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HomeMy WebLinkAboutHAMANN LT 17 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 191113 PID Number: 050-621-04 Dwelling: ❑■ Single Family(SF) ❑with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name DAVE HERTRICH ABSORPTION FIELD Site Address ❑ Deep Trench ❑Wide Trench ❑ Bed ound 24437 WILMA CIRCLE, EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating Total depth fr• original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. HAMANN LT 17 Fill added above original gr.•- Gravel length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total a•=•rption area Number of trenches Dist.between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ 50,+ TANK ❑p Septic ❑S.T.E.P. ❑Holding ❑Other Manufacturer Capacity Surface water 100+ 'ANCH TANK 1000 Gal. Material Number of compartments Lot Line 10'+ NA STEEL 2.0 Foundation 1 g♦ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 Installer drainfield MIKE N ANDERSON, P.E. Drainfield 3034 CO/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) ft Inspection 2„d V' 4/23/19 4/23/19 Location and description dates: aid 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF e c ll Conditional Approval: _ Date 1P��• IAN 1 h 1 , 49TH ••..* / til t, Septic Sy em \- I°r •�• MICHAEL N. ANDLRSCN ...c'47 r' • .„ Approved ,J t,,—..,('-- Date L,_1C( rii f.•• CE 1449 . ``'r F• •..f.., ,� Note: this approval does not include well permit requirements. <<l�ZOFESSIO�.= (Rev 05/02/18) Permit No. OSP19113 - Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: HAMANN LOT 17 PID No.: 050-621-04 MARK A 8 \ C01 46 61 _ \ TC01 48 63 -- -, TCO2 53 65 N CO2 56 68- N CO3 57 70 N \ \ // _X-X \\ \ /\ ----X/ /� \ / \ / 1 \ / X \ / 1 / 1 1 1 © in B milmen DRIVEWAY Ill X r- V 'I N e :II i • I N STEEL K \\ l x /\ \ BENC R\h 1 CO \ X CO2 \\ x TCO CO3 \ I / . . \ . ASBUILT SCALE: 1"=50' rco, TCO1 cos f co) ..f16�S‘CUli111 I ,cos I .•••'�C� Or /4,4•. 1 Irl f ••>1H ♦.v\ �. 9 1.000 STEEL • /• • • YJ(/I ` • 0 MICHAEL N. ANDERSON! SEPTINC .TSSECTION Na/ •• ' ESS` 4'I '�+iauawSit.S. 0 0C.1,ALirro MUNICIPALITY OF ANCHORAGE Ment S On-Site Water&Wastewater Program >o �^ - PO Box 196650 4700 Elmore Road �• 4 } Anchorage,Alaska 99519 6650 Phone:(907)343 7904 Fax:(907)343 7997 4'. httpa/www.muni.org/onsite 4NCM0- ;,0 I)l'Ili/I I1111'ni On-Site Wastewater Disposal System Permit Permit Number: OSP191113 Effective Date: 4/18/2019 Work Type: SepticTank Upgrade Expiration Date: 4/17/2020 Tax Code Number: 05062104000 Site Legal Address: HAMANN LT 17 G:0261 Site Mailing Address: 24437 WILMA CIR, Eagle River Owner: HERTRICH DAVID & KRISTYN Lot Size in Sq Ft: 108900 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 2 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 XReceived By: iffDate: M z Issued B Y 0juut Date: I 8 MUNICIPALITY OF ANCHORAGE • 1S r :::,) 4 i Development Services Department t Phone: 907-343-7904 On- .te Water & Wastewater Section �' Fax: 907-343-7997 At\• 4 k,y ON-SITE SEPTIC/WELL PERMIT ' APPLICATION UFLS Parcel I.D. 050-621-04 Property owner(s) DAVID HERTRICH Day phone Mailing address 24437 WILMA CIRCLE Site address SAME Legal description (Sub'd., Block & Lot) HAMANN LT 17 Legal description (Township, Range & Section) Lot Size 108,900 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field I I Initial I I Single Family (SF) 0 (w/wo ADU) Septic Tank rog Upgrade . Duplex (D) n Holding Tank Renewal H Multiple Dwellings I I Privy n (SF and/or D) Private Well I I u 5 6 7 8 9 l9 Rini? >> Water Storage I I ' �, THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: a AP ! b x. 19 1. g A',, Distance/, I certify that the above information is correct. I further certify that this is in a 8 e with applicable Municipal Codes. IMVL Si nature of( g property owner or authorized agent) Permit/Rush Fees: SpC Waiver Fees: Date of Payment: Lu1I (R Date of Payment: Receipt Number: # loWoll Receipt Number: Permit No. (35 (Q1 U« Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc April 18,2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage,Alaska 99519-6650 Fax 249-7847 Re: New Septic tank permit Legal: HAMANN LT 17 To Whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells,septic or open water issues. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 • A" „, - s { � -.Q.- 4• ,ei wq, / Gtvtkus o N . ifi /t°' ' y- •a ---Vt ciâ a 1's' _ co � MO • . • o • O y - 3C,e ) l `(aril • y I�Yr e-..tIN,n ' E41.tfi.ky %Ire( FtKctd in .08 '� )o w k4.-rV' �O k �O I //✓ ae.�a�.� 1 l �v �y,n 49 v t Yard -4-'zKc.ad u� .a-i' ,.,��,�,.......q.�;i.. 3 • l 1 ,1'11.14,9T1 ••1 ': �.. MICHAEL N. AVARSCN .._j iA • ' S• CE�,9 69 ••...:' • • , -e1 q O 1 . l�i-o tv+o n ti t•( ‘‘) ,„ U v 4- ( • ASBUILT-NO CORNERS SET THIS DATE. • . SEWAR & ASSOCIATES LAND 'SURVEYING I HEREBY CERTIFY THAT I HAVE SURVEYED THE CALEB FOLLOWINO DESCRIBED PROPERTY' Lot 17, ,.....)•!.....7 -,. 0 '14 0-1 p� A� Rei Hamann Subdivision DATES �� •........ ••`• •••:qiS` AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 9/8/91 f". •.• ••'f INDICATED. IT IS THE RESPONSIBILITY OF THE . - 0. 497 ' .••. OWNER TO DETERMINE'THE EXISTENCE OF ANY GRID' EASEMENTS, COVENANTS OR RESTRICTIONS SW261 I t ;i;1 WHICH DO NOT APPEAR ON THE RECORDED SUM,- q •••••. ou•n• Q 6•w•rd . VISION PLAT. UNDER NO CIRCUMSTANCES SI-IDUAD FBS - 1,i}: •. Is_ 691 D ANY DATA HEREON BE USED FOR CONSTRUCTION .: 23-73 d4.:'. .-• ---- ....•.:c• � Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SE:RVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 ® Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~j~,.j<2)[ O'~Z~.'~, PID Number: Address: Phone: ~9~ --J~'~ NO. of Bedrooms: ~S ,~ El Deep Trench hallow Trench U Bed ~ Mound ~ Other LEGAL DESCRIPTION Soil Rating: ~, ~ GPD/Sq. ~t. Total Depth from origiqal grade~f- Lot: [ ~ Block: ~s~ Depth to pipe botlom lrom original grade: GraveJ depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: WE~L: g New ~ Upgrade erCve~:~¢~ NumberoflinesT~DislancebeJweenlines: Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: ' -- Pipe materiah ~ Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: Pump Set at: Casing Height Above Ground: GPM Ft. Ft. TANK From Tank Field Station Tank Sewer Lines ~'~ /¢ Material: -- Number of C~partments: Surface W~t~r l~,O+ i00~( LIFT STATION LOt Size in ga~r: I " po "levelat: "Pump off"l~ High wateralarm at: Foundation ~ ~,~ / ~ DrainCurtain '~ ~LO ~ j~ ()~ ~ ~ Pump Make & Model ]~iectric~l Inspections performed by: Remarks: BENCH ~ARK ] Assumed Elevation: ENG I~E~S ~BAL Department of Health and Human Services approval ~,~..', 72-013 (1/91) MOA 25 Permit No. ~-~l,'-,Jc~O~-'Cr;2-.- Page ~ of ~- Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well. Inspection Report Legal Description: J~kbvl~'~.l I,~ OOT' I '4- PID No.: N 72-013A(2/91) MOA25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910242 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:FUSSELL JOE T & OWNER ADDRESS:P.O. BOX 774355 EAGLE RIVER, ALASKA 99577 DATE ISSUED: 8/19/91 EXPIRATION DATE: 8/19/92 PARCEL ID:05062104 LEGAL DESCRIPTION: HAMANN LT 17 LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS:/ RECEIVED BY -- _..,, (~ ~'~ ISSUED BY: ~~ August 5, 1991 ROBERTSHAFER, P.E. ROGERSHAFER, P.E. OlVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPE-CTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 17; Hamann Subdivision We request you issue a permit to upgrade the septic system serving the referenced property. On July 3, 1991 an adequacy test was performed on the existing septic system. The absorption capacity was unacceptable for a three bedroom house. A test hole was excavated, percolation test performed, and an upgrade design completed. This is a large lot with a gentle slope to the southwest. Due to the large lot sizes in the area, we do not anticipate any adverse effects on the neighboring properties by the installation of the proposed septic system. If you have any questions or require additional information for your review, please contact us. Sincerely, ROGER J. SHAFER~, RJS/ztc 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE SCALE Municipality ot Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 7 8 10 12 13 14 16 17 18- 20- Township, Range, Section: ENCOUNTERED? , S L DEPTH? E SLOPE SITE PLAN Depth Io Water ADer Monitoring? Reading Date Gross Net Depth to Net Time Time Water Drop COMMENTS PERCOLATION RATE .~'P' ~ tm,nules/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '~ _ FTAND ~ FT S & S ENGINEERING ,--'""-T -'~ ~ t A :. _;._...~.~.~ ,..,.~., ~: ~, ~.~ ,~,¢. ~;¥~ , - ¥ ~----~ ~ CERTIFY THAT THiS TEST WAS PERFORMED IN ACCORDANCE WITHE,~L~e~S~,~,VI~'C~A~N'~C~I'~ GUIDELINES IN EFFE&T O~ TI-IlS DATE. DATE: ~ --~'-~ ~ ~ 72-008 (Rev. 4/85) (~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENI'AL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT E~ UPGRADE MAILING ADDRESS /~ ., .-- ~-OCATION DISTANCE TO: Liq~~ca it ' allons IF HOMEMADE: Inside length Width Liquid depth ~v Well f/ Dwelling PERMIT NO. ~g DISTANCE TO: ~ ~ ~ Manufactu,'er /~/q"-- Material Liquid in gallons ,~~¢ Tren~widt~ / Distance be~l~s [: .... ~ --- inches Length 'Width D~pth / PERMIT NO. ~ ~ Type of crib Crib dial r ~ Crib depth Total ~ffective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ ~_ / ~ /~ Driller Distance to lot See PERMITNO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER ~IPE MATERIALS I 013 (Rev. 3/78) PERMZ'i NO. hFFL Z _.HIqT E:I]FJ HI::IF.:E:,"r' L., O C: Fi T ICl ~",1 4_EGf'IL. L. i7 HFIItFtNN [:'EF'FtRTMENT ~' FIEFIL]-'H FIND EN',,/IRONNEI",ITFtL. .OTEC'FION 825 '"L ST'REET., FII"~CHORI::IGE., FIK. 2E;4-4. F2EI ,Z.~ t-4 -- :E;. }: T' lES ~ lie B--0 E-"~ ,:.' 83:C~EC.':J. ) LOT S I ZE tEr_:.',E~E~O S'.;.!_ RRE FEET TYF'E CF SFIIL FIESF~F.'F'TION S'T"=,TEH IS: TRENC:H ttRXIMLIH ;qUI'"IE:ER OF 6E. E F.._JlI= := SOIL RFITING ,::SC.! FT,-.'E:R)="± ,. ._'"~:; THE REC!UIREE:, SIZE OF 'THEE SnIL FtE:':..;CIRF'TION SYSTEH [:, E: F- 'T'H == 'THEE LENGTH DIMENSION ]:L:; THE LENGTH ,::IN FEET) OF THE TRENCH OR DF.:RINFIEI_E:,. THE DEPTH OF F:I TRENCH OR PIT IS; THE [:,ISTFINCE BETI.4EEN THE SURFF~CE OF THE GROUND FIND TFIE BOTTOH OF' THE EXCI-3'v'ATION (IN FEET). THERE IS NO SET HIDTH FOR TF. tENC:klES. THE F. iRFI',/EL. [:,EPTH IS THE MIN]:MUH DEF'TFI OF' GRR',,,'EL BETHEEN THE OLITFFtLI... PIPE FIND THE E:OTTOH OF THE E::.:;CFI',,,'F-¥FION ,:.'IN FEET). F'EF.':HIT FIF'F'L. ICFINT PIFtS THE F..E_,FuI~:,IE, ILI FT TO INFORH THIS [:,EF'RRTHENT DURING THE INSTFtLLFITION IN:,FE~.TI_N:, OF FtNY HELLS RD._TFIL-:ENT TO TFIIS rr'._r~.~ FIND ]"FIE HUHBER f]F F..:E:.-",IE:'ENCES TI-IRT THE HELL. HILL SERVE. ............. -l" 1.4,1'} ,:' 2 ':, ]] NI .:- F:" re- ,-' T' ZCi k...i E; F.# F: E: F.-.: El ,;~ LI :[ F-~: EC E:FtCKFILI_ING OF FtNY SYSTEH 14ITHOUT F.TNFIL INE, F'EC'T.[EN RNE:, FIF'PRO',/FIL. BY THIS DEF'RRTMENT HILL E:E:,IJE, JEL.'f'- ' -' ' TEl F'F'nC;EF:IITIi-1[.4. HINIMUH DISTFtNIE:E EIETHE:EI'.,I R HELL FINE:, FIN'¢ ON-SITE SEHFtGE DISF'OSFIL SYS'TEM IS :[.E~Z~ FEET FOR FI PRI'Y'FITE HELL OF: ±SEI TO 2Em-~ FEET FROH FI PUBLIC HELL [:,EF'EI'.4E:,ING UPON THE TYPE OF' PUBLIC HELL HINIMUM [:,ISTFINCE FROH FI F'RI',,,'Ft]~E HEL. L TO FI F'RI'v'FITE SEHER LINE IS ;--':5 FEE:T FINE) ]"0 F~ COHMUNITY SEHER LINE IS 75 FEET. OTHER REQUIREMENTS MR'-r' FIPPLY. SF'ECIFICPITIOI'.4S FIND CONSTRUCTION [:'IRGRFtf"IS FIRE FIVFIILFIBLE TO INSURE F'ROPER INSTFILLFITION. t C:ERTIFY TFIFIT ±: I Fff"i F'FIHILIF~R HI"I"H THE RELz.!UIRE:MENTS FOR ON-SITE SEHEF.:S FIND HELL. L:; FIS SET FORTFI BY THE HUNICIPFILITY OF F:INCFIORFIGE. 2: I HILL. INSTFILL THE SYSTEM ]:1"4 FIC:CORDFINCE HI'T'H THE CODES. ]:: I LINDEF.:STFtND THFIT THE ON-SITE SEHER SYSTEM I"1F¢¢ F.:EC!UIRE ENLFIRGEHENT IF THE RES I [:,ENCE I S F;.tEMOE:,F.L.~D TO I N~:LUE:,E HOF.:E THFtN 3: E:EE:,F.':OOME!;,. FtPf:'L :[ CFff'EF - BOE: HFIR[:('r' 1:5':.;UED ~. ~,.~ .......... n ~ PDX 97, EAGLE RIVER, ALASKA 99577 a TELEPHONE 694-2588 OWNER OF LAND DEPTH OF WELL 0 or- 7 ADDRESS LEGAL DESCRIPTION A7_ 7 DATE - . Started Ended 4/140174 PERMIT NUMBER 7076 STATIC LEVEL OF WATER FT. DRAW DOWN FT. 0 GALS. PER HR KIND OF CASING MISCL. INFORMATION: p, A T 19 zc-u C4 0 Aq 4A ti ki- 1� n to TI KIND OF FORMATION: IV 6 9 -o 7ql, W19 - / q 0 From_ Ft. to_2_Ft. From Ft. to Ft. 0(6 /VIP From Ft. to Ft. From -Ft. to Ft. 84 From. Ft. to_j_q_Ft.__ _C44 From Ft. to Ft. From--../ 7d - Ft. to_ j?�Ft.Y!� �Z:S &644e*rom_Ft. Ft 4-- to From. -Ft. to Ft. From -Ft. to Ft From Ft. to Ft. From -Ft. to Ft. From Ft. t 5t. 0-1 From Ft. to Ft. From.... Ft. to Ft:__ From, Ft. to Ft. From Ft. to Ft From Ft. to Ft. From -Ft. to Ft. c From -Ft. to Ft: From. --Ft. to Ft. Froin -Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. Froin -Ft. to Ft. From Ft. to Ft. From- Ft. to Ft. From.,_ Ft. to Ft. From Ft. to Ft. From_ Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: p, A T 19 zc-u C4 0 Aq 4A ti ki- 1� o«% e,,058 /V69 ,,s:'k- 2S/• 97( Al"" 11E4 . (iki / /4" -.1 ----,, .i , ,,- - < , t,, .( c)✓ ,v _�� ,,o / if n, a • \1 A1.` t • SIJ f� • e m yE j ° ` . m \ c) ,vr4;° %' 00 S8 j /7---.7-7 ;r•Zz`" ;?,.,j' .0',2-.,./.-.4 1,/ ' '..-1'4 2 .Pew.,�v�,47r . -` ,v" ,'-'?":, ASBUILT-NO CORNERS SET THIS DATE. SEWARD & ASSOCIATES LAND SURVEYING 688-4566 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY: Lot 17, �; Hamann Subdivision DATE: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS ,tr'.�.•' •`.'1-94)� 9/8/91 rj� •� INDICATED. IT IS THE RESPONSIBILITY OF THE t*'. 29TH "� ,, 0 OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: y•••• •• ••••••• •••••®a ,,,,,- EASEMENTS, EASEMENTS, COVENANTS, OR RESTRICTIONS ! „� , `� SW261 / � ...Q WHICH DO NOT APPEAR ON THE RECORDED SUBDI- 0 0 Duane Mark Seward ::00 VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' 4'``�, •.• lS=6�t8 �.0, ANY DATA HEREON BE USED FOR CONSTRUCTION 23-73 k "`t' . •.`�'. ; `"4' OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN: ''h, '�7t,�lual\^°.,.4 AMY LINED. DMS .aye_ w�fo'' KU45 I+ USH ! UNICIPALITY OF ANCHORAGE nr Development Services Department • 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 050-621-04 Expiration Date: I l 2-S--1 1. GENERAL INFORMATION Complete legal description HAMAN N LT 17 Location (site address) 24437 WILMA CIRCLE, EAGLE RIVER Current property owner(s) DAVE HERTRICH Day phone Mailing address SAME Real estate agent Day phon- \ , f 5 F Q4s oscts> 2. TYPE OF DWELLING: 4,0 41.44b/1)-11' o 0 Single Family (w/wo ADU) . ❑ Duplex N 111Multiple Dwellings (Single Family and/or Duplex) d 3 �C997rZ \� 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: /7/0(1 Date: el COSA to be released to the engineer,unless otherwise requested by the engineer. ) 7 S i g COSA Fee $ 'ine) Waiver Fee $ Date of Payment q/a WO Date of Payment Receipt Number Receipt Number COSA# Q'SC«!l a8 Waiver# Ai WA , 4,,,,, fi •pIt awls, ; , '414«..v.• .fes"' L 5 ICA, 'f . IP V 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 'NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 4-24-19 ,ted-s:. a n,4 r� ..°. . •. •• 1,s , .� ,�).'49T ... � 6. DSD SIGNATURE �.......• :2.;I/I System#1 Approved for 3 bedrooms �•�c* ; `.MICHAET;N:ANDERSON .F:— System#2 Approved for bedrooms ���•• at 94 •;_ Disapproved �ill,(/;,:iii�� . •t\-,.. „ & O ESSIVI"—= Conditional approval for bedrooms, with the following stipulalib) \QpIITYO \G . p // .-• �. . C7 W /TE ( sR = 'YIiijS4Az m1 ST _p9O $?Jo Q _.:;s q-,144 = i)) V,C$ NN By: -t"^I(` 0Original Certificate Date: ` I 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 COSA Checklist Legal Description: HAMANN LT 17 Parcel ID: 050-621-04 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Well production at time of test 3+ gpm Date drilled 4110/76 Water storage tank volume 0 gallons Total depth 82.6 ft Well disinfected for coliform test? ❑ Yes No Cased to 82 ft Coliform bacteria is Negative ❑■ Sanitary seal is functioning correctly Nitrate 3.72 mg/L ❑ Nitrate less than MRL (ND) ❑■ Wires are properly protected Arsenic 0 ug/L ❑Arsenic less than MRL(ND) Casing height(above ground) 20+ in. Collected by MNA Date of flow test for COSA 4/18/19 Date of Sample y-1 `I Static water level at beginning of test 38 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) 2019 years ❑ Required maintenance completed Tank type/material STEEL Age of lift station years Measured operating fluid level in septic tank NEW Lift station material ❑� Standpipes/foundation cleanout per record drawing Comments: Date of pumping NEW TANK D. ABSORPTION FIELD DATA Which system tested (date installed) 915!91 Adequacy test date 4-15-19 0 ALL standpipes present per record drawing Results ['Pass For 3 bedrooms Total measured depth from grade 6.25 ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 4.2 ft(min) Water added 500+ gal ❑ N/A—pressurized field New depth 0 in C1 Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min depth into effective ❑� Code-required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 500+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) UN date of test) Gallons introduced 500+ gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet • E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft p✓ Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line>25' 0 Yes if No ft Absorption Field on Lot> 100' �✓ Yes if No ft Holding Tank > 100' �✓ Yes if No ft Neighboring Absorption Fields> 100' Animal Containment> 50' ✓Q Yes if No ft O Yes if No ft Manure/Animal Excreta Storage> 100' Community Sewer Main > 75' E Yes if No ft ✓❑Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations> 10' E Yes if No ft Surface Water> 100' E✓ Yes if No ft Property Line > 5' E Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' E Yes if No ft Private Wells> 100' ✓0 Yes if No ft Water Main > 10' ID Yes if No ft Community Wells >200' ✓❑ Yes if No ft Water Service Line> 10' ['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' p✓ Yes if No ft If absorption field is under driveway comment below Property Line> 10' p✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓Q Yes if No ft Private Wells> 100' 1:1 Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells>200' 0 Yes if No ft Surface Water> 100' p Yes if No ft F. ENGINEER'S COMMENTS ..b.r. r, G. ENGINEER'S CERTIFICATION ,,.....40...:,. vk ;'. �'4 r, 1 s .� r.• '` I certify that I have determined through field inspections and review "' T H ' '•,; of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. •ENIE r, • mitHAtt'"N. ANDERSON :,!--!::;;-$ ;'•. CEt 94159 :'. tFi; •..• �C.` �.. COSA Checklist yellow sheet ��\�0;.:4 Municipality of Anchorage • On-Site Water and Wastewater Program• o�' (907) 343-7904 mala CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-621-04 Expiration Date: 0L 3 , a a 1 1 1. GENERAL INFORMATION Complete legal description Hamann Lot 17 Location (site address) 24437 Wilma Circle Current Property owner(s) Sharpe Day phone 444-4768 Mailing address Same Real Estate Agent Tom Villars Day phone 444-4768 5 61 8 9 10 /i 2. TYPE OF DWELLING: u ® Single Family (w/wo ADU) ti .off ❑ Duplex E APR 2 0 7017 ❑ Multiple Dwellings (Single Family and/or Duplex) `v h 3. NUMBER OF BEDROOMS: 3 !� 01 6 9 L 9 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: Date: t..5/3/ 7 COSA to be released to the engineer, unless of rwise requested by the engineer. COSA Fee $ 5240 Date: Date of Payment 4 lir/49' Date of Payment Receipt Number O'3' 5D Receipt Number_ COSA# l I tO 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 4/19/2017 OF i- �i 5oa oo aa.0°r.r 4,9 uA 6. DSD SIGNATURE B*��� ' • System #1 Approved for 3 bedrooms. System #2 Approved for bedrooms. �� � , Steven N Eng tyr PE2� r� Disapproved. �� 'F`5,- 9 PAO-ESSV`)1,,5" Conditional approval for bedrooms, with the following stipulati ��-�" ' ON-SITE G. WATER AND m m WASTEWATER : C� PROGRAM o +1+� r,r-r, ref F� By: (', Original Certificate Date: 5/3/Q011 The Municipality of Anchorage Devlopment 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 blue sheet 9-1-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system _ Cerrt fkkate of Ort-Sate Systems Approval Checklist Legal Description: , 441,„*/ Lor/7 Parcel ID:d 56-6z/�OCI A. WELL DATA Well type P If A, B, or C provide PWSID# Well Log (YIN) Date completed �4!/7G' Sanitary seal (Y/N) �/ Wires properly protected (Y/N) j Total depth 8 5ft. Cased to '''Z ft. Casing height (above ground) / -74' in. FROM WELL LOG AT INSPECTION Date of test L04/74- V7/27 Static water level Z / ft. ft. Well production 3 d g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Q colonies/100 mL Nitrate Z3 mg/L Arsenic /L/b ug/L Date of sample: .3/27'/7 Collected by: 45— B. B. SEPTIC/HOLDING TANK DATA Tank Type/Material S,Ef?yC /S eei Date installed 27( VR3 Tank size /6dO gal. Number of Compartments 0. Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank (Y/N) At High water alarm (Y/N) r=at Date of pumping ��r�dr'� #7Pumper -"i/JIT 7 /9e."2--5' C. ABSORPTION s4, ui A �� �� 7/ Ticyt,c� Date installed 2//03411r Soil rating (g.p.d./ft2 o it2/bdra) / 7 c System type Tr e Length ,/�l� 3 ft. Width 2. 5 f 5 ft. Gravel below pipe 6'-4- 2 / ft. 55 Total depth ?f�"‘ft. Eff. absorption area 5Z 1ft2 Monitoring tube y Depression over field Date of adequacy test V//'0 -7 Results (Pass/Fail) I For 3 bedrooms Fluid depth in absorption field before test d in. Water added C./56 gal. New depth /z in. Elapsed Time: 30 min. Final fluid depth 0 in. Absorption rate >_ LI-TO g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) _ If yes, give date * �� S 75 6 0 gf cr/tJAA-c_ F" - P -3 Q 44 k-E4 f' t-� D. LIFT STATION AM Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off level at in. High water alarm level at in. Datum _-_ Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: i Septic tank/lift station on Iot/06'1- On adjacent lots /00 Absorption Field on lot /00/4 On adjacent lots /O 0' 14- Public tPublic sewer main &rot," Public sewer manhole/cleanout - Sewer/septic service line Z5 ''k' Holding tank /06 Animal containment areas 50 (f- Manure/animal excrete storage areas /DO ' 4- SEPTIC/HOLDING TANK ON LOT TO: Building foundation /6 (t' Property line /D rr Absorption field S f Water main /a tr Water service line / 2 'r Surface water /0 Wells on adjacent lots /2"6- ABSORPTION 7dABSORPTION FIELD ON LOT TO: r Property line /G 'f" Building foundation /0 '' Water main / 'r`- Water Service line ' ' Surface water /6)0 fi Driveway, parking/vehicle storage 5 Curtain drain U/CH Wells on adjacent lots /04 r F. COMMENTS C'///3//- )FSLCCA C4 fRoLL AZA Q le � bir/5R 2 Orit..v6 //S r. LLl4'T/a/O-Clj/Uivec - TO O/2167l4c 7-040Cft G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and •( ��, review of Municipal records that the above systems are in or� .•`• conformance with MOA COSA guidelines in effect on this data P s. i'41a(F4Elt 's Engineer's Printed Name S revE // Date ///?//7 ��/eft 7 COSA yellow sheet 2-6-15.doc .. G°.`�^ \ Z.:----: fl- • A \\ `- \ l. z, \ /4 sr-4,---------•.__._T=r 6e)' I it, ``Ii, I 0 I_ s 1:---:----. , , . , -___ ._.r---:— ----- . j •oM d i • e r , • ' A . \ 1 i ASBUILT-NO CORNERS SET THIS DATE. SEWARD & ASSOCIATES LAND SURVEYING 688-4566 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE; FOLLOWING DESCRIBED PROPERTY: Lot 17, ;•6� OF Az e41 Hamann Subdivision DATE ..........4 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS ra/c8/91 s '�� ...,:% 04,o INDICATED. IT IS THE RESPONSIBILITY OF THE .4. * : 49 ± • '. S OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: "' EASEMENTS, COVENANTS, OR RESTRICTIONS SW261 yr .6.e.-/;•c-' 4 - a WHICH DO NOT APPEAR ON THE RECORDED SUBDI- .1? .+D ane Mark Seward #0 VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' t lS . LS-6918 .- **(fog ANY DATA HEREON BE USED FOR CONSTRUCTION 23-73 �-,`•'? `, ,�5;; `J* OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN: �k �y�+7xi �t1e A!V15 L.Ir1C3. DMS '`�ry.,.,.r+.+s� 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# _~Z,~,~ _ GENERAL INFORMATION Complete legal description Lot 17; Hamann Subdivision; Location (site address or directions) NHN Wilma Circle Property owner Mailing address Lending agency Mailing address Joe & Traei Fussell P_0.Bo~ 77~355 Day phone Day phone 694-1882 Agent Virginia Kohfi~ld RE/MAX OF EAGLE RIVER Day phone 694'~'200 Address 1~0o ~;¢¢~fx'¢~Pd O/rJu~ #701 E~g.¢~ R~'u¢~: A£a~Jza 99577 Unless otherwise requested, HAA will be held for pickup. 3 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: XX Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA 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 S & 5 ENGINEERING Address 17034 Eagle Ri,,,er L~ep l~oa~l ': agle River, Alaska 99577 Engineer's signature Phone DHHS SIGNATURE X~ Approved for ~-,~,~c~-~-(/~) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ,~ ~¢,.c..c~,-~ Date ('/- / / - 9 / 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) 8ack MOA #21 Legal Description: M~NtC~PAu~Y ~t~UNMENT^~ SERVICES O~VtS~Ot4 Municipality of Anchorage Department of Health & Human Services A. WELL DATA Total depth '7 Cased to ~"'~-~ J Casing height If A, B, or C, attach ADEC letter. ADEC water system number Sanitary seal ~¢7N) _ "~ Wires properly protectedd~N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ Absorption field on lot \ Public sewer main ~ Sewer service line ; On adjacent lots _ ; On adjacent lots Public sewer manhole/cleanout __ Petroleum tank WATER SAMPLE RESULTS: ~"~'~" / ~ Nitrate Coliform E~ ///,cc, Date of sample: ~" ~"-"- B, SEPTIC/HOLDING TANK DATA Date installed '~"'~ I ~ - ~ Tank size Cleanouts~N) y High water alarm (Y/N) Date of pumping ft.L~'/ Other bacteria Collected by:-~.'¢ ¢ t~'/,,,~"~//,.~ Compartments ~ Foun/ation cleanout~N) y Depression (Y/~' ~ /'J /~ Alarr~ tested (Y/N) -----' ""7'-' /~ ~ ! Pumper ,.~,,~ I~ ~.~./~C~ ~. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well (s) on lot [ d;:~'~ To property line [c:~1 ''V Absorption field Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C, LIFT STATION Date inst~l~~ Size in gallons ~ Vent (Y/N) "Pump on~ High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot Manufacturer Manhole/Access (Y/N) "Pump off" level at On adjacent tots Surface water D. ABSORPTION FIELD DATA Date installed c~ ~ Length "'7~:~ Width Total absorption area Depression over field (Y/~? Results (pass/fail) ./~L'~.W Peroxide treatment (past 12 months) Soil rating C:P, ~ ~' '//¢"~System¢r2/.~ type~ ~ ~ Gravel thickness Total depth ~ ~ Cleanouts present. N) k/ , / Date of adequacy test ~/~ for ~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot / ~1'5¢ Onadjacentlots / ~:~:~1 ..jO Propertyline To building foundation ~'{.~! To existing or abandoned system on lot On adjacent lots "'~C;~l ~ Cutbank h.( ~'¢~. Water main/service line Surface water ! ~,~t~ Driveway, parking/vehicle storage area Curtain drain h-~ ~:~--~ E. ENGINEER'S CERTIFICATION Signature Engineer's Name I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effeci $ & 5 ENGINEERING w,~r~¢¢oO~ ~agle River, R~aska 995~ Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL,-,'~) OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date March 5, 1987 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 17; Hamann Subdivision Location (address or directions) Wilma Circle (b) Applicant Name Hoffman Telephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder)~; Buyer []; Other [] (exp!ain); (d) Lending Institution Northland Mortgage Telephone Address Eagle River, Alaska (e) Real Estate Company and Agent Red Carpet/Great, and - Margaret Address P,0, Box 633; Eagle River, Alaeka 99577 Telephone 694-9125 HAA o,owm S & S ENGINEERING 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 ordered by Margaret - Greatland/Red Carpet TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms 3 Other 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 Onsite [~ 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 (11,84) ENGINEERING FIRM PROVIDII~,, ~NSPECTIONS, TESTS, FILE SEARCH, D, , 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 ENGINEERING Telephone 17034 Eagle RLver Loop Road No. 204 Address · Date [)HEP APPROVAL Approved for bedrooms by Approved Disapproved Conditional Terms of Conditional Approval 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 (11/84) Well Classification Well Log Present Total Depth ~c-.-.-.~"~ / Cased to Static Water Level ~_."~-/ Casing Height Above Ground ~ / ~-~ Electrical Wiring in Conduit ~(.,~N) Separation Distances from Well: ,,~.(~&JN. ICIPALITY OF ANCHORAGE (MO~.i AUT.OR,TY A.P.OVA. CHECKLIST- FEBRUARY 1984 _ Legal Description: ~ ol Date Completed _ ~/-/O- ~ ~ Yield Depth of Grouting Pump Set At __ ~/%, Sanitary Seal on Casing Y~) Depression Around Wellhead (Y/~ To Septic/Holding Tank on Lot /z.~¢ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot .//)t~ / .-¢' _; On Adjoining Lots ,/ To Nearest Public Sewer Line ,k,,[~ To Nearest Public Sewer Cleanout/Manhole __~ To Nearest Sewer- Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes ,i~/N) Air-tight Caps (~N) Depression over Tank (Y/~.~ Pumping/Maintenance Contract on File (Y/N) . ./ Holding Tank High-Water Alarm (Y/N) /~'/'~' Separation Distances from Septic/Holding Tank: ~-- "/~,,~$ Size /0o~ No. of Compartments Foundation Cleanout ~.)N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) /~/~ To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation /--///¢ ~ To Disposal Field ~J /~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y~I~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / To Building Foundation Lot To Water Main/Service Line /_O To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field ~',/'/ Depth of Field d) ~ Gravel Bed Thickness Standpipes Present ~/N) Date of Last Adequacy Test To Property Line / To Existing or Abandoned System on ; On Adjoining Lots ._~O )-.L To Cutbank (if present) ¢/¢ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed .... Date c~ ~/,.~-- ~ O $ & S ENGINEEI,tIr, t~ Company7034 ~_g!e ~ive~Loop. Roa~Nolk,.~ No' o¢~(~ -- Oo ~ ~le flyer, Al~sk~ Date of Payment---- ----///~/~ Amount: $ ~¢ ¢ ~ Page 2 of 2 72-026 (11/84) I:::IF'I::'L, t C:Ir:tI",I'T' L 0 C: f;:l'/' I 0 i",1 L ['", (ii f::tL '1 ',/F'E O1:::' :50 1 I_ F:IE:'!i;OI:4:E',T :1: ON ~5'¢E;'l"E]'d I Si;: TRENCH I'11::1;~.=::1:.1','11...li','i I'.,IL.IHBE:I:;i: OF: [3E[:,R!OOM:!~; = 4- SO I L. RFIT I NG ,:: }!.:,Q F'T'v"fi!:F.: 1:, .... :1.7:5 THE Fi'.Fi:QIJ I Fi:El::, ~.; ;[ ;;!!:E: Cfi:;' 'T'HE 2i;O I L I::IB:~;ORF'T ]: ON S'¢:7;T[Zr,1 I i;: THE Lm.~,:~"r'H [::,:l:r'll~r..t~;zo~., [~; T-E [EN,~TH ,::]:1'.,I ~I~:'T::, ~,F THF Tr4:F~.4,-:H nl:~' prm 'r l...lF ]' [::l i', GF~tOUN[::, [~r'4E:, THE BOT"TOM OF' THE: EXCF] v FIT I ON ,~1'.,I ~IFE:T ::,. 'rI.-IE[;;:E :[ ~;, NO :~;[~:'rl" 1'4I[::'TH F'']'I:;~: '['F:E:I"4CHE:~:. ~ 'V'' THE: GF4r¢~ ',' [CL. [>EF'TH Z:~; 'TH[E I"'III"'I]:MIJH E:'EF'TH~3F r~","[):l... E~ETNE:E:N THE OIJTI::I::II--t.. F'IF'E: I::ll'"tE:' THE BOTT'Or,'I O1:: THE E,:',:CFI'v'F:IT F:~"':, E:F:ICI<F:' I L.L I I'.,tC.i OF' l::lf.,l'.~.' SVSTEr,'I FJ I 'THOI.J"[' [::,[ii]:::'F:lFYf'H[i]'.,t"t' I.,.IIL. L [3E :i~;I..l[3jr[~-:CT '1" 1','11 I'-,I I t',II..JH F;, I ':?T'I:::II'-,ICE: E:E TI.,.IE:[~:I'.,I I::1 1.4EI_L , ::!..l;~!lEI I:::'E:I~E'I" I:::'O[~:C-FI F:I:',i:Z vl::t"r~c,_ NELL :E;I:::'E:i]: I 1::' I CFIT I CtI'.,t.:E; I::IN[) L-:Ot~I.F.',T~'.LII.~:'T' Z ON [:, I I",1:!~; TI'::ILJ...Fll" II]IN. ::L: I F:lr't FFII"IIL. II:3[~: NI'f'H I:::'OI:~:TH B'T' 'l"l'-Ilii: MUN I C: I I:::'lhL. I T'¢ F:INCHO I'.,ISF:'EC:'T' I ON I::IN[';, I::IF'F'[;;tOVF:II_ E:"r' TH I ':'~; SENF:IGE: [::' I b:i;l::'Edi;FIL. '_'5"r':~;'FEM 1t: FliCET F:'OI~: I:::1 PI.,.I[3L. I C I.'.IEL..[ .... F~F.:E I:IVI':] .'[ L.FIEIL[~ ]"O :[ I",I:'~;LJFi:E: T'.'~; I=OR ON-!!i;I'TIZ SEN[ERS f::ll"4[::' I.'JEI~.L.~'i; I:::I'Z, SIZ"t" 1.41 L.,L,. I r.,ISTFIL..L. THE :.::;'¢:5'TE I::INE:E I,.I I 'i"H THE: CO[::,ES. I. Jlq[:)[ii:i:;~trii.;TFiN[.':, TFIFIT "i-HE ON.-S;:I:TE :i:;EI.,.IEI;i'.."::';'.r':F:;TIEr'I MFI"r' f,~rEr..:!LIII:;i:E: E:l'.41...l:::ll:~:l:Z!iliEl'"tl.ii.l'.,l'l' IF' 'Fl-Il!!: [~:E~.:,IIi:,['!NCE: ;t:~ii.:, REMO[.':qZL..EI::, TO II'.,ICI..IJIi:,Ei: MORE THI:::Ii'.,! ' i~'F'I~ Cd::liq]" E:Ii)[~: F.IFII:;~'.IJ:, ~'-- I Performed For Bob Hard~ Leoal Bescription: Lot 17 Block This Korm Renorts Soils Loq yes "On,~tsw~lhalh~sando~inionF' 2204 Cleveland Anchorage, Alaska 99503 Date Performed 6/21/76 Subdi¥ision Hamman Subdivision Percolation Test Eagle River ~enth Feet Soil Characteristics ?opsoii Interlayered .coarse gravel groun~n waterer --- lenses and silty Sand's (GP-GM-SM-ML) 16 18 20--- Bottom of Test Hole Was Ground Water Encountered? I~ Yes, At what Depth? yes - 13 feet Date Gross Time Net Time Depth to H20 Net Dron inches inches 6/~2/76 ~ 0 48 0 6/23?76 - 24 hrs " 72 24 6/~$~76 0 48 0 6'/~3ff76 ~ 30 51- 3 6~25/76 60 53-~3/-~ 2-3/4. ' 56'1/4 2-1/2 __ 90 ........ 6~3_3/76 120 58-3/4 2-~/2 Percolation Rate _~"/12 Hinute Proposed Installation: Seenaee Pit Drain Field Depth of Inlet Depth To Bottom Of Pit Or Trench CoM!~ENTS: 175 S~uare Feet Drainaqe Area required p~r_j~edr_Qom. By_ ///~,~-,.~m /~, ~_c~.~__Data Certified BY: CONSTRUCTION TES Test Performed k Date: 6/24/76 LA --~-mes D. Mac I:':1F'l';' 1.. )~ I::i:l:;lt",!-I' I,., (;lI IZ;; 171 ] ;[ 0 I"ll I I.li.:;(~ RL :'iE I"J DEL. Ef:IEiI,.E F: ~. 'v'El:,i', J..13T S ,L I¥t :[ i'.,1:1:I'1U1¥1 I) :t; :!i;'l I::II'.,ICE t:~:I:/t'I,IEEt",t FI HEt .I.. FthIl) I:::lh!"r' Ol",l~<~; ;t; Th: t[:;Et't?'I(:~E I.::' I SF'OSFI!... Str'S"!EH :1; S ::I..131ZI I::;'EETI' F:'OI':'. FI F;'t,;::i;',/I::IT!:~: I.'.IE:L.L. Of,'. ;;:~(.~ff~i FEET I':"()t';: Ft ~':'LII~I.. :[ (:: NELL.. b. IEI_.L l...OI}i:~; I:;:]~;~'.E t~:El:;;!l...I;i:t4:l~{.[)I:':ll'ql:::' HLIST I3E I:(~E'I'LtI:~:NE[)'1'O '1 HE IXS.'F:II;d'I'"iEt'.4T !,I:I;'I'HZI. N ~:Ei i)l::l"r% 13F' 'I"HE t4EL.L :~;t::'[:.;I;::: :[ F' ]: CI'::IT ;I; ()NS l:::lbll::' (.:Ohl:~;'l I,:'.UI:.;:T :t; 131";! [:, ]; f:;IEil~:FIh'lS f:IP.E FI',/FI ;[ Lf:;ll::(:L.h:; '10 :[ I'-,tSI.)I:dE F'b;:OPE~'. :( 1'4 ST I::'I I... !... FIT ;!. I; ) bi. ~76436 ~ob Hardy G~noral Delivery 99577 Subject ~ Permit A penn, it i.~sued by this depart~.~ent for well and/or on-site ~ewer installation on Lot 17 Hat, mort f~bd. ivision has expire(t s~ ~ the issue date ~(.ocl~ In the event you still plan to install the well and/or sate s¢~,wer system~ a new ~r~]it is required. soil test n~!y be used%o obtain a current the well has been drilled, a well lo.~{ should be sent this departm(:nt to docu~,ent thc~. inst~.%llation date. If you have ~'.u%y q%testions re.~ardJ~%~j the abow:~ m~tte, r~ please do not hesitate to contact this office im~e~'t:[a'[:ely at 279~- 2511~ extension 2~.4 or 22.5. Sincerely Sa~itarian LNB ~ 1 j h ~ ince~'e ly ~