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HomeMy WebLinkAboutMOUNTAIN TERRACE ESTATES #1 BLK 1 LT 5 Municipality of Anchorage Page of_ 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 Permit Number: .~¢0~¢0/~'~ PIDNumber: ~-/~,1/-~' Name: ~.,~..0¢7L //~c~//,,//~,¢.~.... Wastewater System: CNew ~ Upgrade Address: ~Q ~¢ /~ ~4~ / 4/4 ¢~$ 7~ ABSORPTION FIELD Phone: NO. of Bedrooms: ~ B Deep Trench ~Shallow Trench B Bed ~ Mound ~ Other ~oi[ Bating: Total Depth from original grade: LEGAL DESCRIPTION Lot: ~ Block: / ~'Subdiv~i°n:~/~ ~ ¢', Deplh to pipe bottom from origin~l/~ ~grade:~ Ft. Gravel depth beneath pipe ~, ~ Ft. Township: Range: Section: Fill ~dded above original grade~ ~/~ Grsvel length: I ~,. . & ~ ~,. Number of lines: Distance be~n lines: WELL: ~ New D Upgrade Gravel width: ,~ Ft. / ~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: I Pump Set at: ~,ing ",ighl Above Ground: TAN K Yi.,u: /¢ GPM ~ ~ Ct. & Ft. SEPARATION DISTANCES ~s~ptic B ~o,~ing ~ S.T.E.P. To Septic Abso~tlon ~ifl Holding Public/Privatel Manu facturer~ Capacity in gallons:/{ Material: Number of Compadments: Su~,ce LIFT 8TA'flON Lot Foundation /O '* /O '* /~ ,~ ~ '" Electrical Cudain /~¢(~ /~W /¢¢ /~ Pump Make & Model Inspections pedormed by: BENCH MARK ' ENGINEER'S SEAL Deparlmenl of Heallh and Human Services app~v~l Reviewed and approved by: ~,¢~'I.¢~ 72-013 (Rev. 9/91) MOA 25 AS-3UILT SYSTEM DE-FAILS/SITE PLAN Permit SW980199 MOUNTAIN TERRACE S/B, LOT 5, BLOCK 1 , , TOP OF SLOPE 25Z) ~ PAINE ROAD ~ Apppox, ~oc~tion oF ditch/we-rep A-D=40,9' ? .... FINISHED GRADE ~ ~1250 GAL,' x _ ' T A-F=41,O' ~ / [ TANK ' SEWER ROCK ~ O~ X~;~ PREPARE~ Y~R', SCALE, ~'~ q~ SCOTT KENNER *~Z[ 9 T TOG[AK, AK 99678 ~ . ENGINBE~ING BOtJNOARY: FLEMING DRAWN: KMD ~ ' ~sa ..... FLEMING oa~[: 12/1~ ~EAGLE RIVER, AK 99577-8736 AC,',O FILE: 98052.DV,/G aos ~o: 98052 (907}696-6~ II/FAX (907)696-81H FROM ; PHONE NO. : Jan. 05 1999 09;50AM P2 WILCO CONTRACTORS 16701 RANSOM RIDGE ANCHORAGE, ALASKA 95516 345~6Z88 OR 522-5443 FAX;345*5947 1/4/99 Attn: Municipality of Anchorage Dept, of Health and Human Services on-site service section PO Box 196650 Anch. Ak 99519-6650 The lift station at Lot $ Block 1 Mountain Terrace has been wired in accordance with all the State and National electrical codes, Bill Wilkinson by SULLIVAN X;I'ER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 e TELEPHONE 688.2759 OWNER OF LAND /.~..)1~(.,~ DEPTH LEGAL DESCRIPTION ~Q~ PERMIT NUMBCR~¢O/9'f_ TAX INDENTIFICATION NUMBER is well located at approved perm}t Iooalion? ¢ O No Method of Drilling: ~ rotaw ~ cable tool Depth of w¢lh /.~ 1 Casing Type ~Wall Thickness , 2 ¢O inches Diameter ~ l/ inches, depth~ /~ / ]eel Liner Type:. Casing Stickup Above Ground: ~ ~ feet Static Water Level (from ground level): _ ~ feet Pumping level;, feet after hrs. pumping gpm Recover Rate:_/0 . gpm Method of Testing: Well Intake Opening Type: ~End ~ Open Hole ¢_1 Screened; Sta~ ____ feet Stepped feet .~ Pedoration~ Sta~ feet_~topped feet Depth: from~ O_ feet, to~ ~ feet Pump Intake Depth: __feet Pump Size_ hp Brand Name_ Well Disinfected Upon Completion? ~ ~ No Method of Disinfection: BORE HOLE DATA RE iVFD DE.r; ~ ~ept. Nealth & Human Services Driller's Name /~--~.--~ ~ ATTENTION: It is the responsibility of the property owner to submit a copy of tho well log to the proper authority. Municipality of Anchorage: Department of Health & Human Bervice$ and/or Department of Environmental Conservation, MatSu Borough: Department of Environmen[~J Co~servati~. IO'd ~~6~i~ 889 PAGE MUNICIPALITY OF is~NCHORAGE DEP~5~RTMENT OF HEALTH 3~N-D HUlV/AN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL 2~KID WASTEWATER DISPOSAL SYSTEM PEP-MIT PERMIT NI/MBER:SW980199 DESIGN ENGINEER:KND ENGINEERING OWNER ND24E:BAXTER TIMOTHY & SUSAN L OWNER ADDRESS:P.O. BOX 109 TOGIAK, D_LASKA 99678 DATE ISSUED: 6/24/9~¥\~,~,r~-~ I~ C~> EXPIRATION DATE: 6/24~99 PARCEL ID:02012108 LEGAL DESCRIPTION: MOUNTAIN TERRACE ESTATES ~1 BLK LOT SIZE: 57825 (SQ. FT.) NUF95ER OF BEDROOMS: 3 THIS PERMIT: 1 LT 5 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC T~uNK / WELL 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 kND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM LYN-DER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE '. 2 4 ~I~D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 [: (907)696-6111/FAX (907)696-8111 June 4, 1998 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Mountain Terrace S/D, Lot 5, Block 1 - Well and Septic Permit Gentlemen: Following a request from the owner, on April 18, 1998 two testholes for the proposed on-site septic system were dug. The results of this test are attached. The lot is to be served by individual well as indicated on the attached site plan. As indicated on the site plan the system can be served by gravity. A 1000-gallon tank will be installed for the proposed 3-bedroom residence. Additional fill will be placed over the system to provide a minimum of 3' of cover when complete if required. While we are within 50' of slopes in excess of 25% the restdth~g grade after construction of the field, as illustrated on the attached cross section, will be approximately 12%, providing a grade that is well within municipal criteria. As indicated by the site plan drainage arrows, natural drainage is away from this site and w~l be maintained after construction. There is no surface water within 100' of tile proposed installation. There are no known curtain drains within 50' of the proposed installation. No public or private wells exist within 200' of the proposed installation excepted as noted on the drawing. This on-site septic system should have no adverse effect on development of adjacent lots. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, ~Ic_'~'~Ib Engineering Attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test Slope cross section WELL ?~ WASTEWATER ME]UNTAIN VACANT 2A (84-44) lA '?%, VACANT PAINE ROAD NO PUBLIC WELLS WITHIN ~00' DF PROPOSED SYSTEM. ND PRIVATE WELLS WITHIN 200' DF PROPOSED SYSTEM EXCEPT AS NOTED, DISPOSAL SYSTEM DETaILS/SITE TERRACE S/D, LOT 5. BLOCK 1 ~L~l LOT 4 ~ ~J~ D VACANT PLAN DESIGN DETAILS 3 BORN X 150 GPO = 450 GPO 450 GPO/O,8 GPO PER SQ, Fl, (7,6 MIN/IN,)= 562,5 S9, FT (568,5/%'(W)) X O,58'(RF) (3,0' GRAVEL) = 65.85 FT, TRENCH USE 1 TRENCH - 66 (L) X 5' (W) X 3'(D) To%al dep%h of' sys~cem is 6.0' From original grade, To%al depth of gravel below dis%rib~tion pipe is 3,0' . NOTES: 1, USE 1000 GALLON SEPTIC TANK. INSULATE TANK IF <4' COVER. 8, INSULATE TRENCHES WITH a" HD BURIAL FOAM, 3, CONTRACTOR WILL ENSURE MAXIMUM 27. SLOPE INTO SEPTIC TANK, 4, ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN, 3' COVER IF REQUIRED, PREPARED FOR: SCOTT KENNER P,O, BOX 109 TOGIAK, AK 99678 FIELD BOOKS COMPUTED: B©UNDARY: DRAV,N: KMD STAKib!G: CHECKED: KMD ACAD FILE: 98052.DWG DATE: 8./3/98 GRID: 3342 JOB No.: 98052 Scare: 1"= 100' PAGE 1 OF 2 ~~_~ ENGINEEI~ING 8044.1 PTARMIGAN BI.VD. EAGLE RIVER, AK 99o77-8r36 (907)696-6111/FAX {9071696-8111 WASTEWAI-~R ~ISPEISAL SYSTEM DETAILS MOUNTAIN TERRACE S/I), LOT 5, BLOCK t 3 A BT SF-I) -----_~_~/ CB C L, S,T /-- PR © P1T BSa3 TH 898-1 SYS- PREPARED FBR: SCDTT KENNER P,m, Bmx m9 Sccte: TmGIAK, AK 99678 PAGE ~,eLo ~ooxs co,.~t~: ENGINEERING BOUNDARY: DR/,~',N: KMD s~c: _ C.ECKEO: KMD ~04d l PTARMIGAN BLVD. *sau,~: o=~a: 6/3/98 EAGLE [~IVER, AK 99577-8736 m,~a ~,ca: Ca,D: 5542 WELl_ I~ PLAN WASTI-WATER ]3ISPBSAL SYSTEM DETAILS/SITE MOUNTAIN TERRACE SLID, LOT 5, BLOCK 1 VACANT 2A (84-44) VACANT ~ZZZZZZZZZZEZZZEZZZEZZZZZZZZZZZZZZr K VACANT Z~¢%lZZZZZZ--Z-' DESIGN DETAILS 3 BERM X 150 GPD - 450 GPD 450 GPD/0,8 GPD PER SO. FT. (76 NIN/IN.)- 562.5 SO FT (562,5/5'0,,/)) X 0.58'(RF) (3,0' GRAVEL) - 65.25 ET, TRENEFI USE I TRENCII 66 (L) X 5' (W) X 3'(D) Tol. o.L dep~uh oF system is .(.~....Fnom o~'i9ino] .qr'ade. To to( depth oF 9Paver bdo~° distribu:ion pipe is %0' NB I'ES: l. USE lO00 GALLON SEPTIC TANK. INSULATE TANK IF <4~ COVER, R, INSOLATE TRENCHES WiTH ~ HI} BURIAL FOAN, 3 CONTRACTOR \,/ILL ENSURE MAXIMUM aX SLOPE INTO .%EP]IC TANK. 4 AE[}ITI[qNAL FILL Y/ILL BE Al]DEl) OVER SYSTEM TO ACHIEVE HIN 3' COVER IF REQUIRED. PREPARED FOR: SCOTT KENNER P,O, BOX 109 TOGIAK, AK 99678 fIELD BOOKS COUPUtEO: BOUNDARY: ORAV, N: STAKING: CHECKED: KMD ASBUILT: BATE: 6/3/98 mod 6/18/98 OWG FILE: ^C,XD me: 98052.DWG CRIB: 3342 JOB N~: 98052 ScaLe: 1'- 100' PAGE l BF 2 l~J~ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 995??-8?36 I (907)696-611 l/FAX (907)696-8111 WASTEWATER BISPBSAL SYSTE~ BETAILS NBUNTAIN TERRACE S/S, LBT 5, BLBCK 1 8 K D PREP&RE]] FFJR: SCOTT KENNER P,O. BOX 109 Sc(ire: I" 20' TOGIAK, AK 99678 PA(]E ~ BF 2 FIELD BOOKS cO,~PuTE~: ~ ]~ d._T~ ENGINEERING s ......... C,EC~e0: KMD -- 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99077-8736 ;,c~p~,L.~:98052.DWG uoB~o.: 98052 (907)69fi-BILI/FAX (90~)696-8111 WASTEWATER iDISPOSAL SYSTEM DE-FAILS 0 NLIUNTAIN TERRACE ',5 K D sco]-r I<ENNER P,O, }}DX [09 TOG[Al<, AK 99678 { Ill D [}OOK% Sca[e: /" 20' PAGE 2! ElF 2 sl,,x,r,c - ' cnrc~o~ 'KPID 304d I PTARMIGAN I]LVD. ~: o~:~, ~/,,,, ....... ~Z,~'/o~, F, AGI,H RIVER, AK 99577-87',~6 ~,,,~a ~ c: c;~o: 35342 ,.,c,,n ~,t~: 98052.DWG ooa .....98052 9871696-fil 1 I/]"AX (90~Q~6-{~111 Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" StreeL Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Z.~/' 5- sLo. E S,TE PLA. 1 2 3 4 ~c~ 0 WAS GROUND WATER 10 ENCOUNTERED? 11 IF YES, AT WHAT DEPTH? 12 13 M0nit0ring7 _ '~""'-./ 15 16 17 18 Gross Net Depth to Net Reading Date Time Time Water Drop / ¢-/~-~ ¢:o~ -- _~" - ,/ ,/..// ~ ~ ,'~ ~ ,. ~ ~/~ ,, 20 /~, ,' / PERCOLATION RATE /~_ tmmutes/mch) PERC HOLE DIAMETER _-- / . 72-008 (R~, 4185) WAS PERFORMED IN PERFORMED FOR LEGAL 1 2 3 4 5 6 7 8 9 10 11 12 13- 14- 15- 16- 17 18 2O Municipality ol Anchorage DEPARTMENT OF HEAL~*H & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST )ESCR,PT,ON ./¢~..,¢/~,'~ 7~Z'/4¢(. ~'~/ /~/'~'/ Townsh,p, Range. Sechon. 7~H ~ ¢~- / Z,~/' ~ s~_oPE s,~E PL^N WAS GROUND WATER ENCOUNTERED? ~F YES, AT WH^T DEPTH? E Oeplh Io Waler AlJer ~ Oro~ Net Depth to Net Reading Date Time Time Water Drop t ¥-/,$- ~ ..$' ;.~ ~ _ _2- =_- PERCOLATION RATE '7[ ~'~ [mmuteumch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ F~AND "~ Fl 72-008 (Rev, 4/85) -7-//~ £ ENGINEERING 20441 PTARMIGAN BLVD. iiEAGLE RIVER, AK 99577-8736 (907)696~'1 I l/FAX i907)696-8i I I Mountain Terrace Subdivision Lot 5 Block 1 Slope Cross Section Scale: Noted Grid: 3342 Drawn b dea Date: 6/98 Prepared For: Scott Kenner P.O. Box 109 Togiak, AK 99678 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DVVELLING Parcel I.D. 020-121-08 GENERAL INFORMATION Complete legal description Location (site address) COSA# 0%C Expiration Date: MOUNTAIN TERRACE ESTATES #1, BLOCK 1, LOT 5 17125 KINGS WAY DRIVE, ANCHORAGE, AK 99516 Current Property owner(s) SCOTT & PHILIPPA KENNER Mailing address Lending agency Mailing address Day phone 17125KINGSWAYDRIVE, ANCHORAGE, AK99516 Day phone Real Estate Agent Mailing Address HALTNESS & TUTTEROW Day phone 227-0599 Un/ess otherwise requested, COSA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: ,/:i'fidividUal Well ' [] · 'individual:Water St0rage [] Individual Holding Tank · COmmunitY C!ass: ':; Well [] Community On-site Public Water SYstem [] Public Sewer TYPE OF WASTEWATER DISPOSAL: Individual On-site [~ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of on-site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Certiticate 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. DSD SIGNATURE ~ Approved for 3 Disapproved. Conditional approval for Name of Firm ARC-tERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD.~ EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFF-US Date 01/12/2011 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and abSorption rates may change due. to subSurface, cOnditions that maY not be obserVed :frOm the surface, changes inland use, local Soil characteristics, Oi;Oundwater levels that may fluctuate dUring the year and the water usage of the family being sen/ed by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a '. system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ~""'"' ."~'~'"~.'~"' ~, ,...~.,. :~.., ,.~:~:~..,...,.... ~..,:~.., ''~' encroachments, deficiencies or discrepancies exist. ..~,.......~~ .., bedrooms. ' bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X WATER AND STEWAT ; : Arsenic Adviso~ Maintenance Agreements Supplemental Engineers Repod Other Original Certificate Date: i- 2 g -// Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MOUNTAIN TERRACE ESTATES #1, BLOCK 1, LOT 5 A. WELL DATA Well type P]~-¥A~ IfA,.B, or C provide PWSID # Date completed $/13~_998 Sanitary seal (Y/N) Y__ Total depth 122 ft. Cased to 121 ft. FROM WELL LOG Date of test 8/1998 Static water level 3zt Well production 10 WATER SAMPLE RESULTS: Coliform NEC colonies/100mL Nitrate 2.31 Arsenic: ND .rng/I Date of sample: 1/7/22011 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed Well Log (Y/N) Y __ mg/L Parcel ID: 020-121_-08 Wires properly protected (Y/N) Y Casing height (above ground) AT INSPECTION 37 ff. 6.8 g.p.m. Collected by:. ArcTelxa 7/30/1998 Tank siZe 1250 gal. 18+ in: Number of Compartments _2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N__ High water alarm (Y/N) Y Date of pumping 1/6/2011 Pumper A+ C. ABSORPTION FIELD DATA Date installed 8/10/1998 Soil rating' (g.p.d./ft2 or ff2/bdrm) 0.8 System type Trench Length 68 ft. Width _5 ft. Gravel below pipe 3.3 ft. Total depth 5._~3 ff. (Measured 1/7/11) Eft. absorption area $62 ft2 Monitoring tube Y Depression over field N Date of adequacy test 1/6/11 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 16 in. Water added 880 gal. New depth 23.5 in. ElapSed Time: 1200 min. Final fluid depth 13.5 in. Absorption rate >= ~,50+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N__lf yes, give date --__=- LIFT STATION Date installed 0 7/3 0/1 9 9 8 "Pump on" level at 44 in. Datum Bottom of tank SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot 10o'+ Absorption field on lot lO0'+ Public sewer main ~'+ Sewer/septic Service line 25'+ Animal containment areas 50'+ in. Size in gallons1 250 "Pump off' level at 4Z Cycles tested Z Manhole/Access (Y/N)__Y High water alarm level at 48 in. Meets alarm & circuit requirements? _Y_ On adjacent lots 100'+ On adjacent lots lo0'+ Public sewer manhole/cleanout lo0'+ Holdingtank loo,+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Absorption field 5'+ Surface water 100'+ Building foundation Water main 3.0'+ Wells on adjacent lots 3.00'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3.0'+ Building foundation 3.o'+ Water Service line 3.0'+ Surface water 3.00'+ Curtain drain ' 50'+ (None Know~) F. COMMENTS Property line $'+ Water service line 3.0'+ Water main 3.0'+ Driveway, parking/vehicle storage 3.0'+ Wells on adjacent lots 3.00'+ E,GI.,EER S CE,TI,ICATIO, I certify that I have determined through field inspections and ~~" ...~ review of Municipal records that the above systems are in ...~:~~..w~ co. .. nce w,'th Moa COSA in erect on thi o te. Engineer s Printed Name ~KF. NNE~r[-[ M. D OTFt~$ Date 3./3.2/20~_3. .... :~'.~........... ~.. COSA Fee $490.00 Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 33' LOT 4 N90° 00' 00"W 260.00' O WELL 81.7 N89° 15' 00"E 250.00' PAINE ROAD UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARY OR FENCE UNES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL MABIUTY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. [] LOT SURVEY SURVEY TYPE [] FOUNDATION AS-BUILT [] FINAL STRUCTURE: AS-BUILT [] PLOT PLAN . . . AS-BUILT . . . LOT SURVEY . . . TOPO~APHY [] AS-BUILT . . . NO CORNERS SET [] REC~-CRTIFICATION AS-BUILT . . . NO CORNERS SET PLOT PLANS & LOT SURVEYS IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. SURVEY CERTIFICATION PLOT PLAN t henlOy certify ~ot 1 how ph~y tFOUNDAIION AS-BUILT ~'INAL S~UC~RE AS-BUILT SYMBOLS · SET REBAR ~ ~ DRAINAGE ~ ASPHALT o FOUND REBAR C C C WOOD FENCE ~ CONCRETE Q ASSUMED ELEV. X X X METAL FENCE ~ WOOD DECK NOTE: ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE ~NILL BE SHOW1q. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by Robert E. Johns, Jr. & Professional Land Surveyors 1700 Brink Drive. ANCHORAGE, ALASKA 99504 Assoc. Scole: Dote Surveyed: Dote Drown: Legol Description: IRec.Lot S.F. IRec. Plot File No. 1" = 50'01117/11 rro'n b~' REJ IChecked ~rWL 01/18/11 rr~d:SW33421w'°' 11-12 MOUNTAIN TERRACE ESTATES #1 BLOCK 1 LOT 5 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING /~i- O~ HAA# 1. GENERAL INFORMATION Complete'legal description ~(~,nJ~ ~,,'(~ ~'z~L¢ ~,/o(,L / Location (site address or directions) Property owner Mailing address /~) ~6~' /~'~ Lending agency. Day phone Day phone Mailin. g address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. :. 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- mg to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 724325 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 verifythat based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the o'n-site water supply and/or wastewater disposal system is in compliance with ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm I~/V~) ~-14~?~1 ~'t/'?~ Phone ~ ~ ~/-p/// Address . ~Oct~// ~/~/~..,/, ~/4' ,~'ve/- / ...,¢,~ Engineer's signature " ~ "~ Date. DHHS SIGNATURE Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date 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 DH HS 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~ (Rev, 1/91)I~aCkMOA ~ Municipality of Anchorage DEC ,~ 0 DFPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MuN~c~p^Uf~O~ NC 825 L Street, Room 502 · Anchorage, Alaska 99501 · Health Authority Approval Checklist A. WELL DATA If A, B, or C, attach ADEC letter, ADEC water system number Log present (Y/N) "// Date completed Total depth. /~ [ Cased to /"~ / ~ Sanitary seal (Y/N) ~. Casing height (above ground) Wires properly protected (Y/N) f Y Date of test Static water level Well production FROM WELL LOG AT INSPECTION /0 g.p.m, g.p.m. WATER SAMPLE RESULTS: Coliform ~ Date of sample:_ Nitrate /, 0'7 Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed __~?/~¢/'~ Tank size '//,;~ 3"4~;:) Number of Compartments ~' Cleanouts (Y/N) V __ Foundation cleanout (Y/N) _ "f/ Depression (Y/N) ~ High water alarm (Y/N) Date of Pumping --- Pumper C. ABSORPTION FIELD DATA Date installed_ O~//D/¢/~ Soilrating (g.p.d./ff~orff'/bdrm) Length'. ~ ~ / W dth ~' ! . Gravel thickness below pipe Effective absorption area. ~'¢-'¢- j~ qu Monitoring Tube present (Y/N) '¥ Date of adequacy test.. Results (Pass/Fail) Fluid depth (ins) Minutes later: Absorption rate = .g.p.d. System type ~'/¢.~///'¢,¢ '~, % ~ Total depth. · Depression over field (Y/N) FoL ~ bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date _ 72-026 (Rev. 3/96)* LIFT STATION Date installed ~) -7 Manhole/Access (Y/N) High water alarm level Size in gallons "Pump on" level at* /7/F /, *Datum "Pump off" level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots /¢0 On adjacent lots /~> ' '~- Public sewer manhole/cleanout ~//}' Lift station /¢,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /~ /¢ Property line //~/~- Absorption field Water main/service line '~ ~'/~' Surface water/drainage /~ ¢ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Building foundation /~ /'~ Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots /~ b ( ~ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review in conformance with MOA HAA guidelines in effect on this date. Signature ~--~(~;~. /_~/'].,/'~.~_ ~ Engineer's Name ,~£~ Date / ,~/~/~ F HAA Fee $. L-~-)[-')- ~ ~' Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number