HomeMy WebLinkAboutEAGLE RIVER HEIGHTS NORTH BLK 5 LT 7Eagle River
Heights North
Block 5
Lot 7
#050-191-13
Municipality of Anchorage
Development Services Department`,
Building Safety Division r -
On -Site Water & Wastewater Program, 4700 South Bragaw St. s, r _
P.O. Bax 196650 Anchorage, AK 99519-6660
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW030032 PID Number: 050-282-26
Name`
DAVID & LYNETTA JORGENSEN
Wastewater System: ❑ New ■ Upgrade
Y P9
Address:
10842 ANVIK CIRCLE * EAGLE RIVER, AK 99577
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 622-5543 4
❑ Deep Trench []Shallow Trench ❑ Bed ❑Mound 13 Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original gado:
GPD/Sq.
FL R
Block: Lot: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneaN pi
5 7 EAGLE RIVER HEIGHTS NORTH
Ft. R
Township: Range: Section:
Fill added above original grade:
I Is
FIL
WELL: ❑ New 11 Upgrade
Drove!width:
Number of lines:
Distancebelwmn linea:
Ft
R
CMeeRfcatian PrW% As,* Total De
Cooed To:
Totol oyw ryDon ores:
Pips material:
D-30 ,
R
Ft.
SQ. FL
Driller. Daft Drilled:
Stale Water Level:
Inatalle
Data installed:
Pl)g`
SOUTHFORK CONST.
3/5/2003
R
tteld:Pump
Set At:
Casing Height Above Ground:
TANK
GPM
R
R
SEPARATION
DISTANCES
aseptic []Holding ❑S.T.E.P. ■Other*
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer.
ANCHORAGE TANK
Capacky In gallons:
2000
From
Tank
Field
Station
Tank
sewer Linea
Well
_
_
_
_
—
Material: STEEL
Number of compartments:
2
Surface Water
**75'+
**65'+
—
**75'+
—
LIFT STATION
Lot Line
5�t
**0�+
—
5�+
—
Sha In gallon.
Manufacturer.
Foundation
5'+
10'+
—
5�+
—
-Pump on level aL
ump aL•
High water alarm at:
Curtain Drain
NO KNOWN
Pump Make el:
Electrical Inspections performed by:
Remarks: *THIS IS A MODIFIED SEPTIC TANK FITTED
BENCH MARK
Location and Description:
WITH A HIGH WATER ALARM FOR USE AS A
BOTTOM OF SIDING BY WALKWAY FOR FRONT DOOR
HOLDING TANK THAT MAY BE USED IN THE FUTURE.
**WAIVERS GRANTED
Assumed Elevation:
100.00
R
ENGINEER'S SEAL
o OF
a
Inspections performed by: AKWWC, INC. Dates: 1st 3/5/2003
.:il!. 4 . I.... ...... 0�
2nd 3/5/2003
3rd —
'• of a A. G ness,,
Development ervices D rtm t Approval
O�
-7sss coop
.o
a
Q
40p4aprofessi0r'
ed and approved by: Date: 4/2 /off
(R�evi2/w
�OO000aa
PERMIT NUMBER: AS -BUILT DRAWING 1 ING PARCEL ID NUMBER:
—
SW030032 050-282-26
ST1 23.3 10.2
ALARM 40.0 20.2
ST2 41.9 22.7
DBL1 44.0 27.3
DBL2 44.0 28.5
J� / BV 43.9 29.5
i x�1t�i/�� j�
/
EXISTING WATER UNE. LOCATED BY
SOUTHFORK CONSTRUCTION WITH WITH
A SGHONSTEDT WATER LINE LOCATOR -
EXISTING
4 BEDROO
HOUSE M
WA
NEW 2000 GALLON SEPTIC TANK.
WIRED FOR A HIGHWATER ALARM FOR
USE AS A HOLDING TANK IN FUTURE.
.t INSTALLED DOUBLE
• �'• c CLEANOUTS
..•a a,:o �, INSTALLED BULL RUN
.. DIVERTER VALVE (BV) WITH
ONE END CAPPED AND THE
' • t OTHER GOING TO THE CRIB
EXISTING CRIB. (THE
EXACT PERIMETER
LOCATION IS UNKNOWN)
3/6/2003
n DRAWN BY:
ALASKA WATER & WASTEWATER C.J.G.
CONSULTANTS, INC. SCALE:
6901 DEBARR ROAD, SUITE 213 •ANCHORAGE, AK 99504 `PHONE (907)337-6179 ' FA% (907)338-3246
1" = 30'
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
DAVID & LYNETTA JORGENSEN (907) 622-5543 2 OF 3
LEGAL DESCRIPTION:
LOT 7, BLOCK 5; EAGLE RIVER HEIGHTS NORTH SUBDIVISION
TYPE OF WORK:
AS -BUILT DRAWING FOR SEPTIC TANK UPGRADE
PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER:
SW030032 050-282-26
TOP OF TANK AT
INLET = 94.55
INVERT OF BUNG -
AT INLET = 94.00
GRADE = 99.30+
ALARM
NEW 2000 GALLON
HOLDING/SEPTIC TANK
ST2
TOP OF TANK AT
OUTLET = 94.57
NOTE: INVERT OF FCO = 95.17
INVERT OF LINE ENTERING CRIB = 92.50
VERT OF BUNG AT
OUTLET = 93.82
ALASKA WATER & WASTEWATER SCALE:
C.J.G.
CONSULTANTS, INC. * .
6901 DEBARR ROAD, SUITE 20 . ANCHORAGE, AK 99504' PHONE (907)337-6179' FAX (907)336-3
N.T.S. ....... ....... ....
246
IREPARED FOR: PHONE NUMBER: PAGE NUMBER:
DAVID & LYNETTA JORGENSEN (907) 622-5543 3 OF 3 QO ff y GOrness:'
EGAL DESCRIPTION: Q y — 953 m�
EAGLE RIVER HEIGHTS NORTH SUBDIVISION; LOT 7, BLOCK 5, 0
TYPE OF WORK: 40ped prOfes 510�0���v
PROFILE AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE Oggpoo�oaQ
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW030032
Date Issued: Mar 04, 2003
Expiration Date: Mar 03, 2004
Parcel ID: 050-282-26
Legal Description: Eagle River Heights North /, 7 f 13'-6'
Design Engineer: 0041 AK Water & Wastewater Consultarr Site Address: 10842 Anvik Circle
Owner Name: David & Lynetta Jorgensen Lot Size: 10824 SQ. FT.
Owner Address: 10842 Anvik Circle Total Bedrooms: 4 Permit Bedrooms: 4
Eagle River , AK 99577 -
This permit is for the construction of:
❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑ Private Well ❑ Water Storage
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.
Received By:
Issued By:
Date: y G"
Date: �,�
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.ci.anchorage.ak.us
(907) 343-7904
Waiver Review Worksheet
WR#: WR030016 PID#:050-282-26 HA#: Permit#:
Date Received: 2128103
Legal Description: Eagle River Heights North Block 5 Lot 7
Engineer: Jeffrey A. Garness, PE
Alaska Water & Wastewater Consultants, Inc.
Applicant: David & Lvnetta Jorgensen
GE_. BG
PP
SA E T Y
Waiver Requested: 0 feet from crib to south lot line 75 feet from proposed septic tank to surface water
Criteria:
Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
................................................•.............................1
Waiver is Granted: X
Waiver is not Granted.
List Conditions or Reasons for above: SEE SkISIMEP?rS LjF=R 00 .rj4S7jPjej4TI A/
DRrEA FEB 28 2003 Airio[Kgo SEajp46-gr F,�T1 16Prtc rgVK Ame 80TH
,power &J0%&E.br OF rHE SuRCRcE 4019ran &yE1000wCMBEK)/M'2146r 6N,
Date: 3! *103 By: VAA/
Imo- Name of Reviewer
...............................................................................
Rec#: 31914 Amount: $1,000.00 Date Paid: 2128103
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907)343-7904
ON—SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-282-26 Permit Number 5WO$00$Z
Property owner(s) DAVID & LYNETTA JORGENSEN Day phone 622-5543
Mailing address (1) 10842 ANVIK CIRCLE * EAGLE RIVER, AK
Mailing address (2)
Zip Code 99577
Legal description (Lot, Block & Sub'd.) LOT 7. BLOCK 5: EAGLE RIVER HEIGHTS NORTH SUBDIVISION
Legal description (Section, Township & Range) N/A
Lot Size (J K2 Acre Sq.Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi ❑
Swimming Pool
❑
Water Softening Unit ❑
Therapy Pool
❑
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.
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Permit Fees: �/'/00 •Uri
Date of Payment: d 1� 9 03
Receipt Number:
oca
Waiver Fees c4 /Ocx),
Date of Payment: a2$ e,75
Receipt Number: x%31 VAN
I_X �z 030 Dt tp
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
February 28, 2003
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragraw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic Tank Upgrade for Lot 7, Block 5; Eagle River Heights North Subdivision
To whom it may concern:
The existing 4 bedroom house is currently served by public water and a private septic system.
The septic system contains a 1250 gallon Sunset plastic septic tank and a crib type drainfield.
The existing septic tank is believed to be collapsing and is causing the system to backup into the
house. The crib is adequately sized for a 4 bedroom house and on 2/25/2003, it passed a septic
adequacy test for a 4 bedroom residence. We are proposing that the existing 1250 gallon septic
tank be completely removed and a new 2000 gallon septic tank be installed. We are also
proposing that the tank be a fitted with a high water alarm so that it can be used as a holding tank
in the future. We are proposing that a diverter valve or a shut off valve be installed between the
tank and the crib in order to stop the flow to the crib when it becomes completely saturated. We
are also requesting that the permit be rushed due to the health hazard caused by the backup of
effluent into the house.
SURFACE WATER WAIVER REQUEST: On October 11, 1995, an 80 feet waiver was
granted from the creek to the existing septic tank. We request that the waiver be amended to 75
feet from the creek to the proposed septic tank. We also request an 85 feet waiver from the creek
to the existing crib. This waiver should have been applied for in 1995, however we are
requesting the same justification for the 1995 tank waiver be considered for the crib waiver. It is
our opinion that the justification for the 1995 waiver should still apply. The following is the
justifications for the waivers:
• The topography in the on the south side of the house is a 1 to 5 percent slope running
approximately north to south. Also, the house is between the septic system and the creek.
In short, if tank or the crib were to overflow, it would not flow towards the creek.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
• The location of the septic system is in a very visible area so that if any effluent was to
surface, it would be noticed and the problem corrected.
• Given the porosity of the soils in the area there would be minimal lateral migration of the
wastewater and would travel straight down.
• These encroachments have existed for almost 28 years and there is no indication of any
adverse effects on the creek.
Given these justifications, there is minimal risk with the granting of these waivers.
LOT LINE WAIVER REQUEST: As can be seen on the attached design drawing, the
perimeter of the crib appears to be encroaching upon the south lot line. The exact perimeter of
the crib is unknown. We request a 0 feet lot line waiver from the existing crib to the south lot
line. We are unaware of any adverse effects on the adjacent properties with the granting of this
waiver.
WATER LINE CONCERNS: The location of the water line is unknown. The water line is to
be professionally located. If the water line is found the be less than 10 feet from the existing crib
or the proposed septic tank, the water line will be relocated so that the 10 feet separation distance
will be met.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing„ and a 5 page construction
specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
I
LOT 10, BLOCK 1•
MEADOW BROOK S)D
1
LOT 11, BLOCK 1;
MEADOW BROOK S/D
MEADOW
LOT 6, BLOCK 1;
MEADOW BROOK S/D
If
/
LOT 12, BLOCK 1;
MEADOW BROOK S/D/� 1' -
STMG \
/ //✓� 4 BEEXIDROOM \
HOUSE
/
EXISTING WATER LINE
(ASSUMED LOCATION)
/A \
PROPOSED SEPTIC TANK UPGRADE I
r
(SEE DESIGN PAGE 2 OF 2)
LOT 6, BLOCK 5;
f EAGLE RIVER HEIGHTS
NORTH S/D
ALL PROPERTIES SHOWN
SERVED BY PUBLIC WATER
/ij`''� /
/� �/� /
/
/
/ LOT 8, BLOCK 5;
EAGLE RIVER HEIGHTS
NORTH S/D
—EXISTING
SEPTIC SYSTEM
ANVIK CIRCLE
EXISTING KEY BOX
LOT 4, BLOCK 5; LOT 3, BLOCK 5;
EAGLE RIVER HEIGHTS EAGLE RIVER
ER/TS
NORTH S/D NORSEIGHI.J
L—J
ALASKA WATER & WASTEWATER C.J.G./J.L.M.
CONSULTANTS, INC. SCALE`
6901 DEBARR ROAD, SUITE 28 * ANCHORAGE, AK 99504' PHONE (907)337-6179' FAX (907)338-3246 1 „ - 50'
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
DAVID & LYNETTA JORGENSEN (907) 622-5543 1 OF 2
LEGAL DESCRIPTION:
LOT 7, BLOCK 5; EAGLE RIVER HEIGHTS NORTH SUBDIVSION
TYPE OF WORK:
SITE PLAN FOR SEPTIC SYSTEM UPGRADE
..... .. . . . ...............
eff ey . Garne s.:
9a C 3 �o G
I
EXISTING
5 SZOEO
M
n T •�.
�.
.y•Cr:p
- \ EXISTIr
EXAG
\ LOCATION IS UNKNOWN)
-0 FEET LOT LINE
WAIVER REQUESTED
EXISTING WATER LINE LOCATION UNKNOWN. LINE— -24
TO BE PROFESSIONALLY LOCATED. IF WITHIN 10 I
FEET OF EXISTING CRIB AND THE PROPOSED
TANK, THE LINE IS TO BE MOVED TO 10 FEET
FROM ANY PORTION OF THE SEPTIC SYSTEM.
NOTE: THE CONTRACTOR SHALL
HAVE THE EXISTING WATER LINE
PROFESSIONALLY LOCATED AND
THE 75 FEET SETBACK FROM
THE CREEK FLAGGED BY A
REGISTERED LAND SURVEYOR
PRIOR TO CONSTRUCTION.
/ c�cwvvur /
EXISTING 1250 GALLON
SEPTIC TANK TO BE
COMPLETELY ABANDONED
--PROP65ED/2000 GALLON SEPTIC
� STANK. TANK IS TO BE A 2
VCOMPARTMENT TANK AND ALSO
WIRED FOR A HIGH WATER
ALARM. TANK IN FUTURE TO BE
USED AS A HOLDING TANK.
—INSTALL DOUBLE
CLEANOUTS
—INSTALL A DNERTER
VALVE IN ORDER TO
STOP FLOW TO CRIB
ALASKA WATER & WASTEWATERS C.J.G./J.L.M.
CONSULTANTS, INC. L" = 30
6901 DEBARR ROAD, SUITE 28 - ANCHORAGE. AK 99504 . PHONE (907)337-6179' FAX (907)338-3246
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
DAVID & LYNETTA JORGENSEN (907) 622-5543 2 OF 2
LEGAL DESCRIPTION:
EAGLE RIVER HEIGHTS NORTH SUBDIVISION; LOT 7, BLOCK 5,
TYPE OF WORK:
DESIGN OF SEPTIC TANK UPGRADE
DATE
READING
OF
ALASKA
WATER LEVEL
READING
WATER & WASTEWATER
i
I
*�*
•.w�m
�••
CONSULTANTS, INC. ........ .. ... .......:....
ooba • wa
2
—
5
0"
8"
3
SOIL LOG — PERCOLATION ST
LEGAL
DESCRIPTION:
—
LOT 1, BLOCK 5; EAGLE RIVER HEIGHTS NORTH SUBDIVISIONA. gas:
—
5
0"
6"
C 7953
PERFORMED
—
—
FOR:
LAURENCE SANDERS DATE: 6/5/2002 rn f'•.
(feat
=_—=
—
5
ORGANICS vg^gaPr.....
6"
TEST HOLE 1
1
SOIL CLASSIFICATIONS
2
"+ GW ORG
a:.% GP ML
3
3 BEDROOM
GM CL -- HousE ANVIK CIRCLE
4
GC OL Eosw --------�-
0• •°e SW MH SEPTIC
5
'•'. SP CH W
---" I>
SM ' '` OH
Sc ID
e
�' IY
DEPTH TO DATE
GM/SM -
GROUNDWATER
(LOOSE) PROPOSED IZ
8
DRY 6 5 2002
W/ COBBLES SITE PLAN SEPTIC lQ
DRY 6/6/2002 1"-100'SYSTEM
9
10
11
12
13
14
15-
51617
16-
B.O.H.
17-
18
PERCOLATION RATE <1 (MINANCH) PERC. HOLE DIA. 6 (INCHES)
19
TEST RUN BETWEEN 5.5 FT. AND 6.0 FT.
20
A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ONO
SOILS
LOGGED
BY: JODY MAUS PERCOLATION TEST PERFORMED BY: ZACH GALL
COMMENTS:
THE INSITU SILTY, SANDY SOIL WILL ACT AS A SAND FILTER.
A.W.W.C., INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS AS PERFORMED IN ACCORDANCE
PERFORMED
BY
WITH ALL
STATE
AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 0 2
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
i
I
—
—
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
6/6/2002
1
—
—
6"
—
2
—
5
0"
8"
3
—
—
6'
—
4
—
5
0"
6"
5
—
—
6"
—
8
—
5
0"
6"
0 £t E GEOTECHNICAL & DEVELOPMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2290
Russell Oyster Earl Elvis
694-2774 - 688-2280
Soils & Foundations Land Development
Ground Water Encountered: Yes No rl_� If yes, what depth
Proposed Installation: Seepage Pit ✓ Drain Field
Comments:
11
SOIL LOG
Performed for:
Name. _14<56C
//���� i,4rEo,�i.'��a�,e S Tel. No.
Nailing
Address: X40• d4X //0/, ZWCVLc ,�it �r2,
.fix, 99j-77
Legal Description: .Ldr
7, `✓4t< E.94�� ��c-wiz f/E�U.sRrs
Depth (feet)
Soil Characteristics
0
1
NJL—
tic -r
7�r
2
3
4
6
7
9
10
11
12
Ground Water Encountered: Yes No rl_� If yes, what depth
Proposed Installation: Seepage Pit ✓ Drain Field
Comments:
11
-- --- - --- --- - -- -Oa SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION
Pouch 6680. Anchorage, Alaska 99602 2762221 TEST
QXSOILS LOG - PERCOLATION TEST
.Sar/Cy.7 �L[-�i/ E67F0'iC
PERFORMED FOR: 12tll MOL<_ GXL/.vrltinG DATE PERFORMED: MOV /3r 9G
LEGAL
1
2
3
4
5
5
7
8
9
10
11
12
13
14
15
16
17
18
19
20
12co.tz if OILC/Can lCd
ziand (ow) and 41 / 601r1
Ti? ?lez 6edded
bandy yxave/ (6a/)
P./d// ;=Idcd , /ccv noo sfua�
Canteot•
<ontaina azandoen Co6hkd
6¢aue/ and Ca6.6/e p4aacelo4
6e1,6-14wx7ded fa Are«-zounded
Sa„x 5teat%o'<ed /ayes
a/ <Vell pealed sande and
gz"d<y aaqf26
/JOT%ONJ OF EXC.9✓.
AW/.0 CIQe—GE
WAS GROUND WATER
S
ENCOUNTERED?
O L
Depth to
Water
0
P
IF YES, AT WHAT
E
DEPTH?
Reading
late
Groff
Time
Net
Time
Depth to
Water
Net
Drop
I I PERCOLATION RATE (minutet/inch)
L--� TEST RUN BETWEEN FT AND FT
COMMENTS KP//�'1MMA LLSinl� C%. ¢ate 01 9Sf Ln 26—'-'el7y Z4",h ihE ha.Y..Z /O.S
PERFORMEDBY: 4/ Wa" r 5;eCERTIFIED BY:
DATE:��o
IQ63oC. roc.
72.008 (7n6)
DF. PAP.1MEN i* OF i".1RONPf .. `ti. Ol9 _;I .A$E
x500 runoP RCF;D
ANCHORAGE, ALASKA 99502
Performed For 5ocr`;L1.-4 `m .i 1d o rs _Date Performed Ze-'2 -2 ?
Legal Descrintion: Loth Block__,7-_SubdiviSion4,"
This Form Renorts Soils I_og ,� Percolation Test_
Depth
Feet Soil Characteristics -
1 —
2 —
4-
A— }z�I /
y
5rJa�ac� sed
— 1
F— �i�OUQ
7 —
8 —
9 —
10 — - ---
,y -I . _j
Was Ground Water Encountered?
If Yes, At what Denth? 0 41
!
_4 ---
Reading
.._ ---Reading DateI Grnss Time I Net Time I Denth to 120 Net Dronl;
Percolation Raten;t:e
Prnnosed Install__ation: an Pit
Deoth of Inlet Rr::!i� rie'Id
.._.� - _—._----
Denth To 3ott(.cj; rf Pit Or Trench
MUNICIPALITY OF ANCHORAGE
O
4
Development Services Department - Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-191-13
1. GENERAL INFORMATION
Expiration Date: Zai 2-C
Complete legal description EAGLE RIVER HEIGHTS NORTH BLOCK 5, LOT 7
Location (site address) 10842 ANVIK CIRCLE, EAGLE RIVER, AK 99577
Current property owner(s) HEATHER & DANIEL MONTGOMERY Day phone
Mailing address
Real estate agent
10842 ANVIK CIRCLE, EAGLE RIVER. AK 99577
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY:
Private Septic
Private Well
❑
Holding Tank
❑
Water Storage
❑
Community
❑
Community Well
❑
Public Sewer
❑
Public Water System
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 950- by q,
Date of Payment
Receipt Number1
COSA # osc I ` 2g
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
-e' Plan
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377
Address 4661 NATRONA AVENUE, ANCHORAGE, AK 99516
Engineer's Printed Name MICHAEL N. ANDERSON, PE
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by and Anderson Construction & Engineering.
6. DSD SIGNATURE
Y_ System #1 Approved for __1L bedrooms
System #2 Approved for bedrooms
Disapproved
Date 10/10/2019
�OFAZ4
�s 1
49TH *�
Of
•.IQCHAEL N. ANDERSON.-
No.
NDERSON:No. CE 9489 /
t p.1�0_/10/19,.•s��
Ilk
sslovo
Conditional approval for bedrooms, with the following stiptil�l4C1�((���
B Original Certificate Date: 1 C9 ^ C 1
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 Checklist blue sheet
C+MZiI+'��7T
Legal Description: EAGLE RIVER HEIGHTS NORTH BLOCK 5, LT 7 Parcel ID: 050-191-13
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system _
A. WELL DATA -PUBLIC
❑ 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.
Comments
B. TANK DATA — 3/5/2003 2000 -Gal
Age of tank(s) 16 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 50"
® Standpipes/foundation cleanout per record drawing
Date of pumping 10/8/2019 --'
Well production at time of test _gpm
Water storage tank volume_ gallons
Well disinfected for coliform test? ❑ Yes ❑ Nc
❑ Coliform bacteria is Negative
Nitrate _ mg/L E]Nitrate less than MRL (ND)
Arsenic — ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION - NA
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA — 15-25'L x 12'W x 6'ED — @ 85 SF/BR = 384 SF
Which system tested (date installed) 1975
® ALL standpipes present per record drawing
Total measured depth from grade 10.6 ft (max)
Measured depth to pipe invert from grade *6.9' (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 3_7
® Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced _gallons
Comments/Deficiencies
Adequacy test date 10/8/2019
Results E Pass For 4 bedrooms
Fluid depth prior to test 7 in (or 37" below TOC)
Water added 620 gal
New depth 15 in (or 29" below TOC)
Elapsed time 1310 min
Final fluid depth 0 in (or 44" (3.7') below TOC)
Absorption rate 600+ gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
*Top of crib (TOC) is approx. 6.9' from grade with 3.7' of the 6'ED measureable.
FWCS
1 2=
COSA Checklist copy.docx
E. SEPARATION DISTANCES
Fro ivate Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Sta ' n Lot > 100'
® Yes
Community Sewer Manhole/Clea
100'
Yes
if No ft
_
® Yes
if No
Neighboring Tank > 100' ® Yes
if ft
Priva er/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ding Tank > 100' ® Yes
if No
Neighboring Absorption Fields >
if No
Animal Contain t > 50' ® Yes
if No
® Yes
if No ft
if No *85
ft
Manure/Animal Excreta Storage_ 0'
Co y Sewer Main > 75' ® Yes
if No ft
® Yes
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Wells on Adjacent Lots:
Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No
Absorption Field > 5' ® Yes if No *5 ft
Water Main > 10' ® Yes if No ft
®
Water Service Line > 10' ®Yes if No `10 ft Community Wells > 200' Yes if No
Surface Water > 100' If septic tank is under driveway comment below
_ Yes if No *75' ft
From Absorption Field on Lot to: (Please enter distances if less than required)
ft
ft
ft
ft
ft
ft
ft
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No *0
ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No ft
Surface Water > 100'
❑ Yes
if No *85
ft
F. ENGINEER'S COMMENTS
'WAIVER WOR PER MOA RECORD DOCS.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
COSA Checklist copy.docx
OF AAir .
* _'4 g Tx
MICHAEL N. ANDERSON.-
''. No. CE 9469 Alfw
10/10/19 oticAf
�' 1<ESSIO�Ay
69
u56�&9,�� ti
RUP nicipality of Anchorag a
• _" �E' TM
a GC) nSite Water &Wastewater Program �a6
[;;;,j 3 (907)343-7904
6 ^ g01591,g5
2
01 s 9C�ificate of On—Site Systems
Approval
o�vo-lql-l3 %f 17
Parcel I.D.-9=��
8-— Expiration Date: o
1. GENERAL INFORMATION
Complete legal description EAGLE RIVER HEIGHTS NORTH; BLOCK 5, LOT 7
Location (site address) 10842 Anvik Circle *Eagle River 99566
Current Property owner(s) David R Lynette Jorgensen Day phone 702-575-3459
Mailing address
Real Estate Agent Eric Sourivonq Day phone 202-0400
2. TYPE OF DWELLING:
■ 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
❑
Individual On-site
Receipt Number
Individual Water Storage
❑
Individual Holding tank
❑
Community ClassWell
❑
Community On-site
❑
Public Water System
0
Public Sewer
❑
Distance: -
Received by:Date:
PASA to be releasetl 'engineer, uness oNenNse requested by the engineer.
COSA Fee $
Date of Payment
!�
10 ffcc�tt�
Waiver Fee $
Date of Payment
Receipt Number
1
Receipt Number
,��C/Sio10
COSA# (j�W4
14`PJ
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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 = ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
M conducMq Anis evaluagon, GEG pmvitletl en angirreedng evaluation mMe wegaM/wsepgc syskmin armrdarrce wiM dw
guidelines and reguladons established by the Moidpa sy cf Anchorage and IMustrypmcgws. The repolmd msN1s describe the
condIDon offha systarma on Me doWs ofMe evaluoum. Sepambondisfanos were measumdmmatlgyidMhWa kaftm.
Hlddan defects crencreachmenfsmay cods! Met were not Idea fiedducingam ovaluagon.fie opemlharmide map wells andsepgc
the year), qumityefcansfrucdan Immediate and war m ewhip), andthe waterusage of he hmilya0zng the sysfemrs. These
conditians can vary, and are w code Me combat of GEG. Saeefaclwytest results donotguarantee futumpedmmance mthe
sys/em/s; fheretae, GEGmeNesno wamany(exprass orlmplledJ regarding Me lmurepedannance mNe wepwseplicsyslem.
GEG makes, no representation whether an alternative asorsepfic system can be NsteAed on thepropedyin Me event edherorthe
current systems fah. The concord ofmfs repod is for the sclebmard mthepmso#adywho retained GEG. Reliance upon the
inhwmatmrpmvidedln this repodbyanyoMorpersonerpady, includmgbutnotHmhdfosubsequenfpmpedypumhasm, u mat
authorized.ln short, GEG msavaws mylagaiduylo myoneotherthan Ma pemoNpar(y whopaldtorgds repot.
6. DSD SIGNATURE
System #1 Approved for _�_ bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following
Phone
337-6179
Date I t) l b
";it l l 11 l(t(/
010 OF q�Tr�rr
ON-SITE
ATER AND rn
STEWATIzD F
Original Certificate Date: 10 ^ u" f (O
The Municipality or Anchorage Develop,emt 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 enginserregistered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. .
7. ATTCHIMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev. 10112112)
If more than 1 septic system is -on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description:
A. WELL DATA
Well type
Date completed
Total depth ft.
Date of test
Static water level
Well productiio'n�
WATER SAMrL-E-rtt`;
EAGLE RIVER HEIGHTS NORTH; BLOCK 5, LOT 7
PUBLIC
If A, B, or C provide PWSID# —
Sanitary seal (Y/N)—
Cased to ft.
FROM WELL LOG
TS:
Parcel ID: 050-191-13
Well Log
Wires properly protected
Casing height (per ground) in.
ft.
—9 -P.M. g.p.m.
Cefifo-ml colonies/100 ml. Nitrate - mg./L.
Arsenic: ug./L. Date of sample: —
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 2000 gal. Number of Compartments?
Collected by:
Date installed 3/5103
Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alar (YIN) N/A
Date of pumping
6/10116
Pumper JITS PUMPING
C. ABSORPTION FIELD DATA BELOW EXISTING GRADE
Date installed 1975 Soil rating (g.p.d./ft'or /bdr ' 85 System type **LOG CRIB
Length 15-25 ft. Width 12112 ft. Gravel below pipe 6 ft.
i
Total depth *10.8+ ft. Eff. absorption area 364 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 9/22/16 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 601 gal. New depth ***2 in.
Elapsed Time: 140 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 -
2,254 GALLON PRE-SOAK PERFORMED ON 9121/16. THERE WAS 10 INCHES OF STANDING LIQUID IN CRIB AT THE
END OF PRE-SOAK.
**41 YEAR OLD WOOD LOG CRIB MAY BE APPROACHING THE END OF ITS STRUCTURAL LIFE
***MEASUREMENT FROM UNDERSIDE OF CRIB LID TO BOTTOM OF CRIB IS 46"
D. LIFT STATION
Date installed Size in gallons Manhole/Access
"Pump on" level at - in. "Pump ofr level
E. SEPARATION DISTANCES
level
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot
Absorption field on
Public sewer main
Sewer /septic service
PUBLIC
On adjacent lots
On adjacent lots
.Ra. sewer manholelcleanout
Holding tank
Anonst containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 54 Property line 5'+ Absorption field 5'+ (ASSUMED)
Water main IV+ Water service line "10'+ Surface water '75'
Wells on adjacent lots 100+ PVT & 2001+ PUBLIC
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Building foundation 19+ Water
Water service line UNKNOWN Surface water '85' Driveway, parking/vehicle storageUNKNOWN
Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PVT & 2001+ PUBLIC
F. COMMENTS
*WAIVERS GRANTED "'PER CONTRACTORS LOCATE WHEN TANK WAS INSTALLED IN MARCH 2003.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in et%ct on this
date.
Engineer's Printed ame JEFFREY A. GARNESS
Date 10 �N /L
(Rev. MUM)
LOT 9 /
~MEADOW BROOK
LOT 6
e�T �OCRgD� N��ti\N BLOCKO
PLOT 7 -�Wl
20,598 S.F. . ,
/
I FENCE CONCRETE 9'c� OF CREEK GE
LOWER WAUCWAY K�Z� \THIS DATE
LEVEL /
ENTRY
o DECK CRM EK
s 2'
DWELLING NAT. I
SGA
NICRETE '� z .. /9� // (OCULATED DATA
PAD HALT (M)=MEASURED' ATA
DWVEWAY i.$ (R)=RECORD DATA Pi�pp PLAT
4' PLASTIC Ohu=OVERHEAD WTILJ7IES
RISER :......,;.. i NAT.=NATURAL
_ /-UTILITY PED -PEDESTAL
® / / POLE _. (TYP.)®TYPICAL
1 �
LOT 10 )) s
) w
\
wze
RECOVERED I
5/8" REBAR-1
(TYP )
v
LOT 11 )
2
SOUTH EDGE ) o
OF CREEK
THIS DATE J j
r r r )
r i
1
Z�J
,irrr
err a�
LOT 9 /
~MEADOW BROOK
LOT 6
e�T �OCRgD� N��ti\N BLOCKO
PLOT 7 -�Wl
20,598 S.F. . ,
/
I FENCE CONCRETE 9'c� OF CREEK GE
LOWER WAUCWAY K�Z� \THIS DATE
LEVEL /
ENTRY
o DECK CRM EK
s 2'
DWELLING NAT. I
SGA
NICRETE '� z .. /9� // (OCULATED DATA
PAD HALT (M)=MEASURED' ATA
DWVEWAY i.$ (R)=RECORD DATA Pi�pp PLAT
4' PLASTIC Ohu=OVERHEAD WTILJ7IES
RISER :......,;.. i NAT.=NATURAL
_ /-UTILITY PED -PEDESTAL
® / / POLE _. (TYP.)®TYPICAL
AS -BUILT
TH
Z
y D.
EASEMENT
_-
NVIK CIR. N
1' R 40'
SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY.
INS ON THE DATE OF SURVEY.
@ IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT
STANDARDS.
BY LINES ARE 11 FT.
ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. REUSE OF
T THE EXPRESS WRRTEN CONSENT OF ALASKA RIM ENGINEERING, INC.
DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR
ASION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON
OR FENCE LINES.
ALASKA RIM ENGINEER NG, INC.
9131 E. FRONTAGE Rb,
PALMM. ALASKA 996445
_ PH: (907)745-0222: FAX. (90/)746-0222
7 DFB: 16-
11
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UTILITY �-7p WATEI
EASEMENT �hJ 'EY
LOT r Li I
BLOCK
LOT 3
RECOVERED I
5/8" REBAR-1
(TYP )
v
AS -BUILT
TH
Z
y D.
EASEMENT
_-
NVIK CIR. N
1' R 40'
SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY.
INS ON THE DATE OF SURVEY.
@ IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT
STANDARDS.
BY LINES ARE 11 FT.
ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. REUSE OF
T THE EXPRESS WRRTEN CONSENT OF ALASKA RIM ENGINEERING, INC.
DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR
ASION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON
OR FENCE LINES.
ALASKA RIM ENGINEER NG, INC.
9131 E. FRONTAGE Rb,
PALMM. ALASKA 996445
_ PH: (907)745-0222: FAX. (90/)746-0222
7 DFB: 16-
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O 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. # L, - 1C'� HAA#
GENERAL INFORMATION
Complete legal description Lot 7; Block 5; Eagle Riven Heights Noa.th
Location (site address or directions) 10842 Anv.ik C.inai'e
Riveh, AK
Property owner
Lee 9
Linda
Moench
Day
phone 694-9317
Community wellN
o C
Mailing address
10842
Anv.ik
C.iacke
Eagie R,ven., AK
99577
Lending agency
Mailing
Day phone
Agent V.inp.inia Koh4.ietd/ Remax EagKe Riven. Day phone 694-4200
Address 16600 CenzeL4ie2d Dni.ve Eagle Rived, AK 99577
m
Unless otherwise requested, HAA will be held for pickup.
oz
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY: r
ing 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. 1191) Front MOA #21
rriw
C
Individual well�j�
z
Community wellN
o C
�
Public water
XXX
5; R
0
Z
NOTE: if community well system, provide
written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site 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. 1191) Front MOA #21
S. 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 furtherverifythat 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 5 & 5 ENGINEERING Phone C Ci y - )-1 7
17034 Eagle River Loop 146ad No.
Address Eagle River,
Engineer's signature
6. DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
Additional Comments
0
bedrooms.
Date
/ o //c /CS
CE • 8801 ;
FrCEES
bedrooms, with the following stipulations:
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 engineers work.
1H@ Aft 1917 Sack MOA k l
B. SEPTIC/HOLDING TANK DATA
Date installed S /) S Tank size 1250 Number of Compartments Cleanouts ON)_�__
Foundation cleanoutON) Depression (Y(,SP_/J High water alarm (YOZ)
Date of Pumping Pumper
C. ABSORPTION FIELD DATA
Date installed S %S Soil rating (g.p.d./ft' or ft'/bdrm) 954121 System type Lr— t 3
M ->e vL K i:5—, -x 25- I
1-engtlt- a4tidtlr Gravel thickness below pipe Total depth
Effective absorption area -55 i Monitoring Tube present(DN)_�__ Depression over field (Y10-4—
Date of adequacy test `I-2S,5S Result as ail) QAS, For y bedrooms
�
Fluid depth in absorption field before test (in.); 11e Immediately after Goo gal, water added (in.): I?
Fluid depth 130 (ins.) Minutes later: ID Absorption rate = Loom g.p.d.
Peroxide treatment (past 12 months) (YiS� ve-,out If yes, give date A
7
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825'L" Street, Room 502 • Anchorage, Alaska 995010 (907) 343-4744
8_Z
Health Authority Approval Checklist r�rl
o
n
9
n
�
D
Legal Description:
P -w Parcel LD.:
C
n
A. WELL DATA
I"P'1
Well e
typ � d �
[f A, B. or C, attach ADEC letter. ADEC water system number
[ra
v s
® O
Log present (YIN)
Date completed
Total depth
Cased to Casing height (above ground
Sanitary seal (Y/N)
Wires properly protec (Y/N)
FROM WELL LOG T INSPECTION
Date of test
Static water level
Well production
g.p.m.
g.p.m.
WATER SAMPLE RES
Coliform
Nitrate Other bacteria
ate of satnple:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed S /) S Tank size 1250 Number of Compartments Cleanouts ON)_�__
Foundation cleanoutON) Depression (Y(,SP_/J High water alarm (YOZ)
Date of Pumping Pumper
C. ABSORPTION FIELD DATA
Date installed S %S Soil rating (g.p.d./ft' or ft'/bdrm) 954121 System type Lr— t 3
M ->e vL K i:5—, -x 25- I
1-engtlt- a4tidtlr Gravel thickness below pipe Total depth
Effective absorption area -55 i Monitoring Tube present(DN)_�__ Depression over field (Y10-4—
Date of adequacy test `I-2S,5S Result as ail) QAS, For y bedrooms
�
Fluid depth in absorption field before test (in.); 11e Immediately after Goo gal, water added (in.): I?
Fluid depth 130 (ins.) Minutes later: ID Absorption rate = Loom g.p.d.
Peroxide treatment (past 12 months) (YiS� ve-,out If yes, give date A
7
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
line
On adjacent lots
On adjacent lots
sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/146C-E NG TANK ON LOT TO:
t -F-
Building foundation S Property line
to'
t
Water main/service line to WA- Surface water/drainage 0 o
_ Absorption field
Wells on adjacent lots •1 {p
EPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
10 tk--
Water maintservice line t o v
Surface water l o D t % Driveway, parking/vehicle storage area S t }
\\ tk
Curtain drain N IDc Wells on adjacent lots '� IAc Property line to
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F. ENGINEER'S CERTIFICATION
I certify that 1 have determined thru field inspections and review of1funicipal records
in conforman=wh gu' elines in effect on this date.
Signature I
Engineer's Name %r &b E1ZT C • o �✓ 4
Date / D //e t/,) S
HAA Fee $ 0
q �
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
CE -8801
Waiver Fee $ LCO
Date of Payment C) —11, -` s' -
Receipt Number C-) t 2gb I 3Sq Lf
MAR -04-2003 1259 5&5 ENGINEERING
907 694 1211 P.09
G� 6E�f
ASBUILT-NO CORNERS SET THIS DATE.
I HEREBY CERTIFY. � SEWARD & ASSOCIATES LAND SURVEYING
THAT i HAVE SURVEYED THE SCALEk.
FOLLOWING DESCRIBED PROPERTY= ���'Jp e��•~�1
AND THAT
ENCRror7, r DATE: i �F 0F. Al 1
AND THAT . ENCROACHMENTS EXIST EXCEPT A3 /
INDICATED. IT IS THE RESPONSIBILITYOF THE 9%z9/yr iAi _S
OWNER TO DETERMINE THE EXISTENCE C'
EASEMENTS, COVENANTS OR OF ANY GRID:
WHICH p0 NOT APPEA ' RESTRICTIONS
VISION PLAT. UNDER NONCfRCUMS7ANCES gBOHyp FBS 1 • •-o.en.,me.e
ANY DATA HEREON SE USED FOR CONSTRUCTION
OF FENCE LINES OR FDR ESTABLISHING DRAWN: lr�
BOUND-
ARY LINES.
TOTAL P.09
Municipality of Anchorage A
Mayoor rom,Department of Health and Human Services
825 "L" Street
Rick MyP.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
October 16, 1995
Robert C. Cowan, P.E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 7 Block 5 Eagle River Heights North
Waiver Request #WR950056, PID #050-191-13, HA950458
Dear Mr. Cowan:
Your request for a waiver(s) of the required 100 foot horizontal
separation of a septic system to the surface water has been
approved. The approved separation distance(s) are a private
septic tank to Meadow Creek of 80 feet.
This waiver approval applies to the existing septic system to
surface water separation only. Any future upgrade to the septic
system will require all separation distances be met or another
approval from this department. Should the operation of the
subject wastewater disposal system cause any contamination or
degradation of the subject surface water, this waiver will
become void.
Sincerely,
Robert W. Robinson
Civil Engineer
On-site Services
RWR/1jm#5
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•MUNICIPALITY OF ANCHORAGE*
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR950056 PID# HA# Permit #
Date Received: October 11, 1995
Legal Description: Lot 7 Block 5 Eagle River Heights North
Engineer: Robert C. Cowan, P.E., S & S Engineering
17034 Eagle River Loop Road, Suite 204, Eagle River 99577
Applicant: Lee & Linda Moench
****** _)kj
Waiver Requested: g septic tank ai4el Meadow Creek (surface H20)
nr� I
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Points:
Waiver is Granted: Waiver is NOT Granted;:
List Conditions or Reasons for above: v y�,-, 11/
Date: By:
C
Rec #: #01380/3544 Amount: $ 625.00 Date Paid: 10-11-95
nG
October 9, 1995
ROBERTC. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907)694-2979
FAX(907)694-1211
HEALTH AUTHORITY Municipality of Anchorage
APPROVALS DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
SEWER & WATER
MAIN EXTENSIONS
REFERENCE: Lot 7 Block 5 Eagle River Heights -North Subd.
SEWER&WATER Request you issue a Health Authority Approval on the
INSPECTION referenced property and grant a waiver for the horizontal
separation distance between the septic tank serving this
property and Meadow Creek at 80 feet.
ENGINEERING STUDIES The mitigating factors involved which support the issuance of
AND REPORTS the waiver are as follows: pp
1. Reference the site plan/topo and photos, surface
WELL INSPECTION effluent would not flow toward the creek.
& FLOW TEST
2. Generally speaking, septic tanks should not be
considered a "continuous" source of contamination as
would a leachfield.
SITE PLANS
3. In going from the septic tank to the creek there is
heavy vegetation. This would prevent surfacing
effluent from reaching the creek.
ROAD DESIGN
In our opinion, the separation distance requirement
prescribed by 18AAC.021 is not necessary in this case.
SOILTEST There is 104.8 feet of separation between the clean-out on
the crib and the creek. The Municipal inspection report from
August of 1975 gives a poor description of the crib
dimensions. We feel with the uncertainty of the location of
PERCOLATION the crib in reference to its separation distance from the
TEST creek a waiver for the crib should not be required.
If we may be of further service, please contact us.
STRUCTURAL& Sincerely, N,up11CIP, L,o of AN�O�COr
MECHANICAL SERVICES DIVISION
INSPECTIONS f rNViRONMENTAt
Robert C. Cowan, P.E.
ONSITE
WASTEWATER yij� 6}.' M bbii
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
