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Home My WebLink AboutRIVER VIEW ESTATES BLK 6 LT 1 r- .... Municipality of AnchoragePage) 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 Inspection Report Permit Number: ~C~ ~ O~rO~ PID Number: 0~ -- 7~2. ~a~ bec ~ ICH E~E ~AA Wastewater System: ~ New ~ Upgrade ,~r~: ~' ~,~ ABSORPTION FIELD No. of Bedrooms: Phone: B Deep Trench ~allow Trench, O Bed D Mound ~ Other Total Depth frpm original grade: Soil Rating: ~ LEGAL DESCRIPTION S ,, , O. ¢ Block: . Subdiv~i°n:f~' ~/J Depth to pipe bottom from original grade: Gravel depth beneath ~ipe Township: ~ Range: ISectiOn: Fill added above origin¢l grade: Gravel length: ~ ,,, Ft. ~ ~ I _~ j F,t. Distance between lines: ~ravel width: Number of lines: WELL: ~5~¢~New Q Upgrade ~+ Ft. I I ' Ft. Classification (Private, A,B,C): Total Depth: ~ Total absorption area:~ Pipe material: Driller: ~Drilled: StaticWater Level: Installer: Yield: ~ IPumpSetat: Casing Height Above Ground: TANK Ft. Ft. ~ GPM SEPARATION DISTANCES ~ Septic D Holding ~S.T,E.P. To Septic Absorption Lift Holding Public/Privale Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~¢0~O&~6 ~A~ Number of CompaRments: Suda'ce LIFT STATION Water J~t4' IO o I~ j~l+ ~ " Lot t+ JOl~ / O l+ Size in gallons: ~ Manufacturer: "Pump on" level at: "Pump off" level at: ~ High water alarm ~t: _ Pump Make & Model lE[ectrical Inspections pedormed by: Drain Remarks: ¢~ ~ ~Tio ~ ~% ¢~¢¢¢~ BENCH MARK ,_ ' Location and Description: Inspections peflormed bY~t~¢ W~t~= 2 ~;~¢w=t'~ates: 1st e ~ ( / ~ Anchorage, Alaska 99504 ,,. ' Department of Health an¢~uman Services approval 72-013 (Rev. 9/91) MOA 25 SW97040B~.0 FINAJ. GRADE 4 FOOT MIN. r--ORIGINAl. GRADE OF COVER--~ ~¢~]' / 101.4B- 102.SO(VARIES) 07.08(I_E~/EL.) MT = 94.62(AVEI~OE) WA'~R FOU~B INSULATION- N~W 12.~0 F. C6LON 5,f,~,P, 'rANK END OF lINE -I'H # 1 MT / / / / NOTE: THE WES/- PROPERTY LINE WAS FtJ,,GGED BY A \ REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. \ THE SEPERATION DISTANCE BE'f WEEN THE NEW-f'RENCH AND THE WEST I.OT LINE IS APPROX. ELEVEN FEET. PREPPED BY'. WATER WASTEWATER ~IVE~ VIEW SUBBIVI~ION, LOT 1,, BLOOK 6 ___ , ...... :... PREPARED FOR', ' PItONE NUMBER: TERRY AND MICHELLE FOREMAN (560) B85-9~44 DA'rE: BY:A.C.6. ] 1 = 40~ 2 OF 2 OF LINE(El) PERCOLATION TES'i- PERFORMED ON \ I'HE BO'Iq'OM OF THE TRENCH 'FO \ INFIRM CONSISTENCY OF SOILS, Facsimile Transmittal Alaska Water & Wastewater Consulting Engineers Date: ~/~ Attention: Prom: Jeffrey A. Garness, P.E., M.S. · Gomment(fO: 7320 East Chester Heights Circle * Anchorage, Alaska 99504 * Phone: (907) 337-6179 * Fax: (907) 338-3246 ARCTIC LIGHTS EI;ECTNIC P.O. BOX 110i35 ANCHORAGE, ALASKA 9951 lnvoice 3ATE I NVOI¢ E # PHONE: (907) 345.7898 FAX; (~07) 345.538~. ~ILL T'C TePry / Mtchetle Foreman 12413 NE 28th S~reet Vancouver, WA 98684 Terry / Michel, re Fr:,reman HCSSBOx 9452 H'Llamd Road Eo~le River, AK 99577 Lt i BIk 6 Ri. vervie~ Sub. Lebor-O3M Owner-Journeymon L~bo~ I_tft 3.5 53,57143 I 187..58 .... · St~t~on Connection 1, Instotl Owne¢-Furntshed Wiring I ~o Lift St~t~on Control BOX 2, ~n~pect & Connect Owner-Furnished Field 3, Cycle Lift Station to Confirm Proper Operation All systems ~ppeor correct occordin§ ~o NEC ~nd Mmnuf~cturer'$ Requirements. Poid ~n fuIt on ~obstte by Former Residence Owner Tenry Foremon Check #775 Thonk you!! MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970408 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:FOREMAN TERRY R & MICHELLE L OWNER ADDRESS:NHN WATERFALL DRIVE EAGLE RIVER, ALAS[CA 99577 PARCEL ID:05079201 PAGE 1 OF 10 DATE ISSUED:12/03/97 EXPIRATION DATE:12/03/98 LEGAL DESCRIPTION: RIVER VIEW ESTATES BLK 6 LT 1 LOT SIZE: 54528 (SQ. FT.} NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 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 (18AAC80). 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: { DATE: DATE: 7320 East Chester Heights Circle ~ Anchorage - Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers November 19, 1997 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 ReP Sewer Upgrade for Lot 1, Bk 6, Riverview Estates To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The existing trench system encroaches upon groundwater, and must be upgraded in order to receive an MO.A Health Certificate (the house is being sold). Comments regarding the proposed upgrade are summarized as follows: 1. SOILS: Attached is a log which shows the soil profile, and the percolation test results. At a depth of 7.5' to 8.0', the percolation rates was 12 minutes/inch. 2. TRENCH DESIGN: a. Percolation Rate: 12 minutes/inch. b. Allowable Application Rate: .8 gallons/day/fl2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 562.5 t22 £ Effective Depth: 2.0 feet g. Reduction Factor = .7 h. Width: 5 feet minimum i Minimum Length: 79 feet. Will make trenches 40 feet long ea. 80 feet total j Effective absorption area = 571 ft2 (>563 ft2 OK) 3. SURFACE WATERS: upgrade There are no surface waters within 100 feet of the proposed septic 4. TOPOGRAPHY: The site for the new trenches is on a moderate slope (15%) that tapers of to a flat bench (1% downhill from south to north), where the existing trench is. Twenty-five feet north of the existing trench the slope drops oft' steeply (100%+) down to waterfall drive. There are no slopes greater than 25% within 50 feet of the proposed site. 5. "HOMEOWNER" INSTALLATION: The seller, Terry Foreman, intends to install the septic system next spring (we are requesting a conditional HAA), after the sale of the house. Per Mr. Cross, this could be treated as a homeowner installation. Mr. Foreman used to be in the business of installing septic system here in the Anchorage area, and is very familiar with the regulations, and installation guidelines. I am confident he would do a professional job. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Sincerely, ~///~E~ ~,TvRFALL CIRCLE LDT ~, BK 6, RIVERVIEW ESTATES S/I]. UNI]EVELDPED DLD SEPTIC SYSTEN TO DE NEW SEPTIC SYS CL[FFDRI] DEAN ELLIS HDMESTEAD UNDEVELDPED WITHIN 200 FEET DF THE PRBPDSED SEPTIC SYSTEM UPGRADE, ISTING N/ELL ~G 3 BEDRODM HOUSE NDTEj THIS IS NOT A SURVEY, THE LOCATINN OF- ALL WELLS, SEPTIC SYSTEMS, AND STRUCTURES IS APPROXIMATE, THE £UNTRACTOR SHALL VERIFY THE SEPARATION DISTANCE FRDM THE SEPTIC SYSTEM UPGRADE TD ALL WELLS ON ADJACENT LOTS, SEPTIC UPGRADEI PREPARED FOR~ PREPARED 3YI LBT 1, }~K 6, RIVERVIEW ESTATES S/D TERRY AN]} MICHELLE FOREMAN ALASKA WATER g~ WASTEWATER 11/18/97 I ]]RAWN: GARNE~S ISCALE,, 1~ = 100, SETA L RAV NCS FOUR FEET BF SOIL CqVER OVER TANK (NIN,) 1,25 INCH PRESSURE LI H ~IA PVE LINE F~ NEW TRENCHES, ' , HOUSE, FOR LIOCATION OF N,T's SEE PLAN DRAWING ,'~1,25 INCH DIA, PVC, 3/16 INCH DIA, r~ /HOLES AT 4 FEET C,C, ~ HOLES TOTAL FOR BOTH TRENCHES, PLACE ~'-~-~---~,L~ /SHALL FACE DOWN, AT'5 FDDT DF' ,94 GPM PER HOLE, DR el GPM, .:' :..~;....> ,.....¢.: ~ ':.? ?'. · , . ~. :,:.~;:,.~...:;,.; .y..~ . - 5' - lO' MIN 5'- ~ SEPTIC UPGRADE~ LOT 1, gK 6, RIVERVIEW ESTATES ALAgI<A ~/ATER g, WAgTEWATER DATE~ 1~/19/97 I DWN: GARNESS ISCALE~ NTS MunJcipa,ity of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIC~.~¢~-I: SOILS LOG -- PERCOLATION TE$'r~,~". JAM[S t: wiLLJ/d,,iS .,'. :. PERFORMED FOR: LEGAL DESCRIPTIONL. L .(g6 ~ I ,_~.1 ~J _~ownship. RanDe. Section: 1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ergo, OeCh lo Water Alter Moniterm(]? SLOPE SITE PLAN WAS GROUND WA1ER ENCOUNTERED? DEPTH? o~,e: // ~'7 Reading Date C~-oss lime Thne Net Drop PERCOLATION RATE __] ..... ~" drlmutes, mcn; PERC ~IOLE DiAMETEfl .__.~ COMMENTS. ~ ~. ~- ~, _._ , 72:;:;~ot. N4~:571~' ALL STATE AND MUNICIPAL GUIDELINES; ,HIS DA,E. DALE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street. Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~'$/'~',,;d Z; ~ -rPHONE LEGAL DESORIPTION LOCATION --' . h Z Manufacturer -~' ~J ~ -- 'S<~ ' ~ ~ ~ ~/~ Material~ ~ . No. of compartments Liq, ca)acit~in ga Ion~ ~ ¢ Inside Iongth / ~ ~'~ IF HOMEMADE: Width Liquid depth ~ ~ Well .... ~ ~ ~ DISTANCE TO: Dwelling P~RMIT NO. ' O ~ < Manufacturer ~rial Liquid capacity in gallons ~ ~ DISTANCE TO: Well ~ ~,~-~, Foundation ~ . N~arestl~ne l~t' PERMIT. NO,.. ~ ~ ~ Top of tile to finish grade ~' -~> / ~ inches ~ Material beneath tile ~ ¢ ' '~ ~ "~ '/~ '~ i/ ~nches Total effective absorption area Length Width ~ ~:~ ~ Depth o PERMIT NO. ~ ~ Type of crib Crib diameter CHb depth- Total effective absorption area ~ Well DISTANCE TO: Building foundation Nearest lot line ~ Class Depth Driller Distance to lot I~ne PERMIT ~O, ~ DISTANCE TO: Building foundation SewarlJne ' Septic tank Absorption area(s) OTHER _~. ~IPE MATERIALS SOIL TEST R~TING INSTALLER _ REMARKS ~Z~ ' - ~' ' ::;--~t ~ ~,:-~ ~:w ~>~J~-?~ -~ I°C6J MUNICIPALITY OF ANCHORAGE Department ~ Health and Environmenta' ~rotection 825 ~ Street, Anchorage, AK. ~9501 # ~-= HANDWRITTEN PERMIT * * * Permit ~l~ WB~__-~N~,_~-R ON-SITE SEWER PERMIT = Applicant:~3_-i~ ~L, _, Mailing Address: ~,~ ~ Location: Phone Number: ~'9~-- Legal Description: ~3 2- / .~/~ ~ . ~W~///~ 3 ~57&Lot Size: Type of Soil Absorption System I~: Trench: / Drainfield: Seepage Bed: Holding Tank: Maximum N~ber of Bedrooms: ~'~$~3'Soil Rating(sq.ft/br) /~ The Required Size of the Soil ~sorption System DEPTH /~ LENGTH ~ ~ · RAV L W DTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). REQUIRED SEPTIC(HOLDING) TANK SIZE = ,~?~ GALLONS * Permit applicant has the responsibility to inform this department during the i~stallation inspections of a~y wells adjacent to this property and the number of residences that the well will serve. TWO(m) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department ~ill be subject to prosecution. ~inim~ distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type ~f public well, Minimum distance from a private well to a private sewer line Es 25 feet and to a co.unity sewer line is 75 feet. Well logs are required ~nd must be returned to this department within 30 days of the well completion. )ther requirements may apply. Specifications and construction diagrams are ~vailable to insure proper installation. · * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 B * * * I certify that: (1) I ~ f~iliar with the requirements for on-site sewers and wells as set forth by the Municipality of ~chorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the ~e~idence is remodeled to Si~ne~: ~ cant ~ SWP/024(1/81) include more~t~//bedrooms. Issued by :/~/~ Date: 0 1 2__ 3__ 5~ 6__ 7 8 9~ '~-~10 __ 11~ Russell Oyster 694-2774 Performed for: E ENG,,4EERING & DEVELOt Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Name.'-~-~r. ,~.~_-~_,~c ~: ~----~/¢)/JJ~, Legal Description: ,~ENT CO. Depth (feet) Mailing Address:.. Earl Ellis 688-2280 No. ~ V- -~?~/ Soil Characteristics PLOT PLAN 12__ 13__ 141 Ground Water Encountered: Yes No-~ If yes, what depth Proposed Installation: Seepage Pit~ Drain Field f Comments: PERC. TEST Performed RELEASE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING oso-79 --ol-o0o HA^# 1. GENERAL INFORMATION Complete legal description Lot 1; Block 6; Riverview Estates OF CONDITIONAL Location (site address or directions) Waterfall Drive (off Hiland Rd.) Eagle River, AK Property owner Mailing address Lending agency Mailing address Agent Address Fletcher Day phone City Mortgage/ Debbie Stonero~yph0ne 277-1544 Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well xxx 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: Individual on-site Holding tank Community on-site XXX 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#21 5. STATEMENT OF INSPECTION BY ENGINEER ~. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Alaska Water & Wast !water Name of Firm ........ ""-~- ~ Circle I- ~ ~A[D $500.00 ~OH ~SC~O~ ACC~ ~O~ S~V[C~S ~O~HED Phone 337-61 79 DHHS SIGNATURE Approved for ..~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date ?- 2 - ¢,¢ 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 satish/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) ~ack MOA Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: Health Authority Approval Checklist I~p L. ~,2 ~(~o Parcel I.D.: OgO--Tqa A. WELL DATA Well type Pv~': Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Cased to :~ ~-~ ~ Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) ~/~-----~ FROM WELL LOG AT INSPECTION ~ / 9 C ~J-' ~ g.p.m. WATER. SAMPLE RESETS: Coliform Nitrate /~J ~' ~ Date of sample: /c~/l~/C]':'~l- Collected by: B. SEPTICIHOLDIN? TAN~((_DATA ~,~ ~..,,.~b tSZJ~'O ~-~ Date installed ~/~/~ ~ Tank size {~ ~'-~ Number of Corn Depression (Y/N) /~0 Foundation cleanout (Y/N) Date of Pumping ~ ~ C. ABSORPTION FIELD DATA Date installed ~/,~/~t~ ~0 ~ g.p.m. ~z~- /-~t~ q ~ J --= '79-6 C~,~.c¢4 ~ Other bacteria / 3artments '~' Cleanouts (Y/N) ~/' High water alarm (Y/N) ~.~_~S Pumper ~J~'~ Length '"7'~~ Width Soil rating (g.p.d./ft~ or fF/bdrm) ° ~ System type ~ ~>~ [~' Gravel thickness below p~pe 'Z., ~-~* Total depth Effective absorption area Monitoring Tube present (Y/N) Depression over field (Y/N) Results (Pass/Fail) For Fluid depth in absorption ~ Immediately after gal. water added (in.): Fluid depth. (ins) Minutes later: Absorption ra--~, g.p.d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* bedrooms If yes, give date LIFT STATION Date installed ~//~/~ Manhole/Access (Y/N) Y~ '~ High water alarm level at* ,¢~lf Cycles tested DJ//~ Size in gallons "Pump on" level at* Z:~r.,~ n *Datum E. SEPARATION DISTANCES "Pump off" level at* (- Absorption field on lot Public sewer main Sewer/septic service tine SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot [~5'-/~ /oo On adjacent lots On adjacent lots Public sewer manhole/cleanout /(,.J//~, Lift station //-~'/'-+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation /~'/~ Property line /0/¢' AbsOrption field / 0 ~'/'- Water main/service line /0/''¢' Surfacewater/drainage /00/+' Wells on adjacent lots /~20 /./- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / //, ~ 4. Building foundation //0 ['~ Property line Surface water Curtain drain Water main/service line Driveway. parking/vehicle storage area Wells on adjacent lots /O0 / /o /0/+ F. ENGINEER'S CERTIFICATION /I I. certify' that I h mi' ield. inspections, and review of Municipal record!~. ,~,,'~ ,~/~e'% ,,~~[t',t' ~,~.' ..... stems are Signature ~~~<~ ~~,, H~ Fee $ 2~('1~ ~, Ct ¢ Waiver Foe $ Date of Payment ~" ~ -~--~ Date of Payment Receipt Number ~'~ ~ ) '~ ~' ~_;( L~ ~ )';~ ~'~ % Receipt Number 72-026 (Rev. 3/96)* 7320 East Chester Heights Circle - Anchorage - Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers November 19, 1997 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Conditional Health Certificate for Lot 1, Bk 6, Riverview Estates S/D. To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The trench system encroaches into groundwater (based upon our test hole and groundwater monitoring data), and must be upgraded prior to the issuance of a non-conditional HAA. An upgrade design package was submitted to your department on 11/19/97. Ideally, we would like to obtain a conditional HAA at this time, and upgrade the septic system next spring. The existing system is functioning adequately, and has never backed-up on the current occupants (they are also the buyers). Based upon my observations, there are no environmental or health concerns associated with granting4[he conditional HAA. The intent is to install the new septic system prior to June 15th, 1997. In addition to the septic system, the well wires need to be fully encased in conduit. If you have any questions, please contact me at 337-6179, or 244-9612. assistance. '~S Sincerely~ Princi }al Thank you for your MUNICIPALITY OF ANCHORAGE A DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # _ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. 'GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner .~'-~'Z~l Mailing address Day phone Lending agency Mailing address .J Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well 7 NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 Name of Firm Address 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 i Inspection. ............ Z//, '7 -g / 77 Engineer's signature _ DHHS SIGNATURE Approved for .. 7933 bedrooms. "' i .': '¢- ,''~ .... Disapproved. Conditional approval for ×x×x~×~:× bedrooms, with the following stipulations: Mo~shall be ~ut in escrow to construct a new wastewater di~sal~stem in accordance with the attached permit number SW970408 by no later than June 15~_ 1998. Monel in escrow shall not be released until this office has Additional Comments given final approval. 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. 72~25 (Rev. 1/91) Back MOA#21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: I~Z>~ ij ~//__ ~.., ['~l~/,¢~_.~t~--c~" ~P~cel I.D.: A, WELL DATA Well type ~-d~'-' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) '~'~' Date completed ~'~ / 8 ~ Totaldepth ~'z~r'O/ Casedto ~ ~.~ II ~ ~,,4 Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) ~ Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: FROM WELL LOG AT INSPECTION · I Nitrate g.p.m. Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed "7/~ ~ Tank size /~--0 Number of Compartments % Cleanouts (Y/N)__ Foundation cleanout (Y/N) ~JO Depression (Y/N) /~.)O High water alarm (Y/N) A"/~ Date of Pumping /0/,~/~';~' . Pumper J° ¢~'~ C. ABSORPTION FIELD DATA Date installed '7/B ~ I Length. _!~--L~ Width Effective absorption area /2 O0 Monitoring Tube present (Y/N) ~__~_ Depression ove~ fiel,d (Y/N) ?_ ' "~~t Results (Pass/Fail) For bedrooms in absorption field Immediately after gal. water added (in.): Fluid depth Fluid depth (ins) Minutes later: %'~~. g.p.d. _.~Peroxide treatment (past 12 months) (Y/N) / If yes, give date / Soil rating ¢~ or fF/bdrm) t/OD System type ~)~,¢-_..j'2 Gravel thiokness below pipe Total depth D. L I F T S~,.,,,,,,,,,.,~ Date installed ~~ Size in gallons ~~ump off" level Manhole/Access (Y/N) High water~ *Datum ~r ~ C sted E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot On adjacent lots On adjacent lots Property line Surface water Curtain drain Public sewer main /kJ /~,~ Public sewer manhole/cleanout , Sewer/septic service line / O O "f" Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~'-/4- Property line //O/'/- Absorption field --%~ Water main/service line I bf+ Surface water/drainage ! 00/+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: /~'/~ Building foundation /0 Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots / 0 0 ENGINEER'S CERTIFICATION I certify that l have~er~j~edt~¢ Id inspections and review of Municipal inc°nf°rmancefth~7/~/HA~A~id rnesineffectonthisdate. Signature ~_ j,/~r y,/~'//.,'j/L-" ~.,,..~ Engineer's Name / Date are HAA Fee $. / Dateof Payment ~ Receipt Number %/¢¢0~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ,~ CT&E Environmental Services CT&E Ret.// Client Name Project Name/# Ciiont Sa~nple ID Ma~x Ordered By PW$ID 976354001 Lt 1, ]~k 6, Rtvervl~w ~t $/D Lt 1, Bk 6, Rivervicw Est Ddnking Water Client PO# Printed Data/Time 10/20/97 15:[5 Coll~ledDate/Tim¢ 10d3/97 i5:20 RwaivedDate/Time 10/14/97 !3:00 Technical Dlrector~ Stephen C. Ede Sample Released B~.~/ N(t)'ate.~ O.lO0 U lotal Co[(¢erm 0,00 0,103 ~£L EPA 300.0 10 ms~ Date :n~t 10/1~/97 GCP 10/14/97 R~M