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HomeMy WebLinkAboutHOCKER BLK 1 LT 4 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231071 PID Number: 042-081-81 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name Daniel & June Constantine ABSORPTION FIELD ❑ Dee Trench ❑ Bed ❑ Mound p ❑Wide Trench Site Address 10081 Flat Top Ave ❑ Other Phone Number of Bedrooms 13 Soil Rating - Total depth from original grade GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Hocker 1 4 Ft. Ft. Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank LineFtz Ft. Well 100'+ 25'+ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface Water 100'+I Material Number of compartments Lot Line 5'+ NA HDPE 2 Foundation 101+ LIFT STATION Manufacturer Capacity Remarks Septic tank install only Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Beeks Contracting Drainfield CO/MT 3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 1438.5 ft Inspection es: 1-, 5/10/23 2nd 5/10/23 Location and description 3rd 4th Bottom house trim @ A ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date OF *: 4A R me ven al **me Septic System Approved �— / Date 5 2- CE 8 49 202--.05.2.9 .' •�qpj i 20 3 Note: this approval does not include well permit requirements. 10e ON 1000G GREER POLY TANK PROFILE SCALE: NTS PA N N O N E E N G S V C , L L C ( C . I . 1 0 8 8 ) UNSUBDIVIDED N88057'41 "E 165.02 (M) 8349T N88057'26"E 165.10 (R)_ 10' UTILITY EASEMENT ------------------------------ o� o� ° ZZ O 0Septic vent (typ) 0 0 $ O O °o—manhole �C:) ZZ Z Z -� N O O 0O 0y OO ° ° O O O Q ° 1.5 OH O � � N Ul 70. 28.5 0 off W Z N O I N --1 _ I 171 N N I C LOT 5 LOT 3A N o O I J (n� N N SCALE: 1 "- 50' N Co � _a U'o off o °' M O 2.0 OH -n LOT 4 C3� 3.3 �� T i 'r ••••.. ..`. VT N j i• � (V ... N 6.6 0 14 Xx I IFOF AQW •,,•••• t• •,'� � `` ,' } • ~. /`'1 cru ,y :... _ . • , Y C9 ,. i e ,� L �• • • •V '4s- •• • ••,•: •:.4 f 32.5 .- U, . . y '. ...38.7 / .49thco � 3 r oWell / •-... .. .• .. 00 00- Elizabeth L. Walatka•. ,o / 8036 - LS 7 .r AW QC6AW BASIS OF BEARINGS N88024'31 "E 330.32 (R1 &M) o N88024'21 "E 165.21 (R) 1 -�-icD N88028'40"E 165.41 (M) O X"Found 3" Brass Cap _ — FLAT TOP AVENUE Monument — RECERTIFIED 5-19-23 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection LEGEND in accordance with ASPLS Standards of the following (R) Record per Plat No. 67-18 described property: LOT 4, BLOCK 1, (R1) Record per Plat No. 79-9 ROCKER SUBDIVISION (M) Measured Anchorage Recording Precinct, Alaska, and that 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 the 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 17th day of MAY , 2010. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED Recert 10-04-22 FRED WALATKA &ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON FB 22-3, pg 64 BE Engineers and Surveyors UNLESS OTHERWISE NOTED. FB 10-2, pg 46-48 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 042-081-09 Legal description HOCKER BLK 1 LT 4 Site address 10081 FLAT TOP AVE Anchorage AK Expiration Date: 2- 5 z� Current property owner(s) DANIEL & JUNE CONSTANTINE X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 5/25/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 042-081-09 Complete legal description HOcker Block 1 Lot 4 Location (site address) 10081 Flat Top Avenue Current property owner(s) Daniel G. & June J. Constantine 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: A Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age New - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ■❑ Seepage Pit Waiver request for: Expedited review requested: 0 Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ `6_� Waiver Fee $ Date of Payment oI Z5/Date of Payment COSA # Mc Z13 11 Waiver # COSA Application—June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) 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 N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to 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 Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F.ENGINEER’S COMMENTS G.CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Phone Engineer’s Printed Name Date MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program -o 'Hent S� PO Box 196650 4700 Elmore Road i Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 V http://www.muni.org/onsite J DeI)artIII ell t On -Site Wastewater Disposal System Permit Permit Number: OSP231071 Effective Date: 4/26/2023 Work Type: SepticTank Upgrade Expiration Date: 4/25/2024 Tax Code Number: 04208109000 Site Legal Address: HOCKER BLK 1 LT 4 G:3043 Site Mailing Address: 10081 FLAT TOP AVE, Anchorage Owner: CONSTANTINE DANIEL G & JUNE J Lot Size in Sq Ft: 44480 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3 This permit is for the construction of: ❑ 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 Received By: ��� CS Date: 4 Issued By: �� Date: 26702-3 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 042-081-09 Property owner(s) Daniel & June Constantine Day phone Mailing address Site address 10081 Flat Top Avenue Legal description (Sub'd., Block & Lot) Hocker Block 1 Lot 4 Legal description (Township, Range & Section) Lot Size 44,480 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) X❑ Septic Tank Q Upgrade Q (w/wo ADU) Holding Tank ❑ Renewal F]Duplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. <s T2 P (Signature of property owner or authorized agent) Permit/Rush Fees: Z Z S Waiver Fees: Date of Payment: / 3Z Z. Z3 Date of Payment: Receipt Number: _ b p Receipt Number: Permit No. OS p Z 3 /O / Waiver No. Permit App_ :c Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com Mailing: P.O. Box 1807 Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201 13 April 2023 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: Hocker Block 1 Lot 4 Septic System Upgrade Permit Request This is a design narrative for a permit to install an upgrade 1,000-gallon septic tank to replace an existing 1000-gallon septic tank on this property. The existing tank is 42 years old and is likely perforated and leaking, it will be abandoned per code. Currently the lot is developed. The proposed system will utilize a replacement 1,000-gallon septic tank that will be connected to the existing seepage pit. This lot and the surrounding lots are served by private wells. Currently there are no wells within 100’ of this upgrade. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5’+ from any property line. 5’+ from any deck/stair support. 10’+ from building foundation. 10’+ from any water line. 100’+ from any surface water. 100’+ from any private wells. 200’+ from any public wells. The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions or concerns, please contact me at (907) 745-8200. Sincerely, SRP Steven R. Pannone, PE, F. ASCE Owner/Civil Engineer Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231071, Curtis Townsend, 04/26/23 K -1 -1 n > < 0 CD c ju) ---I z > o -u �u C) C0 F� z• K m N x cl) > Cf) n m T --j M < 0 r- 0 r- x �a m < -0 0 c m Ln Lo Lf) M �a 0 Z E. C) z > > m 0 U) > 0 Z 0 > wm o M ;;u i o c) 0 c oma �iz I C 21 I 0 0 n> co m 0 Z CA m 0 0 CA ;U 'u'_ C) m z m m > > z >::E O z r- --I r- m 0 (f) m m FTI :j 9 z Q_ n Cm 11 cf) 4— ti Q > Ln — NOTES: PANNONE ENG SVC, LLC (C 1. 1088) REVISIONS DATE P.O. BOX 1807 PALIVER, AK 996;50 04/12/2023 PHONE (907) 745-8200 FAX (907) 745-8201SCALE J 1 50' DRAWN ROCKER BLOCK 1 LOT 4was LJC P.I.D. NO CHECKED 042-081-09 ACP JUNE & DANIEL CONSTANTINE St. R. Pon —PERMIT NO. 10081 FLAT TOP AVENUE CE -81 49 Ospxxxxxx .. SITE PLAN ANCHORAGE, AK 99516.... 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BOX 102954 ANCHORAGE, Argy 99510 PHONE (907) 272-3218 FAX (907) 272-8211 ......1.1!11 r �E OF A "it it ��P _.. . .. ,� CE -8149 ne '1 Jj, �,, �' q'���.,h���y������,y�`.. ''t t'I......x. `~ REVISIONS DATE 04/12/2023 F-0Fd-1Jrt4A-Ja ^r nNl Y ROCKER BLOCK 1 LOT 4 JUNE & DANIEL CONSTANTINE 10081 FLAT TOP AVENUE ANCHORAGE, AK 99516 SCALE NTS DRAWN Esc P.I.D. NO 042-081-09 CHECKED ACP SOIL LOG PERMIT N0. OSPXXXXXX SHEET 2 OF 2 NAME /~ 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 P H ON-~ ~UPGRADE MAILING AD/)R ESS LEGAL DESCRIPTION Abs orp~5on a r e"g DISTANCE TO: I Liq. capaci IF HOMEMADE: Inside length I Width Dwelling . _- , .~- DISTANCE 1 ..~ * Mat/gdah~ Foundation Nearest lot line DISTANCE TO: No. of lines Total length of lines Trench width Well Length of each line Top of tile to finish grade Length / <~ / Width crib Well DISTANCE TO: Depth DISTANCE TO: Material beneath tile Depth Crib depth ' Building foundation inches inches NO. OF BEDROOMS PERMIT NO. No. o~omPartments Li~q u~id depth PERMIT N~.~~'-~ L:~pacity in gallo, j3~ PERMIT NO. Distance between lines Total effective absorption area PERMIT NO. Total effective absorption area Nearest lot lin~t,/,~.~ , Driller Distance to lot line PERMIT NO. foundation Sewer Pine Septic tarrk Absorption area(s) OTHER SOl L TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL · " ......... " " i-"~ "- -" - --" ..... "'''": "~ '"' DEF'~RTMENT ( HERL. TH RN[:, EN',,,'IRONMEN FRL J] EL:I JUN ~. 825 "[~'~ STREET, RNCHORRGE., MK. 995D1 LOT :~.E 4448Et .~QUFIRE FEET TVPE OF 'S; 3'[ L RBSORPT I ON '--,'r.:, l El! I S: TRENCH , , , '"' SOIL RNTIN.~ ,::SI;! FT/'BR)= MR::-:.IM.M NLflE, EF. OF BEDROOMS = ~. ].'HE REQUIRED SIZE OF THE SOIL RBSORPTION _.T_]EM I:, £:, E F- T ~-~ == :F} ~ ...EEI"4£~TI-4,=~: '25 ,.3F.'FI",,-"EL E-,E-:F '] H.-- .¢-.'; '['HE LENG].'H DIMENSION IS ]'HE LENGTH <IN FEET) OF' THE TRENCH OR DRRINFIELD. 'THE DEPTH OF R TRENCH OR PIT IS THE DISTflNCE BETI,.IEEN ]''HE SURFRCE OF THE GROUND RND THE BOTTOM OF THE E)'::CRVRTION (IN FEET). ]''HERE IS NO SET WIDTH FOR TRENCHES· ]''HE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BE]"WEEN THE OU'T'FFtLL PIPE RND 'THE BOTTOM OF THE EXCR',,,'RTION (IN FEET). PERMIT RPPLICRNT HRS THE RESPONSIE,'ILITV TO INFORM THIS DEPRRTMENT DURING THE INSTFILLRTION INSPECTION:5 OF RN'¢ WELLS RD.]'RCENT TO THIS PROF'ERT¥ RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. ~F~LL~NG OF RN¥ :,~: FEM W~THOLI'r' F~NRL ~I.,I:,FEL. E~_N RND RFFRL,RL. B~' THIS E:,E~kI~LL BE SUBJEr::T TO PROSECLT~EN. M~N~MUM D~STRNE:E E,E FI,.IEEF. ~ WELL RND RN¥ ON-:,ITE .... 'AEI,.IRGE r',T,:PFv:'AI. __,_ ._,_._ :~_IEH ~S fEE~ FEET FOR R PR~VRTE HELL OR Z~E1 TO 2E~3 FEET FROM R F'UBL~C 1.4ELL DEPENDING UPON THE TYPE OF PUBL.~C WELL H~N~MUH D~S"I"RNCE FROH R PR~VRTE WELL ].'0 R PR~VRTE SEHER L~NE ~92~ FEET RND TO R COHHUN~TY SEWER L~NE ~S 7D FEET. WELL LOGS RRE RE:QU~RED RND RUST BE RETURNED TO THE DEPRRTHENT I.,.I~TH~N :gE~ DR'CS OF THE 1.4ELL COMPLETION. ~ OTHER REQUIREMENTS HRY RPPLY. ~PEC~F~CRT~ONS RND CONSTRUCTION E:,~FIGRRH9 RRE RVR~LRBLE TO ~NSURE PROPER ~NSTRLLRT!ON. I CERTIF'V THRT i: ~ RH FRMILIFIF.: W]TH THE REQUI...EMENF=, FOR L.I"I-zITE z, EI,..EF.z, RIqD 14ELLS RS SE]'' '1 TI-' " '' FOR]''H B'¢ THE [1 _tN _ _. I F RL I T T OF I=tNI--:H.F. IRFtGE. 2: I WILL INSTFtLL THE :,T:,TEt'I IN FtCCOR. DRNCE WITH THE UJDE.% · ' - - ':'": ' RE~. ~ IRE ENL. RF...~EMENT IF THE 3: I t_INDERSTRND THFIT THE _N-:,I TE SEWER _,~-,TEN MR'¢ - - 'G ' F.:ESIDENCE IS REMODELED 'TO INC:LLIDE MLRE THRN-'-. BEDF.""'MS. 'E ! GNED: ...................................................................... RF:'PL I []FtNT EDHRF.'.D C BRNTZ / LOT '_{IZ[ 'SOIL ~Fil'][N~ (E.O F'lrZSP.)~ 't.~ D~PT'H: 6 ~,ERI'.I£r FiPPt. IC,e~I' H~$ rJ~_ I:~E'&g'ON'SIStLtT¥ TO ~-~,.3HPJ~E~ ,DF ~,_~[r.;~_~,~_-"~"~ 1Ttflr I'H~ H~LL~'~-q-4tU- V4. l~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND'ENVI RONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [~SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DEPTH (FEET) 1 2 3 4 5- 6- 7 8 9- 10- 11 12 13 14- 15- 16- 17- 18- 19~ 20- DATE PERFORMED: SLOPE SITE PLAI IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) __ FT CERTIFIED BY: DATE: Z Z 0 0 0 0 0 0 0 0 0 0 0 0 ~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 © 0 0 0 0 0 0 © Parcel I.D. # 1. ( MUNICIPALITY'OFANCHORAGE - DEPARTMENT OF HEALTH & HUMAN SERVICES . Division of Environmental Services ' On-Site Services Section P.O~ Box 196650 Anchorage, Alaska 99519-6650 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION complete legal description Lot 4; Block I~ Hocker S~bdivisZon 10081 Flat Avenu~ Location (site adi:lress or directions) .o~ Pr0Pe~ oWner D~n~. B~g~s & C~o~. Hugh.~ Day phone ~.d~ng ageno Day phone --- ' .... NOTEi If community Well system, provide written confirmation from. Stat~i~DEc attest- .... ':'. :~ *,~ ~ :~ - in~ to the legality and status of system. ~. '\ '~ ,' .~' ~ ' · attesting to the legality and status of system. 72-025 [Rev. 1/91) Front MOA~I 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 verity that based on the information obtained from the Municipality of Anchorage files and from my inves.ti_,qation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Muhicipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address ,--17034..,...Eagle .River. . Loop__ Road No.~4 Phone d ~- ~3._~ '7 ~/ 6.~,-DHHSi CE-8801. L .~.;~%:;~,~ Additional Comments The ~,un Cipality ofA,,nc?orage Depa~ment of Health and Human Se~l~s (DHHS) tssues Health Authon~ Appr~¢~l ~e~ificate~'b~ only 'upon the repmsen~tions given in paragraph 5 above by an inde~ndent ahdth~ir i~ndin~ i~fitution~ in order tO ~ti~ ~ain f~l and ~tat~ r~uimm~nt~, fim~loy~ of ~H~S do not ~ondu~t in,p~tion, or anal~o data ~fom a c~difieat~ i~ i~u~. Th~ Muniei~al!~ of ~ncgora~ i~ not m,~on~ibl~ for ~o~ or omi~ion~ in th~ prof~mional on~in~e~ work. ~ ......... ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SiTE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN June I, 1995 MUNICIPALITY OF ANCHORAGE D~partment of H~alth and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 4; Block I; Hocker Subdivision CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECEIVED JUN 5 1995 Municipality ot Anchorage Dept, Health & Human Services A Conditional Health Authority Approval (HAA) was issued on 11/21/94 for the referenced property. All work required for the Conditional HAA' has been completed. Please issu~ a full H~lth Authority Approval at this tame. If you require addition~ information, pl~as~ contact us. Sincerely, · OW~, P.E. RCC / ~k 17034 NORTH EAGLE RIVER LOOP "SUITE 204 ° EAGLE RIVER, ALASKA 99577 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. # (:9'-/ '&- ~ ~ I O~ 1. GENERAL INFORMATION Complete legal description Lot 4; HAA# V Aq ~,'(~ Block 1: 'Hocker 'Subdivision £ocation (site address or directions) 10081 Flat Top Avenue Anchorage, AK ~Property owner Mailing address Duane Burgess & Charlotte Hughes Day phone 10081 Flat Top Ave Anchorage, AK 99516 Lending agency Day phone Mailing address Agent Mary Cox/ REMAX PROPERTIES Day phone 276-2761 Address 2600 Cordova st. Suite 100 Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROO~IS: 3 3. TYPE OF WATER SUPPLY: NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Individual well xxx Community well Public water If community well system, provide written confirmation from State lng to the legality and status of system. 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. ...., ........... : ..... ,.,~¢ ,..~.-' :- ' . :"'' -.>"'~i,'!:~ " .. 72-025(Rev. 1/91) Front MOA~21 ,.,,: ..... 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 · ~ ;~mN;;n,~dC. 17034 Eagle River Loog Road No. ~ Address = -,- -, ........ ~ ~ / ...... / Engine,s signature '/~/ Kw ~~ Phone Date I1/,~'/c[q REQUEST YOU ISSUE A CONDITIONAL HEALTH AUTHORITY APPROVAL DUE TO THE IN'ACCESSIBILITY OF PUMPING THE SEPTIC TANK IN WINTER CONDITIONS. A+ HOME SERVICES HAS ~EEN CONTRACTED TO PUMP THE SEPTIC NO LATER THAN &/I/~.~..~ .~ ..... 6. DHHS SIGNATURE Approved for bedrooms. ~ ,Di~pproved. Gonditional approval for ~ ~odroom~, with th~ followin~ stipulations: Date '[;['IiPI; 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 DH HS does this as a courtesy to pumhasers 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-~S(Rev, 1/91) Bec:lc MOA#21 - .... Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L-o?- ~.j~Ccd_./~/)~oc.~.cC~/Z-5/~---~Parcel I.D. A, Well Data Well type /~f¢-I//,¢~/--~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (YN~ /'"/ Date completed ~ /~'/' Driller Total depth /~'~,,~ Cased to ~ ~ Casing height Sanitary seal (~/~) /,[Z/ ~"-~' Wires properly protected (Y~) Date of test Static water level Well flow FROM WELL LOG Pump level1 ~ ~ ~/~¢~,~ ¢ SEPARATION DISTANCES FROM WELL TO: Septic/~tank on lot /~ r ~ Absorption field on lot /~O (~ Public sewer main Sewer service line AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~;:~//'C.A.~,~L~ ~ Nitrate ~/~OC:>~-- //~/-%~ Other bacteria (~,/'/~©'~'~'~' Date of sample: B. SEPTIC/~ =CLD:;;C.TANK DATA Date installed ~?/~ [/~/ Cleanouts~N) High water alarm Date of pumping Tank size /~,~ ~--~-~.__ Compartments Foundation cleanout ('~) ,,~,/o Depression (Y(~),~ Alarm tested (Y/N) .,/~//~ Pumper ,~7~ /'~0/~'/~-~ SEPARATION DISTANCES FROM SEPTICR-I~)L-DtNG'TANK TO: Well(s) on lot ./~v,~ ('_/_- On adjacent lots To property line //---~ ~" Absorption field /~'~ Surface water/drainage 72-026 (3/93)* Front Foundation ,/~--~ ~- Water main/service line/O:~-- CONTINUED ON BACK PAGE Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~tested Meets MOA electrical codes (Y/N) ~ SEPAR~STATION TO: W_~.Ci-offlot On adjacent lots D. ABSORPTION FIELD DATA Date installed o~/ Length /~"f Width Total absorption area Date of adequacy test Manufacturer ~ Manhole/Access (Y/N)_ ~ ~ff" Level at Soil rating (GPD/Ft2) /~')~ ~/'/'~-- Gravel thickness ~ / Cleanout presen Yt~) °d//~- J Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Surface water Results/(¢~il) f/-~': Cji/ ~ System type Total depth Depression over field (Y~[) ~-~ro for '-~ (~'~'~'~) B~drooms After test ~ ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot (/(~)O ~ To building foundation On adjacent lots ~ O ~-- Surface water ¢/~JL.~ Curtain drain On adjacent mots Property line //0 CC- To existing or abandoned system on lot /U////-'-~ Cutbank ~//~ ~-£~- pu$4o,,~ Water main/service line /'C) (%- Driveway, parking/vehicle storage area /(~ ~¢- 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. T T -- . Date II / ~ ~- / ~ ~ H~ Fee $ ~ p Waiver Fee $ Date of Payment ://~ / ? ¢__ Date of Payment Receipt Number ~ ~¢ ~ ~ ~ocolpt ~umb~r ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. November 15, 1994 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORIT~ APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human S~rvi~es Attn: Jim Cross P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 4; Block I; Hocker Subdivision D~ar Mr. Cross~ In an effort to obtain a w~ll log on the referenced property, we have contacted all w~ll drillers known to have drilled w~Is within the Municipality Of Anchorage in 1981 that are still in business. We have also contacted The State of Alaska Division of Mining a~ Water Management and the Water R~sourc~s Division. Contact was also made with the U.S.Geological Survey and the Department of National R~sourc~s. None of th~se efforts have r~sulted in a w~ll log. In our inspection of the existing w~l for the Health Authority Approval on ~! /8/94 we v~rified that the w~ll was at least 153 fe~t deep and is cased b~low 40'. Request you accept this H.A.A. request without an existing w~ll log. If you require additional information plcase contact us. Sincerely, ROBERT ¢. C0WAN, RCC/gk 17034 NORTH EAGLE RIVER LOOP · SUITE 204" EAGLE RIVER, ALASKA 99577 ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. CIVIL ENGINEERS (907) 694-2979 Nov~_~ber 14, 1994 FAX(907)694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL iNSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE D~partment of H~alth and H~man S~rvic~s P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 4; Block I; Ho~k~r Sub~v~ion R~q~t yo~ ~ a Co~o~ H~ A~o~y Approv~ on ~ A+ Hom~ S~rvic~ ~S b~n co~ra~d to p~p th~ s~p~c ~nk no lat~ than Jun~ I, 1995. If you r~q~ any ad~o~ info~on, pl~as~ co~a~ ~. Sinc~r~y, 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ,/ ' DATE RECEIVED INSPECTION APPOINTMENTS ~,. TIME TIME TIME / DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR ~fljFzJ.~,T¥ OF ANCHO RAGE MUNICIPALITY OF ANCHORAGE EN'/IRONMENI,~,L  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 R E C E I V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES D I R ECTIONS~ Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. ] PHONE PROPERTY RESIDENrT (If different from above) ~' ~-~ PHONE 3. LENDING INSTLTUTION. ~ PHONE MAILING ADDRESS 4. REALTOR/AGENT '~ I PHONE MAI LING ADDRESS 5. LEGAL DESCRIx°T_I~)N STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four ~ SINGLE FAMILY [~ Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* * ATTACH WELL LOG. A we~l log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** ,/~,,~/ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY . .. 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ¢~ ~ Connection Verified INSTALLER []]Septic Tank or [] Holding Tank Size: /~--~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Absorption Area to nearest Lot Line 5. COMMENTS F+:I APPROVED FOR ,.:~,~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY /~