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HomeMy WebLinkAboutMEADOW RIDGE ESTATES BLK 2 LT 6\ cii) ALL LAa4e..A C6\ ,L.k(0\ MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251206 Work Type: Septic Upgrade Tax Code Number: 05146116000 Site Legal Address: MEADOW RIDGE ESTATES BLK 2 LT 6 GA 362 Site Mailing Address: 20910 COUNTRY VIEW DR, Chugiak Owner: LARUE CHRIS & SHERRI REVOCABLE Design Engineer: This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: . I)VI)artM("M 6/27/2025 6/27/2026 r• . Z Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 3 Received By: A Date: Issued By: L Date: �' S MUNICIPALITY OF ANCHORAGE Development Services Department g: Phone: 907-343-7904 On -Site Water & Wastewater Section ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-461-16 Property owner(s) CHRIS & SHERRI LARUE Day phone Mailing address 20910 COUNTRY VIEW DR, CHUGIAK, AK 99567 Site address 20910 COUNTRY VIEW DR, CHUGIAK, AK 99567 Legal description MEADOW RIDGE ESTATES BLK 2 LT 6 Number of Bedrooms 3 Engineering Firm FIRST WATER CONSULTING Building Permit Number Not Applicable 0 APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Absorption Field Initial ❑ Septic Tank Upgrade 0 Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: Permit/Rush Fees: Pf Waiver Fees: Date of Payment:GA3125 Date of Payment: Permit No. 05125120 Waiver No. 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! June 26, 2025 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: MEADOW RIDGE ESTATES BLOCK 2, LOT 6 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one deep-burial HDPE septic tank along with a deep trench to serve the existing 3 -bedroom residence. The design is based on the recent test hole conducted on May 30, 2025. No groundwater was observed at test hole excavation or monitoring. The slopes are at 15-20% at the proposed upgrade location. The lot and area are served by public water and the water service line must be staked prior to construction and will be shown on the inspection report. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251206, Curtis Townsend, 06/27/25 6.1' 10. 9' 14 . 0' 0.9' 10 . 0'10. 2' 1.0' 15. 6' 1.0' 14. 3' 24 . 0' 14. 0' 6.1'3.5' 9.2' 3.5' 2.0' 24 .2'22.3' 24. 2' 22. 3' 3B R HO U S E GARAGE GREEN HOUSE FIRST WATER CONSULTING DESIGN CALCS: AREA IS SERVED BY CLASS A PUBLIC WATER & NO WELLS WITHIN 200' OF PROPOSED SEPTIC SYSTEM. NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. MEADOW RIDGE ESTATES BLK 2 LT 6 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251206, Curtis Townsend, 06/27/25 6. 1' 1 0.9' 1 4 . 0' 0.9' 10 .0'1 0.2' 1. 0' 15.6' 1. 0' 14. 3' 2 4 .0' 14. 0' 6. 1 '3.5' 9.2' 3.5' 2.0' 24 . 2'22.3' 24 .2' 22.3' 3 BR H O U S E GARAGE GREEN HOUSE FIRST WATER CONSULTING DESIGN DETAILS: MEADOW RIDGE ESTATES BLK 2 LT 6 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251206, Curtis Townsend, 06/27/25 3030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL : MEADOW RIDGE ESTATES B2, L6 PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 06/09/2025 DEPTH FEET OG SOILS 1 2 ORG/OL 3 4 5 6 GM/sm 7 8 9 10 11 12 13 14 15 16 17 18 19 20 BOH Reading Date Gross Time Net Time Depth to Water Net Drop 6/6/25 30 min 6” 2 8/16” “ 6” 2 8/16” “ 6” 2 8/16” PERCOLATION RATE 12 (MIN / INCH) TEST RUN BEWTWEEN 5 & 6 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 6/6/2025 TESTHOLE # 25-1 DATE PERFORMED: 5/3 0/2025 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: CHRIS & SHERRI LARUE 06/09/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251206, Curtis Townsend, 06/27/25 6.1' 10.9' 14.0'0.9' 10.0'10.2' 1.0' 15.6' 1.0' 14.3' 24.0'14.0' 6.1'3.5' 9.2' 3.5'2.0' 24.2'22.3' 24.2'22.3' R ESID E N C E GARAGE GREEN HOUSE LEGEND EDGE OF GRAVEL DRIVEWAY UTILITY PEDESTAL DECK/BOARDWALK EDGE OF ASPHALT RECORD DATA PER PLAT #72-261 SEPTIC PIPE WATER VALVE RETAINING WALL BRICK PAVERS TIMBERLINE SURVEYING AND MAPPING 17035 BARONOFF AVE EAGLE RIVER, AK 99577 907-242-5320 ryan@timberlinealaska.com FILE NO.: 25.081 SCALE: 1" = 30 FEET DATE: 4/28/2025 SHEET: 1 of 1 MOA GRID: NW1362 SCALE: 1" = 30 FEET(11"x17") 30'0' 60' AS-BUILT OF: ADDRESS: 20910 COUNTRY VIEW DR, CHUGIAK, AK LOCATED IN: ANCHORAGE RECORDING DISTRICT LOT 6, BLOCK 2MEADOW RIDGE ESTATESPLAT #72-261 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl_ PROTECllON ENVIRONMENI'AL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGF DISPOSAL SYSTI=M AND/OR WELL INSPECTION REPORT NAME ~ 0 ~ e OTT 'MAILING ADDRESS O/0 LEGAL_ DESCRIPTION LOCATION PHONE ~NEW ¢o'f~ -'i'35'7~ ~ UP~RADE Well DISTANCE TO: / ~'~ ~,,~,~ ,,~.~ ! Manu [acturer tD~jO ~_ I~ HOMEMADE: Inside ,e~ Liq. capacity in gal ons i Manufacturer ~ --' ~ Well Foundation No. of hnes , ~Length of each] h~ ~ I / Top of tile to fini~ade - NO. OFBEDROOMS Absorption area w /-iL[ Total I e n § tt~.f~p,,~ s Material beneath tile Dwe,ing /$~/~ Material No, of compartments Width Liquid depth PERMIT NO. Material Liquid capacity in gallons Nearest lot line /. Trench widtj~ ~.~) inches ~.1~0 inches Distance bet we)~/ Total effective a.b. Sorp_tior~ea Len§th Width Type of crib Crib diameter Well DISTANCE TO: DISTANCE TO: OTHER Class Depth Building foundatio~r~ Depth ~ PERMIT NO. Crib ...... depth ~ Total effective absorption a~-e~- -- Building f°und~i°~ L~.[ Nearest lot line ~J~er line _jl~,/ Septic tank Absorption area(s) PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE PERMIT NO. DEPARTMENT ,~ HEALTH AND EN',/IRONMENTAL OTECTION 825 "L STREET, RNCFIORRGE, AK. 995~ 264-472~ ( 82C~83:5 ) APPL I C:RNT LOCR'r I ON LEGAL ED SCOTT L682 MERDOWRI[:,GE ES']' XS&S ENG SRB ±96 99577 LOT SIZE T"r'PE OF SOIL RBSORF'TION S"r'STEI"I IS: TRENCH MAXIMUM NUMBER OF: BEDROOMS 694--2979 9~9999 SQUARE FEET SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: £~E:F"TFJ= 9 l_El'46TH= 4-5 6i R r-:l",.." E C [:.EF' TH=~ 5 THE LENGTH DIMENSION IS THE LENG'f'H (IN FEE'r) Of ]''HE TRENCH OR DRRINFIEL[:,. ]'HE DEPTH OF Ft TRENCH OR PIT IS ],'HE DISTANCE BETWEEI',I ]''HE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). ].'HERE IS NO SET WIDTH FOR TRENCHES. ],'HE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE-_-' OUTFRLL PIPE AND THE BOTTOM OF THE EXC:R',,,'F~TION (IN FEET). PERMIT FIPPLICANT HAS THE RESPONSIBILIT'-r' TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS ElF AN'¢ WELLS AD.-IRCENT TO THIS PROF'ERT'¢ FIND THE NIJMBER OF RESIDENCES ]"HRT 'THE WELL WILL SERVE. ]-l.,~[.I ( 2:.:' ) I i"-,I_C.F'E3£:T ][ ¢J~-4~; RE:E E:EQIJ ][ BFICKFILLING Of AN"r' S'¢STEM WITHOUT FINAL INSPECTION AN[:, APPR. OVRL B"¢ THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANC:E BETWEEN A WELL AND Rt",IY ON-SITE SEWAGE DISPOSAL S~'STEM IS :t¢'IE4 FEET FOR R PRI"."RTE WELL OR 150 TO ~"OE'~ FEE]' FROM A PUBLIC WELL DEPENDING UPON THE T'¢PE OF PUBLIC WELL MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE ]:S 25 FEET AN[':' ]"0 R COMMUNITY' SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MA"? APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER. INSTRL. LATION. F'E:I~:I'I ][ -f' IF:~-:F' I RIE'_:. [)ECE[-1E:EF.." Z;_{.. ::.I_E~: E:;.~ I CERTIF'¢ THAT · '1.: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS RS SET FORTH B'-¢ THE MUNICIPALIT'¢ OF ANCHORAGE. 2: I WII_L INSTALL THE S"r'STFM IN FICCORDRNCE WITH THE C:ODES. ]:: I UNI.')ERSTFIND THAT THE ON-SITE SEWER S~"STEM MAY REQUIRE FNLRRGEMENT IF THE RESIDENCE IS REMODELED 'TO ~NCLUDE MORE 'THAN ~ BEDROOMS. APPLICANT~ED SCOTTI'I B'¢__ '~_~.___,: [)RTE .... -~--___ V4. E' SsuEr:, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL_ DESCRIPTION: 1 2 3 7 8 ~0 12 ~3 ~4. ~7 ~8 20 SLOPE SfTE PLAN O P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water' Drop / COMMENTS PERFORMED By: ,'~;~. 8~]~ ~8)~ 72~008 (6/79) PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) FT MUNICIPALITY OF ANCHORAGE Department of HeaLth & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343..4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 6; BLOCK 2; MEADOW RIDGE ESTATES; Location (address or directions) NHN Country View - (b) Property owner . AHF~ #54097 aMailing Address 520 East 34th Avenue (c) Lending Institution Telephone: (home) .Business Anchorage, Alaska 99503 Telephone 561-1900 · : Mailing Address (d) Real EstateCompanyandAgent ~ACK WHTTE ¢0~PANY ATTNr " 10928 Eagle River Road Eagle River, AK. 99577 Address Telephone 694-5500 (e) Mail the HAA to the following address: (or check here E~f hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop Road Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family E~;~ Number of bedrooms 2 WATER SUPPLY Individual Well [] Community ~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site E~XX Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 '>fJo~ s,Jeeu!Ouo leUO!SSe,toJd @q), u! 9uo!os!wo Jo s Jo J JO JOj @lq!suodseJ ),ou s! oOeJOqOU~¢ jo X~iled!o!unR eql 'penss! s! @),18o!jl),JOO e eJojeq e~,ep aZXleUe Jo suop, oedsu! ),onpuoo ~,ou op SHHQ jo soOXOldLu3 's),uew@J!nb@J @),e),s pue leJepej u!e),Jeo XjsRes o), Jap Jo u! suoi~n)j),su~ 8u!puel J!eq), pue sowoq jo sJeseqoJnd o$ Xse),Jnoo e se s!q), seop SHHQ eqL 'e:~Sel¥ Jo e~,e$S eq~, u! poJe),s!be~ Jeeu!bue leUO!SSe~oJd ),uepuodepu! ue Xq e^oqe ~ qde4§eJed u! ua^lb suoRe),ueseJdoJ eq$ uodn XlUO peseq po),eo!j!JOO le^oJdd¥ X),Hoq),n¥ q~,leeH sonss! (SHHQ) seo!^JeS uewnH pue q~le@H jo ),uow),JedaC] e6eJoqouv jo XHled!oiunl~ eql oleg ssoJppv · uoRoodsuf s!q), jo e~ep OH), uo loejje u! suo!lelnOeJ pue 'seoueu!pJo 'sepoo ole),S pue led!o!un~AI lie q),!/~ ooue!ldLuoo u! s! WO),SXS lesods!p ~a),eMe~,seM Jo/pue Xlddns ¢o),e/~ oHs-uo oq), 'uoRo@dsu! pue uop, eORS@AU! Xw wo~ pue sol!J ol~eJoqou¥ jo X),Hedfo!unl/~l oq), woJj paufe),qo uoReuJJo~u! aq), uo poseq ~eq), ~HJ8^ Jeq),Jnj I 'u!eJaq pe~,eo!pu! eJn),onJ),s jo edX~, pue swooJpeq jo Joqwnu oq), Joj a),enbepe pue leUO!~ounj 'ojes s! wo),s/,s lesods]p Jele/~e~seM Jo/pue Xlddns ~a),eM eHs-uo oq), ),eq~ SMOqS leAo~ddv M!Joq~,nv qHeeH s!qj jo UO!~eI~RSOAU! XW leq), XHJOA I 'Moleq UMOqS e~ep uo!),epHeA Oq), JO se pue o),aJoq paxijJe leas Xw Xq Peu!Heo sv NOI.L'Cl/~tIO=INI (3N~¢ V.Lva 'UOblV=i$ =1'114 'SIS=II 'SNOI.LO=1dSNI 9NlalAO~ld IN~I4 9NI~=I~NISN=1 'g w~f-4 jo OWeN A. WELL DATA Well Classification A Well Log Present (Y/N) ____ Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Flolding Tank on Lot "~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments '¢ M~:~'ICIPALITY OF ANCHORAGE (MOA) ~ Health Authority Approval (HAA) t/~[~,~ ,,,.~ CHECKLIST-FEBRUARY 1984 ~_t1~'~--~ Legal Description: {.~ ~ ~ ~ Date Completed Depth of Grouting If A, B, C, D.F.C. Approved CC/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) · On Adjoining Lots ~ t jo. ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole · Date B. SEPTIC/HOLDING TANK DATA Date Installed 6~-'Z't-~Size Standpipes ~/N) ~ Air-tight Caps Depression over Tank (~.,.~) h/ Pumping/Maintenance Contact on File (Y/N) ,~ Holding 7'ank High~Water Alarm (Y/N) '~/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: Ta water-S~Pl¥ Well '~...4¢::~ 1-5' To PrOperty Einb,, ~ ~ ~ To Water: Main/Servic'e,'Line [ ~-> t. To Stream, Pond, Lake or Major Drainage Course Commeots No. of Compartments Foundation Cleanout(-(-~/N) ~' Last Pumped ¢'[ ~ ~--ct - ~' ; for ~ Temporary Holding Tank Permit (Y/N) To Building Foundation To. Disposal Field 72-028 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~, ~-~::::~ ¢/f2~._ Type of System Design Date Installed ~ - ~'-I ~ (~'7.~ Length of Field Width of Field "~--, ~ ~ Square Feet of Absortion Area Depression over Field Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundatior) Lot 1,4/~ Depth of Field ~'~ ~ Gravel Bed Thickness ~ ~:::~ '~ Statndpipes P resen t4t~i~;~4) Date of Last Adequacy Test ; On Adjoining Lots ~ ~ L'4-' To Cutback (if present) To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line I ¢ [~ To Existing or Abandoned System on Comments Date Installed Dimensions Size"~o n s Manhole/Access (Y/N) "P u m.p..O n"~eJ.~..~ __ "Pump Off" Level at High Water Alarm Level at%_ Vent (Y/N) _ ~~ Pumping Cycles during Adequacy Test. Tested for ~emtSmeMntCsA Electrical Codes (Y/N) **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eat~;~ '~['¢cr~ .~.!~a 99577 Receipt No. Date of 'ayment ^mount: 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ANCHORAGE WESTERN DISTRICT OFFICE 3601 C f~TREET, SUITE 322 ANCHORA(;E, ALASKA 99503 O~tober 24, 1989 563-6775 Mr. Roger J. Sharer S & S Engineering 1'1034 Eagle River Loop, Suite 204 Eagle River, AK 99577 PWSIDI fl211431 According to the records on file in this office, the Dawn Water System is in ¢~ompliance wi~h the State of Alaska Drinking water Re~ulationso Vera E, Craig ..~. Environmenta! Field Officer VEClbas 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 1. GENERAL INFORMATION (a) Legal Description(include: ,~"?~ >/~l°t'~'bl°ck'/~"¢ ~.,,¢.-~ 42 I,/¢'subdivisi°n' section,/,.~,¢> ~¢ ~'t°wnship' range) Location (address or directions) (b) ApplicantName%¢~_~'~4 Telephone: *om~:~'2~/V Business ~¢¢¢¢oo Applicant Address I OCt ~%~Ao~ ~V~ .~g, ~O~ (c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other~(explain); (d) Lending Institution _ //"'/~ Address Telephone (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the lollowing address: $ & S Engineering TYPE OF RESIDENCE Single-Family/- Multi-Family.~["l Number of Bedrooms ~ Other WATER SUPPLY / Individual Well El' Community F1 Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL OnsiteJ~ Public[] 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 f11,84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 end 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection, Name of Firm $ 8, 5 E.,"~]hTeorinrj Telephone Address SRB 196x Eagle !~iver, ~lasI~a 99577 ,2., "2_ 9_ - ~' ~- Date - Approved for ~-~'2.L bedrooms 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 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 MUNICIPALITY OF ANCHORAGE (MO~,i HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: WELL DATA Well Classification _ ~.t~L. te.- Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~..D~ t"~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~ ('~ If~) B. C. D.E.C. Approved~N~ Date Completed Yield D,[~,,of Grouting ~'/I/~ Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed .~2. /" Standpipes ~ Air-tight Caps,'N) 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,";,m/Service Line Course Size /0('..~0 No. of Compartments ~ Foundation Cleanout,~) Date Last Pumped ~_2~, J ~....~ ~ ~//~ ; for /'J',~' Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 'Fo Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ ~'-'O~ / ~ fL_ Type of System Design Date Installed ~)~"~' \ "~-- Length of Field Width of Field 3C)¢' Depth of Field El Gravel Bed Thickness ~_,~,~ Square Feet of Absorption Area ¢'~)~ Standpipes Present (~1~ Depression over Field (N~ Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~_~::~(.~ I,P' ~"~¢.,41..~Z..1 4.. To Property Line To Building Foundation ~ To Existing or Abandoned System on t~ J/k-- ;On Adjoining Lots ,~O I-~ To Cutbank (if present) Lot To Water-tV~/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. 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) /1,~//"Pump Off" Level at Vent (Y/N) //~ Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Date MOA $ & S Engineol'it~g Signed Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) BIlL SHEFFIELD, GOVERNOR ANCltORAGE/WESTERN DISTRICi OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 Telephone: {907) Address: 274-2533 To Whom 'it May Concerti: /~.~r."L~,'~ J'//'~) Water System is in compliance with the State Drinking Water Regulations APPLIL ,NT:. FILLS OUT UPPER ONLY ~roperty Owner ~.~(_~L~d..\ ]~x _~ J~[~, I ~i) 4!( ~ .' Phone Buyer '. ~.~ f'-L Address Zip Code Lendinglnstitution ~ ),~. ~.~-'c~¢1,~.{, }~_~. ,J!,,F{~ Phone Address ~;.~ ....;' ~--~.~ Zip Code ~ealty Co. & Agent ~/~/~ Phone Address Zip Code Street Locatio~/- ^(,'~.~,(,,,/(r ~ _ Ty,~ of Residence ~J Single Family [] Multiple Family No. of Bedroorrks [] Other Wat§r. Supply ~J~uJ:t~i~t~a~ ATTACH WELL LOG. A we~l log is required for all wells drilled since June 1975. For wells drilled prior lo that date, give well depth (attach log if available).  Community Peblic Utility Sewer Disposal 1:~ Individual Year Individual Installed:_ Public Utility When Connected to Public Utility: E3 Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector "Municipality of Anchora,2¢" "Dept, of Health ( .,~ APPROVED BEDROOMS ~ 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' © Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72 023