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Home My WebLink AboutTHOMSON LT 4Thomson Lot 4 #067-041-04 -Qu0 =-1. Municipality of Anchorage AIG 21.2011 Community Development Department Page 1 of 3 On -Site Water & Wastewater Program 4700 Elmore St. a P.O. Box 196650 Anchorage, AK 99519-6650 • httpJhvww.muni.org/onsite • (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 141489 PID Number: 067-04-104 ❑ New ®Upgrade Name: PAUL WARD ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address: 7137 CLEMONS CIRCLE *EAGLE RIVER, AK 99577 ❑ Other Phone: (907) 694-6123 No. of Bedrooms: 4 Son Rating: EXISTING GPD/Sq Total Depth from original grade: Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade: F . Gravel depth banes h e: Ft. Subdivision: THOMSON Block: Lot: — 4 Fill added above original grade: Crav ngth: Ft. awns Ip: —Range: — section: _ Grovel wieft Ft. Bede Number of linea: Distance between fines: FL SEPARATION DISTANCES Total absorpt' area: Sa. Ft. umber of trenches: Dist. between trenoMa: Ft. T° Septic Absorption From Tank Field Lift Holding Public/Private Station Tank Sewer Linea Well 100'+ EXISTING — — 25'+ TANK ® Septic ❑ S.T.E.P. 01dolding ❑Other Manufacturer: C."C"t : Surface water 100'+ EXISTING — — ANCHORAGE TANK 1250 Gol. Lot Line 5'+ EXISTING — — NSA Material: STEEL Number of compartments: 2 Foundation 5'+ EXISTING — — LIFT STATION Curtain Drain NONE KNOWN Manufacturer. Capacit, Gal. Remarks: 'Pump on' level at: -Pump off laud at: Hi r alarm at: PER CONTRACTOR OLD TANK WAS DECOMMISSIONED PER UPC Pump Make &Mode• cki<uf InapeoNons performed by: PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Installer SOUTH FORK CONSTRUCTION Drainfield EXISTING CO MT D3034 Inspector GEG, Ltd. BENCHMARK (Assumed elevation) 100.00 Ft. Inspection Dates: 1 st 7/9/1 2nd — L000tion and Description: 3rd — 4th — BOTTOM OF CORNER OF SIDING AT BARN Community Development Department Approval Conditional approval: Date: ENGINEERS .�o�op �o � v� ..�.•...10 S��OQ aoo�P. ............ .......... .. f. yarness ...Q QO 9. C 7 OOQfe^e' �LO�IS• �c��p� X\! P_oo�o0\ Approved: h v1 I Date: PERMIT NUMBER: OSI? 141489 AS -BUILT DRAWING ST1 37.2 53.8 ST2 45.0 60.5 DBL1 47.0 62.4 DBL2 48.5 63.7 COI 55.2 70.0 FCO 9.3 24.3 PARCEL ID NUMBER: 067067-04-104-104 \ DRAINFIELD BARN r DOUBLE C/01 w NEW 1 NEW 1250 GALLON _------- ,J C01 c SEPTIC TANK i ST FCO / CD \ / EXISTING 4 \ — — \ FOROOM HOUS k\ I GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS ....°,.... . ..... .........::... i 3]01 E MMR ROAD. SURE 101 • MCHOR -M 99W7 • WME (907) 357-8170 • FM 338-3218 • WtH3RE: ww.garneesen9lmeHn9991O !.... ... .. ......................... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: rn j r y rness 4 PAUL WARD 694-6123 2 OF 3 �j�i °. CE -79573 ' ��%'• •. pe 7C.I ,.� 4� I.. LEGAL DESCRIPTION: DRAWN BY: THOMSON; LOT 4 PNB .......... ��• TYPE OF WORK: DATE: . RECORD DRAWING 8/20/15 PERMIT NUMBER: PARCEL ID NUMBER: OSR141489 AS -BUILT DRAWING 067-04-104 /rr FINAL GRADE = 99.12-99.28 ST1 / ST2 TOP OF TANK + TOP OF TANK AT INLET = 94.55 AT OUTLET = 94.52 NEW 1250 GALLON INVERT OF BUNG SEPTIC TANK INVERT OF BUNG AT INLET = 93.93 AT OUTLET = 93.73 ,o OF #i GARNESS ENGINEERING GROUP, Ltd ..�:' 4 - CIVIL & ENVIRONMENTAL ENGINEERS % 3)01 E. MMR R . SURE 101 . MIOROWE, M 99607 • PRONE (901) 337-6119 • W 907) 336-3216 • 1YE65W. xxw. amain nwM .coin ... ........... ................; PREPARED FOR: PHONE NUMBER: PAGE NUMBER: A. rness PAUL WARD 694-6123 3 OF 3CE-795jj�� LEGAL DESCRIPTION: DRAWN BY: � F T �,.• �♦ THOMSON; LOT 4 PNB �j Q'' ........... TYPE OF WORK: DATE:i;;$;;:�•�• RECORD DRAWING 8/20/15 On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141489 Tax Code Number: 06704104000 Work Type: SepticTank Upgrade Permit Effective Dates: November 07, 2014 to November 07, 2015 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: THOMSON Site Legal Address: THOMSON LT 4 G:0363 Owner/Address: MILLER MARTHA LYNN & WARD PAUL KELLY 7137 CLEMENS CIR EAGLE RIVER AK 995779611 Site Mailing Address: 7137 CLEMENS CIR, Eagle River This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 85554 Total Bedrooms: 4 N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: Date: �� J Date: / r MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I. D. 067-041 —04 Property owner(s) PAUL WARD & MARTHA LYNN MILLER Day phone 694-6123 Mailing address 7137 CLEMONS CIRCLE *EAGLE RIVER 99577 Site address 7137 CLEMONS CIRCLE *EAGLE RIVER 99577 Legal description (Sub'd, Block & Lot) THOMSON; LOT 4 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: ( Rall that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Upgrade (w/wo ADU) Septic Tank ® Duplex (D) El❑ Holding Tank F1 Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage ❑ SUBMITTAL THIS APPLICATION INCLUDES A VARIANCE/ WAIVERRE(WRI13TFgR Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: tDI� Date of Payment: Receipt Number:(b��1q�J lA Receipt Number: Permit No. �p 11A �y V , Waiver No. (Rev. 01/11) Bvsrxc+ef rearrr>rs,>sCrn, GARNES5 ENGINEERING GROUP, Ltd Ar CIVil8. ENVIRONMENTAL ENGINEERS September 26, 2014 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System for Thomson; Lot 4 To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. We have been contacted by the owner who stated that the septic tank was in a state of failure and needed to be upgraded. We are proposing to decommission the old 1,250 gallon septic tank and install a new 1,250 gallon septic tank. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com NOTE: THE CONTRACTOR SHALL HAVE THE WEST LOT LINE. BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. f116 \ INSTALL DOUBLE C/0'S - CD 11 II I \ ,7 LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AI:D W�^p� �rv�� EXISTING DRAINFIELD \ \ \ DECOMMISSION OLD r SEPTIC TANK PER UPC AND INSTALL NEW 1250 GALLON SEPTIC TANK.— — — — — — fra riL INS3rc,tnF1,. t / �AIL FCO / i EXISTING 4 BED}YOO 4 HOUSE k — i RI i I / 1 \ 1 \ \ CLEMONS CIRCLE I I / GARNE55 ENGINEERING GROUP, Ltd CIVIL& ENVIRONMENTAL ENGINEERS 37(11 E. WU ROOD. BUNS 101 ONONORA M 99W7 ° PHONE (90) 337-61n ° FOX (907) 336-3246 ° W Nn .9ameaxn9� fi g com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: PAUL WARD 694-6123 1 OF 1 LEGAL DESCRIPTION: DRAWN BY: THOMSON; LOT 4 PNB TYPE OF WORK: DATE: �.I SEPTIC TANK DESIGN UPGRADE 9/26/14 u A. e•� MUNICIPALITY OF ANCHORAGE e., ('_L1U. D \Ckxzl�n DE , TMENT OF HEALTH AND HUMAN SER _S A Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NameG DISTANCES JouT,lFor c arc ADD.easSEPTICFROM TO TANK ABSFIELOION WELL ORPT 0. L3a�c 11 057-G-7�. PrIci Permit No No of Betlrwms WELL T- $60 roti No*rN T ii4crjvj1,rr LEGAL DESCRIPTION LOT LINE /o l F v/ h N/r N F LotLi I tllObh �I� FOUNDATION IOwnSMp. Range. SectionA/.ioT A/ Fr Ala r N afr / ^� AS -BUILT DIAGRAM 15nuw loc on m wenD . septic syste t. property noes, tour an /V L tlnvedi water bodies. etc t TANKS 'Y SEPTIC ❑ HOLDING Manua qu.er Capacity .n gallons Material S � No of Companmems z TYPE OF SYSTEM I VTFIENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depm to PIPE wtmm Irom cmgmal grade FT otai Depth Irom original grade 13 FT Fe added awve original grace �FT GravM Depth Diemen, FT Gravel lenga. Z? FT7,T-FT Gravel Ill Total absorption area 52,7- SO FT Distance belween lines � /'t FT Ndmoe, dl lines SOII reLng ZS SO FT Npe material "D 30 3 mslaeer Dale installED 1511 -- -WELLS WELLS PRIVATE ❑ OTHER (Identitvl C.anvti1atiul. tA.R.(, Iola. Depth Cased to FT FT ms:aur. Dale Inslaaw REMARKS: Wrc'L L NU i /.US 7i.1 L C F_. h fi'T L I ONE won No a1It ®®E°0®®ii Performed by. Dale. 5 &3 ENGINEERING ISR B 196X entity that this Inspection was performed according B all Municipal andMOU'RIWR"DAkeF 01 Health Department Approv /"--1 Date. IL!_SCJ_113 72-013 (3:85) ....... hl.. 1,1117411 A- " " MUM I C I FOAL_ I TY OF= ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 2264-4720 C7N—S I TE SEWER ,mac WELL FIEF--tM I T PERMIT NO: 860109 DATE ISSUED: 05/01/86 APPLICANT: SOUTHFORK CONSTRUCT. ADDRESS: P.O. BOX 770567 EAGLE RIVER, 'AK 99577' CONTACT PHONE: 694-4351 LEGAL DESCRIP: SUBDIVISION: THOMSON SECTION: 23 TOWNSHIP: 14N LOT SIZE: 85554 (SQ.FT. OR ACRES) MAX BEDROOMS: 4 Listed below are the options available to system. Choose the option that best fits TRENt--" DEPTH TO PIPE BOTTOM (FT.) 4.0 GRAVEL DEPTH (FT.) 7.0 TOTAL DEPTH (FT.) 11.0 GRAVEL WIDTH (FT.) 2.5 GRAVEL LENGTH (FT.) 36.0 GRAVEL VOLUME (CU.YDS.) 25.0 TANK SIZE (GALS) 1,250.0 ** SOIL RATING (SQ.FT./BR) 125 LOT: 4 BLOCK: NA RANGE: 1W you in designing your septic your site. W - DrA I 11%1 4.0 3.5 7.5 5.0 54.0 40.0 1,250.0 ** 125 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I certify that: 1. I am familiar with the requirements for on-site sewers and 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. 3. 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 4 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 ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APt�RQVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MOST BE DONE BY A LICENSED ELECTRICIAN. SIGNED -�"�---------- DATE: /l��Z_ SOU R CO STR „T. APPLICANT: ISSUED BY�, ��J ---- DATE: -- --gni ----------------- --------------------------- ` Municipality of Anchorage DEPARTMENT OF HEALTH 3 HUMAN'. 1 825 "L" Street, Anchorage, Alaska 995 SOILS LOG — PERCOLATION r PERFORMED/ /;,- �IJj�JrT, LEGAL DESCR 1 - `°,f 2- b � 3 3- 4 4 \ 9 5, �4 6 7 g 9 � , �b to If 12 d y, 61,(((4 14 ° 15L, .; 16 r O C. J — 17 •� 18- 19- 20- COMMENTS 81920COMMENTS G " orf ccs, le C S /L ty �2AdE L G p. T2slasr OF �..f it ; .. NEER'S SEAL) 49 III PRUFLMSA • DATE YER� l2O/Q /i Range, Section: /54 N GROUND WATER 110 )UNTERED7 ,V ES, AT WHAT PERCOLATION RATE )mmutevmc8) PERC HOLE DIAMETER TEST RUN BETWEEN FTAND r—FT LS0 l� SRS 196x PERFORMED BY: EiaIsti[7,1hSli— I CERTIFY THAT THIS T ST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELIN IN FFECT ON THIS DATE. DATg: 72-00.8 (Rev. 4,851 Municipality of Anchoral DEPARTMENT OF HEALTH a HUM 825 "L" Street, Anchorage, Alaska /, I SOILS LOG - PERCOLATI, PERT �RM'EDPO FOR:ts{? LEGAL 1 J O f { 2- 3- 4- 5- 6- 7 34 5 6 7 4.� 8- 10- 11 10 11 O 1 12 � 13 14 15 16 17 18 19 20 4- "ar'yaslr c 60 , /aS�/JR WAS GROUNDWATER /1 ' ENCOUNTERED? /1 IF VES, AT WHAT ,J'�/, DEPTH? IleDepth ,%i I Monit to WFrler Mgb G Manitarin 7 Date: Reading Date Gross Time /✓ ' Z3 PLAN PERCOLATION RATE Iminutesnnctt) PERC HOLE DIAMETEK_ o— TEST RUN BETWEEN FT AND FT !xlr' �2LE'D �. - S a S EN1n~jno SRS 196x PERFORMED BY:Woll CERTIFY TNA THIS EST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI S N EFFECT ON THIS DATE. DATE: 72-008 (Rev. 485) tea''`••'" ' •:ta :91,1 1 oi #1639.69 O', moo'' lu 14 '^st ; / 0, •. � .pyo M N N � I�r-l__ � VJ 1� 1 ,-o #1639.69 5.0�04-24^µ. r 349.17 •o--� .pyo M N N N q N Nm r��1 O'�. Job 0 r• <xm � A � � 10 0 N • CD '1 1� 1 ,-o #1639.69 5.0�04-24^µ. r 349.17 •o--� .pyo N N Nm r��1 O'�. Job 0 r• W N W, REC. tP7 20500 1 ,-o zl p � 1D I .pyo N N N • CD '1 r / I to n %tiF o m / M l �Y N - 2J0 ?S • ow o !b 49 H u ?C4 O/ p V� IN t yl co 93 r y.// i��l p-6 8 0 1~m E JANA of 0 IN 4 mm- X- 0) Imz �� / A A jij -t 20 �M O 1^ r 1> .b A 0 3T ♦ (�� N b y v. �CD I... � / F4 4T6 u - R4. N.0004'OOeW.-- 661.44OAEAS) (661.12 P81-21) BASIS OF BEARING (P771-294) 3> f go I.' i MEAS (1322.24 P77-294) � m� a ^ nl ^ - (N.00*04C6' W. P81 -I. mcg -.n 1 N J S & S Engineering tR6 195x Eanlo.oiver, Alaska 99S77 SUEUECT: /-07-4 n CurvIPUTATION SHEET T/)00/5 -0 /L) S/� DATE: SHEET OF BY CKD p�✓ si 7� �ri/�s-�,E' v� 7Ez DtJ�vs.nG syr z-�� 4ef Xf s-olLs/Zs �Be Pe c, a� sbra L' i 1 � 12S- X 5 f razz 13 '�e� �renv� I 28 LF '04c�p AN,o 1250 6-4L S.T. �se�ve Q� i.7 e�ces.r alb /F'�sc�ie� 1f r 1. Cn�ex#ifi�ed �t11in n�rn DOC CO. Obs SULLIVAN WATER WELLS P.O. BOX 670272,CHUGIAK,ALASKA 99567 • TELEPHONE 688@759 r OWNER OF LAND X&z r .�A<O-Mif�crv4 /"Ijdte,Q DEPTI1 OF NLLL //I ra 11 %C Q ADDRESS deo U iJr 1/44rfTY 4 I910A�" N STATI(' LEVEL OF % ATLR FT. �(a d _ 945 '46 LEGAL DESCRIPTION' �`? for+/So•c7 u .F i00 DRAW DO%V% FT. DATE - Started ?�� EndeGALS. PER HR lets PERMIT NUMBER Q�� KIND OF CASING 6f-04 KIND OF FORMATION From O Ft. to J Ft.-QAj.^1C S71<.K JP _ Frum Ft. to Ft. From a Ft. toj_�*_Ft. Frum FL to Ft. From Ft. to -42 --Ft. .Sri"Td f !; dRL From Ft. to Ft. From7` Ft. to Ft. +SQ,4d _ From Ft, to Ft y650 From1�Ft.to92 Ft. frc` From Ft. to Ft From P-3 Fl. toql Ft._174 0CC4,11Y _ From Ft. to Ft. From .tl4_Ft. to -LD O i Ft.. SANt7 r From Ft. to Ft. From 10 1 Ft. to -J -03 -Fl. Cc AY 1 41HJEsT From Ft. to Ft. From 109 Ft. toLTFI, J*,Jt 6t.41149 4, f 4J47' -/L From Ft. to Ft. From Ft. to Ft. From ErWfROFPt MO Of /tC7kn,__ From Ft. to Fl. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. M1SCL. INFORMATION: V, From Ft. to Ft. From ----- AftL�pAFt. From ErWfROFPt MO Of /tC7kn,__ TTfCTtpN"""(` Tqt FO om FrItpA� Ft. From Ft. to ` I 0";-e From -k From Ft. to Ft. From Ft. to Ft DRILLER'S NAME"`- n t� J • MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4 Thomson Subdivision Location (address or directions) (b) Property Owner Marty Miller/Ke111Tek1 e:Home 694-6123 Business 786-7437 Mailing Address Box 1798 Eagle River Road, Eagle River, Alaska 99577 (c) Lending Institution Alaska Mutual Bank Telephone Mailing Address Eagle River (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: or. Check here ❑, if hold for pick up. List contact person and day phone number below. S & S Engineering SRB 196X Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family Ox Number of Bedrooms four (4 ) 3. WATER SUPPLY Individual Well aX 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 Onsiteticx Public ❑ Community ❑ Holding Tank ❑ 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 72-025 (Aft 8,861 Front 5. ENGINEERING FIRM PROVIDING 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 regulations in effect on the date of this inspection. Name of Firm S & S Engineering Telephone Address SRB 196X Eagle River, Alaska 99577 Date 694-2979 Engineer's Seal The cleanout in question was located by the engineer (S & S Engineering) on a re—inspection of 1-17-87. This property meets MOA requirements. 6. DHHS APPROVAL Approvedfor four(4) bedroomsby l Date January 20, 1987 Approved XXXXXXXXXX Disapproved Conditional Terms of Conditional Approval 161-11111110111 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. Page 2 of 2 77-0751R" 6'861 Back n n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH L1 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL V'1(R1 _ j2C 11„' OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1- S - 87 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name _K" W" -.p Telephone: Home Business 7156 -74-3l Applicant Address t o)C ME r o eL,y Yi tk-rL V -Q - (2 L_ 1?,A y�1� k -y- '1'i 5'li T (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder)g; Buyer ❑ ;Other ❑ (explain); (d) Lending Institution _A -05�(-4 MJTV-4 , 1?1A . !i r- Telephone Address ez,"alW, r=d V -4i , (e) Real Estate Company and Agent I-aot4e, Address Telephone (f) 4A= the HAA to the following address: —5 & 5 ENGINEERING 17034 Eagle River Loop Road No. 20.4 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family 0- Multi -Family ❑ Other Number of Bedrooms 3, WATER SUPPLY Individual Well C 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 Onsite fEL Public ❑ Community ❑ Holding Tank ❑ Note: If communitywell system, must havewritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 0lea) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by myseal affixed heretoand as of the validation date shown below, I verifythat 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 regulations in effect on the date of this inspection. Name of Firm $ NNGINEERING Telephone C 29iFKIW toop Road No. N4 rsr+ir Date 6. DHEP APPROVAL Approved for - 612 bedrooms by Date Approved Terms of Conditional Approval z"7 IZ Conditional alk, CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the 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 requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11,841 r O�ORAGE MgN1CpE � Of t P-Ttl �U �IPALITY OF ANCHORAGE (MOA) EtyylROt�E�� pHEALTH AUTHORITY APPROVAL (HAA) t (\� 9 )gal CHECKLIST- FEBRUARY 1884 264-4720 Legal Description:g A. WELL DATA Well Classification ' 5 G• If A. B, C, D.E.C. Approved (Y/N) N J 1A Well Log Present &N) Date Competed .5�A� Yield Total Depth t (S Cased to Depth of Grouting Static Water Level ifo Pump Set At OL— Casing Height Above Ground 47 Sanitary Seal on Casing ON) Electrical Wiring in Conduit®'N) Separation Distances from Well: Depression Around Wellhead (Yo r To Septic/F Tank on Lot 1'5e�) ; On Adjoining Lots 1001 r To Nearest Edge of Absorption Field or>,L t t Sb ; On Adjoining Lots 1 oh r+ To Nearest Public Sewer Line 1- A To Nearest Public Sewer Cleanout/Manhole 16 To Nearest Sewer Service Line on Lot Water Sample Collected by ei JS ; Date 1'S—Si'� Water Sample Test Results Comments B. SEPTIC/MEHZING TANK DATA Date Installed S 4�4540 Size 1250 No. of Compartments Standpipes&N) Air -tight Caps &N) Foundation Cleanout (Y/N) '_ Depression over Tank (Y69 1 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) h& ; for Holding Tank High -Water Alarm (Y/N) fJ Temporary Holding Tank Permit (Y/N) 14hP Separation Distances from SepticA Tank: r t To Water -Supply Well 13o To Building Foundation r To Property Line lot+ To Disposal Field s To Water Main/Service Line Course 15a 1 1 co -y / To Stream, Pond, Lake, or Major Drainage 0/i%'r. %C.c/r�J Page 1 of 2 1_4 r f 4}d i[P %1JK•* "/'v t n-- 2 e'// C v 6� � Tut 72-026111/84) S� �• C' • - - - 1/l je7 '1 T� r � rt C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I -2-s' * 11U� ✓ Type of System Design Tyra Date Installed Length of Field Zq Width of Field Depth of Field �3 Gravel Bed Thickness Square Feet of Absorption Area SZt- 4b Standpipes Present4pN) Depression over Field (Y& Date of Last Adequacy Test Results of Last Adequacy Test P Separation Distance from Absorption Field: i To Water -Supply Well 5 n To Property Line or-}" r To Building Foundation Sot To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line o t d' To CYtbankk (if present) a To Stream/Pond/Lake/or Major Drainage Course A / A lC ( Z,7 To Driveway, Parking Area, or Vehicle Storage Area -7 o '±- Comments D. LIFT STATION Date Installed Dimensions — Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ' •• Check Permitted Bedroom Rating Against HAA Request •• I certify that 1 have checked, verified, or conformed to all M9A and HAA guidelines in effect on the date of this inspection. Signe8 S ENGINEERING ateP 7 MU Eagle XWw LWP Road No. Compw►a Rkw Alaska 991177 MOA No. kd, C/o Receipt No. /00/ O d r2-3 Date of Payment S •~'•%9'�I� or . j Amount: $ /0 Page 2 of 2 72.026 411,841