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Home My WebLink AboutWYNTER PARK #1 BLK 2 LT 21Wynter Park #1 Block 2 Lot 21 #051-492-22 Municipality of Anchorage " '•• I Development Services Department '•.. Building Safety Division . On-Site Water and Wastewater Program, 4700 S. Bragaw Sl. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.o.anchorage.ak.us (907) 3437904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWO10333 PID Number. 051492.22 Herne' Wastewater System: ❑ New ® Upgrade Aadree.: Peters Creek. AK 99567 ABSORPTION FIELD Phan: Nvnlber d Bedraonn: .11564 3 O Deep Trench ® Shallow Trench 13 Bed 0 Monne O Other. LEGAL DESCRIPTION Sod RaWV Ta" Depth kom agv,ol ands: 1.2 Gpcffe 8.02 FI. Block: Loc Subavblon: Dapm b pim bolts n ken dryM" pride: Gravel dean OeneaN pips: 2 21 W nter Park #1 3.52 Ft. 2.50 Ft. ToomshV: RarVo: tiecaorl: Fal addeG abovea oat limos: Gravel LanpM: 1.9 Ft. 53 Fl. Well: [I New [3 Upgrade G°V°" dev Nembe daMa: Dlaunce betoeen Yves: 5 Ft. 1 na FL Ckwkcamn (Fnvele, A B. C): Trial Depet: Coed m: Total aWapbOrt arse: Pipe MelaW: Public Ft. I FI. 414 F r D3034 & F810 Dollar: D"e Onaed: Stabe Waw Lw": I ntaaer Dole Installed: FL Calkins Const. 812812001 Ynlo: Pump Set OL c+wy Heynl Above Galald: TANK GPM FI. FL SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding PubliclPrlvatc col�b: From Tank Field Station Tank Sewer Line Anchorage Tank 1000G". w.F 200'+ 200'+ NA NA 2s'+ M'1en'L Steel Naob« d cemp.ronenw: 2 Bad000Wow 100'+ 100'+ NA NA LIFT STATION Lot LYS 51+ 101+ NA NA Sao. Gal Faxtdabon 51+ 10'+ NA NA �Pumy ori level al: 'Pump W bvel at; Hyo water awm at;ti V ti In. Catabt tx"n NA '50'+ 1 NA NA Peep Meta & Model Esta"" Impactions pedennad br. Remolka: *none known BENCH MARK Existing septic field and tank abandoned per code top tof foundation Tank Insulated vawn: 100 FL Engineers Stamp +�E OF'ilk a4I Inspections performed by: KND Engineering Dates: 1at 8/2812001 ••: • 9 est F� H •; 0� 2nd 813012001 . •.: •• •. i Development Services Department Approval 8"4yj' osKeenn ;•" "' ' ':'r i neth M. Reviewed and approved by: Date:% �S ,� s '• CE 11 (Rov. IZIM) FOy ZT�� r<C—ai K AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SWO10333 WYNTER PARK ESTATES, #1, BLOCK 2, LOT 21 PID#051-492-22 KEYBOX 21 EXISTING DRIVE N EXISTING BUILDING 25 SCALES i'--- 50' ,Of * 49 53, PREPARED FOR, ISCALE) NTS 87.3 a CALBORN 6 PATSY AUSTIN 21117 SPARKLE DRIVE PETERS CREEK, AK 688-1564 FlEU) BOOKS co Txo: Bourowm.FLEMING DUNN: vBG STN FLEMING "O'M- KMD As"KT F EMING DAM 11/26 D■¢ FLE aao: NW136 Am F"-' 01078.DWG °B "" 01078 A"dV LW ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11 9.03 9.4 1 A -C=23.3' 'n!n 2 B-C=17.2'A A -D=29.1' y 7 FINAL GRADE 01.2 B -D=15.8' A -E=50.8' """ vi B -E=30.8' ,4 1000 GALj A -F=92.1' >n SEPTIC 95.8 E-F=43.0''§EWER TANK •� . `.sn+..�.r' ::.�t� ROCK 96.2 95.9 ,Of * 49 53, PREPARED FOR, ISCALE) NTS 87.3 a CALBORN 6 PATSY AUSTIN 21117 SPARKLE DRIVE PETERS CREEK, AK 688-1564 FlEU) BOOKS co Txo: Bourowm.FLEMING DUNN: vBG STN FLEMING "O'M- KMD As"KT F EMING DAM 11/26 D■¢ FLE aao: NW136 Am F"-' 01078.DWG °B "" 01078 A"dV LW ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11 Municipality of Anchorage t �a George P. 11'uerch, Mayor J ` Bttildiner Sttfety Division P.O. Box 196650(y,.4700 S. Bragaw Strect Anetlorage, Alaska 99519-GG56 • (907) 343.8301 Iittp://h i%ir.ct.anctLoragc.ak.us July 3, 2002 Calborn & Patsy Austin 21117 Sparkle Dr. Chugiak AK 99567 Subject: On -Site Water and/or Wastewater Permit. Permit Number: S W010333 c'Legal Description: Wynter Park # I Block 2 Lot 21 Dear Calbom & Patsy Austin: An On -Site Water/Wastewater Permit, number SW010333, issued by this office for a single-family system, will expire on August 23, 2002. This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may be issued for a fee of $100.00 if the renewal application is received on or before the expiration date of the original permit. When applying for anew permit, the fees are: $400.00 for a wastewater permit and $150.00 for a well permit. If you have any questions, please call this office at 343-7904. Jin,( Cross, P.E. Water and Wastewater Program Enc: Copy of permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SWO10333 Legal Description: WYNTER PARK #1 BLK 2 LT 21 q/ 3:30 Date Issued: Aug 23, 2001 Expiration Date: Aug 23, 2002 Parcel ID: 051-492-22 Design Engineer: 0070 KND Engineering Site Address: 021117 SPARKLE DR Owner Name: Calbom & Patsy Austin Lot Size: 27598 SO. FT. Owner Address: 21117 Sparkle Drive Total Bedrooms: 3 Permit Bedrooms: 3 Chugiak , AK 99567 - This permit is for the construction of: F,/ Disposal Field F,/ Septic Tank 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: 3/0 ,-N /7 w <�, �`Ar-23-01 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.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051.492.22 Permit Number SW 01033-; Property owner(s) Calborn & Patsy Austin Day phone 688.1564 Mailing address (1)12 117 Sparkle Drive, Peters Creek Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Wynter Park SID #1. Block 2. Lot 21 Legal description (Section, Township & Range) Lot Size 0,5 acres/21agj rft. Acres F Number of Bedrooms 3 ;V -571i' THIS APPLICATION IS FOR: Sewer Only ® Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. /A_01�e_ e (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 72100) Waiver Fees: 5p 3 Z/C/)( Date of Payment: o GL / Receipt Number: MD ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 August 9, 2001 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Sewer Upgrade — Wynter Park, #1, Block 2, Lot 21 Gentlemen: The owner has requested we proceed forward to obtain a septic permit to upgrade and replace the existing septic system and tank for the subject lot. The existing septic tank ,r will be abandoned in place and in accordance with municipal standards. On August Y,/ 2001 we dug one testhole for the proposed system. The results of this test are attached. The general slope of this lot is from north to south at a grade of approximately 2 — 5%. We have designed our system utilizing the testhole we excavated for the 3 -bedroom house. The test hole that was performed for the subject lot, as indicated by the attached soils log, has sufficient sand in the soils to negate the need for an I.S.R. The lot is served by a public water system. We propose to install a 5' wide shallow trench. Water was not encountered during the excavation or monitoring. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, MD Engineering M. Duffus, P attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WELL & WASTEWATER DISP❑SAL WYNTER PARK ESTATES, #1, 50 51 NO PUBLIC WELLS WITHIN 20V Or PROPOSED STSTCN NO PRIVATE WELLS WITHIN 2W Or PROPOSED SYSTEM EXCEPT As NOTED ND SEPTIC SYSTCHS WITHIN 2W Or PROPOSED WELL EXCEPT AS NOTED. OFJ9Lq "A, � �* TH 49*. *+ 11� ••-•.•,yCE-9118- y � p"f*n AW ESS1010 21 20 SYSTEM DETAILS/SITE PLA BLOCK 2, LOT 21 s,r . 22 /Js 4 25 23 24 . rN 7 DESIGN DETAILS 3 BDRM X 150 GPD = 450 GPD 450 GPD/1.2 GPD PER SO. FT. (< 1 MIN/IN.)= 375 SO. FT (375/5'(W)) X .64(RF) (2.5' GRAVEL) = 48.0 FT. TRENCH USE 1 TRENCH - 48 (L) X 5' (W) X 2.5'(D) Total depth of system Is 6.0' from original grade. Total depth of gravel below distribution pipe Is 2.5' . NOTES: 1. USE 1000 GAL SEPTIC TANK AND INSULATE TANK IF <4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED. 5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS a SEPTICS. PREPARED FOR: CALBORN 6 PATSY AUSTIN 21117 SPARKLE DRIVE PETERS CREEK, AK 688-1564 FIELD BOOKS .DUND.Rr. STAIWL AsiAIlT: DNC rXX "'O r`E"01078 COMPUTED Won: VBG «a`M- KMD OATO 8/9/C °Na NW136 JOB N: 01078 Scale: 1'= 100' PAGE 1 OF 2 ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 ISTING WASTEWATER DISPOSAL SYSTEM DETAILS WYNTER PARK ESTATES, #1, BLOCK 2, LOT 21 PROPOSED BDRM HOUSE POSED 1000 SEPT TANK Fc A<C�� OF AZq � 1 e* ,49TH CE -7116 A,4 / �2SStDN� � :, POSED PRIMARY F XISTING SHEI M.—a C ❑ TH#2001-1 PREPARED FOR: CALBORN 6 PATSY AUSTIN 21117 SPARKLE DRIVE PETERS CREEK, AK 688-1564 MELD BOOKS COMPUTED. 7w—w, DIRA M: VBG sy� CHEO"- KLID •f&.a4 DATE: w- nC: cm NW13E Am " 01078.DWG " "" 01078 u Scnle: 1'= 20' PAGE 2 OF 2 LlildMW ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 811 ASVD ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8' SOILS PERCOLATION TEST Performed for. Patsy Austin Date Performed: 08/01/01 Project: Wynter Park #1, B2, L21 TEST HOLE # 2001-01 Depth 13- 14- 15- 16 17- 18- 19- 20- ORG— red/brown overburden w/ organics GP/SP—brown, sandy gravel dry, w/ cobbles to 2' SW- fine sand w/ pockets of GP firm density, dry, slight trace of silt towards BOH B.O.H. HOLE PRESOAKED PRIOR TO TEST SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Groundwater encountered? NO What depth? NA Depth to water after monitoring? NONE Date? 08/08/01 Reading Date Gross Time Net Time Depth to Water Net Drop 1 8/1/01 11:00 - 8" - 2 11:05 5 min dry 8" 3 11:06 - 8" - 4 11:11 5 min dry 8" 5 11:12 - 8" - 6 11:17 5 min dry 8" 7 • 11:18 - 8" - 8 11:23 5 min dry 8" 9 • 11:24 - 8" - 10 11:29 5 min dry 8" 11 • 11:30 - 8" - 12 11:35 5 min dry 8" • Water Added Percolation Rate <1(min/in) Pere Hole Diameter 6" Test Run Between 4 feet and 5_ feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. t. .• rfl�fl�ih�f�l�t7T��riLIfF�F�JD �i"�IP.0firl�tllfl�r!d��}-! 825 'L' STREET, ANCHORAGE, AK. 99501 279-2511 WELL FJEFc!F•1.1 -F- PERMIT PERMIT NO. C 77693 ) APPLICHNT RICHARD AUSTIN PO BOX 8793 ANCHORAGE 99508 688-2182 LOCATION SPHRKLE LEGAL L21 B2 WYNTER PARK SUBD LOT SIZE 21780 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR R PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. FJEFRM I T EXFJ I RES E>Er`EMEER .s2r 7_S471 7 I CERTIFY THAT 1: I AM 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 THE CODES. SIGNED APPLICANT RICHARD AUSTIN ISSUED BY ' 8-/6^ %% _URTE_______________ V3. 0 • Municipality of Anchorage O On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-492-22 1. GENERAL INFORMATION Expiration Date: f Complete legal description Wynter Park #1, Block 2, Lot 21 Location (site address) 21117 Sparkle Drive Chugiak, AK 99567 Current Property owners) Arleen Myers Day phone 688-1236 Mailing address P.O. Box 670351 Chugiak, AK 99567 Real Estate Agent 2. TYPE OF DWELLING: E] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System Waiver/Variance request for: El 0 Three Day phone TYPE OF WASTEWATER DISPOSAL: Individual x❑ Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: t/.0 OXMA �� Date: COSA to be released to the engineer, unless otherwise eque ed by the engineer. COSA Fee $ "6 Waiver Fee $ Date of Payment g�) �S Date of Payment Receipt Number!�//�7 Receipt Number COSA 9 0S ! C SI Y lI % Waiver # 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 Certificate of On -Site Systems 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 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE _Jtcff� System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved 04��®11®wm® 0® Conditional approval for bedrooms, with the following stipulations: V.nicipality ,4>�4" t40riginal Certificate Date: of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approk (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COU We sheet r I., c If more than 1 septic system is on the lot; COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems;_>Approval Checklist Legal Description: Wynter Park 01, Block 2, Lot 21 ^-� Parcel ID:051-492-22 A. WELL DATA Well type PWS - A If A, B, or C provide PTJSID a 21_1431 Well Log (Y/N) Date completed Sanitary seat (Y/N)Wires properly protected (Y/N) Total depth ft. Cased to __ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: ft. ft. g.p.m. 9 -13 -m - Coliform colonies/100 mL Nitrate __ mg/L Arsenic ug/L Date of sample: — Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel -_ Date instaeed 8/28/01 Tank size 1,000 gal. Number of C,r^parlrnents Cleanouts (Y/N)._ Y Foundation cleanout (Y/N) Y Depressiun over tw :k ,'Y'='J) _...'_. High water alarm (YIN) 9-23-15 San'lia:y r uan e Date of pumping Pum,^..:r—_.__-- �------__prs C. ABSORPTION FIELD DATA Date installed 8/28/01 Soil rating ig.p.d./ft` or ft2/t arrn)=GPD/SF System type 5' Wide Length 53 ft. Width 5 ft. Gravel below pipe 2.5 ft. Total depth 8 ft. Eff. absorption area 414 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/11 /15 Results (PassrFail) Pass For 3 bedrooms Fluid depth in absorption field before test 2 2 _ in. Water added 450 gal. New depth 24.5 in. Elapsed Time: 1,440 min. Final fluid dept!1. 22 in. Absorption rate >= 450 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & : ype) __,__ N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ —in. "Pump off' level at Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO: >5' Building foundation Property line >5 Water main >10 Water service line >10' Wells on adjacent lots >200' ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation >10' Water Service line >10 Surface water >100 Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Curtain drain None Noted Wells on adjacent lots >200' F. COMMENTS G. ENGINEER'S CERTIFICATION i certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effecl:en this date... Engineer's Printed Name Michael E. Anderson, P.E. Date 8/31/2015 COSA brown sheet 10-10-12.doc Absorption field >5, Surface water >100' Water main N/A Driveway, parking/vehidestorage >10, :OF. in. IAEL E. ANDERSON - CE -4381 : =a .re - g�ls.•�� 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.ci.anchorage.ak.us (907) 343-7904 1,3x" - 1✓F.flx2J CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051492-22 HAA # r�SnJ a t� Expiration Date: — a 9 — O (o 1. GENERAL INFORMATION Complete legal description Wynter Park 01, Block 2. Lot 21 Location (site address or directions) 21117 Sparkle Drive, Chugiak, AK 99567 Current Property owner(s) Patter Austin Day phone 688-1564 Mailing address Lending agency Mailing address Day phone Real Estate Agent Nancy Stahly — Country Realty Day phone 688-8500 Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: 4 ' Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ® 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 engineers 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 rites 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 KND ENGINEERING, Inc. Phone (907)6 6-61111 Address _20441 Ptarmigan Blvd., Eagle River, AK 99577 Engineer's Printed Name Kenneth M. Duffus Date 4/19/05 Engineer's Comments: This investigation was completed In compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. S. DSD SIGNATURE _JZ Approved for _: bedrooms. Disapproved. Conditional approval for bedrooms, with the following Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineers Report Other WATER AND WASTEWATER PROGRAM By: [/�� / �. 0 Original Certificate Date: Municipality of Anchorage •, Development Services Department Building Safety, Division On -Site Water & Wastewater Program • •� 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Wvttter Park $1. Block 2. Lot 21 Parcel ID: 051.492.22 A. WELL DATA Well type Publle If A. B, or C provide PWSID 0 _ Well Log (Y/N) Date completed _ Sanitary seal (Y/N)_ Wires properly protected (YM) Total depth _ft. Cased to _ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production 9 -p.m g,p,m, WATER SAMPLE RESULTS: Coliform _colonie3H00 ml. Nitrate _mgA. Other bacteria _ colonies/100 ml. Arsenic: _ mgA. Date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material seotIdsteel fAnch. I" Date installed 8128101 Tank size 1000 gal. Number of Compartments 2. Cleanouts (YM) Y Foundation cleanout (YM) Y_Depression over tank (YM) H -High water alarm (YRO y Date of pumping NA - New BMW Pumper C. ABSORPTION FIELD DATA Date Installed 0=01 Soil rating (g.p.d./te or fe/bdnn) yz System type shallow trench Length 53 ft. Width ,5 ft. Gravel below pipe 2.5 ft. Total depth § ft. Eff. absorption area 4j4-fe Monitoring tube Y Depression over field N Date of adequacy test NA - New System* Results (Pass/Fall) For _ bedrooms Fluid depth in absorption field before test _in. Water added _ gal. New depth _in. Elapsed Time: _min. Final fluid depth _in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date D. LIFT STATION Date installed NA Size in gallons Manhole/Access (YIN) 'Pump on' levet at —in. 'Pump off level at _ in.High water alarm level at in. Datum Cycles tested Meets alarm 6 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line _JL+ 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 10'+ Curtain drain 50'+ Wells on adjacent bis '+ F. COMMENTS G. ENGINEER'S CERTIFICATION I car* 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 Kenneth M. DuBus Date 04119105 HAA Fee $430.00 Date of Payment �" 7 0 .S Receipt Number 66 % (Rev. 12001) Waiver Fee $ Date of Payment Receipt Number. Kwmwh M. SPARKLE DRIVE w o 0