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Home My WebLink AboutHERITAGE PARK BLK 2 LT 21Onsite File Heritage Park Block 2 Lot 21 #050-211-59 _C1jj*AAb_' Municipality of Anchorage 1W Community Development Department 4IJG Page` Iof 3 On -Site Water & Wastewater Program 0... ''oo s4 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907)34904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191119 PID Number. 050-211-59 ❑ New ■ Upgrade Name: NEIL AND ANGELA LISTON ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ound Address: 19516 LAURA LEE CIRCLE, EAGLE RIVER, AK 99577 ❑ Other Phone: No. of Bedrooms: Soil Rating: Total Depth from origin de: 351-0279 4 GPD/Sq. FL FL LEGAL DESCRIPTION Depth to pipe invert from original grade: Grave pth beneath pipe: F FL Subdivision: Block: Lot: Fill added above original grade: Gravel length: HERITAGE HERITAGE PARK 2 21 ��\v FL FL Township: - Range: _ Section: - Gravel width: ! FL Beds Number of lines: Distance between lines: FL SEPARATION DISTANCES Total absorp' area: Number of trenches: Dist between trenches: To Septic Absorption Lift Holding PubIIGPrivate From Tank Field Station Tank Sewer Lines SQ. FL FL Well 100'+ - - 25'+ TANK ■ Septic ❑ S.T.E.P. ❑Holding ❑ Other Manufacturer. capacity. Surface Water 100'+ - - N/A INFILTRATOR 1530 Gal. Lot Line 5'+ - - Material: Number of compartments: PLASTIC 2 LIFT STATION Foundation 101+ - - Curtain Drain NONE KNOWN Manufacturer. c Gal. Remarks: "Pump on' level at "Pump off" level at High water alarm at Pump Make &Moder Electrical Inspections performed by. PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Installer NORTHERN EXCAVATION Drainfield EXISTING CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 FL Inspection Location and Description: Dates: 1 St 7/11/2019 2nd - 3rd - 4th - TOP OF GARAGE SLAB ENGINEER'S SEAL Community Development Department Approval OF Conditional approval: Date: e� Ar k-/ .49 ........... .••i art / .......... . ♦ Je4r y . Garness # �Aw #. �� ; CE -7 53 t it ♦o�,�Fo•..,7(a��j,...��,�: Approved:°Date: ��/�� o� '°ROFESS\SNP 144°ILIWL � #AECC884 Inspection Report _1-1-12.doc PERMIT NUMBER: PARCEL ID NUMBER: OSP191119 _ _RECORD DRAWING 050-211-59 _t 1985 TRENCH. PASSED ADEQUACY TEST ON 3/28/2019 \ INSTALLED DOUBLE \_\ ' \ CLEANOUTS (DBL3 & DBI -4) _\ NOTE: THE OLD 1250 GALLON SEPTIC _\ TANK WAS REMOVED AND DISPOSED / OFFSITE PER THE CONTRACTOR ` A I B DBL1 28.6 20.0 DBL2 29.0 20.4 ST1 36.1 21.3 ST2 44.3 23.0 DBI -3 49.5 23.7 DBL4 50.5 23.3 F 20, BLOCK 2; TAGE PARK S/D LOT 25, BLOCK 2; HERITAGE PARK S/D \ KEY BOX LOCATION \ PER AWWU DRAWINGS- lo U sump • 5� NEW 15302 -COMPARTMENT \' INFILTRATOR SEPTIC TANK 'k% SSS INSTALLED DOUBLE CLEANOUTS (DBL1 & DBI -2) 4k / /'4 4 �X/OST/NG A eF HQ SFOM PROXI ATE APPROXIMATE OF WATER LINE LOT 24, BLOCK 2; HERITAGE PARK S/D GARNESS ENGINEERING GROUP, Ltd =_ -- - - CIVIL & ENVIRONMENTAL ENGINEERS 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE. AK 99507' PHONE (907) 337.6179' FAX (907) 338-3246' WEBSITE: www.gamessenglneednq.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ANGELA LISTON 907-351-0279 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: HERITAGE PARK S/D; BLOCK 2, LOT 21 J.L.M. TYPE OF WORK: DATE: �, RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 7/31/2019 LOT 22, BLOCK 2; HERITAGE PARK S/D �♦ � e........G.................. a esse�..= ........ l. .; ♦♦�J,r�• CE -7 53 ��_AF Ar LICENSE,I'iy6FE ` •• #AECC884 PERMIT NUMBER: PARCEL ID NUMBER: O8P191119 RECORD DRAWING 050-211-59 TOP OF TANK @ INLET = 97.51 - INVERT OF PIPE @ INLET = 96.91— GRADE =FINAL 100.95-100.99 ST2 2" OF INSULATION (PER CONTRACTOR) -- --p - --------- BAFFLE WALL 1530 INFILTRATOR TANK BAFFLE SLOT i0P OF TANK @ OUTLET = 97.47 a INVERT OF PIPE @ OUTLET = 96.62 OF At --------- ----- - GARNESS ENGINEERING GROUP, Ltd....... ••••••••• ----- — - — _� CIVIL & ENVIRONMENTAL ENGINEERS- - _� •••••••/ � 3701E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK99507'PHONE (907)337-6179'FAX (907)336.3246'WEBSITE:www.gamessengineefing.mm • •••• •• • • • •••••• •••••••• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: a ••A.ar ess' W ■ NEIL AND ANGELA LISTON 351-0279 3 OF 3 �j J, �C -79 ' �= PROJECT/LEGAL DESCRIPTION: DRAWN BY: •�♦� .�•... ( �.' �� HERITAGE PARK S/D; BLOCK 2, LOT 21 J.L.M. ♦ FD '"p"�F ••�• •`' �, �� TYPE OF WORK: DATE:LICE SE ♦♦t�P'1v ESS` RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 7/31/2019 #AECC884 1��VAIL�� H`""""'y MUNICIPALITY OF ANCHORAGE I° � �' F .mcnt On-Site Water&Wastewater Program ��.0 >`;` ' ..=5.;,PO Box 196650 4700 Elmore Road • ��. Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997. http:/lwww.muni.org/onsite fi s._ Dchartmcnt 9'�CHpgP6E On-Site Wastewater Disposal System Permit Permit Number: OSP191119 Effective Date: 4/23/2019 Work Type: SepticTank Upgrade Expiration Date: 4/22/2020 Tax Code Number: 05021159000 Site Legal Address: HERITAGE PARK BLK 2 LT 21 G:0055 Site Mailing Address: 19516 LAURA LEE CIR, Eagle River Owner: MURPHY NEIL J & Lot Size in Sq Ft: 24623 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field Ell Septic Tank ❑ 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 5 Received By: Date: Issued By: Rte. (.1 Date: ® /q MUNICIPALITY OF ANCHORA 5 6 789 Rifiew/o • Community Development Department Phono.-'07-343-1(?19 Development Services Fax: I - 343-7997 On-Site Water & Wastewater Program oz ti� Mayor Dan Sullivan 6 8 £ 9 5 1 E On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 6 `a? l/ Property owner(s) NEIL AND ANGELA LISTON Day phone 351-0279 Mailing address 19516 LAURA LEE CIRCLE, EAGLE RIVER,AK 99577 Site address 19516 LAURA LEE CIRCLE, EAGLE RIVER,AK 99577 Legal description (Sub'd, Block& Lot ) HERITAGE PARK; BLOCK 2, LOT 21 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial Single Family (SF) Absorption Field n (w/wo ADU) Septic Tank ® Upgrade Duplex (D) I I Renewal I Holding Tank Multiple Dwellings I I Privy I I (SF and/or D) Private Well Water Storage n THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: NONE Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: !!� Waiver Fees: Date of Payment: `t�dZ� Date of Payment: Receipt Number: 6a6256,6? Receipt Number: Permit No. QSPIR L t iQ Waiver No. (Rev.01/11) Quanics /7t_o •i ' Advanced Treatment System GARNESS ENGINEERING GROUP, Ltd oea/er ENGINEERING SALES CONSULTING April 19, 2019 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Upgrade for Heritage Park S/D; Block 2, Lot 21 To whom it may concern: The referenced property has a 4 bedroom residence that is served by public water and a private septic system. The septic system consists of a 1,250-gallon septic tank and a deep trench type drainfield that were installed in 1985. We have recently performed a septic adequacy test on the 1985 trench and found it to absorb 600+ gpd. Due to the age of the septic tank, the owners would like to upgrade the septic tank. Attached is a design drawing showing the proposed septic tank upgrade. We are proposing that existing septic tank be decommissioned per UPC and a new 1530 2-compartment Infiltrator tank be installed in next to the old septic tanks. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. you have any questions, please contact us at 337-6179. Thank you f• our as ista •e. di-rely, �, ness, P ., M.S. Pre••.de 3701 East Tudor Road,Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com ` _- \ -\ \ i i / NOTE:ALL PROPERTIES IN HERITAGE PARK S/D ARE \' `q/ ' \ \ SERVED BY PUBLIC WATER /,14/ • "' \ // 1 1985 TRENCH. \' C/ \ t PASSED ADEQUACY — \ TEST ON 3/28/2019 \ \ INSTALL DOUBLE 22: •• �, CLEANOUTS• KEY BOX EXISTING 1250 GALLON SEPTIC TANKS W PER AWU DRAWINGS TO BE DECOMMISSIONED PER UPC /• • • . ,• 70. 0 \'\ ask _--� . ' SUMP -�MF/V)• NOTE:THE WATER SERVICE LINE .•. ' " • S #Oe ��PROPOSED 1530 2-COMPARTMENT •� SHALL BE PROFESSIONALLY • • . . ' INFILTRATOR SEPTIC TANK +14 LOCATED TO CONFIRM SEPARATION �"+i DISTANCE TO THE SEPTIC SYSTEM O� ` ..• �« / / INSTALL DOUBLE /+it/ Q��i'// , CLEANOUTS / '•/ , i44- - , • Ek/ 4 eFO thvG A/0 %04,1 ASSUMED LOCATION OF WATER(SEE NOTE) • LOT 20,BLOCK 2; N HERITAGE PARK S/D • SCALE: • 1"=30' • - LOT 22,BLOCK 2; ' /. . . HERITAGE PARK SID LOT 25,BLOCK 2; HERITAGE PARK S/D /' GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN.BY PROCEEDING • FORWARD WITH THIS INSTALLATION,THE ENGINEER,WELL DRILLER,CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE LOT 24,BLOCK 2; READ THESE SPECIFICATIONS AND AGREE TO HERITAGE PARK S/D ACCEPT THE TERMS AND CONDITIONS OUTLINED. V. Ale t- GARNESS ENGINEERING GROUP, Ltd49 I. .\ _ •; CIVIL& ENVIRONMENTAL ENGINEERS j 0 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179•FAX(907)339-3246•WEBSITE.Www.gamessengineenng,00m •• III PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 to'; i e i y Game' :• i t ANGELA LISTON 907-351-0279 1 OF 1 �•,% ' CE-795 '_�: PROJECT/LEGAL DESCRIPTION: DRAWN BY: �♦ �••. '�) �;.}�� HERITAGE PARK S/D; BLOCK 2, LOT 21 J.L.M. *��D•pp'•�•I •••••'�P'�,.�. TYPE OF WORK: DATE LICENSE ,' 1'"5;��4 DESIGN OF SEPTIC SYSTEM UPGRADE 4/19/2019 #AECC884 J [-5163 `w�r� lFF 4, 4)4 -4- 1J9 0 aM M HF mo { 2 e e 00000pp0 0 G,5'. OF AtN e 0,g,c ... .... ..q�p� TH% oc 44.9 1� ll S-1 OQOoe •''. SHANE A.HOLT °�O / SINGL£FAMILY l� 4e LS-13914 .•'..q5‘-‘51 ��, co FRAME 4p'OJessions%• \-oo 04pp \/./47.--.----..,..,_„, • �, \ ///// '.-\ / AS-BUILT SURVEY 1" =20' \ oT« OOMERAMET Doi ATF ' I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY \\� ///// X10 OF THE FOLLOWING DESCRIBED PROPERTY \\\\,,, 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 ='i'/- DAY OF //I/ MARCH , 2010. "`4`;,,,T-f THE INFORMATION HERFON IS FOR THE USE OF LEWIN INSTITUTIONS SPECIFICALLY TO SEM NN II CONFLICTS BETWEEN EXISTING STRUCTURES ND PLATTED LOT LINES NO/C41 EASEMENTS;ANG IS .4r MOT TO BE USED Fd POSITIONING ACOITT9ML STRUCTURES,IMPROVEMENTS,OR FENCELINES. 45'js., HOLT LAHD SURVEYING EASEMENTS OF RECORD,OTHER TIMM T/OSE APPEARIE ING ON TRECORD PLAT,MNOT T*ON 9309 GROVER DRIVE HEREON(UNLESS INDICATED) MMY �•AYBO ANCHORAGE.AK 99507 ,NTE: FENCELINES TT APPEAR ON THIS ORNIING ME MDT TO BE USED TO DETERMINE / 14175,FB 195-47 345-5513 PROPERTY LINES CO METAMPOSITION ADDITIONAL IMPROVEMENTS. / NM PAVING LOW MECO MY RE MPROXUMTE DUE TO EXCESSIVE SIGN NO/OR ICE. C- 82 CONSTRUCTION --- , II .t r e : 1 Iw4 yrs (A ,:ri.,, A'O) 4t sr w t K• r) it D ••• oo _ ( Aad) Asps 0051) I *STA m r^ . r IK Noi:igiiriai •r. � \ Nam'7,4' TRADITION AVENUE w I r \ < c \ -�" •e/it.6 to \..............d.\\ J#' �t o • I oafIwomfr. 1 i ...A. .fir.. II . 7.44 I 7 s •Q*00.00•R j i Ari Mw9I S -y, 'i •sm.6174.40 r rxmo7►OW A,-. - 4. -.,i. .- JN4. _ • 9L ) "ij p'NT1..la a / I/ 13 , m -... / 4i •,16 I +• _ 440) / Q / 0, .t pd i44.,i 6t( ! // .9 r'`. .... ; _� . swe '-- - • ( ' AL- ter' _ _ • Q' 6h. IA / r M i 0►y LEE E �/ 0. � r'..� LAURA CIRCLE _, 4F 1• 3 �r La 6h. 4«17(A001 1 t ' •t 07A At .�A�L.f I • \ k" . u \ e i 1/ r -4' _� rig") .71(4161 I. I i *4.r• ..r \ *� eA ( ,i t 4 fee CAs raw / Ma,O• .70 e•N(AM f \ \ t• . Om.O-V.00 / J . 07A-.0..642o it /' 4a z. • :44,41461,115.M.---...7 / / i~ ',~-~ 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 [] NEW MAILING ADDRESS ~ / .... ~'~ LEGAL DESCRIPTIO~ ~ r/ -- ~/ ~ ~LOCATION Ma i ~ ~o. of compart~s ~ Liq, capacity in gallons Inside Jength Width Liquid depth IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO, 0 ~ ~ Manufacturer ~ Matedal Liquid capacitg in ~aHons F Well Found~ ~ Nearest~ne ~ ~ PERMIT NO. ~ DISTANCE TO: ~"~ C~ Distance ~p~es ~ength o~ach pne Total leaf ~ines Trench~idth ~ ~O inches ~ ~ No. of lines / grad~~/O Material beneath tile (~,) 92 Length Width Depth PERMIT NO, ~ ~ Tgpe of crib Crib diameter Tota} effective absorotion area m Well B~lding foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(s) ~ STANCE TO: OTHER PIPE MATERIALS INSTALLER REMARKS ~ P~. 694¢379 _ DEPARTMENT' []!~ 'aEALTH AND EI',IVIRGNMEN]EAL F :TECTION 825 I_~--S]"REET, ANCHORAGE, AK 995~ 264-4720 ~ ~C~ PERMIT NO: DATE ISSUED: AF:'PL I CANT: ADDRESS: CONTAC]" PHONE 850:318 ()6 / 18/85 % S&S ENGINEERING GIBBS EXCAMATING SRB 196-X EAGLE RIMER, Al'.:: 99577 694-~9'79 LEGAL DESCR II::'~ LOT SIZE: MAX BEDROOMS: SUBDIVISIGN: HERITAGE PARK SECTION: 7 TOWNSHIF': 14N 24623 (SQ. FT. OR ACRES) 4 LOT: 2 RANGE: 1W Listed below are the options available 'E(~ yl]Lt in desig]~ing yOLlP septic system. Choose the option that best ¢its your site,,. DEi::'TH 'f'O PIPE BOT'FOM (FT'.) 5.0 GRAVEL DEPTH (FT.) '7,,O TOTAL DEPTH (FT.) 12.O GRAVEL. WIDTH (F'T'.) 2,5 GRAVEL. LEIqGTH (FT.) 36.0 GRAVEL VOLUME (CU. YDS. ) .25. () TANK SIZE (GAL. S) 1,250,.0 ~.~ SOIL RATING (SQ. FT. /BR) 125 ~."~' TANI< MUST HAVE AT I_EA~.~I TWO COMPARTMENTS 6.0 5.0 0.5 3,.0 6.5 8.0 20.0 5.0 38 ,, 0 59.0 28.2 38.3 250. ~:~ .~,~ 1,250.0 ~.,~ :~25 125 I certify that: 1. I am £amiliar with the requirements fer on-site se~eps ancl wells as set. £ePth by the Municipality o~ Anchor. age (MOA) and 'Lhe State of Alaska. ~. I will install the system in accordance with all MGA codes anti regL~lat, ions, and in compliance with the design c:ri'Leria o[ this permit. ~]. I wall adhere '~:.o all MOA and S'Late of Alaska requirements ,~o~ the set back distances From any existing well~ wastewater disposal system or public sewerage system on this or any adjacent er nearby lot. 4. I c.u'~derstand that tl'iis permit is valid Fop a maximum o~ 4 bedrooms and any enlargement will require an additienal per'mit. IF A LIFT STATION IS'INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN EL. IECTRICAI_ F'IERMIT AND It]SF'ECTIGN MUS'T' BE OBTAINED~ (2) AS--BUIL. TS WILL NOT BE: APF'ROVE~HOUT AN EL.Et, TRIbAL INS~:EC'F~,[:)ItI REF'GR"F;'AND (3) THE EL_ECTRICAL WOF~ BFJ~)Of~ BY A LICEIqSED 'EI_ECTF~IC]:AN. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG .EGA'DESCRIP,'ON: £2/ d 5 6 7 8 9 10 11 12 13 WAS ~ROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? PERCOLATION TEST / / ~ LATION RATE ~ (minutes/inch) / 14 15 16-- 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop No. 1457-E BETWEEN FT AND ~ FT CERTIFIE~/o A T E: ~/~-~/~'~Z, 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 (~-0 '-~-{{- ,_Z~ HAA# ~ ~'~c~ -r~)L~-°l~ 1. GENERAL INFORMATION Complete legal description Lot 21; Block 2; Heritage Park Location (site address or directions) 19516 Laura Lee Circle Property owner Mailing address Jim and Molly Taylor Day phone 694-4358 19516 Laura Lee Circle Eagle River, AK 99577 Lending agency Mailing address Day phone Agent Caroline McPhee Address 16600 Centerfield Drive, Eagle River, AK Unless otherwise requested, HAA w/l/be held forpickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: 4; NOTE: Day phone 694-4200 99577 Individual well Community well Public water y, xx 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 xxx 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 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 inves_ti_gation 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 ~ ~'"~-/') Phone Address Eagle Riv~r,.~r, AI~.s~~A~E'~' 9577 ' ' Engineer's signature DHHS ~¢6'NATUR E Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 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/gl) Back MOA #21 Municipality of Anchorage ,~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~.~--~ [5~.tz- 7... ~¢..~-r",~,~:J ~p~r..c-Parcel I.D. A. Well Data Well type ~C~/~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to FROM WELL LOG Pump level1 / SEPARATION DISTANCES F/B~/WELL TO: Septic/holding tank Absorption flol~o°~ Purer main Sewer service line Casing height Wires properly protected (Y/N) ~ ,..-'//g.p.m. r'rl g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: Well(s) on lot ~ To property line '~.~ ~ Surface water/drainage B. SEPTIC/HOLDING TANK DATA Date installed (~' ~' ~ ~" Cleanouts~/N) ~ High water alarm (Y~) t-~ ,~ ~,~ .ti ~ Pumper .Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent lots ~--~[ ~ Absorption field '7,.-'7.- L Tank size [/.~0 Compartments Foundation cleanout (Y/N) ~ Depression ("~ · Alarm tested (Y/N) Foundation Water main/service line 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) ~ Manufacturer Manhole/Access (Y/N) Surface water D. ABSORPTION FIELD DATA Date installed ~,~ '- ~ ~- Length '~O ~ Width Soil rating (GPD/Ft') ~l Gravel thickness System type "T"~.-~.,~ ~.- ~ Total depth Total absorption area Date of adequacy test ~ i ~ D ~°l ~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y~ ,.~:> ~ .~'z~.~ Cleanout present ~'N) Results~i'ail) ,-¢ Depression over field ('~ ~,,-~5 for After test If yes, give date Bedrooms Well on lot ¢--o o t '~' To building foundation On adjacent lots '~o ~ +' SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots ~[~ Property line ~ ~ ~ To existing or abandoned system on lot Cutbank ~/¢~ Water main/service line Sudace water t ,, o ~ ¢ Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number ~='/MUNICIPALITY OF ANCHORAGE ~'--/ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date '~"' GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, ~.O 3~' ~ / ,~./~ Z ~/~',~,-/'7"~,/'~ ~ ra~~ Location (address or directions) (b) Applicant Name ~~ ~~lephone:Home &~¢ ¢~usiness~¢7~-'~ Applicant Address ~e~, (c) Applicant is (check one): [:ending Institution []; Owner/builder,~ Buyer []; Other [] (explain); (d) Lending Institution .' , ~'~- ¢'/~ Address ,/~,~,~,¢~'~ ~-~ Telephone (e) Real Estate Compaoy and Agent Address Telephone Mail the HAA to the following address: SRB 196x .Eagle "~.iver, 'Alaska (f) TYPE OF RESIDENCE Single-Family~i~'- Multi-Family~ther Number of Bedrooms WATER sUPPLY. ndiv!dual Well I-I..' Community [] Public~., '~ Not~: If community well system, must have written confirmation from the State Department of Environmental Conservation att~S, ti,~g to the legall,ty and status. 4. SEWAGE D SPOSAL ~ ',' i'. Onsite ' Public E]: 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. ~' 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms 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 -"'i;~i~iicx-'[i~ Telephone Address SRB 1,6x ~///~' / Date DHEP APPROVAL (¢-7]h Approved for //~/-:'¢/¢-- bedrooms by Approved ~ Disapproved Terms of Conditional ApprovAl Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ~, Page 2 of 2 72-025 [11/84} MUNICIPALITY OF ANCHORAGE (MOA~ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 DEPT. OF HEALTH & - ENVIRONMENTAL PROTECTION MAR 2 5 198 Legal Description; I VE D WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above GrOund ~lectrical Wiring in Conduit (Y/N) Separation Distances from Welt: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To N~arest Pt~blic Sewer £ine Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments [--"~ S (.~ If A, B, C, D.E.C. Approved CJ~ Date Completed Yield f~ll Depth of Grouting I-¢k.- Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~-OO ~ 4-- ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed (.o¢~,~"~%~ Size ~,Z~'~--~ No. of Compartments Standpipes ~/,N~ Air-tight Caps~,~F~ Foundation Cleanout Depression over TankJcY'~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High-Water Alarm (Y/N) ~ I ~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ~'~ To Water Main/~-'e'Line ' Course Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, POnd, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~;~ ~ 't c'~ '"'~ Width of Field ~4:~'¢' Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~t~ To Building Foundation Lot To Water Main,~Sef, c~e Line ~,..o ~ ~- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present Date of Last Adequacy Test To Property Line \~\ ~ To Existing or Abandoned System on ; On Adjoining Lots "~ ~¥ To Cutbank (if present) ~'J (A- Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) //"Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** Amount: $ I certify that I have checked, verified, or conformed to all M. OA and 121AA guidelines in effect on the date of this inspection. Signed Company Receipt No. Date of Payment Page 2 of 2 72-026 (~ 1/84) %/.. L l.l ~, ~.~ ' / DE~. OF ~NVlRON.M~L ~ONS~RVATION / ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: ' 27'4-2533 ' i / DATE: To Whom it May Concern: According to records on file in this office the ~ CA ~/~c~?L S~6~iurJ'"o/1 Water System is in compliance with the State Drinking Water Regulations' Sincerely,