HomeMy WebLinkAboutFERGUSON LT 3Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP141118 PID Number: 051-261-31000
Dwelling: E Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New E Upgrade
Name:
GARY & KIMBERLY MARTIN
ABSORPTION FIELD
❑ Deep Trench E Shallow Trench [:1 Bed ❑ Mound
Address
20049 LAUGHLIN ST, CHUGIAK, AK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-854-4274
4
0.6 GPDISF
Max 6' Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.5-2.0 Ft.
Gravel depth beneath pipe
4.0 Ft.
Subdivision Block Lot
FERGUSON 3
Fill added above original grade
Var. 0.7-2.3 Ft.
lGravel length
2 trenches - 53+ ea
Township Range Section
Total -106'+ Ft.
Gravel width
5 Ft.
Beds: Number of Lines
.Distance between lines
I Ft.
SEPARATION DISTANCES
To.
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
I Number of trenches
Dist. between trenches
1
From
Tank
Feld
Tank
Line
1060 FTz
2
10+ Ft.
Well
100+
100'+
NA
-
NA
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1 1250 Gal.
Surface Water
100'+
100'+
NA
--
Material
STEEL
Number of compartments
2
Lot Line
5'+
10'+
NA
__
NA
Foundation
5'+
10'+
NA
--
LIFT STATION
Manufacturer
Capacity
Curtain Drain
NA
'50'+
NA
-----
Gal.
Remarks 'No known Curtain drains.
Pump on level at
Pump off level at
High water alarm at
Field, and lines insulated. D/
tank, -ae/r/
in.
n.
in.
y'1G 10 GIECvWj�rJ t1SIONr�4 fE/ �-/,� Qf� �/'
Pump make and model
Electrical Inspections performed by
417116 — Mod. gravel length to conform with field insp. 5 u.YV
Installer Walker Construction
Tanko
PIPE MATERIAL House to tank D3004 dra nfield D3034
Drainfield D3034 CO/MT D3034
Inspector Arcterra Consulting
BENCH MARK (Assumed elevation) 100 it
Inspdates: 1� 5/29/14 5/30/14
Location and description : Sono -lube foundation for deck
znd
305/30/14 4"'
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
r O� �L k
Conditional Approval:
U
Date��
*14 TH 1
*
EENNNEr
Approved Date it —g
i ssto Sn�
For
Inspection Report 4-7-16 mod stamped.doc
AS-BUILT SYSTEM DETAILS/SITE PLAN Permit OSP141118
FERGUSON SUBDIVISI❑N LOT 3 PID# 05126131000
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A-D=23,15 ti101.20ae"100,0 98.6
MCWTOR TUB
B-D=20.38 auT FINAL GRADE
A-E=28.88 £
B-E=23,10 MM `" /nnuAnu v GG=96.4
A-F=47.22 Ay 1250 GAL
B-F=26.09 'n N SEPTIC 94,8 94.86
B-G=43.30 vm TANK SEWER ROCK
1J•
C-G=55.33 97.6 97.4 TRENCH 1
A-H=63.44 90,70 90.70
oB-H=54.28 53.3'
A-I=75.54 7.61 FINAL GRADE MONITOR TUBE aE ,
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' SEWER ROCK
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TRENCH 2
_90,40 90.40
`o 53.2' 84.30 ea
Ar �� �F<Q& 1 PREPARED FOR,
GARY & KIMBERLY MARTIN scl"ic,
C E20049 LAUGHLIN ST.
9TH * ICHUGIAK, AK 99567907-854-4274KENNETH M FIELD BOOKSCE-7118 9WNDARNDRAW ksclwcMEcKO:KMD3S10Tj�,As9uar. JLS DATE: 10 23 14 DwD. nm' 14-12B MID! NW0856
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On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP141118
Tax Code Number: 05126131000
Work Type: Septic Upgrade
Permit Effective Dates: May 16, 2014 to May 16, 2015
Design Engineer: ARC TERRA CONSULTING INC
Subdivision: FERGUSON
Site Legal Address: FERGUSON LT 3 G:0856
Owner/Address: MARTIN GARY D & KIMBERLY B
20049 LAUGHLIN ST CHUGIAKAK 995676918
Site Mailing Address: 20049 LAUGHLIN ST, Chugiak Lot Size in Sq Ft: 44549
Total Bedrooms: 4
This permit is forthe construction of:
ik Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Receive
Issued
MUNICIPALITY OF
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I. D. 051-261-31
Property owner(s) GARY & KIMBERLY MARTIN Day phone
Mailing address
20049 LAUGHLIN ST., CHUGIAK, AK 99567
Site address 20049 LAUGHLIN ST., CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) FERGUSON LOT 3
Legal description (Township, Range & Section)
Lot Size 44549 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN:
(® all that apply)
Absorption Field
Initial
Septic Tank
Upgrade
Holding Tank
❑ Renewal
Privy
❑
Private Well
❑
Water Storage
❑
Im
TYPE OF DWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D)
Multiple Dwellings
S UBMITTALdlor D)
MAY 12 2014
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
property owner or
Permit/Rush Fees:
Date of of Payment:
Receipt Number: 6q5 J5 ?"
Permit No. 6c5t01LI07
Permit App_9-1-12.doc
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
V
a
o Q►RCTERR,q
April 30, 2014
ARC 1 I:RRA
CONSULTING, INC
212 E. 51" Ave, Anchorage, AK. 99503
Office (907) 868-3791, Fax (907) 868-3793
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Upgrade Sewer Permit — Ferguson Lot 3
The owner has requested we proceed forward to obtain a septic permit to
upgrade the septic system of the subject property.
The general slope of this lot is from south to north at a grade of approximately 7-
12% over the septic area. On April 16, 2014 a testhole was performed to
investigate soils and groundwater. The results of this test are attached for your
review. The proposed upgrade will serve the existing (with 1 -bedroom addition)
4 -bedroom house. We propose to install two 5 -Wide 50' long trenches.
Groundwater was not encountered at excavation but was at 12' at monitoring 8
days later. The groundwater monitoring tube was subsequently monitored
again 12 days later from excavation and was found to be dry.
The property and adjacent lots are served by private water and a class A well,
which is 400'+ from subject property. There is no surface water within 100' of the
proposed system and there are no known curtain drains within 50'. We do not
expect there to be any adverse effect on adjacent lots by the development of this
system. If you have any questions, please contact me at 868-3791 / FAX 868-
3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
Kenneth M. Duffus, P.E.
Attachments: On -Site Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/ Percolation Test
20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793
WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA
FERGUSON SUBDIVISI❑N LOT 3
FLAG PROPERTY LINES
WELL RADII & EASEMENTS
PRI❑R TO C❑NSTRUCTI❑N
NO PUBLIC WELLS WITHIN 200' OF
PROPOSED SYSTEM.
NO PRIVATE WELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED.
NO SEPTIC SYSTEMS WITHIN 200' OF
PROPOSED WELL EXCEPT AS NOTED.
Idw
OF AZ4
*. 9TH
` 10ENNEM M. s
CE -711
W
\ �OFE3310ti�'
Scatel 1'= 100'
DESIGN DETAILS PAGE 1 OF 2
4 BDRM X 150 GPD = 600 GPD
600 GPD/0.6 GPD PER SQ. FT. (18 MIN/IN.)= 1,000 SQ. FT
(1000 / 5 x .50 (4' GRAVEL) = 100 FT. TRENCH
USE 2 TRENCHES - 50' (L) X 5' (W) X 4' (ED)
Total depth of system is 6' from original grade.
Total depth of gravel below distribution pipe Is 4'
NOTES+
1, INSTALL 1250 GAL SEPTIC TANK & INSULATE TANK IF <4' COVER.
2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF < 3' OF FILL.
MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ.
3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK.
4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC...
PREPARED F❑R1
GARY & KIMBERLY MARTIN
20049 LAUGHLIN ST.
CHUGIAK, AK 99567
907-854-4274
FIELD BOOKS
TRACT A
BOUNDARY' BOUNDARY
NNS9'N'E 120.07' �®
s�
STARING: STAKING
CHECKED:
(NNWW E 120.0' R)
ASBUILT: JLS
OATEI
05/12/14
Itl ulury m
GRID:
NW0856
ACAD FILE: FILE
errGais
14-128
.PPRLOC.
g
SEPTIC
I
I
..
APPI
LOT 4 n
LOC.
y
q
8
SEPTIC
X
p
Ytlln
t )\�
LOT 2
C//
4
T3
fC
®rt
1190W W IN.09' (190. ' R)
19
zo
LAUG TREET
W
2s
FLAG PROPERTY LINES
WELL RADII & EASEMENTS
PRI❑R TO C❑NSTRUCTI❑N
NO PUBLIC WELLS WITHIN 200' OF
PROPOSED SYSTEM.
NO PRIVATE WELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED.
NO SEPTIC SYSTEMS WITHIN 200' OF
PROPOSED WELL EXCEPT AS NOTED.
Idw
OF AZ4
*. 9TH
` 10ENNEM M. s
CE -711
W
\ �OFE3310ti�'
Scatel 1'= 100'
DESIGN DETAILS PAGE 1 OF 2
4 BDRM X 150 GPD = 600 GPD
600 GPD/0.6 GPD PER SQ. FT. (18 MIN/IN.)= 1,000 SQ. FT
(1000 / 5 x .50 (4' GRAVEL) = 100 FT. TRENCH
USE 2 TRENCHES - 50' (L) X 5' (W) X 4' (ED)
Total depth of system is 6' from original grade.
Total depth of gravel below distribution pipe Is 4'
NOTES+
1, INSTALL 1250 GAL SEPTIC TANK & INSULATE TANK IF <4' COVER.
2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF < 3' OF FILL.
MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ.
3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK.
4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC...
PREPARED F❑R1
GARY & KIMBERLY MARTIN
20049 LAUGHLIN ST.
CHUGIAK, AK 99567
907-854-4274
FIELD BOOKS
COMPUTED:
BOUNDARY' BOUNDARY
DRAYM:
BMW
STARING: STAKING
CHECKED:
KMD
ASBUILT: JLS
OATEI
05/12/14
DING. FILE
GRID:
NW0856
ACAD FILE: FILE
JOB Nw
14-128
WASTEWATER DISP❑SAL SYSTEM DETAILS
FERGUSON SUBDIVISI❑N LOT 3
CLASS A WELL
N89°56'36"E 120.07' PR400'+ FROM
OPESED SEPTIC
(N90°00'00"E 120.00' R)
10' UTILITY ESMT
NO SLOPES >20%
W/IN 100'+
OF PROPOSED SEPTIC
X29 8
4GPD/SF ADVANCED
ms's
SYSTEM RESERVE �� TH14_1 O
15'LX5' WX4'ED N O
MT '4 CO
O
29 CO
b CO �� N
T
CO FLOW—
i SPLITTER
DECOMMISSION EX TNG CO G FIELD
EXISTI
SEPTIC TANK AND IN LL CggAN ONED z
NEW 1250-GAL S.T. . IN PLACE Q
•% IN THE SAME LOCATION. CO O
FC�f 0 5.0' O
12.0' 0
62.7' No % 4Q01 CO O
w O
s o
2' CANT o 71
0
w
m
FLAG PROPERTY LINES
WELL RADII & EASEMENTS
PRI❑R TO C❑NSTRUCTI❑N
Scale; 1'= 30'
T� PAGE 2 OF 2
OF "L44Sy\ 1 PREPARED FOR, CTE 1� D
GARY & KIMBERLY MARTIN
20049 LAUGHLIN ST.
* 9 TH * / CHUGIAK, AK 99567
907-854-4274 aD
/9 v
•• Iisl'I%1>••i FIELD BOOKS dO.wuim: � <
` C -711 W m r-BOUNDARY DRAW BMW
STNOM STAKING a*aa9: KMD r JLS DAIS: 051214..,
3SIoN= Dft �: a>a NW0856gcoNs
\`__ "D"D F E: FILE ADB N` 14-128 °fa, K 9957 Bl}6
a �RCTERRq
ARC 1 1rRRA
CONSULTING, INC
212E. 51" Ave, Anchorage, AK. 99503
Office (907) 868-3791, Fax (907) 868-3793
SOILS PERCOLATION TEST
Performed for: Gary Martin Date Performed: 4/16/2014
9�„ I"I2E'CH M. DUE 'U5
9116Jk, 14
Project: Ferguson Lot 3 TEST HOLE # TH 14-1
Depth
(Feet) SEE ATTACHED SITE PLAN
1-
- ORG/OL FOR HOLE LOCATION
GM/SM
13- B.O.H.
14-
15-
16-
17-
18-
19 -
HOLE PRESOAKED
20- PRIOR TO TESTING
Was Ground water encountered? NO What depth? NA
Depth to water after monitoring? 12' & Dry Date? 4/24&28/2014
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Dro
1
4/22/14
1:00
6"
-
2
1:30
30 min
44/16"
112/16"
3
*
1:31
6"
-
4
2:01
30 min
45/16"
111/16"
5
*
2:02
6"
-
6
2:32
30 min
4 5/16"
1 11/16"
7
8
9
10
11
12
*
Water
Added
Percolation Rate 18 (min/in) Perc Hole Diameter 6"
Test Run Between 4.5 feet and 5.5 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State
and Municipal guidelines in effect on this date.
Page 2 of 2
Legal DescriptionTerguson Property Owner Name&Address:
Lot:3 Gary and Kim Martin
Block: 20049 Laughlin street
F.aalr River AK 99577
Pump Installation Date: 8-28-08
Pump Intake Depth Below Top of Well Casing:105 Feet
Pump Manufacturer's Name: Dempster
Pump Model:MBF2-50-S2
Pump Size:1/2 hp
Pitless Adapter Burial Depth:10
feet
Pitless Adapter Manufacturer's Name:
Baker
Pitle ss Adapter Installer:
Arctic Pump & Well, Inc.
Well Disinfected Upon Completion? Yes
Method of Disinfection:
Chlorine
Comments:
Pump Installer Name:
Arctic Pump & Well, Inc.
9/16/2008
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water d Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Renewal
Date Issued: Aug 08, 2007
Expiration Date: Aug 07, 2008
Permit Number: SW070195 Parcel ID: 051-261-31
Legal Description: FERGUSON LT 3
Design Engineer: 0000 ZZ - NONE NEEDED
Owner Name: GARY & KIM MARTIN
Owner Address: 20049 LAUGHLIN STREET
EAGLE RIVER. AK 99577-0575
Site Address: 020049 LAUGHLIN ST
Lot Size: 44549 SO. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well ❑ Water Storage
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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55.
PLEASE SEETHE ATTACHED SHEET "PERMIT REQUIREMENTS FOR A PRIVATE WATER WELL". ITIS THE
BURDEN OF THE PROPERTY OWNER TO DETERMINE THAT THE PROPOSED WELL WILL NOT HAVE ANY
ADVERSE IMPACTS ON ADJACENT WELLS OR SEPTIC SYSTEMS AND DETERMINE ANY EXISTING
WASTEWATER PERMITS EFFECT THE LOCATION OF THE PROPOSED WELL. IF THERE ARE ANY
QUESTIONS, PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER PROGRAM AT
907-343-7904.
Received By.
►u7ij/�1.11'l. �I�..
Date: 2 O
Date: g
Municipality of Anchorage
-�� -Development-Services Department
Building Safety Division
- On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. OS 1 —0-161 —3 1
Propert
Mailing
Site address SG(%) -2 Zip Code
Legal description (Sub'd, Block & Lot)
Legal description (Township, Section & Range)
Lot Size L44, 5q9 Sq. Ft.
THIS APPLICATION IS FOR (®all that apply):
Absorption Field
❑
Septic Tank
❑
Holding Tank
❑
Privy
Private Well
Water Storage
❑
Number of Bedrooms
THIS APPLICATION IS AN:
.0030
Moo,
..
Initial
❑
Upgrade
❑
Renewal
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: Waiver Fees:
Date of Payment: 6 Date of Payment:
Receipt Number: ��� 9� Receipt Number:
(Rev. W05)
.......... F�q 4' 1%
,IN U. SWM
IS -9234
LOT 4
0
s
O
OGU,O
AN SUBDIVSIoN
WI TM TRACT A
WEST 120.00'
LOT 3
44f O ACES t
WOOD FRAME
HOUSE �
/ �o
well
+hi5
a ren
AL MON.
173.62'
10' UTL ESMT
WEST
U
/
A.+ — — —
' g'9'
`SEWER
/ VENT
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e
— -t•
far '!�
0
SUBUIL� .
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rn
N
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$ LOT 2
00
P
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—LA UGHUN --- '�� r
ASBUILT OF: L�,ou ie
LOT 3, FERGUSON SUBDMSION L�=�
EAGLE RIVER, ALASKA 99577
SURVEY CERTMCA71ON: SMMI SCHULLER CO. h.a
conducted ,�� cal survey of thisproperty as shown on ede
drawing and ihet the improvements artaaoed thereon are within
the property lines and no encroachments exist otha than noted.
EXCLUSION NOTES:It is the owners responsibility to det tine
the existence of any easements, covenants, or restrictions which
do not appear on the tecorded subdivision plat.
\ HORSE
CORRAL
AV
1�5 � RouS�
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7•set on�nn�n�ni.ww nwswwm •vinr�s��i.e
To: Municipality of Anchorage
August 7, 2007
I have a permit to dig a well on my property Furgeson Subdivision Lot 3. 1 understand
that if my well is adequate and I do not use the previous well it must be decommissioned
and no longer used.
If the new well is also a low -flow well and we place a pump in it aiitd well as the existing
well to use concurrently that we may have-JjpDwells as long as both are in use.
-IU'0
Sincerely,
em�
ea/
Ma in
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
NAMEPHONE EW
ke ❑ UPGRADE
MAILING ADDRESS -
LEGAL DESCRIPTION
__ J C)
LOCATION
NO. OF BEDROOMS
Well Absorption area
DISTANCE TO: J /
Dwelling
i
PERMIT NO. -
~. Z
a~.<
Manufactu
Manufacturer
Material
No. of compartments
rn
_
Liq. rapacity in gallons Inside len th
IF HOMEMADE: y
Width
Liquid depth
CJ
O Y
J Z
Z
DISTANCE TO: Well Dwelling
PERMIT NO.
° Q-—
=-F,
an ufactu rer Material
Liquid capacity in gallons
_
w
Well
DISTANCE TO: ,F /
Uu
Foundation / Nearest lot line PERMIT NO. ��t
�S 7 82G y7�1
J LL Z
- Z w
— —_
No of lines Length of each line
_
Total length of lines Trench width Distance between lines
_
Top finish
InCheS
H
of file to grade i
Material beneath tile. Total effective absorption area
w
Length Width
Depth PERMIT NO.
C7
Type of crib
Crib diameter
a F•
Lu FL
Crib depth Total effective absorption area
LU
y
DISTANCE TO:
Building foundation Nearest lot line
Well
J
jLu
ClassP�j
-F-L4. i v
Depth
' - /
_L�µ� (,ti (/LC)t_
Driller
Distance/to lot line
-.L-f_t.l �a.a-(n«i.t
PERMIT NO
DISTANCE TO:
Building foundation
�tac
Sewer line
/
Septic: tank r
Absorption arca(s)
p
rrty�
aU
_
OTHER
PIPE MATERIALS
) 03 V -- ---
N
SOIL TEST RATING
--
-
INSTA LER
--
--
-
REMFlRKS
O
-
—
5
--_
3�
_
APPROVED DATE LEGAL
�i
DEPHRTMEHT nc HEHLTH HND ENVIRONMENTHL pROTECTION
825 STREET, HNCHOFlo, HGE
264�4720
PFRMIT NO ( S20448 ) /) yM
HPPLICHNT HHMHNN CONSTPOBOX 617 EHQLE RIVER 694~2776
LOCFI, ION
LEG�L LOT ] SEC 20 T15N R1W LOT SIZE 2]000 SQUHRE F�ET
TYPE OF SOIL HBSORPTION SYSTEM ITRENCH
MHXIMIll NUMBER OF BEDROQM_; IL RHTING (SQ FT/BR)� 125
TH� �E��I��D S��� OF THE SOIL HBSORPTION SYSTEM IS�
�P" "T", P.- -0� ��11".4 C��� �� �����-If�
THE HE LENGTH IN FEET) OF THE TRENCH OR DRHINFIELD
THE D�PTH OF H TRENCH OR P�T IS TH� DISTHNC� BETWEEN THE SURFHCE OF THE
GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET)
THERE IS NO SET HIDTH FOR TRI--NCH�S
THE G*RHVEL D1"PTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
������C.- ��r-4 VC l 1FEE ���C.-J ����r.lo�
PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE
INSTfl I LFITION OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE
NUI1.lBI_*R OF THAI THE WELL WILL SERV�
1 co r_J ISE.", �"s. F;;� rR". IEK kj If �
BHCKFILLING OF HNY SYSTEM WITHOUT FINHL HND BY THI�
DEPHRTMENT WILL BE R., PROSECUTION.
MINIMUM DISTHNCE BETWEEN H WELL HND HNY ON-SITE SEWAGE DISPOSHL SYSTEM IS
10I'D FEEll T FR H PRIVHTE ��LL OR 150 TO ��0 FEET FROM A PUBLIC WELL DEP�NDING
UPON THE TYPE IC WELL
MINIMUM DISTHNCE FROM H PR1VHTE WELL TO H PRIVATE SEWER LINE IS 25 HND
TO H COMMUNITY SEWER LINE I� 75 FEET
OTHER �EQU�REMENTS MHY HPPLY� SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS FRE
HVHILHBLE TO INSURE PROPER INSTHLLHTION.
�F -1 11F.- " E -, F�',
I CERTIFT' THHT
iHM FHMILIHR WITH THE F'OR ON~SITE SEWEF.S HND WELL� AS S�T
F"OPTH BY THE MUNICIPHLITY OF HNCHORH�E
2� I WILL IN�THLL THE HCCOFY:-HN[E NITH THE CODES
]� I UND��STA I'lD THAT THE ON—SITj.-, SEWFER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE
RESIDENCE IS REM
SIGNED� ..... ... ~..... —..... ...
—~---~~
MUNICIPALITY OF ANCHORAGE
Department f Health and Environmenta" '3rotection
825 L Street, Anchorage, AK. J9501
264-4720
# # # HANDWRITTEN PERMIT # # #
Permit # q _Sr)n�l WE
Applicant:
Location:
LL R PERMIT
Mailing Address:
_ Phone Number:
Legal Description: / I /::"Gr4IS O 'e✓'
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed:
Maximum Number of Bedrooms:
DEPTH
Lot Size:
Holding Tank:
Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
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.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = 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 that the well will serve.
# # # TWO(2) INSPECTIONS ARE REQUIRED # # #
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
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 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 will install the system in accordance with codes.
(3) yun Itandf
hat the on-site sewer system may require enlargement if
denis remodeled to include more that 3 bedrooms.
Signe: Issued by:
pplicant
Date: ;2 tri
SWP/024(1/81) 40 & 0�3
0 £t E GEM ECHNI CAL Et DEVELuPMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
8
694-2774 SOIL LOG
Soils B Foundations Land Development
Performed for: Name: Tel. No.
A•°aNH••°j•
Mailing Address: �►�+rlri f
Legal Description:
Death (feet)
0
11
*3
�4
13
6
Y
8
9
11
� fxr ea• n•a.0 •aaa�=. � �e.
Soil Characteristics �;4 `A; ,_ R FI L. Uy,ter
7�•"O••eas•w•��d►
Ground Water Encountered: Yes— No� If yes. what
Proposed Installation: Seepage Pit Drain Field
Comments:
Performed by: Date:
.: CF At %j
WQ�to
°°......•°•.'43� 11
r
*= 49L
;*
q•°N••wuuwew•eo•••i••
Pm Earl P. Ellis .�
13
1i!
15
16
� fxr ea• n•a.0 •aaa�=. � �e.
Soil Characteristics �;4 `A; ,_ R FI L. Uy,ter
7�•"O••eas•w•��d►
Ground Water Encountered: Yes— No� If yes. what
Proposed Installation: Seepage Pit Drain Field
Comments:
Performed by: Date:
.: CF At %j
WQ�to
°°......•°•.'43� 11
r
*= 49L
;*
q•°N••wuuwew•eo•••i••
Pm Earl P. Ellis .�
WA ; WILL DR?LLING LVD
Drilling Co. -•--
Driller C4
Well owner /y''rN Lig — Use of well��
Location (address of, Township. Range, h section, if known,
or distance from main road--/,-;' tf F "AeP i v -i , 4'4
to coupleted `r j z
Size of casing Depth of hole /G J feet, Cased to f' `' teat,
Static water level feet (a"M) (below) I*hd surfetee, Finish of
well ( check one) Open end (s-) , screen ( ) . Perforated
Describe sesreen--ar--Te7rforertions `i t �� ! •" r J
Well pumping test at .gals. per (boar) (minute) for hours
witb.ua:_._Seet of drawdown from static level.
-VopRemarks/,w —i':—N •-�,Y p J l�JwIM
c�]i%a ti- /<< u �►i UI4 (' 4' r - ►yt^
Depth in feet from GSve deftils of formations penetrelted,
ground surface size of material, colorand h�rdensa,
c� to
to
to
to C L-
--. -_.to ..
to
to
to -
�to --
■
�.;m�erly �tl�o�t
Municipality of Anchorage
• � Development Services Department
Building Safety Division x ��
On -Site Water and Wastewater Program `
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D /161 JJZbk- at HAA #
I5',)�_
1. GENERAL INFORMATION Expiration Date:
Complete legal description
Location (site addressor directions) e2ODq q qu�6jly
Current Propertyowner(s)�Dnna��arlole J'
Mailing address 1 0.6x 77D.5 F
Lending agency r V Nle i�oPteaae
Mailing address
Day phone 9%1 -,?33a
Z
Real Estate Agent 1?4tnEV 1!6CdrAAh rDayphone &17q—y2106
Mailing Address i�o(st•1C� ,Of",fd7r.d, Q1
Unless otherwise requested, HAA will be by DSD for pickup:
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage 5W 6af
Community Class Well
Public Water System
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 sample results. (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.
TYPE OF WASTEWATER DISPOSAL:
f
Individual On-site
9
$�
Individual Holding tank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 sample results. (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 Health Authority 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 FirmP_UtVNc-Y P klvA/6Y k,5oejATE5, riyL Phone 97y-2332
Address f &vteyRet.b Avv& ,, 5TE /01 �.t6cE �1v 9957
Engineer's Printed Name Marl' Alder Date
5. DSD SIGNATURE
✓- Approved for �5_ bedrooms.
Disapproved.
0
MARK A. ALDER
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X Maintenance Agreements --
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory _ _ Other Kk-%AcJ_ A% X
By_ A . Q� Q, �_ Original Certificate Date: r'
(Rev. 01102)
6 x aL
Municipality of Anchorage
Development Services De art'menf ° �E Ag
Building Safety Division
O-ite,Water & ClasteWeter0rogram s t = *<r
t ��i anc�iorage ak us
EARTH AUTHORITY APPROVAL CHECKLIST
riptioh�R.R07 ��R"Gu50i✓ �'ul3V _ParcelID,. !91 31
<,U"t_"'-'w�a,-_.;r
vnrr _ If A, B, or C provide K D#LLL ell Log'(Y NIOr} �I L
eted 962 Sanitary seal (Y/ Y Wires properlyly protected (Y/N) i'
c d -
i ft Cased to 60 ft.vCdsmgtieight (above`groand) tl 3 In
AT I
'r eget % ft 71 ft
1C�tlOn ��"a,,:°�"xR'1�`'`+"'e'
9Pm gpm
t±+`.�'d�v`2n
i'mwii^tt
V ` colornes/100 ml Nitrate 6i79 mg./I Other bacteria O colonies/100 ml.`
Date of sample 9 8 tCollected by 12 Ekh T/11
49ft� "a, �dww"iMxm `"
a ena — E— FE I- Date installed 8L;-%J981
Number of Compartments 2 Cleanouts (Y/N) Y (Z�
cleanpu Depression over tank (Y/N) Iv High water alarm (Y/N) ®v
iping; IR U Pumper JP_'S
P uMn�.v�
'd 9 g2 . Soil rating (g p d /ftz or ft2/bdrm) ).254 System type 7-ie.EA&_y
5 ft Width ft. Gravelbelow i e )O ft
P p
EfYf af�sorption areaft Monitoring tube �' Depression over field
acytest IZ ResGlts (Pass/Fail� P,�ss For bedrooms
� arm _`YasS�'.`"' da"w#,";i+$'",":'�.e�'a:'>'r'^'»�ss.=�.{z s, "� r ,+"�`Sah�., t�a"l`a4�+• w'+y�°m
n absorption le before test T% n Water added �{bb gal. New depth S8` in
ie mm 4 e�vfi �Fxmal flwd de9p�ths �N &v4m Absorption rate > IOGb d
"' �"�f13��.'a��,-=n"8� -•���°'»"".Ye"vz '�'r`�'r".�.',�4"2�tt�S.: a.%'r�f`i�`^.uw'..t`Rrc±3iii�'w.2i�. �r.. ,..: .... wr. _.., _,:^-
ation treatment(past 12 moJ (Y/N ��vbel� " �n�� Is „nom n:.�e .���e
Building foundation _
Surface water _ n
Wells on adjacent lots
>ra - W 5y5TF,.q
G ENGINEER'S d'E' I (CAT1ON x �@
I certify that I have determined fiiroug�i field in's"pections and;' 49TH-
review of Municipal records that the above, systems are in .. - • r�-q_
conformance with MOA HAA guidelines in effect on this date.
......
En me`ers
Printed Name
/`�) I}IZk f}L V ElZ ; MARK ALDER ;awW
9 sig.• No. CE 9992: ,
Date I EEUI4,60 ) A
� pRer'"rcai0N4•�
Municipality of Anchorage e
Development Services Department
Building Safety Division
$A EiY
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Water Well Advisory
Health Authority Approval # HA040443
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Lot 3 of Ferguson subdivision, the well's
productivity was determined to be 0.23 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 3 -bedroom
residence is 0.31 gallons per minute. All parties concerned are advised that
the production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
Municipality of Anchorage
Development Services Department z °x
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Nitrate Advisory
Health Authority Approval # HA040443
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Lot 3 of Ferguson subdivision, a nitrate
concentration of 6.79 milligrams per liter (mg/L) was reported for the
property's water well sample. The Environmental Protection Agency (EPA)
maximum contaminant level (MCL) is 10.0 mg/L. Although the subject
water well sample is less than the MCL, it is suggested that periodic testing
be performed to insure the wells continued suitability. More information on
nitrates is available from the On -Site Water and Wastewater Program, at
343-7904.
This advisory must be attached to all copies of the subject Health Authority
Approval.
dL RODNEY P. KIGINEY ASSOCIATES INC. Project:
M!_`5
/l. _Jc ES
page. Of
CONSULTING ENGINEERS
10515 CEKfEMM eRm. SURE 101
PHONE: 0) 49 4-2332 FAX (M) 004-1=7
Job No.
Date -
Title: �'D�(-%9 1--/(y&ituAl
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Page 1
Page 2
10/04/2004 17:08 FAX 907 694 1807 RPKA
FAX MEMORANDUM
TO: MOA On -Site FAX: 353-7997
ATTN: Julie Makela, P.E.
FROM: Mark Alder, P. E.
PROJECT: Ferguson Subdivision, Lot 3, Health Authority Approval
SUBJECT: NSF Approval, Code Compliance of Storage System
DATE: October 4, 2004
Julie,
This fax is to follow up on our telephone conversation on October 1 when you were
inquiring about the water storage facilities at the above property.
I have contacted both the contractor that completed the recent tank installation, and
the tank supplier, and have found the following:
The tank does have NSF approval as required by AMC 15.55.070 part C.I. A cut
sheet from the tank supplier, Greer Tank, is included for your reference.
The system was installed by a mechanical subcontractor, by a licensed plumber.
The subcontractor has revisited the jobsite, and written a letter stating that the
installation meets code requirements.
I believe this should take care of the questions you had on our last submittal. We
look forward to receiving approval shortly. Thank you for working with me through
this process.
Please call if there is anything else I can do.
16515 CeMerrleld Drive r' Sidle 101 4^ Eagle River, Alaska a2. 09577
Phone (907) 694.2332 ;r, Fax (907) 604-1807 M marka@rpka.net
R001
Ceesuilloo loolaoors a surveyors
FAX MEMORANDUM
TO: MOA On -Site FAX: 353-7997
ATTN: Julie Makela, P.E.
FROM: Mark Alder, P. E.
PROJECT: Ferguson Subdivision, Lot 3, Health Authority Approval
SUBJECT: NSF Approval, Code Compliance of Storage System
DATE: October 4, 2004
Julie,
This fax is to follow up on our telephone conversation on October 1 when you were
inquiring about the water storage facilities at the above property.
I have contacted both the contractor that completed the recent tank installation, and
the tank supplier, and have found the following:
The tank does have NSF approval as required by AMC 15.55.070 part C.I. A cut
sheet from the tank supplier, Greer Tank, is included for your reference.
The system was installed by a mechanical subcontractor, by a licensed plumber.
The subcontractor has revisited the jobsite, and written a letter stating that the
installation meets code requirements.
I believe this should take care of the questions you had on our last submittal. We
look forward to receiving approval shortly. Thank you for working with me through
this process.
Please call if there is anything else I can do.
16515 CeMerrleld Drive r' Sidle 101 4^ Eagle River, Alaska a2. 09577
Phone (907) 694.2332 ;r, Fax (907) 604-1807 M marka@rpka.net
R001
10/04/2004 17:08 FAX 907 694 1807 RPRA
10/01/2004 17:04 1-907-456-5808 GREER TANK & WELDING
A Hexene Copolymer Linear Low Density Polyethylene
For Tanks, Toys and other non -tank Rotational Molding A,pp/ieations
Formolene L63935U meets all requirements of the U.S. Food and Drug
Administration as specified in 21 CFR 177.1520, covering safe use of polyolefin
articles intended for direct food contact.
Typical Properties of this Developmental Grade
Melt Index, g/IO min. ASTM D123S 3.5
Density, g/cm3 ASTM D1505 0.939
Yield Tensile Streagth, (50 mm/min) psi ASTM D63& 3,300
Flexural Modulus (1.3 atm/minl. nsi AQTAn rvnrn r,n �^
_Heat Deflection Temnerature °C at 66psi ASTM D648 54
E.S.C.R., 100%Igepal _
D1693 >1000 hrS.
10% Igepal >400 his
Low Temperature Impact (ft -lbs.)
1/8" Specimen ARM Std. 60
t/8" specimen ARM Std 196
Formolene L63935U is fully heat and UV stabilized.
The infannation on this document is, to our knowledge True and accuratt. The values listed above are typical, and. are ta>t
to be amstrued as specifications. Usemshould cotjttn results by their own tests.
Published 10/96
19090p2 & 149014001
rm 37429, EM 33710 a PQwh Tme Mn Rd. tm: tees) FPOUsU
LMn99tM NJ 07099 Fax: rer317fe-Y
Q002
PAGE 01/03
Granby Pyre, Ca.Pp,lgp Mnrka
10/04/2004 17:11 FAX 907 694 1807 RPKA
OCT -04-2004 04 10 PN KORNEGAY,CONSTRUCTION 9075691291
10/04/2064 15:07 FAX 907 904 1867 Kr11A
international Mechanical, Inc.
0�8 E. ti0WL�3 >a4A 6W7166176a9
Wall
October 4, 2004
Dolma I. McBride
P.O. Box 770575
Eagle River, Alaska 99577
Reference: 20049 Laughlin Street
Subject: Water Storage System
Dear Mrs. McBride:
On October 1K, 2004, I inspected the water storage system at 20049 Laughlin
Street for code compliance. Dpon my inspection of the water storage system I
found no code violations. The piping between the two tanks looks good. This
system should provide 600 gallons of potable water.
Sincerely,
INTERNATIONAL MECCIANICAL, INC.
Kevin Carey, Certified Plumber
President/Owner
Z005
P.01/01
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. # Cl-) 1 —A10 \ - ?J\ _ HAA # 0
1. GENERAL INFORMATION
Complete legal description
Lot 3; Ferguson Subdivision
Location (site address or directions) 20049 Laughlin Road Chugiak Alaska
Property owner Saupe Day phone
Mailing address
Lending agency
Mailing address
CITY MORTGAGE
Anchorage, Alaska
Day phone
Agent Joe Perrozzi/TARGET REALTY, INC. •Day phone 694-2388'`'.l
Address P.O. Box 774627, Eagle River, Alaska 99577 _
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: if community well system, provide written confirmation from State ADEC attest-
..,.
tt1Q 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.
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 S & S ENGINEERING Phone
17034 Eagle River Loop Road No. 204
Address c-.gla ul.,o r Alaska 99577
Engineer's signature Date
6. DHHS SIGNATURE
By:
Approved for _. _J_F bedrooms.
Disapproved.
Conditional approval for
{� • a e , f:J
C F •. f• d�, � PROFESSOR .s
bedrooms, with the following stipulations:
Additional Comments Note: The well for this property meets existing
State and Municipal Codes. There are nitrates present. It is
C11ggPGtPr1 that A peri odJ rtesti nq he pprforrned to l nsurp- i -he wPl 1 ^�
continued suitability. Nitrate concentration is 7.2 mg/1. EPA
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 a21
e Municipality of Anchorage
Department of Health & Human Services NMI
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: �—oT 3 Fgm�oso,.1 sko Parcel I.D. 46L_210 S/
A. WELL DATA
Well type aW kT-f- If A, B, or C, attach ADEC letter. ADEC water system number a11,
Log present Q.M Datecompleted 1 82- Dr}Iler. V)R_�L-u44
Total depth l0 a Cased to 0 Casing height 1'2 -
Sanitary seal &N)
Date of test
Static water level
Well flow
Pump level
Wires properly protected &N)
FROM WELL LOG
'-0Z
3`f 9—
p.m-
SEPARATION DISTANCES FROM WELL TO
MUNICIPALITY OF ANCHORAGE
AT INSPECTIONNVIRONMENTAL SERVICES DIVISION
►0-�11 SEP 2 3 1991
eco' `"' I V E D
No*,
Septic/holding tank on lot k0c) ; On adjacent lots 100 �r
Absorption field on lot SDC % ; On adjacent lots loo
Public sewer main Hix= Public sewer manhole/cleanout
Sewer service line ZS Petroleum tank 1-f5
WATER SAMPLE RESU TS:
Coliform O o' Nitrate Other bacteria t o ^� E
Date of sample: - `� 1 Collected by: S & S ENGINEERING
Eagle River Loop Rosa No. 204
B. SEPTIC/HOLDING TANK DATA Eaqle River, Alaska 99577
Date installed Tank size IOob 4 -^pe%, Compartments
2
CleanoutsoY N) 4 Foundation cleanoutON) �J Depression (Y& A
High water alarm (YA&P PJ Alarm tested (Y/N) "%
Date of pumping (.v - Z`i
Pumper. `Db)lan..t�s ?")FIFA'4"
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
� i-
Well(s) on lot C> O r On adjacent lots Foundation
To property line 00- Absorption field B I Water main/service line �o t +
Surface water/drainage 1nc:;) rr
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
Meets MOA electrical cod
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
SEPARATtON-10ISTAN CE FROM LIFT STATION TO:
on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off' level at
Cycles tested
Surface water _
Date installed g - 2 - 3--- Soil rating 1257�/59— System type-rtZ�.Jc�l
Length 2s, Width 3U Gravel thickness 10 %
0, Total depth
Total absorption area Sao Cleanouts presentON)y
Depression over field (YAD Date of adequacy test 9 - 13 -`11
Result s1 ail) PDc55 for --T�tA bedrooms
Peroxide treatment (past 12 months) ( _rSo'%�C- V -r,1 \ALnl If yes, give date a� 0.
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 10c� } On adjacent lots 1 S o I Property line 1 0 1
To building foundation 10 To existing or abandoned system on lot R
On adjacent lots
Surface water
Curtain drain
a Cutbank 1/5.- Water main/service line �0 ` ir
C> %4.Driveway, parking/vehicle storage area +
E. ENGINEER'S CERTfFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec,�g�eptiAp{���of this inspection.
S $ S ENGINEERING r y'' •'9 +o
Signature 17034 Eagle River Loapltwul No. 204 TH '•,ic o�
Engineer's Namlagle River, Alaska 99577
�` ZZ 1 R RJ. }IO.FER,P.E. tq
Date �� �'.� e ,s • •\ �
f�, FRF, •, ,W
AW
PROFENP�AW
c�
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21 05 �;?3 G
Waiver Fee: $
Date of Payment
Receipt Number
Time
Time
ie
Dato
Date
Date
a -a
C
Inspector
Inspector
Inspector
Comments
Conditional Approval
sz.-o LS
Date Sewer Installed
Permit No.
Septic Tank Size
fi, '2._ - '� Y
k ZD y
Holding Tank Size
Soils Rating
Well To Absorption Area
Well Log Received
ZS
Well to Tank /CA -V
ES
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner 7
(7 77 P 67
Phone
Mailing Address �� C�
f� l`l•i
v aC�i,. C'(: C/PC/ `� i
f l- '
`C�`)( ,✓vJ
Buyer ,/r- c Cd v'o ck e
1,/ 06,
Address
Address i i//S
��v1 (.QvQ ;C- (�J 30O
Lending Institution _>
t/ ` Com_ �_ t c QC v• lGE E'i
hone
Address
Realty Co. & Agent
Phone r -
Address
Legal Description �-
3 ��J� !_//ate/ &044-
Street Location`_��C
Typepf Residence
77`7 Single Family
VZ
❑ Multiple Family
No. of Bedrooms
❑ Other
Water Supply
i ] Individual
"TTArki %UE L Qr A well log Is required for all wells drilled since June
❑ Community
1975. For wells drilled prior to that date, give well depth (attach log If
❑ Public Utility
available.
See Disposal
yw@pIndividual
Year Individual Installed:
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE- THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.