HomeMy WebLinkAboutEAGLE PARK BLK 1 LT 11Onsite File
0
Lot I I
PID# 050-782-11
Originally thought to be Upper Eagle River Estates
Block 1 Lot 11.
Municipality of Anchorage
146
On-Site Water and Wastewater Program • (907) 343-7904" of 1
S ON-SITE WASTEWATER INSPECTION REPORT OCA. 1�
Permit Number: OSP1612�7 PID Number: 050-782-11 4ey
8?p�,�
Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade
Name:
TOM HULL ABSORPTION FIELD
Address ■❑ Deep Trench ❑ Shallow Trench D Bed ❑ Mound
25460 EAGLE RIVER ROAD ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
4 0.6 GPD/SF 9.5 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 3.4 Ft.6.1 Ft.
EAGLE PARK 401 11 Fill added above original grade Gravel length
Township Range Section 0 - 0.1 Ft.44 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 3 Ft. - - Ft.
To Septic Absorption Lift Station ' Holding 1 Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 528* Ft2 1 12 Ft.
Well +100 +100 - - +25 TANK M Septic 0 S.T.E.P. 0 Holding ❑Other
Manufacturer Capacity
Surface water +100 +100 - - ANCHORAGE TANK 1250 Gal.
Material Number of compartments
Lot Line +10 +10 - - STEEL 2
NA LIFT STATION
Foundation i +5 +10 - -
Manufacturer Capacity
Curtain Drain +50 +50 - - Gal.
Remarks
OLD TANK ABANDONED PER CODE Pump on level at Pump off level at High water alarm at
* FOR NEW TRENCH ONLY in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tandank to to 3034
Installer
GUARANTEED SERVICES Drainfield 3034 co/MT3034
Inspector CHARLES BALZARINI BENCH MARK (Assumed elevation)100.0 ft
Inspection
151 9/16/16 2nd 9/21/16 Location and description
3rd 9/21/16 41° BOTTOM OF SIDING AT HOUSE CORNER
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
/,vP,��OF Al I:NI�1
Conditional Approval: Date ��i ra ,43TN ` � �I�
i* *I
•u.
21N1 '
•
Approve �� „"�f Date LS----1S-17 '
Inspection Report_9-1-12,doc
LEGEND N s��~
0 CLEANOUT
• MONITOR TUBE •'• Jo- ,
® TEST HOLE •11,1104
ff ; .'• It , ill**
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N •. •• ;
00A `!4 • -LES G BALZARINt
�''•. CE-13654 •.Z-%
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tk F°PROFESSw '
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/ SW1 IG TIES
z i'OEWA A/ Et
/ C: 13.3 26.2
ij W / / D: 64 42.4
/ LOT 11
�+ I 4 BR
\ HOME
7
7
TESTHOLE
N. LOCATION.
' ' •• . 1 - NEW 1250 GAL 1
SEPTIC TANK
•.DR VE1648f i
y - FLOW
O (: SPLITTER
I 0'�
I EXISTING 3x75 TRENCH NEW 3x44 TRENCH
RAVEN LANE
PLAN - SCALE: 1" - 40'
-+100.0' BOTTOM OF SIDING ONITOR TUBE
:LUE BOARD INSULATI•
98. FILTER FABRIC •7.1 NISHED
GRADE TESTHOLE
+3' COVER „3,15' 97' ORIG. GRADE
COVER
TESTHOLE ELEVATIONS BASED
ON TESTHOLE 1. NOTE THAT GROUNDWATER MONITOR
,���:t%�% ���! REVEALED NO GROUNDWATER DURING CONSTRUCTION.
1250 GAL TANK _/%Y:IiIj1„�;y •3.6 INVERT
95.4
•5.28
4'4 DISTRIBUTION PIPE •7.5
6.1' EFFECTIVE SEWER ROCK
•1.2 B.O.H 81'
SCHEMATIC ELEVATION - SCALE: NTS
LEGAL DESCRIPTION: EAGLE PARK BLOCK 1 LOT 11
C&M ENGINEERING SERVICES OWNER: TOM HULL I DATE:10/24/16 REV: MDRAWN: CB REF:
907-854-5558
SEPTIC RECORD DRAWING
~ MUNICIPALITY OF ANCHORAGE (-- }
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
~ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
[~I~GRADE
.EGAL DESCRIPTION ~ . (~
· OCAT,O. ! · It t X
I Well I Absorption area · Dwelling PERMIT NO.
DISTANCE TO: ..~ (~.~
~ Manufacturer ~ Materlal NOo of compartments
Liq. capacity in gallons : Inside length Width Liquid depth
~OZ~ INetl Dwelling PERMIT NO.
DISTANCE
TO:
O Z ~ Manufacturer Material Liquid capacity in gallons
~3 Well Foundation Nearest lot line PEHMIT NO.
~ ~ DISTANCE TO:
~ No. of lines Length of each I,ne Total length o. f/lines Trench width Distance bet.eh lines
I-~. Top of tile ,o finish gr,de Material beneath tile *' .~ Tot al e Hec tive~b~r~n area
~ t- Type of cr~b Crib diameter Crib depth Total effective absorption area
u) DISTANCE TO:
· ~: DISTANCE TO:
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER
72-013 (Rev. 3~78)
PERMIT NO~
rqUN Z C Z PAL. Z
DEPARTMENT~ HEALTH RN~ ENYIRON,ENTAL~OTECTION
825 ~ STREET, AMCHORRGE~ AK.
2~4-4720
APPLICANT
LOCATION
LEGAL
JAMES C. SMITH
WREN AND RAVEN
Lll Bi EAGLE PARK
BOX 78~ E.R.
LOT SIZE
694-9116
38000 SOUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3
SOIL RATING (SO FT?BR)= 210
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= :1.1:3 LE1'4GTH= 5..~ GRR"."EL DEPTH= 6
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE E×CAVATION (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 EXCRVRTION (IN FEET).
R EI~. I._1 I RED SEPT I
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM TH3S~~'4'~'~ ~ ,~_~.DEPAF~MENT DURIN.~ THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TI-IQ ( 2 ::' I 1'-ISPECT I I)1'45 ARE REQ.. U I RED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R HELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE HELL OR 150 TO 200 FEET FROM A PUBLIC HELL DEPENDING
UPON THE TYPE OF PUBLIC HELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET,
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO IN~URE PROPER INSTALLATION.
PERI"1 I T EXP I RE--'i:; DECEI'IBER ..~-1.,
I CERTIFY THAT
l: 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 THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEHER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
...........
APPL I C~'~T~~~ ~ ~/ SMITH
,.., -O & E ENG~,NEERING & DEVELO,'~MENT CO.
· Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Ruuall Oyster Earl Ellis
S94-2774 SOIL LOG 688-2280
Performed for: Name'
Legal Description: L~"'
9~
---_10 __
11
Depth (fe~t)
$oll Ch&racterlsllcs
PLOT PLAN
12__
13
14 ,
16__
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
Comments:
Pedormed by:~~''''~5
No ~ If yes, what depth
Drain Field /
PERC. TEST
Date:
GAAB-HD-I
G/RJ:--~TER ANCHORAGE AREA BOROt~H
HEALTH DEPARTMENT ~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
iNSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS
LEOAL DESCRmTION~j/ X/e/' ~Z~ &ig ~
SEPTIC TANK:
DISTANCE EROM WELL MATER AL_
NUMBER
OF
.COMPARTMENTS
LIQUID CAPACITY /~*~/'~ GALLONS. INSIDE LENGTH ~'/t~('"' '~'~'"~"/-""INSIDE WIDTH//~7'~) DEPTHLIQUID
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIAL ~('~/~J'~'~ /~l/J~'~
NEAREST LOT LINE /~7!
OR WIDTH. /~ !, LENGTH /7/-'~ DEPTH
DISTANCE FROM
TOTAL EFFECTIVE ABSORPTION AREA (~&AL-b. AREA)
BUILDING FOUNDATION ~ ~ ,
~ 7 ~'"' SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WEH
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
, FOUNDATIO , NEAREST L~T LINE , OF LINES~ ,
ILTER MATERIAL BENEATH TILT; IN. ABOVE TILE
WELL: TYPE DEPTH ~/~&' DISTANCE FROM WATER
· .. BUILDING FOUNDATIOI~ ' ,SAMPLE ., NEAREST
NEAREST SEPTIC SEEF~AGF OTHER
LOT LINE , SEWER LINE .~ TANK . SYSTEM ,'CESSPOOL , SOURCES
DISTANCES:
APPROVEI
DIAGRAM OF SYSTEM
HEALTH AUTHORI]Y
GAAB-HD-2
GREATE/":ANCHORAGE AREA f~ DROUGH c~e No. ~//~
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS
~'~r 5,~b&V~S~SLEGA, DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
MAILING AD D R ESS .~//D
LOCATION OF INSTALLATION ~i~'~'
, SEEPAGE PIT. ~.,DRAIN FIELD ,OTHER
PERCOLATION TEST RESULTS _?-?,%,f~, ,F~ /))~//~ ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS ISTO SERVEAS/k/~¥N ,~ i'7')1 ~ ,PERMITTO INSTALLA .~ ('~ LZY'~'Y
DIAGRAM OF SYSTEM
DISTANCES:
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE APPLICANTS SIGNATU RE
/ ',GREATER ANCHORAGE AREA BORO~?/-~
HEALTH DEPA~TMEN'T CASE
~' 327 EAGLE STREET
ANCHORAGE, ALASKA 99501
Performed
Legal Descrzpt~on: L~t~lock
This Form Reports a:
Depth
Feet
Soil Characteristics
Was Ground Wate~ Encountered?_.~
If Yes, AT What Depth_~__ ~: ~ .
Location Sketch
Reading Date
Gross Time
Net Time
Depth To H20
roola~ ~ on Kate
Proposed Instal~Seepa~e Pit .....
Depth Of Inlet ~ '-, o ,._ ~ ........ .urazn ~.eld
~-<' u~prn ~o sot~om o~ Pit Or
Test Performed
B ·
Data ~evt~.f~.ed By:
el)Ui NS
•
�t� Municipality of Anchorage 0o&
rp
�t _
_
On-Site Water and Wastewater Program
(907) 343-7904 IA I i
Certificate of On-Site Systems Approval
Parcel I.D. 050 782 11 Expiration Date: Tr WV/ 0 r7 /a0� 1 f
1. GENERAL INFORMATION
Complete legal description Eagle Park Block 1 Lot 11
Location (site address) 9815 wren lane
Current Property owner(s) Glacier Property Solutions Day phone
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Q Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: 01--1/ Date: I D—MAY
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 5aL, Waiver Fee $
Date of Payment r//aalig Date of Payment
Receipt Number 06'86(LD Receipt Number
COSA# O5C l Fletale Waiver#
•
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,
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 CBM ENGINEERING Phone 907-854-5558
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI Date 11/20/18
6. DSD SIGNATURE ,/ k; ' •TH
••••
/ - - p4
f System#1 Approved for I bedrooms
System#2 Approved for bedrooms IrHARLE G BALZARINI
CE-13854 . `YACiii?
Disapproved #4 ;
�s •. .•• � „r
•
�F�P.Rt? ESSION�`�-4
Conditional approval for bedrooms, with the following stpa�
pN_SITE .
wAT E��DR
w GROGRAM
SFR
By: I W i�'�ia--)1744 Original Certificate Date:b�'�C.- C�� -4.0 1
9
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_c '. c
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: EAGLE PARK BLOCK 1 LOT 11 Parcel ID:050:782-11
A. WELL DATA
Well type private If A, B, or C provide PWSID# Well Log (Y/N) NO
Date completed UNK Sanitary seal (YIN) yes Wires properly protected (Y/N)yes
Total depth +2% ft. Cased to +40 ft. Casing height(above ground) +12 in.
FROM WELL LOG AT INSPECTION
Date of test - 11/01/18
Static water level - ft. 288 ft.
Well production - g.p.m. +3 g.p.m.
WATER SAMPLE RESULTS:
Coliform neg colonies/100 mL Nitrate nd mg/L
Arsenic nd ug/L Date of sample: 11/26/18 Collected by: C&M Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/Steel Date installed 9/21/16
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N)yes
Foundation cleanout(Y/N) yes Depression over tank(Y/N) no High water alarm (Y/N) no
Date of pumping n/a Pumpersystem was never used. no sludge
C. ABSORPTION FIELD DATA
Date installed 9/21/16 Soil rating (g.p.d./ft2 or d rn) 0.6 System type trench
Length 74+44 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth 10 ft. Eff. absorption area 1416 ft2 Monitoring tube yes Depression over field no
Date of adequacy test 11/01/18 Results (Pass/Fail)pass For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added +600 gal. New depth 0 in.
Elapsed Time: <144 min. Final fluid depth 0 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN &type) none known If yes, give date na
D. LIFT STATION
Date installed -- Size in gallons -- Manhole/Access (YIN) --
"Pump on" level at-- in. "Pump off' level at -- in. High water alarm level at -- in.
Datum -- Cycles tested -- Meets alarm&circuit requirements?--
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot +100 On adjacent lots +100
Absorption field on lot +100 On adjacent lots +100
Public sewer main +100 Public sewer manhole/cleanout +100
Sewer/septic service line +100 Holding tank +100
Animal containment areas +100 Manure/animal excrete storage areas +100
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation +5 Property line +5 Absorption field +5
Water main +10 Water service line +10 Surface water +100
Wells on adjacent lots+100
ABSORPTION FIELD ON LOT TO:
Property line +10 Building foundation +10 Water main +10
Water Service line +10 Surface water 100' Driveway, parking/vehicle storage +5
Curtain drain +50 Wells on adjacent lots +100
F. COMMENTS
system not used since 2016 upgrade.
G. ENGINEER'S CERTIFICATION " 'OF A ‘
/ certify that I have determined through field inspections and Af ,`�;. / .N4fit
.71--
review of Municipal records that the above systems are in C" • •'51
conformance with MOA COSA guidelines in effect on this date. /07 :49TH t
Engineer's Printed Name Charles Balzarinl
Date 11/20/18 alga -
9 CHARLES G BALZARINT
/'c<GN •
GE-13854 ��1:'
‘‘‘E)PROFESS1O .
COSA canary sheet_2-6-15.doc
Found LOT 10
5/8" Rebar WEST
30' c. 206.82'
Well ® b
N
O N
M
^'`'e AP '----26 i LOT 11 LOT 12
c oy ii it BLOCK 1
EI 1i�
a 4r; oq
I .4-1 Wood Wood Porch
;'
o I _;I �; & Steps i,
i� c
W T 36.9' 7-r=' 1U °'
16.8' 114.3' Il=Oz
o loo I Carport _ 4.1' ', 2—Level Wood o
w/Conc. r 1 i-. Frame Residence a x
bi`N ��. 1_ Z
Z O ,n I Slab--'N ,
`- i 16.5' 14.3 N i o
es. z.. 37.9' =- --- -.� 3.5.1 I
� r'I
I PCC Pad N �1i
N 06� I
I 4o� i_ __2__ 6 —'' Riser Pipe for
• [Septic System (Typ.) I
O
ca I
to
I
a;
C I
206.80'
30' WEST
b
b rn M
RAVEN DRIVE
N
SCALE : 1" = 30'
0' 15' 30' 60'
NOTE: PREPARED FOR:
Dimensions are measured to the wood trim. GLACIER PROPERTIES SOLUTIONS
I hereby certify that an accurate survey of the following described I
property: Q S B
.'''SOF A�... EAGLE PARK SUBDIVISION (P-672) / \
LT
�Q� .qi`,F�,<, LOT 11, BLOCK 1 Dq GRIQ '''
s ri • .'9 was made on
October 10, 2016 and that the improvements DWN. N
�r �;49YH :�` r� situated thereon are within the property lines and do not overlap or �}SP 10/14/2016 SW 056 x
• ••••`• 1 # ;,,encroach on the property lying adjacent thereto, that no
2016 JOB N0. X
#" .F. Lee Karabetn�koff: '~ improvements on the property lying adjacent thereto encroach on FILE NO. F.B.F. 8 JOBS
�,+� • the premises in question and that there are no roadways, 1618
No. 3143-S .�' transmission lines or other visible easements on said property except / f/ N
c�•`'•• .......•' - as indicated hereon. Easements other than those shown on the (�( ARA BEL I�! K O�� N
in
�k ales.1's'��` record plat may not appear on this drawing. SURVEYING
�kZ�,iya.'�►� (907) 337-3434 w
ii°l��•t .,6 Anchorage Alaska, this 14th day of October . 2016. z
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorage,ak.us
(907) 343-7904
Parcel I.D.
1.
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR .5, SINGLE FAHILY DWELLING
050-782-11
GENERAL INFORMATION
Expiration Date:
Complete legal descdption EAGLE PARK SUBDMSION: LOT 11, BLOCK 1,
Location (site address or directions)
9815 WREN LANE * EAGLE RIVER, AK 99577
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
TOMMY REEVES Day phone 694-115
P.O. BOX 775893 * EAGLE RIVER, AK 99577
Day phone
,JOE PEROZZI w/ REIdAX Of E.R. Dayphone 694-4200
16600 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OFWATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTE~NATER DISPOSAL:
Individual On-site
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 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.
Nete: ;41aska Water and Wastewater Conaultants, Inc. shall be paid $ at, or pdor I
to closing for the engineering services provided.
I
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 strocture indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage t'iles and from my investigation and inspection, the
on-site water supply and/or waatewater 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 ALASKA WATER &: WASTE'WATER CONSULTANTS. INC.
Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS. P.E.
Engineer's Comments:
In conducting this evaluation. AKWWC, Inc. attempted to provide a thorough,
conscientious er~gineedng analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system 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 seared by the system.
These conditions are outside the control cf the evaluator of the system. Satisfactoq, test
results do not guarantee futura perfon'nance of the system, horde they guarantee that
there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide
any warranty or fufure 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 benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal Ifght whatsoever.
Phone 337-6179
5. DSD SIGNATURE
Approved for ,~
Disapproved.
Conditional approval for
bedrooms.
· .
bedrooms, with ~e fllowing st~pu~ati~,.. -. ~
~: ON-SITE ~ ~
~t WATER~N~ : ~
~ : WASTEWATER : .:
v%:-..
Attachments:
HM Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
(Rev. I~1)
Original Certificate Date:
~ I~ Legal Description:
Lr
~; ~1~* Date completed
?.,. Total depth 295+
Municipality of Anchorage
Development Services Department
Building
On-Site Water & Wastewatsr Pmgram
4700 south Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLancllorege.ak.us
(9o7) 343-79o4
HEALTH AUTHORITY APPROVAL CHECKLIST
EAGLE PARK, LOT 11, BLOCK 1
Parcel ID: 050-782-11
Date of test
Static water level
Well production
19707
__ ft. Cased to ,K)+
FROM WELL LOG
g.p.m.
If A, B, or C provide PVVSID~ N/A
Sanitary seal (Y/N) YES
ft.
Well Log (Y/N) NO
Wires property protected (Y/N) YES
Casing height (above ground) 12 in.
AT INSPECTION
7/10/2002
291 ft.
5.5 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Arsenic: N/A mg./L.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material UNKNOWN
Nitrate 0.2 rog.IL Other bacteria __
Date of sample: 7/10/02 Collected by:
*INSIDE GARAGE/HOUSE
Date installed
Cleanouts (Y/N)
Tank size 1000+ gal. Number of Compartments U/K
Foundation cteenout (Y/N) *YES Depression over tank (Y/N). NO High water alarm (Y/N) N/A
Date of pumping 7/17/2002 Pumper JR'S PUMPNG
C. ABSORPTION FIELD DATA --ma~c, ~s co~cm) rD ,~ ~ cam
I
Date installed $/8/tg~1 Soil rating (g.p.d./ft~or _~'~-~ 210 System type ***TRENCH
Length 74. ft. Width U/K ft. Gravel below pipe 6
Total depth * 11 ft. Eft. absorption area 8.8.8' ft~ Monitoring tube **YES
Absorption rate >=
Date of adequacy test 7/9/2002 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 4.1 in. Water added 888 gal.
Elapsed Time: 920 min. Final fluid depth 46 in.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN
0 colonies/100 mi.
AKWWC, INC.
UNKNOWN
YES
Depression over field NO
For ,3 bedrooms
New depth 58 in.
450+ g.p.d.
If yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at in.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Size in gallons
"Pump o~ le~_l r.t
Cycles tested
Holding tank
Septic tank/lift station on lot100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 2§'+
in,
ManholedAcc~,s.
High ~rater alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cteanout
N/A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N/A Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water service line 10'+
Curtain drain NONE KNOWN
F. COMMENTS
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots 100'+
G. ENGINEER'S CERTIFICATION
Absorption field 5'+
Surface water 100'+
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
JEFFREY ~ GARNESS
Engineer's Priqted I)lame
Date '~/~ '7/O~"
Date of Peyment
(Rev. 12/01)
Water main N/A
Driveway, parking/vehicle storage __
Waiver Fee $
Date of Payment
Receipt Number
10+
ASE3U]LT
I HEREBY CERTIFY .THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY=
AND THAT NO ENCROACHMENTS EXIST EXCEPT A5
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERI~IINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDE~ SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOLt. D
ANY DATA HEREON BE: USED FOR CONSTRUCTION
OF' FENCE LINES~ OR FOR ESTABLISHING EIOUND-
ARY LINES.
DATE~ ---
DRAWN:
DATE RECEIVED
'=' · "- ,NSPECT ON A"FO,NTME"TS
TIME TiME
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
(~, ~.~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOF~IROj%M£NTAL P~,OTECI'ION
825 L Street - Anchorage, Alaske 99501
UAY 1981
ENVIRONMENTAL SANITATION DIVISION
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts o~t page 1. Incomplete request~ will not be processed. Please allow ten (10) days for processing.
MAILING ADDRESS
PROPERTY RESIDENT (If different from 81~ve) PHONE
2. SUYER PHONE
MAILING ADDRESS
4. REALTOR/AGENT [ PHONE
MAILING ADDRESS
NUMBER OF~BEDROOMS
I--'] One [] Four
[] Two [] Five
[~ Three [] Six
[] Other
STREET LOCATION
6. TYPE OF RESIDENCE
,J~ SINGLE FAMILY
I-1 MULTIPLE FAMILY
7. WATER SUPPLY
,J~'~NDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, glve well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[~"'"INDIVIDUAL/ON-SITE** /t~.., (-7/-) YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE f-] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SiX
2. WATER SUPPLY PERMIT NUMBER
[] INDIVIDUAl. DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SO~LS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4o DISTANCESwELL TO; Septic/Ho,ding Tank IAbsorption Area JSewer Line J Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
~PPROVED FOR .~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
r-I DISAPPROVED .~~(~
DATE BY
72-010 (Rev. 6/79)
~,Peoplea Bank and Tr~s~ ::
)~micipality of. Ancho, rag% i '." , .
. Department of Health ~nd ~ior~meatal 'Px~tection
i -
$R8 196X EAGLE RIVER. ALASKA
Referencel '
~t
A leuer ~st~ adeq~y te~ ~s perfo~ed on ~e ~s~
ca the ref~remoed p~pe~y :at ~e re,est of Oent~ ~ ~lty.
~e septic ~nk ~s ~,~ :and verifi~ to ~ve a ca,city im excess
of 1~ ~llons. ~e"'see~ge pit ~s 'f~l of ~ter and ~d to ~ ·
p~.. ~ter appositely ~ ~l]ons ~s re~ved fr~ the crib~
the ~ter ~s re~arg~ into the ~s~ and after a ~riod of ~ h~s
appr0xi~e~ 63 ~ons of ~ter ~d ~n re~ve~ f~m the c~b.
I~ c~ ~ con~ f~bm ~His test t~t ~e septic ~nk is adeq~te,
however the see~ge pi~ ~ ~ail~ enti~ly. Z~ ~11 ~ neces~
~t you .hnve the absorp~io~ ar~ up~d~ for the ~ee ~droom
residenGe loceted Oa.~bis ~'~. A'~e~t can ~ o~n~ for
~is ~rk f~.the ~ici~lity of ~o~ge, ~,rt~nt of Health
an~ m~or~en~l ~ecti~? 825 L.' ~r~et, Antoine, ~ska. .
If ~ ~y ~.of ~er'se~ce~ pleas~ do not'besiege :to ea~. ,. .....
GREATER ANCHORAGE AREA BOROU{'
HEALTH DEPAR~{ENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
279-2511
REQUEST FOR APPROVAL OF
INDIVIDUAL SE[~AGE AND [VATER FACILITIES
FOR
Approval Requested By ~
Phone -- _
2. Property Owner .... Phone
$.
Number of Bedrooms
Well Data:
B. Depth
C. Size
D. Constructio~ /~ef~./J~/~
E. Bacterial Analysis
Sewage Disposal System:
A.
Septic Tank (If homemade, show diagram on back)
Age
~pproval Reques~ £or ?~,e ~ ~ater Pacilities
Seepage Pit
Disposal Field
1. Numher oe Lines
2. Total Length
Required Measurements
A.
B.
C.
D.
E.
F.
G.
H.
Nell to Septic Tank
~Vell to Seepage Pit
~ell to Sewer Line
Nell to Property Line
~ell to Other Possible Contamination
Foundation to Septic Tank f/ ~
Foundation to Seepage Pit 2~O~
Seepage Pit to Property Line / ~ ~
8. COMMENTS:
APPROVED:~~ ~._ ~ DISAPPROVED:
DATE: ~ DATE:
APPROVAL VALID FOR ONE YEAR PRO,~,I DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH HEALTIt DEPARTMENT
EDll70