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Home My WebLink AboutSAND LAKE #2 BLK 5 LT 3Riand RGL a 4a L4 3 +v o II- 13J4 -3q MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE XNEW ) W' 'E.) C I^ IO Z � l D O ❑ UPGRADE MAII,.jNG ADDRE3 0 =GJI o _..72— rAk LEGAL DESCRIPTION LOCATION I ,,..,,)) `�" z NO. OF B,EDROO� J a- eT / - e I Absorpti n aria Dwelling / PE MIT N . r V DISTANCE TO: y� �E7 / h r� _Yro ~a 22 Manufacturer e Material j ' No. of compartments wF N Liq. capacity in gallons 16 IF HOMEMADE: Inside length - Width - Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. ��Z 02 F Manufacturer Material Liquid capacity in gallons D DISTANCET0: WI / Foundatio - f Nearest lot line 0 P MIT 0. N �,.}. W w= -P � bi C J' uj Z w No. of lines ength of each I' f Total length of li s / le ch yui Distance betwe lines F 7 inches Top tile to finish Material beneath O I— of grade tile Total,eff e al;V ion area ll��.. inches J ��^^ ., f�. Length Width Depth PERMIT NO. Lu 0 Q F Type of crib Crib diameter Crib depth Total effective absorption area as LU LU DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J Lu 3: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS v6 SOIL TESTANG / TRTI E ^ is 0 INS ALLER Lo-ft U 4711 Q/ d REMARKS t �� 10_y_.�r� Hot t !a ef ove,f I nz' t 0 APPROVED DATE LEGAL - svnw ka 11Z /oc4-.�5 0f 72-013 (Rev. 3/78) I Permit # Applicant: Location: Department Health and Environmental 'protection 825 Street, Anchorage, AK. '�.A501 264-4720 HANDWRITTEN PERMIT # # # I ON-SITE SEWER PERMIT 0YSQ / V). C. ASN, 10M Mailing Address :/�X 3 -Of 6 Avca A&B" O/D Phone Number: JS 076 Legal Description: Lire 3 A ,S LAW 14" � � Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: 3 ' Soil Rating(sq.ft/br) _A rLo The Required Size of the Soil Absorption System Is: DEPTH /O LENGTH' GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a 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 and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ d GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # # TW0(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is -25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 '0 3 # # # I certify that: (1) I am 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 codes. (3) I understand that the on-site sewer system may require2TI if the residence is remodeled to include more that bedr �9 Signed: N' �- yt�i� ____ Issued by: Applicant Date: SWP/024(1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE ~� �• DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION LJ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST 1 PERFORMED FOR: 1 �? n `�� _ DATE PERFORM EQ(:'.!bE5t� LEGAL DESCRIPTION: e U LCkhp *�-z a`LA.-t 1 O( 3 ", SLOPE SITE PLAN 1 11gYtit�bYOW� 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 :51 COMMENTS WAS GROUND WATER S ENCOUNTERED? tW L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: -t�X1 Shefn all CERTIFIED BY: 72-008 (6/79) J DATE: Z S ~ MUNICIPALITY OF ANCHORAGE I Z • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ��/�0 Parcel I.D. # 0 1/ 13 '� 3 41 0 0 0 HAA # 14 A 01` ei S 1. GENERAL INFORMATION Complete legal description Lot 3;_B o S,•' 'Sand. fh*6 Srchdrv,iAinn #9 Location (site address or directions) 8231 Seac,UAA StAeet Anchorage, AK Property owner Tenny Cowart Day phone 349-4949 Mailing address 7720 King S-tAeet Anchorage, AK 99518 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. If community wastewater system, provide written confirmation from State ADEC _ I to the legality status of system R attesting and „ •°` _ _ _` r .. xMOA #21 r 5. STAYEMENT 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/ter wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S&DN61;rEERING Phone 6 9 71 17034 Eagle River Loop Road No. 204 Address —_ — . - /I• - — Engineer's signature 6. '-DHHS SIGNATURE Approved for bedrooms. Disapproved _.._ Conditional approval for Additional Comments Bv��,`''-G1' l Date It /o% — t ROBERT C. COWAN F{� CE -8801 bedrooms, with the following stipulations: Date /2 �The Municipality cif,Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificar based only upon the representations given in paragraph 5 above by an independent prof (ortakenglpeer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their[ t 6 . nding institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. '72-M(Rev.1/91) Back MOA4121 - - - O' Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: S'�Y-SO -A105-- Parcel I.D. 01 )19 91-1 OW ,� rJ A. Well Data Well type aR N y If A, B, o (, attach ADEC letter. AD C water system number Log present (Y/N) N// Date completed N Driller (( �� Total depth rv/� Cased to Casing height Sanitary seal (Y/N) P4 Wires properly protected (Y/N) Al� Date of test Static water level Well flow Pump levell SEPARATION DISTANCES FROM WELL TO: Septic/stank on lot 1,5_ 0 r� ; O r Absorption field on lot J 1ST ; On ) Public sewer main PJ 1A Public sewer manhole/cleanout N4 Sewer service line Sd -f //) Petroleum tank �UntE_ f�NOw" WATER SAMPLE RESULTS: Coliform Nitrate O • Other bacteria t Id Date of sample: /��ati 9y Collected by: � ' .reN(rlNr� ,.rOic giver Loo;a Road fee. 204 B. SEPTIC/HOLD= TANK DATA Eagie River, Alaska v,9577 Date installed / 0113� 03 Tank size ) 00 O Compartments Cleanouts 6/ J) Foundation cleanout&N) YE S Depression (Y/rc High water alarm (Y/Q) /-J/A Alarm tested �� la- (Y/N) d Date of pumping l0 /' ri Pumper I" -)- &-Wa SEPARATION DISTANCES FROM SEPTIC/HOMXMG TANK TO: r � Well(s) on lot On adjacent lots lU Foundation /o To property line 1 r� Absorption field /b r Water main/service line /0 Surface water/drainage too -I- 72-026 (3/93)- Front 72-026(3/93)'Front CONTINUED ON BACK PAGE C. LIFT STATION J� Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot�On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Acs (Y/N) NFO . (Ar -E N "Pump off" Level at tested Surface water F"2 �NSPCL7COW (<oPo27 7aZ�o o�i3l£i3 Date installed �U I l 1 `�3 Soil rating�G D/Fn—ISU System type Lenge _Width Gravel thickness �a Total depth Total absorption area __N- +P�U fit= Cleanout present Depression over field (Y/14 /Jo Date of adequacy test_ 10 f a� i /9V Results (pass/fail) for 3 Bedrooms Water level in absorption field before test DIZ�/ After test—Di27� \ V Peroxide treatment (past 12 months) (Y/ f_ V maz f _N bw r1J If yes, give date SEPARATION DISTANCE- FROM ABSORPTION FIELD TO: i � � w,3�z•2 Well on lot - On adjacent lots Property line Y4 To building foundation 3? To existing or abandoned system on lot IVI ' On adjacent lots Cutbank Al.bjI Water main/service line /U Surface water _ /06 Driveway, parking/vehicle storage area o25 't Curtain drain fioNe_ knt6wr E. ENGINEER'S CERTIFICATION l certify that / have checked, verified, or conformed to all MOA and HAA guidelines in egqr�'�fl'ie`tfa e of this inspection. .�:w�� Vii'' � �'. •: < <�.••' / '.,`tip Signature Engineer's Name 1, D 13 rc,2T2r.rrr c CO AN Y��i'•y CE -8301 Date •., 101 HAA Fee $ 3()0, 00 r ov �Waiver Fee $ �! h Date of Payment l l- ) - 9 -1 Date of Payment 1 a" Yl .� Receipt Number -7L'c _ Receipt Number dO�157 (%bS-7 72-026 (3193)' Back lVitmicipality of Anehorage Department of Health and Human Services di 825 "L" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor December 5, 1994 Mr. Robert W. Cowan S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, AK 99577 Subject: Waiver Request for: Lot 3, Block 5, Sand Lake Subdivision #2 Waiver Approval: # WR940065 Dear Mr. Cowan: Your request for waiver(s) of the required 10 foot horizontal separation of a septic system to a lot line has been approved. The approved separation distance(s) are: Absorption Field to Property Line 0 feet This waiver approval applies to the existing septic system to lot line separation only. Any future upgrades to either will require all separation distances be met or another approval be obtained from this department. Sincerely, Daniel J. Roth Civil Engineer On -Site Services kb HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN S&Sl ,rneenrnG November 1, 1994 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 3 Block 5 Sand Lake Subdivision #2 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX(907)694-1211 Request you issue a Health Authority Approval on the referenced property and grant a waiver for the horizontal separation distance between the leachfield and the property line at 0 ft. From the septic inspection report dated October of 1983 the septic system monitoring tube was installed 10 ft. from the property line. The leachfield trench is 40 ft. long, running perpendicular to the tank, and the width of the property is 50 ft. Therefore, it appears the leachfield is 0 ft. from the property line. We do not anticipate any adverse affects on the adjacent properties. If we may be of further service please contact us. Sincerely, 4Roert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Time APPLIC IT FILLS OUT UPPER HAL )NLY Property Owner , - ,, �, , - Date Phone Mailing Address -' ( Zip Code � r Buyer Inspector nit � Address Field Notes: Zip Code Lending Institution _ t ;- ;;. / _ ._ _ i ,. _._ Phone Address Zip Code APPROVED BEDROOMS z %✓— `CONDITIONS OF APPROVAL Realty Co. R Agent=t;:_--- �. ( ) NDITIONALPROVAL` Phone DATE r BY: I / i✓� k\ - �-� Al Address Zip Code '�• Legal Description Date Sewer Installed Well To Absorption Area Well Log Received Street Location J / Well to Tank Type of Residence &Single Family - '❑ Multiple Family No. of Bedrooms _ ❑ Other Water Supply ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. W Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal - Individual Year Individual Installed: _:Q ❑ Public Utility When Connected to Public Utility: O Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector nit � MUNICIPALITY OF ANCHORAGE— Field Notes: CEPT. Of HSi'.LTII c: ENVIRONiv1=NTAL PROTECTION nr,, 2 , L E G , 1 i,j APPROVED BEDROOMS z %✓— `CONDITIONS OF APPROVAL (c ISAPPROVED ( ) NDITIONALPROVAL` DATE BY: I / i✓� k\ - v' Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size j J / Well to Tank 72023 (3182)