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HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 1 LT 41Valli Vue Estates #2 Lot 41 Block 1 #015-341-04 Development Services Department Building Safety Division '~ On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page j of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Address: Phone: Numar of Bedrooma: '~ ~ ~ ' ~ ~ ~3 ~,,,, U DeepTren~ 0 ShallowTren~ U 8e~ O Mound ~ Othen ! Soil Ra~ng: Total Dep~ from original grade: LEGAL DESCRIPTION ~o,~,~ ~. Block: Lot: Subdivision: , Dep~ to pi~ ~om from odgin~ grade: Gravel depth beneath pipe: Township: Range: Section: ~ Fill added a~ve Cginal grade: Gravel Length: Ft. Ft. Well: ~. ~, ~ New ~ Upgrade Grav~dth: Fl. Number of lines: J Oistan~bo~eenlines:Ft. C~assifi~tion (Private, A, B, C): J Total Depth: Cased to: Total ~tion area: Pipe Material: Ori]le~ Dale Drilled: Static Water Level: Installe~ Date Installed: Yield: I P~mp Set a~ } Casing Height ~ove Grou~; TAN K GPMI Ft. Ft. SEPARATION DISTANCES ~ Septic D Holding ~ S.T.E.P. ~ Other: T~ To Septic Absorption Lift Holding Publi¢PHvate Man~a~urec Capacity: Tank Field Station Tank SewerLine ~¢~¢¢~ T~O ~ I~ GaL Material:¢ Number of Compa~ments: Size: Manufacturer:  'Pump on" level at: "Pump o~ level at: in, High waler alarm at: Pump Make & M~el Ele~ri~l Inspections pedormed Rema~s: Engineer's Stamp Development Semices Depa~ment ApprovaIDate:/~/~//~ * ........... T~og°~~ ' Reviewed and PERMIT NO: SW030322 PID NO: 015-341-04 SWING TIES: FROM: COR. "A" COR. "B" TO: S.T.C.O. "C" 18' 20' S.T.C.O. "D" 24.5' 25' DBL. C.O. "E" 26.6' 27' PAGE 2 OF 2 NEW 1250-GALLO N SEPTIC TANK EXISTING /~;; SOIL ABS.--' ~' TRENCH ,, WATER KEY BOX LOT 41 BLOCK PLAN VIEW 1"=30' NEW 1250-GALLON INV. INV. SEPTIC TANK -- 91.2' 91.4' PROFILE VIEW 1"--5' LOT 4t, BLOCK 1, VALLI rUE EST., UNIT #2 SEPTIC TANK REPLACEMENT AS-BUILT INSPECTION REPORT FLATTOP TECHNICAL SERVICES 14530 ECHO STREET ANCHORAGE, ALASKA 99516 SCALE: AS NOTED DRAWN BY TFM OCTOBER, 2003 MUNICIPAL I TY OF A NCHORA GE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P. 0, Box 196650, Anchorage, AK 99519-6650 (9O7) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 21,2003 Expiration Date: Aug 20, 2004 Permit Number: SW030322 Legal Description: VALLI VUE ESTATES #2 BLK 1 LT 41 Design Engineer: 0019 Flattop Technical Services Owner Name: Clifford & Joan Schwandt Owner Address: 10215 Main Tree Drive Anchorage, AK 99507-6933 Parcel ID: 015-341-04 Site Address: 010215 MAIN TREE DR Lot Size: 21084 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [~ Disposal Field [] SepticTank Holding Tank [~ Privy [~ Private Well [~ Water Storage All construction must 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption'system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~¢'"~ ~ Date: Issued By: (~ Date: 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.¢i.anchorage.ak, us (907) 343-7904 ..-ON-SITE SEWER/WEt. L PERMIT .APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. <~>1,.,~' -- .,~ ~! - <::> tTt Permit Number SW Propertyowner(s) CI, Ff-Orc~ ~ ~o¢-~ ~¢_~O~ Dayphone ~¥~'~¥Z Mailing address (1) Mailing address (2) /~r~ ¢&O~' Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size "~.i i C)°o~ AcresO Zip Code Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool [] [] [] [] [] F1 Well Only Water Storage Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Waiver Fees: Date of Payment: Receipt Number: (Rev. 12/00) Date of Payment: Receipt Number: · / I / / /? / / / I / SEPTIC AREA ' - -.... LOT 42 INSTALL NEWi 12~0-GALLON-~ SEPTIC TANK,~ C.O~tDBL \\ i::: ~ EXISTING ~ so,LABS. TRENCH ,~ x~ WATER KEY BOXES SEPTIC AREA LOT 41 BLOCK 1 ABANDON EXISTING 1000-GAL. & 500 GAL. SEPTIC TANKS LOT 40 tI tI LOT 52 LOT 53 NOTE: THE LOCATION OF THE WATER SERVICE LINE IS UNKNOWN AT THIS TIME. PRIOR TO EXCAVATION THE CONTRACTOR SHALL ARRANGE TO HAVE THE LOCATION OF THE WATER LINE FROM THE KEY BOX TO THE RESIDENCE MARKED ON THE GROUND, AND SHALL MAKE SURE THAT THE NEW SEPTIC TANK IS NO CLOSER THAN 10 FEET FROM THE WATER SERVICE LINE. LOT 4t, BLOCK 1, VALLI VUE ESTATES #2 SEPTIC TANK REPLACEMENT SITE PLAN T FLATTOP TECHNICAL SERVICES { 1 INCH = 50 FEET 14530 ECHO STREET j DRAWN BY TFM ANCHORAGE, ALASKA 99516 AUGUST, 2003 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. MUNICIPALITY OF ANCHORAGE NAME Cox1\ MAILING ADDRESS LOCATION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 826 L Street- Anchorage, ALaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE ~U,~L) ~/5/- 7//3[~] NEW ~UPGRADE J , NO, OF BED~MS DISTANCE TO: Manufacturer Well Absorption area Inside length DISTANCE TO: Top of tile to finish gra/de Length Width [ Dwelling I[~' / Width Foundation No. of comp~ments Liquid depth Well Dwelling PERMIT NO, DISTANCE TO: Manufacturer Material Liquid capacity in gallons I , mmuni v Nearest lot line/O '/f- I No. ofllnes / I Longth o, eao~ ' Type of crib Crib diameter Well DISTANCE TO: Totallength Material beneath tile Depth Crib depth Building foundation Class Depth Driller DISTANCE TO: Building foundation Sewer line OTHER Trench width I ' I (¢¢.~/'~ Total effective ab r~i~n area PERMIT NO. Total effective absorption area Nearest lot line Septic tank Distance to lot line APPROVED 72-013 (Rev. 3/78) LEGAL Ja_\\i Permit ~MUNI~IPALITY OF ANCHORAGE ~ Department[ '~ Health and Environmenta? ?rotection 825 - Street, Anchorage, AK. J9501 264-4720 HANDWRITTEN PERMIT * * * ON-SITE SEWER PERMIT ~~OW Mailing Address: ~ ~ ~/~ / Phone Nu~er: ~ ~--~//3 Applicant: Location: Legal Description: O / ~ ~/ ~' Type of Soil Absorption System Is: Trench: ~ Drainfield: Maximum Number of Bedrooms: ~ Seepage Bed: __ Holding Tank: soil Rating(sq.ft/br) /~.~--~ The Required Size of the Soil Absorption System Is: DEPTH /(~) LENGTH C~. GRAVEL DEPTH ~' WIDTH 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 and 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 outfal! ~ipe and the bottom of the excavation(in feet). ~ ~<-~/4'~x~-. ~,~k~3k~ * * REQUIRED SEPTIC(HSLDt-NG-)~TANK SIZE = ~0,32_ ~ -r~ u Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection~and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well 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 this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 8 B * * * I certify that:' (1) I a~u familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that~/?bedrooms. S igne~: .7,~¢¢'~'.~ ~ Issued by: ~ ~~ SWP/024(1/81) GRE ~R ANCHORAGE AREA BO! ~IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION LEGAL DESCRIPTION SEPTIC TANK: DISTANCE ~ FROM WELl INSIDE LENGTH COMPARTMENTS INSIDE WIDTH LIQUID DEPTH __LIQUID CAPACITY /~:~<C?<:~) GALLONS. SEEPAGE PIT: LINING MATERIAL~¥3'I,¢ /~ //~'~CRIB SIZE: DIAMETER__DEPTH ~' DISTANCE FROM: WELL / ~, TOTAL EFFECTIVE BUILDING FOUNDATION '~. NEAREST LOT LINE .2~ <~/. ABSORPTION AREA (WALL AREA) ADDitiONAL ABSORPTION -'~;f SQ. FT, WELL: TYPE CONSTRUCTION ~ DEPTH BUILDING NEAREST NEAR~'~ SEPTIC FOUNDATION LOT LINE SEWER LINE~ TANK CESSPOOL OTHER SOURCES ~ . APPROVED DISAPPROVED REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: LOT SLOPE: REMARKS: Form No, EC~-O31 GreaTer ANCHORAge ArEA BorouGH DEPARTMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. PHONE INSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD OTHER cOmPleTION DATE ANTICIPATED U/ ,~ 7 ~/ ~" FINAL INSPECTION: 24 HOUR NOT~CE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK SEEPAGE PIT ALSO CONSIDER AREA WELLS. ~¥ATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTeD W]TH AIRTIGHT REMOVABLE CAPS. CONFORM TO BOROUG REGULATIONS REGARDING I ALLAT[ON. LICENSED DESIGNER DIAGRAM OF SYSTEM GREATER ANCHO AREA BOROUGH ORD NCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. -- DATE APPLICANT'~ ~]GNATURE G[ ER ANCHORAGE ARr_A BOROUL~H ~ Department of Environmental Quality * -,. . -' ~ 3330 "C" Street Anchorage, Alaska 99503 Performed for ~-o~\~ (~_.:_~..~.~!_~_~ .... Date per?ormed Legal DescriptOr: ~ ~w~ k~ ~ 'This form reports: Soil~ tog % -' ~e~co'~'a'tion test Depth Feet 6- 7- 8- 9~ lO- ll.- 12- !3- 14- Was ground water encountered? tqcS If yes, at what ~epth? 'Reading Percolation-:t~' Date Gross Time minute. Net Time Depth 'Co H20 Net Drop Pro?osed installation: Depth of Inlet Seepage Pit ..... Drain Field Dep~il--t-~-'~c-~'{'~'om of pit or '/artment of Environmental Qualit~ dater and Sewer Questionnaire Date ~'-'..Z.~7..,.5"., Time Subdivision Owner's Name: J, 7~, Mailing Address: ~_~ ~-.,.~ Questions: 1. How many bedrooms are now in your house? -'~ 2. How many bedrooms were in the house at the time of purchase? 3. Were the basement bedroom walls "roughed in" at the time of purchase?_7~_- 4. Was the basement bathroom plumbing "roughed in" at the time of purchase? 5. Did the realtor or builder inform you that you would have to enlarge the existing sewer system if you finished the basement bedroom (s) 6. If on a public water,,s~upply, do you always have an adequate supply of water? 7. Is the pres3ure always adequate? r~-j 8. Who was the builder? ;~;% ]Q~ //_~I /m,,~ 9. Who was the home purchased from? OTHER COMMENTS: Municipality of Anchorage Development Services iDepartment Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING o t~-- 3t./i - Oti/ Expiration Date: /-~ - ~ ~ ,., 0 .~' GENERAL INFORMATION Location (site address or directions) I~' Current Properly owner(s) d ;~ ~ Lending agency Pa c,~c Real Estate Agent N~el ~om~, Unless othe~ise requested, H~ will be held by DSD for pickup. ~ /~ ~ // ~1~ / TYPE OF WATER SUPPLY: Individual Well Individual Water Storage 'Community Class ,A Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site ~] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage D(~velopment 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. Engineer's Printed Name '7'A ~, ,:~o,'-z~' F. z-~c.,o ~ Date 5//2_.2. / DSD SIGNATURE ~ Approved for '~ L~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well FloWAdvisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 01/02) Legal Description: ]-- .NI.., A. WELL DATA Well type. /~ Date completed Total depth ,ft. · · eI .: , : Mun]c]pah ,tY of Anchorage ,., · ' .~;~1I~ I. ~ I "~' ", '1 . , uevelopment . ,ervmes uepar[ment ! Buil'dir{g ~f~ty Divis'ion' : ' on-Site watei- & wastewater,Program ' 4700 s0bth Bragaw St. ' P.O. BOX 196650 !Ah~h6ra'ge, AK 99519-6650 www. i:i.ahchorage.ak.us : ' !i(907)'34,3;7904 ~ HEALTH AUTHORITY APPROVAL CHECKLIST '. ~ ~//< )., b,"cz//,; i~.~ ..~j.,,z, 7~ 2 Parcel ID: IfA, B; or C provide' PWSID # Sanitary seal (Y/N)~ Cased to ft. ' FROM WELL LOG Date of test Static water level ft.' Well production g.p.m! WATER SAMPLE RESULTS: Coliform __colonies/100 mi. Nitrate mg./l. Arsenic: mg./I. Date Of sample: __ B. SEPTIC/HOLDING TANK DATA ~alnk Type/Material ..~'~/~ ha Tank size /Z.~F~ gal. Number of Compartments F, oundation cleanout (Y/N) '7" Depression over tank (Y/N) Date of pumping A/.At. (~n~c,..~) Pumper C, ABSORPTION FIELD DATA Well Log (Y/N) ' Wires properly protected (Y/N) Casing height (above grpund,). ~ ,: AT INSPECTION ft. g'P' Other bacteria c01onies/100 mi. Collected by: . , Date installed ~/.&~. Cleanouts (Y/N) Y; High water alarm (Y/N) in. Date installed ~ / i'7/~ 3 Soil rating (g.p.d:/ft~ or ft~/bdrm) t z~- ~ System type Length ~ ~' ' . ft. Width ~..5'" ft. Gravel below pipe' ~" ft. Absorption rate >= Depression Over field t~'.. F0r~ ~ ~ bedrooms New.depth' ~ -in." If yes, givedate /~. ~, Total depth I~ ft. Eft. absorption area'.&"O"/ ft2 Monitoring tube '7' Date of adequacy test ~/1,3/~' Results (Pass/Fail) Fluid depth in absorption field before test ¢:~ in. Water addedg'f~ gal. Elapsed Time: '~-----) min. Final fluid depth ~.)' in. Any. rejuvenation treatment (past 12 mo.) (Y/N &'type) !D.' LIFT STATION: · . ' i~, Date. .instalied ~' , i 'Pu~p on",level ~'t in. ';Size'in gallons '" "'~n-'o' "ccess ' ~ir :~ , __ ., "Pump off" level a~ !'' ' gh ate alarm le,~ei'at .: ,: .... ! [.. Meets' alarm & circuit requifen~ents? Datum :.~' 'Cycles tested ' ~ ........ " ":--" ~" ' , ' E~., SEPARATION DISTANCES'J,::: -" ' , ," , '11 ' ' , :, , :!, i': sEPARATION DI TANCES FI~bM,WELL ON' LOT, To:'" .!.Septictanldliftsta;tion0n'lot :.ii"i;ii . ' : ::" " ' '' : !'i .': : ;ibh'adjacentlot~' ii'; :, ' ~:i'': ' :.i i' I' 'Absorption field oh lot' ::. ' ':" 'On adjacent lots ,.: ..:: Public sewer mai~ .~..:~ ...': ! ' ' ,,.' ~.·'~: ~''' ',Publicsewermanhole/cleanout~.:, ' ·L', lin ., , : i , ~!~ . :' Sewer/septicserv~ce e : I~, i', ~:, .. Holding tank ;,I, ',~ i ' ;, I, I: !:~ "' :'' " : ; SEPARATION DISTANCES FROM SEPTI HOLDING TANK ON LOT TO: j,, HAA Fee $ ate of Pa,,ment I: Recei 3t Number (ie.v. 12/01) ?Waiver Fee~$i:; i , Date of Payment i, Receipt Numbeq ~z < o Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anohorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-341-04 1. GENERAL INFORMATION Complete legal description HAA# Expiration Date: Lot 41, Block 1, Valli Vue Estates #2 Location (site address or directions) 10215 Main Tree Drive Current Property owner(s) HUD Mailing address '~://?,-F~. ~')~??/%¢ Q Lending agency Day phone 271-4613 Day phone Mailing address Real EstateAgent Paul Moore/Distinctive PropertiesDayphone 727-5494 Mailing Address 1351 Huffman Road/NBA Building, ste. 2C 2D A/A 99515 Unless oth e rwise re qu ested, HAA will be held by OHHS for pickup. HAA piokedup by: ?XZ¢~'/"~.-'¢~ NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site [] Individual Water Storage [] Individual Holding Tank [] Community Class A Well [] Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 less than 30 days old. 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. 72 025 IRev 01[001' 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 investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING Name of Firm 17o~-~, ~-':r~!e Rhcer Loop Road No. 204 Eagle River, Alaska 99577 Address Engineer's Printed Name Robert C. Co~,,an DHHS SIGNATURE b--'"" Approved for L.~ bedrooms. Disapproved. Conditional approval for Phone Date ,., bedrooms, with the following stipuletions. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other ----7 %/-Ol Expiration Date: / - Orieinal Certificate Date: Reissue Date: 75 025 ~Rev 01 00]' Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 MUNICIPALITY Of- ANCHORAGe. "'moCk'MENTAL SERVICES HEALTH AUTHORITY APPROVAL CHECKLIST ' JUL 19 LegalDescription:L07~ ql ~Loc~ I VXtucl V~'¢_ 1~,~7',,¢T.¢....r A. WELL DATA Well type ¢ L~..( Date completed Total depth Date of test Static water level ~ z_ Parcel I.D.: Well production WATEB SAM~S: Coliform / colonies/100 mi D~of sample:. B, SEPTIC/HOLDING TANK DATA __ Pr If A, B, or C provide PWSID # ;;),10 (~ o 5"' Well Log .-~ Sanitary seal W.~r po'~erly protected __ ft Cased to _ ft ~ght (above ground) FROM WELL LOG ~ AT INSPECTION Nitrate mg/I Other bacteria__ Collected by: Tank Ty~e/Material 5'(-'/~ ~-J c / ~ ~-~,~ Clear~outs. ¥~$ ' Foundation cleanout Y~- Date Of pumping ~ / ~/,~ o C. ABsoRpTION FIELD DATA Date installed ~/l? / ~"J Soil rating (g.p.d./ff2 oil~t2/bdrm~ ) Length N ~' ft Width ;~ '/'~ ft Gravel below pipe ~ ft Total depth / 0 ft Effective absorption area''~a ~ fF Monitoring tube'¥4~ Date of adequacy test 7/~ ~'/~o Results(~/Fail) colonies/100 mi Number of Compartments ~ ~ / Depression over tank /v¢ High water alarm __ Pumper ~ $,4,~ r¢ 5' System type in. __ Depression over field ,,v For ~ bedrooms Fluid depth in absorption field before test O in Water added''~ c ~o gal. New depth I in. Elapsed Time: ] ~ min Final fluid depth ~ in Absorption rate >= ~,o~ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type)~va,~.. ~-- ~'~ ~ '~ If yes, give date '-' 72-026 (Rev. 01/00)* LIFT STATION Date installed Size in gallons. ~.~z~a~cess "Pump on" level at in ~q-evel at in High water alarm level at __ in Datu?.~_m ~ Cycles tested Meets alarm & circuit requirements SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~/c,~ m,,,~,.,, ,~,~, ~,.~-,~,.~ ) tank/lift station on lot On adjacent I~zts~----~ Septic Absorption field on lot _.......~~ent lots Public sewer main~ Public sewer manhole/cleanout Se~e line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation fo Property line ~ -/- Absorption field Water main ,")/,4 Water service line / o ~ Surface water Drainage /J //) Wells on adjacent lots bOO ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / 0 r_/~ Building foundation ~ 5-'/-/- Water main Water Service line / o ~ Surface water / O o ~ Driveway, parking/vehicle storage S- Curtain drain /v~,,,,b .~,~o~,,¢ Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name /¢oB~/~'- ¢-', Cou~4~o Date 7/I ~1/ 0 0 HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 01100)' 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 ("~\ d-h _ ~,g\ \ ~ ~'~L~/ HAA # 1. ,GENERAL INFORMATION Complete legal description ,:i. Property owner _ ; M~i. ling address :. -Lending agency Mailing address Agent t) '~' ~,, ,~,~, Address 3 h ~ Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ W 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 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) Front MOA #21 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 . investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Address Engineer's signature S & S ENGINEERING Name of Firm 17[32/1 Fnt, l,~ r~ .... ~ ,.~. ,,~..~ ...... Eagle River~ Alaska 99577 Phone Date ~/1~/~'7 DHHS SIGNATURE 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. Em ployees of DH HS 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~Y25 (Rev, 1/91) Back MOA ~21 :MUNICIPALITY OF ANChOrAGE ENVII~ONMENTAL SERVICES DIV~ION Municipality of Anchorage MAR 14 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division R E C E 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Health Authority Approval Checklist Legal Description: LO7- ~ I SLuC,~ I V/i~u~ Vu ~.. ~"L. Parcel I.D.: A. WELL DATA Well type c. ~-~.¢ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level A If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ Cased to_ __ Casing heig~~;d) __ Wi.~l;~rl~ protected (Y/N) Other bacteria Well production WATER SAM~ Coliform ~ Nitrate .. S .OLD .GTA"K DATA g.p.m. Collected by: ~/z~/?~' ~ Tanksize/?°°&'3'°° (~lumberof Compartments Date installed ~/' ~/g3 Foundat on c ean0~ut.~'~/N) ¥ £ $ Depression (Y/~ ~ 0 Date of P~r~ping~/~" '"~ (~ ~!~-,~' Pumper .~ C. ABSOBPTION FIELD DATA "- :~¢. · Dateil~Sialle~ 't/l'7 /~'3'~' }Soilrating (g.p.d./ft~or]fF/b~-~ I;).-S- System type. High water alarm (Y/~ Length':: 'i ~'. ;~ Width '~ :'~ '/~- Gravel thickness below pipe (~ / Total depth /O Effective absorption area ,¢- o ~/ ~r'~Monitoring Tube present (~/N). ~/~ $ Depression over field (Y,{~ ~,- o gate of adequacy test ~./i~ /~ 7 aesults~/Fail) /o&,~j For Fluid depth in absorption field before test (in.); ~o ~ y Immediately after~'~-;~ gal. water added (in.): Fluid depth ~v/',~ (ins) Minutes later:. /'/!// Absorption rate = (~ 00 --/ g.p.d. Peroxide treatment (past 12 months) (Y/N) /,,o ,~,~. ~,o~.~ If yes, give date bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallon~_ss "Pump on" le~yet~ "Pump off" level at* ~p, ttc/holdlng tank on lot Absorption field on lot Public sewer main Sewer/se?~tic. cservicClf'fi~ Lift station SEPARATION DISTANCES FROM S~-~'~-C~HOLDING TANK ON LOTTO: Foundation (* Property line 6~ '~ Absorption field Water main/service line /0 ~ Surface water/drainage /°° '/' Wells on adjacent lots On adjacent lots .._~-' On a d j a c e n t I.q_~l.l.l.l.l.l¢~ ~ ~anhole/cleanout ~too SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /o -/- Building foundation ;~ ~' -/' Surface water /00 /-¢ Water main/service line /o ¢- Driveway, parking/vehicle storage area Curtain drain ,~ ~,,¢£ ~ ~o ~ ,~, Wells on adjacent lots ~t oe F. ENGINEER'S CERTIFICATION : of Municipal rec~.~a ,~. '.~tems are I certify that I have determined thru field inspections and review ~"'~'~ ' in conformance with MOA HAA guidc~#nes in effect on this date. ,~.. ~.;,,'" ~:~, Signatur ¢.;~ ;i/.~9~ ~'~ Engineers Name ~., ~,~ - · (~ w/~ ~ ~' Date ~/ -14/ . ~ '7 Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (~\/-~-.~Lt~_ Ot~i 1. GENERAL INFORMATION Complete legal description Lot 41; Block Location (site address or directions) 10215 Main Tree Drive Anchorage, AK Property owner Mailing address Lending agency Scott & Eileen C~llaway Day phone 346-2435 (h) 10215 Main Tree Drive Anchora.qe, AK 99516 Day phone Mailing address Agent Address 7825 Washin,qton Ave. suite 900 Minneapolis MN Unless otherwise requested, HAA Will be held for pickup. 2. NUMBER OF BEDROOMS: ~'4 REAL ESTATE SUPPORT SERVICES (Angola Huber) Day phone 1-800-829-7377 55439 3., TYPE OF WATER SUPPLY: ,, Individual well Community well Public water XXX 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: xXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 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 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 inves_ti_gation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s & S ENGINEERING Address ~_Tn'~,~ E~ie p3ver Loop Ro~ Engineer's signatureEaCe River, Ala*ka ~$~ Phone 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: LoT a,-I A. Well Data Welltype CL~IS$ /~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Septic~ tank on lot Absorption field on lot Public sewer main Static water level Well flow~ SEPARATION DISTANCES FROM WELL TO: Wires properly protected (Y/N) FROM WE~O~ g.p.m. Public sewer manhole/cleanout Sewer service line ~nk--~"~_ WATER SAMPLE R~ Coliform . ~ Nitrate Other bacteria ~ple: Collected by: z .g.p. ~ [ I I t ; On adjacent lots ; On adjacent lots Date of pumping B. SEPTICAV~B,I~TANK DATA /~(20 GI~LLO/J -t' .~00 G.~-c ~ Date installed ~/~//~ / ?//~/~ Tank size /~O Compa~ments __ ~ Cleanouts~) Y~ Foundation cleanou, ~) y~ Depression (Y~ ~o High water alarm (Y~ ~o Alarm tested (Y/N) ~/~ ~//~/ ~ Pumper ~+ ~0~~ ~V/C~ SEPARATION DISTANCES FROM SEPTIC/H~=I~I~,N~ TANK TO: Well(s) on lot /C,o~'~ /~/~E~'~On adjacent lots ~.c..~ 7~ ~_Z.~45~'.~ Foundation To property line ~C> ~-~ Absorption field '~' (''~'~ Water main/service line Sudace water/drainage ,,'b"o/'~,~ 72-026 (~/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DIS'I]~,blGE-C~M LIFT STATION TO: WelFor~ On adjacent lots D. ABSORPTION FIELD DATA Date installed ~/i? / Length 4 ~- r Width Total absorption area Date of d.qu.oy Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Manufacturer Manhole/Acoess (Y/N) ~ ~~evel at ~yclos tested Surface water Soil rating (GPD/Ft) /~. ~'/,~ System type - / f Gravel thickness ~-~ Total depth ,'"~ / Oleanout present(~N) '-'/"~'.S Depression over field ('~ ,'~ Results i~fai,) /cAt ~..~ for z~- Bedrooms (~ After test (~ /L./o,~ K/~O~,J~.J .Ifyes, givedate .,,u'/,,~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot~----(J6M~: /¢~:£~/,uT- To building foundation On adjacent lots ;~ Sudace water ~3o~ Cu~ain drain ~O~ On adjacent lots ~0©4f- 7o dL,"~5~.~ Propertyline To existing or abandoned system on lot Cutbank ~o,~ /¢'~-5~7~F-' Water main/service line Driveway, parking/vehicle storage area /O" ¢¢ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date River Loop Road No. 204,¢~ /,¢) /¢ HAA Fee $ / "~ (~. ¢~" Date of Payment c~'~ (-]' ~ (¢ ~ Receipt Number ~'~-"~? L( ~ a % Waiver Fee $. Date of Payment Receipt Number