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HomeMy WebLinkAboutKNIK VIEW BLK 2 LT 7Knik View Block 2 Lot 7 #051-031-38 Municipality of AnchoragePage 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 Permit Number: ~ ~J' ¢t,~ O i 'Z.- O PID Number: O ~ I - Name; A _. ~1~:~ I¢c, ~-~:. ~.-~ A~ Wastewater System: ~ New B Upgrade Address: ¢'o, ¢~x 4"/o0,{~ Cgu~, ~ fl,~'; ABSORPTION FIELD Phone: No. of ~drooms: '~ ~ ~1 CO~' Q Deep Trench ~ShallowTrench ~Bed ~Mound DOther Total Depth from original grade: LEGAL DESCRIPTION soi,.~.~.: I ' r ~GPD/Sq. Ft. :, Block: Subdiv~iom Depth to pipe bottom Item odginal grade: Gravel depth beneath ~ipe Lot: Township: Range: Section: Fill ~dded above original grade: Gravel length: ~ ~- --~ O .., o,~~ ~t. N ~. Gravel width: ~ ~ Ft.Numbertof lines: lDislance ~en lines: WELL: 8x~.q¢~_ New Q Upgrade ~. · Ft. Classification (Private, A,B,C): Total absorption area: ~1 ~ ~¢o: Pipe m~terial: ~ST ~ Ft. Ft. ~O~ SQ. Ft. Driller: ~ Date Drilled: StaticWater Level: Installer: Date i~stalled: /--Cie[d/ GPM PumpSetat: Ft. Casing HeightAb°veGr°und:Ft. TANK __ SEPARATION DISTANCES ~ SepticQ Holding Q S.T.E.P. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~CI&O¢~CE '~¢' t Number of Compartments: Well- ZO¢i~ "~¢~4 ~ ~ ,Z~i~ Material: ~.¢~ ~ '~ Surface Water I~+ loci,- -- ~ LIFT STATION LOt ~ , Size in gallons: Manufacturer: Line ~ j ~ "Pump on" level at: "Pump ¢~ J High water ~larm at: Foundation CurtainDrain ~" ¢O~ ~l)~ .__~ p~Bectrical Inspections performed by: Remarks: BENCH MARK Cocat~on an0 Ooscdption: Assumed Elevation: Inspections performed b~ & s ~Ne!U~BR!NO Dates: 1st '~-VI''~1~ ~,. 2~f~ ~-,-~'~ . 170~4 Eagle Elv~' Loep Road, No. 204 2nd '~ ' ~ z,- '16 6, -~, ' .... Department of He~th an0~i~ ~ gn Services approv~~ ,~,~ u,.~.,, ... ,. ...,./ Reviewed and approved by: , A[~ [~ ~ Date: ~ O~ % '~.,_. 72-013 (Rev. 9/91) MOA 25 Permit No. SW960120 Page 2 of 2 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 LOT 7, BL. OCK 2, KNIK VIEW ESTATES 051-051-58 Legal Description: PID No.:  FCO 4.C 43,0' ST2 14J)' 50,0' DBL1 1 4-.!i 51.0' C01 17.1i' 47.0' ff // CO2 39,!i' 17.0' 6 /// ~d::i' 16.0' " NEV TRENCH AL¢ 1', SIT ; / / ~ / SEPTIC TAN CAL 40' ~ CO1 .... ...... SEPT] U ' '¢ TANK H'm SO O~ flO WATBI FOUND 84.0' I.O.[I. 72-O13 A (Rev. 9/91) MOA 25 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 PAGE 1 OF 1 PERMIT NUMBER:SW960120 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:LEROY ALDERMAIN OWNER ADDRESS:P.O. BOX 670045 CHUGIAK, ALASKA 99567 DATE ISSUED: 6/13/96 EXPIRATION DATE: 6/13/97 PARCEL ID:05103138 LEGAL DESCRIPTION: KNIK VIEW BLK 2 LT LOT SIZE: 20000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST 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 (18AACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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: ENSURE ADEQUATE AREA FOR THE ALTERNATE SITE AND SHOW ALTERNATE SITE AND CUTBANK LOCATION ON ASBUILT./ RECEIVED BY: ISSUED BY: // DATE: ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. June 5, 1996 HEATH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECNANtCAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 995].9 REFERENCE: Lot 7, Block 2, Knik View Subdivision CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-12'11 Request you issue a permit to ins%all a septic system %o serve %he proposed three bedroom house on %he referenced proper%y, A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole. The monitoring tube within the test hole has been checked and found to be dry. This property is served by Community Water System. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. P.E. Rcc/gk Enclosure ENVli~D,~ENTA~" SE~,VtCE$ DiViSION JUN 07 1996 RECEIVED 17034 NORTH EAGLE RIVER LOOP . SUITE 204 · EAGLE RIVER, ALASKA 99577 SITE PLAN DESIGN ~> 0 ~--3 D ~ z or / ~ ~ ~ ~,~ ' / m~ 0~ ~m % ~ / / o ~ m re ~ p~ '' z / ~ ~ m~ 0 0)%~ z0 ~ ~0'% ~ ~ c / o ~ ~ z ~ %~ ~ <z / zo "% '__ ¢~ '~ % z , :k --,".~ Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ,OBE,T c. COWA, Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S DEPTH? ~ E Deplh l0 Waler Af~j, [ M0nil0ri,D? ~ Dale: ~'-~'~ ~'~/'" Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ., 2~' [mmutes/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ F'[ 17034 Eagle Ri¥or Loop Road No. 204 ACCORDA.CE WEa~I~,TI~I~$~.. AL GU~DE'~NES ~N E"~ECT ON TH~S DATE. ~ATE: 72-008 (Rev. 4/85J 00~'o~ ~ ~ · 0 0 0 0 0 0 0 0 0 0 0 ~ ltlg.ioM Xq gu.issud luoa.iod ROBERT C. COWAN, RE. ROBERT A. SHAFER, ,RE. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS HEAUHAUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN REFERENCE: Lot 7, Block 2, Kn:Lk View S/D June 5, 1996 GENERAL: CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 The scope of this project includes 'the installation of a 1000 gallon septic tank and a five foot wide drainfield to serve the proposed 'three bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system J. nstallations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Ail standpJ.pes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 . EAGLE RIVER, ALASKA 99577 Page Two Lot 7, Block 2, Knik View S/D June 5, 1996 Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank)° These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before grave]. (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforatJ, ons faced downward. Grave]. is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 7, Block 2, Knik View S/D June 5, 1996 Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: T_yDe of Pip~ Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM FS10 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield grave], layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 7, Block 2, Knik View S/D June 5, 1996 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wast,water disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be 'the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 7, Block 2, Knik View S/D June 5, 1996 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequencer procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER --' Municipality of Anchorage Development Services Department Building Safely Division On-Site Water and Wastewater Program 4700 South Bragaw St. P,O, Box Jg6650 Anchorage, AK 99519-6650 www.ct.anchorage.ek. Us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL. INFORMATION complete legal descripti?n Lot Localion (site address or directions) 2 2 5 2 8 Current Properly owne~'(s) Allen Smi th Mailing address H**# Expiration Date: 7; Block 2; Enik View Subdivision Inlet Vista Drive, Eagle River, Day phone 688-6464 22528 Inlet View Drive, EaRle Riverr AK 99577 AK Lending agency Day phone Mailing address Real Estate Agent Kathi Olmstead/Remax Day phone Mailing Address 16600 Centerfield D~ive, Ste. 201, Eagle 2. NUMBER OF BEDROOMS: 3 694-4200 River, AK 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding lank [] Community On-site Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certil~cates of Heallh Aulhorily Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered tn the State of Alaska. CertiQcates of Heallh Authority Approval are required for the transfer of lille (except between spouses) for propedles served by a single family on-site wastewater dl~posal ehd/or water supply syslem, 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 priva{e or Class C well and may be reissued with new water sample results less than 30 days old. (Cedificates may be reissued for a period of up Io one year with valid water samples.) Cedi[ic'~tes are valid lot one year for propedies served by Class A or S wells or a public waler syslem. The Municipatily of Anchorage ts not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY EJ~Gi~jEER As certified by my seal al'fixed hereto and as o{' the valldalion da{e shown below, I verify Ihat my Invesltga(ion, based on procedures outlined In the Health Authorlly Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal Sy{lerri Is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I furfJmr i/ed~y (ha{ based on Ihe Information obtained from Ihe Municipality of Anchorage files and from my Investigation and Inspeclion, Ihe on-site water supply and/or wastewater disposal system is(are) In compliance Wilh all applicable Municipal and State codes, ordinances, and regulations In effect at the time of Installation. NameofFirm S&S Engineering Address 1 7~q;, Engineer's Prin{ed Name Robert. C. Cowan~ P.E. Phone 694-2979 River, AK 99577 Date .~ .-'/¢.-0 2 DSD SIGNATURE I.-"' Approved for ~ Disapproved. Conditional approval for .... ~--?., ...... ; ................. ~ .... bedrooms. ~' '* ". ," .~' ~ -,~... L...~..~ ~ bedrooms, with the following stipulations: Additional Comments Attachmenls: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements S~pplemental Engineer's Report Other /'~c."~g----'/~ Original Ce.il]cate Dale: Mnnicipallty of Anchorage Development Services Department Building Safety Division On-Site Water & Westewater Prooram 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.d.enchoraga.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type ff ~ B, or C p~e ~ID ~ W~l L~ ~) Date ~plet~ ~IN) To~ dep~ . fl. ~ ~ ~ ~g height (~e ~und) in. FROM ~~ ~ AT INSPECTION Date of mst S~fic Well p~u~on WATER ~ ~SULTS: Date~ple: g,p.m. Nitrate B. SEPTIC/HOLDING TANK DATA Tank. Type/Material =j~_~:~"/-- Date installed Tenksize'/OOO gal. Number of Compartments ~ Cleanouts(Y/N) '7/ Foundation cleanout (Y/N) F Depression over tank (Y/N) ~ High water alan~ (Y/N) ,~//,,~' Date of pumping ?~_~.0 1 Pumper ,,,,~"~- ! $ C. ABSORFTION FIELD DATA Date installed. _~ Soil ratin~or ~/bdrm) /. ,~ System type 5/'/' ~--,,~-~' ,~ Length ~D fl. Width ~ ff. Gravel below pipe 4 ft. To~al depth ~ It.._Eft. absorption area ~?__~ Monitoring tube ~/~ Depression over field P',/ Date of adequacy test 9 Results (Pass/Fall) _~a¥~,.~ For ~ bedrooms Fluid depth in abso~ field before test,~, Water added '~gal, New depth ~ in. ElapeedTime:...~min. Final ,uid depth O in. Absorp,enrate >= "~-~) g.p.d. Any rejuvenation treatment (pest 12 mo.) (Y/N & type) ,~O,,~'~,~'V'd~,,~,~/ If yes, give date ~ g.p.m. mg./l. Other bacteria ~ colonies/100 mi. D. UFT STATION Date installed ~//~,v~" Size in gaJlons 'Pump on" level at /in. 'Pump off' level at / Datum / Cyctes tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot Absorption field on lot in. Manhole/Access (Y/N) High water alannn level at Meets alarm & ~ requirements? On adjacent lots On adjacent lots Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Water main ! Property line ~' '~' Absorption field ~" Water service line / O/~ Surface water Property line Water Service line Water main in. Curtain drain ~ff~ ~/q~ Wells on adjecent lots F. COMMENTS G. ENGINEER'S CERTIFICATION r I certify that I have determined through field Inspecfions and review of Municipal records that the above systems are in conformance with MOA HAA guidelines In effect on this date. Engi~eer'sPrintedNama ~l')O~i~,.4,/'' ~--. L~'~a'~,4~'~ Date y/,c HAAFee $ 3 -/ ~,C'. vc Date of Payment Receipt Number (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number /9 /~' Building foundation I O ~- Surface water / O O / Ddveway. parking/vehicle storage Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 RO. Box 196650 Anchorage, AK 99519-6650 www. oi.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051 -031 -38 .1. GENERAL INFORMATION Complete legal description Lot 7, Location (site address or directions) Expiration Date: Block 2, Knik View Subdivision 22528 Inlet Vista Drive Current Property owner(s) Jim Madden Day phone 688-4200 Mailing address 22528 Inlet View Drive, Eagle River, AK 99577 Lending agency Mailing address Day phone Real EstateAgent Kathi Olmsted/Remax Day phone 694-4200 Mailing Address 16600 Centerfield Dr., Ste 201, Eagle River, AK 99577 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up NUMBER OF BEDROOMS: 3 ~/'7/0; TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. 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. 72 025iRev 01'001' 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S EN61NEERING Name of Firm ~.7034 E3gl~er ~ ,',,',? ~,.a No. 504 Phone Address Ea~jle Rive~", Alaska 99~77 Engineer's Printed Name DHHS SIGNATURE /.---" Approved for Disapproved. Conditional approval for Robert C, Cowan Date bedrooms. · t, .. ...... ..¢ bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: / " Expiration Date: ~ - _X--- © / Original Certificate Date: Reissue Date: q - Ec- o o D- Municipality of Anchorage SEP 0 5 2000/'~ bPARTMENT OF HEALTH& HUMAN SERVICES ~,~ Environmental Services Division MUNIOIPALITYoFANcI~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (90r~v~sERvlOEs'I~ Health Authority Approval Checklist LegalDescription: J..-g,l'"'J ~-)~V..'Z.-- [,/~t4-d~_u~) ParcelI.D.: A. WELL DATA Well type j~ If A, B, or C, attach ADEC letter. ADEC water system number '~--~ ~'JOI Date completed Log present (Y/N) Total depth Sanitary seal (Y/N) Cased to FROM WELL LOG ~ g.p.m. Casing height (above ground) Wires properly pr~ AT I N S P...~.E6~ION Nitrate Other bacteria Date of test Static water level Well production ~ple: Collected by: g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed 71,-¢-'/,,-- ~J (,, Tank size Foundation cleanout ~i~N), Date of Pumping el ~j.o-o. - c. ABSORPTION FIELD DATA Date installed ¢J Length ~"~ ~ Width Effective ~bs~rption area /?/¢0 Date of adequacy test ¢1 -, ~ Fluid depth in absorption field before test (in.); Fluid depth ~ ~' (ins) Minutes later: Peroxide treatment (past 12 months) (Ye ~ o,='O Number of Compartments 'Z..- Cleanouts~N)_~jL~ Depression (Y~ Pumper "1~' ~. i'Soil rating (g.p.d./fF or ft~/bdrm) J Gravel thickness below pipe Monitoring Tube present ~)N) ¥ Result~ail) ~ t Total depth ~ J ~,~- / Depression over field (Y,~ ¢ For '~ bedrooms Z,. ,I Immediately after ~'OCgal. water added (in.): Absorption rate ~,5"Z) '/''' = _g.p.d. If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) "Pump on" level at* High water alarm level at...~ ~ *Datum Size in gallons E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot On adjacent lots On a~z~cemdots- Public sewer main ~ ~/septic service line Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~,l Property line "~'z~ Absorption field ~'~ Water main/service line I~,1''~ Surface water/drainage lc'old' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ,'¢/'0 / Building foundation // I Water main/service line /0 /~" Surface water /~,~, I .~- Driveway, parking/vehicle storage area Curtain drain "J/)~' Wells on adjacent lots ~ p o J ¢' ,,~ E.G,.EE.'S CE.T,.,CAT,O. .'k ...... '.-~ I certify that l have determined thru field inspections and review of Municipal reco~.~q~Cffie a~l~l[.s are In conformance wlth ~OA HA~ guld~lnes in effect on this date. ~ ~' Signature HAA Fee $ ~-:~ CYI:) ~ ,(%z3 Date of Payment .eoe ,t,umber ('/¢ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 05"l ..o~/-~ ~' HAA# \~(~'~"~--~ 1. GENERAL INFORMATION Complete legal description Lot 7; Block 2; Knik View Location (site address or directions) Inlet Vista Drive Chugiak, AK Property owner Mailing address Lending agency 'Mailing address Agent Address H2C1 Construction/Leroy Alderman P.O. Box 670045 Chuqiakt AK Day phone 99567 Day phone__ 223-8100 Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: MUNICIPALITY OF ANCHOP,.AGE ENVIRONMENTAL SERVICES DIVISION Individual well Community well Public water XXX - SEP 2 6 1996 RECEIVED NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community well system, provide written confirmation from State ADEC attest- ' ' lng to the legality and status of system, ,':' 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 17034 Eagle River Loo~ Road NO; 2.n4. Phone 6 cf ¥ - .:Z~7 77 ' :die :~iver, Alaska 99577 Address Engineer's signature Date D~/~,S SIGNATURE · Approved for ;;7¢/~¢~''~/) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ' Date 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. 72-0'2-5 (Rev. 1/91) Back MOA ~1 MUNICIPALITY OF ANCHOPJ',gE r. NVIRONMENTAI- SERVICES DiViSION Municipality of Anchorage sEP DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental ServiceS Division 825 L Street, Room 502° Anchorage, Alaska 99501° (907) 343[~"~4~· E IV Health Authority Approval Checklist Legal Description: L°~T "/ t CLoc~c '~ ~14~. Parcel I.D.: 0.51 - O'-~i; A. WFLL DATA Well type ~'~h.5~ ~A ~ If A, B, or C, attach ADEc letter. ADEC water system number Lo. present (Y/N) ......... Date completed .... Total depth ...... Cased to __ __ Cas~round) __ Sanitary seal (Y/N) ...... ~roperly protected (Y/N) ~i __ FROM WELL LOG~~ AT INSPECTION Date of test ,~_-~ Static water level Well production ~/ g.p.m, g.p.m. WATER ~AM~~ULTS:  Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed "~ - 'ZCZ --¢~¢, Tank size J oo o Foundation cleanout (~'N) Date of Pumping C. ABSORPTION FIELD r)ATA Date installed '-/ Depression (Y/(~) Pumper Number of Compartments ?-- cleanouts ~N) "if _ High water alarm (Y~ f~ Soil rating (g,p,d,/fF or fF/bclrm) J~Z G?P/Cystem type Length U¢O ~ Width Effective abSorption area ~too Date of adequacy test ~J ~-, Gravel thickness below pipe Monitoring Tube present (~)'N) Results (Pass/Fail) ~, t _Total depth f"f~'- 8.~~ __ Depression over field (Y/~.) 14 For _ ~ bedrooms Fluid depth in absorption field before test (in,); Fluid depth "~ (ins) Minutes later: Peroxide treatment (past 12 months) (WN) Immediately after ~ gal. water added (in.): Absorption rate = ~ g.p.d. If yes, give date 72~026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) .~----~"~ *Datum SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main .~S ew~p~ce line "Pump off" level at* On adjacent lots On Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ Property line Water main/service line ]r,~i4- Surface wateddrainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ~")'o Building foundation Absorption field Wells on adjacent lots Water main/service line Surface water ~ co~ J¢ Curtain drain ~/~ Driveway, parking/vehicle storage area Wells on adjacent lots ~°o~ ~- ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Munic¢ in conformance with MOA HAA E. uidelines in effect on this date. Signature ' Engineer's Name ~ C ¢ ~,~¢J Date HAA Fee $ ~ - ~ Date of Payment Receipt Number 72-026 (Rev, 3/96)* Waiver Fee $ Date of Payment Receipt Number