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Home My WebLink AboutCLEARVIEW LT 22Onsite File -. learviewd 5 "'r MUNICIPALITY OF ANCHORAGE �uj `,n ,1111'17( \� On-Site Water&Wastewater Program �� r,'<" • '� /4):-- PO Box 196650 4700 Elmore Road • z, , ; Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,..,c-: � (3r. 3,r t.,-7 http://www.muni.orgfonsite y ,� F.. l�l'I ,11'I nlctl I 4rycHUI On-Site Water System Permit Permit Number: OSP181181 Effective Date: 7/10/2018 Work Type: Well Upgrade Expiration Date: 7/10/2019 Tax Code Number: 01524261000 Site Legal Address: CLEARVIEW LT 22 G:2740 Site Mailing Address: 7901 ALATNA AVE, Anchorage Owner: CLTE ALASKA TRUST Lot Size in Sq Ft: 59259 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 5 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy Q 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 Special Provisions: ** To close this permit please submit: 1. Well Log 2. Pump Install Log 3. Water sample results ** If the existing well is not incorporated into the water system it must be decommissioned. 7‹.4Received By: Date: -7/////f Issued By: ltljti 0-c A_ / Date: 7//t/ l' MUNICIPALITY OF ANCHOR A 1 ' 6 7 8 9 k** %or:. 1_ Community Development Department Ph• =: 907-343-7• Development Services F- . '07- 343-7997 On-Site Water & Wastewater Program a 6 5 Mayor Dan Sullivan & L 9 On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 015-242-61 Property owner(s) JOHN EVANS Day phone 907-265-6329 Mailing address 7901 ALATNA*ANCHORAGE,AK 99516 Site address 7901 ALATNA*ANCHORAGE.AK 99516 Legal description (Sub'd, Block & Lot) CLEARVIEW: LOT 22 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ❑ Single Family (SF) Absorption Field ❑ ® (w/wo ADU) Septic Tank ❑ Upgrade Duplex (D) Renewal ❑ Holding Tank ❑ Multiple Dwellings Privy ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: G`..Wn Waiver Fees: Date of Payment: 1[lh I3IW1t$ Date of Payment: Receipt Number: OSI IS 118 1 Receipt Number: Permit No. 054:14(1 Waiver No. (Rev.01/11) _ uanics GARNESS ENGINEERING GROUP, Ltd Advanced r,.eocm_nr :,<<.. ENGINEERING SALES CONSULTING Dealer July 3. 2018 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Well Upgrade for Clearview; Lot 22 To whom it may concern: The existing home is served by a private well and septic system. Per conversations with the owner, the well has limited production and he would like to drill a new well. We are proposing to leave the existing well in place to be used with the new well. In short, there will be two wells serving the subject lot. See attached design drawings regarding separations distances and proposed well location. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sin - = y, Jeffrey arne s, P.:., M.S. Presi.- 3701 East Tudor Road, Suite 101 `Anchorage.Alaska 99507-1259 Phone: (907) 337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com Iii‘lCLEARVIEW;LOT 211 CLEARVIEW;LOT 14 / \ / \ -c C"• ° 41 i CLEARVIEW;LOT 21 I / / ALPINE TERRACE; \ / / BLOCK 4,LOT 3 4.41 / • `/ / / CLEARVIEW;LOT 23 / \ CLEARVIEW;LOT 3 •`•POSED 100, / I �'/ElL RADIUS i.........t. \ / / \\ / / / \ OPTIC �j / \ ARE __.\--.. / VVV / �,/ �/ // CLEARVIEW;LOT 2 // \\ I\ 7/ 1 // �4.� I 9I 10, • / 34 / L RADIUS T/ 1c". I // CLEARVIEW;LOT 24`II 1 & % \ CLEARVIEW;LOT 1// / IF \ V / / \ Ti / S ALE: \\ 1"=100' '.mss\� %it • GARNESS ENGINEERING GROUP, Ltd �„b. : ••.: • . . _ _. ... ENGINEERING SALES ,CONSULTING .1••e�� 0 3701 E.TUDOR ROAD,SUITE 101-ANCHORAGE.AK 99507•PHONE(907)337-6179'FAX(907)338-3246'WEBSITE:www.gemeuengkleering.00n ••• • • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: °O:g". i° SS : W JOHN EVANS 907-265-6329 1 OF 2 �.. CE-79r3 .• zir PROJECT/LEGAL DESCRIPTION: DRAWN BY: •�♦�(� .•'e\ • •,• .. CLEARVIEW; LOT 22 D.J.G. 1.�cp••••'••• ••• „��P..,�� TYPE OF WORK: DATE: 44i ESS”:.4 SEPTIC SYSTEM DESIGN UPGRADE 7/3/2018 #AECC884 1�� GEG,Ltd.HAS A 8 PAGE SPECIFICATION I ASSUMED LOCATION OF EXISTING LETTER THAT PERTAINS TO THIS DESIGN.TO TRENCH LOCATION PER CLEANOUT OBTAIN A COPY OF THE LETTER CONTACT / LOCATION FROM PROFESSIONAL LAND SURVEY BY SHANE HOLD,PLS GEG.BY PROCEEDING FORWARD WITH THIS INSTALLATION,THE ENGINEER,WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE / ASSUMED LOCATION OF SEPTIC THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE / TANK PER CLEANOUT LOCATION TERMS AND CONDITIONS OUTLINED. FROM SURVEY BY SHANE HOLT,PLS PRIOR TO DRILLING THE WELL THE WEST LOT LINE,EAST EASEMENT AND SEPTIC SYSTEMS ON LOT 2&LOT 23 SHALL BE PHYSICALLY CONFIRMED BY THE WELL DRILLER OR PROFESSIONAL LAND SURVEYOR. V. EXISTING 5 f::7";,,-*; � � / BEDROOM HOUSE •'•• \ ; .......:::..7.;,...:.i......: i ASSUMED LOCATION OF TANK AND DRAINFIELD •-.-:.. •:..-....;..,.:!......:. ' = '.', /Ai / PER MOA RECORDS;TO BE PHYSICALLY •� '. DRIVEWAY , 1 CONFIRMED PRIOR TO DRILLING THE WELL . •'. '•• / /'\ � ELL RAD, ,..... I RA •D /L• _____ .: ,.. • /us . , I / \ Q' / / \ _ / / / / / CLEARVIEW;LOT 2 / �o�� \ I ADD WELL l�,gDl(/•, / 'G0 y CLEARVIEW;LOT 23 I ,'/ f lot 4:71: ...4 4. a GARNESS ENGINEERING GROUP, Ltd 9 I, ,f • 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507'PHONE(907)337.6179'FAX(907)338.3246'WEBSITE:www.gamessengmeenng.com ; • •9: •�!•; PREPARED FOR: PHONE NUMBER: PAGE NUMBER: • J:. , A. -ata •. s JOHN EVANS 907-265-6329 2 OF 2 ..c ;.,' 79 3 �4. PROJECT/LEGAL DESCRIPTION: DRAWN BY: .♦ � 11311 D • <c, � CLEARVIEW; LOT 22 D.J.G. .4 •................ ..'� .4. , , • TYPE OF WORK: DATE: LICENSE,, II iii 4 SEPTIC SYSTEM DESIGN UPGRADE 7/3/2018 #AECC884 ' 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: ,~f/~' ~¢__2 ~ ~.~ PID Number: ~/~~/ Name: ~ ~ ~~ ~. ~~ Wastewater System: ~New ~ Upgrade ~:~. ~ 1/~1~ ~ll~z~ ABSORPTION FIELD Phone: [ No or, rooms: ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION soilRating: ~ ~GPD/Sq. Ft. Total Depth from original grad~ / Lot: ~ Block:~~/~Subdivisi°n: ~ Depth to pipe bottom from original ~d~Ft. Gravel depth beneath pipe ~ / Ft. Township: I Range: [Section: i Fill added above original grade: , Gravel length: ~/ WELL: D New ~ Upgrade Gravel width: ~4 Number of lines: Igist~w~.,i.es: Ft. ~ - Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ¢~10 Driller: Date Drilled: Slatio Water Level: In,taller:Ft. ~~¢~~-- '~ --.'Date installed: Yield: ~ Pump Set at: I Casing Heighl Above Ground: ~,~ ~,. ~,. TANK SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P. To Septic Absorption Lift HoMing ~ublic/Private ~~ Capacity in gallons: From Tank Field Slation Tank S .... Lines ~/~ - / ¢~ ~ , Ma,eri~3¢ Number o~mpartments: We, /~% /~ ~ ~% ~ Surface ~ ~ Water /~5 /¢~ LIFT STATION Lot Size in gallons: ~ Manufacturer: Foundation ¢/ ~¢ / ~ ~ ~ "Pump on" level at: ~el at: High water alarm at: CurtainDrain ~P ~O~/~ ~¢~/ Pum~[ ~otri~l I~p~tions performed by: Remarks: BENCH MARK Location and Description: Assumed Elevation: ENGINEER'S SEAL Inspections performed by: ~:¢= ~v-~,~l=-~: ~ Dates: 1st ~.~~~. Department of Health and Human Services approval ( /~ Reviewed and approved by: Date://-~-¢~ - 72-013 (Rev 9/91) MOA 25 Permit No $W930337 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SER¥1CES DI¥1SlON P.O. Box '196650 · Anchorage, Alaska 995'19-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report CLEARVIEW, LOT 22 01 ..524261 Legal Description: PID No.: c01 co __.JL/'-[NSULATION N.T.S. 96.2' MT1 86.8 C02 91.8' · 60.8' NO WATER FOUND A B FCO t4.5 27 CO1 18.5 29 COZ 41 77 C03 70.5 35.5 lvlT1 33 65.5 SCALE l" = 40' 157. FOUNDATION WALL UT 1 NEW TRENCH )BL C0 72-013 A (2/91) MOA 25 03:57PM FROM 6941211 P.O1 NOU-Ol-1994 NWMed Anchorage SI'A~ OF i .. I) .IPA.RlllIT OFiNA'rtJI!AI;' IiIaOURcI~s. · " "..:::."~!~i:i:". i r l e, i:O:" .. - · . . . ~.4'.!,."~.;.'...-? " - '[]S' :?!:l?lW' "..'? .-..-:..: · ,. . . 6~... · ~ . ... .. · ., .... DEPTH TO aTATIC WATER.~ ,:../':. '.......:~.~. ./'::~i~;: .. ' '" · ..... . ............. ., ../~,.,-., 4-., i,..;~:':. .. ' , ,,, ' - ,, -~~ Oo~e ' ' "~':'~.. .':-;.';-.:. . ?~'-~. ..... . . ') f .t ~ / ......';./:.. , ........ ~ PACK ~PE ~ .. /,~ /gO ~ ~: f~..: .. 'fire .... ~aa=: ~~- , .... ' ,,, ' '11 [~ J ~ II , .' .......... . ........ ': · . . TOTAL P. 01 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930337 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SYCKS CARY & CAROL R OWNER ADDRESS:P.O. BOX.il0158 ANCHORAGE, AK 99511-0158 DATE ISSUED: 9/02/93 EXPIRATION DATE: 9/02/94 PARCEL ID:01524261 LEGAL DESCRIPTION: CLEARVIEW LT 22 LOT SIZE: 59259 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / 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 AND 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 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER 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: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. August 18, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 REFERENCE: Clearview Subdivision, Lot 22 We request you issue a permit to drill a well and install a septic system to serve the proposed five bedroom house on the referenced property. Two test holes were excavated and percolation tests performed on the referenced property. The approximate location of the test holes are located on the attached site plan. The monitoring tubes within the holes have been checked and found to be dry. This property has enough area for a future septic upgrade, which can be seen on the attached site plan. We do not anticipate any adverse effects on 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. SOIL TEST ~ ~~bert A. Shafer, P.E. PERCOLATION("~&~- y TEST RAS/LSU/lsu STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 · = 50' SCALE IITE PLAN ALANTA AVE. i~ -'fl m O -q r'l Fr'l Z -n Frl r'rl . · ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Clearview Subdivision, Lot 22 o o The scope of this project includes the installation of a 1500 gallon septic tank and a leachfield trench to serve the proposed five bedroom residence on the referenced property. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. Page Two Clearview Subdivision, Lot 22 August 18, 1993 o o A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed- up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. o Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Clearview Subdivision, Lot 22 August 18, 1993 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. o The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. o Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Clearview Subdivision, Lot 22 August 18, 1993 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. o The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE PERFORMED FOR: LEGAL DESCRiPT,ON: LOT / 1 4 7 8 10 12 13 14~ 15 16 17- 18- 19- 20- WAS GROUND WATER ENCOUNTERED? SITE PLAN s IF YES, AT WHAT -'"' O DEPTH? P E Depth 10 Water Alll Monitoring? ~ Dale: F' Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN '~1 ~ . ET AND L~I(~ FT ,. To7~c ACCORDANCE Eagle River, Alaska 12-~8 (Rev. CERTIFY THAT THIS TEST WAS PERFORMED IN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~/fp Township, Range, Section: SLOPE SITE PLAN 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ~..~jl~ENCOUNTERED? S L O P E IF YES, AT WHAT DEPTH? Depth Io Water Aller Monitoring? ~ Dale: ,.,-: Gross Net Depth to Net Reading Date Time Time Water Drop : ~, ~ ,~¥,~ .~'~ ,, : 5o 5 ~Vff '/z" PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ AND ~../r,~,~ ~.:FT PERFORMED ~ ~ ~IN~RI~ ~~ CERTIFY THAT THIS TEST WAS PERFORMED IN 0 a i Ri~ L~ R~ 1. GENERAL INFORMATION COmplete legal description 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 Lot 22; ClearuZew' Subdivision Location (site address or directions) Property owner Mailing address Lending' agency Mailing address Agent 7901 Alatna Avenue Address An~horag~ AK Gary ~ Carol Sykes Day phone P,O. Box 110158 Anchorag~ AK 99511 Day phone Day phone 563-0073 Unless otherwise requested, HAA will be held for pickup. 2.- NUMBER OF BEDROOMS: 5' 3. 'I~PE OF WATER SUPPLY: Individual well XY, X NOTE: Community well Public water If community well system, provide written confirmation from State ADEC attest- 4~:~TYpE OF WASTEWATER DISPOSAL: ing to the legality and status of system._ Individual on-site Holding tank '- Co mmunity on-site . - Public sewer. -- · If community wastewater system, provide written confirmation attesting to the legality and status of systern.? Se 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, an.d regulations in effect on the date of this inspection. Name of Firm S & $ ENGIN~I~iNc_. Phone 17034 Eagle River Loop Road No. 204 Address .~ale my.;. ~_..~2= ~=...~- Engineer's signature ~ Date )/ / DHHS SIGNATURE ~' Approved for .~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ,The Mun~pality of~Anchorage Depa~ent of H~lth and Human Se~ic~ (DHHS) i~u~ H~lth AuthodW '~proval ~ifl~ bas~ only upon the rep~en~tions given m paragraph 5 above by an mde~ndent p~f~?al ~m~r ~ste~ ~n the S~te of Al~km ~e DHHS d~ th~s ~ a cou~to purch~m of hom~ and their, lending mstR~ons m o~er to ~t~ ce~m f~eml and ~te ~u~mmen~. Employ~ of DHHS do not cOndd~ ins~tions or anal~e da~ ~fore a ~ifi~te is i~u~. ~e MunicipaliW of Anchorage is not Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~'~e,,;~.v/~ -~c);~w~/c~,d .~ ~OT-,ZZ Parcel I.D. A. Well Data Well type Log present [(~N) Total depth .~5'- 7 Sanitary seal (~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~/l~/ct~ Driller Cased to ~ ' . Casing height Wires properly protected (~) Date of test Static water level ~'/ Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: FROM WELL LOG Septic/beldi~ tank on lot /~' Absorption field on lot Public sewer main ~5- ' Sewer service line /~ '~- g.p.m. AT INSPECTION z ,_o /~:~9 ~ ~. ,,. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout II I I I I Petroleum tank WATER SAMPLE RESULTS: Coliform ~ d'~-~/~////~/-P ,,,,/ Nitrate Date of sample: /C/~v. / / /~/-/ /E ,,~//- Other bacteria Collected by: B. SEPTIC/H~IL~IW;I~TANK DATA Date installed Cleanouts (~N) V~5 High water alarm (Y~ Date of pumping Tank size /5-r_J ~ Compartments .Z Foundation cleanout (~)N) ¥~s Depression (Y~ /~ ~/~ Alarm tested (Y~)~ ,/Jr_J ~//~- Pumper ,,u~/~ SEPARATION DISTANCES FROM SEPTIC/~ TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots /~ ~ Foundation Absorption field ~' ' Water main/service line 72-026 (3/93)° Fro~t CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~~--..... _ Manufacturer ~ Size in gallons ~ Manhole/Acce~~/N) __ Vent (Y/N) "Pump on" level at ~ ,.-//~'"Pump off" Level at High water alarm level .~ed Meets MOA electrical codes (Y/N) ~ ~ SEPARATION~ROM LIFT STATION TO: Well on ~..~.t~~ On adjacent lots ~ D. ABSORPTION FIELD DATA Date installed '~/2'~//'~'$ Soil rating (GPD/Ft Length ~ ~ W'Mth ~ ' Gravel thickness Total absorption area qfi~ Cleanout present (~N) System type /~s~-,~?/o/-*J Total depth '~- ~' Depression over field (Y~ Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y~)/ Results (pass/fail) ~/~- for ,U/~ After test /{/~ ~/,~-- If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots /~:; ~y- Property line /~ '~-- To existing or abandoned system on lot / Cutbank 5-0 ' +- Water main/service line /o '," Driveway, parking/vehicle storage area /m 'f- E. ENGINEER'S CERTIFICATION Bedrooms 72-O26 (3193)' Back I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in eff.~( 9te of this inspect/on. Signature ,:-'--' ,~.~ ..~ .! ..i .-:= .--.-~ Engineer's Name Date II / HAA Fee $ ,~00,°° Waiver Fee $ Date of Payment t~- c~ - ~ ~ Date of Payment Receipt Number O0 fl Cq ( "74¢q'7~ Receipt Number