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HomeMy WebLinkAboutHAMANN LT 17
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP 191113 PID Number: 050-621-04
Dwelling: ❑■ Single Family(SF) ❑with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade
Name
DAVE HERTRICH ABSORPTION FIELD
Site Address ❑ Deep Trench ❑Wide Trench ❑ Bed ound
24437 WILMA CIRCLE, EAGLE RIVER ❑ Other
Phone Number of Bedrooms Soil Rating Total depth fr• original grade
3 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
HAMANN LT 17 Fill added above original gr.•- Gravel length
Township Range Section Ft. Ft.
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
To Septic Absorption Lift Station Holding Sewer Total a•=•rption area Number of trenches Dist.between trenches
From Tank Field Tank Line Ft2 Ft.
Well 100'+ 50,+ TANK ❑p Septic ❑S.T.E.P. ❑Holding ❑Other
Manufacturer Capacity
Surface water 100+ 'ANCH TANK 1000 Gal.
Material Number of compartments
Lot Line 10'+ NA STEEL 2.0
Foundation 1 g♦
LIFT STATION
Manufacturer Capacity
Remarks Gal.
Alarm location Electrical installed by
PIPE MATERIAL House to tank 3034Tank to 3034
Installer drainfield
MIKE N ANDERSON, P.E. Drainfield 3034 CO/MT3034
Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) ft
Inspection
2„d V' 4/23/19 4/23/19 Location and description
dates:
aid 4m
ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp
OF e c ll
Conditional Approval: _ Date 1P��• IAN 1 h 1
, 49TH ••..* /
til t,
Septic Sy em \-
I°r •�• MICHAEL N. ANDLRSCN ...c'47 r'
• .„
Approved ,J t,,—..,('-- Date L,_1C( rii f.•• CE 1449 . ``'r
F• •..f.., ,�
Note: this approval does not include well permit requirements. <<l�ZOFESSIO�.=
(Rev 05/02/18)
Permit No. OSP19113 - Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: HAMANN LOT 17 PID No.: 050-621-04
MARK A 8 \
C01 46 61 _ \
TC01 48 63 -- -,
TCO2 53 65 N
CO2 56 68- N
CO3 57 70 N
\ \
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/ 1 \
/ X \
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milmen
DRIVEWAY
Ill X r- V 'I N e :II i • I N STEEL K \\
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ASBUILT
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9 1.000 STEEL
•
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MICHAEL N. ANDERSON!
SEPTINC
.TSSECTION Na/ •• ' ESS` 4'I '�+iauawSit.S.
0 0C.1,ALirro MUNICIPALITY OF ANCHORAGE Ment S
On-Site Water&Wastewater Program >o �^
- PO Box 196650 4700 Elmore Road �•
4 } Anchorage,Alaska 99519 6650 Phone:(907)343 7904 Fax:(907)343 7997
4'. httpa/www.muni.org/onsite
4NCM0- ;,0 I)l'Ili/I I1111'ni
On-Site Wastewater Disposal System Permit
Permit Number: OSP191113 Effective Date: 4/18/2019
Work Type: SepticTank Upgrade Expiration Date: 4/17/2020
Tax Code Number: 05062104000
Site Legal Address: HAMANN LT 17 G:0261
Site Mailing Address: 24437 WILMA CIR, Eagle River
Owner: HERTRICH DAVID & KRISTYN Lot Size in Sq Ft: 108900
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field 2 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
XReceived By: iffDate: M
z
Issued B
Y 0juut
Date: I 8
MUNICIPALITY OF ANCHORAGE
•
1S r :::,)
4 i
Development Services Department t Phone: 907-343-7904
On- .te Water & Wastewater Section �' Fax: 907-343-7997
At\•
4 k,y ON-SITE SEPTIC/WELL PERMIT '
APPLICATION UFLS
Parcel I.D. 050-621-04
Property owner(s) DAVID HERTRICH Day phone
Mailing address 24437 WILMA CIRCLE
Site address SAME
Legal description (Sub'd., Block & Lot) HAMANN LT 17
Legal description (Township, Range & Section)
Lot Size 108,900 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field I I Initial I I Single Family (SF) 0
(w/wo ADU)
Septic Tank rog Upgrade .
Duplex (D) n
Holding Tank Renewal H
Multiple Dwellings I I
Privy n (SF and/or D)
Private Well I I u 5 6 7 8 9 l9
Rini?
>>
Water Storage I I ' �,
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: a AP ! b x. 19 1.
g
A',, Distance/,
I certify that the above information is correct. I further certify that this is in a 8 e with
applicable Municipal Codes.
IMVL
Si nature of( g property owner or authorized agent)
Permit/Rush Fees: SpC Waiver Fees:
Date of Payment: Lu1I (R Date of Payment:
Receipt Number: # loWoll Receipt Number:
Permit No. (35 (Q1 U« Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
April 18,2019
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage,Alaska 99519-6650
Fax 249-7847
Re: New Septic tank permit
Legal: HAMANN LT 17
To Whom it may concern:
This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact
any of the neighbors or encroach on any wells,septic or open water issues.
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
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MICHAEL N. AVARSCN .._j iA
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•
ASBUILT-NO CORNERS SET THIS DATE. • . SEWAR & ASSOCIATES LAND 'SURVEYING
I HEREBY CERTIFY THAT I HAVE SURVEYED THE CALEB
FOLLOWINO DESCRIBED PROPERTY' Lot 17, ,.....)•!.....7 -,. 0 '14
0-1 p� A� Rei
Hamann Subdivision DATES �� •........
••`• •••:qiS`
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 9/8/91 f". •.• ••'f
INDICATED. IT IS THE RESPONSIBILITY OF THE . - 0. 497 ' .••.
OWNER TO DETERMINE'THE EXISTENCE OF ANY GRID'
EASEMENTS, COVENANTS OR RESTRICTIONS SW261 I t ;i;1
WHICH DO NOT APPEAR ON THE RECORDED SUM,- q •••••. ou•n• Q 6•w•rd .
VISION PLAT. UNDER NO CIRCUMSTANCES SI-IDUAD FBS - 1,i}: •. Is_ 691 D
ANY DATA HEREON BE USED FOR CONSTRUCTION .: 23-73 d4.:'. .-• ---- ....•.:c•
�
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SE:RVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 ® Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~j~,.j<2)[ O'~Z~.'~, PID Number:
Address:
Phone: ~9~ --J~'~ NO. of Bedrooms: ~S
,~ El Deep Trench hallow Trench U Bed ~ Mound ~ Other
LEGAL DESCRIPTION Soil Rating: ~, ~ GPD/Sq. ~t. Total Depth from origiqal grade~f-
Lot: [ ~ Block: ~s~ Depth to pipe botlom lrom original grade: GraveJ depth beneath pipe
Township: Range: Section: Fill added above original grade: Gravel length:
WE~L: g New ~ Upgrade erCve~:~¢~ NumberoflinesT~DislancebeJweenlines:
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: ' -- Pipe materiah ~
Driller: Date Drilled: Static Water Level: Installer: Date installed:
Yield: Pump Set at: Casing Height Above Ground:
GPM Ft. Ft. TANK
From Tank Field Station Tank Sewer Lines ~'~
/¢ Material: -- Number of C~partments:
Surface
W~t~r l~,O+ i00~( LIFT STATION
LOt Size in ga~r:
I " po "levelat: "Pump off"l~ High wateralarm at:
Foundation ~ ~,~ /
~ DrainCurtain '~ ~LO ~ j~ ()~ ~ ~ Pump Make & Model ]~iectric~l Inspections performed by:
Remarks: BENCH ~ARK
] Assumed Elevation:
ENG I~E~S ~BAL
Department of Health and Human Services approval ~,~..',
72-013 (1/91) MOA 25
Permit No. ~-~l,'-,Jc~O~-'Cr;2-.- Page ~ of ~-
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well. Inspection Report
Legal Description: J~kbvl~'~.l I,~ OOT' I '4-
PID No.:
N
72-013A(2/91) MOA25
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910242
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:FUSSELL JOE T &
OWNER ADDRESS:P.O. BOX 774355
EAGLE RIVER, ALASKA 99577
DATE ISSUED: 8/19/91
EXPIRATION DATE: 8/19/92
PARCEL ID:05062104
LEGAL DESCRIPTION: HAMANN LT 17
LOT SIZE: 108900 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:/
RECEIVED BY -- _..,, (~ ~'~
ISSUED BY: ~~
August 5, 1991
ROBERTSHAFER, P.E.
ROGERSHAFER, P.E.
OlVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPE-CTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, Alaska 99501
REFERENCE: Lot 17; Hamann Subdivision
We request you issue a permit to upgrade the septic system serving the
referenced property.
On July 3, 1991 an adequacy test was performed on the existing septic
system. The absorption capacity was unacceptable for a three bedroom
house. A test hole was excavated, percolation test performed, and an
upgrade design completed.
This is a large lot with a gentle slope to the southwest. Due to the
large lot sizes in the area, we do not anticipate any adverse effects
on the neighboring properties by the installation of the proposed
septic system.
If you have any questions or require additional information for your
review, please contact us.
Sincerely,
ROGER J. SHAFER~,
RJS/ztc
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
SCALE
SCALE
Municipality ot Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
7
8
10
12
13
14
16
17
18-
20-
Township, Range, Section:
ENCOUNTERED? ,
S
L
DEPTH?
E
SLOPE SITE PLAN
Depth Io Water ADer
Monitoring?
Reading Date Gross Net Depth to Net
Time Time Water Drop
COMMENTS
PERCOLATION RATE .~'P' ~ tm,nules/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN '~ _ FTAND ~ FT
S & S ENGINEERING ,--'""-T -'~ ~ t A
:. _;._...~.~.~ ,..,.~., ~: ~, ~.~ ,~,¢. ~;¥~ , - ¥ ~----~ ~ CERTIFY THAT THiS TEST WAS PERFORMED IN
ACCORDANCE WITHE,~L~e~S~,~,VI~'C~A~N'~C~I'~ GUIDELINES IN EFFE&T O~ TI-IlS DATE. DATE: ~ --~'-~ ~ ~
72-008 (Rev. 4/85)
(~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENI'AL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
E~ UPGRADE
MAILING ADDRESS /~ ., .--
~-OCATION
DISTANCE TO:
Liq~~ca it ' allons IF HOMEMADE: Inside length Width Liquid depth
~v Well f/ Dwelling PERMIT NO.
~g DISTANCE TO:
~ ~ ~ Manufactu,'er /~/q"-- Material
Liquid
in
gallons
,~~¢ Tren~widt~ / Distance be~l~s
[: .... ~ --- inches
Length 'Width D~pth / PERMIT NO.
~ ~ Type of crib Crib dial r ~ Crib depth Total ~ffective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ ~_ / ~ /~ Driller Distance to lot See PERMITNO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
~IPE MATERIALS I
013 (Rev. 3/78)
PERMZ'i NO.
hFFL Z _.HIqT E:I]FJ HI::IF.:E:,"r'
L., O C: Fi T ICl ~",1
4_EGf'IL. L. i7 HFIItFtNN
[:'EF'FtRTMENT ~' FIEFIL]-'H FIND EN',,/IRONNEI",ITFtL. .OTEC'FION
825 '"L ST'REET., FII"~CHORI::IGE., FIK.
2E;4-4. F2EI
,Z.~ t-4 -- :E;. }: T' lES ~ lie B--0 E-"~
,:.' 83:C~EC.':J. )
LOT S I ZE tEr_:.',E~E~O S'.;.!_ RRE FEET
TYF'E CF SFIIL FIESF~F.'F'TION S'T"=,TEH IS: TRENC:H
ttRXIMLIH ;qUI'"IE:ER OF 6E. E F.._JlI= :=
SOIL RFITING ,::SC.! FT,-.'E:R)="± ,. ._'"~:;
THE REC!UIREE:, SIZE OF 'THEE SnIL FtE:':..;CIRF'TION SYSTEH
[:, E: F- 'T'H ==
'THEE LENGTH DIMENSION ]:L:; THE LENGTH ,::IN FEET) OF THE TRENCH OR DF.:RINFIEI_E:,.
THE DEPTH OF F:I TRENCH OR PIT IS; THE [:,ISTFINCE BETI.4EEN THE SURFF~CE OF THE
GROUND FIND TFIE BOTTOH OF' THE EXCI-3'v'ATION (IN FEET).
THERE IS NO SET HIDTH FOR TF. tENC:klES.
THE F. iRFI',/EL. [:,EPTH IS THE MIN]:MUH DEF'TFI OF' GRR',,,'EL BETHEEN THE OLITFFtLI... PIPE
FIND THE E:OTTOH OF THE E::.:;CFI',,,'F-¥FION ,:.'IN FEET).
F'EF.':HIT FIF'F'L. ICFINT PIFtS THE F..E_,FuI~:,IE, ILI FT TO INFORH THIS [:,EF'RRTHENT DURING THE
INSTFtLLFITION IN:,FE~.TI_N:, OF FtNY HELLS RD._TFIL-:ENT TO TFIIS
rr'._r~.~ FIND ]"FIE
HUHBER f]F F..:E:.-",IE:'ENCES TI-IRT THE HELL. HILL SERVE.
............. -l" 1.4,1'} ,:' 2 ':, ]] NI .:- F:" re- ,-' T' ZCi k...i E; F.# F: E: F.-.: El ,;~ LI :[ F-~: EC
E:FtCKFILI_ING OF FtNY SYSTEH 14ITHOUT F.TNFIL INE, F'EC'T.[EN RNE:, FIF'PRO',/FIL. BY THIS
DEF'RRTMENT HILL E:E:,IJE, JEL.'f'- ' -' ' TEl F'F'nC;EF:IITIi-1[.4.
HINIMUH DISTFtNIE:E EIETHE:EI'.,I R HELL FINE:, FIN'¢ ON-SITE SEHFtGE DISF'OSFIL SYS'TEM IS
:[.E~Z~ FEET FOR FI PRI'Y'FITE HELL OF: ±SEI TO 2Em-~ FEET FROH FI PUBLIC HELL [:,EF'EI'.4E:,ING
UPON THE TYPE OF' PUBLIC HELL
HINIMUM [:,ISTFINCE FROH FI F'RI',,,'Ft]~E HEL. L TO FI F'RI'v'FITE SEHER LINE IS ;--':5 FEE:T FINE)
]"0 F~ COHMUNITY SEHER LINE IS 75 FEET.
OTHER REQUIREMENTS MR'-r' FIPPLY. SF'ECIFICPITIOI'.4S FIND CONSTRUCTION [:'IRGRFtf"IS FIRE
FIVFIILFIBLE TO INSURE F'ROPER INSTFILLFITION.
t C:ERTIFY TFIFIT
±: I Fff"i F'FIHILIF~R HI"I"H THE RELz.!UIRE:MENTS FOR ON-SITE SEHEF.:S FIND HELL. L:; FIS SET
FORTFI BY THE HUNICIPFILITY OF F:INCFIORFIGE.
2: I HILL. INSTFILL THE SYSTEM ]:1"4 FIC:CORDFINCE HI'T'H THE CODES.
]:: I LINDEF.:STFtND THFIT THE ON-SITE SEHER SYSTEM I"1F¢¢ F.:EC!UIRE ENLFIRGEHENT IF THE
RES I [:,ENCE I S F;.tEMOE:,F.L.~D TO I N~:LUE:,E HOF.:E THFtN 3: E:EE:,F.':OOME!;,.
FtPf:'L :[ CFff'EF - BOE: HFIR[:('r'
1:5':.;UED ~. ~,.~ .......... n ~
PDX 97, EAGLE RIVER, ALASKA 99577 a TELEPHONE 694-2588
OWNER OF LAND DEPTH OF WELL 0 or- 7
ADDRESS
LEGAL DESCRIPTION A7_ 7
DATE - . Started Ended 4/140174
PERMIT NUMBER 7076
STATIC LEVEL OF WATER FT.
DRAW DOWN FT. 0
GALS. PER HR
KIND OF CASING
MISCL. INFORMATION:
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MISCL. INFORMATION:
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ASBUILT-NO CORNERS SET THIS DATE. SEWARD & ASSOCIATES LAND SURVEYING 688-4566
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:
FOLLOWING DESCRIBED PROPERTY: Lot 17, �;
Hamann Subdivision DATE:
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS ,tr'.�.•' •`.'1-94)�
9/8/91 rj� •�
INDICATED. IT IS THE RESPONSIBILITY OF THE t*'. 29TH "� ,, 0
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: y•••• •• ••••••• •••••®a ,,,,,-
EASEMENTS,
EASEMENTS, COVENANTS, OR RESTRICTIONS ! „� , `�
SW261 / � ...Q
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- 0
0 Duane Mark Seward ::00
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' 4'``�, •.• lS=6�t8 �.0,
ANY DATA HEREON BE USED FOR CONSTRUCTION 23-73 k "`t' . •.`�'. ; `"4'
OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN: ''h, '�7t,�lual\^°.,.4
AMY LINED. DMS .aye_ w�fo''
KU45 I+
USH !
UNICIPALITY OF ANCHORAGE nr
Development Services Department • 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 050-621-04 Expiration Date: I l 2-S--1
1. GENERAL INFORMATION
Complete legal description HAMAN N LT 17
Location (site address) 24437 WILMA CIRCLE, EAGLE RIVER
Current property owner(s) DAVE HERTRICH Day phone
Mailing address SAME
Real estate agent Day phon- \ , f 5 F
Q4s oscts>
2. TYPE OF DWELLING: 4,0 41.44b/1)-11' o
0 Single Family (w/wo ADU) .
❑ Duplex N
111Multiple Dwellings (Single Family and/or Duplex) d
3 �C997rZ \�
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well ❑ Private Septic ❑
Water Storage ❑ Holding Tank ❑
Community Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver request for: Distance:
Received by: /7/0(1 Date: el
COSA to be released to the engineer,unless otherwise requested by the engineer. ) 7 S i g
COSA Fee $ 'ine) Waiver Fee $
Date of Payment q/a WO Date of Payment
Receipt Number Receipt Number
COSA# Q'SC«!l a8 Waiver#
Ai WA ,
4,,,,,
fi •pIt awls, ;
, '414«..v.•
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IP V
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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 'NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E. Date 4-24-19
,ted-s:. a n,4
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6. DSD SIGNATURE �.......• :2.;I/I
System#1 Approved for 3 bedrooms �•�c* ;
`.MICHAET;N:ANDERSON .F:—
System#2 Approved for bedrooms ���•• at 94 •;_
Disapproved �ill,(/;,:iii�� . •t\-,.. „
& O ESSIVI"—=
Conditional approval for bedrooms, with the following stipulalib)
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= 'YIiijS4Az m1 ST _p9O $?Jo Q
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By: -t"^I(` 0Original Certificate Date: ` I
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
COSA Checklist
Legal Description: HAMANN LT 17 Parcel ID: 050-621-04
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
❑■ Well log is filed with Onsite (or attached) Well production at time of test 3+ gpm
Date drilled 4110/76 Water storage tank volume 0 gallons
Total depth 82.6 ft Well disinfected for coliform test? ❑ Yes No
Cased to 82 ft Coliform bacteria is Negative
❑■ Sanitary seal is functioning correctly Nitrate 3.72 mg/L ❑ Nitrate less than MRL (ND)
❑■ Wires are properly protected Arsenic 0 ug/L ❑Arsenic less than MRL(ND)
Casing height(above ground) 20+ in. Collected by MNA
Date of flow test for COSA 4/18/19 Date of Sample y-1 `I
Static water level at beginning of test 38 ft.
Comments
B. TANK DATA C. LIFT STATION
Age of tank(s) 2019 years ❑ Required maintenance completed
Tank type/material STEEL Age of lift station years
Measured operating fluid level in septic tank NEW Lift station material
❑� Standpipes/foundation cleanout per record drawing Comments:
Date of pumping NEW TANK
D. ABSORPTION FIELD DATA
Which system tested (date installed) 915!91 Adequacy test date 4-15-19
0 ALL standpipes present per record drawing Results ['Pass For 3 bedrooms
Total measured depth from grade 6.25 ft(max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 4.2 ft(min) Water added 500+ gal
❑ N/A—pressurized field
New depth 0 in
C1 Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min
depth into effective
❑� Code-required soil cover over field Final fluid depth 0 in
❑ System presoaked Absorption rate 500+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) UN
date of test)
Gallons introduced 500+ gallons If yes, enter date
Comments/Deficiencies:
COSA Checklist yellow sheet
•
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout > 100'
Q✓ Yes if No ft p✓ Yes if No ft
Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line>25' 0 Yes if No ft
Absorption Field on Lot> 100' �✓ Yes if No ft Holding Tank > 100' �✓ Yes if No ft
Neighboring Absorption Fields> 100' Animal Containment> 50' ✓Q Yes if No ft
O Yes if No ft
Manure/Animal Excreta Storage> 100'
Community Sewer Main > 75' E Yes if No ft ✓❑Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations> 10' E Yes if No ft Surface Water> 100' E✓ Yes if No ft
Property Line > 5' E Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' E Yes if No ft Private Wells> 100' ✓0 Yes if No ft
Water Main > 10' ID Yes if No ft Community Wells >200' ✓❑ Yes if No ft
Water Service Line> 10' ['Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' p✓ Yes if No ft If absorption field is under driveway comment below
Property Line> 10' p✓ Yes if No ft Wells on Adjacent Lots:
Water Main > 10' ✓Q Yes if No ft Private Wells> 100' 1:1 Yes if No ft
Water Service Line > 10' ❑✓ Yes if No ft Community Wells>200' 0 Yes if No ft
Surface Water> 100' p Yes if No ft
F. ENGINEER'S COMMENTS
..b.r. r,
G. ENGINEER'S CERTIFICATION ,,.....40...:,. vk
;'. �'4 r, 1 s
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I certify that I have determined through field inspections and review "' T H ' '•,;
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date. •ENIE r,
• mitHAtt'"N. ANDERSON :,!--!::;;-$
;'•. CEt 94159 :'.
tFi; •..• �C.` �..
COSA Checklist yellow sheet ��\�0;.:4
Municipality of Anchorage •
On-Site Water and Wastewater Program• o�'
(907) 343-7904
mala
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-621-04 Expiration Date: 0L 3 , a a 1 1
1. GENERAL INFORMATION
Complete legal description Hamann Lot 17
Location (site address) 24437 Wilma Circle
Current Property owner(s) Sharpe Day phone 444-4768
Mailing address Same
Real Estate Agent Tom Villars Day phone 444-4768
5 61 8 9 10 /i
2. TYPE OF DWELLING: u
® Single Family (w/wo ADU) ti .off
❑ Duplex E APR 2 0 7017
❑ Multiple Dwellings (Single Family and/or Duplex)
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h
3. NUMBER OF BEDROOMS: 3 !� 01 6 9 L 9
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Received by: Date: t..5/3/ 7
COSA to be released to the engineer, unless of rwise requested by the engineer.
COSA Fee $ 5240 Date:
Date of Payment 4 lir/49' Date of Payment
Receipt Number O'3' 5D Receipt Number_
COSA# l I tO 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 NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 4/19/2017
OF i-
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4,9 uA
6. DSD SIGNATURE B*��� ' •
System #1 Approved for 3 bedrooms.
System #2 Approved for bedrooms. �� � , Steven N Eng tyr
PE2� r�
Disapproved. �� 'F`5,- 9
PAO-ESSV`)1,,5"
Conditional approval for bedrooms, with the following stipulati ��-�"
' ON-SITE G.
WATER AND m
m WASTEWATER :
C� PROGRAM o
+1+� r,r-r, ref F�
By: (', Original Certificate Date: 5/3/Q011
The Municipality of Anchorage Devlopment 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 9-1-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system _
Cerrt fkkate of Ort-Sate Systems Approval Checklist
Legal Description: , 441,„*/ Lor/7 Parcel ID:d 56-6z/�OCI
A. WELL DATA
Well type P If A, B, or C provide PWSID# Well Log (YIN)
Date completed �4!/7G' Sanitary seal (Y/N) �/ Wires properly protected (Y/N) j
Total depth 8 5ft. Cased to '''Z ft. Casing height (above ground) / -74' in.
FROM WELL LOG AT INSPECTION
Date of test L04/74- V7/27
Static water level Z / ft. ft.
Well production 3 d g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform Q colonies/100 mL Nitrate Z3 mg/L
Arsenic /L/b ug/L Date of sample: .3/27'/7 Collected by: 45—
B.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S,Ef?yC /S eei Date installed 27( VR3
Tank size /6dO gal. Number of Compartments 0. Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression over tank (Y/N) At High water alarm (Y/N)
r=at
Date of pumping ��r�dr'� #7Pumper -"i/JIT 7 /9e."2--5'
C. ABSORPTION s4, ui A �� ��
7/ Ticyt,c�
Date installed 2//03411r Soil rating (g.p.d./ft2 o it2/bdra) / 7 c System type Tr e
Length ,/�l� 3 ft. Width 2. 5 f 5 ft. Gravel below pipe 6'-4- 2 / ft.
55
Total depth ?f�"‘ft. Eff. absorption area 5Z 1ft2 Monitoring tube y Depression over field
Date of adequacy test V//'0 -7 Results (Pass/Fail) I For 3 bedrooms
Fluid depth in absorption field before test d in. Water added C./56 gal. New depth /z in.
Elapsed Time: 30 min. Final fluid depth 0 in. Absorption rate >_ LI-TO g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) _ If yes, give date
* �� S 75 6 0 gf cr/tJAA-c_ F" - P -3 Q 44 k-E4 f' t-�
D. LIFT STATION AM
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:
i
Septic tank/lift station on Iot/06'1- On adjacent lots /00
Absorption Field on lot /00/4 On adjacent lots /O 0' 14-
Public
tPublic sewer main &rot," Public sewer manhole/cleanout -
Sewer/septic service line Z5 ''k' Holding tank /06
Animal containment areas 50 (f- Manure/animal excrete storage areas /DO '
4-
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /6 (t' Property line /D rr Absorption field S f
Water main /a tr Water service line / 2 'r Surface water /0
Wells on adjacent lots /2"6-
ABSORPTION
7dABSORPTION FIELD ON LOT TO:
r
Property line /G 'f" Building foundation /0 '' Water main / 'r`-
Water Service line ' ' Surface water /6)0 fi Driveway, parking/vehicle storage 5
Curtain drain U/CH Wells on adjacent lots /04 r
F. COMMENTS C'///3//-
)FSLCCA C4 fRoLL AZA Q le � bir/5R 2
Orit..v6 //S r. LLl4'T/a/O-Clj/Uivec - TO O/2167l4c 7-040Cft
G. ENGINEER'S CERTIFICATION
I
certify that I have determined through field inspections and •( ��,
review of Municipal records that the above systems are in or� .•`•
conformance with MOA COSA guidelines in effect on this data P s. i'41a(F4Elt 's
Engineer's Printed Name S revE //
Date ///?//7
��/eft 7
COSA yellow sheet 2-6-15.doc
..
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ASBUILT-NO CORNERS SET THIS DATE. SEWARD & ASSOCIATES LAND SURVEYING 688-4566
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE;
FOLLOWING DESCRIBED PROPERTY: Lot 17, ;•6� OF Az e41
Hamann Subdivision DATE ..........4
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS ra/c8/91 s '�� ...,:% 04,o
INDICATED. IT IS THE RESPONSIBILITY OF THE .4. * : 49 ± • '. S
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: "'
EASEMENTS, COVENANTS, OR RESTRICTIONS SW261 yr .6.e.-/;•c-' 4 - a
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- .1? .+D ane Mark Seward #0
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' t lS . LS-6918 .- **(fog
ANY DATA HEREON BE USED FOR CONSTRUCTION 23-73 �-,`•'? `, ,�5;; `J*
OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN: �k �y�+7xi �t1e
A!V15 L.Ir1C3. DMS '`�ry.,.,.r+.+s�
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.# _~Z,~,~ _
GENERAL INFORMATION
Complete legal description
Lot 17; Hamann Subdivision;
Location (site address or directions) NHN Wilma Circle
Property owner
Mailing address
Lending agency
Mailing address
Joe & Traei Fussell
P_0.Bo~ 77~355
Day phone
Day phone
694-1882
Agent Virginia Kohfi~ld RE/MAX OF EAGLE RIVER Day phone 694'~'200
Address 1~0o ~;¢¢~fx'¢~Pd O/rJu~ #701 E~g.¢~ R~'u¢~: A£a~Jza 99577
Unless otherwise requested, HAA will be held for pickup.
3
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
XX
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1191) Front MOA
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 & 5 ENGINEERING
Address 17034 Eagle Ri,,,er L~ep l~oa~l
': agle River, Alaska 99577
Engineer's signature
Phone
DHHS SIGNATURE
X~ Approved for ~-,~,~c~-~-(/~) bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: ,~ ~¢,.c..c~,-~ Date ('/- / / - 9 /
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) 8ack MOA #21
Legal Description:
M~NtC~PAu~Y
~t~UNMENT^~ SERVICES O~VtS~Ot4
Municipality of Anchorage
Department of Health & Human Services
A. WELL DATA
Total depth '7 Cased to ~"'~-~ J Casing height
If A, B, or C, attach ADEC letter. ADEC water system number
Sanitary seal ~¢7N) _ "~
Wires properly protectedd~N)
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well flow
Pump level
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot \
Absorption field on lot \
Public sewer main ~
Sewer service line
; On adjacent lots _
; On adjacent lots
Public sewer manhole/cleanout __
Petroleum tank
WATER SAMPLE RESULTS:
~"~'~" / ~ Nitrate
Coliform E~ ///,cc,
Date of sample: ~" ~"-"-
B, SEPTIC/HOLDING TANK DATA
Date installed '~"'~ I ~ - ~ Tank size
Cleanouts~N) y
High water alarm (Y/N)
Date of pumping
ft.L~'/ Other bacteria
Collected by:-~.'¢ ¢ t~'/,,,~"~//,.~
Compartments ~
Foun/ation cleanout~N) y Depression (Y/~' ~
/'J /~ Alarr~ tested (Y/N) -----'
""7'-' /~ ~ ! Pumper ,.~,,~ I~ ~.~./~C~ ~.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well (s) on lot [ d;:~'~
To property line [c:~1 ''V Absorption field
Water main/service line
Surface water/drainage
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C, LIFT STATION
Date inst~l~~
Size in gallons ~
Vent (Y/N) "Pump on~
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
On adjacent tots
Surface water
D. ABSORPTION FIELD DATA
Date installed c~ ~
Length "'7~:~ Width
Total absorption area
Depression over field (Y/~?
Results (pass/fail) ./~L'~.W
Peroxide treatment (past 12 months)
Soil rating C:P, ~ ~' '//¢"~System¢r2/.~ type~ ~ ~
Gravel thickness Total depth ~ ~
Cleanouts present. N) k/ ,
/
Date of adequacy test ~/~
for ~ bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellonlot / ~1'5¢ Onadjacentlots / ~:~:~1 ..jO Propertyline
To building foundation ~'{.~! To existing or abandoned system on lot
On adjacent lots "'~C;~l ~ Cutbank h.( ~'¢~. Water main/service line
Surface water ! ~,~t~ Driveway, parking/vehicle storage area
Curtain drain h-~ ~:~--~
E. ENGINEER'S CERTIFICATION
Signature
Engineer's Name
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effeci
$ & 5 ENGINEERING w,~r~¢¢oO~
~agle River, R~aska 995~
Waiver Fee: $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL,-,'~)
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date March 5, 1987
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range) Lot 17; Hamann Subdivision
Location (address or directions)
Wilma Circle
(b) Applicant Name Hoffman Telephone: Home Business
Applicant Address
(c) Applicant is (check one): Lending Institution []; Owner/builder)~; Buyer []; Other [] (exp!ain);
(d) Lending Institution Northland Mortgage Telephone
Address Eagle River, Alaska
(e) Real Estate Company and Agent Red Carpet/Great, and - Margaret
Address P,0, Box 633; Eagle River, Alaeka 99577
Telephone 694-9125
HAA o,owm
S & S ENGINEERING
17034 Eagle River Loop Road, Suite 204
Eagle River, Alaska 99577
ordered by Margaret - Greatland/Red Carpet
TYPE OF RESIDENCE
Single-Family ~ Multi-Family []
Number of Bedrooms 3
Other
WATER SUPPLY
Individual Well[~ Community[] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite [~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11,84)
ENGINEERING FIRM PROVIDII~,, ~NSPECTIONS, TESTS, FILE SEARCH, D, , AND INFORMATION
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 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 ENGINEERING Telephone
17034 Eagle RLver Loop Road No. 204
Address ·
Date
[)HEP APPROVAL
Approved for bedrooms by
Approved Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements, Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
Well Classification
Well Log Present
Total Depth ~c-.-.-.~"~ / Cased to
Static Water Level ~_."~-/
Casing Height Above Ground ~ / ~-~
Electrical Wiring in Conduit ~(.,~N)
Separation Distances from Well:
,,~.(~&JN. ICIPALITY OF ANCHORAGE (MO~.i
AUT.OR,TY A.P.OVA.
CHECKLIST- FEBRUARY 1984
_ Legal Description: ~ ol
Date Completed _ ~/-/O- ~ ~ Yield
Depth of Grouting
Pump Set At __ ~/%,
Sanitary Seal on Casing Y~)
Depression Around Wellhead (Y/~
To Septic/Holding Tank on Lot /z.~¢ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot .//)t~ / .-¢' _; On Adjoining Lots
,/
To Nearest Public Sewer Line ,k,,[~ To Nearest Public Sewer
Cleanout/Manhole __~ To Nearest Sewer- Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes ,i~/N) Air-tight Caps (~N)
Depression over Tank (Y/~.~
Pumping/Maintenance Contract on File (Y/N) .
./
Holding Tank High-Water Alarm (Y/N) /~'/'~'
Separation Distances from Septic/Holding Tank:
~-- "/~,,~$ Size /0o~ No. of Compartments
Foundation Cleanout ~.)N)
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N) /~/~
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
To Building Foundation /--///¢ ~
To Disposal Field ~J /~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y~I~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /
To Building Foundation
Lot
To Water Main/Service Line /_O
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field ~',/'/
Depth of Field d) ~
Gravel Bed Thickness
Standpipes Present ~/N)
Date of Last Adequacy Test
To Property Line /
To Existing or Abandoned System on
; On Adjoining Lots ._~O )-.L
To Cutbank (if present)
¢/¢
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed .... Date c~ ~/,.~-- ~ O
$ & S ENGINEEI,tIr, t~
Company7034 ~_g!e ~ive~Loop. Roa~Nolk,.~ No' o¢~(~ -- Oo ~
~le
flyer,
Al~sk~
Date of Payment---- ----///~/~
Amount: $ ~¢ ¢ ~
Page 2 of 2
72-026 (11/84)
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Performed For Bob Hard~
Leoal Bescription: Lot 17 Block
This Korm Renorts Soils Loq yes
"On,~tsw~lhalh~sando~inionF'
2204 Cleveland Anchorage, Alaska 99503
Date Performed 6/21/76
Subdi¥ision Hamman Subdivision
Percolation Test
Eagle River
~enth
Feet
Soil Characteristics
?opsoii
Interlayered .coarse gravel
groun~n
waterer ---
lenses and silty Sand's
(GP-GM-SM-ML)
16
18
20---
Bottom of Test Hole
Was Ground Water Encountered?
I~ Yes, At what Depth?
yes
- 13 feet
Date Gross Time Net Time Depth to H20 Net Dron
inches inches
6/~2/76 ~ 0 48 0
6/23?76 - 24 hrs " 72 24
6/~$~76 0 48 0
6'/~3ff76 ~ 30 51- 3
6~25/76 60 53-~3/-~ 2-3/4.
' 56'1/4 2-1/2
__ 90 ........
6~3_3/76 120 58-3/4 2-~/2
Percolation Rate _~"/12 Hinute
Proposed Installation: Seenaee Pit Drain Field
Depth of Inlet Depth To Bottom Of Pit Or Trench
CoM!~ENTS: 175 S~uare Feet Drainaqe Area required p~r_j~edr_Qom.
By_ ///~,~-,.~m /~, ~_c~.~__Data Certified BY: CONSTRUCTION TES
Test
Performed
k Date: 6/24/76 LA
--~-mes D. Mac
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:( 1'4 ST I::'I I... !... FIT ;!. I; ) bi.
~76436
~ob Hardy
G~noral Delivery
99577
Subject ~ Permit
A penn, it i.~sued by this depart~.~ent for well and/or on-site
~ewer installation on Lot 17 Hat, mort f~bd. ivision has expire(t
s~ ~ the issue date ~(.ocl~
In the event you still plan to install the well and/or
sate s¢~,wer system~ a new ~r~]it is required.
soil test n~!y be used%o obtain a current
the well has been drilled, a well lo.~{ should be sent
this departm(:nt to docu~,ent thc~. inst~.%llation date.
If you have ~'.u%y q%testions re.~ardJ~%~j the abow:~ m~tte, r~ please
do not hesitate to contact this office im~e~'t:[a'[:ely at 279~-
2511~ extension 2~.4 or 22.5.
Sincerely
Sa~itarian
LNB ~ 1 j h
~ ince~'e ly ~