH OR f_'),~;ffr~]7!'.,IF':[ E!..ID. T,t"IF~ r.':,EPTH OF' FI TREi',ICH O1:;,: GI~:OLII'.,ID I=tI'.,!D THE Eu3'T'FOI',I O1::' TH_E: E',:.:iCI:~',/FI'T :[ ON (;I;19, FEb-.."F). 'rHE,~;4'.E :['3 I'.,IO SET I,.!)TDTH I=OR "FI.~II:~!: Gt'q2::'.IVEL. t?,E!::'TH J.S 'FHE t',l;[l'.~;[I-,1Uf,1 DEF"T'H OF Cil:d:l'v'E~L. E~E:T!.,It21Ei',! 'FH[!: ([d. JTFt::fL!... F:']TF:'IE F~i'.,ID -I"lqE 13CiT't"('_'lrq OF THE E',:.:',E:FI'v'FIT ;[ ON EiE (;:~ t.J % rf:;~: !tiZ It::) ::E~; E: IF::' 'T' I::~11~:~'.1"1~'I'' FIF'F:'I_'I:EFII'..I"F bll::l'/~; THE: F;:tE'L-~F'::I'-I'Z:[E.:ITL..i:'I"h.' 'rEi :l;i'-.IFOl:;;fi-,1 "I-H:[tE; DE:F'FhR~:'T'I'1~=:I'.:!T IlL. If t_..I..~ f 1 ..i',! :[I",I"3F'ECT:[ONS CIF:' FIN"/ IIE:.I_.L.=, F:II:)..)'FIE:Et',IT TO TH]:S ~ L ~t EL., ~ I::!1',I[) TI'tIE f";II..II'"IBEI~ OF fi'F':::" .... [',l::.'l'.l :: lES TI'"IFIT THE I.,.IEIJ_ I.d ! LI.. ':'LF.,:' ", I::..-' I'1 ]: t",! ]: I"llJivl [:, ]: ~i.~;'T'l=tb~lZiE ~:,~. [ I-.lc. El :t R I,.IE~:[ ..... I Rh![:, FII",I"/ LiN r. :' .[ I E. SEF!FIGE [' .I. :'1' ...:' L.. ~ .: .... , i'''.:' .... tOO FE%T F''"F' F:I FI' , "~ ~"F OF FUE'!...1--. HELl.-. ~ F'"'H THE ~'.. - '" i"1~[ N ]; r"llJh'l D :[ S"t'F:IblCE F'f~%ll"l FI F'f~;[ ','FI"I'E I"IE!J... TO t;:1 F'I:;?. ;[ VI::I"I"E- SE!'.IER L ]: NE J: S '? FLEE: i' F:Ii"fI:;' TEl F:I COi'INIjN I 'T''¢ SEI'~ER L.. ]: NE ~1: S ';:'~5 FEET. FIVRJi:L..FIBLE TO ].I',:'UF(E F' F:~zF '[H'::~TF:II [ FI'T']'-'I'I. RPPL :[ E:FINT F!I..,.I...EN PONTIE GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHOI:~AGE, ALASKA 99503 TELEPHONE 274-456 I SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF' SEPTIC TANK PERMII'NO ,-COT'/! SEEPAGE PIT DRAIN FIELD . OTHER COMPLETION DATE ANTICIPATED TO BE INSTALLED BY NOTE: TI'II5 PERMIT l:B NOT YALID WITHOUT SOli TEST FINAl_ INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE 13EFARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK ~IZE /~'~ ~O WELL TO SEPTIC TANK- t SEPTIC TANK, I00~ ., SEEPAGE PIT .I/ TO RIVER, LAKe, STREAM, ALSO CONSIDER AREA WELLS, _. SEEPAGE PiT _ ~/0¢ CAST IRON INTO AND OUT OF SEP'rlC TANK AND INTO CR[B CROSSING GAP OF EXCAVATION 5 PEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA E~OROUGH ORDINANCE NO,.2B-68 AND THAT THE ABOVE DATE 7-- ~:'~"~?- ,~ - APPLICANT'S SIGNATURE , ._~ . ¢ OErE CO. Russell Ovsrer 694-~774 Soils Et Foundations GEOTECHNICAL El- DEVELOPMENT Box 90. Davis St,. Eagle River, Alaske 99577 ' 694-2774 or 688-2280 ,SOIL LOG Earl Ellis 688-2~.80 Land Development Performed for: Name: ~ £/2/x/m Mailing Address: Legal Descrtptton:. ,~oT' //. D__e ~_~_ ~.~ 0 1 Sot1 Characterts~Ic~ 2 3 4 7 8 9 Ground Water Encountered: Yes~ No.__._,/ If yes, what depth.._._=_ Proposed Installation: Seepage Pit_ Drain Fte~d~_.. Con~ents: Performed by:__ ~ /f~ ..... ~_ Date ~" Time Date Conditional Approval Date :)ate Sewer Installed Soils Rating Permit No, Well To Absorption Area Well to 'rank Holding Tank Size Well Log Received Property Owner Mailing Address Buyer Address APPLICANT FILLS OUT LOWER HALF ONLY Address Realty Co, &Agent Street Location Phone Phone Phone Type of Residence [~ Single Fatal y L~xMultlple F~i~,(i.e_ t ~ No. of Bedrooms ~'Other · Water Supply ~,Andlvidual ATTACH WELL LOG, A well log ~e reeulree for all wells drilled since ,June ~Communlty 1975. For Wells drilled Drier to that date, give well depth [attach og If EI Public Utility available.) 8ewa~ Disposal ~'lndlvidual ~-~'e:~. ~ ~[C3C~,~_~,~). Year Individual nstalled: I~ Public Utility ~'1~'~ ~. ~-~....,~. ,,.1 ~.~ d-r~.~..~,~ ~ When Connected to Public Utility: [3 Holding Tank ' NOTE: THE INSPECTION FEE MUST ACCO~tPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. EXCAVATION ROBERT A. SHAFER WORK CIVIL ENGINEER 694-2979 March 7, 1982 Allen Ponte P.O. Box 61 Chugiak, Alaska 99567 Dear Mr. Ponte, Reference: Lot 11, Block 1; Wynter Park Subdivision A sewer system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and veriifed to have a capacity of 1250 gallons. The seepage pit was full of water and approximately 400 gallons of water had to be removed. The system was then charged with 1000 gallons of fresh water and after a period of 24 hours approximately 271 gallons had percolated out: of the crib. It can be concluded from this test that the septic tank is adequate for a four bedroom residence, however, the seepage pit appears to only be adequate for approximately 1.8 bedrooms. I regret to in- form you that the system will require upgrading before it can be considered adequate for the three bedroom residence located on this property. If we may be of further service, -please do not ~R'AS/ss cc: Paramount Realty ATTENTION: Louis Rochon hesitate to call. Municipality of Anchorage Department of Health and En'vironmental Protection MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION MAR g 198£ RECEIVED SRB 196X EAGLE RIVER, ALASKA MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-491-42 Certificate of On -Site Systems Approval Expiration Date: /0 — 2-3 - 2aZ3 1. GENERAL INFORMATION Complete legal description Wynter Park #1, Block 1, Lot 11 Location (site address) 24239 Park Dr., Chugiak Current property owner(s) Lorentzen Alaska Comunity Property Trust Day phone 907-227-5056 Mailing address PO Box 77115, Eagle River, AK 99577 --N-ani -Palmer _____--907-229--2352-- _ Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic E Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ - 50 Date of Payment Receipt Number (�j2,606: COSA # OSG 2Z 107 2 Date: Waiver Fee $ Date of Payment Receipt Number 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Crewdson Engineering Phone 907-280-9493 Address PO Box 671389, Chugiak, AK 99567 Engineer's Printed Name James Crewdson Date 1-27-2022 F.. 6. DSD SIGNATURE d *" H �I AJames A. Crewdson System #1 Approved for bedrooms Ci 1527 _System #2 Approved for bedrooms Disapproved - ` � &FES,0k Conditional approval for bedrooms, with the following stipulations: BY Original Certificate Date: Z' —Z The Municipality of Anchorage Development Services Division (DSD) 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 Checklist blue sheet Legal Description: Wynter Park #1, Block 1, Lot 11 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Public Water Supply log is filed withOnsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) 5.5 years Tank type/material steel Measured operating fluid level in septic tank 49 FOR Standpipes/foundation cleanout per record drawing Date of pumping 2-2-2022 Parcel ID: 051-491-42 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) rsenic ug/L [:]Arsenic less than MRL (ND) Collect Date of Sample IFT STATION ❑ Requir aintenance completed Age of lift station years Lift station material Comments: 29 D. ABSORPTION FIELD DATA Which system tested (date installed) 7-82 Adequacy test date 10-23-202' -- --WALL -standpipes -present per record drawing Results [DPass, -For 30 , bedrooms--- edrooms- Total Total measured depth from grade 6.5 ft (max) Fluid depth prior to test 0.0 in Measured depth to pipe invert from grade 3.2 ft (min) Water added 450+ gal ❑ N/A — pressurized field 0.0 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 60 depth into effective 3.3' Elapsed time min p ❑ Code -required soil cover over field Final fluid depth 0.0 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 2000* gallons If yes, enter date Comments/Deficiencies: 'water injection rate: —10-gpm. COSA Checklist yellow sheet E. SEPARATION DISTANCES OF A<q �1 Yes if No ft Public Water Supply Absorption Field > 5' Q✓ Yes if No rivate Well on Lot to: (Please enter distances if less than required or if community well) Water Main > 10' Septic Tank/Lift S n Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' Community Wells > 200' Q✓ Yes if No _ Yes if No ft Q Yes if No ft Neighboring Tank > 100' Q Yes if o ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Animal Containme 0' ❑ Yes if No ft Q Yes if No ft _ Manure/Animal Excreta Storage > ' Community Sewer Main > 75' E] Yes if No ft 0 Yes if ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water? 100' Yes if No ft Property Line > 5'✓Q OF A<q �1 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q✓ Yes if No ft Private Wells > 100' Q Yes if No Water Main > 10' Q Yes if No ft _ Community Wells > 200' Q✓ Yes if No _ Water Service Line > 10' Q✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' OF A<q �1 Yes if No ft If absorption field is under driveway comment below Property Line ? 10' Q✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' Q✓ Yes if No ft Community Wells > 200' Q✓ Yes if No Surface Water > 100' ✓Q Yes if No ft F ENGINEER'S COMMENTS Absorption field is not under the driveway. COSA Checklist yellow sheet ft ft ft W OF A<q �1 G. ENGINEER'S CERTIFICATION Z 1 certify that I have determined through field inspections and review ... , TH J.,J$e,�j of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Ja / t:Crewdson.., j %(c!' 011527 ��,r t1,�0R FESS00 F"' COSA Checklist yellow sheet ft ft ft W Lot 23 _ 1 :4z�UT1L11Y ' _ l MUM Lot 4 8 Lot 12 :. 3 i iQ a 9Q �9 191a--- —_ _ - _ MOTE= THE LOT Is SEMY€9 9Y A COMMUNITY WATER SYSTEM: apei r- i" _ AC11 M Long Associates., inc. Prof-essional Land Surveyors 622-9476 Pham 592-4625 Fox I h@r@by a@r#ify that 1 hov@ eer-vBy@d tie following &9@0140 property►, EQ7 11, @LOOK 1. WYNTER PARK 51,10@IYIPION Ne- 4 (PL4T i+io. 73=149) Anshor-qge Ng@9rdin @i§triet. Almise. @nd th€t the Imprdvements eituat@d thomon ere within the prop@r y Bopp end do not @n6re@oh onto the property Q+joeent ther-@to, thou no improv@rn@nts on the pr@P@rty lying gdjac@nt thereto @nerooeh on iho sorry@yed Premises gnd thst #hero are no modwove. tranernieel@n knee or ether vi@Ibl@ oees?n@nte on mid prop@rty e?cupt g@ Indio@ted h@r@@n. Bated #hie the ' aoy gf cu __� � �� . ®t An0m9el Al@gk@ It 1@ th@ ragpon@ibllity of th@ owner to d@t@rmine the @xiet@nco of any se@@rnent@. @Qv@nent@, or reetrlo lops whi@h do not @pp@er Qn the r@rerd@d @nbdivl@IAn plot, 14W . ......... i ENN- 1 Municipality of Anchorage Development Services Department Building Saiety Division . On-Sile Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK ~99519-6650 w,,wv.ci.anchorage.ak.us (907) 3,43-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING O o ."'%? ~ .:.:.~:'.' ¢ Parcel I.D. 051-491-42 GENERAL INFORMATION Complete legal description Z, ot Location (site address or directions) HAA# O ~ Expiration Date:. ~ - /(~'--' IO ,~ 11; Block 1; Wynter Park Subdivision ~l 24239 Park Dr. Current Properly owner(s) Mailing address Lending agency Danny.Dive]h~ m.~ Day phone_ 688-6324 PO Box 67OR~ Ch,_,g~_ak, AW 995'67 Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2.' NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Public Water System Well TYpE OF WASTEWATER DISPOSAL: '-3.. Individual On-site [] Individual Holding tank 3{~ Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Cedificates of Health Authority Approval (HAA) based only upon lhe representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Cedificates 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 reqdest to homeowners. Cedificates ct' 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. STATEMENT OF INSPECTION BY'ENGINEER As certified by my seal affixed hereto and as of the validation date shOwn beloWl 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 fudher 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. Phone 694-2979 204 Eagle River, AK 99577 Date CAe/Or .~..4..-' ' ";: .. ~ '~;/ ~... ~ [ ROBERT ~ COWAN bedrooms, wRh the following stipulations: Name of Firm S & S Engineering Address 17034 N. Eagle River Loop Ste. Engineer's Printed Name RobPrt_ C. Cnwnn DSD SIGNATURE p/'~ Approved for 'Disapproved. Conditional approval for ' ,,-.~ bedrooms. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: original Certificate Date: {Rev. 01/02) MUnicipalitY of Anchorage DevelOpment Services Department Building Safety Division · On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. B&x 196650 Anchorage, AK 99519-6650 .www. ci.anchorage.ak.us .. : (907) 343-7904 HEAITH'AUTHoRiT~, APPROVAL CHi~C~K'EiS'T Legal.,DesCril~)tior~:, .-LET' I/ A. WELE DATA ' Well type /-f - Date ~:'~mplet'ed, Total ~'el:Jth ft. : '.. Dat'e~; Staff( ~Vater'ievel IfA, B,!or C provide P~WSiD #~_,//4.~) 'Well~'Lo¢ (Y/N). Wires properly [ Casing heigt Sanitary seal (Y/N) : AT INSPECTION Well ,iod~Ci;on' / : .gp:~. ' WATER SAMPLERIqSULTS' . . ~.. " ,' Cohfor~l. , ..... 'I ..'; :c~lonies/100 mi , .~ i Nitrate ~' 'l;" .mg./I. ^rsen!~: .': '~ /ng./i. - 'i i Date ~of sample'.' B, SEPTIC/HOLDING TANK DATA ~ . . - : Tank T~p~/M~teri~i:~~ ' ' ,- :,,~ ~ ,~ .. ' ' : . Date:instalie~ Tank Size I q~ 'rgal. Cleanouts (YIN), Foundation cleanout (YIN) 'Y Depression over tank (YIN) H~gh water;alarm (YIN) , i~', ~a~e of pumping '~//~/~', ~ ;P'umper ~ ~ ~ "' i '~ '~'~ ~1~:~,~ ~. / - /. Other bac!~ria~: - colonies/lO0 mi. cotected:~,::; in. Number of Compartr~ents (. C.; ABSORPTION,, .: ~, .FIELDDATA . ,~.. . '~'~ ~,. . ~..;, ,.~.~ ,.,. ' Date'i ale ~ ; .~1:~., :: r Soil rati .p.d./~ SystOm type "':" ...... dth ~ '~ ': :':' ~ Length. j,~-. ,,,~ ~ , fl. ' ~i 'i. ~ .... I :': LIFT STATION :Date installed : '~ "Pump on" level at in. Datum Size in gallons · "Pump off" level at ' Cycles tested in. 'Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES ~c : TT SEPARATION DISTANCES FROM WELJ4 ON LO O: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic SerVice line On adjacent lots -' ' '//~ adjacent / on ots // / public sewer manhole/cl~out Holding tank ~ . / SEPARATION DISTANCES FROM SEPTIC/~G TANK ON LOT TO: · Building foundation ' ~' / ,F- Property line ~" w,/_ Absorption field Water main / ~;) % Water serVice line / ~ ' .4-* Surface water 0 Wells on adjacent lots : ,:,, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: //' O ~ Building foundation /O ~ Water main t/~)' / ' 4- Surface water ./~{~) ~ Driveway. parking/vehicle storage Property line Water SerVice line Curtain drain ,,/~g'- ~'~'/~/A// Wellson adjacent lots ~,/'~ COMMENTS -. ~. , ENGINEER'S CERTIFICATION · ' '* * * rn~ ections and I ce~fv that I have determined through field ~ ~ . - . . · conformance with MOA HAA~ gu/delmes m effect on th~s dam., ~nnin~r'~ Printed Name /~b~ Waiver Fee $ -'Date of Paymefit Receipt, Num.ber Date of Paymen,[t Receipt Number, o J'- FROM : COWNTRY REALTY PHONE NO. Jun. -] : 90?8881238 10 2804 12:13PM P2 that ! have surveyed the'~otlo~o~g deno'it~r