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Home My WebLink AboutSANDI HEIGHTS LT 10A5andi H ight Lot IOA #011 - 222-48 Municipality of Anchorage :~".~ Development Services Department · ·~:".~' Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Sox 196650 Anchorage. AK 99519-6650 Page of www.cLanchomge.ek.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW030044 PID Number: 011-222-48 Kevin Elfrink Wastewater System: D New [] Upgrade 9325 Endicott St ABSORPTION FIELD p~o~:345.4535 .umberofeedmeml: 3 D O..~.~h O Sh.,~Z~ ClS~ Eicon.. I-loth,,~ Soil Rating: Total Depth from ~gmal grade: LEGAL DESCRIPTION 1.2 o,~,~, 8.04 - 10A Sand/Heights 6.04 Ft. 2.0 .... 0.53 to 0.88 Ft. 54.0 Ft. ~ r-INew r-lUpgrade 6tav~l~na~: 5.0 Ft. Numbe, dlines: ( DtstancebetweenllreS:l NA Cta ss~f, cat~ (P rrvate, ~'~. ~..,...,..,.,.....~ To<al Depth: I Cased to: T O~el llt)soq~tiO~ erea: P~e Matanal: F~ FL 386 Fr~ ASTM D3034 1 F810 R. A+ Home Services 3/28/03 Y~eld:GPMI Pump Set at: Fo Desmg Hei~~ TANK SEPARATION DISTANCES E]septic E~Holding [-~S.T.E.P. ["lOther: Septic Absorptior Lift Holding 'ublic/'Prhrate Manulacturer: Tank Field Station Tank Sewer Une Anchorage Tank 1000 wo= 200+ 200+ NA NA 200+ Steel 2 s...,.w.,.. 100+ 100+ NA NA ~ / ~ LIFT STATION · or ~,. 22 5.0 NA NA F~.~.~, 8 ~8 NA NA ~ ~,. NA NA NA NA Pump Mal(e S M°de' Etectr~al In~pe~on, ped~med by: Lot line waiver to north property line approved on BENCH MARK 3-26-03. ~...u ~.~,,o.: Bottom of siding at southeast corner of house 100.00 Inspections performed by: Cindy Ellis, P.E. Dates: 1'l 3/27103 ~'~'"~ Development Services Department Approval ~t~: Ci[~dy W. Ellis/~] Permit No. SW030044 Page Date: 4/04/03 3 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT IOA. SANDI HEIGHTS SUBDIVISION PID No.: 011-222-48 I I I NOTES: I I I 1. THIS AND ALL I I I SURROUNDING PROPERTIES COO I I I SERVED BY COMMUNI1Y WATER. ADJACENT OCO I I I I 2. 1.O' LOT UNE wNVER TO HOUSE I I I ADJACENT I I I I NORTH PROPERLY LINE. o' I SEPTIC ~ ~ /--ST1 I TH~1 ~_. ~J TBU BOTTOU OF ORIGINAL SEPTIC TANK REMOVED ORIGINAL SEPTIC SYSTEM ADANDONEO--'~ ( \ SEP'~C / sEPTIC \ I ' ASBUILT I SCALE: 1"=50' ST1 17.8 39.2 ¢01 74.2 4e.~s j W. EJJJs Permit No. SW030044 Date: 4/04/03 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION Page 3 of 3 P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 543-4744 On-Site Wostewoter Disposal System and/or Well Inspection Report Legal Description: LOT IOA, SANDI HEIGHTS SUBDIVISION PID No.: 011-222-48 DC01'-~ /-DC02 DC03-~ /-DC04 \ / r,HA /-ST, \ / ~11 II~J. II D~ I II II SEPBC TANK SEPTIC SECTION N .T.S. MTI--~ 91.86' ,co~ co2--,,, ~.. F..,~,,,~C.~ F1N AL GRADE 99'39' - 100F.~,x,~;.43' /--4'¢ PIPE ] Il UOTE: / I II OR~C=N~ C~E = X93.86' x91.86' 54.0' TRENCH N.T.S. Municipality of Anchorage ill-America CJ~ George P, llSterch, ® Mayor 2002 3/27~2003 Cindy Ellis Watkins Engineering Subject: Waiver Request for 1 fl Lot Line Waiver Request #WR030021 Parcel ID #011-222-48 Dear Ms. Ellis: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 1.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, ~eer On-Site Water & Wastewater Program P.O. I~)x 196650 * Anchoragc, Alaska 99519-6650 · Tclcphonc: (907) 3zt3-8301 * I:~tx: (907) 343-8200 4700 ~uth Bragaw Strcct * Anchoragc, Alaska 99507 h t t l)://xx~x~v.ct.anchoragc.ak.us WR#: 0:~0021 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoragc.ak.us (907) 343-7904 Waiver Review Worksheet PID~: 011-~22'48 HA//: Permil~: ~W030044 Date Received: 3127109 Legal Description: Sandl Helahts Lot Engineer: Wp~kin~ Enalneerina Applicant: Cindy Ellis Waiver Requested: 1 Foot Lot Line Waiver Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: Total: Waiver is Granted: Waiver is not Granted: List Conditions or Reasons for above: /'~l~a/~of Reviewer Rec~: ~2990 Amount: $150 Date Paid: 3/2712003 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box Ig6650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Mar 14, 2003 Expiration Date: Mar 13, 2004 Permit Number: SW030044 Legal Description: SANDI HEIGHTS LT 10A Design Engineer: 0844 Watkins Engineering, Inc Owner Name: Kevin Elfrink Owner Address: 3300 C Street Suite 115 ANCHORAGE, AK 99503-0000 Parcel ID: 011-222-48 Site Address: 009325 ENDICOTT ST Lot Size: 10624 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field ~ Septic Tank [] 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 Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Municipality of Anchorage Development Services Department ' Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWEPJVVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-222-4~ Permit Number SW O~OO'~ Property owner(s). Kevin Elfrink Mailing address (1) 3300 C Street, Suite 115, Anchorage. AK 99503 Mailing address (2). Legal description (Lo~t, Block & Sub'd.) Sandi Heights Lot 10A Legal description (Section, Township & Range) Lot Size 10624 .Day phone 727-2150 Zip Code Acres/Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only [] Well Only [] Sewer and Well [] Water Storage [] Sewer Upgrad~ [] THIS PROPERTY CONTAINS: Hot Tub [] Jacuzzi [] Swimming Pool [] Water Softening Unit [] Therapy Pool [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwell~ing and is in accordance with applicable Municipal Codes. (Signature of I~'operty owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: ~ (~'~O.~'~ Date of Payment: Receipt Number: .~>~_(~C_(O ~Vatkins Engineering, Inc. ?.O ]}ox 110~43, Anchorage, AK 99511 (907)$z$9-1851 cwellis~gci.net March 6, 2003 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: Sandi Heights Lot 10A Sewer Upgrade Proposal To Whom It May Concern: Attached please find the application and supporting documentation for upgrading the onsite sewer system at the referenced 3 bedroom house in the Sand Lake area of Anchorage. The original sewer system was installed in 1971 and consists of a 1000 gallon steel tank with a 12 ft x 12 ftx 6 ft log crib. This system has now failed, and it is proposed to install a new 1000 gallon steel tank and a 5 ft wide drainfield. It is proposed to retain the old crib as a reserve system. The old tank will be abandoned in place. The house is served by a public water system, PWSID 210485. The proposed design of the upgraded system is based upon a test hole dug on February 26, 2003 to a depth of 16 ft. The soils log is attached. No water was encountered when the test hole was dug or after 7 days of groundwater monitoring. The soils were sand and gravel, with a coarse-grained sand across the proposed absorption interval. A percolation test was performed between 7.5 and 8.0 feet. The perc hole could not be kept full, resulting in an absorption rate of less than 1 minute per inch. It is proposed that a conventional drainfield be installed using the in-situ sand as a natural sand filter material. Proposed Soil Absorption System: 3 Bedrooms x 150 gpd / BR = 450 gpd Application Rate: 1.2 gpd /ft2 Square Feet Required: 450 gpd 11.2 gpd/ft2 = 375 ~ System Type: Shallow trench (5-wide) Effective Depth: 2 ft Maximum Depth 7.5 ft Sewer Upgrade Permit Application for Sandi Heights, Lot IOA Watkins Engineering, Inc.; March 6, 2003; page 2 Reduction factor = 0.70 Length Required = 375 ~ 1 5 ft * 0.70 = 52.5 ft Proposed Length: 54 ft I am not aware of any adverse effect that this upgrade would have on any adjacent properties' water and wastewater treatment needs. There are no surface water concerns, and the well serving the public water system is greater than 200 ft away. All adjacent properties are connected to the public water system. Thank you for consideration of this permit application. If you have any questions or need further information, please call me at 349-1851 or 360-3389 (cell). Yours truly, Cindy VVJ Ellis, P.E. President Attachments: Permit Application & Fee Site Plan, 100 scale Proposed Upgrade Plan, 30-scale Soil Log I I I c.~ ~ ! I ~ I ~ ( EXISTING SEPTIC ~OT 1o^ ~T I ~ LOT ~ --DOUBLE C.O. ,.,., t-- PROPOS (;ALLON '~00 ~ _ I ~ - u~ i ~ /~ -~'---DV i I I ~ ~x SEPTIC I ~ST,NG ,OUSE ___ I,rF--'~ ~"/~,;-L.', :_ I w EXISTING TAN LOT 9A EXISTING SEPTIC TO BE/ I LOT 6A RETAINED FOR RESERVE--' I I i/EXiSTiNGX~ I Ix SEPTIC/~ I I tx SEPTIC ,/ I I I I I I I KEVIN ELFRINK ~ -'-~i~"%'~ SANDI HEIGHTS SUBDIVISION Jr__:____ .... Watkins Engineering,/nc. DATE: 2/28/03 ~',,,, Cin~yW. Ellis SCA,E: Cindy W. £11is, p.F. DRAWN: DO~ ~.'X~'>.........-.';~.~- P.O. ~OX 110443 ANCHORAGE. ALASKA 99511-0443 CHECKED: CWE PHONE: (907) 349-1851; FAX: (907) 349-1934 ~ /-MOUND OVER DESIGN CRITERIA: (TH~I) ~--~"- fGRADE ,3 BDRM X 150 = 450 GPD APPLICATION RATE: 1.2 GPD/SQ. FI'. -1.5_ ML -2.5 GW ~ \ ~/mFILTER FABRIC 5.0' WIDE TRENCH -3.5 Z cw/sw ~. ~1 450/1.2 ~ ~75 SQ. ~. REQURIED .~ 375/5 X . = 52.5' REQUIRED TRENCH TRENCH: SP ~D~IN ROCK 7.5' DEEP _ 2.0' EFFECTIVE 5.0' WIDE -16,o ~ O) 5~' LON~ I NOTE:--I ALL SURROUNdeD PROPERTIES SER~D BY CO~ ~UNI~ WATER. I I I -SHORECREST DRIVE- m ~ ~m - m E> IST)NO ADJACENTm SI ~P~C - ~mCAL. ' I ) LOCA~C qS APPROXIMATE~ II -- < I iI ~ EXIS3NG~ IOUSE~~J '/~-~ ) m ~ ~ ~ '~ ~PROPOSED ~TEM ~ EXISTiNO mS ~PTIC I o ~ -~ (~'~ ~ o ~ I ~ I X -EXIST~NG ADJACEI r z m SEPTIC - ~Pl~ ~ LOCATIONS ~PRC XIMATE , I I I -94TH COURT- I I KEVIN ELFRINK SANDI HEIGHTS SUBDIVISION "~. Prepored WatkinsEngineering,Inc. DATE: 2/28/03 CindyW. Ellis, P.E. SCALE: 1"=100' ~.,, CE-10517 , .~ P.O. BOX 110443 DRAWN: DJR ~.~_.....:~' ANCHO~GE, A~S~ 99511-0445 CHECKED: CWE PHONE: (907) 349-1851; FAX: (907) 349-1954 Performed For:. Legal Description: 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Soils Log - Percolation Test Kevin Elfrink Sandi Heights Lot 10A Date Performed: Feb. 26. 2003 Township, Range, Section: Slope Site Plan FL T WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Walar After Monitoring? pets: Reading Date Gross Time Net Time Depth to Water I Net Drop Could not fill perc hole. see comments ~ PERCOLATION RATE (1 (minut~,r~cfl) PERC HOLE DIAMETER 6' TEST RUN E~EN 7.5 FT AND 8.0 FT COMMENTS Clean course send. C~ld not keep pe~ hole full of water- water ran ri0h! throu~lh. PERFORMED IN ACC~IT. ALL STATE AND MUNICIPAL GUIDEI~ES IN EFFI~CT ON tHIS DATE. DATE: (• �-tl Municipality of Anchorage On -Site Water and Wastewater Program` t (907) 343-7904 CERTIFICATE OF 4N -SITE SYSTEMS APPROVAL Parcel I.D. 011-222-45 1. GENERAL INFORMATION Complete legal description Sandi Heights Lot Location (site address) __9325 Endicott St. Anchorage AK Expiration Dater7-- R -,?,0`;? -.2- __ Current Property owner(s) Charles Schmidt Day phone Mailing address Real Estate Agent 9325 Endicott St. Anchorage AK _ 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well ❑ individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ WaiverNariance request for: Received by: 3 Day phone TYPE OF WASTEWATER DISPOSAL: Individual N Holding Tank ❑ Community ❑ Public Sever ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ q U 50 Date: coy I D ^ 1 1 Waiver Fee $ Date of Payment —__7 ~21 — 20 Receipt Number e2T(V_Z1 —4 ._. COSA# OSC201 3`-43 Date of Payment Receipt Number Waiver # stance: 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 frorn 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 ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD_, EAGLE RIVER, AI< 99577 Engineer's Printed Name ._KENNETH M. DUFFUS Date Engineers Comments: This investigation was completed in compliance with ADEC and PROP, regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen 01" TT� encroachments, deficiencies or discrepancies exist. �� _1 -, S TI%\ 6. DSD SIGNATURE _ System #1 Approved for bedrooms. �{ \KENNETH tItE,1J System #2 Approved for bedrooms. fc� J F`'',.i • l:r 0, Disapproved. Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: —:2-1 — D; 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 tm.,e sheet_W-10-12.doc Legal Description: SandiHeights Lot 10A Parcel ID: 01.1.-222-48 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 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 CO Static water t beginning of test ft. S. TANK DATA Age of tank(s) 17 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49 Standpipes/foundation cleanout per record drawing Date of pumping 6/15/20 D. ABSORPTION FIELD DATA Which system tested (date installed) 3/27/03 ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade 6 ft (min) ❑ N/A — pressurized field ON 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 Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test Water storage tank volu gallons Well disinfect coliform test? ❑Yes Nc ❑ rm bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 718/20 Results FV -1 Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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 Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft o ft Neighboring Tank > 100' ❑ Yes if No It Private Sewer! `' e > 25T0 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft mg Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main - 10' Animal Containment > 50' ❑ Yes if No ft s if No ft FvJ Yes if No ft Water Service Line > 10' ® Yes if No Manure/Animal Excreta Storage > 100' Commtln' r Main > 75' ❑Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required Building Foundations > 10' ❑ Yes if No 8* ft Surface Water > 100' Yes if No ft Property Line > 5' Yes if No 22 ft Wells on Adjacent Lots: Yes Absorption Field > 5' Yes if No ft Private Wells > 100' Yes if No ft Water Main - 10' Yes if No ft Community Wells > 200' FvJ Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lotto: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No 38 ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No Sr ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' ® Yes if No ft Surface !,Nater > 100' ® Yes if No ft F. ENGINEER'S COMMENTS , Lot line waiver to north property line approved on 3/26/03 #WR030021, Yr Met code nt time of installation G. ENGINEER'S CERTIFICATION 1 certify that 1 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. COSA Checklist yellow sheet OZ,9Z 7; ± & � § )O\ f k®� .-.. ------------------------------------------- /338/S // 0J/GN3 \ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011.222-48 i. GENERAL INFORMATION Complete legal description Sandi Heights S/D, Lot 10A Location (site address or directions) 9325 Endicott Street Current Property owner(s) Kevin Elfrink Mailing address Lending agency NA Mailing address Real Estate Agent NA Mailing Address Expiration Date: /'7z' ~ / O - O/7/- Day phone 727-2150 3300 C Street. Suite 115, Anchorage, AK 99503 Un/ess otherwise requested, HAA wi//be he/d by DSD for pickup. NUMBER OF BEDROOMS: 3 Day phone Day phone TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well [] D [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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 beb,veen spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water sample results. (Cedificates may be reissued for a pedod of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functiona. I and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy 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 ell applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Watkins Engineering, Inc. Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis DSD SIGNATURE t,~ Approved for --~ Disapproved, Conditional approval for bedrooms. Phone 349~1851 Date April 7, 2003 city w. E,is bedrooms, with the following sti[ Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: {Rev, 01~2) Municipality of Anchorage Development Services Department Building Safety OMslon On-Site Water & Wastewater Program 4700 South Bragaw St P.O, Box 196650 Anchorage. AK 99519-6650 wv~v.munl.org/onslte (907) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: San~ Heights Lot ,10A Parcel ID: 011-222-48 WELL DATA Well type A IfA, B, or C provide PWSID # ~04~ Well Log (Y/N) N ~ ~[T,,,,,,,.~~,~,~v,~sed toSanltary seal (Y/N) Wires pmpedy protected (Y/N) __ .~ Casing height (above ground) FROM WE'[~'~,....~ AT INSPECTION Date of test ~ SteUc water level lt. ff. Well production g.p.m. ~ in. Coliform . colonies/100 mi. Nitre Other bacteria colonies/100 mi. Arsenic: mg./I. Date of sample: Collected by: _ e. SEPTIC/HOLDING TANK DATA Tank Type/Material 1000 gallon ~teel tani~ Tank ~lZe 1_000_ gal.. :. Number of Compartments .2 'Fo~,ndatlon cleanout (Y/N) DC0.,' Depression over tank (Y/N) n. Date of pumping new tan.k, .' Pumper NA C. ABSORPTION FIELD DATA Date installed 3/27103 Sbll ret~ng (g.p.dJIt2 er ~fodrm) 1.2 Length 54. . :... ff. ' Wklth $ ff. Total depth 6.04 It. ~ Eft'. absorption area 386 t~ Monitoring tube Y Date of adequacy test NA- new Results (Pass/Fall) N~ Fluid depth In al3sorptlon field before test NA ~ Water added. NA gal. Elapsed Time: NA min. Final fiuld depth NA In. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Date installed 3/27/03 Cteanoute (Y/N) Y. High water alarm (Y/N) n System type shallow trench Grovel below pipe 2.0 It. Depression over field n For 3 bedrooms New depth NA in. Absoq3fion rate >= NA g.p.d. If yes, give date NA D. LIFT STATION B-a~-~.'. *?~J~:l NA Size in gallons Manhole/Access (Y/N) ~--, 'Pump on" leve~,evel at in. Datum Cydes tested Meets alarm & circuit req ' SEPARATION DISTANCES w WELL ON LOT TO: ell __ On adjacent lots Absorption field on lot ~nt lots Public sewer main Public sewer man ut. Sewer/septic sen/ice line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 8 Water main 60+ Wells on adjacent lots 2o0, to crab A Property line 22 Water service line 30+ Absorption field 23 Surface water 100+ Water Service line Curtain dreln None known F. COMMENTS SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5 *waiver approved Building foundation 38 Water main 100+ Driveway, parking/vehicle storage 65+ Surface water 100+ Wells on adjacent lots 200+ New septic syste~m installed on 3/27/03~ Old crtb w abandoned~ Lot line waiver to north property line was approved. ENGINEER'S CERTIFICATION ~.~..,.,~.~ G. I certify that I have determined through field inspections end ~._~..~".~ ~ %.?.~ review of Municipal records that the above systems are in ~ .~...' ~ ~ t.~ J~ , '...~__..~ Engineer's Printed Name Cirldy W. Ellis t.~~~ .F..~B.~~ HAA Fee $.~,~._.~~ Waiver Fee $ Date of Payment->/-. J/A~'~ Date of Payment Receipt Number ~;;>~:7 (-3-~ ---~ Receipt Number (Rev, 12~01)