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Home My WebLink AboutKNIK VIEW BLK 2 LT 12 Municipality of Anchorage Page i of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well ~nspection Report Permit Number: ~d~r ~O'Z~i ~ PID Number: O[-~ I ,~ o5 i Name: ~'Z- ~ i ~-o~'f~VC~ Wastewater System: ~ New ~ Upgrade Address: P.o.. ~ ~'¢~0~~ ~l~u~.~ ~' ABSORPTION FIELD~ No. of Bedrooms: Phone: 'Z~ ~ ~ ~O O ,~ ~ Deep Trench ~Shallow Trench ~ Bed ~ Mound ~ Olher LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: i , 'Z GPD/Sq. Ft. ~ ~ Lot: Block: Subdiv~ion: Depth 1o pipe boltom from original grade: Gravel depth beneath pipe Township: Range: [ Section: Fill added above original grade: Gravel length: Number of lines: Distance between lines: WELL: ~ New ~ Upgra~// Gravel width: '~ Ft. i : .-~ Ft. Classification (Private, A,B,C):, ~ Tota~ I Cased To: To~al absorption area: Pipe material: & ~F~ Driller: ~~ Date Drilled: Static Water Level: Inslaller: Ft. ~'rl~ ~F ~'~ ¢~ Y' Date installed: ¢/'Yield: /GPM Pump Set at: Ft. Casing Height Above Ground:Ft. TAN K SEPARATION DISTANCES ~s~,tic u Ho~6i., : U S.T.E.~. To Septic Absorption Lift Holding Public/Privat Maeufacturer: Capacityin gallons: From Tank Field Station Tank S .... Lines ~0 ~ ~ ~ ~ 0 ~ ~ Number of Compadments: Well' ~0 ~ ~ '~oOi ~ .... ~ I~ Material: ~,~L Sudace w~t.~ i~,~ ~4 .... LIFT STATION Lot ~ L ~_ ~ Size in gallons: Manufacturer: ~ Line O ~ '~;1 i ~ · "P - H' h water a arm a ' Foundation ~ i I O I ~ ~ ~ "Pump on" level at~ e e . g . ~ Pu Electrical Inspections pedormed by: Curtain ~0~ ~ Drain Remarks: BENCH MARK Location and Description: I I A ~ Assumed Elevation:_~ ~;, ......... ?...~ ~. Inspections performed by: s & S ENG~NSERIN~ Dates: 1st ~z- ~¢ ~[. ~ ~";~ -- ~ ~ ......................... t)¥ ~e~.~ ROBERT C. COWAN 17034'EagleRIverL°°PR°ad'N~'2042nd ~"~-'1~' Ct?):,~ C:E-880] Eagle River, Alaska 99577 ~ i [ ~ ~ f ~ "~ ". Department of Health and Human Se~ice~ approval ' ",~,,"~,,,~, '...,..-,,,.~ Reviewed and approved by:.._ ~ ate://-~-~ 72-013 (Rev. 9/91) MOA 25 Permit No, SW960213 2 2 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 12, BLOCK 2, KNIK VIEW ESTATES 051-031-43 Legal Description: PID No.: _ A-- B ~- : FCO 14.0' 12.0' ST1 12.5' 18.5' ~' ~~ :: , , ~ KEY BOX~ DBL1 10.0 27.0 ~_ , DBL2 !0.5' 29.0' ~ / ---'-~- C02 46.0, 70.0';_ MT1 43.0 67.0 ~/ / sT 1 ST2 tOO l' / ~ GRADE ~__ TANK '~t.>,,c','c ] 3','~'~' .d~ 72-O13 A (Rev. 9/91) MOA 25 ROBERT O. COWAN, RE. ROBERTA. SHAFER, RE. HEALTN AUTHORITY APPROVALS SEWER&WATER k~,lN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDR~PORTS WELL INSPECTION & FLOW TEST SI'[E PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEP~LRTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 9~519-6650 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECEIVED AUG '~ 3 1996 Municipaliiy ot Anct~orage Dept. Health & Human Services REFERENCE: The septic inspections fort9 ~eferenced property were _ /~ . Prior to submitting the On-site Wastewater Disposa;L System and/or Well InSpection Report we are waiting for the ~o~T)o~ to be completed. If we may be of further service please contact us. Sincerely, Robert C. Co~an~ ~,E. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 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 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960213 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SCHMELZER FAMILY TRUST OWNER ADDRESS:P.O. BOX 670045 CHUGIAK, ALASKA 99567 PARCEL ID:05103143 LEGAL DESCRIPTION: KNIK VIEW BLK 2 LT 12 LOT SIZE: 20000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 DATE ISSUED~ 7/19/96 EXPIRATION DATE: 7/19/97 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 4 o THE ATTACHED APPROVED DESIGN. 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 (iSAACS0) . 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) 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 THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ISSUED BY: DATE: HEAL'r H AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORI'S WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION ]EST STRUCTURAL & MECHANICAL INSPECTIONS ONS]TE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERTC. COWAN, RE. ROBERT A. SHAFER, RE. July 5, 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 12, Block 2, Knik View Subdivision Reques% you issue a permi% %o ins%all a septic sysLem %o serve %he proposed three bedroom house on %he referenced proper%y, 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, was encountered in the test hole and, after seven day ground water monitoring, the monitoring-tube was found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. This property is served by a Community Water System. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of 'the proposed septic system. 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 I" - 50' SCALE O >m ~ ~ o % z 100' ALAii?AiLRoAD DESIGN SITE PLAN ~ -rlF[ PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 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 ..... Townsl~ip, Range, Sec[ion: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplh to Waler Alter SITE PLAN Meniloril)g? '~ ~"'~/ Date: Gross Net Depth to Net Reading Date Time Ti[ne Water Drop PERCOLATION RATE __. (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FI AND ~ FI d /)--/7 / ' ~t ,.~(~!NEI:,I,(~ I J/KJ L d~ CERTIFY THA, THIS '[EST WAS PERFORMED I, PERFORMED BY: 17~ -.9,~ttver Lep Eoad No. 2~' - ' ~ ' '" ' / ACCORDANCE WITH~I~W~A~~ GUIDELINES iN EFFECT ON THIS DATE. DATE: ~ / 0 / ~ ~ 72-000 (Rev. 4/85) ncnee tn FtEAEfH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SiTE PLANS ROAD DESIGN SOIL TESI PERCOLATION TEST STRUCTURAL & MECNANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN U~-MITM ~AM~M~TER DIMPOMAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. CIVIL ENGINEI:RS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 12, Block 2, Knik View SubdJ_vsion July 5 ,1996 GENERAL: 1. The scope of this project includes the installation of a 1000 gallon septic tank and a leachfield trench to serve the proposed three 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. 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 12, Block 2, Knik View Subdivision July 5, 1996 De 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. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed--up) before gravel (sewer rock) placement. Once the gravel is installed, the dis'tributJ, on pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Moniter tubes shall be of four (4) inchl diameter, installed approximately in 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 shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 12, Block 2, Knik View Subdivision July 5, 1996 Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. 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 (ASS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other 'than listed above must be approved by the inspecting engineer. Insulation shall, be at least 2" thick extrUded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank in].ets and outlets shall be flitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the finall 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. Page Four Lot 12, Block 2, Knik View Subdivision July 5, 1996 INSPECTIONS: Typically there will be a minimum of three (3) 1. nspections required during the installation of the wastewater disposal system. These inspections will occur as follows: e 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 ahd S & S Engineering. 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. Page Five Lot 12, Block 2, Knik View Subdivision July 5, 1996 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 iwith 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 S Municipality of Anchorage • On-Site Water and Wastewater Program ski h (907) 343-7904 s A cry CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-031-43 Expiration Date: 2^ I O 1. GENERAL INFORMATION Complete legal description KNIK VIEW BLOCK 2, LOT 12 Location (site address) 22336 INLET VISTA CIRCLE, CHUGIAK,AK 99567 Current Property owner(s) PATRICK&TERESA FITZSIMMONS Day phone Mailing address PO BOX 671208, CHUGIAK,AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) I 1 Duplex 1 1 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ❑ Holding Tank 1 1 Individual Water Storage C Community U Community Class A Well ® Public Sewer ❑ Public Water System ❑ Waiver/Variance request for: Distance: Received by: ,figX/a 1 , Date: / 1 COSA to be released to the engineer,unless otherwi•- e••-sted by the engineer. COSA Fee $ Jr"� � Waiver Fee $ Date of Payment 1 o _ `1�- Date of Payment Receipt Number 06 Ll Cf 3�D Receipt Number COSA# 05C/q./67? Waiver# 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, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines 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 the time of installation. Name of Firm ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 12/11/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments,deficiencies or discrepancies exist. ��_� -47r Or 4 1- 1 1 / 6. DSD SIGNATURE 74.Q Ti T t /_. _.. _ _ }Li System #1 Approved for bedrooms. tr. KENNI-.111 \r. it .,.. / System #2 Approved for. bedrooms. °'r„ 7116411V -- 1 Disapproved. o • F�fic alOs,V.� Conditional approval for bedrooms, with the followin :stj u at of s \�\Q4��1 Y (jF4Nc - • _-,J ON,SITE tiU -- WATER AND tm V-!,..1 WPROG 'ATER o RAM �� 4, e_ . . J By: L_ (- Original Certificate Date: (^- f -- ( 0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. . 7. ATTACHMENTS: COSA Checklist X.__ Nitrate Advisory • Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.10-12.doc If more than 1 septic system is on the lot: COSA Checklist#_of_ Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: KNIK VIEW BLOCK 2, LOT 12 Parcel ID: 051-031-43 A. WELL DATA—CLASS A Well type A If A, B, or C provide PWSID# 218409 Well Log (Y/N) Date completed Sanitary seal (Y/N)Y Wires properly protected (Y/N) Total depth ft. Cased to_ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic: ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA / `y Tank Type/Material SEPTIC I STEEL Date installed L 4l `3 0 -1 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 1217/2017 Pumper SANITARY C. ABSORPTION FIELD DATA Date installed 8/511996 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type SHALLOW TRENCH Length 37.5 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 9.5 ft. (Measured 12/7/17) Eff. absorption area 375 ft2 Monitoring tube Y Depression over field N Date of adequacy test 12/712017 Results(Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 30.5 in. Water added 600 gal. New depth 35.5 in. Elapsed Time:45 min. Final fluid depth 30.5 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at_in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES -PUBLIC WATER WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway,parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 0 El Engineer's Printed Name KENNETH M.DUFFUS j(s'y`S� `q.\� Date 1211112017 * A, • * ` COSA canary sheet_2-6-15.doc #1 SYN fort `% / 4 2 /` Ilk N. _�� _` Frontier Surveys,LLC Project No:18-008 Date:January 18th,2018 NORTH Ordered By:Lorrie Seward PIat:85-162 Grid:N/A Scale 1"=40' 2.0' 5.0' 2.0' I i 4.4' � 23.4' l 0 14.1' o cri LOT 11 11 i " 2.0' I 11:$ DETAIL"A" o I 11 SCALE 1"=20' rc 5.7' 0.9' I 1.4 15.6' .~ r-. 2.0' i" 0.9 100.4' F. 11 2.0' o ,../ 1.0' '-/ is Knik View Subdivision 24.5' 1.0'" Lot 12, Block 2 N7s"3p,00"w 143. 2.0' 20,000 sq.ft.+/-(net) I 98 / 38,677 sq.ft.+/-(gr.) IA 22336 Inlet Vista Circle ' ' TA 2 Story Wood Framed House ti w/Attached 2 Car Garage 2ND STORY DECK N129.5 . /1 + W ~ s 1 �� SEE DETAIL"A" ppVEDDRIVEWAY I ^ rl �� g. 8 j MI v N j a e l l 646. I- '8i to I (21U-f fLr u.rv. .-r 'r '� 51.8 3 O r�J 'u5 e / j 30.0 w I ce o?m / 'e - ,II RET.WALL / , R.O.iv. r N • / 8 I 1* y W I 111.2 I BOLLARDII- /o V V 87.1 5.9' II �/ Yeo �E-+SHEDS N ,, Q. r, 01 w T P er V N84*56'21"E 126.31 / S ' 103.3' / / 13:7 I r / I / / 1 1 LOT 13 !I Legend: � y Electric Meter/Outside Power -o- Fente �--c Culvert . A Gas Meter al Deck LTA Tel.Ped. 0 20 40 80 S; Septic (0 Water Valve LES Elec.Ped. r- fl.' Feet General Notes: 1.This document is created for the purpose of a single property transaction and is subject to Federal Copyright Law. 2.Excepting for gross negligence,the liability for this survey shall not exceed the cost of preparing this survey. 3.All measurements/setbacks are to the visual/apparent building footprint. 4.Dimensions to property lines are plus/minus O.lft. complies with APIS ards.The s e %e, " F -`t, 1111 conditionsyat the time of the survey.Thiss documege nt doesdnott constitute ayboundaryt urveyland is sub subject to any ements and r` OF q '( •.. .9 11 inaccuracies that a subsequent boundary survey may reveal.It is the responsibility of the Owner to determine ,`Q'.•' .•.Y.toil/ the existence of any easements,covenants,or restrictions which do not appear on the record plat.Under no GI .• `'' . ,,, circumstances should this document be used for construction or for establishing a boundary or fence line. *: 49T"i‘ .* i As-Built Survey of. --7 _ ; Lot 12, Block 2, Knik View Subdivision P FREDENRIC W. X6 E`1 I,Frederic Wagner,hereby certify that this Mortgage Inspection Survey was performed by me,or /,$ 1/19/2018 under my direct supervision on January 17th,2018. 'li'fr�gp D,- Frontier Surveys,LLC FRONTIER. Itttttt`SIOON `.� 650 W.58th Ave.SuiteEAnchorage,Alaska99518 S y" 907.460.1686-info@frontiersurveys.com PROFESSIONAL SEAL www.frontiersurveys.com Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & 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. 051-031-43 1. GENERAL INFORMATION Expiration Date: .. L.~. ~. 0 ? Complete legal description KNIK VIEW ..... SUBDIVISION; .LOT 12f BLOCK 2 Location (site address or directions} 22336 INLET VISTA COURT * CHUGIAKf AK 99567 Curre~.t Pr=party owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address PHILLIP BRIAN LANSDALE Day phone 688-8508 P.O. BOX 671387 * CHUG1AK, AK 99567 Day phone PATRICK MERIFJEREN w/ DYNAMIC PROPERTIES Day phone 3111 "C" STREET * ANCHORAGE, AK 99503 345-6873 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTE1NATER DISPOSAL: Individual Well [] Individual On-site [] Individual Water Storage [] Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Depadment (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil .engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for propedies served by a single-family on-site wastewater disposal and/or water supply system. DSD a!so issues HAAs upcn request to homeowners. Cedificates of Health Authority Approval are valid for S0 days frcm the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (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 Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's wcrk. o INote: Alaska Water and Wastewater Consultants, Inc. shall be paid $ to closing for the engineering services provided. at, or prior 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authofity Approval Guidelines 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 the time of installation. Name of Firm ALASKA WATER & WASTE'WATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation. AKWWC, Inc. attempted to pmvfde a thorough, conscientious engineertng analysis cf the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results de$csbed the performance cf the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levets that may fluctuate dufing the year, and the water usage of the family being served by the system. These conditions ere outside the control of the evaluatcr of the system. Satisfactory test results do not guarantee future perfcrmance ef the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWG, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon er use of this report by any other person or party is not authortzed, nor wi//it confer any legal fight whatsoever. Phone 337-6179 Date DSD SIGNATURE I-.J Approved for ~ Disapproved. Conditional approval for ~ bedrooms. bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other (Rev, 12~01) Original Certificate Date: Municipality of Anchorage Development Services Department 8ul]dlng Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P~O. 8ox 196650 Anchorage, AK 99519-6650 www,cLanchorage.alcus (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST LegalOescflptlon: KNIK ViEWi~'~_"~- .... i SUBDIVISION; LOT 12, BLOCK 2 Parcel ID: 051-~O51r-45 A. WELLDATA COMMUNITY WATER Well type ~ 'A' If A, B, or C provide PWSID# 2184.09 Wall Log (Y/N) ......~ Oatecompleted.~ 8a~ryseal /N __ PmP. e~y.P.retected(Y/N, ' ' ' ' ' Cased to lt. Casing height (above ground) ... in. FROM WEII LOG AT INSPECTION Date of test ..... . ..... Statio water level ~'/~ WATER SAMi~LE RESULTS: Coliform colonies/100 mL Nitrate ~mg./L. ___Other... m. . . Date of sample: ______ Collected by: ABSORPTiON FIELD DATA Date ins~lled .-e/S/lggs Length ,, ,: 37,5. ft. B, SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size, .!1000,, gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping '~/Z~/2,Oog Pumper C. ~ ~r ftflxlrm) 1.2 Soil raUng Width., 5 . fL Date installed 8/5/1996 Cleanouts (Y/N) YES High water alarm (Y/N) NO SANITARY PUMPERS Total depth .*g~4 ,, ft. Eft. absorption area 375 fit Monitoring tube YES Oateofadequacytest ,5/21/2005 Results(Pass/Fall) PASS, Fluid depth in absorption, field before test ~ 8 in. Water added 1545 gal. Elapsed Time: N/A rain. Final fluid depth N/A in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date **LASI' 1289 C, ALLONS CAUSED NO RISE IN THE UQUID LEVEL System type SHALLOW TRENCH Grovel below pipe 4. ff. · Depression over field NO For ,.3, bedrooms New depth *~'18in. 450+ g.p.d. D. LIFT STATION Date installed Size in gallons ~ "Pump on" level at ~ High water alarm level at in. Datum ~ Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main On adjacent lots On adjacent lots ~nhole/cieanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line, 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems ere in conformance with MOA HAA guidelines in effect on this date, JEFFREY A. GARNESS Engineer's Prin~ed/Name Date */-~l ~ HAA Fee $ ~)1-/~. eo Date of Payment '~" 0'~' 0-~ Receipt Number ~:)~)~ ~ (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number I;3 i.I~GAL. OF.S~R~PT)OH . MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services OmSite 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 051-031-43 HAA# ._~, °~c~O ~),~t~ 1. GENERAL INFORMATION Complete legal description Lot 12; Block 2; Knik View Subdivision Location (site address or directions) 22336 Inlet View Circle Chuqiak, AK Property owner Mailing address Lending agency Mailin. g address Agent Lisa Address AmeriSpec Relocation 860 Ridoe Lake !31vd. Dayphone 800-358-7906 Hemphis, Tennesse :38120 Day phone Herrington/FDrtune Properties Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water x× If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank community on-site Public sewer NOTE: xx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. '/2-025 (Rev. 1/91) Front MOA~21 : o 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 corn )liance with all Municipal and State codes, ordinances, and regulations in effe(~J~Jl~ag~f~: ~ . is nspecbon. Name of Firm Address bt~astewater Consultaq, ts, Shall be PAID or prior to, closing for the Engineerihg Services Provtde~ DHHS SIGNATURE Approved for -PH/ £E bedrooms. Disapproved. Conditional approval for Phone_ 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 (Re~, 1/91} Back MOA #21 Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division JuN Z 5 199~, 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)~¢~L~¢~¢o~ ANCHOEAGE Legal Description: r'NVIRONMENTAI. SERVICE8 DIVISION Health Authority Approval Checklist ~ A, WELL DATA : Well type ~__. If A, B, or C, attach ADEC letter. ADEC water system~ Log present (Y/N) Date completed Cased to ~(above grou~id) -- ~res Pr0perlY protected (Y/N)~- FROM WELL L~ AT INSPECTION Nitrate Other bacteria;:, Collected by: Total depth Sanitary seal (Y/N) g,p,m. Date of test Static water level Well production B. SEPTIC/HOLDING TANK DATA Date installed _~/_'~,~___ Tank size Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA /C;~ Number of Compartments c~ Clea~outs (Y/N) Y Depression (Y/N) N High water alarm (Y/N~ Pumper 5~ ~. Soilrating (~orfF/bdrm) 1.2 _Systemtype.~ '~(~ Gravel thickness below pipe Total depth ~ ' .Monitoring Tube present (Y/N) ~ Depression over field (Y/N) ~ _ Results (P~ss/Fail) ~ For ~ bedrooms Immediately after l~l gal. water added (in.): _~3~ ~ Absorption rate ~ = g,p.d. Date installed Length ~..~'~, ~ Width Effective absorption area __3'~,.~ Date of adequacy test. Fluid depth in absorption field before test (in.); Fluid depth d' (ins) Minutes later: 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 level at* E. SEPARATION DISTANCES Size in gallons ~ "Pump ~ "Pump off" level at* ~ *Datum S¥ TION DISTANCES FROM WELL ON LOT TO: ~ ,.~O~)"/' On adjacent lots Septic/holding tank Absorption field on lot Public sewer main ~ Publi~ut N//t Se~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~' ¢'/' Property line /(.~'¢' Absorption field Water main/service line ~:~¢-'~-' Surface water/drainage /C~ '+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ,/~)'+ Building foundation ]O '-e Water main/service line Surface water /OO Driveway, parking/vehicle storage area Curtain drain /~:ut,~_. }~vlocO¥ Wells on adjacent lots F. ENGINEER'S CERTIFICATION ,11 i ceflify that I h~e~i~ul~'eid inspections and review of Municipal in conformancZwi,~ Signature Engineer's Name Date ~ / ~ ~ I HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* aive}Fe e $ ate of Payment eceipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAt. TH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 05~ - c'½1 ~t/~ GENERAL INFORMATION Complete legal description Le ?- HAA # Location (site address or directions) :::Property owne. r Mailing.addresS ,:Lending agency · . 'Mailing address Day phone Day phone ·Agent Address D.%2S- (L :~"/Z~;<;-2-/ '¢'~"~"¢'- /~'> Unless otherwise requested, HAA will be held for pickup. NUtVIBER OF BEDROOMS: -~ TYPE OF WA"I'ER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest~ · lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOAlI21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I ve!'ifythat 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 Address Engineer's signature S & S ENGINEERING 170;~4 Eagle I~iver Loop Road NO, 2,~ Eagle River~ Alaska 9957 Phone Date DHHS SIGNATURE Approved for '7"/~/(' E Z 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 DH HS 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 RIicEIVED Municipality of Anchorage JUN 2 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ,,,,,~,~.~.,,u~ 825 L Street, Room 502. Anchorage, Alaska 99501 ?~0~§-s~-~'~c~ Health AUthority ApProval Checklist IfA, B, or C, attach ADEC letter. ADEC water system number ;~/ Date completed Cased to _ ~t (above ground) .~ires properly protected (Y/N):: Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) AT INSPECTION g.p.m. ' g.p.m. FROM WE~ Nitrate Other bacteria Collected by: ,)0o ~' Number of Compartments D, Cleanouts~/N)___ Depression (Y~ ,~'~ High water alarm (y~N') ~, o Date of test Static water level Well production WATER SAMP~SU LTS: D, afe of sample: B. SEPTIC/HOLDING TANK DATA Date installed I¢/~" ~¢1/,, Tank size Foundation cleanout (~/N) ¥ ~L 5 Date of Purnping ~-:~o ff~' Pumper C. ABSORPTION FIELD DATA Date installed ~/~/¢)(~ Soil rating &.p.'~./fl_.~or ft2/bdrm) Length 3 '7 '/~ ' Width .~S' r Gravel thickness below pipe ~/ / Total depth ~ ~/,~ ' Effective absorption area ~ ''/¢' ~'~ Monitoring Tube present ~__,~N). Date of adequacy test /v~,¢ ( ~' 'r¢'¢~Results (Pass/Fail) /~/-//' ~1 For :~:~ bedrooms Fluid depth in absorption field before test (in.); Immediately affer . gal. water added (in.): Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Absorption rate = !f yes, give date .g.p.d. D. LIFT STATION Date installed Size in gallons _ ~ ._ Manhole/Access(Y/N) ~~ High water alarm level at* _...--.-- - *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sg~ce line On adjacent lots ~Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ / ' ' Property line .go -~- Absorption field ~'~ Water main/service line lo r_/.. ,. Surface water/drainage /co '-¢- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation ! o Water main/service line /OO ~ Driveway, parking/vehicle storage area ~ ,,, o ~.,., ~ Wells on adjacent tots F, ENGINEER'S CERTIFICATION , certify that lhave determined thru field inspections and review of Municipal recor.~.~t~..~..-"~':'¢~--- ~¢~ems are in conformance gui effect on this date. Signature /~/ ' "~ ~.~,~, ~ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-66'50 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 12; Block 2: Knik View Location (site address or directions) Property owner M2C1 Construction Mailing address P.o. Box 670045 NHN Inlet Vista Circle Chuqiak¢ AK Day phone Chuqiak, AK 99567 223-8100 Lending agency Mailing address. Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well xx× Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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 #21 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. $ S S ENGINEERING ~ Name of Firm ................................ Phone C~'-/ .-~ ¢) 7 Address Eagle River, Alaska 99577 Engineer's signature '~'~,,.-~/'J_ ~ ~.~ ~/~: ,-~._~ _ Date'//l~/)¢l~, DHHS SIGNATURE Approved for 3 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 DH HS 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 I~NVII~ONM~N'rAL ,SERVlC~ DIVISION Municipality of Anchorage EEnvironmentnl Services Division 825 L Btreet, Hoom 502 ·Anohamge, Absk~ BBS0] · (g07) 343-4744 Health Authority APproval Checklist LegalDescription: Lol' }21 Ir..'~Loc-JL 'Z.~ ~H4,, ~rie-¢ ParcelI.D.: OL~' A. W .LL DATA . Log present (Y/N) ...... Date completed ~- Total depth Sanitary seal (Y/N) ,,.....-'*Wires properly protected (Y/N) FROM WELLLOG j AT INSPECTION Date of test _ ~ ___ . Static water level _ ~ _ Well production __~'/' __ g,p.m. __ _ g.p.m. WATER ~U LTS: _C~. "Nitrate Other bacteria Date of sample.' i Collected by: B.- S~.P~IClHOLDING TANK DATA Date installed 8 Foundation cleanout (~N) Date of Pumping Tank size j ooo Number of Compartments. :~-- cleanouts ¢~N) 'Y'E.& Depression (Y/(~) I~o High water alarm (Y/~f~ Pumper C. ABSORPTION FIELD DATA Date installed Length ~I. 5' Width Effective absorption area ',.~1' Date of adequacy test Fluid depth in absorption field before test (in.); Soil rating ~r fF/bdrm) I ~ "Z System type Gravel thickness below pipe H" I Total depth P--, Monitoring Tube present (I~N) "fAc, Depression overfield (Y/~") Results (Pass/Fail) ~ For -~; bedrooms ~ Immediately after -'~'gal, wateradded (in.): Fluid depth ~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Absorption rate .... g.p.d. If yes, give date ~--'"~-' LIFT STATION Date installed Size in gallon~.----'''-~ Manhole/Access (Y/N) ~el at* "Pump off" level at* High~ *Datum Cy0Tes tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: l'_~'~olding tank on lot Absorption field on lot Public sewer main I~ Sewer/septic service line 'Z.% 14-- On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station 'Zooi .~ SEPARATION DISTANCES FROM/..S~.E-*E'~.~HOLDING TANK ON LOTTO: Foundation Property line '7o .~ Absorption field Water main/service line IoI f Sudace water/drainage i0o1'~- · Zoo~ ff. Wells on adjacent lots Z coI ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ?.."f Building foundation i O Water main/service line I 014- Surface water ~ O o t't'- Driveway, parking/vehicle storage area ~.~ i~ Curtain drain ~/~' Wells on adjacent lots 'Zoo~ ENGINEER'S CERTIFICATION ~-~'~' ~%. ~.~ " I certi~ that I have determined thru field inspections and review of Municipal reoo~ ~,i~e above~ are 'nc°nf°rman~7~¢~idolinosineffect°nthisdat°' ~''~ ~'",.~';: Signature /(/~ b.-~-~- ~~ ~1~"1":~'' l''~''l I I~ HAA Fee $ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number