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HomeMy WebLinkAboutLEOS LT 10Leo's Lot 10 #051-053-34 Municipality of Anchorage , Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 9951 M650 Page / Of3 www.d.anchorage.ak.us (907)343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: S WO 303q 7 PID Number: OS/— J1 Name: eh r5 ;44 Wastewater System: Pf New ❑ Upgrade Address: 15"15/ n m 4i n f &q1ee#ye1;&q1-5__77 ABSORPTION FIELD Phone:^_-3Oi Number of Bedrooms: ^� OC/ 5 Deep Trench 13 Shallav Trench D Bed ❑ Mountl ❑ Other: LEGAL DESCRIPTION Soil Rating: O Total Depth from original grade: I GPD/Ft' Ft. Block: Lot: Subdivision: I 1-�/7 O �0S Depth to pipe bottom fromodginal grade S Gravel depth beneath pipe: Ft. / Ft. Tovmship: Range: Section: Fill added above original grade:<` /', � FI. Gravel Length: �7 Ft Well: ❑ New ❑ Upgrade Gravel Wdth: 3 Number of lines: I Distance between lines: I I Ft. Ft. Classification (P ate. A, B, Cy): Total Depth: 19 Q � Cased to: �FL Total absorption area: _7 4 au P, CMl: _Z Z c ©�J./�% O Iv A l 2 Ft. CJ Ft' J tr Duller. /r Sk6/, Data Drilled: Static Water Level: 1S Installer: IN `r? Date Installed: t/Qn TCO G Ft. weed ca vol Yield Pump Set ab W �(yQ(,(JJ� Casing Fleight Above& nd: TANK JrD GPM /1 Ft. p FL SEPARATION DISTANCES O'Septic ❑ Holding O S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublic(Pdvate lism darer. /Off�r apadry. From Tank Field Station Tank Sewer Line �'� f / /MO Gal. Well ('Wy ,t t ©� JS T Material. yD p� Number of Compartments: Surface Water � LIFT STATION Lal Line I `ize: nu acturer: ^ v t 'Pump on-tevel ab 'Pump orr level a . High water alarm aL Foundation aCJ in. Cumin Drain �Np ^ PhV Pump Make 8 Electrical Inspections perfomv.W by: Remarks: I" ` t rev of el(� -F,`j�of BENCH MARK 11"le fed Location and Descnplion: �o doe" waivei- o .'� q Assumed Elevauon: Ft. N C) aI 1rY 1 1 o a� z; 17094 Eagle Rlver Loop Road, No. 204 st —/ ��—V[ ^ Dates: 1 Inspections performed by: Eagle *Iasks 995" ' 2nd�- ROBERT c. COWAN...,a�C A Development Services Department Approval �C . CE - 8801 ,•`j-;�'' Reviewed and approved by: Date: � t�i`�FRCFc3°;�''<',, " PERMIT NO. SW030397 PAGE 2 OF 3 Municipal of Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 *Anchorage, Alaska 99519-6650 • Telephore 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 10, LEO'S S/D - P.I.D. No. 051-053-34 R I a' 100' WELL RP�\uS �. c-/ �A�T'S1TE THA TRENCH MTz NEW CO2 DELI & DBL2 ST2 O STI MTI 0 o MT COi NEW 1000 GALLON HDPE SEPTIC TANK TBM A B FCO N N � a 0 a NEW 3 BEDROOM J JI HOUSE 3 0 CD oI J� W"Qy. Q.� �q I N RPQ4U �p0, vN LOT 9 LOT 11 'b 0, SCALE, 1" _ 30' GG(D FRE LEO 16 �o ♦� �.......I-111 ID O A D c9T110 C. COWAN ti j 0 CE -8 R PERMIT No. SWO30397 PAGE 3 OF 3 Yunicipallt of Anchora e DEPARTMENT OF HEATH 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 LEGAL LOT 10, LEO'S S/D P.I.D. NO. 051-053-34 ST1 S 99.0' FINAL GRADE 2" INSULATION NEW 95.5' 1000 GALLON POLYETHYLENE 95.2' SEPTIC TANK c01=99.1' CO2=97.6' FINAL GRAD 2" INSULATION C01=95.0' SR C O2=95.0' MT1=88.0' MT2=87.9' N. T. S. A B FCO 3.0' *1.5'SDA NO WATER FOUND a' ST1 15.0 41 .5 81.9' B.O.H. j �' .Sj ST2 17.5 42.5 TMT 14.0' 39.0' 5BL1 19.0' 42.5' DBL2 18.5' 41 .5' !. ti �.✓... C01 1 3.5' 33.5 p1 ROBERT C. COWAN MT1 16.0' 31.0' `"e, Cc 8801 CO2 1 57.5 1 34.5' �;,`:•.,, * 7 FROM HOUSE 3e�141�� OFFSET 01/01/1999 00:04 6882259 SULLIVAN PAGE 01/01 violer �I1: rLoa by CO. SULLIVAN WATER WELLS F.O.13OX IM V2, CHUQIAK, ALAM OR= - •,7,1.- • 6 I R y ! , 1,t :.2• yr ,1 � ► R . w � 0. -*r, ,I.C- X -T-1 z -,C Jl° aT UMON. It is the responsibility (# the pmperty owner to submR a copy of fhe wait lag to the proper authoflty. Munlcipai )f AnMwage: Depwftent of Health & Human Services and/or Depart rent of Envi onmentat Conservation. Matsu smtug ]epwtMent of Envtronmmtal Conservation. 07/12/2004 00:07 9076942595 HORIZONS INC PAGE 01 .A, ASBUILT SMARD & ASSOC I HEREBY CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS DATE= / INDICATED. IT IS THE RESPONSIBILITY OF THE _ )WNER TO DETERMINE THE EXISTENCE OF ANY GRID: ?ASEMENTS, COVENANTS, OR RESTRICTIONS VHICH DO NOT APPEAR ON THE RECORDED SUBDI- IISiON PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: WY DATA HEREON BE USED FOR CONSTRUCTION )F FENCE LINES, OR FOR ESTABLISHING BOUND- \RY LINES. DRAWN' OF A�®Oma v i 4i �! Duane Mark :toward p ,'. LS -6918 '�JV�`ar ®O O o z8 4 fir 0 N� � M N b b n+� DF' � r U .A, ASBUILT SMARD & ASSOC I HEREBY CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS DATE= / INDICATED. IT IS THE RESPONSIBILITY OF THE _ )WNER TO DETERMINE THE EXISTENCE OF ANY GRID: ?ASEMENTS, COVENANTS, OR RESTRICTIONS VHICH DO NOT APPEAR ON THE RECORDED SUBDI- IISiON PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: WY DATA HEREON BE USED FOR CONSTRUCTION )F FENCE LINES, OR FOR ESTABLISHING BOUND- \RY LINES. DRAWN' OF A�®Oma v i 4i �! Duane Mark :toward p ,'. LS -6918 '�JV�`ar I f � 4 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 / WATER SUPPLY PERMIT Initial L(Ivlo I -I1 -S ZPvy Date Issued: Sep 25, 2003 Expiration Date: Sep 24, 2004 Permit Number: SW030397 Parcel ID: 051-053-34 Legal Description: =dosof 1" Design Engineer: 0003 S & S Engineering Site Address: Unknown Owner Name: Dennis Winter Lot Size: 10185 SQ. FT. Owner Address: 15851 Rasmusson 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. Received By: Issued By: Date: Date: /12J_103 Mtn-iieipa1i4TofAne1ior • Y.O. Box 196650 • Anchomac, Alaska 99519-6650 • Telephone (907) 343-8301 • Fwx (907) 343-8200 4700 Bragaw Sircet • Anchorage, Alaska 99507 wNnx-.muni.org Jl7agor Hark Begich Building SafetS, Division 24 Aug 04 S & S Engineering 17034 N. Eagle River Loop Suite 204 Eagle River, AK 99577 Subject: Waiver Request for Leo's Subdivision Lot 10 Waiver Request #WR040056 Parcel ID #051-053-34 Dear Mr. Cowan:�� 5� Your request for a waiver of the required 10 feet from the"'Absorption Field to the Property Line is approved. The approved separation distance is 0 feet. 5,�P"iC2k This waiver approval applies to the existing`r bsorption Field to Property Line separations only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeff Poet Engineering Tech On -Site Water & Wastewater Program Con-unutzity, Security, Prosperity s a. D Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet WR#: 040056 PID#:051-053-34 HA#:040418 Permit#:030397 Date Received: 09/22/034 Legal Description: Leo's Subdivision Lot 10 Engineer: S & S Engineering 17034 N. Eagle River Loop Ste 204, Eagle River, AK 99577 Applicant: Dennis Winter Waiver Requested: Separation distance 0 Feet Absoption Field & Tank to Property Line Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: ........ 0 N K E E U 5 N N N 0 0 M N N N 0 2 N E 0 0 0 X. 0 N N N K E 0 E 0 0 R N .. ■ E 0 0 N N N 9 0 N M E E E R E X 0 X t a N N K K 0 0 N N t■■ Waiver is Granted: �_� Waiver is not Granted: List Conditions or Reasons for above: Date: 7� By: rr Rec#: 57254 Amount: $175.00 Date Paid: 8/24/2004 ■0000000■0000000000■0000000■0000 I 0 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.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. U1 --b � _� _74 Number SWO3639% Property owner(s) noO�OrSyy I "J I t�L Day phone "t - 330? Mailing address (1)_V,4S M U cs Q&j '-7 i Mailing address Code / 7 S 77 7 Legal description (Lot, Block & Sub'd.) LO -r ffl Legal description (Section, Township & Range) I 3 Lot Size_ �r �) �5 � Acres/Sq. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well (� Sewer Upgrade El THIS PROPERTY CONTAINS: Hot Tub 13 Swimming Pool 13 , Therapy Pool 11 I certify that the above information is cojrect. I further Single Family Dwelling and is in accordance with aboG (Signature of property owner or aitth riz a Permit Fees: Waiver Fees: Date of Payment: ??"1 I ZZ� Date of Payment: Receipt Number: ` 1 q �) �T Receipt Number: (Rev. 12/00) Well Only Water Storage Jacuzzi Water Softening Unit 9 / that this application is being made for a Municipal Codes. HEALTHAUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERTC. COWAN, P.E. ROBERTA.SHAFFR.PF: CIVIL ENGINEERS (907)694-2979 September 22, 2003 FAX(907)694-1211 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 10; Leo Subdivision It is requested that you issue a permit to install a well and septic system to serve the proposed three bedroom dwelling on the referenced property. Lot line waivers of one foot to the west lot line from the proposed HDPE septic tank and two feet to the east lot line to the proposed trench are also requested. A test hole was excavated and a percolation test was performed on 9/17/03. The approximate location of the test hole is located on the attached site plan. At the time of excavation 9/17/03, water was not found. After monitoring, no ground water was found. The soils log is attached for review. Based on the existing soils and ground water monitoring information on the subject lot and surrounding properties, we ask that a permit be issued immediately. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require Shafer, P.E. information, please contact us. 17034 NORTH EAGLE RIVER LOOP • SURE 204 EAGLE RIVER, ALASKA 99577 11 = 40' DESIGN SITE -PLAN mx9 ,4 n� ;o � ru �� 6 m p�A 9�y QNO 2- 2- 9 mxm >N� mzo .xpmv� CUN > �O; �{ 'mil L OTIC O� N o z m js0 � a0 d�ad ti < n 'u�A D O C onO w DESIGN SITE -PLAN d llvl ,4 n� ;o � ru �� 6 m 1 9�y Ul N V 2- 2- 9 rx�a DOm >N� .xpmv� r m O mp"4 > �mr b�.0 lrl o �{ 'mil L OTIC O� D pn��CA O m w js0 n a0 d�ad < �a 'u�A m O C onO 0 r 1 w ati � L— d ^ O=MmO mOm a KO .I 0O I� O m x Z O b 'd1 d llvl ,4 n� ;o � ru �� 6 m 1 -- L 2-3% 2- 2- 9 m >N� w 0 ONU O� DRIVEWAY —a L--- — w 11 a0 d�ad Sm� Om0 �a z O C onO oo` ati Z - r A y \ M ..0 ,OfZ) Om til x Ly��O m =3x a 1 A (03SOd08d) rte^^ 00 m x Z O b ti. d llvl ,4 Ln O w r I O009 ID O r- W l'J m >N� w 0 ONU O� —a L--- — .51Z m x Z O b ti. d llvl ,4 Ln O w ID O r- W l'J m O w ONU f-oO .51Z za�A �a O C onO ati Z - r A y M ..0 tT9 til x m m A rte^^ ISO 0uI r LO d llvl ,4 ID r O w f-oO .51Z za�A �a O C onO ati Z - r A y <<y O x nnn O ,4 Performed. For: Legal Description: Depth CMMIENTS ,0 1 6M Aw WAS GROUND WATER _-- EN000;TE=ED? L s IF YES. AT WHAT DEPTH? L 0 Depth to Water Aller �, P Monitoring? E Date: A40 Rending Date Cross Time Net Time Depth to Nlaler Net Drop I PERCOLATION PATE _t(r. incles5ncq TEST FUN SETPIEET!_ in; ,AME FERC HOLE DIAMETER —FT pE?PORpA D BY: -:57, A ,r'�Gj-LL!/��. CERTIFY THAT THIS TEST f`G'S D PERFORMEIM ACCORDANCE WITH A.LL Sjh�TE AND P'l�^�CIP�.C�L�ES IAI EFFF-CT ON TIAI EFFECT ON THIS DATE. DATE: ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX(907)694-1211 HEALTHAUTHORITY ON-SITE WASTEWATER DISPOSAL SYSTEM APPROVALS CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS SEWER 8 WATER MAIN EXTENSIONS REFERENCE: Lot 10, Leo's Subdivision September 22, 2003 SEWER&WATER INSPECTION GENERAL: 1. The scope of this project includes the installation a 1000 gallon HDPE septic ENGINEERING STUDIES tank and a trench to serve the proposed three bedroom residence located on AND REPORTS the referenced property. 2. Construction shall be in accordance with the approved site plan and design WELLINSPECTION drawings, Municipal permit with any special provisions or conditions, and all SFLOWTEST applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground SITE PADS utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. ROAD DESIGN 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their SOILTEST own systems must also receive prior approval from the Municipal Health Department. PERCOLATION TEST SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. STRUCTURAL& Construction shall include two 4" cleanouts for pumping access. MECHANICAL INSPECTIONS 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RNER LOOP • SURE 2o4 • EAGLE RIVER, ALASKA 99577 Page 2 Lot 10; Leo's Subdivision September 22, 2003 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 10; Leo's Subdivision September 22, 2003 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pine Perforated Solid Cast Iron Yes Yes ASTM 63034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 10; Leo's Subdivision September 22, 2003 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER 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 IS ERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-053-34 1. GE�AL INFORMATION r Completelegal description . Location (site address or dir Current Property owner(s) HAA # dy bit l Expiration Date: a b E � <a S z 'Dennis Winter Day phone 622-3301 tvlailing address 15851 Rasmusson St. Eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent 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 Day phone The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C 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. TYPE OF WASTEWATER DISPOSAL: U Individual On-site [X�C ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C, Cowan Date 0 5. DSD SIGNATURE I a KAUT C COWAN � �E iecf� CE -6801 _�/ Approved for 3 bedrooms.t �> ' „..••' t Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: ( Original Certificate Date: (Rev. 01102) MIMI Develop On -S ity of Anchorage )ervilc' Department I Safety Division & Wastewater &&&am ou h raga St 4nchorage AK R05-19-6650'-, anchorage.ak.us 7}4-7904. Wires [ i I t7P6 Parcel ID: o p t- O 5 3 Date installed 4' 21 Qq D. Date installed Size in gallons Manhole/ "Pump on" level at _ in. "Pu _ in. High water alarm level at n. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION'DISTANCES FRO"IVl`WELt Septic tank/lift station on lot On adjacent lots 16C)'+ Absorption field on lot % r+ On adjacent lots / U Public sewer main 1JV} Public sewer manhole/cleanout NA Sewer /septic service line$ Holding tank 1JVk SEP4RATION DISTAIJCES FRONT SEPI IG%BOLDING TAf K O`IU OT TOS " "" 3 " `ti Building foundation j 2 Property lineAbsorption field 4 - Water main N i�c Water service line. Surface water (CO 14 - Wells on adjacent lots 1t� G SEPARATION DISTANCE FRO PBSOF2PTiON FIELD `ON'i OYTO: Property line " : Building foundation 10(+- Water main )J l Water Service line 10l 4- Surface water I ©t"% t Driveway, parking/vehicle storage 10'4 - Curtain 0i -- Curtain drain Wells on adjacent lots l bc) 14- F. COMMENTS ' Lo T L<:.. r£ Zv 1¢r V 2 "i;. ✓'i 1C Qv 15- ST of J `.�..v�.a0\�� G. ENGINEER'S'CERTIFICAiIOt� V" "` 'x c� "+s��+�� I certify that I have determined through 66 d irispecfto`ns and % o� '. % review of Municipal records that the above systems are in o . conformance with MOA HAA gui e/i a in ect this date. � •• - �% /Q' �0 ROBERT G GOWA.. f Q Engineer's Printed Name 1��+--- '�P� ti CE -8801 `�- Date HAA Fee �7 n for �r 4 ,.....Waiver Fee $ Date of Payrrien't 8 la 3 /© IV Date of Payment r b f /0 ` Receipt Number ©S '7 a is, ossa Receipt Number y . (Rev. 12/01) 8-18-04; 9:34AM; SGS Ref.# Client Name Project Name/# Client Sample ID Matrix Sample Remarks: 1044949001 S & S Engineering Lot 10, Leo S/D Lot 10, Leo S/D Drinking Water ;907 5815301 # 2/ 3 All Dates/Times are Alaska Standard Time Printed DatrMme 08/17/2004 11:43 Collected Datefilme 08/11/2004 13:30 Received Date/Time 08/11/2004 15:34 Technical Director Sttcphen de Release✓ Parameter Results PQL Units Method Container ID Allowable Prep Analysis Limits Date Date lnit Waters Department Nitrate -N 2.55 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 300.0 B (<---10) 08/12/04 JJB col/100mL SM20 9222B A (<=1) 08/11/04 DKC