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Home My WebLink AboutCHUGACH PARK ESTATES BLK 1 LT 7Chugach Park Estates Block 1 Lot 7 #O51-481-48 Municipality of Anchorage Page 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: .~J'~ ~,~oC"/ PID Number: O5 I - ~ - Name: ~¢,~ N~M~5 ~; ~ ~o~ WastewaterSystem: ~New D Upgrade Address: ~'H~' ABSORPTION FIELD I No. of Bedrooms: Phone: ~ -- ~G~ ~ ~ DeepTrench ~ Shallow Trench ~Bed D Mound D Other LEGAL DESCRIPTION Sol, Rating: ~ F,~) Total Depth from o~iginal grade: O .~ GPD/Sq. Ft. Lot: Block: Subdiv~ion: Depth to pipe bo~om from original grade: Gravel depth beneath pipe Township: ~ J Range: -- ~ Section: ~ Fill added above originaIo--grade:o.~ Ft. Gravel length: ~ Ft. I I WELL: ~s~,,~ New Q' Upgrade~ Gravel width: Number of lines: Distance between lines: I ~ Ft. ~ ~' ~ Ft. Classification (Private, A,B,C): Total Dep~ ~sed To: Total absorption area: Pipe material: ~ld ~ / Ft. Ft. ~ SQ. Ft. Driller: ~ Date Drilled: Static Water Level: installer: Date installed: Ft. ~¢~SL~ ~e~S ~-Z~-~ '~GPM IPump Setat: Ft. leasing Height Above Ground:Ft. TANK SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.EP. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~ ~ I ~ ~ Material: Number of Compa~ments: Well- ioo~ i~1~ ~ ~ ~& ~~ Su,a~. -- LIFT STATION Water Ioo~ Joo~+ ~ ~ LineL°t ~ I~ ~ I -- ~ ~ Size in gallons:I~ Manufacturer: ~ ~ "Pump on" level at: ~'II High water alarm at: Foundation Gu~ainDrain ~ ~ ~ d~ ~ ~u~ctrieal~ Inspection* po~ormed Remarks: BENCH MARK Location and Description: Assumed Elevation: Ioo. o F~, Inspections performe,~ENolNEEmNo Dates: 1st '7-z~-q' EIgle Rivar, Alaska 995~ ' Department of Heal~ and Human Se~Jces approval '~;~r ................. 72-013 (Rev. 9/91) MOA 25 Permit No. 2 2 SW960067 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 LOT 7, BLOCK 1, CHUGACH PARK EST. 051-481-48 Legal Description: PID No.: / F ~--10' MIN / [ .... ,I 100' WELI RADIUS -10' MIN ~ T2 FC~) 25.0' 17.0' NEW 250 GAL~ ST' 56.0' 32.0' SEPTI( TANK ST' 53.5' MT 84.0' 83.0' o C01 72.5' 48.0' DG C02 90.5' 88,0' ~ ~ - ................... ~<~T~a ap~7~ ~,~F~ ....... .............. , -C01 = 100.1~ CO~ = 100.5' --MT1 = 100.~ MT2 = 100.5 CTi ff'2~ ~ ~"' "~J~ ~' NEW ~ --' o o 1350 GAL ~5' '~ ~"" ' '": ~ ...... ~""MI'I = 90.3' ~ ~C(~1 = 9t' MT~ 90.5' ~ ~ F~~ C(~3 = 9t' 72-013 A (Rev. 9/91) MOA 25 30-~UL-96 15:03 F~O~:SPINELL HO~ES ID:9073441976 · 0~I.'0 · $~;0'0 t PAGE 1/2 F~O~:$PIN£LL H0~£$ INC 30-JUL-96 15:03 MAI4K IiANSEN P,E. Quality Sand and Gravel P.O. Box 1456 Palmer. AK 9964,5 ID:9~?3441B?G FAX 190:~ 74F),472[ July 15, !996 Project 98'~ ~ P~GE 2/2 Subject: Sieve Ana[ysis of Fdter Sanc~ Gentlemen: The following is the sieve analysis of the sample submitted on 7115196: Sieve % Passing 1/2" 99 3/8" 95 #4 86 #10 76 #20 $7 ~4.0 20 #100 2 #200 1.2 % Required for ADEC Filter Sand Group A Group 8 85 -100 60- 90 25- 50 0- 1.5 0-5 Coefficient of Umformity Cu: 3' Coeff;.cient of Curvature Cc; 1.0 Amount passing one sieve 37 ri.nd retained on next The sample does not conform to Group A or B specifications. if you have any questions, please do nOt hesitate to call. Sincerely. . / Mark Hansen 85 -,100. 0-5 4 Maximum 1 Mgxirnun'~ 45 MaximL~m MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PERMIT NUMBER:SW960067 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:PAYNE RICK E OWNER ADDRESS:9210 VANGARD DR. SUITE 102, ANCH. AK. 99507 PAGE 1 OF 1 ON- SITE WASTEWATER DISPOSAL SYSTEM PERMI~~'~-'~"/~'. ' / ¢ ..~'" "" '~ ;¢'~)'~;*'~ DATE ISSUED: 5/02/96 EXPIRATION DATE: 5/02/97 PARCEL ID:05148148 LEGAL DESCRIPTION: CHUGACH PARK ESTATES BLK 1 LT 7 LOT SIZE: 54503 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2o 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 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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: ISSUED BY:I DATE: DATE: PROPOSED 4 BDRM HOUSE DESIGN :~0 0~:~ m DRIVE z o~ 0~ Z ~ -~ ~mo~ 0 _~0 O~ ~ ~ O~ N.T.S. DETAIL T 15' PROFILE O01:D mOC :~ --n _.~ 0 :::t] U)z Om m O~ 0.~ m:~m i1-1 tnee nq ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. April 12, 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 7, Block 1, Chugach Park Estates Bequest you issue a permit to install a septic system to serve the four bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole. The monitoring tube within the test hole has 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 wells, septic systems or drainage patterns by the installation of the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. A well permit was issued on January 24, 1978. The well was drilled on February 4, 1978. Attached is a copy of the well log. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP . SUITE 204 - EAGLE RIVER, ALASKA 99577 ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN REFERENCE: Lot 7, Block 1, Chugach Park Estates April 12, 1996 GENERAL: 1. e e The scope of this project includes the installation of a 1250 gallon septic tank and absorption bed to serve the proposed four bedroom residence located 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. 17034 NORTH EAGLE RIVER LOOP . SUITE 204 . EAGLE RIVER, ALASKA 99577 Page Two Lot 7, Block 1, Chugach Park Estates April 12, 1996 Septic tanks installed with less than 4 ft. of cover shall be insulated. 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. LEACHFIELD BED INSTALLATION: Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed-up) before gravel or sand placement. If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. 0 Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. The perforated distribution pipes must be no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. Page Three Lot 7, Block 1, Chugach Park Estates April 12, 1996 Se ® Silt barrier material 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, installed at the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. The monitoring tube should not extend below the bottom of the gravel surface. 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 finished grade over the bed must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 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. e Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). e Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Page Four Lot 7, Block 1, Chugach Park Estates April 12, 1996 Se 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. 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, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. 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. 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. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. Page Five Lot 7, Block 1, Chugach Park Estates April 12, 1996 S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST p E R F O R M E D F O R ..-'~~_...~ LEGAL DESCRIPTION: L-"'7 ~ I ~--~'~~"~--"~ Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water A_.q_Her Monitoring? '[~['2-'V Date: SITE PLAN S L O P E Gross Net Depth to Net Reading Date Time Time Water Drop ~ t.~-~-> \-Z..,. 4~ ~ ~'/a., _.__, .._~. ~'. 6~ ~ ~,~ o~7 ~" COMMENTS $ & $ ENGINEERING I , PERFORMED BY: T ~7054 Eagle RiYer Leel3 R.~e~i~.~N ACCORDANCE WI H~rJe~'~lj)a~N~J~~ ' EFFE THIS 72-008 (Rev. 4/85) PERCOLATION RATE '~ J (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT CERTIFY THAT THIS TEST WAS PERFORMED IN by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 OWNER OF LAND /~//,iL 5'c/L.c.i c.)~ ,,--) /,DDRESS ~o ~o~ ~ CL~/~/< LEGAL DESCRIPTION L 7 ~CI< t ~~'~c~ ~ ~/~/ Ended ~-~/ ~ DATE- Started ~/ PEmlT NUMBER 7 ~ O0 ~ ! DEPTH OF WELL ~ gc~ STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR ~ o o o KIND OF CASING (~ -g ~ ~ KIND OF FORMATION: From (~ Ft. to 'c~ Ft. From ~ Ft. to ~ Ft. From $-D Ft. to Cob-' Ft. From ~ ~'~ Ft. to / t'D Ft. From i/t> Ft. to /i~Ft. From / 3 ~t. to. ! ~' g Ft. From_ /fo ~' Ft. to / ~'~ Ft. From / ~o~, Ft. to c~-'/~ Ft. From-- Ft. to-- From~Ft. to from. _Ft. to From Ft. to~ From~Ft. to~ From Ft. to From~Ft. to~ From~Ft. to~ From ;) S~'¢~Ft. to ~) 7(o Ft.___~"/$ ,0<3 From ~ 7L~t. to ~ 70~ Ft. ~----~, t'~ T' Fromm)7~' Ft. to~qc~ Ft. 04w~T ,&-'~ 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 From Ft. to From__Ft. to__ From Ft. to From__Ft. to__ From Ft. to From Ft. to__ From Ft. to__ Ft. Ft. Ft. Ft Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft MISCL. INFORMATION: DRILLER'S NAME '" [~' ''~ ' ...... ~ E:,E:.F'FflRTMEN"I" Ot ,EFIL. TH .Fi.NJ:, E!",IV I F.:ON.r'IEN'T'FIL. F:'. EC:'T' I FiN 825 "I....'" E;"rF.:EET., FtNCHORFIGE., F:iI-:::. 995¢."~7' 279 - 2 5 ± :L F'EF.:HIT NO.".~'- ,~ FtF'F'L.. ! C F,I'-4"~ · _ C;lll I 1:~ LOCRT I 01"4 EFIGL. E F-: I ',,,'E:R LEGFtL. Fi:: Cin F" %." [.'.',f:!TE OF' ! ':'P:i-;UE L. 7 B-1 E:HUGFICH PRRK EST F'lll E:llf ::.:: i 97 E t:::i G L E R I 'v' E F.': L. IiI T E; I ;;E E 694 2588 5E;E~E~E~ S,?.!IJFIRE F'EE'T' M I N t i"lL.tl"! E:, t STFtNC.:E BETHEEt'.,I R HELLE F!I",I[) RN"r' Ot'4-"--S I TE SEHF!GE D, l :.:.-'.;F'O:~.;i::IL 9]"r'S"FEM 19_'; :1. Ce3 FEET FOF-': FI PRI'v'RTE HEEL. L OF,' 2('3C~ FEET FOF.: F'! F'UBLIC .[4EiL!.._. I.'.IEL. L L. OGS I::ft~:E REQUIRE[:' FIND t"tLIST I.E:E f;.:ETUF-:NE[." TO THE DEI;:'FIF::TME!qT I.q'f]"H.'[N ]:e E:, FI "r' :.E; O F' T!"IE t.,4E:L.I_. C OiqF'L.E T ! ON. SF'EC I F I CFtT t Cd",!.S FII",I[) CONSTF::LICT I ON E:' I RGRR.I"tE:'; F~F.:E fa',,/FI I LFIBL_E TO t t",I'Z, LIREi F'ROF:'ER t 1'-4STFtl._LFYF ! O1'.4. I CERT I F":' THFI]" it: I RI'"t FRI'"Ii!;L. IRF.: I.'.I!TH THE F.:EL:!U!F.:EHEf'4TE: FOR Ot",t-S!'I"E SEHER:'.5 FfI",tE:' !.,-IELL_S R'.:.'T, SET FOF<]"H E',"r' THE: I'IUNICtF'FILIT'¢ OF RNCHORf:fEiE. '-2: ! P.IILL INSTRLL THE S'-r'E;-rEH IN FICCORE:,RNCE 141TH THE F':ODES. E; t G N E [:,: F-IPF'I._ I F:FtNT LEE ::-.";ULL. I ',,,'Fd'.,l I S%UE[:, E',"r'_ ...................................................................... [:,FFf'E I t'.4SF'EC:T t ON I.-I ! S-I"ClF.:'-r' '- :SEI.,.IEF.: it C'~ E;EI.,.tER 2 C~ NELL l NSP E~ I.,.IEI_i_. L..OF:i [:,RTE E:.i [:,R I I_l_Ei';.: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us '" (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.051-681-48 1, GENERAL INFORMATION Complete legal description Location (site address or directions) HAA # ~'IF~ · Expiration Date: Lot 7, Block 1~ Chugach Park Estates S/D NHN Plastek Drive Current Property owner(s) Marge & Adam Galindo Day phone 688-0665 Mailing address Lending agency Day phone Mailing address Real Estate Agent Remax/Sharon Minsch MaiJingAddress 16601 Centerf~eld Dr.. Ste 201. Unless otherwiae requested, HAA will be held by DSD for pickup. 2. HUMBER OF BEDROOMS: 4 Day phone 694-4200 Ar q9577 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Cedificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Cedificates of Health Authority Approval are required for the transfer of title (except beb, veen spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to hcmeowners. Certificates of Health Authority 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 less than 30 days old. (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 t,,lunicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. e 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 Health Authority Approval GuideIines 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 thefime.of..[o~J,3~ation. S & $ ENGIN~-~'~mm~ ' 17034 Eag)e River Loop RoarI No. 204 Name of Firm ;.. _.. ,, _~,., ,)q~z'/ Address Engine)er'sPrinted N~,me. Robert C. Cowan, P.E. 5. DSD SIGNATURE Phone Approved for /16 bedrooms. Disapproved. Conditional approval for ~ bedrooms, with the following stipulations: · tk~ ,~) ¥'T. · .... ~ --~..- · '(.; ~._ 2¢. 2'~'. *. ;.~.- ..... Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: Municipality of Anchorage Development Services Department Bulldlng Safety Division On-Site Water & Wastewater Program 4700 Sauth Bmgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchomge.ak.us (907) 343-?9O4 HEALTH AUTHORITY APPROVAL CHECKLIST Parcel ID: 0~""1 - L/~'l .- t~ A~ WELL DATA Well type ~ If A, B, or C provide PWSID # ~ lA Date completed 7.-q-'/g Sanitary seal {~)N) Totaldepth '?-~Z,-~ ft. Casedto ~0~' ft. FROM WELL LOG Date of test 3.-4 - '/¥ Static water level } ~ ~ ~ fL Well production ~"~ g.p.m. Wwes property protected (~) Casing height (above ground) AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Date of sample: SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size /A ~"o gal Foundation cJeanout (~/N) ~ Date'of pumping Nitrate ~/~:~mg.,q. Other bacteria (~ colonies/100 mi. Collected by: , ~*~ <~ ~..T~Z,~- Number of Compartments 2-- Depression over tank (Y~) ,3 Pumper ,~ Date installed Cleanoutsi~/N) High water alarm C. ABSORPTION FIELD DATA Data installed ~./="~ Soil rating (g,p,d,/ft~ or f~/bdrm) ~. ? Length 3-E / fl. Wldth / ~ ~ ft. Toteldepth /O~ fL Eff. absorpUenarea~5'~' ~ Monitoring tube ~ Date of adequacy test. ~''/J ' a) Resu~ail) ~'~,~ Fluid depth in absorption field before test (~ in. Water added ~$? gal. Elapsed Time: ~) min. Final fluid depth ~ Any rejuvenation treuti,ant (past 12 mo.) (Y~, type) System type ~E;z3 Gravel below pipe ~-g" ~ It. Depression over field ~ For ~/' bedrooms New depth O in. in. Absorption rate >= [~ y- g.p.d. ~ If yes, give date /J~f- D. UFT STATION Date installed Size in gaflons Uanhole/Access (Y/N) ~ "Pump on' level~ ~ments? Jn. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/llft station on lot I~o ~ ~ Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots lc'o On adjacent lots Public sewer manholalcteanout Holding tank SEPARATION DISTANCES FROM SEPTIC/NOLDING TANK ON LOT TO: Building foundation 3 o I Property line ~/&' / ~ Water main ~/d ].e* Water service ine. / o / ~' Wells on adjacent lots /oo ~- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Proper'o/line. Water Service line Curtain drain Building foundation, c/~/ ! Surlace water /~ I-~ Wells on adjacent lots /D, I~ Absorption field 'd'- / Surface water /,~ ~ Water main ~/~ Driveway, paddng/vehlcle storage ~-~ /~ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field ir~pection~ and review of Municipal records that the above systems am in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name ~ 0 ~/~4.~' ~'. Date ~"'/I ~"/O I HAA Fee $ Date of Payment Receipt Number (Rm,. 12~oo) s'. h lo , Waiver Fee $ Date of Payment Receipt Number 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 GENERAL INFORMATION Complete legal description Lot 7; Block i; Chugach Park Estates Location (site address or directions) h',~!4 Plastek Drive C,~tugiak, AK prOperty.Owner Mailing address, Lending agency Mailing address Agent Address Spinell Homes Day phone 9~I~ Vanquard Drive Suite 102 Anchoraqe , A~( Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water XXX 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: 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. 1/911 Fron! MOA #21 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 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 & $ ENGINEERING 17034 Eagle River Loop Read. Ne. 204 Address E~le R|ver.~i.~l~ O__~K?7 ~' E n g ineer's signature ~¢/'/t~JL/~-~'/~"'-- Phone Date ~ / ///c~ ~HHS SIGNATURE ~ Approved for 4 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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) Back MOA~21 MUNICIPALITY OF ANCHORAGE ~:NVIRONMENTAL SERVICE,S DI¥1$1ON Municipality of Anchorage AU( 0 & S V,C S_ Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: LoT -7 ~ ~,~-oc~. I , CI-lur.,AcH Parcel I.D.: A. WELL DATA Well type ~'~,~,~A~'~ Log present (~N) Yes I Total depth If A, B, or C, attach ADEC letter. ADEC water system number Date completed 2 - H- -7 ~ Cased to %°~ ~ Casing height (above ground) Sanitary seal ((~N) 'Ye ~ Wires properly protected (~N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: "/- B.~HoLDING TANK DATA Date installed ~'- I o o ~1 {, Foundation c!eanout (~N) Date of, I~umpi'ng /~P,-IJ · Tank size Other bacteria O Collected by: t ..z ~o ¢,~Number of Compartments ~-- 'Cleanouts (~N) ~'~ Depression (Y/i~D ~Jo High water alarm (Y~) ~Jo Pumper ~-~J C. ABSORPTION FIELD DATA Date installed '7 Length 58 Width . Soil rating r fF/bdrm) o.-7 , System type ~' IE~ Gravel thickness below pipe o. ~' Total depth Effective absorption area Date of adequacy test Monitoring Tube present {~YN) Y'~5 Depression over field (Y/~ ~J~ Results (Pass/Fail) ~ ~-~J For bedrooms Fluid depth in absorption field before test (in.); ~ Immediately after ~ gal. water added (in.): -'-'- Fluid depth (ins) Minutes later: ~ Absorption rate = ~ .g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm ~e~g-e~ .~'f~ested E. SEPARATION DISTANCES Size in ~ ~1 at* "Pump off" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: ~holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line J o(::)j IOoI ~' On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station hi//A ioo~ + SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO: ~ ~ Absorption field Foundation E, o Property line ~E, I.k Water main/service line Io ~ -t- Surface water/drainage I oo + Wells on adjacent lots joot~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation N ~ Water main/service line Driveway, parking/vehicle storage area 5o Wells on adjacent lots I oo~ + ENGINEER'S CERTIFICATION * I certify that I have determined thru field inspections and review of Municipal ,nconformance with. M~A ~ guide~nes ,neffecton this date. Signatur~ Engineer s Name /~ .4.7-'~ ~ HAA Fee $ .~.~O-b. Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number