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Home My WebLink AboutSUN VALLEY NORTH BLK 4 LT 12 jor. • 7/15�/cl �'� MUNICIPALITY OF ANCHORAGE \` On-Site Water& Wastewater Program ,011 C / PO Box 196650 S' 4700 Elmore Road c (� Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite d"' 4^,CN°R A�Q t I tpartlt ent On-Site Wastewater Disposal System Permit Permit Number: OSP191256 Effective Date: 7/2/2019 Work Type: SepticTank Upgrade Expiration Date: 7/1/2020 Tax Code Number: 05065209000 Site Legal Address: SUN VALLEY NORTH BLK 4 LT 12 G:0758 Site Mailing Address: 22222 ELKHORN CIR, Eagle River Owner: DEAN SHARLENE M & ROBERT H Lot Size in Sq Ft: 69956 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field Q 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: r � �./' Date: — Issued By: Ali Mir" Date: J 9 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Section � Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-652-09 Property owner(s) Dean 229-0159 Day phone Mailing address 22222 Elkhorn Cir Site address same Legal description (Sub'd., Block & Lot) Sun Valley North BLK 4 LT 12 Legal description (Township, Range & Section) Lot Size 69956 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (E)all that apply) Absorption Field I J Initial ❑ Single Family (SF) J x J Septic Tank U x (w/wo ADU) X Upgrade ❑ Holding Tank J J Renewal ElDuplex (D) [ J Privy Multiple Dwellings n (SF and/or D) Private Well ❑ Water Storage [ J 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. (Signature of property owne or authorized agent) Permit/Rush Fees: aa.5- Waiver Fees: Date of Payment: (0/ 6-1/9 Date of Payment: Receipt Number: CrQt) Receipt Number: Permit No. Q5Pl9125Z Waiver No. G.\Development Services\Building Safety\On Site Water and Wastewater\Forms\Ciient Forms\Permit Application.doc 2T1-�I IV ENGINEERING SteveEng.com Steve Eng,PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 6/24/19 Number of Pages: To: MOA On-Site Services Subject: Sun Valley North Block 4 Lot 12 Advantex Upgrade An existing bed is functioning OK,however the owner wants to upgrade to a Category III Advantex. The existing bed will be connected after new double cleanouts. The entire subdivision is on private water wells and septic systems. The terrain slopes northwest at the site as indicated. The system size is a single family at 4 bedrooms. Please review the wastewater system design for the existing 4 bedroom home. I have included design plans& specs, design guidelines,& soil tests. If there is need for additional information or clarification please give me a call. Thanks-Stv X61 8 9 TO 4 �7 RUSK ff JUN 2 4 2019 c \?THIN' ENGINEERING SteveEng.com b• Sun Valley North Block 4 Lot 12 SPECIFICATIONS& DESIGN GUIDELINES Wastewater System Sizing: This is an existing 4-bedroom, single family home. The absorption bed is currently working. The owner wants to upgrade the system to a Category III Advantex. A design is submitted for a new Advantex. The neighboring lots are developed as indicated in the drawing-no conflicts, large lots. The easements are located on the drawing and are not encroached upon. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications(AMC)& State of Alaska Drinking Water Regulations and Wastewater Regulations. • Connect Existing Bed To Advantex. Double-cleanouts after tank. • 5' minimum between the tank and bed. 10' to property lines. 10'to house. • Solid pipe must be set on well compacted, stable soil • All cleanouts must extend to at least ground level • Approved pipe materials include cast iron,PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, PVC Schedule 40. • Sewer Service Line is minimum 2% slope • Insulation board shall be extruded direct burial polystyrene(Dow Styrofoam HI or equal) • Maintain minimum 10' separation between water line&wastewater system. � ,, Pit • 4.• * Stever:: • • PE AV, ••• k ' S\O DESIGN NOTES: 1. Existing Bed Remains In Place. 2. Sewer Service Line minimum 2% slope. 3. Replace Septic Tank/Decommission Old Tank Per UPC. Connect New Advantex To Existing Bed. 4. Lots Served by Private Water Wells. 5. No Conflicts Within 200'. 6. Check Condition Of Sewer Service Line- Replace If Necessary. 7. Measure Separation Prior To Construction. 7.--\ \',(2 N O_ cf 10% Aske N ighbor Septic \\ s 3,5 Decommission Septic Tank Per UPC O O \ 1- G \i I Bed ting X50 I 10% Slope 0. (N� 0 •c, co 1.1r1 '100 �, 4 Bdr Well IL 0 15% S ope F I c. 1111 r\Je,Noy a) > Q New 1500 Gallon A.vanTex Unit With 1 AX-20 Filte Podf' L 0 S W NOR THRIM :''��.°F '� SUN VALLEY NORTH 1' = 50' ENGINEERING P•. SteveEng.con, 0.1: 4.1,491 .. BLOCK 4 LOT 12 PLAN PO Box 770724 Ea91s River' A/cskc 99577 •�'"'°"/ ' WASTEWATER DESIGN LAYOUT 907.694. 7028 "� UPGRADE TANK 6/22719 2 of 3 > Foundation Cleanout 1 AX-20 Filter Pod AOMMTD R6u.ATED AX 0 000 R&R 1 = / ----7 .. -.'..!..'I 1 ..". t NSIAATED 1 .'—'. ."—..- I, R6ER onnect To Existing w'w'w'..'..'w'w....w. ' '; s...._47___ absorption Bed —AO.p.TRa ON 'r�I..] 1 LfTSTATION I EJIM 1.111117P • )1116h. i I 12' DESIGN NOTES: Advo GALLON AdvonTex 1. Connect To Existing Absorption Bed. . 2. Advantex & Solid Pipe to be Placed on Compacted, Stable Soil, Free from Boulders. 3. Sewer Service Line is Minimum 27. Slope & 3' Cover. 4. Water-Tight Couplings. 5. See Specification Sheet. 6. All Work To Conform to Municipality of Anchorage (AMC) Requirements & Specifications. ") PROFILE END VIEW SUN VALLEY NORTH NORTHRIM Asir . 9'. ENGINEERING r* 49m. *f �,,� ,,• ADVANTEX PROFILE BLOCK 4 LOT 12 PO Box 770724S. sa.. �� Eagle River, Alaska 99577 ,� «-8 .�1, SEPTIC SYSTEM 907.694.7028 44 7/M9 I IP r P A Tl P oat"' Iorown By: 'Scale: • SE i• = 5 ' I SHEET3 of 3 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the"AGREEMENT" made and entered into as of this 07 Day of X � of 20 )9', by and between , herein the "OWNER,"and the Municipality of Anchorage,herein the"MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an AdvanceddWastewater Treatment System(AWWTS), described as A cal✓Q y 7`_/.c Sc locatedcat(legaldescription)/ ✓ �l klorn e� �5 .Ir !/4 /17 Ah' r)W 47 17 -i A y �'Q�4 /Y� �/ �r 2. Maintenance, Repairsm/ and Alterations. (Owner is required to read, understand and initial each section) AO Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. le014 It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s),maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee(typically$400 to $600). )4,6 Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. lee/ Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 • OWNER: By: /, (signature) Date: — �� •P r t (pa, (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this day of „ ° 20 19 , by (_4rj<vek- �� 0 I' 041 OTAR IBUBLIC FOR ALASKA = 'NOTARY: My Commission expires`:7 704 - /D, o:�k33 ,t PUBLIC 11:e.O.VAile MUNICIPALITY: By: J� �;, %CCS �J1(/!er (signature) Date: 7/2/19 Reheee& áU-r-v (( (print name) Title: (rev. 05/18/2018) Page 3 of 3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF NEAL'¥H & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT NAME MAI L~C)/A D D_R.~ESS, LEGAL DESCRIPTION LOCATION Well DISTANCE TO: Length of each No. of lines lin~,// Top of tile to finish gra~le / Length~z' / Widtb .~1 / Type o~f crib- Crib diamete~.,.~.r __ PHONE ~.."~q~ E~UPGRADE I ~0'~ ]~ PERMITNO , Material No, of compartments ~ Material Liquid capacity in gallons lundation Nearest lot line PERMIT NO. Fetal length of lines Trench width Distance between lines inches ~aterial beneath tile Total effective absorption area inches Crib dep.~h - Total effective.~,oT~rZ ¢ ~ Building foundation Driller Nearest lot line Distance to tot line Sewer line Septic tank Well DISTANCE TO: DISTANCE TO: Building PERMIT NO, Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED 72-013 (Rev. 3/78) ~: ......... HUN I F:I PAL I TV OF ANCHORAGE DEPARTMENT OP- HEALTFI AND ENVIRONMENTAL PROTECTION 825 I_ STREET, ANCHORAGE., 8K 9950~. 2~4-4~20 ,]~'-~---"E. ITE '_-%IFZL,IER ~-.- bIIELL PEF'.I'-I I PERMIT NO: DATE ISSUE[): 8403~.~ APPLICANT: DEAN CONST. ADDRESS: ,'.~, S&S ENGINEERING EAGLE RIVER., RK 99577 CONTACT PHONE: 694-29?9 LEGAL DE_bRIF. SUBDIVISION: _.UN VBLLE9 SECTION: 4 TOWNSHIP: lgN LOT SIZE: ~3956 (SQ. FT. OR ~CRES) MA:q BEDROOMS '. 4 LOT: :L2 BLOCK: 4 RANGE: LISTED BELOW ARE TEtE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC Sq.'STEM. CHOOSF THE OPTION THAT BEST FITS ~OUR SITE. DEPTH TO PIPE BOTTOM (FT.) 4, 0 4. 0 4. 0 GRAVEL DEPTH (F'T.) 6. 0 0. 5 3. 5 TOTAL DEPTH (FF.) i0. 0 4. 5 7. 5 GRAVEL WIDTH <FT. ) 2. 5 g~. 0 5. 0 GRAVEL LENGTH (FT,) 140, 0 ** 62, 0 1Si. 0 ** GRAVEL VOLUME <CU. 'CBS. ) 84. 2 7t. t t3:4. 8 TANK SIZE (GRLS) :L, 250. 0 *:+: :L., 2~8. 0 :+:* :L., 250. 0 ** SOIL RATING (SQ, FT, ."'AR) 419 gig 4t9 *,+: GRAVEL LENGTH .':." '75 FT. REQUIRES MULTIPLE RUNS <NOT EXCEEDING 75 FT. EACH) ~-::+, TANK MUST MW,,,'E AT LEAST TWO COMPARTMENTS CERT IF'¢ THAT: 2L. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS 85 SE]' FORTH E:'¢ THE MUNICIPALITY OF ANCHORAGE (MOA) FIND THE STATE OF AL, t~SKA, 2. I WILL INSTALL THE S'¢STEM IN RE:CORDFINCE WITH ALL MOA CODES AND REGULFITIONS., AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF." THIS PERMIT, 3. I WILL ADHERE TO ALL MOA AND STATE OF ALF~SKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY E)<ISTING WELL., WASTENATER DISPOSAL SYSTEM OR PUBLIC SEWERA~3E SYSTEM ON THIS OR ANV ADJACENT OR NEARBb' LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A MA:~:IMUM OF 4 BEDROOMS AND AN'~ ENLARGEMENT WILL REQUIRE AN FIDDITIONRL PERMIT. IF R LIFT STATION IS INSTRLLE[:, IN RN AREA COVERED BY MOB BUILDING CODES., THEN (t) RN ELECT~I~L PERMIT ~/~D INSPECTION MUST BE OBTBINED.~ (2) RS-BUILTS WILL NOT BE APP~WEC~ITHOUT ~N ELECTRICAL INSPECTION REPORT; AND (~) THE ELECTRICALsIGNED 1.40R~(~~~/~~MU~ ~ONF~ R LICENSED ELECTRIC:IBN.DRTE:: ~ ~ '~'~' ~ LOG PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4- 5- 6- 7- 8- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST PERCOLATION TEST '1 10- 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER . /~ S ENCOUNTERED? , /[-,/~ ~ P E IF YES, AT WHAT DEPTH? ~' Gross Net Depth to Net Reading Date Time Time Water Drop COMM E NTS _~' PERPORMEDg ,' 72-008 (6/79) PERCOLATION RATE '-~¢.~ .(minutes/inch) TEST RUN BETWEEN ~"~- FT, ANO .-~-.-., F'F DOC Co, dba SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ~.~ O ADDRESS ,,3*'g ,'.~ o ,~. '}'3 ~""'"'~ LEGAL DESCRIPTION &. /.~ ./~z,/< cd. DATE - Started ~~'S''~ Ended PERMIT NUMBER DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT, GALS. PER HR ~O O KIND OF CASING _ KIND OF FORMATION: From ~ Ft, to '~ Ft, From ~ Ft. to '~ Ft, From ~/ Ft, to ,/.~c3_Ft, From ('> O Ft. to_ tS'"~ Ft, From (-~ f Ft. to '7 ,['~'_Ft. From From._~r? Ft. to !ti .Ft. From_____Ft. to Ft, From I I { Ft. to /~'~' Ft, From ____ Ft, to.__Ft. From Ft. to Ft. From /'~¢) Ft. to /)'~/' Ft. From / .,~q Ft. to / ;"7 Ft, From Ft, to _Ft. Frmn Ft. to __Ft. From Ft. to .... Ft. From Ft. to. Ft. From Ft. to__.Ft. From Ft. to___Ft. From Ft. to Ft From Ft. to_ Ft. From.~Ft, to_ Ft.. From Ft. to~Ft.. From Ft. to_~Ft. From Ft. to_~Ft.. From Ft. to__Ft. From F t to ~ ~- ~ . .cb o % From Ft. to Ft. ~¢~ Ft. to Ft, '~ Frorll MISCL. INFORMATION: DRILLER'S NAME by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGlAK, ALASKA 99567 ,) TELEPHONE688-2759 OWNER OF LAND, ,/--~ ~ (J ,~ '-~"'~ "'~ DEPTH OF WELL ADDRESS ,,~/~ ~'~,'~ × ¢~'.~ ,.~fl Z~' /'~ STATIC LEVEL OF WATER Fr, LEGAL DESCRIPTION ~/ /~ ~/~/(.. ~r' ~?,d'° ~'~ ~'~-~/~ ~ DRAW DOWN DATE-Started 7~/~'''c} Ended_ --///~ff'~ GALS. PER HR KIND OF CASING PERMIT NUMBER KIND OF FORMATION: From ~-~ Ft. to c2. Ft. O ~J _-(Q',~/(~ Jd ,~P-? '~ _ From Et, to Ft. From ~ Et. to -~ Ft.. ('~L~Y ~ ~,~< From~Ft, to~Ft.~ From ~/ Et. to &O Ft. ~Z~*J From _Ft. to_~Ft. Froln~O Ft. to(~ Ft. ~q~ ~.~FO~z~Fr°m Et. to_ Et, From ('~;~ Ft. to 7~ Ft. ~c ~ ~ (~ ~ Frmn Ft. to__.Ft. From 7~ Et. to~/F Ft. ~¢~ From_ Et. to Et. From_ ~r~ Et. to Il/ Ft. ~'Z~ ~/~ ~' From.~Ft. to Ft.. From_~Ft. to. Ft. [~O vc O~ ~ From Ft. to_~Ft. From Ill Ft. to_/~,& Ft. ~/ 6~ ~<m ,~ Frmn Et. to_ Ft. From. Ft. to .... Ft. ~ ~*//~( ~/~"~g [ From.~Ft. to_ Ft. / From.~Ft. to Ft. ~T~/~ Frmn Ft. to Ft From Ft. to_~Ft. From Ft. to__ Et. From Ft. to_~_Ft. From~ Ft. to._~Ft. From Ft. to.~Ft. From Ft. to~Ft. Fromm. Ft. to ~Ft. From Ft. to Ft. Fromm. Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: MUNICIPALITY OF ANCHORAGE I)IVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTF. CTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1'. C~nera]~ Information Application Date (a) Legal Description (include lot, block, subdivision, section, to~ship, range) Lot 12 Block 4 SUN VALLEY NORTH SUBDIVISION Location (address or directions) NHN Elkhorn Drive Eagle Rivers AK 99577 (Mile 6.5 Hiland Rd.) (b) Applicants Name DEANs Robert & Sheri Telephone - Home694 91]B~siness Applicants Address (c) Applicant is (check one) Lending Institution Buyer [~ ; Other ~_~ (explain); (d) Lending Institution First National Bank Address P. O, Box 770548 SR Box 9352 EAgle Niver, AK 99577 Te 1 e~ho n. e_ 6__99 4--21 0 3 Eagle Bivers AK 99577 (e) Real Estate Co. & Agent Address NONE Telephone (f) ROBERT DEAN Mail the HAA to the following address: Eagle River~ 2. T_j~e %f Residence Single-Family Number of Bedrooms 3. Wat~ Individual Well E~ AK 99577 Multi-Family 4 Other (describe) Community ~ Public Note: If community well system, must have written confirmation from the State Department of Envirommntal Conservation attesting to the legality and status. 4. Sewage Disposal 0nsite X~ Public ~ Community ~-~ Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] · 5. E~ngineering Firm Provfdin. g Inspec_tions, Tests_z File Search~ Data and Infor~aat AS certified by my seal affixed hereto and as of the vaiidation date sho~ b~low, ve]:ify that my investigation of this Health Authority Approval shows that the on-'site water supply and/or wastewater disposal system is safe, f~ction~ and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the info[~ation obtain~ from the M~nicipaiity of ~chorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with ~1 Municipal and State codes, ordinances, and regula- tions in affect on the date of this inspection. E~I.E RIVER ENGINEERING SERVICES Name of Firm ~ .... ~GLE RIVE~AI(99577 Telephone ~6~~, P, O. BOX 77329~-- Address l~'~ .~~ 694-5195 Date - ., (ENGINEER SEAL) DH~EP__~r oval Approved for ~'bedrooms ~y.' · Approw~d ~ Co~itional D~sapproued Toms o~ Conditional ApproTal CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE .REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSION~kL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCRASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENT$o 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 SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 HEALTH AUTHORITY APPROVAL (HAA) c;~l~l 9 l; /~V~ CHECKLIST- FEBRUARY 1984 Legal Description: WELL DATA Well Classification /°Pi t/cc We Log Present fY/N) /V Total Death /.'~ 7" Cased to /_'~ '..1" Static Water Level J./.~ '" Casing Heighl Above Ground Electrical Wiring in Conduit (Y/N) _ Separahon Distances from Well: To Septic/Holding -rank on Lot To Nearest Edge of Absorption Field on Lot _ To Nearest Public Sewer Line Cleanout/Manhole Water Samale Collected by .Zc.~_,j Water Sample Test Results Comments ~.-'d-// if A B, C, D,E.C. Approveo (Y/N) Data Completed ~//~ 5-' Yield Depth of Grouting ~/~ Pump Set At -'¢~, 7'-¢-~,-.~ Sanitary Seal on Casing (Y/N) Y Depression Around Weuneaa (Y/N) IL/ : Oil Adjoining LOtS ,/b,¢ '~' : On Adjoining Lots TO Nearest Public'Sewer To Nearest Sewer Service Line on Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/Nj .~ Air-tight Caps (Y/N) _ Depression over Tank [Y/N) .~'/ Pumping/Maintenance Contract on File [Y/N) /¢//'~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septm/Holdmg Tank To Water-Supply Well _/¢~ To Property Line /~' To Water Main/Service L~ne Course /2'~' ~'/ Sizs /'g:~ 6~') ¢:'4 / No. of Compartments ,,,V Foundation Cleanout (Y/N) Date Last Pumped ,"~"e'.~..~ ; for _ Temporary Holding Tank Permit (Y/N) To Buildir/g, Foundation To Di~posa Field ~ / To Stream Pond, Lake, or Major Drainage Comments Page 1 of 2 r2*o26(t 1/84 C. ABSORPTION FIELD DATA Soils Rating in Absorpt on Strata Date In~talled Width of Field Square Feet of Absorption Area ' / Depression over Field (Y/N) /V' Results of Last Adequacy Test Separation Distance from AbsorCtion Field: To Water-Supply Well To Building Foundation '¢',:~,~' / Lot TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field _ '~' ~5-- / Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line '/¢ To Existing or Abandoned System on ; On Adjoining Lots ,~' ~ c- To Cutbank (if present) Comments LIFT STATION Date'lnstalled Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed~ ,,'~ Date ~'/~'"'¢,/~-' 5- Company Receipt No. Date of Payment Amount: $ MOA No. Page 2 of 2 72-026 (11/841 Engineer's Seal