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Home My WebLink AboutTANAINA VALLEY LT 11Onsite File Tanaina Valley Lot 11 #011-051-86 rn)n nr, Municipality of Anchorage, On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT ►WAY g 2®� Permit Number: OSP221047 PID Number: 011-051-86 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ■❑ Upgrade Name FAGERSTROM, CHARLES & CHRISTINE ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 7134 LOWELL CIRCLE, ANCHORAGE, AK 99502 ❑ Other Phone 907-854-8804 Number of Bedrooms 4 S i ating Total depth from original grade GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe in om original grade F{, Gravel depth beneath pipe Ft. Subdivision Block Lot TANIANA VALLEY 11 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines istance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. betwee nches From Tank Field Tank Line Ft' Well >100' N/A N/A N/A >25 TANK ❑p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water > 100' N/A N/A N/A Material PLASTIC Number of compartments 2 Lot Line >5' N/A N/A N/A NA Foundation >1 o, N/A N/A N/A LIF TION Manufacturer Capacity Remarks EXISTING ABSORPTION TRENCH PIPES WERE Gal. LOCATED AND REPAIRED PER THE PERMIT SPECIAL PROVISION Alarm location Elec i installed by Installer PIPE MATERIAL _ House to -tank D3034 Tank to D3034 drainfield JO ' HNS EXCAVATING Drainfield N/A CO/MT 3 Inspector L.TIDWELL BENCH MARK (Assumed elevation) 100 ft Inspdection I5' 3/15/22 3/15/22 Location and description 2nd 3rd 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF AC,q ll1 Conditional Approval: Date � ' low 49TF /r� Septic System � ••BenC 592iller •.' AV �� Approved Date a'O aQ �� sl ' • 41/26/22, • •'�� iliFP Note: pROFESSI��'.- this approval does not include well permit requirements. t��®��`�� I�cv VV/VL/ I Vi I�L 34 Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A LENGINEER1"=50' EXISTING TRENCH TO REMAIN IN SERVICE CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MH1 PERMIT # OSP221047 PID # 011-051-86 TANAINA VALLEY, LOT11 A B FEET 0 50 100 LOWELL CIR 4/26/22 NEW 1250-GAL SEPTIC TANK W/20" MANWAY 4-BDRM HOME ASSUMED WATER SERVICE LOCATION KEY BOX LOCATION A B FCO 12.4 MH1 24.2 SV1 27.5 2CO 30.2 3.2 20.1 24.4 27.4 PLAN AS-BUILT SV1 2CO MT1 25.623.7MT1 PROFILE AS-BUILT (NO SCALE) 94.8 89.4 95.4 99.7FCOMH1 SV11250 GAL SEPTIC TANK 2CO94.7 Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A LENGINEER3/31/22 PERMIT # OSP221047 PID # 011-051-86 TANAINA VALLEY, LOT11 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 On -Site Wastewater Disposal System Permit Permit Number: OSP221047 Work Type: SepticTank Upgrade Tax Code Number: 01105185000 Site Legal Address: TANAINA VALLEY LT 11 G:2122 Site Mailing Address: 7134 LOWELL CIR, Anchorage Owner: FAGERSTROM CHARLES E & Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: ocnr S A 9:6 o r1 n 'v Dupaj•tmcnt Lot Size in 5q Ft: Total Bedrooms: 3/7/2022 3/7/2023 33917 ❑ Disposal Field 0 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 small notify the Development Services Department per AMC 15.55. Provide notification by calling (907) 343-7904 (2417). 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: f f 1. The new septic tank shall be located so that code required separations to deck supports is provided (AMC 1 15.65.205B.d). 2. Existing standpipes that are to remain shall be repaired or extended to grade, as needed. Veronica Pope GE 2022.03.07 Received By: 11:38:18 -09'00' Issued By. Date: I Date: I7 3 10�� 4 MUNICIPALITY OF ANCHORAGE Community Development Department - Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 011-051-86 Property owner(s) Fagerstrom, Charles & Christine Day phone 907-854-8804 Mailing address 7134 Lowell Cir, Anchorage AK 99502 Site address 7134 Lowell Cir Legal description (Sub'd., Block & Lot) Tanaina Valley L11 Legal description (Township, Range & Section) Lot Size 33,917 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (w/wo AD U) Septic Tank RX Upgrade ❑x Duplex (D) ElHolding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (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. (Signature of property owner or authorized agent) Permit/Rush Fees: to 5 ls5 kusq Date of Payment: `i a bQ 2 Receipt Number: d Y ( � 5 b Permit No. 6 3f P� 1 0 Li ' I Permit App_::- : ,'-.,:c iver Fees: Date of Payment: Receipt Number: Waiver No. March 3, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 3/3/22 Subject: Tanaina Valley L11-7134 Lowell Cir Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life. We are submitting this permit application for the replacement of the existing tank. The attached site plan identifies the location of the home and existing septic system. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The home is connected to public water, the new tank will be a minimum of 10’ from the water service line and foundation, and more than 5’ away from the existing absorption trenches. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221047, Rebecca Carroll, 03/07/22 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' EXISTING TRENCH TO REMAIN IN SERVICE CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND TANAINA VALLEY, LOT11 FEET 0 50 100 NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. LOWELL CIR 3/3/22 NEW 1250-GAL SEPTIC TANK W/20" MANWAYDECOMMISON EXISTING TANK PER U.P.C.≥5' ≥10' 4-BDRM HOME ASSUMED WATER SERVICE LOCATION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221047, Rebecca Carroll, 03/07/22 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR'F Na.~e DISTANCES /.~!'516145 I,',t ~A/O,O~ ~ SEPTIC ABSORPTION Addres~ -- TANK FIELO WELL Phone(s) Permit No. No of~eOrooms WELL Lot [ Brock.~ Subdivision Township, Range, Seclion ~S-BUILT DIAGRAM (Show location ol well, septic sys[em, property lines, foundation, TANKS ~ SEPTIC ~ HOI. DING ~ ~ TYPE OF SYSTEM ~ BED ~ W. DRAIN ~ OTHER TRENCH odgin~l grade ~, J FT 0 FT ~0 SOFT ~ FT WELLS ~ PRIVATE ~ OTHER (Identify) ,.~ ~ssificanon (A.B.C) lolal Deplh FT Cased to REMARKS: I-- /'/,~% /~'~0~0~- cedlly th~t Ihls inspecgon was pedormed accordlfl~ to all Municipal and State guidelines in elleclofl this~ .~ / ' / 72-013 (3/85) M LJ N I C :l: F' A L,, I 'F Y 0 F A N C] 1'4 0 R A G g6~p,."~P'JLrll~)l]t OJ' I"t6")~r~lth & I'"lLullarl Serv:Lces J!l~),~ b ~!~,j..p~.;vj;.!, (~rl¢=l'l(DPE~ge!, ~l~?~k.a 99501 '.~;4,:~;-,47,'.,~0 I='(:,rm:Lt ixluml:)er~ 880:L17 I]wr'le r, Name DEE~IE}I~iS IN WOOD 70~2,:L DRII=TWOOD L.,ANE A NI:7, HO F~ AI:Eil !, At::: Day 349'""~10 14 Lot L.~:~gal: Eiubclivimil~r~ TANAINA VALI.,.EY Lot: 11 Block~ - !{~(:,)(:~"'~,,~,(:)rJ~ ~J, 'l"owr~h:Lp: I~ZN Range: AW I....ot Size :]!;39:L7 (~q,, f'L. c)r ac::pes) JvJFA;.~ Bedrooms: 'r'hi!:¢ Permi. t;~ 4 To'La]. C;apac::i. ty: ~ SEI::)TIC TANK: I~linimum total sep'Lic tank c:apac:lty: l~,2f:~O gallr;)ns. t~7~l'iJ.:: llJL.~st hEZVE.) a'L ).~:~aKF['.. ;:E! c:omp<':Ap'[.~llE].rl'J:~, D6.!p'Lh ~:.o top of sE:pt:Lc J'(:.)i:~'J', P6.tqLIiPGMB ~.]")~!~L.~J.a'~..iJ~)n OV~:~)I'~ *J:,ar]J-:: (E~) , INF:ORM D,, Id, H, i:% F'RIOR 'T'O iS]' & 2~N]I) INSI='Et]T]:ONE~ BY E:NBIIxlE:IER:, AF=I"ER OI::"'F:I[;E: FIOUI:rd:~ CAL. I.. 34::5-4681 AND I....IEAVE A MIESE~AGE,, CONSTIRU[','f' PER EIxlGINEI::RE~ AT'rAC',I..JE:D APPROVED DESIJ:3N. TH]:S PERMIT VALID FOR A SINJ3L.E FAMILY REE~IDENCE ONLY ]: CE:RTIF:'¥ 'THAT: 1,, I am familiar wi'Lb 'Lhe r'equirem:~n'Ls for' cm]--..sitr:.~ ~.se~wer's and ~(.:¢llJ:i as ~:e.t. for'LI1 by the Mun:lcipal:i.'Ly OF Anc:hopage (MOA) and in conlp].:i, arlce with the desi(.tn criteria of I will adhere to all IdCJA <:~l]d EJta'Le of Alaska arJcJ 'Lhe State of Alaska. a]. ]. IvlJ:)~ cc)des and r'egLtla'Liorls, 't. h i s p e r' m i 'L, r'eqL~ir'eilier~'L~ fOP the ~:~e~, bi~ck d¢.sposa], system or' pub]. ic:: sewerage ::::yFrLeln (::)r'l 'Lhis (]~' any adjacerit or near, by lot. I urlder, stand tha'L this permit is valid for a max:i, mum oF 4 bedrooms,, _~....,L L~ndLP..,L,.~r~d Uqa( Lh~... c;~af...J.L.y (..)J Lh~.... t, oLa.[ ..,y:,,{~..m 1.:J 4 L)~.dl uom.,, anY..i, enlargemerM'..~will r'el~,// an addi'Lior'lal perm:Lt.,, '~r : '~ ~ ],)('~l~ ..... " . ........................................................... ::)w.'.e.' ) ~NFT :rJ, I W,::,,':,,:) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG .-- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 $1LT-y 3 ~AAID 4 $- 6- 7- 10 11 12 13- 14- 15- 16- 17- 18 19 20 Township, Range, Section: ,~ ",," ~-/aX/ /'~/I/t/ SLOPE SITE PLAN 7/II '7:/¢ WAB GFIOUND WATER ENCOUNTERED? m Reading Oats Gro~ N~ D~)th to Net Time T~me Water Drop / ~hT~¢ o o ~.o" · · ~ __ 3 ~ 3 '7, o" , ~" 't ~o ¢ ~, ~ ', , ~" PERCOLATION RATE I~ (mlnule~incn) PERC HOLE DIAMETER -- 'rEST RUN BETWEEN ~' Fl' AND __ ~ FT PERFORMED BY; .,~, )~4 t~Ab/2~,L/ ~ ]. J~C%¢ ~ ~N0 FY THAT~HI~ TEST WAS PERFORMED IN ., ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS OATF- DATE . 72~8 (R~. ~/~) 3 TW r~ 4. 210~4~' 6 c 1/64 Michaol E. Ande 4381 -E 16 9 14 //'--/do' u._. _~ ~ ~-Z63.08'~ L- -- 33~,g20 · f. Municipality of AnchOrage Development Services 'Department Building Safety Division On-site Water and Wastewater Program 4700 South Bragaw St. P.O..Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING. Parcel I.D. 011-051-86 Expiration Date: GENERAL INFORMATION . .Complete'legal descriPtion Lot 11, Tanaina Valley Subdivision Location (Site address or directions) 7134 Lowell Circle Current Property owner(s) Gus and Lucy Conner ' Day phone '245-1324 Mailing address 7134 Lowell Circle Anchorage, AK 99502 Lending agency Mailing address Day phone Real Estate Agent ,'. Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: Four (4) Day phone TYPE dF WATER'SUPPLY: Individual Well [] Individual 'Water Storage [] Community Class A Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site r~ Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD.) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of · title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 2440773, Anchorage, AK. 99524 Engineer's Printed Name Michael E. Anderson Date /_50 _ 0 5. DSD SIGNATURE V Approved for _ bedrooms Disapproved. Conditional approval for Additional Comments ' 49th .•* ........ ........ MICHAEL E. ANDERSON No. CE-4381 �� ®®®,f ®®fRaissI�®i®®®`a bedrooms, with the following stipulations: .-9h1=CITE •.4i WATER AND • S'�fd�Ei� . PROGRAM ••....•• 9 lJJl1ll Attachments: HAA Checklist X Maintenance Agreements Septic -System Advisory Supplemental Engineer's Report Well Flow Advisory Other By:Z!?�Original Certificate Date: a-4-04 (Rev. 01102) i: :.,Municipality, OfAnch0rage :: i :'i . 1) Development:Services Department Ii .; ;' ;:. ' . On.SiteWfit~r&WastewaterProgram 'i '; :.i',I;~: ~, . r ' ' '" ,~.;. 4700 South Bragaw St ,, ' , ; ~ ~:~ p.O. Bo~.1'96(~50 AnChor~ge, AK.'99519.6650 ~. ~';~.~ . . . , ,, . , . ~ :: , , ; , ,,., ;.., ~ . : : .'/ , : , ...~ . ~ ~,cl.anchorage.ak.us . '~ :.~,:~ ' ' ' EALTH,AOTH,0RITYAPPROV&L CHE LiST Lega Description: Lot ~,TanamaValleySubd~vlslon' -' -': ' ~ ~ ~ ~',: Parcel ID: 0~.05~.86 A WELL DATA ............ , , ............ Well ~ype'Clfiss A. ;. ~'~: '~I, :ifA, ~, 0~ C ~r&v-ae PwsID ~ 2~4706 ~ ~ ' ~6 L6~ (y/N) Date completed- ~ ,,., ';,:., ~'Samta~ seal ~/N)' ,. :; · ': ~: Wires properly protected (Y/N) Total~epth ~,. :. iff. ~ : :' 'casedtd~l i;/~,~ ft.: ~ ~ '..,:, ~"Casin~h~i~ht(ab~oeoround~ in. ' ;;~ ; ~', . FROM WELL LOG ,:,'~, , '~. ~'.. ' ~ ' AT INSPECTION :,,', : Dateoftest.r. ', ',::, ~ .,: ,~, ~ ,:, ,: : .; " : ~,:~: ~ ~;~l .... . : .. · / .. ,, Stat c water level _. ..... ' .. ~ ,ft,:. · : :..~ . ..~ : ',,.~::~:~+ .... ft. . - , ~ , *. , ,~. ~r ~ ~ , : : . ~, ,, . : , - :, , :: , :'~, ,, ~, , , Wel production ..... 1 .... a.~.m. . . ..... ~. . , ~ · r; {~ ?''' . .,' ' ~ , . , ,~. . , ' : : ' ~ i' ' - ;~n , :. ~ ~:' ,.:,~' q., '. ~: ~ ,, ,. ~ ,~ , , . , ; ' ; .: · ,Cohfp~m :' i~, , colonies~100ml., ;;Ni ite::: m~./I. :]::~ ',..' ,Othe?l)fict~ria;~:,~: , ' colonies/100ml. B. SEPTIC/HOLDING TANK DATA ,. ........... , .... . ....... ' ' " ' '1' ' * ' " ..... ~ "i ' . Tank Type/Matera :. Se t c/Steel ..... , .... ; ' : ..... : Date installed r~01251~gRR . : /an~ s~Fe ¢~,auu gal.' .:: 'I; '~Number of Compartmepts:2 :::', ~:.' Clean0uts ~/N) Y' ,: . , : . -::~ FounO~t,0n ~leanout (Y/N} ~ :: Dep?e~slon 0ver:tan~ (Y/N) N ;-"?',High Wa~er ala~;(Y/N) N . , . .,, . ? ~ ~ , ,. ,:, , , :: ,.' , . ~ ,'.,, :~,, ;,,.~, . ~, .... , :,, ~ . :. j~ Dat~pu~,ng 512112003 ~'.. ~ ~,~'. ~ ,u~,,~:r ~~ ' : .... ;C. ABSORPTION FIELD'DATA~ '.-: ~; ' : :': ~ ' ~ ~ ~'~ ' .; . :,:.. ;', ~. .:":' ~ : ~ . *..,,. . , ~ : ,~ ..... ,~ ,. ,':: :, . .... , .:~ , ,~ ~: ,:;. - ~:. ~ ; . . , ,, .: .... :~ Date ~nstall~ 1012511988 ~..; So~l ra~lng .(g.p.~./f[~ or ft/bdrm) ~50 SFIBDRM~ .Syst ~m ~pe ~5'Wide Trench , ' ': ~ ' ' ~' ~ ' ~' ~ ~ ~' ~. ~,:{ · ' F~ '*':~:~ '~,~.' ~ · . ~ . , , , , , ., ~ .~} · .; . ~ . ' ' ' ~ ~'" *~ '' I ..... " .... .... : Length.60 , ~ · ft.. :,. ,~ . WMth~ 5 . . ..... ~.,~ ~. ft Graxe below p pe 4 : · .: ft. ,' ..: Total depth 8.5 ft .... Eft. absorpt~o~ area 600 ft ~ ~ ,,~onRonng tube Y, Del ress on over field N .. :,' Dateofadequacytest.4HS/2004~. I ~:': ;'[ {Res'uts(Pass/Fail}: :Pass' :: '''~ ~ ;'~ ~::I~'.::: For Four bedrooms . '. ~ ,, Fluid depth in'absorption'field before test 0 in. ~ . ~ .Water added690 ga j ,~ ::~ ~: ~ .: ;. New depth39 in . '. .~. Elapsed Time:l,420min.;.I'., ',.. Final fluid depth0,in' .; '-:' : .. Absomtion rate '>=600 . d ,, .. ..... . ..... ,, . . , g.P.. . '..' Anyrejuvenahontreatment'(past12mo.)~/N:&tvpe)~.N::.~.~l ":.",.: :- ~:~ t~: i' ,'~:'.~ivedate .... . ~ . , ,. : ~. , ,.,. ~ , ~ ' . , , , . ; ' ~; ,. ' , ,.q, , ,, : .... ~ ',.,.~ .: :-.~ ,: , ~ . ~, , ,,. v, : :-,,' ~l . : , ' . ; : . . , , : '[ , ~ J : '.:, ,,,~ , , , ; , , , ,~ . , ~ : , ~. - ,, , ; ~ ,{ D. LIFT STATION Date installed Size in gallons _ "Pump on" level at in. "Pump off' level at Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NIA Absorption field on lot NIA Public sewer main NIA Sewer /septic service line NIA CO Manhole/Ai cess (Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots NIA On adjacent lots NIA Public sewer manhole/cleanout NIA Holding tank NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Absorption field >5' Water main >10' Water service line >10' Surface water >100' Wells on adjacent lots >200' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >5' Curtain drain None Noted Wells on adjacent lots >200' F. COMMENTS is G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in 49th ` .< .................... conformance with MOA HAA guidelines in effect on this date. -........ ................. ..........•'••' ' MICHAEL E. ANDERSON t Engineer's Printed Name Michael E. Anderson, P.E. � TX; No. CE -4381 : v A 4V Date 113012004 HAA Fee $ Waiver Fee $ Date of Payment 1 I • 6 �� Date of Payment Receipt Number is Receipt Number (Rev. 12/00) I0 / --- t~4 ~ ~.~, . / ~1~ ~ . / ~7~ ~. *~', LEOENO ~ FOUNDATIOH ~ ~- DRAINAGE ARROW~ ~wYo~'~,. ctnT,~,c~,o~ ' ~ ..... "~ ~ - ~/2 ~ .. .' e~sse;~PPS ~ PO~$ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailin~ address Day phone Lending agency Mailing address Agent ~'~ i' ~ ['4._ ~ v' '--';' "~ , Address ,.¢~. Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well ,.O./z:/' ?¢ ~_~ Public water Day phone Day phone ~, ~'~ - ,'¢'--7~~ / NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) F¢onl 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 aH Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Address ~0 % ~' /.~ ~C, ~ ' ~ , ~. "~ EngineeCs signature ~ ~,c, c, (~t g,'~,.(~ Date DHHS SIGNATURE ~ Approved for ¢ Disapproved. Conditional approval for bedrooms. 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 engineeFs work. Legal Descriptioo: A. WELL DATA Well type Log pres·at (Y/N) Total depth Sanitary seal (Y/N) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN 8 ER'~l~l~uw oF ANCHORAGE Environmental Services Division ENVIRONMENTAL SER¥1C[!S DIVI$10 825"1_" Street, Room 502 · Anchorage Alaska 99501· (907) 343-4744 AUG 22 1996 Health Authority Approval Checklist R E C E I V [! D 'T3,N./XIh,/A. 'x/ALLIS"! ParcelI.D. O Il'- O-'5i'- 8 ~,, Low l1 __ lfA. B. or C. attach ADEC letter. ADEC water sysmm number Dute completed Cased to FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: SEPTI(YltOLD1NG TANK DATA tel ? Date iustalled /0°-5 [f~ Tmlk size Fouudation cleanoat (Y/N) _ ~' Date of Pumping ABSORPTION FIELD DATA Date installed Leubeth ~, O Width Effective absorption area ~,- O Date of adequacy test Casing height (above ground) _ Wires properly protected fY/N) AT INSPECTION g.p.nL Nitrute Other bacteria _ g.p,nl. Collected by: /~¢¢-~ Nmnber of Comparlments ,fl,.. Cleanouts (Y/N) . Depression (Y/N) NJ. High water alarm (Y/N) Fluid depth iii absorption field before test (iii.); Fhdddcpth /40 (ius.) Minutes later Peroxide treatlpent (l)ast 12 months) ~ Y/N) Soil rating /.g_l~Lffl2 or ft%drm) / ~'50 System b,pe ~-'I~.~N C~ Gravel thickness below p~pe ~ Total depth ~, ~ Mmdtoriug Tube present(Y~) ~ _ Depression ever field (Y~) ~ Results (Pass/Fail) ~ For l[ bedrooms Iimnediately afterT~ gal. water added tin.): q7 Abso~tton rate = _ ~ ~) .g.p.d. .fly·s, give date D. LIFT STATION ~1~]c Date iustallcd Size in gallous Manhole/Access (Y/N) "Pmnp o11" level tit* "Pump off' level at* High water alarm level tit* *Datunl Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: NX Septic/holding tar, k ou lot : On adjacent lots Absorption field on lot ; On adjacent lots Public sewer maiu Public sewer manhole/cleauout Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ,~/I Property line ~ 10 Absorptiml field Water maio/service line ~ ~t Surface water/drainage t~'[O Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building fouudation ~'~ {o ~ Surface water /"4 I ~2) Curtain drain Ix'l /D Wells on adjacent lots /"//~ t Water main/service line Driveway, parking/vehicle storage area F. ENGINEER'S CERTIFICATION Property line I certify that I have determined thrufield inspections and review of Municipal sitare ~~~t~ Eugineer'sName [ g~b,~ ~O~t~&~ff ~-~ HAA Fee $ ~ - ~. * Waiver Fee $ Date of Payment ~/'~a~/~),~ Date of Paymeut Receipt Number ~:~//~ ~ ~5>~,,, ¢ / Receipt Number Rev. 8/95 OSS: haa.wk.doc MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Telephone: (home) Location (address or directions) (b) Property owner Mailing Address 7 (c) Lending Institution Mailing Address Telephone Business (d) Real Estate Company and Agent 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 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 rD Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ~ ~.o ~ @§'ed 'HJO~ s,Jeeu!Due i.euo!esejoJd eH) u! 9uo!ss! Luo JO sJOJJe Joj elq !9uodseJ ~ou s! e~.eJOqOU¥ JO ,~l!l.ed lo! un~l eH/'penes! s! el.eo!~!lJeO .e eJojeq .el.ep ezAI.eu.e Jo -:-uo!loedsu! lonpuoo lou op SHHO ~o see/~old uu3 'slueuJeJ]nbeJ el.els pu.e I.eJepeJ u!.e~Jeo ~js!l.es ol JepJo u! suo!~n),Rsu] 6u!puel J!eq~ pu.e seuJoq jo sJes.eqoJnd oi/,se~Jnoo .e s.e s!ql seop SHHQ eqJ. 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WELL DATA Well Classification ~O~Htl,/O/tlll-t/ Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot WaterSample Collected by WaterSample Test Results Comments '~'~ ,qT?A c MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Date Completed __ Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) if A, B, C, D.E.C. Approved (Y/N) Yield ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SI-'PTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) 15-o0 No. of Compartments 'Z- Air-tight Caps (Y/N) _~/ Foundation Cleanout (Y/N) ~Y Date Last Pumped dF-bt( d'ons¢- Pumping/Maintenance Contact on File (Y/N) WET-Ix~ C¢,,r~sr;, ; for Holding Tank High-Water Alarm (Y/N) ,.,V//t Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~500~ q- To Property Line ~ 5' To Water Main/Service Line __ c~O' To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field 72-026 (Rev. 7/88) ~¢ont Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /O - ~?z/-~.~ Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ¢'¢~/ Depth of Field ~. ~¢ Gravel Bed Thickness ~ Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ ~.~D / -~- To Building Foundation Lot ~,[o ¢,E:- d~ ~( L-o T- To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots .~" To Cutback (if present) f,/O ~ /,4./ 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 inspection. Signed ~ ~-~ Company .Z~lPE7Z.~o~J ~(~""¢,lO~,~ ~..~Z.f~4, ~"~ Date MOA No. Receipt No, Date of Payment Amount: $ 72-026 (Rev. 7/88) 8sck Receipt Waiver Fee: $ Date of Payment Page 2 of 2 effect on the date of this Engineer's Seal