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Home My WebLink AboutHERITAGE PARK BLK 2 LT 23 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite v Depill'till e11t On -Site Wastewater Disposal System Permit Permit Number: OSP221379 Effective Date: 10/3/2022 Work Type: Septic Upgrade Expiration Date: 10/3/2023 Tax Code Number: 05021157000 Site Legal Address: HERITAGE PARK BLK 2 LT 23 G:0055 Site Mailing Address: 10416 TRADITION AVE, Eagle River Owner: WOSCEK MARK & TEENA Lot Size in Sq Ft: 20199 Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 5 This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (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: • CO #1 Field was added to the permit 11/9/22 may: s e o `Gi> G Issued By: Date: Date: /O.q /ZZ MUNICIPALITY OF ANCHORAGE MEMSEEMEMEEZIM Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 050-211-57 Property owner(s) MARK & TEENA WOSCEK TRUST... Day phone Mailing address 10416 TRADITION AVEUNUE, EAGLE RIVER, AK 99577 Site address 10416 TRADITION AVEUNUE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) HERITAGE PARK BLOCK 2, LOT 23 Legal description (Township, Range & Section) Lot Size 20,199 Sq. Ft. Number of Bedrooms S APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) � � Absorption Field n cc, ❑ Single Family (SF) Q (w/wo ADU) Septic Tank Q Upgrade Duplex ❑ (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the 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: Date of Payment:2- Receipt Number: l o(aj Permit No. d ISP 9 a 1379 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 0 Frst Water - C O N S U L T I N G W ATE R!VJA 1.1 EWA I ER 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com October 28, 2022 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC UPGRADE PERMIT — OSP221379 LEGAL: HERITAGE APRK BLOCK 2, LOT 23 It has been determined that the existing septic field is saturated, and the residence needs an additional absorption field with a new tank. The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank and field on the above referenced lot. We propose to install a 1500 -gallon HDPE tank and 63' long deep trench with diverter valve per the attached design to serve the existing 5 -bedroom residence. The lot and area are served by public water and the waterline and key box with property line will be staked prior to construction and shown on the MOA inspection report. Available data and the recent test hole show no groundwater and were designed accordingly. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, 4 �� Curtis Huffman, P.E. F�qtWNsutnuu QEuriets _J //'IEA/WASIEWAI EA L 'oNPPOAIs PEANNI4G DESIGN CALCS: 5BR X 150 GPD = 750 GPD 750 GPD/1.2 GPD/SF = 625 SF SAS 625 SF / (2 X 5' ED) = 62.5 FT. TRENCH USE 1 TRENCH - 63'(L) X 2'(W) X 5'(ED) TOTAL MAX DEPTH FROM EXISTING GRADE: -11' NOTES: STAKE NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. PROPERTY LINE & ANY WELL RADII PRI❑R TO C❑NSTRUCTI❑N AREA IS )) SHM ON 9®S -5 INSTALL NEW DIVERM VALVE 4 WMI NEW .nxawxvo �& NEW 15W DAL HDPE TAW NO PRIVATE WELLS WITHIN 1 00'OR PUBLIC WELLS WITF 200' OF PROPOSED SEPTIC SYSTEM. WATERLIN TO BE LOCATED PRIOR TO CONSTRUCTION. DESIGN BASED FROM ERB HAND -DRAWN, DIGITIZED ASB & MOA RECORDS, SUPPORT®SERVICES: ®®® HERITAGE PARK BLK 2 LT 23 okx ° OF .AL PREPARED FOR:FWE `Q� MARK & TEENA WOSCEK �`� 10416 TRADITION AVENUE C r * 9 TH EAGLE RIVER, AK 99577 e FIRST WATER CONSULTING DATE: 10/28/2022 I# rt Huffman j SURVEY: ERB 13030 SUES WAY _ DRAWN: FWCS , N 10/28/2028/202G�� AA 1 10 -- — 2 — ANCHORAGE, AK 99516 SCALE: 1" = 50' 907-350-9566 FirstWaterAK®gmail.com PAGE: 1 OF 2 DESIGN DETAILS: NO KNOWN SHALLOW GROUNDWATER ISSUES, INSTALL NEW 63'L X 2'W X 5'ED FIELD W/ NEW VALVE. MAINTAIN 10'+ FROM FOUNDATION, 200' TO PUBLIC WELLS, 100' TO PRIVAGTE WELLS, 100' TO SURFACE WATER, 5' TO FIELD & DECK SUPPORTS WITH 4' OF COVER OR INSULATION. NSTALL PER AMC 15.65, 15.55, & MASS ... TANK BEDDING, SEPARATIONS, MATERIALS,... Li ZZ FLAT TH22-1 FLAT FLAT INSTALL NEW c 63'L X 2'W X 5'ED I C MT FIELD MT SHED ON SKIDS I C( I I o p SHED -5'- DCO VALVE I EXITING FIE I MH -5 INSTALL NEW DIVERTER VALVE 8 q T WITH NEW 63'L X 2'W X 5'ED FIELD & LT 24 NEW 1500 -GAL HDPE TANK DRIVE LT 23 F_ 5 BED HOUSE NO WELLS WITHIN 200' OF PROPOSED SEPTIC TANK. SITE & AREA SERVED BY PUBLIC WATER. LOCATE WATER KEY BOX & WATER LINE & PROPERTY LINES PRIOR TO CONSTRUCTION & SHOW ON INSPECTION REPORT. 10' UTILITY ESMT. CITATION AVENUE 0 D v 0 z z D r� DESIGN BASED FROM ERB HAND—DRAWN, DIGITIZED ASB & MOA RECORDS, HERITAGE PARK BLK 2 LT 23 PREPARED FOR: MARK & TEENA WOSCEK 10416 TRADITION AVENUE EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK@gmoil.com SUPPORTISERVICES: .40 FOF AZ� C 9 TIFI* DATE: 10/28/2022 I� rtis Huffman SURVEY: ERB 1 4f, CE 128991 DRAWN: FWCS 1 10/28/2022eAW SCALE: 1" = 30' PAGE: 2 OF 2ssio��' 0 First Water S U L T I N G 4YRTTR/WAS! f 0i 11 SPPQPT E PL t7 il 1INCi 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 FirstWaterAKQgmail.com SOILS LOG -PERCOLATION TEST LEGAL DESCRIPTION: HERITAGE PARK B2, L23 DEPTH FEET OG SOILS 1 - ORG/OL 2 3 4 5 6 7 SM/gm-sw 8 9 10 11 12 13 14 15 16 17 BOH wt 20 i *: �sTH ....•:*�r �JJ Curtis Huffman CE 128991. ��' - ,10/26/22 • '�v � �tlil PROFESSI�N� PERFORMED FOR: MARK & TEENA WOSCEK TESTHOLE # 22-1 DATE PERFORMED: 10/17/22 GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: NO - DRY DATE: 10/21/22 & 10/25/22 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION Reading Date Gross Time Net Time Depth to Water Net Drop 10/21/22 10 min 6" 3 13/16" 10 min 6" 3 13/16" 10 min 6" 3 13/16" 10 min 6" 3 14/16" 10 min 6" 3 14/16" 10 min 6" 3 13/16" PERCOLATION RATE 2_7 TEST RUN BEWTWEEN 4 PERC HOLE DIAMETER 6" (MIN / INCH) & 5 FT PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16 TH 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: 10/26/22 '~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 · ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT . / IPHONE E~ NEW- MAILING ADDRESS LEGAL DESCRIPTION ....... ~"~ ~ ~ NO. OF BEDROOMS LOCATION DISTA"CE TO: JWel, /IA 14 ~Z Manufacturer. ~. {~ ,>~ Material ~e.~,l ND. of compartments ~ Liq. ca.pacity~in gallons iF HOME,DE: Inside length ~,/~ Width ~/~ Liquid depth ~O ~ DISTANCE TO: Well Dwelling PERMIT NO. ~i ]A __. z--~o~< Manufacturer . /U/~ Material LiquidcapacitylngaHons , - Well A/~ Foundation / Nearest lot line PERMIT NO(~ . Lenglh Of each,ne _ To,al ~ ~ ~ Top of tile to finish grade - Material beneat~ tile - Total effective absorption area Length ' Width Depth ~ PERMIT NO. ~ - ~ ~ Type of crib Crib diam Crib depth Total effective absorption area ~ Well BuJldin9 ~oundazion Nearest lot line ~ DISTANCE TO: ~' Class ~:::hi ,~ Driller Distance to lot line PERMIT NO. ~ ' 'ng ¢ ' Sewer line Septic tank Absorption area(s) ~ DISTANCE TQ: ~ ~ OTHER ~ 31% ...... r~ A o~ ~r 1~ PIPE MATERIALS ~ ~ * ~[~-~ ~1 ~ SOl L T EST ~ ~ . ~ ~ ~ ~ ~' -- -' ~ ~ ........ ~ ~'~'~ /~0 -' ' --~ ~STALL~R . ~ ~ ¢~ ~ J~N ~ SW~NSO~' ~. ~, ~ - , REMARKS ~ ~. ~.~,¢~ ~ ~--~ .~-- J · · ~ ' -:' '~ I t ~ ~ I ~ ~ ................. ..... ._ :-, _. , , , , , , J ..... ..... ., ~ i ~ ~ ~ ~ ~ ' ' ......................... j .... : t--1 --"T -',-- :--'~ ....... --- --~-- ~ ~ ~ J___~ _ APPROVED/ . / ~' DATE/ LEGAL PERMIT NO. DEF'RF.:TMENT B../HEALTH AND EN,,,IRONMENTRL ~O'FECTION ,¢~.. ~ 825 ,"L'" STREET., ANCHORAGE., AK. 9958i /~/C~ ~ ~ ) v ~ APPLICANT J.C. FOSTER C,¢'0 220~ C ST. LOCATION TRADITION LEGAL L 23 B ~ HERITAGE Pt(. TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH LOT SIZE ~44-477'7 20000 SQUBRE FEET MAXIMUM NUMBER OF BEDROOMS = 5 SOIL RATING (SQ FT?BR)= 85 THE REQUIRE[) SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:,EF"T ~4 = :5: LE~'4GTH= 2 ~_--"t ,]F-:R%-' EL [:. E F'-F H == 4.. THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETHEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY HELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE HELL WILL SERVE. Ti4Cl <2> ~ ~-~5F'EE:TZ 6~-~5 ARE F:E,2L~Z F:E[: .......... BRCKFILLING OF BNM SYSTEM HITHOUT FINAL INSPECTION AND APPROVRL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETHEEN R HELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS &00 FEET FOR R PRIVATE HELL OR ±50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE'TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET TO A COMMUNITY SEHER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPL~. SPECIFICRTIONS RND CONSTRUCTION DIRGRAMS RRE AVAILABLE TO INSURE PROPER INSTALLATION. i CERTIFY THAT ±: i FIM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS AS SET FORTH BY THE MUNICIPFILITY OF FINCHORAGE. 2: I WILL iNSTFtLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. 3:: i UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF' ]'HE RESIDENCE iS REMODELED TO INCLUDE MORE THAN 5 BEDROOMS. S I GNE[: ..... RPF'LiC:ANT J.C. FOSTEF: & ENGINEERS, INC.' 7125 OLD SEWARD HWY. ANCHORAGE, ALASKA 9950:~ ;549 - 6561 PERCOLATION TEST SOILS LOG PERCOLATION TEST 3 4 5 6 7 8 9 10 11 SLOPE WAS GROUND WATER ENCOUNTERED? 12 ~ IF YES, AT WHAT DEPTH? J i ' 14/ I~11~ .~* O~F~.~/~,~,~ -- / Reading Date 17 20 PERCOLATION RATE TEST RUN BETWEEN SITE }'LAN Gross Time Time Water Drop V I.,~L~,~ ~ (minu[es/inch} ~ . FT AND 7 ,. FT COMMENTS PERFORMED BY: 72-008 L_j, 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 ,."~"-*C /c'~,~:...s"/~z~- ~ ,~.~/,~,~,¢,.¢e,¢~,,[] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION Well , / Absorption area O~ I DISTANCE TO: I ~ I- 2 Manufacturer ~ ~ [Liq. capacity in gallons I ,r H^MEMADE I Inside length ' v I IWell / Dwelling 9 ~ z I DISTANCE TO:. I '-' I Well .- Foundation ~ '~ I DISTANCE TO: I ,/V/~.~ ~ ;i-. ~ I No. of lines. I Length o'f each line Total lengthgf lines = z ~ / ~2 .~2. - . ~- ~ ~ Top of tile to finish grade Material beneath tde Length Width Depth <~ I- Type of crib Crib diameter -~dB'~depth ~ I Well / Building foundation " DISTANCE TO: ~, IClass Depth -Bl~ller ~ I Building :[~rt1'~tion Sewer line > I DISTANCE TO: Dwelling Material Material N eares~t~e. Trenc~ width inches inches NO, OF BEDROOMS PERMIT NO. No. o.~,,~,m pa r t me n t s Liquid d~ PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines Total effective absorption area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE 72-013 {Rev. 3/78) LEGAL ,]5i--'--; I TE ( 82t0._=,0 :.., DEF'RRTblENT OF HEALTH AND ENVIRONMENTAL i~ROTECTION ,_,-.._ 'L" STREET, ANCHORAGE: AK. 99501 SEbIER F'EF:~I l' T PERMIT NO. RPPLICRNT JC FOSTER SRR BOX iT~5K ANCHORAGE 9950? LOCRTION LEGRL B2L2~ HERITRGE PARK TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MRXlMUM NUMBER OF BEDROOMS = ~ SOIL RRTING (SD FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: CCEPTH= E: LE~4,3TH= 2;2 ,3[;~fl'-/EL [:,EF"TH= .44-,' c,c,4 LOT SIZE 9'99999 SQUARE FEET 4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFiELD. THE DEPTH OF R TRENCH OR PIT IS THE BISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFflLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). [;:ELi.,IJ I RE[:, SEPT I ,~ TRt'-lb-'. S I Z~-- :]....¢~E-~E-~ G¢IL[ E,t'-lS F'ERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DJF.'ING THE r~._rb~..~r RN[:, THE INSTRLLRTION INSPECTI;Z~NS OF RNY HELLS RD.JRCENT TO THIS .... NUMBER OF RESIDENCES THRT THE HELL HILL =,ERIE. TIH,3 (.=_--"- .':, I t'.I_SP EC:T I ,Ibis BACKFILLING OF ANY SYSTEM HITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECLITtON. MINIMUM DISTANCE BETWEEN R HELL RND RNY ON-SITE SEHRGE DISPOSRL SYSTEM IS i00 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HELL. MINIMUM DISTANCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. F'ERrl I T E:~::P I [;:ES [)EC:E~.IBE~: ---':::L.. 1:-]~ :B2 I CERTIFY THRT t: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND HELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I HILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRV REQUIRE ENLRRGEMENT RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. I SSLIED .................. -/~- IF THE '44. 0 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) LOT 23 Block 2 Heritage Park Location (address or directions) CITATION & TRADITION (b) Property owner Mailing Address (c) Lending Institution Mailing Address AHFC#47948 Telephone: (home) Business Anghoraqe, Alaska 99503 520 East 34th Avenue, Telephone (d) Real Estate Company and Agent Address 694-4200 Telephone RE/MAX OF EAGLE RIVER ATTN: Eva Loken 16600 Centerfield Drive 5u.i~e ~01 Eagle River, Alaska 99577 (e) Mail the HAA to the following address: (or check here ¢(1, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family E~X Number of bedrooms 5 3. WATER SUPPLY Individual Well [] 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 [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. 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 Address Date 5 & S ENGINEERIN~ 17034 Eagle Ri~er Loop Road No. 204 Eagle Rlver, Alaska Telephone 6. DHHS APPROVAL Appro~/ed...for ~ bedrooms by APproved ,~/~ Disapproved Terms of Condi(ional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 DHHSdonotconduct inspections or analyze data before a certificate Es issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) aack Page 2 of 2 A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 Legal pescript on: If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Total Depth" Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~ I..p ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ,.-/_~.,¢~,:~ L,r ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments /%//, ~), /~- ; Date B. SE.T,C..OL.,.G TA.K.ATA ) Date nsta,ed Size / No. of Compartments Standpipesd~N) ~ %~Caps (~!~'N, Depression over Tank (Y/~' b,J Datxe Last Pumped ;for Pumping/Maintenance Contact on File (Y/N) / Holding Tank High-Water Alarm (Y/N) ~/~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: / To Water-Supply Well ~/'"~F- To Building Foundation ¢'--' I'¢F TO Property Line / L~ To Disposal Field To Water Mai'n/Service Line / o Comments To Stream, Pond, Lake or'Major Drainage Course /' C~P ~ Foundation Cleanout~N) y 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / '9f3'Z- .p Width of Field -'G// ? (c~ i) Square Feet of Absortion Area Type of System Design Length of Field ~ ~ / Depth of Field /6) /' Gravel Bed Thickness ,¢?/r Statndpipes PresentON) Depression over Field ('f~_R.)') k.) Date of Last Adequacy Test /..)rig/_./ Results of Last Adequacy Test ~-/~-'C( ¢'/z'r.z~c 7r'~)a~._ '7~'-,/'-~5"-~¢'~ ~z~'~'r~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well '/"J/~ To Property Line JC3 /./-- To Building Foundation /GZ To Existing or Abandoned System on Lot /°' o'/~°~- ; On Adjoining Lots ~.O?~/~._vT' "22./ To Water Main/Service Line C.o g' ( ~- To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~~-~'de4;¢',~ /~m-oo/d' ~O/ ¢¢. To Cutback (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for ~---~'~ Meets MOA~iN) Dimensions Manhole/Access (Y/N) .... "Pu .rn_p_OffZ~L-e-v~i-at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I bat, e che/o~ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this Date Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 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. # 4:~.--~-~,'~ 2..// ,b"~ HAA# ,~,~,_ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) (b) (c) (d) Location (address or directions) ,,~'~ d,~A,~,~A,~'2~ 0~' ~ /~~/~ ~ Property owner ~A~I~ ~S~ Telephone: (home) .Business Mailing Address ~ ~" ~ ~~A~ ~/4~ Lending Institution ~ ~~0¢~~ Telephone Mailing Address /~/ ~' ~~ ~' ~~~'~ Real Estate Company and Agent ~A~ ¢~ ~ ~ ~/ Address ~¢~ ~~/~ ~' ~* ~/ Telephone (e) Mail the HAA to the following address: (or check here ,~hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family [~ Number of bedrooms WATER SUPPLY Individual Well [] Community ~ Public [~/'.,~,~c.~o,~,,~ ~- /-.,',4r'~-4 #r/~/ry Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site ~ 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. 72-025 (Rev. 7/88) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of thevatidationdateshown below, Iverifythatmyinvestig~ttion 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 '[hat 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 compli.ance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection.~~~;> Name of Firm ,/4 S~'~" /'/~7" Telephone -~' Address ~'O4:~ ,4,~,C,7'/C/ .5'/¢¢,'/~' /~'~/"_~ /44/c/¢~,,c/l~C,~/4/4', Date //,/',~¢'/~¢' ~¢ 6. DHHS APPROVAL Approved for ~ Approved ~_ bedrooms by Disapproved Terms of Conditional Appro~,al ./ Conditional Engineer's Seal Date III1 Ill.ti The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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-~25 (Rev. 7/88)Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority;Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: A. WELL DATA ,,4.,//A Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Date Completed Depth of Grouting If A, B, C, D.E.C. A~pproved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public S'ewer Line To Nearest Sewer Service ,Line on Lot Water Sample Collected by ; On Adjoining Lots ; On Adjoining Lots TO NeareSt public Sewer Cleanout/Manhole ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed /cO ~, Size ~ No. of Compartments StandpiPes (Y/N) ~ ¢ Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) /V Date Last Pumped Pumping/Maintenance Contact on File (Y/N) ~ ; for Holding Tank High-Water Alarm (Y/N) -/f-'/~'~ Temporary Holding Tank Permit SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: TO Water-Supply Well ,'¢/~'~ To Building Foundation To Property Line ~2~ ///'/~/'O/&7'-/-/., ~o~To Disposal Field ~/ To Water Main/Service Line ~ /~ To Stream, Pond, Lake or Major D~ain~ge Course ~ . Comments~~ ~.- ~ ~ ~Y 0~ ~, O. 72-o26 (Rev. 7/ee) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 4~,~'- Date Installed ~'~ ~,~'--~ Width of Field Type of System Design Length of Field 5~ Depth of Field Gravel Bed Thickness ¢~// ~ Square Feet of Absortion Area/,¢2 .¢~::~ ~"~'..~ ,,~E',,~¢,~tatndpipes Present (Y/N) ~ ~¢~ Depression over Field (Y/N) ~ Date of Last Adequacy Test ~¢ ~¢~o~ Results of Last Adequacy Test SEPARATION DISTANCE FRO~ ABSORPTION FIELD: To Water-Supply Well ~ To Property Line /~ ~ ~ %~/~/~$"~ To Building Foundation ~¢ ~ To Existing or Abandoned System on Lot ~ ; On Adjoining Lots ~ Z~-~~T'2:¢-/~ To Water Main/Service Line ~ ~ To Cutback (if present) ~ To Stream, Pond, Lake, or Major Drainage Course ~ To Driveway, Parking Area, or Vehicle Storage Area /¢/¢ Comments ~ ~ S ~ ~M ~ ~ MO ~ ~ /Z ~/~/~ , ~ ~/ ~ ~"(/~ - ~. Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test, Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guic inspectio.~.,~ Signed f--"/', "~,"'~'2~ - ~ Company/~ Date MOA No. * "7 7 Receipt No. ~ 0 ~') (jCk.~ Receipt No. Date of Payment /'/~0¢'-:dC:-~P' Waiver Fee: $ Amount: $ ('/V~ Cpr~) Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 on the date of '[his Engineer's Seal ~_ ' CAA/7-, cERTIFIcATE OF sURvEY hereby certify that I have surveyed the following described property: Z-oT' ,~.~ L~/.~C~' 2 /.t~:,?/,r'AC~~-' Anchorage Recording District, Alaska, and ti)at the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska, this -~7'/-/ dayof /4/OV, .,198<~ BARNARD ENGINEERING 7100 OLD SEWARD HIGHWAY ANCHOF AGE~ ALASKA 99518 PHONE: ;549-8748 FOR: ~.5 Z~M// T .SL,//eVcCY' SURVEY TITLE Scale /// = ,.:,~0 / Book No, Drawn by /B/'/"~ ' Checked by//~ ,~. Job No.,~F~Z,% Grid No.~~/W Revisions: ,Td-H L~A//d o~ 5~ CAS/dA AIIC#ORA~E, AK 99..5/0 MUNICIPALI~ OF ANCHO~GE DEPT. OF HEALTH E~I~ONMENTAL P~OTE~ION CERTIFICATE OF SURVEY hereby certify that I have surveyed the following described property: ..5 ¢,' ~ ~1 Anchorage Recording District, Alaska, and that the improvements situated thereon are SURVEY TITLE Scale /~t=30t Book No. Drawn by /'/'~- Checked by/~-~. within the property lines and do not overlap or encroach on the property lying adjacent y~ ~, ~:7' thereto, that no improvements on property lying adjacent thereto encroach on the premises -Job No. "__/ Grid in question and that there are no roadways, transmission lines or other visible easements on Revisions: said property except as indicated hereon. Dated at Anchorage, Alaska, this '7 7'.1/ BARNARD ENGINEERING ' ?100 OLD SEWARD HIGHWAY iANCHORAGE, ALASKA 99518 PHONE: 549-8748 FOR. · '~ ~ APPLIC ~,NT FILLS OUT UPPER HAP ' ONLY Property Owner ~,~C_3 d ~,~]~ Phone Buyer Address Zip Code Lending Institution Phone Address Zip Code Realty Co. & Agent Phone Address Zip Code Street Locatio~ Type of Residence [] Multiple Family No. of Bedrooms -~"* [] Other Water Supply [] Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ,~,~ommunity For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal ,.~,~'~lndividual Year Individual Installed: [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: JUN 5 01983 "~unJcipaJ[ty o;~ "Dept. of ~ ,~ *CONDITIONS OF App~K~$nrnentai Pro;'¢ciion" ( ) APPROVED BEDROOMS ( ) DISAPPROVED Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received · Well to Tank Septic Tank Size 72-023 (3182} ,Tin3e .~ Time . _~,e ~Da'[e Date Date Inspector inspector Inspector ~ M oEPT. OF HEALTH / ENVIRONMENTAL Dine 8ewer Inetalled Permit No. 8eptio Tank Size /~ ~ ~. O-- E' Holding Tank Size Soils Rating Well To Absorption Area Well Log Received g g Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ~. C. ~OS~e~ Phone 344-4777 Mailing Address ~/O 2203 "C" S~ ~c~aqe, ~, 99503 Buyer ~ael D. ~t~n '" Address P.O. ~X 1052, ~chor~. ~. 99510 '~ Lendin~ I~stitutioB ~ ~ of ~{~ ~ ~,~:~'~' Phone 264-5~25 ~hono Realty Co. & Agent H~side, ~c., ~1~ of H~s - ~1 W~d Address ' 603 W. ~dor ~., Anc~rage, ~. 99503 563-3655 Legal Description ~t 23, B 2, H~i~ge P~k Street'Location 4~ & ~a~on, ~gte ~iv~, ~. Type~f Residence , ~ Single Family ~ D Multiple Family No. of Bedrooms D Other Water Supply ~ Individual A~ACH WELL LOG. A well log is required for all Wells drilled since June ~ Community 1975. For wells drilled prior to that date, give well depth (attach log if D Public Utility available.) Sewage Disposal ~ Individual Year Individual Installed: 83 D Public Utility When Connected to Public Utility: ~olding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED'.