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Home My WebLink AboutTONJESS ESTATES BLK 3 LT 13Onsite File Tonjess Estates Block 3 Lot 13 #051-532-05 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201420 Work Type: Septic Upgrade Tax Code Number: 05153205000 Site Legal Address: TONJESS ESTATES BLK 3 LT 13 G:1462 Site Mailing Address: 21549 TONY CIR, Chugiak Owner: MCPHETRES DAVID C & TINA L Design Engineer: C&M ENGINEERING SERVICES This permit is for the construction of: Q Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 1»enr 3 v DCpa1-tIII ell t 10/20/2020 10/20/2021 62371 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: bo vC 0�6 In MjUMCHFAUTY OF 9HCHORA GE Development Services Department R`' l Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION �i Parcel I.D. 051 532 05 Property owner(s) MCPHETRES Day phone 7480878 Mailing address Site address 21549 TONY Legal description (Sub'd., Block & Lot) TONJESS ESTATES 133 L13 Legal description (Township, Range & Section) Lot Size 62,371 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: (® all that apply) Absorption Field 0 Septic Tank El Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) Q Upgrade (w/wo ADU) � Duplex (D) ❑ Renewal ElMultiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: none Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: # 7 1 Date of Payment: 10111 a O ao Receipt Number: cl 31 I'& -b Permit No. C S P) C3 1 LI -20 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System replacement for Tonjess Estates B3 L13 Dear Reviewer, The above referenced property is served by a failing septic system. The owner would like to replace the failing system with a new 4 bedroom septic system. We are proposing to install a new advantex septic tank and a new drain field. The old tank will be demolished per moa requirements. Our review of available documentation and field investigation show that this project will not adversely impact any nearby wells, wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. A testhole was excavated revealing relatively free draining soils and no groundwater. Included with this letter is a permit application and design package, including plans, and calculations. Thank you for your time in reviewing this request. Please do not hesitate to contact me at 907-854-5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 10/2/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201420, Rebecca Carroll, 10/20/20 CHARLES G BALZARINI CE-13854R EGISTEREDPROFES S IO N ALENGINEER 10/5/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201420, Rebecca Carroll, 10/20/20 Residence: number of bedrooms 4 br Water usage/bedroom 150 gpd/br Water Usage 600 gpd type: SHALLOW TRENCH Application Rate 4 gpd/sqft required absorption area 150 sqft trench width (W) 5 ft minimum effective depth 4 ft below distribution pipe see narrative Trench factor 0.5 Min Required Length: 15 ft MOA Sand Depth 0 ft MAX Excavation Depth: 8 ft Min Cover: 3 ft Insulation: 2" blueboard Effluent Pipe: Calc By: CGB Date: 3/3/2020 C&M ENGINEERING SERVICES 907-854-5558 Septic Design Calculations RESIDENCE/LOT INFO DRAINFIELD 4" ASTM 3034 max excavation depth is measured from the high side of the trench CALCULATIONS ARE FOR REFERENCE PURPOSES ONLY USE DIMENSIONS SHOWN ON PLANS CALCULATIONS ARE FOR REFERENCE PURPOSES ONLY USE DIMENSIONS SHOWN ON PLANS Tonjess Estates B3 L13 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201420, Rebecca Carroll, 10/20/20 Performed For: Municipality of Anchorage Development Services Department On-Site Water and Wastewater Section 4700 Elmore St. P .O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Soils Log - Percolation Test r1c, i>H flrES Legal Description: ·10.,v' Tf:~s £"S7ATcS B :3 L I 3 Slope Township, Range, Section: _ _ _ _...:...,:_:__ _ _ _ __ Depth (Feet) -\I ! ~ 1 2 3 4 5 6 7 8 9 -~ _, (- - - - - - - - - - - 10 11 12 13 14 15 16 17 18 19 20 - - - - - - - - -·,J -'. I ., ~ - l < II, ( I ( I /,, ✓ i)f/V'Sc 5 ✓/5.-v) V /lo3(5i£"S P;of( Site Plan '5.iw,i f.A--.....7 WAS GROUND WATER ENCOUNTERED? N0 IF YES , AT WHAT DEPTH? fvOA./£. ~ l----+ --+ ---+ --+ --1 ----+ --+ ---+ --+ ---i Depth to Water After :11/A Monitoring? ~1 p Date: {O/ / Reading Date Gross Time Net Time Depth to Water Net Drop (J 'ti 11 J..:40 D 0 o ~ I (;), ; 10 >$D l{- lytb Lt-4116 J \ ·r I I 0 0 0,.,'1,: 3 I ~?0 L/ -4/lb 4-o/l6 ', ~: ;;._ 0 0 0 Cj l.✓f:u )- ~ ?0 Lf-Lll/b U-1.,1(/6 ........ b ~[/---- PERCOLATION RATE 7 (minutes/inch)PERC HOLE DIAMETER b _. TEST RUN BETWEEN y FT AND s:_FT coMMENTs Pi:-ilR>i2~~o 1:,..,.1 wcot2MNU ½lr:tH 1iY1oiA: 12:lf. mvtt.cMEN·$ PERFORMED BY: ( ,, ~(tL:'}...,}/l:p.1.J__. I C. ~~ll 0,1~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: l b/I- - - - - Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201420, Rebecca Carroll, 10/20/20 r 4-1 qp F q N -71 74r ;4 I hereby Certify that I have su;vjv�j- . L olk)w�i pm� L L r t e Anchorage RecLiSL(ing Precinct, Alaand that the improve.- Tnent's %itvated thereon arc within the proplemY Nnet and do riot VVeTiAr or encruacli on Ole Pmperty lyrng adjacent th'cTetn, that nO Mprovemcnts+ on PmFerty 1 -yin adjamnt thereto 4encroach an the premdes Sri question and tg-lt then' A; IL r 4-1 qp F q N -71 74r ilk, VC: X !7- rL j '1 rA it •4 • L rp z OWS ":�7 I Fl. 5 W, ,:W& OV, r: I hereby Certify that I have su;vjv�j- olk)w�i pm� L r t e Anchorage RecLiSL(ing Precinct, Alaand that the improve.- Tnent's %itvated thereon arc within the proplemY Nnet and do riot VVeTiAr or encruacli on Ole Pmperty lyrng adjacent th'cTetn, that nO Mprovemcnts+ on PmFerty 1 -yin adjamnt thereto 4encroach an the premdes Sri question and tg-lt then' A; are nt, roadways, transrnivimin lines Or other visible easements T I tin said prupvrty, ew ep t Ai indicated h emon. z Oa Wd A I EagI q River. Alaska* day Qf 9 Ir RUB ER'r C_ 101 iN 50 N SCALE: Registered Land Sun-tY - No. of 880� LS Snx 77-N56. Eagle Rim. Alaska 57-7 99 L .4 /V S-04—:0 .2, ilk, VC: X !7- rL j '1 rA it •4 • L rp z OWS ":�7 I Fl. 5 W, ,:W& OV, r: I hereby Certify that I have su;vjv�j- olk)w�i pm� L t e Anchorage RecLiSL(ing Precinct, Alaand that the improve.- Tnent's %itvated thereon arc within the proplemY Nnet and do riot VVeTiAr or encruacli on Ole Pmperty lyrng adjacent th'cTetn, that nO Mprovemcnts+ on PmFerty 1 -yin adjamnt thereto 4encroach an the premdes Sri question and tg-lt then' are nt, roadways, transrnivimin lines Or other visible easements T I tin said prupvrty, ew ep t Ai indicated h emon. Oa Wd A I EagI q River. Alaska* day Qf 9 Ir RUB ER'r C_ 101 iN 50 N SCALE: Registered Land Sun-tY - No. of 880� LS Snx 77-N56. Eagle Rim. Alaska 57-7 99 L -Phone (9M 694 MUNICIPA111TV (Pip ANt'HORAffi. ADVANCED MAIN'1 YNANC#. AN1t UVIIIA114 AGkVE1s EN'1 1 1171 MAIN 11INANft'1 i AND J(PIPA1II IlORIJ IMPNI, 1iergin the "/Wjk J,+1 il1NJ N ryrd,& a&) Chteri9d Irttct €A 111'111N # Dity of t3c.)Wbe-41 420690, by WW bOW0 n �I �-ut �'�,tr�y r� r,�f+o �-rte, , f�rCln t#te.,t��Vl�1fJlt," the Mu»3�ipai`tty a1' Arwhorage, hcrein the "MUNIVIVAI,I'1 Y", In stix4►rdx", with AmluxW Munkipal Code (AMC) 15.0.163. In consideration or the mutual 4wv rrt,�ost"WrWA heret)", the trdn uo thi* Awrc:cittcnt agree as f'callowtc: I . jUxgaged 3X&gMajff Irestmlfit b1glegig, 'Ibe Munici;wlity gram's per W44jim to the Owner to utilize aW operate an Advani,,W Wa*wwaW'I'rea~t Sym (AWW S), detrc ri hed as4 - ADVANTEK _ _ -- jocuted at tie l dcsc;rilriion) TC7NJOSS Et3TATES 531_n- 2. 1aIntenanec.-tees)a and Alterat;Iga. (Owner hs required it) read, understand and initial each section) Throughimt the term of this Agreement, the Owner shall enter into a service agrreernent with an A WWr.44 service and maintenance provider appr(sved by the Munkipjity or the manufacturer's representative. 'f-heAWW'I'.S'mWlbt,-minWnedinamatisfacuny condition capabfe of performing as designed and producing treated wMic effluent in ac )rdra nee with the equipment's approval for operation in. t1V Municipality. It shall the the responsibility crf the 0- caner during the term of this Agrcenwnt to pay for all repair(s), nu, intcna=, adjuxtment(s), replacennent cam, and inmve ion coos. This inziudes an annual maintenance fee (typically fN) to Vii). Owner agrees that only maintenwwe and rclrair perumncl approved by the Ilk4unicipality or the manufacturer's representative will inspect and make any n ssmy rnaintcnamx, repairs or permitted alterations to thesystem, �Owner racknowledues that regular maintenance of an AWWfS reduces the potential failure or the system, which could include wwap backup and cooly repairs err dram%eld replacement. (rev. 05/19/201,R) Page I of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. 4P Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. -i:��Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void.. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05118/201$) Page 2 of 3 ff [All! OF MAU A j 44, 1111011 JIHMAL 1ANTRIM Ito Amppong i1joilmooll witm bidiff-c" ow 111ko ti / ifily (it' lieflle by ve,NtAoty 111114' lit )1t rel A!l K A JUNN1P'P,,P 0, WILLEUX My�tt:iiiIkvi i iiia v x 11 M! now, A 10014,4114 AMMAMLY: T "hilva owho 10"1"1 1110", f h IV, 0511 NO W M) INWV A 03 LEGAL DESCRIPTION LOCATION ( ~ MUNICIPALITY OF ANCHORAGE t '~ DEPARTMENT OF HEALTH &'ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE DISTANCE TO: Well /OO ' Foundati?~ Top of tile to finish grade ~ Material ~neath tile DISTANCE TO: D NO. OFBEDROOMS ,,,~--~W I [--I UPGRADE Width Material Trench wi~ inches ~(~ inches No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons Distance between lines ~W~/~ Total effective .bso~t~ area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Septic tank REMARKS APPROVED 724)13 (Rev. 3~78) "~'~?IUNICIPALITY OF ANCH~AGE ' . ' ~ DEPfiRTMENT 0 HEALTH AND' ENVIRONMENTAL I/'%]:ECTION ' -' , ' 825 L"STREET, ANCHORAGE, AK 9~50i .~ ~ - ~64-47~ 'ON--SITE SEWER' & WELL PERrIIT PERMIT NO: .. 848382 DATE ISSUED: 05?24?84 *. APPLICANT: KIMPTON BUILDERS ADDRESS: ~ ~. S&S ENGINEERING - . . .. " EAGLE RIVER, AK ~577 CONTACT PHONE: 694-2~7~0 · {'LEGRL DESCR[P: SUBD[V~ZON: TON~E~S E~T LOT: ~' ~ECTION: 2 TOWNSHIP: 15N RANGE: LOT ,SIZE: ~ ' 62371 (SQ. FT. OR ACRES) MAX 'BEDROOM~: ~ . EISTED BELOW RRE THE OPTION~ AVRILRBLE TO YOU IN DESIGNING YOUR ~EPTIC SYSTEM. CHOOSE THE OPTION THAT BEST-FITS YOUR SITE. ............ ?GRRVEL DEPTH (FT. > · 6 O , "0. 5 ~TOTRL~ DEPTH (FT.> t~.9 5.5 7.' ' GRAIL WIDTH (FT.) ' ' XtT. 8 5. GRAVEL LENGTH (FT.) ~ [ 32: e / · 34. 8 41. [GRR~L VOLUME <CU. YDS. ) ~ .t9. 2 / 21. 4 TANK '~IZE (GR~) ~~~' eee. ·. l, eee. e ** l, eee. e ** SOIL' RATING '(SQ. FT. /BR) t25 t25 · * TANK ~ST HAVE.fiT LEfl~T TWO COMPARTMENTS ~i. I fib FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS fiND WELLS tis SET .... FORTH B~ THE MUNICIPflEITY Of ANCHORAGE (MOA) fiND THE STATE Of flLflSKfl:". ' 2. I ~WILL INSTALL THE SYSTEM IN ACCORDANCE WITH fiLL MOA CODES fiND REGULflTIO~S, · .fiND IN COMPLIANCE WITH THE DESIGN CRITERIA Of THIS PERHIT. i. :~. 'I WILL ADHERE TO RLL HOfl fiND STATE Of ALASKA REQUIREMENTS FOR THE SET BACK . 'DISTANCES FROM tiNY EXISTING WELL, Wfl~TEWflTER DISPOSAL ~YSTEM OR PUBLIC -.SEWERAGE SY~TEH ON THIS OR flN~ ADJACENT OR NEflRB~ LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR fl HflXIMUH .Of ~.BEDROOM~ fiND tiNY ENLARGEMENT WILL REQUIRE fin ADDITIONAL PERMIT. If R LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, - THEN (i) AN.ELECTRICAL PERMIT AND INSPECTION HUST BE OBTAINED; (2) RS-BUILTS i WILL NOT BE fiPPROVED WITHOUT RN ELECTRICAL INSPECTION REPORTJ AND (3> THE ELECTRICAL WORK MUST BE DONE LICENSED ELECTRICIAN. fiPPLICANT: i'ISSUE BY DRTE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L* Street, Anchorlge, Alaska g9501 264.4720 SOl LS LOG - PERCOLATION TEST 9 .,..~ I~1 ~[,. MUNICIPALITY OF ANCflOP, A~E DEPT. OF HEALTH & · ---10 - ,~ __ EN~RON,M. ENTAL PROTECT[OI~ WAS GROUND WATER MAY 3 2 'r984 £NCOUN*ERED~ · EGA~DESC.,PT,O.: /.~ 13 ~t ~ q ~ ~ SLOPE SITE PLAN 5-~. 13 ,- 20- COMMENTS RECEiUrnFvES. ATW"AT ¥ L I.,OEPTH? Reading Date s L O P E Time SOILS LOG FT AND CSRTIFI£ PERFORMED BY: 72-008 (6/79)' I-I PERCOLATION TEST Net Depth to Net Time Water Drop (minutes/inch) FT by SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688.2759 KIND OF FORMATION: ' DEPTH OF WELL ,~ ~ ~) STATIC LEVEL OF WATER FT. DRAW DOWN GALS. PER HR K{ND OF CASING From _ff~ Ft. to c~ Ft. From ,"-'~' Ft. to From__Ft. to Ft. · From '-~ ~" Ft. to ~ '~' Ft. From '~'~ ~' Fi. to '~Ft. Fmm~Ft. to Ft. From'~ ~ Ft. to ~/~ Ft. Fr~Ft. to Ft. From~Ft. to Ft. From ~ / ~ Ft. ~o ~ C ~Ft. F~m '~ ~' ~t. to' ~ ~ ~ ~t. Fr~ Ft. to ' Ft. From Ft. to Ft. From~ Ft. to ~Ft. From · Ft. to From~Ft. to From__FL to From __Ft. to ~/.~ ~' ,0 ~ ~O,--~ ~ ~ 7'o ,-~ From--Ft. to t?~'~ .,JOc./~ From __ Ft. to ~". ,'~ ~ ,o ~ ~O *="~ ~'-'/ From__Ft. to From Ft.t~ ' From ~Ft. to From Ft. to From Fi. to From ' Ft. lo From Ft. lo From Ft. to Ft. Ft. Ft. Ft. Ft Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft. From__Ft. to Ft. From Ft. to Ft. From__Ft. to Ft. From__Ft. to From__Ft. to From__Ft. to Ft. Ft. Ft M,ISCL. INFORMATION: / ...~-0 lC)/' DRILLER'S NAME DEPARTMENT OF HEALTJ~ & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 995:19-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~ParcelI.D.# t'%~- ~,'~,~-C~,-(-~-,c~ HAA# GENERAL INFORMATION Complete legal description Lo;~ 13; E~.ocE . 3 ;.. Tot{ j ~6 'E6;bz~6 Location (site address or directions) 51549 Property Owner Mailing address Lending agency Mailing address 51S49 To~ C.Z,,t~e Clu~.q~c~, Agent La~c~l L, ecLIze/ERA F~OFESSZO~IAL REAL ESTATE Address 5705 Gamba, Su,~e 500 A~¢ho~cc~qe, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 5 '~ TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: Day phone 'Day phone 698-9055 Day phone 27J-5776 A[ 99503 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system.. 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. J STATEMENT OF INSPECTION BY ENGINEER. As certified b~ 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 ahd/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 RIv~' Loop J~f Address . Eagle Elver, Alaska ~'~7~ Engineer's s~gnature ~. DHHS SIGNATURE /~ Approved'for ."~''/'~'--~' ('~) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given In paragraph u 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. Well Data Well lype ~:;)~-t~, ~ Log present (~)N) ~{ Total depth "~-~ c:>~ Sanita~7 sea~l) Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/~olding tank on lot Absorption field on lot Public sewer main ' Sewer service line "~' If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ ._,~ z.~ Driller Cased to ~ ~ ~ ~ Casing height FROM WELL LOG AT INSPEC~ON M WELL ' ' ~, ~ ~ ; On adjacent lots ~- ; On adjacent lots Public sewer manhole/cleanout Petroleum tank SAMPLE RESULTS: J Collected by: Other bacteria ~3 ~' & $ ENGINEERING 17034 E~ff~e Rlw. ! ~p ~O~d/~o. 204 Eagle River, Alad<a 995~ .DING TANK TO: ' llots ~oc:)~' ~''' lid ~ ~ t c:>~c:> Compartments "7_.. ,~nout (~N) i "/ Depression (Y.~ ,-~ (y/N) Alarm'lested Pumper' ,",'. Foundation ~' Water main/service line CONTINUED ON BACK PAGE C. UFT STATION Date Installed Size in gallons Vent (Y/N) 'Pump on' level at High water alarm level Meets MOA electrical codes (Y/N) D. ABSORPTION FIELD DATA Length "2..-"] t Total absorption area Date bf adequacy test Manufacturer ' . .:~ ~anhol~^ccess (Y/lq) ..~F3~'tested Soil rating (GPD/FF) Width- '~"C>~ Gravel thickness -'~q ~3 ~' Cleanout present (~/N) ' y ~ ~ -. ~ "Z..c~ .~ Results (;t~ail) /~.,,~-~-~ Waterievel In absorption field before test '~ Peroxide treatment (past l2 months) (y~) ~...~r,... ~,,.~,,~,~ '' SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Surface water Well on lot ~, m:"-~ To building foundation On adjacent lots Surface water Cu~ain drain System type "T"~-e-~C~ Total depth t o~ Depression over field for ~,fter test If yes, give date On adjacent lots t o c, Property line To existing or abandoned system on lot Cutbank ~",, Water main/sen/ice line Driveway, parking/vehicle storage area Bedrooms E. ENGINEER'S CERTIFICATION I cerfl'fy that I have checked, ve#fied, or con~OA and HAA guidelines in effect on the date of,.this inspection. Signature $ & S EhlClNE£RIN~'~A HAA Fee S ,~0~'~, ~'~ · Waiver Fee $ Date of Paymant / Z~ ~/~..~ - ~' Date of Paymant Receipt Nu_mber- ,~ · .... MUNICIPAUTY OF ANCHORAGE ......... ... _":.,/ ...... '[ ~?--:' ".~i "i : DEPARTMENTOFHEAL~rHAND'ENv1RONME'NTALP'ROTECTION ', ::" ~ ~..~'. ~'i ' ! -~ . ':;.~ .: . DIVISION OF ENVlRoNMENTAL HEALTH :~ . .-:~..: , .' :'.'.. ::.. '. · CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL · " OF ON-SITE SEWER AND W~TER FACILITY ~"~(~' [ : Application Date Ocl~:~r 22, 1986 t 1. GENERAL INFORMATION '.' (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 13; Block 3; Tonjes~ Subdivision Location (address or directions) ~ O..,~..D (b) Applicant Name H°~eL"~c°n Telephone: Home 688-9022 Business 688-3864 Applicant Address P.O. I~X 771266, Chucjiak, Alaska 99567 (c) Applicant is (check one): Lending Institution []; Owner/builder ~; Buyer []; Other [] (explain); (d) Lending Institution ;Lla.ska Mutual Bank Address Eagle River, Alaska (e) Real Estate Company and Agent Address ~l~,~hone (f) ~fa~t~e HAA to the following address: $ & S Enqineerlng SRB 196X Eagle River Road ' Eaqle River, Alaska 99577 Telephone none/refinancing 2. TYPE OF RESIDENCE '~ ' Single-Family'S] ~ Multi-ad[] Other Number of Bedrooms 3. WATER SUPPLYO\ Individual Well IXI Community t"l Public [] Note: Jf community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. · SEWAGE DISPOSAL Onsite r~ Public [] Community I"1 Holding Tank [] Note: If community well system, ~nust have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 ?=.e=s {~l,~,) ENGINEERING FIRM PROVIDIN~i INSPECTIONS, TESTS, FILE SE. ARCHi DA fA AND INFORMATIO~I As certified by my seal affixed hereto and as of the va dat on date shown below, I venfy that my investigation of this Health Authority Approval 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 westewater 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 5 & $ ENGINEERING Telephone SRB 196X Address rr.A~LE RIVER, AK 995// Date DHEP APPROVAL Approved Disapproved Conditional Terms of Conditional Approval CAUTION Date ///~/~'~' The Muncipslity of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 engineers work. Page 2 of 2 WELL DATA I~UNICiF/~-IT~ .~c '~,*~MUNI~IPALITY OF ANCHORAGE (MOA) Ct[~. OI= Ht:^C'"HEALTH AUTHORITY APPROVAL (H~) ~1~ F~C~O~HECKLIST. FEBRUARY 19~ ~0CT~9~ Legal Description: RECEIVED Well Classification ~: ~' 'If'A, B, C, D.E.C. Approved (Y/N) Well Log Presenti~N) Date Completed ~(c~/~ ~' Yield Total Depth .~.~o O Cased to ¥~/ Depih of Grouting ' Static Water Level S~'/ Pump Set At Casing Height Above Ground '~/~ ~' Sanitary Seal on Casing {~N) Electrical Wiring in Conduit {~N) Depression Around Wellhead (Y~ Separation Distances from Well: To Septic/Holding Tank on Lot ~'/o,~ · To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots *,/~:~ / ~' ; On Adjoining Lots /~/'/- ~V/~ To Nearest Public Sewer ~'!/q TO Nearest Sewer Service Line on/Lot .~, ,{- ~,~ ~__. X,~,~.,-,'3-'~> t~',,x ~ ; Date t <3 /Z '~/ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDINGTANK DATA Date Installed '"') "~,l - Standpipes (i~N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) ~'J///~ ' ; for Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: Size ~',~"=~ No. of Compartments ~' ~-- Air-tight Caps ~)~'N) Foundation Clsanout Date Last Pumped /'~/2..5-/,~ Temporary Holding Tank Permit (Y/N) To Water°Supply Well /~ ~" · To Property Une /Z:> ~'.-/- To Water Main/Service Line ~ ~'''/' Course ~ Comments To Building Foundation To.Disposal Field To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ ~ 3/-~f~ Width of Field ~.~ 'j. Square Feet of Absorption Area Depression over Field (Y,~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well Length of Field ~ ~pth of Field ~Gravel ~ Thickness Standpi~ Pre~nt ~N) Date of ~st Ad~uacy Test To Building Foundation Lot /'~,//:t To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Property Line ~'c~ ~'~ To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots TO Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (WN) Pumping Cycles during Adequacy Test, Meets MOA Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA~,~and HAA guidelines in effect on the date of this inspection. .¢; & q ENGINI:ERING Date /~/Z. ~/~'" Signed CompanySR B 196X MOA No. -~-"~ . - ,~ Receipt No.EAGLE RIVER, AK · Date of Payment Amount: $ Page 2 of 2 #,. ~.:, *,. .,,.~ :~.,~' HUNICIPALITY OF ~CtlOKAOE DIVISION OF ENVIi~.O~NTAL ~ALTH DEPAR'I~4~.NT OF I~ZALTH AND ENVII~O~8{ElqTAL I~OTECTIO~ APPLICATION FOR ~:ALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 7/~./~ ~ Description (include lot, block, subdivision, se_ct__ion, township, range) Lega~) 7..- · I% $ (a) Location (address or directions) (b) Applicants Name Applicants Address (C) Applicant is (check one) Lending Institu~iou Buyer~ I Otber~(explain); (d) Lending Institution Home Business ~ ; Ovner/builder~; Telephone (e) Address Address (f) Mail the HAA to the following address: 2. Type of Residence Siugle-Famlly~ Number of Bedrooms 3. Water Supply' Hulti-Famtly ~ Other (describe) Individual Well ~. Community ~-~ Public ~-~ · Note: If co~ununtty well system, must have written confirmation from the State Depar~men= of Enviroomental Conservation attesting to the legality and status. Sewage Disposal Onsite~i~ Public~-~ · Community~-~ Holding Tank~--~ Note~ If community veil system, must have wri:ten confirms:ion from the State .Department o[ Environmental Conservation attesting to the legality and status. [Page 1 of 2] Engineering Firm Providing Inspections, Tests, File Search, Data ar~ Information As certified by my seal affixed hereto and as of the validation date sho~n below, verify that my investigation of this Health /~thority Approval show that ~he o~si~e water supply and/or ~s~ewa~er disposal system is ~fe, f~c~ion~ a~ ~eq~e for the number of bedrooms a~ ~pe of s~ruc~ure ~ndica~ herein. I further verify cha~, based on the. info~ion ob~ain~ fr~ ~he ~nicipali~y of ~chorage files a~ from inves~isatio~ a~ ins~ction, ~he o~si~e ~ter supply a~/or ~s~ewa~er system Is in compliance ~th ~1 ~nici~l and Scare c~es, ordinances, and ~ions in effect on ~he da~e of ~h~s lns~c~ion. Name of Fl~' ' ~ ~ ~'F'I~[~N~ Telephone " CAD, ION THE MUNICIPALITY OF ANCHORAGE DEPA~T~Eh~ OF HEALTH AND ENVIR01~'M~NTAL PROTECTION (DREP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESEnt- ATIONS GIVEN IN PARAGRAPH $ ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE ~/EP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES ~ND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~ND STATE HEQULRE- MENTS. ~'MPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS LN ~ PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RRI/eJ/D18 [Page 2 Of 2] 7-19-84 MUNICIPALITY O~ A'~C~ORAGE (MOA) I"IF. ALTH .~lrl'dO~ APPI~0VAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALf'~, OF ANCHOP. AC~ DEPl OF HEALTH & ENVIRONt~fNTAL PROTECTION 'AUG 11984 RECEIVED Nell Log Present ~) Total Depth 700 ' Cased to Static Water 5evel ~ ! ~ Set At Casing ~etgh.t,.Abo~e Ground Elec~ical .Wi~i6g in Cc~luit Sepa~ati~.p.istar~s f~cm Well: ! To .Sept~ Ta~k, cn ~t /O ~ ; ~ ~Joini~ ~ /d ~ To'~'~-of ~tion Field ~ ~t /~d ' ; ~ ~joini~ ~ C~~j'" ~/~ ~ ~st ~r ~vi~Li~ ~ ~t Wa~ Be Separation Distances fzcm Septic ,/~olding Tank: TO ~ate=-Supply Wsll To Property T.,im ...~9 -~ Co~eTo ~ter Mai~Se~lee r'ine To Building Foundation ~; To Disposal Field .b--- / To St~e~, Pond, Lake, c~ Major D~ainage [Page 1 of 2] 2-15-84 ABSORPTION ~E~ ~TA Soils ~ating in Absorption St=ara Date Installed 7/~--3/~¢ Width of Field ~-~ ~' Squa=e Feet of Absorption A=ea Dep~ession over Field (Y~ Results of Last Adequacy Test Sepa=atio~. Distance f~cm Abs(xptic~ Field: TO Wate=-Supply Wsll ,/61;~ ! To l~ope~ty Line /49 ! TO Building F .ougdation /~ ! To Existing c~ Abandoned System Lot '~//~ ; On adjpining Lots ~ ! TO St=e~/Pond/Take/~ Majc~ ~aina~e Course To Driveway, Pa=king A~ea, (x Vehicle St(xa~3s A=ea ~ {~ Length of Field ~-~ Depth of Field /Gra%~l Bed ~f~ss ~// D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High ~ate= Alarm ~evel at Tested fo= Electrical Codes(Y/N) C~nts Di~nsions Manhole/A~mss (Y/N) "Pump Off" Level at /Vent (Y/N) s du~ing,Adequa~y__ Test. Meets ~A Check Pe~-mitted Bedrocm Rating ~ainst [{AA B~gusst - ... I ce=tify that I have ~hscked, verified, c~ oonf~d to all M6A HAA Guidelines in effect on tbs date of this inspecticn. . · - ,, KBi/d5/s ': - ....... [Page 2 of 2] 2-15-84