HomeMy WebLinkAboutSCIMITAR #2 BLK 2 LT 24Scimitar #2
Block 2
Lot 24
#051-132-42
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP131016 PID Number: 051-132-42
Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade
Name:
ELIZABETH J. LEE
ABSORPTION FIELD - EXISTING
® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
19606 TULWAR CIRCLE, CHUGIAK, AK 99567
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
_ GPD/SF
-- Fl.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
-- Ft.
I Gravel depth beneath pipe
-- Fl.
Subdivision Block Lot
SCIMITAR #2 2 24
Fill added above original grade
-- Ft.
Gravel length
-- Ft.
Township Range Section
Gravel width
-- Ft.
Beds: Number of Lines
Distance between lines
I Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
__ Ft2
--
Ft.
Well
100'+
100'+
100'+
-
25'+
TANK E Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1 1000 Gal.
Surface Water
100'+
100'+
100'+
Material
STEEL
Number of compartments
2
Lot Line
5'+
10'+
5'+
__
NA
Foundation
51+
10'+
5'+
--
LIFT STATION
Manufacturer
Capacity
Curtain Drain
NA
*50'+
NA
--
-----------------
Gal.
Remarks Existing septic tank decommissioned
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
per code. New tank insulated.
Pump make and model
Electrical Inspections performed by
InstallerMIKE ANDERSON
PIPE MATERIAL House to tank D3034 d a afield Tank to D3034
Dminfield -- CO/MT --
Inspector ARCTERRA
BENCH MARK (Assumed elevation) 100 ft
Inspdates 1M 2/25/13 3/1/13
Location and description
2nd
3'd 4'"
BOTTOM OF SIDING
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
�r►`Z
4 c7i�t
Conditional Approval: Date
AW
Approved 3 Date - T- 3
Approved
1DA1P1^
'� • 98 10113, AW
Inspection Report_9-1-12.doc
AS -BUILT SYSTEM DETAILS/SITE PLAN Permit: OSP131016
SCIMITAR #2 BLOCK 2, LOT 24 PID# 051-132-42
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PO BOX 671515
CHUGIAK, AK 99567
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On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP131016
Tax Code Number: 05113242000
Work Type: Septic Upgrade
Permit Effective Dates: February 20, 2013 to February 20, 2014
Design Engineer: ARC TERRA CONSULTING INC
Subdivision: SCIMITAR #2
Site Legal Address: SCIMITAR #2 BLK 2 LT 24 G:1261
Owner/Address: LEE ELIZABETH J
PO BOX 671515 CHUGIAKAK 995671515
Site Mailing Address: 19606 TULWAR CIR, Chugiak Lot Size in Sq Ft: 50477
Total Bedrooms: 3
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Receive(
Issued B
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division — Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-132-42
Property owner(s) ELIZABETH J. LEE Day phone
Mailing address PO BOX 671515 CHUGIAK, AK 99567
Site address 19606 TULWAR CIRCLE. CHUGIAK. AK 99567
Legal description (Sub'd., Block & Lot) SCIMITAR #2 BLOCK 2, LOT 24
Legal description (Township, Range & Section)
Lot Size 50,477 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
(w/wo ADU)
Septic Tank
®
Upgrade ®
Duplex
ElHolding
(D)
Tank
F]Renewal
❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
property owner or authorized agent)
Permit/Rush Fees:
Date of Payment: T-l/Sflj
T
Receipt Number: 65-�5221-7
Permit No. C6 I10l (o
SCIMITAR TANK.doc
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
February 14, 2013
ARC 1 uRRA
CONSULTING, INC
212 E. 51"Ave, Anchorage, AK. 99503
Office (907) 868-3791, Fax (907) 868-3793
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Septic Tank Upgrade Permit — Scimitar #2 Block 2, Lot 24
The owner has requested we proceed forward to obtain a septic permit to
upgrade the failed septic tank on the subject lot. The proposed upgrade will
serve the existing 3 -bedroom house.
The adjacent lots are served by private water as noted on the design. There is no
surface water within 100' of the proposed tank. We do not expect there to be any
adverse effect on adjacent lots by the development of this tank. If you have any
questions, please contact me at 868-3792/FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
C
Kenneth M. Duffus, P. .
Attachments: On -Site Sewer Application
Wastewater Absorption System Details/ Site Plan
20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793
(WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA
NO PUBLIC WELLS WITHIN 200' OF
PROPOSED SYSTEM.
NO PRIVATE WELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED.
NO SEPTIC SYSTEMS WITHIN 200' OF
PROPOSED WELL EXCEPT AS NOTED.
DESIGN DETAILS PAGE 1 OF 2
DECOMMISSION EXISTING SEPTIC TANK PER CODE
INSTALL NEW 1000—GALLON SEPTIC TANK
INSTALL FCO AND POST TANK COs — CONNECT TO EXISTING SYSTEM
NOTES:
1. INSULATE TANK IF <4' COVER.
2, CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK.
3. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS & SEPTICS.
PREPARED FOR1
ELIZABETH J. LEE
PO BOX 671515
CHUGIAK, AK 99567
PHONE
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PAGE 2 OF 2
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(d'NWMW1Oft16-
301 R. International Airport Rd.
Anchorage, Alaska 99516
(907) 563-3770 Ph (907) 5636502 Fax
w� . alaskapumwater.com
March 1, 2013
Re: Water Storage and Re -Pressurization Equipment installation —19606 Tuiwar
To whom this may concern:
Alaska Pure Water Products (APWP, Inc.) completed the installation of the proposed equipment for
19606 Tulwar Circle.
All equipment proposed was plumbed, installed and sanitized in accordance to local and/or state code
and regulations.
Submitt
ris Mitchell, WQA GWS -11, Cl, MST
Technical Sales &Services Director
State of Alaska, Registered Specialty Contractor License# 33830
On -Site Water System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP131020
Tax Code Number: 05113242000
Work Type: Well Upgrade
Permit Effective Dates: February 26, 2013 to February 26, 2014
Design Engineer: ARC TERRA CONSULTING INC
Subdivision: SCIMITAR #2
Site Legal Address: SCIMITAR #2 BLK 2 LT 24 G:1261
Owner/Address: LEE ELIZABETH J
PO BOX 671515 CHUGIAK AK 995671515
Site Mailing Address: 19606 TULWAR CIR, Chugiak Lot Size in Sq Ft: 50477
Total Bedrooms: 3
This permit is for the construction of:
N Disposal Field N Septic Tank N Holding Tank N Privy N private Well Y 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Receivec
Issued B
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-132-42
Property owner(s) Elizabeth Lee Day phone
Mailing address PO Box 671515 Chugiak, AK 99567
Site address 19606 Tulwar Circle
Legal description (Sub'd., Block & Lot) Scimitar #2 Blk 2 Lot 24
Legal description (Township, Range & Section)
Lot Size 50,477 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑ Initial X❑ Single Family (SF)
(w/wo ADU)
Septic Tank ElUpgrade F-1Duplex (D)
ElHolding
Tank E]Renewal El
Multiple Dwellings
❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage X❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
or authorized agent)
Permit/Rush Fees: L -2Q7 C-oota
Date of Payment:
Receipt Number: 30aa€q
Permit No. OSP / 5102_0
Permit App_:: .
Fees:
Date of Payment:
Receipt Number:
Waiver No.
February 22, 2013
ARCTERRA
ERRA
CONSULTING, INC
20441 Ptarmigan Blvd, Eagle River AK. 99577
Office (907) 696-6111, Fax (907) 868-3793
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Scimitar 42 Blk 2 Lot 24 Water Storage Tank
Gentlemen:
The owner has requested we proceed forward with the installation of a 300 gallon potable water
storage tank in the garage area of this residence. Though the current well production meets MOA
and ADEC flow rates the lender is requiring additional storage capacity.
Alaska Pure Water Products will be furnishing and installing all of the equipment and
components which meet the current NSF/ANSI standards for this upgrade. The storage tank will
be labeled conspicuously with the words "Potable Water".
Attached for your information is the equipment specifications for the tank, pump, and other
components.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
Dea L. Duffus
ArcTerm Consulting, Inc
attachments as noted
• '� Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-13242 Expiration Date:
1. GENERAL INFORMATION
Complete legal description SCIMITAR #2 BLOCK 2, LOT 24
Location (site address) 19606 TULWAR CIRCLE CHUGIAK, AK 99567
Current Property owner(s) ELIZABETH J. LEE Day phone
Mailing address
Real Estate Agent
PO BOX 671515, CHUGIAK AK 99567
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
SAD
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class _ Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 400— — Waiver Fee $
Date of Payment 31q/12) Date of Payment
Receipt Number 02 Receipt Number
COSA # 8x (�j (d� Waiver #
/3
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.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 3/1/2013
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA 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 r y,
occupants or can ArcTerra guarantee that no unseen _ 'l
encroachments, deficiencies or discrepancies exist. 't� , v��„+E:.Ib
6. DSD SIGNATUREy' �—
System #1 Approved for bedrooms. `-
System #2 Approved for bedrooms. *L
r►,rtr,�.r�,
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
0
The Wn
upon the
Original Certificate
Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
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 blue sheet 1040-12, o
4
1
If more than 1 septic system is on the lot:
COSA Checklist # _of _
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description: SCIMITAR #2 BLOCK 2, LOT 24 Parcel ID: 051432.42
A. WELL DATA
Well type PRVT
If A. B, or C provide PWSID #
Date completed 9-9.1981
Sanitary seal (Y/N) Y
Total depth 300 ft.
Cased to 40+ ft.
FROM WELL LOG
Date of test
9.9.1981
Static water level
150 ft.
Well production
2.3 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 0.595 mg/L
Arsenic: ND ug/L Date of sample: 215113
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC 1 STEEL
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (YIN) Y Depression over tank (Y/N) N
Date of pumping NA- NEW TANK Pumper
C. ABSORPTION FIELD DATA
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 24 in.
AT INSPECTION
11 -Is
OM012
2W /S3 ft.
2.25 g.p.m.
Collected by: ARCTERRA
Date installed 212 512 01 3
Cleanouts (Y/N) Y
High water alarm (Y/N) N
Date installed 12.31.1981 Soil rating (g.p.d./ft2 or ft2/bdrm) 85 System type TRENCH
Length 32 ft. Width 3 ft. Gravel below pipe 4 ft.
Total depth 7 ft. Eff. absorption area 256 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 1111 512 01 2 Results (Pass/Fail) PASS For 3 bedroom:
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 18 in.
Elapsed Time: 55 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at —in.
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Size in gallons
"Pump off' level at _ in.
Cycles tested
Septic tank/lift station on lot 1004
Absorption field on lot 1001+
Public sewer main 751+
Sewer /septic service line 251+
Animal containment areas 504
SEPTIC/HOLDING TANK ON LOT TO:
Manhole/Access (YIN)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 1001+
On adjacent lots 1004
Public sewer manhole/cleanout
Holding tank 1004
Manure/animal excrete storage areas 100'+
Building foundation 54 Property line 51+ Absorption field 5'+
Water main 101+ Water service line 101+ Surface water 1004
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main
Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that 1 have determined through field inspections and review of
determined through field inspections and review of Municipal records that
inspections and review of Municipal records that the above systems are in
Municipal records that the above systems are in conformance with MOA
above systems are in conformance with MOA COSA guidelines in effect on
conformance with MOA COSA guidelines in effect on this date.
COSA guidelines in effect on this date.
on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 31112013
COSA brown sheet 10.10-12.doo
in.
EAST 126.81
OFA V4�4
0
oP . pOl
s 'SHANE A. HOLT If,
LS -691 4. ' �O
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EX15UNG STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
HEREON ( UNLE55 INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCES5IVE SNOW AND/OR ICE.
AS -BUILT SURVEY 1" = 30'
NO CORNERS SET THIS DATE
TUL WAR
DRI VE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 24, BLOCK 2, SCIMITAR , UNIT NO. 2
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS _27TH DAY OF
FEBRUARY 2013.
HOLT LAND SURVEYING
600 H[GHVIEW DRIVE
F5 156-39, 157-52 ANCHORAGE,AK 99515
345-5513
mm
MUNICIPALITY OF ANCHORAGE
0A,. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
l t JI ENVIRONMENTAL ENGINEERING DIVISION
825 L Street Anchorage,
- Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME y� 5-'-N
_Cx 3YSCIUPGRADE
LAN EW
MAILING ADDRESS _
O LCA
LEGAL DESCRIPTION
�OF
LOCATION
NO.. OF BEDROOMS
Well
DISTANCE T Absorption area Dwelling
Uy _ � o._
N Z Manufacturer Material
H 'A. ,
E
PERMIT NO.
No.
No, of compartments,.) ,
/—
Liq. cin gallons
IF HOMEMADE: Inside length Width
Liquid depth
6(72 DISTANCE TO: Well Dwelling
PERMIT NO.
a:7 ti
Manufacturer
Material
Liquid capacity in gallons
C]
wx
DISTANCE TO:
_
Well t
vo+-
Foundation
/
Nearest lot line ~�
f_
PERMIT NO.
,
J w z
Zw
No. of lines
/
Length of each lin
_7U
Total length of lines. Trench width
r
Distance between lines I
inches_
/��/�r
_ __�.ZYi.'�
Top of rile to finish grade
QN
Material beneath rile {{�
�Cq
Total effective absorption area
C]
��
��'� inches
w
Length
Width
-��'
Depth
PERMIT NO.
Q J-
° a
w
Type of crib
Crib diameter
Crib depth
Total effective absorption area
V)
DISTANCE TO:
Building foundation
Nearest lot line
j
Class n
Depth -p
Driller
Distance to lot line
PERMIT NO.
LU
/—
DISTANCE TO:
.w
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
r
D
PIPE MATERIALS
SOIL TEST R4TING
j
INSTALLER
-
REMARKS
Ae- s-/ ,�� 0-2-
F
--
i
,�A
APPROVE _ DATE LEGAL
1
I CERTIFY THRT
1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND HELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE.
2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES
]� I UNDERSTHND THHT THE MHY REQUIRE ENLHRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS
'
ISSUED Wjl.��rlujr
.��
0,
`_°
RATISM I fz�
1: 10"ROM.. 1: Q "W A
"A V ii��1- -11' 11 j , �: 11, �7 11 ..:i�
/lj()
DEPHRTMENT
rr HE�LTH HND
ENYIRONMENTHL nROTECTION
825
STREET, HNCHORHGE,
HK9/1 // // /
264�4720
'/
'
17) 1 1
55 1 -1 FEE 15 El�
1 1 is: FT: IF" Q IF" M4 7
FAZ �HTT[MORE
�
W I/ RNHTIO�FHPLICHHT K HIRPORT R ]45~5919
LOCHTIOM
TOLWHR RD
/���n*`��u/ �/�l
(��mm\ b7/
LEGHL
LOT 24 BE- E'-:: 2
??�'
LOT SIZE 18000
TYPE OF
SOIL HBSORPTION
SYSTEM IS� TRENCH
MHXIMUM
HUMBER OF BEDROOMS
SOIL RHTING (SQ FT/BR 8
THE REQUIRED
SIZE OF THE
SOIL HBSORPTION
�I]-- lI 1- - 1017 M
W3 W 1-1 0: JR!
un -ii F�����
THE
LENGTH DIMENSION
IS THE LENGTH (IN
FEET) OF THE TRENCH OR DRHINFIEL
THE
DEPTH OF H TRENCH
OR PIT IS THE
DISTHNCE BETWEEN THE SURF E -
MOUND
HHD THE BOTTOM
OF THE EXCHVHTIUN
(IN FEET),
THERE
IS NO SET WIDTH
FOR TRENCHES.
� dVAIy
THE
GRHVEL DEPTH IS THE
MINIMUM DEPTH
OF GRHVEL 8ETWEEN THE O
HND
THE 8OTTOM OF THE
EXCHVHTION (IN
FEET>
HAR K wit k
-H X Q PEE Q �K 11",
3, IE -P.- M fvj K
�'IE ��_J ���
PERMIT
HPPLICHNT HHS THE
RESPONSIBILITY
TO INFORM THIS DEPHRTMENT DURING THE
INSTHLLHTION
INSPECTIONS
OF HNY WELLS HDJHCENT
TO THIS PROPERTY HND THE
NUMF�:ER
RESIDENCES THHT
THE WELL NII. -L,
�~�
�W C�f <7 Gh >
����M 10 _T_ JE
401 FG: K ilom:! _E [Fi,;!! IIFE.��
BHCKFILLING
OF HNY SYSTEM
NITHOUT FINHL
INSPECTION HND HPPROVHL 8Y THIS
DEPHRTMENT
NILBE SUBJECT
TO PROSECUTION
MINIMUM
DIST8NCE BETWEEN
H WELL HND HNY
ON-SITE SEWHGE DISPOSHL SYSTEM IS
100 FEET
FOR H PRIVHTE WELL
OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE
TYPE OF PUBLIC
WELL
MINIMUM
DISTHNCE FROM H
PRIVHTE WELL TO
H PRIVHTE SEWER LINE IS 25 FEET HND
TO H COMMUNITY
SEWER LINE
IS 75 FEET.
OTHER REQUIREMENTS
MHY HPPLY.
SPECIFICHTIONS
HND CONSTRUCTION DIHGRHMS HRE
HVHILHBLE
TO INSURE PROPER INSTHLLHTION.
��114,:!!
lEvIl 1 , Ill �X F04 X
F;ir,� OTT 12,�12-1Ew__-_:1!-.
9 CHE P -.:J!_ 1- . P
I CERTIFY THRT
1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND HELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE.
2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES
]� I UNDERSTHND THHT THE MHY REQUIRE ENLHRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS
'
ISSUED Wjl.��rlujr
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0,
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SOI LS LOG
MUNICIPALITY OF ANCHORAGE
os, DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
-� SOILS LOG - PERCOLATION TEST
PERFORMED FOR:—L- -, �_--cl L{]Yi �"��C)�C'• DATE /PE`R, FORMED:_
LEGAL DESCRIPTION: {�% rD�Fr�Li Y;) I� , (� (� , T /C�c? j- StJ cY /t
SLOPE SITE PLAN 1
DEPTH �C
(F ET) r����i 1 —T —T-1 1
r
14
15
16
17
18-
19
20
COMMENTS
pc'oe k S/
WAS GROUND WATER — „ \ ,� L
ENCOUNTERED? �_
O
P _
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
10 I
i
Net
Drop
3
4
,
5
�'•
6=�
i`
8
P
r IJt
.._. 9
� N
0
10-
12
12
13
14
15
16
17
18-
19
20
COMMENTS
pc'oe k S/
WAS GROUND WATER — „ \ ,� L
ENCOUNTERED? �_
O
P _
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch)
FT AND ®. FT
PERFORMED BY: VC �-�/l_o n �- - CERTIFIED BY: ✓ }, _DATE
72-008 (6/79)
9 -'SOILS ( LOG
MUNICIPALITY Of- ANCHORAGE
11
0 .moi DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
1 TEST
825 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:. ���GL./J�LI�L�// DA�T/E PERFORMED:
LEGAL DESCRIPTION:
r SLOPE SITE PLANCE%-/
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
PERFORMED BY:
72-008 (6/79)
v,eXJ
WAS GROUND WATER L
ENCOUNTERED?
0 z
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
k/ �
c c V� M1 fJ7//7 o.N
CERTIFIED BY:
FT AND
(minutes/inch)
—e FT
TE:
a
n
Q 00
4 c
IMUNFCIp''El7y
q-1Ar�Ot�GE
EPfl.�OF k3fALT4+H & w
EM/Ir ONM�NTAL: FROT ECTIUI�[' i
FFD 6 19 7
Qv
p
Fa
F--
�
N
3
w
z
°
®
Q
a
x
O
O
0
0
0
0
0 O 0 0 O
0
O
y
a
a
�
p
Q
x
_/�
Q
U
i
¢3
w
X
;
N
LU
O
�
t
F
i
O
O
O
O
O
O O O O
O
O
r
i
z
O
/
O
v
to
v) W
O
w
;E
0
�
0
%
O
�
0
/tom.
0
;� �. o? z. t.
O 0 O 0 O
O
Z
O
Ial W
p
k•
[�•
w
Ga,
f�,
w C�.. t:a w (a.
k.
6c,
0
Q
.'..-1
3
��!NT two �- p TRE 1-1 W 1: W V 0 ���1H Q'I EPI Ks: P41 A A. K SO VIT�
I CERTIFY THHT
1� I HM F8MILIRR NITH THE REQUIREMENTS FOR ON~SITE SENERS HMD NELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE
2� I WILL INSTHLL THE SYSTEM IN HCCDRDHNCE ��TH THE CO��S
SILow ED�~
HPPLIcalm EDNHRD LHTTIMORE
MUNICIPALITY OF ANCHORAGE „}
• Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERT[FICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. #`^ (% �� 7� " `�2 HAA #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
t1 VL'2'�
(b) Property owner Telephone : (home) Business
Mailing Address
(c) Lending Institution �L..�h442t."�'g ephone
Mailing 4r1riracc
(d) Real Esta
Address
Telephone (a ,t �/ -
(e) Mail the HAA to the following address: (or check here � if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
17034 Eagle River Loop Road No 2o4
Fac(le River, Alaska 99577
2. TYPE OF RESIDENCE
Single -Family (9 Number of bedrooms 3
3. WATER SUPPLY
Individual Well �Y) Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site Public ❑ Community El Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I 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 & 5 ENGINEERING Telephone Q�f�2 /r-7 �!
17034 Eagle River Loop Road No, 204
Address Eagle River, Alaska 99577
Date /Z�Z
6. DHHS APPROVAL
Approved for bedrooms by Date L
Approved .2< Disapproved Conditional
Terms of Conditional Approval
-� CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in 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.
72-025 (Rev. 7/8B) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984 wi
343-4744
Legal Description:
A. WELL DATA
Well Classification 1� a��`1iQJh� If A, B, C, D.E.C. Approved (Y/N)
Well Log Present LV/N) Date Completed "tel �S t Yield 2 '� G F,__1 ` .
Total Depth�2�pI Cased to old Depth of Grouting
Static Water Level It`?0
Pump Set At
Casing Height Above Ground Sanitary Seal on Casing VPN)
Electrical Wiring in Conduit's/N) Depression Around Wellhead (Y/(�[J)
SEPARATION DISTANCES FROM WELL:
t �
To Septic/Holding Tank on Lot On Adjoining Lots 4 -
To
To Nearest Edge of Absorption Field o Lot On Adjoining Lots \ �(
To Nearest Public Sewer Line N To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by S S lrs> (L-�r4 ; Date
Water Sample Test Results
Comments N
B. SEPTIC/HOLDING TANK DATA
Date Installed Size �—�cDc:�> No. of Compartments
-7--
Standpipes (-VN) Air -tight Caps ('N) Foundation Cleanout (Y/Io -t
Depression over Tank (Y/iOQ N Date Last Pumped
Pumping/Maintenance Contact on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) r Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well 1 C� To Building Foundation
To Property Line \C�:) -t To Disposal Field
To Water Main/Service Line
i
To Stream, Pond, Lake or Major Drainage Course \ �'b --
Comments �1rz5
72-026 (Rev. 7/88) Front Page 1 of 2
19
\ 2-
C ABSORPTION FIELD DATA
Soils Rating in Absorption Strata _ ,per.
Soils Type of System Design
Date Installed Length of Field
Width of Field
Square Feet of Absortion Area
Depression over Field (YO
Results of Last Adequacy Test
Depth of Field
Gravel Bed Thickness �T
2-45lo b
Statndpipes Present 4y71V)
Date of Last Adequacy Test
T M - A — P/fflawrws .
15
SEPARATION DISTANCE FROM ABSORPTION FIELD:
t
To Water -Supply Well c:-,> k To Property Line
12- ZI - eel ____
'7-C7:1 1 _t
To Building Foundation To Existing or Abandoned System on
i
Lot >� ; On Adjoining Lots �� "-
To Water Main/Service Line r k To Cutback (if present) 1'
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION Its
Date Installed
Size
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N) -
.,Pump Off' Level at
Vent
**Check Permitted Bedroom Rating Against HAA Request**
Pumping Cycles during Wd-equacy Test.
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
a9'o'•,.;. -' A Nt tai
inspection.
5 & S ENGINEERING t. aR•" , � �
Signed 17034 c.,..l.. kteP-Leo fl'Y
r� 0% vo4
Facgle River, Alaska 99577
Company 6
Date
MOA No.
Receipt No. c;?, 0 J-7 / G - 4/4/9/
Date of Payment X02 -1v2-/ �1
Amount: $ , / 7 0 67 U
Receipt No.
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
QI P�VIp �18�)rtV
abast ft, RJ�a��,r e
�n�rC vj JtO'_rnn�'0,
CHEMICAL & GEOLOGICAL, LABORATORIES OF ALASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE: (907) 562-2343
FEDERAL TAX ID N 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order R 11022
Date Report Printed: DEC 27 88 0 11:43
Client Sample ID:L24, B2 SCIMITER Client Name S & S ENGINEERING
PWSID :UA Client Acct SNSENGP
Collected DEC 22 88 B 15:05 hrs. P.O.B NONE REC D
Received DEC 22 B8 0 16:00 hrs. Req B
Preserved with :4 DEG. C Ordered By : RJS
Analysis Completed :DEC 23 88 Send Reports to:
Laboratory Supervisor :STEPHEN C. EDE 1)S & S ENGINEERING
Released By 2)
Special
Instruct:
Chemlab Ref #: 3793 Lab Smpl ID: 1 Matrix: WATER
Sample
Remarks
Allowable
Parameter Tested Result/Units Method Limits
NITRATE -N
ROUTINE SAMPLE
SAMPLE COLLECTED BY RJS.
0.30 mg/l EPA 353.2 10
1 Tests Performed See Special Instructions Above UA=Unavailable
ND= None Detected See Sample Remarks Above
NA= Not Analyzed LT=Less Than, GT=Greater Than
I ime
��
Time
10 �--
Datil
Date
Date
Inspector
Inspector
Inspector
Comments
Conditional Approval
Date Sewer Installed
a �_
l Y -_s' 'r�
Permit No.
Septic Tank Size ;4 p
_ (
Holding Tank Size
Soils Rating
Well To Absorption Area
Well Log Received
Well to Tank
_ APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner d'J_ Phone��
Mailing Address
Buyer / -—
Address
Lending Institution c Z_y y �� �
Phyne--�-
Address O
Realty Co. & Agent Phone e
Address
Legal Description '- �.�
Street Location f�7
Type,V Residence
I,n Single Family
❑ Multiple Family No. of Bedrooms
❑ Other
WatgE,Supply
* Individual ATTACH WELL LOG. A well log is required for all wells drilled since June
❑ Community
1975. For wells drilled prior to that date, give well depth (attach log if
F-) Public Utility available.)___________
SeDisposal
individual Year Individual Installed:
❑ Public Utility When Connected to Public Utility:
__
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATES).
I.dwand C11-10 Patricia
8911 Porest village
Ancb.orage. AK
U)t. 2A. nIt 2 F;oi-m--Ltar S, , civ,
7,,9,proval :c -.)r tIv-,-! I-IldiVidtUll 9 o ar0l watey- f'w!jji_j- ins, Cannot
Se granted until. tho, followinc.1 its s lm-,rr bonn comple.tod.
A woll lo(fnom ittea to is office far
reviml.
The water arin.lysin roport ncP(I,i to be ml mitten 1
"rom Llle Cberil Labe 56:3 I' Street-, 'or onr � vim .
Please notlf-v this (10par-l-Illont- -For a reinspection k -Awn the
llotdi.screnaricj-n- !vivo bemi correct -.-O. -rF tlm-.re are ally
Rol—'rt c. Pratt
m
rFl!-I--
m , f7; C)C' 0 VtV j, I-oll I qn1l I,. 1] 0 j,j.nt
P 11 , nC,
I /T)/