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HomeMy WebLinkAboutTONJESS ESTATES BLK 2 LT 6 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181175 PID Number: 05183223 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name araeABSORPTION Sholly FIELD ❑ Deep Trench El Wide Trench El Bed El Mound Site Address 25168 Prince Circle ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 376-0270 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Tonjess Est 2 6 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft2 Ft. Well 1 QQ'+ na na 25'+ TANK 9 Septic ElS.T.E.P. El Holding ❑ Other Manufacturer Anchorage Tank Capacity 1000 Gal. Surface Water 100'+ na na Material Steel Number of compartments 2 Lot Line 10'+ na na NA Foundation 10'+ na na LIFT STATION Manufacturer Capacity Gal. Remarks Septic Tank Replacement Alarm location Electrical installed by PIPE MATERIAL House to tank Tank to D3034 drainfield Installer Dean Drainfield CO/MT D3034 Inspector BENCH MARK (Assumed elevation) 100 ft Inspection 1st 7/11/18 7/11/18 Location and description dates: 4a Deck 3d 7/13/18 'h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp,% ., nl Conditional Approval: Date c ° a'. Steven W. PE a?st Septic Syst n� rte,..' Approved—� Date '7 i 00 \v F ;y =.��Z p,. as' cl`''',4OFEOS"��`�4"? Note: this approval does not include well permit requirements."""} (Rev 05/02/18) N'lo f : Ln e0 m Z�% �ro0 (b ((D rn \m Z�} �o v Dk � o o j rn �I N �o� 0 w 1> F C53F 3_ N'lo f : . �r�t+ir�+a►'�� m \ F- -0 3> F— Z C D —I _ n F9 n F9 /76-6 O -6 1> F C53F 3_ nrTI; --a 70 a N ' D n C- pU)p Gl -i F9 —I 0 ,,DZ7 ZD` fid;; F9 od �a S' r �';DF9 N -< n \ ED —I d r0 ro o.. n U h cn w n o Q n P 3 -v n n_ i v 4uws3V _._ r ro f Q �o 0 0 tZI 0 W n�� O N'-' V X LrlN N \0 n \ m \ mrd fTl r0 rD r0 N /76-6 O -6 C53F 3_ -3x N CD n —I UI —I oh 00 \ pU)p Gl s QUO od �a Vi r0 U h I i n n of MUNICIPALITY OF ANCHORAGE ,,, On-Site Water&Wastewater Program S PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http:!/www.muni.org/onsite I)cpartint•tlt �hCNOR"VE On-Site Wastewater Disposal System Permit Permit Number: OSP181175 Effective Date: 7/5/2018 Work Type: SepticTank Upgrade Expiration Date: 7/5/2019 Tax Code Number: 05183223000 Site Legal Address: TONJESS ESTATES BLK 2 LT 6 G:1462 Site Mailing Address: 25168 PRINCE CIR, Chugiak Owner: SHOLLY GARY L & CYNTHIA M Lot Size in Sq Ft: 63524 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 2 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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: G�--' Date: 7 Issued By: RQJJcQA CIAJUC& 19 Date: i 8 L � s BCDPALITY OF ANCHIFTzAGE " UB • Community Development Department +.. ` Phone: 907-343-7904 Development Services Division M' Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 05!- S32- �-3 Property owner(s) 5 64 0 L y Day phone -/ /C Mailing address Z Sl CP ('„rc/e Site address S4-4,4 Legal description (Sub'd., Block & Lot) '% K/,I eJ',J' Legal description (Township, Range & Section) Lot Size CSS 501 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank Upgrade uplex (D) ❑ Holding Tank ❑ Renewal ■ 5 c3 "/ 8 9 u v' I• e Dwellings ❑ Privy ❑ w Q�j �; .-3:nd/or D) Private Well ❑ �"3"�" Water Storage ❑ °- JUL 0 2 10183 ti cu THIS APPLICATION INCLUDES A VARIANCE /WAIV•' ; R• 6 8 L Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. YVAL (Signatur of property owner or au orized agent) Permit/Rush Fees: 21S.0O Waiver Fees: Date of Payment: 1!3/ l D Date of Payment: Receipt Number: 0 1(00D? Receipt Number: Permit No. OSPI$111 S Waiver No. Permit App_9-1-12.doc 71 - RIM ENGINEERING SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 7/2/18 Number of Pages: f( To: MOA On-Site Services To.i Qss F f Subject: PNM Block 2 Lot 6 Septic Tank Failure The subject septic tank has failed-a new tank will replace the old one. The existing trench appears to be working OK . Please issue a permit so the tank can be replaced. The existing trench will remain. Please review as soon as possible. If there is need for additional information or clarification please give me a call. Thanks-Steve \CRTHIM ENGINEERING SteveEng.com Tonjess Estates Block 2 Lot 6 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 3-bedroom home.Most of the neighboring lots are developed. The current septic tank has failed-the trench still functions. These lots are near an acre and are served by the public water.No adverse impacts are expected from tank replacement. The easements are depicted on the lot. The slope is indicated in the area of the septic system. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications(AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • New 2- compartment, 1000 gallon septic tank. Watertight couplings on inlet&outlet. • 5' minimum between the tank and trench. 10' to property lines. • 4' of cover or insulation is required for tank; an equivalent of 1" insulation for 1' foot soil cover. Minimum of 2' soil with insulation. Tank& solid pipe must be set on well compacted, stable soil. • 4" diameter cleanouts with airtight caps are required l' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field,not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs,ASTM D-3034 may be used in lieu of cast iron. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2%slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene(Dow Styrofoam HI/equal) . OF :4(Pt �� . '•,rh. IC, . l.• . 9 1 r* 'i 0 Ao if,f:',-0.;;•.. &N oven W. Eng , 11 .6, *0 rF. 2 . ..•, ... DESIGN NOTES: 1. Existing Trench Remains In Place. V _ 2. Sewer Service Line minimum 2% slope. 57. Slope / 3. Replace Septic Tank/Decommission Old Tank Per UPC. 1 Connect New Tank To Existing Trench. 4. Lots Served by Private Wells. Septic 5. No Conflicts Within 200'. 6. Check Condition Of Sewer Service Line— Replace If Necessary. 7. Add Double Cleanouts Before Tank If No FCO. 8. Insulate Tank If Required. Existing / 57. Slope/ 1Trench / V / 5% Slope/ r,_ / ew 1000 Gallon -100 Septic Tank w/DCO's Decommission Old d� Septic Tank Well ° O PER UPC Septic Ulm `co _ 3 Prince Circle 3 / ISriveway :arin 5% Slope/ v/II. vacant / 5% Slope/ V 5% Slope / Septic NOR THRIM r o� 1' = 50' t�... .k TONJESS ESTATES ENGINEERING �P-'• SteveEng.com • • • BLOCK 2 LOT 6PO DESIGN Eagle Riveox r. Alaska770724 99577 a 4 ' LAYOUT :T � WASTEWATER UPGRADE 907.694. 7028 REPLACE SEPTIC TANK °a x/2/19 r, 3 Foundation Cleanout 7 Tank Cleanouts Fin ^amide Opposing Cleanouts Between Septic Tank & Trench ute 4 Foot Cover or Equal 1000 Gallon Steel To Bed 'Anchorage Tank' Or Equal lid Pipe Match Elevations To DESIGN NOTES Existing FCD & Line 1. Use Existing Trench. 2. Septic Tank & Solid Pipe to be Placed on Compacted, Stable Soil, Free from Boulders. 3. Sewer Service Line is Minimum 2% Slope & 3' Cover. 4. Water-Tight Couplings. S. See Specification Sheet. 6. All Work To Conform to Municipality of Anchorage (AMC) Requirements & Specifications. 7. Decommission Old Septic Tank Per UPC. 8. If No FCD, Install DCD's. NOR THRIM .< ". N y:oR 'ENGINEERING ; , SEPTIC TANK PROFILE . 4,0 TDNJESS ESTATES STATES SteveEng. com * '49m . *jPO Box 770724 4, . BLOCK 2 LOT 6 Eagle Rlwr, Alaska 99577 ] 0 907.694.7028 � (Zi e _ Dob: " By , SHEETTANK REPLACEMENT 7/2/18 (°`° SE 'scale: i = 5 I of 3 SE MUNICIPALITY OF ANCHORAGE 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 ~ ~L~.X IPHONE I~EW Dwelling ~t~ gatlons IF HOME'DE: Inside le~ DISTANCE TO: ~ Well ~ 'Dwelling PERMIT NO. Manufacturer Liqu d capacity in gallons DISTANCE TO: No. of lines J / Foundation , IMaterial Neares~lin/~ Trench wid~ inches IWe. /2-0 / · ..g,h ,,.,,e Top of tile to finish grade Length. Type of cr~'b DISTANCE TO: Class DISTANCE TO: Width Crib diameter Well Depth I~ildir~f°~ n~a t iO~n' I Total Materia} beneath tile f 7~,'~ inches Distance between lines PERMIT NO. b depth Total effective absorption area Jilding foundation Nearest lot line Driller Sewerline Distance to lot line IPERMIT NO. Absorption area(s) Septic tank PIPE MATERIALS SOIL TEST RATING /2-5' OTHER APPROVEDi 72-013 (Rev. 3~78) ." .,. ,..., .... ~.... ,,';~ ,. ..... .:..<~.,- ....... · - ....,.. ..... ) ............. ',. '. . i:-'~ .~ - .. """; "- '" "~", """. ., . ' ' ' :. : ,::" D OCCo. dlaa "'" · · WATER WELLS '~'*~:":::"'.'T' '." ~' : - ': '"'P.O. flOX272, CHUGIAK. ALASKA 99567 · TELEPHONE688-2759 OWNER OF LAND ~ "':': ~ ' DEPTH OF WELL LEGALDESCR]~IO~ ~' ~ '~4 ~ :'~ T~'~~'~:''-':'.:.DEAw ~OWN ~. '" "' DATE-Sta~ed '' Ended ~ ~ ~:': ~. PER'HR / ~ O PERMIT NUMBER ,~.' .' .... '; ..:' C.:,.: KIND OF CASING "~..~'::::-.'-.'.. ,~. ',',. , .... ., .- ' ...... :'.', ..- . ........ · , From ~ 'Ft.t~ , o~ Ft. e-~..JLc'/,~/Gu,¢to~"~J '" ~ From Et. to From · 'Et. to--Ft. ,)~o~J ' : 'From :::,. . .. ..... F,~,,,~ Ft. to.~ Ft.' '~~' '),:.:"7'...:. From From '* ..Ft. to Ft.. ~a, O - ': '--"::': '"' "From · ' MUNICIPALITY OF ANCHORAO~ ~' '"' Fl. ~o ' '"': Ft. D£P?. OF HEALTH&- ENVIRONMENTAL PROTECTION - '" Ft. to ' Ft. "' ' "- Et. to '" "Et.' .'0CT:l 9~0,~, Ft. to ' ' "Ft~ Et. to ' 'Et. " ~' ' Ft. to. Ft. - ........ From,/_~_~ Et. to From Et. to From ,/~ Y' 'Ft. to . From Ft. to Ft. From ' Ft. to Ft. From Ft. to Ft. From Ft. to 'Ft. From__.Ft. to Ft. · .~... :.; -' ~rom ''.' Ft. to ' Ft. From~.F{...to Ft. · : ' · From .... · From From From · From From__ From Ft. to " Ft. ' ' "'' ~Ft. to Ft. ' Et. to Ft. Et. to Ft. Et. to Ft. Et. to Ft. Et. to Ft. ~Ft. to Ft. _Et. to Ft, Ft. to.~,Ft. MISCL INFORMATION: .'. .... ~o' cr ,/ -r-o.-r~ ~. c~" c ~,r,.o ~. '. ~.~....~' ~ / HUN I (; I PAL I TY OF ./~.NCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ~ANCHORAGE, AK 99501 264-4720 ON--SITE SEWER & WELl P. FRMIT PERMIT NO: DATE ISSUED: 840575 07/15/84 APPLICANT: ADDRESS: CONTACT PHONE: A&S CONSTRUCTION P.O. BOX 2071 EAGLE RIVER, AK 688-9675 ~577. LEGAL DESCRIP: SUBDIVISION: .TONJESS EST.' LOT: SECTION: 2 TOWNSHIP: 15N RANGE: LOT SIZE: 55920 (SQ.FT. OR ACRES) MAX BEDROOMS: 5' BLOCK:. Listed below are the options available to you in designing your. septic system. Choose the option that best fits your site. ~ 'I N GRAVEL DEPTH (FT.) · · 5·0 0·5 5.0 \ TOTAL DEPTH (FT.) ' ' 8.0 6.5 8.0~ \. ' GRAVEL WIDTH (FT.) 2.5 22.0 5.0 . ~ GRAVEL LENGTH (FT.) 105.0 **. 45.0 . 75.0 ' GRAVEL VOLUME (CU. YDS. ) 54.0 55.0 \ 47. S TANK SIZE (GALS)' 1,500.0 ** 1,500.¢] ** ~ 1,500.0 SOIL RATING (SQ. FT. /BR) . 125 125 '~ · * GRAVEL LENGTH > 75 FT. 'REQUIRES 'MULTIPLE RUNS (NOT EXCEEDING 7j T. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS 'I certify that: 1. I am familiar with the requirements for on-site sewers and well~.as .set forth by the Municipality of Anchorage (MOA). ~nd the State oF Alaska. 2. I will install the~system in accordance with ail MOAcodes and~regulation and in compliance with the design criteria of this permit· 5. I will adhere to ail MOA and State of Alaska requirements ~or the~et back. distances from any existingwell, wastewater disposal system or public sewerage system on t~is or any adjacent or nearby lot.. 4. I understand that this permit is valid for a maximum of 5 bedrooms and any enl~r'gement ~ill require an additional permit. IF ~ LiFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES~ THEN (1) AN ELECTRICA~ PERMIT AND INSPECTION MUST BE OBTAINE~; (2) AS-BUILTS ~T~A~EW~PROV~I~K t~ST/3~IT~ ~ ~L~?~ ~;~?~N~EPDRT, AND (5) THE SIG~ED __~~~ .... '.. DATE, ~.~__~_ _~___: . APPLICANT: A~CO~RUC~ION , ' ' '. ~ / ISSUED BY ~__~ ...... ,~ DATE: MUNIC'IpALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] 825 L. Street, Anchorage, Alaska 99501 264~t720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 · 15 16 17, 18- 19- 20- COMMENTS PERFORMED BY: 72.008 (6/79) SLOPE SITE PLAN WAS GROUND WATER J~ ENCOUNTERED? · - O ~ O P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE /~ (minutes/inch) TEST RUN BETINEEN FT AND ~ FT MUNICIPALITY 0F ANCHORAGE "A C, Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. _9.594-02-8� 0-T / 8 -322 3 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: Tonjess Est Block 2 Lot 6 25168 Prince Circle Current property owner(s) Sh011y 01 — L) - 2 (9 ZO_ Day phone 376-0270 Mailing address Real estate agent Tiffany Day phone 376-0270 b 1 8 9_70 2. TYPE OF DWELLING: rb Rx Single Family (w/wo ADU) R Duplex a- AUG 2 8 ZO-10 31 0 Multiple Dwellings (Single Family and/or Duplex) -- 3. NUMBER OF BEDROOMS: 3 ZZ 01 6 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic Z Water Storage 1771 Holding Tank El Community Well El Community El Public Water System El Public Sewer El Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. 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 NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 8/27/19 Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: 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 engineers work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisolpr;.' r:, ,`:• Arsenic Advisory Other ` 't :' ; Legal Description: Tonjess Est Block 2 Lot 6 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA - ❑ Well log is filed with Onsite (or attached) Date drilled 7/84 Total depth 185 ft Cased to 40+ ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 30 in. Date of flow test for COSA 8/12/19 Static water level at beginning of test 42 ft. Comments B. TANK DATA Age of tank(s) new years Tank type/material Steel Measured operating fluid level in septic tank new ❑ Standpipes/foundation cleanout per record drawing Date of pumping new D. ABSORPTION FIELD DATA 7/84 Which system tested (date installed) 7/84 ❑ ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade 4 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 Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 05183223 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 3.6 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by NRimEng Date of Sample 8/2/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 8112/19 Results Q Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 8 in Elapsed time 30 min Final fluid depth 2 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date no 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 Community Sewer Manhole/Cleanout > 100' ✓❑ Yes if No ft 0✓ Yes if No Neighboring Tank > 100' ✓❑ Yes if No ft Private Sewer/Septic Line > 25'E] Yes if No Absorption Field on Lot > 100' [✓ Yes if No ft Holding Tank > 100' Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' G. ENGINEER'S CERTIFICATION�'.r Community Sewer Main > 75'✓❑ Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100' ft ft ft ft ft Q✓ Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' 0✓ Yes if No Water Main > 10'✓Q Yes if No ft Community Wells > 200' 0✓ Yes if No. Water Service Line > 10' ❑✓ 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' Q✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' ✓❑ Yes if No ft Community Wells > 200' ✓❑ Yes if No Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION�'.r °Pi 1 certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with r c e MOA COSA guidelines in effect on this date. t ' ' Steven v:. Ent V�bJ 4 r w. as P� � i-PROFESSI1'14 COSA Checklist yellow sheet ft ft ft �r \ \ 0 \ o v z J U)o L4 m=o .Cj z• N m0x O j rn '- O 'OR °reC I L� on / / \ 26.7 9.0' \ a 76.9' .� ''/ R• .2A � 4 q o m n 00 C) z --qt M U 0 0 0 ci �. o tj N0 Ln O Z x p Cz n0) N { • W I to o m M M z in in 06'691. 3«0£,01•.00 S r 0 rn r- 0 U7 PLOT PLAN AS BUILT X SCALE 1" 50� GRID --NVI 1462 Project No. 19-444/R1 _ /� 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang � A S S o c i a t e S y (n C. (907) 522-6476 Phone op4Q�p0� (907) 522-4625 Fax aG p04 Professional Land Surveyors km en®langsurvey.coo F A jonothan*langsurvey.com I hereby certify that I have surveyed the following described property: Lot 6, Block 2, TONJESS ESTATES (Plot No. 82-59) Anchorage Recording District, Alaska, and that the improvements situated theroon 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 surveyed Premises and that there are no roadways, transmission lines or other visible easements on sold property except as Indicated hereon. Dated this the Z'L''� Day of �`� ""t ca ! at Anchorage, Alaska 11 is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. 49TH 1• KENUETH' LANG o ,Q 4PF '••.LS -5202.•' e�G � A Ned 4Q4RO SSIONA7- DOOO�a�© AECC963 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING (~...~1- .~.'~-~, - ~-~ NAA# 1. GENERAL INFORMATION Complete legal description Location (si.te address or directions) Propert, y owner' K¢~h~Fn Eldridge, Mailing a'~J~?~s's" 5605. Are.~c Blvd. Ler{ding agen:cy Mailing address ' 25168 Prince. ¢i~[ Ea~le I~ve~, AK Suite 2651 Day phone 688-~6~ Anchoraqe, AK 99505 Day phone e 4 Agent "Lo~u~.~.~,o~e./'REMA× OF EAGLE RIVER Address 16600 Ce~f,~'.~d Dr. Su~C~e 201 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: $ '~ TYPE OF WATER SUPPLY: Individual well Y, XX Community well Public water NOTE: Day phone 694-4200 Eaql¢ F,,~ve~, AK 99577 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 If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 72-025 (R~. 1.'~11) leronl MOA 1121 5. ' STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm. $ & s ENGINEERING Phone C"~/~/' - -~' 7~,;' 17034 Eagle River LoQp Road Nov 2~4 Address E~ale River. Al~:,:b. 9eC77 , Engineer's signature /'~Z~,"~;/~, . . " ~ - Date ~' //Y/~/~ DHHS SIGNATURE Approved for ~'~ Disapproved. Conditional approval for bedrooms. 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 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~--c,-~'b, 'l~'Z-. '"~ ~_ 5% ~-~"Parcel I.D. A. Well Data Well type ~t~L ~'-fC.. If A, B, or C, attach ADEC letter. ADEC water sys..t, em number Log present (~N) Total depth Sanitary seal (~) Date of test Static water level Well flow Pump level1 Cased to FROM WELL LOG "7--6~ Absorption field on lot Public sewer main Sewer service line SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ Dc,~¥ Date completed "/--~,~ Driller ~,~..,,.~_,5.~ ~-~ Wires ~;op~ prote~ AT INSPEC~ON g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ..,, ,Nitrate Tank size "5. ct % Other bacteria .Collected by: S & S ENGINEERING ......... i ~ Bald NI, IH Compartments Cleanouts~)" .... ~ ...... ~ ?,.Foundation cleanout(~l) High wat'e? alarm (Y{~, .. '~'.~J*) Date of ~mping '/~: ~ '¢ Pum~r SEPARaTiON DISTANCES F~O~ ~EPTIC/HOLDING T~K TO: Well(s)on~l*~ '.' )~ t~,:.. On adjacent ~ts /oo ~ To pm~y line ~' '~-~':i'~' Abso~tion field /~ / Sudace wateCdrainage /~ o / ~ Depression (Y/~) Alarm tested (Y/N) ,Foundation /..C' / Water main/service line 72-026 (3~3). Fro~t CONTINUED ON BACK PAGE C. UFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) ."Pump on" level at "Pu~ o~ L/~v~'''''/ High water alarm level __ . Meets MOA elect~7.al codes (Y/N) .~ N TO: Wetf-o"n'~t : On adjacent lots D. ABSORPTION FIELD DATA Sudace water Date installed "7 -- ~ ~ Soil rating (GPD/Ft~) /.2.r' ~///~ ,System type Dfz~.,.f,,% z~- x> Length '~3 ' .W',:tth -P' / Gravel thickness .3 / Total depth ,5' ~ ~Total absorption area ~.Z.5'- 5f .Cleanout present (I~N) .,4' Depression over field (y/.~ ,J' Date of ad~:l~acy test~'7.---g, .~j~ Results,~i~a~) f'~--w~, for '~ Bedrooms Water level in absorplion lield before test ~, /.~-;~-,~,/ o'~-/>~-Ntertest o Peroxide treatment (past 12 months) (Y~[~) /~,~ ~. F',.)o ,.3tJ It yes, give date ~//~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain ~//~ HAA Fee $ Date of Payment Receip~ Number On adjacent lots I / ~) ~ ~' Property line ,~o ' ~' To existing or abandoned system on lot "J~- Cutbank /'J/~' Water main/service line /o ~ + Driveway, parking/vehicle storage area -~,~ I cer~y lhat l have checked, vefifiedo or conformed to all MOA and HAA guidelines in e~~his ins~ection. ..... ......... :;' · t'~OD ~ ~ ' ' Waiver Fee $ ": Date oi Payment Receipt Number }RJNICIPALITY OF DIVISION OF ENVIRONMENTAL HEALTH DEPAIIIMENT OF HEALTH AND ENVIRONMENTAL PKOTECTION APPLICATION FOR ~EALTR AUTHORITY APPROVAL CERTIFICATE Legal ~escription (include lot, block, subdivision, section, township, range) Location (address or directior~s) (b) Applicants Name ~.~ Telephone- Home Business (c) Applicant is (check one) Lending Institution ~-~ ; Owner/builder~ ; Buyer.~--~ ; Other F--q(explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent (f) Address Telephone e HAA to the following address: Type of Residence Single-Family~ Multi-Family~-~ Other (describe) Number of Bedrooms.~ Water Supply Individual Well ~ Co~munity ~--~ Public ~--~ Note: If community well system, must have ~rritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage'Disposal Note: If community well system, must have w~itten confirmation from the State Department of Environmental Conservation attesting to the legality and status.. [Page 1 of 2] 5. En~ineerin~ Firm Providin~ Inspectionsr Tast~ .File Search; Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval 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 M~nicipality 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 regula- tions in effect on the date of this inspection. Name of Firm Address Date (ENGINEER SEAL) Telephone Approved for ~ bedrooms Approved ~ Disapproved Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES h'~ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN TH~ 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 REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA EEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/e]/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANC~3RAGE (M(~) HEALTH Nn~ORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNIClPAU'W OF ANO'IOP,.A~E DEPT. OF HEALTH & ENVIRONMENTAL PROT['CTION OCT 9 RECEIVED ae Well Class i f ication/~/L~ ~ Well LOG P~esent Total Depth /~ ~'- ' Cased to Static ~4ater Level , .~_~- ' Casing Hsight Above Grcxlnd /~" Electzical Wiring in Conduit ~) Separation Distanc~s f~cm Well: To Septic/~idi,~j Tank cn Lot //.~- ' To Nearest F~ge of Absc~ption Field on Lot To Nearest Public Sewsr Line If A, B, c~ C, D.E.C. Ap$~OV~d(Y/N) ?" of outi Pump Set At ~ ~ Sanitary Seal o~ Casing ~ Depression A~ound Wellhead (~_ . ; On N~joining Lots ~F~ ~-~ ' ; On Adjoining Lots c~ ~J m~ To Nearest Public Sewer Cleancut/Manhole ~/;~ To Nearest Sewer servioe Line on Lot Water ~ ~st ~sults ~ ~/3~ r~ / B. SEPTIC~ANK D~TA Dete Instaii. d 7/~ De[~essior~ over Tank ~i~in~n~ ~a~ Holdi~ Ta~ Hig~te= ~a~ (Y~)N/~ ' ~~y ~ldi~ Tank ~r~t (.X~)~/~ ~ati~ Dista~s ~ ~ptic,~-Ta~: To ~te~upply ~11 //~ ' To ~ildi~ F~n~ti~ TO ~rty Li~ /o To ~ter ~i~i~ Li~ /~ ~ To S~; ~, ~e, ~ ~jor ~aiPm~ Air-tight Caps ~ Date Last Pumped NO. of Ccalpa~tmsnts ~-- Foundation CieanoutG~ cc~nts [Page 1 of 2] 2-15-84 C. AB~ORPTIO~ FIELD DATA Soils ~ating in Absorption St=ara Date Installed Width cf Field Square Feet of Absorption A~ea Depression over Field (Y~ ~sults of Last Adequacy 9bst Date of Last Adequacy Test Type of System Design/J~,Jr~o Length of Field Depth of Field Gravel Bed Thickr~ss Standpipes P~esent Separation Distance f~cm Absorption Field: To Water-Supply W~ 11 / / ~ ~ z To ~ty Li~ /~ ~ To ~ildi~g F~n~ti~ ~ ' To Existi~ or ~n~md Sys~m ~ Lot ~ ~ ; ~ ~joini~ ~ ~ ~ ~ To ~te~~vi~ Li~ ~ ~ To ~t~(if ~e~nt) ~~ To S~e~nd~ke/~ ~j~ ~aiPm~ ~ ~ ~ &= To ~i~way, Pa~ki~ ~ea, ~ Vehicle St~ ~a /~ ~ D. LIFT STATION Date Ir~talled Size in Gallons '~,v On" Level at High Water Ala=m Level at Tested fo~ Electrical Codes(Y/N) DimePsions Manhole/Access (Y/N) Vent (Y/N% Pumping Cycles du~ing Adequacy Test. Peets ~4DA C~,,,~nts ** Check Permitted Bedroom Rating A~aiP~t HAA ~equest I c~=tify that I have checked, verified, c~ oonfc~d to all ~ on the date of th_is inspection. ~' n SRB196X . KB1/d5/s [Page 2 of 2] ~ffect 2-15-84