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HomeMy WebLinkAboutDENALI HEIGHTS LT 3Denali H ight Lot #068-03! -03 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201373 PID Number: 068-031-03 Dwelling: © Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name Kenneth Magwire AORPTION FIELD E01 D Trench ElWide Trench ❑ Bed ound Site Address 3743 Cotton Grass Dr. Other Phone Number of Bedrooms Soil Rating Total>10111'original grade .907-863-3230 3 ISF Ft. LEGAL DESCRIPTION Depth to pipe invert from original e Gravel depth beneath pipe Ft. Subdivision Block Lot Denali Hts 3 Fill added above original gr Ft Gr I length Ft Township Range Section Gravel width Ft. Beds: Number of Lines Dist between lines Ft. SEPARATION DISTANCES To Septic Absorption 1Lift Holding Sewer Total orption area Number of trenches Dist. between hes From Tank Station Field I Tank Line Ft2 Well 1.00+ j TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100+ i GREER 1000 Gal. Material Number of compartments Lot Line 5+ ; NA Plastic 2 Foundation 10+ ATION Manufacturer Capacity Remarks Gal. Alarm location Elects lied by Installer PIPE MATERIAL House to tank Tankto D3034 drainfield D3034 JR's Excavation Drainfield CO/MT D3034 .In Areterra Consulting BENCH MARK (Assumed elevation) 100 ft inspection Location and description dates: 10/15/20 2"d 10/16/20 3'd 4'h Garage door frame ON-SITE WATER AND WASTEWATER. SECTION APPROVAL Engineer's Stamp Conditional Approval: Date e : `'"` :' � A. Septic System Approve-0Date 1 �2 Note: this approval does not include well permit requirements.5 kr1cv vorucr rod AS -BUILT SYSTEM DETAILS/SITE PLAN Permit OSP201373 DENALI HEIGHTS LOT 3 PID# 068-031-03 ­..._._....___.__ ... .... .... --.-.1... ------- u cz A—C=76.7' 1.NEW 1000 GAL TANK B—C=80,0' 91.68 91.68 A—D=80,4' B—D=82.5' Aa A—E=72.8' B—E=76.3' A—F=73.9' '63 of B—F=77.5' A—G=82.4' 1000 GAL B—G=84 1' A—H=83.3 SEPTIC B—H=84,8' TANK M86.8186.64 OF A, PREPARED FOR: KENNETH MAGWIRE 3743 COTTON GRASS DRIVE 9T EAGLE RIVER, AK 1. IORMTH M. S FIELD BOOKS COMPUTED: 6 f 'N/A CE -711 BOUNDARY: DRAWN y- KSD 1,1v STMN G: N /A CHECKED: KMD AMU- DAM 10/21/21 DWG. nLF-- GR10- SW759 ACRD MLE: FILE 'M No' 20186 Fflp.d Rv 1Pnn1/nAnnN'HA;nh+c/1n+ 119MRF; SCALE, I' = 50' SCALE, NTS Replace V.2.dwg 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 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201373 Work Type: SepticTank Upgrade Tax Code Number: 06803103000 Site Legal Address: DENALI HEIGHTS LT 3 G:0759 Site Mailing Address: 3743 COTTON GRASS DR, Eagle River Owner: MAGWIRE KENNETH L Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: 9111/2020 9/11/2021 Lot Size in Sq Ft: 217974 Total Bedrooms: 3 ❑ 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 Received By: �. % &� Date: Issued By: DEb WOoXor)4 Ass Date: 9/11120 MUNICIPALITY F tr`Y Development Services Department On -Site Water & Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 068-031-03 Property owner(s) Kenneth Magwire Day phone Mailing address PO Box 771143, Eagle River, AK Site address 3743 Cotton Grass Dr., Eagle River, AK Legal description (Sub'd., Block & Lot) Denali Hts Lot 3 Legal description (Township, Range & Section) Lot Size 217,974 Sq. Ft. Number of Bedrooms 3 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank ® Upgrade 0 ❑ (D) Holding Tank ❑ Renewal ElDuplex 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. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: -0070 GUU Date of Payment: 1 D a2d,�0 Receipt Number: ©7q 7 G Permit No. 05 P 2D 1. 73 Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201373, Deb Wockenfuss, 09/11/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201373, Deb Wockenfuss, 09/11/20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES 06F-031 0 3 Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON—SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Fi DISTp NCES 12 I S7 TO SEPTIC ABSORPTION Address FROM TANK FIELD WELL O l Ml I Phone(s) to G14 — 5791 7 Permit No. z> 3 No. of Bedrooms 3 WCL D OQ i - — 4- 10 LOT LINE 1d— 1 1 �•' LEGAL DESCRIPTION Lot Block Subdivision FOUNDATION -�� 117 gat Depth to pipe bottom from original grade FT Township, Range, Section ` 1 �-� N AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway, water bodies, etc.) TANKS � 1 a n . .1_111 Fill added above original grade A FT SEPTIC ❑ HOLDING I Manufacturer / Capacity in gallons Material No. of Compartments �Glzt� '2— TYPE TYPE OF SYSTEM ❑ TRENCH ❑ BED 9 W. DRAIN ❑ OTHER Depth to pipe bottom from original grade FT Total depth from original grade FT r � Fill added above original grade A FT Gravel depth beneath pipe 3 FT Sj r Gravel length 4 FT Gravel width S FT Total absorption area 47 -()SQ FT Distance between lines SIA FT Number of lines Soil rating SOFT Pipe material FVe— AI-STtA 0 —2 Installer `' c S a r�sT .I Date Installed I& - WELLS ❑ PRIVATE ❑ OTHER (Idem itvl Classification (A,B,C) rlET Total Depth FT Cased to FT Installer Date Installed: REMARKS: a IN 95111111111 NERMENV E MEMM ME REMEN"Mm WMENNINUM NNERMINFRE IMEMIM1100 !�JMf�NNIM ■ MMENE11100 NEWEEMME Scale: •jV ' ? InspectiioonsPerformed by: Date: cn� I P,. S`ENGINEER'NG' ' certify that thi inspe 'on was performed according to all �3S uggIc Iziv6r_ Cool ROad X-C. 204 Municipal a 5[�te 41 delines i;�eif" gl� bja��at�: r^.JFJ- - IVEIrr c l Health Department Approval: &i z 9. Date: ,2 — a O 7P-013 (3/85) ENGINEER's SEAL ..� s �'Ti'�� .,r1 i ,P_iY t.� "•DIY mob= °": cz � � .', ��'f• _ ° �,, Ya '! Or• '.�HQLrO — n032 ��C ,T9^'fin JO O Y ..NZ,. va4 au a.u. naa�u io OffII �'C c «„ ;�oGer'r d. 5�6c+,-fEt• a tr i ivy,. LQL'7 d PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 14 17 18 20 Township, Range, Section:'""r'l~ , ~, ~, ~~.~ SLOPE SITE'PLAN t DEPTH? p - Depth to Water After t Monitoring? ~,, ~ Date: '~> Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ AND FT COMMENTS /' / Eagle River, Alaska 99577 - / / ,,cco.o,,r~c~ W,~-H,,._ S~',,~'~,,,~O.U,,,,C,~^, ~,0~.,~~/~ O~ ~H,~ 0^~. 72-008 (Rev. 4/85) • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s F r T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 068-031-03 Expiration Date: 1. GENERAL INFORMATION Complete legal description Denali Heights Lot 3 Location (site address) 3743 Cottengrass Dr. Eagle River, AK Current Property owner(s) Ken Magwire Day phone Mailing address 3743 Cottengrass Dr. Eagle River, AK Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless btherwise requested by the engineer. COSA Fee $ l �F 50 60V Date of Payment 10/ Receipt Numbe��rqq 0 1 V 3 G COSA# sc�a 159 3 Waiver Fee $ Date of Payment Receipt Number 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 ARCTERRA CONSULTING, INC. Phone 696-6111 Address 2044.1 PTARMIGAN BLVD.. EAGLE RIVER. AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date /o -� Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assess ent of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption. rates may change due to subsurface conditions that may not be observed from the surface, changes]nland use, local soil characteristics, groundwater levels that may fluctuate during the year and the wafer usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give.any estimate of how long a system will function satisfactory for current or future 4+t\ occupants or can ArcTerra guarantee that no unseen OF' AL\ encroachments, deficiencies or discrepancies exist. q 6. DSD SIGNATURE KEN System #1 Approved for bedrooms. �4�`�.raE 1 System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the followi`r�i�ati�r g WATER ARID lrJASTLv'A o J -Jq�-cA�- .r r-\ 0 Original Certificate Date:. -I '-2 62-07 The Municipality of Anchorage Development Services. Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon.the,representations given in paragraph 5-byan.independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage isnot responsible for errtors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheer 10-10-12.doo X Nitrate Advisory Arsenic Advisory Other Legal Description: Denali Heights Lot Parcel ID: 068-031-03 If more than 1 septic system on tot: COSA Checklist # of Structure served by this system A. WELL DATA Adequacy test date 9/8/20 FN Well log is filed with Onsite (or attached) Well production at time of test 4.0 gpm Date drilled 9/1990 Water storage tank volume gallons Total depth 145 ft Well disinfected for coliform test? ❑ Yes _ Nc Cased to 138 ft 01 Coliform bacteria is Negative Sanitary seal is functioning correctly Nitrate 1.01 mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ME Arsenic less.than MRL (ND) Casing height (above ground) 24 in. Collected by Areterra Consulting Date of flow test for COSA 9/8/20 Date of Sample . 9/11/20 Static water level at beginning of test 80 ft. Absorption rate 450+ gpd Comments Any rejuvenation treatment (past 12 months) B. TANK DATA T STATION Age of tank(s) New* years ❑ Requir aintenance completed Tank type/material Septic/Plastic Age of lift station years Measured operating fluid level in septic tank New- Lift station material Standpipes/foundation cleanout per record drawing Comments: Date of pumping : New Installed 10/15/20 D. ABSORPTION FIELD DATA Which system tested (date installed) 8127/90 Adequacy test date 9/8/20 ALL standpipes present per record drawing Results Q Pass For 3 bedrooms Total measured depth from grade 5.5" ft (max) Fluid depth prior to test 17 in Measured depth to pipe invert from grade 2.5 ft (min) Water added 450 gal ❑ NIA — pressurized field New depth 19 in Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time 30 min Code -required soil cover over field Final fluid depth 17 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: ":Marked insulated on previous COSA COSA Checklist yellow sheet E. SEPARATION DISTANCES . From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' V1 Yes if No ft Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water> 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certifythat 1 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. COSA Checklist yellow sheet G LLC N00'07'23"W 500.72'co y 0 v. O CQ P '� 11-12 CR -2 z O o T O o 0 M— f- W Ld z co Lo oo co 00 AW N00"07 23 W ®�•, 3aoM O Zs nolqz c o x30 0 n `JI�t(j.Scd 'O.Oe N p F^ �7.. �3� .Q" y �y m N CO J or- VJ .o•zi N a > O v 10Q ; 4 •V O H030 X030 S r. U Z o c o 0 no >13 o `a - u' a z �� A c00n °��, '= o 3 p 04 oOL ,ZC) �v oo v c o o 0.-ato o Nw� a0e, 1WS3 3)&1,5l W® J W a o . 6, o op 3 - � Q v �, .� aci y � � ca R O ,L6 •a �9 o �oz -0 oaG m 0.4 w G z ° W 0) 2�a SSb�10 NO1100 v H > o _ a .Y ` o Municipality of Anchorage Dev. elopment Services Department ; ,.~ ': ;. ~ ~.,.: .Building Safety Divisiqn :, . · ~ · .. '.. ,' i~ ii ~,; . · On-S te Water and WasteWater Program '.. . '. ', ..... ..,. - .:~ ;..-,, , ..~ , ~4700 South Bragaw SL ,. .. ....... P.O. Box 196650 :Anchorage, AK 99519-6650 ..... ~ ' -~ ,www.ci.anchorage.ak.us . (907) 343 7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING /I-7-o/ Expiration Date: .Lot 3 Denali Heights Parcel I.D. 1; GENERAL INFORMATION "Com~letelegaldescription .... Location (site address or directions) -: Current Property owner(s) "-~M I'i address Lending agency Mailing address Jan Wilk'le Dayphone 696-/,550 Day phone Kathy Gera6i/Greatland Dayphone 694-9125 Real Estate Agent ...:"'MailingAddress 11411 Old Glen H~¥ Eagle River, Al( 99577 :' Unless otherwise ~q~ested, HAA will be held by DSO for pickup. 2. NUMBER OF Bi~DhooMs: ~ TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class .~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of AJaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties sewed by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Cedificates 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 may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. · STATEMENT OF INSPECTION ..,. ENGINEER ' v;...{ .~ ~,j,j,. ,, .-. · ...... " d he f ~e v n d wn b rify th y i t'-g' ~ As certified by my seal affixe reto end as o alidatio ate she elow, Ive at m nves aeon, Ith Auth dty'App va[ G Id~tin'~s f applicati ho'wi' th ' § th6 H o re u or this on, s at the ba ed cn procedures outlined in ea 6n-~ite water supply and/or wastewater disp'&~al.~y'stem Is(:~)%afc; ~un~tional and ~dequat6 for 11],~ nu'mber of bedrooms and type of structure indicated he~'eid.'l further' verify that b~s&d 'dn the infoAmation obtmned from the Municipality of Anchorage flies and from'm~,'~lnvestigation and ~tnspectlon,. the on-site water supply and/or waste'water dispo§al system is(are) in Complian~ Wi~ all applicable Munl~cip~len~ ~tate codes, ordinadces/ and regulations in effect at the ~me of installation. .... ' "': .... ~-' ; '~ :'' .... ' ....... ~'"~' 6~9 ..... ;Phone -2979 NameofFirm S & S En,~'ineer'inp; Address 17034 North R~lP R~vPr' ~,~nn? Fm~lp ~Iver, AK 99577 Engineer's Printed Name Robert- C. Cowan P.E. - ~'- .;Date,,~ July..,25,-,2001 ; ~ '~ -- ..~ ~ . . , ' · ..,.--,~'.'~ ,,'~c ~,~. " '~ : . . (? .... :,-.~' :'r ' ,,,.. _,' ~' · ' Disappr, ov. ed,..... Conditional approval for ' ' .' -' I~edr(~o~', ~ith-th~'following stlpu at~ons:' ' Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Mainten:~nce Agreements Supplemental Engineer's Report Other By: ~~,/ ~.~, po.~ Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 wvw.cl.enchoroge.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST WELL DATA · Well type ~.Iy',A Date completed Total depth parce~o: 0¢$' D3/-o 3 Date of test Static water level Well production If A, B, or C provide PWSID San~ary se~ (YIN) Well Log (Y/N) ~ Wires properly protected (Y/N) Casing height (above ground) FROM WELL LOG AT INSPECTION ~ g.p.m. ~[' ~'' g.p,m. WATER SAMPLE RESULTS: Coliform O colonies/100 mi. o.te of ..mp,e: B. sEPTIc/HOLDING TANK DATA Nitrate 0- ~°-I~mg~I. Othe~ bacteria · . ~Tank Type/Material "' Tank raze · gal. O colonies/100 mi. Foundation cleanout (Y/N) Date of pumping 'lO/aP c. ABSORPTION FIELD DATA Date installed ~_/,) ' Length ~'~ ' fl. Date installed Cleanouts (Y/N, Depression over tank (Y/N) ~ 0 High water alarm (Y/N) /~//,~' Pumper ~"-~[~ t5 Width '~' ft. Gravel below pipe ~ ff. Totaldepth..~._._~'~fl. Eff. abs~pfionarea ~ 'l~ionltoringtub, ~ Deprassion~erfiald~ ~ Dateofad.uacyt., ~/~/0] Resul.(P.~Fall, ~' For ~ b.room, Fluid dep~ in abs~fi~ fl~d bef~ t.t/0.~. Wa~r edded~. N~ depthl~in. Elapsed Time:J 3 ~ m~. Fin~ fluid depth l~.~in. ~sorption ram >= ~ g.p.d. ~y rejuvenati~ ~b.ent (p~t 12 ~.) (YIN & ~e) ~ 0 If y~, gna date ~ D. UFT STATION Date installed /,/ /~ SEPARATION DISTANCES Size in gallons 'Pump off' level at in. Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & clmuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/II--an lot Absorption field on lot / ~ ~ /*/'- Public sewer main /~//~d~ S..qwe/~septic servloe line ~*.~ /-,~ .. On adjacent lots On adjacent lots Public sewer rnsnhale/deanout ,%/,///'~1c Holding tank /V/~ SEPARATION DISTANCES FROM SEPTIC/H~,Bf~TANK ON LOTTO: Building foundation ~ ~' Property line ~ W' Absorption field ~" ~' Watermaln--/'*//,~1~ Water se~'ice line //{~/'/"' Surface water Welts on adjacent ints /4~O SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /'(2 / *' /,,~. -A- Building foundation / 0./~. Water main Water Service line ~/0 /.e- Surface water /~:~2//... D~eway, parking/vehicle storage Curtain drain/I/~VL~- ~..~,/~"q/~/Wells on adjacent lots /~/7/-'- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have dete~nined through field inspections and review of Municipal mcorcis that the above systems am/n conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name ~ ~,~c/LT' ~. C~ t~4~ Date '7/~. ,y'/~ i HAAFee S 3 ~. ~"~ Date of Payment "7 / ~ -~ / o I Receipt Number (9 o '~ ~' ~f I ~. (~. 1~) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~(~'"~:~ ~ '1~_~ ~ - ~.-.~ Naa # ~F~ i~ ~ \ ~-~("'~ ~' 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3; Denali Heights Location (address or directions) NHN Cotton Grass D~,~.ve (b) Property owner Mailing Address (c) Lending Institution Mailing Address Dis ot~ll Construction Telephone · (home) P.O.Box 770210 Eagle River, Alaska 99577 Business Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here E]~ if hold for pick up.) List contact person and day phone number bblow: S & S ENGINEERING 17034 Ea,31e Ri~ver Loop Road No. 2~ Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family J~ Number of bedrooms 3. WATER SUPPLY Individual Well (~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site E:X Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 Ad dress Date $ ¢, ~ ::~GINEERING ', 7'034 Eagle River Loop Road No. 204 Eagle River, Alaska '~'~5~ Telephone 6. DHHS APpROvAL Approv_ed for ' bedrooms by Approved Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Sack Page 2 of 2 ~.~,~ MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) '~" CHECKLIST - FEBRUARY 1984 ENVIR 32.-, ': .... u~,,=,~;~ 343-4744 MAR 2 7 1991 Legal Description: ,/~ ~,~ ;.J~.lO~/l' A. WELL DATAR E C E IV E D Well Log Present (Y/N) ~ Date Completed Total Depth I~-~ Cased to Static Water Level ~ ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot / To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Depth of Grouting Comments If A, B, C, D.E.C. Approved (Y/N) ~'/~'O Yield Pump Set At L2 ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Nearest Public Sewer Cleanout/Manhole I ; On Adjoining Lots ; On Adjoining Lots B. SEPTIC/HOLDING TANK DATA Datelnstalled ~-ZT-~OSize [f)r"~D~/ Standpipes (Y/N) C~ Air-tight Caps (Y/N) Depression over Tank (Y/N) /~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~/~A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line [ C~ /'~ To Stream, Pond, Lake or Major Drainage Course Comments No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped /,~//A ;for / Temporary Holding Tank Permit (Y/N) / To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed _~- ~ '-~ Width of Field ~' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ~ ~/'/ Depth of Field ~ Gravel Bed Thickness ~ Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ,/r_q~ -~ To Building Foundation (~5~ Lot /r~/~A ~ To Water Main/Service Line ,/ {~ ~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ! To Property Line [ O 'lc ; On Adjoining Lots To Cutback (if present) I (oo d' To Existing or Abandoned System on ! Comments D. LIFT STATION Date Installed ~ Dimensions Size in Gallons ~ Manhole/Access (Y/N) "Pump On" Level at ~. "Pump Off" Level at High Water Alarm Level at /~)'N~j//~ Vent(Y/N)_ Tested for ' ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) "~ Comments ~ **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date ~ & 5 ~NGINEEE[NG 7034 Eagl~ Ri¥~r Loop Road No. 204 Eagle River, Aia=k, ;~$77 MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 OWNER OF LAND ADDRESS _~ _~ Doc co. MAR 2 It 1991 SULLIVAN WATER Health & Human Services P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688.2759. LEGAL DESCRIPTION DATE- Started · PERMIT NUMBER ! DEPTH OF WELL ./~-?/_ STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From:~_ ' · Ft. to O~ FrOm ~. Ft. to ~ Cl From ' ' Ft. FrOm':: :'." Ft. to _ Ft. I~T ~t~ [ ~/ From__ Ft.~--6 ~/ ~dd~ From Ft. ~ From. -Fr°m Ft. to Ft~ From From · Ft. to Ft. From From Ft. to From' · ' FLto F~om Ft. to From' Ft. to From':::,: ' Ft: t° Ft From Ft. From Ft From Ft. From Ft. From Ft. From Ft. From Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft~ Ft. to Ft. Ft. to Ft. · Ft. to · Ft.. Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to, . Ft. Ft. to Ft Ft. to Ft. Ft. to Ft. Ft. to Ft. ,Ft. to, Ft~ DRILLER'S NAME