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Home My WebLink AboutSANDI HEIGHTS LT 8A,,ndi H ight Lot 8A #011 - 222- 50 Municipality of Anchorage ,....:~, '~' Development Services Depadment :' Su ding Sal'e y Division On-Sile Water and Waste~let Pt~fam. 4700 S. Bmgaw P.O. Box 196650 An~orage. AK 99519-6650 Page ~.cl. ancho~age.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ~0~ IO~ PIONumbeE OII- "- ~3~ F;~ ~ WastewaterSystem: ~New ~Upgrade '~ "~ ~: "~'~" Well: ~New ~ Upgrade ~"~ SEPARATION DISTANCES ~septic ~ Holding ~ S.T.E.P. ~ Othec To Septic Abso~pltor Lift Holding Pu~r~l~ Tank Field Station Tank S~r [~e ~ ~ ~ ,-,- 37'13' V'"'~ L~7,~ $~re~ ~4~ ~v~t~ BENCH MARK _ ~ ~ A-.....,~ S & $ ENGINEERING nspect ons pe,ormed by. 17034 Eagle River L--P Road, "o.~ DevelOpme~ ~ Services Department Approval ,~. ~ · h ~'- ............. ,~'~ Reviewed and approved by: ( ~ PERMIT NO SW020105 PAGE 2 OF 5 Municip. oLit.. _y_..oF' ,A,n c:h,o,? ~ig,e' DEPARTMENT OF HEALTHAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ®Anchorage, A.~l~sk~ 99519-665,0~ Te.l.e, Ohone:. 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LECAL LOT SA, SANDI HEIGHTS S/D P.LD. NO. 011--222-50 DRIVE ~ I m , I ~ ~ I I ZO~ ~ ~.> (OK roR I ~-~-~-~-~-~-~-~-~F~- I , 9 4 th C 0 URT PERMIT NO.Sw020103 PACE 3 OF' 5 D........ N_u Q ic ip. g I, i";. y_.o. F .A. nE h.o..r' g g.e' I-I-'AI-R/MI-'NI OI'- HEAL]~H AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION · P.a. Box 196650 ~.,Anchorage, A~!l~ska 99519-665.0 · Te.[ephone: 343-4744 ON-SITE WASTEWATER DISPOSAL :SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT SA, SANDI HEIGHTS S/D P.LD. NO. 011-222-50 ST1 ST2 /99.5' FINAL A, ,,/'1 NEW 1000' ~ 94'4'/ I GALLON 94.2 I SEPTIC TANK FINAL GRADE~---- MT1 = 87.9' -/ COl =99.5' 02=99.5' · NO WATER FOUND 81.q' B.O.H. A B FCO 19.5' 11.0' ST1 21.5' 9.5' ST2 27.5' 9.0' DBL1 29.0' 10.0' OBL2 50.5' 11,0' C01 44.0' 51.0' MT1 4-4.0' 52.0' C02 14.5' 40.5' 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-?904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: May 10, 2002 Expiration Date: May 10, 2003 Permit Number: SW020103 Legal Description: SANDI HEIGHTS LT 8A Design Engineer; 0003 S & S Engineering Owner Name: John Fishbeck Owner Address: 9405 ENDICOTT STREET ANCHORAGE, AK 99515-1043 ParcellD: 011-222-50 Site Address: 009405 ENDICOTT ST Lot Size: 12241 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 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. 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. Issued By: ~ Date: -'c' /l ° /c ~" Date: Municipality of Anchorage Development Services Department Building Sal'ety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ct. Rnchorag e.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING ParcelI.D. Oil - ~3,~ - 5-0 Permit Number SWO~ O/O.~, Properly owner(s) ~-'O Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Lo'f- Legal description (Section, Township & Range) Lot Size I '~,1 ~ f'lt' ! AcreO Day phone ¢/,~ .s-o 2.. 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 Water Softening Unit I cedify that Ihe above Information is correct. I fudher cedify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes, $ & $ ENGINEERING ~/~/2 ~ 17034 E.gl. Rlver Loop Road No. 204 (Signature of property owner or authorized agent) Permit Fees: t/¢00 C~. e $ # ) Waiver Fees: Date of Payment: ~'//~'/ o Z... Date of Payment: Receipt Number: ~ I fi ¥ $' 7 Receipt Number: (Rev. 12/00) May 8, 2002 ROBERT C. COWAN, P.E. CML ENGINEER~ (907) 694-2979 FAX (907) 604-t2t t SEWER&WATER 8OILTEST MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot SA, Sandi Heights Subdivision It is requested that you issue a permit to replace th~ septic tank (if necessary) and install a new trench to serving the existing three bedroom dwelling on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 4/26/02 no water was found. After monitoring, ground water was not found. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic tank. The installation of this septic tank will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, RCC/b Enclosm'e · t7034 IqORTH EAGLE RN~R LOOP; SUITE 204 ~ EAGLE RIVER ALASKA ~9577 B.J.J. R.C.C. 5-8-02 1 OF 1 , .~o~,,,..,..-... , LOT 10A ,, DRAINFIEL[ CRITERIA: ~2.~' ~P ', I I I I z 6.0' EFFECTIVE I I Zl q 3.0' WI~[, ~ mi I~ I ~ LOT 3 ~1 ~, ~_ , ' _SEP ~ ~1 I I1 EA ~ I I~ I ,SCPT~ T~K I I GRAVEL ~ (TO ~ vtnJ¢~OI J J z I I o o . EA z o ~ .r~ I I -- -- I I ' I I I ~ J ~, , ,, , I I h~* I I I . ~o~ ~o/ I ...... F'- I ~1 , ,.. : LOT S 94th COURT Municipality of Anchorage I Development Services Department Building Sa fety Division . ,.. On-Site Water and Wastewater Program 4700 so~th ~=gaw S~ "~:" '-'~ ' ~.Z;..' ' '. ....../.,~-'~'~ P.O. Box196650 Anchorage. AK~9519-6650www.ct.anchomaeak.us ~.~ ..,~,~o RC:;;~T C CO'.:A.~ .. ,-~. (9O7) 343-79O4 / / Soils Log - Percolation Test / / Performed For: ~1'~I Ft.5,1~HBRcK Date.Performed: ~/~ Legal Description: J-'~'7'* ~'~ .,('/L~',J I H'~ I ~:/~ r $ ~'t*/.O Township, Range. Section: 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 18. 19- 20- 5~ SIoDe Site Plan WAS GROUND WATER ENCOUNTERED? /'~ 0 S IF yES. AT WHAT DEPTH? ~ L O Depth to Water After p Monitoring? D/q'~ E Date: ~'/3/0~- COMMENTS ~i C.~. Reading Date Gross Time Net Time Depth lo Water Net Drop PERCOLATION RATE /~ I (n~ute~'~c~) PERC HOLE DIAMETER TEST RUN BEI~/EEN ~:) '/3-- FT AND PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ,~'-'/~/0 ~-- ROBERT C. COWAN. P.E.,. CML ENGINEERS (907) 694-~7B FAX (907) 694-12t i ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS · REFERENCE: Lot 8A, Sandi Heights Subdivision May 8, 2002 GENERAL: The scope of this project includes the verification of the existing 1000 gallon septic tank, replacement with a 1000 gallon minimum septic tank if required, and installation of a new trench to serve the existing 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 ttealth 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 gonstructed 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. 17034 NORTH EAGLE RIVER LOOP 4 SU1TE 204 · EAGLE RIVER. AI.A~KA ~9577 Page 2 Lot SA, Sandl Heights Subdivision May 8, 2002 All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 fl. 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 fl. 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 (rafted-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced do~mward. 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 ban'ier 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 ofthe monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert ofthe 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 4 Lot 8As Sandi Heights Subdlvlalon May 8, 2002 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 ofthe 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 contxactor 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 owners 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. 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, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / INSTALLER Page 3 Lot SA, Sandl Heights Subdivision May 8, 2002 MINIMUM MATERIAL SPECIFICATIONS: I. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the e Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM FSI0 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type ofpipo 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 the installation of the wastewater disposal system. These inspections will occur as follmvs: MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251074 Parcel ID 011 -222-50 Legal description SANDI HEIGHTS LT 8A Site address 9405 ENDICOTT ST Current property owner(s) BRIDGES TANYA Expiration Date: 1/31/2026 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: �y: �i� :.0 �L-�� Original Certificate Date: J/ 1 U/LULO This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Z Development Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcell.D. 01122250000 Complete legal description SANDI HEIGHTS LT 8A Location (site address) 9405 ENDICOTT ST Current property owner(s) BRIDGES TANYA 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 916-704-4177 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑■ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 23 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $5D Date of Payment 1 COSA # D 5C. a 5107 LI Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 COSA Checklist Legal Description: SANDI HEIGHTS LT 8A Parcel ID: 01122250000 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments No Well On Lot- Water Provided By Public Water B. TANK DATA Measured operating fluid level in septic tank 50 Date of pumping 1/31/25 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/15/02 Q ALL standpipes present per record drawing Total measured depth from grade 12 ft (max) Measured depth to pipe invert from grade 7 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. 0 Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficienci COSA Checklist June 2022 Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes 400@66 ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 2/26/25 Results Q Pass Fluid depth prior to test 0 in Water added 450 gal New fluid depth 4 in Elapsed time 30 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 60 Effective depth used 0 in Effective depth remaining 60 in in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Yes Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft Water Main > 10' ❑■ Yes if No Manure/Animal Excreta Storage > 100' Community Wells > 200' Community Sewer Main > 75' ❑ Yes if No ft r] Yes if No ft ❑■ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10'■❑ Yes if No ft Surface Water > 100'■❑ Yes if No ft Tank to Property Line > 5' ❑■ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑■ Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' ❑■ Yes if No ft Community Wells > 200' ■❑ Yes if No ft Water Service Line > 10' ❑■ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & STATENIENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm NorthRim Engineering Phone Engineer's Printed Name Steve Eng Date _ COSA Checklist June 2022 694-7028 2/5/25 4!1111� OF S1 # .•49 TH.. *. r Steve En ,,® CE-6256;Fi 2'1 29' MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT r�'On-Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC251074 Subdivision: Sandi Heights Block: , Lot: 8A 907-343-7904 Fax: 343-7997 The septic tank for this property is 23 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more, not including engineering, surveying, MOA permitting fees or site restoration. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. I I 30.0' I I I M Z I �-z v o O 0 0 O m O N � � ;0 o M M o i ASPHALT PAVEMENT 3.8' DECK 42.1' Lot 8A 12,241 s.f. Lot 9A Nq I� 4.0' a 24.2' ,W U �W 24.2' 10' UTILITY EASEMENTS X 8.0' STORAGE S 89'58'00"E '135.86' CHAIN-LINK FENCE x 72.4' DECK _-3.7' x 8.0' STORAGE CV N N 89'58'00"W 135.86 W. 94th COURT WOODEN FENCE I � Lot 6A I� (n O O O C o Lot 7A M O 0 u -i 04 NOTES: GROUND LEVEL IMPROVEMENTS SHOWN ARE APPROXIMATE. DATE OF SURVEY: 27 FEBRUARY 2025 PLOT PLAN ___ AS BUILT _X_ SCALE _ 11 30__ GRID _ SW 2424__ Project No. J25=0481A1 P.O. Box 210005 ��}} Lang &Associates, inc. Anchorage, Alaska 99521-0005 soopI, _ 1 Professional Land Surveyors sure y�a64surve com �.F.'�.��4� surve g y. I hereby certify that I have surveyed the following described property: ��P Soo 8A, SANDI HEIGHTS SUBDIVISION (Plat No. 71-134) lo - LOT y�0o Anchorage Recording District, Alaska, and that the improvements situated thereon are""" "" """' within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyedQO premises and that there are no roadways, transmission lines or other visible NATHAN LANG• 0 Z easements on said property except as indicated hereon. OD S-9944. • J Dated this the J Day of RG– –_____, - at Anchorage, Alaska o p o 40oR��fSSIONA� dao It is the responsibility of the owner to determine the existence of any easements, DOpppoo� covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963 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 wv~,v, ci.ancho rage.a k.us (907) 343-7904 Parcel I.D. Oil -~.3.~ - 5-0 1..G. I~N ERAL INFORM.ATION '. Complete legal desc~dption CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING': Expiration Date: L0c~tion (site addr6{'s' or directions) "Current Property owr~ei-(s) · --' Mailing address Lending agency c qO 5- Dayphone (:,~(~-0 3'J-O ,4 ,~c.~' 4,c' ~q.to .2. Day phone Mailing address Real Estate Agent Day phone Mailing Address Un/ess otherwise requested, HAA wi/I be held by DSD for pickup. NUMBER OF BEDROOMS: 3 3. ;i'YPE OF WATER SUPPLY: ' Individual Well [] Individual Water Storage [] Community Class ,A Well [] Public Water System [] TYPE OF WASTE~NATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site ' [] 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 4 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 we!l and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Ceffdficates are valid for one year for properties served by Class A or B we!Is or a public water system. The Munic!pality of Anchorage is not responsible for e,,Tcrs or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that t~e on- site water Supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm i~.v,~ ~le Ri,tot L~p Road No, 2~ Address ~l. River. al,,u~ Engineers Printed Name ~0~gA~ bedrooms. DSD SIGNATURE V'/ Approved for ~' Disapproved. Conditional approval for Phone Date ,,~'/;L //0 Z- ~.~:,~.,~;L.:.,..~,.~ %.. .~,,. ~- ..... :.. ~"rY'~'~'~'""~ x._..~,.~ ~it.'"/',;,': ' - ';%',~"'~.'" bedrooms, with the following stipulations: Additional Comments Attachments: HA,& Checklist Septic System Advisory Well Flow Advisory ..- ,..~,~.:'-ON-SITE "~" ~': WAI~-r~ANU : ~' ~ ; WA~TEWATER : -- PROG~M .' .... .."2 X By: ~,.,~L ~,~ Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: 5'/Z ~/C 7_ Municipality of Anchorage Development Services Department Building Safety DIvision On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 19665O Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7004 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDesoflption: LeT' ~/~ $,4,~el q t~t6-~IrJ g/9 ParcellD: A. WELL DATA wen type A Date completed Total depth Date of test Static water level If A. B, or C provide PWSID # ~, I O'¥ fJ" wen Log (Y/N) ~ Sanitary seal (Y/N) Wires pmpe~.rt~o~3T~ected (Y/N) ft. Cased to ft. ~si~l~etght (above ground) wen production J g.p,m. WATER SAMPLE RES~~.' Coliform ,,,""colonies/100 mi. Nitrate mg./I. Ara~ rng./L Date of sample: B. SEPTIC/HOLDING TANK DATA TankTyba/MaterlaI .,Y~,~T /C // ~'T' & ~. C- Tank size 'i° e,o. - gaL" .' :'. Number of Comparlments Fo-ed'atio. ~Jea.out(~) ~ D~pra,,ion ovar tank ~'~ Date of pumping H~J~- - ~ ~ Pumper C. ABSORPTION FIELD DATA' ' g.p.m. in. Other bacteria Collected by: colonies/100 mi. Date instened ,.~ / ,.r"/o ~ Cleanouts~/N) 'Y/-' J High water alarm (Y/I~ ~, o Date =tenedr/~A ?-" Totaldepth f 3.. ft. Date of adequacy test $~nrating (g.p.d./ft2orft2/'Ddrm)'~?~_--~"__-~-~t'_~.) Systemtype T,<e~,c" ft. Wldth ~ it. Gravel below pipe ~ fl. Eft. absorption area'~/~- ~ Monitoring tuba ~'~'J' Depression over field ~/o /~///t' -/''4~ Results (Pass/Fan) For __ bedrooms Fluid depth in absorption field before test ~ gal. New depth Elapsed ~me: min. F~epth in. N~sorption rate >= Any rejuve~3~l~ (past 12 mo.) (Y/N & type) If yes, give date. in. g.p.d. D. LIFT STATION Date installed "Pump on" level at Datum E. SEPARATION DISTANCES Size in gallons Manhole/A~s~*~~ in. 'Pump off'~alarm level at Cycles tastad Meet~ alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lit Absorption field on lot Public sewer main On adjacent lita ~e/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 7 / Property line 'j '7 / Absorption field Water main I b (+ Water service line / 0 ~c Surface water Wells on adjacent lots leo SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I ~ ~ Building foundation Water Sewice line / 0 /~L Surface water Curtatndrali/o~,~4~ /~o,.,x Wells on adjacent lits Water main /0 ~ D~iveway, paddng~ehlcla storage /o + F. COMMENTS G. ENGINEER'S CERTIFICATION / cerSfy ~a! / have detenn/ned through field/n~s and ~an~ ~ MOA H~ gu~e//nes /n eff~ ~ ~/s da~. ~'~~::'""'~ Engin~fsPdnt~Na~ ~0~ ~. ~0~ Oa~ ~/~ //O ~ Date of Payment Receipt Number (Rev. 12mt) Data of Payment Receipt Number