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HomeMy WebLinkAboutCHANDELLE ACRES LT 4Chandelle Acres Lot 4 #051 -O63-79 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231222 Work Type: SepticTank Upgrade Tax Code Number: 05106379000 Site Legal Address: CHANDELLE ACRES LT 4 G:1460 Site Mailing Address: 23832 IMMELMAN CIR, Chugiak Owner: ALASKA BLOOM TRUST Design Engineer: C&M ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: `hent S J Q r. v lleparrment Lot Size in Sq Ft: Total Bedrooms: 7/25/2023 7/24/2024 40036 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing -- -- J Special Provisions: • The end of the trench is to be located prior to tank installation in order to confirm that the required tank -to - field separation will be met. ` ec Date: Issued By: L Date: 71zg/ Z 3 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051 06 379 Property owner(s) BLOOM Mailing address Site address 23823 IMMELMAN Day phone Legal description (Sub'd., Block & Lot) CHANDELLE ACRES LOT 4 Legal description (Township, Range & Section) Lot Size 40,036 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ (w/wo ADU) Septic Tank x ❑ Upgrade x ❑ (D) ❑ Holding Tank ElRenewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: NONE Distance: NA certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees:3�� Waiver Fees: Date of Payment: Receipt Number: Permit No. Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System for CHANDELLE ACRES LOT 4 Dear Reviewer, The above referenced property is currently served by an older septic system with a leaking tank that needs to be replaced immediately. We are requesting an expedited review of this application. Our review of available documentation and field investigation show that this project will not adversely impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. As shown on the plan, the tank will be greater than 10’ from the house foundation. The tank will be of MOA approved construction. The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover or a minimum of 4’ of cover without insulation. The repair must be performed by a moa certified installer in accordance with MOA requirements. Repair of the proposed system will not negatively impact adjacent lots. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leach field, well, and other applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 7/18/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231222, Deb Wockenfuss, 07/25/23 CHARLES G BALZARINI CE-13854REGISTEREDPROFESSION A L E N GINEER 7/8/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231222, Deb Wockenfuss, 07/25/23 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS ~ ~ Manufacturer Material ~ No, of compartments Liq. capacity in gallons IF HOME.DE: Inside length ~ Width Liquid depth ~ -- ~ Manufacturer Material Ciquid capacitg in ~allons 9 Well Foundation Nearest lot line PERMIT NO. ~ DISTANCE TO: ~ ~ ~ No. of lines Length of each line Total length of lines Trench width~ Distance between~ines ~ ~ ~; ~ /o~' ~ ~n~h~ /~' ~ ~ ~ Top of the to finish grade Material beneath ti~ ' Total effective absorptiop ar~ Length 'Width ' Depth PERMIT NO.  Tg~e of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER p_v,d, T ST INSTALLER REMARKS "' :l 3, " 72-013 (Rev. 3/78) OWNER 0F LAND ADDRESS LEGAL DESCRIPTION DATE- Started PE~IT NUMBER hy DOC Co. dba SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 DEPTH OF WELL STATIC LEVEL OF WATER FT. Ended DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From ~ Ft. to~-----Ft. _,LOc/_~',~,~_~?~,~,{D From__ From ~ Ft. to 7~'~Ft. /~,~'D,~4-,O ~ ~OO~From From 7~ Ft. to Ig( Ft. ~ wd~O ~/ From__Ft. to Ft. From~Ft. to /.~',~ Ft. From /~'oI' Ft. toi~'~",Ft. Fro~ ,¢:~ Ft. to /75" l*t From ]~' Ft. to--Ft. From Ft. to Ft. From Ft. to Ft. From ) 7~ Ft. to.~Ft. From-- Ft. to Ft From Ft. to__Ft. From Ft. to__Ft. Fromm. Ft. to Ft. From~ Ft. to Ft. From~Ft. to Ft. From__ From__ From__ From From From__ From__ From__ From__ From From From From From Ft. to Ft. to Ft. to Ft. to__ Ft. to .Ft. to __ Ft. to __Ft. to Ft. to Ft. to Ft. to__ Ft. to__ Ft. to Ft. to Ft. to __,Ft. to__ , Ft. to Ft. Ft. Ft. Ft Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft. Ft MISCL. INFORMATION: /'77 7 DRILLER'S NAME ~/~ ~ MUNI CI F'AL I TY OF A~'4C~ORA 'SE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION · . 99~t 1 825 L STREET, ANCHORAGE, AK =] 264-47...°0 ON.--S ~ 'TF" SE~]EF~ 8.:. WEL. L F"EF:[~ I T' PERMIT NO: DATE ISSUED: 840648 37/._'. 1/84 APPLICANT: ADDRESS: CONTACT PHONE: KELLY SCHUNKLE C/O S&S ENGINEERING SRB 196X EAGLE RIVER, AK 99577 694-2979 LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS: SUBDIVISION: CFIANDELLE ACRES SECTION: 3 TOWNSHIP: 15N 40036 (SQ. FT. OR ACRES) 3 LOT: 4 RANGE: 1W BLOCK: N/A Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. DEPTH 'TO PIPE BOTTOM (FT.) GRAVEL DEPTH (FT.) TOTAL DEPTH (FT.) GRAVEL WIDTH (FT.) GRAVEL LENGTH (FT.) GRAVEL VOLUME (CU. YDS.) TANK SIZE (GALS) SOIL RATING (SQ. FT./BR) TRENCH BED ~. DRA I N 4.0 4.0 4.0 5.0 0.5 3.5 9.0 4.5 7.5 2.5 26.0 5.0 105.0 *.* 50.0 113.0 ** 53.4 48. I 83.7 1,000.0 ** :1.,000.0 ** 1,000.0 ** .549 284 349 ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements CDr on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State o£ Alaska. ~. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set. back distances from any existing well, wastewater.disposal system or public sewerage system on this or any adjacent or nearby lot.. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL F'ERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSI--'ECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. AF'F'LICANT: KEL. LYL/SCHONKLE C/O S&S ~NGINEERI?4G MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOl LS LOG PERCOLATION TEST PERFORMED FOR: ~'~. ~- Y' LEGAL DESCRIPTION: ~L~;~ ~' 1 3 4 5 6 7 d>~v~ 8 DATE PERFORMED: SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? COMMENTS PERFORMED BY: 72-008 (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TESTRUN BETWEEN ~ FTAND · R~ l~5X ' (minutes/inch) .. FT • Municipality of Anchorage On-Site Water and Wastewater Program (907) 343-7904 S w r ¢ r r Certificate of On-Site Systems Approval Parcel I.D. 051 -063-79 Expiration Date: / © / LH 7 1. GENERAL INFORMATION Complete legal description Lot 4, Chandelle Acres Location (site address) 23832 Immelman Circle, Chugiak, Alaska 99567 Current Property owner(s) Barbara Erb Day phone(907)7485480 Mailing address 23832 Immelman Circle, Chugiak, Alaska 99567 Real Estate Agent Derek Hert/Core Real Est- Day phone(907) 242-4968 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well fiC1 Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: — Y Date: —7((4(( COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ J2(D, b'� C ! I Waiver Fee $ Date of Payment 1110111 Date of Payment Receipt Number 2,113 TO ' Receipt Number COSA# t crl I a3 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 Pinard Engineering Phone(907) 232-1347 Address PO Box 871347, Wasilla, Alaska 99687 Engineer's Printed Name Paul E. Pinard Date 7/8 (1f OF pp ee ..�� f A•ii . O F 6,as 9 •° 4,:q6,-z. ...tin. * .49h . •` e % :pir .0a 6. DSD SIGNATURE yaie 1'Pa€41;E...Pinard • 4 % 46 Si pa-a. aCc lik v c► .__ . System#1 Approved for bedrooms ��s�, 7. �_4793 -- $i System#2 Approved for _ bedrooms °� F x` ,11 SFA, •••• ��pROFESSI�\\- �� Disapproved �vpg®® 1®�� Conditional approval for bedrooms, with the following stipulations: 7f �� ;r• ,-.,; ,,"1 iV J A)'`V\ �` � , . , \iS� rom�\, � • )n V C / By: f'"' 11 Original Certificate Date: 7'( 17 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet j c , 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: Lot 4, Chandelle Acres Parcel ID:051 -063-79 A. WELL DATA Well type pvt If A, B, or C provide PWSID# Well Log (Y/N) y Date completed 6/84 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 179 ft. Cased to 40+ ft. Casing height (above ground) 16 in. FROM WELL LOG AT INSPECTION Date of test. 6/84 6/28/17 Static water level 160 ft. 157.2 ft. 0.6+ Well production 3 g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 0.877 mg/L Arsenic ND ug/L Date of sample: 6/14/17 Collected by: PinardEngineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 8/84 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) I Depression over tank (YIN) N High water alarm (YIN) NA Date of pumping 7/6/17 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 8/84 Soil rating UpoLittivr ft2/bdrm) 36.9 System type Trench Length 105 ft. Width 2. 5 ft. Gravel below pipe 5 ft. 1 @ 65 ; 1 @ 40' Total depth 9 ft. Eff. absorption areal 050 ft2 Monitoring tube Y Depression over field N Date of adequacy test, 6/28/17 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before tesf&32:4 in. Water added 520 gal. New depi36.0 in. Elapsed Time: 895 min. Final fluid de h 30.4 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N & type) None Known If yes, give date D. LIFT STATION NA Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100' + On adjacent lots 1001 + Absorption field on lot 1001 + On adjacent lots 100' + Public sewer main NA 75± Public sewer manhole/cleanout .NA 47019 4- Sewer/septic service line 251+ Holding tank NA i ---76.-÷ Animal containment areas 50' 4- Manure/animal excrete storage areas 100' + SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 ' + Property line 5 ' + Absorption field 5 '+ Water main NA IO Water service line 10 I + Surface water 100'+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: OProperty line 10' + Building foundation 10' + Water main NA /(�f Water Service line 10' + Surface water 100' + Driveway, parking/vehicle storage 10 1 + Curtain drain None Known Wells on adjacent Iots100' + . Pall` 0.A vta.-1^ Lys '-CP \ Fwd F. COMMENTS i 0.0.46041644,..e G. ENGINEER'S CERTIFICATION Jf� OF Ai . "'. I certify that I have determined through field inspections and 1, G,.• th % •• review of Municipal records that the above systems are in `fir conformance with MOA COSA guidelines in effect on this date. ; •• ' + 3sr.. ': tS \ Si Engineer's Printed Name Paul E. Pinard A t' ;� � �; Paul E.�Pinard .�, Date 7/8/17 .15 . CE -4793•,���(�1 <4;`p,•.,i..... 114411-i COSA yellow sheet_2-6-15.doc S - / 2,7 . A ag oo co-r- io /�s- `� ��i° N - ...- „--ft"---. app 0Y 4 'sem Gdti,a. III”" SOI or.45. f4C.T • 1,� rag ��NvJrI Q2/VE Ss.LA. LINK.FEUC.E \'' N 11? lit) Ltr K Z4 ' 7 I � (....or. 97 \. . Ne g‘ x m •. sa.2 r,11 n dor 3 \fj/ w000 �.. ,r OECK XVe o - k id F xEuun� Y�om�/ / SEPTIC . -,®1ht° >AI •, .- Ct�vNouTS v ti. 5•,--.... ., ��--1te -1P� Z (./a r 5 c X ... •c 7 "-:: s ir J. COG / N., 3-`3 . Zc'v ,: -.N o Lor? ' �. IJ Bg 1541 E t 323.55 / _ max- -a-- x- -- -x- - - X— — a—^ I - (N^JN L/NK st)I- I L.nr 2. ,.dr 3 FENCE LK:1,414J \\\%‘ AS-BUILT NO CORNERS SET THIS DATE AA /� �E►1 f.J I)_ .fse. OF A� ,j� I hereby certify that I have performed a Mortgagees inspection of the following A K ••����••�� '� described property: 4I Ir - r") Q►,•• ..4: �♦ LOT 4, CHANDELLE ACRES LEEJEFTE) d� I , .,r�>3. or �:49TN i\ . 1 * V Anchorage Recording District, Alaska, and that the improvements situated 0 FOU or, L '---'5'S Gd-Q lie.. •• ••••I> thereon are within the property lines and do not overlap or encroach on the �o 0 property lying adjacent thereto, that no improvements on property lying Rf=�� ••..• ••••• •••••••• •:G.../ adjacent thereto encroach on the premises in question and that there are no • 01-1F-TC) 0 7� . PAUL E. FOX /kg/ roadways, transmission lines or other visible easements on said property +9 3745 - S ••.A.-g'ss' except as noted hereon. �•••�•••••.••pt'��C) Dated at Anchorage,Alaska this 21 st day of MARCH ,1992. r. PARCEL CONTAINS: 40.036 sq. ft. ��4\ 1:—. LOW LIMITED EASEMENTS OF RECORD.OTHER THAN THOSE SHOWN FIELD BOOK No. MISC-9201 Engneers,Surveyors&Planners ON THE RECORDED PLA T.ARE NOT SHOWN HEREON. Anchorage.Aleska W.O.ly 91..07 7 • Municipality of Anchorage• U , t Development Services Department- Building Safety Division 54 E r On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On-Site Systems Approval (COSA) # OSC 171283 During a recent COSA on-site inspection and test of the potable water supply well on Block , Lot 4 of Chandelle Acres subdivision, the well's productivity was determined to be 0.56 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3-bedroom residence is .31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.ancho rage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lo t: /4, Location (site address or directions) Current Property owner(s) Scott: Hat: t:enburg Mailing address,,~-~~:;~-'~ ~_~J,L~'~Y'~ I~ t [tt Lending agency HAA# /J-F)r-T,C.~£ C, Expiration Date: Chandelle Acres 23832 Immelman Circle ~h . j Day phone 688-4867 Day phone Mailing address Real Estate Agent Mailing Address Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well 3 TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) 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. DHHS 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. 72,025/Rev OI ~01' 5. ' ST/~TEMENT 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 the Health Authority Approval application show 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. Se Name of Firm ENGINEERING Address 17034 Eagle River Loop Road No. 204 Engineer's Printed Name Robez:t: C. Cowan DHHS SIGNATURE Approved for '~ bedrooms. Disapproved, Conditional approval for __ Phone Date II/~'~/~ ." ,,--'~ ~. ........ bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: Reissue Date: 72-025 (Rev. 01,'00)' Legal Description: Municipality of Anchorage ~ Department of Health and Human Services RE C E I V Division of Environmental Services On-Site Services Section 825 'L' Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 NOV 2 9 2000 www. ci.anchorage.ak.us (907) 343-4744 UUNIClPNJ~y O~ ANCHORAGE ENVIRON. SERVICES DM$10N HEALTH AUTHORITY APPROVAL CHECKLIST FROM WELL LOG A..WELL DATA Well type Date completed Total depth Date of test Static water level Well production .,~ WATER SAMPLE RESULTS: ff A, B, or C prov/~/PWSID # .__ Sanitary seal (1//,.5 Cased to ~4- ft ft g.p.m Parcel I.D.: Well Log Wires properly protected L~(~...~ C~ing heig~ (~e ground) / ~n. AT INSPECTION ~ g.p.m Coliform O colonies/100 mi .ate of samp,e: Co,ected by: / -- B. SEPTIC/HOLDING TANK DATA Nitrate 0 ,..~" mg/I Other bacteria 0 colonies/lO0 mi S & S ENGINEERING 17034 F.~g~ RIv~ Loop Road NO. 204 Eagle River, Alaska 99577 Tank Typa/Material ' ~/-/c ~L Date installed Tank size /~ gal Number of Compartments Cleanouts Foundation cleanout (//'g~s Depression over tank ,4,/c~ High water alarm Date of pumping ///~.,g~/d7/~ Pumper '-,~'~:~ ! C. ABSORPTION RELD DATA Date installed */8~ Soil rating ~r ft2/bdrm) ~"~ System type Lenath /O~"ft · Width ~_~_~ Gravel below pipe ~" /C~ Totalde~th~_~tt Effectiveahsor~on~re~/~"~)ft~ Monitoring tube ~ Depressiofl over field Date of adequacy test~ ~/-~ Results (Pass/Fail) ~ For ,~ bedrooms Fluid depth in absorption field before test ~ in Water added ~ gal~'. New depth -~ IO,~in. Elapsed Time:. ,:~ min Final fluid depth ~'/~'/' in Absorption rate >= "/L~'~?-)g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type)/~,,Y~- /~'~'Jf/A/ If yes, give date 72-026 (Rev. 01~0)' D. LIFT STATION Date installed.J L,,'~--~ "Pump on" level.at~' in Datum E. SEPARATION OISTANCES Size in gallons "Pump off" level at __ Cycles tested in Manhole/Access High water alarm level at __ in Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lif~tatien on lot //'~ ! Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots / ~'~ On adjacent lots ~/~ Public sewer manhole/cleanout Holding tank ,/v'/,~- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation Water main /~'/,,~ Drainage /Y/A- Property line Water service line / Wells on adjacent lots /~ /~- Absorption field .~- Surface water ('d~/~- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line //0 /-,- Building foundation /~::)//" Water main Water Service line Curtain drain Surface water /d*'~ ~ Wells on adjacent I°ts /~r~ ~- Driveway, parking/vehicle storage F. COMMENTS ENGINEER'S CERTIFICATION ,, Ice.ih/thatl 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 sPrinted Name /~43 ~,~ 7- (::. ~'o ~,,),,~ Date II /~.t'/eo t! <~, : ............ .,~. ,, HAA Fee $ c~'/~- ~ Date of Payment .~,~~ Receipt Number ~ Waiver Fee $ Date of Payment Receipt Number 72-02~ (Rev. 01,1)0)° MUNICIPALITY OF ANCHORAGE ~i~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 4 Chandelle Acres Location (site ~8"d ~sSor .d i'rections) 23832 Immelman Circle, Peters Creek, Alaska Property owner -', ~,¥na. S.chunke Mailing address 23832 Imm~ilman Circle, Chugiak, Lending agency..N°~est M~tgage Mailing ~d~ress 2550 Den~li St, Suite 1406, Agent Bonnie King, Aurora Properties Address PO Box 6701923, Chugiak, ~ 99567 Unless otherwise requested, HAA will be held for pickup. Day phone 688-4844 Alaska 99567 Day phone Anchorage, AK 99503 Day. phone 688-4939 NUMBER OF BEDROOMS: 3 ',4 TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 LCMF Limited Phone 562-1830 Address 139 E 51st Avenue, Suite B, Anchorage, AK 99503 Engineer's signature .; _. '~=~_ ~¥~--(~.~- ~o I DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. __-. ~-~ Date March 12, 1992 bedrooms, with the following stipulations: Additional Comments By: 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, 1/91) Back MOA ~t21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~7"4// ~_.~4~//~,/~_~,, ,~.~'~ Parcel I.D. A. WELL DATA Well type -~;"~'//~'/"/'-~) If A, B, or C, attach ADEC letter. Log present (Y/N) "~/g.5' Date completed / Total depth / 7~Cased to / 7 Sanitary seal (Y/N) ADEC water system number Driller Casing height /, 5/ / Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot / Public sewer main Sewer service line AT INSPECTION /5,-5'- / ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform cO ~ ,~/-_, Nitrate Date of sample: Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA, Date installed,.' ? Tank size Cleanouts (Y/N)' ~ ¢~ , : FCrUndation cleanout (Y/N) High water alarm (y~N). '::'-; '~/'~r, Alarm tested (Y/N) Date of pumping ' ,'~./'~'//ii~' / Pumper J SEPARATION DISTANCES FROM~;EPTIC/HOLDING TANK TO: Well(s) on lot /c~O / :' / ,' On adjacent lots ! ~ / / To property line /,-~' Absorption field Compartments Depression (Y/N) Surface water/drainage Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed '~f/~ 5/ / 5-/ Length ?~5- Width Total absorption area /',~',~ .~..~'~', DePression over field (Y/N) Results (pass/fail) ~ Peroxide treatment (past 12 months) (Y/N) Soil rating ,~'/~ Gravel thickness Cleanouts present (Y/N) Date of adequacy test for System type Total depth bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ? ~:' .~ To building foundation On adjacent lots ~/~-~-- On adjacent lots //~; Property line To existing or abandoned system on lot Cutbank /t/~..~.. Water main/service line Surface water Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guide Signature ~~ ~ ~~.~-~.-- .~ Engineer's Name--~'~3,,~"-~_,.~, -~-'~.,~;< Date '"~ .~,~X~ \ ~'i ( ~' ~ ~ '~.~' ;'J~~',lblaW~te of this inspection. IF ~ ~ ee' A'*e --~. ~ HAAFee$ /7~' Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS RESULTS for INVOICE t 51718 Chemlab Ref.t 92.0890 Sample t 3 Matrix: WATER FAX: (907) 561-5301 Cllent Sample ID : TAP WATER L4 CHANDELLE ACRES PWSID : UA Collected : }/~R 8 92 { 15:23 h~s. Received : MB 9 92 ~ 09:00 h~s. Preserved with : AS REQUIRED Client Name :SCOTT HAYTENBORG, P.E. Client Acct :SCOTT]iA BPOt : POt :NONE RECEIVED Req! : Ozdered By :SCOTT HATTENBURG Analysis Completed : M~ 9 92 Laboratory Supervi.mo~ STEPHEN C. EDE ReleasedBy :~ ~.~ Send Reports to: l)$COT! H~TTENEURG, P,E. Parameter Results Units Method [llowable Limits NITRATE-N 0.81 mq/1 EPA 353.2 10 Sample ROOTINE SMiPLE COLLECTED BY: SCOTT H~TYE~URG. Remrks: 1 Tests Performed ' See Special Instructions Above UAmU~va~lable ~- ~one Detected '* See ~ple Remrks Above MA- Not A~l~ed LY-Less Member of the SGS Group (Socidtd GdnOrale de Surveillance) ADEQUACY TEST REPORT INSPECTOR: ~,~:~?~ NO. OF BEDROOMS: ~ CALCULATE PEAK LOAD JOB NUMBER SEPTIC TANK SIZE: TYPE OF S,A,S, :. (MEASURED IN FEET.> Flow Vol. 3umul. A S.T. S.A.S.MT #1 S.A.S. MT#2 Rate (gad Vol. Liquid /~ Liquid A Liquid CCOM~ENTS Time i( gP~9 i( ,qa]3 S.T. Level Level Level ' 3&o ~. / o ~ ~ ~ / TEST RESULTS~ REVIEWED BY: DATE: '~'/I! / ~' SHT.: OF __ PREPARED BY: SUBJEC~ ~:~7-' 5/ ,C__J-/-zt~/~ ~ (907) 562-1830 FAX (907) 562-1831 ~.~,~., ".,-!,-,J_~.._~_/~-~L~..;,'":,~,., _/~.,.z~ . ~ : ~ : lt~ '' --. .... ,~ "~' ....... ~'- -, ~:-~ ":~'~~ ..... i ..... . . ~ .. '~ ~ . .... · ::. ::. :.: ',~z~~/l = ~,~/ ~ ' . · · t · . .~, .' ~ . ~ . , z~.~ ,' ~ ~,~ '.-' ~ '. '1'. '[: ...:" .. , "[ ' .,' t ~i ~ ' ' , ~. ' ! _:..: ~t~ ~.~, ~. ~ .'i'~ 'r .. ,' .: . . · :: .' '.~: ~ ,'. ~.~.: ':..::F~,~'.'~, .'~:" ~, ~ ~ i ; : ~ ~ : ~ : : .... i': -:., .. ::.::.:..~ · .:. :--~: -: :.--.::. :-: ~.' :-':-:: ::~': ,' · ...... . :::'. :..: . ...: :: '[ · ~'. . -: t ........ :: ............ .......... ..... .:. ~] 7 ~' . "~ /-2 ..:~:'...' .' ~': .'..~...: :' .~. ' :' .~, :._::t..'~ :.t ~. ~'. , ' , ,., ~--,. - '~ ~ ' - · ~ ~. ~.~e~k~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~¢-~-~,--, ~'~.L~t~.oix,~. Telephone: Home ~-' z:~_~ Business _. . Applicant Address ~--~'~t'O ~..<-,-.r "~u~"/~.. ~ ~- _/~i& i ' (c) Applicant is (check one): Lending Institution [] · Owner/builder]li~4 Buyer [] · Other [] (explain); (d) Lending Institution ~ ~ ""J ~' Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Marl'the HAA to the following address: TYPE OF RESIDENCE Single-Family,~r~. Multi-Family [] Number of Bedrooms '~ Other WATER SUPPLY Individual Well~l-- Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~i~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 ¢1,84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the 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 Address Date 8 & ~, ENGINEE~N~ PH. 60~2379_ Telephone DHEP APPROV, ~L e~*/~ Approved for~ bedrooms by Approved ! / x Disapproved Terms of Conditional Approval Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) iGUNIC1PALITY OF ANCHORAGE · Dc. PT, OF HL,~?'~ & .~ViRONMENTAL ~RO ~'ECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY '1984 264-4720 Legal Description: ~ '4' WELL DATA Well Classification Well Log Present 4~;)N) ~, ~'. If A, B, C, D.E.C. Approved (Y/N) '/ Date Completed ~ / ~1" Yield k Depth of Grouting Pump SetAt Sanitary Seal on Casin~C)/N) Depression Around Wellhead (Y~) Total Depth [~;1 ' ~" Cased to Static Water Level ~ Casing Height Above Ground Electrical Wir!ng in Conduit (~N) Separation Distances from Well: To Septic/~ Tank on Lot _ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line _ Cleanout/Manhole ¢~ Water Sample Collected by Water Sample Test Results 'D ' · On Adjoining Lots ~ O.~ ' On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on / Comments B. SEPTIC/~TANK DATA Date Installed Standpipes ~)N) Air-tight Caps ~N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/~Tank: To Water-Supply Well To Property Line ~ To Water Mare/Service Line Course '~ /A ~ - ~ . ~:~r' Size ~, ~ No. of Compartments '~- Foundation Cleanout ~'N) Date Last Pumped ~ G_...~,_~ ~.3/~ 'for Temporary Holding Tank Permit (Y/N) To Building Foundation ~¢Z'~ To Disposal Field ~' ¢ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ - ~ -~:~ Width of Field '"~'" Square Feet of Absorption Area Depression over Field (Y/.~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ¢o/¢~ To Water Ma~/Service Line [. c::, ~r To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 1(~,,9....- Type of System Design Length of Field ~. Depth of Field Gravel Bed Thickness ~.z~C, Standpipes Present ~N) Date of Last Adequacy Test _~J ~:~,~.) To Property Line To Existing or Abandoned System on · On Adjoining Lots ~ To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MpA and~HAA guidelines in effect on the date of this inspection. Signed Date~-- "'- 8 & ~ E~GllfdFJ~RIN~ MOA No. Company , ~ Receipt No. P~' ~ ~'~%~ Date of Payment Amount: $ ~ Page 2 of 2 72-026 (1 ~1/84)