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HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 16BEngle River Volley Ranchettes Lot 16B #050-222-19 Municipality of Anchorage Page of 3 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: S w o 1 V 3 v7 piD Number: Name Wastewater System: b New 'Upgrade Address: / ,r,,;.,,, O ABSORPTION FIELD Phone: No. of Bedrooms: 3 O Deep Trench ,',Shallow Trench ❑ Bed O Mound ❑ Other LEGAL DESCRIPTION Sod Rating: D, 8 Total Depth from original grade: 7 e GPD,Sq Ft LOC Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe / /6 Q E4SC eei,rt+ C�./k XA /e-4 ar O"er =' Ft 41 Ft TOwnsh�D: Range- Section: Fill added above original grade: Gravel length: a/ ft S % Ft WELL: 17 New ❑ Upgrade Gravel width: S Numberoflmes: a Dsunu oe ween wes Ft /O Ft Classificationnvata. A.B.Ct: Total Depth: Cased To: Total absorption area: Pipe material: P� j a' a Ft I Ft S 70so Ft AST*" 3 a 3 Y FJ�1 d Driller Date Drilled Static water Levee. Installer. 1" 4e134" jam-' Date installed: Ft. Ex -6N6 S 11,-,7/0, Yield Pu Set at: Casing Height Above Ground-. TANK GPM Ft. Ft. SEPARATION'DISTANCES; 7,� y.Septic C3 Holding ❑S.T.E.P. To septic Abso,otMn L,1t Hdldmq DubliVilmatO Manufacturer. Capacity in gallons: From Tank Field station Tana sewer Linea A,voA.•q 1L /On., Material: Number of Compartments: Well /yo w // Surface LIFT STATION Water Erol �!// rrvo Lot ., I Sue in gallons. Manufacturer Line ob Foundation ' 'Pump On" level at: -' um0 off.. level at High water alarm at: fb a Curtain ?ump Make N ElectrZl Insp;Niol performed by Drain BENCH MARK Remarks: O,.r re -N c,.,Avi..r r f%/.Ail Location and Description: r., d.: el..+ls.:re/ %O aF L..serere ad .rf e..le N i� a�/f � OYr %/••+f Lrp✓Ir i✓/!// E.IIMKI..I'tCrl IN .r,_rA a Wre <0 Assumed Elevation: ENGINEER'S SEAL of At �• a� s ham' Inspections performed by: Dates: is a " live 49 2nd -0113 — Department of Health and Human Services approval CE-BrA a ���� -/� �l &ft Date: S67 �°e••�y; Reviewed and approved by: 6f 72.013 A" 9,911MOA 25 Permit No. SWO10307 Page 2 of 2 Municipality of Anchoroge 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 Legal Description: EAGLE RIVER VALLEY RANCHETTES. LOT 168 PID No.: 050-222-19 WHIRLAWAY DRIVE 30.0' HOUSE HOLE_ nn emx r4 6. 0 v5 EBS ---------------- TiRiMRi � 10' UTILITY EASEMENT SCALE 1'-40' S.I..O Dn A 8 C 35.3' 6.6' D 58.1' 7.8' E 69.4' 1.0' ■ - TEST HOLE R - MONITOR TUBE O - SEWER CLEAN OUT ♦ - KEY Box — — - EASEMENT ®- PAVED DRIVE ® - DECK ELEVATIONS ^y TOP Or CONCRETE. BASE Or STAIRS 8/14/01 (NOT TO SCALE)ASv SUMED ELEV • 100-0 ENGINEER'S SEA H 000000p�0 ORIGINAL o '`Lv•OF ••4 GROUND �. LEVEL AT. rri Dv�Pr :-.' ADDED ru TRI %.B ate: 49 TH ........................ 4 3' GVT ! 83.1 79.0 0 ....:................... TANK p OO `.t)LLOUIISA.. SUrTTEEi 9R.3 l3 iR� 917 \ TQ� 89 717 ���40`0 0 • rtUF ES�`�s EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 01-031 Calculated By: LB Date: 8/14/01 Legal: Eagle River Valley Ranchettes Subdivision Lot 16B TEST HOLE 1 Single Family 3 Bedroom Dwelling Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 450 gallons Percolation rate = 13 minutes per Inch Wastewater application rate = 0.8 gallons per day per square foot Required absorption area = 563 square feet Trench width (W) = 5 feet Gravel depth (D) = 4 feet Required length = Shallow trench factor • Required absorption area / W Shallow trench factor = (W + 2) / (W + 1 +2 D) Shallow trench factor = 0.50 Total Excavation Depth = 7.0 feet Required length = 56 feet Qo�P�� ....F•• .. 9500 49TH N• .r+.�haJ./ !c/c -.LOUIS A. !if 0 c fl'• CE -6736 O�Q�Fo.•. .• ��d f ��/.i DO�..'°POFESStO�o 01.031Cal 1:29 PM8/14/01 MUNICIPALITYOFANCHORAGE / ��� ,� Q p. Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street / P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 CJ 3G A M ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 09, 2001 Expiration Date: Aug 09, 2002 Permit Number: SWO10307 Parcel ID: 050-222-19 Legal Description: EAGLE RIVER VALLEY RANCHETTES LT 16B Design Engineer: 0024 Eagle River Engineering Services Site Address: 018634 WHIRLAWAY RD Owner Name: Leonard & Sandra Holladay Lot Size: 17955 SO. FT. Owner Address: 18634 WHIRLAWAY ROAD Total Bedrooms: 3 Permit Bedrooms: 3 EAGLE RIVER. AK 99577-8333 This permit is for the construction of: Disposal Field Q Septic Tank ❑ Holding Tank [] Privy All construction must be in accordance with: 1. The attached approved design. EJ Private Well ❑ Water Storage 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. y-13-0/ C#1f&b-F D DEEP rhrvcK Received By: Issued By: OF s iG u h9 A 5_-'f^,a70 rRENCy FWOM A Date: 9 0 Date: L 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.enchorage.ek.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 05 aQa — 191 Permit Number SW I0 0+ Property owner(s)LeovNavJ a v,,clra- WoL(ctde!2. Dayphone 5&3-795Q Mailing address (1) 15?& 34 L) yas_leou-Q Mailing address (2 a� t�2f All Zip Code 019577 Legal description (Lot, Block & Sub'd.) L 1% 8 , 5� 1P Pl de r 014 ie,a Ranch e-tfi?S Legal description (Section, Township & Range) Lot SizeLl�gs�J Acres/S Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only 9 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 Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: 320.00 Waiver Fees: Date of Payment: 7/30/01 Date of Payment: 7 '40/01 Receipt Number: 7 el 0 Z Receipt Number: 0 0 0 (Rev. 12100) 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 July 30, 2001 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 16B Eagle River Valley Ranchettes Narrative & Permit Application Dear Mr. Cross: The proposed well and septic system will have very limited impact on adjacent properties for the following reasons: I. The surrounding lots are large; there is public water available, allowing sufficient room for several septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. The soil is adequate for leaching. 4. Surface drainage will not be affected and is not a major consideration in our design. This lot is now on it's 3rd upgrade system, the existing tank is the original tank and will be replaced. The existing bed is flooded and will be abandoned in place. The surrounding lots have been upgraded in 1985 and this septic system placement will not affect the development of any other lots surrounding this unit. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \2001\01.031NAR WHIRLAWAY DRIVE 30.0' 99'59'15"E 13. Cn �•.. �...� v:.w... r.' : may,. tr r • O n HOUSE 4- n Lu SEPTIC +30' in n SEPTIC +30' o ° o REMOVE k BURY 2 0 16.4' EXISTING TANK INSTALLREPLACE a' Q Z CLEAN OUT 10• Z yL r — J 7.8 TEST HOLE TOUD sx ABANDON D 8985 1 — �too. 1L2 — 3S• — 1tSx 13.5'_ 23 .8'_ _ _ — WATER wIN - 10' UTILITY EASEMENT S89' 9 1 1 3.0 SEPTIC +30' ® — TEST HOLE - MONITOR TUBE 11 o - SEWER CLEAN OUT 4 - KEY BOX — — - EASEMENT COMMUNITY WATER NO WELLS - PROPOSED LEACH FIELD NO SURFACE WATER EXISTING LEACH FIELD NO KNOWN CURTAIN DRAINS ©- ® - PAVED DRIVE DECK WELL SEPTIC SITE PLAN LEGAL: EAGLE RIVER VALLEY RANCHETTES LOT 168 OF OWNER: LEONARD & SANDRA HOLLADAY". 5,� � CONTRACTOR: N A * .49TH *4 J09#01 —031WS DATE: 8/8/01 SCALE 1 " = 30' ,�....' EAGLE RIVER ENGINEERING SERVICES o ',LOUIS A. BUTERAP.O. 773294 w' EAGLEoRIVER, AK 99577 (907) 694-5195 FAX: (907) 694-3297 a r Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Leo hp rd 4 Sandrol He lladgy DATE PE LEGAL0ESCRIPTION:F ijc_QT4t•y__I[s1(t"ripIc5[+ tte S_LI BTOwnShlp, Range, Section: 3 4 5 6 7 8 9 to 11 12 13 14 15 16 17 18 19 20 Fill And Tel spar SLOPE (G -n) I r S;Ityy SQiJy Gmder Dehse Grey Streq Ks WAS GROUND WATER ENCOUNTERED? Dry I IF YES. AT WHAT DEPTH? Maple to Water After Monitorinp7'7.7. FF O:IC 7/7/f s— a. 11 SITE PLAN Reading Date Gross Not Time Time Oepth to Water Net Drop 7l2 2/61 1 it IS' 10. /' 11:14.1s, to A; if 4' 1"Y11 3 y1f, V 4s ' In A1 TI AF rr Y 4 a" S' I lr I 'F 1 ' ' 4 / 4 lr :1 9 o L 4 l/ I: 00 C• 716" r. I. 0 1 '1410 a q 9 /' 1:43. o ..; 6' to 1/L" .. PERCOLATION RATE Imml,:es.mcnl PERC HOLE DIAMETER 6 TEST RUN BETWEEN FT AND 7 FT COMMENTS PERFORMED BY, E. R, E. S . I CERT.FV THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. CATE. Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 Eagle River, AK 99577-3294 (907) 694-5195 tel (907)694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Lot 16B Eagle River Valley Ranchettes July 30,2001 A. GENERAL 1. The well and septic plan are for a 3 bedroom 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 1000 gallon minimum, MOA approved, existing tank is to be pumped and crushed and buried onsite. 2. Two after tank cleanouts are to be provided. Line to existing bed is to be disconnected. 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 excavation prior to rock placement shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 7' at any point with relation to ground surface at trench location. 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. Mounded soil or combination of soil and extruded board insulation to a depth of Y 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 = 7' GRAVEL DEPTH = 4.0' under pipe, 2" over pipe TRENCH LENGTH = 70' TRENCH WIDTH= 2.5' SOIL RATING= 0.8 GPD1ft2 BEDROOM CAPACITY= 3 SEPTIC TANK = 1000 gallon MINIMUM Twenty-four (24) hours notice required for all inspections. 12001\01.031spc EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 01.031 Calculated By: LB Date: 7/30/01 Legal: Eagle River Valley Ranchettes Subdivision Lot 16B TEST HOLE 1 Sing:a Family 3 Bedroom Dwelling Deep Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 450 gallons Percolation rate = 13 minutes per inch Wastewater application rate = 0.8 gallons per day per square foot Required absorption area = 563 square feet Trench width (W) = 2.5 feet Gravel depth (D) = 4 feet Required length = Required absorption area / 2 / D Required length = 563 / 2 / 4 Required length = 70 feet Total Excavation Depth = 7.0 feet e ..... LOUIS A. BUTERA '' CE -6736 O1.031Cal 9:06 AM7/30/01 Municipality of Anchorage Development Services Department Building Safety Division i On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Lou Butera Legal description: Eagle River Valley Ranchettes, lot 16B The attached paperwork has been reviewed and Is being returned for the following reasons: ❑ Original signature or stamp missing on_____ ❑ Calculation error in design. _____ ❑ Additional soils information needed._____ ® Water monitoring results inadequate. Recheck ground water for minimum 7 day water monitoring. ❑ Discrepancy in information submitted._____ ❑ Topographic information missing or inadequate._____ ® Incomplete; missing Show dimension from propery line or dwelling to proposed system. ❑ Incomplete; missing_____ ❑ Additional adequacy test information needed. _____ ❑ Water sample unacceptable. _____ ® Measured/proposed distances/dimensions missing. Show distance between proposed system and existing systems. ® Locations of all soils, percolation and water monitoring tests not shown. Show test hole location on site plan. ❑ Proposed system too deep for soils information submitted._____ ❑ Well log required. _____ ❑ Omission in narrative._____ ❑ Insufficient fill over tank or field_____ ® Other. Are you including a diverter valve for future use of existing systems? Name of reviewer: Jim Cross Date: 08/06/01 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK law' V � W/7 Municipality of Anchorage. ilk -� Development Services Department / Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.enchorage.sk.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 050-222-19 HAA# 05b3(9 Expiration Date: %— 14— 0iv 1. GENERAL INFORMATION Complete legal description Lot 16B Eagle River Valley Rancheftes Location (site address or directions) 18634 Whirlawav, Eagle River, AK 99577 Current Property owner(s) Robert & Jill Alatalo Day phone 622-0888 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 18634 Whirlawav, Eagle River, AK 99577 Day phone Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 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 5 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. 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 less than 30 days old. 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. (R. 11199) 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 Health Authority Approval Guidelines for 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Ena. Svc. Phone 272-8218 Address P.O. Box 102954 Anch AK 99510 Engineer's Printed Name Steven R. Pannone P.E. Date VW05 Engineers Comments: In conducting an adequacy test I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of 4 the test, and separation distances measured to readily identifiable features. The operational life of all ,A'( wells and septic systems depend on the local soil condition, ground water levels that may fluctuate {r during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results" do not guarantee future performance of the system, nor do they guarantee that there are no hidden dcfc 00 or encroachments. PES can therefore not provide any warranty for future performance nor give any 00 estimate of how long the system will continue to meet the operational requirements of the AD. or 0 C) MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon �J or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 1 6. DSD SIGNATURE —3Z Approved for 3 bedrooms. Disapproved. Imaq\olt OF Ai /en R. Ponn, No. CE 8149 Conditional approval for bedrooms, with the following stipulations: rM nU4ld III ICI ILb. HAA Checklist X Septic System Advisory Well Flow Advisory 4o O Expiration Date: (RN. r IM) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: —7-1 T —0,6, - Reissue Date: Municipality of Anchorage • Development Services Department Building Safety Division O"Ite Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196550 Anchorage, AK 995196650 www.ci.enchorsge.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 168 Esale River Valley Ranchettes Parcel I. D.: OW22249 A. WELL DATA Well type AWWU If A, B, or C provide PWSID 6 _ Well Log _ Date completed _ Sanitary seal _ Wires property protected Total depthFROM WELL Cased to ft Casing h (above ground) in. LOG INSPECTION Dale of jest Static Water level Well production WATER SAMPLE prliii'7ui1 Data of ml Nitrate Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material Anchorage Tank ft g.p.m mgA =Ysen cteria coloniesM00 ml mgA Date installed SM212001 Tank size 1000 gal Number of Compartments & Cleanouts Y Foundation cleanout 11 Depression over tank tj High water alarm NI. Date of pumping 612912005 Pumper JR's Septic Pumper* C. ABSORPTION FIELD DATA Date installed SM312001 Soil rating (g.p.dA? or fe/bdnn) System type Shallow Trench Length JLft Width _q... It Gravel below pipe A_ it Total depth $ ft Effective absorption area iatt? Monitoring tube X Depression over field dL Date of adequacy test 6130/2005 Results (Pass/Fall) P For I bedrooms Fluid depth in absorption field before test 46125.6 in Water addedM gal. New depth4sin in. Elapsed Tune: U40 min Final fluid depth 46125.6 in Absorption rate >- 450+ 9-p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date (Rev. 11199) D. LIFT STATION Date installed Siza allor�� Manhole/Access 'Pump on' level at _ in'Pump ofr level a _ in High water alar level at _ in Datum Cycles tAs Meets alar 6 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot On a cent lots Absorption field on lot n adjacent lots Public sewer main Uc sewer manhole/deanout Sewer /septic service One Holding k SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 31' Property line _At Absorption field 10' Water main 10+ Water service line 25+ Surface water 100+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10' Building foundation 15' Water main 100+ Water Service line 25+ Surface water 100+ Driveway, parking/vehide storage 10+ Curtain drain _None Observed Wells on adjacent lots 100+ F. COMMENTS G. P= l ; F, • ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and +S review of Municipal records that the above systems are in t i conformance w;M MOA HAA guidelines in effect on this date. i» Engineer's Printed Name Steven R. Pannone. P.E. +�F ss a en R. Ho o j1 ♦% �o. C; Bts9 Daft ;1141,95- HAA 11K1oS HAA Fee Waiver Fee $ _ Date of Payment tJ Date of Payment Receipt Number. �� 7� Receipt Number (Rev. IIM) i Ilk w.yio�.�w,rylpp� ,�,rd ASBUILT-NO CORNERS SET THIS DATE. . SEWARD & ASSOCIATES LAND X 69"-f7 r 0 . I HEREBY CERTIFY -THAT 1 HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: !YJIIEiF'///ff' /S�CIF`iG9�tCiYETTE j LOT/�Q� ' AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SCALE: / X20 DATE, GRID, ..vwsf� FB: $VIM DRAWN: o"vf 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.enchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL/`/Gr FOR A SINGLE FAMILY DWELLING Parcel I.D. HAA# H JAq o f D L3� Expiration Date: 9 — Ir- 02- 1. GENERAL INFORMATION Complete legal description �'` �6 Q AzrG oe,,L414Ilet Location (site address or directions) Current Property owner(s) i/o /y+do y Day phone Mailing address l fr63 </ trA •s14 E<. 4 .e' Lending agency Day phone fQ 3 - s yo , x 137 Mailing address Real Estate Agent �u^ SHH�d �« /�i Day phone S a ' 7c0 -z" Mailing Address yam`/,. Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site 12 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 5 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 less than 30 days old. (Certificates may be reissued for a period or 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 engineers 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 EaCle River Engineering Services Phone Address Box 773294, hagRiver, AIC 995773294 Engineer's Printed Name' Date `a:..fsC. .: »...j.»` 01 5. DSD SIGNATURE X01 %; ti L0°� $ ° -' � s1 Approved forbedrooms. Disapproved. 3 Conditional approval for bedrooms, with the following stipulations: ` J . W11 -vi 16- W., Additional Comments �X : WATERAND ' m: .WccTFWATEET Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other _ By: Original Certificate Date: (Re,. 1200) p Municipality of Anchorage • "' Development Services Department Building Safety Dlvlsion On-site water & Wastewater Program 4710 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.66W WWW.cl.anchorage ek.us j (907) 343.7904 j: HEALTH AUTHORITY APPROVAL CHECKLIST '.X A. !� Legal Description: L -of /6 6' G�<tLQ ��t"' �4/10.� '(k^n'YarcellD: A. WELL DATA 1 Well If A, B, or C provide PWSID # _ Well Log (Y/N) I 4 Date com ted _ Sanitary seat (Y/N) _ Wires property protected (YIN) Total depth ft. Cased to fl. Casing height (above ground) in. FROM WELL LOG AT INSPECTION ° Date of test Static water level IL ft. Well production 9.p.m. 9'p'm' WATER SAMPLE RESULTS: Coliform colonies/100 ml. to mg.A. Other bacteria colonies/100 ml. Date of sample: Coll B. SEPTICIHOLDING TANK DATA Tank Type/Material Date installed 8 - a -0 / Tank size /o -P+' gel. Number of Compartments Cleanouts (Y/N) Y I' Foundation cleanout (Y/N) Y Depression over tank (Y/N) High water alarm (YIN) N/1 I' Date of pumping /Wet-' Pumper N Ag C. ABSORPTION FIELD DATA { Date installed 9- r 3-o n Soil rating (g.p.d./ft= or ft'Ibdml) v & System type S w• ��4:� ss�// Length -4'2 ft. Width S ft. Gravel below pipe ft. Total depth _7 ft. Eff. absorption area S 70 ft° Monitoring tube -.,V Depression over field i✓ Date of adequacy test ive. ✓ Jye-* - Results (Pass/Faiq _o� For 3 bedrooms Fluid depth in absorption field before test = in. Water added_ gai. New depth= in. Elapsed Time: =min. Final fluid depth _-=M. Absorption rate >=--74-,1Sb g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) IvV4 If yes, give date - — i�, h 1 - D. UFT STATld Date installed \ "Pump on" level at ' in. Datum E. SEPARATION DISTANCES Size' gallons Manhole( (Y/N) -Pump evel at _ )n. High water alarm I at in. Cycles tested Meets alarm & circutt ants? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/llh@tation on lot NIA On Absorption field Public sewer main Sewer /septic service line On adjacent Public sewer Holding tank SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 31 r Property line ..�/ Absorption Held_ iD Water main 4-/o r Water service line t/v Surface water Wells on adjacent lots t 100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /.? Building foundation & Water main _ t /o Water Service line t /o Surface water t suJ' Driveway, park nolvehide storage /S Curtain drain J o ^'e F. COMMENTS G. ENGINEER'S CERTIFICATION Wells on adjacent lots A,'° ^ e 6tra✓) I certify that t 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 date. Engineer's Printed Name 1- o w.i ed ev,w Date &-/v-oi HAA Fee $-300.00 Waiver Fee $ _ Date of Payment _ 8/ 15 %0 I Date of Payment Receipt Number 2f %O 3 Receipt Number (Rev. 12/00)