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Home My WebLink AboutSKYHILLS PH 3 BLK 3 LT 245kyhills Block 3 Lot #011-122-56 Inspection Report _1-1-12.doc Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water & Wastewater Program 4700 Elmore St. -P.O. Box 196650 Anchorage, AK 99519-6650-http://www.muni.org/onsite (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191070 PID Number. 011-122-56 ❑ New ❑ Upgrade Name: STEPHEN RIBUFFO ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ound Address: 8240 SKY MOUNTAIN CIRCLE ❑ Other Phone: No. of Bedrooms: Soil Rating: Total Depth from origins ode: - 5 GPD/Sq. FL Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade: `ve epth beneath pipe: F\i Ft. Fill added above original grade` Gravel length: Subdivision: Block: Lot: SKYHILLS PHASE 3 3 24 FL Ft. Owns Ip: anger section: Gravel width: Beds Number of lines: FL Distance between lines: Ft. SEPARATION DISTANCES Total absorp' area:[lumber of trenches: Dist. between trenches: To Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines SQ. FL Ft. well N/A EXISTING 25'+ TANK ® Septic ❑ S.T.E.P. ❑Holding ❑ Other Manufacturer. Capacity: Surface water 100'+ I/ n q ANCHORAGE TANK 2000 Gal. Lot Line 5'+ _ Material: Number of compartments: � V /`1 STEEL 2 LIFT STATION Foundation 10'+ Curtain Drain NONE KNOWN Manufacturer. C Gal. Remarks: OLD TANK DECOMMISSIONED PER UPC PER CONTRACTOR "Pump on" level at: "Pump ote' level at: High water alarm at: STANDARD COATED STEEL SEPTIC TANK VERBALLY APPROVED BY MOA ON 4/16/2019 Pump Make 8 Motlet Electrical Inspections performed by: PIPE MATERIAL House to tank D3034 Tank to EXISTING/D3034 drainfield Installer ARM SERVICES Drainfield EXISTING CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Ft. Inspection Location and Description: Dates: 1 St 4/17/2019 2nd 3rd - 4th BOTTOM OF BACKDOOR THRESHOLD ENGINEER'S SEAL Community Development Department Approval ao�0000 00 OFAr4h Conditional approval: Date: 49 TT .. ... ...............� O�p .'.Jef e/y A. Gayness: Q E-795 m`Q �04f� J ... 0 Approved: Date:�p a o� LICENSE 0 profession dc'o ODO�DO�� #AECC884 Inspection Report _1-1-12.doc PERMIT NUMBER: PARCEL ID NUMBER: OSP191070 RECORD DRAWING 011-122-56 A I B ST1 23.9 39.9 ST2 34.0 31.1 DBL1 35.7 30.1 DBL2 36.5 29.8 SKYHILLS PHASE 3; BLOCK 3, LOT 24 10, T. NEW 2000 GALLON STEEL SEPTIC TANK =r` ALL SURROUNDING LOTS WITHIN 200' OF THE PROPOSED UPGRADE ARE SERVED BY AWWU WATER EXISTING DRAINFIELD EXISTING 5 BEDROOM HOME GARNESS ENGINEERING GROUP, Lt NGINEERINGoSALES oCONSULTING, — 3701 E. TUDOR ROAD, SUITE 101' ANCHORAGE, AK 99507' PHONE (907) 3376179' FAX (907)33"246 'VVEBSITE: w gamessengmeering.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: STEPHEN RIBUFFO - 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: SKYHILLS PHASE 3; BLOCK 3, LOT 24 D.J.G. TYPE OF WORK: DATE: 11 SEPTIC TANK RECORD DRAWINGS 4/18/2019 10' SLOPE MAINT, ESMT. APPROXIMATE LOCATION OF WATER LINE PER 2001 INSPECTION REPORT BY TOBBEN SPURKLAND. P.E. DRIVEWAY Gam' J N SCAL 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: OSP191070 Work Type: SepticTank Upgrade Tax Code Number: 01112256000 Site Legal Address: SKYHILLS PH 3 BLK 3 LT 24 G:2222 Site Mailing Address: 8240 SKY MOUNTAIN CIR, Anchorage Owner: RIBUFFO STEPHEN Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: y/I -TI IR �z�cnr 11�°� ~ a f V ll�partmenr Lot Size in Sq Ft Total Bedrooms: 4/1/2019 3/31/2020 41347 ❑ 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 LsAk 10 Zoon 54 cold -}1k_ P14J�\ eoa:wl because '►ks 4ke 0V� 0 i'�ne,H cAv� qeA riotkn v,ow Received B� Issued By: Date: `` ` [ Date: / 5 Community Development Department Development Services On -Site Water & Wastewater Program Parcel I.D. 011-122-56 Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Property owner(s) RIBUFFO STEPHEN Mailing address 8240 SKY MOUNTAIN CIRCLE *ANCHORAGE, AK 99502 Site address 8240 SKY MOUNTAIN CIRCLE *ANCHORAGE, AK 99502 Legal description (Sub'd, Block & Lot ) SKY HILLS #3; BLOCK 3, LOT 24 Legal description (Township, Section & Range) Lot Size APPLICATION IS FOR: ( ® all that apply) Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Day phone Sq.Ft. Number of Bedrooms 5 APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: Aad® Date of Payment: 3429��9 Receipt Number: 6wo tL-1 Permit No. 0 splq lC Y6 Waiver Fees: Date of Payment: Receipt Number: (Rev. 01/11) ///iV/i �7d aC�^tr.• GARNESS ENGINEEWNG GRO tLJ1C 9 Ltd ENGINEERING -SALES CONSULTING March 26th, 2019 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for Sky Hills Phase 3: Block 3, Lot 24 To whom it may concern: Advanced Treatment Sys[cm D& rrtc D - - The subject lot is served by AWWU water and a private septic system. Per the request of our client (ARM Services), the owner would like to upgrade their septic tank with a new 2000 -gallon epoxy coated steel septic tank. We are proposing to decommission the existing septic tank per UPC and install a new 2000 -gallon steel epoxy coated septic tank. See attached design drawings for tank location and other MOA requirements. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your 3. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com GEG, Ltd. HAS AN 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. SKYHILLS PHASE 3; BLOCK 3, LOT 24 ,/— — — 10' DRAINAGE ESM T. P / P / / / ALL SURROUNDING LOTS WITHIN 200' OF THE PROPOSED UPGRADE ARE SERVED BY AWWU WATER EXISTING DRAINFIELD rPROPOSED 2000 GALLON EPDXY COATED STEEL SEPTIC TANK; INSTALL DOUBLE CLEANOUTS AFTER TANK _ — EXISTING 2000 -GALLON STEEL L —SLOPE MAINr ESMT. /SEPTIC TANK TO BE DECOMISSIONED PER UPC CONFIRM INTEGRITY OF FCO; REPLACE/REPAIR AS NEEDED EXISTING 5 BEDROOM HOME wwl/"Aps Z4A&1�c 4PPROXIMATE LOCATION OF WATER LINE PER 2001 INSPECTION REPORT BY TOBBEN SPURKLAND, P.E. DRI�VEWAYYI; ' �P N J� SCALE: GARNESS ENGINEERING GROUP, Ltd -- -- ENGINEERING oSALES oCONSULTING �-- — 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE. AK 99507 -PHONE (907) 337-6179 • FAX (907) 338-3246' WEBSITE: www.gamessengineen.ng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ARM SERVICES 907-688-9433 2 OF 2 PROJECT/LEGAL DESCRIPTION: DRAWN BY: SKYHILLS PHASE 3; BLOCK 3, LOT 24 D.J.G. TYPE OF WORK: DATE: I, DESIGN OF SEPTIC TANK UPGRADE 3/27/2019 Municipality of Anchorage '"" Development Services Department .'~;,~ Building Safety Division "~ On-Site Water and Wastewater Program, 4700 $. Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 Page I of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PermitNumber..~b'Ott~'l~ PIDNumbec Ot%--t'L'z.- "'"": H,~.t.,.~ls,,I.~,., ~ '~.~.~g,~.t,,' WastewaterSystem: ~]'New I-IUpgrade '~"": '"/,,~o ¢.. ~,&..,.~ %1,~,~ ABSORPTION FIELD LEGAL DESCRIPTION I, 2- O,,. Well: [] New [] Upgrade ~ ~'. [I TANK SEPARATION DISTANCES ¢$eptic [] Holding [] S.T.E.P. [] Other. Fmm~~ Septic Absorptior Lift Holding Pub~ic/P~vat{ Uanda~a~,~ Tank Field Station Tank Sewer Ll~eA-~ ~ H TlGr~ V,. ~ ca. V/ LIFT STATION c,,,,~ D~-- Id]c) Itl o ~,n,~. a ¥~, "'"~": BENCH MARK ~ · E~ineer's'Stamp · -,.¢. O. "....,..-~ Inspections performed by: I ~. Dates: 1~t '~/~-7/~ I ~'o,,:,,,.;"- ........ et~Se~ices,,D,e partme nt_ A ,.~,.. Developing//~ ~ ~.,..~_ pproval~ . -' 4... Reviewed ,nd ~pproved by: Date: ~- ~ ' '''~ '°° "' ' ~' ? I I I I I I I I I ~'ANDA~D 4-B~ .~ .,eTANLM~7 rRLT~ 7 fT Of' RC~.~ !'~/ 49th SPURKLAN]) N TOBBEN SPURKI. AND P.E. 203 W ISTN. AVENUE ANCH. AK. .9.9501 279-3916 LOT SKY ~tOUNI'AIN CIRCLE ~(ICNEI. SOHN AND DAUGHTER SEPTIC SYSTE~I AS BUILT DATE: NOK 14, 2001 SHEET: 2/$ fiR/D: 2222 PERHIT # SVOIO]71 PID It 011-1~-56 SKHO324~.DVG MUNICIPALITY OF ANCHORAGE Development Sen/ices Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jun 07, 2001 Expiration Date: Jun 07, 2002 Permit Number: SW010171 Legal Description: SKYHILLS PH 3 BLK 3 LT 24 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: SK'YVIEW INC. Owner Address: 8240 SKY MOUNTAIN CIRCLE ANCHORAGE, AK 99502- Parcel ID: 011-122-56 Site Address: 008240 SKY MOUNTAIN CIR Lot Size: 41347 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] DisposalField [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage Ail construction must be in accordance with: 1. The attached approved design. 2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing, Received By: Issued By: / Date: ~/~- 7--~ Date: ~; -- 7-01 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 011 -- l Z Z -- 5'(, Permit Number swOl..(2~ Property owner(s) ~'.~; ~.~-~5¢~,1 Mailing address (1) 7~o $1rt ,McL,%~ address (2)~ 5~Y Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size 4/, ~ 7 Acres/Sq.Ft. Day phone Zip Code ~ Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Well Only [] Water Storage [] Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: ~ ~I.O ~ Date of Payment: ~-/~.~/O/ Receipt Number: ~'~ ?0 (Rev, 12/00) Waiver Fees: Date of Payment: Receipt Number: 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 24 BLOCK 3 SKY HILLS//3 S/D MICHELSOHN AND DAUGHTER Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 May 28, 2001 We are submitting an application for the installation ora septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the ad.~oining properties, (sheet I/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic ofthe septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: No Ground Water or Impervious Layer to 17 R. Use Standard Trench Soll Rating. From Testhole 05/18/01 4.3 mia/in ~ 1.2 gal per sq.fl/day No. of Bedrooms 4 Required Area per Bedroom: 150/1.2 = 125 sq.ft. Total area required: 12.$ x 4 - 500 sqft Testhole depth 17 feet Bonom Rock At I I feet Top Rock At 4 feet Rock Depth 7 feet Minimum Trench Langlh $00114 - 35.70 IL SYSTEM CONFIGURATION STANDARD TRENCtl TOTAL LENGTII 50 FT TOTAL WIDTH 2 FT TOTAL DEPTII I I FT ROCK DEPTH 7 FT COVER 4 FT SEPTIC TANK 1250 GAL The installation of this septic system will not prevent septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage eoorses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoffwill not result from this iustaIlation. / Ii kT IN. ?~ // msa~ sPv~o ~ Lot 24, BLOCK 3 S~ 203 · ism ~v~Nu~ II-~- SKY MOUNTAIN CIRCLE II DATE: MAY 28, 200I A~c~. AK. 9950~ II UlCHE~OH~ A~O OAUGHT[R ~ SHE~' I/a ~RIO: 2222 279-$9 ~6 # SVOIOXXX PID # YY SKHOS24LD~G I I I I I I I I I I I 23 ST,4ND,4RD 4-BL'Df~OW $ 1,250 ~4L T4NK fl' LOI~ ! / / / / / 49th [OBBEN SPURKLAND P.E. 205 Y~ 15TH. AVENUE ANCN. AK. 9950! PERMIT # SVO1OXXX ~o~ Z4/S~OCK S SKY H~ SKY MOUNTAIN CIRCLE I I MICHELSOHN AND DAUGHTER U_ Piti # YY SEPTIC SYSTEM DESIGN DATE: MAY 28, 2001 SNEEr: 2/3 CRID: 2222 SKHOS~ 43.flVG PR/W41~ IRENClt Standard Trench, 2' I,qde 50' Long 11' Beep ZS' Sewer rock 4' Cover NO SCALE $~ £~rrle~ 7.0 £~ of Septic Rock Effective Monitor Cteanouts Cover NO SCALE 1250 gal Sept~ tank 1258 gal. septic tank Anchor=ge~03 ~tSth A~eA ~~[ I SKY WOUNTAIN CIRC~ " ~~jl I ~ATr, WAY 28, 2001 I Munlcq:al[ty o! Anchorage DEPARTMENT OF ~EALTH & HUMAN SERVICES 825 "L" Street. Aut;horage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED LEOA' DESCR,PT,O": L. ( ;Z~, r~ ~..~, s~.., Ih'Il Township, Range. Section: i SLOPE &'"'"'/ 8 10 WAS GROUND WATER ENCOUNTERED? 11 IF YES, AT WHAT DEPTH? 12 13- 14 15 16 17' ~8 - 19- D~plh to Waist kllerJ Mofliloring? ~.~r~ Dale: ~ SITE PLAN ..I :o- ~ PERCOLATION RATE {mmute~lnch) PERC HOLE DIAMETER . TEST RUN BETWEEN ~ ~T AND '7' FT DISCLAIHF~ ~n.nd~atR~ conditions ~ndicatRd are for the dates Past and future presence and/oe depth of groundwater can not be shown only. predicted trom these oDse~Lr~lons. ~. ~ PERFORMED BY; I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCEWITH^LLSTATEANDMUNICIPALGUtCELINESINEFFECTONTHISDATE. DATE: ~.y ~ZB/2-~" I 72-008 (REv. 4/85) . Municipality. of Anchorage .... ' {{~'~ Development Services Department · ~t,~_'~.~.~l~J~'l' ' ~'" , "' ~ "" '" Budding Safety Division ' ' .... ~.~/ ' .... On-Site Water and Wastewater Program' ' ~.. ~_~.t ', . . .. . · . ~4700 South Bragaw St. ~--~'~,~. :, .. . · . P.O. Box 19,6,650 Anchorage AK 99519-6650 . . %~., .~.,. ~ ~, . : ,. '. ., . '.,....,~.. :~:.. ~..,;. :. ,,,~.,,, .,.,,.:-)'ww~v.ci.anchorage.ak.us,v, , .'..' .' .~.... ,::; ...,,: ...~,~" "~,,.,-~-";' ,,':.:'., ,.', ,..;:,v.,::-~,,, '-..,: ....... ,-,~...-.(907)343-7904'...'.-' "., :,, . .',,: -,, ,, CER:rlFICATF' OF HEALTH AOTHORITY APpR0~/~i~ .....,.,:' ..---v.,. , .,..-,, ...:,- . ~ ........ _.,....,. _.. .;... ~.,. .. ............. FORA'SINGLE I--AMILY DWELLING" '-. '"'. .," ~"~?'/,~.,.,",'.... '"' ' ' '" ' '. "' .' :." .... ' .... Expiratiofi Date: I GENERAL'INFORMATION "-:' ....... ' ". '. ',~ . -' · ........" ........ Completel~al;descfipti6n' .'. Lo"C~q ~ ~'~.V,E~ ..~.~ -- Location (sit~'a~Jdr~s~'0r~irections) ~ K.'-~ t,-{OoNTA4 N CZ(P-¢LI~- · Current Property own. er(s) ~,c .~[~,1.,~; Mailing address Lending agency Day phone ':~2..~.;- Day phone Mailing address Real Estate Agent Day phone Mailing Address Un/ess o~hetwise requested. HAA wi# be held by DSD for pickup. NUMBER OF BEDROOMS: L/ TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Pub!lc Water Systsm Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding tank [] Community On-site Public Se,,'/sr The'Municipality of Ahch0ra~' D~ve!opment Services Depadment (DSD) Issues Certificaies of ~e~lth ~kuth6rity 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 Eansfer of title (except betYzeen spouses) for properties served by e single family on-site wastewater.disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval ere 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. S:rATEMENT OF INSPEC'I;10'N BY'ENGII~EER''' ' ~ As certified by my seal a~xed I~ereto and as of the vahdat~on date shown below, I verify that my Investigation,' ..... '" based On procedures outlined In the Health Authority Approval Guidelines for this application, shows'that th'e . on-site water supply and/or wastewater disposal_ system Is(are] safe, functional and adequate for th6'numSer of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained fr6m~ the ,' Municpa fy of Anchorage ties'and from my nvestgation and inspecton the on-s~te water supply,and/or. '. wastewater d sposa system s(are) in comphance w~th all applicable Mumc=pal and State 'codes.,, ord~na~c~s,,~.~ . and regulations In effect at the time of instalIatlon., Name of Firm "I'~,D.¢.~-.' u~-t~.~.~. ~ Phone.~P-~.."'J~ ,~c~ .Engineer's Printed Name · · I ~'~'~'./.~_..~[?',~l~[~,~' ':-Date','-~*o/o~-.,: , .~' -.' .... ' .... "'"- '- ' " · ~':TF: ~'"..'4.'~,~,,,,q>,'.,--, ~.' ;.' ~ .. ; ...', , . .:. ,' , . . .. 1~.'~..~ ,¢,~' '~.~ ., . ,. ,,-, .~,, , -,~. ,..'~..'~ ,. % .... ........ i .... ,,.~.:.~,.~,i~,..,, .,~~..t. ~..~. ,,~.. ~.~..~ .:,f.~ .~,,.. ...... -%~'" I'; ,L~ '.. ; ': . -,'' ~ .... ~-'~.z. ," .... iE~IGNEERS,' ' ".: ' '' ~ ...... , ..... ~ ,' ..... ' ~"' ,.~l~!.4..{h--~-,.,.~o'~,~--~,,,~ , ...... ,, .. ..'..: . . .: . ... . . ...... .,,,,s.'r^l,?, -."- .... ~ ~',: .... ,--".., - .', it ' g.,..~,,' ';',~' , ' ,"' ~',?' '"~1 ~ ... '..'~%.", '. · . -' ~',~ ~v'. __~'.'.? J~.~.,," ....... DSD SI~NATURE:,i .: .... ..-.",; .... ' .: .-" '1,~~ 2- .L .¢~-:,~-~ ' ".;,:;:,'" ' 'L':., ,'."' "- ............ ' N~ C~,.~:...,-.. ,.,~,;.?, ........ . · Approved for, bedrooms. . . ,, a.~,., ..... ,,t...,., . , Disapproved. ' ' '--- '"'- ' - Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Attachments: HAA Checklist X Septic System Advisory - ....... L Maintenance Agreements Supplemental Engineer's Report Other '~ .... ' ~ .: ....~,:'~.' -:'-.:, ,..,. Odginal 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 www. ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WELL DATA Well type Date completed __ Total depth ft. If A, B, o~ C provide PWSlD # · Sani~ sea (Y/N) FROM WELL LOG Parcel ID: otl- Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION in* Date of test Static water level ft. ft. Well production g.p.m, g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mi. Nitrate Date of sample: Collected by: mgJI. Other bacteria colonies/100 mi. B. SEP13C/HOLDING TANK DATA Tank Type/Material ~ Tank size e0-OOC:) gal. Number of Compartments ~ Foundation cJeanout (Y/N) ~ Depression over tank (Y/N) ~ Date of pumping ~'l~/~3t' Pumper ~'/,~ D.te tnsta,l Cleanouts (y/N) High water alarm (Y/N} Co ABSORPTION FIELD DATA Date installed ~/~"/ol Soilrating (g.p.dJftZorfl~l~W~) I. ~ Length ~, O ft. Weth ~- Total depth I ~ ft. Eft. el~orption area ~'"1.0 ~ Monitoring tube y Date of adequacy test I,~J~, Results (Pass/Fail) Fluid depth in absorption field before test__4~in. Water added ~"gal. Elapsed Time: __ min. Final fluid depth in. ,,~sorption rate Any rejuvenation treatment (past 12 mo.) (Y/N & type) System tYPe Tv ~.v~C. ~ Gravel below pipe 7 Depression over field fro For ~-~ bedrooms N~,~pth ~/In. >= g.p.d. If yes, give date D. UFT STATION Date installed 'Pump on" level at in. Datum S, ize ia gallons jManhole/Access (Y/N). Pump off' leveJ.~*~in. High water alarm level at Cycles ~ Meets alarm & circuit requirements? 'sEP^RAT,O. o,ST..c£s SEPARATION DISTANCES FROM WELL ON LOT TO:/ Septic tank/lift station on lot ~. ; ~ . / On adjacent lots Sewer/septic service line ~ Holding tank ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: In. Building foundation I ~, Property line ~, P Absorption field Water main j ~ ~) .b_. Water service line ~'/3 ~'' Surface water Wells on adjacent lots t~/~,. Property line Water Service line Curtain drain SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ~ C) Building foundation /-~.-..'..~ [P-O-P-- SurPace water ~ ~ t"3 t--II ~ Wells on adjacent lots ~_Z~y Watermaln l~O~- Driveway, panVJng/vehicte storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review ~f Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printad Name ~1~'~-...~v~-I~.~,~ Date HAA Fee $ ~7~-~-'' ;ate of Payment Receipt Number (Rev, '12/00) Waiver Fee $ Date of Payment Receipt Number R06,/O