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Home My WebLink AboutMCKINLEY VIEW ESTATES BLK 2 LT 5McKinley View Lot § Block 2 #051-792-09 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221478 PID Number: 051-792-09 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ®Upgrade Name ERIC & DAVICA HINTON ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound ❑ Other Site Address 22471 CENTURION DRIVE, CHUGIAK _r�_M� Phone Phone Number of Bedrooms 3 Soil Rating GPD/SF Total depth from original grade Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot MCKINLEY VIEW ESTATES 2 5 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area Ft2 Number of trenches Dist. between trenches Ft. Well 200'+ -- 25'+. TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ -- GREER 1000 Gal. Material Number of compartments Lot Line 10'+ __ NA HDPE 2 Foundation 10'+ __ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer ,J RS PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 15` 5/17/23 2„d 5/18/2023 Location and description 3`d 4'h TOP OF MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date �i�``�\\ 'W. t •• •• •••• •••••••• �•,• Curtis Huffman CE Fc�x�F • /ts$ oa3•4c��/ l`i �pROFESSIO��' .� Septic System Appr ved - Date Note: Zisapproval does not include well permit requirements. k. — ..1 PID:051-792-09 PERMIT:OSP221478 FIRST WATER CONSULTING MCKINLEY VIEW ESTATES BLK 2 LT 5 Lot 14 20' DRAINAGE, T&E EASEMENT Lot 4 15' T&E / EASEMENT cEN,�VR�pN i Lot 12A / / / / SOUTH 7.00' NOTE: THIS LOT IS SERVED BY A / COMMUNITY WATER SYSTEM. PLOT PLAN AS BUILT _X_ SCALE _ 1 " 40' GRID _ NW 1459 Project No. _22-69 /A? __ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 La n g & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax QQQ Professional Land Surveyors kenmlongsurvey.com P OF A C �0 jonathan0langsurvey.com ov'� .• ..S Q I hereby certify that I have surveyed the following described property: LOT 5, BLOCK 2, McKINLEY VIEW ESTATES SUBDIVISION (PLAT No. 62-225) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the ____ Day of "a�C CVYU-A Cam` at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH yl KENNETH N o 2. yJa QnZo"ZSSIONN- AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221478 Work Type: SepticTank Upgrade Tax Code Number: 05179209000 Site Legal Address: MCKINLEY VIEW ESTATES BLK 2 LT 5 G:1459 Site Mailing Address: 22471 CENTURION DR, Chugiak Owner: HINTON ERIC C & DAVICA M Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: ,�xent Is, t�('I)211'C117F7nC 12/6/2022 12/6/2023 20091 ❑ 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 3 Received By: S �'�—� w C Date: Issued By: Date: 2 Z O Z 2 UH C PAL0TY OF HC H0 G j -- Development Services Department _ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-792-09 Property owner(s) ERIC & DAVICA HINTON Day phone Mailinn address PO BOX 670466, CHUGIAK, AK 99567 Site address 22471 CENTURION DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) MCKINLEY VIEW ESTATES BLOCK 2, LOT 5 Legal description (Township, Range & Section) Lot Size 20,091 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field F-1 InitialEl Single Family (SF) Q (w/wo ADU) Septic Tank El Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: '� P_5 Waiver Fees: Date of Payment: /C /A3/2;2 Date of Payment: Receipt Number: 3 02 *?-qq Receipt Number: Permit No. 06,019 911472 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! November 23, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: MCKINLEY VIEW ESTATES BLOCK 2, LOT 5 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221478, Curtis Townsend, 12/06/22 FIRST WATER CONSULTING MCKINLEY VIEW ESTATES BLK 2 LT 5 DESIGN DETAILS: MAY CONSIDER INCREASING SEPTIC TANK SIZE TO 1500-GAL FOR FUTURE CONSIDERATION. NO WELLS WITHIN 200' OF PROPOSED SEPTIC TANK - VERIFY AT CONSTRUCTION. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221478, Curtis Townsend, 12/06/22 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: :~/~ R70077 PID Number: O~/- ~ -~ N~: ~&E~ ~~y Wastewater System: ~New ~ Upgrade Address: I~ ~=oo~ ~~o~,,~ ~57~ ABSORPTION FIELD No. of Bedrooms: ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other Total Depth from original grade: LEGAL DESCRIPTION sog Rating: O,~S GPD/Sq. Ft. Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Lot: ~ Block: ~ ~ ~ ¢~ ~,- ~ .~' Ft. ~' S ' Ft. Township: [ Range: Section: Fill added above original grade:/ Gravel length: .... ~ ' ~ Ft. Ft. Gravel width: Number of lines: Distance between lines: WELL: ~ New ~ Upg ~ .~ ~R. I Classification (Private, A,B,C): ~ Cased To: Total absorption area: Pipe material: Driller: ~ Date Drilled: Static Water Level:Ft. Installer:~ ~ Date instaged~ y'~- Pump Set at: Casing Height Above Ground: TAN K GPM Ft. Ft. SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. TO Septic Absorption Lift Holding 'ublic/Private M~t~rer: T~ Cap~cityingailo.s: From Tank Field Station Tank Sewer Li .... [ O Well- ~O1~ ~0'~ ~ ~ ~l& Material: ~L Number°fC°~artments: Surface Water ~0~'~ 100'~ ~ ~ LIFT STATION Manufacturer: Lot I~ LJ~e IO1~ ]O ~ ~ Size in gallons: Fou.dation ~l, ~0'~ ~ 1 ~ "Pump °n' level at: ~f'' level at: IH'gh w~t~r"''~"t: CurtainDrain ~ ~ ~ ~ ~o ~J ~ ~ ~ Pu~ Electrical Inspections performed by: BENCH MARK Remarks: , Location and Description: I,~,~.d ~tio.: /00 ~, Inspections performed by: ~ ~,~¢~eiae Dates: 1st ~-~o-q 1 ,~v¢/~ .... a ~ . CE- 8801 DePartment of Heal~ and ~uman Services ~pproval '*',,"~%'.~:~ ..,,, ,,,, Reviewed and approved by: ~; ¢~ Date: ¢-//--¢~ '~'"" "-::;';;;,.,,:~ 72-013 (Rev. 9/91 ) MOA 25 PERMIT NO. SW970079 PAGE 2 OF 2 PlunlclpaLily oF Anchopcge DEPARTli~ENT OF HEALTH AND HUHAN SERVICES ENVtRONPIENTAL SERVICES D~VIStON P,O, Box I96650~ Anchorage, A~aska 99519-6650 ~Te~ephone~ 343-4744 ON~$~TE WASTEWATER ~SPOSAL SYSTE~ AN~/OR WELL ~SPECT]ON ~EPO~T LOT 5, BLOCK 2, MCKINLEY VIEW ESTATES P.Lm NO. 051--792--09 ISTll co2j MT2I A B C 22.5' 8.5' - 24,0' 11.5' - 26.5' 16.0' - 27.5' 18.0' - 28.5' 19.0' - 38.5' 28.5' - 39.5' 22.5' - - 57.0' 48.0' - 54.0' 48.0' 20' UTILITY & DRAINAGE EASMENT ATH# 1 ~,TH#3 Mr1 SITE NEW 1000 GAL. SEPTIC TANK TRENCH ST1 99.3' ST2 N.T.S. FINAL MT C0 CO1 = 96.5' CO2 = 100.1' INSULATIO CO1 = 93.6' CO2 = 93,6' MT1 = 87.0'/ ~, MT2 = 87.0' NO WATER FOUND 80.5' B.0.H. SCALE 1" = 40' l't a c PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970079 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:CHARLES WILFORD W & OWNER ADDRESS:16906 RIDDELL ROAD EAGLE RIVER, ALASKA 99577 DATE ISSUED: 4/30/97 EXPIRATION DATE: 4/30/98 PARCEL ID:05179209 LEGAL DESCRIPTION: MCKINLEY VIEW ESTATES BLK 2 LT 5 LOT SIZE: 20091 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AMD HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. ? SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: D TE: ROBERT C. COWAN, RE. ROBERT A. SHAFER, P.E. April 21, 1997 HEALTH AUTHORITY APPROVALS SE~NER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FI_OW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 5, Block 2, Mckinley View Estates S/D CIVIL ENGINEERS (907) 694.-2979 FAX (907) 694-1211 Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on the referenced property. Test holes were excavated and percolation tests performed. The approximate locations of the test holes are located on the attached site plan. At the time of excavation no water was encountered. The monitoring tubes within the test holes have been checked and found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert Co Cowan, P.E. RCC/mg Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 1"-60' SCALE SITE-PLAN DESIGN >8 ZO ~ ou~ L~ 0 PERFORMED FOR: LEGAL DESCRIPTION: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST COMMENTS DATE PERFORMED: , Lo-r -~ it I~oc,~ '2~ t Township, Range, Section: ~1 ~, ~J~'~.~ SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN S L IF YES, AT WHAT -- ~ O DEPTH? p E Depth to Waler After Monitoring? ~ ' Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE t~0 (m~nutes/inch) PERC HOLE DIAMETER ~, ~! TEST RUN BETWEEN '~I~,~'~ FTAND . ~-~"~' FT PERFORMED BY: ~..~_~_~ ~!e ~Ye~ L~ R~a-J ~o. ~ I - CERTIFY THAT THIS TEST WAS PERFORMED 72-008 (Rev, 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4 7 8 11 19 20 COMMENTS ~,~.~¢y. ~ ~, Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? L IF YES, AT WHAT --~ O DEPTH? p E Depth to Waler After q t/~ '//'l~ Monitoriflg? D~-/ Dale: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~O (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND '~7 FT PERFORMED BYi 7034 Eagle River Loop Road No. 204 ACCORDANCE ~t~i~.~T~[~-,I~IPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4 7 8 0- 12 13 '14 17 18 19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORM D ~ ~ ~ Fownship, Range, Section: WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT i,~,~ DEPTH? ¢~. pO E SLOPE SITE PLAN I I Depth tO Water/~, ! ,~, ~?] ~,~ Monitoring? Vf"~'~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ tminutes/inchj PERC HOLE DIAMETER TEST RUN BETWEEN ~'~ FT AND L., FT COMMENTS PERFORMED BY: ................ / I ~'~,a,,,~ ~ ~ver ~.g~p I[gag I~. ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WIT~[~~ GUIDELINES IN EFFECT ON THiS DATE. DATE: 2~ ~ '~1 / ~ '7 72-008 (Rev. 4/85) 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 '7~'~--- O~ NAA# 1. GENERAL INFORMATION Complete legal description .~,~.~.~'~_~e.~. /~'~/~A~,x~y ~.~ ~x~o~ Location (site address or directions) Property owner ~¢-'~'-¢-.~' ~ ¢/"~-' -~'-~'=-"'~*~ Day phone Mailing address -~-'~ Y;~/z"~'~;'~'~"¢-~ -~¢'~- ~¢-"~--'*'¢-~¢ /'~-"¢¢'--/~'¢ Lending agency Day phone Mailin. g address. Agent Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and es of the validation date shown bdow, 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 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 ¢¢~ ~. Engineer's signature DHHS SIGNATURE P/ Approved for ~ Disapproved. Conditional approval for bedrooms. ~..~. ¢.,,, ·, .'~.~ ~ ~ ¢',,.~,,.' ~ ..'~ ~ ¢~k~S :f, KEHLEY bedrooms, with th-e following stipulations: Additional Comments By: 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 DHFIS 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 R E C E I V DEPARTMENT OF HEALTH & HUMAN SERVICES SFP ~ 5 ZOO{] Environmental Services Division 825 L Street, Room 502° Anchorage, Alaska 99501 · (901~[~N:~A-L~,4~ ANCHORA(3E ENVIRONMENTAL SEEVICES DIVISION Health Authority Approval Checklist Legal Description: -~'~'.~/~x~'~.,.~¥, .~J~r~ ~-~';~7', Parcel I.D.: A. WELL DATA Well type If A, B, or C, attach ADEC letter, ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Date completed Cased to FROM WELL LOG Static water level , Well production WATER SAMPLE~ Colifo'rm ~ Nitrate ~ple: Casing height (above ground) Wires properly ~ g.p,m, g.p.m. Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Date installed Length ~o ~,,/ .Width Tank size Depression (Y/N) '~ High water alarm (Y/N) Pumper '-~'~' ~ Number of Compartments .2~ Cleanouts (Y/N) ~ Soil rating ~or ft=/bdrm) Z/, ~-~' System type ,~. 5"~'~ Gravel thickness below pipe ~, 5-W'~ Total depth '" '~ ''~'~ Depression over field (Y/N) For ~3~ bedrooms Effectiv® absorption area /~) ~ '~ Monitoring Tube present (Y/N) Date of adequacy test ~ ~ ~ Results (Pass/Fail) Fluid depth in absorption field before test (in.); Fluid depth ;'~'~//'~ ~ (ins) Minutes later:. Immediately after'f?~'~gal, water added (in.): Absorption rate = '~ ~'-~ q.p.d. If yes, give date '~ Peroxide treatment (past 12 months) (y/N) 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on~l?ve~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main S~ line On adjacent lots Public sower manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation / ~ ~ Property line ,,~,~ '~.~'~ Absorption field Water main/service line ~'~-'~-~'~'/Sudace water/drainage /~ '/'~',~ Wetls on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ o-~ Building foundation ~ p~-~J Water main/service line --~.5~'"~,/~,~ Sudace water /~ ~ ~,'~'-.-~ Driveway, parking/vehicle storage area ___~-~ Curtain drain ,c/,~-~,~ ;,'~ ~'~'.~-,,-'- Wells on adjacent lots '~'/~ '~'~ ~"~ HAA Fee $ Date of Payment ENGINEER'S CERTIFICATION ~.-~.'~.%'~.,. I certify that I have determined thru field inspections and review of Municipal record._s.~.,h~o,,,o,~.'~ms are in conformance w/t~ MOA H~ guidelines ~n effect on th~s date. Si. nature Engineer's Name ~-~ 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 9;~ - e¢1 HAA# 1. GENERAL INFORMATION Corn plete legal description Lot 5; Block 2; McKinley View Estates Location (site address or: directions) '"~ ' Chuqiak~ AK Mailing address ,.16906 Riddell Eagle River, AX Centurion Drive Day 99577 696-161o Eending agency '-.7' '~M~iling ad'dreSs ~'..,~ Day phone A~.ent Addre..~, Day phone Unless '}therwise requested, HAA will be held for pickup. NUI~BER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: No?E:' Individual Well community well Public water xxx If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. , ' 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-s[';:e xxx Community on-site Public sewer If community waSte Water system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev; 1/91) Fror~ 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 all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Nameof Firm ........ i~D1,,,,,.i,~,~RoadNo. 204 Phone (~q ~_ ~_c( 7~ Eagle River, Alaska 99577 Address _.?~j / ~ / Engineer's signature v _./-4~ - Date (~ / fi' ct' ? DHHS SIGNATURE j_~Y~__ 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 engineer's work. 72-025 (Rev. 1/9'l) Back MOA~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES MuNiCIPALITY O~ ANCHOP, AGE ENVIRONMENTAL SEP, VI( ION JUN Environmental Services Division 825 L Street, Room 502- Anchorage, Alaska 99501. (907) ~43-47 ~1~ [ C ~ Legal Description: A. WELL DATA Well type ~L^~ °'/~,~ Log present (Y?N) Health Authority Approval Checklist If A, B, or C, attach ADEC letter. ADEC water system number 7_ t o/o ~T "( Date completed Total depth FROM WELL LOG Date of test Static water level Well production ~ g,p.m. Casing height (above ground) Wires properly Protected (Y/N) AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate ~ Other bacteria Date of sample: - Collected by: B. SEPTIC/HOLDING TANK DATA Date installed -~ *-7..o -°¢1 , Tank size Foundation cleanout ((~TN) Date of Pumping l (2oo Depression (Y~) Ha Pumper ~ Number of Compartments ~- cleanouts ((~) ¥/E5 High water alarm (Y~ ~o C. ABSORPTION FIELD DATA Date installed ~' 20-(:1.1 Length ~0 ~ , Width 'Z · 5 Effective'absOrptiOn area Date of adequacy test ~ ~,,U Soil rating Oor f¢/bdrm) d). '~.-(' System type ~r-~.E~c~ Gravel thickness below pipe ~" Total depth ~ ~- ~1~ ~ Monitoring Tube present (~N) "fE~; Depression over field (Y~ I~ Results (Pass/Fail) ~ For --~ bedrooms Fluid depth in absorption field before test (in.); ""---- (ins) Minutes later: Immediately after ~ gal. water added (in.): Fluid depth Absorption rate = "---' g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* 13. LIFT STATION E. Date installed Manhole/Access (Y/N) "Pump on" level at* High water alarm level at* ..._-~------~ *Datum , Size in gallons _-~--"'P-u~p off" level at* SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Publio sewer main Sewer/septic ser_gDhce-tffl~"~' ~-°o~ + On adjacent lots 'Z-oo~ ~ ~t lots ~c sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~ ~ + _ Property line ~ 5 ~4- Water' main/service line iO~'t- Surface water/drainage Ioo 14 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ! ~ I ~L Building foundation I o I + Surface water ) oo~ + Curtain drain I'J/¢& Absorption field ~ Wells on adjacent lots Water main/service line lo Driveway, parking/vehicle storage area Wells on adjacent lots ~,,~e ENGINEER'S CERTIFICATION in conformance with MpA ¢-IAA gu~!delines~in effect on this date HAA Fee $. Date of Payment 7'2-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number