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HomeMy WebLinkAboutSTUCKAGAIN HEIGHTS #1 BLK 1 LT 3 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON -SITE WASTEWATER INSPECTION REPORT Permit Number:.OSP231371 PID Number: 041-021-31 Dwelling: 2 Single Family (SF) El with ADU F1 Duplex (D) El Two Single Family Project: F1 New Z Upgrade Name LLOYD D RICHARDS ABSORPTION FIELD - EXISTING El Deep Trench El Wide Trench [-] Bed [:1 Mound Site Address 9641 BASHER DRIVE, ANCHORAGE El Other Phone f Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot STUCKAGAIN HEIGHTS #1 1 3 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES TO Septic Absorption;LiftStation Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. ; Well 100,+25'+ TANK 2 Septic El S.T.E.P. El Holding r_1 Other Manufacturer ANCHORAGE TANK Capacity 1500 Gal. Surface Water 100'+ Material EPDXY STEEL Number of compartments 2 Lot Line 5'+ NA Foundation 10'+ 1 LIFT STATION Manufacturer Capacity Gal. Remarks 2 manholes installed. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tankto 3034 Installer MICHAEL N ANDERSON, PE drainfield Drainfield CO/MT Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 15 3125/24 Id 3/26/2024 Location and description dates: 2 3 rd 4 th TOP OF MANHOLE ON -SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date 7H .... .... id . ......... . Septic Syste Approved .......... . k Curtis Huffman 04?,�9". - Date CE128991 AW e�--.6/12/24 Note: this does include OPROFESSO approval not well permit requirements. (Rev 05/02/18) PID:041-021-31 PERMIT:OSP231371 FIRST WATER CONSULTING STUCKAGAIN HEIGHTS #1 BLOC 1, LOT 3 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 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231371 Work Type: SepticTank Upgrade Tax Code Number: 04102131000 Site Legal Address: STUCKAGAIN HEIGHTS #1 BLK 1 LT 3 G:2043 Site Mailing Address: 9641 BASHER DR, Anchorage Owner: RICHARDS LLOYD D Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: �cnt As �» *:• ;�; : � Tr ar h rte. t�epartment 11/6/2023 11/5/2024 66509 ❑ 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 Ree6ved-By: G Issued By:� Date: Date: __11461Z --Z' 3 MUNICIPALITY OF ANCHORAGE 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. 041-021-31 Property owner(s) LLOYD RICHARDS Day phone Mailing address 9641 BASHER DRIVE, ANCHORAGE, AK 99507 Site address 9641 BASHER DRIVE, ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) STUCKAGAIN HEIGHTS #1 131, L3 Legal description (Township, Range & Section) Lot Size 66,509 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 Septic Tank El Upgrade F (w/wo ADU) (D) ❑ Holding Tank ElRenewal F-1Duplex 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: Z � Date of Payment Z I -,0 21 Receipt Number: gi TZ z Permit No. Waiver Fees: Date of Payment: Receipt Number: 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 ! !! October 20, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: STUCKAGAIN HEIGHTS #1 BLOCK 1, LOT 3 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. A 1500-gallon HDPE tank is to be installed for future consideration or flexibility. No groundwater was noted in the MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel septic tank may be required. The lot and area are served by private water with no known private wells within 100’ of the proposed septic tank. 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 OSP231371, Deb Wockenfuss, 11/06/23 FIRST WATER CONSULTING STUCKAGAIN HEIGHTS #1 BLOC 1, LOT 3 DESIGN DETAILS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANK Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231371, Deb Wockenfuss, 11/06/23 ,63.'19.93 11:47 9672587536 ' • i• ..L M'�NYF'I:1ad1•M1�14h.YM 15 '93 11140 907 VISTA REAL ESTATE ;C� cRst>,Irarr fly u ao� H F.2/2 Yrhs �f $gr segs ThQ Crus H. rp gYi�r 6b—%826 � 'i43R*V •r�'egurn'•'er_AI T M10 4j 0 0 ?& I LOT 3 �a f ' y r n fLRJ I N Hi!� Ic JIM,, owndry' �r>faanrftbkll to a Wrrn�Sr I R LY ( H f'•1 C� [ IR IC 0 /1 �r rx�r�vnao i�`eny aaro�sante, aavanrntr, a rYrtulrr�orta r/ri'e41 w/r►a� i�r' s G with Ili TA !t L iY4TE Unilsr nr eC aPDwt De Ne9i9 qub�IsA�rq� pldq N e Wnfe4oniqq�� ehaukd �n eslr 1l6PO11f1 Ya vnad fir +r'�{w �Rf iuifr:ryv�SWk w fere +stSWllerrkry iriuyrrly Ihr�ef+Yi tl ►Ar<F �k � ■..�. C r �ror;� .err'rac�i fieri aondv- ci i•y �u+tin- (~ MUNICIPALITY OF ANCHORAGE k~/ DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION ENVIRONMEN'I'AI_ ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELl. INSPECTION REPORT MA, L,NOAO /// LO~ATION DISTANCE TO: Manufacturer I F HOMEMADE: Inside length [ Width Well Dwelling Foundation DISTANCE TO: w~,, //~ f -/-- Length of each/~'~FT No. of lines Top of tile to finish grade Length Width Crib diameter Well Total len gt~A~f ~e~7.- Material ~eneath tile Depth Crib depth Type of crib Building foundatio~ DISTANCE TO: 31ass Depth Driller Building foundation Sewer line DISTANCE TO: OTHER Material Nearest Io~/~ Trenc i th inches NO. OF B~OOMS PERMIT NO~0 5~,_~ [ No, of com<~_en~ts Liquid depth PERMIT NO, Liquid capacity in gallons PERM,T NO. ~,,)~¢ .~ / Distance bet we~e~ Total e f f e c t ive. ebs f~i~za~mea PERMIT NO, Total effective absorption area Nearest lot line Septic tank Distance to lot line SOIL TEST RATINGt~L~.¢ NSTALLER REMARKS DATE 72-013 (Rev. 3/78) DEPARTMENT ;.- HEALTH AN[:, EN./IRONMENTAL 264-472e l~O l K~~ ~ ¢ '~ APPLICANT HERZOR CONST. 2418 ERST 28TH. LOCATION STUCKRGR I'N, HTS. .~, LEGRL LOT ~ BLK ~ STUC:KRG~IN HTS LOT SIZE 68888 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [)EPTH= it2 L E ~'41]i TH = :1_6 GAR"eEL [)EPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND RND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCAVATION (IN FEET). F:EE~IJ IRED. SEF'TI 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. TI40 (2) I f4SF"E,STICiI4S ARE RE~t] I ~:ED, BRCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION RND APPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A HELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS t80 FEET FOR R PRIVATE HELL OR t58 TO 288 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE HELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERt'-11 T E:4F' I F.:E.S E)ECEFIBER _---~-'1¢ I CERTIFY THAT l: I AM FRMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND HELLS RS SET FORTH B9 THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. ........ APPLICA CONST. ~SOI LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST 2 3 ~4 6 8 SLOPE DATE EE.EORMED: ~5~-'~T ~-~ 10 11 14 · 18 20 COMMENTS WASG.O.NDWAT"R ENGO.NT".ED? )F YES, AT WHAT DEETH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE minutes/inch TEST RUN BETWEEN FT AND -- FT DATE: 72-00g {6/79) Well Log For ..... ....~.../.~-. ..... .~..~..~......,.~.....~,..~..,.,.~.....~.........~..~.f..~....~.~..~-~ ........ : ...... i .............. ~ ..... '.., ...... Location.... ~4.~.~./,..~-.......~...~..( .~..~...~.~. ...... .4.~ .~..,.~....n....~.,4~'~'....-~... .......... Date completed ..... ..~...-...,,~.....T....~...~.. .......... :~ ............................................... , ............. Depth of well .......... ~:f. ...................................................... i ................................ ~.~ o~ ~s~n~ ........... ~L'...../...... ................................ ~..: ....... ~ ................................. Distance to wa~erl.....~.../~...~....~.......,~/..~....~....~...~...~.. ........ ...7.,/.../. ....................................... Distance to water while pumping ........... ~..~..~'.....i ...... i ......... i .......... i....at rate of ...... ~ .......... ..~..Z...O. .................... gallons per.hour. ~7 Formation from to Driller DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE, ALASKA 99507 THAT IS A MANHOLE 2 MANHOLES MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section �`� ' Fax: 907-343-7997 Parcel I.D. 041-021-31 Certificate of On -Site Systems Approval Expiration Date: 3/26/2025 Legal description STUCKAGAIN HEIGHTS #1 BLK 1 LT 3 Site address 9641 BASHER DR Anchorage AK Current property owner(s) RICHARDS X The On -site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: M bedrooms, with the following stipulations: Original Certificate Date: 6/20/2024 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 Approvaijune 2022 Development Services Department t rPhone: 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. 041-021-31 Complete legal description STUCKAGAIN HEIGHTS #1 BLOCK 1, OT 3 Location (site address) 9641 BASHER DRIVE, ANCHORAGE, AK 99507 Current property owner(s) LLOYD D RICHARDS Day phone 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: N Private Well R Private Well serving 2 dwelling units R Private Well serving 3+ dwelling units R Community Well or Public M Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic R Private Septic serving 2 dwelling units r_1 Holding Tank r_1 Community Septic or Public Sewer 5. SEPTIC TANK: Z Steel F Plastic F Concrete F Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: El AWWTS 0 Bed 0 Deep Trench 0 Wide Trench R Seepage Pit Waiver request for: Distance: Expedited review requested: D 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 Waiver Fee $ Date of Payment (P Date of Payment COSA # 0 -S c -?, cl I/ ) V Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: STUCKAGAIN HEIGHTS #1 BLOCK 1, LOT 3 Parcel ID: 041-021-31 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 9/3/1980 Total depth 88 ft Cased to UNKNOWN – ASSUMED 40’+ ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12* in. Date of flow test for COSA 10/13/23 Static water level at beginning of test 74 ft. Well production at time of test 5 gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 4.24 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 4/25/2024 Comments *Recessed well in driveway – new artesian plug installed for protection & a daylight drain that was tested and functions adequately. B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NEW 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) 9/29/1980 ALL standpipes present per record drawing Total measured depth from existing grade 17 ft (max) Measured depth to pipe invert from grade 11* ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective 7.2’ 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) N If yes, enter date Adequacy test date 10/13/2023 Results Pass Fluid depth prior to test 3 in Water added 450 gal New fluid depth 8 in Elapsed time <15 min Final fluid depth 3 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 96 in (MOA 8’ ED) Effective depth used 13 in (Final fluid depth & missing ED noted below) Effective depth (ED) remaining 83 in Comments/Deficiencies: Approximate total measured depths from existing grade & *min measured from double post tank cleanout invert. ED per elevation measured shots & appears approximately with 0.8’ or 10” of missing ED. COSA Checklist.docx 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 6/13/2024 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 or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 06/13/24 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 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING: Parcel I.D. # L'~~\ \- C'~\ - ~\ HAA# Lot 3; Block 1 ?S~ucka.qai~ 'He~Lghts Location (site address or directions) 9641 Basher Anchorage, AK Prope~y owner Dr. Jim Libby Day phone Mailing address 9641 Basher Anchorage, AK 338-3358 (h) 377-1566 Lending agency Mailing address. Day phone = Agent ' Ralph Nobre.qa/VISTA REAL ESTATE Address 5000 C S~e.~.t~ S~ite. 100. Anchora~a¢. AK Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: XXX Individual well NOTE: Day phone 562-6464 99503 Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: XXX Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 investigetion 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Name of Firm ,',,, .......... ~ ..... Phone_ Address Eagle River, A~a 995~,~ Engineer's signature DHHS SIGNATURE ''X 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 engineees work. 72-025 (Roy, 1/91) Back MOA #21 Municipality of Anchorage Department Of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lol-.~ /~/- I ~/Wc,t'/~(..~A//J h'7-5 -~'/~ Parcel I.D. A. WELL DATA Well type ~ If A, B, or C, attach ADEC letter. ADEC water system number Logpresent~)'N) ~/'/~-~- Date completed ~/,?/¢P'O Driller~EL?'R/.~/LL.//U~ ~'O, · , ~/~J Totaldepth ~ Casedto 40+ Casing height I~'LO~ Sanitary seal (~/N)~'?-~, FROM WELL LOG Date of test Static water level '// Well flow Pump level 7 Wires properly protected (Y~) g.p.m. AT INSPECTION ~//~/~ ~t~llc~'.~ ~'~ ~(_5 ' ~i,,~/IkONMENTAL SER', IC-:S olVISlON ~o~ K~JO~J g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main /uo,u'~ Sewer service line /(.~0 ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /,J~././~- WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: ~//~/~;~-~ B. SEPTIC/HOLDING TANK DATA Date installed ~/~-~'/~O Cleanouts CN),~/~ High water alarm (YN~ Date of pumping Z//'~ / ~.~ Collected by: Tank size Foundation cleanout ~N) Other bacteria (:~ S & S ENGINEERING 17034 Eagle River L~op Road Eagle River, Alaska 99577 Compartments Depression (Y/~b Alarm tested (Y/(~) ""C"/'//,~t !,,.~' Pumper~-.:~/~Cr/~ . ./~'o~7717~.'; ': SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ·/OO/'¢-4'~ On adjacent lots /'OO To property line ~O ~ ~ Absorption field Surface water/drainage /JO~E Foundation Water main/service line ~ ~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE Manufacturer Size in gallons Manhole/Ac. cs(Y/N) Vent (Y/N) "Pump on" leve~'~~_ ~ "Pump off" level at High water alarm level _ ~ ~'~-y. cles tested Meets MOA ele~_ ~ SEPARA?J.QN'DISTANCE FROM LIFT STATION TO: ....~el~ lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed '~/Z 7/~ Soil rating 2,-~ ~//~E-/"Y~c°'~ S ys t e m t y p e ~'-'~"~"~JC// Length /~ __Width ~-~ f / ' Gravel thickness ~ Total depth Total absorption area ~x/~O¢~ Cleanouts present&N) Depression over field (Y~ .~O Date of adequacy test Resu~ts~fail) ~JJ for Peroxide treatment (past 12 months) (Y/N) ~o~ ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //~ ~ ~ On adjacent lots /00~ Property line ~O~ To building foundation ~ f ~ To existing or abandoned system on lot On adjacent lots ~0'~ Cutbank ~° ~ ~Wate r mai n/service lin e Surface water ~o~ ~J&~ Driveway, parking/vehicle storage area /~ ~ Curtain drain E. ENGINEER'S CERTIFICATION :: I ce~ify that I have checke~ied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ~ ~34 Eagle River L~p Road No. 2~ . "'~ ~'?,¢,(- Date ~Ea~le .Iver, Aleska 99577 ~ //~/~Z , ~.. , .... bedrooms HAAFee$ /?) ¢~0 Date of Payment , ~ '/9- ~)-~ Receipt Number~'~/¢Z// ~ ~/~,~'~ 72 026 (Rev. 3/91 ) 8ack MOA 21 Waiver Fee: $ Date of Payment Receipt Number HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P E ROGER SHAFER, P E March 18, 1993 CIVIL ENGINEERS (907~ 694 2979 FAX 694-1211 Municipality of Anchorage Dept. of Health and Human S~rvic~s Anchorage, AK REFERENCE: Lot $; Block I; Stuchagain Heights The wall located on the referenced property has been placed in the driveway. The w~ll casing has been cat off b~low the ~v~ay surfac~ w~ch ~ an asp~ pav~d s~fac~. Th~ w~ ~sing ~ ~q~pped an ad~quat~ sa~y s~ and ~xtan~ appro~y 12" abov~ ~ ground s~fac~ m~s~ed from th~ bo~om of th~ p~ ar~. A ~t iron v~v~ box cov~ h~ be~n p~c~d ov~ th~ pit ~ flush w~h ~ ~ph~ paved s~fac~. wires leading into the wall casing have not been placed in conduit however since they are entirely balow the ground surface they are adequately protected. Extending this wall casing to a h~ight of 12" plus above the asphalt paved surface is not practical in that it will s~riously impair the access to the garage. It is also impractical to place a daylight drain in the bottom of the pit area d~¢ to an excessive long distance that it would have to be run in order to find a downslope area for It is my opinion that the wall c~ing installation and terminationis acceptable and mee~s the fu~ intent of the regulatory reqair~ments even though it is not a conventional type inst~lation. Since the surface urea of the driveway consists of an asphalt paved surface, water drainage is away from the pit urea and the o~y water that would tend to fill the pit would be the water that f~l directly ov~ the pit area. Since there is a fairly adequate sealed cover over the pit the amount of water that would enter the pit during even a heavy rain storm would be negligible. If for some reason water was injected directly into the pit to the extent that wat~ would r~e above the wall casing, the sanitary s~al on top of the wall casing is adequate to prevent infiltration into the well. Request you approve the attached H~z~th Author~y Approval and accept the termination of the w~ casing as it pre, enVy exists. er service, please contact us. ~BERTA. SHAFER, P.E. /' ENCLOSURES 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAO DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ROBERT SHAFER. P E ROGER SHAFER. P.E w~:f.L FLOW TEST DATA CIVIL ENGINEERS (9O7) 694-2979 FAX 694-1211 ON SITE WASTE WATER O~SPOSAL SYSTEM DEStGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Wojmc~ Namm Sample~ '- r~) lo~abi s ~C EmtDacL Analysis Anal T~)t ParammLmr ........... ~ .............. Unit~ Limits Result ~u~l, ~te Date Init ~ 8015~-N//~TE-N ........ EPA ~3,2/3~,0-- mg/) ~'' ~ ...... . I.~N ~ ~ VI ~.. INSPECTION DATE DATE DATE NSPECTOR NSPECT f INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF .BA'T" ENV,RONMBNTAL 1 825 L Street - Anchorage, Alaska 99501 '~ - ENVIRONMENTAL SANITATION DIVISION /}PR ~ ~ Telephone 264-4720 DIRECTIONS: Complete all pa~ts on page 1, Incomplete requests will not be p~oce$$ed. Please allow ten I10} days ~or processing. PHONE ~. PROPERTYOWNER ~f-- MAILING ADDRESS PROPERTYRESIDENT(Ifd[fferentfromabove) ~ PHONE"g'gq ~ 2, BUYER MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS B. LEGALDESCR'PT'ON ;TREET LOCATION 6. TYPE OF RESIDENCE ~' NUMBER OF~BEDROOMS SI " [] One [] Four NGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~'~ Three [] Six [] Other 7. WATERR SOJ~P S LY [~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach ~og if available,) 8. SEWAGE DISPOSAL SYSTEM E~'iNDiViDUAL/ON.SiTE** /¢2'~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NU~MBER OF REDROOMS ' [~//SINGLE FAMILY [] ONE [~ THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY ~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~'~DIVIDUAL/ON -SITE DATE INSTALLED E~PUBLIC UTILITY ~'C) ©~7~ / Connection Verified INSTALLER Size: /~5~O If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS I~ APPROVED FOR ,.~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79) DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME OATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOL~Nv)RONMENTAL PROTECTION:  825 L Street * Anchorage, Alaska 99501 i ENVIRONMENTAL SANITATION DIVISION SEP 2 1980 Telephone 264-4720 D Er'E I ~IEi~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEi~'~'A~IJ~IIf-IVE~;j~- DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PROPERTY OWNER PHONE MAILING ADDRESS . / PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS ,..END,NG,N IPNONE 4. REALTOR/AGENT PHONE MAILING ~ 5. LEGAL DESCRIPTION OF RESID E 6. TYPE~E ' [] On~,~ [] Four ~E FAMILY ~o [] Five J [] MULTIPLE FAMILY ~ Three [] Six 7, WATER S~IP~LY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY [] Other * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8, SEWAGE D/[SISOSAL SYSTEM ~' INDIVIDUAL/ON-SITE** [] PUBLIC UTI LITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~OlO (Rew 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 Con~rection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~]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 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [] APPROVED FOR BEDROOMS [] ' CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev, 6/79)