HomeMy WebLinkAboutLOMARU LT 6Lomaru
Lot 6
#051-101-24
Permit Number:OSP221253
Tax Code Number:05110124000
Work Type:SepticTank Upgrade
Effective Date:
Design Engineer:
Site Legal Address:LOMARU LT 6 G:1359
Owner:DEROHWER TIMOTHY R & PAMELA D
Site Mailing Address:22933 GINA CIR, Chugiak
Lot Size in Sq Ft:31772
Total Bedrooms:3
This permit is for the construction of:
Disposal Field 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 Chapters15.55 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
7/18/2022
7/18/2023
C&M ENGINEERING SERVICES
Special Provisions:
Locate the beginning of the field prior to installation to confirm that the 5' separation between the tank and field
will be met. Install a cleanout or monitor tube so the field can be located in the future.
Expiration Date:
Received By:
Issued By:
Date:
Date:
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
Deb Wockenfuss 7/18/22
Locate the beginning of the field prior to installation to confirm that the 5' separation between the tank and fieldp
field can be located in the future.
gg p
will be met. Install a cleanout or monitor tube so the
Charles Balzarini, C&M ENGINEERING 7/20/22
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. 051 101 24
Property owner(s) DEROHWER
Mailing address 22933 GINA
Site address 22933 GINA
Day phone
Legal description (Sub'd., Block & Lot) LOMARU LT 6
Legal description (Township, Range & Section) LOMARU LT 6
Lot Size 31,772 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
(® all that apply)
Absorption Field
❑
Septic Tank
El
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
0—
APPLICATION IS AN: TYPE OF DWELLING:
Initial ❑ Single Family (SF) ❑
Upgrade
(w/wo ADU)
Q
Renewal
Duplex (D) El❑
Multiple Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
00
Distance: TBD
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
C&M ENGINEERING
(Signature of property owner or authorized agent)
Permit/Rush Fees: Waiver Fees:
Date of Payment: 11 `� a D a a Date of Payment:
Receipt Number: 0-7 a D Receipt Number:
Permit No. OS P g a Q 5 3 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Proposed Septic System for LOMARU LOT 6
Dear Reviewer,
The above referenced property is currently served by an older septic system with a leaking tank that
needs to be replaced immediately. We are requesting an expedited review of this application.
Our review of available documentation and field investigation show that this project will not adversely
impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing
onto and off of the subject property.
The exact location of the existing leachfield is unknown. The leachfield will be located and a cleanout and
monitor tube installed. Once the extents of the field are located, we will apply for separation distance
waivers if necessary.
As shown on the plan, the tank will be greater than 10’ from the house foundation.
The tank will be of MOA approved construction.
The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover or a minimum of
4’ of cover without insulation.
The repair must be performed by a moa certified installer in accordance with MOA requirements.
Repair of the proposed system will not negatively impact adjacent lots.
Upon completion of the installation, a record drawing will be submitted showing the location of the new
tank, leach field, well, and other applicable features.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini@gmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
7/7/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221253, Deb Wockenfuss, 07/18/22
NOTE: INSTALL ALL COMPONENTS IN ACCORDANCE WITH MUNICIPAL CODE,
APPROVALS, POLICIES, AND MANUFACTURER'S RECOMMENDATIONS.
AN ASBUILT SURVEY MUST BE COMPLETED AFTER THE INSTALLATION OF THE
SEPTIC SYSTEM COMPONENTS.
10' UTIL EASEMENT
INSPECT AND CAMERA ALL EXIST. SEWER LINES
TO REMAIN. LOMARU PRIVATE
NOTIFY THE ENGIEER IF GROUNDWATER IS ENCOUNTERED COMMUNITY WELL
IN THE TANK EXCAVATION 100' RADIUS
LOCATE BOTH ENDS OF LEACHFIELD AND LAYOUT PRIOR TO
STARTING TANK REPLACEMENT WORK.
5' MINIMUM
BTWN TANK
AND FIELD
APROX. OLD FIELD
LOCATION
LOCATE
END OF FIELD
AND INSTALL
CO/MT
x
LEGEND
O CLEANOUT
® MONITOR TUBE
® TEST HOLE
0.5%\ SLOPE INDICATOR
3 BR
HOUSE
R
*7 7H �
i
CHARLES G BALZARINI
I �F6, •. CE -13854 •����A-
AUve
���F�pROFESSIONP -�
NEW DOUBLE CLEANOUTS /
NEW 1000 GALLON MOA COMPLIANT /
SEPTIC TANK W/ INSULATED MANWAY
RISER AT FIRST COMPARTMENT
10' MIN FROM HOUSE /
10' MINIMUM
/ BETWEEN FND
\ AND TANK /
2
/ NEW FCO
LOMARU
LOT 6
3 BR
HOUSE
`— JAPPROX. WATERLINE/
EP
C&M ENGINEERING SERVICES
907-854-5558
LEGAL DESCRIPTION: LOMARU LOT 6
i
SITE PLAN
/ \ LOMARU
LOT 3
NOTES:
ADJACENT LOTS SERVED BY LOMARU
1. THE PROPOSED SEPTIC SYSTEM IS GREATER THAN:
COMMUNITY WELL.
100' FROM ANY PRIVATE WELLS
200' FROM ANY PUBLIC WELLS
NO SEPTICS WITHIN 30' OF PROPOSED
100' FROM ANY SURFACE WATER
NEW SYSTEM
50' FROM ANY STEEP SLOPES
C&M ENGINEERING SERVICES
907-854-5558
LEGAL DESCRIPTION: LOMARU LOT 6
OWNER: DEROHWER DATE:7/5/22 1 REV:0 DRAWN: CBj REF:
SITE PLAN
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street • Anchorage, Alaska 99501 Telephone 264-0720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
NEW
Da„{ F}�CIG,Z' `L
❑UPGRADE
MAILING ADDRES
LEGAL DESCRIPTION S
/ L omq�u
LOCATION
NO. OF BEDROOMS 3
DISTANCE TO:
Well
Absorption area
Dwelling 7
PERMIT NO.
t,–,f
D Y
Pn UA1
•7
dZQ
Manufacturer
GK..E
Material
No. of Compartments
Z
WM
v1�—
a
Lin. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
DISTANCE TO:
Well
welling
PERMIT NO.
_1OZ
S F
Manufacturer
Material
Liquid capacity in gallons
DI
DISTANCE TO:
Well
Foundation
8
Neares 9t line I
PERMIT NO.
�.�
W
Q.
No. of lines
Length of each lige
Total length lirfes
Trench wid h
&0
Distance between lines
s: a
Inches
Top finish
Material beneath
of tile to grade 7
tile
Total effective abssorEtjpn area
O
.3
�' inches
4��--��
Length
Width
Depth
PERMIT NO.
W
(7
Q61_
Type of crib
Crib diameter
Crib depth
Total affective absorption area
W 1
/P
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Oe th
Driller
Distance to lot line
PERMIT NO.
J
J1
DISTANCE T0:
Building foundation
Sewer line
Septic tank
Absorption areafs)
OTHER
PIPE MATERIALS
p Irc-
SOI L TEST RATING
7 S 34,161t—
INSTALLER
PfiUL 6039S -xc
REMARKS
V ' - y_`���Z i
.:!e OF a
,•.
orx.e;gT �• `�
r.
lclaarl A. S}a}•f i L
• 1. �I
ti J•
f
APPHOiV DATE LEGAL
p $ 9 saaa�s -ER1;dG
72-013 He .3/76) I,,v e,•, `_"
:.` r*'ianment of Health 6 Environmental Protto�m r n.rur w
p Ir/On-site SIe/wlreer[Well/ Permit Application
Name of Applicant �+ W L C �l Day Phone
Mailing Address // A / Zip Code
Legal Description s L6 a
TYPE OF PERMIT: Number of Bedrooms 3
_ Sewer Only I plan to have the necessary inspections conducted by:
Municipal Inspectors
Sewer Upgrade (Included In the Permit Fee)
Approved Engineering Firm
Well Only (Permit Fee is Waived)
Combined (Sewer 8 Well)
FOR DEPARTMENTAL USE ONLY
Soil Rating 6:711 TYPE OF SYSTEM: Pit Drainfield Trench_
/ Seepage Bed Mound System �Ha^ndwritten
Total Depth Gravel Depth / Width V /
I
For upgrade only: Add to length and/or add gallon tank. 3 8 L F
72-012 (W)Fee Collected Receipt it
4= _.._
1
t itnc'
aea�8s, Ped+
7884 "PosFll^ aou
ycolch" _
.. _REQUEST' 6 t�'.
FRS
please To
U IyEAO
HANDLE
pPPPOYE •
and
FORWARD
vou"'
!� KEEP OR DISC
APC
,,.t• � sEV1EW WITH M
l
t�
ucracuaen7wii neaitn ana nnvironment,'� erotectzon
825- Street, Anchorage, AK. 99501 I"
264-4720
Permit # C * * HANDWRITTEN PERMIT
WELL AND/OR ON-SITE SEWER PERMIT n
Applicant: 7� a -at ki e / Mailing Address:-�i�
Location:
Phone Number: � 4FZIZ ; %7
Type of Soil Absorption System I
Trench: Drairnfield: Y.— Seepage
Bed: Holding Tank:
Maximum Number of Bedrooms: %._� Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH — 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::-.-
Theegravel 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 U 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 thdt the well will -serve.
* ' * TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection and approval by this departme
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fe
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 3 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 wil install -system in accordance with codes.
(3) I unds and/� the on-site sewer system may require enlargement if
th� i /, 76s remodeled to include more th 3 rooms -/Si ne :( �Z��'�-Issued b `g � �� Y
/Applicant / c_
Date:
SWP/024(1/81)
MUNICIPALITY OF ANCHORAGE
p% .7 ' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 2643720
SOILS/LOG - PERCOLATION TEST
PERFORMED FOR: �i� U IU /lel-C� 7"7'771 0/y7jE �RfOf�MED'.
LEGAL DESCRIPTION: G
y SOILS LOG '
❑ PERCOLATION
TEST
SLOPE SITE PLAN
:1
WAS GROUND WATER S
ENCOUNTERED? O O
P
IF YES, AT WHAT E
DEPTH?
r==M�mm
PERCOLATION RATE N/� (minutes/inch)
72-008 (6/79)
DEPTH
(FEET)
ORGAN IC.
1
. " .
s
3
)
a°
126411
4+
0
5/2
5
W 1TH 'ROC
•
PO
� Z INCH
6
•.CIP-
7
6
4616f-
9
ctsycy
it
O
ROCK
col
12
iSoTr6m 0 -r-
-r-13
13-
RD LE
14
= OF ACq�t
'A
5
15-
16
16-
17-
17
Rubart A. Shofar
•�
•.
16
tlkEpPROFES`%e'
��\\ta`'
19
�+a'
20
y SOILS LOG '
❑ PERCOLATION
TEST
SLOPE SITE PLAN
:1
WAS GROUND WATER S
ENCOUNTERED? O O
P
IF YES, AT WHAT E
DEPTH?
r==M�mm
PERCOLATION RATE N/� (minutes/inch)
72-008 (6/79)
PERCOLATION RATE N/� (minutes/inch)
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE Ak
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services 94
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D.# ��� �(�,t-�L� HAA#�at19�11R1`1
1. GENERAL INFORMATION
Complete legal description Lot 6; Lomaru Subdivision
Location (site address or directions) 22933 Gina Circle, Chugiak, Alaska 99567
Property owner TnrPaa waikPr Day phone 6RR-9787
Mailing address 22933 Gina Circle, Eagle River, Alaska 99567
Lending agency
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. 'NUMBER OF BEDROOMS: 3 b
3. TYPE OF WATER SUPPLY:
Day phone
Day phone
Individual well
Community well xxx
Public water
NOTE: If community well system, provide written confirmation from Siate ADEC attest -
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
77-025(Rw.1A11) From M0AF21
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 of this Health Authority Approval application 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 Phone
3 & 3 ENGINEERING
Address 17034 Eaale River Loop Read No 204
legle River, Alaska 99577 12-
3-RZ
Engineer's signature Date Z'
6. DHHS SIGNATURE
Approved for _ bedrooms.
Disapproved.
By:
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates 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.
ncn (n... ijsn sKk MOA m
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LOT 6o L2MR2U SSD Parcel I.D.
A. WELL DATA
Well type COMMVJJlrY A If&B, or C, attach ADEC letter. ADEC water system number Z/ 3469
Log present &N) VES Date completed f I / &o/ 92 Driller A*L. 02f[ LIM11G CU,
0011,
ZZ I r
Total depth
Cased to
Casing height
Sanitary seal (Y/N)
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
1 foo
T
Z8
r1
rno
Well flow
g.p.m. g.p.m.
t'i7
0
Pump level
w
io
SEPARATION DISTANCES FROM WELL TO:
, t1JAt1/Ep (o-ZI- gTj
rn
0
N
Septic/holding tank on lot
170 'F
; On adjacent lots
1
Absorption field on lot
t�Lv k
; On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer service line
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Nitrate
Other bacteria
Date of sample:
Collected by:
B. SEPTIC/MetOWS TANK DATA
Date installed 6136 1.03 Tank size 1066 Compartments Z
CleanoutsYN) yES Foundation cleanout&'N) YES Depression (YAM NO
High water alarm (Y�4 AIO Alarm tested (Yo A%/A
Date of pumping 1 1/181gi: Pumper JR 5 cESSPooL pump. -RS
SEPARATION DISTANCES FROM SEPTIC/H@t9" TANK TO:
Well(s) on lot 4 cOmm"I'll Ito'. On adjacent lots I%14- Foundation
Topropertyline 10 + Absorption I ield 5
Surface water/drainage
+WANE/L ISsuep dr CSC 4/?- 1/
72026 (Rev. 7/91) Frani
Water main/service line
(0'
i
t
CONTINUED ON BACK PAGE
C
K1
m
STATION
Date insZaHa Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" a ump off' level at
High water alarm level cies tested
Meets MOA electrical codes (Y/N)
SEPARATION DI E FROM LIFT STATION TO:
n lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed �! 30 1 83 Soil rating tZS—System type T2E�f(
Length �$1 Width S Gravel thickness Total depth r% f
Id
=; Total absorption area 3%S Cleanouts present &N) YES
�
1 ' Depression over field (YoNO Date of adequacy test �� Zo /9Z
,.Results pas /fail) PSS for 3 bedrooms
Peroxide treatment (past 12 months) (Y/N) /UOA1E ' KIJ( WAJ If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot C"m"OA'f") 1Lt OnadIacentlots tPropertyline5If
To building foundation -i8 = To existing or abandoned system on lot
r
Onadjacentlots' 3o f Cutbank WA Water main/service line /Ut
Surface water _50'4 -
Driveway, parking/vehicle storage area ZO
Curtain drain V0A-1E KNOW Al
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date —of inspection.
S & S ENGINEERING+�. 0F
.Z ��'�`�
,•......,.,/Js ?�
17034 Eagle River Loop Road No, 204 W ?;� ,
Signature Earl!o River, Alaska 90577 w y' `: TM .�
........ ....»....
Engineer's Name � ,
Date Ftoc_R SHAFER:,W,
HAA Fee $ 1,7D, 00
Date of Payment LZo"O P — 9 Z
Receipt Number 2• �ZZEZ C 1�0-517
,
72-029 tale. 3N1t Bxk MOA 21
., No. 15
Waiver Fee: $
Date of Payment
Receipt Number
SENT BY:ADEC ANCHORAGE :12- 2-92 : MUM :ANCHORAGE/WESTERN D04S&S ENGINEERING :# 1
5
WALTER J. NICKEL, GOVERNOR
U
DEPT. OF ENVIRONINIENTALCO
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
Mr. Bruce C. Headle
Lomaru Subdivision & Water Association
HC 79, Box 4170
Chugisk, AK 99577
Post -It" brand tax transmatel memo 7671
t of P• , 1u ,
To
rom
Qa M
co. 5 ',Mae ,
CG'MfC — A.D.O.
Dept.
pnomet 34S. 7755
Faaa 691- r:lt
"" z49 -9•B3
November 30, 1992
RE: Public Water System Identification No. (P'VYSID) 213467, radiological testing
requirement.
Dear Mr. Headle:
This letter is to ecknowledgc- receipt of your letter dated No.'embe! 23, 1992 with an
attached receipt from Chemical & Gooloylcal Laboratories for Gross Alpha testing. The
Department has reviewea this Information and found it sufficient tj setisfy the
requirements of 18 AAC 80.200(a), therefore, the abovo water system is granted interim
compliance until lab results are received for this sample. Upon notification of satisfactory
results for Gross A!pha tasting and as long as all other sampling requirarrents are in good
standing your system will be in compliance vrlth State of Alaska Drinking Water
Regulations (18 AAC 80).
Thank you for your cooperation with this Department, If there are any other questions
please do not hesitate to cal.
Sincerely,
Michael Cu, E.I.T.
Environmental Engineering Asst. 11
M L/pf
3 n �j E OF
n n K n / WALTER J. H/CKEL, GOVERNOR
DEPT. OF ENVIRONMENTAIXONSERTIATION
ANCHORAGE DISTRICT OFFICE (907) 349-7755
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
November 18, 1992
Mr. Ray Shafer
S & S Engineering
SUBJECT: Lomaru Subdivision
Class "A" Public Water System, PWSID 213467
Dear Mr. Shafer:
I have completed a review of this office's files concerning the monitoring status of the
above -referenced Class "A" Public Water System and found the following:
The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on October 8, 1992. This does meet the provisions of
18 AAC 80.200(a), of the State Drinking Water Regulations.
2. The last inorganic Chemical Contaminants Sample results were submitted
to this Department on June 25, 1990. This does meet the provisions of 18
AAC 80.200(a), of the State Drinking Water Regulations.
3. The last Radioactive Contaminants Sample results were submitted to the
Department on July 28, 1988. This does not meet the provisions of 18 AAC
80.200(a), State Drinking Water Regulations.
4. There are no records of Organic Chemical Contaminants/Volatile Organic
Chemical were submitted to this Department on July 31, 1992. This does
meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations.
Issuance of this letter does not imply that the above -referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations.
If you have any questions on the above information, please do not hesitate to contact this
office at 349-7755.
Sincerely,
/.•'ref
Michael Lu
Environmental Eng. Asst. II
�. r
x plaited on wyded paver by CD
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH V
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date October, 2, 1986
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 6; Lomaru Subdivision
Location (address or directions)
(b) Applicant Name Teresa Walker Telephone: Home 688-9737 Business
Applicant Address . SR 3, Box 1313, Chugiak, Alaska 99567
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ;Buyer 13; Other ❑ (explain);
(d) Lending Institution
Address
Telephone
(e) Real Estate Company and Agent none/refinancing
Address
MMhone
(f) YM the HAA to the following address:
2. TYPE OF RESIDENCE
Single-FamilyKl' Multqr3
13Other
Number of Bedrooms
3. WATER SUPPLY
Individual Well Q Community ❑ Public ❑
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 n Public ❑ Community ❑ Holding Tank ❑ it I :
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)
5. ENGINEERING FIRM PROVIDIN. INSPECTIONS, TESTS, FILE SEARCH, DASA AND INFORMATION
As certified by my seat 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`&-"NGtNEERt Telephone l0 rev- Ze(
Address
Date
6. DHEP APPROVAL -T \`'
Approved for WOOL -r/bedrooms — " '"
Approvedy Disapproved Conditional
Terms of Conditional Approval
V�1
%3
;.n JL Shaw
Ne. tu7R
t'F1A
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 engineers work.
Page 2 of 2
rt -ole (nis)
n
�
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1964
264.4720
Legal Description: Loi (. Low-tA2u F.�
A. WELL DATA
/ 1
Well Classification C ~'-4u Ur r7 If A, B, C. D.E.C. Approved (Y/N) (�l
Well Log Present (Y/N)
Date Completed Yield
Total Depth Cased to Depth of Grouting
Static Water Level
Pump Set At
Casing Height Above Ground
Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N)
Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
; On Adjoining Lots
To Nearest Edge of Absorption Field
on Lot ; On Adjoining Lots
To Nearest Public Sewer Line
To Nearest Public Sewer
Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by
; Date
Water Sample Test Results
Comments /71F
C t e i�c/ 4�f7�AciLid
B. SEPTIC/HOLDING TANK DATA
Date Installed (a -30' 83 Size /Ooy No. of Compartments ?-
Standpipes (PN) Air -light Caps ON) Foundation Cleanout 6)N)
Depression over Tank (YO Date Last Pumped lO — 7--19
Pumping/Maintenance Contract on File (Y/N) NSA —;for
Holding Tank High -Water Alarm (Y/N) LYA Temporary Holding Tank Permit (Y/N) NIA
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 0 tc*%Ar u.",tY 120 f To Building Foundation L
To Property Line /o' To Disposal Field
3�
To Water Main/Service Line ro,+ To Stream, Pond, Lake, or Major Drainage
Course NSA
Comments o'f' Wa'L✓'d"- ! 5'"l-f4f*0 jr y �i& C 2( ✓N'✓/ f Y3
Page 1 of 2
72-026(11/84)
75 rl
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata S Type of System
Date Installed ' �' Length of Field
Width of Field Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area - 335 Standpipes Present
nw.. �n..rnu�1 K ANtJ1U1tACE
DEPT. OF HEALTH 3
EWIRONMENTAL PROTECTION
OCT 131986
4 :_ ADAY
D '
Depression over Field (Y I� Date of Last Adequacy Test —Lo ' "�Lr� �o�
.�
5hT15�ctop Fad 3 CiR
Results of Last Adequacy Test
Separation Distance from Absorption Field:
/
To Water -Supply Well To Property Line S
Ile
To Building Foundation / �/ r To Existing or Abandoned System on
Lot On Adjoining Lots �r 4
To Water Main/Service Line n�/4 To Cutbank (if present) All',
To Stream/Pond/Lake/or Major Drainage Course
To DrivewParking Area, or Vehicle Storage Ar
Comments Gt/Cc/r/L cSsc-.rte. /
D. LIFT STATION
Date Installed
Size in Gallons
't
/S
r-7
WG'/
Dimensions —
Manhole/Access (Y/N)
"Pump On" Level at "Pump Off' Level at
High Water Alarm Levet at
Tested for
Electrical Codes (Y/N) _
Comments
" Check Permitted Bedroom Rating Against HAA Request •'
Vent(Y/N)
OE
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection
Signed S & S ENGINEERING Date /0 _/1 -ET 6
Company B 196X MOA No.
EAGLE RIVER, AK"577
Receipt No. 3no/ 0020
Date of Payment W//31(,
Amount: $ laS
Page 2 of 2
72-026 (11,60)
n
OFU WILLIAM A. [GAN, GOVERNOR
866;A'F. CDIl 6s�i�'6@6GD�DHEiD H:QIl. Q fD:itiE:E6C'.a'CIlQD� /
50UTHCENTRAL REGIONAL OfffCE
MACKAY BLDG.
March 16, 1973. 778 DENALI STREET
ANCHORAGE 99501
Dir. Tommy Heinrich
Kullberg $ Associates
Box 10-046 -Klatt Station
Anchorage, Alaska 99502
SUBJECT: Lomaru Subdivision Water System -Peters Creek Area
Dear Dir. Heinrich:
We have reviewed the plans and specifications for the
subject project and have the following comments:
(1) As this project was well underway before the
implementation of the new State Waste Water Regula-
tions the old classification of a semi-public well
will be retained in this case and the 200 ft.
protective radius is not deemed to be applicable.
(2) Satisfactory bacteriological and chemical
analyses of the tater nust be furnished before
complete approval for the project can be given.
With the understanding that the analyses referred to
above will be provided the plans and specifications for the
subject project are approved for the features with which
this department is concerned.
cc: GRAB -DEQ ✓
Yours truly,
Kyle �J. Cherry 2
Regional Environmental�Fn ineer
g S
RECEIVED
!11: P::G1973 Ahi
GREATER ANf'Sr ;pE AREA 8ORoUGH
DEPT. OF E. Y^'„ ''"'Al 70AEITY