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HomeMy WebLinkAboutGLENN VIEW ESTATES WEST PH 2 BLK 2 LT 18Glenn View West #2 Block 2 Lot 18 #051-793-35 • t Municipality of Anchorage e, Development Services Department . Building . Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW 03n /fir(, PID Number: OSr' 7 5 3 "3 .5 - of Name: �2 e (/ "AI C • Wastewater System: g New ❑ Upgrade Address: p 3 gvv x. 70 0 cis; fj C Jam- ABSORPTION FIELD Phone: 2 2 3..^/ Jo Number of Bedrooms: OY Deep Trench 0 Shallow Trench 0 Bed 0 Mound 0 Other. LEGAL DESCRIPTION Soil Rating: �J O. O GPD/Ft2 Total Depth from original grade 7 Block:2 Lot V Subdivision: / G'L64 view 6s7 -47 -es w. Depth to pipe bottom from origi grade: .2• Ft. Ft. Gravel depth beneath pipe: C. S Township: Range: Section: Fill added above original grade: Al O/f< Ft. Ft. Gravel Length: v 3 Well: $. IC ❑ Ne . ❑ Upgr - • e Ft) PV Gravel width: J! A. Number of lines: // Ft. Distance between lines: Ft. Classification (Private. A. B, C): Total Depth: Ft. Cased to: Ft. Total absorption area: ' Ft2 Pipe Material: bib / Driller. Date Drilled: Static Water Level: Ft Installer. Sd Tf/, r. k. Ca — Date Installed: 7iJ o3 — 7/Z //0..? Yield: GPMFt. Pump Set at Casing Height Above Ground: Ft TAN K SEPARATION DISTANCES 54 Septic ■ Holding ■ S.T.E.P. ■ Other: To From Septic Tank Absorption Field Lift Station Holding Tank oubiic.PrivateManufacturer Sewer Line "52/(e/c4CSC 734//(. Capacity. (25-0 Gal. Well ' 4 .-.. Material: 57-66L Number of�ompartments: Surface Water / 061.1.. loaf?„ 1�/4 Aset LIFT STATION A,r/jet Lot Line 35I /C /.f — Size: Gal. Manufacturer. Foundation ,Z 0(4- 301 t — „- 'Pump on' lev at: in. 'Pump off vel at: In. Hi water alarm at: in. Curtain Drain -'- . - .— -- Pump oke 8 Model Ele mat Inspections performed Remarks: /4-E Sag I' /ani' % �i:nl e(1 R4iJ'6.Q BENCH MARK t O�vr Fdor -It- / /'v.rQ c,t-rra Location and Description: s V,.! O PLRT y 44 cs acini Fig( 7 44 DSD, /N'GREgsi,1C 7-0 7-. . fAssumed Elevation: Ft. AE sale pr, n/ ,4RGel 7a P1 q f7 2 106. 2 OF 4 2 4d Inspectionsperformed by:A/O /� ` st P grit EAI C, Dates: 1 7AP/r3 rP��.•..........; o% :49TH re• ''. s,,1r :•• 2nd 7//61296.3 �. •. ''``•••• ... ,�•. •• c re ••••..• • ••• •••• • :•.• ?t Development P Reviewed and approved by: Services Department Approval P PP oval Date: (o/27/0; I' �` = Strrusn.w. Fav . '� µ i �,,�' 41' i!' •• rf tau • ? or, Qt 4, •••••�•••••••••��a,,', (Rev. 12/00) 4'': opROFESS1�wtx\- d Final Grade El, Foundation Cleanout Opposing Cteanouts Between Septic Tank & Bed To Mid -Point of Deep Trench Elevation 87.5 a, a 0 0 ti Foot Cover Elevation = 87,5 d (/)ai O4) d o d L t7 S U In 'J Monitor Tube of Anchorage (AMC) TRENCH END VIEW SEPTIC TANK PRDFILE cli d. L O) aJ rt •e) N Z3 c+' c _CI, iii Q:,; N FL- O a, c a4 �--i' :i; ti_ L O —3O" . 0 e a,V'1-'Q' r. _ LA c dN s' '1'E:4';: F- a, F- 111— ha, .X z A CU U L L a i- s_ 'rd re f �i rP yi Lu -8 ) ) a 3 aa,, wF°v)Nv) v)aw A .-+(U ('') Ni. U7..0 in 111 AS -BUILT ELEVATIDNS igor n tgyl 0 L0 o O o , Q. 43 o`� n $' w W 0 «® // G± cc DESIGN NOTES: / CL 6 C•1 0 E Water System 0 E _ 7�� • > 2 \ *S.; /\'%1 1 v © © 2 v o . f$� . ■ o 71) ` \ j \ / ;¢ / `G \ ail O \ -- \ §§i �,:1 = i C / % \#{ •R • ilitil r-4 Ico o -- \ \ -rdz % } \*a r NI r x %�e � S + g /r at 2 ai cm 41 C3 w CVO 0 gl I— CS) ( 0 BUFFER LANDSCAPING EAS T&E EASEMENT AS—BUILT LOCATION 32 \ ? c \ \• 0CO 00re 0ar 0 /\ cc 0o��\m«mw� \�cG s y«l\ I HOMESTEAD cr (NOT BUILT) MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial AY& 9 0,1X9.4 Date Issued: Jun 17, 2003 Expiration Date: Jun 16, 2004 Permit Number: SW030196 Parcel ID: 051-793-35 Legal Description:[GLENN VIES -ESTATES PH 2'BLOCK 2:LOTi8 i' Design Engineer: 0838 North Rim Engineering Owner Name: LEROY ALDERMAN Owner Address: 21222 POLLY CIRCLE CHUGIAK , AK 99567 - Site Address: 21222 POLLY CIRCLE Lot Size: 48737 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 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. Received By: Issued By: Date' Date: /i 7/03 Parcel I.D. 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 SEWER/WELL PERMIT.APP! CATION .._ FOR A SINGLE FAMILY DWELLING OS 1 Property owner(s) Z—CFZoy i4t1)trtr Mailingaddress (1) 04 -*11 :4 ti Permit Number SW0_30/q6 Day pho ne St (2) 2.( _ R - Pokl C.� 1' C JL Zip Code CLL UN Legal description (Lot, Block & Sub'd.) ct c (SIL ggCC0-1 1 pl,..es e.. Legal description (Section Township & Range) C f'ltft- Lot Size f'-- Acre 48 737 THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Number of Bedrooms Well Only Water Storage 4/ Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner r authorized agent) Permit Fees:'\ --too Waiver Fees: Date of Payment: `\ \ 1033 Receipt Number: 3 U°1 k (Rev. 12/00) Date of Payment: Receipt Number: . y. NorthRim Engineering 17237 Bear Paw Circle Eagle River, AK 99577 907-694-7026 907-830-4186 June 11, 2003 Dan Roth MOA On -Site Water & Wastewater Program 4700 Bragaw St Anchorage, AK 99519 RE: Glen View Estates West #1, Block 2, Lot 18, Chugiak Dear Dan, Please review the submittal for the water & sewer design for the proposed single family home. The entire subdivision is served by a Public Water System. I have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Sincerely, NorthRim Engineering Steven W. Eng, PE, Design Enclosures B•. 0 oo O p M M K J J W Z U W N O 1-O'J (1) )- � W a I- NU LJ Z U(7) J W Q N _Ix co w m v Uc N Z W d E2 r jLJO < CO DESIGN NOTES: O > J T N O r..7 z:3 a"9 0 `,� < ^� J G u E fist}_ J ; ;; -toa 0 v7 3 a) a) O L j N F— J S I- N r6 1- N W N W co cn w W_ Z wO J J 0 CO M 0 (5 z E W = W CD O z Z w CO ij ani t) N W Public Water dJ •oo c\f o F S 01 V— 14-1 i0 00 O N vM u U) Er) o 03 DD Z Z W U Z a -UQ• 1=-mInp CIO C W - U' Z ����_ Q Q <Q (N) ,ti l •66 W03 Ze Z CO O «•o U) U 1 0 1- M„8S,80.00 N oo. HOMESTEAD S2 (1 W 1- O z z ID W A N N O .(1u � QQii u - ~ c 03 CC • LE i A U �a Cu •#, -P Qi X cuN E a-. N Dl L4. 0 cs - PU 3 O vj to 3 'a •}a — N +' c j L A 0J _c _S2 0 L 3 +' 3 1-- E5£ -E UC °MHu) cv Pi �r 1 M k0 orated Pl.- Ater i.- r• liter Fabri• • •l `•;� • .w{•• L,Jt�J� ;`. t :- • • • • • cu • • • •,S-. •, s •• i.��;.lv cs • .'.rf•.�{A�V•� •-1 • ll�'`10 I.g.". $ .4041-6 1•4100. Sl w0.4611•4.0llii�wli&Nef4N�let%rf •-X44 .4. -•A i, 0 14 .40:44a- 1��1.4040:�y�` �; 0; ;�fN 4���)9,X040• ,1,)ll�,)'l 1/40 i444144.4.4°)e.. 44:PiRv.4. et 1,404,46040 1 l4')� 1�,}1. 11I `40.1w�%))ii 44,4•444. �It....041s4.60., , 'l!.Ll�,).0..).11! 1.4.04.1.0040 :' At., •-.0444 l• 0,440..).0-1•l� , 4, • 1 40i 'l1iijsAtt et .)'l1?'l1?'l�I LMInimun 6' to Bedrock, 4' to Groundwate V) LJ Q CO V) wo 3J w/•�i a z u LJ J J 0 XI II RENC. FLAN & ':I a O CU u� • A (4 g tD Foundation Cleanout Opposing Cleanouts Between Septic Tank & Bed Tank Cleanouts -• Y E d O N O 0) d d S- O O s o U in c N < • • DESIGN NOTES: U M v "0 d > d • C2- t7O U S UU 0) `� c -15 • O cb 4- X N a III 0)0 W U 0 >, Cl- 4i-�QiiN "0 Li 473 E - O U1 W E d N - +; O U s O. E Q., 't-' 4- £a lo � us ms E N 0, Q��y L a �0Q,Sav) 4- N S- O O O as Od)Li- (1)0 FS Ut U +' U .p -F' £ O > c L 'n 4- 1- maiI-CS C4)PI- U.Y E ! N N A US L Ly iO 5 a, -�a-N3d� � F°ii)NV)3v)¢� --. cu cri 4 tri ko M V) 4. W O bce) w co LAE— w H QJ Z U LA J _I L7f� • W) • W m 8 TRENCH END SEPTIC TANK PR❑FILE Glen View Estates West 411, Block 2, Lot 18 NorthRim Engineering SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is a single family home projected at 4 bedrooms. This requires a 12500 gallon septic tank. This is about a 1 acre lot and no adverse impacts are expected from development. The neighboring subdivision lots are large, about 1 acre and are on public water. No water wells are in the vicinity. The lot to the west (Lot 19) is developed with no conflicts to the existing septic system, property line or water line. Soil tests found typical soil for this area; a shallow sand layer with denser underlying material. The system was sized for the denser silty sandy gravel and a portion of the sand layer (1.5') which had a better perc rate. An application rate of 0.87 GPD/FT2 was used for sizing the absorption trench. A 15 foot deep monitoring tube revealed no groundwater. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment septic tank • Watertight couplings on inlet & outlet • 5 foot minimum between the tank and bed. 10 foot to property lines. • 3 feet of cover or insulation is required for trench; an equivalent of 1" insulation for each foot soil cover. • Tank & solid pipe must be set on well compacted, stable soil • 4 inch diameter cleanouts with airtight caps are required 1 to 4 feet 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 feet 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 • Trench to be placed level, minimum of 4 feet to groundwater, 6 feet to bedrock from drain -rock • Drain rock to be '/2 inch to 2V2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down • Silt barrier (filter fabric) to be installed above the drain rock • Smeared trench sides must be raked or scarified before drain rock placement • Backfill over drain rock must not be less than 36" • The finish grade must be mounded to promote drainage over the bed • 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 shall be extruded direct burial polystyrene (Dow Styrofoam HI or equal) 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 Soils Log - Percolation Test Performed For: �2 C .1� /'VC Date Performed: 012/03.., CA/03 7, Legal Description Fj�i 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.anchorane.ak.us (907) 343-7904 Soils Log - Percolation Test Performed For: 4/ 2 C .7 bfie. Date Performed: 7' 1O3 t !/3/0-? Legal Description:GL6 j.f B2 � L. PI Township, Range, Section: Slope T-21 a 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- •• AAP. A. ORaitNic.4 SP S I° GP GPI 54•JOyy G2r9r/kz, 7-1144 % WAS GROUND WATER ENCOUNTERED? Na IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? 61. ?- Date: 6/Ife- s L O D P Site Plan /7 64a - Reading Date Gross Time Net Time Depth to Water Net Drop C/V453 — / Li %i 1 / / ,$- %z Z 1 /5'�� '�/8 3 1 l 5' ''s�f. 1 157/4' PERCOLATION RATE T (minuteynch) TEST RUN BETWEEN 5 FT AND COMMENTS)C/ C %- Pg,ec.Co„•t P�fiV pSF_ Tff_ 1 leo2 15J'/CAL PERFORMED BY: PERFORMED IN ACCORDANCE T ALL STATE ANDeONICIPALG GUIDELINES FECT ON THIS D-47,71 TIFY A E.rHAT DATES TEST WAS62 PERC HOLE DIAMETER b FT a ii9/ �-/a J'o• , . Parcel I.D. 051-793-35 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date: 7 - / IL - 1. GENERAL INFORMATION Complete legal description Glenn View Estates West PH2, Block 2, Lot 18 Location (site address) 21222 Polly Circle Chugiak, AK 99567 Current Property owner(s) Kevin & Bonnie Mitchell Day phone P.O. Box 770854 Eagle River, AK 99577 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: n n II Single Family (w/wo ADU) Duplex Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System x Four TYPE OF WASTEWATER DISPOSAL: Individual Ix I Holding Tank Community Public Sewer n n WaiverNariance request for: Distance: Received by: t COSA to be released to the'engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 174 % C) Waiver Fee $ Date of Payment 7 -2'- `3 Date of Payment Receipt Number/ i_�) T-2\/7 c-(;-- Receipt Number 1 COSA # 1 3 6 1 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. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE 1 System #1 Approved for System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms Phone 522-7773 Date 7/29/2013 o 0 ac D*oa 491L1 oe0000 oeaa o— 0 % OMICHAEL Cs mpills NJ v. I ° CE -4381 0 9 4 E�� Nom' 4t'' bedrooms, with the following stipulations: Llllll((U ((((((( d� J ON-SITE WW, STI tWAANTSDER n7 PROGRAM" ')))T)SE�1 By: i Theg?tunicip ty lel Original Certificate Date: R —/ 3 nchorage 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 blue sheet If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Glenn View Estates West PH2, Block 2, Lot 18 Parcel ID: 051-793-35 A. WELL DATA AWWU Water System Well type If A, B, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N)_ Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/18-21/03 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 7/9/2013 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 7118-21/03 Soil rating (g.p.d./ft2 or ft2/bdrm) .8 GPD/SF System type Deep Trench Length 63 ft. Width 3 ft. Gravel below pipe 6.5 ft. Total depth 10 ft. Eff. absorption area 819 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7/14113 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 65 in. Water added 840 gal. New depth 78 in. Elapsed Time: 180 min. Final fluid depth, 74 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date 1. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum Cycles tested in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. E. SEPARATION DISTANCES AWWU Water System WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots N/A Absorption field on lot N/A On adjacent lots N/A Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line N/A Holding tank N/A Animal containment areas N/A Manure/animal excrete storage areas N/A SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5 Property line >5, >5' Absorption field ' Water main > Water service line >10 Surface water >100 Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line > Building foundation > 10 Water main N/A Water Service line > Surface water >100' Curtain drain None Noted Wells on adjacent lots > 100' F. COMMENTS Lot is served by AWWU Water System. Driveway, parking/vehicle storage >10' 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. Engineer's Printed Name Michael E. Anderson, P.E. Date 7/29/2013 COSA brown sheet 10-10-12.doc ®i1* % %, Gri Rs` :9 < 8 • f xif 40 •MORE. E ANDERSON . W .1— CE • 4381 es \q`"Yr 911.67' '`'_ip„k 0•dr Parcel I.D. •i. Municipality of Anchorage Development Services Department a Building Safety Division 1".1 - 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 t -ORA SINGLEfAMiLY vWELLING- ori--�3--�� GENERAL- INFORMATION` Completelegal description 'eL.Enf V/et J 64r#177.54 • EL -d eK L, Lor fJ Location (site, address or directions) '..POC -1-7 0,(getC7 QJJCt4k_. aqS t49"1 Current Property.owner(s) //2 e1, .Z�CC_ Day phone 2 2S i/ocr Mailing address....;, ..-;%.Q • CQx 6" %�a�s ChfuG fc Lending agency Day phone Mailing address Real Estate Agent. Day phone HAA # .OWU lQ Expiration Date: 4/2 z/o¢ West P112 Mailing Address . Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS:. _ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System .4 ' 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 civii 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 well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year witn 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. . Name of Firm ALO&'TW . �rlCwtei4 Address /?0U7 /490 Engineer's Printed Name STeiiF GtiJ G ' • 5. DSD SIGNATURE X Approved for 't Disapproved. . Conditional approval for edrooms, wi h the folliivring"stipulations' '. Additional Comments' Attachments: HAA Checklist Septic System Advisory Well Flow Advisory (Rev. 01102) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: I/2 2/o4- Municipality of Anchorage Development Services Department ' Building Safety Division On-Site Water & Wastewater Progthm 4700 South Bragaw St. • .; P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us 1 , 1 (907) 343-7904 . .... ! : I HEALTH AUTHORITY APPROVAL CHECKLIST i• .. - ,., i Legal Description: :C6.-66! Vic4 _I ,ecsni-mr p6 rg, /3 2, L I t A. WELL DATA .j•131.4c_ c,...s/47-6/2_; Well type , If A, B, or, C provide P SID # Well Log (YIN) Date complete I I; Sanitary seal /N) Wires properly protecte (Y/N) Total depth ift. Cased to ft. Casing height (abo ground) in. 1 , FROM WELL LOG AT INSPECTION Date of test Static water level 1 Well production i WATER SAMPLE R SULTS: doliform colonies/100 ml. Nitrate m ./I. • Other bacteria colonies/100 ml. Arsenic: Mg./I. Date of sam Collected b I IL B. SEPTIC/AOLDING TANK DATA ,,,,„_ A Date installed 7/2//0.3 Tank Type/Material vL-41--/iOreotre; 77.1dte_. Tank size /Z50 I'gal. Number of Compartments 2 Cleanouts (Y/N) y I I' Foundation cleanout (Y/N) y Depression over tank (YIN) ,A( High water alarm (Y/N) ,V/,q Date of pumping • 46cA1 P il%pise'rri--- I I C. ABSORPTION FIELD DATA _o--), Date installed VZ-yo--) Soil rating (g.p.d./ft2 or4&E),1,.(1).Qs_ft System type Ili" 7724O_1 Length Kif ft. . Width - 3 ft. Gravel below pipe ‘ --C. ft. a 1 Total depth 1 I ft. Eff. absorption area Pf? ft2 Monitoring tube 7 Depression over field A( Date of adequacyI test Afi- SlYeseralftlintFail) For bedrooms II, Fluid depth in absorption fi- before test in. Water added New pth in. 1 Elapsed Time: L in Final fluid depth in. Ab .rption rate >= g.p.d Any rejuvena treatment (past 12 mo.) (YIN & type) 03-1-713LE6-- Parcel ID: ft. . ft. g.p.m. If yes, give date D. LIFT STATION Date installed .__ Size in gallon "Pump on" level in. "Pump o leve! at in. Datum Cyc! . tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Manhole/ cess (Y/N) ____ High ter alarm level at in. M is alarm & circuit requirements? PU(3uc_ LA)m-reg_ Septic tank/lift station lot On adjacent lots Absorption field o of On adjacent lots Public sewer .ain Public sewer man!,lle'cieanout Sewer /s ptic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation _. a 0 r'C _ Property line 35 r Absorption field Water main (6 `t Wells ori adjacent lots /00 'r .S14 - Water service line e (Gil- Surface water /tat 111- SEPARATION r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line _ /d LI- __. Building foundation. 3d��_ Water Service line (6 `+ Surface water / 0 4'4 - Curtain `+ Cu Iain drain of/4 Wells on adjacent lots _LOo rT F, 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 HAA guidelines in effect on this data Engineer's Printed Name S TEL/5 C,qj Date _fZrar//U? Water main /6(e. Driveway, parking/vehicle storage __2Q111- HAA Fee $7:77-7—, Waiver Fee $ Date of Payment 1Z/ L2-1/0? Date of Payment Receipt Number 4LLoE & is (Rev 12/01) Receipt Number ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: cZ 4/"%/ 4sr�r Je./d's7- Z,ZeP -/PBZ AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRI CTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SEWARD & ASSOCIATES LAND SURVEYING 6 9 4- 0 8 2 9 SCALE: DATE: ///� GRID: FB: DRAWN: