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HomeMy WebLinkAboutOLSON HEIGHTS BLK 1 LT 6EMARM "u, #018-231-07 5/3/I? 7;tn.k MUNICIPALITY OF ANCHORAGE On-Site Water& Wastewater Pro ram o� s 9 ♦ .. PO Box 196650 4700 Elmore Road �f'_'" * ; Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 c• \: ,% http://www.muni.org/onsite ;. DC pa Ille 11 On-Site Wastewater Disposal System Permit Permit Number: OSP191121 Effective Date: 4/23/2019 Work Type: SepticTank Upgrade Expiration Date: 4/22/2020 Tax Code Number: 01823107000 Site Legal Address: OLSON HEIGHTS BLK 1 LT 6 G:2936 Site Mailing Address: 4451 E 135TH AVE, Anchorage Owner: OYLER STEVEN W & KATHY D Lot Size in Sq Ft: 49469 Design Engineer: C & M Engineering Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field Q Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The engineer is to confirm the trench location prior to Inspection Report approval. If needed, a waiver request and fees are to be submitted for review. Received B : /I y Date. Issued By: &,--"(,(16,—cy„--e*re_____ Date: Y/?-3lGf Ras. MUNICIPALITY OF ANCHORAGE (Pt4A/ • , its Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION RUSH Parcel I.D. 018-231-07 Property owner(s) Steven Oyler Day phone Mailing address Site address 4451 E 135th Ave Legal description (Sub'd., Block & Lot) Olson Heights Block 1 Lot 6 Legal description (Township, Range & Section) Lot Size 49,469 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade n Duplex (D) ❑ Holding Tank LJ Renewal n Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well n Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: 3(.00 Waiver Fees: Date of Payment: LI 1251 IQ Date of Payment: Receipt Number: 0 t(oV"Q Receipt Number: Permit No. n9 p V 1 1121 Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 04/22/2019 RE: Proposed Septic System Modification for Olson Heights Block 1 Lot 6 Dear Reviewer, The above referenced property is currently served by an older 4 bedroom septic system. The 1250 gallon tank has failed and is in need of immediate replacement. We are proposing that the existing tank be replaced with a new 1250 gallon (minimum) tank constructed and installed in accordance with MOA requirements. A polyethylene or advanced coated tank is recommended. As shown on the plan, the tank will be greater than 10’ from the house foundation. The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover. The repair shall be performed by a moa certified installer in accordance with MOA requirements. The engineer will inspect the tank before backfilling. Repair of the proposed system will not negatively impact adjacent lots. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leachfield, well, and other applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE (04/22/19) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191121, Deb Wockenfuss, 04/23/19 ft F* CLEANOUT � '�� / �SP191121, Deb • MONITOR TUBE ' Z TEST HOLE \ .. .... ...... 0.5% \ SLOPE INDICATOR . , , , .. , .. , .. . CHARLES G BALZARIM �O �+��'F�,•, CE -13854 .•��`��� L WELL FOR MCCABE �, pROFESSIONP \ LOT 4 MORE THAN \ 200' FROM SEPTIC UPGRADE o /� EXISTING FOUNDATION J 2 BR HOME CLEANOUT Flo ola C) a- NEW AFTER L TANK COs ad � REPLACE EXISTING 1250 GAL TANK. �a'DRIVEWAY a DEMOLISH OLD TANK PER I MOA REQUIREMENTS \ d ° III \d EXISTING DRAINFIE III TO REMAIN ° d � III III LOT 6 / a ;� ISI LOT 7 I FLAG WELL RADII PRIOR TO CONSTRUCTION 100' NEIGHBORING WELL RADII SEPARATION DISTANCE NOTES: THE PROPOSED SEPTIC TANK IS GREATER THAN: 100' FROM ANY PRIVATE WELLS 200' FROM ANY PUBLIC WELLS / 100' FROM ANY SURFACE WATER / 10' TO ANY PROPERTY LINE OR FOUNDATION SCALE: 1" = 30' LEGAL DESCRIPTION: OLSON HEIGHTS BLOCK 1 LOT 6 C&M ENGINEERING SERVICES OWNER: STEVEN OYLER DATE: 4/22/19 1 REV: 11 907-854-5558 EAST 135TH AVENUE SITE PLAN MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAL"fH & ENVIRONMENTALPROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L. Street - Anchorage, Alaska 99501 Telephone 264-4720 - ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NE.. *"� = ❑ UPGRADE ---- -------_ _..— ---L MAILING ADD SS LEGAL DESCRIPTION L.� LOCATION NO. OF BED OOMS Well Absorption ar n Dwelling DISTANCE TO: Absorption � �/ / — F- Z Manufacturer Material PERMI O AO 0 � 17/ No. of com artments p rap,Xp4➢y�i Ions Inside length Width ® IF HOMEMADE: �T Liquid depth _j DISTANCE TO: Well Dwelling PERMIT NO. 0 z Q Manufacturer Material Liquid capacity in gallons wL) W a U Well DISTANCE TO: 116 No. of lines -Length (rf-�7P�el"rye— Foundation -^� <(J��s.,� Total len of lines g Nearest lot lir]J' !!1/ — Trend PERMIT NO ?'//`9,S -'j Distance begin ines ~ z __ / ll l inches f- Top of the to finish grade kft Material beneath tile inches Total effxlve as rption area L_ I _ - w Length Width—f--��--- Depth PERMIT NO. Qr a0. Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line w J Class DISTANCE TO: Depth Building foundation Driller Sewer line Distance to lot line PERMIT NO. Septic tank ALU bsorption area (s) OTHER PIPE MATERIALS n '12-')6)cl (_j' (� rQ' SOILTESTRATING I V - - L(L5z INSTAL6E t REMARKS_- i L a s LEGAL APPROVE ^jJ �{//j(DA�TE ,�j oN 0 L A . ri - k-, Ifu� DEPHRTM�NT p� HEHLTH HND ENVIRONMENTHL 825 '. STREET. HNCHORHGE, HK. 9S 264~4720 "R ��P.A. 1: -T, :5 K W I Q PERMIT NO ( 810]71 ) HPPLICHNT MERLE BEETER SRH BX 1546�E LOCHTION HUF HN HREH LEGAL LT iBLK J. OL5EN HTS S/D LOT TYPE OF SOIL HBSORPTION SYSTEM IS: TRENCH o"x�����P� �?OTECTION ^ � /1 F&T W Q Fit rel][ -T- SIZE 4000(SQUHRE FEET �~ MAXIMUM NUMBER OF 8E1-:1R01_1MS =: 4 SOIL RHTING (SQ FT/BR)� 150 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS: ���� � �K NR 121 _1- 11-1 :.-­­ 7r!Z5 �Fi", W.,::A %-, IEE. L_ �LEE, ���� I,. THE 1_0107H DI1-1ENSIOri IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINF_ IELD. THE DEPTH OF O TFIENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROUND AND THE BOTTOM OF THE EXCHVAl" ION (IN FEET)� THERE IS NM SET WTDTH FOR TRENCHES THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRH/EL BETUEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET) �I 1E."I" 1 --fl ����I ill' -V fow N! v< S S; 1: E J.- !_5 F--11 R It C:m�� PERMIT HPPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTHLLHTION INSPECTIONS OF RNY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES TI IHT THE WELL WILL S.:ERVE. ~�1 11-4 F_- EE (�:: _T_ I 111D VA �IF­�, ��K:,.­� 0 1, F", I I BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION AND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVHTE QF,LL OR 150 TO 200 FEET FROM H PUBLIC WELL M."PENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNTTY SEWER LINE IS 75 FEET. WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPRERTM�t-AT WITHIN 30 DHYS OF THE WELL COMPLETION. OTHER HPP� AND CONSTRUCTION DIHG�HMS HRE HVHILHBLF" TO INSURE PROPER INSTHLLHTION. IF-, 0r,_-- F;?, Pro I r' .1: F.> Q IT: Q 01 Q FET Q 00- :1. VFK 130- I CERTIFY THHT 1: I HM FHMILIHR WITH THE REG1UIRE:MENTS FOR ON-SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2: I WILL THE IN ACCORDHNCE WITH THE CODES. ]� I UNDERSTHND THHT THE ON�S�TE SEWER SYSTEM "AY REQUIRE ENLRRGEMENT IF THE REMODEL[ --,E,, TO INCLUDE MIDRE 'THAN 4 BEDROOMS SIGNED_ .�~__�^_�~~ H�PLICHNT MERLE BEETER x SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Aiaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: —lij e- DATE PERFORMED: !� LEGAL DESCRIPTION: /-o 7r(7 i3LD�%C" / O L5p/V !- a;g © R&60V I C. coV gsF;, SLOPE SITE PLAN P—P FT7TT-1 I I I I F 1117 2 Q: 3 a 4 5 6 7 8- ; 9 0 � fl 10- 0 12-( 0 13- d 14 - N 15- d 16- 17 18 19 S A N D Y GRli4VE@. (&P) GKAQFLL:T sRA)D ?00KL'- CYR"Elo (_5P) K�o O V1 WAS GROUND S�L7— ENCOUNTEREDWATER L 10 I O 7 IF YES, AT WHAT t' DEPTHI O Reading e ' T1 ,. Gross ��•i{me Nei Depth to Net - +., 1 Time Water Drop A 01...:... • ;! 20 PERCOLATION RATE_ Vt—t 04L., L(minutes/inch) TE T RUN BETWEEN. FT AND/ FT COMMENTS ( .Q C7 ti=z �L2�p— / tog 01 PERFORMED BY: A e A4� dG/Y.Ott/ CERTIFIED BY: - DATE: l 7 2 -008 (6/79) MUNICIPALITY OF ANCHORAGE 91 - S • DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On -Site Services Section % P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 1 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ©/ HAA # �� q 4-"'�' LL�_S 1. GENERAL INFORMATION Loi: 6; Block 1; Oaon Height -6 Complete legal description —�— Location (site address or directions) 4451 E. 135th S-tneet Anchoicage, AK _ Property owner T Ma,Lk D/cumm Day phone _ 659-7655 Mailing address 4451 E. 135th St. Anchwtage, AK 99516 Lending agency Mailing address Day phone Agent Na.ti.ona2 PlcopentU Inoectiov,5 Inc. Day phone 800-333-9807 Address 236 S. 108th Ave. Suite 3 Omaha, Nebkazka 68154 Unless otherwise requested, MAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4iv ' 3. TYPE OF WATER SUPPLY: Individual well XXX _ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. A. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 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 MOA 021 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate forthe 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 ofjNs inspection. Name of Firm S & S ENGINEERING Address Eagle Riyer, Alaska Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for 0 Additional Comments bedrooms. Phone Date vlw ra bedrooms, with the following stipulations: a11TIC 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 (Rev. 1/91) Back MOA 1121 Municipality of Anchorage Department of Health and Human Services 44 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L,�T6 &Duc H6/6H7-S _Parcel I.D. S/v A. Well Data Well type L??,1VAa5- If A, B, or C, attach ADEC letter. ADEC water system number AJ/�,- _ Log present N) VLS Date completed _ Z4 �'� Driller S 2EW &2O5. 0(Z1u INGI/NC Total depth _ 2Z Cased to / �' / Casing height r7 _ Sanitary sealY&I) `�� Wires properly protected ON) $ _ FROM WELL LOG AT INSPECTION rn Date of test Z4 I8/ 8 �� 1 0 z Static water level — z r) z ? Well flow c�_g.p.m. 4 g.p.m. (10 m 0 Pump levell ll% _ UK � < i C) 1, SEPARATION DISTANCES FROM WELL TO: k y C Septic/holding tank on lot �Uc7 rt / ; On adjacent lots _o« O' RI Z Absorption field on lot _ �n0 fi ; On adjacent lots 00(-/L'- _ Public sewer main _ ! S Public sewer manhole/cleanout foo rfi Sewer service line ZS F Petroleum tank AZ A-, fUowy _ WATER SAMPLE RESULTS: Coliform OU/K_,e— Nitrate0124 Other bacteria / — "-k— Date of sample: V// meq- Collected by: Sr S 6�xi6//�J L-e1AJ1 13. SEPTIC,E 4G604N@rTANK DATA Date installed -51 Zc) / W Tank size / ZS -0 L Compartments Z Cleanout (Y/ ) fL __Foundation cleanouY/ ) _!4.Depression (Yg No _ High water alarm (Y& f� Alarm tested (Y/N) Date of pumping J —Pumper f,"S 6�,�/G SEPARATION DISTANCES FROM SEPTIC/49L4)FNF--TANK TO: Well(s) on lot 403 r�L On adjacent lots ��U Foundation S _ To property line / 0 /4- Absorption field S �4— Water main/service line l0 Surface water/drainage 72•02s(3/93)•Front CONTINUED ON BACK PAGE C. LIFT STATION N o IJe Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LI Well on D. ABSORPTION FIELD DATA On adjacent lots "Pump off" Cycles tested Surface water Date installed S� ?U4 (Y i Soil rating (GPD/Ftz) SU �1�2 System type INLI4 r r Length //� � Width 3 � Gravel thickness �- � Total depth � Total absorption area (c)C� LCleanout presen (Y/) Depressions over field (Y/O N Date of adequacy test ���� �� Result pas ail) �O� for 1 v02 Bedrooms i Water level in absorption field before test After test d W Peroxide treatment (past 12 months) (Y/N) AfblUE (-✓NII If yes, give date N/A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot L (.—J- On adjacent lots /00(_r/_ Property line Z To building foundation ff To existing or abandoned system on lot Aju-�J6 Zf&e:g�/J% On adjacent lots 20 r f_ Cutbank SO f Water main/service line /0 (4 - Surface water SCA r -14- Driveway, parking/vehicle storage area Curtain drain lL t_� k kJJ-tJ1,1 E. ENGINEER'S CERTIFICATION l cerUfy that/ have checked, verified, or Signature s g Engineer's NdQ34 sada rver, op d 0.204 cackle Date < e; HAA Fee $F�- Date of Payments r (� Receipt Number 72-026 13/931' Back this inspection. Waiver Fee $ Date of Payment Receipt Number L a� INSPECTION APPOINTMENTS /�, ,� sl�lll� D,Ai'cRECEIVED otl_&A � TIME TIME �4 TIMI_-- 7�= DATE — DAT DATE INSPECTOR INSP C ❑ One E7 Four ❑ Other_ ❑ Two ❑ Five Cl MULTIPLE FAMILY 10, Three E7 Six 7. WATER � ,S{U�PPLY e T MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. Of N :A!'TIi DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT [r IRONMENIAL I rOTECTION 825 L Street - Anchorage, Alaska 99501 depth (attach log if available.) • AUGi 2 ENVIRONMENTAL SANITATION DIVISION -YEAR ON-SITE SYSTEM WAS INSTALLED. Telephone 264.4720 II REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW�F7�L�CIV11P DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. _ 1. PROPERTYOWNER F—j - ' - _-- PHONE MAILING ADDRESS �2_ PROPERTY RESIDENT (If different from above) - _ - - PHONE 2. BUYER PHONE MAILING ADDRESS- - - -- - - - - 3. LENDING IN^STITUTIONI — �_ t� \Nr \ ;— \�< L �\ \ PHONE %- MAILING ADDRESS - — 4. REALTOR/AGENT C� PHONE MAILING06 1 5. LEGAL DESCRIPTION — STREET LOCATION - � � k - - C> V— 'Lim ��f'\trti pGF 6. TYPE OF RESIDENC - NUMBER OF BEDROOMS ❑ One E7 Four ❑ Other_ SINGLE FAMILY ❑ Two ❑ Five Cl MULTIPLE FAMILY 10, Three E7 Six 7. WATER � ,S{U�PPLY e * IQ INDIVIDUAL* ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. Fol wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8: SEWAGE DISPOSAL SYI3TEM I'.9L INDIVIDUAL/ON-SITE** -YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE El PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED / I INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER /j TOTAL ABSORPTION AREA MATERIAL j 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS Z --APPROVED FOR 3 BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE ( BY Pi -n OM ql m `l "71 -11 "l "11 ITI 'Ti n v C9 � > o 7y i7 r`d X T7 M W M W M X W z > > m tz7 � 0 0 0 0 0 0 0 0 0 O --1 H r a > C4 Irl Oil �11 ITI -n ql In ql to ITJ m �11cy" :o" 0 0 0 0 0 LTJ C) :(D �(X) :0 :(D -rj T) -11 -Tl T 11 m -M -M -i H -3 H -q -i H --i P) P) 0 :F I -j 0, -j . . . . . . . . . . . fj iU)q :(DW. :t3 :0 (D: fl (D:chi iUl io C+ ch a 01 z ql nl w w -rl m m PO -m "rl � m Oil °l � pu %11 -Tl PV x -n m> Otz) 0 0 0 0 0 0 0 0 0 0 0 0 r IV 00 > tn z IT'r. ITI . . . . . . . . . m . �l 'Tl TJ OTI 171 �21 ITI 171 �71 In n Ch I a > :F, (DO 0 0 0 0 0 0 0 0 0 0 0 0 iia OD C) 00 0 C) '11 H 'Tl ;=z H -i "11 'Tl H H -3 H H -i -q -1 -1 . . . . . . Kn O)Q: . . iz O-qi . . Qb ()J . . :0Y D� :0 !1 0) i ill P) i P) SD :0 ?5: c+ (D: ic+ •y 1�� 'd: ::� "d: (D �J I : SD am .41 (D i D) H to oii: i Ott: :r r n c+ (D 4 f -j :uq Minici alit of Anchorage P y 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. n I q, - Z31- O,? HAA #___04D Expiration Date: 7 GENERAL INFORMATION Complete legal descttption If Erg al $ I j Location (site address br directions) 4N_4;I L I T S l- All qq6-1� !. Current Property ownef(s) D EApaF A u i i Mailing address, Lending agency Day phone _C4/- y f 7 0 Day phone Mailing address - Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 95� Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 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 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. (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 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 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. Eagle River Engineering Services Name of Firm 10421 VFW Rd Suite 201 Phone 69�-Sfg Eagle River, AK 99577 Address Engineer's Printed Name 6. DSD SIGNATURE _ ' Approved for __L4_ bedrooms. Disapproved. . Conditional approval for _ Da bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date:�(1[('qlt�d (Ray. 01J02) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program S • r . 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci-anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel ID: ori- A. WELL DATA Well type;::�w.Yrs If A, B, or Cprovide PWSID # _ Well Log (9N)yrs Date completed �o/� y/g-I Sanitary seal (VIN) _yam Wires properly protected 04) v� s Total depth _Lr 1 _ft. Cased to t tfT- --)—ft Casing height (above ground) ,73 in. FROM WELL LOG AT INSPECTION Date of test _G/� y /s Static water level i 3D— ft 7 - ft. Well production io g.p.m. Le. 3 g.p.m. WATER SAMPLE RESULTS: Coliform D colonies/100 mi. Nitrate 1.14 mg./. Other bacteria O colonies/100 ml. Arsenic: mg./I. Date of sample: ZQ�Alq Collected by: B.•-SEPTIC/HetSMG TANK DATA Tank-Type/Material, 57,C� L Date installed Tank size lAs-o gal Number of Compartments 2 Cleanouts (DN) 1, t Foundation cleanout (Y)N) YF.5 Depression over tank (Ypq) ego High water alarm {Yo Date of pumping _ZQ1Af:1.,200iP Pumper i' C. ABSORPTION FIELD DATA Date installed i- ao" Soil rating (g.p.d./ft2 or dr LrO System type _ i.erAje ff Length 7s' ft. Width 3 ft: Gravel below pipe _ *1 ft, Total depth 14 ft. Eff. absorption area jg10 ftZ Monitoring tube vs5 Depression over field .moo Date of adequacy test /a/,p /A w Result ss ail) _ For _moi bedrooms Fluid depth in absorption field before test // in. Water added &am gal New depth ?,57n. Elapsed Time: 38 min. Final fluid depth /r in. Absorption rate >= co o O g.p.d. Any rejuvenation treatment (past 12 mo.) (WIQ type) If yes, give date 4-�t Date installed Size in gallons "Pump on" level at _ in. Datum E. SEPARATION DISTANCES tested y� at _ in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot yoir Absorption field on lot /n 1 Public sewer main -0 7' Sewer /septic service line -t Z S Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots If ruo On adjacent lots * I u o Public sewer manhole/cleanout Holding tank -t (00, SEPARATION DISTANCES FROM SEPTIC/ Ft@ TANK ON LOT TO: Building foundation isProperty line+ru' Absorption t S' Water main 1 ro' Water service line -+/a, Surface water Y. r we ' Wells on adjacent lots 4100, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line io Building foundation -ftol Watermain Fav Water Service line tro' Surface water .'.90, Driveway, parking/vehicle storage ? 3 r Curtain drain *TQ ' N,NC K.tJOc.a t/ F. COMMENTS G. ENGINEER'S CERTIFICATION Wells on adjacent lots l certify that I have determined through field inspections 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 /D 1Z2IQN HAA Fee $ so n -fo5-fep ��~ Waiver Fee $ _, Date of Payment to l a"1-[D�i Date of Payment Receipt NumberIgo / A5 Receipt Number (Rev. 12101) CL NOV-11-2004 THU 09:50 AM LANTECH FAX NO. 5616626 P. 01 LOT ! LOT 4 N 89'54'31" E 165.00' ,OT 7 �p S 89'53'00" W 165.00' �P� OF A(a po4p o — o •• EAST 135th AVENUE ......... Ichacl L. Jokola ; ` V� ' LS -7835 ° e •: Li `'tu1bl 4g0fsaelonct NOTE 1: SNOW AND ICE MAY CONCEAL MINOR SURFACE FEATURES. NOTE 2: THIS DRAWING IS NOT TO BE MODIFIED FOR USE AS A PLOT PLAN. rXXXIEKKKKERS gig CLUSION NOTES: It N the awnen reeppnsib5lty to de termil"s LEGEND: SET FND aunCKLD �..1h�(e mistance of any weaments, camantE. or rwtrlctlons 6/e'00 W/CAPS 5/6' RO 0 U L. which do not appwr on the recorded subdivision plat. NOTE: 3.25' ALMON. A momwrNT Under no cbwmstaftm should any data heron be used for INO A TACK 2j construction, .r for wtablUh(nO property 161aa. FENCE- . . ttUR11EY CERTOCATION: LANTECH hw conducted a OVLRKANG- 0 t91 '_ �rr� � "hvdeel rarev of thh arnevty a• shown w this WOOD 0ECK5- I w wre w"M Is prvpsrt "Nen 1 w wa AO WOMOcn- A4•Iy1Lr- - .... •.W 1t..-+.. LrOI�3`1I2T1CTION SURVEYORS -PL ANNERS-E GINEERS mwts wlet O r n ORAVCL- A S— E3 U I L T OF: LEGAL DESCRIPIWN, sEp11 ZLDPIPCs- WAWA WFLL- ST BENSON BLVD. 103 r2004—�L-43 (17x) 387-6626 LOT 6p BLOCK 1, AGE. ALASKA 99503 907 562-5291 1 V HEIGHTS SUBDIVISION NU4pER: NOK10 2004 m IS -AO' 779-a6OLSON 3A NRe °°seas` cat x10 Mw