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Home My WebLink AboutKRISTAS LT 127AOnsite File Kristas Lot 127A #051-144-57 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP121380 PID Number: 051-144-57 Dwelling: RM Single Family (SF) R with ADU El Duplex (D) El Two Single Family Project: El New RM Upgrade Name EGGIMAN BRETT & ALEAH Al!!RPTION FIELD El De Trench R Wide Trench El Bed El Mound Site Address 21625 Tarika Avenue Chugiak AK 99567 Other Phone Number of Bedrooms Soil Rating � depth from original grade % 3 GISF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original gr p Ft. Gravel depth beneath pipe �_, Ft. Subdivision Block Lot KRISTAS 127A Fill added above original grade Ft. Gralength Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dista between lines Ft. SEPARATION DISTANCES To Septic Absorption LiftStation Holding Sewer Total absorption area Number of trenches Dist. between tr-e)q h 7tP From Tank Field Tank Line Ft? Well > 100' NA NA NA NA TANK ❑® Septic El S.T.E.P. 0 Holding 1771 Other Manufacturer Greer (installed 2012) Capacity 1250 Gal. Surface Water > 100' NA NA NA — Material Number of compartments Lot Line > 10' NA NA NA NA steel 12 Foundation > 10, NA NA NA NA LIFT STATION Manufacturer Capacity I Remarks 2" insulation was provided over tank Gal. and DCO downstream of tank in Dec2020 Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 d,ainfield Tankto 3034 Installer ARM Services in Dec 2020 Drainfield CO/MT3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection 1s, 12/21/2020 12/28/2020 Location and description 2"d 3'd 1/7/2021 4" bottom of siding point A ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date Aw TH ...................... U sL.2 Vse ;4, Date rb,� , No. C 119N Septic System Approved Date Note: this approval does not include well permit requiremenfs. (kev uoiuzi its) 1250 GALLON TANK INSTALLED 2012 EXISTING 14' x 29' x 9' EFFEC TI VE DEPTH SEEPAGE PIT INSTALLED 1973 LOT 126A P2 04 ,3 3EDR00 o HOUSE TANK VARIANCE OS V201039 e - CQ( / \ NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE ----- — 7 I � SCOPE OF WORK 1. ANEW 1,250 GALLON STEEL SEPTIC TANK WAS INSTALLED IN 2012 AND TIED INTO 15'BLMEASEMENT EXISTING ABSORPTION SYSTEM. 2. IN DECEMBER 2020, THE TANK WAS EXCAVATED AND 2" OF INSULATION WAS PLACED OVER THE TOP AND BACKFILLED TO A DEPTH OF 3.15'. DOUBLE CLEANOUTS WERE TARIKA AVENUE PROVIDED DOWNSTREAM OF THE TANK. THE SEEPAGE PIT WAS LOCATED AND THE ORIENTATION WAS CONFIRMED. THE MISSING MONITOR TUBE WAS LOCATED AND EXTENDED ABOVE GROUND. THE SEEPAGE PIT HAD 37" OF WATER IN THE MONITOR TUBE IN JAN 2021. 3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. Tank Record Drawings Prepared for 4 Brett and Leah Eggiman .•�� F . , �� 21625 Tarika Ave Chugiak Alaska 99567 `?� ''•:�� 4 TH �. KRISTAS LOT 127A ////�� ;; OSP 121380 """""""' EKLUTNA ENGINEERING, LLC ��•••••�N ��••�•� DATE: 1/20/2021 j� =. CURTIS TOWNSEND :`�i 19162 MOUNTAIN ROAD �j��`• No. CE 1AV 1 04 �• 'Ar m DRAWN: CLT �` � . CHUGIAK, ALASKA 99567 SCALE: 1" = 50' /Zo ..... •� (907) 406-1058 414%,L PID: PID: 051-144-57 SHEET 2 OF 3 Z O� ti0 Z¢ B O p0 W Q2 W JO 54'-8" DCO 43'-0" 56'-2" �U ¢� Qj OU R I— O 4nn e O 4nn) !� F 1,250 G STEEL TANK 2" INSULATION OVER TANK BENCH MARK IS BOTTOM OF SIDING AT POINT A MARK A B SV1 32'-11 " 46'-7" SV2 41'-4" 54'-8" DCO 43'-0" 56'-2" DCO 44'-2" 57'-4" CRIB MT 73'-1 " 74'-1" 8' DIA x 9' EF DEPTH LOG 29'x 14'PIT a 37" WATER JAN 2021 Tank Record Drawings Prepared for ...�""�111, Brett and Leah Eggiman .............��qs��♦ 21625 Tarika Ave Chugiak Alaska 99567 TH�� KRISTAS LOT 127A ; 4 - • OSP 121380""................ ". ' ' .. ................ EKLUTNA ENGINEERING LLC DATE: 1/20/2021 � ': CUT TOWNSEND '� 19162 MOUNTAIN ROAD DRAWN: CLT ��s'•.,, No.l E 1 904' CHUGIAK, ALASKA 99567 •� (907) 406-1058 SCALE: 1 - 10 PID: 051-144-57 SHEET 3 OF 3 XXXXXXXXXXXXXXXXX OHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHU OHU OHU OHU OHU LO7 1% LO7 1A LO7 1 E W S S SS 0ROW00 ROW 1' %L0 ES070' %L0 ES07*RA9EL DRI9EWA< ED*E O) 3A9E0E17 ℄ 7ARI.A A9E1UE℄ U33ER %OWER< LA1EN89° 57' 00"W 131.19 N00° 17' 50"W 294.72S89° 46' 03"W 150.00 S00° 04' 33"E 274.0210 0 ' W E L L R A D I U S 1 101 1101&UL9ER7 LRW 1A .ULVWD'V SXEGLYLVLRQ ST )W 1 7DULND AYH 1 SWRU\ WRRG )UDPH HRXVH L 1 R 0 0 0 G E PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. November 11th, 2020. Legend: Scale 1" = 50' Gas Meter Electric Meter/Outside Power Light Pole Septic Telephone Pole Fence Overhead Utility Lot 127A, Krista's Subdivision General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 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. All dimensions to property lines are plus/minus 0.1ft. ARM Septic Services 20-595 11/16/2020 86-24 1258 E Elec. PedestalWater Well Street Sign Concrete STA T E O F ALA S K A49 TH ROYEVRUSDNALLANOISSEFORP DERE T S IGER Pierre M. Stragier NO. LS-9812 11/16/2020 G E S x W Engineer: Legal Description: Permit: Report Type: Municipality of Anchorage P.0 Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 (907) 343-7904 Fax (907) 343-7997 httv://www.muni.or-q/onsite Planning and Development Services Department On -Site Water and Wastewater Program On -Site Sewer/Well Submittal Comment Sheet SPURKLAND ENGINEERING KRISTAS Lt 127A OSP121380 Septic On -Site Review Completed By: The attached paperwork has been reviewed and is being returned for the following reasons: 10/26/2012 J.Crewdson 1. Burial Depth: The top of the septic tank appears to be 3 feet below grade and not insulated. Please revise to be in accordance with the code. AMC 15.65.050F 2. Double Cleanout: The installation does not appear to include a double cleanout within ten feet of the septic outlet in the line between the septic tank and drainfield. Please provide. AMC 15.65.050C 014. Septic Tank Type: Some of the septic tanks sold by Greer in the MOA this year are not approved. Please substantiate that the tank is approved. Note: The distance between the standpipes on the approved tank versus the unapproved tank is different, which may be a way to determine which tank was installed. 04�. Inlet/Outlet Connections: The tank is required to have water fight inlet and outlet connections. Please substantiate. sparMand Engonavomg Environmental Consulting and Design SEPTIC SYSTEM DESIGN Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 Elmore Rd. Anchorage, Alaska 99519 Subject: Kristas Lot 127A Septic Tank installation Ladies and Gentlemen: October 19, 2012 The septic tank at the above referenced property was replaced without a permit in June of 2012. On August 8th, 2012 I inspected the installed septic tank serving the three bed room residence. I have attached an installation permit application, an inspection report and record drawings for your review. Sincerely, Lars Spurkland, P.E. Civil Engineer 203 West 15t4 Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurldand@gci.net Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT 0-51 Permit Number: PID Number' -144-57 Dwelling: M Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Fol Upgrade Name: BOB STARK ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 21944 OBERG RD., ANCHORAGE, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original gradeGravel R. depth beneath pipe Ft. Subdivision Block Lot KRISTA'S 127A Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft Ft. Well 100' >25' TANK ■ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. SurfaceWater >100, Material Number of compartments Lot Line >5' STEEL 2 NA Foundation >5' LIFT STATION Manufacturer Capacity Curtain Drain >50' Gal. Remarks *TANK INSTALLED WITHOUT PERMIT Pump on level at in. Pump off level at in. High water alarm at in. JUNE 2012 Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank Tank to drainfield 3034 HOME OWNER Drainfield CO/MT Inspector LARS SPURKLAND BENCHMARK (Assumed elevation)100 R Inspection 1n $/$/12*d Location and description dates: 2" 3" 4m BOTTOM SIDING @ "1" ON SITE PLAN COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL 1 ngipepr's Stamp Conditional Approval: Date gyp.'' A 49T i 9 �rLnKLArvD-koz �� cIj . 1 50 •�c� Aooroved Date mspecnon Report_a- i- i [.coc WeH LOT 128E 2 SWING AES g OM A 5.0 20.5 RE ZOENCE B 325 46.0 N I 3 C 40.5 54.0 'A 2 CID D 43.0 56.0 Septics INSTALLED 1250 G. SEPTIC TANK Area LOT 127A KRI i T'S S/D NOTE: THIS 1S NOT A SURVEYED PLAT. WELL &SfPTlC TARIKA AVE LOCATIONS WIN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION All LOCATIONS SHOWN ARE APPROXIMATE. 25 0 25 50 75 100 125 150 SCALE, 1' = 50 FT ELEV.=98' FOUNDATION CLEANOUT = 95.0' F = 5.0' OF •.,gyp,• ................ AV �.. ♦♦i 4 • 4 t s CONNECTED TO 1250 GALLON SEPTIC TANK �, „(µ�.. , , „ ..... ,, EXIST DRAINFIELD • � •• SPURKLAND • ��♦'J, :• No. c 11500 °ti.� A�UM£D ELUA77YON /00 FEE® "r f,�U\p�sy � ::••• SPURKLAND ENGINEERING KRISTA S LOT 127A RECORD DRAWING 9, 2012 g20033yVq1K5TH.95AD1VENUE BOB (907} AIM 21911 OBER 0.., TCHUGIAK, AK 99577 SHEET+ AU/UST CRIB, NW1258 PERMIT # PID N 015-144-57 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION 051 - Parcel I.D. 9-�- 144-57 Property owner(s) BOB STARK Mailing address 21625 TARIKA AVE., CHUGIAK, AK 99577 Site address SAME Legal description (Sub'd., Block & Lot) KRISTA'S LOT 127A Day phone 688-0427 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (0 all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El Septic Tank ElUpgrade Fx_1 (w/wo ADU) Tank El Renewal ❑ Duplex (D) El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Lcv(�_ (Signature bf property owner or authorized agent) Permit/Rush Fees: oZM Date of Payment: !o I a a I a I'a, Receipt Number: 0%6-1 Permit No. 0SPIo113W0 Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. MUNICIPALITY OF ANCHORAGE Development Services Department N':j Phone: 907-343-7904 On -Site Water & Wastewater Section — Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-144-57 1. GENERAL INFORMATION Expiration Date 3-ZI -202-7 Complete legal description KRISTAS LT 127A Location (site address) 21625 Tarika Avenue Chugiak AK 99567 Current property owner(s) EGGIMAN BRETT & ALEAH Day phone Mailing address 21625 Tarika Avenue Chugiak AK 99567 -- Real estate agent Day phone 2. TYPE OF DWELLING: _ 0 Single Family (wo AD F1Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic Q Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment Receipt Number COSA # 05C21172 -IB Date: Waiver Fee $ _ Date of Payment Receipt Number 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC Phone 907.406.1058 Address 19162 Mountain Rd Chugiak AK 99567 % Engineer's Printed Name Curtis Townsend, PE Date Z ZU/ zo,7/ .�. 6. DSD SIGNATURE W System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms `+ ..TM ......... T�� • • d• burtis L. TownsOnd i oars AV' bedrooms, with the following stipulations: �lllll((((rrrr , r/, 4,4 i� O/V o% S�AMD rte^ OGS A 44 Z Original Certificate Date:/ 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 Checklist blue sheet Legal Description: KRISTAS LT 127A If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled unk Total depth unk ft Cased to unk ft FOR Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) > 18 in. Date=of flow test for COSA 1217/2021 Static water level at beginning of test 17 ft. Comments B. TANK DATA Age of tank(s) 9 years Tank type/material septic jsteel Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping Dec 2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 1973 ❑ ALL standpipes present per record drawing Total measured depth from grade 11.4 ft (max) Measured depth to pipe invert from grade 2.4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 051-144-57 Structure served by this system Well production at time of test 3.5 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.60 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 121712021 C. LIFT STATION ❑ Required maintenance com Age of lift station %y arfi Lift station material/ Adequacy test date 11712021 Results 0 Pass For 3 Fluid depth prior to test 50 Water added 450 gal New depth 78 in Elapsed time 1440 min ❑ Code -required soil cover over field Final fluid depth 50 in bedrooms in Absorption rate ' 450 F-1 System presoaked g p d (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 1- months) 00 date of test) if yes, enter date Gallons introduced gallons Comments/Deficiencies: no reports of crib freezing, still lots of freeboard in crib COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Lj�j Yes Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' ❑ Yes if No 92 ft Private Sewer/Septic Line > 25'✓[� Yes if No ft Absorption Field on Lot > 100' E Yes if No ft Holding Tank > 100' 171 Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50'[]✓ Yes if No ft [71 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M,/Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' F/71 Yes if No ft Property Line > 5 Lj�j Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' ✓� Yes if No Water Main > 10'✓Cj M Yes if No ft Community Wells > 200'[]✓ Yes if No. Water Service Line > 10' [✓1 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' [D Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Q Yes if No Water Service Line > 10' M Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' F71 Yes if No ft F. ENGINEER'S COMMENTS OSV201039 for tank to well radius G. ENGINEER'S CERTIFICATION 1 certify that 1 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. . COSA Checklist yellow sheet OF AZA ' 7H I .... • 'Cu(tiS L ind No. CE llso4` ft R ft ft 00 Ln N e•i �L N O N \ N to W m M a O Q� W N O ZT. Ln O L- CL 3 U O J V) J (u U m L 'a O y_ LL O NO N O J O L2 O ip a N 7/•tR7 M..nC./L _nnN / Cy •y am: ¢ .C) Q lL �3i ±- W N @ LL Ir I J M N Z'L6 soi — / 7— CV) M / \ ZO"tiLZ 3d£E.tiO o00S"tiLZ 3d£E.tiO o00S 3NV-1A 8-9M09 613ddn 3 LO O J i W U W U 0 m U n h w a) @ Z i W U f m U w a) @ EN OZcN O _0O ACA; NvOOQ SEU L a) N O a) O D N m ,D Ir In C 3 @ O ,C c y O a) CL N 7 O N =n C N O` C 3 N T@ow a) a w 00 ami - m O O N @w U)) C �Na C m d , =3 ~O O O v;w m-0 "ON U o @ a) @ C y C cm Q 3 C U .O L S ci @ J @ @ L N V5OCNUa O N ono 00 —q c ul > t ,cco N bio Ln tOp - U @ O C) Ql oN 0 E�� O cc G i_. NE U t a) E w 'N o •N H _O @ O a� = 'O N U E Y N N T cc C C O .O @ C °D a1 U CL a) o J 7 C U aai d j, > :3`.� V) C O t c. a �° a ua N u o U `LSE yo m J O > OI V) w ' v c m-0 3 0 A E-0 d •� a) fl 5. Lo v0 ate) �� caa'i x G fnwmmc 2 E L N N c� U @ °) Q CL a) E E a) @ T� Q 7 > a Q) U I L >' h Q� L O oo @ C O aww_mo U. A ro N ��T C a1 -a Z C @ V 'F cuE LD �i s ° o aTi� ++ N 0O �.c° °? v o 0� 3 O• U c U c Q Z a) N Q L O@ X L F U a) w H O Q _l O_ _� L Ln LL � 0) 3 UJ LL U m N @ in ~ CL k @ o 0 o E \\ i v o UO �� 3 0 Q° w CL C m P J _ O o_ i CL:E @ ^ �� • • o2�L// Q O LbD @ ai N NLU C C V // Ln J � Y . "00 LA LS1 T I `• N Q I Q a) -C CLai L) N ol LU LL ccm N E �• ••Q4 - G b /�••• 6 oma- Z w a n a@) E C7 Ln S �Ni C7 C'i ri v 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 November 24~ 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot ].27 A Krista~ T~5N R1W Sec. 8 Location (address or directions) Chugiak (b) Applicant Name Audrey Mason Telephone: Home 694-9508 Business 694-4200 Ap¢icantAddress P.O. Box 772849 Eagle River, Alaska 99577 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [-] (explain); (d) Lending Institution G,M.A.C. Telephone _ 276-3949 Address ._~07 E, Northern Lights Suite 201 Anchorage, At( (e) Real Estate Company and Agent N/A Address N_/~ 9950S Telephone N/A (f) Mail the HAA to the following address: D'iek]]D hy engineer TYPE OF RESIDENCE Single-Family [] Multi-Family Number of Bbdrooms Other WATER SUPPLY Individual Well [] Community ~ Public [] Note: If community well system, rnust have written confirmation from the State Department of Fnvironmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public C1 Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, Page 1 of 2 72-025 (11,84) ENGINEERING FIRM PROVIDIhG INSPECTIONS, TESTS, FILE SEARCH, DA I'A AND INFORMATION 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 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 comptiance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone EAGLE RIVER Ef~GINEEFdNG SERVICES Address Ed,~L~ff-dVE4:{TAK-99 577 Date ~/~/'~ /~-,;: 4;. P. 0. BOX 773294 694-5195 DHEP APPROVAL Approved for W'~cc-~'~'3~bedrooms by ~' ''/'~' '"~¢~'t,~,,~ /' Approved Disapproved Conditional __ Terms of Conditional Approval Date / ¢' ~'¢ - ~'¢ 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 institutions 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 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MG,.~I HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: -~--'~;'~ WELL DATA Well Classification Well Log Present (Y/N) Total Depth '~-¢/ / Static Water Level .~' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot /¢2// To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~.¢ ~..~ ~z_,:_ If A, B, C, D.E,C. Approved (Y/N) Date Completed /¢'-~ ~ Yield Cased to~ %~' ~*~/%~Depth of Grouting /;%/¢¢ Pump Set At 1~/ ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots /I '7 ' ; On Adjoining Lots __.2'~¢~¢ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~-¢-¢-' ; Date / /" ~ -¢':- g ~ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) kJ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) '"~'.',~ Separation Distances from Septic/Holding Tank: To Water-Supply Well //2/ To Property Line To Water Main/Service Line Course Size /2 J'-o No, of Compartments 2 Air-tight Caps (Y/N) ~)' Foundation Cleanout (Y/N) Date Last Pu m ped /2' - / ~ /",,~ ; for Temporary Holding Tank Permit (Y/N) ? To Building Foundation ~J'" To Disposal Field '~¢'" To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 MUNICIPALli¥ ur ,~-,, ....... DEPT. OF HEALI'H & ENVIRONMENTAL pRc.)l ECTiON R£CEIV£D 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / Width of Field /~' 2'2( Square Feet of Absorption Area 7 2y Depression over Field (Y/N) Adequacy Test Results of Last Separation Distance from Absorption Field: To Water-Supply Well //? To Building Foundation 9'0'- Lot /-¢ o,,~. To Water Main/Service Line _ /v To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design /~"~ Length of Field 2¢ Depth of Field ~ ~- Gravel Bed Thickness %" Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~9o * To Cutbank (if present) LIFT STATION /.)//,~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump 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 c~12ecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ~_.. ~.~..~7%~__..~:..~_ ....... Signed ~..---' ,~ ~%__:.~-,:~L~:. Date / MOA No. Company Receipt No. Date of Payment Amount: $ Page 2 of 2 Eagle River Engin0ering Services P. 0. Box 773294 Eagl0 River, Al( 99577 694-5195 72-026 (11/84)