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HomeMy WebLinkAboutMCKINLEY VIEW ESTATES BLK 2 LT 11 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 Nome: ~pgrade ~/~//~/~. ~ Wastewater System: D New Address: J Z25~5' ~/~[~/. ~ ' ABSORPTION FIELD Phone: ~ ~ ~ ~N ~ Deep Trench ~ShallowTrench ~ Bed ~ Mound ~ Other Total Depth from original grade: LEGAL DESCRIPTION SoilRating: ~, ~ GPD/Sq. Ft. ~/~ Lot: ~/ BIock:~ ~/~/~' ~ub~iv~ion~/~ ~ ~ Depth~/~t° ?pe bottom~ ~ ~,~'fr°m original grade:/~Ft. Gravel depth beneath P~P~" ~ Ft. Township: ~ Range: ~ion: Fill~k//¢~/,/added above__ ~. ~°riginal grade: Ft. Gravel~.~_length:~ ~.~ Ft. WELL: ~ New / ~ Upgrade Gravel width: Number of lines: Distance between lines: Classification {Private, A,B,C): } ~ /Total~-~ Cased To: Total absorption area: Pipe material: ~'~/~ Yield: .~-~- Pump Set at: Height Above Ground: TAN K ~ GPM Ft. Ft. SEPARATION DISTANCES ~septic D Holding D S.~P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank S .... Lines ~ ~ ~ Well- Material: Number of Compadments: Surface / w~t~ /~ ~ /~ ~ ............. LIFT STATION Lot , Size in gallons: I ~'cturer: Cu,ain , Pum~ & Model I Electrical Inspections p:~ bY: Location and Description: Inspections pedormed by: /¢~/~ ~n~/~d~' ~'~¢Z Dates: 1st ~~,~.~ epar m nt o, .ea,th ,_ and .uman Se. ces ap ova, 72~013 (Rev. 9/91) MOA 25 AS-BUILT SYSTEM DETAILS/SITE PLAN Permit SW980241 McKINLEY VIEW ESTATES BLOCK 2, LOT 11 PI98051 792-15 / SCALE Y' = 50' ~-C=54,5' s ~o~ ~ A-$=47,l' N [ TANK J SEWER ROCK a-E=72,2' ~ j B E=47,a' "ONITBR TU"B ...... UT A-F=61,2' SPLITTER ~ FINAL GRADE A-G=8a,3' SEWER ROCK ~ TRENCH ~ ~ I CHUGIAK, AK 99567 ~ ,~. ~/ . /~ .~~ ~ ~;i ..... CHECKED: KMD 20441 PTARMIGAN BLVD. ~ ~0FEssiO~~ ~ 7/29/98 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 16, 1998 Expiration Date: Jul 16, 1999 Permit Number: SW980241 Legal Description: MCKINLEY VIEW ESTATES BLK 2 LT 11 Design Engineer: KND Engineering Owner Name: Terry & Laurie Day Owner Address: 22535 Centurion Circle Chugiak, AK 99567-1868 Parcel ID: 051-792-15 Site Address: 022535 CENTURION DR Lot Size: 20085 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy Private Well [] Water Storage All construction must 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. The groundwater level shall be monitored at installation. If the level is less than 10.5 feet from the original grade the system shall be redesigned with a 4.5 foot separation from that level. Received By: Issued By: Date: Date: 1[~~ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 July 13, 1998 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Sewer upgrade permit - McKinley View Est. S/D, Lot 11, Block 2 Gentlemen: On July 6, 1998 the owner had the monitoring tube/cleanout in the existing system excavated to determine the condition of the system. There was 5' of water in the system and it is in failure. A testhole was then dug for a replacement field and the results of the test are attached. The general slope of this lot is from east to west at approximately 5%-10%. We have designed our system utilizing the testhole excavated for the existing three-bedroom house. The lot is served by community water. We propose to install two 5' wide trenches with a gravel depth of 3'. Water was encountered at 11' during the excavation but during monitoring we were only able to reach a depth of 10.5 feet where we encountered mud. Total depth of the system will be 6.5' with additional fill placed over the system if necessary. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. Because the system is in failure and the family is still living in the house we are requesting your expedition review and approve of this permit application. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, ~iq~) Engineering Kenneth M. Duffus, P.E. attachments: On-Site Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test 3 WASTEWATE DISPOSAL SYSTEM DETAILS/SITE ESTATES BLBCK 2, LET 11 4 HcKINLEY VIEW LOT 12 aLL LBTS SERVED WITH CDMMUNITY Y/ATER / LOT 10 / / SEPTIC LOT gYSTEM PLaN 17 SEPTIC // ]DESIGN DETAILS S BDRM X 150 GPD = 4~0 GPD SEPTIC / / 450 GPD/O,6 GPD PER SQ. FI, (28,0 MIN/IN,)= 750.0 SQ, FT (750/5'(W)) X O,58(RF) (3,0 GRAVEL) - 87,0 FT, TRENCH USE 8 TRENCH - 43,5 (L) X 5' (W) X 3'(]3) lotcL dep~ch oF system is 6,5' Crom omigino. L gPcde, To~cl dep"ch oF grovel below di$t;ribu~cion pipe is 3,0' , NE]TLS: l, 2, 3, 4, USE 1000 GALLBN SEPTIC TANK, INSULATE TANK IF <4' CDVER, INSULATE TRENCHES WITH av HD BURIAL FBAN, CDNTRACTDR WILL ENSURE HAX~HUN 8× SLDPE INTB SEPTIC TANK, A]]3ITIDNAL FILL WILL BE ADDED DVER SYSTEN TEa ACHIEVE HIN, 3' CBVER IF REQUIRED, CBNTRACTDR SHALL VERIFY INTEGRITY BF TANK AN]} REPLACE IF NEEDED, PREPARED FDR: TERRY & LAURIE ]]AY 8~535 CENTURION CIRCLE CHUGIAK, AK 99567 (907) 688-8389 FIELD BOOKS COMPUTED: 80UNDARY: __ DRAWN: EM D ASBUILT: OWC, FILE; ACAD FILE: 98086.OWO DAZE: 7/8/98 OR,D: NWl 459 Jo~ So.: 98086 Scc~[e: 1"= 100' PAGE 1 DF 2 ~.~N~ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-61 t 1/FAX (907)696-8i]i K WASTEWAYZR I}ISPBSAL SYSTEM DET/~ILS McKINLEY VIEW ESTATES 9kBCK a~ B~T 11 NG SYST~J~d i SPLIT /// PREPARED FBR~ TERRY & LAURIE 22535 CENTURION CIRCLE CHUGIAK, AK 99567 (907)688-8329 FIELD BOOKS COMPUTED: BOUNDARY:__ DRAWN: EMD STAKING: CHECKED: K MD ASBUILT: DWG FILEt ACAD FILE: 98086.DWG DATE: 7/8_/98 CRUD: NWl 459 Jo. No: 98086 Sec[e: 1"= 20' PAGE a DF 3 ~(H~ LNGINEERING~ 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8?36 I (907)696-61 i 1/FA× (907)696-8111 20441 PTARMIGAN BLVD. EAGLE l, uvb:v,, Ai-,. ~D77-?57,.50 SOILS LOG -- pEfl~OL~TION TEST ED FOR ~/~' I~,, DATE PERFORMED: PERFORM :__ ~ Gross Net Depth to Net ReadingDate Time Time Water Drop I '7-7-~5 /o',/~ ~ z ~ ~ Io,'q~ -- ~" -- ~ l/:97 ~o~,'~ ~ ./~Za." 2 3 4 '~/ 8 10 PERCOLATION RATE --~) [m,nutes/,nch) PERC HOLE DIAMETER TEST RUN BETWEEN /~ FT AND'~ FT ENCOUNTERED? _ . _ 11 12 13 14 15 16 17 20- Depth to Water A~er Moniloring? -- /~/ Gross Net Depth to Net Reading Date Time Time Water Drop ' 1/,' Z/ 30 ~,k~ ~/~; ' ' ~/ ~ /" ~taJ' ACCORDANCE WITH ALL STATE AND MUNICIP~GUIDELINES IN EFFECT ON THIS DATE DATE: 72-008 (Rev. 4/85) ~UN~C~PALITY OF Ai'~C qORAGE ENVIRONMENTAL EklGiNEERH~G D~V]StON 825 L Street- Anchorage, Alaska 99501 Telephone ~64-4720 ,¢Y,.-~' ~;M AND/O~'~ WFLL ~NSPECT~ON REPORT ON-SiTE SEWAGE DISPOSAL © e ": .... LOCATION ~ ~ I Manufacturer iAb~°rp~ntrea NO, OF BEDROOMS i~aa~ j No, o~rtments Widt~ - Liquid c~pt h - DISTANCE TO: IF HOMEMADE: Well DISTANCE TO: Wel ~ C~ No. of lines Length of each line Topof Length Type of crib Width Crib diameter Inside length OTHER SOIL TEST RATI G :~ DAT~, LEGAL Building foundation Sewer line DISTANCE TO: Well Building foundation DISTANCE TO: Class Depth Driller Crib depth  Tota) effective~abs2rption area st lot line ~'-~o ~' i~-~e T'~'R M IT N O. j Se~t~-c t~nk 1Absorption area(s) I Dwelling PERMIT NO.  MaLerial Liquid capacity in gallons Found~ / ~ ~l~are~'-Io [ lithe I ~'~'~M.L~-.L~O-~ -- ~'~ Total length of I~]es / Trenc~d~ I Dista~ce~%t~ lines ~ ~ inches ~ ' ~;~'~ beneath tile~ -- ¢ ' -~Tota, effect~ absorption Depth I PERMIT NO. [:,EPRRTMENT t NEF~LTH FiND ENVIF..:ONMENTEIL ..OTEC.['ION 825 '"L" STREET., FINC!iORRCiE., RK. 9950i 264-,::,t720 ,Z} P",~ .... :ES Z '%' E ':'E~; EEC ~.,.~ EE F:: F" EiZ F~: ~""1 :.~: -F 8!:0035 ) F:IF'F"L l CFtNT L OC':t::IT I 0 t",1 LEGFtL STEVEN L. SKRGGS P.O. LO]" ii E:LK 2 MCKINLEY VIEW EST BOPHD. CHUG IRK LOT SIZE 688.-2831 2i:0000 SQI. JRRE FEET TYPE OF SOIL FiBSORPTION SYSTEM IS: TRENCH MFIXiMUH NLIMBEF.': OF BEDROOMS SOIL RRTtNG (SQ FT/BR)= 1.25 THE REQUIRED SIZE OF THE SOIL RE:SORPTION S"r'STEM IS: THE LENGTH DIMENSION IS THE LEIqGTH (IN FEET) OF THE TRENCH OR [:'RRIf',IF'IEL. D. THE DEPTH OF R TRENCH OR PiT IS; THE [:'ISTFtNCE BETWEEN 'THE SURFFICE (:IF:' 'THE ii[el .NE' FIN[:' 'THE E:OTTOM OF THE E,.'.,UM,,,MFIUN (IN FEET). THERE IS NO SET WtE:'TH FOR TRENC:HE::;. THE GRFlVEL DEPTH IS THE MINIMUM DEPTH OF GF.:FI',,,'EL BETWEEN ]"HE OIJTFFILL PIPE FIND THE BOTTOH OF THE EXCFt',,,'RTION (IN FEET.'.',. PERMI]" F:tPPLICFINT HRS THE RESPONSIBIL. ITV .['0 INFORM -['HIS DEPFtRTMENT DURING THE INSTFILI..FITION INSPECTIONS OF RN'¢ WELLS RDJRCENT 'TO THIS PROPERT'¢ Bf.,ID THE NUMBER OF RESIDENCES TI-iRT THE WELL WILL SERVE. BRCI<FILLING OF' RNV S'.-/S]"EM WITHOUT FINRL INSF'EC:TION RND RPF'ROVRL E:h-' THIS DEF'RR.['MEN]' WILL BE SUE:JECT TO PROSECUTION. MINIMUM DISTt:::INCE 8E'TWEEN R WELL FIN[:, ANY ON-SITE SEWRGE DISPOSFtL S"r'STEM iS t00 FEET FOR Ft PRIVFi]'E WELL OR ::[50 "FO 200 FEET FROM Fl F'UBLIC I.,.IELL DEPENDING UPOht THE T"?F'E OF PUBLIC I-,.tELL MINIMUM DISTFINCE FROM ta PRIVFlTE WELL TO Fl PRIVRTE SEWER LINE IS 25 FEET FIN[:, 7'0 Fl COMHLINIT'¢ SEWER LINE IS 75 FEET. OTHER REQLIIREMEN.[% MRV FIPF:'L'¢. SPECiFICFiTIONS RND CONSTRUCTION [:,IFIGRAMS ARE FlVFlILFlBLE ]"0 INSURE PROPER: INS]"RLLWFION. I C:ERTIFY TPIRT l: i F'~t"I F'FIMILIRF.: WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND 1.4ELL. S Ft::T, SET FOF'.TH E?¢ ]"HE MUNICIPRLIT¥ OF FiNCHORRGE. 2: I WILL INSTFiLL THE S'¢I:.;TEM IN RCCOR[:'RNC:E WITH THE CODES. 3: I 'FIND 'THRT ON-SITE SEWER S"/STIEM MFI'¢ REQUIRE EI',ILRRGEMENT IF THE RES I[)ENCE REMOD[ INCL. U[:'E MORE THRN 3 BE!}ROOMS. L:'."; t GNE[:,: STEVE[ V4. 0 2__ 3__ 4__ 5__ 6__ 7__ 9 10__ 12 13__. 14__ 15 16___ O&E ENGa IEERING & DEVELOI"'aVlENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 J~u-sell Oyster 694-2774 SOIL LOG Performed for: Name: -4~-/q/'-'-2/~. &/E~* ~ ~-~2 .~/~41 ,d Mailing Address:_~' L~ , ,/~¢2~ ~-;,~ ~ / Legal Description: J-,:~ T /// ~z'~ d..-/.~..~,., Earl El~i~ 688-2280 Depth (feet) Soil Characteristics PLOT PLAN PERC. TEST Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: Performed by: No /'/ If yes, what depth Drain Field.__ Date: APPLI( NT FILLS OUT UPPER HAl ONLY Property ~wner ~ ,~ , / ,/i i: ~.%~( // }~, :. ' ~ , ! '~ .~,~ / Phone t Mailing Address ~- ('~ ) - : , ( ? ~ / : ~¢ Zip Code ~ :~ ~ ".. ~ ~ ~ '~ "/ . ( /_. ~. ~ ~ , ~"']/ ?, ,~( ; ' /'~ Zip Code Address Phone Lending Institution (~' /[ /~,i Address Zip Code Realty Co. & Agent [~'~ ¢?~,:~, [ ~:/'~ , ~.;:, )~:. ~.;~ /~, ;:~:;~ (: ~,~ ~ , ~ . , .... Phone Legal Description Type of Residence ~ Single Family ~'~; ~ Multiple Family No. of Bedrooms ~ Other Water Supply ~ ~ ~ ~ ~~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. Individual ~ ~ ~ ~ ~ For wells drilled prior to that date, give well depth (attach Icg if available). Community ~ Public Utility Sewer Disposal ~ Individual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Inspector Inspector Inspector Inspector ~:~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* Soils Rating Date ~wer Installed~ ¢ Well To Absorption Area ,q , Well Log Received (:) : Well to Tank " Septic Tank Size 72-023 (3/82) MUNICIPALITY OF ANCHORAGE Division of Environmenta~ 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 Parc~ll.D.¢ /'~<:'- '~:" ~, '~' ' /~i HAA~ '.i' '~'~ (" -' -. '. Co nplete legal description Location (site address or directions) ,_~nchng agency [)ay ' phone ___ Mailing address >., g e n t /\ d d re S S Day phone otherwise requested, H/\A ,,vii! o~. held~o~ - ,o~.'"~(.~.; * Individual well Community well Public water NOTE: If community well system, provide written confirmation P'om ,?i~te ADEC ....... " lng: to J't~e legality and status of system. '7¥?E OF WASTEWATER D~SPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community ~vastewatex system, provide written confirmation fromotate~ ..... 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 verifythat 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. Name of Firm KND Engin~ring 20441 Ptarmigan Blvd. Address Eaale Engineer's signature bedrooms. D~/$ SIGNATURE · "¢ Approved for I~K,{~[P Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date 72~325 (Rev. 1/91) Back MOA ¢Y21 J U L Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SE~IulI~E$~ Environmental Services Divisio~!vl~ON~tENT^L$~P'vjc~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well ~pe ~ ~/~ /~/ If A, B, or C, a~ach ADEC le~er. ADEC water system number Log present (Y/N) / Date completed / Total depth Health Authority Approval Checklist Parcel ,.D.: Cased to / Casing height (above ground) / // Wires properly protected (Y/N, Sanitary seal (Y/N) / FROM W E LL/~G Date of test / Static water level / Well production / WATER SAMPLE RESULTS: AT INSPECTION / g.p.m. g.p.m. / Coliform / Date of sample: // B. SEPTIC/HOLDING TANK DATA Date installed ~_~.~ Tank size Foundation cleanout (Y/N) Date of Pumping' C. ABSORPTION FIELD DATA Date installed 7/¢~ Length ~ t Width Nitrate/ / Other bacteria / /Collected by: // / //~z~ ~) Number of Compartments __ Depression (Y/N) /t// Pumper Soil rating (g.p.d./ff ~-- Cleanouts (Y/N) ~" High water alarm (Y/N) ---' Effective absorption area ~ z~. Monitoring Tube present (Y/N) ~/ Depression over field (Y/N) /~/ Date of adequacy test // Results (P.~'ss/Fail) /~or //bedrooms Fluid depth in absorptio~ld before test (in.); / Immediately after.///~___ gal. water added (i/.' ~le~iodxidd¢~ttrheatm~t (past 1~' (in2S)mMoin~ts~S(~ AbSl~es, give datrpti°}~ rate =e ///g.p.d. 72-026 (Rev. 3/96)* System type .5~/~/./~ ~/ Gravel thickness below pipe J~. ~, Total depth ~. ~ -~ LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. -~'EPARATION DISTANCES Size~allons __ "Pump on" le~l/at* F. / "Pum~off" level at* / SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / / Absorption field on lot / Public sewer main // Sewer/septic service line On adjacent lots / On adjacent lots / / Public sewer manhole/cleanout ___~/ / Lift station SE!PARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation /~ /4- Property line //D /+ Absorption field __ / / W'ater main/service line ~ ~ Surface water/drainage //~¢~ ¥ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / Property line ,/¢~) ¢' Sudace water Curtain drain / / / Building foundation /~:~ '~ Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records.~J1~ in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name. ~- Date HAA FeeS Date of Payment Waiver Fee $ ~f~i~stems are '.... * Date of Payment Receipt Number 72-02.6 (Rev. 3/96)* 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 ---)c'~.:_,_,_,~_ \/~ HAA# ~--~-'~°~ \ [~')~ 1. GENERAL INFORMATION Complete legal description Lot 11... Block 2... Mc Kinley View Estates Location (site address or directions) 22545 Centurion Drive Property owner Mailing address Lending agency Mailing address Frank & Pat Lusk Hampton, Vir.qinia Day phone Day phone 279-7611 Agent Bob Brock D~NAMIC PROPERTIES, INC. Day phone Address 501 West Northern Lights Blvd., Anchora.qe, Ak. 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '-~ / TYPE OF WATER SUPPLY: Individual well Community well XX Public water NOTE: If community well system, provide written confirmation from State AD£C attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site XX -., Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER 6. 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. Name of Firm S & S ENGINEERING Address ~. 7034 E-~9!,,_l~i~c-r Loop ~agle River, Alaska 99577 Engineer's signature DHHS SIGNATURE ._Tz~_. Approved for .5 bedrooms. ...... Disapproved. Phone Conditional approval for bedrooms, with the following stipulations: Additional Comments Date _ , Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in th(; 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 rs not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Legal Description: A. WELL DATA Well type /~ Log present (Y/N) Total depth Sanitary seal (Y/N) Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Z. ~ ~. ~ ~% Cleanouts ~'/N) \/ High water alarm (Y~ Date of pumping Tank size Foundation cleanout Compartments Depression (Y~ Alarm tested (Y/N) Pumper '~ff-. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 'boo~ ~' On adjacent lots To property line ~ O Absorption field Surface water/drainage '1 ~) b I 4-- Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LliF'T STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes~.Y/N)' SEPARA'f'IO_N~rI~TANCE FROM LIFT STATION TO: ~/etC'on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump on" level at ~-~ Y~'~"Pump off" level at ~-- Cycles tested Surface water ABSORPTION FIELD DATA Date installed '~/-' ¢ % ¢ Length ~,'; "~ ' Width ¢~? Total absorption area ~ '~ ~:; ~ DeF~ression over field (Y~N~ ~'~ Results ~a~s.s)fail) ___?/~.~ P(;roxide treatment (past 12 months) (Y,~ _ Soil rating I Gravel thickness Cleanouts present ~¢'~YN) Date of adequacy test__ for /~ ~'~/ If yes, give date System type r ~¢~ ___ Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ¢~ocP ~ ¥ On adjacent lots t~//~ Property line To building foundation ~;,o' \' To existing or abandoned system on lot On adjacent lots__ ~ ¥_ ...... Cutbank ~lh~ Water main/service line Surface water ___ \ 4.~c~ ~- _ Driveway, parking/vehicle storage area Curtain drain __ ;'5'1 ~ IE. IENGINEER'S CERTIFICATION t certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on. the. d&te ~f this inspection. Engineer's Name Date HAA Fee $ Date of Payment_ //4"~ 4-// /) ~,,? '~.-'~ -'~ 72-026 (Rev 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number ~"~ ') I! !.r"~ j!. i i.jx. ,~, ~, DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 WALTER d. HIOKEL, GOVERNOR (907) 563-.6775 December 2, 1991 FOR: S & S Engineering RE: PWSID #-210697 My review of the records on file in this office reveals that the Mckinley View Estates Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria samples requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer BR/cf O..f'/ 7Pi MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~i[~J(~ OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date May 11, 1988 6ENER~E INfORmATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 11; Block 2; McKZ~6y Vi~ Estat¢~ Location (address or directions) Property Owner Cit!¢ FederaZ SavZngsT~Ch~RC.~ome Business Mailing Address (b) (c) Lending Institution 'Northland Mortgage Telephone 274-5150 Mailing AddresS · (d) ReaI,Estate,Companyand Ag-ent JACK WHITE COMPANY/Connie Bat¢~ Add¢~s's' '10928 Eagle Riv6r Road, Eagl6 River, Alaska 99577 Telephone 694-5599 (e) MailtheHAAtothefollowineaddress:or:Checkhere~, ifholdforpickup. List contact person and day phone number below. S & S ENGINEERING/694-2979 17034 Eagle River Loop Road~ Suite Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms ordered by Connie. Bates WATER SUPPLY Individual Well [] Community [] 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 Onsite [] 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 fRev 8/861 Front · HJo~ s,Jeeu!6u8 Im~OjSSej. oJd eqt u! suoiss!Luo ,~o s Jo,ua .~oj elqisuodsa,~ ),ou s! aSeJoqouv j.o A,IilBdpNnIN eqj. 'panss! s! e~.Bo)j.!].Je3 B eJOJ. eq ~qep eZAIBUB .~O suo!~.o@dsu! ~.onpt,~o3 ~.ou op SHHO ,LO see,AoldLU3 's)uetue.qnbe,~ a:l. Bl.s pUB leJepaJ u!Bpe3 A:Is!:I, Bs o) Jap,lo l! suo!~,n:l!)SU! 5u!puel J!eq~. pub seLuoq J.o s,lesBqoJnd o) Ase~.,moo e sB sN~. seep SHHQ eq/'B>tsBIV ,to e!.B~S eq.) u! pa.Je~.s!SeJ .~;~eu!Sua leuo!ssapJd .)uapuedapu! uB Aq e^oqe ~ ttdB,i!§B,md u! UeA!5 suojI. B~.ueseJdaJ eql. uodn Aluo pasBq sel. BogFpe3 i~:^oJddv A)!.~oq~.nV q~.leeH senss! (SHHQ) saoi^~eS UBLUnH pUB qI. IBeH ~,o .lueLu.pBd@c] eSe.Joqouv )o A~!ledp!unR @q_L NOI/RV3 IB^oJddV leUOil.!puoo :1o sLu~e± -- IBUOi)ipuoc) pe^oJddBs!c] ~. pa^oJddv e~BO euoqdelaJ. 9Ni~=INION~ S '~ S 'uo!~oedsu! s!q~ ¢o e~ep uo ~.oejja u! suoil. BIn6aJ pub 'SaOUBU!pJo 'sapo3 ele~.S pUB IBd!o!un!AI lie H)!M aoueildLuoo u! s! LUe)sAs IBsods!p J@IBMe].SBM Jo/puB Xlddns JCl. BM e)!s-uo eql 'uoi:i. oedsu! pue uo!~.eOf~,seAu! ALU LUOJJ pue sel!J, eOBJoqouv ,Io Aliled!o!un~ aq~. LuOJ:l petJ!e:i, qo uoilBLuJo,tu! @q~. uo peseq ~eql A~!Je^ .leq)Jn,t I 'ulaJeq pe~.eo!pu! @Jn~onJ:is ,to adX~. pue SLUOOJpeq J.o jaquJnu {:)?,nbepB pUB leUO!~.ounJ 'e,tBS S! LU el. sAs IBsods!p Jel, eMel. SBM Jo/puB Alddns Ja~.eM @~,fs-uo L':IIBeH siq:l ,to UO!I.BOiJSeAU! ALU l. Bql. X,t!.leA I 'MOlaq UMOqS e:lBp UO!)ep!lBA eq:l ,to SB pUB o)eJeq pex!,t)B IBeS XUJ Aq pefJipeo sv NOI.LVINIJO_-INI aNY viva 'HOt:IV:IS =1'11-1 'SJ. S3.L 'SNOILO::IdSNI 9NIOIAOUd iNUIJ 9NIEI33NIgN3 WELL DATA ~'~y OK,&~tI~I'c~'I'P~LITY OF ANCHORAGE (MOA) MuNICtPA~I~.q SER~L~tC~.,-~I~j,,THORITY APPROVAL (HAA) ~1, ' CHECKLIST - FEBRUARY 1984 264-4744 Legal Descri~on' 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: I_ To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot "~ ~4'~ To Nearest Public Sewer Line Cleanout/Manhole /~ If A, B, C, DEC. Approved~/~N) Date Completed Yield Cased to Depth of Grouting 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 Y Water Sample Collected by ; Date Water Sample Test Results Co m ments ~. ~/,~ ,, Z->. B. SEPTIC/~TANK DATA Date Installed '¢'~.~,¢~'Z-~ ~(~5"~ize Standpipes~{~)N) V Air-tight Ca ps 4t*/~1) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/l~ Tank: To Water-Supply Well "~ ".-~'~' To Property Line To Water Main/Service Line Course Comments No. of Compartments y Foundation Cleanou('~N) ~'-/ i~Pate/,A, Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026 fRev 8/861 Front (), ABSORPTION FIELD DATA Soils Rating in Absorption S~rata ~ '~4J~ Date Installed 9, ~ "~.- -- c~%¢~'~ ~/'~7~ Type of System Design Length of Field '~-~ Width of Field '~,2 ~ ....... Depth of Field ~ ~. Gravel Bed Thickness ¢'2~. Square Feet of Absorption Area ._""'~?l~_-~_" Standpipes Present~'/4~4) ~-/ Depression over Field (Y~'~,~ ~-'"~ Date of Last Adequacy Test Results of Last Adequacy Test _ _ ~:?/¢"¢"1_-""~; >~¢:~c'~-~'-L%q..~,~( *- '~ '~.~-- Separation Distance from Absorption Field: To Water-Supply Well .... ~'~ _~-_~C_?~Z~ .... To Property Line To 13uilding Foundation ~/~ .~)~. I~_ To I.~ System on · ' .... Existing or Abandoned Lot ~ /Z~. ; On Adjoining Lots 'Fo Water Main/Service Line t, ,~ ..... To Cutbank (if present) 'Fo Stream/Pond/Lake/or Major Drainage Course ~- '?~-~ "Fo Driveway, Parking Area, or Vehicle Storage Area _ _ _ "~ ¢.L) ~ Comments I-). Date~ls~talled ...... Dimensions Size in Gallons%--.---. ~,. Manhole/Access (Y/N) "Pump On" Level at _ _ ~"Z-'----~ "Pump Off" Level at High Water Alarm Level at . ~Vent (Y/N) Tested for __ . . Pu~d~4;~Cycles during Adequacy Test. Meets MOA Electrical (:)odes (Y/N) _ Com menl:s ~'-~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, w.~rified, or conformed to all MOA~and F~AA guidelines in effect on the date of this inspection. (]omp~gl~~g2g MOA No. ~ ~ ~ Receipt No. /~;;]](~ ~ Date of Payment ~-'L~.- ~:-~ _ Page 2 of 2 8/86/ Rack STEVE COWZ-)ER, GOVERNOR ANCNOR~6E/WESYERN DISTR~CT 360~ "C" STREET° SUITE ~334 ANCHORAGE. ALASKA 99503 PWSIO e: -%~I,~SZZ To Uho~ It May Concern~ Accordin~ to the records on ?i1~¢ in this of?ice, the __~f/_~kLxc~i¢,~/. .... 0~.,~ '~:~':L~,~ Uater System is in compliance t,.~ith th~ State o¢ Alaska Drinking Uater Regula(¢.ons, APPL ( FILLS OUT UPPER HA[ ONLY ~, · , Phone Prop( rty Owner / ~/:~'" i':. ~L.~ /! ,~', : ' Zip Code Mailing Addre~ ~:" <%' ',;~'~'.;~t: ~ , ,,.'~/ ,. ~' , ,. · ~ < Buyer ( ~ ' ' ' ~ "' ; Address Zip. Code Lending Institution Phone Address Zip Code Realty Co. & Agent Phone Address Zip Code Street Locati~ ~, ¢ ,' ,~ ¢ . ,., Type of Resi~nce "~. Single Family '~ "Multiple Family No. of Bedrooms ~ Other Water Supply ~ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ' ,~,Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal "~2 ;: '~' ~ Individual Year Individual Installed: ~ [er': 1~ ¢~:' '( ~' Public Utility When Connected to Publi8 dtility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICtPALI'fY !~;' APPROVED BEDROOMS *CON DITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROV~A,L* DATE - ~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received Well to Tank Septic T~k Size 72-023 (3/82)