HomeMy WebLinkAboutSCIMITAR #3 BLK 1 LT 16SC.tmi mar
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP221464
Work Type: SepticTank Upgrade
Tax Code Number: 05113283000
Site Legal Address: SCIMITAR #3 BLK 1 LT 16 G:1261
Site Mailing Address: 19729 BELDUQUE CT, Chugiak
Owner: SMITH LARRY M & ANNETTE H
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft
Total Bedrooms:
o��rent
Department
11/30/2022
11/30/2023
40301
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
• Locate the beginning of the field prior toinstallation to confirm that the 5' separation
between the tank and field willbe met. Install a cleanout or monitor tube so the field can
be located in thefuture.
Resei =.By: —f SS t teA to ) ��) C Date:
Issued By: Date: 2
1DVIUHMPAUTY OF AHC HORA G E
.' -"
o�;r:.f
Development Services Department = Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-132-83
Property owner(s) LARRY & ANNETTE SMITH Day phone
Mailing address 19729 BELDUQUE CT, CHUGIAK, AK 99567
Site address 19729 BELDUQUE CT, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) SCIMITAR #3 BLK 1 LT 16
Legal description (Township, Range & Section)
Lot Size 40,301 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑ Initial ❑
Single Family (SF) x❑
(w/wo ADU)
Septic Tank
M Upgrade 0
Duplex (D) ElHolding
Tank
ElRenewal ElMultiple
Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
nature of property owner or authorized agent)
Permit/Rush Fees: AZ_
Date of Payment: Ig Z2';l
Receipt Number: 1 q 0 7/ J
Permit No. QS pg:I,Y6-a
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
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November 08, 2022
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: SCIMITAR #3 BLOCK 1, LOT 16
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached
design to serve the existing 3-bedroom residence. The lot and area are served by private wells.
The design will not impact any of the neighboring properties. Please contact us if you have any
questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221464, Deb Wockenfuss, 11/30/22
FIRST WATER CONSULTING
NO WELLS WITHIN
100' OF PROPOSED
SEPTIC TANK
SCIMITAR BLOCK 1, LOT 16
DESIGN DETAILS:
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221464, Deb Wockenfuss, 11/30/22
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/L -UIS they. 3//251•
MUNICIPALITY OF ANCHORAGE/
R
�® 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 �S n�
sem,C;l�
'i
17� NEW
UPGRADE
MAI LING ADDRESS
P }�Y 47 A/ / 9 jG
LEGAL DESCRIPTION
LOCATION
NO. OF BEDROOMS
U Y
DISTANCE TO:
Well ��t7 1
Absorption area
Dwelling �� /-
PERMIT N -
3
a Q
Manufacturer
Material
No. of compartments
UJ
rn
Liq. capacity in gallons
(��0
IF HOMEMADE:
Insideleug,
Width
Liquid depth
Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
J CD
= z
Manufacturer
Material
Liquid capacity in gallons
DISTANCE TO:
Well Foundation ��
36
Nearest lot line (4
PERMIT NO.
zNo.
of lines
-Length of ea h lined Total length o_f lines
.3
Trench wi th
-4,
Distance between I,in s
F. W�
inches
Y
'V
H
Top of tile to finish grade / Material beneath tile /,
�f
Total effective absorption area
inches
Z�
Length
Width Depth
PERMIT NO-
W
F
Type of crib
Crib diameter r" p
Total effective absorption area
a-
Wa
W
DISTANCE TO:
Well Bu' foundation
-
Nearest lot line
Class
Depth Driller
Distance to lot line
PERMIT NO.
J
W
3:DISTANCE
TO:
Building foundation LTewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
SOILTEST-RATING
95Jo
tj/C
INSTALLER
P_6-er E
REMARKS
PCrzm,r A0P)P/2!n -7-0
l/
4
S>
x)41. 0 CoN'rj3—r/mis
V -
�/(�.?may'.;'' • � a
�
'V 4 W
C
t oo Is on,. _tee no ,�
R0620 A. So
For
APP V DATE LEGAL
xx
'"aUW�!M
�> 694-200
/L -UIS they. 3//251•
^ WKWK|RENT ^c
HEHLTH
HND ENVIRONMENTFU _"ROTECTION
SEWER LINE IS 25 FEET
825 ��/
STREET/
HNCHORHGE/
F EET,
^
264~4720
Hjk!D MUST
BE RETURNED TO THE
�FEL. U FOR Thl KV
cy P -A ---
sm x w a as REE my m Fit
�Q Fit 1-wT
1 7
PERMIT NO, ( 820].355 )
OTHER REQUIREMENTS MHY
HPPLICHNT MYERS CONSTRUCTION
PO BOX ]51, CHUG1AK
DIHGRHMS
6944144
LOCHTION
INSTHLLHTIQN.
LEGHL L16 B1 SCIMITHR
LOT �IZE
42000
SQUHRE FEET
TYPE OF SYSTEM
I�: TRENCH
MAXIMUM NUMGER OF BEDROOMS z
�
SAM. PARTING (W FT/BRA;
85
������ � �������� ������ F
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF: THE TRENCH OR DRHINFIELD.
THE DEPTH OF H TRENCH OR PIT IS THE BETWEEN THE SURFACE OF THE
GRO01D HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHYHTION (IN FEET).
���� E':-- F,', lr' I YCE., ��I�,.q �I - :-IL����
PERMIT APPLICANT HAS; THE RESPONSIBILITY TO INF8RM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS HDJHCENT TO THIS PROPERTY HND THE
NUMBER CF RESMENCES THHT THE WELL WILL 5ERVE
1-0 ���I Y.kF. A If", W C: W I C -M fr-Al.1.1--v Fol FT: EEE� P_J 1 F,�" FE K,,> �------- ~
BHCKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPRQVHL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTHNCE BETWEEN A WELL HND ANY ON-SITE SEWAGE DISPOSAL SYSTEM Is.;
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM FROM
H PRIVATE
WELL TO H PRIVHTE
SEWER LINE IS 25 FEET
HND
TO H COMMUNITY SEWER LINE
IS 75
F EET,
WELL LOGS ARE REQUIRED
Hjk!D MUST
BE RETURNED TO THE
DEPHRTMENIT
WITHIN 38
DfflYS
OF THE HELL COMPLETION
OTHER REQUIREMENTS MHY
APPLY.
DIHGRHMS
HRE
HVHILHBLE TO IH.,. -.URE PROPER
INSTHLLHTIQN.
���M 1 A- 9ZE: 12E M IJETRE, Fy 1121.0 �sa 12"�
I CERTIFY THAT
1: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS,7 HND F'JELl LS HS SE
FORTH BY THE OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES
]: I UNDE D THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLHRGEMENT IF THE
RESIDENCE /S P..'EMODELED TO INCLUDE MORE THAN ] BEDROOMS_
SIGNED
ISSUED B
• - - - }� SOILS LOG
MUNICIPALITY OF ANCHORAGE
ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: V AS DATE PERFORMED: 62
LEGAL DESCRIPTION:
E SLOPE SITE PLAN
brc��1� i
1 � 1
2 4' stlil Sand c Ick
COMME
qa,^ anf tl.
Z 1
yo
9
r
Robor4 A. Shr,'ar a t
ra N 1457•'.
e 'ev
OFfSSION
WAS GROUND WATER S
ENCOUNTERED? O L
O
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
3
Net
Time
Depth to
Water
Z7 L1
—4
5
6
Q
I
7't]
•
8
�9
u-�
10-
0
11
11
12
43 . 4)
13
4
14-
15--
151617
16-
17
81920 18-
19-
20
COMME
qa,^ anf tl.
Z 1
yo
9
r
Robor4 A. Shr,'ar a t
ra N 1457•'.
e 'ev
OFfSSION
WAS GROUND WATER S
ENCOUNTERED? O L
O
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE /v/A (minutes/inch)
TEST RUN BETWEEN / FT AND FT
c
PERFORMED BY ! Y CERTIFIED B DA
11
72-008 (6/79)
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological a Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Please complete either to, lb or Ic.) A.D. L. No.
Borough Subdivision Lot Block Ib. qtrs. Section No. Township N Range E Meridian
I I I
DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
5. OWNER OF WELL:
Address;
Street Address and Area of Well Location
2. WELL LOG Feet Below
Surface
4. WELL DEPTH: (final)
5. DATE OF COMPLETION
r
Material Type Top Bottom
6, E] Cable tool Rotary Driven E] Dug
11 Auger C3 Jolted ❑ Bored Other
7.USEA_0 Domestic E] Public Supply El Industry
Irrigation 0 Recharge 0 Commerical
Test Well Other:
8. CASING: E] Threaded 0 Welded
cliamiin. to __33_ ft. Depth Weight —lbs./ft.
diam, in. to ft. Depth Stickup ft.
9. FINISH OF WELL:
Type..- Diameter:
Slot/Mesh Size: Length
Set between ft. and ft.
Backfilling — Gravel pack
.0. STATIC WATER LEVEL: ft.
0 Above or E] Below land surface Dole
Equipment used:
11 . PUMPING LEVEL below land surface and YIELD
ft. after _hrs. pumping _ g.p.m.
ft. after hrs. pumping _ g.p.m-
MUNICIPALITY OFA -
ENVIRONPLL A—
12.GROUTING Well Grouted: 0 Yes Ej No
Material: E] Neat Cement E] Other:
15. PUMP: (if available) HP
Length of Drop Pipe ft. capacity 9 P.M.
0 Subm. 0 Jet 0 Centrifical Other
14. REMARKS:
16. WATER WELL CONTRACTOR'S CERTIFICATION:
Temperature F ❑ C
This well was drilled under my jurisdiction and this report is true to the best.. of, my knowledge and belief;
Registered Business Name Contract
License Number
Address:
Signed:
Date:
Authorized Representative
[Form 02-WWR (11/81) Copy Distribution; WHITE-Stote OGGS, PINK
-Driller, CANARY- Customer
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date /Z - 4 P O�
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
`�-5 % ( lam✓ L!i.-�IPi S_-05:z'�
(b) Applicant Name( s �n� �v L71-4 Telephone: Home Lo�8s -5®� Business `SUPS' (�
6Q, 55-2< - 2-19
Applicant Address �C, ( l� r� C �I IP��J�✓c i� /'`' tea
(c) Applicant is (check one): Lending Institution ® ; Owner/builder 5; Buyer ❑ ; Other ® (explain);
(d) Lending Institution ��� o%�u� Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) -Matt the HAA to the following address:
2. TYPE OF RESIDENCE
Single-FamilyZ Multi -Family ® Other
Number of Bedrooms
3. MATER SUPPLY
Individual Well CommunityEl Public El
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Public 0 Community ® Holding Tank El
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025(11/84)
i
5. ENGINEERING FIRM PROVIDIN%'INSPECTIONS, TESTS, FILE SEARCH, DAi";� 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 ;•, o';;: —— Telephone
Address
MR
Date
�W�
6. DHEP APPR
Approved forOVA bedrooms by Date
ApprovedDisapprove Conditional
Terms of Cnditional Approvalo
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
MUNICIPAL]f(E%tfNCA49#WRITY APPROVAL (HAA)
DEPT. OF HEALT
ENVIRONMENTAL FEBRUARY 1984
�64-4720
OEC 13 1985 Legal Description: 16 CbLV--- )
RECEIVED
A. WELL DATA
Well Classification If A, B, C, D.E.C. Approved (Y/N)
'A
Well Log Present( PN) Date Completed �7"k10 — I5Z Yield
t
Total Depth mot Cased to Depth of Grouting
Static Water Level t 20 ' Pump Set At U, iL
Casing Height Above Ground 'M Sanitary Seal on Casingo/N)
Electrical Wiring in ConduitC�Y N) Depression Around Wellhead (Y1V
Separation Distances from Well:
To Septic/H Tank on Lot
4___ ; On Adjoining Lots
To Nearest Edge of Absorption Field on jLot tA" ; On Adjoining Lots 1A—
To Nearest Public Sewer Line r j' To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by s 44 Date �2 'li " e<5
Water Sample Test Results 50�T1 S
Comments
pow,
B. SEPTIC/ TANK DATA
Date Installed 1—%9—g7 --Size t `�
Standpipes C0/N) Air -tight Caps (VN)
Depression over Tank (Y/A
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High -Water Alarm (Y/N)
Separation Distances from Septic/HeWiftg Tank:
To Water -Supply Well It_ '--
To Property Line
M
A
No. of Compartments 'L
Foundation Cleanout (Y/®
Date Last Pumped 12-- !1 —'9i'
" l�
for
Temporary Holding Tank Permit (Y/N)
To Building Foundation 23
To Disposal Field S t-%�—
;�s Jj-'.
x
To Water Main/Service Line / To Stream, Pond, Lake, or Major Drainage
Course ^�,%A
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 13 n— Type of System Design Lt-_ A
Date Installed C>— e Z Length of Field -2,
N
Width of Field La b Depth of Field e
i
Gravel Bed Thickness 41J
Square Feet of Absorption Area Standpipes Present (�M)
Depression over Field (Y/6P Date of Last Adequacy Test t -Z-
Results
ZResults of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well t ®rte t -'r To Property Line -t?-
r
To Building Foundation To Existing or Abandoned System on
r'�
Lot
To Water Main/Service Line to I"�'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
On Adjoining Lots _ r'a-
To Cutba[k (if present)
Date Installed Dimensions
Size in Gallons M nhole/Access (Y/N)
"Pump On" Level at I "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
i,
f af�3 tai "Lt.l1�;i
Signed G =- v 5r Date
o Is +n
Company „t 3 MOA No.
Receipt No.
Date of Payment►
u
S ,
Amount 0c) �f. 9��0 ,3 �., .,ems. � +
4"
i�h}Pili A. >Itl k.i0y
J
Page 2 of 2
72-026 (11/84)
-
APPLK AT FILLS OUT UPPER HAL, -,ONLY
Property O�.vner Myers Construction, Inc.
Phone
Mailing Address
i r AK zip code 99577
694-9633
Buyer Larry
M., & Annette Hankiks Smith
Date
Address PSC
2 Box 3102 Elmoendorf AFBF AK Zip Code 99506
Date
01
Lending Institution
First Federal Savins & Loan
Phone
813 W. Northern Lights, Anchorage 9951pipCode
274-6565
Address
1 1w.n
Inspector
Realty Co. & Agent
Commonwealth Totem -Realty, Inc.: (Jim Montague)
Phone
Inspector \
PO Box 911, Eagle River, AK 99577 L-``" "=
694-9494
Address
- Zip Code
Legal Description
Lot 16, Block 1, Sckmitar Subdivision #3
Street Location
NHN Beldqque Court
Type of Residence
- - -
EXSingle Family
❑ Multiple Family
No. of Bedrooms 3
'CONDITIONS OF APPROVAL
❑ Other
( ) DISAPPROVED
Water Supply-
`.'� �� : '
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975.
11 Coividu
❑ Communini ty-
« ]4e,( Ld
For wells drilled prior to that date, give well depth (attach log
if available).
LJPublic Utility
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
Sewer Disposal
%I Individual
Year Individual Installed: 1982
-
❑ Public UtilityWhen
Connected to Public Utility:
-
❑ Holding Tank
-
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time �
ALA A1_lI/�;
Time 1
AtC o
n1—L�``
(-� 3`' Sd
Date
Date
Date
01
Date
7
1- 1-52 uQn
C)
1 1w.n
Inspector
Inspector
Inspector, 1
Inspector \
OF ANCHORAGE
Field Notes:
MUNICIPALITY ^.
UFvT C" ,
TION
R - C E I
( APPROVED BEDROOMS 2,�--
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL' I
6!//
DATE
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
Well to Tank
72023 (31ffi)