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HomeMy WebLinkAboutT12N R3W SEC 22 LT 27 S2Onsite File T12N R3W Sec 22 Lot 27 S2 PID# 015-521-34 The 1994 trench may not be tested for a 3 bedroom COSA. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221336 Work Type: SepticTank Upgrade Tax Code Number: 01552134000 Site Legal Address: T12N R3W SEC 22 LT 27 S2 G:2637 Site Mailing Address: 11131 GAMACHE DR, Anchorage Owner: LAMAY ROY & JULIE TRUST Design Engineer: C&M ENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: enr v. Department 8/30/2022 8/30/2023 100500 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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: • A test hole is required prior to construction of the absorption field, inthe location shown on the site plan, to confirm minimum separation toimpermeable soil and seasonal high groundwater, as well as percolation rate. Construction may proceed at your own risk prior to 7-daygroundwater monitoring. If results require a design change, constructionshall stop pending approval of a change order. Please submit results withthe inspection report (or change order, if required). CO '_ I _L CAvde 5 '�'he �,'e1�5 OJ GI C b unq e—j bel 'oo rv, Co(.A-n �o /00M Gv J 10161 -0 -7 - Received %6%zz Received By: Issued By: Date: Date: MUMMPAUTY OF AHCHORAGE POSR Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 015 521 34 Property owner(s) LAMAY Mailing address 11131 GAMACHE DR Site address 11131 GAMACHE DR Day phone Legal description (Sub'd., Block & Lot) T12N R3W SEC22�,� 1-4 27 52 Legal description (Township, Range & Section) Lot Size 100,500 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 Tank 0 Upgrade ❑ X (D) ❑ Holding Tank ElRenewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑� Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: NONE Distance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: _-fY 3 6 0 370 Waiver Fees: _ Date of Payment: _0zl7 �-f LZ Z to19 s -L Date of Payment: Receipt Number: 06 y 8 7,0 Receipt Number: Permit No. DS /02 Z /?, 3 6 Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc C&M ENGINEERING SERVICES Ph: 907=854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System for T12N R3W SEC 22 Lot 27 S2 Dear Reviewer, The above referenced property is currently served by an older septic system with a leaking tank that needs to be replaced immediately. We are requesting an expedited review of this application. The owner is ready to replace the tank and has determined that the leachfield should also be replaced. They would like the system sized for 4 -bedrooms. The soils on the lot are relatively slow draining and the design is based on the historic soils logs. The total depth of the system accounts for fill added after the original system was installed. The bottom of the new fields will be at a similar relative depth to the existing. Our review of available documentation and field investigation show that this project will not adversely impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. As shown on the plan, the tank will be greater than 10' from the house foundation. The tank will be of MOA approved construction. The tank shall_ be covered with a_.minimum, of 2° moa approved insulation_and.3'_of. cover.or.a minimum of 4' of cover without insulation. The fields will be insulated with a minimum of 2" moa approved insulation and 2' of cover or 3' of cover without insulation. The repair must be performed by a moa certified installer (or approved homeowner) in accordance with MOA requirements. Repair of the proposed system will not negatively impact adjacent lots. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leach field, well, and other applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini(a)gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 9/17/22 CHARLES G BALZARINI `., CE13854 CSM ENGINEERING SERVICES 907-854-5558 Septic Design Calculations Residence: T12N R3W SEC 22 LOT 27 S2 RESIDENCE/LOT INFO number of bedrooms 4 br Water usage/bedroom 150 gpd/br Water Usage 600 gpd system type: CONVENTIONAL type: Shallow Trench 0.45 Application Rate gpd/sqft required absorption area 1333.33333 sqft trench width (W) 5 ft gravel depth (D) 4 ft Shallow factor 0.5 Min Required Length: 133.333333 ft Based on historic testhole below distribution pipe Use Length: 70 ft two trenches Max ex depth 7 ft Note, fill added after construction of exist fields 'DIMENSIONS FOR REFERENCE ONLY. SEE PLANS FOR DIMENSTIONS TO BE USED IN CONSTRUCTION" Calc By: CGB Date: 9/15/2022 311 *� 'CHARLESf G BALZARIWI CE13854\��`= ��lpi� PRaFESSIONA�.� NOTE: INSTALL ALL COMPONENTS IN ACCORDANCE WITH MUNICIPAL CODE, APPROVALS, POLICIES, AND MANUFACTURER'S RECOMMENDATIONS. AN ASBUILT SURVEY MUST BE COMPLETED AFTER THE INSTALLATION OF THE SEPTIC SYSTEM COMPONENTS. NEAREST WELLS TO THE NORTH J AND EAST ARE GREATER THAN 200' FROM THE PROPOSED SYSTEM. NEW 1250 GAL (MIN) MOA COMPLIANT TANK WITH INSULATED MANWAY RISER AT FIRST CHAMBER REPALCE FOUNDATION CLEANOUT AND PIPE IF NECESSARY THIS PORTION OF DECK r — " TO BE MOVED/REMOVED NOTE: TOP OF DECK IS LESS THAN 18' ABOVE GRADE_ — / — — — HOME I DRIVEWAY \ I r I \ S&S TH-1 \ \ \ 100' WELL RADIUS \\ \ \\ I I Sg THE EXISTING DRAINFIELDS ARE SIZED FOR 3 -BEDROOMS AND -MAY NOT BE USED FOR -A \ _� COSA FOR 4 -BEDROOMS. THE EXISTING FIELDS SERVE AS THE ALTERNATE SITE, RELYING ON A CAT II OR III AWWTS TO MEET RESERVE AREA REQUIREMENTS. I EXISTING S '+-------------�---�---- EXISTING WELL \ I\ GOA l LATTA LOT 6 100' WELL RADIUS. CHARLES G BALZARINI •% 6,•. CE -13854 .•�c`�� f l sTF� • .. g,5,2z .. • ���� ill�� ROFESV0ON. — NEW TANK MUST NOT "BEUNDER DECK OR WITHIN 5' bF ANY DECK FOUNDATION. RELOC, TE \ DECK/FOUNDATION IS REQLi4RED. NEW DOUBLE CLEANPUTSI I \ IVERTER VALVE I I I \ \ I I � REMOVE AND DISPOST OF EXISTING TANK , , / CONNECT TO XISTINLG LINE I / f r.- 1 1 / THE PROPOSED SEPTIC SYSTEM IS GREATER 100 FROM ANY PRIVATE WELL 200' FROM ANY PUBLIC WELLS 100' FROM ANY SURFACE WATER 10' TO ANY PROPERTY LINE OR FOUNDATION 5' TO ANY DECK FOUNDATION THAN: \/ LEACHFIELDS TH- TO REMAIN 100' WELL RADIUS FOR Tl 2N R3W SEC 22 LT 26 E220' OF S396 \ SCALE: 1" = 30' / I LATTA LOT 7 `/ 100' WELL RADIUS /I TO STARTING MARK OUT RIOR CONSTRUCTION. R/ OPOSED 'PESTHOLE 50-50 FLOW SPLITTER W/RISER w � I ui Sq, cn w I I 33 II > I I ROADWAY II I I EASEMENT II 0 50' _ 1J \TWO 5X70 tHALLOW TRENCHES W,(4' EFF. SEWER ROCK M EX. DEPTH 7 -FEET (M SURED AT DEEPEST PORTION OF EACH TRENCH) INSTALL // TO CONTOURS LEGEND O CLEANOUT • MONITOR TUBE ® TEST HOLE 0.5%\ SLOPE INDICATOR \ C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: T12N R3W SEC 22 LOT 27 S2 OWNER: LAMAY DATE- 8/5/22 REV: DRAWN: CB REF: SITE PLAN 1/Z o f LO -1- 27 01.5,5 Z 1-3/. -1 IV L �j S L l_ L 2, _��. I Z N., I�. � W, t. N1. ; AL w -r4- z4s) a'oht u BD_ to L 0 7- x l4 30. I� 1� I N49'5-1-. Iz"E L[--- G -,END a FOUt4D I/z" KERAR 4 SETT zs-/8" Rt 9A R wt-rm cAV MARKED "L_5 -- GOq I" 0 Fo%3N[) !" MOM PIPE 1 J/ 790.52 FCC— The, -- ThC° as e � C� rC C 0,- 0y: , - v i E T. 4i F —Es M--. 33 R a!\ D E5 M T'- a 'm (FER PA-rFNrj �^ 14a.z' EA S"r IIz'6 AVE. N`60� 52' 0C> 3Z`3 3l DA51 5 OF DgAV IN C,- ftA-r No. FINAL- ST1RuC'T"U9E a5- BUILT " SIS—BUILT GASTALDI LAND SURVEYING Jeff A, Gastaldi, R.L.S. 4726 West 881h Ave. Anchorage, Alaska 99502 PHONE 248--5454 GR IV DATE 263.7 1 to - IB- `'+ F.8.J08 NO. a4• 11, I hereby certify that ! have surveyed the property depicted above and that no encroachments exist except as Indicated. It Is the rosponslbllity of the owner to determine the existence of any easements, covenants or restrictions which do not appear on the recorded subdivision plat. Under no circumstances should any data hereon be used for construction or for establishing boundary or fence lines, ANCHORAGE RECORDING DISTRICT, ALASKA I rr = SSCP r 49 TPi a • V • w , w • • .... y3 S ff©ry A. Gastaldt • w q f.5 '' •' iS - 6091 w' VAS � or I -o -U Z7 GQAVEL MVE ion oa 2' fi �9 Q i-- c N N CAN1 " At � Z4` N. ce.,E RE4 4" E%IS"r113G N 5V(Lp1Ma R' M z�xi�s y, sis - CA", ela&VE) .• z^x't'B.w. KANT (BELowJ v 58rTo2 VENTS L[--- G -,END a FOUt4D I/z" KERAR 4 SETT zs-/8" Rt 9A R wt-rm cAV MARKED "L_5 -- GOq I" 0 Fo%3N[) !" MOM PIPE 1 J/ 790.52 FCC— The, -- ThC° as e � C� rC C 0,- 0y: , - v i E T. 4i F —Es M--. 33 R a!\ D E5 M T'- a 'm (FER PA-rFNrj �^ 14a.z' EA S"r IIz'6 AVE. N`60� 52' 0C> 3Z`3 3l DA51 5 OF DgAV IN C,- ftA-r No. FINAL- ST1RuC'T"U9E a5- BUILT " SIS—BUILT GASTALDI LAND SURVEYING Jeff A, Gastaldi, R.L.S. 4726 West 881h Ave. Anchorage, Alaska 99502 PHONE 248--5454 GR IV DATE 263.7 1 to - IB- `'+ F.8.J08 NO. a4• 11, I hereby certify that ! have surveyed the property depicted above and that no encroachments exist except as Indicated. It Is the rosponslbllity of the owner to determine the existence of any easements, covenants or restrictions which do not appear on the recorded subdivision plat. Under no circumstances should any data hereon be used for construction or for establishing boundary or fence lines, ANCHORAGE RECORDING DISTRICT, ALASKA I rr = SSCP r 49 TPi a • V • w , w • • .... y3 S ff©ry A. Gastaldt • w q f.5 '' •' iS - 6091 w' VAS � Septic System Owner -installer Agreement The On-site Water and Wastewater Section (On-site) may issue an approval for a homeowner to perform work on an on-site wastewater disposal system to serve that individual's owner - occupied, single-family or duplex home if the homeowner meets and agrees to the following requirements: 1. The property owner and excavation equipment operator may perform work on no more than one owner -installation project in a 12 -month period. 2. Owner's projected active involvement with the installation: 3. The name of the excavation equipment operator: los, Z-4 Inc-, ,r 4. 1 agree that there will be no monetary compensation for installation services rendered. 5. The name of the inspecting engineer: C O/V c'IhjPeg ir,,3c4 6. 1 agree to discuss the following items.with the inspecting engineer: a. Permit design criteria and specifications. b. Inspection requirements set forth in AMC 15.65.070. c. Advance notice given to the On-site Water & Wastewater Section for all required municipal inspections (AMC 15.65.070A). 7. 1 agree to have the project -specific On-site Wastewater Disposal System Permit available at the construction site for the duration of all related work. 8. 1 agree that if the system is an advanced wastewater treatment system (AWWTS), I will obtain additional installation instructions and approval from the equipment distributor. As owner of (legal description) [ /1'3) (A p / S �2 c)r Za �- % I agree that the information above is true and accurate. 5c c�ZZTi2� �� 5P) A) Owner's printed name: r!.a%i c w Owner's signature: �- - - _ Date: _ _2Z r f �� � 8� Q ddress �P O�-Box 19,6650 * Anchors a �Alaska�99519 6650*� �www�mum org`'�'k#�� � `� '�" vX `r s .�.,�.._r......srs_c.s'r.;�.tir.�..,5.-u..!:�-�..:�ra�'• .�.,..�ata�stt�.ez�u :t..�m+,:��.., ,ori-s..x.�.r..�a.t�r..�.s_ ...�<�;Fs,� ^.-�`r,'. 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: ~WgL/O,qq:/ PID Number: Name: ~ Wastewater System: J~ New [] Upgrade Address: ABSORPTION FIELD 4¢~)C/¢G)tt~'''~'~'.t 4/t~ ~9~'-0~-- No. o~edrooms: O Deep Trench ~Shallow Trench 0 Bed 0 Mou.d O Other LEGAL DESCRIPTION S°ilRating: ¢.~¢ GPD/Sq. Ft. T°talDepthfr°m°riginalgrade: WELL: ~New ~ Upgrade sr.w~dt,: Nu~o~u,~s: D~anc~.~,~.~i,e.: ~/~ ~lL&l~ ~* ~ StaticW~terLevel: Dateinstalled: Yield: ~ GPM Pump Set ~t~:]~ Ft. Casing Height Above~Ground:~t. TANK SEPARATION DISTANCES ~s.,ti. ~ Ho~,.~ :From Tank Field Station Tank Sewer Lines ~ ~ ~ we~k ]7~~ 121 ' ~ ~ ~. ~ToP~ , ~ LIFT sTATION Sudace water /~ ~ Ibd ~ ~ Foundation /Z ~ Z~ ~ Cu~ainDrain -- '" ~0~ E ~ 0~ - p~del Electrical Inspections pedormed by: BENCH MARK Remarks: ~N~- WdA~EETE~ ~-~ /~. OD Fl, 17034 Eagle River Loop Read, NO,~ Inspections performed by: ~..,. m..~. ,I..v. ees~ Dates: 1st q-/2-~ 2nd G-2d'9¢ Department of Health and Human Services approval Reviewed and approved by: ~. Date: ]2 -/- P~ 72-013 (Rev. 9/91) MOA 25 Permit No.Sw940159 Page 2 of. 2 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 THE SOUTH 1/2 OF LOT 27, T12N, RSW, Legal Descri~tio~CTION 22, S.M., AK PID No.: 01552154 CO 1 !C02 iFINAL GRADE NEW 1260 GAL N.T.S. 100' WELL RADIUS O WELL 3 BDRM HOUSE SCALE l" = 40' CO CO SEPTIC TA~K 93.4 CO6& MT (CO4& co6) 86.4'i 86.4 A77.9' NO I~ATER FOUND GASTALDI LAND SdRVEYlNO N CE-8801 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE ~',~'~'~" DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM ANCHORAGE, ALASKA 99519-6650 0N-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940159 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:LAMAY ROY & JULIE OWNER ADDRESS:7130 BEAUMONT COURT ANCHORAGE, AK 99502 2200 DATE ISSUED: 6/01/94 EXPIRATION DATE: 6/01/95 PARCEL ID:01552134 LEGAL DESCRIPTION: T12N R3W SEC 22 LT 27 S2 LOT SIZE: 100500 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 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 CRAPTERS 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) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEMUNDER 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: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. May 23, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORtTY APPROVALS SEWER & WATER MAIN EXJENSiONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST ~ PERCOLATION TEST STRUCTURAL & MECHANICAL iNSPECTIONS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: S~ of Lot 27, NE¼, Sec. 22, T12N, R3W Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroomhouse on the referenced property. Test holes were excavated and percolation tests performed. The approximate locations of the test holes are located on the attached site plan. The monitoring tubes within the test 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 rev~e contact us. information for your ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP o SUITE 204 ° EAGLE RIVER, ALASKA 99577 ~ ~ o~ ~ ~ ~ o ~o R~ ~ ~ , I I ~ ~b~ I I J ~ z ~ ~ o ~ ~l ~ ~ ~Z~ 3~> ~ I I~I ~ u~u~ O~~ ~ ~ ~ I I J o ~ i I i C / ~ ~ ~ ~ ,~///~// //-- ~ ~ I ~ / / ~ I ~ / ~ ~ ~ ~o~. // //~,., / ~ ~ I ~ ~ ,~ _ _ ~ ~. ~ _ _~ _: _ _ _,~, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 6 7 8 9 10 11 12 13 14- 15- 16- 17- 18- 19- 20- ~OWR$~i~, Range, Section: --'~l~/~t t~--~d2d/ SLOPE,.~,'~Z/. ' SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Monitoring? ~ Dale!; Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~) (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN _.~__..~FT AND ~"~ FT COMMENTS / / 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 ~'Y~,'~? 4 § 7 13- ~.o,~. ~5- 16- 17 18 19 20 ~/:{'~-F ~3r ;;2,?Township, Range, Section: SLOPE T,~,a~ SITE PLAN I N 10~ ~ WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? _ -- p / I De,th to Waler Afterr~ .~.~ ~ E MonitarinD? LY$.V~' Date: Reading Date Gross Net Depth to Net Time Time Water Drop :5~ ~ -. ~%~ ~" PERCOLATION RATE ¢'~"~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN "~,~ FTAND L.~,~,~ ET PERFORMED BY: i 7034 Eagle Eiver Leap Road NO, 204 ~-~'~E~T FY THAT TH S TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEL~tJ~IN ~T ON THIS DATE DATE: 72-008 (Rev. 4~85) ~ LOCATIO~ OF EELL DEPARTMENT )F N/~TUR~,L RESOURCES DIVI ,ION OF W/~TER WATI R ~ iLL RECORD , ~/~ Depth ~f C~in~:~ __ft ' _(~ __1 D~TH TG GTATtC WA~l R L~EL= MS rHOD OF DRILL~NG~ ~ ai~ rota~ ~ cable ~ ~ublic s~pp~y ~ othe: ~ c.,~ ~?~-u.: ~ __,,, ~ ~',. ~, .'~ W~LL INTAKE OPENING 'YPE~ ~ open end O screen~ ~ ~e~orated ~ c~n t cie DoFzhs of opening~ ~, to ~ ft 81o:/Mesh Size: ~ GROUT TYP~ Volu~ ,e: ~ . Del,th: ~ fl [o ~ ft ~. - PUM. PIN$ LEVEL AND YIELD: ~ · ft after _~ hr~ p: nping._~g; n PUMP INTA~ DEPTH= ~ _ ft ~ ors~0wer: ~ . WE~ DISINFECTED UFOH COI~P~ 0N? ,~ YES ~ I 0 C~T~CTOR ~FORMATIO~t ~ , I EMARK~ ~~~~~, Po ~ox ~ ~ ~" ~GLE RIVER I ~ 9g ,77~116 Parcel I.D. # O/3'.~-~; ~ ~ 1. GENERAL INFORMATION Corn plete 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 S NGLE FAU LY DWELUNG $o. ~ od Lo~'~'Ti';S~c ~2~'TI2N~' Location (site address or directions) Property owner Mailing add tess Sorr~s Drive & E. 112th Av6nu6 ........ Anchorage~ AK Roy Lc~ay -'- Day phone 244-5557 (w) 248-6225 (h) 7130 B~au~.ont ¢ir~ Anchorage, AK 99502 Lending '~gency. Day phone Mailing address. Agent Day phone - Address Unless otherwise requested, HAA will be held for pickup. 2, NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: .... Individual well XXX ' ' Community well NOTE: tf community well system, provide written confirmation from'State ADEC attest- ~-..... ing to the legality and status of system. 4, TYPE OF WASTEWATER DISPOSAL: ...... Individual on-site ×XX · , ' mm ity0 e ' ' ,,~c. ~f ~ommuni~ wastewater system,'provide wri~en confirmation from 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 17034 Eagle River Loop Road Address Engineer's signature Phone Date DHHS SIGNATURE '~" Approved for _~2 Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Oomments ,-' B~. /--:~'~, ";('-;/,~ ~ Date / 2 - / - ~:~e ~b~'ic(~li~ ~f'~orage Depa~ment of Health and Human Se~ices DHHS)i~ues Health Authori~ :,~pproval Ce~ fic~'~Esed only upon the representat OhS g van n paragraph 5 above by an ndependent p o~onal eng~]~r, reg stered n the State of Alaska The DHHS does this as a coudes to urchasem of hom~ '~ ~.~u . -'. ,'. . · Y P an~their lending msbtubons in order to ~tis~ ce~ain federal and s~te requirements. Employes of DHHS do not conduct Inspections or anal~e data before a ce~ifi~te s issued. The Municipali~ of Anchorage is not responsible for errom or omi~ions in the profe~ional, engin~ffs work, ':..,..~,,~ ." , .,.. ~ ·. ~ '.~-. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHEOKLIST A, Well Data Well type ~U¢¢7~-- If A, B, or C, attach ADEC letter. ADEC water system number Log present(~/N) ~/E$ Date completed (~/~/¢ Driller ,/¢z.?/~E' ,~./z.~.~x,,'~ Total depth ~ Cased to 2;~ Oasit)g height Sanitary seal (Y/N) y~'~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test (¢ ¢~/' - ~"~ Static water level ~(o Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/.'-:.¥-.:t~ tank on lot / '/ Absorption field on lot /~-/' ; On adjacent lots Public sewer main ;r-J/~ Public sewer manhole/cleanout Sewer service line .._~_~_~_~_~_~_~_~_~0 '¢ Petroleum tank ,/~J/~ WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: Other bacteria O Collected by: S. SEPTIC/HOLDING TANK DATA Date installed °7)~r6 I~ cf Tank size I¢~,~ ~-¢rr.. Compartments Cleanout~.~N'~ /~/~ ~ Foundation cleanout (~/~) F~ Depression (Y,~ High water alarm (Y/~ ~)/¢,Z~ Alarm tested (Y/r~ ¢,xD//~ Date of pumping /'J/,~' f~J '~::/.-~ ~/-~l~ Pumper ,~/~ Eagle t,tiver, 2 SEPARATION DISTANCES FROM SEPTIC/~=:~i TANK TO: Well(s) on lot 1 7 3 ~ To property line /0 '-~ Surface water/drainage On adjacent lots Absorption field /00 / co '-/- Foundation / 2 2. / ' Water main/service line 72-026 (3/93)* Front "~ [O00 GCc ~,~¢~'D CONTINUED ON BACK PAGE 'C.-~LIFTSTATION , ~ / vent (Y/N)_ --"~t Manhole/Acc~,SS~p"'off" Level at High water alarm level _~_ Cycles tested __ Meets MOA electrical codes (Y/N) ~ SEPARATI~FT STATION TO: ~ ~11 on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed -9/~ength _~ L~ ~' Width Total absorption area Date of adequacy test~,//g- Soil rating (GPD/Ft2) ~_~ ~ Gravel thickness ,.~, Cleanout present ~/N) ~y'J Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) System type 'Vt,"/f)~ Total depth Depression over field (Y/r~' for .~ ,~.~ Bedrooms After test SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ~ / To building foundation On adjacent lots Surface water ! OD ' Curtain drain E. ENGINEER'S CERTIFICATION On adjacent lots /~,~ '+ Property line 2-7 ¢ To existing or abandoned system on lot Cutbank f~),,,/,,8 Water main/service line Driveway, parking/vehicle storage area /0 I certify that I have checked, verified, or conformed to all MOA and HAA late of this inspection. Engineer's Name Date I0 CE - 880] HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Sack Waiver Fee $ Date of Payment Receipt Number