HomeMy WebLinkAboutPREUSS #3 BLK 11 LT 10
MUNICIPALITY OF ANCHORAGE
\ 'Al C t
On -Site Water & Wastewater Program
�\lPO Box 196650 4700 Elmore Road ` f%• .
% Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
�\ l http://www.muni.org/onsite
— � DepaI- rtnent
�rCHOR PGF.
On -Site Wastewater Disposal System Permit
Permit Number: OSP221012 Effective Date: 6/9/2022
Work Type: Septic Upgrade Expiration Date: 6/9/2023
Tax Code Number: 05057225000
Site Legal Address: PREUSS #3 BLK 11 LT 10 G:0056
Site Mailing Address: 20745 LUCAS AVE, Eagle River
Owner: FORWARD PAUL W & DONNA G Lot Size in Sq Ft: 22697
Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
Q Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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
Received B)
Issued By:
Date:
6/9/22
Date: / Z
- ntcnt S'
Municipality of Anchorage X
Department
P.O. Box 196650 e 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Proqram
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV221005 COSA#: Permit#:OSP221012
PID#: 050-572-25
Legal Description: PREUSS #3 BILK 11 LT 10
Engineer: North Rim Engineering
Your request for a waiver of the required 10 feet horizontal separation from the absorption field to
the property line has been approved. The approved separation distance is 1.0 foot.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
Waiver is Granted: X Waiver is not Granted:
Date: ('5 , /9 12—Z Approved by: lit/v�cl�t�
Name of Reviewfer�
**** VARIAN C E/WAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
. . I
Development Services Department 1
P P 4� --- j Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 050-572-25
Property owner(s) FORWARD PAUL W & DONNA G
Mailing address 20745 Lucas Ave
Site address same
Day phone 696-3976
Legal description (Sub'd., Block & Lot) PREUSS #3 BLK 11 LT 10
Legal description (Township, Range & Section)
Lot Size 22,697 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑ Initial ❑
Single Family (SF) 0
Septic Tank
Upgrade E
(w/wo AD U)
Holding Tank
❑ Renewal ❑
Duplex (D) El
Privy
❑
Multiple Dwellings ❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A WAIVER REQUEST FOR:
Lot Line
Distance:l
I certify that the above information is correct
applicable Municipal Codes.
(Signature of property owner or authorized
Permit/Rush Fees: 5G 5
Date of Payment: 11a6h 2
Receipt Number: 03`195 D
Permit No. OSPZ.Z/OIZ
I further certify that this is in accordance with
Waiver Fees: A2 25
Date of Payment: -,-n -I e
Receipt Number:
Waiver No. 0 2 (12 z I oo S
GADevelopment Services\Building Safety\On Site Water and WastewatefformslClient FormsTermit Application.doc
SteveEng.com
Steve Eng, PE, PH
907-694-7028
SteveEngPE@gmail.com
Date: 6/8/22 Number of Pages:
To: MOA On-Site Services
Subject: Preuss #3 Block 11 Lot 10
Septic System Upgrade
The owner desires to upgrade the septic system. The existing septic system is 40-years old and
still functioning, but best if replaced. A new soil test was recently completed which will require a
STEP system due to the presence of groundwater monitored in May. No bedrock was discovered
in the test hole or nearby water wells.
The design calls for a new trench and a new STEP tank. The existing trench is to be
decommissioned due to the groundwater recently discovered by the new test hole. Slopes and
easements are depicted on the drawing. The terrain is generally a flat slope at the trench site, and
sloping toward the south. The system design size is a single family at 4 bedrooms.
The trench will require a lot line waiver due to presence of groundwater in the test hole. The 50
trench is squeezed between some fruit trees on the east and the lot line to the west. The owner
does not want to cut into the hill with the fruit trees. The superior soil in the trench will allow
good percolation/treatment. I walked the entire area with the owner of Lot 10 and the neighbor
on the west. We discussed our plans as we looked for wells in the area. No wells are impacted by
this lot line waiver. The neighbor’s septic system is on the other side of the lot from the lot line
waiver, so will not affect it. Nothing substantial exists along this lot line that can be impacted.
Please review the wastewater system design for the existing single family home. I have included
design plans & specs, design guidelines, & soil test. If there is need for additional information or
clarification please give me a call.
Thanks-Steve
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221012, Deb Wockenfuss, 06/09/22
SteveEng.com Preuss #3 B11 L10
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 4-bedroom, single family home. This is a
developed subdivision. A new trench is planned + new 1500 gallon STEP tank. The
existing trench to be decommissioned. No adverse impacts are expected from trench/tank
upgrade. No conflicts to the other lots will take place by this septic system construction
upgrade. A new soil test reveals SM w/gravel. An application rate of 1.2 GPD/FT².
Trench Length = 500 FT²/5x 2 = 50 trench, 5 effective. A new 1500 gallon STEP tank
will be installed; Decommission old tank per UPC. Easements depicted in the area, public
water serves these lots. Lot line waiver to 1 requested due to limited area; no water wells
are in the area, the soil percolates well. 7 trench depth requested due to recent soil test.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
New 1500 Gallon STEP tank. MOA-Approved.
Decommission old tank per UPC. MOA-Spec Material Under Tank.
10 minimum between the tank trench, tank to house. 10 to property lines,
3 of cover or insulation is required for trench; 2 Minimum thickness for insulation
can substitute for 1 cover.
Tank & solid pipe must be set on well compacted, stable soil.
4 inch diameter cleanouts with airtight caps are required 1 to 4 from foundation
wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two
adjacent opposing cleanouts between the tank and the absorption field, not more than
10 from the tank positioned to provide cleanout access towards the tank and towards
the absorption field.
All cleanouts must extend to at least ground level.
In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
Trench to be placed level, minimum of 4 to groundwater, 6 to bedrock.
Drain rock to be ½ to 2 screened, distributed uniformly throughout the trench.
Force main to be 1.25 Schedule 40 PVC or equal.
Distribution pipe to be 1.25 Schedule 40 PVC w/ 1/8 orifice @ 12 on-center.
Silt barrier (filter fabric) to be installed above the drain rock.
Smeared trench sides must be raked or scarified before drain rock placement.
The finish grade must be mounded to promote drainage away from trench.
Insulation must be placed over any pipe installed under driveways or parking areas.
Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
Sewer Service Line is minimum 2% slope.
Septic Tank to be pumped every two years or when required.
Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221012, Deb Wockenfuss, 06/09/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221012, Deb Wockenfuss, 06/09/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221012, Deb Wockenfuss, 06/09/22
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Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221012, Deb Wockenfuss, 06/09/22
",~,~, 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
PHONE
MAILING ADDRESS [] UPGRADE
LEGAL DESCRIPTION
] Well t Absorption
DISTANCE TO: ] /~ ~ area , I Dwelling PERMIT NO.
~ ~ ~a. ~f compartment~
Liq~a~ti~igallons IF HOMEMADE: Inside length Width ~ Liquid d~pth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO,
~ Well f Foundation Nearest lot line PERMIT NO.
,o. of lin~s Length b~,
Tot~ I~gth ~f li~ Trench
_ wi~ Distance
~nches
~ ~ ~ Top of tile to finish grade Material beneath tile
Length Width Depth PERMIT NO.
~ ~ Type /°f cr/ Crib .~-Cri~h~ Total effective ab
~ DISTANCE TO: Building foundation Sewer Pine Septic tank Absorption area(s) '
OTHER
PIPE MATERIALS
SOl L TEST RATING ~
.... .
-~., ~, ,: ,~,,
APPROVED . DATE LEGAL
/
FERMI] NO.
DEPRRTMENT ,~,, HERLTH RND ENVIRONMENTRL ,., ,.d]TECTION
· L-iL?Pi '"1 '" STREET, FINCHORRGE, FfK. Z-':r_='.5E~±
~Z~NI--S 1. 1-El ~.'-;E~.--~EF~" F"EF4:~.I 1. T
,' 9±0±9? )
HF F L t _.HNT
L -]:RTION
LEGRL
LINDR F RF..F.._R
EFtGLE R I ',,,'ER
L±O B'l,± c'F~'=ll"",- -.
57±4 PRUESS LRNE
LOT
:, .. ,~:E
F FF' OF z, JIL RE:SORPTION '- .... IS
-, T_-,TEH : TRENCH
- I
MH,:.~ItlJM NUMBER OF BEr)RCnMS = 4
SOIL RRTING (SL.'.! FT,- BR:: = ±4E~
THE RE6!UIRED SIZE OF THE SOIL RBz, JF..FI"-C 'IUN- S'¢STEM IS :
[- EF TH-- 1~2~ I__[--_"~'-~(]~T~-~= .4- ,--:=" ~.3F-:F't'..."EL. [:.EiF"TH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF' R TRENCH OR PIT IS THE DI~TRNCE BE'F~4EEN THE SURFFICE OF THE
GROUND RND '['FIE BOTTOM OF THE E:qCFI'v'RTION <IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRB',/EL DEPTH IS THE MINIMUM DEPTH OF GRR'./EL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
F-: f£ L----_~ Et 1. F..:F_: [::.-, 25EF"T 1. E: TRt'-.It-( '_:3 I ZE= :ii_ 2 5~2-1
F'ERMIT RPF'LICRNT HRS THE RESPONSIBILIT'T' TO INFFIRM THIS DEPRRTMENT C, URING THE
INSTRLLRTION IN_-,FE..TIONS'-' P nF_ RN'¢ WELLS RDJRCENT TO THI'E. FR_FERT.~''tR' ' "RND THE
NUHBER OF RESIDENCES THRT THE WELL WILL SERVE.
l'_E.~,:) .:: ;:2 ::, I ~'-~_c. PEL-: l- 1. ~:,}'-~}$ F~ F..:E F-:E L---..~I_, 1'
BRCKFILL!NG OF FIN'T' '-'"- ' '-' t .... ¢,P~,r-;,i'~,,,,¢,/ B~' THIS
_-,T.:,TEfl ~4ITHOUT FINRL IN=.FE_.'fIUN RND ...........
F~EF'RRTMENT WILL E:E --;UBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETNEEN R WELL. RND RNY ON-SITE SE~qRGE DISPOSFIL S'¢STEM IS
:100 FEET FOR ~ PRIVRTE NELL OR '150 TO 200 FEET FROM FI PUBLIC WELL DEPENDING
UF'ON THE T'¢PE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM FI PRIVRTE ~4ELL TO R PRI'v'FITE SEWER LINE IS 25 FEET RND
TO R COMMUNIT'¢ SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MFI'¢ RPPL'¢. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVFIILFIBL. E TO INSURE PROPER INSTRLLFtTION.
F E~4-..r 1 1' T' E.::-=:F" 1' F-: .E.-]":-': [:.EL-t-E f. IE:EEF-: 2:::fL.. tgE::t
! CERTIF"r' THFIT
±: I RM FRMILIRF.: WITH THE REI2UIREMENTS FOR ON-SITE SEWERS RND 1.4ELLS RS SET
FORTH B~" THE MUNICIPRLIT'¢ OF RN]HORRGE.
2: I WILL INz, IHL_ THE ~'¢STEM IN RCCCRDRNCE WITH THE CC[,ES
2::_f LINDERSTRND THR'F THE ON-'~ITE_ SEWER S~'STEM MR'T' RE6,LIRE ENLRRaEMENT' 'P IF THE
RESIDENCE IS REMODELED TO INCLU[:,E MORE THRN 4 BEDROOM'5.
__ _ _ ............... ._
RF'F'L IE:RNT L Z NDR F NRF..ER
',,,'4. 0
........ ...............
~ .-~ O & E EN.,L,~:~NEERiNG & DEVELO.,,~'MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774
Earl Ellis
688-2280
~.~IL LOG
Performed for: Name: /-- i/,J/P~ ~_.~' ~:~C---~ . Tel. NO
Legal Description: ~-~-~- /~ ~'~'~ [ / ~'~,L~-'-/~/..~5~-
Depth (feet)
Soil Characteristics
5__
6__
7__
8__
9__
-.~.---~10 __
I
PLOT PLAN
PERC. TEST
14__
15__
16__
Ground Water Encountered: Yes
No If yes, what depth
Proposed Installation: Seepage Pit
Drain Field
Comments:
Performed by'~~'~*~'~ % ~
Dato: ~,dg~/~
PERMIT NO.
DEPFIRTMENT C" HEALTH AND ENVIRONMENTAL =-"OTECTtON
":'""'.~ '"L~J STREET., ANEHORAGr-", Itl-.'.:.
264-472F.~
I-.~E[_L F' EE~:: ~-1 I -l-
RF'PL I CRNT
LOCRT I ON
LEGRL
LIN[.',A FHRKEF.. .~714 ~'C'~l I'-'-
_ ...... ~..=,.=, LANE ~La- '- ._,'~-~,. ,.
LUCRS _.IF..EET
L i0 B ii PRELl=,.=, =,UE, C I,, I=,IUN LOT SIZE
20000 SQURF.:E FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM A 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 R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS
OF THE WELL COMPLETION.
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 RS SET
FORTH BM THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
SIGNED:_
APPLIC:RNT LINDR PARKER
t SSLIE[:, BY____
V4. 0
· ~.. Department ~, Health and Environmental rotection
~ ~ 825 Street, ~chorage, AK. '~501
264-4720
· * * HANDWRITTEN PERMIT * * *
~ ~~'N~E~R PERMIT
Applicant: L,~J~ ~~a Mailing Address: ~ ~ ~ ~U~S L~.
Location: ST~ ?~eUSs L~ PhOne Nu~er:
escr t o :
Type of Soil ~sorption System Is: ~
Trench: Drainfield: Seepage Bed: Holding Tank
Maxim~ N~ber of Bedrooms: ...~ Soil. Ra~ing(sq~ ft/br)
The Required- Size of.the SOil ~sorption. System
DEPTH LENGTH
GRAVEL DEPTH
WIDTH
The length dimension is the lenqth(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(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).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS * *
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. ·
* * * TWO(2.) INSPECTIONS ARE REQUIRED * * *
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 ~elI or 150 to 200 feet from a 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 is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 1 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
Signed: Issued by: '~//~"~
Applicant / ~3--
Date:
SWP/024 (1/81)
tx~ch or ~iL is the distance ~%ween Lhe surfa0e of the Oread and
~epth ~ the ~~ de~h 0f ~r~vel ~twe~n the outfall ~i~ and
of the excavation(in feet),
REQUIRED SEPTIC(HO~ING) TANK Sl2~ = ~LL~S ~ ~
4istahce be~ n ~ell <~ ~ny om-alee $e~a~e dis~al syst~ is 100
forth by t~ ~ioipality of ~o~rage. :
( er¼fie rilli g
by
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759
OWNER OF LAND
ADDRESS ~'~ '7'. ,
LEGAL DESCRIPTION
DATE - Started ~ .'
PERMIT NUMBER
DEPTH OF WELL ~/~/~
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GA . PER .R
KIND OF CASING
KIND OF FORMATION:
From ~; Ft. to c.~ Ft;
From ~ Ft. to (-,! ~ Ft.
From ~' ~ Ft. to ~i', i~ Ft.
From , :? i~ Ft. to "'? ~:'~ Ft.
From :::' Ft. to / / o Ft.
From Ft. to.~Ft.
..... h)
From. .,',,:i; Ft. to ¢ ),:s Ft.
From .'? ~' Ft. to /?O Ft.
From :'~ ~) Ft. to~tOd Ft.
From__.Ft. to Ft.
From ; %/ Ft. to--Ft.
From Ft. to Ft
From :, ", Ft. to ~"-' ~ c~ Ft.
From ~ "~;'Ft. to c~'TA' ~,~ Ft.
From ~:~ ': Ft. to.~ :)~,,¥ Ft
From
From
From
From
From
From ;: ? Ft. to ,)'~7'.,)Ft. 'g ~'
~ ;,t:~?,~" ,~'/<
From ',': .: Ft. to ,7i~ };' Ft..i'~;SzP/eo</~:
From :~O,¢"~ t~Ft. to
From Ft. to.__
From ,:,/o Ft. to
From ~ ~'r~ Ft. to
From Ft. to
From___ Ft. to
From ~i'.~'¥? Ft. to
From "~OO Ft. to
From__Ft. to
From "It~ Ft. to .
From Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
Ft to__
Ft. to
Ft,
Ft,
Ft.
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__Ft
Ft
MISCL. INFORMATION: · ,:, /' .
DRILLER'S NAME
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot; block, subdivision, section, township, range)
Lot 10; Block 11; Preuss Subdivision ¢3
Location (address or directions)
20745 Lucas Street
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
Lynda Frank
20745 Lucas S~reet,
Telephone:(home)
EaRle River, Ak. 99577
Telephone
-Business
(d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER ATTN: Eva Loken
Address 16600 Centerfield Drive Suite 201 Eagle River, Ak. 99577
T~lephone 694-4200
(e) Mail'the HAA to the following address: (or check herej~zif hold for pick up.)
List con~act person and day phone number below:
~,.'z03-!. E=~!e P.!¥e? L_,:-o_p P.o_~_-I .~!_c-. 204
Eagle River, Alaska 9957?
2. TYPE OF RESIDENCE
Single-Family ~ 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 th legality and status.
SEWAGE DISPOSAL
On-site~;~. 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 (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. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm $ & S ENGINEERING Telephone ~ ~'*'/g~' ~¢"~ '~
17034 Eagle River Loop Road No. 204
Address Eagle RJYer, AJask:a 995?7
Date
6. DHHS APPROVAL
Approved for ,Z// bedrooms by
Approved ~ _:Disapproved
Terms of Conditior~ai, Approval
Conditional
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, 7/88) Back
page 2 of 2
WELL DATA
Well Classification
Well Log Present (Y/N) Date Completed
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELl_:
To Septic/Holding Tank on Lot .~O /-
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
MUNICIPALITY OF ANCHORAGE (MOA)
.,l~e~ltb,.A0thority Approval (HAA)
~t~]~..,~KI~IS~T- FEBRUARy 1984
~AL SE~ 343-4744 '
Depth of Grouting
Legal Description: ? ~'/- ( O; g loc-I</
If A, B, C, D.E.C. Approved (Y/N) ~
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots 2-
To Nearest Public Sewer Cleanout/Manhole
; Date
SEPTIC/HOLDING TANK DATA
Date Installed ~.~,2~Size ! ~-_'3'-0~.*1 No. of Compartments
Standpipes (Y/N) t,~ Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ~/~
Foundation Cleanout (Y/N)
Date Last Pumped (~ ~ ~ ~ ~ ~ O
Temporary Holding Tank Permit (Y/N) ~J )//4.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line
To water Main/Service Line
To Building Foundation
To Disposal Field
To Stream, Pond, Lake or Major Drainage Course /~/.~.
Comments ~.~ ~ .~.;~ ~, N~ ~ d~C~ ~ __~ ,~'-'~. '~' ~~oo/
72-028 (Rev. 7/88) Front Page 1 of 2
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area .~ ~- (O ¢
Depression over Field (Y/N) t,J
Type of System Design
Length of Field
/
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
2_4:)0
To Water-Supply Well
To Building Foundation /
Lot h.}
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~)~
To Cutback (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N) ~
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines i _n~eC~?~i:~'~,H~e date of'this
inspection. ~.. ,.~ ,,~]~-~,~ ~~.~.~
Company ~., ~/;~-'% ~ ~
Receipt No. ~/¢~ ¢ / E~ Receipt No.
Date of Payment ~" ~-~ ~ X~ Waiver Fee: $
Amount: $ / ~ ¢O-() Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
· .,. .... D/~-.,:~'RECEIVED
', iNSPECTION APPOINTMENTS
'~TiM E~ TIME TIME
DATE DATE DATE
NSPECTOR INSPECTOR I NSPECTOh
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~IRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501 ~ Q ,
ENVl RONMENTAL SANITATION DIVISION
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITfES
)IRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
, ~HONE
I. PROPERTY OWNER
~AI L~G AD--SS
PROPERTY RESIDENT (If different fro~ above)" ' ' PHONE
PRONE
2, BUYER
MAI LI~G ABD~SS
4. REALTOR/A E T I
MAILING ADDRESS
5. LEGAL DESCRIPTION
;TREET LOCATION
- -- NUMBER OF BEDROOMS
TYPE OF RESIDENCE [] One E~'~our
~-'~-SI NG LE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other~
7. WATER SUPPLY
~;~'N DI VI DUAL*
[] 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. SEWA'GE DISPOSAL SYSTEM
[~'"~ D I VI DUA L/O N-SITE**
[] 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)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
[] OTHER
2. WATER SUPPLY
INDIVIDUAL
COMMUNITY
PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
E~]Septic Tank or [] Holding Tank
Size: / .~ ~-L_% If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4, DISTANCES
WELL TO:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
MANUFACTURER
MATERIAL ·
Septic/Holding Tank Absorption Area
Sewer Line
INearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
DATE
[~//APP ROVE D FOR '~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 6/79}