HomeMy WebLinkAboutDELUCIA LT 38!/-~.,~[~ MUNICIPALITY OF ANCHORAGE
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
IPHONE I ~I~'NEW
LOCATION NO. OF BED~S
To: Dwellin~ [ PE~T~
'~Z<~ Manufactur~ ~ .,~e / N°'°fc°m~artmentsz
- ' ~ Inside len~ Width Liquid depth
~OZ~ ' DISTANCE TO: Well ~ Dw~nh PERMIT NO.
O z ( Manufacturer ~ ~ 7 Material Liquid capacity m gallons
, We20~ Foundati~o Neare~e
, ~ DISTANCE, TO: ~ le~f lin~ Trench w¢~
Distance bet~ e Ii s
~, ~ ken,th ~each lin~ Total
~O inches p~
~',~ Top oftiletofinishgra~ ~ ~ ~ ~ ~ /~ i- ~a~or ea
: M~rialL~eneat~il~¢ Total ef
inches
Length ' Width Dbpth / PERMITNO.
~ ~ Tgpe of crib Crib diameter C Total effectiue absorption area
m Well B~lding foundation Nearest lot line
~ DISTANCE TO:
Driller Distance to lot line PERMIT NO.
~ Class~ Depth
m Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
PIPE MATERIALS .,
-' I , -' ,ws,..., ' - ~
72-013
MUNICIPALITY OF ANCF, ,AGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE., AK 99501
264-4728
PERMIT NO'
[)ATE ISSUED:
0[-4--5 I TE- '_=.EL,lEA
840480 ~
k~_,,, l~,. ~_,4
F'EE'I'.I I T
APPLICANT'
ADDRESS-
CONTACT PHONE'
PAT TILTON
X SiS ENGINEERING
EAGLE RIVER, AK 99577
LEGAL DESCRIP'
LOT SIZE'
SLIBD I V I S I ON' DELLIC: I R
SECTION' ~ TONNSHIF'- i5N
i5000 (SQ. FT. OR RCRES',
LOT' 2:8
RANGE: iW
BLOC:K' NA
I CERTIFY THAT:
i. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA.
2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS,
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
3. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY EXISTING NELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
IF A LIFT STRTION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (i) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT~ AND (3> THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED
APPLICANT'
ISSUE[:, BY
~ ~' ~ yl~ $01L$ LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR: ,t~,~
LEGAL DESCRIPTION:
8
9
10
12
13
SLOPE
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE PL/~
S
L
O
P
E
14
! ~,Reading IGr°ss Net Depth to Net
Date
Time Time Water Drop
t5-
(minutes/inch)
COMMENTS
PERFORMED
I FT
SOl LS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
LEGAL DESCRIPTION:
1
2
3
5
6
7
8
9
SLOPE
DATE PERFORMED:
SITE PLA
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
PERFORMED
72-008 (6/79)
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
! Gross Net Depth to Net
, Reading Date Time Time Water Drop
· /
PERCOLATION RATE
TEST RUN BETWEEN FT AND
CERTIFIED B~
(minutes/inch)
FT
GRE' 't ANCHORAGE AREA
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL """
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
~ ~ ~-~ MATERIAL
LIQUID DEPTH_
~'~,~,~,,. NUMBER OF
COMPARTMENTS
LIQUID CAPACITY /~i~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS (
BUILDING FOUNDATION__
ADDITIONAL ABSORPTION
CRIB SIZE: DIAMETER DEPTH ~ DISTANCE FROM: WELL
TOTAL EFFECTIVE
, NEAREST LOT LINE__ ABSORPTION AREA (WALL AREA) ~
SQ. FT.
WELL: /~/e'f~
TYPE
BUILDING
FOUNDATION __
CONSTRUCTION
NEAREST NEAREST
, LOT LINE , SEWER LINE
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK , SYSTEM
C ESSPOO L
OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
PIPE MATERIAL:
REMARKS:
Form No. LQ-031
GreaTEr ANCHOragE ArEa BorOUGh
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456!
SEWAGE DISPOSAL SYSTEM I APPLICATION AND PERMIT
PERMIT NO.
,NS' A,_'ATION ,-OCAT,ON
'_EGAL DESCR,PT,ON
INSTALLATION Of: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SEEPAGE PIT L/~' DRAIN FIELD
TO BE INSTALLL~~ BY
PHONE '~$ ?--/O2-/
OTHER
SOIL TEST RESULTS
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTS
fOUNDATiON TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT DRAIN FIELD
SEPT,C TANK TO SEEPAGE P,T WALL'~/$/
SEPTIC TANK ~
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
SEEPAGE PIT ,DRAIN FIELD
///
DIAGRAM OF SYSTEM
DRAIN FIELD
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE Pit
DRAIN FIELD
SEPTIC TANK, .,SEEPAGE Pit .,DRAIN FIELD
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUt OF SEPTIC TANK AND INTO CRIB CROSSING GAP O~F
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PI~_
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BORO~..~ REGULATIONS REGARDING INSTALLATION,
~ ICENSED DESIGNER
I CER~.~Y THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
Performed For
Legal ~escrintion:
This ~orm Re~orts
"One test is worth a thousand opinions"
582~ TUDOR ROAD. ANCHORA(~£. AL..AIKA 89507 · TELEPHONE 333-847~'
Lo t_~B 1 ock~$ubdi ¥~ si
Soils Loo ~l~ Percolation Test
.nenth
Feet Soil Characteristics
3
5~
9
Was Ground Water Encountered?_~
I~ Yes, At what Denth?
Readinq Date Gross Time Net Time Depth to H20 Net Dron
Percolation Rate Minute
Proposed Installation~ SeenaQe Pit_~ Drain Field
~Cn~ME~h of Inlet --~/ Dent~To Bottom Of Pit O~ Trench
~~-~ D--J~ C--~r~i fi ed
~~ Date: ~'~--~ ~_~_
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC261130
Parcel ID 051 -141-23 Expiration Date: 1/16/2027
Legal description DELUCIA LT 38
Site address 22824 DAN I EL CT
Current property owner(s) FRANK ANDREW JOHN &
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory X
Tank Age Advisory Arsenic Advisory
Other
MUNICIPALITY OF ANCHORAGE
Development Services Departmentg Phone: 907-343-7904
On -Site Water & Wastewater Section ��� Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 05114123000
Complete legal description
Location (site address)
Delucia Lot 38
22824 Daniel Ct
Current property owner(s) Andrew Frank and Lisa Rayanne Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: 0 Private Well serving #1 dwelling units
❑ Other Non-public well as regulated by MOA ❑ Water Storage
❑ Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: ■❑ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑I■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 10 - See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ■❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $
Date of Payment
COSA# ' �c—ZL�(
Waiver Fee $
Date of Payment
Waiver #
COSA Application_Apr2025,doc
COSA Checklist_May2025.docx
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. DISPOSAL FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_May2025.docx
E. SEPARATION DISTANCES
From Well on Lot to:(Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’Yes if No ft
Disposal Field on Lot > 100’Yes if No ft
Neighboring Disposal Fields > 100’
Yes if No ft
Sewer Line/Main > 100’ Yes if No ft
Sewer Manhole/Cleanout > 100’
Yes if No ft
Sewer Service/Septic Line > 25’Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Disposal Field(s) on Lot to:(Please enter distances if less than required)
Tank to Foundation > 10’Yes if No ft
Field to Foundation > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main/Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
Wells on Adjacent Lots:
Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Phone
Engineer’s Printed Name Date
Date: 5/26/26
P.O. Box 670269 Chugiak, AK 99567
P: (907) 688-2759 F: (907) 688-2259
AK Built Construction and Design.
RE: - 22824 Daniel Court. Chugiak, Alaska
Well Camera Inspection
The well is steel cased beyond 100’ with a 2’ Stickup. All welded joints look good with no leaks.
The Casing is in good condition with no holes, cracks or leaks. The pitless area appears to be
sealed and in good condition. There is no indication of surface water contamination.
Well Log
Stickup: 2’
Pitless: 11’
Pump Depth: unknown
Steel Casing: 100’+
Total Depth: Unknown
00
SOI0;n
El— O0
i
N
O w
OLd
L
O
27.0'
o�
Q
t17 O
DANIEL COURT
N89°58'40"E 100.33'
(S89'59'00"E 100.00' R)
1—X—
x
SEPTIC •I
VEN i
(tYp)
GRAVEL
D/W x
i
24.0' i
• EX
I
N
O I
X
•
EXISTING
HOUSE
LOT 38
WELL o
n =
(S89'59'00"E 100.00' R)
I
ANCHORAGE RECORDING DISTRICT, ALASKA
ASBUILT OF:
DELUCIA SUBDIVISION
LOT 38 PLAT P-684
SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: UAIE: SCA1F:
MAR 3, 2016 1"=20'
16-012 1RA" By: MIo® 11 O 0 no w:Boq PA £
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1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC261130
Subdivision: Delucia, Block: , Lot: 38
A water sample revealed a nitrate concentration of 6.35 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Mailing Address: P. O. Box 1966SO * Anchorage, Alaska 99519-6650 * www.muni.org I
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address: P. Q. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
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
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address '~,~,
Lending agency
/
Mailing address
Day phone
Agent
Address
Day phone ~'-~/ZJ~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~ 'w
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.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
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
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
Address
Engineer's signature
David R. Dayton P.E.
20210 Denalar St.
Phone
DHHS SIGNATURE
,~ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms,
with the following stipulations:
Additional Comments
Date //~- ?-
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.
72-025 (Rev, 1/91) Back MOA ~t21
( Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~T- ~)(~) D~-t. Lc-/~ ~ Parcel I.D.
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~/~z-.~,~,,J Driller
Cased to //--" ~ Casing height ~,2~"
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
AT INSPECTION MUNICIPALITY OF AN(SHOP, AGE
////~/~' 2_ EH_vtI~ONMENTAL SI-'RVICE$ DIVISION
P "c IV D
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line ~/~-
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank 4//~-
WATER SAMPLE RESULTS:,
4::). ///* ~/~,~
Coliform <3~(' ///; z./fS~z//Nitrate
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Tank size I O~:)~C) Compartments
Foundation cleanout (Y/N) Y Depression (Y/N)
~J/~- Alarm tested (Y/N)
////ff/~ ~ Pumper ~,'~/~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ,/'~' ~ On adjacent lots
To property line ~"~! Absorption field
S u rface wate r/d rain age J~D~"J~-
/'.~ '~_5'- Foundation I
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Manufacturer
Manhole/Access (Y/N)
Vent (Y/N)
"Pump on" level at
"Pump off" level at
High water alarm level
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
Soil rating ,/~ z~//~'~-System type
Gravel thickness //42 Total depth ,/'~
Cleanouts present (Y/N) Y
Date of adequacy test t///
for
D. ABSORPTION FIELD DATA
Date installed ~/~///~/
Length ~ !
Width
Total absorption area ~) '~;~'
Depression over field (Y/N) ,/~
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot
To building foundation
On adjacent lots .~:"o'~-
Surface water
Curtain drain
....~ !
On adjacent lots ./~' ~ ~ Property line
~ ¢ To existing or abandoned system on lot
Cutbank ~ ~ Water main/service line '~<:~'~'~-
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 this inspection.
David R. Dayton P.E.
20210 Donalar St.
Signature ..._ ~. ,,i__~__ ,.,...--~ .----,
Engineer's Name '~.'_~ ~'~::~--/~~ ~
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
D. R. DAYTON, P.E., R.L.S.
~~~xX~ Chugiak, Alaska 99567
20210 Donalar Street
[907)~~
696-2417
November 16, 1992
WELL FLOW TEST
Legal Description: Lot 38, Delucia Subdivision
Date of Test: November 13, 1992
Well Depth: 165 ft.
Static Water Level: 154 ft.
Requirements: 450 gallons per day for 3 bedrooms.
Test:
The well was pumped at' varying rates until the draw down stablized.
Pumping was then continued for a total of 4 hrs. 56 min.
Results:
The well produced 1.5 gallons per minute with a draw down of 7.1 ft.
Conclusion:
The well is currently functioning adequately for a-3 bedroom home.
D. R. DAYTON, P.E., R.L.S.
~~~ Chugiak, Alaska 99567
20210 Donalar Street
(907) ~x~
696=2417
November 16, 1992
ADEQUACY TEST
Legal Description: Lot 38, Delucia Subdivision
Date of Test: November 13, 1992
Absorbtion System: 20' x 10' effective depth trench
Septic Tank: 1000 gallon, 2 compartment, steel tank
Soils Rating: 100 sq. ft. per bedroom
Daily Design Flow: 450 gallons per day for 3 bedrooms.
( DHHS Records)
( DHHS Records )
(DHHS Records)
Test:
456 gallons of water were injected into the absorbtion trench
in a 4 hr. 56 min. period.
Results:
The absorbtion trench accepted the daily design flow in 4 hr.
56 min. with a 0.2 ft. rise in the monitor tube liquid level. After
water injection was stopped, the liquid level in the monitor tube
returned to the original level in less than 20 minutes.
Conclusion:
The absorbtion system is currently functioning adequately for
a 3 bedroom home.
MUNICIPALITY OF ANCHORAGE
, DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRO~iENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1 General Information Application Date ~//~/~k/~
· '/ z/
(a) Legalpes_cr~ption~-~inc~ludezlot, ~o~D subdivision, section, township, range)
Location (a~d~re~! or directions)
/V
!
(c) Applicant is (check one) Lending Institution ~--~ ; Owner/builder~;
Buyer ~--~ ; Other ~ (explain);
(d) Le nd i n~I ~stitutio n~~'~ B~/.~ ./~z~ ~z~/ Telephone
Address ~/~ ~. -
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the H~ to the following address:
2. T'pey of Residence
Single-Family~
Number of Bedrooms
Multi-Family ~
Other (describe)
3. Water Supply
Well~ Community~-~ Public~-~
Individual
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.
Onstte~ Public ~ Community ~-~ 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]
En~ineerin8 Firm Providing Inspections, Tests, File Search, Data and Informatioa
As certified by my seal affixed hereto and as of the validation date shown h~low,
verify that my investigation of this Health Authority Approval shows that the
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
based on the information obtained from the Municipality of Anchorage files and
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm
Telephone
Address
Date
DHEP Approval
Approved for ~li ~i_(__.bedrooms
Approved~
Terms of Conditional Approval
CAUTION
THE bRINICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH kND ENVIROnmeNTAL PROTECTIO:
(DHEP) ISSUES HEALTH AL~HORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENt-
ATIONS 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 kYD
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~*2qD STATE REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
A®
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH ALrI~ORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
Well C lass i f icat ion f'~7 ~/¢~
Well Log P~esent ~
Total Depth ~ &C%'~/ Cased to
Static Water Level ~/ ~
Casing He igh. t,. Above Ground .~ ¢ /f
Electrical Wiring in Conduit (~.~Y~
~UNICIPALITY OF ANCHO,gA~...5
DEPT. O:F HEALTH &
~'NVIRONM~NTAL ?;:~C TEC i'ION
'$£P 2 5
RECEIVED
Legal D/escription: ./_~ /)~/~-£~
(/g /~ Yield
Date
~leted
~ ~ - ~pth of Grouting
~ ~t At
Sanit~y ~al on Casing~
~ession ~nd ~l~ead
Separation Distanc~..s from Well:
To Septic~ Tank on Lot
To Nearest Edge of .Absorption Field on ~ot /"~,~' f~
Seweri.,Line. /¢/~ To Nearest Public Sewer
To
Nearest
Public
AJ/ /1% To Nearest Sewer Service Line on Lot
C leanout/Manhole
Water Sample Collected By %, ~ <]~/~¢ef/F& ~; Date
Water Sample Test Results ~9 ~/~' ~:~:;' '7'"~ ~'7
Ccm~ents
On Adjoining Lots
; On Adjoining Lots
Be
SEPTIC/HOLDING TANK DATA
Date installed 7/¢~ ¢ Size /~
Standpipes ~ // ~.~ Air-tight Caps (Y~'
Depression over Tank (~f!~ Date Last "J,'Pumped
Pumping/Maintenance Contract on File (Y./NCJ/~9- ; for
Holding Tank High-Wate~ Alarm (Y/N)/~//A~ ~Temporary Holding Tank Permit
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /~3~ ~ To Building Foundation
To Property Line /~ ! To Disposal Field
To Water ~service Line ~C'~ !
Cour se
No. of Ccmpartments ~
Foundation Cleanout ~)
(y/N)
To Stream, Pond, Lake, (r Major Drainage
Con~ents
Receipt 9
Date Paid:
Amount: ~".
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 7/y/~/
Width of Field
Square Feet of Absorption Area
Depression over Field (Y~
Results of last Adequacy Test
Separation Distance from Abscrption Field:
Type of System Design~/~
' 'Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present ~Y~)
Date of last Adequacy Test
To Water-Supply Well
To Building Fcundation ~C9 ~
Lot ~ ZC I~ ; On Adjoining Lots
To Water Mi~./Service Line ~&~ ¢ To Cutbank(if present)
To Stream/Pond/Lake/or Major Drainage Course
To Drlveway,/Park. lng Area, or Vehicle Storage Ar~a
To P~operty Line /'~
To Existing or Abandoned System
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Ele ctr ical Code s (Y/N)
Di~e ns ions
,,apJ~ole/Access (_Y/N)
f" LeVel at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
Meets MOA
Comments
Check Permitted Bedrocm Rating A~ainst HAA Rmquest
I certify that ! have checked, verified, cr conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed
Company
KB1/d5/s
[Page 2 of 2]
2-15-84
~' k_¢ D~Ti~ RECEIVED
INSPECTION APPOINTMENTS
DATE DATE DATE
NSPECTOR INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE /vlUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchora~, Alaska 99501 [NVb
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
o.
DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proce~ed. Please allow ten (10) days for processing.
P~PERTY RESIDENT (If ~fferent from above) .~ PHONE
MAILING ~DRESS
3.~__r LEND~-~BTtTUTION O. ' ' '~5 -~X~.~ PHONE
M~~D D R ESS
4. R~A.~p~/5~ENT ~
MAI LING ADDRESS t ~ -
5. LEGAL DESCRIPTION
l., .
6.TYPE OF RESIDENCE
"[~., SINGLE FAMILY
I--7t MULTIPLE FAMILY
NUMBE~F,BEDROOMS~
One ~ Four
Two ~ Five
Three ~ Six
[] Other
7. WATER SUPPLY
I
NDIVIDUAL*
COMMUNITY
[] PUBLIC UTI LITY
8. SEWAGE DISPOSAL SYSTEM
[~ INDIVIDUAL/ON-SITE'* EAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBliC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
~,-o,o,,.~. ~,~_,d~ ! "'ir L....-- ~,~ ,.
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.) ~,.Ov\~.., C~L)Ct',I "" i(C
THIS SIDE FOR OFFICIAL USE ONLY
,]
1. TYPE OF RESIDENCE
E~"~'~l NG L E FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] ONE E~THREE [] FIVE [] OTHER
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
2. WATER SUPPLY
E~"~INDIVI DUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[~'11~1 VI DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
E~'S'~ptic Tank or [] Holding Tank
Size: /~0~ ¢,~ If Tank is homemade
give dimensions:
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
PERMIT NUMBER
DATEINSTALLED
INSTALLER
SOILS RATING
MANUFACTURER~
MATERIAL ,Clef ]~~
I Septic/Holding Tank IAbsorption Area
Sewer Line [ Nearest Lot Line
DATE
[]~'-- APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany Certificate)
[] DISAPPROVED
72-010 (Rev. 6/79)
David and F~oberta ,.~:or .h_ad
~eedles Road, I,ot 3~q Delucia
Chugiak, AK 99567
Subject: Lot 3~, Delucia Subdivision
Approval for the individual sewer and water facilities cannot
be qranted until the following items have been completed:
~e water analysis reDort needs to be submitted to this
office from the Chem Lab, 5633 B Street, for our review.
The sentic tank ~umpe~ with a receipt submitted to this
the actual nmnber o-~ ~t1:~,. ~u~d-..,, Thi~..is .tO-v~rif~ the~?
An test needs to be performed on the existing
~dequ~cy
leaching area. This test will determine if the system is
adequate according to National Standards. A listing of
private firms performing the test is enclosed. This report
needs to be submitted to this office for our review.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 26~-4720.
Sincerely,
Enclosure
npii 5/pt,..p,
Robert C. Pratt
Associate Environmental
EXCAVATION
ROBERT A. SHAFER
WORK
CIVIL ENGINEER
694-2979
June 14, 1982
MUNICIPALITY OF ANCHORAGE
~'~T ~'~ '.'~'~r'4 ~.
ENVIg,:~!. :t,,A. ~ ,o E -.. i
Jeannie Erhart
4797 Business Park
Building F-6
Anchorage, Alaska
99 503
2 1982
RECEIVED
Dear Mrs. Erhart,
Reference: Lot 38: DeLucia Subdivision
A sewer system adequacy test was performed on the system
located on the referenced property as you requested. The
septic tank was pumped and verified to have a capacity of
1000 gallons. The seepage pit was charged with 1000 gallons
of fresh water and after a period of 24 hours all the water
had percolated out.
It can be concluded from this test that the waste water '
disposal system serving the three bedroom trailer located on'
this property is currently functioning-adequately. However,
the system cannot be guaranteed against subsequent failure.
If we may be of further service, please do not hesitate to
call.
Sin(- ' ~
of
cc: Municipality Anchorage
Department of Health and Environmental Protection
Commonwealth Area Realty
SRB 196X EAGLE RIVER, ALASKA