HomeMy WebLinkAboutEAGLE CREST #1 TR A LT 44Eagle Crest
T ac? A
Lot 44
#050-304-07
~ Municipality of Anchorage page
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: PID Number: C~'O
Name: ~,,)V~ P + p/~-IA/..-r4~ /~, $~'~ Wastewater System: ~New Q Upgrade
Address:
Pho,e: g~g . ~.~ ~ ~NOrOfBedroo~s;~ ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION, S°ilRat'ng:,,I'~0 GPD/Sq. Ft.
Lot: Block: Subdivision: Depth to pipe bottom from original grade: G ravel depth beneath pipe
TownsMp~ ~ ~ ~ ~ }Section: ~ Fill added shove original grade: Grawl length: ~ O Ft.
Number of lines: Distance between lines:
WELL: ~New ~ Upgrade G~a~e~ ~iath: ~ Ft. t I ~ /~ Ft.
Classi=ation(, ~ 5~0~T~-(Private' A.B.C): T~ .ID>pth: Ft. Cased To:~..,O Ft. T°tal abs°rpti°n ~:3__v O SQ. Ft. Pip%~ateria,:
Driller:
Date Drilled: Static Water Leval: Installer: Date installed:
Pump Set at: I Casing Height Above Ground:
TANK
SEPARATION DISTANCES ~eptic m Holding m S.T.E.P.
TO Septic Absorption Eift Holding )ublic/Pdvate Manufacturer: Capacity in gallons:
From Ta~k Field Station Tank SewerLines : ~'[~ ~J~ ~ ~ ~
Well /05' //~ ~ ~g ' Material:FT~_~ Number of C~partments:
Surface
w~t~r fO0~ /¢O~' LIFT STATION
Lot / / ;Size in ~~turer:
Foundation ~* I I ~ IHigh water alarm at:
BENCH MARK
Remarks: ~ ~// ~~
Location and Desoription:
Assumed Elevation: ~_~ ~,
ENGINEER'S SEAL
Inspections performed by: ~:~ Dates: 1st ~/Z ~/o ~
Department of Health and Human Services approval
Reviewed and approved by: _~~ Date: */'~ '
Perm'it No. SW 2 of 2
Page
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 345-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOT 44, TRACT A, EAGLE CREST ADD. 1
PID No.: 050-304-08
SCALE:
SWING TIES
A B
1 'I-.2' 46.0'
22,6' 41.3'
26.7' 15.4'
~,3.2' 16.6'
45
SECOND
N89°59'OO'~/.m. 132.00'
~ ...'.:...~ ·
. ';,;: ..? ' ~ ~ ~ _
LOT 44
N89°59'00'~/ 13~,00'
STREET
43
TEST HOLE
MONITOR TUBE
SEWER CLEAN OUT
WELL
EASEMENT
LEACH FIELD
DRIVEWAY
ELEVATIONS
(NOT TO SCALE)
TOP OF ~/ELL
ELEV = 85.4'
ORIGINAL
-r'
GROUND 0
LEVEL AT~ ~
96,0'
'--~ 75,0'
NO BE])RDCK
DR G'dT
7/14/0,.5
ENGINEER'S SEAL
~.."' 49 T~ "..~
%?~;. · ........ . ..%~
by
OOC CO.
SULLIVAN WATER WELLS
P.O. BOX 670272, GHUGIAK, ALASKA 99567 · TELEPHONE 688-2750
OWNER OF LAND: /~*~&~' .,~ 'J'"",~_ ! Tf-J BORE HOLE DATA
................ ' .......... bEPTH
&DDRESS: ........
DATE; ~/j~ / 0 3
,' -/ " ·
PERMIT NUMBER' O~ O/~ ~ Date of I~ue ~_-~- ~
T~ IDENTIFICATION NUMBER: ~ - ~- O ~
Is well I~ated at approved pe~lt location? ~ J NO
Method of Drilling: ~ta~ ij cable tool
Depth of welh ~0 ..........
Casing Type ~ ~ Wall Thickness ' ~ .. inches
Diameter~ inches, depth ~ ~ O feet
Liner Type: ~D*~ .,.
Casing Stickup Above Ground: ~' f~
Static Water Level: ~ feet
R~over Rate: ~gpm
Method of Testing: ~ ~
Well Intake Opening Type; ~n end Q open hole
~ Scmen~; Starl feet Stopped ~ feet
~ Perforations St~t ~f~ Stopped feet ,,,
Depth: from O feet, to ~ ~ · . f~t
Well Disinfect~ Upon Completion? ~es J No
Method of Disinf~tion: ~ ~~ ~
~mments:
..... Driller's Name
ATfENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority, Municipality
~f Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation, MatSu Borough:
Department of Environmental Conservation.
I0/I0 Bgva NVAI]]RS 6B~EBB9 88:88 666I/~8/I8
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK gg51g-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Jun 06, 2003
Expiration Date: Jun 05, 2004
Permit Number: SW030172 Parcel ID: 050-304-07
Legal Description: EAGLE CREST #1 SUBDIVISION TRACT A LOT 44
Design Engineer: 0024 Eagle River Engineering Services Site Address: 19434 SECOND STREET
Owner Name: PAULA K. SMITH Lot Size: 17820 SQ. FT.
Owner Address: 19434 SECOND STREET Total Bedrooms: 3 Permit Bedrooms: 3
EAGLE RIVER, AK 99577-
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
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak,us
(907) 343-7904
ON-SITE SEWERJWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
0 7
~.~ ~ ~ _/ Number SWO ~O1 ~
Parcel I,D. ~ ~ ~ /t~C / '-'~ . Permit
Mailingaddress(1) /~1~7 ~te~¢ ~ ~
Legal description (Lot, Block & Sub'd.) ~L ~ ~E~T ~1 ~0. T~8E Y ~ LO~ ~
Legal description (Section, Township & Range) ~N~E ~E~F ~/ ~6~ TN~c~ ~T ~4
LotSize /7 ~'..~o ~Acre~' . Number of Bedrooms ~
THIS APPLICATION IS FOR:
Sewer Only [] Well Only []
Sewer and Well ~ Water Storage []
Sewer Upgrade []
THIS PROPERTY CONTAINS:
Hot Tub [] Jacuzzi []
Swimming Pool [] Water Softening Unit []
Therapy Pool []
I certify that the above information is correct. I further certify that this application is being made for a
Sin/gle Family Dwelling and is in accj~dance with applicable Municipal Codes,
7
'2
7
/..¢
(Si~neture f pro,ertl, o,,vnar or ~uthorized agent)
Waiver Fees:
Date of Payment:
Receipt Number:
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
June 2, 2003
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Lot 44, Tract A, Eaglecrest Addition #1
Narrative & Permit Application
Dear Mr. Cross:
The proposed septic system upgrade will have very limited impact on adjacent properties for the
following reasons:
1. The surrounding lots have wells located properly, allowing sufficient room for
septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. This pemait is for the installation of a 3 bedroom system only, soils are ideal for a
short deep trench system.
4. Drainage will not be affected by the leachfield installation and is not a major
consideration in our design.
This work will not affect the reserve area on adjacent lots as we are located a sufficient distance
from the lot lines. If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\1997\03-021 NAR.DOC
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
LEGAL:
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
Lot 44, Tract A, Eaglecrest Addition #1
June 2, 2003
A. GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health and State Department
of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet
Municipality of Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any
adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer
approval,
8. It is always recommended that a surveyor locate the nearest lot line position and the location of any
easements.
9. Any remaining open test hole excavations shall be filled.
B. SEPTIC TANK
1. Septic tank and lift station shall be 1000 gallon Anchorage Tank model or equivalent.
C. TRENCH
1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5",
3. The total depth of the trench excavation is not to exceed 13t at any point in relation to ground surface
at test holes.
4. The effluent line within the trench shall be laid level within 0,03'.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed
over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface water runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any
Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 13' GRAVEL DEPTH = 10' under pipe, 2" over pipe
TRENCH LENGTH = 20' TRENCH WIDTH = +3'
SOIL RATING = 1.20 GPD/ft~ BEDROOM CAPACITY = 3
SEPTIC TANK = 1000
Twenty-four (24) hours notice required for all inspections.
\1997\03-021 trench specs.doc
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 03-021
Calculated By: LB
Date: 6/2/2003
Legal: Eagle Crest Addn. #1 Lot 44 Tract A
Single Family 3 Bedroom Dwelling
TEST HOLE 1
~ccp Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom = 450 gallons
Percolation rate = 2.5 minutes per inch
Wastewater application rate = 1.2 gallons per day per square foot
Required absorption area = 375 square feet
Trench width (VV) = 3 feet
Gravel depth (D) = 10 feet
Required length = Required absorption ama / 2 / D
Required length = 375 / 2
Required length = 19 feet
Total Excavation Depth = 13.0 feet
/ 10
03-021 .xls 7:29 PM612/2003
ZZ
O0
7~
Z
N00°08'45'~4 135,00'
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG" PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DATE PER FGRMED:
Township, Range, Section:
1
4
7
8
@
12
13
14-
16-
16
17
2O
COMMENTS
7-// ~
SLOPE
WAS GROUND WATER
ENCOUNTERED?
Ii= YES. AT WHAT
DEPTH?
Qept~ t8 Wamr Alter
Momtori~D? 0~,~'
PLAN
Gross Net Death to Net
Reading Date Time Time Water Drop
/ /o :~,, ,' ~-,~ ~ '- 5~'
~ lb: ~ t~o /~ ~,5 ~'- II~''
PERCOLATtON RATE ~- '~ [mmutes,,ncml PERC HOLE DIAMETER
TEST RIJN EETWEEN ~ FT AND ~ , , FT
PERFORMED BY: ,/~'~ vxW''~'''Z'J [ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ;N EFFECT ON THIS DATE. DAT:~.
72-008 ~Rev 4,851
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG '--- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:.
DATE PERFORMED:
Township. Range, Section:
7
8
13
COMMENTS
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
Reading Date Time Time Water DroI3
PERCOLATION RATE c'~., '~ {m,nutes, mcm PERC HOLE DIAMETER '..
TEST RUN BETWEEN ~ FT AND ~ FT
PERFORMED BY: I' ~' ~ ~ ~
CERTIFY THAT
ACCORDANCE WITH ALL STATE ANDMUNtC[PAL GU~DEL[NESIN EFFECT ON THIS DATE, DATE. ~.-
72-008 IRev, 4,85t
.--.- ,o, 2nd Street
~ ~: 10' UTIL ESMT.
~ S 89'56'00" E 132,00'
57
' ' ~'- · Robert E. John% Jr. ~ Assoc.
gm~~, ~:;, ~.~ , Profe~lonol Lend Su~eyors
PLOT ~ ~ LOT ~U~
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
Parcel I.D. 050-304-07
Expiration Date: �De C 111 2090
1. GENERAL INFORMATION
Complete legal description Eagle Crest #1 Tract A Lot 44
Location (Site address) 19434 Second St, Eagle River, AK 99577
Current property owner(s) Anthony & Wanda Zangrilli Day phone (352)679-4474
Mailing address 19434 Second St, Eagle River, AK 99577
Real estate agent
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well❑
Private Septic
Q
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distan
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ S50 Waiver Fee $
Date of Payment g a(o o2Ooi . Date of Payment
Receipt Number 43 23 b -b Receipt Number
COSA # OSC2.11519 Waiver #
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 Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 8/24/21
BY Original Certificate Date: ?1371,&.2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
K
� A
��:49TM •�a
6. DSD SIGNATURE
'
System #1 Approved for 3
bedrooms
rj BenjakfySchiller �
System #2 Approved for
bedrooms E��lF9Fo 8/24 292
Disapproved
kk PROFiSSI*
Conditional approval for
bedrooms, with the following stipulations:
,,1111,,,,.
BY Original Certificate Date: ?1371,&.2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist yellow sheet
COSA Checklist
Legal Description: Parcel ID:
If more than 1 septic system on lot: COSA Checklist # of 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.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test?Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
Standpipes/foundation cleanout per record drawing
Date of pumping
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA ______________________
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Adequacy test date
Results Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
Eagle Crest Sub #1, Tract A Lot 44 050-304-07
■5.0
6/18/03
291
290
■
■
18 Forge Engineering
8/10/21
251
8/3/21
18
Septic/Steel
49
■
5/28/21 JR Pumping
Deep Trench
6/26/03 8/10/21
■3
14.8 80
5.2 575
114
■
■
■
1440
78
>450
819
Presoak ended when trench fluid level at top of effective depth.
✔
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to:(Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’Yes if No ft
Absorption Field on Lot > 100’Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’Yes if No ft
Holding Tank > 100’Yes if No ft
Animal Containment > 50’Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
From Septic/Holding Tank on Lot to:(Please enter distances if less than required)
Building Foundations > 10’Yes if No ft
Property Line > 5’Yes if No ft
Absorption Field > 5’Yes if No ft
Water Main > 10’Yes if No ft
Water Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
If septic tank is under driveway comment below
From Absorption Field on Lot to:(Please enter distances if less than required)
Building Foundation > 10’Yes if No ft
Property Line > 10’Yes if No ft
Water Main > 10’Yes if No ft
Water Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
F. ENGINEER’S COMMENTS
G. ENGINEER’S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
8/24/21
✔✔
✔
✔
✔
✔
✔
✔
✔✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
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
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. DSO- ~0¥ - 4)7
.;
GE'NERAL INFO~,MATION
Complete legal description E,.~ ~-L~'
Location (site address or, directions)
Current Property owner(s) "~z ~
Expiration Date:
, l. oTqq--~ TgAcr',4, T#ltJ.~.ll,
Day phone ~G-~I
· Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: ~
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 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 propertiesserved by a private or Class C well 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.)
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.
4. 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 this application, shows that the on-
site water supply and/or wastewater dispOsal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. 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(ara) in compliance with all applicable Municipal and State codes, ordinances,'
and regulations in effect at the time of installation.
~_.~r~_~ /~,V~-._ ~,ME~--~,N~-' phone
Address /0 ¥~,~-I VF'/~/ ~zb/ ~'lx t-rE' ~_o I
Engineer's Printed Name (_.,~/~.l ~'~-o/o//~E.~_ f~. /~/~J:3 Date
Name of Firm
bedrooms.
DSD SIGNATURE
~ 'Approved for · ~
Disapproved.
Conditional approval for
· "' ,',~r. ~ v "~,
· ,' ':':.:';,
Kg,'/s cl~oP,asr, wooD &-~
......
bedrooms, with the following stipulations:
Additional Comments
.,,~(
, ,2,.'.:,o¥,~- ...... ;
&X~,".. ' ".
~: WATER AND } ~-6!
- ' BtiA$')I:WATER :
..~ .'
.~ t PROGRAM : --
.,, z//l.O)))))9u
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
By:
(Rev. 01/02)
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ,~"'"- '~ - 0 /-/'
Legal
A. WELUDATA '
Mfinic!pa!ity ofiAnchorage
Development Services Department
., ! Building Safety Division ~ ·
i i! On-Site Water ~ waste~vater Program
· .',; ~ 4700 South Bra~awSt. ·
P;'O.!Sox 196650 Anchorage, AK 99519-6650
:i. 'www.ci.anchorag~.ak.us ': : !ii
: "i!~ : (907) 343-79,04 ' ' '
HEALTH AUTHORITy A PROVAL CHI bK iST
· ~' ~ ' i {, . ' 1~,. liFii':~ :
parcel ID:
If/~:, B, or C i3rovide
:! i,Sanitarylseal iYIN)'
.i Cased tO
Well ty~e
Date cbmpleted ~'/t~/0 >
.Total d'epth ~q I ft.
Date'o,f test
.Static water level
Well production
WATER sAMPLE RESULTS:'
Colif6r~ colonies/100 mi.
FROM'WELD LOG : ~
Nitrate .~; IO0 mg./I.
.', WelljLog(Y/N) -., ~'. , -
Wires prOperlYilSrotected (Y/N)
· Casing heighl (above grOund)
11~ III?!:~, : .
AT INSI~ECT, I ,ON
in.
~ colonies/100 mi.
Othe I' il;
· . ,ribacteria
Colle~ied
Fired d, epth m absorption field before test ~ ~n. . [Water added
Elapsed T,me: .~'~m. .,,:~! Final fired depth,
Any rdj;t~venati;n treatment (p~;:12 mo'.) (YIN ~ iype)
Absor '~te >:
For ,~ I~edrooms
New depth~/in.
¥.5'D g.p.d.
/es, give date ./
,i
D. LIFT STATION
Date installed '
"Pump on" level at__
in.
Datum
Size in gallons
"pump off; ~.
Cycl-- ,-.-~ed
SEPARATION DISTANCES
sEpARATION DISTANCES FROM wELLoN LOT TO:
Septic' tan'k/lift station on lot
,Absorption field on lot
Public sewer main ,
Sewer/septic service line'
~/Access (Y/N)
High water alarm level at
;
Meets alarm & circuit requirements?
On adja'cent'lots'" - 4 O0 ~. -~--.
On ~dj~c~n'tiots ' I O0 'f' ~'~.
Public sewer manhole/cleanout:: ~, ~10O: '/''
Holding tank ' ~ ~
SEPARATION DISTANCES FROM SEPTIC,~ICLDff,'C TANK'ON LOT TO:
Building foundation ~ '¢ ' 'rCt. Property line I~
Water main I00 + ~"-f, water service line
Wells on adjacent lots 7~'/~,,'// .
in.
'AbsorPtion field
'r' ' :..~.:Surface Water"
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line o1..~ ° Building foundation II ~' '¢~'/. Water main
Water Service line ,~.~'+ '¢"'-/'.' Surface water I0~'¢" '--~'i/-, Driveway, parking/vehiclestorage~",=,.1
Curtain'dr~in ~-"~,J Wells' on adjacent lots '1 o~ .'.r: ..[-.f.
COMMENTS
ENGINEER'S CERTIFIC/~TION "
I certify that I hav~ determined through field i~spections and
review of Municipal records that the above systems are in
conformance with MOA HAA g'ui~lelines in effect on this date.
Engineer's Printed Name
Waiver Fee $
Date of Payment,
Receipt Number
HAA Fee $ q~
Date of Payment
L l'z(olChq
Receipt Number (~,~'! ~)'~
(Rev. 12/01)
/; 3:14PM;
/SG$ Ref.#
Client Name
Project Name///
Client Sample ID
Metrh
1041807001
Eagle River Ensinecri~g
Eagle Crest #1 1,44. Tract A
Eagle Ct'cst #1 L44, Tract
Drinking Water
Sample Remarks:
;~07 5615301
All Dates/Times are Alaska Standard Time
Printed Date/Time 04/20/2004 8:$7
Collected Date/Time 04/15/2004 ]5:00
Received Date/Time 04/16/2004 13:33
Technical Director ~;~-. Erie
Parameter
Waters Department
Nitrate-N
Microbiology Laboratory
Total Coliform
Un/ts Method
O. IOOU
0. I00
mg/L EPA300.0
coVl0(~mL SMI8 9222B
Container ID Altowablc Pszp Analys/s
Lfmfts Datc Date Init
B (<=lO) 04/16/04 JIB
A (<=1) 04116104 DKC
89/11/2883 1B:47
4-5
g0727GT~04
ROBERT E JOHNS JR
l
2nd Street
.Z
. N 89'~6'00.' W 132. O0'
S 8956'00" E
.:
~WELL
57
132.00'
PAGE
02
,m,,mn4 ~M,e md Mq,W%
AS-BUILT
Robert E. Johns, .
" &: Asso¢
Profoaslonal Land Su, rveyora
842r 12 A~
~ 0 t Lot &F. Rec. Plat r~e No.
I
11,2003 ~: w.o.
:
SUBDIVISION ADDITION NO i 1
SYMBOLS;
-
o ~,~ ~ G".~ -~--
,WHICH DO NO.3', APP.'AR ON.,,'TI-4E: RK'G'C)RDI~) b"UBDIVI~ON PLAT. ALL O~$¥AN~5_ARP' Iq£OOIq, D. UNLeSs' e,11-1rJ~v,A~G:
t,l, iC.~.~ NO ~R~JUel'ANC:rr_.S ~40ULD AN A~T~,'L? al~ LI$1~'i'C~ CCe~imj~CIN CK F'C~ Icb'rA~J.qHlNg BOUNDAR~ 0RiIrE:NCE· LINES.
~ I~Sl' ,ANC:[:S PREVAJL O'V~R SCALJI,~ R~00LmlICFt MAY ¢AU~ ~ IN SCALE. I