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Home My WebLink AboutT15N R1W SEC 18 LT 98TI5N RIW Section 18 · Lot 98 #051 - 172- 31 es(tPALtry,o, MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program \`, Sr^ • `, PO Box 196650 4700 Elmore Road . Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax: (907)343-7997 r, http:JJwww.muni.org/onsite epar['tient _ On-Site Wastewater Disposal System Permit Permit Number: OSP171187 Effective Date: 7/21/2017 Work Type: Septic Upgrade Expiration Date: 7/21/2018 Tax Code Number: 05117231000 Site Legal Address: T15N R1W SEC 18 LT 98 G:1155 Site Mailing Address: 19932 ADRIAN AVE, Chugiak Owner: HALL GEORGE ANDREW JR & Lot Size in Sq Ft: 108900 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 3 This permit is for the construction of: 0 Disposal Field Il Septic Tank ❑ Holding Tank ❑ Privy El Private Well El Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: �� Date: S / Issued By: gli)Ce-CA Date: 7N-20 7 MUNICIPALITY OF ANCHORAGE • ' .4 .',.��) Community Development Department w _, / Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051- / 7z - 3 r Property owner(s) /rn j Z. Day phone Mailing address / ?9'._ Z 4 bg j/4/'/ AVE Site address -Sf11IN6- Legal description (Sub'd., Block & Lot) Legal descriptionti (Township, Range & Section) 775 /Q7 SEC / a L. 7(p.Lot Size /O�yQc Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (CA all that apply) Absorption Field X111 Initial • Single Family (SF) 67890 (w/woADU) r Septic Tank Upgrade i' ihMili \tp Holding Tank ElRenewal ^ ❑ �-x (D) El Multt• e Dwellings ❑ Privy ❑ a- JUL 1 7 cUi7 and/or D) Private Well ❑ C w Water Storage Eliin� a68L95 THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. L7 (Signature o prope y owner or a orized agent) Permit/Rush Fees: 4) 50 Waiver Fees: Date of Payment: 7119/0 Date of Payment: Receipt Number: 0.211-03 Receipt Number: Permit No. ►IS19/x'1(3-7' Waiver No. Permit App_9-1-12.doc [\bTF- IM ENGINEERING SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 7/15/17 Number of Pages: To: MOA On-Site Services Subject: T15N R1W Section 18 Lot 98 Septic System Upgrade An existing crib is failing on the subject lot. A new soil test reveals sand w/gravel soil. The design calls for a new shallow trench and a new septic tank. The entire subdivision is on private water wells and septic systems. The terrain slopes southeast slightly at the trench site. The system size is a single family at 3 bedrooms. Please review the wastewater system design for the existing 3 bedroom home. I have included design plans& specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Thanks-Steve 1%.. . . $ i co .' *•.:'17 of .* r4'" T��IMs �� • ENGINEERING ♦11 pis Sloven w Ego • �� SteveEng.com T15N RI W Sectiot $9t0E �5� '�.� 41. SPECIFICATIONS & DESIGN GUIDELINES 14 ``•••. Ati I i y ' Wastewater System Sizing: Design is for upgrade to exiting3 -bedroom septic system. This is a mostly developed subdivision. These lots are near 1 acre and are served by private wells and septic systems. No adverse impacts are expected from trench/tank construction. No conflicts to the other lots will take place by this septic system construction. The easements are located on the drawing and are not encroached upon. An application rate of 1.2 GPD/FT2. Trench Length = 375 FT2/5' x .78 reduction factor= 58.5' trench, (1.5' effective). A new 1000 gallon septic tank will be installed. Existing concrete block septic tank& crib to be decommissioned per UPC. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment,New 1000 gallon septic tank. Install new Double Cleanouts. • 5' minimum between the tank and trench. 10' to property lines. • 2' of cover or insulation is required for trench+ Insulation; 2" Minimum thickness for insulation can substitute for I' cover. • Tank & solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required I' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain-rock. • Drain rock to be '/2 inch to 2 '/2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down. • Silt barrier(filter fabric) to be installed above the drain rock. • Smeared trench sides must be raked or scarified before drain rock placement. • Backfill over drain rock must not be less than 36". • The finish grade must be mounded to promote drainage away from trench. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) • DESIGN NOTES: 1, Total Depth of Trench is 3.5— Insulate. Terrain Slopes Slightly Southeast. 2. Sewer Service Line minimum 2% slope. Lot 97B 3. Private Water Wells. �Lt( 4. Decommission Old Crib/Tank Per UPC. R100.1 5. Measure Well Separation Prior To Construction. .E3 / /PQ..) eEL! EV6 e ��,�5 R101 0 Existing Well Flat Slope cr, II ON Flat Slope i-' 0 J 3 Bdrm 100 2Y.,Slope New 1000 Gallon CO/MT w/ Septic Tank T� 0 w/ Double Cleanvuts col .'''... ..... .........-- Septic Septic Tank (Concrete Block) 0 8. Decommission Old 2'Is`ope Septic Tank/Crib Log Crib 0 PER UPC riot Slope CO CU Lot 129 / 0 R100.0— ��f 1 ��- °F.'� T15N R1W SECTION 18 1' = so' NOR THRIM y~! .! ENGINEERING •* '; m *• LOT SS PLAN Po sox 770724 ,;,,,.. LAYOUT E.9+. Rh., Nei" l9a» " / WASTEWATER DESIGN 907.694. 7028 �?�t7 UPGRADE SEPTIC Date 7/15/17 2 0 3 Foundation Cleanout Tank Cleanouts Fin ^amide Opposing Cleanouts Between Septic Tank & Trench 4 Foot Cover or Equal To New Trench 1000 Gallon Steel 'Anchorage Tank' Or Equal Solid Pipe Monitor Tube DESIGN NOTES: C❑ e 5-10% Slope 1. Depth Of Trench @ 3.5'- Insulate.. P 2, Septic Tank & Solid Pipe to be Placed on Compacted, Stable Soil, Free from Boulders, Original Ground 3. Sewer Service Line is Minimum 2% Slope & 3' Cover. 4. Water-Tight Couplings. 2' Cover 5, See Specification Sheet. Filter Fabric 6. All Work To Conform to Municipality of' Anchorage (AMC) + 2' Insulation 3,5' Requirements & Specifications. 7, Check Well/Surface Water Separation To Septic System Prior To Construction. Effective Depth 1,5 ~-5' NORTHRIM P� 4' s*.49m '+ SEPTIC*+, SYSTEM PR❑FILE T15N R1W SECTI❑N 18 ENGINEERING ,> t LOT 98 PO Box 770724 t •it SW*Eng go s Eagle River, Alaska 99577 �1� . CE— 90,.694.7028 �� vif ‘4,- SEPTIC SYSTEMD°te:7/15/17 !Drown By: SE =1Sai,: I SE S❑ILS LOG - PERC❑LATI❑N TEST TI- IM Date Performed: 6/15/17 ENGINEERING Performed For: Andy Hall Legal Description: T15N R1W Section 18 Lot 98 DEPTH (FEET) Organic T,H. Location: See Attached Design 2 - : :. 3 _ 4 - ;''Q4.. =: SM Sand ' 5 - .... : ,...:::0 w/ Gravel Low Silt 6 - Groundwater? Yes 7 - Depth 9.5' 8 - 4 Water Depth After Monitoring.8.5' Date: 6/28/17 10 - • .:'• '.. # Date Gross Time Net Time Depth Net Drop 11 - 1 6/15 0 -- 7' -- 12 - 2 6/15 10 10 min. 10.5' 3.5' 13 - ''':7 3 6/15 12 -- 7' -- 14 - : 4 6/15 22 10 min. 10.5" 3.5" 15 - 5 6/15 25 -- 7' -- 16 - 6 6/15 35 10 min. 10.5" 3.5' 17 - -- 7 6/15 377' -- 18 - 8 6/15 47 10 min. 10.5' 3.5' -- 6/15 50 7" -- 19 - 9 20 - 10 6/15 60 10 min. 10.5' 3.5' 21 - Percolation Rate 3 min./inch Perc Hole Diameter 6' Test Run Between 3' and 4' Comments: Presoaked. Measured to nearest 1/16th inch. Performed By NorthRim Fng, Iz' ---' CERTIFY THAT THIS TEST WAS Performed in Accordance with All State/Municipal Guidelines in Effect ON THIS DATE. DATE: 6/28/17 .....,, NORTHRIM fl ' '+��* TESTH❑LE LOG TH ENGINEERING PO Box 770724 :40t --------- Eagle --- ---- -- Eagle /Moor, Alaska 99577 r� 907.694.7028 f C GE❑TECHNICAL Dot*: �T: 6/28/17 I 1 E 'ATER ANCHORAGE AREA BORC' 'iH 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-251 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM DISTANCE FROM WELT ,'/,/~ MATERIAL (/OJ-/~,~-~-- ,~/~C/~ NUMBER OF -- COMPARTMENTS LIQUID CAPACITY /'~ GALLONS. INSIDE LENGTH· 7/~.5-' z, ·INSIDE WIDTH ~?/~'"/ LIQUID DEPTH SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER OR WIDTH /~' (Y4~'~J DISTANCE FROM WELL /X ~,~_.~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH /2 / , DEPTH ~ , BUILDING FOUNDATION.__ SQ. FT. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WEU ~FOUNDATIO~ . NEAREST LOT LINE .OF LINES / DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TypF~)/Ei//~_-,~ , DEPTH. ~C-' DISTANCE FROM WATER ., BUILDING FOUNDATION -- .SAMPLE ~J¢/~' , NEAREST LOT LINE //,/~ ~/~ ~? NEAREST __ SEPTIC / SEEPAGE OTHER · SEWER LINE ., TANK //~' , SYSTEM /~ ~ CESSPOOL ~ , SOURCES__ DISTANCES: "'~ ~;7/b~ DIAGRAM OF SYSTEM GREATEx, 327 Eagle St. ~NCHORAGE AREA HEALTH DEPARTMENT Anchorage, Alaska 9950! 279.2511~ ]~/'''/ SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT/-/b'///x/ ~'~-~v.-wr .,.,; ' MAILING ADDRES~HONE NO. , RESIDENCE ADDRESS ~'~',/~ LOCATION OF INSTALLATION LEGAL DESCRIPTION L~ ~::~'~' _ ~, APPLICATION TO INSTALL: SEPTIC T,,~NK ~ , SEEPAGE PiT l/"" , DRAIN FIELD. , OTHER FINANCED THROUGH ('~" TO BE INSTALLED BY F~ TEST RESULTS ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED . SEPTIC TANK SIZE/~ ' TYPE~, SEEPAGE AREA DISTANCES: I certify that I am familiar with the requirements of Greater Anchorage Area Boroug~Ordinance No. 28-68 and that the above described system is in accordance with said code ,. ... 9ATE t~ APPLIOA~TS ~ ~ATU ~, ' ~REATER ANCHOR/.'~E AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 CASE Performed F?r .~da ~ , , Date Performed i) ~'- y(.~ ,, , Depth Feet Soil Characteristics Was Ground Water Encountered?__.L If Yes, At What Depth~ Looation Sketch Reading Date Gross Time Net Time Depth To H20 Net Drop ercola~ion ,ate 'Minute' , Proposed Instal~Seepage P~t c--- Drain Field Depth Of Inlet ;{ ~ Depth To Bottom 0'~ Pit Or Trenc~ COMMENTS: .... f4c,~' ,~ .~ ~'~' ~/~1., , - ..... Test Performed Data Certified By: ~ ~ ~. Date: Municipality of Anchorage • On-Site Water and Wastewater Program (907) 343-79041.` S f f t T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-172-31 Expiration Date: (r 1. GENERAL INFORMATION Complete legal description T15N R1W Section 18 Lot 98 Location (site address) 19932 Adrian Ave Current Property owner(s) Hall Day phone 240-4255 Mailing address same Real Estate Agent Owner Day phone 240-4255 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) OCT lb i.u,. ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 6 ti i °I 6 8 La 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: Date: /O//,�,% COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 52L Date: Date of Payment 101I4'/18 Date of Payment Receipt Number G CIO '30 Receipt Number COSA# �5(' ' (JJ� 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724,Eagle River Engineer's Printed Name Steve Eng Date 10/16/2018 • • 4 '' 6. DSD SIGNATURE """" - System #1 Approved for E bedrooms. �. , System #2 Approved for bedrooms. vi� /(�•` : `9 Disapproved. a�F o�•° -- .T_J Conditional approval for bedrooms, with the following stipulations": ,Y ur Ah, ON-SITE -57- WATER vWATER AND 't=. n3 WASTEWATER Z= p PROGRAM o: 0q - • SERV1�Fc,� Original Certificate Date: /C 1 7 -/ The Municipality of Anchorage 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.doc 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: T/54i ,1 /t J SEL' 8 LO l 78 Parcel I D:05 I/72 31 A. WELL DATA Well type P If A, B, or C provide PWSID# Well Log (Y/N) Date completed /7 7/ Sanitary seal (Y/N) y Wires properly protected (YIN) Total depth l 5 ft. Cased to 15 ft. Casing height(above ground) / 2 in. FROM WELL LOG AT INSPECTION Date of test /4/55/4 Static water level ft. /k, , v ft. Well production g.p.m. —f— g.p.m. WATER SAMPLE RESULTS: AA Coliform 0 colonies/100 mL Nitrate Al U mg/L Arsenic /`(U ug/L Date of sample: /c/'2//F Collected by: /V ( t PI, Ey. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sr_PT!C.-/ST I5EL Date installed P/2 3/1 ? Tank size /0 00 gal. Number of Compartments Z Cleanouts (Y/N) Foundation cleanout(Y/N) y Depression over tank(Y/N) AV High water alarm (Y/N)Date of pumping Nc.U1 Pumper C. ABSORPTION FIELD DATA Stix Date installed P123717 Soil rating (g.p.d./ft2 or ft2lbdrm) • 2 System type �d'etc-r4 Length b7 ft. Width 5 ft. Gravel below pipe " -S ft. Total depth 5 ft. Eff. absorption area 3? / ft2 Monitoring tube y Depression over field Alec-3tuDate of adequacy test A�EResults (Pass/Fail) !'" For 3 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.) (Y/N &type) If yes, give date D. LIFT STATION A/A 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: Septic tank/lift station on lot ZOO"* On adjacent lots /00 + Absorption field on lot /CJ a ,� On adjacent lots /1,0 O 'fi Public sewer main /00 (f Public sewer manhole/cleanout /00 ,f' e Sewer/septic service line 2' 5 -F Holding tank /00 (74. Animal containment areas 5� "F" Manure/animal excrete storage areas /70' rf` SEPTIC/HOLDING TANK ON LOT TO: Building foundation l o e-i- Property line /`0 ''T Absorption field /0 (4" Water main /aF'- Water service line /0 fi Surface water /QO' 14- Wells 4Wells on adjacent lots /0 0 'I-- ABSORPTION FIELD ON LOT TO: Property line /0 "f Building foundation /0 (I' Water main /0 / 11- Water Service line /0 k7- ( Surface water /00 'f Driveway, parking/vehicle storage /0 r Curtain drain S0 i Wells on adjacent lots 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 (S-i if:476 IIII Date /G��V// /;C/to • COSA yellow sheet_2-6-15.doc 4---.7..<-„,---- �Z79 i9•C %/1/ .977E ,r Y•3 f'O�•i/T /'0e" 41k• - •• A"' EI -_• f ---- /t= ` . /0 • /- A. 0 1.r • / t 1 1 b fill 6t. i . � F .4 •` ll % ii`. 6 • /Z_'X/6'' 4 c ./..442 1 AZO .+. D D`•� 1 \, \ f - I . N1 I • 6PFr • •f w A Y 1 _wrf 1 Gr'x • H O 1 X .ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 • I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: _v,osasaAO FOLLOWING DESCRIBED PROPERTY: 07 OF A 1 ',! 2-^ sE-- - 7 -V �i�.i��/ DATE: �Q- .•' , •. t.S',�_b AND THAT NO ENCROACHMENTS EXIST EXCEPT AS /‘' ,- 1/4'' or s ,, 4 INDICATED. IT IS THE RESPONSIBILITY OF THE * ;' a-f.) -• ti * $ OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: 0 d EASEMENTS, COVENANTS, OR RESTRICTIONS "ice-s's f , ;%, :l•des•. •. WHICH DO NOT APPEAR ON THE RECORDED SUBDI- �j ; Duane Mark 9ewerd VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' 9�_ �z $ •. LS-*IV; `5' ANY DATA HEREON BE USED FOR CONSTRUCTION - t'`.*:••'d � `P + OF FENCE LINES, OR FOR ESTABLISHING BOUND ' `.3•••.- ARY LINES. DRAWN: ��x �'� • ' '- Municipality of Anchorage ~.~'4- ~,~L~.~?] Building Safety DMsion ~ On-Site Water and Wastewst~r Program 47C0 Sou~ Emgaw SL P.O. Box lg6650 Anchorage, AK 99519~650 v~.ci.anchomge.ak, us (907) CERTIFICATE OF HEALTH AUTHORITY APPRO%~t. FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. Expiration Date: GENERAL INFORMATION Completelegaldescription LoT' cl~I ,~3~'C. I~t"~ I'~l"-.I,~ '~::~ Locat~cn (site address or directions) I, c{ c:[~ ~,~t~ 1'4 Current Property owner(s) '~ o..~..~, ~.~-'L,.-~,.. 'I'Yt~cL~. Day phon~ ~ t~- ~t..~..,"~, Mailing address ~.0 -~,=b4 77 0 Iql E r~ 9q677-' cbtql Lending aoency Mailing address Real Estate Agent Day phqne Day phone _G ~ ~ ,."' Mai!lng Address Unless otherwise requested, HAA w;ll bo held by DSD for pickup. NUMBER OF BEDROOMS: .~ 3. TYPE OF WATER SUPPLY: ' Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Indivldua! Holding tank Community On-site Public Sewer The Municipality of Anchorage Deve;opment Services Department (DSD) ~s~ues Certi,Scates of Health Authority Approval (HAA) based only upon the representations given in paragrapn 4 by an ~c, dependent professional civil engineer registered in the State of Al,~ska. Certificates of Has!th Authority Appr~v=i ere required fcr the transfer of flue (except beb,veen spouses) for Froperties served by a singte-f.~mily on-site w~st.o, water dispos31 and/or w.~ter supply system. DSD also issues HAAs u[con request to homeowners. Certificates cf Health Authority Approval are valid for 90 days from the date of issue fcr propeffJes served by a prfzete cr Class C well and may be reissued with new water sample result--. (Certificates may be reissue3 fcra I~¢dcd of up to cna year with valid water samples.) Certificates are valid for eno year for properties se~'zed by Ciasa Acr B we!Is er a public water system, The Municipality of Anchorage is not responsible for errors or omissions in the profes...icnal engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As ce.~fied by my seal affixed hereto and as of me validation date shown be!ow, I vedf7 thst my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this applicaticn, shews that the site water supply and/or wastawater disposal system is(ara) safe, func'Jonal and adequate for the number of bedrooms and type of structure indicated herein. I ~rther verify that based on the infermaticn 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 Sb3te c~des, ordinances, and regulations in effect at the time of installation. NameofFirm ! ~bJ,.~ ~,,~.r'~...~:x.,,~.~:~.K."~ Address .~0 7> ~ I ~1.~,.~ 14. ~ .~ Engineer's Printed Name "'i"~/, J3-e..~_ ~~ Phone 7q- Date "'/- ~- Z- -D 7__. ~; .~,-'-/..,"- .; .- :. DSD SIGNATURE ~"~'~.~, T,~-,.-.*.--,-'!,.,~ * -..:.:.' Approved for ~ -~ bedrooms, t,. -...,'~, c: ;:.-.~ .,...:..-.;. , .... ..::..:,.," , Disapproved. . -,~,, :...'. ,':....,. . Conditional approval for bedrooms, with the following stipulations- -' Additional Comments ~ : WASTEWATER : ~ <0~, ~C~.~, :9 Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: Odginal Certificate Date: MuniCipality of Anchorage Development Services Department Bulldlng Safety OIv~inn On.~ Water & Wastewater Program 4700 8oulh 8ragaw St P.O. 8ax ~g6850 Anchorage, AK gg$'lg-6650 www.cLenchorage.ek, us Legal Descflplion: A. WELL DATA Wa, Date completed HEALTH AUTHORITY APPROVAL CHECKLIST IfA, B, otc provide PWSID # ~_~//~- Wall log (Y/N) Sanlte~ eeal (Y/N)..~ FROM WELL LOG Cate of test Static water level Wall production WATER SAMPLE RESULTS: Arsenic: O. oO b~mg.a. e. SEFTIC/NOLDING TANK OATA g.p.m, Date of sample: __ Tank size j.~ gal. Wires properly protected (Y/N) Casing height (atxwe ground) AT INSPECTION Ce Other bacteria in. g.p.m. I ¢~ colonies/100 mi. 4¢ Number of Compartments Foundaltun cleanout (Y/N) '-/ cate of pumping ~, ~ ABSORPTION FIELD DATA Depression over tank Pumper '-I /q /'~ Date installed I q 7 I c~no= (Y/N) High water alarm (Y/N) txi cam~te,ed IqTI so, rad.g (g:p,d-JR~'ore/tx:lrm) ~ Systemtype J,~ Length l,P,. lt. Width ,~-,i It Gravel below pipe ~ lt. Total depth ~ ft. Eft. absorption area ,,9~8 ~ Monitoring ~pe y Depression over field Fluid depth in absorption field before testlt-') in. Water added Io~r_~ gal. New depth /'/_~ in. ~sed~-~ne: ,~.1 ~.~ · Final fiuld depth ~ zJn. At~sorpfion rate >- ~/~'O g.p.d. Any rejuvenation tm..alznent (pest 12 mo.) (Y/N & type) N If yes, give date O. UF'F. STATION /Iz Manh~~. Date installed · in gallons (Y/N) 'Pump on' level at ~/'fn. 'Pump off level at In./.Righ wa~r alarm level at Datum / Cyol. tested J~ Meets elam9 & ~Jtt reqUirements? E. SEPARATION DISTANCES in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankalff station on lot Absorption field on lot Pufilic sewer main Sewer/septic se~ce line On adjacent lots On adjacent lots Public cewer manhole/oleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots Pmpe~ line ._~ Water sen, ice line ~- Abeoq~on field Surface water SEPARATION DISTANCE FROM ABSORP'F1ON FIELD ON LOT TO: Property line. wmr Service Curtain drain Building foundation '7~. . Water main Sutfacewater I~'1-O. Ddveway, paddng/veNclestorage: ~'O Wells on adjacent lots ~71 e ~7 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through fleldinspectinns and review of Municipal recon~s that the above systems am in conformance with MOA HAA guidelines in effect on this date. E.gin. . .am, HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number £va Loken ASI~U~L? FOLLOW;NO DESCRIBED PROPERTY, -' ' DATE: ~N~ ~ D~ERHIN[ THE EXIS~ OF ANY ~ENTS, COVENANTS~ OR RES~I~IONS WHICH ~ NOT ~PEAR ON THC RE~ VISION P~T. UNO~ NO C{RCUMSTANCE$ S~ ~Y ~ATA H~EON BE US~ ~ CONDUCTION ~ FENC[ LINE~ OR ~R EST~LISHING AEY LINES. D~AWN~