The URL can be used to link to this page

Home My WebLink AboutMCKINLEY HEIGHTS #1 BLK 6 LT 4McKinl Y Heights Block 6 Lot 4 #051-213-03 Municipality of Anchorage ,"~ ' :c~ 4~', Development Services Department Building Safety Division '~ L~ ·On-Site Water and Wastewater Pfogram, 4700 S. Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 Page www.cl.ancho[age.ak.tts (907) ~43.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. ~'{,'~J DJ 0 0'~ PID Number. "'-Ed+£ri~urv{g,r~e5~ Wastewater System: nNew ~Upgrade ~74Y10') //t~"/~c,~'~/~'~ t~) ~'7 ABSORPTION FIELD SEPARATION DISTANCES ~Septic D Holding Q S.T.E.P. ~ Othec Tank FieM Station Tank S~ ~e ~ ¢~ ~ 1¢0L 100; k / UFT STATION 15' ~a' BENCH MARK ,¢, c>/ ~....~ ,., ~o~ ~.¢.,~,.,~,-~,~ ~-2~-01 " .... '" Develbpment Se~ices Depadment Approval - PERi, IT i~O SW010028 PAGE 2 or D ........ H u_0. i c i p..o !, i .-lc y_o. F bI'"AI~/MbN/ Dh HbAL/H AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION · P.B. Box 196650 ~,,..Anchor'oge, At~skc~ 99519-6650 · Tetephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4~ BLOCK 6~ McKINLEY HEIGHTS #1 P.I.D. NO. 051--215-05 EXISTING STI: DBL1 & (DIVERTER VALVE) GREENHOUSE MT / /' 6E-8801 PERMIT NO. SWO10028 PACE 3 OF 3 Municipo[i't oF ~n c h.o.r' g g.e. DEPARTMENT OF HEA~TH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 eAnchorage, A[ask~ 99519-6650®Te[ephone~ 343-4744 ON-S~TE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 6, McKINLEY HEIGHTS #1 P.I.D. NO. 051--213--03 ST1 ST2 /- 97.9' FINAL GRADE 2" INSULATION o,~ ~'~ 1300 GALLON I~ , "'"" POLYETHYLENE I "-94.3 CO1 C02 MT2rl n n MT1.-]CO1 = 88.3' II II Iii Ico2 = 89.5' ,~2" INSULATION III "--t-t-Ldcoi= 86.5' ..~11 S~C02 = 86.4' MT2 = 83.7' MT1 = 83.9' · NO WATER FOUND 73.7' B.O.H. A B FCO 2.5' 26.5' ST1 19.5' 36.5' ST2 21.0' 35.0' DBL1 22.5' 54.0' DBL2 25.0' 34.0' DV 24.0' 35.5' C01 71.5' 81.0' MT1 72.0' 82.0' C02 157.0' 146.0' MT2 152.0' 141.5' MUNICIPALITY OF ANCHORAGE Development Sen/ices Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTE~VATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Mar 02, 2001 Expiration Date: Mar 02. 2002 Permit Number: SW010028 Legal Description: MCKINLEY HEIGHTS #1 BLK 6 LT 4 P-629 Design Engineer: 0003 S & S Engineering Owner Name: Ed & Cristy Burgess Owner Address: P.O. Box 670107 Chugiak. AK 99567- Parcel ID: 051-213-03 Site Address: 021919 BIRCH LN Lot Size: 35284 SQ, FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design, 2. Ail requirements specified in Anchorage Municipal Code Chapters 15,55 and 15.65 and the State of Aiaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15. a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~Z_ ~ Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SiTE SEWEPJWELL PERMIT APPLICATION FOR A SINGLE FaMiLY DWELLING Parcel I.D. Permit Number SW OI oe ~ Property owner(s) ~'d ~ ~l/" ;5'"J'y .~u{r-~S~ Mailing address (1) P0 ~o g ~7~ J O~ Mailing address (2) ~FH ~ ;~ ~ ~ ~h Zip Code Legal description (Lot, Block & Sub'd.) L~ ~ & l~h K,'. Legal description (Section, Township & Range) Lot Size O. 9 ~Sq. Ft. THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade J~ THIS PROPER'P/CONTAINS: Hot Tub Swimming Pool Therapy Pool Day phone Number of Bedrooms /"(/ Well Only Water Storage Jacuzzi [~ Water Softening Unit I cedify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accord~ap, opplicab~ Municipal Codes. S & S ENGINEERING '~"~-v~ L~." ~_..-. 17034 E~te River Loc~ Road No. 204 (Signat~ ~'~)~'~t~a(~kw~5or77authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) ROBERT C. COWANo P.E. February 26, 2001 CIVIL ENGINEEnS (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 4, Block 6, McKinley Heights Subdivision It is requested that you issue a permit to upgrade the septic system serving the existing four bedroom dwelling on the referenced property. One test hole was excavated and a percolation test was performed on 2/9/01. The approximate location of the test hole is located on the attached site plan. Ground water was monitored and after seven days the hole was dry as shown on the attached soils logs. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, RCC/bjj Enclosure 17034 NORTH EAGLE RIVER LOOP - SUITE 204 · EAGLE RNER. ALASKA 99577 1" = 40' L-~ 0 DESIGN SITE-PLAN / / Municipality el Anchorage ~ ¢~ .:' ~- .. '~{~, DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502~650 ,., ~ .............. :...,..~ 801~$ LOG ~ ~[~O~TIO~ TfiST .... PERFORMED FOR:~~~ DATE PERFORM ~ ~ SLOPE SITE PLAN 1 2 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14 15- 16- 17- 18- 19- 2O WASGROUNDWATER ENCOUNTERED? NO '~oH IF YES, AT WHAT DEPTH? L/ OeF, h Io Waer Alter Cross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE /~ (mmutes/~nch) PEAC HOLE DIAMETER TESTRUN eETWEE. COMMENTS ....... ~ .......... i ...... ,... =~1 . CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) ROBERT C. COWAN. P.E. CML ENGINEEr~ (907) 694-2979 FAX (907) 694-121 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 4, Block 6, McKinley Heights S/D February 26, 2001 GENERAL: The scope of this project includes the installation of a new 1250 gallon minimum septic tank, and installation ora new trench to serve the existing four bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed other~vise, 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. 17034 NORTH EAGLE RIVER LOOP . ,E;UffE 204 . EAGLE RIVEn. ALASKA 99577 Page 2 Lot 4, Block 6, McKinley Height. 8/D February 26, 2001 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. ofcover 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 (rafted-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution 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. Monitor tubes shall be of four (4) inch 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 ofthe gravel as noted on the design. Page 3 Lot 4, Block 6, McKinley H®lght. $/D February 26~ 2001 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 Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: .Type ofP pe Perforated ~olid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) 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 inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% i g th #200 ' pass n e sieve. o When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. Page 4 Lot 4, Block 6, McKinley Helghtm a/D Februar~j, 26, 2001 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. 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 u'enches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineefing's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / INSTALLER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL iNSPECTION REPORT IPHONE /,~NEW NAME MAILING ADDRESS ~ o. t~o~ IS-~:~ ~__~- .~c~ ¢?-~u~-, ¢~N. ~ ff 5-77 LEGAL DESCRIPTION LOCATION O v DISTANCE TO: ] ~- ;~ Manufacturer ~. '~ ILiq' ' in gallons IF HOMEMADE: DISTANCE TO: Well, Manufacturer DISTANCE TO: [Well ,o. of,ines / I Length of..~ I,n. Top of tile to finish grade Length Width Type of crib Crib diameter Absorption area/ Inside length Dwelling Foundation ~ I¢ I Total , en gt h,,h~.~i~es JMaterial beneath tile ~rib depth Well Building foundation DISTANCE TO: Driller Building foundation Sewer line DISTANCE TO: OTHER Dwelling ,/ ~. Material~ 7 Widt h~'T~e~'~ PIPE MATERIALS SOIL TEST RATING INSTALLER 5t~ r:_ REMARKS Material Nearest lot line Trench width /~) ~ ~"/~ nches ~7t'~¢)) inches DATE 72-013' (R'ev, 3/78) Total efZec2ive absorption J_Nearest lot line IDistance to lot line Septic tank NO, OF BEDROOMS PERMIT NO, No. of compartments ~.. Liquid depth PERMIT NO, Liquid capacity in gallons Distance between lines /V~,//~ - Total effective absorptioJi~ area PERMIT NO. area NO. on area(s) by DOC Co. ~ba SULLIVAN WATER WELLS OWNER OF LAND ADDRESS / ~) LEGAL DESCRIPTION DATE- Started .<~?;~ PERMIT NUMBER P. O. BOX 272, CHUGIAK, ALASKA 99567 , , TELEPHONE 688-2759 ~) l~ ,~' ~ .~O ~'tS..':' ~" ~ DEPTH OF WELL ~] / ~,~ ~' [ ~:,~ ,~ ~;. STATIC LEVEL OF WATER FT. f.~ z~.~.' ~ /"~ ~'/~ t ~ <~ ~/EDRAW DOWN FT. , ~/,/~ s GALS. PER HR ]~-~ 0 K ND OF C,SiNG C /cz/ KIND OF FORMATION: From t~ Ft. to ~-~ Ft. O ~-~iG~" rf ~ ~ ~;~-~ ~ From ~ Ft. to Ft From ~' Ft. to /0 ... Ft. ~',-~? ~ ~'~,:~ From~Ft. to Ft From /O Ft. to ~ ~ Ft. ~:~'~ d~,~:~.~-'.~:. ~,~;~ From Ft. to Ft. From Ft. to F~ ~;'1 ( Z ~.c // From~Ft. to Ft, From C~/ Ft. to-~fi Ft. G~d, ~'/~:/'~.:~'~ ~' From~Ft. to Ft From~Ft. to ,Ft. /~?~;/-<~,G~T,~ ~ ~,;;:T'Z~ From~Ft. to Ft. From Ft. to__Ft. From Ft. to Ft. From Ft. to__Ft. From Ft, to Ft.. From~Ft. to Ft, From Ft¢to Ft. Fmm Ft. to Ft. From.~.Ft. to Ft.. From. Ft. to Ft. ~ From ~ Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to From Ft. to__Ft. From Ft. to Ft._ From Ft. to Ft. From Ft. to Ft.. From Ft. to.~Ft. From Ft. to MISCL. INFORMATION: DRILLER'S NAME /,~ !::'E:P.':H :I: T HE DEI:::'FIRTi"iEI',Fi" L HEFiI.,..TH F,:ii',,ID EN'v' :t: t:;;~Ot'.,ti'"IEt'.,Ft'FtL , .O'TECT :i: ON :!:3;::~:5 -' L. "' STREIE:T., FINC'HOt.T::Iq(3E., I::1t'(. fl..,,..il ~!:iE L. Ii_ ..... iF:::,1 Ii"..,,ii IiZ)' C) l!,"",,i! ....... rEeF; % "Ii'"' EE :£E~; EE b,Jl fEE Ii:;:;;: ':: 8::~. ECi:.: 4',E; i'iR)':i]:i'tLiM t",t iI'iF~ER *:::il;:' EdE[:,I:;;:OOHS = :iii: SOIL. RFtTING TF.t['~: :~'::: } T F'F'", :E;:t:ZE OF THE SO t L FtE~SORPT ].' ON :~;"¢Si;TEH I S: THE LENGTH D :1: HEN:}:; I ON :1: S THE LEt",iGTH ( i i",t FEET ::, OF THE TREt",iCH OR DF:FtI NI::' ].' ELD. THE DEPTH Oi::: FI TFi:EI",!CH OR F:'ZT I::5 THE i},iSTF!i",ICE E~E'T'NEEi",I T'HE SUI:;?.FFtC:I:E O1::' THE Gl'b:}iji'.,it) FIND THE E~ErTT(]M OF:' THE EXC:FI',,,'FtTION (Il'-,! FEET). THERE ]:S i",t('] SET t.4 :i: [.,TH FX]F: TREi",iCHES. THE GRFiVE:L. DEF'TH ]::':.7, THE HtN:[t"!LIH [.'EF'TH OF GR!::tVEL BtE'T't-'.tEEt',! T'HE OL.r'FFi::IL!.... F:'IF'E FII'.,t[., ]"HE EiOTTOt',! 1/3i::' ]"HE EXC:i::t',,,'Ft'T'I Oi'-,l ( ~ N FEE'T' ). I ~1 , I t . I::]F,'F't i C!:::It'-,IT HI;;t'fl!; THE I:;;:ESI::'ONS I E: I L i 'T'Y 't .... ]: NFOt::d't TH I S E:,EI:::'FIF,;:'T'MEt'.,IT [:,I F.,: I i'.,ll]i THE :i: i',,IEFT'FtI,,J...F:Fi" ]: O1.,i t i'.,IEi;PIiEC]".i: (}NS OF FIN"r' HELLS FI[:'J'F:iC;EhtT 'T'O TH :[ S PROI::'EF::T"r' 1:::II",1[:, ]"HE i'.,tf HF ii:F' Ot:::' F:E:E; ]: DEi",iC;ES 'T'Hi:;:I]" 'T'HIE t,]ELL, i.,.t ]: LL "'" :" .......... .: TH t iEff:ICt'(I:::'iLL];i",IG ()F FtN"i" :,r :,.Ell i,.t]:T'H(]t...iT t::'iI",!FI!..., ttqSF'ECTt']t",I i::ti",t[:' FiPF:'R":',,,'F:!I._ t:'~' . DEI:::'FIR]"HENT I.,.i]:LL Ei:IE :iSijEL]'EC'T TO F'RO:E;EE:UT]:Eii",I. i'i.'[NtHtJI"! D].'STFItqC:Ii;.~: I3E"t"I.,.!EEEi:N Ft NELL Fti'.,I[:, R?.,I'¢ ON-SiTE SENF:IGE [.,tSF'OSF:tL SY'.:!!;"f'Ei"'I :L6~Z, F!:EET FOR 1::i F'RIVt:']]"iE klEL. L Oi;?. :.l..5,~.~, t"0 2,31;~, FE;ET FROH FI PUBLIC I.,.fliEt....L. I]:,EPlEI'.,IDtNG LIPON THE 'T':-,.I;:'E OF F't..tBL.]:C NELl. H I i",i ].' HLiH D t STFti'qCE F'ROH Ft F'R ii:',,,'F!"FE i4E'M.... TO F3 PR I',,,'RTE '}'.';ENER L I hie l S 25 FEET F:tN[:, "FC~ F:I CCd"li'iLII'.,!IT'.¢ :E;Ei,.!ER i...INi}i: ]:S 75 FEET. i.,.!li;i:L..L. LOGS I::IF;:E REi;!Lt]:t::;:EED RND HUST BE F,;:E]"LiRI'-,iE[.':, TO THE DEF'RRTHENT I.,.Ii[TH:~.t'-,t OF:' THE HELL. C()i'tPMi~TFZOht. C)'T'HEi:;;: RE(PU].',r':;:Ei¢tE]'.,FT'S HF:ff !:::d::'Pl....h". SPECi'F']:CI:::!T]:ONS FIND CCd",I:i~;TRLICT]:ON F:t',,,:F!:[ LI::'iE:L.E TO Z i",iSUI:RE PF.:OF'ER ]:t",tSTi::d...LFtT I Ot",i. ].' (:::ERTl F"¢ 'T'HF!'T :L: ]: FIH F:'t:::IH]:L. IF~R I.,.ItTH TFIE F.::Et~UIF.::EHEI",!TS F:OR Ot",t-SI]'E 5EI.,]EE5 FlhtD WEL. L.S FIS SET F'O~II']"H El'r: THE HUN]:.C:IF'FIL. IT'¢ OF .?.: i i.,.IiLL.. ;iit',ISTFriLL. THE 5=¢STIg.':H IN FICCOFII[:,I:~hE:I!.~i 14ITH THE C:O[:,ES. ii:: t LJt'.,!DER.'!~;'T'Ffl'.,tL'.', 'T'HFFf' THE ()I'.,t...-:SITE SEI4EF: :E;'¢STEM HFt'.¢ RE~:)U]:f;?.E Et'.,IL. RRGE]'"fENT IF' THE RES I i}IENC:E :[ S RIEHO[:,EiLE[., TO ii.' hI(;LL]DE HOF:E THFthl '.'ii: BEDROOHS. DEPARTMENT OF HEAl-TH .AND ENVIRONMENTAl., PROTECTION 825 L. Street, Anchorage, A~aska 99501 264.-472 SOILS LOG - PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION; 1 2 3 4-- 7 8 10 12 ~4 17 2O ' ' SLOPE~¢,/ ..... /STS~T': ~L~ SOILS 'LOG PERCOLATION TEST ENCOUNTERED? IF YES, AT WHAT DEPTH? G Reading Date T 72-008 (6/79) Gross Net Depth to Net Fime Water Drop PERCOLATION RATE RUN BETWEEN P/ __/~- .... (minutes/inch) FT AND FT CERTI FI E~~(/~ -- Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE Of HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O5"/ - ;~1 3 -0.3' 1, GENERAL INFORMATION Complete legal description/--eT 'q Location (site address or directions) HAA # ).l ,q O i o o -/ / Expiration Date: Current Property owner(s) [/) £ c~,R,~7¥ G u.¢r,-,¢ r r Dayphone ~; $'~' - ¢.J' ~' 7 Mailin~address P.0. ~ox 6')olo-/ ~ c/./u(,.J~,c , /.I~: c}wj,-(, 7 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Un/ess otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class __ Public Water System Well [] [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A er B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastawater 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 flies 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 s & $ ENGINEERING Phone ~-~.~, ~.agio ~lver L.cop Road No. 2~ Address Eagle River, Alaska 9~ Enginee~sPHntedName RO~ C. Co{~ Date 5 bedrooms ~ Approved for ~ · -I, .:~: ................ .,, ~'~ D~sapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: /..~ - I/' D / (Rev. 12/001 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.onchorage.ak.us (~07) 343-7~04 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescriptton: Lo'r- ~/ 0ce¢~ 6 PleK',~J.,~Y H~/~,~'J #/ParcellD: O.C'l-)-I~-0 3 WELL DATA Well type J~A)t V#~''j-- IfA, B, orCprovidePWSID# -- WellLog(~) ~'~ J' Da~ple~////~ ~s~ ~) ~J ~sprope~pmt~) ~ J To~ depth ~ / fl. ~ ~ ~0 ~ fl. Cas~g he~ht (a~ve ~nd) ) ~ ~ In. FROM ~ L~ AT INSPECTION ~ ~ g.p.m. J. 0 g.p.m. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform O colonies/100 mi. Date of sample: ~/'//~'/o I SEPTIC/HOLDING TANK DATA Tank Type/Material S~,~ T t C Nitrate ?.q?~- mg./L C~tested by: Tank size I ~ OD gal.' Number of Compedments ~- Foundation cteanout (~tN) ¥~ $ Depression over tank (Y(~.D~ N o Date of pumping /v/~l -- /~'~, Pumper ~ Other bacteria O colonies/100 mi. S & S ENGINEERING :?~,'; ~.~;w E~er ~ Re~d No. 2G4 Faille RI'mr, A/ask, 99577 Date installed (~ / ;~ ~ / O I C eanoute ¥ High water alarm (Y~J~. /v ~ C. ABSORPTION REin DATA Date installed [O /;)-I /O I Soil rating ~r ~Fodrm) I.~) System type. Length ' ' ~o 5'-' fl. Width ~ ft. Gravel below pipe '~ o ~ ft. Total depth '5'-' ft. Eft. absorption area 5"o"7 ~ Monitoring tube ¥~ f Depression over field ~' ~' Date of adequacy test /v'/A --,~ ~,~"~Results (Pass/Fail) ...., For y bedrooms Fluid depth in absorption field before test ~ed gal. New depth in. Elapsed Time:__ min,~...~ dep~ ~. Absorption rate >= ~ g.p.d. Any reju~t (past 12 mo.) (Y/N & type) If yes, g~ve date D. UFT STATION Date installed 'Pump on' level et Datum , Size in gallons M~ ~ in .p~ water a_larm ~vel at __ In. ~-'C'~tested . Meets alarm & cbcult reqmmment~? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanYJlifl station on lot. } 0 Absorption field on lot Public sewer main Sewer/septic sewiCe line /4-- Holding tank On adjacent lots / 0 d "/' On adjacent lots Public sewer manhole/ctaanout Absorption field Surface water SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ) Water main /d / A Water sen, ice line I 0 '/'- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '~ 3. Building foundation "~ Water Sen/ice line / 0 '/'' Surface water / o 0 -4.. Curtain drain /~ '~ ~, /; Water main Driveway, pafldngh/ehJcle storage 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 w~th MOA HAA guidelines in effect on this date. Engineer's Printed Nama /~ ~)~ £,<. 7' C. ~'~) ~/~ ~/ Date l'3.// (o /0 / HAA Fee $ Date of Payment Receipt Number (Rev. l?J00) Waiver Fee $ Date of Payment Receipt Number CE-8801 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 'L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 Parcel I.D. t~"/ 1. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING -Z/5 -O3 HAA#_/:/A O / oo '7/ Expiration Date: (,~ - GEI~iERAL II'FORMATION Complete legal description : / Location (site address or directions) Z.,/,¢ / ~' Current Property owner(s) Mailing address /f~ Lending agency. Mailing address Day phone. Day phone Real Estate Agent Mailing Address Day phone ~,~ Unless otherwise requested, HAA will be held by DHHS for plckup. HAA picked up by: ."~Z ~ NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the. transfer of title (except between spouses) on properties served by a single family on-site wast~water disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private oi' Class C well and may be reissued with new water sample results less than 30 days old. 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 work. 72-025 (Rev. 01;00)° 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address $ & $ EI',~GiN~' =.P. INC' Phone ~' Z~'~¢) Engineer's Printed Name ~0 ~t/t ~- C. (2 ~ ~4~.,, Date ';;).//"~ '7 Conditional Health Auth~:Jt~ Approval ~s :eques~ed.. S~pHc s~st,em ~o be upR:aded by Ju~e 15, 2001.The:e ~({R~ffem~nent (no 'ove~low~ so,aRe) and Lhe~e w~[~r~ve~se result of granting Conditional HAA,L%~;~/.:.~[4~ ' rS?.' ,%7% ~. ON-SI ~ · ~=,' . ~ /.,~, DHHS SIGNATURE ~ . ~ ..... ~( _. ~s~ . ;~ ........... ~... , - ~TE · -,. · · Approved for ~ bedrooms. ~ d.'. ROG~M .' ~ ~,?~ ~,~,rov~. ~% ... ... ~.,, ~, ~-.... .,..~-~ -- ~/ Cond~tzonal approval for ~ bedroo~ ~~ng The septic system shall be upgraded pursuant to the attached permit ~SW010028 no later than 6-15-Ol.Money shall be placed in escrow for 1.5 times the high hid from a minimum of 3 certified contractors.The balance of the escrow funds shall be released after aR opproved certificate of Health Authority Approval has been issued by this Department. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other ~//-~" Expiration Date: Original Certificate Date: ~L ~- .- ,¢2 / Reissue Date: 72.¢25 (Rev. 01,00)' M. icipality 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.ancherage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ' · ~' --~ -.~ ~) Parcel ID: ~"/-Z/;~ - ~ 4~/ A. WELL DATA Well type ~[~1VPc/-~- Date completed ~_.~/~'~ Total depth ,r~ ~ ft. Date of test Static water level Well production If A, B, er C provide PWSID.# '-' ~an~r~ seal.N) .~ Cased te ,~0 ~. Wires properly protectec~/N) Y~-'~ Casing height (above ground) /f /"i~' in. FROM WELL LOG AT INSPECTION ]o O g.p.m. WATER SAMPLE RESULTS: Coliform C~ colonies/100 mi. Data of.mpte: ~_//.~/0/ SEPTIC/HOLDING TANK DATA Nitrate 0,q?~.mg./L Collected by: Other bacteria O colonies/100 mi. gal. Numbe~ of Compartments Date Installed .~/__~ C,aenou. ) High water alarm (Y/N) ~ / ~ Tank Type/Material Tank size Date of pumping ///~/01 Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 o (~0 System type / Length :~ ft. W~lth ~... ~ ft. Gravel below pipe Total depth E.~' ff. Eft. absorption area.,~_.ft Date of adequacy test I/~.~/01 Results(Pass/Fail) ~t~..~/....- For ~ bedrooms Fluid depth in abserptio~ field before test ~ in. Water added V gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= Any rejuvenation treatment (pest 12 mo.) (YIN & type) /~,'~ ,~'19'/{/~ If yes, give date g.p.d. Datum J Cycles tested Manhole/Access (Y/N). High water alarm level at. Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot / OO Absorption field on lot /(~) /''~ Public sewer main · /~/ Sewer/septic sew/ce line ~"/~'' SEPARATION DISTANCES FROM SEPTIC/HOLDING 'rANK ON LOT TO: Building foundation ~'- f~'- Property line ~' ~' / Water main /d'/,,o~ Water service line. Wells on adjacent lots ,/~7~ ~./--- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /{~ ! '/- '/- Water main Building foundation Water Service line ttC~) On adjacent lots On adjacent lots Public sewer manhole/cleano~t Holding tank in. Absorption field ~- /j._ Surface water. /OO /,r-- Surface water /~)O !'/- Driveway. parking/vehicle storage /O /~- Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspactJons and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name ~?~)~ Date '"~-/; '7 HAA Fee $ Date of Payment Receipt Number (Rev. 12K)0) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date k~-/~=~' ~'/''/~ (;; GENERAL INFORMATION (a) Legal .Description (include lot, block, subdivision, section, township, range) Location (address or direct~pns) (b) Applicant Applicant Addre~ (c) Applicant is (check one): Lending Institution []; Owner/builder.~; Buyer []; Other [] (explain); (d) Lending Institutior¢:~~ "¢~ ~¢¢¢/~/~'~".~ Telephone Address ~¢¢~z~,~¢.¢~, Real Estate Company and Agent (e) Address ne (f) ~ the HAA to the following address: TYPE OF RESIDENCE Single-Family/[~ Multi-Family [] Number of 'Bedrooms '~ Other WATER SUPPLY Well,¢~/ Community [] Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmenial Conservation attesting to the legality and status. 4, SEWAGE DISPOSAL Onsite/[~/ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environrnental Conservation attesting to the legality and status. Page I of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING ,,,~SPECTIONS, TESTS, FILE SEARCH, DAT~, ,-~ND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation of this Health Authority Approval shows that the omsite 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 Date EAGLE RIVEll¢ A~ q957'. J[IN 5 ItJ 6 Approved for ~_~7..~ bedrooms by :"i'~'l¢'f'' " Date ~'h~lM- Approved ~ Disapproved Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending illstitutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2¢f 2 72-025 (11/84) WELL DATA Well Classification Well Log Present ~'~/N')' Total Depth ~7// Cased to MUNiCIPAt. I~'Y OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MO.~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKUST- FEBRUARY ~984 j tJ i'l 0 (i t986' 264-4720 Legal Description: ~ z~ ~ ~ [~ ~ ~.~ ~ I ~! P R If A, B, C, D.E.C. Approved (Y/N) Date Completed '~-//¢~'~ Yield ¢/' Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (~-)/4k~ SeParation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot ~,/ To Nearest Public Sewer Line Depth of Grouting Pump Set At Sanitary Seal on Casing Depression Around Wellhead,¢¢~ Cleanout/Manhole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~¢/ Stand pipes ~,N') Air-tight Caps Depression over Tank Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water-M"~4~/Service Line Z Size /C::) ,.D~ No. of Compartments Foundation Cleanout ~/4~) Date Last Pumped ,..~_ .~o~c;~'(. '~///2~ ; for ~ Temporary Holding Tank Permit (Y/N) Course To Building Foundation '7 To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ ~ /~'-- ~3 Width of Field ~ Square Feet of Absorption Area Depression over Field.(-Y~") Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //"'~ ' To Building Foundation /-~ / L o t "~¢"//¢~/ To Water Ma-m/Service Line ~/+ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness ~'/' Standpipes Present Date of Last Adequacy Test To Property Line .... To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) ump Off" Level at Vent (Y/N) _ Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to alljuNMOA and..LH~idelines~D _ in effect on the date of this inspection. Signed .... Date. Compan~RB 196X MOA No. EAGLE .IVEP~. AK 9,95~7~,, Receipt No. :~ F~ [o ;~ "-'~ Date of Payment __(o~- (~'?~, Amount: $ ~ ~} 6~, Page 2 of 2 Froperty Owner Mailing Address Buyer N% FBLLS OUT UPPER HAl ONLY Address Zip Code Lending Institution ¢;.: )t.:) i¢9~/'1 '/::, Phone Address Zip Code Realty Co. & Agent Phone Address Zip Code Legal Description L street Locati~ Type of Residence '~ Single Family [] Multiple Family ~] Other No. of Bedrooms ~_ ~¢ Water Supply [] Individual E~ Community [] Public Utility ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available). Sewer Disposal [~,' Individual LJ Public Utility ~ Holding'Tank Year Individual Installed: __ / ' '; --;' When Connected to Public Utility: NOI'E: THE INSPECTION PEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 'rime Date Inspector Field Notes: Time Date Inspector Date Inspector Time Date Inspector MUNICIPALITY O -F~qq'C'rTOR7~G 1:: -- DEPT. Of: H!:ALfH 8: ENVIRONM~zN I'AI. pRO [F_C flON ) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CON DITI( DATE *CONDITIONS OF APPROVAL 72.023 Date Sewer Installed Well To Absorption Area Well to Tank tWell Log Received Septic Tank Size