HomeMy WebLinkAboutLENNIE HEIGHTS LT 1Lennie Heights
Lot 1
#051-063-53
On -Site Water and Wastewater Program • (907) 343-7904 Page / of 3
ON-SITE WASTEWATER INSPECTION REPORT
Number: D 5 P 1 N 12 3 6 PID Number -05 10,6/ 3 5 3000
1g: tWSingle Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New a Upgrade
E R S ON RR ABSORPTION FIELD
3 8 2 5 �- E,gajF_ e1R�j E Deep Trench ❑Shallow Trench ❑ Bed ❑ Mound
Number of Bedrooms Soil Ratin ❑Other
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7GPD/SF V�% Ft.'
�_ DESCRIPTION Depth to pipe invert from original grade Gravel deoth benearn e
Townshi Fill added above original grade
P Range Section Z. S',< Ft
Gravel width Beds: Number t
SEPARATION DISTANCES 3 _
Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenc
From Tank Field Lift Station Tank Line
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well �Q i 2S, TANK�fep Septic ❑ S.T.E.P. ❑ Hol
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Curtain Drain
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drair
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dates: t 2 /c// pm/y Location and description
3m 4'° 7 7—o P �F DECK
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Enginaera&�
Approval:
Approved
Date
Date 7-3/-
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On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
OSP141236
Tax Code Number:
05106353000
Work Type:
Septic Upgrade
Permit Effective Dates: July 21, 2014 to July 21, 2015
Design Engineer:
NORTH RIM ENGINEERING
Subdivision:
LENNIE HEIGHTS
Site Legal Address: LENNIE HEIGHTS LT 1 GA460
Owner/Address: ANDERSON LARRY L & GINGER S
23825 LENNIE CIR CHUGIAKAK 995675568
Site Mailing Address: 23825 LENNIE CIR, Chugiak
This permit is for the construction of:
Lot Size in Sq Ft: 27998
Total Bedrooms: 4
Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions:
1. The Engineer needs to do groundwater confirmation prior to the construction of the septic field.
Construction may proceed at your own risk before the 7 day water monitoring is complete. Please
submit stamped and signed results with the As -built Inspection Report. If the results require a
design change, construction of the system will stop pending On -Site review and approval.
2. The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a
percolation test. The Engineer needs to do an additional percolation test prior to the construction
of the septic field. Please submit stamped and signed results with the As -built Inspection Report.
If the results require a design change, construction of the system will stop pending On -Site review
and approval. AMC 15.65.060.B.3
Received B)
Issued By:
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
hftp:/Iwww.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
mint
SP
C �
C �
Department
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP141259 COSA#:
PID#:051-063.53
Legal Description: Lennie Heights Lot 1
Engineer: North Rim Engineering
Applicant: Larry and Ginger Anderson
Permit#: OSP141236
Your request for a waiver of the required 14 feet horizontal separation from the absorption field
to the existing absorption field has been approved. The approved separation distance is 10.0 feet.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
.......................................r.......................................
Waiver is Granted: X Waiver is not Granted:
Date: / ZZ Approved by:
Name of Revig er
.........................................................f".....................
**** VARIANCEMAIVER REVIEW ****
MUNICIPALITY OF
Community Development Department
Development Services Division C*
On -Site Water & Wastewater Program
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. O 5'1- 663- 5.3
Property owner(s) .41164,2,f onP Day phone cPSq- Boo 7
Mailing address Z_? JP Z 5 L1_ g /iF rr2CL�
Site address S.o- 1W_
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section)
Lot Size 27, 9 90 Sq. Ft.
APPLICATION IS FOR:
(0 all that apply)
Absorption Field
TYPE OF DWELLING:
Septic Tank
❑
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms_
APPLICATION IS AN:
TYPE OF DWELLING:
Initial ❑
Upgrade
Renewal ❑
Single Family (SF)
(w/wo ADU)
Duplex (D) ❑
Multiple Dwellings ❑
Receipt Number: 005.5-j01
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I furtf as`-11-ordance with
applicable Municipal Codes.
(=-Y- QE JUL 0 7 2014
(Signature of property owyr6r or authorized agent)
Permit/Rush Fees: Got
Waiver Fees:
Date of Payment: 1 T
Date of Payment:
Receipt Number: 005.5-j01
Receipt Number:
Permit No. 0`5 L
1 2-5So
Waiver No.
Permit App_9-1-12.doc
TPI 12 M
ENGINEERING MEMO
Steve Eng, PE, PH
P.O. Box 770724, Eagle River AK 99577
(907) 694-7028 tel
northrimeng@aol.com
Date: 7/7/14
To: MOA On -Site Services
Subject: Lennie Heights Lot 1
New Trench Design
Number of Pages: 5
An existing crib system has failed on the subject lot. A new trench has been designed on the
previous soil test. The design calls for a deep trench to connect the existing 2000 gallon concrete
tank. The subdivision is served by private on -lot systems. Slopes are at 5-10%.
Please review the wastewater system design for the single family home. I have included design
plans & specs, design guidelines, & soil tests. If there is need for additional information or
clarification please give me a call.
Thanks -Ste
TH Imo -
ENGINEERING MEMO
Steve Eng, PE, PH
P.O. Box 770724, Eagle River AK 99577
(907) 694-7028 tel
northrimeng@aol.com
Date: 7/18/14 Number of Pages: Z
To: Deb Wockenfuss, MOA On -Site Services
Subject: Lennie Heights Lot 1
New Trench Design
Your 7/17/14 Comments
I.. The locations of the neighboring wells have been measured and included in drawing.
'2. No slopes are greater than 25% within 200' of the property.
3. We formally request a waiver to the failed crib. It appears that we will be able to keep a 10'
separation. The crib will be pumped out of wastewater prior to any excavation; this will
remove the potential for getting wastewater into the new trench. There should be no slope
stability problems. The existing soil is GM which maintains a vertical slope very well during
trench construction. The cribs will be crushed and filled to maintain soil stability. The trench
is located at the best position, due to property lines, well radii, and powerlines.
4. Powerlines measured and included in drawing.
5. New double cleanouts (DCO`s) added to design.
6. Existing foundation cleanout (FCO) included in drawing.
7. Slope info included.
8. Swing ties were measured from the house corners to the crib cleanouts. The crib cleanouts
are drawn to scale as measured from the house.
Thanks -St
;4''2ts'. ev
-Tlzll rg(
6!50-663-53
dS#01 ZS9
ENGINEERING
Lennie Heights Lot 1
SPECIFICATIONS &DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 4 -bedroom, single family home. The
existing cribs have failed. A new trench has been designed. The existing concrete tank
will be utilized. Neighbor lots are served by septic systems and private wells; there are no
conflicts. The topography slopes to the south at about 5% - 10% slope at the trench site. A
previous soil test indicated a GM soil at the trench. No bedrock was encountered. An
application rate of 250 FT2/bdrm will be used for the trench. Trench length = 1000 FT2/7'
x 2 = 71.4', say 72'.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• Existing Concrete Septic Tank to be used.
• 5' minimum between the tank and trench. 10' to property lines. 10' minimum
between trench and existing cribs.
• 2' of cover and insulation is required for trench; 2" Minimum thickness for insulation.
• Tank & solid pipe must be set on well compacted, stable soil.
• 4 inch diameter cleanouts with airtight caps are required 1' 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.
• Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain -
rock.
• Drain rock to be ''/i' to 2 '/2" screened. Drain rock to be distributed uniformly.
• Perforated pipe to be installed level with perforations down.
• Silt barrier (filter fabric) to be installed above the drain rock.
• Smeared bed must be raked or scarified before drain rock placement.
• The finish grade must be mounded to promote drainage away from trench.
• 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)
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Municipality of Anchorage)
DEPARTMENT OF HEALTH & HUMAN SERVICES
t. � n�C:3. yda G':.a '... a'.; a..: r113P •Pry
825 "L" Street, Anchorage, Alaska 99502-0650'
SOILS LOG — PERCOLATION TEST
N
PERFORMED FOR: �i'O/'� DATE PERF I1,4o
LEGAL DESCRIPTION: ���f%!l7-P i/ / S Township, Range, Section:
DEPTH SLOPE SITE PLAN
Q 2 G TT.
14th 1 (3.0, /�/,
15
16
17
18
19
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT /� L
O
DEPTH? /
P
0epthto Water After�J 0Montt
Monitoring? �`_ gate:
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
tik9 3 wt.
---
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PERCOLATION RATE�r �� (minutes/inch) PERC HOLE DIAMETER
/)TEST RUN BETWEEN _ FT AND �_ FT
COMMENTS
PERFORMED BY:
ACCORDANCE)
72-008 (Rev. 4/85)
I --E� Gr . CERTIFY THAT THIS TEST WAS PERFORMED IN
MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: S- /7 s'/9 .�
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Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
C7 G J 5
Permit Number: PID Number:
Name:
Wastewater System: ❑ New ❑ Upgrade
Address�23 � •
ABSORPTION FIELD '
Phone:
No.of Bedr ms:
O Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 1�Other
LEGAL DESCRIPTION
SoilRating:i7.7113P.
Total Depth from origin Igrade:
f
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pioe
a= NSE E/6N,z5
L(/f//f'/I/ d Ft.
V. 75- (o . ,S Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length,` ,
f/
fCAlO/�iV Ft.
3 a///S"' c� Ft.
WELL: � New ❑ Up r
Gravelwi th:*'
�� Ft.<'
Numberoflines:
Distance between lines:
Ft.
Classification (Private, A,B,C): To epth:
Cased To:
Total albsorption a•�a:
Pipe material:
FL
Ft.
/ l
4 a 9 rte, r!J JAI'%" SQ. Ft.%2
Driller: Date Drilled:
Static Water Level:
Installer:
Date installed:
Yield:
Pump Set at:
I
Casing Height Above Ground:
TANK
,s GPM
Ft.
Ft.
SEPARATION
DISTANCES
Xseptic ❑ Holding O S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer: —_
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
Well-
r
�•
Material:
Number of Compartments: ,
/
2.�
o
Surface
LIFT STATION
Water
Lot
Size in gallons:
Manufacturer:
Line
/
/
Foundation
L 1
/
'Pump on" level at: "Pu level at:
High water alarm at:
N f.
JO
Curtain
Pump Make el Electrical Inspections performed by:
Drain
Remarks: 1)�PF11 04 rks — hl d
BENCH MARK
3,
Location and Description:
rl.A
SI4JL✓N ON 14q(-4 Nt) lr�A¢,M/A4f.[
7OP d/ L nrc2L; 1
fNi.4�t.
�Sc, t, t w I rrrr� G u r a�.; ro r^�
F4i N/
Assumed Elevation:
OF Dk,<,d A C-At13 joXj) NO L..>Ard2 _
lE
W t r rt r .V la p r'-' A o 1-7 v •^'r 0/' /) c 6 V' e "2 _ C R %i
(JiME,v Srp r�3 Ei Tr Mtj'T4 /i FKJ:+1 F16&- J91CTV2rFs yr�� k, �:
.l..h•Ht.l t••
a ash r,
S 8 S ENGINEERING f r7 7 ��.•
Inspections performed by: tees: 1st _ . •.••
OOP 1110ad N0. Q L VDB RT C. cawmq
CE
Eagle River, Alaska 99377 2nd — �p�•ti r
-8804 �'
.
Department of Health and Human Services approval f 0����
'Al
le
Reviewed by: Date:
and approved
72-013 (Rev. 9/91) MOA 25
PERMIT NO.
PAGE 2 OF 3
Municipality of Anchorage
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 LOT 1, LENNIE HEIGHTS SUBDIVISION P.I.D. NO. VI l —OG j—S" J
A
THIS LINE WAS
NOT EXCAVATED_
LOCATION IS
ASSUMED.
EXISTING 2000 GAL.
CONCRETE SEPTIC TANK
PER MUNICIPAL RECORD
AND PUMPING VERIFICATION
(EXACT DIMENSIONS UNKNOWN)
SCALL I" = 40'
EXISTING CRIBS
LENNIE CIRCLE
4K
ROBEC
ROBERT C. COWAAN i,��
"%S CE - 8801 r{ ��
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ROBERT C. COWAAN i,��
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PERMIT NO. PAGE 3 OI' 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SER=IES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ® Anchorage, Alaska 99519-6650 ® Telephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM ANIS/OR WELL INSPECTION REPORT
LEGAL LOT 1, LENNIE HEIGHTS SUBDIVISION P.I.D. NO. (S ( - 04 3 - s--3
96.6'1"1 r 1 FINAL GRADE
/� r 2 95.6'
INSULATIO 2�
5.9'
DEEP
8.4'
DEEP
90.7'
d i_@ (Tk 87.2'
EXISTING CRIBS
N.T.S.
r
MONITERING TUBE
yf ROBERT C. COWAN �2
6; Ci - $601
79.0' WATER FOUND +sr>
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
uo- el.
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-063-53
1. GENERAL INFORMATION
Complete legal description Lennie Heights Lot 1
Expiration Date: / ® m
Location (site address) 23825 Lennie Circle Chugiak AK
Current Property owner(s) Anderson Day phone 854-0007
Mailing address same
Real Estate Agent Diane Shearer Keller Williams Day phone 854-0007
2. TYPE OF DWELLING: r i
® Single Family (w/wo ADU) F-1SHI
DuplexF-1Multiple Dwellings (Single Family and/or Duplex)SU13MITTqU
Received by: Date: a i
COSA to be released to the engineer, unless other6se requested by the engineer.
COSA Fee $g��� `�'� Date:
Date of Payment3b
Receipt Number
,�� o0145
1 6✓�2
COSA # V ?1 1
Date of Payment
Receipt Number
Waiver #
3. NUMBER OF BEDROOMS:
4
x e.
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank ❑
Community Class C Well
❑
Community ❑
Public Water System
❑
Public Sewer ❑
Received by: Date: a i
COSA to be released to the engineer, unless other6se requested by the engineer.
COSA Fee $g��� `�'� Date:
Date of Payment3b
Receipt Number
,�� o0145
1 6✓�2
COSA # V ?1 1
Date of Payment
Receipt Number
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 NorthRim Engineering
Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng
Date 7/28/2014
6. DSD SIGNATURE
System #1 Approved for bedrooms.
System #2 Approved for bedrooms.
4 Sfcvan
Disapproved.
"= rr
Conditional approval for bedrooms, with the following stipulations: -
Original Certificate Date: i B
The Municipality nchorage Devlopment 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 9-1-12 .o
If more than 1 septic system is on the tot:
. COSA Checklist # _of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description:./— EVAI/F_ /QTS L OT / Parcel ID: OSl- O 63— S3
A. WELL DATA
Well type( If A, B, or C provide PWSID # Well Log (Y/N)
Date completed _+� ZSanitary seal (Y/N) V
Total depth Za— ft. Cased to 410't11t. T
2y/ FROM WELL LOG
Date of test
Static water level
Well production
` ft.
g.p.m.
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
///�a
�r g.p.m.
WATER SAMPLE RESULTS:
Coliform _Qcolonies/100 mL Nitrate 2.7 mg/L
Arsenic 0.2`5 ug/L Date of sample: 713 1
Collected by: A4?2A tf'pl
J
B. SEPTIC/HOLDING TANK DATA
/
Tank Type/Material 59 / /r= kr _/7OF—
Date installed SJ2,re
Tank size 266V gal. Number of Compartments —41
Cleanouts (Y/N) _ U
Foundation cleanout (Y/N) V Depression over tank (Y/N) _,6,Z
High water alarm (Y/N) tt% _
Date of pumping '7124(11(!4 Pumper S )4&1/12JLZ.
Z f7:JJ1MP
C. ABSORPTION FIELD DATA
Date installed .2 / Soil rating (g.p.d./ft2 or ft2/bdrm) Z 5 d System type
Length 7z ft. Width 3 ft.
Gravel below pipe _7 ft.
Total depth 10 ft. Eff. absorption area/0a_fe Monitoring tube _�(_ Depression over field AL
Date of adequacy test Mew Results (Pass/Fail)
For bedrooms
Fluid depth in absorption field before test in. Water added
gal. New depth in.
Elapsed Time: min. Final fluid depth in.
Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
If yes, give date
D. LIFT STATION AM
Date installed Size in gallons
"Pump on" level at in. "Pump off" level at
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Cycles tested
d
Septic tank lift station on lot
i
Absorption field on lot
Public sewer main NR
Sewer /septic service line Z S -f
Animal containment areas 5 0
!
Manhole/Access(YIN)
in. High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots /00 4f -
On
On adjacent lots M0 ,"F
Public sewer manholelcleanout /✓
Holding tank
Manure/animal excrete storage areas Zoo t
SEPTICIHOLDING TANK ON LOT TO:
Building foundation S If -Property line /0 �f Absorption field /D t
Water main IV Water service line /0 Surface water
i
Wells on adjacent lots 00
ABSORPTION FIELD ON LOT TO:
r
Property line / - ! L') 7` Building foundation lQ r Water main /V -
Water Service line /G Surface water %QO /r Driveway, parking/vehicle storage l0 !'F`
Curtain drain A14 Wells on adjacent lots 00 %r
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 COSA guidelines in effect on this date.
Engineer's Printed Name
--/ 5 % fr_t/G AN G
Date �' 7
COSA brown sheet_10-10-12.doc
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MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services ik
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # CSI - 0 6 3 - s- 7 HAA # C)'
1. GENERAL INFORMATION
Complete legal description
Lot 1; Lennie Heights Subdivision
Location (site address oI directions) NHN Lennie Circle
Chugiak, AK
Property ownerSharon Child> Day phone
Mailing address k'23825 Lennie Circle Chugiak, AK
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: if community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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 & S ENGINEERING Phone G Gi Y — )L -C, 7 el-
17034
Eagle River Loop Road No. 204
Address Eagle River, Alaska 99577
Engineer's signature
Date /G1 c
�.�
OF
C AIV
6. DHHS SIGNATURE It
Approved for bedrooms.
Disapproved.
Conditional approval for 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.
72-025 (Rev. 1M) Back MOA 621
Municipality of Anchorage
C*j- DEPARTMENT OF HEALTH & HUMAN SERVICES.
Environmental Services Division 0
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
I
Health Authority Approval Checklist
Legal Description: 1--c>'r LFA n tSS Parcel I.D.: �e'-) i
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm lev t-11—
ycles tested
E. SEPARATION DISTANCES
"Pu
'Datum
Size in gallons
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot / C)o On adjacent lots I o,-'
Absorption field on lot /oo On adjacent lots /y
Public sewer main Public sewer manhole/cleanout
Sewer /septic service line •? S Lift station N /k / D o ! f
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation S Property line 16) Absorption field 5 -
Water
Water main/service line �� f Surface water/drainage loo /f Wells on adjacent lots /00
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
l' % 1�
Property line 10 fBuilding foundation 1 lWater main/service line
Surface water c 1 Driveway, parking/vehicle storage area
Curtain drain P°n� i% !a,fW -J Wells on adjacent lots /o 0 1 �
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal recorSta(vstE
in conformance with MOA HAA guidelin s in effect on this date. ��' �"' .........
.• ••'�• S
Signature 9 ti. I
/.. ....+«..i.«
Engineer's Name �D/S aiit-I C. co
/ f o ROBERT C. COWAN!
Date `� r �l (� -7 �0 CE - 8801
HAA Fee $ 00 Waiver Fee $
Date of Payment=(Jl "f.7
Receipt Number q
72-026 (Rev. 3/96)"`
Date of Payment
Receipt Number
F
are
municipality
of
Anchorage
October 31, 1986
P.O. L X 196650
ANCHORAGE, ALASKA 99519-6650
(907)264-4111
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
To: All Engineers Performing HAA Inspections
Recently we have reviewed several Health Authority Approvals which
requested approval on undocumented systems. Some of these were
installed prior to establishment of the then Greater Anchorage Area
Borough code in 1986; others were simply installed without benefit of
inspection. Since the departmei: has begun to take a critical look at
the influence of on-site wastewater systems on the quality of groundwater,
a natural extension of this position is to ensure that both known and
unknown systems meet proper separation to underlying groundwater.
Therefore, the following policies have been established and must be
adhered to in future submittals, effective immediately.
1. Water monitoring adjacent to the undocumented system will be
required (minimum seven days). In lieu of an actual test hole,
we will accept evidence from the engineer which conclusively shows
through supporting documentation that there is no seasonal high
groundwater within four feet of the bottom of the system. For
instance, if these holes on lots surrounding the subject lot all
show monitored water table results at 13 feet, and the system is
installed at 8 feet, an approval could proceed.
2. Unless the engineer is able to determine exact dimensions of an
undocumented system installed prior to 1968, and it also meets
proper design criteria for the number of bedrooms requested, no
approval will be signed for more than three (3) bedrooms. Appropriate
soil testing would be a method for obtaining approval for a greater
number of bedrooms.
3. Systems installed after the effective date of the ordinance (1968)
which are undocumented must have the engineer provide dimensions of
the system and verify type and size of tank. Appropriate soil testing
will be required as well as water monitoring. This will apply even if
the department has previously signed a Health Authority Approval on the
property.
If you have any questions on these policies, please feel free to call
our staff members at 264-4744.
Sincerely,
R.W. Robinson, Manager
On-site Services
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LEGEND �, �,