HomeMy WebLinkAboutKNIK VIEW BLK 4 LT 1Knik View
Block 4
Lot I
#051-031-57
MUNICIPALITY OF ANCHORAGE
Ori -Site Water & Wastewater Program
F0 W)c Y9m5d 4700 Elmore Fk) d
Anohomp AJmkR RK16680W Phone. (QD-n 343-7904 PAN' (W7) W-7997
http)Av ww.munl oFW ire
On -Site Wastewater Disposal System Permit
Parmit Nurnher: 0gP211037
Work Type: SepticTank Initial
Tex Cede Number: -051 031 57000
ISke Lnpal Addmgn: KNIK VIEW BLK 4 LT 1 G 1R7
Site Mai Iiing Address: 22231 BIRCH CAEEK DH. Chugiak
Cwnar; WING ERT ER ,JAMES E
lDesipn Engineer: FIRST WATER CCNSULTING
This permit is for the constrtion of
EffigitFvn Dom-
Enlratlon Date:
Lot Size in Sg Ft:
Total Bedrooms:
2PROD21
:2r2 D.22
46640
❑ Disposal Field 9 Septic Tank 0 Holding Tank ❑ Privy ❑ Private Wall ❑ Water Storage
Al I eonsttuction %half be in scoortlanoo whh:
1. Tho attached approved design.
2. All req uiramerms specified Irl Anchorage Muniap-al code G haptens 1:5.55 and 1.5-65 and the State of Alaska
Waslewatar Di bpm4 Re3uFatio4n (18AAQ72) and DrMking Wetor D9gulaliionB (I aAAC80�
3. The wastewater code r$quir@5 inspections dulling the Ins#allation. The engineer shall notify the Dsvaloprrll�rlt
Services Deparirxlenl per AMC 15.65. Provide notificalim by cakling (907)343-79 +4 (247).
4. From October 15 to April 15. a subsurface wid absorpncn syslam uad€rr conRtrUalion during freezing weather
shall to either:
a. Opened and CIciseol on the same day, or
h. Covered, sealed, and heated ID proveol tMOZiing
Received By: aar� X61 021
Issued By: Date;
3
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
February 16, 2021
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK PERMIT
LEGAL: KNIK VIEW BLOCK 4, LOT 1
The owner has requested that we obtain a septic permit to serve a proposed shop and connected
to the existing septic absorption field on the above referenced lot. The proposed shop will have
one bathroom with no living area. We propose to install a 1000-gallon HDPE tank to serve the
proposed shop. The lot and area are served by private water. The design will not impact any of
the neighboring properties. Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211037, Rebecca Carroll, 02/26/21
FIRST WATER CONSULTING
KNIK VIEW BLOCK 4, LOT 1
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211037, Rebecca Carroll, 02/26/21
Q = FND 518"
ANCHORAGE
,3\p
EQ
�R1�E
PLOT PLAN OF:
KNIK VIEW SUBDIVISION
LOT 1 BLOCK 4 PLAT 9947
SURVEY CERTIFICATE: 1, John L. Schuller. Have conducted a
physical survey of this property as shown on this dra A* and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat. Cinder no circumstance
should any information on this drawing be used For construction of
fences, structures, improvements, or for establishing boundary lines.
21-018
FEB 8. 2021 1 1"=30• 1 edwllxQak.net
JL5 I NW1557 1 210121
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2: It is the contractor's responsibility to check
top of foundation grade and building setbacks
in relation to the lot I ine and easements.
. F 44 -%'%
49TH.
HN L. SCHULLER.
M�s LS -1,0408 ;
t
►r:��fessional �-
�C4 tiQ p, L��Rt�'�to
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274--4992 fax
Municipality of Anchorage ":'
Development Services Department
Bu di.g Sa~ely Division
On-Site Water end Waste~ter P[~ram, 47~ S. ~agaw SL
P.O. Box 196650 Anchorage. AK 99519-6650 Page
~.cLancho~age.ak.us (907} 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: 5~ Oj~O~5 PIDNumber:
~ 5~a~de~ ~r,~ ~n~, ~?~' I~ ABSORPTION FIELD
LEGAL DESCRIPTION ~..w j, ~
Well: ~ New ~ Upgrade ~
., 9-10-
SEPARATION DISTANCES ~ sepuc O Hoeing O S.T.E.P.
TO Septic Absorption Lift Holding PuCCini(
Tank Field Station Tank S~,L~* Prem/e~ 5
,~.w.. IO0~ lO0~ ~ / LIFT STATION
"~" I ~ m-d'~' ~e~*~ ~d~ BENCHMARK
Inspections pedormed by:~70~agle ~ve~ Loop~;~Road, NO~uams: 1" ~- [~[
Develbpme~ t Services Department Approval
Reviewed and approved by: ~. ~ ~ . Dale: I ~ * ~ '
PER,lIT I~O. SW0'J 0095 PAGE 2 OF .~
D ........ M w n_.ic ip. g_.Li .t y_o. ? .A.n_c h.o. C o. g.e.
I-I-'AH/IVlI:::N/ gl- Hb_AL/I-I ANL] HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ·Anchorage, Al(~skc~ 99519-6650·Telephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
gE:GAg LOT 1, BLOCK 4, KNIK VIEW S/D Pig. NO. 051-031-5'7
P£Rm'r No. SW010095 eAC£ 5 oF .3
Municip. o.[i't;._ y_oF .A.n_.c h.o.r' o..c:Le'
DEPARTHENT OF HEALTHAND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.0. Box 196650 ®Anchor'age, Alaska 995Ig-6650oTelephone, 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
L£CAL LOT 1, BLOCK 4, KNIK VIEW S/0 e.lmD. NO. 051--051-57
ST1 ST2 /- 99.5'
96.'..3' J ~ %-96.0'
C01 C03
C02
MTln n nMT2 ICO1 = 99.3' ~,~ CO4 MT4 ~r,r~,~ -
II II II/qo° : 99.0, "" 11 I1
~CO1 = 95.3' ~ ~~C03 = 95.8'
:~95.8'
MT1 . ....~ ~MT~ = 94.g' MT4 95.1'
' [,tTa = ~5.0' ': ....
A B C
FCO .37.5' 13.0' -
ST1 51.5' 22.0' -
ST2 55.0' 24.0' -
DBL1 57.0' 25.0' -
DBL2 58.5' 26.0' -
FS 86.0' 41.0' -
C01 73.5' 44.0' -
MT1 72.0' 45.0' -
C02 - 45.0' 59,0'
MT2 - 42.5' 57.0'
C05 91.5' 59.5' -
MT5 89.0' 56.5' -
C04 - 55.0' 72.5'
¢1T4 - 56.5' 74.5'
·
WATER FOUND ® 90.2'
86.7' B.0.H.
March 7. 2002
UNICIPAI.ITY OF ^NC!IORAGE
I) :parhncnl of I Icallh ariel I luman Services
I~ [ ). [lox 196650
A ~chorage. AK 99519
R ~FERENCE: I.ot I; Block 4; Knik View Subdivision
lesl hole ~as excavated and percolation test performed on thc abo~c referenced lot.
~e approximate location of the lest hole is located on the attached inspccli(m report.
rough the trench extends beyond thc test hole radius, thc soils remained consistent
rotlghOllt excavation or thc ~ ~ nc f es.
'c do not anticipate any advcrsc effects on neighboring wells, septic systems or
-ainage patterns by thc installation or the septic system.
r'OU rcquirc additional information, please contacl us.
~ccrcly.
~?crt C. Co~an, ILE.
17034 NORTH EAGLE RNER LOOP" SURE 204 * EAGLE FINER, ALASKA 99577
ROBERTC. COWAN, RE.
ROBERTA. SHAFER, RE.
CML ENGINEERS
(907) 694-2979
FAX (907) 694-1211
by
SULLIVAN WATER WELLS
P'.O. BOX670272, CHUGIAK~ ALASKA 99567 o TELEPHONE6~8-2750
OWNER OF LAND:
ADDRESS:
LEGAL DESCRIPTION: ~'/~ I ~· L) J ~.~J
PERMIT NUMBER: ~ ~O0 ~Date of Issue ~
T~ IDE~IFICA~ON NUMBER: ~- d ~ ] .
Is w~ I~ated at appr~ permit location? ~ ;~ No
Method of Ddlling~ ~ ~o~ 0 ~ble tool
Depth of well: ~ [
C~ing TyPe~Wall~lcknessJ ~ ~ · _inches
Diamet~ ~ i ~ inches, depth _ ~ / feet
Lh~Type:
C~ing Stickup Above Ground: ~. feet
Static Water L~el: ~ feet
R~er ~te: ~ ~ gpm
Met~ of Testing: ~ ~
W~I Intake Opening Ty~e: ~nd O o~en hole
~ Sc~n~; S~ff f~t Stopped feet
0 Perforati~s S~R feet ,St~pe~ feet
G~ut Type: ~-- Volume l~
Depth: from ~ f~t, tO~ 0 ~ feet
Well Dis~nf~t~ Upon ~mpletion? ~s Q No
Met~ of Disinfect;on: _ ~ ~ ~ ~ ~ ~,
~mmenm:
BORE HOLE DATA
Driller's Name
A'I-I'ENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municlpallty
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu BOrough:
De~adment of Environmental Conservation.
MUNICIPALITY OF ANCHORAGE
Development Services 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 I WATER SUPPLY PERMIT
Initial
Date Issued: May 02, 2001
Expiration Date: May 02, 2002
Permit Number: SW010095 . Parcel ID: 051-031-57
Legal Description: "KNIK VIE-'~N SUBDIVISION BLOCK 4 LOT 1 r
Design Engineer: 0003 S & S Engineering Site Address: NHN KNIK VISTA DRIVE
Owner Name: WALDEC ENTERPRISES INC. Lot Size: 0 SQ. FT.
Owner Address: 6208 STAEDEM DRIVE Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE, AK 99504-1628
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
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 ( 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.
Municipality of Anchorage.
Development Services Department
Building Safety Division · r
On-Site Water end Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWEPJWELL PERM T APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.O.~'l -- 043 - 3 2
Permit Number
Properly owner(s) T [ O
Mailing address (1) P'O'
· ~j address (2~//M I(MII~
Legal description (Lot, Block & Sub'd.) L o 3-
Legal description (Section, Township & Range)
Lot Size Acres/~[~)
2/, 787
THiS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool []
Therapy Pool []
Day phone
~1 V~ Zip Code
Number of Bedrooms
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.
17034 Eagle River Leap Road No. 2(34
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
o~7o~3
Waiver Fees:
Date of Payment:
Receipt Number:
2001
ROBERT C. COWANo P.E.
CML ENGINEERS
(907) 694-2979
FAX (907) 694-12t t
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 1, Block 4, Knik View S/D
It is requested that you issue a permit to install a well and a septic system to serve the
proposed four bedroom dwelling on the referenced properD'.
A test hole was excavated and a percolation test was performed. The approximate location
of the test hole is located on the attached site plan. At the time of excavation 8/1/95 water
was found at 8.0 feet. After ground water monitoring, water was found at 6.5 feet.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
Enclosure
tt034 ~3Rl14 FJkGL£ RNER LOOP ~ SUITE 204 ~, EAGLE RIVER, ALASKA 99577
""~ LOT 1. BLOCK 4, KNIK VIEW
~,,-. ~
rri,,g DESIGN CRITERIA:
~%%/ SOILS = 1.0 OPD/SO.FT.
~ ~ .600/1.0 : 600 SQ.FT.
,,o...~.,..~.o. % _~ ~~ / /
~,x, c,o,),,,-,~- xx///~
0.5 EFFECTIVE ./ / /' / / ~- ,
5.0' WIDE ./ / / . ' / ~ j
120' LONG (2 ~/60~ACH) / ' // / '~
,~ /~'Y o~ /' ~ ~ ~
' / / ~%~/ o/ /
/ ,~ / .. .
/ /.~/ .( .' .... ~~t~"~ ,,~
~ ~ / /
Z~/ /~ / . ~:==
~/~ ~ ./' ~ 2'~.,. ,,
//- ~/ .... ~ - ~ ~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION: ~ ~ ~Z~ ~ tJ( ~,t/-.~/iF..~ownship. Range, Se~ion:
SLOPE
3
4 - ~%~
5
6
7
9
,o
11
WAS GROUND WATER
ENCOUNTERED?
DEPTH? pO
/o- ~?- ~ ~7 -~,5-/ E
~h lo Waer AJter ,~ I
~i~67 ~ ~ ~ ~
SITE PLAN
/o/- -r/c.4~ (,.J
Gross Net DePth to Net
Reading Date Time Time Water Drop
13-
14-
15-
16-
17-
18"
19-
20-
COMME.TS
PERCOLATION RATE ~ Im,nuteS/mch) PERC HOLE DIAMETER
TEST RUN BETWEEN "~ FT AND I~ FT
S & S ENGINEERING ~, - "~
PERFORMED BY: I , TFp,,~g~, / ,~. iD CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle River Loop Road No. 204
ACCORDANCE WITH A~a~'~[~:)~IvlI~'i~I~I'JIDELINES IN EFFECT ON THIS DATE. DATE: ~ ~'~ "~ ~'
72-008 (Rev. 4/B5)
SEWER & WA~R
ROBERT C. COWAN, P.E.
CIVIL ENGINEERS
(907) 694-297g
FAX (907) 694-121 t
ON-SITE %VASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 1, Block 4, Knik View S/D
July 6, 2000
GENERAL:
The scope of this project includes the installation of a 1300 gallon Premier
polyethylene septic tank and drainfield trenchsto serve the proposed four
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 installations. 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.
t f~34 k~O RTH E~GL~ RN~R LOOP; SU~'E 20t ~ EAaLE R~V~R, A~A~KA ~§77
Page 2
Lot t, Block 4, Knlk View $/D
July 6, 2000
3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
4. 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 TRENCII/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 gravel (sewer rock)
placement.
Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel 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
shosvn 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.
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.
Page 3
Lot t~ Block 4, Knlk View S/D
July 6, 2000
MINIMUM MATERIAL SPECIFICATIONS:
o
Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type &Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 0aVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) 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, Femco, or
equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
All 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, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during thc installation of the
wastewater disposal system. These inspections will occur as follows:
Page 4
Lot 1, Block 4, Knlk View
July 6, 2000
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.
3. 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 ofthe contractors work rests with the oxvner and the M.O.A.
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 Engineefing's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
Municipality of Anchorage
Development Services Del3artment
Building Safety Division
On-Site Water and Wastewaler Program
4700 South Bragaw St.
.,:.O. Box 1§6650 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. 051-031-57
1. GENERAL INFORMATION
Complete legal description Lo t
Location (site add~ess 6r di~:ections)
Cu~?ent Property'owneris) w ~ '1 ri ~ r, ~ n ~- ~,,,-p r ~ ~ ~, ~
Majlingaddress. 670R qtoedeTM Dr.
Lending agency
Expiration Date: /LO -.3..~.. ~ ~,,~.
1;' Elock 4;
NHN Knik Vista Dr.
Knik View Subdivision
Day phone
Anchorage, AK 9950/~
Day phone
Mailing address
Real Estate Agen~
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
Day phone
3. TYPE OF WA'I:ER SUPPLY:
Individual Well
Individual Waler 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 De~elopmenl Servlces Depadment (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations glven In paragraph 5 by an Independent professional ctvil
engineer registered in the Stale of Alaska. Certificates of Health Aulhorlty Approval are required for Ihe Iransfer of
litle (except between spouses) for propedles sewed by a single family on-site wastewaler disposal ahd/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 wail and may be reissued with
new wa~er sample results less ~han 30 days old. (Certificates may be relssued for a period of up to one year with
valid water samples.) CeHific~3{~s are valid roi' 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 ct the validalion da{e shown below, I verity Ihat my Investigallon,
based on procedures outlined tn the Health Authority Approval Guidelines for lhls application, shows that Ihe
on-site water supply and/or wastewater disposal system is(are) sat'e, functional and adequate for the number of
bedrooms and lype of structure indicated herein. I furlher verify Ihal based on Ihe information obtained [rom the
Municipality.of. Anchorage files and from my Investigation and Inspection, Ihe on-site waler supply and/or'.'..~
wastewaler;disP.°sal system is(are) in compliance with ell applicable Municipal and State. codes, ordinances," '
and regulations In effect at Ihe time of installation.
*' Name oi' Firm S & S En~inerin~. Phone 694-2979
Address17034 N. Eagle River Loop St.e. 204 ]3a.~le River, AK 99577
Engineer's Printed Name Robert C. Cowan Da~e "7//~/o z...
5. DSD SIGNATURE
[/"' Approved for · Lj/...
Disapproved.
Conditional approval for
' -~' ~='~' -'.."~'-~L
·
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Cedificale Date: '~-o~-.,~- 0.,.~,,_
Municipality of AnchOrage
Development Services Department
Building Safety Division
On-See Water & Wastewater Program
4700 South 8mgow St.
P.O. Box 196~50 Anchorage, AK gg519'6650
www. cLanchorage.alcus
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDesctlpfion:~-eT' / ~L*C~ 4./ /c~'/~
Parcel ID: 0 5"1 -0 71 - 5" 7
A. WELL DATA
Wa: type P~4rL
Date completed .~/, l
~ROr~ WEU.
If A, B, or C provide PWSID # -
Casady) 61 ~
Date of test
Staficwater level
Wall production
WATER SAMPLE RESULTS:
Nsenlc:
Wall Log(~N) V~. J
Wlres properly protected (~/N)
Casing height (above ground) / ~ ~ in.
'ATINSPEC~ON
Data of adequacy test ~/~ - ~e.~/ Results(Pass/Fail)
Ruld dep~ in abeoq~Jon field before test ~.-'""'"~r added
gal.
Elapsed 'rime: min.~ depth in. Absorption rate >=
Any reJ~,~, ~realment (past 12 mo.) (Y/N & type)
For ~ bedrooms
New depth in.
g.p.d.
If yes, give data
Total depth ~ ft. Eft. absorpfion area ~eo
Gravel below pipe 0 · .Y' ft.
B. SEPTIC/HOLDING TANK DATA
Tank 'fyl:X~:Mate'rlaT"~-~-~E.~T_, 4. / fle/' F...
Tank tl~e } '~. e o'. gat."...: ~- ..Number of Compemnents
Fou?dauo. cleanout~N) ' y/-$~ Depression aver tank (Y~D
C. ABSpRPTION FIELD DATA , ~
Data :~a.. ~ed ~///'/o / SoIl rating ~r ~/bdrm)
~#,4/~ver. Alaska 99577
Data installed c~ ,//o / o /
c~eanout= ~) Y~-~
High water elarn~ (Y~) ,,~ ¢~
~)~ ¢olonles/lOOml. NllmtaO,!. rngJI. Otherbectarla 0 colonles/lOOml.
,,,g./L ~ Data of ~ample: "'l/l&/°"~. Collected h,,~'~.~ - ~IgGINEERING ·
"~0~ ~ t.gt~ ah,,, Lwp
D. UFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons
in. "Pump or level at
Manhole/Access (Y/N)
ttigh water alarm level at
Meets alamt & drcult requirements?
in.
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Se~c tenlull~ ste~on on lot / 3 ~ '
Absorption field on lot ! ¥ 3
Public sewer main ~v/&
Se~er/se~c sewlce ilne o~ ~ "~.
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main ~//~4 Water sen~tce line / 0
Wells on adjacent lots
SF~t~tATION OIST.~RCE FROM ,t~OR~ON RELD ON LOT,TO:
Properly line '~ ~ :) 'Bulidtng fOundafion ']o · Water main ·
Water Sen/loe line tO +
F.
Absorption field · )Y
Sun'ace Water ,/0 d /-~
· Wells de adjacent lots., f.eO' ~' "
G. ENGINEER'S CERTIFICATION
I ~'~at I ha~ de~/n~ ~m~h field ~ end
m~w ~ Mun~pal m~s ~at ~e a~ s~ am ~ '
~an~ ~ MOA ~ gu~ellnes.~ eff~ ~ ~ da~.
~gin~s Pdn~ Name ~ ~ ~ ~,
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/01)
Date of Payment
Receipt Number
LEGAL DESCRIPTION
~ NO.
g~-47
JlJL-19-L~O02 11:~8 ~$ Er~I~Y_~I~Ci
90'7 6c3~ 1~.1I P.02
P.!
NORTHERN TESTING LABORATORIES, INC.
~'~-N
0.10
MC~, Ualt$