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HomeMy WebLinkAboutMCKINLEY VIEW ESTATES BLK 1 LT 1Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201289 PID Number: 051-792-01 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name David and Sonya Wagoner ABSORPTION FIELD ❑® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound site Address 22568 Centurion Dr Chugiak ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade q ,8p?" GT 0.6 GPD/SF 8.4 - 9 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.4-4 Ft. Gravel depth beneath pipe 5 Ft. Subdivision Block Lot McKinley View Estates 1 1 Fill added above original grade 0.6 Ft. Gravel length 100 Ft. Township Range Section Gravel width 3 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding I Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1000 Ft, 2 11.5 Ft. Well > 100' > 100' NA NA >25' TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water > 100' > 100' NA NA Material Number of compartments Lot Line > 10' > 10' NA NA NA plastic 2 Foundation > 10' > 10' NA NA L STATION Manufacture Capacity Remarks 4 bedroom system, valve was turned to drain Gal. house to old trench Alarm location Electra I-:. tailed by PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer JRs Septic Drainfield 3034 CO/MT 3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspeection 9/14/2020 1m 9/11/2020 Location and description ction 2�d 3'd 9/15/2C6 41110/26/26 bottom siding point A ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp AL���4 Conditional Approval: Date e e o o � p,• �(�nntZTOWnSB ¢� 9�c+' Date��/ Septic Syste mOFESSO0 Approved lit/ Date 2FppR too. CE 11., � f Note: this approvales not include well permit requirements. kmtev uofuu ion DESIGN PARAMETERS BEDROOM: 4 (600 gpd) SOIL RATING: ASSUMED 0.6 GPD/SF AREA REQUIRED: 1,000 S.F. SYSTEM TYPE: DEEP TRENCH 100' x 30" x 5' EFFECTIVE DEPTH YIELDS 1,000 SF EXISTING 108' x 3' x 5' EFFECTIVE DEPTH TRENCH z w M w V) w w z 0 x Li a J W 0 z Q J U U U w w 1250 G TANK-- / � DIVERTER VALVE DCO — — TH1 M T1 SPLITTER VALVE —� f 29 F -- SLOPE 29% 12 T2 T CO3 TH 3 LSLOPE L SLOPE 10% NEIGHBORING SEPTIC IS >10' FROM PROPERTY LINE THIS LOT AND ALL NEIGHBORING LOTS ARE SERVED BY A COMMUNITY WATER SYSTEM AND THERE ARE NO WELLS WITHIN 100' OF THE SEPTIC SYSTEM DECK IS/< 30" IN HEIGH 3 BEDROOM HOUSE Z /"--- 10 B SLOPE 2% 100' x 36" x 5' EFFECTIVE DEPTH TRENCH, (2) 50' LONG TRENCHES CONSTRUCTED BM IS BOTTOM OF SIDING HOMESTEAD ROAD AT POINT A, ELEV 100' Septic Record Drawing Prepared for DAVID AND SONYA WAGONER 22568 Centurion Chugiak, Alaska 99567 MCKINLEY VIEW ESTATES BLOCK 1 LOT 1 EKLUTNA ENGINEERING, 19162 MOUNTAIN ROAD CHUGIAK, ALASKA 99567 (907) 355-9820 Gy s 0 / SCOPE OF WORK 1. REMOVED EXISTING TANK. REPLACED WITH NEW 1250 GAL TANK. THE TANK WAS PROVIDED WITH A MINIMUM 20" 0 MANWAY RISER SERVING THE FIRST COMPARTMENT. 2. CONSTRUCTED NEW TRENCH HAVING DIMENSIONS OF 100' x 30" x 5' EFFECTIVE DEPTH, BROKEN INTO TWO SECTIONS. MAX DEPTH OF EXCAVATION WAS 9'. 3. SLOPE TO DITCH ALONG OBERG IS 29% SLOPE. DROP IN SURFACE HEIGHT IS < 10' BELOW INVERT ELEVATION OF WEST TRENCH. TRENCH IS > 20' UP -GRADIENT. 4. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. OSP201289 LLC DATE: 2/16/2021 DRAWN: CLT SCALE: 1" = 30' PID: 051-792-01 SHEET 2 OF 3 50' x 3' x 60" EFFECTIVE DEPTH TRENCH, WEST MARK A B C D w0 J z N Q 12'-4" W N > O J 0 c.) 7.3 vii 2" INSUL 10'-5" 19'-5" C01 l 94.8 1250 GAL CO2 SEPTIC TANK 72'-9„ 50' x 3' x 60" EFFECTIVE DEPTH TRENCH, WEST MARK A B C D SV1 12'-4" 15'-9" SV2 10'-5" 19'-5" C01 26'-6" 56'-9" CO2 55'-11" 72'-9„ CO3 52'-7" 63'-10" C04 11'-10" 41'-11" Septic Record Drawing Prepared for DAVID AND SONYA WAGONER 22568 Centurion Chugiak, Alaska 99567 MCKINLEY VIEW ESTATES BLOCK 1 LOT 1 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUGIAK, ALASKA 99567 (907) 355-9820 50' x 3' x 60" EFFECTIVE DEPTH TRENCH, EAST 95.5 OG GM 80.5 TEST HOLE DUG 7/22/2020, WATER LEVEL MONITORED TILL 7/29/2020. NO GROUNDWATER PRESENTED ITSELF OSP201289 DATE: 2/16/2021 DRAWN: CLT SCALE: 1 1/2" = 1' PID: 051-792-01 SHEET 3 OF 3 ®�P�E OF ® 49TH �............... . �...................... � B� : CURTIS TOWNSEND.T Giv ® ' No. E 11904 'X ® {`' lk 30' CD 0 0 N CL! C'7 oD 0 O MA +' e 1A LU W as r a S 7�p43 S2� E Raised / Garden 194.2 j, 6'xB' -, Shed 10'x1 / 4.5' Deck PvM t / �ault I C Iss / I LOT 1Yard c / BK 1 Light t W Septic lam/ Pipes I f I I L J Water Key a� \q q�' O O q RISO Uq, �/ R= 225,00' L= 102.58' z Q H L L 1 FD RBR �- N 0°07'15" W 10,60' ber TV FD RBR 15' T&E Esmt Optic�n.ped R= 20,00' — _ Vault dzS R= 20,00' 31,42' L= 31.45' FD RBR S 8952'45" W 102.92' FD RBR L= 0 co WEST HOMESTEAD ROAD OF ; ''t►I I hereby certify that I have surveyed the following described property: Lot 1, Block I, McKinley View Estates Subdivision, Plat No. 82-225, Anchorage Recording District, and that no encroachments exist except as indicated hereon. This As -built will only show the easements that appear on the recorded subdivision Plat No. 82-225, Anchorage Recording District; under no circumstances should this data hereon be used for the construction or establishing of boundary or fence lines. 0 20,w McKinley View Estates Subdivision ASSUILT SURVEY Lot i Block 1 David & Sonya Wagoner SCALE IN FEET .AS Depicted on: Plat No. 82-225 22568 Centurion Drive 1"= 40' Chugiak, Alaska 99567 Anchorage Recording District Surveyed: Sept. 29, 2020 GRID: NW1459 DRAFTMRM '1 9TH ..:: ,.... .........f ��� • Anthony P. Boneto LS -10393 q ' /,i/o lg� gip. 'p rrltttt\t\���� APS Land Surveying 12204 East Prince of Peace Drive Eagle River, Alaska 99577 (907)227-1361 �v S Septic Pipes Wood Fence 2�, 19 Total Septic / 30 Pipes S U Septic / Pipes FraMe jg' / House 194.2 j, 6'xB' -, Shed 10'x1 / 4.5' Deck PvM t / �ault I C Iss / I LOT 1Yard c / BK 1 Light t W Septic lam/ Pipes I f I I L J Water Key a� \q q�' O O q RISO Uq, �/ R= 225,00' L= 102.58' z Q H L L 1 FD RBR �- N 0°07'15" W 10,60' ber TV FD RBR 15' T&E Esmt Optic�n.ped R= 20,00' — _ Vault dzS R= 20,00' 31,42' L= 31.45' FD RBR S 8952'45" W 102.92' FD RBR L= 0 co WEST HOMESTEAD ROAD OF ; ''t►I I hereby certify that I have surveyed the following described property: Lot 1, Block I, McKinley View Estates Subdivision, Plat No. 82-225, Anchorage Recording District, and that no encroachments exist except as indicated hereon. This As -built will only show the easements that appear on the recorded subdivision Plat No. 82-225, Anchorage Recording District; under no circumstances should this data hereon be used for the construction or establishing of boundary or fence lines. 0 20,w McKinley View Estates Subdivision ASSUILT SURVEY Lot i Block 1 David & Sonya Wagoner SCALE IN FEET .AS Depicted on: Plat No. 82-225 22568 Centurion Drive 1"= 40' Chugiak, Alaska 99567 Anchorage Recording District Surveyed: Sept. 29, 2020 GRID: NW1459 DRAFTMRM '1 9TH ..:: ,.... .........f ��� • Anthony P. Boneto LS -10393 q ' /,i/o lg� gip. 'p rrltttt\t\���� APS Land Surveying 12204 East Prince of Peace Drive Eagle River, Alaska 99577 (907)227-1361 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:/Iwww.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201289 Work Type: Septic Upgrade Tax Code Number: 05179201000 Site Legal Address: MCKINLEY VIEW ESTATES BLK 1 LT 1 G:1459 Site Mailing Address: 22558 CENTURION DR, Chugiak Owner: WAGONER DAVID S & SONYA G Design Engineer: EKLUTNA ENGINEERING, LLC" This permit is for the construction of: R1 Disposal Field El Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration date: »>C_nr [ U � Dopa rtntent Lot Size in Sq Ft: Total Bedrooms: 8/14/2020 8/14/2021 31265 ❑ 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 (2417). 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 Received B Issued By: y: Date: 4 /L Date: 4 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 051-792-01 Property owner(s) WAGONER DAVID & SONYA Day phone Mailinq address PO Box 670055 Chugiak AK 99567 Site address 22568 Centurion Dr Chugiak Legal description (Sub'd., Block & Lot) MCKINLEY VIEW ESTATES BLK Legal description (Township, Range & Section) Lot Size 31,265 Sq. Ft. Number of Bedrooms 4 1 LT 1 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) 0 (w/ o' D Septic Tank M Upgrade Fx� Duplex (D) ❑ Holding Tank ❑ Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the abov info ation is correct. I further certify that this is in accordance with applicable Municipal d . (Signature of property owner or authorized agent) Permit/Rush Fees: q4L' 25 Date of Payment: + Receipt Number: Permit No. C_bV lb -f ?) Waiver Fees: _ Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201289, Deb Wockenfuss, 08/14/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201289, Deb Wockenfuss, 08/14/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201289, Deb Wockenfuss, 08/14/20 Municipality of Anchorage Page ( 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: •vI -7-"Z''11 fit' PID Number b I -1-1.7---e-) / Name Wastewater System: ❑New El Upgrade Address: 2�U%j� C44-r�.E�-L'ta2 . �I�i �{�- ABSORPTION FIELD Phone © (p j .2_60No. Bedrooms of Bdr _X-0eep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating D GPD/Sg. Ft. Total Depth from original grade:,"- Lot: ( Block: I 1' Subdivision: -1 hi i.-6.-•-/ V IEa) .. Depth to pipe bottom from original grade: 51 - 2 Ft. Gravel depth beneath pipe / (- Ft. Township: Range: Section: Fill added above original grade: Li - 2-1 Ft. Gravel length: ice--F- ceFt. WELL: ❑New El Upgrade WELL: Gravel width: d F Number of lines: Distance between lines: 2- / Ie, F L t. Classification (Private, A,B,C):Total Ce 1r-1 a r-4 r -- Depth: Ft. Cased To: Ft. " Total absorption area: lte© SQ. Ft. Pipe material: 1 V —i ae2-� p4rrll,—. 3o .4-r�JG Driller: ( Date Drilled: Static Waler Level: FL 1 staller: p.., 1`l &AcksI t 1 Y"M G%A' ate installed: 2�� Yield: GPM Pump Set at: Ft. Casing Height Above Ground: Ft. TANK SEPARATION DISTANCES .: eptic ❑ Holding ❑ S.T.E.P. To From Septic Tank Absorption Field Litt Station Holding Tank Public/Private' Sewer Linesi4i,l Manufacturer: I/ r ., r-r,,rr"(r— Capacity in gallons: t •"z/ Well 2400 f'f 2-,Z) fi _'- ..Z4 t 1-- . Material: ; g.•6.Lr- Number of Compartments: Surfacer Water 1 DO --1-I� "I" o r LIFT STATION LiLnne (D'4- Iorf -- Size in gallons: Manufacturer: Foundation 1 2- f -20G ._...--- "Pump on" level at: "P -. alt" level at: High water alarm at: Curtain Drain . 10_ '�-t 1�-� r 0 �/ `--/�-� ,d,� Pump - - : Model Electrical Inspections performed by: - Remarks: BENCH MARK Location and Description: P6e-1 .6-'12--P P. ----C‘ tT i..(. .e A-SFpj0-r-re 1 c - Oz9'(7 c, ,;--9 1"--1— Assumed Elevation: ENGINEER'S SEAL G )> �r er��,Rt�r(="r�,, ;« S & 5 ENGINEERING 17034 Eagle River Loop Road, No. 204 �3 Inspections by: Dates: 1st `--ZCo performed Department of Health .d Human Seryaces approval � �% �( Date: � Reviewed and approved by: - :r' !�= ,F(i,, 72-013 (Rev. 9/91) MOA 25 Permit No SW920416 Page 2 of 2 Municipality of Anchorage 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 Legal Description: MCKINLEY VIEW ESTATES SUBDIVISION BLOCK 1, LOT 1 PID N0' 05179201 Co1 CO2 SCALE 1" = 10' A B C01 CO2 CO3 C04 C05 MT1 MT2 C06 50' 51.5' 42.5' 54.5' 56.5' 41.5' 56.5' 63' 26.5' 32' 95' 47.5' 101' 92' 99' 55.5' C06 FINAL GRAD INSULATION T2 C05 C04 CO CO CO2 NEW 1250 GAL col SEPTIC TANK 6 3D' A B 42 TBM (BOTTOM OF DO I R) 4 BDRM HOUSE SCALE 1' = 40' 82.9' 82.9' • 76.9' NO WATER FOUND EW TRENCHES ENGINEER'S SEAL 72-013 A (Rev. 9/91) MOA 25 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 PERMIT PERMIT NUMBER:SW920416 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:KRUEGER BERNARD A & LORRAINE OWNER ADDRESS:23847 CHANDELLE DRIVE CHUGIAK, AK 99567 PARCEL ID:05179201 LEGAL DESCRIPTION: MCKINLEY VIEW ESTATES BLK 1 LT 1 LOT SIZE: 31265 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED:12/13/92 EXPIRATION DATE:12/13/93 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: 1/ f 1///( ISSUED BY: r' C` �-fti�-'CL c ``. DATE: 212 r 4-12-93 R.)' fH,TFER CALLED 19NP i s 60/NO r0 us4- 414 TER/1"iliE s17E /t2m ORi6iNtft 5 Pric 1757-E/ „„ r s/ /9 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGERSHAFER, P.E. December 7, 1992 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 REFERENCE: McKinley View Estates Subdivision, Block 1, Lot 1 We request you issue a permit to install a septic system to serve the proposed 4 bedroom house on the referenced property. Two test holes were excavated and percolation tests performed on the property. The approximate location of the test holes are located on the attached site plan. This property is served by a Community Water System. There are no community well protective radii which encroach upon the property. As can be seen from the site plan this lot has enough area for another future septic upgrade. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Sincerely, Roger J. Shafer, P.E. RJS/LSU/lsu 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 m WEST HOMESTEAD ROAD r O co -10 h. 0 � 0n2rn ko 0 0 cn ")- (r.; y rrl(1) rri O r O ti Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: U4 -t-• 11 R -oz 1.44 - DATE PERFORMED"kHv<',..�. LEGAL DESCRIPTION:\ r6)1, t�t� f V\ lL-t rll—� Township, Range, Section: SLOPE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17- 18 19 20 E DR- b1 r oc/ , / a ' / • / r I ®, COMMENTS L per. \Li e. -s -r. WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S 1 L (�1 t� O tom^ P E Depth to Water Atter 1 9 2 Monitoring? ik Date 2A' SITE PLAN to N 1, 1 Reading Date Gross Time Net Time Depth to Water Net Drop ?V- aozlt-..J L. t?G4-k® D i e -2o -g2 1-1-,,e, — Vie." "'-' M .4u t,› 1.....a 1" +/9' 3 1 2, 4'0 N 36.14 " SIL " s v V.t 0 " '95704 `la" PERCOLATION RATE ZD (minutesiinch)) PERC HOLE DIAMETER TEST RUN BETWEEN 4 FT AND 7 FT PERFORMED BY: S & ING',NEFRiNG 1 11 CERTIFY THAT THIS TEST WAS PERFORMED IN 7034 Eagle River Loop Road No. 204 19_2.1 `( ACCORDANCE WITH TOfF„�iNRliykt119ey.3UIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Rev. 4/85) �i PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: ✓Oi 1 1'L -4L ` V1JLE_{ Township, Range, Section: SLOPE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 • .o w • b , • /. 17- 18 19 20 COMMENTS (.9`t 67(2- WAS GROUND WATER ENCOUNTERED? IJ(.% S IF YES, AT WHAT ✓,I p DEPTH? P E Depth to Water Alteril Monitoring? Date 5 /2-4) 12 SITE PLAN T N 4 tti L V Per Reading Date Gross Time Net Time Depth to Water Net Drop i79-406. -'11-1wi 0, V6s R®1®D t eb- -o_1� t2.°35- —�- 02: `,-- 'V41- tC7 ,n,1- 541z• i" `17 rt -s. • M 554,," "lig" 1 '.1 5 r S" t i.2." te. 1\-1- - ?µ tly:- '1 4 1...,s-- " 5 " 'ix. - PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 4 FT AND 'J FT PERFORMED BY 5 & 5 ENGINEERING 1 (----2---(p CERTIFY THAT THIS TEST WAS PERFORMED IN :7034 Engle River Loop Road No, 2t54 ACCORDANCE WITH pt ri.IST ,6094401§4I?,t1,7GUIDELINES IN EFFECT ON THIS DATE 72-008 (Rev. 4/85) 2.1 DATE Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. ' •' P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AU T FIORITY APPROVAL I -OR A SINGLE F=AMILY DWELLING Parcel I.D. 051-792-01 1. GENERAL INFORMATION • Complete legal description Lot 1; Block 1; McKinley View Estates S/D Location (site address or directions) •.22568 Centurion Dr Chugiak, AK Current Property owner(si Shirley Ronningen Day phone 552-3132 HM# 8-3")-4-1 0 -50q -24P Expiration Date: R - Q2 7- 01 - Mailing address Lending agency . 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: 4 PO Box 671854 Chugiak, AK 99567 3. TYPE OF WATER SUPPLY: ' • Individual Well Individual Water Storage Community Class A Well Public Water System 0 WIZ 3 TYPE OF WASTEWATER DISPOSAL: Individual On-site E Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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 tor 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,irispection,- the on-site water supply and/or w wastewater disposal system is(are) in compliance'ith all .appfic able Municipal and State codes, ordinances, and regulations in effect at the time of installation. ' • • • Name of -Firm S &. S. Engineering 'Pitilif- 694-29-79 Address 17034 N. Eagle River 'LP'RD; 'Eap1e"Ri'vei-•, AK 99577. Engineer's Printed Name Robert C. ''Cowan Date 8/•.1/ 5. DSD SIGNATURE '' !! Approved for `i- bedrooms. • Disapproved. . • ;. OFA • j''# ROW.C.COWAN..:�4C✓ cE -8801 .',�',� Conditional approval for ' • bedrooms.: with the following' stipulations; t.♦1. t Additional Comments' `l`tt((ftfftOfFfrij��v• Q •• Jam: ON•Sl l.t • .�� WATER AND ... m. WASTEWATER : PROGRAM • _. By: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory .Other (Rev. 01/02) / �' , f Original Certificate Date: g - 2_.7-03 .. /.., Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.clanchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lor 1 ' at—OC—V. I ; I/I LelrLelC K I n! ,—V ( A. WELL DATA CIA) &T Well type A Date completed _ Sanita -eal (Y/N)_ Wires properly protected (Y/N) Total depth ft Ca --d to ft. Casing height (above ground) Parcel ID: O$! —q12- 2- 0 / If A, B, or C provide PWSID # 21O47 .7" Well Log (YIN) Date of test . i Static water level Well production WATER SAMPLE ' SULTS: Coliform Arsenic: mg./I. B. SEPTIC/HOLDING TANK DATA /� / Tank Type/Material ' /P 1 L 171L Tank size (e2—lb gal. Number of Compartments Foundation cleanout (Y/N) `r Depression over tank (Y/N) /J Date of pumping 0 ( (n3 C. ABSORPTION FIELD DATA 3 Soiflrating (g.p.d./ft2 or ft2/bdrm) !/ FROM LL LOG AT INSPECTION ft. g.p.m. olonies/100 mi. Nitrate mg./I. Date of sample: Pumper TR is ft. g.p.m. in Other bay eria colonies/100 ml. Collect d by: Date installed 4 f 2 , iqs Cleanouts (Y/N) High water alarm (Y/N) Date installed Length SUB rrL ft. Total depth F3.y ft. Date of adequacy test Width System type L . 7 -e°-NC ff ft. Gravel below pipe • ft. Eff. absorption area /tft2 3 Monitoring tube V Depression over field AJ Results (Pass/Fail) P/� �S For 4 bedrooms New depth in. Absorption rate >= �p dd g.p.d. 1 ' Fluid depth in absorption field before tests in. Water added4/6 added,/6gal. Elapsed Time: / 5 in. Final fluid depth 2� Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date �' D. LIFT STATION Date installed "Pump on" level at Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line SEPARATION DISTANCES FROM SEPTIC/HO Size in gallons Manhole/Access (Y/N) "Pump off" level at _ in. High water alarm level at Cycles tested Meets alarm & circuit requirements? Building foundation Water main 10 1.4 - Property line 0.A2ft-tM1-1N, r On adjacent Tots On adjacent lots Public sewer manhole/clea .ut Holding tank in. G TANK ON LOT TO: Water service Zine 1 � ! Absorption field '1 - 10 Surface water / GID /— Wells on adjacent lots 1,00 4 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 0 14-- Building foundation 1 0 '4-- Water main / 0 11- Water Service line 1 ,0// {- II Surface water / Ol f -(- Driveway, parking/vehicle storage 1 01+ Curtain drain /Jd1J6 KiJ DV)AJ Wells on adjacent Tots -f- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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. 2613'-21- C. Cu,,,.i Engineer's Printed Name Date Caa.1103 .....w ... A��Stt1�k % e:<...., :or "4/ ri s 1 ROBERT C. COWAN i �- v �Ofr CE - 8E0 1 r`{``✓ tl�1,.ti..!' N t <Y. -•.:s --:- HAA Fee $ 3 75'. "J Date of Payment Receipt Number OW O 5-7-7 (Rev. 12/01) /tea -/o 3 a. • Waiver Fee $ Date of Payment Receipt Number CVOCV3LS3WOH 'M 30 30 w U ni.S .zs.sa OC)ERG ROAD N IX)°UI'32'W 210.00' 15' ELEC. Il TELE: EASEMENT 8 0 15' ELEC. a int. EAsEbrENr co ;oro, A- 102.5E1' N CCNTUR1,1 V F U1 O Fpc- „Loi; -1 9 6, c f1 Eci2,1 to - g118(03 N r r x x U f0 NO1 m Gans (r r n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH 8).. HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I D # 051-79201 HAA # 1. GENERAL INFORMATION Complete legal description Lot 1, Block 1, McKinley View Estates Location (site address or directions) 22568 Centurion Drive, Chuaiak, AK 99967 .Property owner Bernard Krueger Day phone Pager ,°267-7a69 Mailing address - 22568 Centurion Drive, Chuaiak, AK 99567 Lending agency Day phone Mailing address Agent a - • Day phone 694-4200 AddresQ 16600 Centerfi.eld Drive, Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 1UILDE 3 OF BEDROOMS: iiS: `''V19E7 J's' WATER SUPPLY: Individual well Community well Public water 4 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 Public sewer xxx 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 Hy' STATEMENT OF INSPECTION BY ENGINEER 1\:-; rertified by my se J �rfi)Y,r (I E1 ' fo mid as of the validatior) d Lu :,iu)wn bciow, I vor ify iiIA 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. 1 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. s a? s ENGINEERING Mame of f=irmor IvLoop Phone ( p Road No. 204 Address l;agle River, Alaska y957.7 /T t T Engineer's signature s —! Date L'A ] lS SIGNATURE Approved for ) bedrooms. Disapproved. Conditional approval for /62 • ''a:W ,N C -18301 bedrooms, with the following stipulations: Additional Comments /.0 Date -7".> 7-- 61 `6 C AU`lrioN,p.- b 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 ars 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) Buck MOA 021 t ECEIVED Municipality of Anchorage JUL 21 1998 DEPARTMENT OF HEALTH & HUMAN SERVICES ANCHO Environmental Services Division VIROMUNICIPALITYTAI $E V10ES NVIR®NMENr/1 ERVICES D 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Lor- Legal Description: 11/ i' Nz. Y R FG °''/ U_ 5 7 TES Parcel l.D.: 0 5✓/ 7q -5/ A. WELL DATA Well type G Ar' S 4 If A, B, or C, attach ADEC letter. ADEC water system number a R 0 6 cf 7 Log present (Y/N) Date completed Total depth Cased to Cas 's.' eight (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAM RESULTS: Colifo Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed L//0- 7 /9 3 Tank size ' ' U Number of Compartments Cleanouts I/N) Y t J Foundation cleanout N) "j Depression (Y/61 '. 0 High water alarm (Y1 ✓/ 0 Date of Pumping ,7' /0 / 9 S Pumper k S P ''' P,.0,1(/ C. ABSORPTION FIELD DATA Date installed / 7 ! Soil rating g. .d./ft2 or ft2/bdrm) 0 • System type 1' "� !' a Length / 0'CS )or' L Width 3 Gravel thickness below pipe "S Total depth ` i ° Effective absorption area / 0 F 0 i-' Z Monitoring Tube present N) Yes Depression over field (Y No Date of adequacy test -7/ P 3 / `f Results (Pass/Fail) 0 �f- S J For ' "7 bedrooms Fluid depth in absorption field before test (in.); I . S 11 Immediately after -76/ gal. water added (in.): 3 r �i ' Fluid depth S (ins) Minutes later: ''/ ° Absorption rate = �G> 0 g.p.d. Peroxide treatment (past 12 months) (Y/N) Ne:i<"JO ° "I If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) "Pump on" level . ' "Pump off" level at* High water alarm level at* Cycles E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: C'o y l r9 7 E Septic/holding tank on lot On adjacent lots Absorption field on lot in-adjant lots Public sewer main — Public sewer manhole/cleanout Size in gallons *Datum Sewer /eptie-s ry a line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ) Property line Jo Absorption field Water main/service line / 0 -1' Surface water/drainage 0° f Wells on adjacent lots 0 0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line % 0 �- Building foundation 9"o t Water main/service line / 0 4 f Surface water / o o + Driveway,3 0 parking/vehicle storage area Curtain drain u °'' - cc A/C id rs) Wells on adjacent lots 0 u "-,1_ F. ENGINEER'S CERTIFICATION em` F q qg! I certify that I have determined thru field inspections and review of Municipal reco lri L#t2' a'brw4-14,17 s are in conformance with MOA HAA guid lines in effect on this date. or (-7 / 1 Signature Engineer's Name X0,0 Q " (. C L./ Ais) Date 7()-0/01 U,c..�.. r.A ROBERT C. COWAN hC ? f'f:' CE-aaoi �{\v J ?`4 #4t�� Li''hb1ESS�u+\k �k HAA Fee $ Date of Payment //2c,/ Receipt Number ,✓�. � 1 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number