HomeMy WebLinkAboutSCIMITAR #2 BLK 4 LT 10AOnsite File
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MUNICIPALITY OF ANCHORAGE
y
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
ONff A�NEW
EJUPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
NO. OF BEDROOMS
2 �e
DISTANCE TO:
Well
/bn
Absorption area
1:5-0
Dwelling
'=-) -5—
PERMIT NOY/, v(c
�_ 2
iL <
Manufacturer
Mate
r;��
No. o—
f cZrtrnLnt,
UJ �_
"Ij� _e�
_A_R�
Liq. capa ? ity in gallonsF
IF HOMEMADE:
Inside length
Width
Liquid depth
DISTANCE TO:
Well
I
Dwelling
PERMIT NO.
_j 0 z
—
0�<
Manufacturer
Material
Liquid capacity in gallons
J!
LU
DISTANCE TO:
Well
Foundation
Nearest lot line,-
PERMIT NO.
LU r
_j L
No. of lines
Length
of each line
Total length of nes
Trench vvidth
Distance betvvee lines
P21LU
:� cc
C>/,Ie.,-,
960
Vo
n 76
I.-
Top of tile to finish grade
Material beneath tile
Total effectivd abs t
_5,�;rea
I _X_
_
':�r
Length
Width
Depth
PERMIT NO.
w
<
0.
LU
Type of crib
-,C�r"r
Crib depth
Total effective absorption are
w
(A)
DISTANCE TO:
Well
—Building foundation
N—a—a —re o �tl i n e
_j
_j
Cl
Depth
Driller
Distance to lot line
PERMIT NO.
LU
DISTANCE TO:
Building
foundation
Sevver line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTAL ER
'59
42�
REMARKS
61
4-H
APPROVED
DATE LEGAL
-7 1 P 5.
/Z_U115 thev..J11nj" I.,
r-1 1 TV I !F—=' FR L_ I _T' F7 F�:# P-4 C:: �-f F1 C3 EE 77
DEPARTMENT HEALTH AND ENVIRONMENTAI TECTION
- 1j''
.825 V -STREET, ANCHORAGE, AK. 99611
264-4720
t4 EE i-- L__ f=T T40 10 c) syl --- wy I -I- E=z "m E= L4 E� FT F=* U- F -C rel I _r'
PERMIT NO. K 210401 )
APPLICANT OSkPONST
LOCATION
LEGAL LTIO BLK4 SCIMITAR
SRA BX 6105 A3 745
IV n?
LOT SIZE 20000 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = -S SOIL RATING (SQ FT/BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
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 KIN FEET).
STEEF=17-110 "If-FAPA10 n0mlw0TEEz==: "I-C&CACD CAFAL_L_C?P4<7.
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.
-- -- -- -T'I,.,j C) c- �". _- -, > 1 141 Y0 1=1 IET 12 _T" 1 TO 04 10 f=i FQ En FQ EF__ #:-:-! k -u I r --g::7 EE C --
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A 14EL-L 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 L013S FIRE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'FEEF"l-41-F E>E=C7E=tlE3E=FR :01-v "lL low 13"1.,
1 CERTIFY THAT
l: I Ate! FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE,
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED: ----------------------------------------
APPLICANT GSkCONST
-----------
BT ... PO.
ISSUED ___DA E_
V 4. 1 -D
0 &,E EN&.--AEER1NG & DEVELOi--�AENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
Earl Ellis
694-2774
SOIL LOG
688-2280
Performedfor:
Name:
Tel. No.
15
-3
Mailing Address: '5
Legal Description:
7- e , 9 e, o C
7- 2
75<T I -LY .1 7-19Ae-
Depth (feet)
Soil Characteristics
0
2
3
E3
—4.
4
r
5
6
7
8
9
PLOT PLAN
10
tJ 0 6 -,,4 L a
11
12
13
PERC.TEST
14
e, ro "'f-1
15
16
Ground Water Encountered: Yes— No. If yes,
what depth—
Proposed Installation: Seepage Pit— Drain Field
--A
Comments:
NO. 1745-0
Performed by: Date:
I NZI F-- F-1 P -A C ED FR FA C3 EFE
DEPARTMENT'vi HEALTH AND ENVIRONMENTAL�YROTECTION
825 'L" STREETo ANCHORAGE, AK. 99501
264-4720
JAJ FZ7 1_ t_ A if inz m x -TV
PERMIT NO. < 810022 )
APPLICANT DAVID L. KERR SRL 3BOX 1435 CHUGIAK AK. 688-2611
LOCATION CULWAR DR.
LE13AL LOT 10 BLK 4 SCIMITAR SUB LOT SIZE 185130 SQUARE FEET
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 1-013S ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F=w FEE Fil fol 1 7- EHEX 1" 1 -'F. r -o EE C2 EZ P1 E3 EE—= F�_' .' :: L "E % _: L
1 CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
S I GNED: _z4-7&04�"Aj
DAVID KERR
APPLIC
V4. 0
ISSUED B DATE
by
DOC Co. Oba
SULLIVAN WATER WELLS
P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 6882759
OWNER OF LAND DEPTH OF WELL
ADDRESS S fv Y IDS" C 0 /"fji "/= 44� STATIC LEVEL OF WATER FT. D'
LEGAL DESCRIPTION 10 %:4 f: e4Si.,.iT2A RAW DOWN FT.
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DATE. • Started
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KIND OF FORMATION:
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MAR 9 1981
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DRILLER'SNAME " ' I _
Q��
S711 /9�
MUNICIPALITY OF ANCHORAGE
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
Parcel I.D. # H A A # SO �A
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) '516 '� " 7 s -e, -4-4
Property owner _6� Y_e:5 Day phone _7
Mailing address -5 e
Lending agency
Mailing address.
Agent —
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: -3
3. TYPE OF WATER SUPPLY:
Day phone
Day phone
X
Individual well
-Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
individual on-site X
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.
72-025(Rev.1/91) Front MOA#21
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 Eagle River Engineerjn� Services Phone '-Izl- 57�-,z<-
P-15. Box 77�52,Y4, tagle ffiver, AK 99577-3294
Address
Engineer's signature Date
6. DHHS SIGNATURE
Approved for T 4� bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By:
111TIC
ale,
.14
%
W, Cal .0
Cot
t
L u era
ev
736 00
bedrooms, with the following stipulations:
Date 5-- � 0 - 2 Ct
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 orderto 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 engineerjs work.
72-025(Rerv.1/91) Back MOA#21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERViRgEIVED
Environmental Services Division a
825 L Street, Room 502 *Anchorage, Alaska 99501 * (90#�441�749
Municipality ol A!',GnOfage
Health Authority Approval Checklb*t. Health & Hurnan ServiceS
Legal Description: r tvR Parcel I.D.:
A. WELL DATA
Well type /�?/ t/-4 7�5 If A, B, or C, attach ADEC letter. ADEC water system number /I/ 1A
Log present (Y/N) Date completed a - �V-&/ —
Total depth x4fe) Cased to Casing height (above ground) -
Sanitary seal (Y/N) Wires properly protected (Y/N) /V
FROM WELL LOG AT INSPECTION
Date of test C./ Y
Static water level '6"o
Well production Iva 9 -P.M. 7, g.p.m.
WATER SAMPLE RESULTS:
Coliform 4� Nitrate Other bacteria
Date of, sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed /��/ —Tanksize- 1-25-0 Number of Compartments �:) Cleanouts (Y/N)
Foundation cleanout (Y/N) Y - Depression (Y/N) IV High water alarm (Y/N) 1v )A
Date of Pumping 7- -2 X- �T
C. ABSORPTION FIELD DATA
r
Pumper Jf- J,
Date installed 7 - / 7 - 5�s_ Soil rating (g.p.d ./ft2 or4id �rm IF5- System type
Length —Width 15- Gravel thickness below pipe -Total depth
Effective absorption area )on
/ Monitoring Tube present (Y/N) Y Depression over field (Y/N)
Date of adequacy test
Results (Pass/Fail) /"q 4'-j
For -3 —bedrooms
Fluid depth in absorption field before test (in.); 6 Immediately after -5-61 gal. water added (in.):
Y�
Fluid depth (ins) Minutes later: Absorption rate = __g.p-d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date /14
72-026 (Rev. 3/96)*
D. LIFT S ION
Date install
T
sA
t a'
'ON
Manhole/Acces (Y/N)
High water alarm Ile el at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at* "Pump off" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot On adjacent lots
Absorption field on lot
Public sewer main
Sewer /septic service line
On adjacent lots
Public sewer manhole/cleanout -�114
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
ILII,q
Foundation Property line /,0/ —Absorption field
Water main/service line Surface water/drainage 1-olo el " Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 14 " Building foundation 4- 7,;) / Water main/service line
Surface water Driveway, parking/vehicle storage area.A�J
Curtain drain Al /
F. ENGINEER'S CERTIFICATION
Wells on adjacent lots
certify that / have determined thru field inspections and review of Municipal
-/-/0/
tems are
. �Po
in conformance with MOA HAA guidelines in effect on this date. 06
16
49
Signature
Engineer's Name
%
0
Date
FES
HAA Fee
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
'I
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environment�l Services
On -Site Services Section 44
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # HAA
1. GENERAL INFORMATION
r
Complete legal description
Location (site address or directions)
Property owner 1�e- gz Day phone
Mailing address
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: it community wastewater system, provide written confirmation from Statel'
attesting to the legality and status of system.
72-025(Rev.1/91) Front MOA#21
31ATEMENT 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 rArlula ions in effect on the date of this inspection.
-flalgie River Engineering Services
Name of Firm P.0 Rny771294, 11---.3294 Phone Sqv-s-/�J-
Address
Engineer's signature Date 57J
6. DH7 SIGNATURE
Approved for
Disapproved.
Conditional approval for
Additional Comments
LM
bedrooms,
WTIC
bedrooms, with the following stipulations:
Date Y2
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Autho0
Approval Certificates based only upon the representations given in paragraph 5 above by an independer
professional engineer registered intheStateof Alaska. The DHHS does this as a courtesy to purchasersof hom,
andtheirlending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdor
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is
responsible for errors or omissions in the professional engineer's work.
72426 (Rv. 1/91) Back MOA #21
Municipality of Anchorage RECEIVED
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division DEC 22 1998
825 L Street, Room 502 *Anchorage, Alaska 99501 a (907) 343-4744
Municipality ot Anchoi'aga
Health Authority Approval Checklist 0ept. Health & Hurnan Services
-2
Legal Description: �e "04 Ilal- _1� L -f 16 elk 1/ Parcel I.D.:
A. WELL DATA
Well type rr' V e? 2-C If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed
fRe— L�s Cased to ie417-16 Casing height (above ground)
Total depth
Sanitary seal (Y/N) ye- S Wires properly protected (Y/N)
Date of test
FROM WELL LOG
2- - -,-- /- �s I
Static water level 4.:)
Well production g.p.m.
WATER SAMPLE RESULTS:
AT INSPECTION
12-lq-!P'3
9 -P.M.
Coliform Nitrate z9o<R8 �5/z_ Other bacteria
I yl�es
Date of sample: 12,111/f F Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 11��/ Tank size / ZJ_k�' Number of Compartments 2- Cleanouts (YIN)L�_�
Foundation cleanout (Y/N) le -S Depression (YIN) W6� High water alarm (Y/N) _/�/ 1-f
Date of Pumping Pumper j
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./fl:2 oCft2iik�dp�Ti Wf Systerntype
L
Length Width Gravel thickness below pipe Total depth
Effective absorption area Monitoring Tube present (Y/N) >�_ Depression over field (Y/N)
Date of adequacy test —Results (Pass/Fail) Pa_s_� For 3 bedrooms
Fluid depth in absorption field before test (in.); Immediately after� �611 gal. water added (in.):
* �Y-C)
Fluid depth (ins) Minutes later: Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (Y/N) /V"./ — If yes, give date 114�1_14
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm IeVe�i at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
on" level at* "Pump off" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
)On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main
Sewer /septic service line
11L_1A_
-�- -2- _� - /
4- lzve_�,
+/Oz� /
Public sewer manhole/cleanout Al�_4_
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation _Z_ e-;, Property line �- /Z.') —Absorption field
Water main/service line Surface water/drainage Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Pronertv line /_ 10 Building foundation * Water main/service line
Surface water
Curtain drain
F. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area ve
Wells on adjacent lots -,�- loe�,
I certify that i have determined thru field inspections and review of Municipal records bA
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name
Date 7 - -A Louis A. Bu
CE -6736
HAA Fee $ s()n,LL
Date of Payment \9,- C,�
Receipt Number In L �`
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
so
are
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
1. GENERAL INFORMATION
4/28/86
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 10, Block 4. Scimitar #2 T15N R1W, Sec. 10
Location (address or directions)
Seika Drive
(b) Applicant Name Greg Lyall Telephone: Home 688-3590 - Business 561-1666
Applicant Address SR2 Box 151, Chugiak, AK 99567
(c) Applicant is (check one): Lending Institution 11 ; Owner/builder M ; Buyer 11 ; Other El (explain);
(d) Lending Institution NIA Telephone
Address
(e) Real Estate Company and Agent N/A
(f)
Address
Telephone
Mail the HAA to the following address:
' i 1 , I !
2. TYPE OF RESIDENCE
Single-FalmilyEl Multi-Family[3 Other
I
Number of Bedrooms '4
3. WATER SUPPLY
individual Well 13,, 'Community El Public D
I � I
Note: If communitywell system, must havewritten confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsitel@ PublicO Community[3 HoldingTankEl
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 (1 IJ84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
A
AS certified bymy 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
forthenumberof 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.* with Municipal wavier well–septic tank distance, and
trench–driveway separation.
Name of Firm EAGLE RIVER ENGINEERING SERVICES Telephone
Address EAGtE RIVER, AK 99577
Date P. 0. BOX 773294
694-5195
DHEP APPROVAL
Approved for bedrooms by Date
Approved Disapproved Conditional —
Terms of Conditional Approval
,s; �*,,s e -x s ,
1 57_R�' 4:p K 46r- �4-�
CAUTION
Louis A. Butera 4Z,
CE -6736
CES SO"kr�
4 - 7-,7 , a 42
, ( / g> �-'
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 orderto 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 (11184)
DEPT, OF HEALT�
MUNICIPALITY OF ANCHORAGE (IvI6�1 ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA) 'PR
CHECKLIST - FEBRUARY 1984 A
264-4720
Legal Description: /-,) 7�
a tv 1 7- T/
A. WELL DATA
Well Classification R/C I t,,IA r 6
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) Date Completed Yield qs' 7-cv-lea
Total Depth 'S' e, Cased to Depth of Grouting /V 1A
Static Water Level Pump Set At
Casing Height Above Ground Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) /�V Depression Around Wellhead (Y/N) /V
Separation Distances from Well
To Septic/Holding Tank on Lot On Adjoining Lots
To Nearest Edge of Absorption 44don Lot/�O'�� On Adjoining Lots
To Nearest Public Sewer Line A�/4 To Nearest Public Sewer
Cleanout/Man hole AVIA To Nearest Sewer Service Line on Lot
Water Sample Collected by Date A-1
Water Sample Test Results 54 t-lf IS �'ft 69
Comments
B. SEPTIC/HOLDING TANK DATA
Datelnstalled S' e No. of Compartments
Standpipes (Y/N) /V Air -tight Caps (Y/N) Foundation Cleanout (Y/N)
Depression over Tank (Y/N) /L) Date Last Pumped &PAZ916
Pumping/Maintenance Contract on File (Y/N) 14 --IA- ; for
Holding Tank High -Water Alarm (Y/N) I'l"114- - Temporary Holding Tank Permit (Y/N)
Separation Distances from Sg��c/Holding Tank
To Water -Supply Well To Building Foundation
To Property Line To Disposal Field
To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026(li/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design
Date Installed I§F�-1 —e-(
Length of Field
Width of Field
Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area 3 7,9
Standpipes Present (Y/N)
Depression over Field (Y/N) /L_1
Date of Last Adequacy Test
Results of Last Adequacy Test
7c& ex -
Separation Distance from Absorption Field:
To Water -Supply Well
To Property Line
To Building Foundation
To Existing or Abandoned System on
Lot /Ve
On Adjoining Lots t- 3e) /
To Water Main/Service Line
To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course
'lo 0
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test, Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certifythat I havechecked, verified, orconformed toall MOAand HAAguidelines in effectonthe dateof this inspection,
Signed - , - I *wHvier.wel to taRk reqiJired.
Date C a so waive 10 to rive.
//7//
Company 4SC65S MOA No.
Receipt No.
Date of Payment
n ineer'�`S�'ai
Amount: $
LOUI� I_
01,%
Page 2 of 2
72-026 (11/84)
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 Date4/9/86
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 10. Block 4. Simitar #2 T15N RlW Sec. 10
Location (address or directions)
Seika Drive
(b) ApplicantName Greg Lyall Telephone: Home 688-3590 Business N/A
Applicant Address SR2 Box 151, Chugiak, Alaska 99567
(c) Applicant is (check one): Lending Institution El ; Owner/builderin ; Buyer D ; Other D (explain);
(d) Lending Institution N/A Telephone
Address
(e) Real Estate Company and Agent N/A
Address
Telephone
(f) Mail the HAA to the following address:
pickup by applicant please call
2. TYPE OF RESIDENCE
Single-Familyt] Multi-Family[3 Other
Number of Bedrooms 3
3. WATER SUPPLY
IndividualWellM CommunityD 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 M Public 11 Community 13 Holding Tank
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 PROVIDhvi� INSPECTIONS, TESTS, FILE SEARCH, 6AI�A 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
forthenumberof 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. *with waiver of well to tank separation, and ok of trench tc
Name of Firm drive way separation. Telephone
Address EER1,11G SERVIGES
Date EAGLE RIVER, AK 99577
P. 0. BOX 773294
694-5195
OF 4P
Louis A. But�--r
CS-67�6 Eh biAeer's Seal
0 1: E 9 vi
6. DHEP APPROVAL
C.;�.-4 Ln, tr I C,#'/ #1 &4- Y
Approved for bedrooms by Date
Approved Disapproved Conditional 4_�
Terms of Conditional Approval
706
/IT &Y
rcd- C� -P- we -it *-e>
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)
4/28/86
Mr. Steve Morris
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Anchorage, Alaska 99502o650
Ref:Lot 10, Block 4, Scimitar #2 WR86-044
Dear Mr. Morris;
I have inspected the septic tank located on the above refer-
enced lot as required for wavier of well to septic tank separation
distance. The tank was uncovered and found to be in excellent
structural condition with caulder couplings on all fittings. The
sewer pipes are all P.V.C. 3034, which were properly bedded in the
surrounding soil. The fittings were checked for tightness of seal
and the ground around the tank was inspected for septic leakage.
There was no evidence of leakage, the tank was installed level and
the line leading into the tank was insulated with 6" of foam. it
should be noted on the asbuilt that the installed tank is a 1250
gallon capacity tank.
On the basis of this investigation we are asking that you issue
a new HAA with out condition.
Sincerely,
o Buter P.E.
u utera,
April 16, 1986
P.0--�-)'OX 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Lou Butera, P.E.
Eagle River Engineering Services
P.O. Box 773294
Eagle River, Alaska 99577
Subject: Lot 10 Block 4 Scimitar Subdivision #2
Waiver Request, WR86-044
Dear Mr. Butera:
Your request for a waiver of the well to septic tank separation distance
requirement for the subject lot has been conditionally approved. The
100 foot separation distance requirement will be waived to 55 feet after
the department receives documentation attesting to the integrity of the
septic tank and its inlet and outlet fittings. The tank should be
equipped with watertight fittings (Calder or equivalent). If the
inspection reveals significant corrosion or structural damage the tank
must be replaced. Documentation of this inspection must be submitted
to this department prior to June 15, 1986.
This waiver will be valid for the existing septic tank only.
Sincerely,
e4
Stephen S. Morris
Civil Engineer
On-site Services
SSM/ljw
4/8/86
Mr. Steve Morris
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Anchorage, Alaska 99502o650
Ref:Lot 10, Block 4, Scimitar Unit #2
Dear Mr. Morris;
On behalf of my client, Mr. Greg Lyall, I am submitting
a request for wavier of septic tank to private well horizontal
separation distance of 55' for the private well located on the
above referenced lot.
The well was indicated on the inspection report as being
+100' distance from the septic tank location. Actual field mea-
surements indicate a distance of 55'. The inspection report
is also dated incorrectly and should be dated 1981. The well
log enclosed shows that the well goes into solid bedrock at a
depth of 12' , with the casing seated in solid bedrock at a depth
of 20' . . Water is obtained from a depth of 168-175 feet. The
septic 'tank inlet and outlet elevations are approximately 7'
lower than the ground level at the well head. This is favorable
as any seepage would be directed away from the well. There is
a break in the surface topography were the lot slopes steeply
to the west at a +25% sloiDe. One can assume that the bedrock
surface also slopes steeply away from the well as the soil log
performed for the leach trench shows no bedrock to 141 . The
soil in the area of the septic tank is rated at 85 sq. ft. per
bedroom. The well has no pitless adaptor, the water supply line
exits through the top of the well and enters the house through
a utilidor. The absence of a pitless adaptor would provide one
less connection where surface water infiltration could occur.
The area is one of low population density.
If there are any questions or concerns please call me at
my office 694-5195.
Sincerely,
Lou Butera P.E.
5. LEGAL DESCRIPTION
D�,,_, RECEIVED
INSPECTION
APPOINTMENTS
::2�
TIW
NUMBER OF BEDROOMS
TIME
TIME
>4 SINGLE FAMILY
LJ Two 0 Five
0 MULTIPLE FAMILY
Three El Six
DATE
DATEL I cu�j
DATE
COMMUNITY
since June 1975. For wells drilled prior to that date, give well
Ell PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
;�; INDIVIDUAL/ON-SITE**
/0/9/ YEAR ON-SITE SYSTEM WAS INSTALLED.
INSPECTOR
INSPECTOR INSPECTOR
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
ANCHORAGE
D , EPT. �F IJEALTH &
1�41TAL
MUNICIPALITY OF ANCHORAGE PROIECT'ON
PROT ECTWIRONIA�
DEPARTMENT OF HEALTH & ENVIRONMENTAL
825 L Street - Anchorage, Alaska 99501
C,
1w
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 p\EcEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER
PHONE
MAILINGAIDDRESS
PROPERTY RESIDENT (if different
from above) PHONE
2. BUYER
Dan@ NP'ne-
PHONE
)4_u� =2611
MAILING ADDRESS
//qz�_
-W '3jrX
3. LENDlNGMSTITUTION
I
Ab :j�e lof 0,09,1
PHONE
mAILING'ADDRESS
4
-6 3 5
4. REALTOR/AGENT
PHONE
12:72-6`3_74-
k �DCALJLMC-J,
LI G A D UR ESS
'AM!2__-,kA
'15-,
Ln
5. LEGAL DESCRIPTION
'�Vr /0 , &k
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
1:1 One ED Four C] Other
>4 SINGLE FAMILY
LJ Two 0 Five
0 MULTIPLE FAMILY
Three El Six
7. WATER SUPPLY
INDIVIDUAL*
ATTACH WELL LOG. A well log is required for all wells drilled
COMMUNITY
since June 1975. For wells drilled prior to that date, give well
Ell PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
;�; INDIVIDUAL/ON-SITE**
/0/9/ YEAR ON-SITE SYSTEM WAS INSTALLED.
ED PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) #
'DID
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
0 SINGLE FAMILY
0 MULTIPLEFAMILY
NUMBER OF BEDROOMS
El ONE E--] THREE ED FIVE
C] TWO 0 FOUR Ll SIX
El OTHER
2. WATER SUPPLY
L-.1 INDIVIDUAL
0 COMMUNITY
El PUBLIC UTILITY
Connection Verified_
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
E] INDIVIDUAL/ON -SITE
OPUBLIC UTILITY
Connection Verified —.--
PERMIT NUMBER
DATE1NSTALLED
INSTALLER
F—]Septic Tank o)- 0 Holding Tani<
Size:—,) 0 (0 D If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES WELLTO:
S=Absorption
Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
"PROVED FOR BEDROOMS
0 CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
DATE
BY