Press Alt + R to read the document text or Alt + P to download or print.

No preview available

The URL can be used to link to this page

Home My WebLink AboutDANIELS HEIGHTS LT 10Arn � N`"PALL • MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program , n PO Box 196650 4700 Elmore Road111) y �. Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 \ °� �' httpa/www.muni.org/onsite Drpartment94.CNONp6'` On-Site Wastewater Disposal System Permit Permit Number: OSP181351 Effective Date: 10/4/2018 Work Type: Septic Upgrade Expiration Date: 10/4/2019 Tax Code Number: 05106173000 Site Legal Address: DANIELS HEIGHTS LT 10A G:1461 Site Mailing Address: 21220 MONRON ST, Chugiak Owner: HEALY KIERAN J & MILDRED M Lot Size in Sq Ft: 18200 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 3 This permit is for the construction of: 0 Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: / _ Date: /vs aIssued By: - // Date: Mira • MUNICIPALITY OF ANCHORAGE Development Services Department ' Phone: 907-343-7904 On-Site Water & Wastewater Section ax: 907-343-7997 618910 77 ON-SITE SEPTIC/WELL PERMIT APPLICAT OCT 0L 101 n 3 Parcel I.D. 051-061— 73 Property owner(s) 4AL �/ Day phone ''-s—a7V 7 Mailing address 2 / azo / /14 0/J'O S 7` Site addresst— Legal description (Sub'd., Block & Lot) 6 4 Ai/6:2.4 `(' /7/F/ C1IT S' L tO,,Q Legal description (Township, Range & Section) Lot Size /J ZOO Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field [ Initial ❑ Single Family (SF) — (w/wo ADU) Septic Tank1.11Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. P/5 (Signature of property owner authorized agent) Permit/Rush Fees: J�c Waiver Fees: Date of Payment: <o/a f« Date of Payment: Receipt Number: 69-9/9D Receipt Number: Permit No. 10S00 7/35/ Waiver No. G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 1\lCRTFIM ENGINEERING SteveEng.com Steve Eng,PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 10/2/18 Number of Pages: To: MOA On-Site Services Subject: Daniels Heights Lot 10A Septic System Upgrade An existing septic system is failing on the subject lot. A soil test reveals silty sand w/gravel soil and no groundwater. The design calls for a new trench and a new septic tank. Most of the subdivision is on public water. The terrain slopes southwest and is flat slope at the trench site. The system size is a single family at 3 bedrooms. Please review the wastewater system design for the existing 3 bedroom home. I have included design plans& specs,design guidelines, &soil test. If there is need for additional information or clarification please give me a call. Thanks-Steve • Qt A * 1\bTFRIM . .. . . •s ENGINEERING :SteveEng.com Daneils' is I i,110AE"v og 1 'F .., a 2,1:14 ; SPECIFICATIONS & DESIGN GUIDELINES 1*;;`R FEss�� v:' Wastewater System Sizing: This is an existing 3-bedroom, single family home. This is a developed subdivision. These lots are large with public water serving most of the area. No adverse impacts are expected from trench/tank upgrade. No conflicts to the other lots will take place by this septic system construction upgrade. A soil test reveals silty sand w/gravel. An application rate of 1.2 GPD/FT2. Trench Length=375 FTP/61x 2 = 32' trench, 6' effective. A new 1000 gallon septic tank will be installed; Decommission old tank per UPC.New foundation cleanout to be installed,or alternatively a double cleanout before the tank. The water line is depicted on the drawing. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications(AMC)& State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment,New 1000 gallon septic tank. Install Double Cleanouts. • Install foundation cleanout. Decommission old tank per UPC. • 10' minimum between the tank trench,tank to house. 10' to property lines, • 3' of cover or insulation is required for trench; 2" Minimum thickness for insulation can substitute for l' cover. • Tank& solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Trench to be placed level,minimum of 4' to groundwater, 6' to bedrock from drain-rock. • Drain rock to be 'V2 inch to 2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down. • Silt barrier(filter fabric)to be installed above the drain rock. • Smeared trench sides must be raked or scarified before drain rock placement. • The finish grade must be mounded to promote drainage away from trench. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034,PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene(Dow Styrofoam HI/equal) DESIGN NOTES: 1. Total Depth of Trench is 10'. 2. Sewer Service Line minimum 2% slope. 3. Public Water System. 4. Decommission Old Tank Per UPC. 5. Insulate Sewer Service If Under Driveway. 6. Install New FCO Or Add DCO Before The Tank. J 37. J No Slope Conflicts Lot 9 Septic Decommission Old Septic Tank Per UPC n Install New FCD v Or Double Cleanouts „tet Lot 10B Septic 3 Bdrm r��04°-/ No Conflicts / Flat Slope / _ Previous sio TH / Drainfield / 3% Slope CO2/MT C❑1 —3 0 L Road Ditch No £ Conflicts New 1000 Gallon Septic Tank w/ Double Cleanoutsl Homestead Rd NOR THRIM -'��O.k'h�4 1" = 40' � DANIELS HEIGHTS ENGINEERING r'N' �� SteveEng. com * :4 m '' * LUT 10A DESIGN Po Box 770724 .. . .. LAYOUT Eagle River, Alaska 99577 .. ct- fi# WASTEWATER 907. 694. 7028 �k 104/18 + UPGRADE SEPTIC Date: SHEET: 10/3/18 2 of 3 Foundation Cleanout / Tank Cleanouts Fin ^ate de ❑pposing Cleanouts Between Septic Tank & Trenches , ..4 4 Foot Cover or Equal 1000 Gallon 'Anchorage Tank' Mounded Cover To Match Terrain Dr Equal Monitor Tube Solid Pipe _fleanout DESIGN NOTES: 1. Depth of New Trench is 10'. . • 2. Septic Tank & Solid Pipe to be Placed on Compacted, Stable Soil, Free from Boulders. Filter Fabric --___, . 3. Sewer Service Line is Minimum 2% Slope & 3' Cover. * __*:= 4. Water-Tight Couplings. . t : S. See Specification Sheet. '_: '= =f=!.t-ez .: 6. All Work To Conform to Municipality of Anchorage (AMC) ,: P.00„ "Odi" Requirements & Specifications. 6' '= '`=`'"•=`'''` 10' 7. Maintain 3' Cover Over Trench Or Insulate. = '''•`'-' .AD . Drain Rock ! ' '=!=!=!:'= 0: i,%%i:i Vii: r. %i:•:•:0:i: , 3' _ N OR THRI M4:7‘,Z"' :7. , `, ENGINEERING ��. TRENCH END VIEW DANIELS HEIGHTS SteveEng. com :� 9111 . .; SEPTIC TANK PROFILE LOT 10A ' Po Box 770724 • ��-' SEPTIC SYSTEM Eagle River Alosko 99577 14 • >//,# UPGRADE Oats: 'Drown By: cae: 907.694.7028 10/2/18 SE ISlI• = 5 ' SHEET:3 of 3 SE SOILS LOG - PERCOLATION TEST I\ERTI--RIM ENGINEERING Date Performed: 8/15/18 ENGINEERING Performed For: Kieran Legal Description: Daniels Heights Lot 10A DEPTH (FEET) T.H. Location: See Attached Test ow :„Y, Organic 1 - Boring Location Map 2 - ' ''� SP Sand 4 .4:7,-7. 2 W/ 5 - %;.'4";,:g':'-'-:A.';.'` ' Gravel 6 - -, ,, Groundwater? No 7 - : ' 4,.., Depth -- 8 - % 4'':',h:1.- Water Depth ?t; iry 9 - "= . .?'<- ' After Monitoring,None Date: 10/1/18 10 - ' 'j ' # Date Gross Tine Net Time Depth Net Drop 11 - ''!*;`>f4` 1 8/15 0 -- 6" -- 12 - ;A,.,:.<----;-,-'• 2 8/15 10 10 chin, 2" 4 13 - ;" ,:c,...- .;-: vi` "• 4: 3 8/15 20 -- 6" -- 14 - :':.;—• ,z":i; 30 4" -� r;• . 4 8/15 10 Min: 2" 15 - u" ` Y 5 8/15 30 -- 6" -- 7Y2.:.77":,,:', -:r' 6 8/15 40 10 rein: 2" 4" 17 - 7 8/15 40 -- 6" -- 18 - 8 8/15 50 10 thin: 2" 4" 19 - 9 8/15 50 -- 6" -- 20 - 10 8/15 60 10 rein, 2" 4" 21 - Percolation Rate 2.5 min/in Perc Hole Diameter 6" Test Run Between 4' & 5' Comments: Performed By NorthRim Fng. I .5-C CERTIFY THAT THIS TEST WAS Performed in Accordan e with All State/Municipal Guidelines in Effect ON THIS DATE. DATE: /G Z/ / NOR THRIM -I_of`Z% ENGINEERING iris--.....-.� DANIELS HEIGHTS TH SteveEng. com •*:49m .,* LOT 10A PO Box 770724 Eagle River. t999577 . 7' � T E S T H O L E LOG: 907647028 let rc .. T. GEOTECHNICAL 10/2/18 1 N •1 1 Lot 9 , 33.0' 1 ui WATER—\ i VALVE S 89'58'08"E 148.41', 0 N ati a' I- 63.2' .��O��C� b,1. ,'35 �0 12.0' W LJ 0 4.0'x10.3' DECK I .o.'� �°'' I. N C' N't,j •\,P. . 4,:• SEPTIC N Pi PE N , w 7.8'x8.2' �' GRAVEL. '..• o Z Lot 1 OB N CACHE 1.7 CANT— DRIVEWAY O 0 o CHAIN- LINK U, CeZ o0b FENCE Q Z 12.0'x25.9' ri *II M CONCRETE PAD N 8.3'x16.3' �' SHED TEST HOLE � Lot 1OA �4 18,200 s.f. �Ix N 89'59'25"W 119.70' g ID I HOMESTEAD ROAD PLOT PLAN AS BUILT X SCALE 1" = 40' GRID NW 1461Project No. 18-463/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang (Sc Associates , I n C . (907) 522-6476 Phone 00000 (907) 522-4625 Fax opo F A /��4 Professional Land Surveyors kenOlangsurvey.com 9 jonathanOlangsurvey.com ,1:1Z-.......\<4... ' s I hereby certify that I have surveyed the following described property: if ) i� O� LOT 10A, DANIELS HEIGHTS SUBDIVISION (PLAT No. 85-63) 9TH �* J Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed oo� KENNETH LAr�6 o premises and that there are no roadways, transmission lines or other visible �, r 1 easements on said property except as Indicated hereon. Q �,'Ljt . O� 04 �F •.LS-5202.••. gJp� Dated this the Day of '-'1-7'1'1'''" ' ''') —, , at Anchorage, Alaska d 4,0 '•••. a•>0� . °PESSIONAL O� It is the responsibility of the owner to determine the existence of any easements, ��40poo�� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE DEPAR,.,,ENT OF HEALTH & ENVIRONMENTAL PRO'iECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SiTE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION RE?©RT NAME ~/ /?~ ~/,~.~¢~,~ ,,,¢~.~ ,~. _~ PHONE LEGAL DESCRIPTION [] UPGRADE DISTANCE TO: Manufacturer Li, DISTANCE TO: Manufacturer IF HOMEMADE: Well DISTANCE TO: No. of lines// Top of tile to finish grade Length Width Type of crib ;rib diameter DISTANCE TO: DISTANCE TO: Well Depth. Building f~ndation Abs orp~,~¢~:ea Inside length Dwelling Foundat~y t:~? Material N eare2,~ line.~- Trench width /¢ I .'t~E:~ inahes Driller Sewer ne tile inches NO. OFBEDROOMS~__ No. of corr?~rtments Liquid depth PERMIT NO. Liquid capacity in gallons p E R M ~--'1~ O/.~2 /:-- Total e~ec~v~a~'os~0~ption area PERMI~ ~'' Crib depth Total effective absorption area Building foundation Nearest lot line Distance to lot line NO, on'area(s) Septic tank OTHER PIPE MATERIALS SOl L TEST RATIbfG LEGAL 3 (Rev. 3/78) L::LX!i~ E:5 E.;KL. UTh!FI EFIST THE L. tE!'.,iGTI."! D ;[ I"iEN'.;:~; )Z Ois! i :.~i; THE LiE?',!(.~iTH ,:; ;I; I',! FLEET) OF:' 'THIE "!"I:;i:I.::'~;t'.,ICH OF.': Dt:;~:I::I :[ htl:: ;[ IELD. "!'i-.ii!i!; Di!;I:;:'"FI-I (;ii:'-" i::'! Tt';~:I::*.HCH 0i;;?. i:':';i;T X'/!; 'THE I}, ;[ S'I'I::it',!CE tiEdE'I"NEtEt',t THE '.iii;Ut:;;:l:::'l:::lC['~i: OF THE (/il:;~:E&.ii',hS, Fff',iD Yl...iii!; E',OT"i'Oi'i (:)i:::' Tl...iii!( I!!;;:.:;E:!::-iVFI'T :i; ON (;t.'i',i FEET). "i"IdiEi:;?.iZ ;i;'ii; hi0 :ii:;i!iY'i" l.,.i ); D'i"H i;::'Oi;;;: 'THi!!!Z Ed:;i:i:::!Vi!iL. i;)i.*.!;PTH ;i;S THE H];tq~Hl...li'! DEPTH OF l;:il:;i:Flk.,'El._ E:E'I"I.,.i!EEi',I TI...IIE OU"I"t::'I::ii....L. F:' ;[ I:::'E Fd'.,ii;) 'T'HiE i3(.'.'r'!"TO!','t OF 'THE i?ii;:.:;CF!',/Ff'I';t;OI'q (;t;i',! FEET). i'I]:N);HLiH D;i::i~:;TFIt",IE:i!i!' E~I~;"I"i.,.iEiEH !:::! t.,.!I~i};LL i:::II',ID i:::ti'.,!"/ Oi'.,I.'...:;i!;;i;TE SEt.4t:::tGE D;I::E;F'QSI::IL. Sh.%'TIEPI ZS ::i..i;~)!?.~ i:::'i;i!:iET i:::'O,~;;: I::;I !:::1;;;: ;i: ',,,:t:::!'T'i::i; !,!iEL. L 01:;;: :;i..SEi TO 2S(!;~ FEE'T l;::'1:;;:Ot'i t:::1 F:'UBL.:[C i.,.IIEI....L E:,t'.'~:l:::'E(t'.,I[)];t'4(Ji Lii:::'Oi',! "i"Hi; "i"'./l:::'E Oi:::' i:::'UE:L :( E: i.,,!Ei.,.[ H :i: N :l:i"il...ii"l i:::, :i::ii;Ti::iNCE F'i:,U:3?i i:::t I:::'i:;i::t: VFfT'E 1.4EL. L. TO Fi F'[;;: :i: ',/!::f"t"!i~:: E;EI.,IEI:;;'. L. :i:lqE ]: S 25 I::'EET l:::ihli) TO I::! E:OHi'iLli',i :i: 'i%/ :!!!;iEi4EI:;;: L :i; hiE: X ::;i; 75 Fl:ii:ET. QTHi!::i;;i: i:;::iE(;:Li :i: F.':E:HENT:!i!; i"!!:::t? !:::ii::'i::'i./.¢. :~i;I:::'EC :1: F ;i: E:Fi'T' ]: Oi'.,!'.iii; I::1I'-,![) E:ONSTF.':LtE:T:f. ESI l.'.';,:r. I:::IGI:;~:t::tt',IS i:::II:;?.E i:::t',,,:¢::l:i:l...i:::l[!i;t....!:ii: TO ;t:I',iSUi:;i:IE i:::'i:;U::)i:::'!i!:l:;;: i'::'"r' T H t:::1'!" i:::'Fd"i:i:L.;i;l::'tt:,;: !,.i ;.( "i'l'"l THE; I:;i:E~.7..'U:!:I:',;:Et"!Ei,Fi"S 1:::'0i:;?. OI',t""S;I;TE :!:~;IEI.'.IIEI::~:S' FIt',ID I.'.tEM....:!~; FIS SET THE !'il. ji'*,I ;t.' E: 'i; I:::'I:::iI... iI: T"/ OF:' t::tt',E:HOi?.I:::!(:i*E. ;i;t',i:i!?fl:::lL.L TbiiE :}i;"/STl/:'?i ]:i",i I:::t(.;:CE~f;;:I;.'-'I:::ti',tE:IE I.,.I];"i"H THI:i~ E:OI'X:.'::L';. LihiE;,t)~;i:;i:'.E;T!:::IhiD i"Hi:::l'i' THE ;i;:}i REt'IO!;)EM::;D TO MUNICIPALITY OF ANCHORAGE Departmenf ~f Health and Environmenta' Protection · 825 ~ Street, ~chorage, AK. ~950! 264-4720 *** ~30~91 HANDWRITTEN PERMIT * * * Permit ~ ¢-m ~-~ WELL AND/OR ON-SITE SEWER PERMIT Applicant: ~:7~ ~/~,~:~/~3' Mailing Address :~0 ~ Location: E~o~%~$~ P~ P~ 5 {~ /0 Phone Nu~er: ~- Legal Description: ~p~ ~- 7/~-- ~ /~ Lot Size: Type of Soil ~orption System Is: Trench: / Drainfield: Seepage Bed: Holding Tank: Maximum N~ber of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil ~sorption System Is: L NGTH 'W DTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minim~ depth of gravel between the outfall pipe and the bottom of the excavation(in feet). · * REQUIRED SEPTIC(HOLDING) TANK SIZE = /DdO GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minim~ distance from a private well to a private sewer line is 25 feet and to a co--unity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. · * * PERMIT EXPIRES DECEMBER 51~ 1 9 8 3 * * * i certify that: (1) I ~ f~i!iar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand tN~at-~he on-site sewer system may require enlargement if the re~n3[~' is remodeled to include more that 32bedrooE~~ Date: // / ~ SWP/024 (1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST 11 12 13 14- 15- 16- 17- 18~ 19- 20- PERCOLATION TEST DATE PERFORMED: SLOPE SITE PLAN WASENcOUNTERED?GROUND WATER ~ ~(,._} oSL P E IF YES, AT WHAT ,.~-- DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __-'~,~"~; __ (minutes/inch) ,) ~:'t.:J TEST RUN BETWEEN ~ FT AND ~) COMmEnTS ft~wd ~ P~f'jh4r,'n t'r4u:~:~:~ ~'~:u,~/,'~d~z~ ,~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CER'flFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date .~/~/ GENERAL INFORMATION (a) (b) Legal D~escription (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Nam~,~p~t_,¢;~(~,~) ,~~-~Telephone:Home ~¢',~- ~'/"-¢?~/ Business. Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] {explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address /~hone (f)' ~v~a~the HAA to the following address: TYPE OF RESIDENCE Single-FamilyJ~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well [] Community [] Public/~ ~ "~]~--4-4~ Note: If community well system, must have written confirmation from the State Department of Environ mental Gonservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~k' Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72+025 (11/84) 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 disposat 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 8, $ Englnee~ng Address ~Dn ~oz_ Date Ea,~le .~lver, Alesks ~5'7~ Telephone ¢ oF AL 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) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~?" /~X WELL DATA Well Classification I"~I,A)~ ~: ¢,% Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~.¢.~ ~ 4- To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by If A, B, C, D.E.C. Approved~/.N) Date Completed Yield Depth of~ Grouting f..L \~mp Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~.N-)' Air-tight Caps Depression over Tank~¥¢~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding T__ank: To Water-Supply Well ' ~-~)~ To Property Line To Water Main½Scr;'ice Line ~" Size ~./(_24g~ ' No. of Compartments Foundation Cleanout~:~/-N') Date Last Pumped ; for Temporary Holdin9 Tank Permit (Y/N) To Building Foundation To Disposal Field _ Course Comments TO Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field __ Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Depth of Field Gravel Bed Thickness Standpipes Present ~) Date of Last ^Oequacy Test Type of System Design Length of Field Separation Distance from Absorption Field: 'fo Water-Supply Well ;~--'~l ''f' '--~t~'~ c~t~ To Property Line ~ t +- To Building Foundation ~"~ ! To Existing or Abandoned System on Lot /'~/~ ; On Adjoining Lots To Water Main/~.cr'.~-~ Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutbank~.~present) · -~¢,~ D, LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) 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 M/CA an/¢ HAA guidelines in effect on the date of this inspection. Signed S & S Engln~ring Date -~//~///~( SRB 196x Company ~.~. e:~. ~..~.- .,~,.,..,.? MOA No. Receipt No. Date of Payment Amount: $ ~o Page 2 of 2 72 026 (11/84) BIl.l !~H~.~:£t£ID~ GOV£RNOR ~-~.qephone: ANCHORAGE/WESTERN O:,!,-,ICi OFFICE 437 "E" STREET, SUITE ANCHORAGE, ALASKA ~9501 274-2533 DATE: PWS To Whom it May Concern: '"-i~ '~_.]~]4",~ /~ According to re~.ords on file in this office the:~,&_ ~::.Z!~].~ //)[ZT;~{/~ ]~2,f P-/'Water Syste: is in compliance with the State Drinking Water Regulations Sincerely, MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal .Description .(include_lot, block, s~ubdiviaion, section, township, range) Location (address or direc~i0~ :: : ~9 : " ? ~' ' ' ~ ~'.'..~.. <~ : . ~ . ~'4~' ~ (b) Applicants Name ~' -' Applicants Address Telephone - Home Bus ines s (c) Applicant is (check one) Lending Institution Buyer ~ ; Other~ (explain); (d) Lending InStitution · ~ ; 0wner/builder~,; Telephone Address (e) Real Estate Co. & Agent Address (f) Telephone Mail th~ HAA to tile following ,address: 2. ~ype of Residence Be Single-Family~ Number of Bedrooms Multi-Family~ Other (describe) Water S__u_p_~l~ Individual Well ~ Community ~ Public ~ .": :~ ':" '~,'~ ~'' ~ ' Note: If community well system, must have ~itten cogitation from the State Department of Enviro~ental Conse~ation attesting to the legality and status. Sewag?.. Di..s. posal Onsite,~ Public ~ Community ~--~ tIolding 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] 5. E__n~ineering 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 regula- tions in effect on the date of this inspection. Name of Firm Address (ENGINEER SEAL) Telephone DHEP Approval Approved for J~ bedrooms Approved ~ Disapproved Terms of Conditional Approval By Conditional CAUTION THE M~INICIPALITY OF ANCHORAGE DEPARTMENT OF H~ALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY A~ INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ~SKAo TttE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. 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. (DHEP SF~L) RR4/ej/D18 [Page 2 of 2] 7-19-84 A® Well Classification Well Log P~esent (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances frcm Well: To Septic/H~Tank on Lot ZC~C~ MUNICIPALITY OF ANCHORAGE (MOA) ri.~v! .:.~ ..'~:' J-~;~.I!~,~'.~ HEALTH AUTHORITY APPROVAL (HAA) ~:/~' ',,: I~h..~ ':~ ,'! I ~ . CHECKLIST - FEBRUARY 1984 Leqal Desc~iption:/'~/O~ ' ' rf A, m D.E.C. proved(¥/N) Date Completed Y'~d Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot~LTO ~.~- ; On Adjoining Lots To Nearest Public Sewer Line C leancut/Manhole Water Sample Collected By Water Sample Test Results CC~e nts ~ '/ />/~/ TO Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date SEPTIC~ANK DATA Date Instal lad ~Z/~ ~ Size /~ No. of C~a~tm~nts f~ S tandpi~e s/~/~/' / -~Air-tight caps/(~ Foundation Cleanout ~ Depressio~/over Tank ~/ Date ~La/%~umpe.d -~ /t/~ ~/ ~-~ Pumping/Maintenance Contract on File (~..~.~n~_ , for '---- ~; Holding Tank High-Water Alarm (Y~f//~' Temporary Holdi~/3 Tank Permit (Y~///~ Separation Distances from .~ptic/Holding To Water-Supply Well ~ [ '~---' TO Property Line /~ ~'~ To Water Main/Service Lir~ .~.~33 ~ Course Comments Tank: ~-- / To Building Foundation ~ To Disposal Field /',~-- ? To Stream, Pond, Lake, c~ Major D~ainage Receipt % Date Paid: Amount: [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed ?/ ~ ~ Width of Field ' / ~iP t, Length of Field Depth of Field Square Feet of Absorption ~Area Depression over Field (Y~.~ Results of Last Adequacy Test Separation Distance frc~ Absorption Field: To Water-Supply Well 2~&~0 (.~' To P~operty Line Gravel Bed Thickness ~?'~ ~' Standpipes P~esent ~) Date of Last Adequacy Test _~C/(f Ct/ /o ('f To Building Foundation z~-- ~" Lot /oLD ~_3~ ; On Adjoining To Water 4~i4%~Service Line ~O (~L To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Core, rents /~/aP ,~3/~ To Existing or Abandoned System Lots ~cp /.w( To Cutbamk(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) ",~m~f" Level at /~ /.,~///~t (Y/N) Pumping Cycles ~ufing Adequacy Test. Meets MOA Co~ents ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conforn~d to all MOA HAA Guidelines in effect on the date of this inspection. MOA No. KB1/d5/s [Page 2 of 2] 2-15-84 N Z 1/16 Cor. t~ 37,309 s.f. I J 37,309 s.f. 296.92 J , 296.92 LOT 4 J J I 37,307 N 8et~)' ~7'm~.~_~_ ~, , N 8~'27"E 296.88 ~ : 296.88 LOT 2 I i LOT 9 37,302 ~.~. ~ p I 3~302 s.~. ud~t~ easement ~ T ~ 296.86 ~ '1 296.86 Ufifl~ eesemenJ I J LOT I J I LOT 10 3~29~ s.~. ~ I 37,2~ s.f. ] I J I Iron Pin set by K&A N~O~ - ~?_!=~.A__T_~_E =~O--W N E R S H I ~_a.~n.~_~D~E DI C AT IO~ SUE MOUN~E 5750 GLENN HWY ANCH, ALASKA 9~50~ NOTARY'S ACKNO~ _L/~_,~,~. ' /-~ :~ ~J I, Ihe undersigned registmed lurYetor, hereby certlJy Ihar o ~nd ~ ~i ~ DTI000266 PLAT APPRO _V.~L_ Plat ap,.oroval by Borough Planning CommrsJon this ~.~ I ~' of - ,~,,~,1972'. day This Plot contains 8.56 acres EKLUTNA EAST SUBDIVISION A RESUBDIVlSIO~"mOF LOTS 5,6,7 &8, BLOCK 5 0~ EKLUTNA HEIGHTS SUBDIVISION,LOCATED IN THE SE 1/4 SE 1/4 SECTION 3, T 13 N, R 1 W, S. M. ALASKA [ KU[LBERG .& AS. SOC. RAWN BY: RLCISCALE:I" 100' I DESIGNED BY, uw.I DATE, CHECKED ElY, te.I APPROVED, I ANCH,; SHEET I C~Cl GRID ' NW 14~1 JOB NO.