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HomeMy WebLinkAboutFOSTERS LT 62BFosters Lot 62B #051-282-44  Municipality of Anchorage Development Services Department Funding Safety Division On-Site Water and Waslewater Program, 4700 S. Bragaw P.O. Box 196650 Anchorage, AK 99519-6650 Page I °f3 v,w,v, cLanchomge.ak, us (907) 343-?~4 ON-SITE WASTEWATER DISPOSAL SYSTEM .AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION SEPARATION DISTANCES ~Septic D Holding B S.T.E.P. D Othe= Septic Abso~tion Li~ Holing Pu~li~at~ Tank Field Sta~on Tan~ Se~r ~e ~~ ~ Gat BENCH MARK Development Se~lces Depa~ment Approval . --~,'~'~-~' CE-8801 ~:,'~'~;~ P£R~IT NO. SW020259 PACE 2 OF 3 _. Hun_i_cip. g_ti-[;.y_o.{' .A,q_h.o,.r'99.e. DEPARTMbN/ Uh HI:::AL/H AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,B. Box 196650 ®Anchoro. ge. At.sRo. 99519-6650 e, Tetephone~ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LECAL LOT 62B, FOSTERS S/D P.[.D. NO. 051-282-44 NEW 1000 GALLON_.__J~'/ST1 SEPTIC TANK - ~LcJsT2 CO2 MT1 ~DBLI&DBL2 ~.~'~,~. "v¢'~,~CO 1 -~ ~1H~2 PERMIT NO. SW020239 PAGE 3 OF 5 Municip, o. Ji-t oF .A.n_c h.o, .r' g g.e. DEPARTMENT OF HE~.THAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D, Box 196650 ~Anchoroge, A[~sko 99519-6650~TeJephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT L£OAL LOT 62B, FOSTERS S/D P.I.D. NO. 051-282-44 ST1 ST2 /99.2' FINAL G~ ~SULATION __. ~,/I NEW 1000 ~ I GALLON I J SEPTIC 'rANKI CO1 4Ti, Jco1 = 98.1' / lC02 99.4' /FINAL GRADE =,~/2" INSULATION ~CO1 = 93.6' C02 = 93.6' ~-MT1 = 89.7' NO WATER FOUND 81.7' B.O.H. A B FCO 53.5' 4.0' ST1 56.5' 15.5' ST2 58.0' 21.5' DBL1 61.0' 30.0' DBL2 62.0' 31,0' CO1 83.0' 46.5' C02 46.5' 41.0' MT1 46.0' 38.5' N. T. S. .~T.. ,.' %' .,'" '¢' '~"~'""- CE 880! ',,;%:.-, .............. / /, Slle Plan See Site Plan 20- t::OULIEUt$ ~P bale Gross time I'lel Timebepth Io WaterI, lbl bmp /o I0 I~' /0 /o' ~'/¢" ¢' bEIql~ohUEI3 IH Ai:CohUAHcE WItH ALL StAlE AND MUNlt~ll~Al: UUIDELINEs tH g. 10. tt- t2- {:~- {J- tS- 17. 20- Slle Plan See $t~e Pla'n bale moss ~lme ~|et Time Deptl~ Io Water ! N~I brop ! ! t hBhFONMEB IH Ab~onO~hcE ~ttl ALL STATE AND MUHIblPAL GUIDELINES IN EFFECT ON Tills UAIE. UA/~: I 1',~ /' ~' I 01/~0/2003 1.5:25 345~287 Job No.: 02-1 M ~_DRILLING, PAGE 81 Dr/fling, Znc. *P.O. gox l10378,Aflchnrage. AK 99511, 6907-345-4000,907-34~.3287 Fax, Pmnit No. Dom~s~{c · WelIDevelo~me~' Metk~d: Air surge Notes: · $tatlc~nterlevel($WZ) , 39' __ (~v) Oelo~)topofcaslngfTOC). · Wellyleld test dt , i2 $Mlonspo minute (GPM)/ge~l~w~,Ji~w~G4~for Jpirh 100% of drowdown (DD) from st~g!c loel (~WL). · Me~hod: Air lift · D~e ofcooW~n: 24 Sc{~mb~r 2002 · l~mp Install: Well Log ])eptb tn feet from -" top or casing. Dct~ils of' romalio_ns penetrated, slz~ of materi~k color and barrios. 0 TO 2 CasingstickuP 2 TO 16 Cobble gravel: silty - 16 TO 19 Sil~t~ravel: damp .......... "'19 TO 21 Grave!ly.sand: damp 21 TO 40 Bedrock: grcc~iitstone argillite ....... 40 TO 210 As above: gravy 210 TO 247 As above: green layers 247 TO 260 As above: brown layers 260 TO 265 As above: little wa~er seap_in.fraclure ............... 265 TO 340 As above: gray 340 TO 345 As above: litmle more water 345 TO 366 As above: a lot of water in fracture zoo.e__ TO ''' TO T0 ..... TO ....~ ~ ~nan~ a ....... ~.__..~~ TO , . .i~ ~o'~. ~.4 & .~. ROBERI' C. COWAH, RE. ROBERT A. SItAFER, RE. Date: CIVIL ENGIhlEERS (907) 694-29?9 FAX (907) 694.12 J I MAJN EXl EtlSIOt.~ ,$EW~I1 & WATER INSI~CIIO~ TV'ELL t~,'SPECTK~I & FLOW SITE PLAflS $01t. IES! ~nCO[AItOH lEST Slr, UCIURN. & 01'1SlIE W,kO, i EWAT E R Municipality of Anchorage DEPARTMENT OF IIE~J~TI{ AND llU~AH SERVICES 825 ~ Street P.O. Box 196650 Anchorage~ Alaska 99519-6650 REFERENCE The eep[~c inspections for the re£erenced property were performed on ~-~0-0~ and ~-~-~. Prior to submitting tile On-site Wastewater Disposal Syste~ and/or Well Inspection Report we are waiting for kite ~5~R,/~V~y to be completed. If we may be of further service, please contact us. Sincerely, Robert C~ Cowan, P.E. 17034 h'Orlll I EAGLE RIVER LOOP & SUITE 204 · EAGLE RIVER, ALASKA 995?7 MUNICIPALITY OF ANCHORA GE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Jul 22, 2002 Expiration Date: Jul 22, 2003 Permit Number: SW020239 Legal Description: FOSTERS LT 62B Design Engineer: 0003 S & S Engineering Owner Name: Rod Metcalf Owner Address: 654 Harp Circle Eagle River, AK 99577- Parcel ID: 051-282-44 Site Address: Lot Size: 49954 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [~ Privy [] Private Well ~--~ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Ddnking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to Apd115, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995t9-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/~ELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number SW Mailing address (1) 1~.-~'/"// /'//~ff'~ '~'~' r"~./~--- Mailing address (2) ~------.~/~_ ~ ;I,'e/'; /'~/~' Legal description (Lot, Block. & Sub'd.) /--- ~'~- o/~)..O~j '~-'O.5~/'.~ Legal description (Section, Township & Range) Lot Size q ff 9 '~4'/ Day phonej~~u~ Zip C~de _~::~ ~--~'7'7 Acre~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Number of Bedrooms ~' [] Well Only [] ~ Water Storage [] [] [] Jacuzzi [] [] Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. ~J2 ~"/~------ S & S ENGINEERING 17034 Eagle River Loop Road No. 204 (Signature of property owner or authorized agent) Permit Fees: .~r'..~.,.~O. ,,; Waiver Fees: Date of Payment: ~ / ! ~' / O ~-. Date of Payment: Receipt Number: (2 3- ~.q 5' 9~ ~ Receipt Number: (Rev. 12/00) SEWER&WATER MNN EXTENSIONS SEWER&WATER I~CTIE~ ENGINEERING STUOIES A.NO R~PORTS WELL INSPECTION & FLOW TEST SITE Pt.ANS SOft. TEST PERCOCATtON TEST I:~SPC~AL SYSTEM I~ESIGN ROBERT C. COWAN, P.E. July 17, 2002 CML ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 62B, Fosters Subdivision It is requested that you issue a permit to install'a well and a septic system to serve the proposed three bedroom dwelling on the referenced property. A test hole was excavated and a percolation test was performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 5/17/99, water was not found. After monitoring, no ground water was found. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. ccmjj Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE204 · EAGLE RIVER, ALASKA 99577 LOT 62B, FOSTERS S/D n~TCN ~RIT~RT~. ~J~ _ pRi TO ANY EXCAV.TION ............ ~* 5 BDRM - 450 GPD PHONEI (907)694-2979 DR [INFIELD CRITERIA: / ~ 7.0' DEEP 4,0' EFFECTIVE 5,0' WIDE 38' LONG PROPOSED PERFORMED FOR: Munlclpalily of Anchorage DEPARTMENT OF. HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: ,~.~ 3~' ~ ~ jO r,~ko ~'e~ Township. Range. Section: SLOPE I I I SITE PLAN n ,©. ' ' 6 8 WAS GROUND WATER . 10 ~ ENCOUNTERED? ~_.'~,' )~ s ~ ~t~ IF YES, AT WHAT O · ., DEPTH? p 12 - ~ '..... ~ ~/~ E 14 15 16 17- 18- 19- 20- Gross Net Depth to Net Reading Da;e Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN . COMMENTS ~-**""-~ ~- _.~'~ z ~,~ ~, .~.. ~"...~ ~,~: Z/o ~'" Z~" ~l, PERFORMED BY: ~/' ~'"~ ~ r ~- I ~'~----~~~'-~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. ~' /~;"~" ~ '"~ --~---)'~ 72-0~8 (Rev. 4,85I SEWER&WATER MAJN EKTEN~IONS SEWER&WATER INSPECTION ENG~N'EERING STUDIES ANOREPORTS WEtJ. INSPECTION & FLOW TEST SOI/.TEST PERCOCATION TEST STRUCTURN. & MECH,~CAL INSPEC~ON5 ONSJTE W.a~TEWATER DISPOGAL SYSTEM ROBERT C. COWAN, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CML ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 62B, Fosters Subdivision July 17, 2002 GENERAL: The scope of this project includes the installation of a 1000 gallon HDPE septic tank and a drainfield trench to serve the proposed three bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground · utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577 Page 2 Lot 62B, Fo.ters Subdivision July 17, 2002 3. All standpipes on the septic tank shall extend a minimum of 12 iriches above final grade. 4. Septic tanks installed with less than 4 fL of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line betxveen the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The tint cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier coven the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. : Page 3 Lot 62B, Fosters Subdivision July 17, 2002 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 62B, Fosters Subdivision July 17, 2002 The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading ofthe property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner% representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work r~sts with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to can3' out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUMU PA UT V OF AHCHORANGE Development Services Department r Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-282-44 1. GENERAL INFORMATION Expiration Date: Complete legal description Fosters, Lot 62B Location (site address) 17660 Pioneer Dr, Eagle River, AK 99577 Current property owner(s) Barbara Pennington Day phone 907-223-9203 Mailing address Same Real estate agent Day phone 2. TYPE OF DWELLING: F-1 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: Private Well El Private Septic 0 Water Storage 0 Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for.- Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ _550 Date of Payment �/ /� Z z Receipt Number COSA # DS GZZ 12 0 l Date: Waiver Fee $ 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm_Crewdson Engineering Phone 907-280-9493 Address PO Box 671389, Chugiak, AK 99567 Engineer's Printed Name James Crewdson Date 5-9-2022 OF AL 6. DSD SIGNATURE �.. ... �'..� d System #1 Approved for 3 bedrooms amesA. Crewdson..- 011527 n.011527 .i System #2 Approved for bedrooms P` . •,�.= _...... Approved- _..__ Disapproved \\\tOFESSO � Conditional approval for bedrooms, with the following stipulations: ,OGF 4� By: __ 11�j� , N_)_J Original Certificate Date: I 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 Checklist blue sheet COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA 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 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 of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Fosters, Lot 62B 051-282-44 2+ 9-24-02 1100 366 28.3 24 Crewdson Engineering 5-6-22 102 5-6-22 Onsite records show 2 well logs. MW Drilling is the active well, Per owner: the Sullivan well was decommissioned within a year or two of being drilled. 19.7 steel 49" 10-11-2021 9-23-02 5-6-22 3 9.5 1 5.5 450+ 2 120 1 450+ No* *per owner ✔ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) 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 From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No 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 septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft Property Line > 10’Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S 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. ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Scuth Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 ¥^vw. ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APFROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-282-44 1. GENERAL INFORMATION .: '.. 'Completelegal d~scription Lot 62B; Location (site address or directions) 17660 .:.,..',.. Current Property owner(s) .,. Mailing addr&ss Leii'ai~ig agency · Mailing address Real Estate Agent Mailing Address Expiration Date: Fosters Subdivision 654 Harp Cir. Pioneer Drive Eagle River, (o :5 0 o.5-7 Day phone 229-3028 AK 99577 Day phone Day phone 2. NUMBER OF BEDROOMS: 3..iTYPEOF. WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL:, :~ Individual On-site [] Individual Holding tank []" Community On-site [] Public Sewer The Mu.nicipality of/~ncho~:age Dev~!opmen{'Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an indepen.dent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except be~veen spouses) for properties served by a single-family Ch-Site wastewater dispesal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90. days. from the date of issue for"i~reperties served by a'private or Class C well and may be reissued with new water sample results.' (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties'served by Class A or B weils or a public water system. The Municipality of Anchorage is not resp8nsible for errors cr omissions in the professional enginee~-'s work. 4. STATEMENT OF INSPECTION BY ENGINEER As codified 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 Authori['t Approval Guidelines for this application, shows that the on- site v.',=ter 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 Municipalit/ of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(ere) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm S & S Engineering Address 17034 N. Eagle River Loop Ste. 204 Engineer's Printed Name. Robert C. Cowan DSD SIGNATURE [,"/ Approved for Disapproved. Conditional approval f6r' Phone 694-2979 Eagle River, AK 99577 Date ~./7/o 27 bedrooms. ~ ¢,?,: ............. ,, ,., ~ bedrooms, wi[h lhe fol~0wing stipulations: Additional Comments Attachments: HAA checklist X · Septic System Advisory - Well Flow Advisory .... · Maintenance Agreements' Sbpplemental Engineer's Report ':. ,.,,.""~er ' .. ' "' .... " By: Original Certificate Date: ~- ! 5 - ~)-~ M!micipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program. 4700 South Bragaw SL P.O. Bax 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak, us (907) 343-7~34 HEALTH AUTHORITY APPROVAL CHECKLIST ~ DATA Well ~pe If & B, or C p~de ~ID ~ ~ Da~mpleted~/~ Sani~seal~lN) ~ To~l dep~ ~ff. Cased ~ ~ff. FROM ~ LOG Date of test Static water level ~ "~ ft. Well production I ~' g.p.m. Parcel ID: , Well Log (Y/N) y Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION V WATER SAMPLE RESULTS: Coliform ~) colonies/100 mi. Arsenic: '"' mg./I. B. SEPTIC/HOLDING TANK DATA Nitrate /, D rog. Il. Other bacteria ~ colonies/100 mi. Tank Type/Material ~ Tank size ~ gal. Number of Compar~ents Foundation .cleanout (Y/N) ~// ' Depression over tank (Y/N) Date of pumping /~/(-,'"~ .... "Pumper "-' C. ABSORPTION FIELD DATA · Length ~ · ft. Width ~' fL Total depth'~.~ ff. Eft. absorption area ~0 ~ Monitoring tube Results (Pass/Fail) Date of adequacy test /~J (-'~ Date installed ~ Cleanouts (Y/N) t.~ High water alarm (Y/N) ,~) System type Gravel below pipe '~[ ft. L/ Depression over field For '~ bedrooms Fluid depth in absorption field before test in. ~-New depth in. Elapsed Time: min. Fin ' in. Absorption rate >= '¢~'~-"'~ g.p.d. Any rejuvenation tm'~tment (past 12 mo.) (Y/N & type). ~ If yes, give date ~ UFT STATION Date installed '~/,~ ._ on" level a/ in. 'Pump Datum / Size in gallons 'Pump off level at Cycles tested in. Manhole/Access (Y/N) High water a~rm level at Meets alarm & drcuit requirements? in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift~,+~ff'on on lot / Absorption field on lot /00 ~"~' Public sewer main /,J Se.~l"/septic service line ~ ~'' ''~ SEPARATION DISTANCES FROM SEPTIC/~ TANK ON LOT TO: Building foundation ~' ~ Property line ~ ~' Absorption field Water main ~- Surface water Wells on adjacent lots /(~&~) /~' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / (~) 14-- Building foundation /~) / '~- Water main Water Service line / Curtain drain /~,'~ On adjacent lots On adjacent lots Public sewer manhole/cleanout · Holding tank Driveway, parking/vehicle storage Fe COMMENTS -., ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are/n conformance with MOA HAA guidelines in effect on this date. ~.z..~-~.~-'7~EE.~ ~,,,.~.~ C. Engineer's Printed Name Date 3 HAAFee $ ~75'. ~.~..o. Date of Payment ,~./~ =/0 Receipt Number Waiver Fee $ Date of Payment Receipt Number (Rev. 12/01) 2 BASIS 298.84' (R) 2/3/03 AS BUILT 57-71 S 00015'36"W 298.80' (M) 6/26/02 PLOT PLAN 55-45 1.8' x 9.0' DATE FLD. 8K. O CANTILEVER ♦1&Vka TAx CA + tyC 1 CANTILEVEEVE R p ♦�� •+••%��•• �� _ Pole 27.3 `�Q►�• •� p , p ®: ••• 0 d o i 9� • well ° 147.5' .. •...�.., S q F- G4'' z r M � Z 1 (D a, v is 4" PVC SEPTIC _ M_ w 1 7.0' Z n D N o ••••••••o •••��Iil� N p STD -PIPES (TYP) i! W 3 u, u I o m �. am D. Fleming 0� _> M- Q I N X 14.2' s�, e • J ,% LS -5773 o ' j d c�1 w 4.0 x 15.3' ♦� �f6 '•. • •o 9J t ' N - U I 96.6' 34.3, DECK O' p • • ... a •► -j I *� rofessionol Lo ♦` ry CO CO CO I W z I G¢P���o Lv o - - NOTES= Easements not appearing on record subdivision Z J I 4 ;n plat are not shown unless description of easement is U-1 i provided by client. It is the responsibility of the owner 1 ~ 46 0 W or builder, prior to construction, to verify proposed N N building grade relative to finish grade and utilities I w w connections, and to determine the existence of any I" M easements, covenants, or restrictions which do not zo zo appear on the recorded subdivision plat. 5 0600931 "W 150.33' (M) S 06°52'43"W 150.3 0) 0) Elevations based on assumed datum unless otherwise 30 4 (R) v) u) indicated, and bearings and distances are record data. S 00030'01 "W 39.90 (M) S 00°33'51 "W 39.95' (R) SSS Engineering Engineering S8S 17034 EAGLE RIVER LOOP ROAD S' R EAGLE RIVER, ALASKA 98577 �S�r`so (907)894-2979 S 62A /SsR s�� LEGAL DESCRIPTION s' 79 LOT 62B FOSTERS SUBDIVISION TYP. I — 112" ALCAP ON 5/8" REBAR RECOVERED PLAT NO. SCALE GRID 99-94 1 " = 40' NW 753