HomeMy WebLinkAboutT14N R1W SEC 17 W2E2NW4NE4 REM · Municipality of Anchorage Page [ of /-P
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: .SW G,5'DO~ PID Number:
Nam~¢¢~ ~~ ~~ Wastewater System: ~New B Upgrade
Address:
¢ ~~,~¢¢~7 ABSORPTION FIELD
77~z
Phone: ~V'~O~7 po. of B~ooms: O Deep Trench ~Shal~owTrench
Total Depth from original grade:
LEGAL DESCRIPTION so,.~,~.g: ~. ~ ~.~/sq.~,.
Lot: Brock: Subdiv~ion: Depth to pipe bottom from odginal grade: Gravel depth beneath ~ip~
Ft.
' J J Fill a~ded above original grade: Gravel length:
WELL:~v,~q~i~ ~;~ ~/~N w /~~.~C Upgrade, ~/~ ,~ ~, w,~t~: ~, ~,. Nu~b.~[o, .i.~: ~.t~.~Ab~tw~. ,i~,:Ft.
Classification (Priwte. ~B.C): I Total De,th: Cased T~: I Total absorption area: Pipe material:
PumpSeta,: FE3~,1 ~. ;-~fl~' m~ TANK
Yield: /~ GPM ~ ~ / Casing Heighl Above Ground:
SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P.
To Septic Absorption Lffl Holding )ublic/Private Manufacturer: Capacity [n gsllons:
.From Tank Field Slation Tank Sewer Lines A~CA ~
/ / I Material: Number of Compadments:z
s~.,~, ' ' / / / ~ LIFT STATION~~/
Water ~DD ~ /O~ ~
Lot i ~ Size i nufacturer:
Line /0 + JDI+ JO +
Foundation /0 t~ /~ ~ "~p on" lo,el at: levol at: :
Cudain Drain :/ ~ / Pum~ Elect rica, ~nspectio~ bY:
Remarks: WCl~ ~ff ,~ 1~/30/~¢, , BENCH MARK
Lo,rich and Description:
Assumed
Elevation:
ENGINEER'S SEAL
Inspections performed by: ~D ~~ Dates: 1st ~/z~/q~'. , ~'~~]~~ ~ ~ % ~ ',
Health and Human ~e~,ces approva,
Department
0f
72-013 trey 9/91) MOA 25
t' AS-]}U1LT PLAN
WATER AN]3 WASTEWATER A]3SBRPTIE]N SYSTEM
W1/8, E1/2, NWL/4, NE'1/4, Sec, '17, TLTN, R'1W, S,M,
EAGLE RTVER RBA]3
S89°58'0~"E
15' UTiLiTY EASEMENT SEC. 17, T17N, R1W, S.M. °'~5'
~ UTILITY EASEMENT
~C~200' Well Radius (assumed Closs~
TRACTS A & B co °° P & M SUBDIVISION
EL JAY SUBDIVISION d (1~81--319)
(P82 ,372)
17 - TANK CO
SHED
18 - TANK CO TH #3/ ~ ~ I
I
20 - POST TANK CO
22 - CO ~ B A-17=119 +/-
24 - MT ~ A-27=159
25 - CO B 27=102 +/,-
A-22=173 +/,-
26 - MT 65 i B-22=150 +/-
27 - CO ~ , F-17=150 +/,-
F-27~157
~'~) OF A.~.4 ~ NOTE: HUB ELEV.@ GROUND.
~ ~ c~-,i,;~/.~ ~ >REPhRED FBR: KND ENGINEERING
~Ssp~ P,B, Box 7736a9 EAGLE RIVER,6%_6~l~AK, 99577
~~ EagLe River, AK 99577
SCALE: 1' = lO0' I
AS- BU1LT
WASTEWATER
~i/B, E1/8~ NWl/4,
111,5 LF TRENCH
]3ES] GN ]3ETA LS
A]BSEiRPT~FIN SYSTEM
NE1/4, Sec. ]_7, T17N. Ri_W, S.M.
P,I,D, 050-971-02
56.5 LF o£ Trench
PREPARED FOR:
Larry & Mary Crcb~ree
P,B, Box 773629
Ecgte River, AK 99577
KND ENGINEERING
2044I PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
696-6111
12/30/95 I ])RAWlNG
MBT TI] SC^LE 19504-S2
WIIEATONWA~I{WI!LL~ INC.
190~ ~?~.2041
P.02
Howdte Investments
_ ,, O, ATE OF I£$TJ tl/30/95 ....
LOCATION 0~ ~ELL (Legal Descrlption):
W£LL O[.PIH: 245._._._~,~ FT. CASING;, ,,.245
DATE O~ILLI~G C~L[TED: 5/05/.75
STATIC ~ATER LEVEL (Top of Casing): 197
Mile 3 Eagle River Rd,
FT SCREEN: NO
nRILLER;Bi)I Sullivan
...... FT DAT£: 11/30/95
L
Clock Pumping Started/ Depth to ~raudown/ Pumping
Time Stoppedm Hln, Watert ft. Recovery Rate, GPH
10:00 AM 0 197 (swl.) 0 0 i~.Start
· 0:0i A~ i ' ZOl m~
~0:2o ~M ~ 204 ~Z ..
10:35 AM 35-'~ 204 ..... 1.2 ·
iO~4n AM 40 204' ~Z. .
so ....... 204, ., ' '
~ ~55 204 .
!~oo AM ~o-~ zo~ mz ....
~Q.O PM '~7~
_1tO0 PM lO0" 13 houes zuq 12 ·
_2,00 PM ' 26~ ' '" ' 12
,~COVERY
~=00 PF1 t 0 t' . . .204 0. . t/~' .
· H ) ,, 198
~-' 35 .....
MUNICIPALITY OF ANcHoRAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW950083
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:CRABTREE LARRY D & MARY K
OWNER ADDRESS:21022 EAGLE RIVER RD
EAGLE RIVER, ALASKA 99567
DATE ISSUED: 5/23/95
EXPIRATION DATE: 5/23/96
PARCEL ID:05097102
LEGAL DESCRIPTION:
T14N R1W SEC 17 W2E2NW4NE4 REM
LOT SIZE: 405900 (SQ. FT.)
AR3NK~ER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK 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 ( 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:
BY:
DATE:3"-23 - F.~z--
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
Dan Roth
On-Site Services
DHHS
825 L Street
Anchorage, AK 99501
Dear Dan:
REF: W1/2, El/2, NWl/4, NE1/4, Section 17, T17N, R1W, S.M.
May 18, 1995
1) Water monitoring was conducted on Test holes #5 and #7 on May 17th. No
water was encountered.
2) The total depth of the ~rench has been corrected to show only a total depth of
It is my opinion based on the soils investigation conducted that the soils strata
located at 12' on test hole #7 and described as ML (hardpan) has a percolation
rate less than 120 min./inch.
Thank you for your consideration of this request. If there are any questions,
please call me at 696-6111.
uffus, P.E.
~,~Engineering
Attachments:
Wastewater Absorption System Details (Dtd 5/17/95)
Soils Log/Percolation Test(s)(#5/~v7 showing additional
monitoring)
Per your May 5th comments I have modified the proposed design and provided
the following comments for your consideration:
(90Y)696-6111/FAX (907)696-8111
April 30, 1995
On-Site Services
DHHS
825 L Street
Anchorage, AK 99501
Dear Sirs:
REF: W1/2, El/2, NWl/4, NE1/4, Section 17, T17N, R1W, S.M.
Attached is our request for an on-site sewer permit for the above lot. A well was previously
drilled May 5, 1975, and I have attached a well log for your files.
As shown on the site plan, there are no conflicts with existing on-site well, sewer systems or
with potential reserve areas. In addition, there are no class "A" public wells within 200' of the
property, and sufficient distance ( 200' ) is provided for one (1) commercial well located to the
east which has not been documented according to ADEC.
This lot is generally flat for the first 450' with a slope of 2%- 4% running north and south. There
is adequate area directly east of the test hole locations on the lot to install both an original and
a replacement system. The natural slope will provide positive drainage away from the
proposed installation site as well as existing or potential wells. There is no surface water
within 200 feet of any portion of the proposed installation.
We performed eight soils tests, three within in the proposed absorption area, and conducted
seven percolation tests on this property. The design we are submitting is based on poorest
soils conditions encountered(12 - 13 min./inch). In addition, water monitoring was conducted
on seven of the test holes with results posted on the soils logs. After monitoring the test holes
for over seven days there was no water located in the test holes where the system is located.
Thank you for your consideration of this request. If there are any questions, please call me at
696-6111.
Sincerely,
Kenneth M. Du'f~.E.
KND Engineering
Attachments:
On-Site Well and Sewer Application
Wastewater Absorption System Details
Site Plan
Soils Log/Percolation Test(s)(8)
Well Log
, STTF PLAN
,I WATER ANI) WASTEWATER A]]SF1RPTIFIN SYSTEM
N 89'59'0D" W
EAGLE RIVER ROAD
I N B9'57'57' W
329.79'
~ 15' UTILITY EASEMENT SEC. 17, T17N, RIW, S.M. °-~EASEMENT
200' Well Radius (asBlumsd~ ~
TRACTS A &B ~J~ 8~ _~31~I~BDIVISlON
ELJAY SUBDIVISION ~ ! I
(P82_372)
o ---Wl::)OD WELL SHED
o I
WELL AREA
SEPTIC AREA ~ II
LOT SIZEI 435,600 SF I
WELL RR~][, HQU$£
FDBTPRI~q' 58,138 SF
rDTRL ~ AVR~LA~LE
r[~ sr-PnC sYS?£# 377,462 SF ~ Replacement flelc
~.~'' =_?.. "'~· PREPARE]) FDR, KNI) ENGINEERING
~ ~,~/¢j.:. /,X Lo. Pry & Mc~r'y Cro. lo'l:ree ~?044! PTARMIGAN
Eo, gl.e River, AK 99577 ~)*TE,""'"
SC~L£, t- = zoo' 95-S1-101
Ndl/2,
DESIGN DETAILS
NdASTENdATER ABsnRPTInN SYSTEM
El/2, NWl/4, NE1/4, Sec, 17, T17N,
["'l
dd d
dd d
RINd, S,M,
P,I,I], D50-971-02
I
DESIGN CRITERIA
· ~. ~-?~:m .~,'~ PREPAREI) FOR~
~~ P,B, Box 772629
E:D~e River, AK 99S77
1, ~nILS RATING O.B GPI]/SF
:~, 5 I}EI]RDDM HOUSE = 5 x 150 GPI}/I~EI]RnnM = 750 GPB
H, 750 GPI} * O,B GPI]/SF = 938 -qF AI~snRPTION ARE~
4, 938 SF/~5'w)¢O,SF) = 94 LF TRENCH (MINIMUM)
~. ~' HI} INSULATInN REQUIREI} riVER TRENCH IF ¢ -~' r, RnUNI} cnvER
6 ~' HI} INSULATInN nVER TANK IF ¢ 4' cnvER
7. INSTALL 15DD GAL ST£EL SEPTIC TANK
KND ENGINEERING
2D441 PTARMIGAN I~LVI]
EAGLE RIVER, AK, 99577
696-6111
~/ll/~ I]RAVINr,
To :~^~£ 95-~2-0102
PERFORMED FOR:
LEGAL DESCRIPTION:
1
8-
9-
10-
11
12
13
14
15
16
17.
18-
19-
20-
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Township, Range, Section:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Deplh Io Waler Aller..r ~
Moniloring? -- Date
Gross Net Depth to Net
Reading Date Time Time Water Drop
~1~ ~ YY'/
z ~ ~ ~' ~ ,~,~
PERCOLATION RATE [~ (m~nutes~inch) PERC HOLE DIAMETER
TEST RUN BETWEEN [ FT AND '2. FT
PERFORMED BY: .~.~"T~ . ~/,.~.'~---~,~,0(~ I ~c~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. ~ [~'}~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
7-
8
9
10
11
12
13
14-
15-
16-
17
18
19
20
DATE PERFO
COMMENTS
Township, Range, Section:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED? ~'/~b
IF YES. ATWHAT ' I SL
DEPTH? ~ j,~,~' pO
E
D~plh 1~ W~te[ ~l~r , ~
Monit0ring?L~,~ (.o Oal~ ~
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE J ~ ,~* (m,nutes4nch) PERC HOLE DIAMETER ~:~ I~
TEST RUN BETWEEN J FT AND ~ F'I'
72-008 (Rev. 4/851
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
2
6
8
10-
11
13-
14
15
16
17
18
19-
20-
-F~ 4~ ~ ~?~-~-~)Township, Range, Section:
SLOPE
WAS GROUND WATERNJ-lo
ENCOUNTERED?
IF YES, AT WHAT ~-
DEPTH? -- pO
E
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
q{~, ~'.,t I 5'
COMMENTS
PERCOLATION RATE __ (mmute,~'~nch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~-'x[/'~-FT AND. ~ '/'~' F','
PERFORMED BY: ~ ~ ~-/"~~-"" ~' O, ' J~kr~ CERT'FY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/~)
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
5
6
7
8
9
10
11
12-
13-
14-
15-
17
18
19
20
COMMENTS
Oeplh to Water Alter
Mon[Ioring? Date:
Township, Range, Section:
SLOPE SITE PLAN
(]ross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE J. ~'~ (mmutes,'mch) PERC HOLE DIAMETER
TEST RUN BETWEEN Z~ FTAND'~> F'I'
72-008 (Rev. 4/85)
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: ~'~ ~
2
3-
4-
8
9
10
11
12
13
14
15-
17-
18-
19
20
COMMENTS
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED;' ~'/~"~
IF YES, AT WHAT
DEPTH?
Moniloring? -~
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOEATION RATE ~/~ imm utes/,~[cT/ER C HOLE
TEST RUN BETWEEN )//j~r- FT AND ~FT
DIAMETER . ..
I '~/~/J ~') TEST WAS PERFORMED IN
PERFORMED BY: ~/(~ ~'A.,~-~,. l, , '.~ CERTIFY~./~.THAT];IIS
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIOELINES IN EFFECT ON THIS DATE. DATE. /
/ /
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
5
6
8
9
10-
11
13-
14
15
16
17
18
19
20-
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
q-~ ~ ~- (_ p,,~,, 4 ~,z)Township, Range, Section:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED? ~',~
S
L
IF YES, AT WHAT
DEPTH?
E
Monitoring?
PERCOLATION RATE '""-- ImmuleS~nch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND 'Y F'£
ACCO.O^NC* W,*H AL~ ST^** ^*0 MUN~C~*^~ ~U,OEL,NES,N E**ECT O" T.~S OATE.
72-008 (Ret,. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
o^TE: q/2y ,r
PERFORMED FOR:
LEGAL DESCRIPTION:
2
3
4-
5-
6-
7
8
9
10
12
13
14
19
2O
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
.~~SEAL)
~ ~ DATEPERFOI~
~ ~ ~ ~ff~ownship, Range, Section:
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Oeplh to Water Alter
Monitoring? Dal~
Gross Net Depth to Net
Reading Date Time Time Water Drop
.Cz/
PERCOLATION RATE ~[L-~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ~ F'I'
PERFORMED BY:~-/b',,~,Tx,~.j~.j ~" ~'_,..~ I CERT, IFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS OATE. DATE. ~/Z]/¢5
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
2
DATE
7
8
9
10
11
Township, Range, Section:
SLOPE
WAS GROUNDWATER
IF YES, AT WHAT O
P
Depth ~ Water After ~ --
MonitodflD? Date: i
SITE PLAN
13-
14
15
16
17
18-
19-
20-
COMMENTS
Reading Date Gross Net Depth to Net
Time Time Water Drop
· o ~ ,~'~
~ ~ ~ ~//~
PERCOLATION RATE ~[' ' {minutes/tach) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND '~ FT
PERFORMED BY: ~ ~ I .~r'., CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE:
72-008 (Rev. 4/85)
PERFORMED FOR: ~?Z~'-d ~.~;{T~ DATE PERFOR, ~ e'
(~,~} lownship, flanoe, Section:
Y
SLOPE SITE PLAN
4
6-
8-
9
10
11
12
13
14
15-
16-
17
18
19
20
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
./
WAS GROUND WATER
ENCOUNTERED?
I~'~, ~AT
DEPTH?
O~plh ~ Water Aflc[ /
Moni~ring~ ~
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOL^T,ON R^TE 11,4
COMMENTS ~-(~L ~
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE
TEST RUN BETWEEN
(minutes/tach) PERC HOLE DIAMETER
FTANO ~ Fi'
72-008 (flev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DATE PERF
~'i~- ~ ~ ...~;'q ',,O / Township, Range, Section:
SLOPE
1
3
WAS GROUND WATER
ENCOUNTERED?
$
IF YES, AT WHAT ~)
DEPTH? p
E
Depth
M0nit~ring?
SiTE PLAN
8
9
10
11
~2--- ~H
13-
14-
15
16
17
18
19.
20-
Gross Net D~pth to Net
Reading Date Time Time Water Drop
3:e¢ -- ,Tz. -.
' o7 I 8 t/~ I
PERCOLATION RATE 1,3'~. (m,nutes/,nch) PERC HOLE DIAMETER
TEST RUN BETWEEN I FT AND ~ E ~'
I ~(~ ~) CERtiFY THA} THIS YEST WAS PERFORMED IN
ACCORDANCE WITH ALL SIA]E AND MUNICIPAL GUIOELINES IN EFFECT ON 'HIS DA'f E DAlE
'r
Municipality of Anchorage ~"-~,~49 T~H
DEPARTMENT OF HEALTH & HUMAN SERVICES ~I,,,,.~oo..,~,,-*.*I~....o-..o
825 "L" Street, Anchorage, Alaska 99502-0650 ~ ~~.
SOILS LOG -- PERCOLATION TEST '~ Kenneth
.
L~GAL OESCmPTION: '~ZJ ,'~ '[~ ~g~ ~o~Township, Range, Section:
~rgC C ~"; ~ SLOPE SITE PLAN
5
6
7
8
9
10-
11
13
14
15
16
17-
18-
19-
20
COMMENTS
--N~' ~O ~'~
PERFORMED
WASGROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Monil~dng? Dalm
Gross Net Depth to Net
Reading Date Time TimeWater Drop
/ ?4'
PERCOLATION RATE J'~ ~ tm,hUlaS/tach) PERC HOLE DIAMETER
TEST RUN BETWEEN J FT AND ~ F'f
I '~J'~'~ CERTIFY THAi THIS TEST WAS PERFORMED IN
ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON 1HIS DATE DATE _ '~/ ~-I ' ~:~~''
12-008 (Rev. 4/85}
,,, , "2,1£F' ;:~:_q "9~E 9:E:2: RE I'11:1::~; LiP '~_(r_~t.E
RECEIVED
MAY 2 1995
Municipality of Anchorage
Dept, Health & Human S~rvioes
,", MuniCipfility of AnchOrage
Development [Services Department
.'!'! i ' i,. .... Buildin~ safety Division' -
i. ~ .' on-site wate~:~& Wastewater Progra.m : 'i ;',:
LegaI
'*A. WELLDAT / 'i: i ' ~ !;:, i . .' ,~
.
Well type Private . i,:'~ I~f.A, B, or c pro,~
Date completed 5/5/1'975'~ Sa'nitaiT s.e.~
Tot I depth. :245 ' ft. :i ~;:'i Cased to
! i' ::!.: FROM WELL' LOG ; '
" Date of test' ~'': .;
:= -,', ' [,: ~:[: !.: , .I": ~
.r Static wate 'leVel .~,:i 11,9 ,...~ ,.
'J' Well production~:~; . ~ ~ '~'
.!!., .' i4700.~outh Bragaw St...i ' /'= !':I ~
! ~ '~" '!' P~O. BOx 196650 Anchorage, AK 9{)5i9-6650 .!! .! ~
; i~ ~ ~... :: -;. ..www.ci:anchorage.ak.us: '.. '~ i! '~,
:~ .' .. '~ .., ' ~ (907)'343-7904' · · ,i ; I '~
; :: HEALTH AUTHORITY APPROVALS:CHECKLIST. .,
Description;. Wlr/2,E 1/2.NWl ~4!NE1/4.SEC1 7;T14N.R1W~Par( .~1: ID:
i~,:(Y/'N) Y . ii ';i Wire~= r~{ected ~iY/N) Y
.5*,'.~ft. .;. Casing above ground) 3 5"
., ;.. ,; '~ ,! ! ' ,, ' i
:.ii!i: :* ¥' ,::*.' '"
9/04
.... ....... ,
WA+ER SAMPLEiRESULTS:';: ;:. ';.' , .... : ", .....
, , . ,~.' ~ ~' ! ~ I :' .
' ' ...... II.Other bacteriai! 0 i colonies/100
" " ~'~ =,;-i ...... ~, ~!,I :~ ~:~r' ~ I . , !l. ~'~
Coliform : 0~. colOnies/lOO:ml. Nitrate', mi'. :' '
, ' ': r' ' ' " ' ='':' ' ~ ;'~ '<' ' ', 'I~'' ' '
Arsenic: NA mg./I.';E e 0 ~ ~:J~ ~ ,~:~: .;. oh~t, ~
SEPTIClHOLDINGTANKDATA~: ~.:" :.:',' : ~. ~,:; ;'. ~; 'H
Tank Type/Material .~ SEPTIC/STEEL" Date i~stalled"6/a4/1995 ',:~,' Tan~ size '1 500 gal.
Number of Compadments'~ ~i~ Cleanouts (Y/N)~ . ~;: .~':: :':. '~:: ~. ' ~:
Foundation cleanout (Y/N)~Oepress~on 'over tank~.(Y/N) N "~H~g~ wat~ larm '(Y/N) ~
Date ofpumping AX1 9/04 .... .... =Pumper~ SANITARY ......... ..
ABSORPTION FIELD DATA ,, ,., · . ~. ,~ t ..... i '. ~ I~; ,~
= ~ , , . .. , ~ ; ~ '. , , [ ~;.I ; , II I [
Date ;nstalled~oil~rat;ng :..(g.p.d./ftZ.or. fl~/bdr~)~ ? ~ ~tem type TRENCH
.i ....., r ...... . ~"~' ~'{e~t, . .....~ '~ .il~"'~,.., ."'=- i=~' ;~ ~., ~ .........
'Length 11Z':'=~'.J' -.ft:~Wdth';5~:'~ :,' ~'~',~':~::~::; ~"~' ?ff:L~GraVe~ ~lowpipe 4.4' ff.
'Tota depth 8.98" ~ff. Eft.. absorptio~ a~ea ~1115 ftC, Monito[ing:tube.y~ .'Depression over field N ' ,
....... . ,1 = , ~.! ......... . ..... ..... -
Date of adequacy test :.4/19/04~, ~", ~ Results (p~ss/Fad).:,Fad ~..?.~ ~ .For ~ bedrooms
' Flui~ depth in absorption field before;test~t~n.I ~': .Water added 780~gal. l.:' .New depth 49.3 ~n.
ElaPsed Time:~14~0 min.. ~;~ .. Fid~l' fluid d~pt~'~im' ~ ;' ?',~] ~' Ab~'d]ption rate '>= 603 ' .g.P.d.
. ... .. . I ~ . ... .,.. . .
'. ., , ,., ~ ; , . .~ ,
LIFT STATION
Date installed NA
"pump on" level at
Datum
E. SEPARATION DISTANCES
Size in gallons.
Manhole/Access (Y/N).
__ in. "Pump ofF' level at__
in. High water alarm level at
Jn.
Cycles tested
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
On adjacent lots 1 00'+
Absorption field on lot 100'+
On adjacent lots 1 0 O' +
Public sewer main 75'+
Public sewer manhole/cleanout 1 0 O' +
Sewer/septic service line 25'+
Holding tank 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation $'+ Property line 5 ' +
Water main 10'+ Water service line 1 0'+
Absorption field 5 ' +
Surface water 1 0 O' +
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 1 0'+ Water main 1 0'+
Water Service line 10'+ Surface water 1 00'+
Driveway, parking/vehicle storage 1 0 ' +
Curtain drain 50'+
Wells on adjacent lots 1 0 O' +
COMMENTS
· See attached letter
ENGINEER'S CERTIFICATION
I cerlify that I have determined through field inspections and
review of Municil~al records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Kenneth M. DIJffus
Date 05/05/04
HAA Fee $430.00 + $175 Rush
Date of Payment 5/3/04
Receipt Number ~'1 L( ~'7_ ¢J~.f
(Rev, 12/01)
Waiver Fee $
Date of Payment
Receipt Number
I~ND ENGINEERING, INC,
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
May 3, 2004
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. BOx: 196650
Anchorage, AK 99519-6650
Subject: Conditional HAA ! Septic Upgrade - T14N R1W Secl7...
Gentlemen:
On April 19, 2004 we performed a septic adequacy and well flow test. Subsequently, the
septic system has been identified as in failure. The owner has requested we proceed
forward to obtain a conditional Health Authority Approval on the subject lot.
The owner plans on attempting a rejuvenation treatment followed by an additional
adequacy test 30 days after the treatment. In the event that the treatment does not
work, an amount of one and a half the highest bid will be escrowed at closing to cover
the potential costs of upgrading the system. The proposed upgrade design & estimates
are attached.
There are no public or private wells within 200' ,o,f our proposed system location except
as noted. There is no surface wa!er within 100 of the proposed system and there are
no known curtain drains within 50. We do not expect there to be ~ny adverse effect as
a result of granting the conditional approval or on adjacent lots by the development of
this system.
If you have any questions, please contact me at 696-6111/FAX 69628111.
Respectfully submitted,
11~,~I]~ Engineering, Inc.
Attachments:
Wastewater Absorption System Details/Site Plan
Construction Estimates
Water Analysis
As-built Survey
, I
~/ASTE~ATER ABSDRPTIDN SYSTEM
P,I,]). 050-971-0;:)
GAL ,~..PTZC TAH~ ~5~ K~lLqJ)4
J8' ~ FRE]H ~.~*lu~ OF' T~ ~
I
3~ LF' of' Tre~.h J
i
]]ESIGN CRITERIA
~. SOIL~ RATING O,B GP]~/SF
E, 5 I~EDROOM HOUSE., 5 X 150 GPD/~EDROOM = 750 GPD
3, 750 ~ + O,B GPD/~F = 93B ~F A~DRPTION AR~A
4, 93B SF/CS'w)(O,SF) = 94 ~ TRENCH CHINIMUH>
5, E' HD INS~ATIDN REQUIRED OVER TRENCH IF C 3' GRDUND COVER
7. INSTALL 1509 GAL STEEL SEPTIC TA~
PREPARE]] FDR,
J KN]] ENGINEERING
Lo. pp & Ho.r- Cpt~b'l:r'ee 20441 PTARHIGAN ]~LV]]
P.D. ~o× 773~29
EAGLE RIVER, AK, 99577
Eo.g[e River', AK 99577 ~'3/i?/~ --I~,~VZNG '
I. ar ~a s~£ 195-SE-DlO2
' I
I SITE PLAN.
' WATER AND WASTEWATER ABSBRPTIEIN SYSTEM
; N 89'59'00' W ..
EAI3LE RIVER ROAD
I N B9'57'57" W
-15' UTIUIY EASEMENT SEC. 17, T17N, R1W, S.M. I~-' 15' U'flUTY
EASEMENT
/
200' Well Rodlua (assumed Ciasa 'El' well If/
150,
I
TRACTS A & B ~ BDIVISION
ELJAY SUBDIVISION
(P82-372)
mi, :': Well Rod m '""'"~WOOD WELL SHED
WELL AREA
)oeed Hc
SEPTIC
LOT SIZD 435,600 SF
LE~' U3T PERZNET£R
VEI.J. RA])I~ HaUSE
FI~ SE:PI']C SY~TEN 377,462 SF ~lacoment flold
_ N 8g~'O0' E
q~.~ ~J/~ ~ ILarrv & Mary Crabi:reel ED441 PTARMIfAN ~kV]]
~,%;~:,~,~- IP,D, Box 7736E9 I EAGLE RIVER~ AK~ 99577
May 03 04 11:29a R&L Person 90?-688-46?8 p.1
Richard Person Construction
24120 Ramblers Rd.
Chugiak, AK 99567
907-688-4678 pA/fax
BID #
04-5590
DATE 5/3/2004
Larry & Mar3., Crabtrce
PO Box 773629
Eagle River, AK 99577-3629
FAX ~flDate:
696-81 ! ! KND
CONTACT #'s:
696-6111 Brcu
I . DESCRIPTION I
- W 1/2 E 1/2 NW l/4 '
Sec 17 T17NRIW SM
I OPTION l-
- Construct an "L" shap.e,d leach field paralleling the cxisting leach field, totaling 94 lineal feet xvith 4'
! of effective sewer rock 5 wide, tied into cxisting tank. '
- Backfill to rough grade with positive drainage
OPTION 2:
- Install wa Advantex AX-20 gravity fed field: 30'Lx5'Wx4'D
- Abandon old tank and field.
- Backfill to positive grade.
TOTAL. I
SIGNATURE(s):
BID #
SIGNATURE ABOVE indicates acceptance of terms & guarantee of payment.
BID/PROPOSAL valid for fO days from date. PRICES may vary after that time.
AMOUNT
9,995.00
Septic Systems · FoundatiOns
Water Une~ · Drain T~le~
Chu§~a~
Afl m~zaf~J [~ gul~'~r~e~([ la I~ U 8p,K:tl'~ed. AJI ~ lo tm ct0d~lmd In B lUb~11rff~l~
PROPOSAL. T,.
Ncaa:. Tlda Prapoe~ may ~ wlthdrmvn by ua If I1Ol
'~", I _~ ,
84
FROM : WALKER CONTRACTING FAX NO. : 907 694 4858 May. 04 200;3 07:;37AM Pi
~ ' = ~ ~_.D~. RECYCLED .¢" PROPOSAL & ACCEPTANCE 4RC460
~ CARBONLESS SPEED!SET® ~' 3-PART
PROPOSAL & ACCEPTANCE
53i3
-. ., '.; '.'_
ClT~¢:2 1~,~¢.~. STATE Z P
........ .............................. ..............
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· '"" ' ....... :' ":" '"" '::' 2:: :".'!. ?::
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~:.~,?t~-¢~.:~ '~:~ F;~:.~.' .~ ' ~/¢~,~ TO TH~ LE~ ' '" ""' ........... '"' ~" ':" · ........ '" ·
':,:"' .:.-: '. ' : :'.. ?: "1 ..... " ' ' ' · ~'-'· ' : . .
..... . ~; ~ ~ ,~~.~¢,¢~ · :......-.~ . .
·
~ Recycled Paper
HBUgE DETAIL
EAGLE RIVER RBAD
serse,o ,E
389.65'
'~'k SEPTIC VD~T$
S89'58'02°E
330.07'
I herby certify the following described property,LOT
BLK , W 1/Z,E 1/2,NW t/4,NE 1/4,SEC. 17, T14N. RI~
Anchorage Recording PrecincJ;, Alaska, has been
su~eyed by me, or at my direction, and %hat the
improvements situated thereon are within the
property lines and do not overlap or encroach on the
property-l~ng adjacent thereto. That no improvements
on the property lying a~jacent [hereto encroach on the
premises in question and thai there are no roadways,
transmission lines, or other visible easements on said
property, except as indicated hereon.
.titutions specifically to show any conflicts between
existing structures and platted lot lines or easements
and is not to be used for positioning additional
structures or fencelines. Easements of Record, Other
than those shown on the recorded plat, are not
shown hereon.
BLS
ASSOC.
P.O. Box o.o < .
ANCHORAGE, AK 99523~
Tele. (907) 526-6050
-F-a-x (-gQ-7-)--862--604q~ --
DATE: 9-18-95
SCALE: 1" = 200'
GRID: SWO057
4--30--04;16:41 # 2/ 2
;CT 8nd E ;5e15301
S CT&E Environmental Services Inc.
200 W. Potter Drive
Anchorage, AK 99518-1605
Telephone: (907) 562-2343
-- = ~ ~ ~'~ ~imile:(907) 561-5301
200 W. Potter Drive
)rinking Water An ysis R/eport for Total Coliform Bac. t ria
Anchorage, AK 99518-1605
· · Tel: (~07} 562-2343
RE,4D, I~$.T,.~[ICTIO. N$ ON.REE, E,RSE'.8IP._Ii..thF~FORE cor. r.~cr~vO. $.4Ml,.r.? . Fa:c {907).561-5301
· MUST BE COMPLETED BY ~rATEK SUPPLIER ' TO BE COMPLETED BY LABOKATORY
PUBLIC WA'lEi[ sYsTEM I.D. #
PRIVATE ~VATER SYSTEM
I 13
,~end J~esults .
Company Flame
El Send In~olce
._.96~
Fa:~ l~umbcr
ZipC~c
,B/loath : . DaY Year
SAMPLE TYPE: ' "'
~" Ro~ti .ne · 0
D with~lab teL-ho; . ' ~ '" ')
fl Special Purpose
~A~LE,LOCA~O~
Treated Water
l}.ntreated.Water
Time Collected
· 'Cdlecteil 13.y.
Analy..,;is shows this .Water SAMPLE io be:
~ Satisfactory
13 Unsati.sfactor¥ ..
13 8araple.over 30hours o.ld, results may
be unreliable
O' Sari~l~ tooj~.'ng i~.transit; sample should
not ~e,ov~Yltglltou. rs old'at e~amination
to indicat6 reliable results. Please smd
.nexy:$' .ample. via special deliverT.mail.
Analytical Method:. J~r' Membrane Filter
Analyst
Jun
Date: Time: ' I '
Client noiifl.ed of tiasatlsfactory resulis.:.
Phbncd Sp~ke with --
Date: T/mc:
Comments:
BACTERIOLOGICAL WATER ANALYSIS .i~EC. ORD
MIlO-MUG Result: Total.C6liform
Membra.e Filter: Direct C~unt
· Verification: LTB
FecaIC01iform Confirmation ..
Final Membrane Filter Results
~eponed ~_ ~, (~r~/
[]
Faxed
Faxed
?C~ C61onies/l~0 mi
:. BGB · COLIFIRM rNrc=~oo N.,.~,,. ro co..,
" OB ' Otherllact~a
Coliform/100 mi
,f
l)=lte ,l~l~(J Time
ti--
SG$ ]~t.g I04215tT30I All Dates/Times nre Alaska Stnndard Time
Name
~.,~atrix
0~/04/2004 !!:02
04/29/2004 13:00
C~4~29~2~ l~:~b
Stephen (2. Ede
Engineering
TIgNR! W~I 7W2E2NW4NE4REM
4N~I W&eci 7W2~'..~N W4NE4P~_.3~
Dd,,klng W.~ier ~
Rele~s~ By
TOtal Colifo,., 0 C~L'10 .0m..l.-,,.{lC' o° 9222D'
- PRELIM iNP~RY ~
· " j
A~alys~ S f~Om: ---.0470512004
Run operator: JS
DilUtiOn: 1.00
~mount: 1. 0000
=vi
::3.
~, ·
14 1~ rain
3.55 0,38 4.%42
5.38 30.90
6.9G 0o01
7.53 .0.5~ 15.873
9..40 5.54 107.563
1~.2~ 0.17 5.3~2
8 i G.Ol' 59.]0 1074.486
34.485
This {eport ha~ been creates by.lc Net
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
~7'7 / - ~ :~- HAA#
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner /-W,<-,¢-~, ¢/~/¢-,~[ /d~F ~_,~,4_,~?g~,~Dayphone ~/~/-5~?
Mailing address /2. ~. /-'~k '/'~7_3~-~_~ L~-4-~-~- /~/, .... &_w~., ~. ~,"~/~?'7
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
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, 1/91) Front MOA~I
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 ~vith all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm ~A/.~0 E~_~,~, 0 t,,_l ~ ~-_~ ,z,~..'~ Phone
Address Z~ ~,~/-/ ,~,4~,'~,~.~/('~-,._, ~h~z-~'z~
Date
Engineer's signature k ~/'~j .-;' ....
DHHS SIGNATURE
Approved for
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 enginee¢s work.
W
tx)
W
Z
Z
W
' Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services D~v~s~on
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744-...~
Health Authority Approval Checklist .
' ' : W%. ~'/z;~w'/4.~/~.~lT.Ttq~RtWParcdI.~.: DSO - ~7/
A. ~LL DATA
Well type ./A/ID, If A, B. or C, attach ADEC letter. ADEC water system number
Log present (Y/N) y Date completed ~-/~- / 7~
Total depth ~Z c/~ ' Cased to ~ z./,~ /' Casing height (above ground)
Sauita~y seal (Y/N) ¥ Wires properly protected (Y/il)
FROM WELL LOG AT INSPECTION
Date of test /I /~,0 [ q~' //
Static water level [ q ~ ' /
Well production I Z g.p.m. ../ g,p.m.
WATER SAMPLE RESULTS:
Coliform ~)
Date Of sample:
SEPTIC,q-IOLDING TANK DATA
Date installed fi,/2.~/~- Tank size
Foundation cleanout (Y/N)
Nitrate LB, I ~ ~.~ a /~ Other bacteria
(/ Cf !
/;~'OO Nuinber of Compartments ~ Cleanouts (Y/N)
Depression fi/N) tic/ High water alarm (Y/N)
Date of Puntping
Pumper '
C. ABSORPTION FIELD DATA
Date installed
Length ///, ~' t Width
Soil rating ~ or ft2~dra0 0.~ System type ~4/m/t6~' '/r~
Gravel thickness below pipe q, q ~ Total,depth
Effective absorption area /~ Il5' ~.~. Monitoring Tube present(Y/N) ~ Depression over field (Y/N) fit/
Date of adequacy test ~ Results (Pass/Fail) ~/ For ,~ bedrooms
Fhiid depth in absorption~d before test (in.); ~mmediately after gal. t~er added (in.): /¢
Fhtid depth ~(ins.) Minutes later: /~ Absorption rate -~ g.p.dJ
Peroxide t t~ement (past 12 lnonths) (Y~ Ifyes l~ve date J
D. LIFT STATION
Date installed
Manhole/Access (Y/N) ~./~ump oa' Ic,,el at*
High ;','tiler ahmn level al* *Datum
Cycles tested
E. SEPARATION DISTANCES
Size in gallons j~
~ulnp ofF' level at* ~
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding taak oil lot
Absorption field on lot
Public sewer maiu
Sewer/septic service line
; On adjacent lots
; Ou adjacent lots
Pablic sewer manhole/cleaaout
Lift statiou
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Bailding foundation
Water mai,ffservice linc
Property line
Surface water/drainage
Absorption field
I Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Water main/service lille /0 %
Surface water
Driveway, parkiug/vehicle storage area
Curlain drain At,&
Wells on adjacent lots / O O ~ Jr Properly line / ~ t 4
F. ENGINEER'S CERTIFICATION
I certiJ, i2 that 1/,ave determined thru field inspections and review of Municipal ,'ecords~eO~v~~. a,'e
in coa)brmance with MOA lt~ gai~lelines m eJfect on this date. ~0 ,0,*~"~*% 4.& ~a
.............................................................................................................. ~.x~G~ ~ ......
HAA Fee $ ~ · ~ Waiver Fee $
Date of Payment /~~ Date of Payment
Receipt Number /~ &a¢) Receipt Number
Rev. 8/95 OSS: haa.wk.doc
complete legal descri
Location (site address or directions
Address
_ 2 ; ; ~', Day phone' ' ..... ~::
Unless otherwise requested, HAA will be held for
NU~,BER OF BEDR(
;WATER SUPPL¥:i
~ ,,!;~, ~..~, .,~ :,;;~,-.,, ....... Public. wate
-: ::~:.:: ?~:' N..TE: '- If communttywell'system; provt~e wrttte~ ~fi~'matto
::4 ::L\ i,i~.;',-;.:';:;J;~,¢:: :~,tng to the legahty~,aod~status, ofsystem.~,,'~:~, r,~: ~( ;~:~ ~ ~'
· 4. TYPE OF WASTEWATER DISPOSAL : -.:~. -..
,: ~ ·' : ':.:: Indivdua on:Ste,il :'!::' .:' .~":~' ' i : .,:.i.:ii':'::,
' ~ , , Community,on-site ~.,~ ~ ,,~, · .~,,,~,.. ,,. ,. ~ ~.~,, ~;~r:~ :~ -~? ,,- : ..,,~;,~:,.: .
: NOTE: if community wastewater system, provide wri~en confirmation from State ADEC
attesting to the legality and status of system.
·: : ~ 5. , STATEMENT OF INSPECTION BY ENGINEER',~;i'L :~'~ ~i~ ~ ::
~ · i ~i As certified by my seal affixed heret° and,as of the validation date Shown'belOw, I Veiify that
ii~ i,ii~V~jgati(~n o~flqjSHe~dth',~th6ri~ ApP~-°vai apPliCati°~ S, hoWS t~gt t~ on~sii~ ~'~;~e,~)l
~ :e~:~unCt!o~i a~d ~d~equ~t~ ~ the n~e~0~'b~ ~b~;~:
~erver f tha~ baS~ 'on t'~b i~0rm~ti~{~i~'~ ~ ~.~
the on-site wate[;~;~:
6. DHHS SIGNATURE .............. ;~'~<;::~,
_ Approved for
bedrooms. · -,:; ,~ ·
.~' .:,.~,z4,~,/~,:. :': ~v · Conditional appr0vaF for ~': ~_ bedrooms ~w th,,the:foll6wm~ ;.~t~lSUlatl0ns!
. ... ' 'y~?".'~F? -
-' Fill· shall, bO'-added so that ~' maxim~}~gr~de"~f;;2~%":-~i~; b'e
theydralnfleld:to, a poznt'-40 feet south: of
d~cat~ng a cross sect~ontal, v~ew meeting th~'s~h~requx~ement.-
The Municipalit9 6f Anchorage Department of Health and Human Services (DHHS) ~ssues Health.Author ty
Approval Certificates based only upon the representations given in paragraph 5, above by an independent
~)rofessional 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.