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HomeMy WebLinkAboutSEACLIFF BLK 3 LT 4eacliff Block 3 Lot 4 #011-221-46 Municipality of Anchorage Paye _L_of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5LJ 93000 PID Number: 01)ZZIqL Name. �1Wastewater System: ew ❑ U rade TZ . �. A nt 1)C LA" �{oD t�,f Y P9 Address: 5Z EN6)torr Ste- ABSORPTION FIELD Phone: No. of edrooms: O Deep Trench W&Ilow Trench O Bed O Mound O Other LEGAL DESCRIPTION Soil Rating: Total Deplhfrom Original grade: Z GPD/Sq. . Ft. 7''6" Depth to pipe Lot: Block: ` Subdivision: bottom from original grade: Gravel depth beneath pipe y% —6 Ft. Ft Township: Range: Section: Fill added above original grade: 4 Gravel length: 104t. FI WELL: ❑ New ❑ Upgr de_,,> Gravel depth: Numberoflines: Du`� Was: L� Ft IFt Classification ( B,C): Total Depth, aced To: Total absorption areCa::// Pipe malarial: GI Ft. FI. 76 0 SO. Ft. O O Driller: rifled: Static Water Level: Installer: Data installed: Ft. 0)-3 Yield: Yield: Pump Set at: Casing Heign ound: TANK GPM Ft. Ft. SEPARATION DISTANCES 40reptic O Holding 0 S.T.E.P. To Septic Absorption Lift Holding- rivals Manufacturer: /'nrM Capacity in gallons: From Tank Field Station Tank Sewer Lines (aK-a�c/r� ' 0-c? Well Material, Number of Compartments: nrbr AprL4cA s L � Water LIFT STATION Lot 1 / Size in gallons: urer. Line Foundation v 301 1 "Pump on" level at: p off' level at: High water alarm al: Curtain h ` N Pump odel Electrical Inspections performed by: Drain �fqV /,� 1 Remarks: BENCH MARK _. . – _ , _ ... . A Location and Description: Assumed Elevation: lGaqFf ENGINEER'S SEAL app Or Al '% d.�[4X� D06e®3 ESdy pi99 9 - � VZ®eD fleD Inspections performed by: A1zift.1 M—, Dates: is:> ° %off u ec �©yes aeouaa scD a aeaea 2nd a0 cco �eC-ooao 00000a ooa ooaDo `.� �� Michael. E. Anderson e �W Department of Hea and Human Services approval f ,r\€t 4381 • E uD4e �� Reviewed and approved by: Date: 72-013 (1/91) MOA 25 - 014 Permit No..sv 9'2'0ej:2— Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: I 72-013 A (2/91) MOA 25 PID No.: OI 14/1.1 6 e� ^.v�QG'f ^. GC;fjly 3(i'J.3G 800000 0 (� �e `. Michael E. Anderson p<vo 4M] -E o or 00000\ Permit No. %30!24 Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PID No.: p)IMIffe— U AI Q q'-�'- I.l%��\�\moi --�V �� %$'�._--C�+v���%-- / --jj�_ _-T'Y,..�• ce ►a4 F:4k. �'TI Ci Izcxr.-K b ��. ��� �Ibi ifv� . sa Igor-�� �Ajlor`I In= Q,4� �flr'i�,c+n'fp•1 72-013 A (2/01) MOA 26 4 «o , F� W1iFi ��'c e 9aC50 �OpdE C Michae! E. Anderson `cn 4331 - E MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930049 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:RHODES R J & CLARA A OWNER ADDRESS:9352 ENDICOTT ST ANCHORAGE, ALASKA 99516 PARCEL ID:01122146 LEGAL DESCRIPTION: SEACLIFF BLK 3 LT LOT SIZE: 13050 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 N THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 4/05/93 EXPIRATION DATE: 4/05/94 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: DATE: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 March 29, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "U Street Anchorage, AK 99502-0650 Subject: Lot 4, Block 3, Sea Cliff Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: Installation of an onsite wastewater system on this lot will have little, if any impact on surrounding properties because: 1. The lots in this subdivision have very good soils for natural percolation and are served by a community water system. 2. The lot has sufficient area for the wastewater drainfield system, and any future system that may be required. 3. Installation of the onsite system will not affect surface or subsurface drainage in the general area. Sincerely, Michael E. Anderson, P.E. i µ3 NIl C.1Cd t], 1:❑df'lSpil RAs» R,s £ƒ 1/V'rQse7)A)»212ec6 }_2'. eromnP Ekr*y� CoQ 2\ � � \ t 0 9 w g E nd m Z ` y nE / ®\GRED � ® < 0 / Permit No. Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: �- `/ !36 3 SEACG /r PID No.: ENGINEE !S SOL)- �J - r � frG .JG ;r, A4�chael C Andoi o i 4381 E n 72-013 A (2191) MOA 25 O F� •� Municipality of Anchorage +,4r—,J DEPARTMENT OF HEALTH h HUMAN SERVICES5©`` 825'L- StreeL Anchorage. Alaska 99502-06,50 SOILS LOG — PERCOLATION TEST 6� 4 PERFORMED FOR:- OT [�E V/ E.V T GATE P LEGAL DESCRIPTION: G y Se,4e-_ Townsnio. Range Section: DEPTH SM SLOPE (FEET) SITE PLAN 1 SILTY SAI.ID I I ( I I GM TN 2I I I I I I I Si N I cry GReAVcL 3 Sw I 4 Wi'LL (,R4DE.D SANr�s w/GRAVEL I I I ` ITNII 5 6 7 8 9 10 11 12 13 14• 15• 16• 17- 18- is - 20 - Sw W 6L L G&ADEG SA Nos w/t,5Ss GR.4V�-=L WAS GROUND WATER ENCOUNTERED? —A-10 IF YES. AT WHAT DEPTH? cam Is war Attar Mo(emnng? o r p� 3' /S• 43 m Rewin9 I Date I I Net�OWet,)m Tim. to er Net Dtm 3 l o I o I I i z_ " , s I I I I I I I I I PERCOLATION RATE °2' S {mmutevlmml PERC HOLE DIAMETER 6 TEST RUN BETWEEN .3 FTAND 51FT COMMENTS SRC I'IOLE ARE SO A KED CL£Au I�,IF I I �yZalA�iti� OI IS PERFORMED BY: F -A D D-) 1 1I THAT T IS/TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 72-008 (Fier- 4,65) V O C` Muniaoauty of Anchorage DEPARTMENT OF HEALTH d HUMAN SERVICES E'ti \y/ 825'L: Street. Anchorage, Alaska 99502-0650, u SOILS LOG — PERCOLATION TEST L. Anuerson b3£il -1; PERFORMED FOR:— J a LEy EMT U c°°f90=/�.,� DATE PERFbId E.aFT()F[- , Z' 'i LEGAL DESCRIPTION: Townsnio. Range Section- oEPrH - SSLOPE SITE PLAN (FEETI W 1 VJELL 6RAD15D SANDS 2-- 3 3 GP POORLYrjX,4DED 4 6R AVEL. W/5,4AJD 5 6 7 8 SW 9 WELL GRADED 10 SA 1`( D WISo M e 11 GRAVEL. 12 13 14 15 17 18 19 20 WAS GROUND WATER ENCOUNTERED? N O IF YES. Ar WHAT OEPTH? 3•is, g3 um IS war ma Mom"? No UJetv pale Radu�q ( Oa • GCOSS I T Not I T rt>. WzsB to N&t Oreo 3 2 43 I o /. S /. 5 I 3 " 3.0 q, S .5 1.5 I 8,5" I I .5•. .5" 1 I t I I I I I I � � I PERCOLATION RATE 3 Imuwtewinaf) PERC HOLE DIAMETER u TEST RUN 8ETWEEN '3 FT AND _V FT COMMENTS ��%Z K- I-IOCE P2E CJEAM V�J E_I_ f267N7m SDILS PERFORMED BY: - IiJ. %YLEA lip =-FATiFY THAT ?HIS/TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE ANO MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE OATE 72.008 (Rev, 41861 Municipality of Anchorage . , .:• Development Services Department Building Safety Division On -Site Water b Wastewater Program 4700 Bragaw Street P.O. Box 196650 " Anchorage, AK 99519.6650 �/i www.muni.org/onsite 4' (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL / FOR A SINGLE FAMILY DWELLING p Parcel I.D. CIII' I"!Ike COSA# a !42 1. GENERAL INFORMATION Expiration Date: _ 5' —0 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SEACLIFF: BLOCK 3. LOT 4 9352 ENDICOTT STREET 'ANCHORAGE, AK 99515 RICHARD DUNKIN Day phone 350-0494 9352 ENDICOTT STREET *ANCHORAGE, AK 99515 Day phone BERT DOZARK W/ REMAX Day phone 257-0425 110 W. 38TH SUITE 100 'ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSO for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 4 TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ —/ Ind 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 ehgineer 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 samples. (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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. '1 further verify that based on the ... . igformation obtained from'the'Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system ls(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. . Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone .337-6179 Address '3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, e4o� F 004 conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and Q ... 1111.. 1111...... septic systems depend on the local soils condition, groundwater levels that may Q•.111.1. D fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test .•.. r. G.. e.. .. results do not guarantee future performance of the system, nor do they guarantee that 0 Y 1Qp E 9 .•' there are no hidden defects or encroachments. GEG, LTD. can therefore not provide QJ' .• C 5 r7��.. 3 , q`v any warranty or future estimate of how long the system will continue to meet tho `I operational requirements of the ADEC or MOA DSD. The content of this report is for ^°0 Pro f es sto^o 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 it confer any legal right whatsoever. 5. DSD SIGNATURE ON-SITE Approved for 1+ bedrooms. �; WATER AND WASTEWATER Disapproved. _ PROGRAM Conditional approval for bedrooms, with the fllowing stipulations: ��.•• •1111... Attachments: / COSA Checklist l/ Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Reort Nitrate Advisory Other O - . By: Original Certificate Date: � -� r . (Rev. 11105) Municipality of Anchorage Development Services Department ° Building Safety Division On -Site Water & 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: SEACUFF; BLOCK 3, LOT 4 Parcel ID: A. WELL DATA Well type Date completed Total depth Date of test Static water level Well production PUBLIC WATER If A, B, or C provide PWSID# Sanitary seal to ft. FROM WELL LOG ft. g.p.m. Well Log (YIN) opUr protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./L. Other bacteria Arsenic: a e7o—sample-.:— Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 6/93 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 9/27/07 Pumper NORTHLAND C. ABSORPTION FIELD DATA BEtow EXISTING GRADE Date Installed 6/93 Soil rating (g.p.d./ftorqEE01.2 System type TRENCH Length 56 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth •8.6 ft. Eff, absorption area 560 ft' Monitoring tube YES Depression over field NO Date of adequacy test 5/14/08 Results (Pass/Fail) PASS _ For 4 bedrooms Fluid depth in absorption field before test20 in. Water added 750 gal. New depth 25 In. Elapsed Time: 10 min. Final fluid depth22 in. Absorption rate >= 600+ g.p,d, Any rejuvenation treatment (past 12 moa (YIN & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access water alarm level at in. "Pump on" level at in. 'Pump off" E. SEPARATION DISTANCES Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line PUBLIC WATER On adjacent On adjacent lots Holding tank manhole/cleanout Ani inment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 1000+ i Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Buildingfoundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION i certify that I have determined through field inspections and 0 ,i! 'F i /1 . . ..... review of Municipal records that the shove systems are in , conformance with MOA COSA guidelines in effect on this 0 , date. J A. Garne s: Engineer's Printed Name JEFFREY A. GARNESS �Qa r ' 953 .• ` 4 {� �Qt�e e sl[q Date =! t�i�n $ I.0 -'yore sslo�aQo COSA Fee A tl; 'o Date of Payment r(�yo8 Receipt Number 8�30r1` (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SN E { a 1 33 3E�98 � # fill YYtfodd3aal�2YIClC2B;s4. � , in 7 J/i \\ N, ` , C I ]I 'istyl \ \ / r` • +-4 • FFF � --rz_ '� >.' aT-`--• •` LLL — �--� 1 �-�! •J II Y ^�. s v ! - 1001 41 dM BLO,FF o I Jg1 �\ i R i w .;, w i \ �t. %i ;SEACUFF o i \ I i C] S 1 g 8 "✓J lW9A +t+4 1®® �� d5 �• y"n �� n P' ���i���r✓id� � �s•����� ®Q®®®®©©® May 13 08 02:40p RE/MAX Agent Service Cent J .i 907-258-9005 rr p.2 A v it K y w �1 C w4•t. JSS• ; Alt 31 "C "I � w Yang sd� A� zo40 a : 30 • e m C 4 :sE �s- `, 7; X F m � M C © 'IS I 4 0 (AVM AINI) 1332J1S 110010N3 I 4 O 0 K 2 L ��sVOCjC�`•— D O o 41f61• ; 'IS (AVM AINI) 1332J1S 110010N3 I 4 O 0 K 2 L ��sVOCjC�`•— D O o 41f61• ; 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-221-46 HAM HA C7 1 O 1 O!� 1. GENERAL INFORMATION Expiration Date: Complete legal description SEACLIFF SUBDIVISION; LOT a BLOCK 3 Location (site address or directions) 9352 ENDICOTT STREET, ANCHORAGE AK 99515 Current Property owner(s) ROBERT & LOUANNE GUNDERSON Day phone 348-1370 Mailing address 9352 ENDICOTT STREET, ANCHORAGE, AK 99515 Lending agency Day phone Mailing address Real Estate Agent CAROL BUTTLER w/ REMAX Day phone 257-0161 Mailing address 2600 CORDOVA ST. ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 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 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 engineers work. Note. Alaska Waterand Wastewater Consultants, Inc. shall be pald $855.00 at, cr prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verity that my investigation, based on procedures outlined In the Health Authorityaoproval 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 ype of structure indicated herein. I further verity that based on the information obtained from the Mun/dpaW of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system Is(aro) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm AKA WATER k WASTEWATER CONSULTANTS. INC. . Address 6901 DEWR ROAD, SUITE 28 • ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: in conducting tihis evaluation, AKM, too. attempted to provide a thorough, conscientious engineering anaWa of the system in accordance wlm ADEC and MOA DSD Guidelines d Reguladons. fie reported results described the performance of the system under dbe conditions encountered at the time of the test and separation distances measured to readily klendfiable features. The operational filo of afl wells and septic systems depend on the local lolls condition,"groundwator loves that may fluctuate during theyea , and the water usage of the famlybeing served by the system. Those conditions are outside the control of the evaluator of the system. Satisfactory lost results do not guarantee future performance of me systom, nor do they guarantee that there are no hidden defects or encroachments. AVVYVtir, Ino. can Moralore not provide any warranty or future estimate of how long the system wpl continue to meet the operational requirements of the ADEC or MOA DSD. The content of NIs report Is for the solo 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 It confor any kigal right whatsoever. 5. DSD SIGNATURE Phone 337-6179 Date 3 0� Approved for _� bedrooms. Nz \Q4.y' .'`y0i Disapproved. �J=:� .ON-SITE .• ' WATER AND Conditional approval for bedrooms, with the fllowing stipulation9: WASTEWATER PROGRAM //JJJI1)1)))1)lh Attachments: HAA Checklist C/ Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By- C/t o ��. Original Certificate Date: 3 " -2 -7 O (RW. 12M) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SEACUFF SUBDIVISION; LOT 4, BLOCK 3 Parcel ID:_ A. WELL DATA IPUBLIC WATER Well type If A, B, or C provide PWSID# _ Well Log (YIN) Date completed Sanitary seal (Y/N)_ Wires properly protects Total depth ft. Date of test Static water level Well production WATER SAMPLE Coliform Cased to ft. Casing FROM WELL LOG colonies/100 mL Nitrate D�f sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Collected by: STEEL 011-221-46 ground) in. g.p.m. —mg./L. Other bacteria colonies/100 ml. Date installed 6/93 Tank size 1500 gal. Number of Compartments 2 Cieanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 3/13/2001 Pumper McDONALDS C. ABSORPTION FIELD DATA ve ow FINA cRADF Date installed 6/93 Soil rating .p.d./ r ft'Ibdrm) 1_2 System type TRENCH Length 56 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 9.6 ® MT ft. Eff. absorption area 560 ft' Monitoring tube YES s Depression over field NO Date of adequacy test 3/15/2001 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 16.5 In. Water added 11 129 gal. New depth 295 in. Elapsed Time: 110 min. Final fluid depth 19.5 In. Absorption rate >= 600+ g.p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed "Pump on" level at —in. E. SEPARATION DISTANCES Size in gallons Manhole/Ac fN 'Pumo off" evoi a _m. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main — On adjacent lots On Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5'+ Pro line 5'+ Absorption field 5'+ Building foundation Property Water main 10'+ Water service line 10'+ Surface water --Loo, �+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line P rtY '9 Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS 'PER 1993 SEPTIC AS—BUILT & HAA G. ENGINEER'S CERTIFICATION o `�.•� "'� 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. :... 0 Jt F as:Engineers Prin ed me JEFFREY A. GARNESS C •: �c°G Date 7 Z3 Of 4��400000o�o HAA Fee $ 300 • Date of Payment Receipt Number oZ 1D (Rev. 12100) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • �,/ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services dh On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1211,1"Z/l+(' 1. GENERAL INFORMATION HAA # �AQq 2 LJ -c) q Complete legal description Location (site address or directions) 9'7�a?i �NpIGo� r t�J T4K Property owner L•1 4p4' 62AZ& Day phone Mailing address Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone 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 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 921 J. Q 1 M 1 c1Y1G1`Y 1 Vr IIYAr GV 1 IV17 o I GI\L711�GL.n As certified by my seal affixed hereto and as of the validation date shown below, I verify that;,,; 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. Name of Firm AN EIZSSOPJ CA16)AlcM::M41V 6 Phone 044- 937-t& Address lea. Sox ZVo -17S ANtxlyo"Z, r- A)z-g957, Engineer's signature % Date //17 93 6. DHHS SIGNATURE %- Approved for bedrooms. Disapproved. Conditional approval for Additional Comments UITIC Anderson l bedrooms, with the following stipulations: Date /--16lo— 9Y 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 orderto 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 Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: !��r4• pkj �" W �L Parcel I.D. of j VZ --«'1 A. MLWiMrA[, NM% Well type Log present (Y/N) Total depth Sanitary sea Date of test Static water level Well flow Pump IeveT___� or C, attach ADEC letter. ADEC water system number Date FROM WELL LOG TION DISTANCES FROM WELL TO: Septic/holding tank o`h'let—. Absorption field on lot Public sewer main Public sewer service line — WATERSSE UoLTS._' Coliform Date of sample, —� B. SEPTICTANK DATA Date installed Tank size Wires properly protected (Y/N) g.p.m. AT INSPECTIO On adjacent lots ; On adjacent lots Public sewer Petroleum tank Collected by: I;C?tg er bacteria Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) T► Depression (Y/N) High water alarm (YI/Nl)' Alarm tested (Y/N) �/�si Date of pumping NIS rn ;a ' o z n i PT7 M D Ir -r, �. oA r K o 9.p -m< z M W 2 ® y 00 vi r) O M Z SEPARATION DISTANCES FROM SEPTIC/It=991= TANK TO: U Well(s)onlot u Onadjacentlots 04 Foundation �I �1 I To property line OI Absorption field (fir Water main/service line 44t. a Surface water/drainage ��'%� + 72-026 (Rev. 3/91) Front MOA 21 - CONTINUED ON BACK PAGE C. LIFT STATION Date! ii led Size in gallons Vent (Y/N) "Pump " level at High water alarm level Meets MOA electrical codes (Y/N) y� Manufacturer Manhole/Access (Y/N) SEPARATION DI3TAfCE FROM LIFT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA mp off" level at Cycles tested Surface water . Date installed _�o I I y Soil rating �Z'�w System type Length Width -Gravel thicknessTotal depth Total absorption area 5s'0 Cleanouts present (Y/N) Depression over field (Y/N) IV Date of adequacy test New Ls�� Results (pass/fail) Now 1�I"L for bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I r On adjacent lots Property line t Z7;,Cld VL To building foundation To existing or abandoned system on lot N f► On adjacent lots 174 Cutbanl< Water main/service line> Surface water >i[�O' Driveway, parking/vehicle storage area> Curtain drain —V _ F. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name — / Date // p /C%.f 00d00030y9`�tr y%'�-' t h5sdrecl �. hntierson `;' „ 4381 - k W, ° c, HAA Fee $ Waiver Fee: $ Date of Payment G ' v _ 2 _ Date of Payment Receipt Number % �� 7352' Receipt Number 72-026 (Rev. 3/91) Back MOA 21