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HomeMy WebLinkAboutHIGHLAND HILLS #1 BLK 1 LT 8 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181228 PID Number: 05038223000 Dwelling: IM Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: New IN Upgrade Narroe_ Robert J Abbey ABSORPrnom FIELD ❑ Dei�Trench 171 Shallow Trench E] Bed ound Address 5828 Hiland Road, Eagle River ` o Other Phone Number of Bedrooms Soil Rating ITotal depth fro original grade 3 -GPMFI FL LEGAL DESCRIPTION Depth to pw med ftm om derma rye FL Subdivision Block Lot Highland Hills #1 1 8 Frill added above ongmal g Ft. G 7 Ft. Township Range Section Gravei eukth FL Beds of uses des FL SEPARATION DISTANCES T01 Septic AbsorptionHolding Sewer Lift Station r Total ab tion area Number of trenches Dist. between rhes From Tank £ FwJd Tank s LineFeL well 1 00+ 1_ 1 _ _ I _TANK M Septic [IS.T.E.P. ❑ Holding ❑ Other ktuitdackffer Greer Tank capacity` 1(}00 Gat. surface water a 100+ - - - Material Number of compartments Let tine x 5+ - - - I Steel 2 I I NA Foundation 5+ _ ( _ _MT STATION err Gal. _ Curtain Drain NA NA NA NA Remarks Distance from Tank to Field is 6' Pump on level at Pu iev High water alarm at in. Pump make et Electrical Ins rformed t3y PIPE TERIAL c use to tank D3034 Tank to drairrfreld D3034 Installer TERRITORY NORTH CONSTRUCTOR, Drainfield NA CO/MT Inspector MATT AMSDEN BENCHMARK (Assumed etevation)100' It Ins dactiontes: 1� $118/18 �a Location and description 2 37' e I Deck Comer on East Side of House COMMUNITY DEVELOPMENT DEPARTMENT APPROVALAW o 0 =1 Aw • �•.'f `P Conditional Approval: Date 49 rH00 °m��•LucasM.R d I;�° 15,CE -12595 =A Ar k %�RO sA J�FESSIC_) Approved ` { � t� Date 51311-20.2Q, Inspection Report 9-1-1Z.doc PARCEL D. 050-382-23 ORIGINAL 11/17/18PREPARED: LMR SHEET ROBERT J ABBEY DRAM LMR PN SITS, LA LOT 8, BLOCK 1, HIGHLAND HILLS #1 REQ EVYED- TNC 114,22-22 1 SEPTIC SYSTEM REPLACEMENT ag�lw PERM'i'i NO: OSP1 81228 NOTE- - P01% AND 1 E THE "IF Ckku&DE I 11 T A B AR CORNERS OF THE WALL. 7— DECK H;EllT AT WAS NNEAR A rllS ASSUMED, TO BE 10-010' 3- TANK DIMENSIONS 8' LONG, 58" DIIA 10, 0, 10, 20' SCALE: 1 20' OF A i 49 ........................ Lucas M, Runm-ddlill 4 -- CE 12595 mss'` o-saw f it rafass%�N ORIGINAL 11/17/18 sHEEnr ROBERT J ABBEY Dfbkv ft� Lw, SITE PLAN LOT 8, BLOCK 1, HIGHLAND HILLS #1 REVIEWED: TNN 14.22.212 2 1 SEPTIC SYSTEM REPLACEMENT DATE: PERMIT NO: OSP181228 PARCEL I®: 050-382-23 FINISHED GRADE 99.65 TOP OF TANK AT INLET TOP OF TANK AT OUTLET 96.5 96.33 ( 2' RIGID INSULATION -------- — ------ --- ------------- -------------------------------------------------- OF������ INVERT OFBUNG NEw 1,000 AT INLET GALLON INVERT OF BUNG STEEL TANK AT INLET i� ! 95.85 95.68 49T"* • *. �............ '01_ csas V Ram$ CE — T1250-5 0 - NU1Lcf1Pt-Ofess*%O"' ` (1 1. ELEVATION BASED ON T3M — DECK CORNER ALONG E WALL = 100.00 �LSYSTEM C t z 2 SECTM MEW — HTS E\.1./ tf { NOTE: VERTICAL BENCHMARK IS DECK ELEVATION OF 91TO.O' FL 1SHM GR6 LTA 99-65 TOP OF TANK�fiss Lm. BOTTOM OF FQBOTM 3 96.98' o SCXL PRISM OF FOOTING � ROBERT J ABBEY ORIGINAL 11/17/18 PREPARED: LMR SHEET AS—BUILT LOT 8, BLOCK 1, HIGHLAND HILLS #1 DRAVM: LMR R"EIAED: MA 3 SEPTIC SYSTEM REPLACEMENT DATE 422.22 Dayna M. RumfeltREGISTEREDPROFESSIONALL A N D S U RVEYORNo. LS 13322NORTH3/19/22 ,>JN\0'P"`irr OR MUNICIPALITY OF ANCHORAGE .,„-,C 11: On-Site Water&Wastewater Program S PO Box 196650 4700 Elmore Road _ /, Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,-. http://www.muni.org/onsite EhtiAt is Dcpartmcnt HNC{,OR46 On-Site Wastewater Disposal System Permit Permit Number: OSP181228 Effective Date: 8/16/2018 Work Type: SepticTank Upgrade Expiration Date: 8/16/2019 Tax Code Number: 05038223000 Site Legal Address: HIGHLAND HILLS#1 BLK 1 LT 8 G:0558 Site Mailing Address: 5828 HILAND RD, Eagle River Owner: ABBEY ROBERT J Lot Size in Sq Ft: 73462 Design Engineer: RANDALL LUCAS M Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Q Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 Special Provisions: V "" Prior to tank installation, the location of the bed is to be determined to confirm that the 5'tank-to-field separation is being met. \ \ Date: v Received By: �\`�\ ` k2,1v Issued By: _ ,✓ , 1,_ Date: ( 03 MUNICIPALITY OF ANCHaniAGE Development Services Department \ \_ Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION • Parcel I.D. 050 -- 3s 2 .. 1 .--000 / d Q! Property owner(s) Qoto� Q10(0 Day phone 10-1(p UI�J r0 Mailing address SS328 tkaote) P. Site address 652121 ht taint) Rol Legal description (Sub'd., Block & Lot) H lqt s, ills ' I L { __ 19) L Legal description (Township, Range & Section) Lot Size 1514'2_ Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ie. Initial n Single Family (SF) Septic Tank [ Upgrade (w/wo ADU) Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: PA Distance: I certify that the above information is correct. I further certify that this is in accordance with appli able Municipal Codes. \I))of o ert own rg - - p p y e orauthorized agent) Permit/Rush Fees: SL,q ` Waiver Fees: Date of Payment: 7/ 40((( Ck 071 ,7cI Date of Payment: Receipt Number: c�0.-1 Receipt Number: Permit No. e6QI 12 22. Waiver No. G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Highland Hills#1, Block 1, Lot 8 5828 Hiland Road, Eagle River, Alaska 99577 Robert J Abbey Wastewater Upgrades Design Narrative The homeowner is seeking a new tank. During routine pumping and system inspection, it was discovered that the existing tank needs to be replaced. IMPACTS TO ADJACENT PROPERTIES No impacts are anticipated.The existing topography of the area does not flow towards adjacent properties. WELLS The proposed tank replacement will be in the same footprint so no surrounding wells should be impacted. DESIGN AND CALCULATIONS The existing septic system was designed to serve a 3 bedroom residence. It has a 1000 gallon tank currently. MOA code requires 1000 gallons. Technical Specifications General 1. Scope. The scope of this project is to replace the existing septic tank. 2. Construction. Work shall conform to the approved drawings.The Engineer shall approve all changes to the drawings. All construction shall conform to applicable Federal, State and Local codes and regulations.The contractor is responsible for utility locates and any other permits required to complete the work as shown on the plans. .0,\\\%1 �, • OF ,q�q l� Wastewater System p. .S�/ 1. All components must meet or exceed standards set by %* ' 49 \ *i the Municipality of Anchorage, specifically, Chapter �. / -p•. Lucas M Randall . `, 15.65 of the AMC. /j 9 •. CE — 12595 '•.,1/15111 • Cse5" ,,j 1 . 1‘r1\\\‘‘., art es\ems.,`." / N89'4IO2"E 220.58' LOT 9 . 100' RADIUS FROM WELL 11 EXISTING CO/MT 1.' --4-: /7 ��� "' oF .44111 I PROPERTY LINEQ \ �2o\\ O CONNECT TO%%\‘"--‘4-..\\v.T..\\\\\\ g ....-o).. 4g TH *' r7- \m�\ EXISTING BED Wm. �� \ do i �o'• Luoos M Randdl L INSTALL NEW DOUBLE CLEANOUT / m _ ¢ BETWEEN TANK AND EXISTING BEDs3I / Y r`�� ,•cc` NEW 1,000 GALLON TANK t M - /rrl `°o I'I' o��A APPROXIMATELY SAME FOOTPRINT �� I I��f\;����� OF OLD TANK �r ` 4 , \ FOUNDATION . CO (EXISTING) T 3 BEDROOM` 1 Z ‘1•.• HOUSE \ • ml , - ., 2 • 3I• \ ` • , \ 0 •S 1I \ \'\ • 4:. I o 17LOT 8 \ 1 • Q 2� \ 8. 14 .2• _ zI Q \ \ • W . I j ?\ \ EDGE OF DRIVEWAY 100' RADIUS FROM WELL oF • . 1\\I. U W • N 33' SECTION LINE EASEMENT I \ .\ . ti. \ NOTE: \ 1. ALL REQUIRED SEPARATION DISTANCES FOR THE \ \• NEW SEPTIC TANK WILL BE FIELD VERIFIED AND _ \ ENFORCED AS PER MUNI REQUIREMENTS. 2. NO WELLS WITHIN 100' OF THE SEPTIC SYSTEM. • 3. EXISTING TANK TO BE DECOMMISSIONED/REMOVED ; 20' HIGHWAY EASEMENT IN ACCORDANCE WITH ALL MUNICIPALITY AND DEC REGULATIONS AS WELL AS THE UNIFORM PLUMBING CODE. • D. EXISTING BED SHOWN FROM AVAILABLE — — — — — — • I North DOCUMENTS PROVIDED BY THE MUNI. ri II 989'41'02"W 227.32' - .. ,it �' ,, I III 1 i,III LOT 7 ill Iii ROBERT J ABBEY PREPARED:LMR SHEET SITE PLAN LOT 8,BLOCK 1,HIGHLAND HILLS#1 SCALE EVIE R . LMR REVIEWED:MA SEPTIC TANK REPLACEMENT 1"=40' DATE: 8/16/18 NOTE: 1. NEW SEPTIC TANK TO CONFORM WITH ALL REQUIREMENTS WITHIN CHAPTER 15, SECTION 15.65.205 SEPTIC TANKS AS i WELL AS DEC STANDARDS. 2. IF SEPTIC TANK IS NOT INSTALLED AT LEAST 4' BELOW THE EXISTING SURFACE DUE TO EXISTING CONDITION CHALLENGES, INSULATION WILL BE PROVIDED BY THE INSTALLER AS PER MUNI REQUIREMENTS 3. MAINTAIN A MINIMUM DISTANCE OF 5' FROM TANK TO ABSORPTION FIELD. EXISTING GROUND SURFACE 4' MIN (SEE NOTE 2,Li— FIELD DOUBLE CLEANOUT f � CONNECT TO EXISTING DISPOSAL `\\V‘‘`,\-1 5' I-- 1 OF 44111 NEW 1000 GALLON • 1 // STEEL TANK —(0 49TH i\ TO HOUSE - =:C ;;;PigEgi;? /•73' Luno. Al Randall • ® SEPTIC SYSTEM ///so. � — 1 PLAN VIEW — NTS //Lor .•• •• o�F 111 \\\�ic `� ROBERT J ABBEY PREPARED:LMR SHEET ORAVNJ: LMR PLAN VIEW LOT 8,BLOCK 1,HIGHLAND HILLS#1 REVIEWED:MA L SEPTIC TANK REPLACEMENT DATE: 8/1 3/1 8 • Municipality of Anchorage (ENGINEER'S SEAL) Development Services Department +4; OF ,14111 I/ On Site Water and Wastewater Section _ • S+ ?.r...... 4700 Elmore St. 0.. �.4- ..÷ i, l P.O.Box 196650 Anchorage,AK 99519-6650 *•.' 49 T"Hcy--T� .,,,...,-o.,.._. www.muni.orq/onsite (907)343-7904 i• /p', Lucas M Randall .m -,,Opp... CE 1 59 .'�°i— Soils Log - Percolation Test �"i 7o' `Z• � 0)\ ``_ Performed For: ROBERT J ABBEY Date Performed: 6/29/18 Legal Description: LOT 8,BLOCK 1,HIGHLAND HILLS#1 Township,Range,Section: Slope Site Plan T '— _ _ II= 111 Depth -—El --1(,- = ,1 1 1, `1 (Feet) I7fp14$2.0O �� \ \ ` \ 0-1.5' ORGANICS 1- aq'll(4 �' \ \\ ' 0 n 3-•• - m \ ��1\-.4-1••\\\\', \ \ 4-.. 1.5.-16' GM WITH LARGE \ \ \ `} . \, t . , ROCKS UP TO 2' DIA. ` II II J ``` 5- • O 111 1 � 1 1 111 6-- ? 0 / / , . \I \ \ 7_1100.„,.. - • \(-\ ,\`r \\\ 111 I 8- WAS GROUND WATER I 9- • II ENCOUNTERED? NO `� 1 O-: ' IF YES,A7 WHAT DEPTH? L _ I —_-- Depth to Water After P - ,-�� - 11- •ill __T Monitoring? E 9 _ BOTTOM OF TEST HOLE 6/29/18 & 7/6/18- - - - - - - "_--_.- -_-_. 12 .. NO WATER ENCOUNTERED. Date: - 13- MONITORING TUBE INSTALLED. 14-�. Reading Date Gross Time Net Time Depth to Water Net Drop 15- 411 ; 1 6/29/18 12:15 PM - 0" - 16-II 2 6/29/18 12:27 PM 12 MIN 6" 6" 17- 3 6/29/18 12:41 PM 14 MIN 6" 6" 18- 1 6/29/18 12:54 PM 13 MIN 6" 6" 19- 1 6/29/18 1:09 PM 15 MIN 6" 6" 20- PERCOLATION RATE 2.25 (minutes/Inch) PERC HOLE DIAMETER 6" TEST RUN BETWEEN 4' FT AND 4.5 FT COMMENTS GROUNDWATER WAS MONITORED FOR 7 DAYS. NO GROUNDWATER PRESENT IN THE MONITORING TUBE AT ANY POINT. PERFORMED BY: ATWATER ENGINEERING I LUCAS M RANDALL CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/26/18 N 89'42'02" E (N 89'53'00" E) 220.58' (220.58) 30' OC: I SHED 16.3'x 14.1' 080'X8.2' 0 • cCi a, a t4 I w pn FURNACE ON CONCRETE PAD '\ tit 'a 0) 3 p 6 r « d z o 200 b _ 1 2-STORY 4...V.', �,, O (D WOW M li\ .i•••. '±- ... �• N 11 0 ', o In .' - 85.6' . In WOOD \ w \ DECK ,, co M a GRAVEL I,r n O 3 eDRIVEWAY SIJ to 3 a o 0 N 0 WVy 0 In \ ` v n L . 30' 3 HIGHLAND HILLS SUBDIVISION 10 UNIT NO. 1 LOT a I BLOCK 1 S z PLAT 74-13 LEGEND \I • 5 O EXISTING RE8AR \ 15, 1 . Fl cW, EXISTING WELL w I w tat EXISTING SEPTIC VENT �� J OCO EXISTING SEPTIC CLEANOUT I\. \ I © EXISTING TEST HOLE p \ o --Lr-J EXISTING POWER POLE \ ` l , - -----... 1----. EXISTING OVERHEAD UTIUTY '� • ... ..... ...... .. ......EXISTING EDGE OF GRAVEL DRIVEWAY I t ,5; rI S 89'41'02" W (S 89'52'00" W) 227.32' (227.32') EI] `k NOTES: p NORTH 1. BASIS OF BEARING IS ALASKA STATE PLANE ZONE 4. 2. PROPERTY UNE IS RECORD PER PLAT 74-13 ASBUILT- NO CORNERS SET THIS DATE HIGHLAND HILLS SUBDIVISION UNIT NO 1, ANCHORAGE RECORDING DISTRICT ROTATED TO FOUND MONUMENTATION. I HEREBY CERTIFY THAT AN ACCURATE SURVEY OF THE FOLLOWING DESCRIBED 3. EASEMENTS OF RECORD PER OTHER THAN PROPERTY: THOSE SHOWN ON THE RECORD PLAT ARE NOT SHOWN HEREON. ����\\\� LOT 8, BLOCK UNIT HIGHLAND HILLS E _� 4. AU.EXISTING BLE ABOVE GROUND SEPTIC SYSTEM HERFEATURES LOCATED ATTMTHE it.. AC9 ++ WAS MADE ON JULY 14, 2018 AND THAT REON ARE TIME OF SURVEY AND SHOWN HEREON. j*•49^ *�I IMPROVEMENTS WITHIN THENPROPERT�GTHE ADJACENT TO ^ 1 II, ••' THE PREMISES IN QUESTION AND THAT • 1 , THERE ARE NO ROADWAYS, TRANSMISSION LAV E I I ' E 2 Do V.:.'. ..., UNES OR OTHER VISIBLE EASEMENTTED ON SAID 'Doyno M. mfelt; / PROPERTY EXCEPT AS INDICATED HEREON. f#g • No.1332 �/ DATE: 8/12/2018 FB: 18-002 SURVEY & MAPPING +�44% A_�� GRID: SW 558 DRAWN: DMR 2010 S.BAaNYMm CR W.W.IA AR 916S4007)-301-S177 ,\�\\\���! SCALE: 1' = 30' FILE: 18-002ASBUILT  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~ PHONE LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~ DISTANCETO: Well ~b Absorptionarea~__ , Dwelling ~/, ~ERMITNO.~/ ~f ~ ~ Manufacturer ~'~ ~ Mat~al~.~ ~-L No. of compartmen~ ~n gallons IF HOMEMADE: Inside ,e~ Width Liquid dep~ ~ Manufacturer Material Liquid capacity in gallons ~ Well~ Foundation Nearest lot line PERMITNO, No, of lines Length of e Total length of lin~s Trench w~dth Distance between lines ~' ~ Top of tile to fiMsh grade Material beneath tile ~ Type ~Nrib Crib diameter Crib d~ Total effective absorpt~a are~, ~ '~ DISTANOETO: Well Building~/~ation Nearestlotline -- ~lr ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MA L INSTALLER _, , .,~.~,¢.~. ~. ¢ "~ ~.' ., ~, 't-'" ~ 'L~, .~:"-'3".', ¢':': .... 72-~ MUNICIPALITY OF ANCHORAGE ~ Health and Environmenta' Department ~rotection 825 ~ Street, Anchorage, AK. ~9501 264-4720 Permit WELL AND/OR ON-SITE SEWER PERMIT ~Y Type of Soil ~sorption System I~: Trench: .~ Drainfield: Seepage Bed: Holding Tank:~ The Requlred Size of the Soil Absorption~System Is: DEPTH : LENGTH :7~ . GRAVEL DEPTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING} TANK SIZE = ./~/(?C?--~-- GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minim~Lm distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I u~and tha~the on-site sewer system may r%quire enlargement if ~ r~/~/?/ remodeled to include more th,.~edrooms. S igne~://~ ~/~f~ ./~/~//~/~____~ Issued by SW~?/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 254-4720 SOILS LOG - PERCOLATION TEST [] SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL. DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS SLOPE SITE PLAN IF YES, AT WHAT DEPTH? ~ Gross Net Depth to Net Reading Date Time Time Water Drop I ~., i 4 j-,; ~q-p (~ " /or~''~ -~.~ '" PERCOLATION RATE TEST RUN BETWEEN 72-008 (6/79) ~'(~ (m.~utes/inch) /-~ FTAND ..~-~' 'Z~ FT ~?WAI'ER WELL RECORD STATE OF ALASKA DEPARTMENT OF NAI'URAL RESODRES Division of Geologicot 6~ Geophysicol Surveys Drilling PormH No, LOCATION OF WELL (PIOOBO complole either la, lb or lc.) A.D L. NO, Soc$ion No. Town~hJp -- RG~ge Meridian ~J DISTANCE ANO DIRECT~O~"~'~:OM ROAD INTERSECTIONS 3. OWNER OF WELL: I0, STATIC WATER lEVEL:_ .... ~ Abov0 or ~j Below lend surfaco Dote 16. WATER WELL CONTRACTOR'S CERTIFICAIlON: J5 Walo~ l~mper,~ture ~ o [-] F [-~ C 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. fl ~"~") - .~.*~ -~-~.% 1, GENERAL INFORMATION Complete legal description Lot 8i Block Ii Hi,qhland Hi~s Subdivision ~II Location (site address or directions) NHN Hiland Drive (second house on right past ~ire station) Property owner __ Mailing address Lending agency Mailing address Agent Address Lorrcine Kush C/O Remax Eagle River __Day phone. 16600 Center Field Drive Eaqle River AK Day phone Eva Loken - REMAX OF EAGLE RIVER 16600 Centerfield Drive, Suite Day phone 694-4200 201, Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- .lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. XXX 72-025(Rev. 1/91) From MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S&S ENGINEERING Address __.ZZO3Xt. EaCeJ~a~pJ~.N~ Eagle River, Alaska Engineer's signature DHHS SIGNATURE . ~ ~ ~ Approved for /-/,~'"~(¢ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does th is 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 profession&; engineer's work. 72-O25 (Rev, 1/91) Back MOA ¢~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ ~ ~¢-- \ ~'~A~.-~, ~-t.~C'tParcel I.D. A. Well Data Well type Log present~b~, N) Total depth Sanitary seal ~)(.~N) If A, B, or C, attach ADEC letter, ADEC water system number Date completed c~ ~.2..ZA JO'5 Driller Date of test Static water level Well flow Pump level1 FROM WELL LOG Absorption field on tot Public sewer main Sewer service line SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ o ~ ~ ~ Cased to \ ¢)o~ CC, ¢-~. Casing height Wires properly protected~'~/N) AT INSPECTION g.p.m. ;On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform c'~ Nitrate ~, t ~ Date of sample: ~ ~ //-t ~-~-1'~ Collected by: B. SEPTIC/HOLDING TANK DATA Other bacteria Date installed \-o ~ ~ .~ '~ '~ Tank size \ ~ ~ c, Compartments Cleanouts~/N) k./ Foundation cleanout~,~/N) .l/ Depression (Y ILILl~) High water alarm (Y(~) ~ Alarm tested (Y/N) Date of pumping ~;~ ~ \ L~ ~ °1 ~ Pumper ~,¢~-, (_..~¢.~-%S¢'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ ~ c.) On adjacent lots To property line k,o ~ Absorption field Surface water/drainage \ ~ c:;) Foundation ~'~ ~ Water main/service tine \ c:) 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DIST~"~ROM LIFT STATION TO: We~ On adjacent lots Manufacturer Manhole/Access (Y/N) Surface water D. ABSORPTION FIELD DATA Date installed Length ¢5¢~,' Total absorption area Date of adequacy test c~ .. ¢. D ~ct $ Results~fail) Water level in absorption field before test ~ Peroxide treatment (past 12 months) (Y/~ ~O ~ ~ Width O Cleanout present (~/N) V Soil rating (GPD/F¢) ~ ~ Gravel thickness System type Total depth ~ ' Depression over field (Y~' for After test 'dC ~/~ If yes, give date ~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ ~ ~ To building foundation \ ~ On adjacent lots "~ 'o \ 4-- Surface water ~ o ~ Curtain drain ~5~0~.~ On adjacent lots ~.- Property line \ ~ Cutbank To existing or abandoned system on lot "~o\ ~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I cert/fy that I have checked, verified, or conformed to all M~a~ gu/del/nes in ~ $ & $ ENGINEERING Signature .......................... ,~.- ~/'~,,~ / ;~ ~,~F~.le River, Alaska ~9577 ~ Engineer's Date /~//~/¢*.~' ,../, HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I,D, # ~_~.z..~ -~. ~5 ~¢:-.~.-:.~-L~ HAA # __ t'~\ ~ ~'~f- ('..¢L\~ ~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block,,subdivision, section, township, range) rJot 8; Block_l_; [:~:~z~..?J:Hills Subdivision ~1 Location (address or directions) NHN Hiland Drive (second house on right past fire station) (b) Property owner 5ohn Nilcock and Penelope Sl~6ne: (home) Mailing Address Business (c) Lending Institution Mailing Address NORTHLAND HORl%AGE Telephone 694-7872 11421 Old Glenn Highway, Eagle River, Alaska 99577 (d) RealEstateCompanyandAgent RE/MAX OF EAGLE RIVER - Eva Loken Address 16600 Centerfield Drive, Suite 201, Eagle River, Alaska 99577 Telephone 694-4200 . Mailthe HAAtothefollowing address:(orcheck here ~,ifholdforpick up.) . Listcontactperson and day phone numberbelow: S & S ENGINEERING/694-2979 (e) 17034 Eaqle River Loop Road, Suite 204 _~le River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family I~ Number of bedrooms 3 3. WATER SUPPLY Individual Well ~X Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site,'~: Public [] Community [] Holding Tank [] Nole: 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 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FII.E 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 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 Telephone Address ~?'~4 ~a¢~giver Loop Road No. 204 E.,.,~ River, .Mast~ 99577 ~ /~/ /~ Date / ~ 6. DHHS A~PROVA~L A, , rov ,or ' Approved_ ~.g.3~____:~Disapproved Conditional 'l-errns of Conditional Approval The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in par~'.graph5above by an independent professional engineer registered in the State of Alaska. The DHFIS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdo 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. 7/88) Back Page 2 of 2 Well Classification Well LogPresent~N) ~ Date Completed Total Depth¢'Z- L''~ ~C~o!~UNICIPALI'I-Y OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 Legal Descr~pbon: Cased to \~ ~"'~¢~ Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) .. _ Yield \, '7-. ~Prd Static Water Level z2d._o' Casing Height Above Ground \7.~~ "- Electrical Wiring in Conduit (~N) ~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot \ c>E:~ ~ ~'~ To Nearest Edge of Absorption Field on Lot Pump Set At Z.~--~ Sanitary Seal on Casing (~N) ~/ Depression Around Wellhead (Y,(~b ; On Adjoining Lots \L.~c::~\> ; On Adjoining Lots To Nearest Public Sewer Line t,.~ Jj~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Z-%' ~ ~- Water Sample Collected by ~ ~ ~ ~1~ L¢~ I,,~.~-~¢-.~ ~ L~ ;Date Water Sample Test Results ~-~/:~,~c~-,t,.~.~r~P_._,,( - ~-~J~-~'- Comments B. SEPTIC/HOLDING TANK DATA Date Installed \O~%~9>--''~ Size Standpipes ~/N) ",/ Depression over Tank (Y~)) _ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ¢'~,---- \ E:x:>o No. of Compartments Air-tight Caps ~/N) ~ Foundation Cleanout ,~_~1i~. h,~ [:)ate Last Pumped ;for " Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line \(::~ ~- To Stream, Pond, Lake or Major Drainage Course Comments ~"~ To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed \ ~ "2~ ~ /--~-~ Width of Field Square Feet of Absortion Area Depression over Field (Y~.~ Results of Last Adequacy Test Type of System Design ~¢..A~) Length of Field .d¢.~,~ Depth of Field ~'" Gravel Bed Thickness ~" 0/4 Statndpipes Present (~N) %¢ Date of Last Adequacy Test \L'-) .~.~\_c~ L~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ Cb~ ~ ~ To Property Line To Building Foundation \ ~ ~ ~ To Existing or Abandoned System on Lot ~'~/A- ; On Adjoining Lots "~ ~ ~- To Water Main/Service Line \~ ~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutback (if present) D. LIFT STATION Date Installed Size in Gallons .p~ High Water Alarm Level Tested for Meets MOA Electdca~ Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent J~ ~ Pumping Cycles during Adequacy Test, **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. $ 8, $ ENGINEERING 17034 Eagie River Loop Noad Ne, 204 Date of Payment Amount: $ /~d:2 72-026 (Rev 7/88) 8ack Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Property Owner Mailing Address Buyer APPLIC FILLS OUT UPPER HA[ ONLY ( / /.!-'/;' (~ ,¢~ /,~, ,.~77.-_,~ ~_ ¢.-- Phone Address Zip Code t_ending Instilution /,~/~6.,,4/~, . ;~, /)! ~J ~/.)~/.S ';¢ ~. ¢.., /~ ,,~. ,,) Phone ~ ?E' /'-,'.F / Address Zip Code Realty Co. & Agent Phone Address Zip Code Street Location Type of Residence [;~/SIng le Family ~ E~ Multiple Family No. of Bedrooms - ~'--~ [] Other Water Supply ¥ Individual ATTACH WELt. 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 ~ndividual Year Individual Installed: [] Public Utility When Connecled to Public Utility: [] Itolding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED· Time Time Time Time Date Date Date Date Inspector Inspeclor lespector Insp6ctor (": ¢~) APPROVED BEDROOMS { ) DISAPPROVED CONDITIONAL APPROyAL* DATE _ ~ :', ~ ;?' ~i~i.,"' BY: :.~ ~ - *CONDITIONS OF APPROVAL .--:::: . :,. .- , ; Soils Rating 72-023 (3182) Date Sewer Isstalled Well To Absorption Area · Well to Task / ~- Well Log Received Seplic Tank Size ADEQUACY TEST WATER AND SEWER INSPECTION WELL INSPECTIONS AND FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN EXCAVATION WORK ROBERTA. SHAFER January 16, ].984 CIVIL ENGINEER 694-2979 Disotel Construction SR 9385 Eagle River, Alaska 99577 Reference: Lot 8: Block 1~ Highland Hills Subdivision A well septic inspection was performed on the system located on the referenced property, as you requested. Alt the cleanouts to the septic system were visible and equipped with an adequate seal. The well casing was found to have an adequate sanitary sea]. and the well wires from the pump were in conduit. The ground around the well casing adequately sloped away from the well. At the time of this inspection a water sample was taken from the kitchen sink and submitted to Chemical and Geological Laboratories of Alaska for coliform bacteria analysis. The results of this,test were sat,isfacto~y. If we may be of further service, please do not hesitate to contact us. ( ,." ~ ~' S 1~ y, ' '-~AS/ss CC: Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA 99577