HomeMy WebLinkAboutPREUSS #4 BLK 7 LT 8
Municipality of Anchorage Page
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
~~ ~~ ~ Wastewater System: ~ New pgrade
Address:l ~ ~~ ~, ~~ ABSORPTION FIELD
Phone: ~ N°' of Bedrooms:
eep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION So,.a,n~: ~*~PD/Sq. Ft.. ~ Total Depth from original grade:,
Lot: ~ Block: ~~~Subdivisi°n: ~ Depth to pipe bottom from original~grad~: Ft. Gravel depth beneath pipe ~ / Ft.
Township: Range: Section: Fill added above original grade~ ~ Gravel length: /
Ft. ~ ~ Ft.
WELL: Q New ~ Upgrade Gravel width: ~ / Number of lines: Distanc~between lines:
Classification~ ~(Private' A,B,C):~ ~) Total Depth: Ft. Cased To: Ft. Total absorption area~ SQ, Ft.
Driller: ~ Date Drilled: Static Water Lever: ~ ~¢ Date instalfed:~/~/
Yield: [ Pump Set at: Casing Height Above Ground:
GPM~ Ft. Ft. TANK
SEPARATION
DISTANCES
~Septic U Holding ~ S.T.E.P.
To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Cap~c~ons;
From Tank Field Slation Tank S .... Lines
Well [~/ ~t/ ~ ~ ¢~ Material:~~ Number~mpartments:
Surface ~¢~ ~¢¢ ¢ T~
Water I ~ ~ LIFT STA
Lot ~1 ~ Size in gallons: Manufac~
Foundation Curtain Brai. ¢~' aO~ ~' ~ ~ ~% ~ ' ~um~ Model Electrical Inspections performed by:
Remarks: BENCH MARK
Location. ppd Description:
J Assumed ElevatiOn:
ENGINEER'S SEAL
S & S ENGINEEEING
BepartBenl of Health ¢~d M~ma¢ Cervices appr~aI/
72-013 {Rev. 9/'91) MOA 25
.Permit'No. SW930386 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:p ...... S'JBD!VIS!ON JzA ~, ~r-v 7, LOT B PID No.: 05057242
CO1 COZ
101.5' ~ FINAL GRADE MT C03
; ~ ~ GRADE ~~5'+
FINAL
.
~ N~.W
N.?.S. gl.6' N'O WATER FOUND ·
~-1o' u*m. ~su,.
/ ~m~T~ ~ cn?~u- '1' ~ CO1 55 0 64'5
/' k ~ "~ cos lo~:o 75:o
72-013 A (2/gl) MOA 25
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:SW930386
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:HUFFMAN WALTER &
OWNER ADDRESS:10210 RONALD PL
EAGLE RIVER, AK 99577
PAGE 1 OF
DATE ISSUED: 9/22/93
EXPIRATION DATE: 9/22/94
PARCEL ID:05057242
LEGAL DESCRIPTION: PREUSS #4 BLK 7 LT 8
LOT SIZE: 19600 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION 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 OR 343-4681 AFTER BUSINESS HOURS
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:
HEALTHAUTHORITY
APPROVALS
SEWER&WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOlE TEST
PERCOLATION
TEST
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
September 15, 1993
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
PO Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Preuss Subdivision Unit #4, Block 7, Lot 8
Request you issue a permit to upgrade the septic system
serving the referenced property.
An adequacy test performed on the existing system found the
system to be in a state of failure.
Two test holes were excavated and a percolation tests
performed in the area of the proposed upgrade. The
monitoring tubes within the holes have been checked and
found to be dry. The approximate location of the test holes
are located on the attached site plan.
This property has enough area for a future septic upgrade,
which can be seen on the attached site plan. We do not
anticipate any adverse effects on neighboring properties by
the installation of the proposed septic system.
If you have any questions or require additional information
for your review please contact us.
rt/. RAS/LSU/lsu .PA. SMa e--f%-f~, .
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
OESIGN
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA99577
1'' .=. 40'
SCALE
UPGRADE
m
0
~CmO~ ~
~O~Om
m
0
~ om
I ~o~ ~
0~0
~o~Z
'~Z~
0
0N-SiTE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Preuss Subdivision Unit #4, Block 7, Lot 8
GENERAL-
1.
o
o
The scope of this project includes the installation of a
1000 gallon septic tank and a leachfield trench to serve
the three bedroom residence located on the referenced
property.
Construction shall be in accordance with the approved
site plan and design drawings; Municipal permit with any
special provisions or conditions; and all applicable
State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any
necessary underground utility locates.
Unless specifically agreed otherwise, the property owner
shall be responsible for final grading areas subsequently
depressed from soil settling.
Contractors installing wastewater disposal systems must
be certified by the Municipal Health Department for
system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic
tank manufacturer. Construction shall include two 4"
cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
Ail standpipes on the septic tank shall extend a minimum
of 12 inches above final grade.
o
Septic tanks installed with less than 4 ft. of cover
shall be insulated.
Page Two
Preuss Subdivision Unit #4, Block 7, Lot 8
September 15, 1993
o
A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the
tank and the leachfield there shall be two adjacent
cleanouts (unless an effluent pumping system exists
within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the
tank. The first cleanout, in line, shall be to clean
toward the leachfield. The second cleanout shall be to
clean toward the septic tank.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on
the design. The bottom of the excavation shall be within
2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed-
up) before gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
o
A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
o
Monitor tubes shall be of four (4) inch diameter and
installed approximately in the locations shown on the
design. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This
is equivalent to the effective depth of the gravel as
noted on the design.
Backfill over the final gravel layer must not be less
than twenty-four (24) inches. Insulation must be
installed when the backfill depth is less than thirty-six
(36) inches. The finish grade over the trench must be
mounded to prevent the formation of a depression after
settling.
Page Three
Preuss Subdivision Unit #4, Block 7, Lot 8
September 15, 1993
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
o
The following pipe materials are approved for use in
septic system installations in the Municipality of
Anchorage:
o
Type of Pipe
Perforated Solid
Cast Iron
ASTM D3034 (PVC)
ASTM F810 (HDPE)
ASTM D2662 (ABS)
Yes Yes
Yes Yes
Yes No
Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi
140N, or equal) must be installed between the final
leachfield gravel layer and the native soil backfill.
Ail leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the #200 sieve.
When sand is being used as a filter material, it's
gradation specifications must conform to current M.O.A.
or D.E.C. requirements.
Page Four
Preuss Subdivision Unit #4, Block 7, Lot 8
September 15, 1993
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and before
the installation of any gravel. A septic tank may be set
in place, but may not be backfilled before this
inspection.
The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
The final inspection is to occur upon final grading
of the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre-
construction meeting will take place on-site.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PE~Q~
Township, Range, Section:
SLOPE
11
12
13
ENCOUNTERED? ,
IF YES, AT WHAT ~
DEPTH? p
Depth 1o Water After
Monitoring?
SITE PLAN
14
15
16-
17-
18-
19
2O
g,o.H.
Gross Net Depth to Net
Reading Date
Time Time Water Drop
6 /~~ I~ ~" ~.~
PERCOLATION RATE~ (minutes/inch) PERC HOLE DIAMETER ~// '(,~
t !
TEST RUN BETWEEN ~AND~FT
COMMENTS //9 ~ ~ ~~
/034 Eagle River [~p Eead ~. ~ ~
PERFORMED BY ~1~ ~ ~ ~
: ' ....~;, ~J~a ~ ' -~///~w ~ -~ CERTIFY THAT THIS TEST WAS PERFORMED
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN~~ON THIS DATE. DATE:
72-~8 (Rev. 4/85)
IN
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
SLOPE
8
9
10
WASGROUND WATER
ENCOUNTERED?
11
1
3
4
12
13
16
17
18
19
20
SITE PLAN
S
IF YES, AT WHAT ~ (~
DEPTH? p
E
Depth to Water
Monitoring? /_/l'-~atate gal ~--'~
Gross Net Depth to Net
Reading te Time Time Water Drop
7,,
EROOLAT.ON.A.E ,m,.u,..,. ., ERO.OLEO,^METER
/
TEST RUN BETWEEN ..~----../~ND ~ FT
COMMENTS -----' ,/ /'
PERFORMED BY:' ~~ ,S ENGINEERING I ~'~ ~ u:-F~rTFY THAT THIS TEST WAS PERFORMED IN
11034 Eagle' River Loop Road NO. 204 /~///
ACCORDANCE WIE"a~eLIqEfv~p~-dl~li~jc~L GUIDELINES rN EFF/ECT ON TH ~ u.~,/~. DATE:
/
72-008 (Rev. 4/85)
_D PLAC ~_
k;,: MUNICIPALITY OF ANCHORAGE
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
~AME
MAILING ADDRESS
LEGALDESCRIPTIF~-'~ ~ ?
LOCATION
DISTANCE i Well Absorption area
TO: ~;~' ? ' '
Manufacturer
L q. capac ty Inside length
IF HOMEMADE:
Well
DISTANCE TO:
Manufacturer
Wel~
DISTANCE TO: //(_~c,!¢ n~/
No. of lines / Length of
Top of tile to finish rade
Length Width
PHONE
Dwelling ~'/--')
Material p.~-~
IWidth
[~NEW
[] UPGRADE
Dwelling
Material
Foundation/,o (-f' Nearest lot lin,~O_ /
Trench width
Total length of lin.e~ ~/ :A~ ~-inches
Material beneath tile
(.,/)~[pt~?/, inches
Depth
NO'OF BEDRO~MS_i.~
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines ~///~.¢. r
Total effective absorption area
PERMIT NO,
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO,
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s}
OTHER
PiPE MATERIALS
SOIL TEST RATING
¥~TER rtl L A[COAO
r. rtlllrg Permit NO.
~dr.m .P.O. ~ox
S~rHt ~drefl Ind Aree o[ Veil L~itl~
~r~ice CNletl~
Grvl-Glay ~ ~?- &. ustx;~,ctc ~P,bltc Su~ly Oldultry
tla~ and' Si],t 10' J. i9 .... :'
Cl~ ~>~ ~d . L ' ' '
Orvl 'iDb ZSD FINISH OF ~L; -. ·
'
I ,
, - te.gth of O~ PIN
..... ' [rive sho~ ~. 590 ft.
~TER ~LL CONTRACTOR'S CERTIFICATION:
This ~ll ~ drlll~ under ~ Ju~sdlctl~ e~d this re~rt Is true to t~ ~t of ~ k~l~ end belief:
~::, ?~; ,:', ....:yj :::, q ::
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April 18, 1979 R&M No. 951111
Mr. Don Zimmerman, Jr.
P.O. Box 396
Eagle River, Alaska 99557
Subject: Soil Investigation for Sanitary Sewer System, Lot 8,
Pruess Subdivision, Eagle River, Alaska
Dear Mr. Zimmerman :
Block 7,
At your request of April 17, 1979, we conducted a subsurface soils investi-
gation at the proposed location of the sanitary sewer system on the subject
lot. The investigation complied with those procedures required by the
Municipality of Anchorage Department of Health and Envirorm~ental Protection.
This investigation, which was accomplished on April 17, 1979, consisted of a
test pit excavated to a depth of 14 feet below the existing ground surface.
The test pit was sited according to your instructions and its location is
shown in attached Drawing A-01. Excavation was accomplished with a backhoe.
Ail material excavated was continuously monitored by an experienced
engineering geologist.
The topography at the excavation site is generally horizontal. At the time
of the investigation the site had original vegetation consisting of aspen and
birch trees. The top of the test hole was located at original ground
surface.
The soils encountered in the excavation are shown in the test hole log in
Drawing A-0]. This log displays specific conditions encountered at the test
location. However, subsurface conditions may vary in other parts of the lot
without any apparent surficial evidence of the change. Groundwater was not
encountered and bedrock was not encountered. At the time the hole was
excavated seasonal frost was not present and permafrost was not encountered.
We appreciated this opportunity to be of service to you. Please contact us
if you have any questions concerning this letter or if we can be of addi-
tional service.
Very truly yours,
R&M CONSULTANTS, INC.
Ernest R. Rahaim
Staff Geologist
GS/rm/12-U
ANCHORAGE FAIRBANKS JUNEAU VALDEZ WA$1LLA ~'
'BORING NUMBER 3 Dafe Completed: 4.17.79
SOIL DESCRIPTION
'IC MATERIAL ..... 25'
SILT W/TRACE ORGANICS 1'
SANDY GRAVEL, GW
Numerous Cobbles
14'T.D.
LOCATION SKETCH
No Scole
Lucas
Test Pit 3
2'~ ~ 100'
10'
NOTE: Di$TANCES SHOWN ARE APPROXIMATE AND HAVE
NOT BEEN MEASURED BY SURVEYING METHODS.
EXPLANATION
~ ORGANIC MATERIAL
~;~ "' Little Visible Ice O:10' Vx
-- ~:~.~ ~ A.B. ~/CE DESCRIPTION
~ ~Ss 72,5Z1°/o 85.9pcf
,s.~: I I ~WATEN COGENT
~ BEDROCK
~ FROZEN GROUND W,O.-WNILE DRILLING
TYPICAL SOILS LOG I
Ss Z4 "SP£1T SPOON WI~'N /40£~ HAMMER
SAMPLER TYPE SYMBOLS I
~ SILT' ~ BFDROCK
~ SAND B/CE. MASSIVE
SOIL SYMBOLS
Lot 8, Block 7
Pruess Subdivision
Eagle River, Alaska
GRID.
PROd. NO.
DWG.NO.
OF TRANSMITTAL
ANCHORAGE OFFICE
P.O. BOX 6087, ANCHORAGE, ALASKA 99502 TEL,
(907)
279-0483
FAIRBANKS OFFICE
[] P.O. BOX 2630, FAIRBANKS, ALASKA 99701
JUNEAU OFFICE
[] P. O. BOX 1786, JUNEAU, ALASKA 99801
WASI LLA OFFICE
[] P,O, BOX 1240~ WASILLA~ ALASKA 99607
TEL. (907) 452-1655
TEL. (907) 586-6342
TEL. (907) 376-5288
GENTLEMEN: WE ARE SENDING YOU
PI~ Attached
[] Under separate cover via
ATTENTION L}'~H },,,)E- L.L/~,I ~'~ ~=~
the following items:
[] Shop drawings [] Prints
[] Plans [] Samples
[] Specifications [] Copy of letter
[] Change order
[] Other
THESE ARE TRANSMITTED as checked below:
[] For approval [] Approved as submitted [] Resubmit copies for approval
[] For your use [] Approved as noted [] Submit copies for distribution
[] As requested [] Returned for corrections [] Return ~ corrected prints
[] For review and comment [] .
[] FOR BIOS DUE 19 [] PRINTS RETURNED AFTER LOAN TO US
If enclosures are ~t as no~ed, kindly notify us at once.
002650
June 27, 1979
Don Zimmerman, Jr.
P.O. Box 396
Eagle River, Alaska
99557
DEPT. ur · ......
ENVIRONMENIAL p[;OIECq'ION
JUL 1 5 197'3 R&M No. 951201
Re: Soil Investigation for Sanitary Sewer System, Lot 8,
Subdivision, Eagle River, Alaskal
Dear Mr. Zimmerman:
Block 7, Pruess
On June 26, 1979 we conducted an inspection and percolation test at the above
referenced project site. Our observations and test results are contained
herein.
At the time of this investigation a hole had been excavated for placement of
septic tank and leach field. The leach field was approximately 14 feet in
depth.
The soils encountered in the investigation at the location of the percolation
test (adjacent to the septic tank) consisted of a sandy gravel with trace
silt and occasional cobble from the surface to four feet in depth. Beneath
this layer a well-graded sand with trace silt and trace to some gravel and
occasional cobble was encountered to the total depth of excavaton at 9.5 feet
(see Drawing A-01).
A percolation test was performed within a secondary hole at the base of the
excavation and extended from 9.5 feet to 11.5 feet in depth. The data in
Table 1 contains the average infiltration from the depths indicated to the
bottom of the hole. The measured percolation rate was 19 minutes per inch.
We appreciate this opportunity to be of service to you. Please contact us if
you have any questions concerning this letter or if we can be of additional
service to you.
Very truly yours,
R&MCONSULTANTS, INq.:
Michael C. Hartley
Geotechnical Engineer
MCH:JMB/dj/L4-H
Jim McCaslin Brown
Senior Geologist
July 6, 1979 R&IVl No. 951201
Don Zimmerman, Jr.
P.O. Box 396
Eagle River, Alaska 99557
Re: Soil Investigation for Sanitary Sewer System,
Subdivision, Eagle River, Alaska.
Lot 8,
Block 7, Pruess
Dear Mr. Zimmerman:
This letter is submitted as a supplement to our report on the subject
property dated June 27, 1979.
On the basis of a site investigation this date, the following additional
information is provided per the request of the Municipality of Anchorage,
Department of Sanitation.
1. No groundwater was noted in the trench excavation to a total
depth of 15 feet.
2. A percolation test was performed earlier in the material shown on
the soils log from a depth of 4 feet to 9.5 feet. This material was
noted to extend to a depth of 15 feet at the point investigated and
appears to be fairly uniform throughout the length of the trench.
We appreciate this opportunity to be of service to you. Please contact us if
you have any questions concerning this letter or if we can be of additional
service to you.
Very truly yours,
R&M///CONSU LTAi~ITS, INC.
Gary ~. Smith
Senior/Geologist
GAS/rm/L2-V
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH &'HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Lot 81
Block.~7,i~ Preuss Subdivision #4
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Walt Huffman
10210 Ronald Place
Day phone
Eaql~ River, AK 99577
694-6565
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.,
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XXX
/f 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
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~a~°4 Phone ~
Address .i!'~le
Engineer's signature Date
DHHS SIGNATURE
~ Approved' for i.~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
By:
Additional Comments
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 DH HS 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.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~aE-~ ~ ~~ Parcel I.D.
A. Well Data
Well type'"~ ,
Log preser~N) '~/
Total depth ~) Cased to
Sanitary sea~/N)
FROM WELL LOG
Date of test
/
Static water level
Well flow
Pump level1
If A, B, or C, attach ADEC letter. ADEC water system number ~/-'~' . ,
Date completed ~:¥-f'~ Driller ~7~,- ~ ~ ['~
g.p.m,
:::~) / Casing height
Wires properly protecte¢/N)
AT INSPECTION MUNICIPALITY OF ANCHORAGE
oct
g' [CRIVRD
SEPARATION DISTANCES FROM WELL TO:
/
Septic/holding tank on lot /'~=~
/
Absorption field on lot
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~
Date of sample:
Nitrate
~:~. 2 ~/~/'~- Other bacteria
Collected by: ~ ~ ~
B. SEPTIC/HOLDING TANK DATA
Date installed ~'/::~! ~.-'~
Cleanouts N/
High water alarm (Y/~
Date of pumping
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:' '
Tank size l ~ ~'/~4...~- Compartments ~
Depression
F°undati°n clean°ut~/N)Alarm '~ted (Y/N)[es ~--~/~' (Y/~) '/~
Pumper ),..)~---'//--~ ~ ~
Well(s) on lot Iz~'~I On adjacent lots I~:) '-Jr"- Foundation
To property line ~ Absorption field Water main/service line
Surface water/drainage I ~ { ''Ir''''
[o
CONTINUED ON BACK PAGE
72-026 (3/93)* Front
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA codes (Y/~....~
electrical
SEPARATION DISTANCE~M LIFT STATION TO:
Well on lot,/'/" On adjacent lots
D. ABSORPTION FIELD DATA
Date installed
Length } (~ / Width "~/
Total absorption area /~ ~
Date of adequacy test /,,~/CA- .
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y~))
Manuf~
M,j~Rt'C'ole/Access (Y/N)
"Pump off" Level at
Cycles tested
Surface water
Soil rating (GPD/Ft2) 4:~, ~ System type'~
Gravel thicknessr ~ / Total depth /E2 ~- /~ /
Cleanout presen~N)%/ Depression over field (Y/~ ~
Results (pass/fail) ikl,~u. ) ~'~'~for ~ Bedrooms
Aftertest
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot I(~ I / On adjacent lots I ~ I ~ Property line
To building foundation ,¢~¢'~ To existing or abandoned system on lot
On adjacent lots '~ '---~-'-'- Cutbank t,.._l ~ ~' Water main/service line
Surface water I (~/~.._ Driveway, parking/vehicle storage area
Curtain drain h.~---- ·
E. ENGINEER'S CERTIFICATION
Iced/fy that lhave checked, verified,~pfo~to all MOA and HAA
Signature /~~~-
Engineer's Name //~__.~_
Eagle River, Alaska
HAA Fee $
guidelines in effect on the date of this inspection.
Date of Payment /0- i(- ~ ~,
Receipt Number :_~d._~ ~cL~.)
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
,'~qUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264=4720
Application Date _2/~/4~-~'~'
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township..~ range)
Location (address or directions) ~ / { ~ q
(b) Applicant Name -- v~.~ /¢~ Teleph~e: Home B.siness ~
Applicant Address~ ~ ~ ~/¢~
(c) Applicant is (check one): Lending institution ~; Owner/builder ~; Buyer ~; Other~ (explain);
(d) Lendinglnstitution /~¢*,~ ~d¢¢ ~;%ne
Address ~.~¢~ O~ /.
(e) Real Estate Company and Agent ~¢¢~ ~//¢~¢*~ /~ ~ ~
Address %'~ ~¢
Telephone ~ ¢¢~ ~~
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Singte-Farnily,¢~ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well,~, Community [] Public
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. ~,
SEWAGE DISPOSAL
Onsite~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84}
'
ENGINEERING FIRM 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. 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 /,~ ,~
Address ~. _. ~
Date ~J~
Telephone
Approved for '-'/"/"'f"c-c¢~]bedrooms by
Approved )~ Disapproved Conditional
Terms of Conditional Approval
Date
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
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: L,~--t~. ~'~
Well Classification
Well Log Present4~'N)
Total Depth ~O ~
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit(~N)
Separation Distances from Well:
To Septic/I-I~ Tank on Lot
Cased to '~(-~,O
Date Completed ~- z~r -~7'~ Yield
Depth of Grouting '--~
Pump Set At ~ ,eL,,
Sanitary Seal on Casing(.~N)
Depression Around Wellhead (Y~)
~"~ ~ ; On Adjoining Lots
IfA, B, C, D.E.C. Approved (Y/N) i,..~/~
, _%' ~p~-4 4-
To Nearest Edge of Absorption Field on Lot L~::> ; On Adjoining Lots
To Nearest Public Sewer Line t")/~r To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ~ ~ ~-~ I~ ; Date q ~ ~ ~ ~
Water Sample Test Results ~/~~~~
Co m m e n ts ~ ~ ~ ~¢ ~~ % ~~' I ~
B. SEPTIC/PFeEDING TANK DATA
Date Installed '''~- ~
Standpipes
Depression over Tank
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/444~4¢i,qg-Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line ~, ~ ~ 4-
Course ¢~ /)~'
Size ~, ~ No. of Compartments
Air-tight Caps ~IN) Foundation Cleanout (Y/~_
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84) _
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata '~ '~"'~ ¢ / ~ Type of System Design
Date Installed "~ ~ ~ ~ -~¢'~t Length of Field ~.z.~.4~,
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/,~
Results of Last Adequacy Test
Separation Distance from Absorption Field: f
Depth of Field
Gravel Bed Thickness '""""'
Standpipes Present ~N)
Date of Last Adequacy Test
To Water-Supply Well
To Buildin9 Foundation
Lot
To Water Main/Service Line ~, ~ ~ 4-
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line ~. ~ I..W
To Existing or Abandoned System on
; On Adjoining Lots "2-~- C;'~"~
T9 Cutbank (if present) z*'~/~N'
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
Manhole/Access (Y/N)
. ]"Pump Off" Level at
I~ /A Vent (Y/N)
/¢ Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Sinned ~ ~ ~ ~E%~611~E~[[~(~- Date
Compafiy;, ,~L~ ~'[VER, A~S~ ~9~ MOA No.
Receipt No,
Date of Payment ~%'
Amount: $ ~
Page 2 of 2
72-026 (ll/84)
POUCH 6-650
ANCHORAGE, ALASKA 99502-0650
(9O7) 264-4111
TONY KNOWLES.
MA YOR
DEPARTMENT OF HEALTI-t AND ENVIRONMENTAL PROTECTION
August 15, 1985
Mr. Robert Shafer
S & S Engineering
SRB 196X
Eagle River, Alaska
99577
Subject: Lot 8 Block 7 Preuss Subdivision ~4
Dear Mr. Shafer;
The request for a waiver to 87 feet from the well to the
septic tank on the subject lot has been approved. The
waiver is valid for a three bedroom single family dwelling
onlyo
Sincerely,
Susan E. Oswalt
Acting Program Manager
On-site Services
SEO/pah
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
SYSTEM DESIGN
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
',UL 2 9 1985
RECEIVED
ROBERTA. SHAFER
July 27, 1985
CIVIL ENGINEER
694-2979
Municipality of Anchorage
Department of Health and Environmental Protection
825 L Street
Anchorage, Alaska....._~?~!
~t 8; BlO~"7; Preuss Subdivision ~4
REFERENCE:
Request you issue the attached Health Authority Approval
and approve a waiver for the existing septic tank
located 87 feet from the private well on the referenced
property.
The existing on-site waste water disposal system
was installed in July 1979 under MOA permit #790117
and was inspected by the MOA. A waiver of 87 feet
was granted by the MOA at that time.
It is our opinion that the horizontal separation
distances prescribed by 18AAC72.021 are not required
in this case. The existing well is 390 feet in depth
and extends through many layers of clay from 65 feet
toyOTa fret. The stoic water level is approximately
247 feet from the surface. The topography in the
~rea is such that surface flows, if any, would not
be in the direction of the well.
Included for your review in addition to the Health
Authority Application are the following documents:
A. A copy of your approval dated August 11,
1982
B. Copy of the well log
C. A recent coliform bacteria analysis showing
satisfactory results
D. Copy of MOA permit and inspection report
If you require additional information, please contact
us.
RAS/ss
SRB 196X EAGLE RIVER, ALASKA 99577
DATE RECEIVED
INSPECTION APPOINTMENTS
TIM~ TIME TIME
INSPECTOR_ , ~ INSPECTOR INSPECTOR
MUNICIPALIT~ OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF H~ALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~RONMENTAL P~OTECTION
825 L Street - Anchorage, Alaska 99501
DEC 2 0 1979
ENVIRONMENTAL SANITATION BIVlSION
RECEIVED
~EQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1, incomplete requests will not be processed. Please allo~ ten (10) days for processing.
1. . c - , PHC
MAI LING ADDRESS ~ - ~
PROPERTY RESIDENT (If difCerent from a~ve) ' PRONE
3. LENDING INSTITUTION/ ' ~ % . ~ . ~ . I P~gN[ . ~
MAILINGADDRESS ~~ ¢ /// f~~
5. LEGAL [)~'~CRIPTION~ - , ¢ , ~
TR E E'~ LO'QTAT~ O ~ -- - .
i. TYPE'O~ RESIDENC'~"~ NUMBER OF~BEDROOMS
[] One [] Four
[~/S!NGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [~ Three [] Six
[] Other
7. WATER SUPPLY
[~INDIVIDUAL~
[] COMMUNITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
' '~]~'j N D I V I D UA L/ON-SIT E**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) 1
Property Owner
AppLiQ T FILLSOUT UPPER HAL ,,¢NLY
Bu~ter
Zip Code ~'~ ~77
tPhone
Address Zip Code
Lending Institution /ky/~'~O/'Y'/'/'/~ L, ~/Qi/,,J/~. ~)../--" ~j~,~j~ Phone
Address ~OJ~ ~ ~~ Zip Code
RealtyCo.&A~nt ~ ~E ~JJ~ ~/~)V~'/ ~ ~ Phone
Legal Description L~S ~ Z ~~ ~
Street Locati~ ~O'~ ~. - "
Zip Code
Type of Residence
Single Family
Multiple Family No. of Bedrooms
[] Other
Water Supply
~ Individual AITACH WELL LOG. A we~l log is required for all wells drilled since June 1975.
[] Community For wells drilled prior to that date, give well depth (attach log if available).
[] Public Utility
Sewer Disposal ,~ Individual
[] Public Utility
[] Holding Tank
Year Individual Installed: !
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
.~.~~ ~. ~,~(~ Date Date Date
Inspector Inspector Inspector Inspector
( ~ APPROVED BEDROO~ *CONDITIONS OF APPROVAL
( t ) DISAPPROVED
Soils Rating Date ~wer Installed Well To Absorption Area ~ ~O z~ - Well Log Received
I ~ ~ -- I ~- ~? WelltoTank ~ '? Septic T~k Size
72-023 (3182)
