HomeMy WebLinkAboutDEARMOUN #2 BLK 2 LT 7bearmoun #2
Block 2
Lot 7
#018-401-36
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
- ENVIRONMENTAL SERVICES DIVISION
~ P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~'Hlq4O2c/O PID Number:
Name:
,~;~/~,¢,¢-/'~ ~e~ ~ Wastewater System: D New ~ Upgrade
Address:
/~ ~~ ~. ABSORPTION FIELD
Phone:
~NoofB~rooms: ~DeepTrench DShallowTrench ~Bed ~Mound ~Other
LEGAL DESCRIPTION so, Rating: Total Depth from original 9rade:
/, Z GPD/Sq. Ft.
Lot: Block: ~ Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe
Township: J Range:
~ Section: Fill added above original grade: Grave~ length:
: ' . '~.. /.7 Ft. /B. Fh
WELL: D New ~ uPgrade Gravel width: Number of lines: I Distance belween lines:
'" ' ' ' ~ Ft. /I - Fh
Classific~ on {P vate~B,C ~/~ , Total Depth: Cased To: Totalabsorption area: Pipe material: ~/O
Driller: Da~..: Ddged: Static Water Level: InstaUer: Date installed:
Yield: I P.mp Set at: ' Iqasing Height Above Ground:,
~PM Ft ~t. TANK
SEPARATION DISTANCES ~Septic U Holding U S.T.E.P.
TO Septic Absorption Lilt HoId~n~ Public/Prival Manufacturer: Capacityin gallons:
From Tank Field Slation Tank Sewer Lines ~~ T~
Well /~.~ i ~ / ~ I ~ ~ ~ ~ ~+ Material~ _~ Number of Compartments;
Surface
Water /O~ '* ,/¢ '* -- LIFT STATION
Lot Size in gaPons:~ Manufacturer:
Line ~1 / ZO I ~
Foundation ~ O / ~ ~ ¢ ~ ~ "Pump on 'level at: ~at High water alarm at;
I
Curtain
Drain ~O~, :, ~ ~, ~ Electrical Inspections performed by:
Remarks: Zc~t~ ~ 7/z~/~q ~AO~ ~,~,~ BENCH MARK
Loc~tion and Description:
~ ~ ¢ ~/'~V-- /~-¢~e Assumed Elevation:
ENGINEER'S SEAL
17034 E~le River L~p Road, No. 2~ ~ /._ ~-
Inspections performed by: E~l~ ~l~r. Al~b ~J~ Dates: 1st ~-22- ~ ;, ¢ .... . ........
Department of Hea ump s approval.
Reviewed and approved ~ Date: /
Permit No.Sw940290 Page 2 of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Descr[ptio~EAEMOUND SUBD. #2; BLOCK 2, LOT 7 PIDNo,: 01840156
2
i CO1 C02
i~ /FINAB
NEW
86J 1000 GAL
SEPTIC
TANK
~.T.S. A l~
'[ ........................................... FCO '1'?;5' 2I~0
........................................ ~ = C01 40.0 23~0
C02 46.0 27i5
COS 61.5 38[5
I ·
i C04 55.0 44~5
MT1 57.5 4015
~ looo GAL.
~ SEPTIC TANK
NEW TRENCtir--~
SCALE 1" = 40'
CO3&
2 EDRM
HOUSE
75.0~
· 69.0' i~O WATER FOUND
PROPERTY SERVEDi BY A
C(~MMUNITY WATER SYSTEM.
N
iPARATION WAIVER
BY D.E.Q. ON
7/~28/94 FOR THI~ PROPERTY.
ENGINEER'S SEAL
WELL
72-013 A (1/93) *
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE I~' ~'~'--~-'"'%'~ ~'
P.O. BOX 196650, 825 "L" STREET, ROOM 502 ~9 ~CHO~GE, ALAS~ 99519-6650
ON-SITE WASTEWATER DISPOS~ SYSTEM (UPG~E) PE~IT
PERMIT NUMBER:SW940290
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:MORGAN BRIGHAM ALFREDO
OWNER ADDRESS:13840 SCHUBERT CIR
DATE ISSUED: 8/12/94
EXPIRATION DATE: 8/12/95
PARCEL ID:01840136
LEGAL DESCRIPTION: DEARMOUN #2 BLK
2' LT 7
LOT SIZE: 14882 (SQ. FT.)
NUMBER OF BEDROOMS: 2 THIS PERMIT: 2
THIS PERMIT IS FOR THE CONTRUCTION 0F:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ISSUED BY: /~~
DATE:
DATE:
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
July 31, 1994
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTIJ AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER &WATER
INSPECTION
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
Municipality of Anchorage
DEPARTMENT OF HEAL TH AND HUMAN SERVICES
825 L Street
Anchorage, Alaska 99519-6650
REFERENCE: De Armound Subdivision #2, Block 2, Lot 7
We request you issue a permit to upgrade the septic system serving the
two bedroom house on the referenced property. Attached is the waiver
granted by the D.E.C. on 7/28/94 for the separation distance from the
proposed septic tank and leachfield to the class 'A' well serving the
referenced property
existing septic system is in a state of failure.
A test hole was excavated and a percolation test performed in the area of the
proposed upgrade. The approximate location of the test hole is located on the
attached site plan. The monitoring tube within the test .h~le has been checked
and found to be dry. Attached is the proposed upgrade design.
We do not anticipate any adverse effects on neighboring properties by the
installation of the proposed septic system.
If you have any questions, or require additional information for your review,
please contact us.
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
1" = 50' SITE PLAN
SCALE i
/
/
--4 ~Li'l.'
O"-'[-'"Oe "0 ~'j
~ ~ ~o~r.~
Z
CIRCLE
WALTER J. HICKEL, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
(907) 349-7755
July 28, 1994
Mr. Robert Shafer, P.E.
S&S Engineering
17034 North Eagle River Loop
Suite 204
Eagle River, AK 99577
RE:
Lot 7, Block 2, De Armound Subdivision Addition #2; Horizontal Separation
Distance Waiver to Class "A" Public Water System (PWSID No. 211936) Source.
ADEC Project No. 9421-WV-157-039
Dear Mr, Shafer:
This letter is in response to the materials received in this office July 22, 1994, regarding
a request for a waiver of the required horizontal separation distance from a septic system
to a Class "A" well. The Department has completed its review of the submitted materials
which included a cover letter, completed waiver of separation distances plan review
checklist, soils percolation Icg, and well logs from surrounding lots. Based upon this
review, variance from the required separation distance (18 AAC 80.030 and 18 AAC
72.015) between a Class "A" well and an on-site septic system is granted subject to the
following comments:
This Department regards the issuance of waivers very highly and must
evaluate the potential adverse impact to the environment and public health.
The absence of a well Icg for the Class "A" well in question for which the
waiver is requested hinders the review process. However, based upon an
engineering analysis of the information provided, it appears that the
subsurface soils and topography in this area are amenable to allowing a
lesser horizontal separation distance with minimal potential for
contamination to the subject well.
Expansion of the subject property without prior approval invalidates the
waiver granted for a reduced horizontal separation distance from the Class
"A" public well.
This approval does not grant additional authorizations, nor does it obligate any other
state, federal, or local regulatory body to grant required authorizations.
Mr. Robert Shafer, P.E 2 July 28, 1994
Thank you for your cooperation with this Department, if there are any questions regarding
the above please do not hesitate to call.
Sincerely,
Michael Lu, E.I.T.
Environmental Engineer
enclocf
Municipalit~ of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: B~IG
8
9
10
11
12
13
14
15
16 --
17
18
19-
20-
~EAL)
lownship, Ran§e; Section:
WAS GROUND WATER
ENCOUNTERED?
$
IF YES, AT WHAT ~-- ~)
DEPTH? p
ELOPE SITE PLAN
Moflitoring? ~i _~"~'~/ Date: "7/'''
~ Gross Net Depth to Net
Reading Date Time Time Water Drop
~ ,o ~:~ ~ gV~,, --
-- (minutes/inch) PERC HOLE DIAMETER
COMMENTS
PERFORMED BY:
$ & $ Cr~INEERING
;ERTIFY THAT THiS TEST WAS PERFORMED IN
iN THIS DATE. DATE:
72~008 (Rev. 4/85)
GJER ANCHORAGE AREA BORO,~iiI~
HEALTH DEPARTMENT ~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
N? 606
MAILING
ADDRESS *~'~(~;f ~?~ ,~; ~/'/-~J~. PHONE
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WELL J*~ /
LIQUID CAPACITY '?~'0 GALLONS.
MATERIAL ;~Z-~CJ~ ~'~'~-COMPARTMENTsNUMBER OF /
INSIDE LENGTH ·INSIDE WIDTH ~DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH / ~ f, LENGTH 2~-~ ! , DEPTH
LINING MATERIAL ~ 0~/2('~16x $~w ~i~.. DISTANCE FROM WELL ~1~. -~i/, , BUILDING FOUNDATION. ~
/ ~
NEAREST LOT LINE I~/ IOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ SQ. FT.
TILE DRAIN FIELD:
,~NDA ' -
lION , NEAREST LOT LINF ~
DISTANCE FROM WELL
ABSORPTION ARE/ SQ. FL LENGT~H LIN~......~,.-'~
TOTAL LENGTH
· OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
.DEPTH OF FILTER MATERIAL BENEATH TILE__IN. ABOVE TILE
WELL:
LOT LINE
TYPE '~)~'-' J/~/) ""'~'"~'~-~,'/ , ~- DISTANCE FROM
DEPTH//,'~'¢ I'l,~tl~¥~, BUILDING FOUNDATION
/~ /~ NEARES~ /~ SEPTIC t SEEPAGE
SEWER LINE ~ , TANK.
., SYSTEM
WATER
SAMPLE ~O/U,~-
CESSPOOL
, NEAREST
OTHER
, SOURCES~/-~='
DISTANCES:
DIAGRAM OF SYSTEM
· · i ! i ~ ~ -~ -i ~-~ ~..-~ ~ .~ ~..L.~ ~ ~
Grl
ANCHORAGE AREA BorScH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
PERMIT NO.
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
INSTALLATIO~ OF: SEPTIC TANK SEEPAGE PIT , DRAIN FIELD , OTHER ~
TYPE AND ~[ZE OF FACILITY TO BE ~ERVED f~
FINANCED THROUGH. ~ . TO BE INSTALLED BY
SOiL TEST RESULTS NOTE~ THIS PERMIT IS NOT VALID WITHOUT ~lk ~SI
CO~PLEtlO~ DAt~ ANTiCiPATeD {~
PHONE
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
DIAGRAM OF SYSTEM
MINIMUM DISTANCES, REQUIREMENTS
fOUNDATION TO SEPTIC TANK ,~ /
FOUNDATION TO SEEPAGE PIT ~ ~ · DRAIN FIELD
SEPTIC TANK tO SEEPAGe PIT WALL //~ ~
SEPTIC TANK SEEPAGE PIT ,
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK ~/
DRAIN FIELD
WATER MAIN TO SEPTIC TANK----/~J
DRAIN fIELD ~/~/
SEPTiC'TANK, Z ~ I SEEPAGE PIT
TO RIVEr, LAKE STREAM.
., DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST lEON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
OR
LICENSED DESIGNEE
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AEEA BOROUGH ORDINANCE NO. 28-68
Depth
6---
ER.,A!_~,R ANCHORAGE AREA
HEALTH DEPAkT,WENT
32%" EAGLE
ANCHORAGE, AoA.;KA 99501
..... " uearmoun ~u~alvlsion
This Form Reports a: S~r~o~._~_~
Tract A
SOil ~ha~
~ -- Location S~e~ch
brown sandy silt (~)
gray, clean sandy fine to
coarse gravel (GW)
becoming more sandy by ~
9'
· _
If Yes, At What Depth~ = ......
Date
Net Dmop
Proposed ~ns-allatxon: Seepage Piz X Drain Field
Depth Of Inle~ -
__~is mater iaf~~
.
Test Pemfom~d
Data Certified By:_j~~~s, Inc.
Date:
Municipality of Anchorage
Develo P m e.ni~d,~ es~i,cDeivSis,~e Partment
On-Site Water & Wastewater Program
4700 Bragaw Street ,'
P.O. Box 196650 ./
Anchorage, AK 99519-6650
www.muni,org/onsite /I ~"~
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEHS APPROVAL
FOR A SINGLE FAHILY DWELLING
1. GENERAL INFORMATION
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
DEARMOUN # 2~ BLOCK 2~ LOT 7
15840 SCHUBERT CIRCLE
DONALD WESTER
15840 SCHUBERT CIRCLE
Day phone C/O AGENT
Day phone
ED ERICKSON Day phone 227-5275
5801CENTERPOINT DRIVE # 200 *ANCHORAGE, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well [] Individual On-site ·
Individual Water Storage [] Individual Holding tank []
Community Class A Well · Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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 GARNESS ENGINEERING GROUP, Ltd.
Address 5701E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone 557-6179
Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
aystem under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features, The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the e valuator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benellt of the owner listed above,. Any reliance upon or use of this report by any
other person or patty is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
~ Approved for ~ bedrooms.
Disapproved.
Conditional approval for
, ON-SITE ;
· ~: WATERAND ;m=
~ : WASTEWATER : .=
~ ; PROGRAM .' ~
bedrooms, with the fllOwing stipulations: ~ ~"..
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL 0HECKLIST
Legal Description:
A. WELL DATA
Well type
DEARMOUN # 2, BLOCK 2, LOT 7
COMMUNITY WELL
IfA, B, orC provide PWSID# 211956
Parcel ID:O i ~- ¢¢ OI '
Well Log (Y/N)
Date completed
Sanitary seal (Y/N ~roperly protected (Y/N)
Cased to __ft.
Casing height (above ground)
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
in.
WATER SAMPLE RESULTS:
Coliform coloniestl00 mi.
A_~.~.. n i c~_-------I:l~.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size 1000 .gal.
g.p.m, g.p.m.
Nitrate
Date of sample:
SEPTIC/STEEL
__ mg./L.
Number of Compartments 2
Other bac ' 'u~/~l:~ m-f.
Collected by:
Date installed 8/22/1994
Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES
Date of pumping 2/5/2008
C. ABSORPTION FIELD DATA
Date installed 8/22/1994
Length 18 ft.
Depression over tank (Y/N) NO High water alarm (Y/N)
Pumper MCDONALDS PUMPING
~BELOW EXISTING GRAOEI
Soil rating (g.p.d./ft2oO 1.2
Width 2 .ft.
Total depth '11.85 ft. Eft. absorption area 270 ft2 Monitoring tube YES
Date of adequacy test 2/21/2008 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 54 in. Water added 594 gal.
Elapsed Time: 147 min. Final fluid depth 75 in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN
N/A
System type DEEP TRENCH
Gravel below pipe 7.5 ft.
Depression over field NO
For 2 bedrooms
New depth 87 in.
500+ g.p.d.
If yes, give date -
D. LIFT STATION
Date installed Size in gallons ~ ~
"Pump on" I~ High water alarm level at__ in.
Datum ~ C~ts alarm & circ~t requirements~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
NO WELL ON LOT
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
anout
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main 10'+ Water service line 10%
Absorption field 5'+
Surface water 100'+
Wells on adjacent lots '134'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation. 10%
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots '155'
Water main 10'+
Driveway, parking/vehicle storage 10'+
F. COMMENTS
*ADEC PROJECT ~ 9421-WV-157-039
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date
COSA Fee $ ~
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
/04/2008 15:45 FA]( 907 261 2201 PNWT-TITLE -+ GARNES ENGNRS [~003
89'56'00'
14
125.00
U~ILE~$ ~HI~WN
90,00
AS-BU/L-T
improvemen~ ~]~u~ted ~here~ are ~th~ Lhe
BOBBY
F.
I) UR~
'DATE: -~- i I-~;4
~CALI~ f, = ~0'
GRID:
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.#
1, GENERAL INFORMATION
Complete legal description
Lot 7; Block 2; D~Armond Subdivision #2
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Brigham Morgan Day phone
C/O Mar~ Cox Remax Prop6rt~es 2600 Cordova Str~t Anchoraq~,, AK
Day phone
Day phone
99503
Unless otherwise requested, HAA will be held for pickup,
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
I ndividual well
Community well XXX
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
lng to the legafity and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank '.,,
Community on-site
Public sewer
· NOTE: If community wastewatersystem; provide written confirmation from State ADEC
attesting to the legafity and status of system.
72-025 (Rev. 1/~1) Front MOACY21
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 wastewatar disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verifythat 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 in;~pE,ctiOn.~. , ·
i7034 Eagle Rive[
Name o! i-irm r~,oop Road .No.
Address ~/
Engineer's signatur~~~ Date
6. "DHHS SIGNATURE
~ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date /
Th~ 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 enginear registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirernents. 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.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~,1~ -~ ~.~/~ '~ ~'~Y'o,~'~2-' Parcel I.D.
A. Well Data
Well type ,~,
Log present (Y/N)
Total depth
Sanitary seal (WN)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
g.p.m.
AT INSPECTION
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
ew~r service line
WATER SAMPLE RESULTS:
Petroleum tank
Coliform Nitrate Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed Tank size \ ~ ~. Compartments
Cleanouts~t) ,,~ Foundation cleanout ~1) X// Depression (Y~_~
High water alarm (Y~ ~ Alarm tested (Y/N)
Date of pumping t~l~', ~ I~ Pumper
SEPARATION DISTANCES FROM SEPTICt, .~U~L~J=ING TANK TO:
Well(s) on lot ~ /-~// On adjacent lots
To property line I ~ t~c Absorption field
Sudace water/drainage / ~ ~
72-026 (3~93)* Front
~-~
Foundation ~'
Water main/service line
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N) ~-~
SEPA~ FROM LIFT STATION TO:
Wetl'0n lot On adjacent lots
Manufacturer
Manhole/Access (Y/N)
Sudace water.
D. ABSORPTION FIELD DATA
Date installed
Length /~
Total absorption ama
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (YJ~
,~,.~.. ~ z~ Soil rating (GPD/Ft
Width ?--J Gravel thickness
,~,5'~ Cleanout pmsent~/N) /
'J'/.~ ~/~_~.l Results (pass~lail)
,.1
System type
'7, 5- Total depth 1
Depression over field (Y/~)
~ for
After test
If yes, give date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots /o,o '+- Property line
.~" ' To existing or abandoned system on lot
Cutbank ~ ' ~- Water main/service line
Driveway, parkingNehicle storage area
E. ENGINEER'S CERTIFICATION
and HAA guidelines in
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
F ~ APPLICANT FILI~-S oUT UPPER HA(~'ONLY__
Mailing Address Zip Code
Address
Address Zip Code
Realty Co. & Agent ~'~ j\' [ ' t' ~ , ~ Phone
Address
Street Looation
Single Family
Multiple Family No. of Bedrooms
[] Other
[] Individual A*CrACH WELL LOG. A we~l log Is required for all wells drilled since June 1975.
.J~ Community -- For wens drilled prior to that date, give well depth (attach log if available).
Public Utility
Sewer Disposal
~,~ Individual
Public Utility When Connected to Public Utility:
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQ~JEST BEFORE F~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
u,I IlIICIPALITY OF ANCH GE
Field Notes: pEPT. OF H
~.J ,l,.,~ ENVIRONM,~NTAL pgO~[CTION
,P~',,~,,~ NOV 2 8
RECEIVED
( u ) A~ROVED BEDROOMS 'CONDITIONSOFAPPROVAL
( ~,~'~DISAPPROVED
{ ) CONDITIONAL APPROV
DATE
Soils Rating Date Sewer Installed Well To Absorption Area / ~'o Well Log Received
'~/ Well to Tank ~ /c/: ~ Septic Tank Size --~ .~-'~
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Time of Inspection
oato
REQUEST FOR APPROVAL OF
%~%V%DUAL SE~ER & WATER FACILITIES
FOR
Address:
Prooertv ~ner:
Type of Facility to be Inspected:
Number of Bedrooms:
6. Well Date:
7. Sew*ge DisPosal System:
C. Septic Tank: 1. Size
D. o.epage Pit: 1. Size ~m:/~ 2. Material
E. Disposal Field: Total Leng of Lines
Distances:
A. Well To:
C.
Septic Tank /~)' , Absorption Area /~f
, ~earest Lot Line ./~"~ , Other Contamination
Foundation to Septic Tank ~1; . ~//
~ AbSorption Area
Absorption Area to Nearest Lot Line
Sewer Lines
Req,ms.t for Approval of Sewer & Water Facilities
. Pa~e. Two
.Aonroved, ~g~ pproved Date '
Approval Valid for One Year From Date Signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGP, AM OF SYSTF~.,
I cer~zf¥ that the information contalne., in this request for approval to be a true
and accurate representation of the subject sewer and water facilities located at~
Signed Date