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HomeMy WebLinkAboutHIGHLAND HILLS #2 BLK 2 LT 6Onsite File Highland Hills #2 Block 2 Lot 6 #050-382-37 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211263 PID Number: 050-382-37 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name BEVERLY SINNOT ABSORPTION FIELD ❑ Deep Trench ® Wide Trench ❑ Bed ❑ Mound Site Address 5717 HILAND ROAD, EAGLE RIVER ❑ Other Phone7Number of Bedrooms Soil Rating Total depth from original grade 3 0.45 GPD/SF 6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft. Gravel depth beneath pipe 4 Ft. Subdivision Block Lot HIGHLAND HILLS #2 2 6 Fill added above original grade VARIES 1.45 - 2.08 Ft. Gravel length 2 X 50' 100 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1000 Ftz 2 10 Ft. Well 100'+ 100'+ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ 100'+ Material HDPE Number of compartments 2 Lot Line 5'+ 10'+ NA Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks EXISTING SYSTEM DECOMMISSIONED Alarm location Electrical installed by Installer DENALI EXCAVATION Tank to PIPE MATERIAL House to tank 3034 d a of eld 3034 Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection 1M 7/29/21 7/30/21 Location and description 2�d 3'd 7/31/21 4" 8/2/21 TANK MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date �,. Curtis Huff ♦ • Huffman Septic System Approved - 8 lc�s�•C8/3/12021991 Date /w/ E 28 Note: this approval does not include well s 3120991 �.�.� pROFE*06A� permit requirements. ��,���► trcev uavu ia/ PERMIT: OSP21263 N O CD M 10 O n fr1 (n PID: 050-382-37 WELL OR,q VIEL RAVE WALKWA 3BR HOUSE DECK A -C=9 3' FCO B — C = 2 5 9' , rtis Huffman DCO99.72 CO DCO M gM A -D=9 7' FWCS 1" 30 cs 8/4/2021 = \ =°141DFESSIO�Pti PAGE: 1 OF 1 95.66 B -D=28 4' A - E =12.1' 9508 1000—GAL 94.9 B - E = 31.2' HDPE TANK A -F=55.9' B -F=68.4' A -G=58 7' B -G=71.1' A -H=68.2' LOT 6 MT - NO FOUND STAKED WELL RADIUS PRIOR TO CONST. CO �M T I TH21-1 MH CO DCO 0 * DCO FID C D E NEW 1000—GAL HDPE TANK B *BM—TOP OF MH F M FENCE— T G CO DECOMMISSIONED EXISTING FIELD — REMOVED & BACKFILLED W/ SILT CO MT CO MT 88.74 FINAL GRADE T FILTER FABRIC FD SPLITTER \P5.29 85.29 SEWER ROCK 88'80 CO MT FINAL GRADE C0 MT 89.31 FILTER FABRIC 85.29 85 SEWER ROCK B -H=84.7' SEPTIC SECTION 81.29 81.29 A -I=519' SCALE; NTS MT CO TH21-1 V ORG/OL GM/sm 16' 71.29/B-01-1 GROUNDWATER ® 12' 7/6/2, B -I-83 8' HIGHLAND HILLS #2 132, LOT 6 SUPPORTSSERVICES: A -J=50.6' PREPARED FOR: B -J=82,9' BEVERLY SINNOTT A -K=35.0' , rtis Huffman 5717 HILAND ROAD B -K=67.6' 1 CE 128991 EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 13030 Sues Way Anchorage, Alaska 99516 (907)350-9566 FirstWaterAK@gmail. corn F.W.. ���.�' C. S d �� T1,*�" # C � * 0 DATE: 8/4/2021 , rtis Huffman SURVEY: HOLT 1 CE 128991 DRAWN: SCALE: FWCS 1" 30 cs 8/4/2021 = \ =°141DFESSIO�Pti PAGE: 1 OF 1 OF q jq�;4p CO '49 r SHANE A. HOLT...' p LS -6914 0` Q�a d o �ArO fessiona\ foo SURVEY ORDERED BY: DAR WALDEN KELLER WILLIAMS THESURVEYDA TA AND MEASUREMENTS HEREONARE PREPARED FOR THE OWNER OFRECORD AS OF THEDATE OF THIS SURVEY. ANYUSE OF THIS DRAWING BY THIRD PARTES IS PROHIBITED UNLESS WRITTEN PERMISSION IS PROVIDED. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON, UNLESS NOTED. NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. EAST24596 AS-BUILTSURVEY I" =301 NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY 0 THE FOLLOWING DESCRIBED PROPERTY LOT,, BLOCK2, HIGHLA AID HIL L S SUB. UNI T2 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 3RD DAY OF AUGUST 12021 HOLT LAND SURVEYING 9309 GROVER DRIVE 15098, FB214-28,215-29 ANCHORAGE. AK 99507 MUNICIPALITY OF ANCHORAGE Ori -Site Water & Vwastawater Program PO Buy 1%650 4700 Elmore Read Anchorage, Alaska 9951 M650 Phone: N?0 343-7904 Fax (907) 343.7907 hilp:lA Vw. mund.orgtnske On -Site Wastewater Disposal System Permit Permit Number_ 0$P211263 Work Type: $$plc Upgrade Tax Gude N urriDer . 0!50 2$70X Site Legal Address- HIGHLAND HILLS #2 SLK 2 LT 8 G:0558 Site Mailing Address: 5717 HILAND RD, Eagle River Owner; SINN OTT BE VERLY Design Engineer, FIRST WATER CONSULTING This permit iS fur the ct}ristruution of. Effective Date: Expiration Date: cnt y. f. 4 w]}111 CI]1�'llt Lot SEze in Sq Ft, Total Badroem5: 71122021 71122022 72414 91 [disposal Field d Septic Tank Ll 11-olding Tarok © Privy ❑ Private well © Waiter Storage All construction shall be in accordance with, 1. The attached approvO dauign_ 2. All requirements specified in Anchorage [Municipal codW Chapters 1.5.55 and 1:5.65 and the Stale of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Vater Regulations (18AAG80) 3. Thitr weL6luvvuOdr wdu iequrres iri6pet.l uric during the ITlstelletian. The engineer shall notlfy the Developmem ervioes Depertmunt per AMC 15,65. Provide nctificatfun by caiiing (9 07) 343-7904 (2417)- 4. From Ontaber 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same dray. cf h. Covered, sealed, and heated to prevent freezing Recelved By. Issues! By: ` #� 7/1212021 Date- Date: ! 1 _20 j 3 Development Services Department On -Site Water &Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-382-37 Property owner(s) BEVERLY SINNOT Day phone Mailing address 5717 HILAND ROAD, EAGLE RIVER, AK 99577 Site address 5717 HILAND ROAD, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) HIGHLNAD HILLS #2 B2, L6 Legal description (Township, Range & Section) Lot Size 72,414 Sq. Ft. Number of Bedrooms 3 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx_1 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El Upgrade El El (D) Holding Tank ❑ Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: 2h 201 Date of Payment: Receipt Number: 'I 4 "7 (0 5 Receipt Number: Permit No. C-sP 2 112 6 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com July 6, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: HIGHLAND HILLS #2 BLOCK 2, LOT 6 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install two shallow trenches and 1000-gallon HDPE tank to serve the existing 3-bedroom residence. The design is based on the recent test hole conducted on June 29, 2021. Groundwater was observed at test hole excavation or monitoring as noted on the attached soils log. Due to the groundwater observed, the existing field will be decommissioned in place per code. The slopes are moderate at 10-15% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211263, Rebecca Carroll, 07/12/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211263, Rebecca Carroll, 07/12/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211263, Rebecca Carroll, 07/12/21 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: HIGHLAND HILLS #2 B2 L6 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/6/2021 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 GM/sm 5 6 7 8 9 10 11 12 13 14 15 16 17 BOH 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 7/3/21 30 min 6” 15/16” 30 min 6” 14/16” 30 min 6” 14/16” PERCOLATION RATE 35 (MIN / INCH) TEST RUN BEWTWEEN 6 & 7 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: YES IF YES, AT WHAT DEPTH: 12’ DEPTH TO WATER AT MONITORING: 14’ DATE: 7/6/21 TESTHOLE # 21-1 DATE PERFORMED: 6/29/21 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: BEVERLY SINNOTT 7/6/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211263, Rebecca Carroll, 07/12/21 OF q jq�;4p CO '49 r SHANE A. HOLT...' p LS -6914 0` Q�a d o �ArO fessiona\ foo SURVEY ORDERED BY: DAR WALDEN KELLER WILLIAMS THESURVEYDA TA AND MEASUREMENTS HEREONARE PREPARED FOR THE OWNER OFRECORD AS OF THEDATE OF THIS SURVEY. ANYUSE OF THIS DRAWING BY THIRD PARTES IS PROHIBITED UNLESS WRITTEN PERMISSION IS PROVIDED. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON, UNLESS NOTED. NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. EAST24596 AS-BUILTSURVEY I" =301 NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY 0 THE FOLLOWING DESCRIBED PROPERTY LOT,, BLOCK2, HIGHLA AID HIL L S SUB. UNI T2 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 22ND DAY OF JUNE ,2021 HOLT LAND SURVEYING 9309 GROVER DRIVE 15098, FB214-28 ANCHORAGE. AK 99507 NAME MUNICIPAI_ITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telex)hone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ ,Z C~ - ~- ~ ]PHONE LEGAL DESCRIPTION J~NEW ~]UPGRADE LOCATION · ~ I- Z Manufacturer Liq~)aci~ty-m gall0r:~s I H MEMADE I DISTANCE TO: / ~')] I 'M~n ufact u rer DISTANCE TO: No. oflines, wel~ DT- I Length of ,,~.c~_ lige Top of tile to finish grade Absorption are~a,,_.~ I M~t(h~ria~ IlS de length I Width Dwelling Length Width Type of crib Crib diameter Well DISTANCE TO: Foundation Total leng/~l Material Nearest lot lin, e %)(¢~ inches NO. OF BEDROOMS PERMIT NO. No. of compartments Liquid depth PERMIT NO, Liquid capacity in gallons PERMJT NO. Distance between Total effective absou~Jon area DISTANCE TO: Budding foundatmn OTHER PIPE MATERIALS ~,~'\ SOl L TEST RATING NSTALLER REMARKS Material beneath tile Dlpth ~i~r~u ndation Driller Sewer line inches PERMIT NO. Total effective absorptioa area Nearest lot Iine Distance to lot line Septic tank PERMIT NO. Absorption area(s) · ,t.,., :I.'?6X. i'i]Tf':fi... DE]::"TI'I (F:'!',, } Ed::::('iV',i!]..., VO! .L?]i!! (C:...,!:, "./):}"!i;~ ) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 1I 12 13 14 15 16 17 18 19 2O COMMENTS PERFORMED BY: 72-008 (6/79) [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST SLOPE SITE _AN ENCOUNTERED? '/~"' O P E IF YES, ATWHAT DEPTH? Gross Net Depth to Net Readin9 Date Time Time Water Drop PERCOLATION RATE ~'~"~'~ (minutes/inch) TEST RUN BETWEEN ~ FT AND ~ FT WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ Geophysical Surveys' Drilling Plrmlt No. LOC&TION OF WELL (Plealo compllll olthlr la, lb or I'c.) A.D.L, NO. T'-~'°::~'T~$i~ugh I Gubdivillon Lote~ookI iL.II I/4qtre. Section No. TownlhiPN[--~ Rangl E('-~ Morldion  DISTANCE AND DIRECTION FROM ROAD INTERflECTIONS $, OWNER OF WELL: Street Addre,, and Area of Well Location ~gle ~vert ,'~ 9?577 ~. WELL bOQ Feel Surfoce 4, WELL DEPTH: (final) $. DATE OF COMPLETION Material Typo Top Bottom rock black water '~' ~ 99 ~.usE= ~ Do~.,.~ ~ pu~m~ su,p,~ ~ ~.d~.,,~ diam. ~3 Im to__~ ft. Depth Welght~lb,./ft ~UNJCIPALi~ OF A~L lu~ I~lam, In. fo fl. Depth Stlckup ~t. ~[V?.~EHTAL pRc r~CTiO~ e, F~N~SH O~ WELL: .... ~ s % I ~ ~ Set belweln ft. and fl. ,o. STaTiC WATER LZV[L, ~ aSove or ~ Below land ,urface Date Equipment II.P~PING LEVEL below iond ~urface and YIEC. D ~ ff. Brier . . hrs. pumping ~ g.p.m. i2.GROUTING Well Grouted: ~ Yel ~ No Motertat: ~ Neat Cement ~ Other: ' "' ~ Lenglh of Drop Pipe 7~ fl. copaclly g.p.m. 14. REMARKS: 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperolur~ ____~ ~ F ~ C MUNICIPALITY OF ANCHORAGE 'M -A 11," �A " ..... H, � ..... ervices Department Phone & Wastewater Section Fax Certificate of On -Site Systems Approval Parcel I.D. 050-382-37 1. GENERAL INFORMATION Expiration Date: Nov 10 1 am I Complete legal description HIGHLAND HILLS #2 BLOCK 2, LOT 6 Location (site address) 5717 HILAND ROAD, EAGLE RIVER, AK 99577 Current property owner(s) BERVERLY SINNOTT Mailing address Real estate agent 5717 HILAND ROAD, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) F-1 Duplex F-1 Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well z Private Septic z Water Storage El Holding Tank 0 Community Well 1-1 Community El Public Water System El Public Sewer 1-1 Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: .5(,, L/3 Waiver # COSA # 0 I I q 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN PE Date 7/3012021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the •�• well and septic system. Therefore, any estimate of how long a system will function satisfactory ���:' • • • . / �,� �f� for current or future occupants or guarantee that no unseen encroachments, deficiencies or f discrepancies exist can be given by First Water Consulting & w . /� � . i '• . r ...... ..,...`.. 6. DSD SIGNATURE •Curtis Huffman ��' •' • �`�� System #1 Approved for 3 bedrooms CE 128991 �� �s`•, •' � .� iTF� • .7,/30/29 •'F� System #2 Approved for bedrooms ���F�PROFESStoNA�.� Disapproved Conditional approval for bedrooms, with the following stipulations: 2 ON-SITE AND ER PROGRAM By: ( Original Certificate Date: J�/04) O21 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: HIGHLAND HILLS #2 BLOCK 2, LOT 6 Parcel ID: 050-382-37 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 6/16/1985 Total depth 99 ft Cased to 25 ft (INTO BEDROCK) Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/8/2021 Static water level at beginning of test 7 ft. Well production at time of test 6+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 4.19 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by & SULLIVAN Date of Sample 6/29/2021 & 8/5/2021 Comments B. TANK DATA Age of tank(s) NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank * Standpipes/foundation cleanout per record drawing Date of pumping * C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: *NEW SYSTEM D. ABSORPTION FIELD DATA Which system tested (date installed) NEW SYSTEM ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade 3.4+ ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date NEW SYSTEM Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10’ Yes if No ft Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 7/31/2021 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMFNTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application [)ate ~'~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 6 Block 2 Highland Hills #2 T14N RiW Sec.28 Location (address or directions) Hiland road (b) Applicant Name Car]. Disotell Telephone: Home 69q-5_797 _ Business 6~4-5'797 Applicant Address SR_9.~85, Eagle River Ak. 99577 (c) Applicant is (check one): Lending Institution []; Owner/builder~(; Buyer []; Other [] (explain); (d) Lending Institution N/A Telephone Address (e) Real Estate Company and Agent N/A Address Telephone (f) Mail the HAA tO the following address: Pickup_ TYPE OF RESIDENCE Single-Family,S] Multi-Family [] Number of Bedrooms _ '~ Other 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. 4. 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 (tl/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION " As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Hea~th Authority Approval shows that the on-site water supply and/or wastewater disposal system is sate, 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 --F.?,~LE ,~V[~, ~,~.L%NE~,".[.N6-~EEVICES Telephone Address EAGLE I~IVEfl, AK tt9577 Date P. 0.~OX 773294 Engineer's Seal Approved for bedrooms b Approved ,/~'/ Disapproved Condition~¢" Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. AL MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORrrY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 LegaIDescription: -/o ¢. "'~,~L PROT£c ~ ;, ,,. i RECEIVED WELL DATA Well Classification Well Log Present (Y/N) Total Depth ~'~' / Cased to ¢2.¢- / Static Water Level '3 / Date Completed -~.3~¢- ~//¢,~c5-- Yield ,e~'~c . Depth of Grouting Pump Set At ~" 3' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) If A, B, C, D.E.C. Approved (Y/N) Casing Height Above Ground Electrical Wiring in Condait (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot //¢¢ '/- ; On Adjoining Lots TO Nearest Edge of Absorption Field on Lot /¢¢~ ''~ ; On Adjoining Lots ,/~ ~ To Nearest Public Sewer Line /'¢~/-4 To Nearest Public Sewer Cleanout/Manhole ,4///4 To Nearest Sewer Service Line on Lot ~ 5-/'' Water Sample Collected by '~"~*"'~'~ ; Date Water Sample Test Results ..~-~ '/-,".r _~ ¢ Comments z~5 B. SEPTIC/HOLDING TANK DATA Date Installed ~/,~/¢¢3~ Standpipes (Y/N) ,Y' Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) /' ./'¢//2'4- ; for ~ _ Size /~¢ ~/ No. of Compartments ~ Air-tight Caps (Y/N) Y · Foundation Cleanout (Y/N) ~ ~ Date Last Pumped /'~"c~ ~"~¢;,¢~ ~ ¢ ~, _ Temporary Holding Tank Permit (Y/N) /¢/,/~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /oo 7- To Property Line /~ ~- To Water Main/Service Line Course /q/'o ,-¢ ¢ To Building Foundation _ ¢'// / To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~<~ :~ ' To Building Foundation 7~'~-- Lot "¢'"¢' '~ e. To Water Main/Service Line /¢ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area z.¢, .~.,)~,~ Type of System Design Length of Field Depth of Field /'~ Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~'~ To Cutbank (if present) Comments LIFT STATION ~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments Page 2 of 2 72-026 (11/84) ** 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 ~~.~¢¢7:~ - Date Company .~-/E',/.¢- ,~', MOA No. Receipt No. ~ ~ ~}% ~ Dateof Payment~ '~-- '"¢ [~ ~' ~A~TH ~ %~. ~ Engineer's Seal Amount: $