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HomeMy WebLinkAboutCALKINS LT 8 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221424 PID Number: 050-211-13 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name DELORES & STEPHEN HANSEN ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 19215 CITATION ROAD, E.R. 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SFJ Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot CALKINS 8 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FtZ Ft. Well 200'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Tank insulated. New field CO/MT installed and waiver submittal of property line to existing field. Alarm location Electrical installed by Installer JRS PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034. Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection1s' 11/09/22 2nd 11/10/22 Location and description 3r11 11/17/22 4'h TOP OF MH / RISER ON -SITE WATER AND WASTEWATER SECTION APPROVAL �9��Z�\ Conditional Approval: Date Q"�`. • ts,�t 4..- ... ....�... .... ........`�`..... Septic System Approved �� Curtis Huffman / - Date I I Z� 2� � �l�c�c •. CE 128991 iiAiw is�F • t U18/22 •��� . . [ AW ,,`F�pROFESSIONAMW P Note: this approval does not include well permit requirements. . kf uv u:NUL! 101 PID:050-211-13 PERMIT:OSP221424 FIRST WATER CONSULTING CALKINS LOT 8 MUNICIPALITY OF ANCHORAGE �1»cnt On -Site Water & Wastewater Program PO Box 196650 4700 Elmore RoadEr Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 n http://www.muni.org/onsite L7cparrmenc On -Site Wastewater Disposal System Permit Permit Number: OSP221424 Effective Date: 11/3/2022 Work Type: SepticTank Upgrade Expiration Date: 11/3/2023 Tax Code Number: 05021113000 Site Legal Address: CALKINS LT 8 G:0055 Site Mailing Address: 19215 CITATION RD, Eagle River Owner: HANSEN DELORES A & STEPHEN F Lot Size in Sq Ft: 16916 Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 3 This permit is for the construction of: ❑ 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 Special Provisions: Locate field to verify separation to tank Add MT to the west end of field to verify it is on property Received By: 1.-t°W r WIC Issued Date:2.— Date: MUNICIPALITY OF ANCHORAGE 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. 050-211-13 Property owner(s) DELORES & STEPHEN HANSEN Day phone Mailing address 24811 HORSESHOE ROAD, AKELEY, MN 56433 Site address 19215 CITATION ROAD, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) CALKINS LOT 8 Legal description (Township, Range & Section) Lot Size 16,916 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank Upgrade R Duplex (D) ElHolding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: X15- Date of Payment: (ol Il 122 d2k Receipt Number: 10 \ kk Permit No. 05e2 2 - Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc FrO Wdel , I 1. C D N S U L T I N G r , 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com October 7, 2022 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: CALKINS LOT 8 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPUANC OSP221424, Tim Ecklund, 10128122 The owner has requested that we obtain a septic permit to upgrade the existing aged septic tank on the above referenced lot. We propose to install a 1000 -gallon HDPE tank per the attached design to serve the existing 3 -bedroom septic / residence. The lot and area are served by public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Guts t !� t �GtS VO Aslrvl Au ^PC FT & PI ING of Anchorage REVIEWED FOR CODE CC OSP221424, Tim Eddund, DESIGN DETAILS: INSTALL NEW 1000—GAL HDPE TANK. MAINTAIN 10'+ FROM FOUNDATION, 200' TO WELLS, 100' TO SURFACE WATER, 5' TO FIELD & DECK SUPPORTS WITH 4' OF COVER OR INSULATION. INSTALL PER AMC 15.65, 15.55, & MASS... TANK BEDDING, SEPARATIONS, MATERIALS,... 0 I Lot 7 10' UTILITY EASEMENTS S 89°42'52" 125.20' Lot 15 ° DECOMMISSION S.T. & INSTALNEW I XISTING NO P BUC PROP ED WI IN 200' OF PTIC T NK. NO PRIVATE 1000 GAL HDPE S PTIC TANK MT WITHI SEPTI TANK 100' PROPOSED A WITH NEW CO. �G m VERIFY 5'+ S TO FIELD ADD MT IF EQUIRED. s Z LOCATE & STAKE WATERLINE DCO PRIOR TO CONSTRUCTION. (/) CO MH alp. 62.9' o :D Sr,jA 0 FCO 3 BEDROOM SEPTIC _. Q m 4h. HOUSE Q GRAVEL L® V Lot 16 16,902 S.F. r 14.7 Fc� U1 O 1.3'x1.0' CANT O a WIRE FENCE ° STAKE ALL PROPERTY LINES, EASEMENTS, WATER LINE, ETC... PRIOR TO CONSTRUCTION & ADD TO IR AS EQ. — N 89'42'52"W 125.20' DESIGN BASED FROM ROUGH MOA DATA & LANG ASB SURA Y, CITATION ROAD n CALKINS LT 8 SUPPORT®SERVICES: OFAL PREPARED FW: DELORES &SSTEPHEN HANSEN 19215 CITATION RD 9 TH EAGLE RIVER, AK 99577 FIRST WATER CONSULTING DATE: 10/7/2022 tis xlfman SURVEY: REJ CE 128991 13030 SUES WAY DRAWN: FWCS 10/7/2022 �' ANCHORAGE, AK 99516 SCALE: 1" = 30' �`' PAGE: 1 of 1 907-350-9566 FirstWaterAK@gmail.com GRE/-,,F.R ANCHORAGE AREA BOR..JGH Department of Environmental Quality 3330 C Street , . ~ .0.%Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME I~'/~ e'/.)"~ j~/~r T~ .~ MAILING ADDRESS SEPTIC TANK: DISTANCE FROM WELL INSIDE LEN. GTH MANUFACTURER ~g.g$C" T MATERIAL //~//~/-~'T"/~.~ COMPARTMENTs_.NUMBER OF ~, INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY Z¢~:~ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION '~/ NUMBER OF LINES / DISTANCE BETWEEN LINES ABSORPTION AREA '~ ~ DEPTH: TOP OF TILE TO FINISH GRADE NEAREST LOT LINE TRENCH WIDTH~'~' IN. TOTAL EFFECTIVE FT. LENGTH OF EACH LINE / DEPTH OF FILTER __ MATERIAL BENEATH TILE IN, ABOVE TILE ' IN, WELL: ,/O~ 7" TYPE _ BUILDING FOUNDATION__ CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST LOT LINE___, SEWER LINE__, OTHER SOURCES DISAPPROVED REMARKS DEPTH SEPTIC SEEPAGE TANK , SYSTEM DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE:_ REMARKS: DIAGRAM OF SYSTEM DATE G.A.A.B. Form IgQ-032 LOG OF DRI,'~.ING by A ,D L OWNER oF LAND .~_t.~._c_.._~..'...~_r_.~$ ........ .d._.,..~ ................. ADDRESS .................................................................................................. WELL SITE _~.~_.~......~--~-~---~ D~TE--STARTED ....... ~/~/~- ~- ....................................................... DRILLI~ COMPANY STATIC LEVEL OF WATER FT .... ~i._7....~.. .................... DRAW DOWN FT ...... ~*~'Z .................................................... GALS. PER HR,, 7 ~ O KIND OF FORMATION: FRO~ ....... ~-- ............ FT. TO ...... 3. .............. FT......~._.'~.i_/~.~T_.~....~.. ~. ~'/"~' FRO~..... ~ ~..~.'?. ....... FT. ~o~ ........ ~. ........... ~. -~ ~ ~ ~ ~ ~ ~'~% .... ~'~ ~ FHOM ......... '~ ........... ~. TO__._..~.~_ ....... FT ....... ~ Z.~ ............ FROM....~_~ ........ FT. FRO~ ........ ~.~ ........ ~T ........................................................................... FHO~ ...... z ................................................ ~ ................................................... ~o~ ...... L. ~ ~. ~o__.J~ ........ ~.J~c~..~ ~o~ .......... : ............. ~. MISCL. INFORMATION: DRILLER'S NAME .... .~_.':::. ........................................................... Gte/ --r ANCHORAGE Area BO! UGH DEPARTMENT OF ENVIRONMENTAL QUALITY :3330 "C" STREET ANCHORAGE, ALASKA 99:503 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGHI SEEPAGE PIT ., ORAl FIELD . 'THER , COMPLETION DATE ANTtCIPATED FINAL INSPECTION: ;[4 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENTO~ ENVIRONMENTAL QUALITY AUTHORITY .WILL BEBUBJECT TO PROSECUTION. SEPTIC TANK AREA SIZE /,'~ /'~TYPE ~ // MINIMUM DISTANCES, REQUIREMENTS ~ DIAGRAM OF SYSTEMw ~ FOUNDATION TO SEPTIC TANK ,~' ' ~ FOUNDATION TO SEEPAGE Pit ~ DRAIN F~ SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK ~'~ (' ., SEEPAGE Pit TO NEAREST LOT L'NE. WELLTO SEPTIC TANK X~/' DRAIN F'ELD ~ /(~ WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, ~ ,~- , SEEPAGE PIT TO RIVER, LAKE, BTREAM. · SEEPAGE Pit CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEet INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT F'TTED W:TH A, RT:GHT .EMOVASLE CAPS. ~ ,., CONFORM TO BOROUGH R~ULATIONS REGARDING INSTALLATION. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-G8 AND THAT THE ABOVE DESCRIBEO~TEM IS IN ~DANCE WITH SAID CODE. 'O ~ E GED1 _CHNICAL ~r DEVELL.)MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-27'/4 or 688-2280 RusseE Oyster 694-2774 Soils~tFoundations Perfomed for: Legal Description: ZoT- ~-~, SOZL LOG Name: ~tltng Address: Depth (feet) Sotl Characteristics Earl Ellis 688-2280 Land Development 10 11~ 12 ...... ~3 14 /~o 15 16 Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comnents: No / If yes, whit depth Drain Fie~d Date:. Performed by: -~Tr/P~J-- ;c iia Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-211-13 Legal description Calkins Lot 8 Site address 19215 Citation Rd Eagle River Current property owner(s) Hansen Expiration Date: Z / 2-. ZS X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: 11/21/2022 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 U5 u MUNMPAUTY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-211-13 Complete legal description CALKINS LOT 8 Location (site address) 19215 CITATION ROAD, EAGLE RIVER, AK 99577 Current property owner(s) DELORES & STEPHEN HANSEN Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ® Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 0 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 1�5b_ Date of Payment II ilolzz dt�_ 5�°103 COSA # o5 C z2_15y1 Waiver Fee $ Date of Payment Waiver # COSA Application—July 2022.doc COSA Checklist 2022.docx COSA Checklist Legal Description: CALKINS LOT 8 Parcel ID: 050-211-13 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - PUBLIC OR CLASS “A” WATER Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NA – NEW TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 3/1/1976 ALL standpipes present per record drawing Total measured depth from grade 9.3* ft (max) Measured depth to pipe invert from grade 4.5* ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective 4.83* ORIGINAL MT Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 9/27/22 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 9/28/22 Results Pass Fluid depth prior to test 3 in Water added 500 gal New fluid depth 7 in Elapsed time 1440 min Final fluid depth 1 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 84 in Effective depth used 29 in (Missing ED + 3” fluid start) Effective depth remaining 55 in (1” fluid end) Comments/Deficiencies: *AT GRADE AT TEST. ORIGINAL DOUBLE CLEAN OUT (DCO) INVERT & EXISTING MONITORING TUBE (MT) SHOW 4.83’ EFFECTIVE DEPTH (ED) AT TEST. NEWLY INSTALLED CO & 1” STEEL MT MEASURED AT 6.82’ ED WITH 3” OF FLUID ON 11/17/22. MOA INSPECTION REPORT (IR) SHOWS 7’ED. COSA Checklist 2022.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No *7+ ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *EXISTING FIELD TO PROPERTY LINE (PL) MEASURED AT 9.3’ FROM NEWLY INSTALLED CO & 8.3’ FROM ASSUMED FIELD TO PL. REQUEST MOA WAVIER OF 7’ TO EXISITNG FIELD & PL. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 11/17/22 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 11/17/22 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com November 18, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: LOT LINE TO FIELD WAIVER LEGAL: CALKINS LOT 8 Per the recent attached as-built survey by Lang & Associates, Inc dated November 18, 2022, the existing septic field is within the required 10’ separation distance to the lot line. The measured distance is approximately 9.3’ from property line to the closest and newly installed existing field clean out and we are therefore requesting a waiver to 7’ to lot line at this time based on the record inspection documents within the MOA file. The system has been in operation since 1976 with no known issues, the area is served by public water, and we do not expect there to be any adverse effect on the subject or adjacent lots be granting the waiver. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. ul'�,D,111 Munlclpality of Anchorage 1)rpartment P.O. Box 196650 • 4700 Elmore Road Anchorage. Alaska 99519-6650 a (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221075 COSA#:OSC221541 PID#: 050-211-13 Legal Description: Calkins Lot 8 Engineer: Curtis Huffman Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 7.0 feet. This waiver approval applies to the proposed absorption field. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: Approved by: Name of Reviewer ............................................... ■ ............................. ■ 1 **** VARIANCE/WAIVER REVIEW **** . MUNICIPALITY OF ANCHORAGE - - DEPARTMENT OF HEALTH & HUMAN SERVICES ' Division of Environmental Services On-Site Services Section P.O. Box 196650 Ancl~orage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SING LE FAMILY DWELLING Parcel I.D.# 050-211'-3.3 1.' *GENERALINFORMATION Oomplete legal.:description HAA# HA940075 Lot 8 Calkins Subdivision _:.LoCation (site address or directions) 19215 Citation Road ' '~':;~-~'~"~'* '"'~--'~" '-: Eaqle River, Alaska 99577 - '~::i:'!"-~::~'~!~:~?O~"'r-¢B:~i'Sres/Michaol Ric~ards0~~ DayPh~e '696L36~'~) - _` ~". Mai'lin~::~s~:::19215 citation Road Eagle River 99577-563-4400 (w) Mailing address ' Agent · .'-'"Address' "'- '! '" - - ..;'...~j'::..;.~.;.':.'._L...:: ~'.:.~*_,_:..*.~?...:~....;;· . .:. .... · ' .'**. Unless otherwise requested, HAA will be he[d'forp[ckup. : .2.*.*- NUMBER.OF BEDROOMS: -. Three (3) ~;'7.:.:;~; ....... :;;:.:;. ~,:..;:;:;;~ ' Individual well -'~':~' ~ '; *. '::.:;'". pUblic water Day phone Day pho~..e _, 4;-' TYP'E'-oF W-~STEWATER DISPOSAL: · ' Individual on-site ·..~* ...... ~.:·: '.': Pub lC sewer ' '-:'~:~ ':'NOTE: ::~Tf'~"o~n**'m;~lity wastewater system, Provide Writtenco~firr~atid. attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY: ENGINEER,~i:.%~ ~-~ A~ c~rtified by. my seal affixed'hereto and as of the v~lidationdate shown below, I verify that my investigation bf 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 furtherverify 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 corn pliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm S & S 'Enqineerinq Phone 694-2979 17034 Eagle River Loop Road, Suite. 204., Eagle River 99577 ~' Address Engineer's signature 6.'.' DHHS SIGNATURE ..... '.'-.::xxxxxx^pprov~d for. three(3) 'bedrooms.::.'..: .. ...... ' · . Has:met the conditional He&lth..approval'"'dated 3-1-94. It now '. ' meets MOA standards. Copy of connect attached' Date :April 10, 1.995 q';T'l/[:'}t II : · :: 'of Anchorage Department of Health and: H~h~ :~e~i~;~!':'iDl~lh~?S*~0as Health ~6~al Ce~ificates based only upon the representatioh~:~i~en in:ParagraPh 5 ab~ge bY an independent lineer registered in the State of Alaska. ~.~ does this a~ ~ou~yto purch~m of homes ~' nsi d ~c0~ai r~ iremenB, E~Pl0Y~SOfDHHSd not :~:~,::: institutio n or erto ~tis n f~emland state u o or analyze data before ~ ce~ificate3s j~,~e~,~Ihe Municipali~ ~of Anchorage is not 72~ (Rev. t~1 ) ~ck MOA ~1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchor:age, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal descri ption Lot 8; Oalk~ns Subdivision Location (site address or directions) Property owner Mailing address 19215 C,b~z~,~on Road Ea~le River) AK D~lor~s and Micha~IRichardson 19215 Citation Road Eag£e River, 99577 Day phone , &96-3668 Ih) 565-4400 (wi AK 99577 Lending agency Mailing address Day phone . Agent Address Day phone . Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: $ '~' '\ 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site XY, X 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. 7~-0~ ~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 furtherverify 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 s & s ENGINEERING 17034 Eagle River Engineer's signature DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for ~ bedrooms, with the following stipulations: ~OtV£~ ~AtR£L. BE _E~£~O~.~E0 TO C~IV~E~?' H~cf~ To 1MF~TER /tND ,913ft~Z~O/J.?~ 7'H£'-;~F_I.:L .PROP~.R~~ Additional Comments The Municipality of Ar{~:~{orage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representa:tions given in paragraph 5 above by ah 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 ordertosatisfycertain federalandstaterequirements EmployeesofDHHSdonot .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 (Re~.~1!91) _Bac~( MOA I~21 MunicipalitY of Anchorage Department of Health and Hbman Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type ~t Log present ~)/N) Total depth Sanitary seal ~'N) Parcel I.D. If A, S, or C, attach ADEC letter. ADEC water system number Date completed -2~., ~ ~-~ L~ Driller Cased to ~ ~ ~ ~ .Casing he.i~ght Wires properly protected ~ FROM WELL LOG g.p.m. Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ ~ \~'' Absorption field on lot Public sewer main Sewer service line AT INSPECTION g. ECEIVED FEB 1 5 1994 ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout~, Petroleum tank Municipality ot Anchorage Dept. Hee~lt~ & Human Services WATER SAMPLE RESULTS: Coliform D) Nitrate Date of sample: '~-~ t~ ~cl. ~-~ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts ~'N) High water alarm (Y~[,~ Date of pumping Collected by: Other bacteria ~ $ & $ ENGINEEEING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Tank size ~ c~c> 4:~ Compartments Foundation cleanout (Y~l) ~ Depression Alarm tested (Y/N) ~\c~ -~1 ~ Pumper '~.~ ~...~.-~P~c~ Well(s) on lot \o~ ~'~ To property line Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent lots \ (~ Absorption field ~ ~ ~ 72-026 (3/93)* Front Foundation Water main/service line CONTINUED ON BACKPAGE C. LIFT STATION Date installed Size in gallons vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPA~UFT STATION TO: W. etil~n lot On adjacent lots Manufacturer Manhole/Access (Y/N) ..------' Surface water Length ~ [ Total absorption area Date of adequacy test D. ABSORPTION FIELD DATA Date installed Width Soil rating (GPD/FF) \~'-c> ~/~'C-- System type "G ~ Gravel thickness "7 ~ Total depth Cleanout presentatiON) ~ Depression over field (Y~ Resul~ail) ~x~-(',S for After test If yes, give date '"//~- Water level in absorption field before test Peroxide treatment (past 12 months) ('~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /o ~ I v-- To building foundation On adjacent lots '~-~c, I ~ Surface water / o~ /~' Curtain drain E, ENGINEER'S CERTIFICATION " On adjacent lots / oo ,r ~-- Property line / ~ ~ ~' To existi/ng or abandoned system on lot Cutbank "J/',~ Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformedTII MOA and HAA guidelines in effects, on the date of this inspection, Signature S & S ENGINEERING Engineer's ~ River/Ala~lca ~9~ Date HAA Fee $ Date of Payment Rece .t Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number ANDERSON BROS. CONST TEL:l-907-694-5244 apr 04,95 12:05 No.001P.01 ANDERSON BROTHERS CONSTRUCTION GENERAl. CONTRACTOR P.' O. I)OX 170129 EAGt. E RIVER. AK 99577 S & S ENGINEERING ATTN: ROBERT SHAFFER FAX: 694-1211 RE', MIKE RICHARDSON 19215 CITATION L.8 CALKINS SUBDIVISION EAGLE RIVER, ALASKA ANDERSON BROTHERS CONSTRUCTION TIED INTO THE MUNICIPALITY OF ANCHORAGE WATER MAIN AND INTO THE EXiSTINg 3/4" LINE AT THE WELL. THE WELL PUMP WAS PULLED AND CASING CUT BELOW THE PiTLESS, THE CASING WAS FILLED WITH GRAVEL AND CAPPED WITH 20 MINUTE ALL-CRETE. SINCERELY; KENNETH L. ANDERSON PARTNER ANDERSON DROTH[RS CONSTRUCTION ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. 14, 1995 C;IVll ENGINEERS (907) 694-2979 ~ AX (907) 694-1211 SEWER & WATER MA~N EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SiTE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL S'fSTEM OESIGN D~lor~ ~ Mi~ha~lRi~h~rd~on 19215 C~tation Rd. Eagl~ River, AK 99577 REFERENCE: %or 8~ Calkin~ Subdivisio~,~ D~ar Mr. and Mrs. Richardson, A Conditional Health Au. thority Approval w~ issued on th~ r~f~rcnc~d prop~rt~ on M~ 7, 1994. T~ H~ A~horty Approv~ ~ ~s~ by ~ D~pa~ of H~ ~d H~n S~vic~ ~nd w~ m~d~ con~o~, r~q~ th~ hom~ ~ b~ ~nne~d to the pubic ~ sff~t~ and th~ ~ng w~ to b~ abandoned by J~ I, 1994. If a final H~Ith Authority Approval is to b~ issued, it will b~ n~c~ary for ~o~ and your contractor to satisfy th~ D~p~¢nt of H~th and Human S~rvi¢cs that all conditions of th~ approval hav~ b~n m~t. c¢ ~an Roth, Man~ipality of Aneho~ag~ R- CEIVED MAR 1 5 1995 · ~,~:~ o~ Anchorage Health ,~ Human Services 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 April 5, 1993 ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOl'TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage Department of Health and Human Services Attention: Dan Roth P.O.Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 8 Calkins Subdivision Conditional HAA Dear Dan, RECEIVED APR 1995 D M.u.nic~pa!ity of Anchorage Health & Human Services For your files, attached is a letter from Anderson Brothers Construction describing the procedure used in abandoning the well located on the referenced property. Also attached is a copy of the water connect card from AWWU. We are forwarding this information as a courtesy. We were released from this project at the time the conditional approval was issued. For further information, please contact the owner. Sincerely, cc: Delores & Michael Richardson 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, AL/:gSKA 99577 0 M < z I 50.0' I � I � Lot 7 —10' UTILITY EASEMENTS S 89'42'52"E 125.20' i_ 1 0 1 Municipality ofDrage On-site Water and ste:mter REVIEWED FOR COD UAN OSP221424, Tim EcW 11/03/22 Lot 15 SEPTIC Od PIPES c��fc • O C ' ^ G/�AuEL y w 14.7.^�. cn °"I o O c6 M FENCE 8.2'x16.3' SHED—E 62.9' Lot 8 16,902 S.F. o`er N 89' 1.3'x1.0' CANT WIRE FENCE 2"W 125.20' o I Lot m In NOTE: THIS LOT IS SERVED BY A PUBLIC WATER SYSTEM. PLOT PLAN AS BUILT _X_ SCALE _1" 40' _ GRID NW 0055 Project No 22-68 /1 ��r Associates, � 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 LangCSC. A S S o c i a t e S, inc. (907) 522-6476 Phone (907) 522-4625 Fax Professional Land Surveyors ken®longsurvey.com o O F ,A ©© Jonothan®longsurvey.com �! ''9s�p I hereby certify that I have surveyed the following described property: LOT 8, CALKINS SUBDIVISION (PLAT No. 72-216) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent_ thereto,_ that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the _?� _ Day of ��_�E'=Y�' _�N, of Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH y % KENNETH G. LANG o 4©U���FESSIONM- AECC963 0 M V) 5; Z I Lot 7 —10' UTILITY EASEMENTS c- in^* w f% r% "r- w nr r% f% N 89042'52"W 125.20' I CITATION ROA1r IV Lot 15 Lot 16 NOTE: THIS LOT IS SERVED BY A PUBLIC WATER SYSTEM. PLOT PLAN ___ AS BUILT _X_ SCALE _ 1 „ _= 40' _ GRID _ NW 0055Project No. ____ 22=682f_A2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, i n c. (907) 522-6476 Phone _ _ — -- _ _ - —_ �. '• ��A�A�' �(907) 522-4625 Fax �oFN� N, lProfessionaI Land Surveyors kenOlcngsurvey.com !�v''�0 jonathanAlangsurvey.com �P' • I hereby certify that I have surveyed the following described property: LOT 8, CALKINS SUBDIVISION (PLAT No. 72-216) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. �4- Dated this the ____ _Day of ________________, of Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. CO of * `49TH • � 0 TRAVIS A. WILSON ��j FFG,,, . �No. 156408 . ki ROFESSIONP�mkw kXXX �-P � State of Alaska AECC963