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Home My WebLink AboutHULSE #2 LT 10Hul Lot 10 #050-521-73 Municipality of Anchorage ."', '-'-:, Development Services Departmenti~r~?"~' Building Safe~ Division On-Site Water and Wastewater Program, 4700 S. Bragaw St.-- P.O. Box 196650 Anchorage, AK 99519-8650 Page ~ of .~. .. www. ci. anchorage ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW020114 PID Number: 050-521-73-000 REKER WastewaterSystem: [] New [] Upgrade POB 772904 EAGLE RIVER AK g9577 ABSORPTION FIELD NA 10 HULSE ADDITION #2 0 ~t. 0.7 EXISTING PRIVATE ~,. ~, 245 ~ pvc sch 40~ astra 3034 ~, midni~htsunexcavatin~ 612~2002 ID Septic ~ Holding ~ S.T.E.P. ~ Othe~ ADVA~ S EPARATION DISTANCES Tank Field Station Tank s~ L,.e ~ ORENCO 1500+~ w. +100 +100 +100' n/a +100' FIBERG~SS 2+ pump basin ~=w.. +100 +100 +100 ~a ~ / LIFT STATION 180 ~ ORENCO ~ 30' 75' 40' n/a~ 36 ~ 34 .~ 38 PEF~0 orenco SPARROW ELECTRIC LICENSED ELEC. advantex ~0 system InstallS. existin~ tank pumped crashed and BENCH MARK buH~ onslte, existing leachfield abandon~ in place. New TOP OF WELL CAP leachfield has 1.25' laterals with 118" o~ce spaced at 2' with 2 ~ 100 runs of pipe. each mn of pipe has a cleanout at ~e end marked Engineers Stamp Inspections pedormed by: EAGLE RIVER ENGINEERIN Dates: 1" ~/~ ~ ~a/~-~ ~-~ · Development Se~ices Depa~ment Approval ~"~'~--'--~"~ Permit No., 020114 Page 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage. Alaska 99519-6650 Telephone: 345-4744 On-Site Wostewoter Disposal System and/or Well Inspection Report of 2 Legal Description: , HULSE #2, LOT 10 PID No.: O50-521-73-000 RIO0.O' L=89.15' R=50.O0' SCALE: HOUSE / / MI'H2 ./I '- I~[ \,... II \,.,.. I~''~ --~--- ~ES[ LOtiONS ~[ ~[D OFF THE HOUSE LaoTIaN FROM 1985 ~BUILT SU~ ~O ~E CORRECTED FROM OUR PERMIT SUBMI~AL 5-02. TEST HOLE MONITOR TUBE SEWER CLEAN OUT WELL EASEMENT LEACH FIELD DRN['WAY · 6/24/02 ENCINEER'S SEAL ~.- ........· ~ LOUIS A. BU~RA ~-25-2002 09:12;~1 Fl~tl E.R. Engtneertn9 Suc$. TO 34379<3? P.O~ Office: (907'} 344-5539 "SPARROWSi' ELECTRIC INC 7310 Bulen Ortve · Arctmmge, AK 995C7 FAX: (~:)7) 344,55,38 '"SPARROW'3"' .~[.,F~"f'I~: Z'tAS W'~.E.D THIS SYS~'F.,M ACCORDING TO MANUFAC'fURES RE, COMIdI~AT/O~ ~ TO MUIq~C1PLE, STATE AND~ NATIONAL 1E2.E, CTRIC COi)~ STANDARDS. TH~ WORK ON Tlt~ ~ ~ 1 ~M WAS I~D bY' JOURI,/LrYMAN ~1 ~CTR/C~AN, SYSTEM C14ECY~ ~ t'ERFOR~F_D AT JO~SrTE t.~ON ,C~Ota~...~'~O1~T C~F ~:~O~,CT. I~3¢'ESIONALLY YOURS: MUNICIPALITY OF ANCHORAGE Development Services Depa~lment On-Site Water & Waslewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 15, 2002 Expiration Date: May 15, 2003 Permit Number: SW020114 Legal Description: HULSE#2 LT 10 Design Engineer: 0024 Eagle River Engineering Services Owner Name: Reker Owner Address: 25449 Crystal Creek Rd EAGLE RIVER, AK 99577-0000 Parcel ID: 050-521-73 Site Address: 025449 CRYSTAL CREEK DR Lot Size: 72745 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 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 Wastewatar 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. Issued By: J~' Date: Date: Municipality of Anchorage Development Services Department Bui{ding Safety Division On-Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 A~chorage, AK 99519-6650 www.ci, anchorage, ak. us (907) 343-7904 ON-SITE SEWERJWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING ParcelI.D. C35"~)" 5'-~1 - 77-.).~o Permit Number SW OZ, O//~t F=rc;o~· c'.':nor(s) Mailing address (1) Mailing address (2) Day ~hcne Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Let Size /-P + Acres/Sfl-EL '"/o~ 7q~- " THIS APPLICATION IS FOR: Sewer Only 1-'] Sewer and Well [] Sewer Upgrade ~, THIS PROPERTY CONTAINS: Hot Tub [] Swimming Pool [] Therapy Pool [] Number of Bedrooms ,, z./,, 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 ?n accordance with applicable Municipal Codes. (Signature of property owner er authorized agent) Permit Fees: Date of Payment: Receipt Number. (R...v. 12/C0) Waiver Fees: Date of Payment: Receipt Number, Eagle River Engineering Services Louis Butcra, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax May29,2002 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 10 Hulse Subdivision #2 Addition, ADVANTEX SYSTEM Dear Mr. Cross: When excavating for the original permit #20114, septic tank replacement, xve discovered a high ground water situation. The existing leachfield will therefore have to be replaced and due to limited area available and separation distance to ground water table requirements we are utilizing the Advantex system. An area has been cleared and a bench constructed that will accommodate a 5' wide leachbed and 35' horizontal distance to change in slope of 25%. This bench was created out of a 25% slope and the native soil material that will accept effluent has been percolation tested in 3 different holes on the uphill side of this bench. We do not believe that construction of this system on this benched slope will result in any surfacing of effluent. Adjacent to the bench and relative to the uphill side, a deep hole was excavated with ground water monitor installed that was placed to determine ground water table separation of+2' will be obtained as assumed allowed by Advantex. The system will utilize the Orenco lift pump basin to the leachfield. The existing leaching system will be completely abandoned. We would like to start xvork on this system immediately for home closing. The proposed revised septic system upgrade will have very limited impact on adjacent properties for the following reasons: I. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. This permit is for replacement of the septic tank and leachfield with an Anchorage tank Advantex system, requiring reduction in leachfield area and 2' vertical separation to ground water table. Surface drainage will only be affected at the leachfield site and will not affect the neighboring properties. This work will not affect the reserve area on adjacent lots. lfyou have any questions please call our office at 694-5195. Louis Butera, P.E. k2002\02.004n UAR.DOC ~ / \ R--50.O0' ~ .~, ~ i L-89 15' o J~luu.u ~ 1 - · ~C ~ - ~EST HOLE ~STAL CREE · - UONITO. TUBE THIS IS NOT AN ~ND SU~ AND IS ~ ~1~ o - SEWER CLaN OUT BASED OFF AN AS BUILT SURV~ DONE IN 1983 ~ + - WELL LOCATIONS ARE APPROXIMATE. - .... ~SEMENT '~ - PROPOSED L~CH FIELD NO SURFACE WATER c ~--.- EXISTING L~CH FIELD NO KNOWN CURTAIN DRAINS ~- DR~AY WERE/SEPTIC SITE. PLA LEGAL: HULSE ~2, LOT 10 EAGLE RIVER ENGINEERING SERVICES' ~ '~ou,s ~. Bu~R~ · P.O. Box 773294 EAGLE RIVER, AK. 99577 (907] 694-5195 FAX: (907] 694-3297 EAGLE RIVF- ENGINEERING SE..,ICES P. o. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 SCALE Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel [~agle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM - MOA CERTIFIED INSTALLER LEGAL: Lot 10 tlulse Subdivision #2 Addition REV June 1 I, 2002 A. GENERAL I. The well and septic plan is for a 4 bedroom single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of llealth and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. B. ADVENTEX SYSTEM AND SEPTIC TANK I. Septic tank shall be a fiberglass 1500-gallon tank capacity of MOA approved construction for use with Advantex system. Install as per manufacturers recommendation. Existing tank is to be pumped and properly disposed of. 2. Install one AX-20 filter pod over septic tank capable oftreating 600 gallons per day ofwaste flow. 3. Install Orenco 24" pump basin PB-2496 outside septic tank, with OSI pump model PEF 40 and controls to allow 23 gallon dosing of septic leachfield. Set pump float to 13.5" above pump, timer for 1 minute dose time. Controls to be installed to MOA code by licensed electrician. 4. A receipt from a licensed electrician shall be provided to the engineer verifying lift station wiring to all applicable codes. C. DRAINFIELD TRENCII I. The trench is to be located in the benched area shown on tile site plan, this area will require building out tile transition of the slope to allow leachfield placement 35' from the edge ora change in slope of +25% or extending the top of slope. 2. The total depth of the drainfield excavation is not to exceed 2' relative to gruund elevation at ground water monitor tube and located in scarified native GM soil material. The bottom of the trench shall be level, plus or minus 1.5" prior to placing sand. A 2' layer of coarse sand is to be placed over the native soil material to allow an effective depth of 4' to the measured ground water table level at the ground water monitor tube. 3. A one foot layer of gravel is to be placed over the sand material. The effluent piping is to be buried within tile gravel layer with 2" of gravel cover over the piping. 4. The completed trench gravel and piping is to be covered with typar fabric material. 5. Soil or combination of soil and extruded board insulation to a depth of+3' or equivalent is to be placed over tile leachfield. The upper slope may be raked down over the leachfield to provide cover material. 6. Existing trench is to be abandoned in place with pipes cut offor removed. RECOMMENDED LEACIIFIELD DIMENSIONS: TOTAL DEPTtl = 4' above water table. GRAVEL DEPTtl = 0.$' under effluent pipe, 2" over pipe DRAINFIELD LENGTtl = 45' DRAINFIELD WIDTI! = $' SOIL RATING -- 4 GPD/fl2 BEDROOM CAPACITY = 4 EFFLUENT PIPE = 11/4" from pump basin to leachfield then manifold to I" PVC with I/8" holes oriented down spaced at 2' OC. 2 runs in leachfield 2' between pipes 1.5' from sidewalls of trench. Twenty-four (24) hours notice required for all inspections. ~2001\02-004 adventcxTrench- spec.doc Total Dynamic Head (TDH), feet m Mumczpality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 SOILS LOG "-- PERCOLATION TEST 15. 16. 17 18 Louis ~ B~e .~ F 19 20 ,/-././Se. ~ ~. Township. Range. Section. I I ,--t' '1' I li\l i WAS GROUND WATER ENCOUNTEREO~ SITE PLAN I I I I '.1 I I I t I I I I I I'llllllll I I i I I I I I I Ei I I I ! I Municipality of Anchor3ge Cevelcpment Services Oepar~.ent n~cl~'l~ P.O. Box 1~ ~e. Soils Log - Percolation Test ~ T,,~ ~.~ I / ~ r~ 7. 0 ~.~ ~: 13- 15- 16- 17- 18- lg- 20- CCMMENT$ ,Z~--' ~/ ~, r_-.~-., T~hlp. Range. Se~on: :T I~/I/, ~ I I/V ~,,le Plan / I ~12~10~ ~.o0 , ~ ~ , ~:~o.o~ ~o~;~ lar'%~' ~e" Municipality of Anchorage Ceve!cj:me~t Semites Oe~'~men~ C~-~,te ~ter a~d W~t~ater 4~ ~ 8~3w SL P O. 9ox 1S~ A~o~e. AK ~951~6~0 Soils Log - Percolation Test ? ! ~-~. r I ~-i.~ ~0- 0:' , Rea¢ing IIII Municipality of Anchorage Cevelc~ment Se~/ices Oepar',m. ent C~;te ~ ~ Wu~tee P~ P O. Box · ' .,.. Softs Log - Percolation Test 2- 3- 4- 5- 6- 7- 8- 11- 12- 13- 15- 16- 17- 18- 19- 20- EAGLE RIVER ENGINEERING SERVICES P. O. Box 773294 EAGLE RIVER. ALASKA 99577 Phone 694-5195 CHECKED BY DATE o --50.00 ~ R;0~.0, ", L'--89"s' , , 0F OPE o ._ ..... -- ~ ~ ~~~~ ~ ~C~Ys... ~ - TEST HOLE ~ I~L C~ · - MONITOR TUBE BASED OFF AN AS B~T SURV~ ~ONE IN 1983 ~ ~ + - WELL LOCATIONS ARE APPROX~TE. ~ ..... ~SEUENT ............... ~ t ~----:- PROPOSED L~CH FIELD ~ - DR~AY WELL/SEPTIC SITE PLAN LEGAL: HULSE ~2, LOT 10 ~ OWNER: REKER - CONTRACTOR: N/A 9~ ~O"~02-O0~WS/D*TE: ~/29/02 I SCALE ~ = 6O': ~~~...~ EAGLE RIVER E~CI~EERI~G ~ERVICEE ~ ..~ou~s*. P.O. ~o~ 773294 ~,~ .... .... ~= ~ RIVER, ~. 995?7 '~.~ '" frilI (907) 694-5195 ?AX: (90~) 694-g29~ /"%, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~;TION · ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~ IPHONE I [~'~EW LEGAL DESCRIPTION LOCATION DISTANCE TO: Well ~ Absorpt~n~e~ v Dwelling o'T z4J t~[O O Material I F HOMEMADE: I Width ~ Liquid de~pth NO. OF BEDROQ~ PERM' COa O No, of compartments Liq. capacity in gallons D STANCE T~ Inside length _.~Dwe ng Man~ Well DISTANCE TO: Well P ~-i~/" No. of line~ I L,cj;gJ~b of each line Top of tile to finish gr2de~ ~. /3,,2.S F°~a~0T-/ /~,.~) INearest lOt line Total length o;~ lines I Trench wicJ&h., tOO I D(.~ inches Material beneath tile PERMIT NO. PERMIT NOir..~ O (~ '~'~ Distance ~,~een lines Total effective absorl~(~r~ Length ! Width Depth Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Depth Driller Distance to lot line Building foundation Sewer line Septic tank DISTANCE TO: PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS SOl L TEST RAT~/N~ ~)¢ ! REMARKS A~ DATE LEGAL by [DOC Co. dba SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK. ALASKA 99567 · TELEPHONE 688-2769 OWNER OF LAND ADDRESS ~' .... LEGAL DESCRIPTION DATE - Started ,Y;" PERMIT NUMBER / :; -,, ~, DEPTH OF WELL __: ~ / /~ /47 STATIC LEVEL OF WATER F'r. ~?,' ~/~,. ~, .'~: ~'~',:5~,:~? ,:~:~ ~:~ ~DRAW DOWN FT. Ended ,; .- 7f ) GALS PER HR KIND OF CASING ~ '"~ ~'t'~ KIND OF FORMATION: From Ft. to ,~::~'~Ft. ~ ,.dcf' ,~' ,:, .~r,~ ,/.~-~ - -,~- From.- From ~, Ft. to / :i/ Ft. ~ < ? ~ ,~ ..... : -:~ ~,~,::'~rom~ From ' -i Ft. to ,~ ,-) Ft. , ~,- .,~,K,,~ :-,' ,'- From~ From From. Ft. to Ft. . ,,:, 7 2~ .... >'~'; ~:'~ From From Ft. to ,' ,. From_~_Ft. to Ft. From ~_Ft to. .Ft From Ft. to Ft. From Ft. to Ft, From ~ Ft. to Ft. From __ Ft. to Ft. From __ Ft. to.~.Ft. From. Ft. to Ft. From___Ft. to. Ft. From Ft. to. Ft. From Ft. to Ft Ft. to__Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft Ft. to Ft. From Ft. to__Ft. From Ft. to___Ft. From Ft. to__Ft. From Ft. t¢' Ft. From__Ft. to Ft. From ~ Ftfto Ft. From__Ft. to__Ft. From Ft. to Ft. From__Ft. to .Ft. From Ft. to Ft._ From Ft. to Ft. From Ft. to Ft~ MISCL. INFORMATION: 7 PERMIT NO. APPLICANT LOCATION LEGAL SMOOT CONST INC LtO HULSE #2 ~'~UN~Cz~t ~l ~l'~' OF DEPARTMENT OF'HEALTH AND ENVIRONMENTAL PROTECTION ~]~. ' 825 "L' STREET, ANCHORAGE, AK. 99501 264-4?20 WELl. ,~ND ]3N ' S ItE SEt4ER PE~:F1 I T/- 6~4-9455 TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDRLOM=. = 4 PO 80.;~ 1811 E.R. 995?? LOT SIZE 999999 SQUARE FEET SOIL RRTING (SQ FT/"BR)= THE REQUIRED SIZE OF THE _-,LIL ABSORPTION SYSTEM I:,: [:"EPTH= 8 LFNiSTI-I --q-5 GRR~'EI DEPTH= 4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE 8ND THE BOTTOM OF THE E×CAVATION (IN FEET). REC-!LI I RED SEPT I C Trl~-~( S I ZE: 1258 GFtLLO~-IS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RE_tDENuE_ THAT THE WELL WILL SERVE. TWO ( 2 :) I ~'.iSPFE:T I OF4S RRE I~..EQLI I REC', BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE NELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NELL MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. NELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE NELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERI~I I t E;-(P I RES [~ECEMBFR __'~-1 .. I --q-8;' I CERTIFY THAT i: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. -~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE Rq.E_ I ~.ENCE~ ' I_'~._REMO[:ELED~ TCI ~gDE'l MORE THAN 4 BEDROOMS. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST PERFORMED FOR: ,.EGALDESCR,PT,ON: Llo H UL'SE ~'l:)P '~'Z.." DATE PERFORMED:__ [] SOILS LOG PERCOLATION TEST 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS O-/ NO. ]732-E Juno 22~ J ~6~ SLOPE WAS~RO~NDW^TER /')0 [ ENCOUNTERED? 0 P E IF YES, AT WHAT DEPTH? SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop %l../ - -- 5' ~t .._ I 'i'~P, ER CO LATIO N RATE__ J "~"~ (minutes/inch) 'EST RUN BETW FT AND ~"'"1~,~.~, FT PERFORMED BY: ~~~~1~__ Parcel I.D. 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.ci.anchorage.a k.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY AF PROVAL FOR A SINGLE FAMILY. DWELLING Expiration Date: Location (site address or directions) Current Property owner(s) .~,.~, ,~,-"~ ~,'?,,-.,,2. ,~'~'/<--,Day phone "~=?-,~'~-~,7 Mailing address f~,~/~ 1. GENERAL INFORMATION Complete legal description ~-- Lending agency · Mai"i Real E Mai Unless 2. NUME Day phone DISPOSAL: Indk Corr! Pub! The Municipality of Anchorage Development Services Department (DSD) 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) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to horneowners. Ceait~cates 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 may be reissued for a period of up to one year with vatid 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 cmissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER ' · "-'"'Name of Firm Address 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, functional and adequate for the number of bedrooms an~.fype of structure ndicatad herein. I further verify that based on the information ~'btained from the Municipalit~h~Anchorage flies and from my investigation and inspection, the on-site wate~ supply, and/o,r, wast~.w..a~r.~P~sal system s(are) n compliance with all applicable Municipal and State codes ordi~ances,...~ a~n. d...[e~u,~l~.'~o~s' in effect at the time of installation. . ' ;~' ~g' Phone 4>"~' -$'/¢~ Engineer's Pdnted Name ~..~/..~; ,~zz. ~ 5. DSD SIGNATURE / Approved for L~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: ~ -.-.'~. ~ c ~ Legal Description: A. WELL DATA Well type Date COmpleted g'~' . Total depth ,/~90 ft. Mnnicipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519--6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST If A, B, or C provide PWSID # ,4/,~ Sanitary seal (Y/N) ,W Casedto t'~' ft. FROM WELL LOG ,~/'.3. ft. /'G" g.p.m. Parcel ID: ~'~- -~'~/- '7.,q -ooo Well Log (Y/N) Y Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~) colonies/100 mL Date of sample: ~--2~'- 0.2. B, SEPTIC/HOLDING TANK DATA W~ras propady protected (Y/N) Casing height (above ground) AT INSPECTION ft. /o z./ g.p.m. in. System type Gravel below pipe 4), ~ ft. __ Depression over field For l/ bedrooms New depth ~ in. ""'"'- g.p.d. If yes, give date- ' Tank Type/Material ~ee'~¢',,-,,.."~.,, .~'-,,'~'?/< Tank size /)'"'~ gal. Number of Compartments Foundation cleanout (Y/N) ~Y "Depression over tank (Y/N) Date of pumping /v'~./ 7"/~,,v~ Pumper C. ABSORPI'ION FIELD DATA Date installed ~'--d .2 Soil rating (g.p.d./ft2 er-~-&~n) ~/ Length ~ 5-' ft. Width :~' ft. Total depth ~ ft. Eft. absorption area 3-~-~' ft~ Monitoring tube Date of adequacy test ~V£~, ~c;e~,~/ Results(Pess/Fail). Fluid depth in absorptio~ field before test ' ' in. Water added ~gal. Elapsed Time: L,,-~ min. Final fluid depth ~ in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Yin & type) Date installed ~ -- Oe~.. Cleanouts (Y/N) ~/' High water alarm (Y/N) ~ Nitrate ~o,~ mg./I. Other bacteria ~ colanies/100 mi. Collected by: ~c,~/~ ,~., ,,~,,. D. LIFT STATION Date installed Z~'- ~,~- Size in gallons 'Pump on" level at "~' in. 'Pump Datum ~ ~ ~ Cy~test~ E. SEPA~TION DI~CES SEPA~TION DIST~CES FROM WELL ON LOT TO: Septic ten~ s~tion on lot ~sorption field on lot ~ = Public s~er ~in Sewer/seHic sewi~ line /~ SEPA~TION DIST~CES FROM SEPTIC/HOLDING T~K ON LOT TO: Building foundation Water main Wells on adjacent lots ManholeJAccess (Y/N) )/ High water alarm level at, ~ J' in. Meets alan~ & circuit requirements? .YzC'J- On adjacent lots On adjacent lois '/'/~'-~" Public sewer manhote/cteanout Holding tank Absorption field Surface water Property line .~-~ Water service line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Date of Payment Receipt Number (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number F. COMMENTS G. ENGINEER S CERTIFICATIO I certify that I have determined through field inspections and conformance with MOA HAA guidelines in effect on this date. Encneer's Printed Name Z,,,,~ ~,,~ ~.~..._ C~'" ..'"_~FF - De,e HAA Fee $~L~L~~ Property line ~5'- / Building foundation ~'5,'" Water main Waler Service line /z//?/ Surface water Y'/~',, / Driveway, parking/vehicle storage Curtain drain ,,v/.~ Wells on adjacent lots -/-/,~',~' / \ '%, AS BUILT SURVEY' I hereby cer~ifv that a s_urvey of ~t ~ ' , 8took Subdivisio~ was made on .b~ ~ and that the improvements situated thereon are within the property lines and do not overla~) or encroach on the properW lying adjacen't thereto. that no improvements on property lying adjacent thereto enCroach on the premises in cues,ion and that there are no roadways, transmission lines or other visible easements on said properS.' except as indicated hereon. Dated at Anchorage. Alaska. ~is '~'--~ day of 19 CONSTRUCTING ENGINE=RS° INC. SRA Box 60, Anchora(2eo Alaska 9950? ~-25-2002 ~9:llAH FROH E.R. Engineerln9 .~,c~. CT&E Env~ronmen:~l Se~lces Inc. 5435'997 P.~4 CT&E Ref.~ 1021543001 Oleut Name Eagle l~ive~ Englnetring ~j~ Nam~ ~I~ fi2, ~t 10 ~t Sample ID ~ ~2, ~[ lO O~e~ ~ PWSID 0 Nm'a~e.N AIl Date~gTIm~ are Alaska Standard Time Printed Date/Time 03/29~2002 9:57 Coll,.~ct ed Da t e/'l~ me 03/2~2002 16:00 l~.ce]ved DatdT'une 03/27/2002 9:00 U~m Mcd-,~ Umiu Duc D~ l~it 0.2o9 0.200 mg/L EPA 300.0 (<10) 03/'2'//02 ~DT ~i¢~obiolo~y Laboratory To~l Coliform coL'lOOmL S~,{18 9999n (<1) 03/27/02 SBH Jun-24-02 11:04A Perm4t Counter 907 343 8250 P.02 Municipality of Anchorage Development Servic~ Department Building S~'c~ Division On-Site Wattr and Wa.~cwatcr Pmg~ 4700 Bragaw Sa'cot P.O. Box 1966~ Anchorage. AK 99~19-6650 www.¢Lanchomge.~k.u$ PROPERTY OWNER AGREEMENT FOR THE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owners agree to the following: Submit to th- Mvnicipality of Anchorage, on a~: am.ual basis, an inspection and operation statement from a registered professional engineer. This inspection and operation statement shall verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any deficiencies have been repaired and that the system is functioning as designed. (Signature) (Signature) (Printed Name) (Printed Name) (Notary Seal Here) COUNTY OF I certify that I knOw,or have ~atisfa~tory evidence that ~-v~ /~ /~-~e~ ~ //t~~ ~' ~ is the person who /appeared before me, an~said person acknowledged that (he/she) signed this instrument~nd acknowledged it to be (his/her) free and voluntary act for the uses and purposes mentioned in the instrument. Dated: ~ ~ O°°~ th State Notar~P~ub, lic~ iq and for e Residing at: ~/~ .......... : appoxnt expires~ ,-.~--~F VIRGINIA GOERZ NOTARY PUBLIC STATE O~.,W~SHINGTON OOMMISolON EXPIRES JANUARY ,15, 2004 APPLI?' NT FILLS OUT UPPER HA ONLY Property (~'ner _:~ '~(..2d..~ '? (~.)2.,~? % /~.~.~: /_~ /~ .~ Phone 7 Lending Institution G C~ ¥9 ~(~._ X I ~ C'~ Phone Phone Realty Co. & A~nt / Address 1/~? Zip Code Legal Description ~ )~ [~( ¥ [ ~ ~ Street Locatim T~of Resi~nce ~ ~ Single Family ~ Multiplo Famll~ ~o. o[ Bodroo~ ~ Other r Supply ,,~ ~ ~C~ A~ACH WELL LOG. A w~l log is requ,red for all wells drilled s,nce June 1975. Individual ~ ~[~ For wells drilled prior to that date. give well depth (attach log if available). Community ~ Public Utility Individual ~ ~ q~ ~-~q ~ -q ?~ Year individual Installed: ~ Public UliliJy When Connected ~o Public UliliJy: ~-~ ~ Holding T~nk NOTE: THE INSPECTION FEE ~UST ACCOMPANY EACH ~E~EST BEFORE ~OGESSING CAN BE INITIATED. Time Time Date Date Date ~ Date Inspector InSpector Inspector Inspector ~ ~ ~ ,? ' MUNICIPALITY OF ANCHORAGE . ECE! ED ( ~ APPROVED BEOROOM8 'GONDITIONS OF APPROVAL (/ ) DISAPPROVED DATE ~'~ ~ SOHS ~fing D~e ~we~ ~ns~Hed ~eH To Absorption A~e~ / ~ ] We~ Log ~eceNed