HomeMy WebLinkAboutMCKINLEY VIEW ESTATES BLK 3 LT 4McKinley View Estates Lot 4 Block 3 #051-792-34 Municipality ff' of Anchorage., _ E[c- Department of Health and Human Services � . Division of Environmental Services°h%> On -Site Services Section 825 "L" Street Room 502-JI1IL:. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.clanchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5 (Al 000302. PID Number: 051— Name: 792 -_31/ Chuck' Se-I,je61e Wastewater System: New X Upgrade Address: 2Z70 Sr.,, ec t Ci v-Jeti&A k ABSORPTION FIELD Phone: Nu of Bedrooms: j0 Deep Trench 0 Shallow Trench ABed 0 Mound 0 Other. LEGAL DESCRIPTION SOA Rating: Os GPD/FF To al Depth from original grade: / Block: 3 is 1 Subdivision: I 41 Me. C—inley w viegS i. Depth to pipe bottom from alpine! rade: / / ODA. { , J FI. Gravel depth beneath pipe: Qr/ a / U Tavmship: Range: S m: Fill added above original grade.�i `/ I. Ft. Gravel Length: (OO I(/ Well: ❑ New r� Gravel width: FI. Number of lines: 3 Fl. Distance between lines: S Classification (Private, A, B. C): Tial th 114 Ft Cased to: El Total absorption area: 1013 Ft' FI. Pipe Material: pato a�3o3 ( Driller. v/ r �,%I dV Date Drilled: Static Water Level: Ft. Installer. � // /J 1 WO//�ev (.I1�1/ Date Installed: 01 /01UD / Yield: ti AS -BUILT SYSTEM DETAILS/SITE PLAN MCKINLEY VIEW S/D, LOT 4, BLOCK 3 Permit 9N/000302 PID# 057-79z -3y NO WELLS PUBLIC WATER SEPTIC SYSTEM +30 NO WELLS PUBLIC WATER SEPTIC SYSTEM +30 A -C=76.3' B -C=9.7' A -D=76.5' B -D=15.2' A -E=76.2' B -E=22.3' A -F=63.1' B -F=66.3' A -G=106.5' B -G=115.4' 4' SOLID FROM HOUSE d E d2 IP N1 91.07 LI111 fILIEN FABRIC INSULATION Nil EXISTING SEPTIC 87.9 TANK SEWER ROCK 90.61 90.30 X67.0 FINISHED GRADE vANIES PREPARED FOR: 60.0' CHUCK SCHIEBLE L 4, B 3, MCKINLEY VIEW EST. CHUGICH, AK FIELD BOOKS BOUNDARY: BOUNDARY STAKING: STAKING ASBUILT: ASBUILT DWG. FILE: ACA° FILE: 00063.DWG COMPUTED: DRAWN: VBG CHECKED: KMD DATE: 9/21 /00 GRID: NW1459 " N`: 00063 SCALE: NTS CB3.2D SOH ]1 D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-6111 AS -BUILT SYSTEM DETAILS/SITE PLAN MCKINLEY VIEW S/D, LOT 4, BLOCK 3 Permit PID# A -C=76.3' B -C=9.7' A -D=76.5' B -D=15.2' A -E=76.2' B -E=22.3' A -F=63.1' B -F=66.3' A -G=106.5' B -G=115.4' NO WELLS PUBLIC WATER SEPTIC SYSTEM +30 4' SOLID FROM HOUSE NO WELLS PUBLIC WATER SEPTIC SYSTEM +30 I lie o FINISHED GRADE I I 1111 • I, 91.07 LL I I II1i'i FILTER FABRIC IKSATI6V 11 -� EXISTING SEPTIC 87.82 TANK SEWER ROCK 90.61 90.30 `87.0 KENNETH KENNETH M. DU ''.... CE -7116 J .......... FESSIONP— PREPARED FUR: 60.0' n of vARIES CHUCK SCHIEBLE L 4, B 3, MCKINLEY VIEW EST. CHUGICH, AK FIELD BOOKS BOUNDARY: BOUNDARY STAKING: STAKING ASBUILT: ASBUILT COMPUTED: DRAWN: VBG CHECKED: KMD DATE' 9/21/00 SCALE: NTS < 76.77) Dox END ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 DWG. FILE: 111D: NW1 459 ACAD FILE: 00063.DWG J06 NW 00063 (907)696-6111/FAX (907)696-8111 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW000302 Legal Description: MCKINLEY VIEW ESTATES BLK 3 LT 4 Design Engineer: 0024 Eagle River Engineering Services Owner Name: Chuck & Doris Schieble Owner Address: 2270 Seneca Cir. Chugiak , AK 99567-2288 This permit is for the construction of: Disposal Field Septic Tank crIo1Op 34,0„, 917(o0Q,Dpim Date Issued: Aug 16, 2000 Expiration Date: Aug 16, 2001 Parcel ID: 051-792-34 Site Address: 022740 SENECA CIR Lot Size: 30030 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 Holding Tank I I 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (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. Issued By: Date: fe-//' 2A, Date: 8- Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax July 26, 2000 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 4, Block 3 McKinley View Estates Narrative & Permit Application Dear Mr. Cross: The proposed septic upgrade/well and septic system will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large and have septic systems located so as to allow sufficient room for septic sites. This is an established subdivision and there is an approved community water system in place so there are no well radii to avoid. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity and lot size. This is the secound system for this lot and will be installed with a diverter valve in order to make the original system useful. 4. Drainage will not be affected and is not a major consideration in our design. The original leachbed was installed on this lot in 1992. It is our opinion; that if the system was not installed with a passive sand liner, that would be the reason for the short lifespan. The soil log shows organics to a depth of 3.5 feet and the system was installed at 1.5 feet to provide water table separation. It is our intention to utilize the original soil logs for the replacement system, as they are properly located and adequate The only change in our design is to specify an excavation depth of 3.5 feet with scarification and placement of 2 feet of coarse sand to allow a passive sand filtration and a total depth of 1.5 feet. We are reasonably certain that the water table monitoring done in 1992 is adequate and will verify conditions at time of construction. If you have any questions please call our office at 694-5195. Sincerely, ouis Butera, P.E. \2000\00-049NAR Septic System +30'. No Wells Public Water N w Un 0 LOT 3 0 0 co 0 0 Existing LOT 5 raj Septic System +30' FA. 0j„ No Wells F Public Water NO SURFACE WATER NO KNOWN CURTAIN DRAINS 589'58'20'W 239.50' No Wells 0 • 0 TEST HOLE MONITOR TUBE SEWER CLEAN OUT WELL EASEMENT PROPOSED LEACH FIELD EXISTING LEACH FIELD DECK WELL/SEPTIC SITE PLAIN LEGAL: Lot 4, Block 3 , McKinley Veiw Est. OWNER: Chuck Schieble CONTRACTOR: N/A JOB#00-049WS DATE: 7-26-00 SCALE 1" = 40' AEAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 ...\\\\a\\\\\\\llp c OF 44 Hi 1i11, S1 *:49TH >\ * // -- "ice .�.. c • LOUIS A. BUTERA • �� LP• CE 6736 == /ie i''11111LROFESSIWI\t..c�� c EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 00-049 Calculated By: LB Date: 7/26/00 Legal: McKinley View Estates L4, B3 Single Family 3 Bedroom Dwelling Bed Subsurface Wastewater Disposal Field TEST HOLE 1 Water use at 150 gallons per bedroom = 450 gallons Percolation rate = 14 minutes per inch Wastewater application rate = 0.5 gallons per day per square foot Required absorption area = 900 square feet Bed width (VV) = 15 feet Gravel depth (D) = 0.5 feet Required length = Required absorption area / Bed width Required length = 900 / 15 Required length = 60 feet Total Excavation Depth = 1.5 feet Pper • ; 49TH D OO t LOUIS A. BUTERA� OO (A J, '•• CE -6736 SQ 004��\\\ f? LC NP����a i 00-049bcal 5:22 PM7/26/00 Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Lot 4, Block 3, McKinleyView Estates Subdivision July 26, 2000 A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 9. Any remaining open test hole excavations shall be filled. B. SEPTIC TANK/LIFT STATION 1. Existing tank is only8j(f years old and assumed to be in good condition without inspection. A "BullRun" diverter valve is to be installed. C. BED 1. The Bed excavation is to follow the ground contour excavating to sandy gravel material no deeper than 3.5 feet below existing grade. The ground is to be built up with coarse sand and leveled to a point where the deepest part of the system is no more than 1.5' below natural grade. 2. The top of the sand layer shall be level, plus or minus 1". 3. The gravel bed is to be 1' thick with the 4" pipe laid with 6" of gravel beneath it. 4. The effluent line within the Bed shall be laid level within 0.03'. 5. The Bed gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the Bed is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 3.5' for sand, 1.5' for gravel GRAVEL DEPTH = 0.5' under pipe, 2" over pipe BED LENGTH = 60' BED WIDTH = 15' SOIL RATING = 0.8 GPD/ft2 BEDROOM CAPACITY = 3 SEPTIC TANK = 1000 Inspections for initial excavation prior to sand, sand layer, gravel and pipe. Twenty-four (24) hours notice required for all inspections. \1997\00-049spec Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST /c ST ,te - PERFORMED FOR: 0/7179/7-1--4513 /Le:e/e/Al a:' 4.6.. 3 l � r LEGAL DESCRIPTION: (/�G"�c% CS% 2 3 4 5 6.16 7 8 9 10 11 12 DEPTH (FEET) —To? s9' S,e-r/ S trO 0 LCA 4>u+c 5 /c77 _Se7uor C,C'/iv�L w n'' -ESL CoA j/5 Township, Range, Section: SC -c. �, 729V)Ge/LI SLOPE SITE PLAN WAS GROUND WATER. ENCOUNTERED? IF YES, AT WHAT DEPTH? agr/r'a of v mJ �-vLc GW g'i eg v� COMMENTS Les ]th to Water After mitring? �'— Oat S L O P E N igen a Reading Date Gross Time Ne Time Depth to Water Net Drop 6/4/794 9 3 0 0 7 /0 c. 3v 8 V6 / lG /0 `= 0 7%B /0 3° 30 9 S�/G 23//(.. /0 -3-2 0 7 // Q 3c) 9 %c z_ *5,6 PERCOLATION RATE /17 (minutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN 3 LFT AND ¢ /1/4 --FT /25- —Ce sN. -6 dv Gicn-r67yT o'i',eC..e -7a-7-- PERFORMED asT PERFORMED BY: '• "-' )gyf4.1 ( CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Rev. 4/85) • PERFORMED FOR Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST ?C'.57 /7-, c- M/ CLQ /2-X/2/,✓ LEGAL DESCRIPTION: N %-..J SC 't -U% t.G 1 2 3- 4 5 6 7 8 8.5 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (FEET) Sic,-<;' Sera.)o Vf-G Arm ICS �-i u �; (:)741a 7414 --� Or $ . QITJEER' EACs. �-;Y V I* /491.0� fi • i Z-0 , olk _..:1 r,,6'-'7 L - WMM•N•••••• : CC r es David R. Dayton �-u .f #� '••• No. 2205-E 1aa.r3" 1 ``a SgtpoS DATE PERFORMED: Township, Range, Section: SLOPE S�ryS-raa yG v w>rrr- s ce-r° 3(1.-T'-/ �c'hut -taw.-} ti-ta WAS GROUND WATER ENCOUNT-ERED? IF YES,AT WHAT DEPTH? yL-5 E Depth to Water Alter 5;6. 6/3)9Z. -- Monitoring? / 3/5LMonitoring? Dal • SITE PLAN T N -res/ 0 L Reading Date Gross Time Ne Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN (minutesonch) PERC HOLE DIAMETER FT AND FT COMMENTS PERFORMED BY' CERTIFY THAT THIS TEST WAS PERFORMED IN ' y/ ACCORDANCE WITH ALL STATE ANO MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Rev 4;851 . Municipality of Anchorage Page of Z- _L_ . 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 5t&/ 9`11O 2 PID Number: OS/ -79 z - 35, Permit Number: Name: Wastewater System: New • Upgrade Address• ABSORPTION FIELD Phone: NO of Bedrooms: 0 Deep Trench 0 Shallow Trench CBed 0 Mound 0 Other LEGAL DESCRIPTION Soil Rating: O.� GPD/S GPD/So. Ft. Total Depth from oginal grade: /.... Lot: Block: Subd vision: 7 � y'bj��',:.,�� 11r-=�-J (��T Depth to pipe bottom from original grade: /;d Ft. Gravel depth beneath pipe U. S Ft. Township: .) 1- (S , Ran 4 // K) Lis Section: , 1 T Fill added above original grade: .• � Ft. �' Gravel length: G: O Ft. WELL: ■New ■Upgrade Gravel width: /..5 -Ft Number of lines: 3 Distance between lines: 4%' Ft. Classifi tion (Private, A,B,C): ICU. 60(.- i 9I r€Ie.- Total Depth:' Ft. Cased To: Ft. Total absorption area: 9&6, so. Ft. Pipe material: Pt' 3o34), ,f -love F8io Driller: Date Drilled: Static Water Level: Ft. Installer: (,..t.).11 -(/t �>A.st;r- Date installed: IV/4A a/.rA'/ Yield: GPM Pump Set at: Ft. Casing Height Above Ground: Ft. TANK �1 SEPARATION DISTANCES i'lfSeptic 0 Holding ❑ S.T.E.P. To From Septic Tank Absorption Field Litt Station Holding Tank Public/Private Sewer Lines Manufacturer. -r-- A5C id- / .J.1� g– Capacity in gallons: ) 0 Gd Well" �/ »/, {t///1 Material: 7-6i. t— Number of Compartments: Z '--- Surface Water (oma 11–(ouT 1 j ) O _.___ Size in gallons: LIFT STATION Manufacturer. stJ/, Lot Line Foundation G•- — — "Pump on" level at: "Pump off" level at: High water alarm at: Curtain, Drain Na " r t4eNfr Pump Make & Model Elec rical Inspections performed by: Remarks: BENCH MARK Location and Description: Fec r t.. csQ._ 7:31- (__. Assumed Elevation: (EX,e Et ENGINEER'S SEAL • David R. Dayton P.E. Inspections by: 20210Donatar St. Dates: 1st 0/9'fri performed Chug)ak,Afaska99567 2nd i W r` '7/..' P a�� '1-1/97 Department of Health,arid Human Services approval Ge`� Date: / ��Reviewed and approved by:/ `-f Permit No. 5v19V02-oct Page 7- of 2 Municipality of Anchorage 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 Legal Description: tor q 8Le., 3 Me; Kt.ifyi/L-13Dr PID No,: c)5/- 79Z -35/ o1. 3 441.. TAN* 72 -013 A 11/931 • flc% 4 c. Or - 9851 sz z r2 L. rri -r 3 co 4. co .* cot. Iz 1 1 - o4.4. otl a 7 ° JO 17.* ts e S" Cc,8721 1,3•1- V37 ?-- ezr± ENGINEERS SEAL to, Nr - PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE 1.%_ j y/ 16d.` ti' 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:SW940204 DESIGN ENGINEER:DAVID R. DAYTON, P.E. OWNER NAME:FERRIN CHARLES R OWNER ADDRESS:22740 SENECA CIR EAGLE RIVER, ALASKA 99645 PARCEL ID:05179234 LEGAL DESCRIPTION: MCKINLEY VIEW ESTATES BLK 3 LT 4 LOT SIZE: 30030 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 6/27/94 EXPIRATION DATE: 6/27/95 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) . 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 AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: (14-E�7,74 ISSUED BY: DATE: z j' S, DATE: 6-27��� D. R. DAYTON, P.E., R.L.S. 20210 Donalar Chugiak, Alaska 99567 June 22, 1994 Municipality of Anchorage Dept of Health & Human Services On- Site Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Attn: Mr Robert Robinson Re: Lot 4 Blk 3, McKinley View Estates Dear Mr. Robinson, In June of 1992 you for the subject lot. The The owners are now going The design has been 24' x 40' bed. All other the same. Please review the revised design and issue a new permit. (907) 696-2417 issued an on-site septic system permit (SW920145) system was not built and the permit expired. ahead with the home and request a new permit. revised to a 15' x 60' bed from the previous aspects of the previously submitted design remain Sincerely, 2 David R. Dayton • W e wV Loi 4 1t Ma' 3 1110.rr,�e vwca f3 e_ — ) 0 00 Z CO M.12, `istL p2G 14 mN.fcy. 0,5 g PcPIS' W4- E- "i dz.cr e i r - c.lsa 1145-0 4'5b 900 /s z 900 R ?_zs-r,' D T. Com G4 Ss 1E. noo 4Atm.) a2 Orr. T+w+c- aofrrcDNt. o deo 1 . IGv eao, G9--.GUU'a] }>l.Ac.tr 6>" S wt= . T .Oac l.INDc 2 g"I?sti- rPiP3 PLA -C 2 " 5C-f-ta f? -v c./c... °V C rt. 4---s Pte. P,Pp 'PLA -G 2L' I Usui.c..�eo,u c'\) & S L Z A lYt,n9irnu� t ii �- ov C i/�Svc.s -6 11..)QcdTTC- Ta„ . 4 P'psI.36. LPA t5Ac,tLi'-1G_.(. Czyv L �s TI -+''p4 ,' Of xik_Arq% S9e WGA.,%c aoarceA9ce.a:f`. • 0 (J� 1, �z cY�l ( 7 '/.s _'� A 4.1,,, �.3 le-^&`lC+[�cTv 96.. 1196ittio `i , F ,_ David R. Dayton e ey 0 NO. 2245-E .1 4'7 44 ti,N,PR©FL,5.kti 4 David ft. Dayton P.E. MC 78 Box 1026 Chugiak, Alaska 99567 i u /474 47/1 Z Z/Z Tom Fink, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 June 22, 1993 Charles Ferrin PO Box 770927 Eagle River, Alaska 99577 Subject: Lot 4 Block 3 Mc Kinley View Estates Subdivision Permit #SW920145, PID #051-792-34 The subject permit, issued June 22, 1992 by this office for a single family well and/or on-site wastewater system, has expired as of June 22, 1993. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as -built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $200.00 for an on-site wastewater permit; $75.00 for a well permit and $275.00 for a combined on-site wastewater and well permit. If you have Sincfgrely, any questions, please call this office at 343-4744. Smit 7, P. E. Pbgram Msnager On-site Services enc: Copy of Permit 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:SW920145 DESIGN ENGINEER:DAVID R. DAYTON, P.E. OWNER NAME:KUNKLE CAROLYN R OWNER ADDRESS: 825 N. ONTARIO ST. BURBANK, CAL. 91505 PARCEL ID:05179234 LEGAL DESCRIPTION: MCKINLEY VIEW ESTATES BLK 3 LT 4 LOT SIZE: 30030 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 6/22/92 EXPIRATION DATE: 6/22/93 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: IN THE CONSTRUCTION OF THIS BED DRAINFIELD, THE ORGANICS AND SILTY SAND MUST BE REMOVED TO A DEPTH OF APPROXIMATELY 3 FEET AND A 2 FOOT SAND FILTER LAYER THEN INSTALLED PRIOR TO PLACING THE SEPTIC)OC)S. � (' RECEIVED BY: 2 L 474_ e DATE: DATE: ISSUED BY: _ T` p.O ° c, r ai iN r f r✓PTiL 'i'S N\.-12)CS1�,r�1 LOT 4 t?D r 3 MnY)&3t-ni vttrU Cs'7 r3 e_ — ) 0 0 c) c. w,.) 2 Co nN.P. K. P..C. 0,51 PcQ/S R' WA--rz L -7-A1-6�.,8 e 1 - c S.7 13,15-0 4.5b o© z -4- z.4' ,nr 064 Soo -sem i '37,� C.�so 2sc.4_0'*3 / w�o,e,�Na, 41.,.v40'' Z.rase+c„n 4�asm /D' 074v - C, O c -a rn 1 +o4` FOJ".11:1P.-7 J SGP xx}x,c: .. ©-rir- t- o V. r361:=, 1 . 1 oe,,o t� zociva moi, uL e. CI-" "Pct r- Pc3 PLA 2." Sc-�u ,z 2-0 PP,Pc PLA -r - PLA -r -cis 2L` / kISvutz.-r•-,tz. -A e C- a r M i ra, rnArA. �5 1..ss rtfiAA, Le_ (0 V GK.- VOSLIGile'r7tiej Iii 4> wG, t iL 60,CAC- TArso ti David ft. Dayton P.E. MC 78 Box 1026 Chugiak, Alaska9956T— G/1/9z z/z W A--rtf E PTI C S'i' sTT,A., ern. Loj 4 13t_C3cr... 3 n e, \ f re-cJ ) O©O &Po, c.c....) Z C-0, J L- 1 r&r — tis.T i3 4s -o S DO erz Z4"' mr 3' )000 a'e- GO +^n 0A --J-10 oet6 GRou.+o , h-0c)N U s k Z 4- s& 4 ' C,�-1ADD 0-erzr.1AL 4 UN Y 4c,' �rr�szrua Atz*4 6 1' add L)o-rTc'r41- o - 12) 1 .11'3€c4.7.J Oeo61 Grz�nuo -Pc c,rs " SEtU 2 Z,oc.ic oc'e. Cl-" ,ti �1P3 PLAeu- Z" SEua0+�c2 FPGA -cam 2,KisuLA.-,-,oma, a t %`r l �,J„M,,n,1„L, �i 1. L.-- O v b7., )k) OLAN r J Itisv� rc 1A�c+I>FN� ��f✓rt cv • JG4 on&i `sem %?:195)6®9 aeN•. ° ,tt� n ,:.�•,lil R. Niy'ton '47° • NO. 2295 9F `?aen,eseoa6pYY� �a David R. Dayton P.E. MC 78 Box 1026 Chugiak, Alaska 99567- Z17- D. R. DAYTON, P.E., R.L.S. HC 78 Box 1026 Chugiak, Alaska 99567 DESIGN NARRATIVE Lot 4, Block 3, McKinley View Estates :+t rto (907) 696-2417 The test holes revealed the same type of soils in the locations for the original and replacement systems. The receiving soils are a silty sandy gravel with a percolation rate of 14 minutes an inch, which allows a loading rate of 0.5 gpd/SF. For a 3 bedroom home, the bed size was calculated at (3 x 150)/0,5 = 900 SF of absorbtion area. The lot slopes from Southeast to Northwest at approximately 2%. The subdivision is served by a "Class A" Public Water System and therefore contamination of wells is remote. The system will have no significant impact on future drainage systems on adjacent lots, reserved space/surface or subsurface, or on drainage. Respectfully, David R. Dayton PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST /Z, -3-- /// c..-- `J1 iiL� (� LEGAL DESCRIPTION: /4 el - (i) ..� ;":=c.-.�.:_ `sic;'^; S/•h-+J) etrua-3 COMMENTS A,�:� ,rz_ i9 ®uas...v.. RPU®.e�Pe«,asawti P.P.AAtame, Pw PPON 196&m.i e Uj tea Duvid R. Duytvw 640, 22OO-`'.EV Prial DATE PERFORMED:' Township, Range, Section: SLOPE Nia •• ILE Ems ENE mom mos WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Alter Monitoring? S L 0 P E Date: c/ - . 72s SITE PLAN /91 1j, Reading Date Gross Time Net Time Depth to Water Net Drop 6/(// 12 � Sc' c 7 /L., r:.[.' (•, `"f /t .ce' ' <>5/ Z 3%L.. %G' iv cF 7 PERCOLATION RATE /17 (minutes/inch) PERC HOLE DIAMETER FT AND �� I /1/2 - FT TEST RUN BETWEEN '3 //l PERFORMED BY: ' ') ,lt 4124, t u/C CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 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: ///l /i (H`i /C % j.�✓i4� LEGAL DESCRIPTION: /' %" DEPTH (FEET) 2- 3- 4- 5- 6- 7 - 8- 9- 10- 11 - 12- 13- 14- 15- 16- 17- 18- 19- 20 - /7.& s'/v c Gti /(%U L 7— GIIKEER' EA14 tra%° ncwoua±tnaeaeee'ej©®sa ,.., vats oe'n9o®a,t3©m so 1° David H. Dayf,on $ 1) O•ne NO. 2295-t �qo 4\'j;,'a ffi4 q,,, ®moi. O®®®ON'®Ovv.,$ fifif 541 2 / ` i/ ., 4)/ i DATE PERFORMED: �'° Township, Range, Section: SLOPE ,(4t .. c' i,//1t ) *iTv :.. 1.9f.1d )1 1.-7-`-� iA MEM MUM MEM WAS GROUND WATER ENCOUNTERED? Y&5..; IF YES, AT WHAT DEPTH? s L t-' 0 P E Depth to Water Atter Date.( Monitoring?/1/7..- / /'s c; /Z/10 SITE PLAN Reading Date Gross Time Ill ■.■PI Net Drop 111111M1 111 EKON 11E11111INIENI 1 III III RIPE SUE II 111 MI 11 111 In= 11 •11 /-21111111110 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER FT AND FT COMMENTS PERFORMED BY ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN / % DATE L-/�,/%•'; l._.. L(907) 343-79 Municipality of Anchorage IT1T AL On -Site Water and Waste APR 2.0 2015 Gretchen St€tllev CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-792-34 Expiration Date: 4 "i q / 7 1. GENERAL INFORMATION Complete legal description McKinley View Estates Block 3 Lot 4 Location (site address) 22727 Homestead Rd, Chugiak, AK Current Property owner(s) Bennyhoff Day phone 907-854-2327 Mailing address same Real Estate Agent Caiq Bennett Day phone 907-242-3251 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System TYPE OF WASTEWATER DISPOSAL: ❑ Individual EZI ❑ Holding Tank ❑ ❑ Community ❑ Public Sewer ❑ Received by:n Date: COSA to be released to the engineer, unless t ierwise requested by the engineer. COSA Fee $ 5524" . Date: Date of Payment tl/1alil!C Date of Payment Receipt Number VV94(tn Receipt Number COSA # 6 SC! 67/s3 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 onsite 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 NorthRim Engineering Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Phone 694-7028 Date 4/20/2015 cr., O€ AL u °a il91 0 ¢.-= eae 6 6. DSD SIGNATURE° 52* gig s °aoa e V 3 on System #1 Approved for 3 bedrooms. � o System #2 Approved for bedrooms. Disapproved. ' Conditional approval for bedrooms, with the following stipulationsw'• •• .tllitt Stir,:. \YOF C`'-, j ON-SITE', WATER AND 7WASTEWATER a- PROGRAMco . .•1,� Qom` NT By: (///. Original Certificate Date: ! - 3 - / The ivlunicipalit 7. 'chorage Devlopment Services Division (DSD) Issues Certificates of On -Site Systems Approval (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 COSA blue sheet 9-1-12.tlac 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: 44nki o e q 14 ea.' 41 B3 ,Cly/ Parcel ID: OS!- 7?e- yr A. WELL DATA f !%g'«C .-,4-TEAL Well type If A, B, or C provide PWSID # Well Log (YIN) Date completed Sanitary seal (YIN) _ 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 ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Talk Type/Material Sfrf C /� snicee_ „ Date installed cP//6/PV Tank size /ada gal. Number of Compartments 2 Cleanouts'(Y/N)' 7 Foundation cleanout (Y/N) >/ Depression over tank�(Y/N) A/ High water alarm (Y/N) ! N Date of pumping 4/7/7//.. 4 Pumper etui44/ town"✓s' C. ABSORPTION FIELD DATA Date installed q/7/0 0 Soil rating (g.p.d./ft2 or ft2/bdrm) (3. 5 System type 861 Length ‘61 ft. Width / 5 ft. Gravel below pipe 0. JY ft. Total depth Z 5 ft. Eff. absorption area 9 ao ft2 Monitoring tube y Depression over field a Date of adequacy test yny!//S Results (Pass/Fail) �iAS�I For 3 bedrooms Fluid depth in absorption fieldbeforetest /) in. Water added 450 gal New depth 0 in. Elapsed Time: 3 3 min. Final fluid depth 0 in. Absorption rate >= L1'SO'7°- g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) A/0 If yes, give date D. LIFT STATION NA Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Abq Septic tank/lift 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 Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation S Property line / D 1.4- Absorption field /Q `# Water main / & It. Water service line /0''?` Surface water /®o (sem Wells on adjacent lots Z O U ABSORPTION FIELD ON LOTTO: Property line /0 I¢ Building foundation l d t Water main 70 +- Water Service line /a /r Surface water / QO '+ Driveway, parking/vehicle storage 2'51r Curtain drain /06 fi Wells on adjacent lots Zap 4- 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 effect on this date. Engineer's Printed Name -- i ev EAl6 Date q 2 0g5 COSA yellow sheet 2-6-15.doc �o�vl�Qjal Ite t^tc. SvWLEng e 44d1:!'.°.•S: C ole <j?) , ebr 'eigra ,°� `' C. r - c- , --o` R= - • 6 -s-r,ya v- 3TC' •" r-. Ho„ra . -Jet .a Y.'', AS -BUILT . Jr:‘—tc.G u?&. I hereby certify that I have surveyed the following described property. {-cT i{-. FIcc.AZ , 1 S 5-4.<-'ht0.- Y'. 7 i 9” F :-Li U-• . .'-7 Anchorage Recording Precinct, Alaska. and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmisstun lines or other visible easements on said property except as indicated hereon. Dated at Eagle River. AIavka - this f3_ Th day of 5 _ae % r 199' -4 - ROBERT C JO}{NSON "Alcc4; SCA LE: Registered Land Sunvevor No. F&I-LS Bt» _-0a�6. EaRicer. Alaska Q9577 Phnne inn -i hQ4-: gle ��: 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 05 - /92 3'{ HAA# D00 9a - Expiration Date: 1. GENERAL INFORMATION Complete legal description McKinley View Estates Block 3, Lot 4 Location (site address or directions) Current Property owner(s) Chuck Schieble Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well 121 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site 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. (Rev. 11/99) 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 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KM" Fnnin�__eering Phone 696-8111 Address 90441 Ptarmigan Fagle River AK 94577 Engineer's Printed Name _Kenneth nuffus Date 04/91/911011 ..-be A( 9a� � �--'°' :;j, �y ENGINEER'S ;'x STAMP ........,......r..- 43 F`aa 6. DHHS SIGNATURE Kenneth M. Cufiu! d , N ., CE 7116 .° c,•, bedrooms. Approved for 3 PROFEssto`t��� Disapproved. �'�'WWIP'P� Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: de Expiration Date / ;Rev. 11/99) Original Certificate Date: J 0 - S cs ci Reissue Date Municipality of Anchorage E C E I V E Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 SEP 2 6 2000 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: McKinley View Estates Block 3, Lot 4 Parcel I.D.: 051-792 '3 A. WELL DATA Well type Public If A, B, or C provide PWSID # Well Log Date completed Sanitary seal Wires pr rly protected Total depth ft Cased to ft Casin• • - ght (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft ft Well production g.p.m g.p.m WATER SAMPL SULTS: Colifor colonies/100 ml Nitrate mg/I Other bacteria colonies/100 ml Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Date installed 0791 Tank size 1000 gal Number of Compartments 2 Cleanouts y Foundation cleanout y Depression over tank n High water alarm n/a Date of pumping 09/30/471 Pumper fah%1iry C. ABSORPTION FIELD DATA Date installed 09/07/00 Soil rating (g.p.d./ft2 or ft2/bdrm) 0_5 System type Bed Length 60 ft Width 15 ft Gravel below pipe 0.81 ft Total depth 1.5 ft Effective absorption area 900 ft2 Monitoring tube y Depression over field n Date of adequacy test Results (Pass/Fail) For abedrooms Fluid depth in absorption field before test in Water add e : New depth in. Elapsed Time: minim - w. depth in Absorption rate >= g.p.d. If yes, give date A e)uvenation treatment (past 12 mo.) (Y/N & type) (Rev. 11/99) D. LIFT STATION Date installed Size in gallons "Pump on" level at in"Pump off level at in Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT Septic tank/lift station on lot Absorption field on lot Public sew Manhole/Access High water alarm level at in Meets alarm : cult requirements? On adjacent lots On adjacent lots n Public sewer manhole/cleanout wer /septic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 101+ Property line 11:11+ Water main 25'+ Water service line 25'+ Drainage 1001+ Wells on adjacent lots 2nn'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Water Service line 25'+ Curtain drain 100'+ F. COMMENTS Building foundation 1n'+ Surface water 100'+ Wells on adjacent lots 700'+ Absorption field 10'+ Surface water 100'+ Water main 25'+ Driveway, parking/vehicle storage 25'+ esittr"V®eta_ �tOFA< 11 e D. ®fiIt e: ••egt9 UD ® 491.1 /; 5:', t 'A AC! 0e eoo telso ' --- W®• •n•••••• •.• 4"\ �n c Kenneth M. Dufiu• i41 ®® N!e CE 7116 , ,��c# 0 �� fle9,,, ......NPP "' 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 Kenneth rinffus Date 09/21r2nnn HAA Fee $ aX.) •45° STAMP Waiver Fee $ Date of Payment (—g19` 00 \ Date of Payment Receipt Number b (o3 q 7 t \ Receipt Number (Rev. 11/99) JJ 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 L/` CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I D # C4j 1— 7c1 2. "34' 1. GENERAL INFORMATION Complete legal description 3-N HAA# �I 94-09-9`7 LcT 4- &lcLT, 229W, Location (site address or directions) 5t .A- C. L� Property owner Cri-A-,x.t_cs h -SAO Day phone Mailing address R .Sok 7 7 cue Z7 rAat.3- A._ 4Gi 7 .7 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water will be held for pickup. NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer X. 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. Name of Firm Address Engineer's signature David R. Dayton P.E. 20210 Donalar St. iugiak, Alaska 99567 Phone ln9Wv?9/7 Date /,/,%. ' �y 'JIO nanaM•,^ti's Q► 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By Additional Comments Date `.6/ CAUTION 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 (Rae. 1/91) Back MOA p21 „ Municipality of Anchorage/ f 7 r'� r Department of Health and Human Services oil 1‘ii__ HEALTH AUTHORITY APPROVAL CHECKLIST C`1,, ril Om m 7 1 O M. Legal Description: �,.� ” d- '2(iParcel I.D. 0-5-/ '7,‘7,42 --3‘,',/ il t G / A. Well Data ( m / Well type r ,e-&"l.a , If A, B, or C, attach ADEC letter. ADEC water system number _4 e' 69. Z Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow g.p.m. g.p.m. Pump levell SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ; On adjacent Tots Absorption field on lot ; On adjacent lots Public sewer main Public sewer manhole/cleanout Petroleum tank Sewer service line WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TA K DATA Date installed Tank size /66 3 Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) High water alarm (Y/N) J/// Alarm tested (Y/N) A{1/4 - Date of pumping /v s;K -3 YS p i"- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot Pi it On adjacent lots A3/41- Foundation ., To property line / Absorption field L'z Water main/service line 2'ri Surface water/drainage / D 1' 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed A1j% Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed .S/;1!-/ Soil rating (GPD/Ft2) System type :_•';'(_-/.2_1 Length L'!1 Width Gravel thickness c, ', iii, ,,r4,/,:.,Total depth=c` Total absorption area _ �J RC1 +' Cleanout present (Y/N) Y Depression over field (Y/N) A' Date of adequacy test /j:4,: S '5'2 6sults (pass/fail) for Bedrooms Water level in absorption field before test After test Peroxide treatment (past 12 months) (Y/N) /C7' If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot A-1// On adjacent Tots //z Property line /s0' To building foundation 6'0 To existing or abandoned system on lot -4X------ On c 6 -.�"On adjacent Tots z.<, 7 Cutbank A 2/Z9 Water main/service Zine Surface water i G'r,' Driveway, parking/vehicle storage area Curtain drain N� E. ENGINEERS CERTIFICATION I certify that f have checked, verified, or conformed to all MOA and NAA guidelines in effect on the date of this inspection. Signature David R. Dayton P.E. 20210 Donalar St. Engineer's Name Churdak, Alaska 99567 Date HAA Fee $ J(2t' 'JO Date of Payment / Receipt Number d'' cl 12M �> 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number