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HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 2i ic��h 1��9s
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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: SV PID Number: os/ X31 39
Name:
Wastewater System: ❑ New Z Upgrade
Ga./
Address:
�� Y3;, ti1r. IafH,j P
ABSORPTION FIELD
Phone: �$g _ o �3
No. 0Bedrooms:
El Deep Trench ❑ Shallow Trench ❑ Bed XIMound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
O�
Total Depth from original grade:
/
GPD/Sq. Ft.
1',�.7
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
3 ile/Tlr >w lr
4>131 Ft.
�' 7 Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
/
77_r�
Ri W
5 -c -c if
2.0 / Ft.
60 Ft.
e` �' _" 7y
WELL. ❑Upgrade
Gravel width:
l s
Number of lines:
3
Distance between lines:
y S-
Z4/0 -rd, -❑New
Ft.
Ft.
Classification (Private. A,B.C):
Total Depth: Case er`
Total absorption area:
Pipe material: 30,�y Pvc
Ft.
QOO SQ, Ft.
I — IV r I vC Sc fr `iO
Driller:
D rl lied: Static Water Level:
Installer:
Date installed:
Ft.
�—;L1—�%�
Yield:
GPM
umSet at.
Casing Height Above Ground:
TANK
FL
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
AWz-H
/Z r'p
Material:
Number of Compartments:
Well
A
Surface
---
i
LIFT STATION
Water
��
Lot
Line
3v /
10
30
i
lS
Size in gallons:
17.50 I
Manufacturer:
Foundation
/
/ z
'p /
��
"Pump' level
"Pump 0f' vel at:
r alarm at:
High. te11
I 1Y
/O
&Model
Curtain
Pump Make
I Electrical Inspections performed by:
Drain
/✓�.--.._._._____-._---
-
SS-os-zo-yNF
4,A
Remarks: 7 r'a;/Hc( Sectio(
BENCH MARK
Location and Description:
X/ST/^'G TFN:r Pym•• E /a/Ld LlCA�IOn.N
W./.tei `—Q ✓l L/c%t iQ�
/.✓ LfJGE
�D✓�LI C�+_� �ca/ /'fJu1C
Assumed Elevation:
Oe. 0-� Pt
ENGINEER'S SEAL
i OF At
., „
• qE ..•••••.. '� i
s y ••�y
�R�S �-
••••••• »'•'••••'~••••l
Inspections performed by: Dates: 1st
�•••
2nd 6—z/-9�
�. »----- . »
Lo A. But ero :,
�j ti.• e"14As 't
Department of Health and Human Services approval
Department
t�
Reviewed and approved by: �% Date: -� 2,
E'ROfESS����
I ♦ �..
72-019 (Rev. 9/91) MOA 25
I
Permit No. SW980187
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ® Anchorage, Alaska 99519-6650 Teiphone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Northwoods L2 Bilk 3 PID No.: 05173138
{
I
I i
McManus Dr.
I
SWING TIES
15 UGIRZ Easemen_ —t — " A—C = 86.7'
_-- —— — B—C = 73.9'
A—D = 79.1'
B—D = 91.2'
a
Bored o0 0
Pbon
°
.
O .aa
o
C°7,;4
o8aeo
Abandoned PRESSURE PIPE DETAIL
Tank
2" PVC Monifold
To tank
I �
3, 4.5' 3'
BED 4.5'
1250 gal D DETAIL
Lift Station G
Lot 2 a 1-1/4" PVC Sch 40
TH1® Orifoces 29" OC
m
`x A - TEST HOLE
n • - MONITOR TUBE
o - SEWER CLEANOUT
v - WELL
- PROPOSED LEACHFIELD
— — - EASEMENT
A
BI
SCALE 1"=40
j 6/23/98
ELEVATIONSQ TOP OF CONC PAD, REAR DECK
(NOT TO SCALE) Asp PUMED ELEV = 100.00 ENGINEER'S SEAL A
�
ORIGINAL
m oDO F O�p 4
4
f
p
! d '
GROUND 2 ovP'� .••-•.......
� LEVEL AT: p
97.8 r
2' ADDED FILL
~m p 49TH
-i'O
2"35PSI INSULA➢ON GWT®89.8 .••... •.••••"""::""' OD'
TANK 878
W/Lift
94.2 42 97.5 97.5
�O c. Louis A. Butero
96.8
Q S •, CE -6736 Z Q
oFESS0\ o
0000
L1_ l Lo - ��1U - - l N
�� L,_ _A
PAGE 1 OF 1
CLL, -L) n J LIL `k" nv
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:SW980187 DATE ISSUED: 6/18/98
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 6/18/99
OWNER NAME:HETLET LARRY & BARBARA
OWNER ADDRESS:22432 MCMANUS DR
CHUGIAK, ALASKA 99567
PARCEL ID:05173138
LEGAL DESCRIPTION:
NORTH WOODS BLK 3 IT 2
LOT SIZE: 20000 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK 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:
RECEIVED BY: DATE:
S
ISSUED BY: DATE:/(/ /
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
June 11, 1998
Jim Cross, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Northwoods Lot 2 Blk 3
Narrative & Permit Application
Dear Mr. Cross:
The proposed septic upgrade will have very limited impact on adjacent properties for the
following reasons:
The surrounding lots are large, allowing sufficient room for septic sites and there
is a community water system.
2. Immediate neighboring septic systems are all +30' distance.
3. Drainage will not be affected and is not a major consideration in our design.
This system is to utilize a lift station so that the more permeable upper soil layer may be used for
the leachfield design. Sand will be imported to level the bed after the topsoil layer has been
removed. The field will have sufficient cover and will be insulated to prevent freezing.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
11997\98 -035 -NAR
McManus Dr.
— 15' Utility Easement _ —
Properly abandon
Existing Tank
Lot 1
1
EX�sttng
Septic
Existing
Tank
Existing
Tie into House
existing
line
with
Cleanout 1250 gal
Lift Station
Lot 2
NO SURFACE WATER
NO KNOWN CURTAIN DRAINS
77)
TH1® m
,0-2%
0-2%
All Septics
+30'
-11 1 1,1 ,0-'2% "
t -,/r cow
rvx Cb.00.°o o
00
..•au
°o
x.ar .w ° o
0 800 n '•
PRESSURE PIPE DETAIL
Lot 3
2" PVC Manifold
To tank 0 Zq
3' 4.5' 4.5' 3'
BED
DETAIL
WELL/SEPTIC SffE PLAN
LEGAL: Northwoods Lot 2 Blk 3
OWNER: Hettllet
CONTRACTOR: N/A
JOB# 98-035 1 DATE: 6/11/98 SCALE 1" = 30'
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-329
® — TEST HOLE
• — MONITOR TUBE
o — SEWER CLEANOUT
p — WELL
— — EASEMENT
— PROPOSED LEACHFIELD
EXISTING LEACHFIELD
ooh
OF��opo
q
;* 49TH *<
.L ............. T.......•
�•• LOUIS A. BUTERA �•
�;J+ '. CE -6736 2 z-
4:7 ,O PES '•....•.•• <ro
0
O�On�'ESSIONp �o�
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: Northwoods Lot 2 Blk 3 6/11/98
A. GENERAL
1. The well & septic plan is 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 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 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 WITH LIFT STATION
1. The septic tank shall be an Anchorage Tank 1250 gallon septic tank with integral OSI lift station
pump model OSI-05-20-HHF.
2. A receipt from a licensed electrician shall be provided to the engineer verifying lift station wiring to
all applicable codes.
C. BED
1. The bed excavation is to follow the natural land contour and remove the organic layer to underlying
sandy soil. Total depth of the bed bottom will vary across the bed.
2. The bottom of the bed should then be leveled utilizing sand material (<5% fines), to plus or minus
1.5".
3. The total thickness of the gravel layer is to be 1.0' .
4. The effluent line is to be a 1-1/4" PVC line with 1/8" holes drilled 29" OC within the leachfield,
placed face up with orifice shields placed over holes located mid depth in the 1' gravel layer.
5. The bed gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed
over the bed. Mounded side slopes not to exceed 3:1. Final cover material to be 4" of topsoil and
seeded.
7. 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:
BOTTOM OF GRAVEL LAYER = 1.0' BELOW GRADE' (apporximately)
GRAVEL THICKNESS = 6" under pipe, 4-1/2" over pipe
BED LENGTH= 60' BED WIDTH= 15'
SOIL RATING = 0.5 GPD/ft5 BEDROOM CAPACITY = 3
SEPTIC TANK = 1250 with lift station
EFFLUENT PIPE = 1-1/4" PVC with 1/8" holes oriented up with orifice shields spaced at 29" OC.
Twenty-four (24) hours notice required for all inspections.
11997198 -035 -spec
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 98-035
Calculated By: LB
Date: 6/11/98
Legal: Northwoods Lot 2 Blk 3
Single Family 3 Bedroom Dwelling
Bed Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom =
Percolation rate =
Wastewater application rate =
Required absorption area =
Bed width (VI) =
Gravel depth (D) =
TEST HOLE 1
450
gallons
14.1
minutes per inch
0.5
gallons per day per square foot
900
square feet
15
feet
1
feet
Required length = Required absorption area / Bed width
Required length = 900 / 15
Required length = 60 feet
Total Excavation Depth = 1.0 feet
Import sand for leveling low points
Mound and insulate, lift station utilized
OF'q�-�gs;p0O
*�. 0
49 rH*
�'. LOUIS A. BUTERA i
J,'• CE -6736 �4G
o4�dFoPROFESS10NPo-��4
98-035-cal.xls 2:36 PM6/11/98
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
Job #: 98-035
Legal: Northwoods Lot 2 Blk 3
Date: 6/11/98
Press. Effluent Lateral:
Assume T head at orfice
25 GPM flow rate
.42 GPM per 1/8" office
25 / .42 = 67 offices
Pipe Length 162
Spacing = length/#of offices
= 2.42 feet
Spacing = 29.0 inches
OFq
.' 49TH
Vn". LOUIS A. BUTERA .- 2"
J CE -6736 ��G
004 0 0 PRO...... NPo����
• '��4�7lt s"*
�.. .�M_{N{M.N�NN.Npi.• •
Municipality of Anchorage - `
1N04it"46NNNy1 •"" 6#6 M
DEPARTMENT OF HEALTH & HUMAN SERVICES Louis A.Btrterd
825 "L" Street, Anchorage, Alaska 99502-0650 �A ' .�' CE4736
SOILS LOG - PERCOLATION TEST $ '+r..__-0.1. o
PERFORMED FOR: I-rGTT/1t7— 1 DATE PERFORMED:
LEGAL DESCRIPTION: _1V0r%tic✓noaS 4oT� 6/k3 Township, Range, Section:
ESLOPE —t SITE PLAN
FEET) �OSO// I I I I I
2 SAydy G/AV�i
3
4-
5-
5
6 �vrerws� Gr
LHj/ 7/
7
a-
8
9--
C2
10
11
12
13
X.rn'w yr Til
14
15 l,s
P°YC.
16
17
IF YES, AT WHAT
DEPTH?
Depth to Water After S /
Monitoring?
■■■■.■■■■MENOMMMENE■
■■■■■■.■■■
■■■■■■■■■■
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
I,s
TEST RUN /3
-?.'SS
COMMENTS (WT ��o"'ra/
M/ �I6
FT
rr , 7k kl 77,
l#1 �1
t
—77;
/u/G /S
/
l�T/1n�7<9� T-wo 3o J -G
t?> IAeje
L4eoF
PERFORMED BY:
41e
CERTIFY THAT THIS TEST WAS PERFORMED IN
I v r6
3o
Z3 Z/i 6
Z 2// '
3o
-2.33
Z Z
5
IN,' r-3
3 S Z1/6
3s11&
/6 „
20Q
uPERCOLATION
I/-{
RATE t (minutes/inch) PERC HOLE DIAMETER
I,s
TEST RUN /3
Z•S'
/y
COMMENTS (WT ��o"'ra/
BETWEEN FT AND
acs/ >C/av rrcV.*A0 s -77j -r
FT
rr , 7k kl 77,
l#1 �1
t
—77;
/u/G /S
/
l�T/1n�7<9� T-wo 3o J -G
t?> IAeje
L4eoF
PERFORMED BY:
41e
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
J
®
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
�&N EW
0 UPGRADE
MAI LING ADDRESP
LEGAL DESCRIPTIO
LOCATION �.A,tO � ��x R�
�/{/O` l' !�/A�bsorptio�nVFa
NO. OF B POMS
v
DISTANCE TO:
Well
/
-
Dwelling
PER NOe
�" 0-5
.Y
waz
Manufacturer ,>
M�F�}' I
No. of compartments -
l—
J
Liq. c ciyy gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
0 Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
JaZ
= z H
Manufacturer
Material
Liquid capacity in gallons
DISTANCE TO:
Well
Foundation
Nearest lot line
PERMIT NO.
w=
J LL Z
No. of lines
Length of each line
Total length of lines
Trench width
Distance between lines
H Z W
CC
I
inches
F-
Top of tile to finish grade
Material beneath tile
Total
cc
effective absorption
area
0
inches
LU
0
Length `.,
5f
Width
Dep ��G ��
p T
,' /
i
Type of crib
Crib diameter
Crib depth
Total effec ' aiosP,c
w
y
DISTANCE TO:
WgJlf /`
�i�� 4
Building Smu ti L
��J 7
Nearest lot linef`�
J
Class -,�/
L
Depth
Driller
Distance to lot line
PERMIT NO.
J
C� v�
7
Lu
�
DISTANCE TO:
Building found ion
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
-
SOIL TEST RATING j
6
INSTALLER \
`
v
REMARKS
S l �,
elf S'bNil
;f
ncs
4r
A. 0
�o
p �a
APP OV
DATE LEGAL
WW
;(kf
cyq s tnev. of fa)
MUN1jCfPALf1-'POF ANCHORAGE_ —
e DEPA TR HENT OF HEALTH & ENVIRONMENTALPROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
ON-SITE SEVVAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME - -
PHONE -
A NEW.
rI
❑ UPGRADE
MAILIL1�A, REf
LEG/AL DESCRIPTION
4" Z >
LOCATION # 4 /,/
t/f//�Y/!/t-.ice �ft?.
NO. OF BE OOMS
v
v Y
ISTANCE T0:
Well
Absorption wa
_J
Dwelling
PERN�.]' NQ<' _03
i
_
of compartments
LU f
3
Liq. ca achy in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth.
Z
DISTANCIr TO:
Well
Dwelling
PERMIT NO.
O. Q
Manufacturer - -
Material -
-
Liquid capacity in gallons
J=
DISTANCE TO.
Well -
"
Foundation
Nearest lot line
PERMIT NO.
w
J LL Z
No, of lines
Length of each line
Total length of lines
Trench width
Distance between lines
�R¢
--
-
inches
-
� p.
Top of tile to,finish grade
Material beneath tile
Total effective absorption area
- G
inches
-
LU
Length t
Width
Dep P
Type of crib
Crib diameter
Crib depth Total effeciI-' o rga<
LU
LU
rn
-
DISTANCE TO:
W I
gU
Building undauoy�
- -
Nlot hn
earest !� -
Class- �_
,
Depth
Driller
Distance to lot line
PERMIT N
_ )
_
- -
DISTANCE TO:
Building founds ion
/
Sewer line
Septic tank
Absorption area(s) -
OTHER
-
PIPE MATERIALS- -
_
SOILTESTRATING ..
r Q /f
INSTALLER t
00
REMARKS
.:,p.,s,
�.
f= as..r.,w,.._
r.. ,. r' .0 -inn < .'.. �M4-^-:6•
a
°s
t
IA57
J
IA5
Oa •a rte. —
�7
APPROV bf% DATE LEGAL -
77-0j.,S (Rev. 3/78)
Pi 99 PA X L.; IL F `l L_ X I I -T, R—H r— 1`4 a--. 1 t 1 -cc. " K 1~..
DEPARTMENTL_/HEALTH AND ENVIRONMENTAL _..'OTECTION
825 'L' STREET, ANCHORAGE, AK 9-9501
264-4720
PERMIT NO. r (_;10503.
APPLICANT PJ&S 600 E BENSON 274-731.5
LOCATION MC MANUS DR
LE13AL LOT 2 BLK 3 NORTHWOOD S,, -D LOT SIZE 20000 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH /2S_
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING 45Q FT/SR)=e._
THE REQUIRED SIZF 0 THE SOIL ABSORPTION SYSTEM IS:
0 IE F`T-of;;?nvEFL
6 L_ E
THE LENGTH DIMENSION IS THE LENGTH (,IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF 'THE
GROUND AND THE BOTTOM OF THE EXCAVATION f'IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
FR FE I. -A 11 1 F;'.'E: V -o -*F. FE F=" ".1_ 1 � _r n 1'':11' 1-" "_=5 Ir :::rm EF_ ::L r -N lzi C-3 � FA t- L_ r__l VA E5
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
-r 1.4 C -_l PC 2N > I r-4 = F=m E 1 li I f .':11'-.1 :S F-1 F;:" F= FV.0 E: ID tjI F_ rs qF=
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION,
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE 15 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
I CERTIFY THAT
i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: 1 UNDERSTAND THAT THE ON-SITE !:--EWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED: --- ------------------ 2
APPLICANT PJ,8-S
2 -
ISSUED BY- _._.._..._.__...DAT E
.......DATE--- L723�1 V4.0
DEPARTMENT �;, HEALTH AND ENVIRONMENTAL i TEC T I ON 1h ,unS L i
rr ''L' : TF T', hit•dC=:Hr::jR.AGE. N!'::. 1!'=i=+0 bul
` — 264-4720 ^a
PERMIT NO. 8105w_i'3
APPLICANT F',T.g.- 600 E BENSON 2 'i._- i :15
L OCAT I ON MC MANdt-i�' DR - � :_��€�_io6 ;QUARE FEET
LL i tT �: E,L.t': � N�d� �F�:7tiWCu�iC:F •.'C:` LOT_, I •:,.E
TYPE OF =COIL ABSORPTION ION'd 'SY'STEM IS: TRENCH �i
`OIL RATING F-T,'E:R',=
MAXIMUM NUMBER OFE�EE:"F:��i�:�ti:=• - - -
THE REQUIRED SIZE OF THE ::OIL ABSORPTION SYSTEM IS: J�
THE LENGTH D I MEN S I C iNd IS THE LENGTH I Fd FEET OF THE TRENCH OR. DRA i N�?F I EL r).
THE DEPTH OF4A TRENCH OR PIT IS THE DISTANCE BETWEEtd THE 'SURFACIE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (INS FEET).
THERE IS t•.10 SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH I'S THE MINIMUM DEPTH CSF' GRAVEL BETWEEN THE OUTFALL F'IF'E
AND THE BOTTOM OF THE C t-!`• ATI ON•d (IN FEET).
F_p ry CA u 3!t- 6,-- u-- C. f:-; L= 1=" .�- I c: ""R-_" = 1 `"-v F_- =: :2L 071 f3 9- fl"'_; F= 9 E_ . 4__ R3 !'
Jl
PERMIT APPLICANT Ht=!'• TFi�f:E�F'�F uj ILI7`r' TO INFORM THIS DEPARTMENT DURING THE
INd'=l"ALLfTFIONd INSPECT -F •d`,' WEt_C._'; T.ACENdT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES C E'NdC:/T"_TEM
HE WELL LL SERVE.
:''tE.
__ r-4 5 -� = 1F : �: fl. a fl_._�1 �a'F 'a "E,Ii�`f FIL C_:CNd�3 QF'. t-1Nd'rdITH� I,i 1T 1•lld=yFE�{ IiiNd tdC` !if'F'F:�_�'Y`AL. k:'r' 7HI:
C:`EF'Fif=:`!t1E:NdT Cdl:LC_ E:F_Ti PROSE C:!_IT IONd.
MINIMUM D I'STAr.-IC:E BETWEEN A klELi_ AND ANY Ohl --SITE EWA13E DISPOSAL `STEM IS
11:0 FEET FOR A F•RI`v'ATE WELL OR J.50 TO 200 FEET FROM A PUBLIC: WELL DEPENdDINdi3
UPON THE TYPE OF PUBLIC. WELL.
m I N+1 I hium D I E, T AN•dCE FROM A PRIVATE WELL TO A PRIVATE :=•EWER LINE I := 25 FEET AND
'Tp A COMMUNITY SEWER LINE .I' 5 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE F'F:?: PER INSTALLATION.
C -0E : Ems: f"I �� E -
I CERTIFY THAT
1: I AM FAMILIAR WITH
FORTH
FOR ON-SITE _,EbIEF:' AND WELLS AS SET
FORTH B THE MUNICIPALITY OF ANCHORAGE.
: I WILL INduTAE_E_ THE 'SYSTEM IN ACCORDANCE w I TH THE CODES.
T
UNDERSTAND THAT THE Or -4 ---SITE SEWER 'SY'STEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3: BEDROOMS.
SIGNED
APPLICANT PJ8,
ISSUED BY-
b=3
L__-
6- D =G -D f' �• r�
PERFORMED
LEGAL DESCRIPTION
l
! J ❑ SOILS LOG
-MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
I ` -/ SOILS LOG — PERCOLATION TEST
`✓ 1 �d� '� C ' DATE PERFORMED: �� f�IJGJ
i
L
DEPTH Ej
2 v ' -5 S" yummy gla�i�
3-
Date
Gross
Time
4
4-
Depth to
Water
Net
Drop
6-
6
(
Z2�e d i
S%s�
Ohl
`
r
7
8
9
10
11
12
�o a
I 41-
13
14
U
AY- XL 11
15
16
9Y
Pc"
r
` y� d
17
18-
8
.e
a
20
20
COMMENTS
RA3art A. Shc • 5P 4',
;,. 1457 c
SLOPE
SlfE PLAN
WAS GROUND WATER S
ENCOUNTERED? L
O
P
E
IF YES, AT WHAT <�
DEPTH? (�
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
p
l
(
Z2�e d i
S%s�
C
Glia
�o a
I 41-
3 y
S-0
U
AY- XL 11
3 !r
PERCOLATION RATE �� (minutes/inch)
'L
TEST .RUN BETWEEN FT AND FT
T,..
PERFORMED BY: 7�%='i'l�ix" CERTIFIED
72-008 (6/79)
DA
bbl X (--)-Z
0 SOILS LOG
MUKIFICIPALITY OF ANCHORAGE
•
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: DATE PERFORMED: -2- Z- fe,,f-1
LEGAL DESCRIPTION:
DEPTH SLOPE SlYE PLAN
(aF E W)
� %Sp /��
1 al
All 4,—
•
3-
4- vW
5 v?. I
-71
6-
7-
9-
10-
11
Date
Gross
Time
WAS GROUND WATER
:e s
Net
Drop
2 Z6 ;e
ENCOUNTERED?
LO
E
16-
3
P
12
Iq
0
E
IF YES, AT WHAT
C4
18—
DEPTH?
13
ort A. Sh 4'j
14-
Date
Gross
Time
Net
Time
15-
Net
Drop
2 Z6 ;e
E
16-
3
Iq
0
17-
C4
18—
ort A. Sh 4'j
14S7.
19—
u
20
COMMENTS
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
2 Z6 ;e
E
1-3,
3
Iq
C4
PERCOLATION RATE
TESTF!UN BETWEEN
PERFORMED BY: CERTIFIED
72.008 (6/79)
(minutes/inch)
FT AND FT
u?' SOILS LOG
MUNICIPALITY OFANG�IW� °; OF ANCHORAGE �Y(
F H-A.LT'H &
. DEPARTMENT OF HEALTH AND ENV[ RONW*T&L�RROTE�'F O TEST
OLanON
825 L. Street, Anchorage, Alaska 99501 264-4720
\\ r
SOILS LOG — PERCOLATION fis;f2 8
PERFORMED FOR: PJ & S R E CEIVTE PEED
MED: April 23, 1981
LEGAL DESCRIPTION: Lot 2, Block -3, Northwood Subdivision
.�H Organics and organic silt, dark SLOPE SITE PLAN
brown, wet, soft, tree debris.
1 -- (Pt -OL)
Gravelly -sandy -silt, light
z brown, stiff, moist, with some
organics.
Silty -gravelly -sand, gray,
moist, compact, rounded to sub -
rounded particles to cobble
size.
(GM -SM)
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
EMMEMMONN
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
NNEEMENEEN
4-23-81
3:55 PM
20 Min.
19 3/4
2 3/4
EMENEMMME
■■NE■■L'■■■
0111"EpM11
EMIIMMEM
4:05 PM
30 Min.
21 3/4
no
4
4-23-81
REEMENNEE
40 Min.
23 1/4
1 1/2
5
4-23-81
MEM
IMMOM■MEMENMEMN,
24 1/2
1 1/4
6
4-23-81
4:35 PM
60 Min.
25 1/4
3/4
.MENMEM■
NEENEENEEN
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
2
4-23-81
3:55 PM
20 Min.
19 3/4
2 3/4
3
4-23-81
4:05 PM
30 Min.
21 3/4
2
4
4-23-81
4:15 PM
40 Min.
23 1/4
1 1/2
5
4-23-81
4:25 PM
50 Min.
24 1/2
1 1/4
6
4-23-81
4:35 PM
60 Min.
25 1/4
3/4
PERCOLATION RATE
TEST RUN BETWEEN
COMMENTS
PERFORMED BY: Howard Grey & Assoc., Inc.
72.008 (6/79)
TE:April 27, 1981
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
825 L Street, Anchorage, Alaska 99501 2644720 TEST
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: PJ & S DATE PERFORMED: April 23, 1981
LEGAL DESCRIPTION: Lot 2, Block - 3, Northwood Subdivision
Organics and organic silt, dark SLOPE SITE PLAN
2
Date
brown, wet, soft, tree debris.
(Pt -OL)
Gravelly -sandy -silt, light
brown, stiff, moist, with some
Net
TimeDrop
Net
2
__a 6_;
3:55 PM
20 Min.
' organics.
2 3/4
3
4-23-81
4:05 PM
3�-
.
(GM -ML)
4
4-23-81
4:15 PM
40 Min.F251/4
1 1/2
5
4-23-81
4:25 PM
50 Min.
Silty -gravelly -sand, gray,
4
6
moist, compact, rounded to sub -
4:35 PM
60 Min.
3J4
rounded particles to cobble
5
N
size.
(GM -SM)
14
15
1s
17
18
1s
20
e V15 Gr
y'
WAS GROUND WATER S
ENCOUNTERED? Yes L
O
P
IF YES, AT WHAT 13' E
DEPTH?
Reading
Date
Gross
Time
Net
TimeDrop
Net
2
4-23-81
3:55 PM
20 Min.
lei
2 3/4
3
4-23-81
4:05 PM
30 Min.
2
4
4-23-81
4:15 PM
40 Min.F251/4
1 1/2
5
4-23-81
4:25 PM
50 Min.
1/4
El
6
4-23-81
4:35 PM
60 Min.
3J4
N
Reading
Date
Gross
Time
Net
TimeDrop
Net
2
4-23-81
3:55 PM
20 Min.
FDepth
2 3/4
3
4-23-81
4:05 PM
30 Min.
2
4
4-23-81
4:15 PM
40 Min.F251/4
1 1/2
5
4-23-81
4:25 PM
50 Min.
1/4
El
6
4-23-81
4:35 PM
60 Min.
3J4
PERCOLATION RATE 15 , ®`%% mutes/in
TEST RUN BETWEEN _4�s,�,,
COMMENTS 0 P •• s•� +
Howard Grey & Assoc., Inc.
PERFORMED BY: y CERTIFIED B e I •eae•s,e• e.ee. ee •ee ee a•e ••
ca Richard A. Lowman
or
April 27, 1981
x 5,
�o
Gp
°moo 190 K 8
Parcel I.D. 051-731-38
Municipality of Anchorage z
u ...
On -Site Water and Wastewater Program
(907)343-7904 saeery.
Certificate of On -Site Systems Approval
Expiration Date: -6 - 6 —
1. GENERAL INFORMATION
Complete legal description North Woods, Block 3, Lot 2
Location (site address) 22432 McManus Dr
Current Property owner(s) Robert and Regena Evans Day phone
Mailing address 22432 McManus Dr. Chugiak, AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
El
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
El
Public Sewer
❑
WaiverNariance
Received by: Date:I3 Z6i S
COSA to be released to the ng' eer, unless otherwise requested by the engineer.
COSA Fee $ 622:k '/
Date of Payment '?1a-76 5
Receipt Number 000M
COSA #_ ©5CIS�5?—
Waiver Fee $
Date of Payment.
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation dateetiown 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.
In conducting an adequacy test, 1 attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe 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 soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC
Phone (907)272-8218
Address P.O. Box 100217, Anchorage Alk. 99510
Engineer's Printed Name Steven R Pannone Date 7/21/2015
6. DSD SIGNATURE r
_kz System #1 Approved for bedrooms "t$iever i2. am
CE -8149
System #2 Approved for bedrooms -
Disapproved �ES9
Conditional approval for bedrooms, with the following stipulations:
uy, L f 10s LYJ s� - viiyntal ueiflflCatc Date:_
Th4 n f ®rage 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.
ATTACHMENTS:
COSA Checklist X• Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA We sheet t. -, c
If more than 1 septic system is on the lot:
COSAChecklist# ± of 1
Structure served by this system 1 T
Certificate of On -Site Systems Approval Checklist
Legal Description: North Woods, Block 3, 4ot 2 Parcel ID: 051-731-38
A. WELL DATA
Well type Public If A, B, or C provide PWSID # AWiR%fJ' Well Log (Y/N)
Date completed Sanitary seal (Y/N) _ Wires properly protected (Y/N)
Total depth % Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m, g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S.T.E.P./Steel Date installed 06/21/1998
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over(t�ank (Y/N) N High water alarm (Y/N) Y
Date of pumping 29 6r5 -Pumper_�6 IT�(^� PUMpegs
C. ASSORPTIONTMLD DATA
Date installed 06/21/1998 Soil rating (g.p.d./fiz or ft2/bdrm) 0.5 GPD/SF System type Mound/Bed
Length 60 ft. Width 15 ft. Gravel below pipe 0.7 ft.
>F
Total depth 4.4 .fl. Eff. absorption area 900 ftZ Monitoring tube Y Depression over field N
Date of adequacy test 05/06/2015 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 3 in. Water added 498 gal. New depth 8. in.
Elapsed Time: 140 min. Final fluid depth 3 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes; give date
D. LIFT STATION
Date installed 06/21/1998,
"Pump on" level at 42 in.
Datum Bottom of Tank
Size in gallons 250 Manhole/Access (YM) Y
"Pump off"level at 40 in.' High water alarm level at 44 in.
Cycles tested -_ Meets alarm 8 circuit Meldirerrnts?
E. SEP*RATiON DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septid-service line 25±
Animal containment areas 50+
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 1(}0+
Holding tank 100+
Manure/animal excrete storage areas 100+
- - -SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main .10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+` Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
System is at 90% Capacity
*Added 28-�of insulation over entire field
G. "ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the- above systems are in
conformance with MOA COSA guidelines in eSect on this date.
Engineer's Printed Name Steven R. Pannone
Date 7/21/2015
. COSA canary sheet 2-6-15.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 1.0+
McMANUS DRIVE
LO io
N N
Valve
1
Elec. Pedestal--`� 15 Utility Easement
Tele. Pedestal
a N
N IFlag Pole m
Asphalt
Drive SCALE 1 " = 20'
Steps -I & Landing 0' 10' 20' 40'
PCC
LOT 2
BLOCK 3
Wood Shed
(No Foundation)
in
0
E
Chain Link
Fence
LOT 42 1 LOT 41
LOT 40
1 hereby certify that an accurate survey of the following described PREPARED FOR:
`.++tIk1kjkyt property:
..OF.A1q+t+ NORTH WOODS SUBDIVISION (79-195) PANNONE EN(
p ; •• J �I LOT 2, BLOCK 3
r TH �c,� was made on June 17, 2015 and that the improvements
49 ;,,,, ,,, I situated thereon are within the property lines and do not overlap or —B
AS
encroach on the property lying adjacent thereto, that no
2••••••••• • improvements on the property lying adjacent thereto encroach on 0W' DATE
Lee lnikoff: the premises in question and that there are no roadways, JSP 6/24/201
No.. 314 3143-S transmission lines or other visible easements on said property except FltF N0. F.B. 2015
�D�•dtZyp +' as indicated hereon. Easements other than those shown on the 1530 PG. 21
+� SSONa +��
�i��+� KARABELn record plat may not appear on this drawing.
li
Anchorage Alaska, this 24th day of June 2015. C/ /9)1/f:-VIAII
Bi—Level Wood Frame
1
ro
Residence on Concrete
°
Block Foundation n
o
LOT 1
ro
LOT 3
z
19.7'
Upper Floor
o
o
Wall Line
0.8' x 1.1'
.7 0
Cantilever
N
`v 42.6'
Wood Deck Upper
15.2'
Floor Level
Wood Steps & Landing
Storage Under
PCC Pad
Woad Deck °
Lift Station Man Hole
`Clean
Out (Typical)
LOT 2
BLOCK 3
Wood Shed
(No Foundation)
in
0
E
Chain Link
Fence
LOT 42 1 LOT 41
LOT 40
1 hereby certify that an accurate survey of the following described PREPARED FOR:
`.++tIk1kjkyt property:
..OF.A1q+t+ NORTH WOODS SUBDIVISION (79-195) PANNONE EN(
p ; •• J �I LOT 2, BLOCK 3
r TH �c,� was made on June 17, 2015 and that the improvements
49 ;,,,, ,,, I situated thereon are within the property lines and do not overlap or —B
AS
encroach on the property lying adjacent thereto, that no
2••••••••• • improvements on the property lying adjacent thereto encroach on 0W' DATE
Lee lnikoff: the premises in question and that there are no roadways, JSP 6/24/201
No.. 314 3143-S transmission lines or other visible easements on said property except FltF N0. F.B. 2015
�D�•dtZyp +' as indicated hereon. Easements other than those shown on the 1530 PG. 21
+� SSONa +��
�i��+� KARABELn record plat may not appear on this drawing.
li
Anchorage Alaska, this 24th day of June 2015. C/ /9)1/f:-VIAII
MUNICIPALITY OF ANCHORAGE
RECEIVED
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services JUN 2 4 1998
On -Site Services Section
P.O. BOX 196650 Anchorage, Alaska 99519-6650 MUNluPHUTY OF ANCHORAGE
NVIRONMENTAL SERVICES DIVISION
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 05 -/ 7 313 S HAA # V\M9\n\,4E1
1. GENERAL INFORMATION
Complete legal descriptionVvi TkW-'ae-4 1,4'! '), Woc-k
Location (site address or directions) Li 3 2 A'&- •N%r7rAs per,
C A uQ i•C1 k 14k vets -d
k .Property owner`'C.Fjrr f �� �6�,f« zT/,- 7- Day phone
Mailing address 2'x:,`/32 /1l�NL,>�,S b.- CLQ 2,•uk Ak qC/
Lending agency Day phone
Mailing address
Agent , 11 %i Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
LSC
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
F;. STATEMENT NT OF INSPIFCTICN CSV 1ENGINEER
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 Phone
Address
Engineers signature — r_'� Date
1064 -T 0
a Golfo
�0°ege�oL3ueegdo ooa'oopio n»�sra _,o °
Louis
%°
6. DHHS SIGNATURE ��A ��°"e5®����•
Approved for E bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By: i% 1r/ J ot-� 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-M (Rev. 1/91) Back MOA P21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERvR C i V D
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (9Qj)PZ@44T
Health AuthorityApproval Chec
Municipality of Anchorage
pp ld . Health & Human Services
Legal Description: /V-11714 w +r° Ler 2n 131 � - Parcel I.D.: O5-/ `7 3 f 3� 8
A. WELL DATA ewm'71 WaTer
Well type
Log presen /N) _
Total depth
Sanitary seal (Y/N) _
Date of test
Static water level
Well production
WATER SAMPLE R
Coliform
Da of sample:
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to Casing h
FROM WELL LOG
B. SEPTIC/HOLDING TANK DATA
Date installed '%' Tank size
Foundation cleanout (Y/N)
9 -P.M.
Nitrate
Collected by:
ground)
protected (Y/N)
AT INSPECTION
Other bacteria
Number of Compartments Cleanouts (Y/N)
Depression (Y/N) High water alarm (Y/N)
Date of Pumping Pumper
C. ABSORPTION FIELD DATA
Date installed �` �� ` ��
Soil rating (g.p.d./W or ft2/bdrm)
System type w` oClk4e7l�
Length �� Width
/� Gravel thickness below pipe
s~ Total depth % d
Effective absorption area Monitoring Tube present (Y/N)--Y— Depression over field (Y/N) ✓V
Date of adequacy test iVA Nuy Results (Pass/Fail) l�t=� For 3 bedrooms
.NA
Flu -id -depth -in -absorption field before test (in.); Immediately after_ gal. water added-(im):
Fluid depth (ins) Minutes later:----'rption rate = g.p.d.
Peroxide treatme,nt-(pn-s`t- 2 onths)(Y/N) r If yes, give date ---•-
72-026 (Rev. 3/96)'
D. LIFT STATION
Date installed K__ '162— 6M
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested /f/ tw
E. SEPARATION DISTANCES
`1 y
JUN 2 4 1998
Ari. if P._JPALI I Y OF ANCHORAGE
1RONAhENTAL. SERVICES DIVISION
Size in gallons yA///dD>S
"Pump on" level at* Lid "Pump off' level at* `7J�
*Datum T4-tik.
SEPARATION DISTANCES FROM WELL ON LOT TO: /VAS w"`r`=r +/v
75 1411
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewerls c service line
On adlacen ts—
On adjacent lots
manhole/cleanout
Lift station
' A/u tea r v„ 7cr
�I f.,' �-r S 7 liG✓/ `\
SEPARATION DISTANCES FROM SE-Pi10/I#@tDIN&T*W ON LOTTO:
Foundation to r Property line 30 / Absorption field 19
Water main/service line f s a Surface water/drainage IVA Wells on adjacent lots f 2
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
r �
Property line to Building foundation /0
Surface water /V4
Water main/service line r -moo
Driveway, parking/vehicle storage area 12 C�
Curtain drain oktioow� Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
l certify that l have determined thru field inspections and review of Municipal
in conformance with MOA HAA guidelines in effect on this date.
Signature)
Engineer'sName
Date G1� e &irf
HAA Fee $ :� (j() ,
Date of Payment (-�r� 1
Receipt Number �7i
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
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J MUNICIPALITY OF ANCHORAGE U
Y
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 -94 /W
el
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions) A ff
(b) Applicant Name �6 41
l,--rVephone: Home 0 Business
Applicant Address 17-e fe- "7 0
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution��� Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
S & S ENGINEERING
SR B 196X
EAGLE RIMER,
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms
3. WATER SUPPLY
Individual Well 11Community 11 Public /I U �U4,0-o"o-e'l�
Note: If community well system, must havewritten 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.
72-025 (11/84)
Page 1 of 2
5. ENGINEERING FIRM PROVIDINU41NISPECTIONS, TESTS, FILE SEARCH, DA -s -A 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 RMICCK d Telephone �
Address
Date E®Z9 ERftMRA V OOr.�
. 4S�!
OF A <.4
_„an®0000..
^se�AA<
i 8 A. S11 o< IV..
o t�
Doe
Q
Pn Ce owe ao oo®..a1Q�..e� .
6. DHEP APPROVAL
Approved for bedrooms by nn. Date 2/f 7)
Approved il/ Disapprov 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)
A.
AGE
�OOff 0'
MUNICIPALITY OF ANCHORAGE (MOA)J
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: L2– BLiC-3 NoR.T-H W aj>
VO
WELL DATA
�� �t-i PAt If A, B, C, D.E.C. Approved Y/N
Well Classification PP ( )
Well Log Present (Y/N) Date Completed
Total Depth
Static Water Level
Cased to
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Depth of Grouting —
Pump Set At
Yield
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
— To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Date
Water Sample Test Results
Comments (r�RTHyyoob w_AATc'Z 5Y576A
B. SEPTIC/HOLDING TANK DATA
Date Installed Size 1000 No. of Compartments
Foundation Cleanout ((YQ}
/
/
Date Last Pumped VI 8-(P
Pumping/Maintenance Contract on File (Y/N) "( ; for
Holding Tank High -Water Alarm (Y/N) tjA Temporary Holding Tank Permit (Y/N)
Z'
Standpipes (&N)
Depression over Tank (YJ&
Air -tight Caps (CIN)
+h
Separation Distances from Septic/Holding Tank:
To Water -Supply Well Z oo' f
To Property Line
To Water Main/Service Line
N/ N
l o`4
10? 4,
To Building Foundation
To Disposal Field5,�4.,
To Stream, Pond, Lake, or Major Drainage
Course
Comments/ c a cenlcyl%.P�zo i9+✓!9 Ex T/=k/d�cr%
Page 1 of 2
72-026( 11184)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata5/Type of System Design 3
Date Installed Lelt13 S(P Length of Field - 3Its
�
Width of Field Z 1 Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area 7%B 9 Standpipes Present O/N)
Depression over Field (Y6
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well
To Building Foundation
Date of Last Adequacy Test�/A&
To Property Line
To Existing or Abandoned System on
Lot N/ A- ; On Adjoining Lots -16
i
To Water Main/Service Line To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area 5
Comments &FG✓ A4 7: W A-$' /NS 74 cc r - g i tiJ 0S'.J ez e- ,geb
D. LIFT STATION
Date Installed Dimensions
Size in Gallons A Manhole/Access (Y/N)
"Pump On" Level at 'Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
Pumping Cycles during Adequacy Test. Meets MOA
I certify t�lgj��d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed SR B 19AX Date �I /igG
Compar AGIE WER AK9967i7 MOA No 010-_r
Receipt No. .2 !�
Date of Payment
Amount: $ Zli
Page 2 of 2
72-026 (11/84)
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGENESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
DATE: l��
PWS I.D.# /331a
To Whom it May Concern:
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
According to records on file in this office the In 64 Ak wl ,a d
we, % Water System is in compliance with the State Drinking
Water Regulations
Sincerely,