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HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 4 LT 16 PERMIT NO. FqU[4 I C I PAL I T~r' OF A[4CHOF:AGE DEPARTMENT oF~-~EALTH AND EH'¢IRONMEHTAL P?~TECTION 825 'L' STREET, ANCHORAGE, AK. 995~- 264-472~ Ot4--S Z TE SEHER LIPOE:RDE PERI~ I T 788661 ) RPPLICRNT LOCATION LEGAL LARRY KOCH 3607 E. 67TH Ll6 B4 CAMPBELL HTS S?D ~607 E. 67TH LOT SIZE 349 3245 0 SOUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: PIT MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR>= 0 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMEHSION IS THE LENGTH (IN FEET> OF EACH SIDE FOR 8 SEEPAGE PIT. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETHEEH THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION <IN FEET). THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IH FEET), REI~LI I RED SEPT I C TCt[4F( S I ZE----- '~ 25~-~ G~:tLLOf-IS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMEHT DURIHG THE INSTALLATION INSPECTIONS OF ANY WELLS RDJRCEHT TO THIS PROPERTY AND THE NUMBER OF RESIDEHCES THAT THE WELL WILL SERVE. TI40 ( ¢ > I t4--<:;PECT I 014S ARE REC~.L: I RED BACKFILLING OF ANY 'SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPRP, TMEN~ HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETHEEN R HELL AND ANY ON-SITE SEHRGE DISPOSAL SYSTEM IS t00 FEET FOR R PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER IHSTRLLRTION. PERtd ! T E×P I RES DECEr4BER --?--~L.. :L_'~- 78 I CERTIFY THAT l: I RM FAMILIAR HITH THE REOUIREMENTS FOR ON-SITE SEWERS AND HELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLRROEMEHT IF THE RESIDENCE IS REMODELED TO IHCLUDE MORE THAN 4 BEDROOMS. iSSUED BY .......... V3. 2 ...... P.O. Box 196650 Anchorage, Alaska 99519-6650 , . . ..~ .. ~ '.. ,: ;.: ' 343-4744 -_" · ' cERTIFICATE OF HEALTH AUTHORITY . ' APPROVAL FOR A SINGLE FAMILY DWELLING ~ . MUNICIPALITYOFANCHORAGE : :'...~ ::.,'."/,-","-~ (~') ' DEPARTMENT OF HF.~. LTH & HUMAN SERVICES. ~____~' ;~,,; ~'~::~> Division of Environmental Services ':: .,~'~...:~- .,On-SlteServlcesSecflon . ,. · .. ;:,.:;: '.'. ':' Parcel I.D. # ~'~ 0"7~ ' '" -- ; I ',-~" HAA # M A · '1.- GENERAL'* INFORMATION ;-'": ..? ..-.E: ::,. -." .; .-' - ................. CcJwpb~. H~,Kq/.'~t~ · , Complete Itu3al description' 1.o~.t~ ll~octz ~t ' ' ' ~ Location (si~e .address or directions) 07 E. ~7gt · .... ":- A,Cho~c~cl¢~ A~ Pr(~pertyowner 'A~/GKA U.S.A. FEI). CREDZT ~NION Dayphone 786-~109 P.O. Box. 196615 Ancho~,'/~e, Al( 99519 Day phone Mailing address Lending agency' M:~lling ....,., ,.,~'" '"" · Aoent ?' ' .... -: ..... Day phone · ',~ '" ". ........ .,.i:.%: - /~QQr~ss · , .~ ,. . ~....., . '- !";:' Unless, otherwt,se requested, HAA will be held forptckup. - "· /'~:' --':. ~:~.:. fO c. ,~, ~ ..... ,,..?,*~'.,...~ ...... ,..,. ............. ,..1.. ..d'.~ , ..... '-;2,. NUMBER OF BEDROO..M.S:.:' '*~ ' .~,,~, ~t,*' *~.~..~ ~:.'-<:~'.".;'~i:~ " ' · . .,'~. ' '"-'~";''=. ' .... '- ' .,'," ~...,,',,. ' ',- I~I' ,-, o. · ..., J ....,, ,.,.~. , 3. TYPE OF WATER SUPPLY: . ..,, ',,'~.,.',, , ~ Individual,well YJ(X "-.:Vr~ ~: ?,,,~\'~% ~..~", - ' Community well .-...; . . o .., ._.,.:.: ~ .;,' ,.',::.:~:. ~ ~, . -:-- --':' :-"-. ':' '-- ...... P~ bli'E~.'t ~'F If community well.system, provide written confirmation from State ADEC attests~': :~ 'c,~ ................. lng to the legality and status of system. .................. ..... - . ~..,. .......... .... . .., , '~ ...... ,~, .'. 4:'--TYPE OF WASTEWATER DISPOSAL: ---. -, ........... : ~ .... ~ .- .... ..:.. ,. .... · ' '"' In_.vtdual on-site . . · .. .... ' ~' -.- ..... ,,.: ............... Holding tank ~-,..-. ............. - . -~ ....... - , ........... Community on-s te ''~ ............ · ! ....~ "~ ~3'~'"'Y"'~':'"":. ':' ~: .- ' · ~c,i ~ NOTE: ,~. If communitytw..~as, tewater system, prowde written confirmation from State ADEC :' :L :'),-; ..... .,-. '... ~-attestinot~the~egahtyandstatus~fsystam-C~;.~``~.-~c`~1~t~r~`.A~`~::~[ 5. STATEMENT OF INSPECTION BY ENGI~I~'£R ~ ~ '~'~ '" *~'' *':~ ~ As ce~ifi~ by my s~l affix~ hereto and as of the ~lidatio~ date shown*~i°w, I vert~ th~ my lnv~tigation of this Health A~hoH~ Approval appli~tion sho~ that the on-site water supply an~or wastewater dis~l s~tem is ~fe, functional and ad~uate for the numar of ~r~ms and ~ of stratum Indi~t~ herein. I fu~her veH~ that bas~ on the Info~ation ob~in~ ~om the Municipali~ of Anchorage fll~ and from my Inv~tigation and Ins~ion, the on~ite water supply a~Wor waste~ter dis~l s~tem Is In compliance ~ith all Municipal and S~te c~es, ordinances, and ~ulations in eff~ on the date of this ins~ion. Name of R~ s & s ENGINEERING Phone. ~ ~ Y- ~ ~ ~ 170~ E~le Riv~ L~p R~d Addre~ Engin~fssignature . . . ' D~te. :J~/~ 6. DHHS SIGNATURE '; ,.' , ~,~ I~l', ,,Approved for bedrooms. ,,'~-~: .... Disapproved. .. ~:.t : :~.t) ~ ~ <~ .......... ~ ........ . '.,' ......' .... ..:: .... ' . ~ ,'~; "'.~H ,'~ Condlt}onal approval for ' ~ bedrooms, with the following stipulations: '.. ~.,~ , :."~.. , . , . .. ..... · ...... ...'/',, ,:: ,,' · . ..... · __ .. : . ' Additional Comments By:. ~/'/%, " Date /,'~- 2- ¢/'7/ The Municipality of Anchorage Department of Health and Human Sen~ic~ [DHHS) Issues Health Authority Approml C~rtlficat~ ~ one' upon the mpr~ntations given in 'paragraph 5 above by an Inde~dent pr?fesslona! engineer registered in the State of Alaska. The DHHS does this as a courtesy to pumhasers Of homes : and their lending Institutions In order to satisfy certain federal and state requirements'. Employess of DHHS do not .; ::; - · conduct Insp~fions or analyze data l~om a cedificate I~. I~,~.u~d.~'h~ Mum¢lpalR~ of Anchorage ~ not ,: · .. } . r~l:~nslble ~or errom or omI~lons In the prof~tonal er~in~r'~ work.%~ ~,~;[ e r<,:"~ ~:,'z~.,: / · . . : ' '-:.: ~ '..: .;', ; , - . .. ~. ........ . ....... ~ ~,/.. , -~ . ..... ~ .... .. Legal Description: A. Well Data Muni?ipality of Anchorage Department of Health' and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ~arc~ll.D. 0'~-- Total depth ~.~' 4---- Sanitary sea~) ~ 072 -76- Well type /")d~_ / d,,~ 'T'&' If A, B, or C, attach ADEC letter. ADEC water system number /4..J/~ Log present (Y~) ,,~ Date completed /420 ./Z. Driller (..,(.- ~ Casedto //~../~ Ca§ing height//'-.J ./.,3 f-.r~. Wires properlyprotecte~) .' ¥ ' g.p.m. AT INSPECTION /; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /~ /~ ~ Collected by: Date of test Static water level Well flow Pump level1 FROM WELL LOG Septic/holding tank on lot Absorption field on lot Public sewer main "~,;'~' Sewer service line High W; :er alarm (Y/N) , ' , /r Alarm tested (Y/N) ~ Date °f pumping / Pumper ' · ~ Well(s) or~lot' On adjacent lots _ __ .l~oundation %,, To Surface water/dr'~i~a~e ~ .... SEPARATION DISTANCES FROM WELL TO: ,. WATER SAMPLE RESULTS:. Coliform ~) Nitrate Date of sample: B. SEPTIC/NOLDING TANK DATA Date Ins1 ~lled 72-026 (3~3). F~t CONTINUED ON BACK PAGE C. LIFT STATION * Tot~ abso?~on area Dat~:~f a2iqiacy tes~ Water level Peroxide treatment,  Manufacturer ~ Manhole/Access (Y/N) ~- /Vent (Y~N) ~'Pump on' level at Pump off' Le.~ [ High water alarm level ~ ~Cycles tested ,~' · Meets MOA electrical codes (y/~ ~' SEPARATION DISTANCE FROM~ STATION TO: ~31'~a~acenLbte'~' ' Surface water Soil rating (GPD/Ft~) ,Gravel thickness Cleanout present (Y/N) ',pass/fall) .System type Total depth Depression eve ~CE FROM ABSORPTION FIELD TO: give date Well on lot ,Property line To building On adjacent lots Surface water __ or abandoned system on lot .Water main/sen/ica line ,, parking/vehicle storage area Curtain drain __ E. ENGINEER'S · . . ' o._...,?._-~,~,~.,,. __,~ ,. . . . I cerb'fy that I have checked, verified, or conformed to all MOA and HAA gu/delines ,n e~f~.~ cn~F c~,[.h?s ,nspect~on. Signature ~,,u.~q ~:a~o ~<~or ~.oo~ ~o~1 No. ~ *,L ~,".. ...".~.,~ Date Eagle River, Alaska 9.')$7'~ HAA Fee $ ,~ Date of Payment .eceipt Numar Waiver Fee $. Date of Payment Receipt Number. 72-026 (~3)' Back 10/BS~CJ4 11:49 '°CT~E E~IRC~AL gib SER~,)ICI~$ ¢lliml $~J~lc ID Commercial Testing & Engineering Co. Environmental L~borltory Services LABORATORY ANALYSIS REPORT ~.510~-3 LIA IIIX4 CA~BE~ ~g~ WA'W~ ]~t~SlZ) WORK O~t~ t~27~2 Fr~tedlhte 10/071~ ~21:~2 Collec~ll~e 10/05/94 ~] II:J~ ~'~. lL¢cdvelJhte I 0/05.~'4 ~ 1~:30 Techalcal Dir~cPor ~rEPHEN C. £DE ' N~a:¢-N Allowable £~1. ~ L[mtts Da~: D~te hi/! 10 10/0~/~)4 MC~ * See $~e~ I~trzt~o~s Abo~ e U= lh&t~c~ ~o~valm is thcp~ai~ ~c~ion limit. LT- ~:s ~ " 5633 B St oh AK 99618 1800 (~7) 5~2 : (g07) 561 5301 ~ feet. An ors~, · -- Teh -2343 Fax · EN~RONMENTAL FACILITIES IN A~$KA. COLO~DO. FLORID~ I~01S. MARY~ND. NEW JERSEY, OH~. UTAH. WEST MUNICIPALITY OF ANCHORAGE DEPAR~E~ OF H~LTH & EN~RONME~AL PROTECTION ~// ENVIRONMENTAL ENGINEERING DIVlilON l/ REOUE~ FOR ~PROVAL OF INDIVIDUAL WATER ~D SE~ DIRECTIONS: ComMm all loams on p~ge 1. I~.~..~plete requ~t~ will nm be pro;e.~l, P~m allow ten (10) days for pro~in~. I PROPERTY RESIDENT (1! diffe~t from MAILING AOORE~ ~ ~NDING I~TIT~ION PHONE PHONE PHONE MAILING ADDRESS MAILING ADDRESS STREET LOCATION ~. TYPE OF RESIDENCE '~ SINGLE FAMILY1 [] MULTIPLE FAMILY 7. WATER EUPPLY INDIVIDUAL· [] COMMUNITY [] PUBLIC UTILITY 8. EEWAGE OISFQ~AL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY NUMBER OF BEDROOMS, ~, [] One ~ ~'~o~rr [] Other__ [] Two ~ Five r-1 Three [] Six · ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that data, give well depth (attach log if available.) **if individual/on-site, give installation date ~/q~.~ If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ' 'i i; THIS SiDE FOR OFFICIAL USE ON~. DATE RECEIVED -~'~ : INSPECTION APPOINTMENTS I TIME T~ME TIME DATE DATE DATE : INSPE~ , INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [--I SINGLE FAMILY [] ONE [] THREE [] FIVE D OTHER [] MULTIPLE FAMILY [] TWO [] . FOUR [] SIX PERMIT NUMSER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER , []INDIVIDUAL/ON -SITE DATE INSTALLED , _ []PUBLIC UTILITY Connection Verified INSTALLER []SepficTenk or []HoldingTank Size: I f Tank is homemade SOILS RATING give dimensions: TYPE OF TANK - MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES S~pt;c/Ro/dtng Tank IAbsorpt]o~ Area I~et*aer Line ~ Nearest Lot Ll~te WELL TO: I I 1 At~orption Area to rmare~; Lot Line [~PPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [~DISAPPROVEO LEGAL DE$CRIPTI N (Rev. 3/78) Rev. July 19~285 3 ' FEDIRAL HOUSING ~DMINIST'RAT~ON f~-~ *~'m~,~d HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.~TO BE COMPLETED BY FHA INSURING OEFICE MORTGAGEE MORTGAGOR OR S~ONSOR SUK)IYISION NAME TOTAL NUMAR:' I /. :~ ¥. [] No WATIR SUPPLY [] Public system [] Community system ]Community system S~WAGE DISPOSAL BY: [] Public system SERIAL NO. [] New installation PART II.BTO BE COMPLETED BY HEALTH DEPARTMENT It is the opinion of the [] State [] County .[~ Local Department of Health that this individual water-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the tern with proper maintenance: [] Can be expected to function satisfactorily, and is not likely to create an insanitary condition DATE SIGNATURE [] State [] County [] Local Department of Health that this individual sewage-disposal sys- Cannot be expected to function satisfactorily Use of the above gad for Health Deportment Inspector's sketch os well os use of the bock of this form is ot the option of the health authority. PART III.~FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITERt I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that'the Individual water-supply system be considered [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. DAT~ SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main, feet. Size of main. inches. Individual wells [] are [] aze not oust ,o~ary in neighborhood. Give most ~ecent record of failure of wells in immediate vicioity to furnish adequate supply of water Properlies in nelghbo~hood [] are [] are not being developed with both individual water-supply and sewage.disposal systems. Lot size. feet wide feet deep. Dwelling set back from front property line feet. Individual water supply from: [] Drilled well. [] Driven well. [] Dug well. [] Bored well. D~stanc® of well frorm Building foundation, cast iron sewer feet; tile sewer, seepage pit.. feet; cesspool Well const~ucflom Diameter, inches. Total depth, feet. Type of casing Approximate depth to pumping level of water in well feet. Approximate yield, Sealed watertight to depth of feet. Exteriot space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete. [] Wood. I-1 Metal. Openings in well cover watertight: [] Yes. [] No. P~mp~ [] Shallow v~ell. I'-1 Deep well. Length of drop pipe feet. Pump cap~city, Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit. Pumproom properly dcained: [] Ye~. [] No. Pump mounting watertight: [] Yes. [] No. Type of stocage: [] Pressure. [] Gravity. Capacity,. .gallons. Has bacteriological examination of water been made? [] Yes. [] No. If answer is "yes," give date Quality of water [] is [] is not satisfactory for human consumption. Installation [] does [] does not comply with approved exhibits, if any. Inspection made by: [] State. [] County. [] Local Heahh Authority. Inspacred by Date of inspection feet; nearest lot line at [] front, [] side, [] rear, feet; septic tank, feet; disposal field, feet; other sources o( possible pollution, feet. Depth of casing,. .gallons pet minute. .gallons pet minute. (Tm J) 19 fe~t, feet; ~E~~rf~OVAL OF INDIVIDUAL SEWAGg AND WAT~ (Fill out In T~ipl~) ~ ~ues=~nE 2. ~'~. Of p~y,o~'~ · ~. ~m?:o~.~ms in house ~ . ~~~ b. Dete~ent.. '" ' --' , I~ d. Distance f~ well to closest existing o~ ~ed . 1. ~wer line 2. Septic tank_/~/. '' R. 3. Seepa~e Area //~/' ~. Cessp~l,' ~ . . . - ,'  5. P~pe~y Line,, /~ / ~ "~_~ ...... ' 6. O~her sources of poss~le contamination, i.e.. ~eeks lakes,  houses, ham, draina[e attch, etc. . b.' Sep=lc ~k uapa=~y ~ gallons 1. If "home made" show d~a~ram on ~verse s~de~ of ~h~s fo~. . 1. 'Dls~anc~ to p~pe~y line, .~01 ~o house ~atlon. ~f{/" . -. Pefco/at lon~ Tes~ ~sults f. ?e~'colaticn Test performed by Use t~.e ~everse.side of this form to show dia£ram. Dla~ra~ should include '%he fo~].~.,inZ ~nfor~ation: ~Foperty lines;.well location, house location, · t"~c tank location, disposal area location, location of percolation tes~, a~ direction of ~ound slope. Tke ~"T'.,,,~$~,n on tkfs form is true and correct to the best of my knowledEe. t .~ %~natu~e of Applicant bate $iFned ~O_.BE FILLED OUT BY HEALTH DEPART~ENT PERSONNEL ~ab.ove described sanitary facilities are hereby approved, sub~ec.~ to the ...... r611ow~n~ conditions: The above de$cPlbed sanitary facilities are disapproved for the followin~ ' Apple',al is valid for one yea~ followinE the date of approval. .- CPJ:cw December 29, 1978 ~780661 Larry Koch 3607 East 67th Avenue Anchorage, Alaska 99502 Subject~ Lot 16 Block 4 Campbell ~eights Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date° If there are any further questions, please contact this office at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Specialist ~B/lJw enc~ copy of permit NORTHWEST PROPERTIES ~015 OLD SEWARD HIGHWAY ANCHORAGE. ALASKA 99502 LARRY ~:. KOCH NORTHWEST PROPERTIES 7015 O1~ SEWARD H[GHWAY ANCHORAGE:, ALASKA LARRY $o KOCH PROPERTY MANAGER A~gust 30, 1978 Les Buckholz Department of Environmental Quality 825 L St.' Anchorage, Ak. RE: Lot 16 Block ~ Campbell Heights Dear Mr. Buckholz: I, as the buyer of the above referenced property, am asking that a septic tank not be installed there due to availability of public sewer in the near future. I realize there are additional costs of an assessment and hook up of the public sewer and agree to incur these additional costs. larry S. Koch LSK:lap · .MunicipalitYof Anchorage 3000 A,,CTIC BOULEVARD ANCHORAGE, ALASKA 99503 (907) 277-7622 GEORGE M.$U&LIVAN. MAYOR August 25, 1978 DEPARTMENT OF ENTERPRISE ACTIVITIES Sewer & Water Ufility TO WHOM IT MAY CONCERN: Subject: Sewer Availability Legal: Lot 16 Block 4 Campbell Heights Plat No.: P243B Tax Code: 014-072-15 Owner: Larry Koch A.S.U. Grid: 4841 The Anchorage Sewer Utility has a project scheduled for this area, howeyer, scheduling of construction is dependent on bonds. Therefore, this department cannot give a specific date as to when sewer service will be provided. Tentative proposal for construction is 1979. Sincerely, OEWS - Engineering Technician IV Anchorage Water & Sewer Utilities JGT:nrs Jt~e 21, 1970 LouAnn Per, on l~rthwest Properties 7015 Old Sewerd Highway Anchorage, Alas~ 99502 Subject: Lot 16 Block 4 Campbell Heights Subdivision ~e well serving the subject property is presently in a pit and the top of the well casing is below ground level. Before approval may bo granted, the well casing will need to be extended twelve(12) inches above ground level and the pit filled with imperv~us soil. The s~er syst~n ~ill need to be tested for adequacy.. Refer to handout given to ~ou. If the adequacy test fails, final approval can not be issued until an upgrade of the syste~ is completed. If th-re area g-7 further questions, please contact this office at 264-4720. Sincerely, P~bert C. Pratt, Associate Environmental Specialist