HomeMy WebLinkAboutNORTH SLOPE BLK 1 LT 5North Slope
Block 1
Lot 5
t; A( t 1.7 t MwM a �K
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181404 PID Number: 050-511-32
Dwelling: »❑ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑ Upgrade
Name:
Jean & Josephine Gonsette
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
12077 W Riverwood Dr, Crystal River, FL 34428
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
(352) 795-0555
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
North Slope 1 5
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
>100'
N/A
N/A
NSA
>25'
TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
11000 Gal.
Surface Water
>100'
N/A
N/A
N/A
Material
Number of compartments
Lot Line
>5'
N/A
N/A
N/A
Steel
2
NA
Foundation
>10'
N/A
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
Noted
Gal.
Remarks Tank replacement only.
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank D3034 Tank to
drainfield Exist.
PCN
Drainfield Exist. co/MT
Inspector J. Millette
BENCH MARK (Assumed elevation) 100 ft
Inspection 15 11 /13/18
Location and description
2nd
3 r 4th
Bottom of front door jam.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval: Date
law
TH
`., � ..
Benja »chiller
CE 12592 •4``
�i' • R 6/28/19 .t
Approved /r d Date 7/0/0
P,qUESS ' tpN��``
F --
inspection neporrt_a- i- i z.aoc
NORTH SLOPE BLOCK 1 LOT 5
����yN|T�f(7����1�1�n�
. `_.^=.. ,�~^`^. .`'.-,°-,
NEW 1OOO-GALb3NTANK wW
DOUBLE CLEANOUT
-~~ �
EXISTING
ABSORPTION
TRENCHES
{�|Fl��O��O-�11-���
' '^� '' "^^" ^' ' ' ""-
/
/
/
13
/
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--`-`__
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' CQwCRETE BLOCKS
0441
Qf
(81
\
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/
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A 8 LEGEND
": x / 5n / rnn C:xmmrr /
svi 32.8 21.9 2CO DOUBLE CLEANOUT
il
' '- FCO ' FOUNDATION CLEANOUT
2CO2 412 275 FG - FLOW SPLITTER VALVE
. �� MH MANHOLE
"ev ,aumw/ 8 O
CE 12592 MT - MONITORING TUBE
FEET
v 8V'SEPTIC VENT
'n 1^=5U'
TH-TESTHOLE �
NORTH SLOPE BLOCK 1 LOT 5
PID # 050-511-32
�'` ENGINEERING
PROFILE AS -BUILT
(NO SCALE)
uu.�
It13�1� 7avt�
MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program
PO Box 196650 4700 Elmore Road
x a` Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.org/onsite `�1t ,.
Dcpartim tit
NCHURPG
On-Site Wastewater Disposal System Permit -Or
Permit Number: OSP181404 Effective Date: 11/9/2018
Work Type: SepticTank Upgrade Expiration Date: 11/9/2019
Tax Code Number: 05051132000
Site Legal Address: NORTH SLOPE BLK 1 LT 5 G:0703
Site Mailing Address: 30924 PRUDHOE BAY AVE, Eagle River
Owner: GONSETTE JEAN &JOSEPHINE Lot Size in Sq Ft: 90866
Design Engineer: FORGE ENGINEERING Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field Q 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
Special Provisions:
1. The tank is to be installed 10' or more from the building foundation and 5' or more from deck supports.
2. The field is undersized for a 3 bedroom house and must be upgraded.
Received By: Date:
/ /
Issued By: � " l Date: 1
EPLAI\I
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division — Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 050-511-32
Property owner(s) Jean & Josephine Gonsette Day phone
Mailing address 12077 W Riverwood Dr, Crystal River, FL 34428
Site address 30924 Prudhoe Bay Ave
Legal description (Sub.d., Block & Lot) North Slope, Block 1 Lot 5
Legal description (Township, Range & Section)
Lot Size 90,866 Sq. Ft. Number of Bedrooms
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(El all that apply)
Absorption Field E Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade C Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy U (SF and/or D)
Private Well LJ
Water Storage
IRUSIA
THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 4–1' ) Waiver Fees:
Date of Payment: if (Ct j I 0JAi 0 Date of Payment:
Receipt Number: 0 31'6?D Receipt Number:
Permit No. OSP L O+ Waiver No.
Permit App_ :..c
November 9, 2018
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
11/9/18
Subject: North Slope Block 1 Lot 5 -30924 Prudhoe Bay Ave
Septic tank replacement
Dear On-Site Services Engineer:
The septic tank on the above lot has collapsed and needs to be replaced. The existing home is a 3 -
bedroom. We are submitting this permit application for the placement of a new septic tank. The
attached site plan identifies the location of the existing home, well and septic system, as well as
the location of the new septic tank. The drainage pattern in general will not be changed by the
construction.
The existing tank will be pumped dry and decommissioned per code. The septic system is sized
for 2 bedrooms, but the tank is a 1000-gallon tank. The tank will be replaced with one of the same
size and will be placed outside the 100’ well radius and 10’ away from the foundation of the home.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181404, Deb Wockenfuss, 11/09/18
10050 0
FEET
1"=50'3-BDRM HOMENOTE:
NO SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
NORTHSLOPE BLOCK 1 LOT 5
Nov 09, 2018
PRU
D
H
O
E
BAY
AVE
REMOVE EXISTING
1000-GALLON TANK
EXISTING
ABSORPTION
TRENCHES
INSTALL NEW 1000-GALLON
TANK W/ DOUBLE CLEANOUT
ENSURE 10' SEPARATION
FROM FOUNDATION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181404, Deb Wockenfuss, 11/09/18
I np:
WELL:
Driller:
Yield:
Municipality of Anchorage Page of .2
LENT OF HEALTH AND HUMAN SERVICES
90NMENTAL SERVICES DIVISION
forage, Alaska 99519-6650 • Telephone: 343-4744
Nosal System and/or Well Inspection Report
PID Number: O 5 S11 3 4
Wastewater System: ❑ New 9Upgrade
is like 4-44 P, i ABSORPTION FIELD
No. of Bedrooms:
oZ ❑ Deep Trench RShallow Trench 0 Bed ❑ Mound ❑ Other
_GAL DESCRIPTION Soil Radng! Total Depth from original grade:
0"/S' GPD/S . Ft. /, o ,
Block Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe
S /✓orlb S/c e O.f
Ft.
Range: Section: Fill added above original grade: Gravel length:
FL 7bia! of
El Upgrade Gravel width: Number of lines: Distance between lines:
c wecc -� R. /v
e, A.B.C): Total Depth: Cased To: - Ft.
Total absorption area: Pipe material:
Ft Ft. S/O SO. Ft, ASI.-. 30 34 Fcp le
Date Drilled Slant Water Level Installer:
Date installed:
Pump Set at: Casing Height Above Ground:
GPM Ft. FL TANK
SEPARATION DISTANCES I,Gentir M u_.:__
To
From
Septic
Absorption
Lilt
Holding Puhlic/Private Manufacturer -
_
Capacity in gallons:
Tank
Field
Station
Tank Sewer Lines
Well
Material:
Number of Compartments:
Surface
Water
11-/vp..',
LIFT STATION �J/.c
Lot
Line
,
6 $
20 �
a,a
Size in gallons:
Manufacturer:
Foundation
7/
o24 r
O
'Pump on' level at:
"P off" level at:
High water alarm at:
Curtain
Drain
Pump Maked
Electrical Inspections performed by:
Remarks: 7/ri l c tU Lee ,+ e:,- BENCH MARK
F r / b�ea fop,,, St�(i/,'f,�,✓ • Za ye f rfn w Location and Description:
rj//o/.»'err /.wr4>/iee A�rov.�fe Cf:<Kc.."s
Q'rJ Ak- e. r<;,✓, A// F/.... L4�d Assumed Elevation:/00
Pt
,3a r.../ Foos,. /fie tr re� /mac ioat ''•� OF 1.
6 W Pre E.rif Jri.gr ,f rf't+.vr . %/o%fG� Sv+: / fm✓PI, /i®Ip�`h�,•'':. ••.
/eeS@r.i e. L}rGc T4s Ni lrr ,o.-. ..ia4 d, �SA ti• �,.
Inspections performed b : E�sle �. F . " """'° «••«•••••«:.,,
^^r Dates: 1st
Y
2nd t05;7
Louis A, Borers fy
Department of Health and Human Ser ices approval �i`�•,'«, CIE '•�
pP ! fit, �..
Reviewed and approved by: A, Date: /�
72-013 (Rev, 9191) MOA 25
10._191 -1?
Permit No. 97-00305
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: NORTH SLOPE •i L5 BLK 1 PID No.: 05051132
Flow pij\s \ o
P
oe Bab Ra\
as ° °6 \
Y
•r0
2y
ReseNe Ared
® Two 5x33' Trenches
THI
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iH4
'U t
Reserve Q !�
Two 5x44' Trenches
H3 ^
y
Ocuz to — 601
ELEVATIONS woEEx
Mr To SCALE) ^sV surcu aev � Tone
esow. -
oEV L IT.
S'
srm Ixw..na�rs e res
EgS�IxG IffLLVV''--
TAM ig rig
d3i� as s
15' UTWTY EASEMENT
®
- TEST HOLE
•
- MONITOR TUBE
O
- SEWER CLEANOUT
-0
- WELL
— —
- EASEMENT
- EXISTING LEACHFIE
7 7�
10/,x/97
ENGINEER'S SEAL
i
49TH ...
•.LOUIS A. BUTERA.z
•,• CE -6736 ,•'��G�
AFD ••" .. • • �,F�o
�W,fROFESS10Noo
y
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON -SITE -WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW970305 DATE ISSUED: 9/10/97
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 9/10/98
OWNER NAME:SJODIN TODD D & LEAH H
OWNER ADDRESS:30924 PRUDHOE BAY AVE.
EAGLE RIVER, AK 99577
PARCEL ID:05051132
LEGAL DESCRIPTION:
NORTH SLOPE BLK 1 LT 5
LOT SIZE: 90866 (SQ. FT.) -
NUMBER OF BEDROOMS: 2 THIS PERMIT: 2
THIS PERMIT IS FOR THE CONSTRUCTION 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 (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
1. THE .'ORGANIC ,LAYER/FILLWILL NEED TO BE REMOVED.'
2. THE SYSTEM WILL NEED TOTAIN 4_FT_SEPARATION-
DISTANCE-FROM THE EXISTI5 'YER
3. THE'A,LTERNA.TIVE;`ITE TEST HOLE WILL NEED TO BE DRILLED..
RECEIVED BY: - DATE:
ISSUED BY: �` DATE:
'A
J al+T)
Eagle River Engineering ,Services
Louis Butera, P.E. `
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 TEST RECORD (907) 694-3297 fax
Legal Description: a S Q S. 6 /� k
Client: Date:
Type of Test: ❑ Well Flow. Septic Adequacy ❑ Well & Septic LJ Other
Time
Meter
Reading
Well
Level
(BTC)
MTI
(AB/
TP)
MT2
(AB/
BTP)
Tankl
(AB/
TP
Tank2
(AB/
BTP)
GPM
PSI
Remarks
loos
3v``
G�
Or
53 � 9a
3e'q
s3
Io,Sa
SZ `t L'
30 `
11;623
S3 5 �?
11,45
su dye
tet,
r:Z6
f '37
(I :17
5-7
5 I
5'-f2
CIM j/NNCte'll/Z];
]z .u?
12;!%
S`1�jo7�
Iz:Z�
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r: 7�y6
�6
71SH�vy
1.17
S`�751
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4,t`�
_..._..._ ._.._... .-.....�..... ..... ........,...t' Fx" -naarc OVLLUIZI i o I r - ociaw 1 op 01 rlpe
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: North Slope Lot 5 Blk 1
8/18/97
A. GENERAL
1. The drawing and or site plan shall be a part of this specification.
2. All materials and workmanship shall meet the Anchorage Department of Health and State Department of
Environmental Conservation requirements.
3. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer.
4. All excavations and depths are advisory and are to be verified in the field by the contractor to meet
Municipality of Anchorage, Department of Environmental Conservation requirements.
5. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval.
6. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements.
7. Any remaining open test hole excavations shall be filled and graded.
B. EXISTING SEPTIC TANK
1. The existing tank is to be utilized in the upgrade of this system, and does not need to be uncovered for
inspection or replacement unless required by permit special provisions.
C. EXISTING DRAINFIELD
1. The end of field cleanout shall be repaired on the upper drainfield and a monitor tube installed in this field. Soil
depth shall be verified over the entire existing drainfield system, and material added as needed to provide 2' of
ground cover over entire system.
D. NEW DRAINFIELD
1. The drainfield is to follow the natural unfilled land contour to maintain uniform total depth of the drainfield
bottom. All trees over 4" are to be preserved
2. The bottom of the drainfield shall be over excavated to a level of 0.5' below the organic layer into the accepting
soil layer(at approx. depth of 3'), scarifying the soil layer with backhoe teeth, and backfill with an engineer
approved filter sand material meeting MOA specifications, to a total depth of P below natural ground surface
as measured at the uphill side of the 5' wide drainfield.
3. The bottom of the drainfield gravel is to be at P below existing natural (unfilled) grade and is to be 1' thick.
4. The effluent line from the septic tank leading to the existing drainfield shall be located and a Zabel flow splitter
installed to allow equal effluent dispersion to new and existing drainfield system. A second flow splitter is to be
installed to split effluent within the new system to the upper and lower drainfrelds. The upper drainfield will
overflow to the middle drainfield by use of an inline invert ("Tee") on the 4" leach line of the upper field.
5. The effluent line within the each drainfield shall be laid level within 0.03'.
6. The drainfield gravel is to be covered with typar fabric material.
7. A combination of soil and 2" extruded board insulation is to be placed over each drainfield, a minimum of 2' of
soil shall be utilized. Area between each drainfield is to be filled to allow for surface drainage between the
fields. Soil cover is to be placed and sloped not to exceed 3:1 sideslopes. All uncovered and new flow lines are
to be insulated with 2' of burial foam 2' wide centered over the lines. The area over the leachfields is to be
covered with a soil material that allows seeding and seeding is to be provided.
8. Test holes as required by the engineer are to be excavated in the area shown on site plan to explore for a
reserve septic area. This will need to be accomplished and feasibility confirmed prior to any installation
of the new system. It may be required that a curtain drain be installed to make the area suitable for a
leachfield. This would be bid as a separate item
RECOMMENDED LEACHFIELD DIMENSIONS:
SAND LAYER- approx.3' excavation depth, 2' thick GRAVEL DEPTH = 0.5' under leachpipe, 2" over pipe
TRENCH LENGTH= 100' (total) TRENCH WIDTH= 5'
SOIL RATING = 0.45 GPD/115 BEDROOM CAPACITY = 1 addn. 2 total
11997197-050-spc.doc
/ SEPTIC I I v
WELL +200'00, ,2� /Y
(� C
SEPTIC +200'
WELL +200'
NO SURFACE WATER
® 2g1 \ excavate test hale/
THI in this area For reserve si/te
SEPTIC «200'
SELL +200'
0�
IY UTILITY EASEMENT
WELL SEPTIC SITE' PLAN
LEGAL: NORTH SLOPE Lot 5 Blk 1
OWNER: S'odin
CONTRACTOR: N A
JOB 97-050 1 DATE: 9/10/97 SCALE 1 " = 60'
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-329?
®
- TEST HOLE
\ doe
- MONITOR TUBE
0
-&
¢y Ra\
- WELL
N 2S
- EASEMENT
�S•230�,
Install Net
EXISTING LEACHFIELD
Floe Split.,.
4
XISTING
TANK
loo'
DS�
•
unknown Drainautf with
Sti antEnll loc.
As Per
Per S6S Engr.
19
1992 /
/ SEPTIC I I v
WELL +200'00, ,2� /Y
(� C
SEPTIC +200'
WELL +200'
NO SURFACE WATER
® 2g1 \ excavate test hale/
THI in this area For reserve si/te
SEPTIC «200'
SELL +200'
0�
IY UTILITY EASEMENT
WELL SEPTIC SITE' PLAN
LEGAL: NORTH SLOPE Lot 5 Blk 1
OWNER: S'odin
CONTRACTOR: N A
JOB 97-050 1 DATE: 9/10/97 SCALE 1 " = 60'
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-329?
®
- TEST HOLE
•
- MONITOR TUBE
0
- SEWER CLEANOUT
- WELL
— —
- EASEMENT
- PROPOSED LEACHFIELD
EXISTING LEACHFIELD
���� ❑F A<y X90
G
* .49TH'
c
'LOUIS A.-BUTERA
10 CE -6736 o
IN
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
August 18, 1997
Jim Cross, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: North Slope Lot 5 Blk 1
Narrative & Permit Application
Dear Mr. Cross:
MUNICIPALITY OF ANCHORAGE
ENVIONMENTAL SERVICES DIVISION
AUG 20 1937
RE( F! Ep
The proposed septic upgrade will have very limited impact on adjacent properties for the
following reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, due to lot size.
4. Drainage will not be affected and is not a major consideration in our design.
The existing system installed in 1992 was tested for adequacy for 1 bedroom and passed;
however, the owner wants to upgrade the system to 2 bedroom capacity. Additional test holes
were excavated to verify capacity of the soil to accept an upgrade and replacement system. Our
design calls for a duplication of the existing system with two 50' trenches to be added to the
existing leachfield system with flow splitter to regulate flow to each system. This along with the
requirement of a 2' sand bed below the leach trenches will result in a conservative design that
based on testing of the existing system will produce an adequate installation.
The existing and upgrade will be located on a 30% slope as that is all that is available on this lot.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
11997196-050-NAR.noT
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: North Slope Lot 5 Blk 1
8/18/97
A. GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health and State Department
of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet
Municipality of Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any
adjacent multi -family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer
approval.
8. It is always recommended that a surveyor locate the nearest lot line position and the location of any
easements.
9. Any remaining open test hole excavations shall be filled.
B. SEPTIC TANK
1. The existing tank is to be utilized in the upgrade of this system, and does not need to be uncovered for
inspection or replacement unless required by permit special provisions.
C. TRENCH
1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom.
2. The bottom of the trench shall be over excavated to a depth of 3' andA#ckfdlcd With 2' of an engine
approved sand material having <5% passing a #200 sieve.'
3. The depth of the trench gravel is to be at 1' below existing grade.
4. The sewer line leading to the trench shall be located and a Zabel flow splitter installed to allow equal
effluent dispersion to each trench system.
5. The effluent line within the new trench shall be laid level within 0.03'.
6. The trench gravel is to be covered withtypar fabric material.
7. A combination of soil and 2" extruded board insulation is to be placed over the leachfield, a minimum
of T of soil shall be utilized. Soil depth shall be verified over the existing trench system, and material
added as needed to maintain 2' of ground cover. All uncovered and new flow lines are to be insulated
with 2' of burial foam 2' wide centered over the lines
8. The area over the trench is to be finish graded into the slope to prevent ponding of surface water
runoff.
9. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any
Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
SAND LAYER- 3' excavation depth, 2' thick GRAVEL DEPTH = 0.5' under pipe, 2" over pipe
TRENCH LENGTH = 60' (total) TRENCH WIDTH= 5'
SOIL RATING = 0.45 GPD/ft5 BEDROOM CAPACITY = 1 addn.
Twenty-four (24) hours notice required for all inspections.
11997797 -050 -NAR
ay Rd
30.0
Install Zabel N %5 230• ` \
Flow SPliter o KX15nNC• w
TANK
♦�l 100'
Curtain Drain with
TWO 50' `aG unknown outfall loc.
DPAINMGAS As Per 565 engr.
�}1oJO 1992
yf T¢9
0 SEPTIC +100' Z�l
kD
r7 ti�I, 3 SEPTIC Aet 0
WELL 40B'Y�}�
C12 tiru
IT UTILITY EASEMENT
SEPTIC ally -.%✓
wELL +dP r �
mow.
NO SURFACE WATER ,411/YdyZd.:r
WELL/SEPTIC SITE PLAN
LEGAL: NORTH SLOPE Lot 5 81k 1
®
- TEST HOLE
0
-MONITOR TUBE
I
- SEWER CLEANOUT
-0
- WELL
— —
- EASEMENT
- PROPOSED LEACHFIELD
- EXISTING LEACHFIELD
OWNER: Sjodin
CONTRACTOR: N/A
JOB# 97-050 1 DATE: 8/18/97 1 SCALE 1 " = 60
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3291
OF• q�%s poQt
. wry
* i49 TH
:.........
•• LOUIS A. BUTERA
�'� •• CE -6736 '
4 `� 0?
Municipality of Anchorage
\\ DEPARTMENT OF HEALTH & HUMAN SERVICES :...
825 "L" Street, Anchorage, Alaska 99502-0650 8� s
SOILS LOG — PERCOLATION TEST`
PERFORMED FOR: 8110"/ DATE PERFORMED
V
LEGAL DESCRII
DEPTH
Ty ^
(FEET)
2
3
Q
4-
5
5
0
6
8-
91011 9-
to -
11
12-
21314151s17
13-
14-
15-
16-
171
18
19-
M
C7R W;Th fq/lal
Clar7Soye si�7t
Spic - Grcy, Mos r
F.r7e.v .¢ 70,
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Range, Section:
S
L
%s 0
E
Depth to Water After i
Monitoring? - 73 Date: $
JI It FLAN
®®®®m
20 "�9t!j jrl O
PERCOLATION RATE
(minutes inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND ;Z FT
i
COMMENTS !✓GI ,6. 3of F//-/!7ciC
�5� �,� 7t- �✓,�i i✓�t 6e�,t"ri8rn
PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
20 "�9t!j jrl O
PERCOLATION RATE
(minutes inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND ;Z FT
i
COMMENTS !✓GI ,6. 3of F//-/!7ciC
�5� �,� 7t- �✓,�i i✓�t 6e�,t"ri8rn
PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
IE"q
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
i «. ».. ....
a25 "L" Street, Anchorage, Alaska 99502-0650
!^ i3 A
Lw&veers
�
SOILS LOG — PERCOLATION TEST
. CE6736
PERFORMED FOR: 410w/N DATE
LEGAL DESCRIPTION: f l/ 4"1 t am Township, Range, Sectim
} DEPTH -� ) SLOPE
I (FEET) !O sod, 0--ga li cs
1
2 --
1erlerIV
IV wi T,{r Srr n o/
3 f"ANG 41-/6
4 wlbrow't $'POTS
5
6
7
Sorr G iPnd
s gra we./
9
U i
10 WAS GROUND WATER
ENCOUNTERED? _ YG C
Ser7wW Ty
11 s
IF YES, AT WHAT L
12 DEPTH? S / p
E
13 Depth to Water Alter
Monilorinp7
14
15
R
16
17
18
19
20
SITE PLAN
®®=mm
�®'
uPERCOLATION RATE (minutesiinch) PERC HOLE DIAMETER
TEST RUN BETWEEN 1 FT AND .Z FT
COMMENTS
PERFORMED BY:I '���' S'•'"'�T- CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATEv- 19 - ' 7
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 97-050
Calculated By: LB
Date: 1/1/96
Legal: North Slope #1 Lot 5 Blk 1
Single Family 1 Bedroom Dwelling
Subsurface Wastewater Disposal Field
TEST HOLE 2, Added Area
Water use at 150 gallons per bedroom = 150 gallons
Percolation rate = 31 minutes per inch
Wastewater application rate = 0.3 gallons per day per -square foot
Required absorption area = 500 square feet
Bed width (W) = 5 feet
Gravel depth (D) = 0.5 feet
Required length = Required absorption area / Bed width
Required length = 500 / 5
Required length = 100 feet
Total Excavation Depth = 0.5 feet
vS dpi
�F.. O.... A
A, q� 0
OF*_ :`49TH
�OnO�S
LOUIS A. B36TERA !42�o
V 4�44�O�FESS@0"-
97-050-cal.xls
ro
PERFORMED FOR:!5 0a, to DATE PERFORMED: i`1'/'5r-1
LEGAL DESCRIPTION:/Vo FFM Vviv S.. bd,.. L.�s Bl I..t Township, Ranae. Section:
-/ 3
1-
2-
3-
4-
5-
6-
7
s
9-
10it10-
11
12-
13
14-
15
16-
17
18
19
20
COMMENTS
OH
�Al
L�•�rey,rlee Anse
C 14 4/t'1
b" -ore>,derSe
vA4er ex1me4j G gt
SLOPE
WAS GROUND WATER
ENCOUNTERED? /1/0
i3VNom OC re- - IF YES, AT WHAT
hole DEPTH?
Depth to Water Atter r
Monitoring? 70gate:
SITE PLAN
Reading
'T (ENClryFtWSSEAW F-
Municipality of Anchorage',,,,,
„
DEPARTMENT OF HEALTH 8 HUMAN SERVICES eI
ns. Louts A. Cwtero O+a
825 "L" Street, Anchorage, Alaska 99502-0650r
a ked a
SOILS LOG — PERCOLATION TEST
+YF
��;��,_+«,,,,,
PERFORMED FOR:!5 0a, to DATE PERFORMED: i`1'/'5r-1
LEGAL DESCRIPTION:/Vo FFM Vviv S.. bd,.. L.�s Bl I..t Township, Ranae. Section:
-/ 3
1-
2-
3-
4-
5-
6-
7
s
9-
10it10-
11
12-
13
14-
15
16-
17
18
19
20
COMMENTS
OH
�Al
L�•�rey,rlee Anse
C 14 4/t'1
b" -ore>,derSe
vA4er ex1me4j G gt
SLOPE
WAS GROUND WATER
ENCOUNTERED? /1/0
i3VNom OC re- - IF YES, AT WHAT
hole DEPTH?
Depth to Water Atter r
Monitoring? 70gate:
SITE PLAN
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
re
a ked a
`+'18
–T -- sorb
a
/o .
4' -
rp
W'Z
35
(
N'_ lase
rb
S
y y0
4 - 6°
Y so
lv
47 4,
6 "
PERCOLATION RATE 17-7 (minutes/inch) PERC HOLE DIAMETER
r
TEST RUN BETWEEN 11 S FT AND FT
PERFORMED BY: EALLE .P/a-ET C'N�.w,�tEipi.Vf I -' � .<' — - - CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4?85)
r
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 97-050
Calculated By: LB
Date: 9/19/97
Legal: North Slope #1 Lot 5 Blk 1
Single Family 2 Bedroom Dwelling
Shallow Trench Subsurface Wastewater Disposal Field
TEST HOLE 3, Reserve Area
Water use at 150 gallons per bedroom = 300 gallons
Percolation rate =
17.7
minutes per inch
Wastewater application rate =
0.6
gallons per day per square foot
Required absorption area =
500
square feet
Trench width (W) =
5
feet
Gravel depth (D) =
1
feet
Required length = Shallow trench factor * Required absorption area / W
Shallow trench factor = (W + 2) / (W + 1 +2 D)
Shallow trench factor = 0.88
Total Excavation Depth = 3.0 feet
Required length = 88 feet
OF gC�oO
49TH `.v*
..............................
...........................
'LOUIS A. BUTERA:'A
�• CE -6736
97-050-cal.xls
a _ i
Muntelpallty of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:l041^ DATE PER
LEGAL DESCRIPTIONAPrA+ 16UC S« �d v. 4r1'.4' 31klTownshlp, Range, Section:
7g,
2-
3-
4-
5-
6-
7-
8-
9-
to-
11
-
91011
12-
13-
14-
15-
16-
17-
18-
19
213141516171819
201
COMMENTS
SLOPE
OH
41%)
L4 5rey, Med. den Se
very • 6fwe grey
Boom o�
7e9/r bole
WAS GROUND WATER
ENCOUNTERED? A/ O
S
IF YES, AT WHAT L
DEPTH? 0
P
E
OePlit to Weer Abu
Monitaringi 7, 7 pew 9-a s- S 7
OF
�/491rN."�'w
a
w aeayan4,�aaa.c.aas w ....
Depth to
Watei
Louis A Boom
OE6736
PLAN
s
Reading
Date Grom
Time
Net
Time
Depth to
Watei
Net
Drop
Preso ked
z
�i. c,
/C
1 �' 3 �ti �
1 %l
7 76
Y.,Z/p
!• I'(s
Sa
1
r-3"la'
fb.e
PERCOLATION RATE �• °j % (minutesAnch) PERC HOLE DIAMETER baa
TEST RUN BETWEEN 1 FT AND FT
PERFORMED BY: CWHZF iFIvei? Zlvd-1 ✓ "C. enydt I /..--:- _ r = CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE
72.008 (Rev. 4/85) .
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 97-050
Calculated By: LB
Date: 9/19/97
Legal: North Slope #1 Lot 5 Blk 1 TEST HOLE 4, Reserve Area
Single Family 2 Bedroom Dwelling
Shallow Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom = 300 gallons
Percolation rate = 7.3 minutes per inch
Wastewater application rate = 0.8 gallons per day per square foot
Required absorption area = 375 square feet
Trench width (W) = 5 feet
Gravel depth (D) = 1 feet
Required length = Shallow trench factor . Required absorption area / W
Shallow trench factor = (W + 2) / (W + 1 +2 D)
Shallow trench factor= 0.88
Total Excavation Dept = 2.0 feet
Required length = 66 feet
��. OF•A.�gsao
49TH '•.�
I ...........................
Vn LOUIS A. BUTERA.=
O f'•,• CE -6736
4��W pROFES9lO—V'
SEPTIC «200'
WELL +200'
NO SURFACE WATER
15' UTILITY EASEMENT
WELL/SEPTIC SITE PLAN
LEGAL: NORTH SLOPE Lot 5 R1k 1
UWNLK: Sjodln
CONTRACTOR: N A
JOB 97-050 1 DATE: 9/10/97 SCALE 1 " = 60
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-329
®
— TEST HOLE
e
— MONITOR TUBE
a
— SEWER CLEANOUT
— WELL
— —
BQy
— PROPOSED LEACHRELD
— EXISTING LEACHFIELD
Ra
5 23•j
\
Install Zabel
Flaw Spliters
Q�
p,
W
EXISTING
p
TANK
Y
1•
28', 34',
38'�
URAINFI
all 5' w
➢S�
de
c'V
Curtoin Drain with
unknown outfQU loc.
As Per SLS
�S
Engr.
1992
H2 Cf
i
of �i
SEPTIC
WELL +200'00,
�
To be tied in
IF alternate
O, WReserve
location is used
Area
40
li
Two 503' Trenches
l
ONN
THl
•,Zh?%3 SEPTIC
,1X51
l/ WELL *200'00'
^
vg'J
TH4
Nu
�p
Two 5.44' Trenches
v r;
H3
/
v
�
SEPTIC «200'
WELL +200'
NO SURFACE WATER
15' UTILITY EASEMENT
WELL/SEPTIC SITE PLAN
LEGAL: NORTH SLOPE Lot 5 R1k 1
UWNLK: Sjodln
CONTRACTOR: N A
JOB 97-050 1 DATE: 9/10/97 SCALE 1 " = 60
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-329
®
— TEST HOLE
e
— MONITOR TUBE
a
— SEWER CLEANOUT
— WELL
— —
— EASEMENT
— PROPOSED LEACHRELD
— EXISTING LEACHFIELD
Municipality of Anchorage Page , of 2 -
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
Permit Number:�727 PID Number: \1'�2
Name:
Drr./1 S
Wastewater System: ❑ New Upgrade
Add1�ess:g3 �►as��
ABSORPTION FIELD
Phone: /
S
No. of Bedrooms:
❑Deep Trench Ahallow Trench 11 Bed 11 Mound 11 Other
LEGAL DESCRIPTION
Soil Rating: � 2
Total Depth from original
GPD/Sq. .Ft.
Lo : Blocky:: SubdivLisi`on: �
.�W I
Depth to pipe bottom from ooriginal grade:
, . Ft.
Gravel depth beneath pipe -
�. S Ft.
Township:
Range:
Section:
Fill added above original grai:12, ._
Gravel length: 1
` 'fit.
\� Ft.
WELL: ❑ New ❑ Upgrade
Gravel width:
Number of lines:
Distance between "I tj
Ft.
v
t.
Cla n (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area: /
Pipe material: �Sto
-k 12_
Ft.
Ft.
J SO. FL
Driller:
Date Drilled:
Static Water Level:
In taller:
Date installed: r7
1
Ft.
1`7%1 A'iLi.��--�+"�i1"
Yield:Pump
Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
Septic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
�
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
k" e) (
( C:;�
Well
f
Material:
` /
Number of Compartments:
Surface
�aok
�vC2+
LIFT STATION
Lot
t
t
Size in gallons:
Man er:
Line
Foundation
t
1ca
t
/�
�.
"Pump on" level at:
"Pump off' level at:
igh water alarm at:
Curtain
C t�
"Jd
/
/„
Pump Make & Model
Electrical Inspections performed by:
Drain
BENCH MARK
Remarks:
�
Location and Description:
Assumed Elevation: p
Z-� Ft
ENGINU, SEAL
' e,e
c
e6
&
S & S ENGINEERING
17034 Eagle River Loop Road tt%M4 St 1 D—Cj�
Inspections performed by: e
�� ��s., Deas �� eo ®aA a�0
mag a fuer, as a 7
2nd k��
i0G R SHAPER a
��A�948c N°' 296
Department of Health ru H man Servi approval
moo'
Reviewed and approved by: Date:
72-013 (Rev. 9/91) MOA 25
Permit No. �� ��3�� 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: 'r25� I �`�' 4�t PID No.: ���✓ ll'I,y
l
Go Go 3/ SiG TiS+►L
A
Got
',. '.. Cal
A
w4
13 w5<__
Got
22
1�1
L+
F<-
Lam%
r77'
42_i
col i
'r4k-
� co r!1'r
�ZS �Nfl — o fj
coo
H
1'e 04�
45 e° p 6a V1
�* Fa...R.-�A �'" %$
o
€auai9a0e9aerowese ee ncs
Ra160ae6eeea m6Y de O Y06 68
�a WOGE J. HAF o F f
1
No. 8 :J o r
.` g"
�EyeO% ee�e; Mr
pROFE5���
72-013 A (Rev. 9/91) MOA 25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW920327
DESIGN ENGINEERS & S ENGINEERING
OWNER NAME:WILLIAMS KENT J &
OWNER ADDRESS:HC 83, BOX 2445
EAGLE RIVER ALASKA 99577
PARCEL ID:05051132
LEGAL DESCRIPTION: NORTH SLOPE #1 BLK
LOT SIZE: 90866 (SQ. FT.)
NUMBER OF BEDROOMS: 1 THIS PERMIT: 1
1 LT 5
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED:10/02/92
EXPIRATION DATE:10/02/93
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
1. REMOVE 2' OF FILL AND 2' OF ORGANICS AND INSTALL 3'
SAND LAYER.
2. PROVIDE CURRENT WATER MONITORING INFORMATION.
3. PROVIDE FINAL GRADE OF 3:1 SLOPE OVER TRENCHES.
RECEIVED BY:
DATE:
ISSUED BY: tu4 ___ __ DATE: / D - a - 4 Z
HEALTH AUTHORITY
APPROVALS
ROBERT SHAFER, P
ROGER SHAFER. P.E.
September 11, 1992 CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
WATER
MAIN EX g
TENSIONS 7 Anchorae AK 99519-6650
MAIN EX
SEWER &WATER REFERENCE: North Slope Subdivision, Block 1, Lot 5
INSPECTION
We request you issue a permit to upgrade the septic system
ENGINEERING STUDIES serving the referenced property.
AND REPORTS
An adequacy test was performed on the existing system and the
absorption capacity of the system was found to be inadequate.
WELL INSPECTION A test hole was excavated and a percolation test performed.
&FLOW TEST The approximate location of the test hole is located on the
attached site plan.
We do not anticipate any adverse effects on neighboring
SITE PLANS properties by the installation of the proposed septic system.
If you have any questions, or require additional information
for your review, please contact us.
ROAD DESIGN
Sincerely,
SOIL TEST Roger J. S afer, P.E.
RJS/LSU/lsu
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
0
a
r=5'
SCALE
84Y4
)�
§\\ \K
\
�2 ./R
/
/
\
§(
( �
~ � �
7 � %
%
o
r
\
7
�
\
2
R
1
$r
\
%
c�
?
rri
�
)C
m <�
o
�
S
C)
�
O
�
c
R
E�
3
)%
rte'),
®2\°\d
2 e
a
w
c
o
\
r q
/- 9
9
rrl}
M
\
\
\_
\
§
2\\
\
\ co
°
moi
\
)[
)
§
2
r
PERFORMED
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
DATE PERF
LEGAL DESCRIPTION: L,6 t/I �g>k-1 [Township, Range, Section:
F—DEF—TH-1 SLOPE SITE PLAN
1
2
3 /� h
4
5
lay
6 `r
i
r
7 P
i
8— c10,
9
10 7
iF
12
13 r
6 w
420',/ Fr
14
15
i ;J
i,. uF r\nchorage
16 ept.1 ! ith UL
Human Services
17
81920 18-
19-
20
COMMENTS
WAS GROUND WATER
Gross
Time
ENCOUNTERED?
Net
Drop
S
IF YES, AT WHAT
L
/�/J�/� O
_/"`��
DEPTH?
P
E
Depth to Water or i
ms's
Monitoring?
Date:
Reading Date
Gross
Time
Net Depth to
Time Water
Net
Drop
��1 0
'2 -
PERCOLATION
PERCOLATION RATE 411- (minutes/inch) PERC HOLE DIAMETER 4:5
1 L4
TEST RUN BETWEEN "t FT AND FT
5 8, 5 ENGINEERING �7
PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN
17331 Eagle River Loop Road No. 204 1 p^ 9 Z
ACCORDANCE WITH ",S . } ;A%Ipat""SS VGUIDELINES IN EFFECT O THIS DATE. DATE:
72-008 (Rev. 4/85)
a Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Yv �L�If'�►� IS DATE PERI
LEGAL DESCRIPTION: fVGiL1'
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COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
ip, Range, Section:
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Depth to Water Aller
Monitoring? Date:
SITE PLAN
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Time
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PERCOLATION RATE J573 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 4 FT AND '57 FT
PERFORMED BY: S & S ENGINEERING I T'-" Yom-' CERTIFY THAT THIS TEST WAS PERFORMED IN
17934 Eagle River Loop Road No. 204
ACCORDANCE WITH ftgj%g APAyA4 Ik0SftGUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4785)
MUNICIPALITY OF ANCHORAGE Jl,
/® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
EW
P 0 F�/LJgsl
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❑ UPGRADE
MAILING ADDRESS
0, 7 -Z-2- �&1/aS1L.LA
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LEGAL DESCRIPTION
Q A
LOCATION
NO. OF BEDROOMS
j�
Well
Absorption area
Dwelling
PERMIJ NO.
U Y
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�'
�� A.S
a Q
Manufacturer �A -
Mat rial
No. of compartments
Lu
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N
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IF HOMEMADE:
Inside length
Width
Liquid depth
-
DISTANCE TO:
Well _� y
A
Dwelling
PERMIT NO.
Ja z
= z FManufacturer
Material
Liquid capacity in gallons
O
J
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DISTANCE TO:
Well
�p
Found tion
Nearest lot line l
PERMIT
•���
J LL
No. of lines
Length o each Ijne.
Total length of liges
Trench idth'I
Distance betwe n i es
Q
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Top tile finish
Material beneath tile
Total effective tion
of grade I
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Length Width
Dpth
PERMIT NO.
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Type of crib Crib diameter
rib depth
Total effective absorption area
w
w
N
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4rBuilding foundation
Nearest lot line
DISTANCE TO:
J lClassDepth
� C.
Driller
Distance to lot line
PERMIT NO.
J
W
�
DISTANCE TO: Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER �I
PIPE MATERIALS I
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SOIL TEST RATING
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INSTALLER
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REMARKS
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DEPARTMENT (3' -JEALTH AND ENVIRONMENTAL F \TECTION
^l _ J
ANCHORAGE, AK 995uM
264-4720
PERMIT NO: 850355
DATE ISSUED: 06/25/85 /
APPLICANT: % S&S ENGINEERING IDAHO PINE
ADDRESS: SRB 196�X
EAGLE RIVER, Al-:.'. 99577
CONTACT PHONE: 694~2979
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS:
SUBDIVISION:
SECTION: 32
90865 (SQ.FT
2
NORTH SLOPE
TOWNSHIP: 14N
. OR ACRES)
Jn
P0ou��
LOT- 5 BLOCK: 1
RANGE.-
Listed
ANGE:
Listed below are the options available to you in designing yourseptic
syc
.. -;U--m. Choose the option that best '-its y
** DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION
** DEPTH TO PIPE BOTTOM < 4°0 FT. MAY REQUIRE A LIFT STATION
** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT.
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
'
EACH)
I certify that:
1" I am familiar with the requirementsfor on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulatipns,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4" I understand that this permit is valid for a maximum of 2 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS~BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION �EPORT; AND (3> THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN"'
SIGNED
APPLICANT:
ISSUED BY
,
DATE:
% S& IN-
DATE:
���--'r>�3K����][��k
DEPTH TO PIPE BOTTOM (FT.)
3,O **
30 ** �
GRAVEL DEPTH (FT.)
0.5
TOTAL DEPTH <FT")
3"5
4"0'/ �
GRAVEL WIDTH /FT.)
22.0 '
5.0~/
GRAVEL LENGTH (FT")
44"0
149.0*
GRAVEL VOLUME (CU.YDS.)
35.9
41.4
TANK SIZE (GALS)
1,O00.0
1.,000"0 *
SOIL RATING (SQ.FT^/BR)
320
\ 424 /
** DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION
** DEPTH TO PIPE BOTTOM < 4°0 FT. MAY REQUIRE A LIFT STATION
** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT.
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
'
EACH)
I certify that:
1" I am familiar with the requirementsfor on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulatipns,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4" I understand that this permit is valid for a maximum of 2 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS~BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION �EPORT; AND (3> THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN"'
SIGNED
APPLICANT:
ISSUED BY
,
DATE:
% S& IN-
DATE:
❑ SOILS LOG
MUNICIPALITY OF ANCHORAGE
ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720 �-2- S
SOILS LOG — PERCOLATION TEST �S J
PERFORMED FOR: (016- hl P-4DATE PERFORMED:
LEGAL DESCRIPTION: tl-UT `7L�l/�.%)12,� •J`--'�%` `�7
P SLOPE SITE PLAN
20
COMMENTS
PERFORMED BY:
72-008 (6/79)
(k
Reading
F
Gross
Time
T
14
Net
Drop
b`r L
Z'
k -,','ADA,
3C) ,�I�•
5 `¢
9-
-3
aao•
16
'i.e �..aac•'=.0 a •:a u meas
17
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at
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10-' 10
11
WAS GROUND WATER
` / S
L
ENCOUNTERED?
O
12
IF YES, AT WHAT
P
/ E
DEPTH?
13
Le 3— �
20
COMMENTS
PERFORMED BY:
72-008 (6/79)
(k
Reading
Date
Gross
Time
Net
Time
14
Net
Drop
b`r L
Z'
k -,','ADA,
3C) ,�I�•
5 `¢
9-
-3
aao•
16
'i.e �..aac•'=.0 a •:a u meas
17
Ubert A. ShwFer a W,
0" H®. 1457-E
at
18-
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19-
o
t0 �b
Itp
20
COMMENTS
PERFORMED BY:
72-008 (6/79)
(k
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
b`r L
Z'
k -,','ADA,
3C) ,�I�•
5 `¢
9-
-3
;
`,
I, P
� C7)
o
t0 �b
Itp
PERCOLATION RATE
TEST RUN BETWEEN
CERTIFIED
5-+ (minutes/inch)
FT AND 4 FT
DA
i]
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Parcel ID 050 -511-32
Certificate of On -Site Systems Approval
OSC251129
Expiration Date: 12/16/2025
Legal description NORTH SLOPE BLK 1 LT 5
Site address 30924 PRUDHOE BAY AVE
Current property owner(s) FRENCH CHLOE
X The On-site system(s) is/are approved for 2 bedrooms
By:
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
Original Certificate Date:
4/25/2025
This rtificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
sys m(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
MUNICIPALITY OF ANCHORAGE
"R
WOMEW
o4fOtt
I
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 050-511-32
Complete legal description North Slope Block 1 Lot 5
Location (site address) 30924 Prudhoe Bay Ave
Current property owner(o) Chloe French
2. ON-SITE SYSTEMS SIZED FOR BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: nN Private Well 171 Private Well serving 2 dwelling units
F-1 Private Well serving 3+ dwelling units El Community Well or Public
F-1 Water Storage
4. TYPE OF WASTEWATER DISPOSAL: * Private Septic F] Private Septic serving 2 dwelling units
F71 Holding Tank 171 Community Septic or Public Sewer
5. SEPTIC TANK: RN Steel R Plastic R Concrete R Fiberglass
Age 7 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: R AWWTS r_1 Bed E] Deep Trench A Wide Trench R Seepage Pit
Waiver request for:
Expedited review requested: n
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ 5�o Waiver Fee $
Date of Payment
COSA # 0.5C 2.5 112"l
Date of Payment
Waiver #
COSA ApplicationJune2022
COSA Checklist
Legal Description: North Slope 131 L5
Parcel ID: 050-511-32
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
X Well log is filed with Onsite (or attached)
Date drilled 1985 Total depth 60 ft
Cased to 60* ft
FiN-1 Sanitary seal is functioning correctly
* Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 4/15/2025
Well production at time of test 6.3 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes R No
R Coliform bacteria is Negative
Nitrate 0.855 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L R Arsenic less than MRL (ND)
Collected by Forge Engineering
Static water level at beginning of test 0** ft. Date 4/15/2025
Comments *Well log shows sand & gravel mix to bottom of well
**Well is not pressurized at this time. Artesian cap may be needed in the future
B. TANK DATA
Measured operating fluid level in septic tank 9
11
Date of pumping 12/16/2024
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1997
* ALL standpipes present per record drawing
Total measured depth from grade 3.58 ft (max)
Measured depth to pipe invert from grade 3.16 ft (min)
❑ N/A — pressurized field.
❑R Per record drawings, field is insulated.
❑ Monitor tubes go to bottom of effective.
*
If not, state depth into effective
C. LIFT STATION
❑-Reqired maintenance completed
Age of lift station ------years
Lift station material \
Comments:
Adequacy test date 4/15/2025
Results Q Pass
Fluid depth prior to test 0-0 in
Water added 473.2 gal
New fluid depth 0-0 in All MT's dry
Elapsed time 75 min
Final fluid depth 0-0 in
Absorption rate >300 gpd
❑ Presoaked required if FIELD STATUS — POST RECOVERY
(Required if house vacant or field not used for more Effective depth (per record drawings) 6" in
than 30 days prior to date of test)
Gallons introduced N/A gallons N/A date Effective depth used 0 * in
Any rejuvenation treatment (past 12 months) N/A Effective depth remaining in
If yes, enter date
Comments/Deficiencies: *5 MT's calculated effective depths: 5", 9", 3", N/A, 5"
MT 4 was pushed over and we could not accurately measure depth
COSA Checklist June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
❑■ Yes if No ft 5C Yes if No ft
Neighboring Tank > 100' no Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft
Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' FN_1 Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft
0 Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' M Yes if No ft Q Yes if No
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0 Yes
if No
ft
Surface Water > 100'
❑■ Yes if No
Tank to Property Line > 5'
0 Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
Q Yes
if No
ft
Private Wells > 100'
Yes if No
Water Main > 10'
0 Yes
if No
ft
Community Wells > 200'
Yes if No
Water Service Line > 10'
M Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
ft
ft
ft
ft
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Forge Engineering
Engineer's Printed Name Benjamin Schiller, P. E.
COSA Checklist June 2022
Phone (907) 522-7773
Date 4/15/25
Cq�,tl�
Aw'
%ow
* •49 `
Beniakrry Schiller
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-NT
PLOT PLAN ___ AS BUILT _X_ SCALE _1==_ 40=_ GRID _ SE 0703 Project No. 22_—_2_3_61A1 ____
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, Inc. (907) 522-6476 Phone 000p
4�
(907) 522-4625 Fax 4COQ��op
Professional Land Surveyors ken*langsurvey.com o F, F . q L,
Jon athonAlangsurvey.com
I hereby certify that I have surveyed the following described property:
LOT 5, BLOCK 1, NORTH SLOPE SUBDIVISION (PLAT No. 69-131)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the --- * _ Day of ___i!_a�' _�'_`._, at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
49TH .7*
pp KENrN_�H G. LAN a
•.LS -5202. gJ4G
�QnhpFESSlONA1- ��
AECC963
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-51 T-32
Expiration Date: � 1-.2-0 ZZ
1. GENERAL INFORMATION
Complete legal description North Slope Block I Lot 5
Location (site address) 30924 Prudhoe Bay Ave, Eagle River, AK 99577
Current property owner(s) Jean & Josephine GOnsette Day phone
Mailing address 12077 W Riverwood Dr, Crystal River, FL 34428
Real estate agent Krlstel Gordan
2. TYPE OF DWELLING:
/P+A nXnr%P_' 7n
Day phone lG i �,ZlUU- i U26
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Famiiy and/or Duplex)
3. NUMBER OF BEDROOMS:
2
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Private Septic
A
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 2550// Waiver Fee $
Date of Payment. -16'A2 Date of Payment
Receipt Number Dcr73SD Receipt Number
COSA # 03C -2: L1 16'Z— 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering (M J•) Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 4/25/22
TM
6. DSD SIGNATURE
System #1 Approved for 2 bedrooms P nj 7 /
,�— Y pP % �.•• Benjam�niSchiller CE 1259.•:�
System #2 Approved for bedrooms �� F��sr�; . 4/25/222 . •,��?``��
Disapproved C1tlF�pROFESSIONP����
Conditional approval for bedrooms, with the following stipulations:
OFA
WATER AND
ST(;V!,'ATER z
PR_G ,
J��),V)T SERVIC���`��\\\
Original Certificate Date:
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
Legal Description: North Slope Block 1 Lot 5
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 7/9/1985
Total depth 60 ft
Cased to 40+ ft
0 Sanitary seal is functioning correctly
*1 Wires are properly protected
Casing height (above ground) 24+ in.
Date of flow test for COSA 4/6/22
Static water level at beginning of test 0 ft.
Comments *Flow rate limited by well pump.
B. TANK DATA
Age of tank(s) 3 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 49
❑® Standpipes/foundation cleanout per record drawing
Date of pumping Alaska Quality Septic 4/28/22
D. ABSORPTION FIELD DATA Multi Trench
Which system tested (date installed) 10/6/92 & 9/1997
Q ALL standpipes present per record drawing
Total measured depth from grade `3.6&3.8Sµ (max)
Measured depth to pipe invert from grade �'3.2s3.1 ft (min)
❑ N/A — pressurized field
❑- Monitor tubes go to bottom of effective. If not, state
depth into effective
0 Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Parcel ID: 050-511-32
of Structure served by this system
Well production at time of test +6.6* gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes FOR No
❑ Coliform bacteria is Negative
Nitrate 0.839 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L A Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 4/11/22
STATION
❑ Require intenance completed
Age of lift station .
Lift station material
Comments:
Adequacy test date 4/6/22
Results Q✓ Pass For 2 bedrooms
Fluid depth prior to test 0/0/0/0 in
Water added 500 gal
New depth 0/0/0/0 in
Elapsed time 1440 min
Final fluid depth 0/0/0/0 in
Absorption rate >300 gpd
Any rejuvenation treatment (past 12 months)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: Water added to 2CO post tank. With flow splitter water sent to all trenches. *Depths of two most recent trenches.
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'
Q Yes
if No
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' P1 Yes
if No
ft
Private Sewer/Septic Line > 25' [E] Yes
if No ft
Absorption Field on Lot > 100' 0 Yes
if No
ft
Holding Tank > 100' 21 Yes
if No ft
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' Rl Yes
if No ft
F-1 Yes
if No
ft
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Q Yes
if No
ft
n Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' El Yes if No ft Surface Water > 100' Q Yes if No ft
Property Line > 5'
Q Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100' Yes if No.
Water Main .> 10'_ -
Q Yes
if No
ft
Community Wells > 200' Ev] Yes if No
Water Service Line > 10'
0 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' .:
�J
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
O
Yes
if No
ft
Private Wells > 100' Yes if No
Water Service Line > 10'
0
Yes
if No
ft
Community Wells > 200' ❑r Yes if No
Surface Water > 100'
a
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l 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 yellow sheet
* -149 TH
..
Benjarrrt�.ichiller
CE 12592
$k i�lF�. 4/25/22 , .v w
PROFESSIONP.�
ft
111
ft
Municipality of Anchorage
On -Site Water & Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-511-32 Expiration Date:
1. GENERAL INFORMATION
Complete legal description NORTH SLOPE S/D• BLOCK 1 LOT 5
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
30924 PRUDHOE BAY AVENUE, EAGLE RIVER, AK, 99577
LAVON ZUBAR Day phone 694-4169
30924 PRUDHOE BAY AVENUE, EAGLE RIVER, AK, 99577
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY:
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Waiver Fee $
Individual On-site
Date of Payment
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
Received by: �f : Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ L46)U
Waiver Fee $
Date of Payment �l�Jl �¢3 C
Date of Payment
Receipt Number dna 6 �'U O
Receipt Number
COSA # n—'o—,
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.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering 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 served by the system.
These conditions are outside the central of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future 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 bene9t 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 right whatsoever.
6. DSD SIGNATURE
VGNSystem #1 Approved for bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone
337-6179
Date -7 66
ooboopp
.49
.......... .. ...... .........�
n� I
1
ess! G
CE 79� �O
P
1P. I .. )iPa , .3.�oQo
�n.. Pro fllesei//o:=n
bedrooms, with the following stipulations:
tOFttC�r�//i
J= ON-SITE
WATER AND
AI ATr_o Z^
Original Certificate Date: 9
PROGRAM
The Ndniclegity Ancl i ge Develop, emt Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only
upon the repres' nata Ions given in paragraph 5 by an independent professional civil engineerregistered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 11/05)
Nitrate Advisory
Arsenic Advisory
Other
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
NORTH SLOPE S/D; BLOCK 1, LOT 5
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 7/9/1985 Sanitary seal (Y/N) YES
Total depth 60 ft. Cased to *40+ ft.
FROM WELL LOG
Date of test 7/9/1985
Static water level 10 ft.
Well production 5 —
9 -p.m -
WATER SAMPLE RESULTS
Coliformq '� colonies/100 ml.
v
Arsenic: / 'oug./L.
B. SEPTIC/HOLDING TANK DATA
NitratP'5'-%g./L.
Parcel ID: 050-511-32
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
7/9/2013
Date of sample: 7/9/2013
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments ?
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping -7131 j t3 Pumper T9 '-Sf Lyn
ft.
5.9+ g.p.m.
Collected by: GEG, Ltd.
Date installed 7/1/1985
Cleanouts(Y/N) YES
High water alarm (Y/N) N/A
C. ABSORPTION FIELD DATA BELOW EXISTING GRAD 11992 SYSTEM/1997 ADDITION
10/5-6/92 0.3/ DUAL TRENCH/
Date installed 9/1997 Soil ratingg.p.d./ft or ftlbdrm) 0.45 System type MULTI TRENCH
113 TOTAL/
Length 102 TOTAL ft. Width 5/5 ft. Gravel below pipe 0.5/0.5 ft,
*2.9, 2.8 565/
Total depth*3.6, 4.0, 3.8 ft. Eff. absorption area 510 ft Monitoring tube YES Depression over field NO
Date of adequacy test **7/9/2013 Results (Pass/Fail) PASS For E bedrooms
Fluid depth in absorption field before test E in. Water added 355 gal. New depth 0 in.
Elapsed Time: = min. Final fluid depth 0 in. Absorption rate >= 300+ g.p.d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
**TESTED WEST TRENCH OF 1992 SYSTEM. ALL OTHER DRAINFIELDS WERE DRY AT TIME OF INSPECTION.
ALL DRAINFIELDS INSULATED PER INSPECTION REPORTS. 24" SOIL COVER ACHIEVED FOR ALL DRAINFIELDS.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level of in. "Pump off' level at wa er alarmlevel
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOTTO
Septic tank/lift station on lot 100,+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main
Sewer /septic service line 25'+
Animal containment areas 50'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 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.
Engineer's Printed Name JEFFREY A. GARNESS
Date
(Rev. 11105)
Page 1 of 1
Poet, Jeff W.
From: zuber@mtaonline.net
Sent: Monday, August 12, 2013 4:38 AM
To: Poet, Jeff W.
Subject: Property ID #050-511-32-00016-000
Mr. Poet:
I am in the process of selling my house at 30924 Prudhoe Bay Ave, Eagle River, AK
This past Friday my realtor (John Erkins @ Northern Trust Realty) called and said that you had
requested a copy of the property appraisal. Well, there is no formal appraisal document. This
is an all-cash sale and both parties have waived having a formal appraisal done. If there are
any specific details you are searching for, please let me know and I can provide them directly
to you.
Sonja Blewett (at Garness Engineering Group) advised John Erkins that your concern may be
that the house has a two-bedroom rated septic system and that the Muni's current records list
the house as a three-bedroom home. In that respect the Muni's current records are in error -
my home has been listed for many previous years in the Muni's records as a two-bedroom and
continues as a two-bedroom at the time of the current sale. Why the current record has
morphed into "Y bedroom is unknown to me, other than a presumption of some sort of data
entry error at the Muni's end.
If you need any additional information, you can contact me either by email or telephone at 694-
4169.
Sincerely,
Edna L. Zuber
8/12/2013
Avet3ri res
ASRI III T
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OFFENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
acwruui & AbLiu :lA:fE6 LAND SURVEYING 694
SCALE:
*O'"luQAo
DATE
GRID: r • . • ..... ,/�„��
#DDuena Merk Seward
FB- f �'. LS- 918
'fir
/
DRAWN:
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES M}i
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 1. D. # �� / ' IQ HAA #
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner *-N v" V�� �' Day phone
Mailing address
Lending agency
Mailing address.
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: t
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Day phone
Day phone
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
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm g EPbIGINF GING Phone
1 i •13=i Eagle River Loop Road No. 2041
Address 991; 7
Engineer's signature
6. DHHS SIGNATURE
Approved for
Disapproved.
0
�
bedrooms
Conditional approval for
Additional Comments
IIITIC
Date --
O,F A4_e31
'�saecHe�o�e044 �i
e 2i t
ee
e Vit. a�
Si AFE�i s
W4/C °ey o9v'v��.
� t1FE3SO'
1?��
�n'YaaI'llb`�.
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 engineer's work.
72-025 (Rev. 1/91) Back MOA H21
a Municipality of Anchorage
Department of Health_ & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Ldp ) IVd� Parcel I.D. 4!1
A. WELL DATA
Well type If If A, B, or C, attach ADEC letter. ADEC water system number
Log presentON) y Date completed -7 Driller �-
r �
Total depth Cased to Casing height \Z
Sanitary sealdpN)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
r
Wires properly protectedd'N)
AT INSPECTION
U rJ0.
g.p.m. \ C5�f7 4?V
o -A V-.
m
SEPARATION DISTANCES FROM WELL TO:
iPVp
z
Septic/holding tank on lot �� ')-
; On adjacent lots
`S` -r
m
k
Absorption field on lot c� ; On adjacent lots
E,
Public sewer main a Public
sewer manhole/cleanouta
ci>
e
(
Sewer service line Z
�y
Petroleum tank
O
r
WATER SAMPLE RESULTS:
Coliform 4 '
Nitrate 'rte. J Other bacteria i5�)_
Date of sample: 8��-9�� Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed �" ` Tank size k r-_� Compartments Z
Cleanouts (?/N) — Foundation cleanouttVRJ) V Depression (YQ ^�
High water alarm (Y/N) Alarm tested (Yc/-N)
tom -J
Date of pumping k
- �� Pumper IZ S
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
drk I k
Wel l(s)onlot `� On adjacent lots � �� Foundation t(,o'
I � -I-
To property line lr�t .4 Absorption field � k Water main/service line o
Surface water/drainage k ofl k
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off" level at
Cycles tested
Surface water _
Date installed �C;1' G---11-- Soil rating n•-;�2 c(y (;t/ctp.m tvn,, �, 1f::�t(5 _1�S
t t rr15J�.-
Length Width Gravel thickness t Total depth
Total absorption area Cleanouts presents NV)
Depression over field (Y/ +-� Date of adequacy test
A
Results (pass/fail)✓`f—' G� f ST'�''� for I bedrooms
Peroxide treatment (past 12 months) (Y� If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
t
Well on lot On adjacent lots—_� ��t -- Property line k
To building foundation To ex'sting or abandoned system on lot 1 co `_
,
On adjacent lots ` `r Cutbank '�' Water main/service line VtD 4-
Surface water �('� Driveway,
parking/vehicle storage area _
Curtain drain
E. ENGINEER'S CERTIFICATION
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
ell,
E. t ENGINEERING C tet+ �ooa2eEa v°a�% t7ro�l�
1 /a #41 Fogle !fiver Loop Road No. 204 3 ." -0�° �+ o°gQD�
Signature
....,:. ,-.;df.r,Alaska 99577
k�
azner,c nv mmceu aro
Engineer's Name
Date
HAA Fee $ / 0
Date of Payment 0-' /8
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
4 F'.C1Gf i'; J. SONAFU
Jo. 6`L1a
Py,`'ae e'
'Oe
f �)%t,IOFESSICf AAt 'd
MUNICIPALITY OF ANCHORAGE
�• Department of Health & Human Services
\ DIVISION OF ENVIRONMENTAL SERVICES —
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # � - — � � ^ �— HAA #
L) f 9 g (: r)
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 51 Block 1, North Slope #1
Location (address or directions)
Prudhoe Bay Road
(b) Property owner Susan Ryan Telephone: (home) Business
Mailing Address 628 F. Street, Anchorage, Alaska 99501
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent Target Realty/ Myrna Johnston
Address P.O. Box 774627, Eagle River, Alaska 99577
Telephone
(e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.)
List contact person and day phone number below:
17034 Eagl® River Loop Road No. 204
age
2. TYPE OF RESIDENCE
Single -Family ® Number of bedrooms ONE
3. WATER SUPPLY
Individual Well ® Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site 0 Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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. 1 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 Telephone
S&SENGIN
Address 17034 Eagle River Loop Road No. 204
Eagle River, AlaSKa
Date
a
t� iTMlow�t P.. diae#W at.
NO. MONR
6. DHHS APPROVAL �' C �/�r
Approved for _4r.r.�bedrooms by - Date
Approved :AZ Disapproved Conditional
Terms of Conditional Approval
CAUTION....,
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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. 7788) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
• Health Authority Approval (HAA) j
MUNIGIPALIT ORAGE CHECKLIST - FEBRUARY 1984 -
ENVIRQNMENTAL CES DIVISION 343-4744
MAR 2 2 1989 Legal \\Description: `-� 5 �✓l,cx tl 1
A. WELL DATA E C E I V E
Well Classification R)'-2 \J , If A, B, C, D.E.C. Approved (Y/N)
Well Log Present Date Completed - Yield S
Total Depthk.. Cased to LCX2_ Depth of Grouting
Static Water Level �� �I Pump Set At
Casing Height Above Ground �2 A Sanitary Seal on Casing (TM
Electrical Wiring in ConduitVPN) `f Depression Around Wellhead (YL
SEPARATION DISTANCES FROM WELL:
t )
To Septic/Holding Tank on Lot ll -"- ; On Adjoining Lots
To Nearest Edge of Absorption Fieldin Lots t '� ; On Adjoining Lots
To Nearest Public Sewer Line To Neareft Public Sewer Cleanout/Manhole .
To Nearest Sewer Service Line on Lot 25
Water Sample Collected by s�'l ; Date
� 1
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed :I- I-e>v Size No. of Compartments
Z
Standpipes/N) Air -tight Caps4N) Foundation Cleanout(VN) .
Depression over Tank (YIN? (Date Last Pumped 3 - ?_JO - B
Pumping/Maintenance Contact on File (Y/N) Q ; for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
I /
To Water -Supply Well �� `� To Building Foundation t�
To Property Line b t,l' To Disposal Field S
To Water Main/Service Line �
(�
To Stream, Pond, Lake or Major Drainage Course �� k
Comments -�>�t�ol+� 1 �-
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata �Z� �/+�- Type of System Design 1244E!1 ct 4�
Date Installed Length of Field
I 1 .
Width of Field
Depth of Field
Gravel Bed Thickness
Square Feet of Absortion Area AZ -,4--,# Statndpipes PresentgWN)
Depression over Field (Y/I�P_
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD
Date of Last Adequacy Test �
_ \ o ---
To Water -Supply Well To Property Line \< 1
)X
To Building Foundati—To Existing or Abandoned System on
Lot n1 A ;--On Adjoining Lots ���I`
To Water Main/Service Line 1� t To Cutback (if present) h�
To Stream, Pond, Lake, or Major Drainage Course k-
Y�
To Driveway, Parking Area, or Vehicle Storage Area o —
Comments I I rj` '/S lrt �T '� `? t E' ,
D. LIFT STATION / n
Date Installed J /�
Size allons
"Pump On" Lev
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Check Permitted Bedroom Rating Against HAA Request"
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test.
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
inspection.
Signed g & 5 ENGINEERING,
Company 17034 Eagle River Loop Road No. 204
Eagle River, Alaska
Date
MOA No. C_ E9�-
//
Receipt No. 0 5 ����-3 < CF 30
Date of Payment �� T2 � 7
Amount: $ / X61- 61Z>
Receipt No,
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
of this
.10
•°,
No. 14.97 e
fit. y�� �0 F''c :i 5'tt1ML etc
0
MUNICIPALITY OF ANCHORAGE
i DEPARTPJIENi'617 HEALTH AND ENVIRONMENTAL PRO, ACTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
r
l
1.: -GENERAL INFORMATION
Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
i
Location (address or directions)
(b) Applicant NameJ`LJO-e,-64P Telephone: Home--'?-Zk--&L Business
Applicant Address
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder,; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution 4w4 e" CXnfL '__21�c �elephone
Address
(e) Real Estat
Address
Telephone
(f) kW the HAA to the following address:
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms
3. 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;
5. ENGINEERING FIRM PROVIDING ,vtSPECTIONS, TESTS, FILE SEARCH, DAI�__AND INFORMATION
j 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
- forthe numberof bedrooms and type of structure indicated herein. I further verify that based on the information obtained
L" 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
I
the date of this inspection.
Name of Firm Telephone
Address r
I Late
I
RM
DHEP APPROVAL
Approved for &W -EL bedrooms by
Approved Disapprove
Terms of Conditional Approval
Conditional
CAUTION
¢Op ppOoap,.ue• °� ee¢o o¢8D1
�, [k bed A. Shafer
"a No. 1457•E a
A�eD �6oe°vo naoc 0¢ y�6
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 engineers work.
Page 2 of 2
12.025 ti,,�,<,
MUNICIPALITY OF ANCHvKAv=
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
�G22'
RECEIV-E®
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (M03 j-/
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal D scription: 1 -1c:7 -1S
Well Classification S . r If A, B, C, D.E.C. Approved (Y/N) t.-3 %/;�'
Well Log Present 09N) Date Completed r7-9 - e6- Yield S UPM
Total Depth Lat9 J Cased to IQA� Depth of Grouting
Static Water Level ' o Pump Set At
Casing Height Above Ground 3Im" Sanitary Seal on Casing (DN)
Electrical Wiring in Conduit (LVN)
N)
Separation Distances from Well:
Depression Around Wellhead (YW
To Septic/*4ak frg Tank on Lot L OJ I+ ; On Adjoining Lots ti Ln-;)r�t To Nearest Edge of Absorption Field on Lot t -k" ; On Adjoining Lots Lc 14-
To
4To Nearest Public Sewer Line ri To Nearest Public Sewer
i
Cleanout/Manhole A- To Nearest Sewer Service Line on Lot Z5
Water Sample Collected by S Art Date g-('91 es
Water Sample Test Results S
Comments
B. SEPTIC/Het-D" TANK DATA
Date Installed I - t - 85' Size No. of Compartments Z
Standpipes LVN) Air -tight Caps ON) Foundation Cleanout ON)
Depression over Tank (YO Date Last Pumped t-z6A�
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) A
Separation Distances from Septic/Heldiflg Tank:
To Water -Supply Well t coo k To Building Foundation
To Property Line �� 1 t To Disposal Field
i
To Water Main/Service Lirte + To Stream, Pond, Lake, or Major Drainage
Course 110
Comments
Page 1 of 2
72-026(11/84)
-SRi3 19OX
„ its GIVER, ALASKA . g,51--
-PNe i 4.2,
F130
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