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HomeMy WebLinkAboutT13N R1E SEC 10 N2SE4NW4SW4 trcev voivu/i oy Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 221300 PID Number: 05098201 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name MOYER ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 33017 CUMULUS ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 4 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot N2SE4NW4SW4 Fill added above original grade Ft. Gravel length Ft. Township Range Section 13N 1E 10 Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well +100 - - - +100 TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water -}- 100 _ _ _ Material Number of compartments Lot Line +10 - - - NA POLYETHYLENE 2 Foundation +10 __ _ LIFT STATION Manufacturer Capacity Remarks TANK ONLY Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank Tank to drainfield J RS Drainfield CO/MT Inspector C.BALZARINI BENCH MARK (Assumed elevation) 100 ft Inspdection 1st 9116/22 n 9/17/22 Location and description 2 Back Deck 3rd 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 4�' OF A`.4tS�, Conditional Approval: Date •49 �* TH ... ..' rr Septic System � HARLES G BALZARI. j Approved Da F�� . • CE -13854 .••�`� Ngt�: this approval does not include well permit requir me PROFESSIONP�� 5/15/2�1� trcev voivu/i oy CHARLES G BALZARINI CE-13854R E G ISTEREDPROFE S S I O N A L E N GINEER 5/11/23 O 09-,J :31VDS ooz ooL 09 9z of 0 pepinipgnsun S1NVO ,0 l .Oi=..l :91005 TV13G 3snOH -1 o P" . '10, Up4 s 0I a o Q-.•• �y6pp NI MNCO ;I N in OQ: I � a :U >N jm10, Qom•, H� ppp�d•�. .Y.•.���oo �o10� U N L O V) , L N OJ N (n _ Q C O N {\ (n Li — C O L. J a. mo L L o- 9 m m m m m Zm ¢ c m m N'm ° 0 b aamm°o° p z E a m m ¢ m ° c c ao>O.W= o wE E«•N20 m�—�m rn¢mc0 wEL c 0. 0 3 w C c 0 0 O W° m 0 O U O w 0.2. U W 9 U 0 a C_ 3 m 0 M2 0= O� c m r m >` m O O y O c m m U C 0 >> z oc m m L~ 6 m L 0 w O c � O«9 t•4Y� t m 0'0 ° o m L„ w N o c' Tfm O'o m,C m3wLEc0 Re m m>° N .6ina aym Z 0 U t E m m c ti 0 0 I e� M 10 m U U W MUNICIPALITY OF ANCHORAGE »ent S On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road ° r •_' `r•'' �- Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 " n http://www.muni.org/onsite v llepartment �NCHORPG� On -Site Wastewater Disposal System Permit Permit Number: OSP221300 Effective Date: 8/11/2022 Work Type: SepticTank Upgrade Expiration Date: 8/11/2023 Tax Code Number: 05098201000 Site Legal Address: T13N R1 E SEC 10 N2SE4NW4SW4 G:1106 Site Mailing Address: 33017 CUMULUS RD, Eagle River Owner: MOYER DAVID A & NANCY C Lot Size in Sq Ft: 214315 Design Engineer: C&M ENGINEERING SERVICES Total Bedrooms: 4 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: Issued By: Date: Date: W.//Zz' 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. 050 982 01 Property owner(s) MOYER Mailing address Site address 33017 CUMULUS RD Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Day phone T1 3N R1 E SEC 10 N2SE4NW4SW4 Lot Size 214,315 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Date of Payment: Absorption Field ❑ Initial ❑ Single Family (SF) 0 Septic Tank ❑ Upgrade ED(w/wo ADU) Holding Tank ❑ Renewal ElDuplex (D) E] Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: NONE Distance: NA I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: #;Z, 5 Waiver Fees: Date of Payment: T 7 ,2,0-9,� Date of Payment: Receipt Number: 6 2 1) 57b Receipt Number: Permit No. 5 P02,2 I S 00 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Clie nt Forms\Permit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System for T13N R1E SEC 10 N2SE4NW4SW4 Dear Reviewer, The above referenced property is currently served by an older septic system with a leaking tank that needs to be replaced immediately. We are requesting an expedited review of this application. Our review of available documentation and field investigation show that this project will not adversely impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. As shown on the plan, the tank will be greater than 10’ from the house foundation. The tank will be of MOA approved construction. The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover or a minimum of 4’ of cover without insulation. The repair must be performed by a moa certified installer in accordance with MOA requirements. The replacement septic tank is being installed near a deck foundation. The deck foundation is greater than 5-feet away from the proposed tank location. Repair of the proposed system will not negatively impact adjacent lots. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leach field, well, and other applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 7/28/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221300, Deb Wockenfuss, 08/11/22 CHARLES G BALZARINI CE-13854R EGISTEREDPROFE S S IO N ALENGINEER7/28/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221300, Deb Wockenfuss, 08/11/22 ~1 MUNICIPALITY OF ANCHORAGE · DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE , ~ UPGRADE LEGAL DESCRIPTION ,, DISTANOETO: IWell +tOO' IAbs°rpti°narea~ Dwelling ¢ ¢ ~ ~, Man ufactu ret ~ Mate rlal S~ ~_ ( No. or, mpa ,truants Liq. capaci y in ~11~ s Inside length Width Liquid ~ ~ ~ DISTA TO: Well Dwelling PERMIT NO. oZ~ ~f ~ ~ DISTANCE TO: '~1 OD /0 ' ~ mrench~i~h / Distance bet ' es ~ No. oflines~ Lengthofoach~e~ Total length of li~ ~ ,'~,O ~inches Total effect Top of tile to finish grade Material beneath tile Length Width Depth PERMIT NO. ~ ~DISTANCE TO: Wel~ ~ ~ding found~ Nearest I~ ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS ~ ( SOl L TEST R ~. REMARKS APPR E DATE ~ EGAL / . ., ..... DOC Co. dba SULLIVAN WATER WELLS P. O. BOX 972, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS ?0 g.)~o~- /O// ~:2'~'<~'~ ~/O~?~. STATIC LEVEL OF WATER FT. ~m ~z~o~;~¢~o~O~y ~/~ I "DRAW DOWNFT, LEGAL DESCRI~ION DATE- Started ~ o~5~/~ Ended / O//Z ~/ GA~. PER HR PE~IT NUMBER KIND OF CASING KIND OF FORMATION: From (]) Ft. to L/. / Ft. e;~ e-/"' ' ~ o ~' .2 From Ft. to Ft. From(9~ Ft. to /-~,) Ft. C~<~' ~'~-~'<~ From Ft. to Ft el, ,~ ~/¢: A From Ft. to Ft, From__.Ft. to__Ft, g.O ~/~ From Ft. to~ From__.Ft. to , Ft. From Ft. to Et From___.Ft. to~ Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From ~ ~t. to__ ~e ..... From Ft. to Ft, From Ft. to From Ft. to Ft, Fromm. Ft. to~Ft, From Ft. to Ft, From Ft. to Ft. From Ft. to Ft. From From ~t. to Ft. From , Ft. to Ft, From Ft, to Ft. From Ft. to. Ft, From Ft. to Ft. From Ft. to From .:Ft. to Et. From Ft. to ' Ft. MISCL. INFORMATION: DRILLER'S NAME ~ L.,[::F'~ff,: 1 ~']~: 1"4 F , HE:HL i H hiNL:, f:r'~',,,' ]. RUNr,1E.N [ HL .dj I ECL:g Z UN ~IF f. L Z .... -, ~ I SHOCq .... "- ..... . .... L. ~.:,[p.ljL. lZJf4 fj'.:t- F'3 P:I¢.:.:; j.l]i:~.j. E. E:. .... ;" ~q' - J -' ;,,,'iS z'roR CENTER ~,~ F'RST LEGRL T:!.E:NR:t. EN2SEq. NHq. LOT SIZE ;22(3~;ae)E~ SQi. JRRE FEET T'¢F:'E OF' :E;()IL RBSOF:F'TIEq'.4 S¥STEH tS: -.i;b-~-'L l"!!a'.:.~:Zf"iLIH F4Ui"!E~E~[ g!::' E',ED[?.O()HS = ,::[ SOIL ~:F!TII',!G (:SQ F'T/E[R)= :LSE~ THE L. EN 3'TF. E:,'JZ r"l :Zl",J':: Z '"~N Z S TFIE LENGTH ( Z f',! FEET) OF' THE "rRENC:H OF: THE DEPTH OF la TRENCH OR F'ZT ZS THE DZS'TRNCE E:ETP.iEEN THE SL.I~:FFICE OF THE GROUND RN!:;, THE E~OTTOI"I OF -!'FIE EXCRVRTiON (IN FEET). 'THERE iS F,!O SET k!ZD"i'H FOR TRENCHES. THE GRRVEL DEPTH ZS THE H!NZHU!q DEPTH OF GF;'.F:IVEL.. BETHEEt",! 1"HE OUTFRLL F'ZF'E RND THE E',QTTOH OF THE E',:4CRVRTiON ,::IN FEET). F'ERHIT FIF'F'L. ICFiN-F HF!S 'T'HE RESF'ONSI_E,'iL. IT'¢ TO iNFOF'.H THIS DEF:'RRTHE:I",FF DURING THE ZNSTFIL. LRTiOI',! IN'_::';PECT:[OI'-,IS OF:'.F:!N'?' NEL. LS R[::,._TFICEN-F TO 'TH!S; F'RC)F'EE~:-["¢ RND THE NUH[3EF;: OF' RESIDEHC:ES THF'IT ]'HE NELL. I.,.iiL. L_ fSEF:VE. E~F:ICK:FIL. L. iNG OF' RF,I'¢ S'?'S'TEH NITHOUT FZNRL IN'_'-:;F'EC-rIC~N RND t::IPF:'ROVF1L B'./ THiS E:,EF'FIRTHENT HILL BE SLIELZEC:T 'f'O F'RO'E;EC:UTION. ~:, :'"[ :[:''7' j E~ J,l[ZI J :::d,, ;.~ 2 ....,'"~ .... J h-' f"lZi",tii'i[..If'! DZSTFIF,ICE ,E , ~ Lr, ..,_.., .......... FII'.Jr'~ .... ,,4~ I'"Ih-~':;TT[: .:,E!..IH.~. DI'~;F"Z':FIL :, ~:a ,_r! '[_,':' , ::(.E~6~ FEET FOR I::I PR!VF!'I"E 1.4ELL OR ZSE~ -to ;2¢)i~i F'EET FF:OH FI F'UBLZC 14ELL DEPENDING i...IPOl'.,! THE 'T'.r'F'E OF' F'LtBL. i C; I,.~ELL. I',IZNZHUH !')ISTflF!C;[/ FROH Fi PRI',/FYFE !.,.iELL TO F! F'RZVF!TE SEt.,.!ER L.~F,IE iS ;25 F'EET RF,1D TO FI COHHUF,IZT"r' SEi4ER LiNE iS 75 FEET. OTHER R:EGLiiE:EH[Ei',,iTS HFi"r' FIPPL."r'. SF'EC~F'ICRTtC[!",!S FIND E;Cd~,iSTF:LIC;TZO~,! [:,ZfiGRflllS RF'.E R',,,'fiILFI[3L.E TO ]:!",!SUF;:E F'F:OPER i CEF:TIF:./ THF!T !: i FtF! F:F:!i~qII...IFiR HITH THE Fi:EqLiZf,;:EHENT5 FOR Oi",I~,S:I:TE SEP.!E,q:5 RND I,.IEI....!....S FIS SET FOFi'.TI-! [3"r' ']"FIE HI.)N t C I PFiL ! 7'"? OF FIt",ICHOF'.FiGE. 2: i klZLL. INSTRLL.. THE S¥]~;TEH ZN RCCOF:DFiF,!CE [,.!~"['!.~ THE CODE:S. 2:: ! LIi:.,iDEF;'.S'I"t-4i'.,I[) THFiT 'THE ()i",I-,.'S!TE SE!4ER S¥S"i"EH PIF~'¢ ¢:Ei]:iUIRE ENL. F~RGEt"IENT IF THE RESZDEF,iC:E ZS REt"1CiDELED TO :[NC;LUDE FtORE THRN ~. E~[EDF'.OC~FIS. PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4 § 7 8 ~0 ~4 ~7 ~8 2O MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE [] PERCOLATION TEST WASGROUNDWATER /~? ~ ~I ENCOUNTERED? E IF YES, AT WHAT DEPTH? °ATE PERFORMED: ~ SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS //~,//~ ¥~ /. z ,~.~ ),.ftc "/~" ' ~ ~ DATE: ~ ~ CERTIFIED BY: 72-0(~8 (6/79) 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. 050-982-01-000 Expiration Date: 8/26/2023 Legal description T13N R1 E SEC 10 N2SE4NW4SW4 Site address 33017 CUMULUS RD Eagle River AK 99577 Current property owner(s) MOYER DAVID A & NANCY C X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: 0 Original Certificate Date: 5/26/2023 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 Waiver #OSV231027 for field separation distance of 0 feet to property line. COSA Approval_June 2022 , MUNICIPALITY OF 6H Development Services Department N r�T 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. 050 982 01 Complete legal description T1 3N R1 E SEC 10 N2SE4NW4SW4 Location (site address) 33017 CUMULUS Current property owner(s) MOYER 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑■ 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 <1 - 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: ❑ 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 $ S50 330 Waiver Fee $ Date of Payment 5A 5/Z'� Date of Payment COSA # D5 c231 l cl 6 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 C&M ENGINEERING CHARLES BALZARINI, PE 3/23/23 C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System for T13N R1E SEC 10 N2SE4NW4SW4 Dear Reviewer, An asbuilt survey uncovered that the existing leachfield encroaches on the property line. We are requesting a waiver. The requested waiver distance between the field and the lot line is 0-feet. This will not adversely impact the neighboring lot as it is large and unsubdivided. If the adjacent property is ever developed, there is sufficient space for development. The encroachment has existed for years but was not previously identified due to the lack of an asbuilt survey. Thank you for your time in reviewing this request. Please do not hesitate to contact me at 907-854-5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 5/24/23 Municipality of Anchorage �� I)eparhnrnt P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV231027 COSA#:OSC231146 Permit#: PID#: 050-982-01 Legal Description: T13N R1E SEC 10 N2SE4NW4SW4 Engineer: CM Engineering Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 0.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: Z 5/z3 Approved by: Name of Reviewer **** VARIAN C E/WAIVER REVIEW **** ParcelI.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES :)ivision of Environmental Services On-Sits Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 . 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description N ~; SE ~; NW ~; SW ~; s~c~ 1o; T13N; RIE; S. M, Location (site address or directions) MZ,6e 12.5 Eagle Rivc, A Road Pro perty owner Mailing address Brian & K~lly Van-Dorn Day phone Lending agency Day phone Mailing address Agent K~is~in Mayb~_~y' HOMEQUITY-CALIFORNIA Ray Heb~r~ Re/Ma× of Eagl~ River Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Xx NOTE: Commu_nity well . Public water 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 X× 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. 72-02.~ (Rev. 1/91) Front MOA#21 s3uawwoo l~UOp,!ppv :suo!l~lnd!],s I~UIMOIIOj eql qi!M 'suJooJpeq Jo~ le^o~'dde Ie~oq~puoO] -- 'pe^oJddes!Q 'SLUOOJpeq ~ Joe pe^oJddv ~ ~il:ln.l.¥N 915 SHHQ '9 A. WELL DATA Well type Log present Municipality of Anchorage /~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ParcelI.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed l'O- "~c~ -~ ~ Driller ~ot.~, ,Jix,~ Total depth Sanitary seal t~N) z¥O~ Cased to Casing height Wires properly protected ~YN) FROM WELL LOG Date of t~st' \ Static water' level Well flow Pump level sEpARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer ~rvice line AT INSPECTION ; On adjacent lots On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Co,form Date ol sample: ~' ~2-q[ ~ I Nitrate Collected by: B. SEPTIC/HOLDING TANK DATA Date installed. ~ Cleanouts(~/N) High water alarm (Y~) Date of pumping Tank size Foundation cleanout ~N) Other bacteria /J~ ~JF~ S & $ ENGINEERING 17034 Eagle River Leep Road NO. 204 Eagle River, Alaska 99577 Y /-/ Alarm tested (-Y~N) ::~.~-. 4-~-S~r~ Po~,,'-/~, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot [Oc>~4' On adjacent lots To property line J C~ ri- Absorption field Surface water/drainage I ~ ~ Compartments ~" Depression (Y/d~ Foundation Water main/service line J 72-0~6 (Rev. 3/91) Fror~t MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical S~NCE FROM LIFT STATION TO: "~/ell on lot On adjacent lots Manufacturer Manhole/Access~----------~ "Pump on .... Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed L~ ~ Length ,¢~. c~ ~ Width '"~ b, Total absorption area Depression over field (Y/~ Results {I[~'fai I) Peroxide treatment (past 12 months) (Y~ Soil rating Gravel thickness Cleanouts presen:[ (~N) Date of adequacy test for If yes, give date Sys'~em type Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot ) To building foundation On adjacent lots Surface water Curtain drain On adjacent lots I c,o Property line ~ ~:~ ~ '~' To existing or abandoned system on lot ~ J/~' Cutbank ~ //~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S cERTiF!CA'TI0N ' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ '/?(~ rJ:'':2 Date of ayment ? / ReceiptN,mber ~ r~ {'-~Y~''/ ~ 72-026 (Rev. 3/91 ) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AuTHoRITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. #. ('~'~d~('b '-~ ~ -(~)\ HAA # ~:'~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) N~ SE~ NW~ SW~ TI~N~ RIE~ Ss~ion I0~ SM Location (address. or directions) 2419 Eagle. River .Road, Eagle River, Alaska Chuck and S~Y Laird Telephone: (home) 694-3317 (b) Property owner Maii,ing Address. 2419 E~g~e River Road, Eagle River, Alaska 99577 Business (c) Lendin, g In?if'utien ' ,,' Mailing Address Telephone (d) Real Estate Company and Agent HOMEQUITY/Mik6 Lewis - HOMEQUITY //4200-30124 Address 400 East Las CoIinas Boulsw. rd, S~it6 300, Irving, T¢.xas 75039 Telephone 214-506-8884 (e) Mail the HAA to the following address: (or check here [~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Su~t& 204 Eagle Rivt~, Alaska 99577 2. TYPE OF RESIDENCE Single-Family [~ Number of bedrooms ordered by Mik~ L~wZs/HOMEQUITY 3. WATER SUPPLY Individual Well,~Z]( Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality ahd status. 4. SEWAGE DISPOSAL On-site [~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this' Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date ~. ~ S EHc~INI~ERING 17034 Eagle River Loop Road No. 204 ,-_.~~., t~,,~r. Alaska 99577 Telephone 6. DHHS APPROVAL App~:oved for 4/ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88)Back Page 2 Of 2 //~------~.~ ;,;.:MUNI?~P,A, LITY OF ANCHORAGE (MOA) kt~i~-'.'l~,.~_.-~ul;i:~;c.nc::s ~.HiiJ(I;l'ft Authority Approval (HAA) · ~,.~. ~ ' ' cHECKL ST - FEBRUARY 1984 "" ,~ ~.~ ~ 343-4744 Legal Description: k)~; ~ A. WELL DATA Well Log Present,N) ~ Date comPleted /o~f Yield TotalDepth/~Oas~dto /fi/ Depth of Srouting Static Water Level / O Casing Height Above Ground Electrical Wiring in Conduit ~)N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / (~r~ To Nearest Edge of Absorption Field on Lot Pump Set At 6,6 u/~ Sanitary Seal on Casing eN) Depression Around Wellhead (Y/~) ;'On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by ~ ~ Water Sample Test Results ~__~ ~ '~/._.% Comments To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date Installed ~' ~ - ~' Size Standpipes (Y/N) Y Depression Over Tank (Y/N) /.*.'~-~-O?JNo. of Compartments Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) ~ Date Last Pumped / ~)~ ~',P t Pumping/Maintenance Contact on File (Y/N) ; for Holding Tank High-Water Alarm (Y/N) /'d / ~ Temporary Holding Tank Permit (Y/N) SEPARATi'ON DISTANCES FROM SEPTIC/HOLDING TANK: To Water-sUPply well 1 'l-o:propertYLine,-;, ~ / C.P : To Wa~er Main/Service Line / To Stream', Po~d;"Lake or Major Drainage Course To Building Foundation To Disposal Field 72-026 {Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Lc ~/~,/"~ Type of System Desig, n Length of Field ~ ~' Depth of Field / (Z~ Gravel Bed Thickness ~ Statndpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Resultsof Last Adequacy Test .~b. ¢r~L/~--~'~f~ ~ ~L SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well / (©O ' ~ To Property Line /' O To Building Foundation ,/~ ~ To Existing or Abandoned System on / ' Lot ~ r~ ; On Adjoining Lots ~O To Water Main/Service Line / ~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ~/f~O ~ To Driveway, Parking Area, or Vehicle Storage Area ¢'~ ,%~ Comments D. LIFT STATION Date Installed Size in Gallons %', "Pump On" Level at H gh Water Alarm Leve at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Perrn'itted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect.er~'[.h~ f~%of this inspection. Company 17034 ?gle El~e~ Loop Rea4 No. 204 Eagle R~vef, Alaska ~517/ MOA No. ~ ~¢[~' ~_~ Receipt No. ~/L/~7', ~¢~ ? Receipt No Date of Payment ~: Z/~ ~? Waiver Fee; $ Amount: $ /~¢/OO Date of Payment 72-028 (Rev. 7/88) Back Page 2 of 2 ~- :~, FILLS OUT uppER HA[:~ONLY · Bu er C ' / Realty Co. & A~nt Phone Address Zip Code Street Locati~ Type of Resi~nce  Single Family Multiple Family NO. of Bedroo~ ~ Other Water Supply  Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. Community For wells drilled prior to that date. give well depth (attach log if available). ~ Public Utility Sewer Disposal  Individua~ Year Individual Installed: . Public Utility When Oonnected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector /V LJNICIPALITY OF ANCHORAGE Field Notes: DEPT. OF HE>.!.TH /.f',~ O ENVIR~ )NMEN'i AL P;~Oi ECTIC ix[ RFC[IV,CD ~ APPROVED BEDROOM8 *CONDITIONS OF APPROVAL ( ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' Soils Rating Date Sewer Installed Well TO Absorption Area Well Log Received Well to Tank Septic Tank Size 72-023 (3182)