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HomeMy WebLinkAboutHERITAGE PARK BLK 1 LT 5H eritage Park Block 1 Lot 5 #050-211-33 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION *0 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME GEERA L aEZ06 ES PHONE �� �D�I KNEW ❑ UPGRADE MAI4LNG ADDRESS B6x I-2-12. E tE Ki%jFR A1< W,57.7 - LEGAL DESCRIPTION L®'r S 13 L OC IC .Z 14E is rrAGE PARK LOCATION off TRA Dirt PAI AVC, int EA(5:i_6 RI VCk NO. OF BEDROOMS . � Uy DISTANCE TO: lf't%iJ�C�1f�Al Absorp n areas V Dwelling T P _ E IT NO. EZ f Manufacturer r,� lC Material jC� No. of compartm 0Li . c a 't 'n gallons IF HOMEMADE: Inside length Width Liquid depth Z DISTANCE TO: Well Dwelling PERMIT NO. = Z F Manufacturer f VMaterial Liquid capacity in gallons O DISTANCE TO: Well �f'jYVi/ Foundation,®i Nearest lot line, r PERMIT NQ. w= J LL z F Z w No. of lines Length of each lire r Q Total ,h of}ines f Trench id �h �- 6 .aarJa�s Distance between lines CC Top of tile to finish grade M—aaWiiaall be aft, eVheq� 7 � Total ef}gcti•ve absor�ion� y/rJ('f ' ' Length Width Depth PERMIT W F Al.�. c� Q F Type of crib Crib diameter C e h Total effective absorption areaLL ••e•••• •• Wd A •• °e wWell DISTANCE TO: 113uilding foundation Nearest lot line 00® ® , ® e J Class I Depth Driller Distance to lot line J Alk Lu DISTANCE TO: Building foundation SewerlmV Septic tank 0 9 e1OHN E- ANSON g m� 11334E so � OTHER ,• t7 T ® / ®® PIPE MATERIALSso por-T- e� AsIM I 34 ` z 2 SOIL TEST RATING v 'e+ �. INSTALLER oNS "A2- SZ?UICE5 REMARKS 5'TY 6PO V0?1A 6- _56D77C -k D f C'r J OAJE AS to (a It PIPE D/J N0'Pr(4 CIUD OF ' SCf,'?1_10 A� i5c���tN`Y - wtEN '�`v�rr i S © DUE !.l o - �-So cc p okc r c 1 iA( APPROVED DATE LEGAL 72-013 (Rev. 3/78) M MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ` ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME /' PHONE �j NEW c+ l7 �:.K'/`� G... S�1V f C. E/^�.,,'�y'o J�1 UPGRADE MAI LING ADDRESS `9 4 e I,q -j} LEGAL DESCRIPTION _ { TA 61 LOCATION NO. OF BEDROOMS ION IAL, t7u EAC( l`l0E, J DISTANCE TO: Well rnifl y.-- Absorption area C Dwelling , �`J PERMIT NO. f J — /6W/C� L) < .o le PZ Manufacturer r- Material �, No. of compartments WF ur Liq, capacity in gallons IF HOMEMADE: Inside length/VA A Width Liquid depth 080 VA. NA z DISTANCE TO: Well <I Dwelling PERMIT NO. 2 z < Manufacturer ! %—; Material Liquid capacity in gallons t DISTANCE TO: Well fr t I �lv/I %i' Foundation � �� Nearest lot lme 1 � PER I NO. ��-- /�� �•� %' � � �/�� ELI J LL Z No. of lines Length of each lige Total length of lines '-: Trench w'dth t, Distance be lines Z w (_, f„-� ' t , (i inches F Q F finish Material beneath the Total effective absorption area Top of the to grade ,, ' r=, r. �!i, Vk; •, inches 312. p �.� , lair?rlt t` f 1 a 5- Sri-'4. Length i Depth - PERMIT NO. LU r' Q F Type of crib Crib diameter � �` �` j Crib depth Total effective absorption area as W U w Well ` r Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J Lu Lu g Buildin foundation SeWor line Septic tank Absorption area(s) DISTANCE T0: OTHER L-07- 7- PIPE MATERIALS PIPE SOIL TEST RATING VO 7_ INSTALLER REMARKS , � rrA-,v L vf{ J USE I;' a 6+ OF A4q® ® ° ° o° `.r. VVAPPROV X Pa W H[l C. cl i!A020N DATE LEGAL pv °% 1834•i 72-013 (Rev. 317*& Ilv l ESSIQ4dPN' #5 .oz , U Department f Health and EnvironmentF +protection 8251--,Y Street, Anchorage, AK. x,9501 264-4720 # # HANDWRITTEN PERMIT # # # Permit # �Lsno�iln W N -SITE SEWER PERMIT 91 Applicant: WChD j LY)-eele- Mailing Address: -.:Z/ D_ 5 a -rd Location: Phone Number: 3y Legal Description: (, 5 'g / �Ierl. I nC Pa,-I(_L Lot Size: -" Type of Soil Absorption System Is: Trench: Drainfield: ,< _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: - L/— Soil Rating(sq.ft/br) — Y6 The Required Size of the Soil Absorption System Is: DEPTH LENGTH 40 _ GRAVEL DEPTH L1 WIDTH The length dimension is the length(in feet) of the •trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ �� D GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # # TWO(2) INSPECTIONS ARE REQUIRED.* # # Backfilling of any system without final inspection .and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. # * * PERMIT EXPIRES DECEMBER 31, 1 9 u 3 # # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that edrooms. Signed:cIssued by: Applicant c- <�' C�1 �_Q-A Fate SWP/024(1/81) S11 Zama 7125 OLD SEWARS-_-HWY. & kNGIAEERS. INC. ANCHORAGE, ALASKA 99503 $i 349-6561 I'EACO I.ATION I(ST SOILSLOG PERCOLATION IES1 �B�GYyooH45 !�/l/ nll PIIIrOIIMEu/�3�3_— Pr:HrOItMFD r-oR Zji�-/- 2-. -�-------- LEGAL OEscRIPr1DNe �e �tcrLl slrJ'u N = —-- St_OPE. i 'o'e'• • I — �. Grave / ,,,r/Tr4ce -<d A - - -- - -- - cd i SnwI L c tai e �Qyy� %✓0.GG Si 1 f BYDetJ N Qr, / p c- c a -S i oK o/i Cobb es ry coarse / well5or�eI h — Reading Date 0 Net Time Depth to Water Net Drop Grave. wLe S;1.1 .-,wee I u1/ e1/ Nc/� -5'.J V G r \� � 1 li"l tliS! [ r1/ To S . / D e w s / G {q hili - WAS GROUND WATER $ ENCOUNTERED? C P IF YES, AT WHAT E DEPTH? — Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE 1; 5 , / / It- (minutes/inch) TEST RUN BETWEEN FT AND _ FT COMMENTS PERFORMED BY: 12OOH t6//91 J P-6vo O`?o.;Xw Municipality of Anch age • -• Development Services Department ' Building Safety Division •'" .' ' On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-211-3- COSA # 00/0a01D Expiration Date: ?— a G-- / 19 1. GENERAL INFORMATION Complete legal description Heritage Park Block i Lot s Location (site address) 2o6ig Tradition Avenue. Eagle River. AK g9s77 Current Property owner(s) Kelm A& Vernon T Johnson Day phone 622-7202 Mailing address 2o6ig Tradition Avenue, Eagle River. AK ggsn Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: _3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ® Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems 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. (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. 4. 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 102gg4. Anchorage, AK ggslo Engineer's Printed Name Steven R. Pannone, P.E. Date 7/1a/og Engineers Comments: In conducting an adequacy lest. I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the testand separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the syster These conditions are outside the control of the evaluator of this system. All systems eventually fail at satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will i confer any legal right whatsoever. 5. DSD SIGNATURE _jZ� Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: l� Original Certificate Date: 7- tam nosi Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: _Heritage Park Blocks Lot Parcel ID: oSo-211.3a A WELL DATA Well type AWWU If A, B, or C provide PWSID # _ Well Log (Y/N) Date complete Sanitary seal (Y/N)_ Wires properlyprole (Y/N) Total depthft. Cased to ft. Casing h fight (above ground) in. FROM WELL G INSPECTION Date of test Static water levet Well production WATER SAMPLE g.p.m. g.p.m. mL Nitrate mg/L Other bacteria '-telQnies/100 mL genic: _ ugA Date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Greer Steel Date Installed 6/24/1g81 Tank size i000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YM) N High water alarm (YIN) NIA Date of pumping xo/7/2oo8 Pumper JR's C. ABSORPTION FIELD DATA Date installed 6/23hg8a Soil rating (g.p.d./ft2 or ft2/bdrm) 85_ System type -Deep Trench Length 25 ft. Width i..S ft. Gravel below pipe 8 ft. Total depth 11,75 ft. Eff. absorption area 312.4 ft2 Monitoring tube Y Depression over field N Date of adequacy test 718/2oog Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test §2 In. Water addedr,So gal. New depth62 In. Elapsed Time:.q min. Final fluid depth 62 in. Absorption rate >= &So+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) No If yes, give date LIFT STATION Date ailed Size in gallons Manhole/Access (Y/N) "Pump on" leve in. "Pump off" level at _In. High water ala vet at In. Datum Cycles tested Meet arts & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LO Septic tank/lift station on lot On ' ent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/clean Sewer /s is service line Holding tank imal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ao+ Property line zo+ Absorption field s' Water main so+ Water service line }o+ Surface water zoo+ Wells on adjacent lots zoo+ { Pamon^i C SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line %* Building foundation zo+ Water main moo+ Water Service line %a+ Surface water _1oo+ Driveway, parkingfvehicle storage 3+ Curtain drain None Observed Wells on adjacent lots Zoo+ F. COMMENTS G. ENGINEER'S CERTIFICATION �.�P�, •• 1 certify that 1 have determined through r Id Inspections and { t u review of Municipal records that the above systems are In conformance with MOA COSA guidelines in effect on this date. i "_ j �ASteven < { Pamon^i C Engineer's Printed Name Steven R Pannone. P.E. �47 � s , No. CE 8t a3 f, Date 711'41200q ees��.DO A�..1F�St'�\l:•• COSA Fee $ _v 9 Date of Payment I Receipt Number % / { (Rev. 11/05) Waiver Fee $ _ Date of Payment Receipt Number Municipality of Anchorage • -� Development Services Department •'`•' •`' Building Safety Division •; On -Site Water and Wastewater Program t ' 4700 South Bragaw St. ' " It T' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ek.us 343-7ge.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPRO AL FOR A SINGLE FAMILY DWELLING'.::!., Parcel I.D. 050- a l x'33 GENERAL INFORMATION Complete legal description Heni HAAn Expiration Date: Location (site address or directions) Vo O Tad t i o n AV Ln!� j, RtJQ ✓ Current Property owner(s) M2100AA W I e K Day phone IAL -73341 Mailing address arm e Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 21 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System 0 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 Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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 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. 4. 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 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. l 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 Eagle River Engineering services Phone (rA y-:5 195 Y.O. Bo: 773294, Eagle River, AK 99577-3294 Address Engineers Printed Name LOUIS A, I�u f e ✓G> Date/�/-o� vii.•E 4� S Ba � Louls A. Buten 5. DSD SIGNATURE �i1d '�, � CE4736 ""41' 10 !/ Approved for 3 bedrooms. d�Dp Disapproved. Conditional approval for bedrooms, with the following stipulations: OF `` Fj Additional Comments 1-1: WATERAND • m - WA Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineers Report Well Flow Advisory Other BY: Original Certificate Date: g - iD - Co (Rev. 72'CO) Municipality of Anchorage • Development Services Department Building Safety Division On-Ske Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /%r* L S , Ar J Parcel ID: OS o - e rr- 7? A. WELL Well type Date core Total depth ft. Date of test If A, B, or C provide PWSID # _ Well Log (YM) Sanitary seal (YIN)_ Wires properly protected (YM) Cased to ft. Casing height (above ground) in. LOG AT INSPECTION Static water level ft. Well production g. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Other bacteria ft. g.p.m. colonies/100 mi. Tank Type/Material X fer / Date installed / 9 J-3 Tank size I~ gal. Number of Compartments a Cleanouts (YM) X Foundation deanout (YM) Depression over tank (Y/N) —,Y High water alar (YM) W14 Date of pumping IC -,13-101 Pumper -7e t C. ABSORPTION FIELD DATA Date installed5/ 8 3 Soll rating (9�d4fir or f'tbdr) _!Lr System type _ moo• r -e— &- Length S ft. Width '40,,r ft. Gravel below pipe Jr ft. Total depth J.? ft. ER. absorption area iii 112 Monitoring tube Y Depression over field nV Date of adequacy test 3 -A / Results (Pass/Fall) fr For 3 bedrooms Fluid depth in absorption field before test ' "Tin. Water addedSpO gal. New depth S> in. Elapsed Time: 14 min. Final fluid depth *4 in. Absorption rate >= yI'o g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) Al !A If yes, give date — D. UFT STATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES SEPARATION Septic tankAtft sta'on lot Absorption field on lot Public sewer main Size in gallons "Pump off level at _ In. tested Manhole/Access (YIN) _ High water alarm level at Meets alarm d circuit requirements? FROM WELL ON LOT TO: Ne we /I On adjacent I On adjacent I Public sewer In. Sewer /septic service line _�� Holding tank ], SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: �• S' / Property � t/a' Absorption 8 / Building foundation line rPtion field Water main f /o Water service line Surface water ri-wo / / Wells on adjacent lots t A10 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line W Building foundation yrs Water main Y/v Water Service line 'tr o / Surface water Y/v d ' Driveway, parking/vehide storage _42( Curtain drain /✓owe- Wells on adjacent lots F. COMMENTS �/�4n wr.t H+ it/. t.•��/.f f/e// /l .v/r JA.....+s../ rnfject /'yvrt �../ f..+Ys..a! /7.. tr�••a...•1 c.+s /t •'. ��/ .rs /tr!' /j 4 t � fkrl�-t ! !•4 %ice w+ i%.w.d �++r•v�f�r YrA p 4�+ G. ENGINEER'S CERTIFICATION d.% ..ter rc7.r +/ h/ �^1 • y ; •e/ t I certify that I have determined through field inspections and OF AJ. �%4 .r. QiV review of Municipal records that the above systems are in �f 9NG���, conformance with MOA HAA guidelines in effect on this date.Jr Engineer's Printed Name z AA, Yte,--t Date 8 /'/ -o r �� �, . Loub A BOM i'i 1 HAA Fee $ 3 0 0. O O Waiver Fee $ _ Date of Payment 8 - /S -n I Date of Payment Receipt Number '37 3 Receipt Number (Rev. 12/00) Parcel I.D. # MUNICIPALITY OF ANCHORAGE AaL • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-211-33 HAA # 1. GENERAL INFORMATION Complete legal description Lot 51 Block 1, Heritage Park S/D Location (site address or directions) intima Tradition Property owner Mailing address Lou Hefner Day phone 694-6874 Lending agency Day phone _ Mailing address Agent Remax/Virginia Kohfield Day phone_ - 16600 Centerfield Dr., Suite 201, Eagle River, AK 99577 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water XXX 694-4200 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 XXX Holding tank Community on-site Public sewer 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. S & S ENGINEERING Name of Firm 37nm Faule.River Loop Road No. 204 Phone G y - c, 7 c7 Eagle River, Alaska 99577 Address _ . 1-7 O Engineer's signature 6. DHHS SIGNATURE Approved for F bedrooms. Disapproved. Conditional approval for Additional Comments IA 1t1TIC Date /o /> a 9 OF �•' ' ' �:9 p >< ROBERT C. COWAN CE -8801 bedrooms, with the following stipulations: Date /0-/(6',7 �? The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA M21 Municipality of Anchorage j DE PARTMENT OF HEALTH &HUMAN SERVICESv SvuFAu v c t A; �h 0* Environmental Services Division "' �N.ventAl. SERVICES D 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 / Health Authority Approval Checklist 4 Legal Description: L) %,5_ Bok 1 14t,� 1 rRGI- PW -k- Parcel I.D.: 0 V 0 1 _ 3 3 A. WELL DATA Well type T GC%q r If A, B, or C, attach ADEC letter. ADEC water system num Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level) Well Droduction FROM WATER SAMPLE RESULTS: Date of sample: B. SEPTIC/HOLDING TANK DATA Date completed Cased to Nitrate Casing height (above ground) Wires properly protected (Y/N) g.p.m. Collected by: AT INSPECTION Other bacteria Date installed Ht_ 5 Tank size e ✓ 6111- Number of Compartments /- Cleanouts (Y/N)_y Foundation cleanout (Y/N) Depression (Y/N)_ High water alarm (Y/N) Date of Pumping /" Pumper R ,s C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm)"'�J System type Length Z S Width 5 Gravel thickness below pipe Total depth 2- Effective absorption area 3/ S, Monitoring Tube present (Y/N)-Y-- Depression over field (Y/N) Date of adequacy test M - V49 Results (Pass/Fail) A4 5 S For 5 bedrooms il ii Fluid depth in absorption field before test (in.); % Immediately after J &gal. water added (in.): .� 7 Fluid depth / (ins) Minutes later: I Z-6' Absorption rate = ''/ 5- b g.p.d. Peroxide treatment (past 12 months) (Y/N) /1/0 If yes, give date kNc w„� 72-026 (Rev. 3/96)` D. LIFT STATION 0 /A Date installed Size_an- gal lons Manhole/Access (Y/N) _ "Pump on" level at' "Pump off' level at` _ High water alarm -level at' 'Datum Cycles tested E. SEPARATION DISTANCES 11/11 SEPARATION DISTANCES FROM WELL ON LOT TO: �I T� l/(,x Septic/holding tank on lot On adjacent to s�-- — Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout SeweJseptic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line Absorption field `� u Water main/service line �.�� Surface water/drainage 0 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: '/ k/c0✓&ST'1D) / Property line 4 ! �' �'�2 Building foundation ��� Water main/service line �:r✓ Surface water �. Curtain drain Driveway, parking/vehicle storage area Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance with �OA HAA uidelm s in effect on this date. Signature Engineer's Name Date A 0 A 7- / 0 - /0 /Ia / aI HAA Fee $ ,� &Z5 " Date of Paymenty11a //9 Receipt Number G�� li✓�i (6i,�z 72-026 (Rev. 3/96)"` Waiver Fee $ Date of Payment ij �� � GhOin. d4)RrL•r�(. all,t;IPa 4hL ab$ ��s are Ax r � f >. ROBERT C. COWAN f CE � 8801 (Jk's 0, E550!ry� 1 01) /FV7 ' Receipt Number Municipality of Anchorage �} Department of Health and Human Services 825 " L" Street Mayor Rick yrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage. ak. us October 16, 1998 S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 Attention: Robert C. Cowan, P.E. Subject: Waiver Request for Lot 5 Block 1 Heritage Park Subdivision Waiver Request 41WR980075, PID #050-211-33, HA980359 Dear Mr. Cowan: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 4 feet from the absorption field to the property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744. Sincerely, A /, / !/ effrey W. Poet Engineering Tech On-site Services ljw 417 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section WR# I I )Q L)R(O PID# Waiver Review Worksheet 050-211-33 HA# HA980359 Permit # Date Received: October 13, 1998 Legal Description: Lot 5 Block 1 Heritage Park Engineer: Robert C Cowan, P.E., S & S Engineering 17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska 99577 Applicant: Lou Hefner Waiver Requested: Lot line waiver of 4 feet from the absorption field to the property Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: / C3 - / (, - `j By: c Rec #: 04268/6164 Amount: $_115.00 of &reviewer Date Paid: 10-13-98 HEALTHAUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN S&S\ nneening October 14, 1998 RECEIVED MUNICIPALITY OF ANCHORAGE OCT 15 1998 Department of Health and Human Services E)e n'C'Paliiy of Anchorage P.O. Box 196650 P Health & Human Services Anchorage, AK 99519 REFERENCE: Lot 5, Block 1, Heritage Park S/D ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Request you issue a Health Authority Approval on the referenced property and grant a waiver for the separation distance from the west property line at 4 feet. See attached copy of as built. We do not anticipate any adverse effect on the adjacent properties. - If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/skh Attachment 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Sent BY: RE/MAX OF EAGLE RIVER, INC.; 9076960214; Sep -28-98 10:08; Page 212 S 85,21,551E G U) TRAPIT100 AV J013 NO,: 09095 ZONED FIELD BOOK: .5 13.5 48.41 C X GRID: 1.1W 055 DRAHN BY: J3�rM CHECKED BY:M SCALE: 1"'• �o"PLOT PIAN: 7125 OLD SEWARD HWY- S&S ENGINEER Ss INC ANCHOME, ALASKA 89502 . FOLL014IIIG DESCRICED PROPERLY, THAT I MAVt SURVEYED IRE HEREBY CERTIFY I OF A4 1 . HERITAGE 'PARr, zNIS SIJUAIEU THEREON .......... LOI 15 BLK- THAT THE IMPROVER ANCHORAGE RECORDING DISTRICT, M.. AND T? I ENCROACH OH THE PROPERTY LYING ADJACENT 0 APE KIIKIN THE pnDpEqly LINES AND DO NO 0 1 IWpOVEMjHjS ON PROPERTY LYING ADJACENT THERETO ENCROACH ON 0 49 - IISSION LINES IIAEREIO. THAT N( io. w ... .. THE PREHISESIN OUESTION AND THAT THERE ARE No ROADWAYS. IPARS� 10• a SEMEgIS ON SAID PROPERTY EXCEPT AS 11401CATEO HEREON. OR Olpts VISIBLE EA . . . DAIED THIS ?I DAY OF 1JC)V. j9b5. ANCHORAGE- ALASKA' )n BUILDER. 10 i,..•fib IT Is m RESPONSIBILITY OF UUjLuING GRACE�RELER ATIVE 10 FINISHPRIOR GRADE ANDCONSTRUCTIUTIL17YON. 10 VERIFY PROPOSED I DEIERMINE THE EXISTENCE or ANY EASEMENTS. COYENANIS. 'COMNECTIUNS AND lc IME RECORDED SUBDIVISION PLAT OR RESIRICIIOqS WHICH DO NOT APPEAR ON APPLIC `VT FILLS OUT UPPER HAL UNLY Property Owner .. / I,i j'�%l �� iv �y r. (� 0 Photfe� _-PI J -J Mailing B^dress gCode Buyer Zip Code Address Inspector Inspector Inspector Phone Lending Institution f 7--- Address _.-- ) Zip Code Realty Co. & Agent C'.g y✓ y- y �2- % zl 1 , c, ;.' ,,`� 1' / /C-' {- , %7i � "� /�� F/�i'� � � _ Phone Address S' �� Zip Code `� / j ' t rp trek Legal Description rr Street Location�� �(f �FJ PJ /q- Type of Residence L'. O. Single Family ❑ Multiple Family No. of Bedrooms ❑ Other 3� Water Supply ❑ IndividualI ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. wells drilled prior to that date, give well depth (attach log if available). IS Community vY — _--,�__{�� ( DISAPPROVED __ ❑ Public Utility ( ) CONDITIONAL AP ROVAL- Sewer Disposal _E�1, Individual ? Year Individual Installed: f I ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Cetu Date Date Date Date `J lam' Inspector Inspector Inspector Inspector - Field Notes: t rp trek I 1 qq 1� Banc IN f G lJ L'. O. 3� APPROVED BEDROOMS 'CONDITIONS OF APPROVAL — _--,�__{�� ( DISAPPROVED __ ( ) CONDITIONAL AP ROVAL- DATE I __11 2> BY: 2� Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size S! _ a 3— 8 Well to Tank 72023 (3)821 -r, 't S