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Home My WebLink AboutDELUCIA LT 22 I . :;- Municipality of Anchorage Page ? of o3.. 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:-~14J 4~ -~ O ~--f'-? ~ PID Number: ~J'-/-/~//- Name: ~°e /'~'~-" M Wastewater System: D New D Upgrade Address: ABSORPTION FIELD Phone: ~ ] No. of Bedrooms: ~ ~ Deep Trench ~ Shallow Trench ~ Bed ~Mound ~ Other I LEGAL DESCRIPTION SoilRating: Tota~moriginalgrade:~ GPD/Sq Fi. Lot: Block: Subdivision: Depth to pipe bottom from original grade: ~vel depth beneath pipe Township)~ ~ Range: I Sec"on~ Fill added above origin~- Gravel length: / ~ Ft. Ft. I Distance between lines: WELL: ~i~D New D Upgrade Gravel width:~ Number of lines: Ft. ~ Ft. Classification (~rivate. A.B.C): Total Depth: Cased To: Total~tion area: Pipe material: ~F/~ F~ ~ Ft. SO. Ft. Driller: ~ Static Water Level: In'tier: Date Installed: Yield: ~ ~ump Set at:/ GPM. F,. Icasing Height Ab°ye Gr°und:Ft. ~.~ TAN K SEPARATION DISTANCES ~Septic ~ Holding D S.T.E.P. TO Septic Absorption Lift Holding 3ublic/Prlvate Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~ ~= ~ ~ ~ ~ / Material: Number of Compartments: Well /~ ~ / ~ g/~. ~/~ ~ ~ / S~,[ac~ J LIFT STATIO N Wafer ~/~J~ ~/~ ~ ~/~" Lot / /~ Size in gallons: I Manufacturer: Line ~ ~-- /~ /I Foundation ~/ ~/' ~, ..~p o~..,~,~o,r' ,ove, ~t: Gurtain Pump~ak~del I Boetdeal Inspection* pedormed Drain ~/~ I Remarks: ~g~ ~ ,~./~./ BENCH MARK Location and Description: . . fi, ~'~ - ~ Z-~//.~ ~/~/~ ~C ~.--~ ~ ~'~'~ ~ ~Assumed ¢~/ ~,~¢Y ~ Bevati°": /~ 2~f~~ ~.~ ,~ ~.~( ..:- ., ~,~<.~' Inspections performed by: ~/e ~ ~;~. Dates: 1st /~/~///~ ~ ' '~' ':'~ '~ %. CE 67~5 ~ ~/~' Department of Health and Human Services approve! .... ,..,,:~' .... .,, Reviewed and approved by: Date: I~ 0 '... Permit No. SW030439 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: LOT 22, DELUCIA SUBDIVISION PID No.: 051-141-59 z S 89'59'00" E 81.30' S 89'59'd0" E EXISTING I LOT E 1 EXISTING HOUSE ABANDONED LEACH FIELD ~ S~B-OUT FOR FU~RE N 89'59'00" W 81.50" NEEDLES LOOP ELEVATIONS ~,, (NOT TO SCALE) ~ ^ssuu~ ~.[v = loo. oo' 81.30' APPROXIMATE EXISTING WELL A~ROXI~A'~ ~' SCN. E 1'-30' NEW ~1250 CAL SEPTIC TANK SWING TIES A B 98.9' g4.6' N 89'59'00" W 81.30' I 11/22/05 ENGINEER'S SEAL o..F...A. ~.. .... ~.:q,..¢~,, ~..' 49 lH '~1~ '..~& ~...." ........ ~ ............ ':.?.i~ ]O MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 15, 2003 Expiration Date: Oct 14, 2004 Permit Number: SW030439 Legal Description: bELUCIA LT. 22. Design Engineer: 0024 Eagle River Engineering Services Owner Name: Sandy & Keith Hjelmstad Owner Address: 22595 NEEDELS LOOP CHUGIAK, AK 99567-6402 Parcel ID: 051-141-39 Site Address: 022595 NEEDELS LOOP Lot Size: 12195 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ['--] Disposal Field r-~ septic Tank [] Holding Tank E~ Privy [~] Private Well [] Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a water supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~ 0ct-14-03 12:57P Pemit Counter 907 343 8250 P.01 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewate'r Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWEI~./VVE[.I PEI~.M!T APPLICATION FOR A SINGLE FAMILY DWELLING Permit Number .SWO,~O~'~?' Property' owner(s) _~ AK/~ Mailing address (1) c,~,~.~q,,~ JL,_'~O~ ~l~.~ Mailing address (2) Legal description (Lot, Block & Sub'd.) . Legal description (Section, Township & Range) Lot Size I Zip Code /4- Day phone ,/,,~C 'Acres/~ Number of Bedrooms ~.~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade ~/'/~,~, THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool r-i Well on~ I--i I-'] Water Storage I-"1 ' r'"] Jacuzzi [] " r'"] Water Softening Unit r"l i certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) '""~ Permit Fees: ~% O Waiver Fees: Date of Payment: ! (""~ I I ~ I [~ '-~ Data of Payment: Receipt Number: L.~"~ ~'-~) 0 %--~"eceipt Number: {Rev. 1~) Eagle River Engineering Services Louis Butcra, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax October 13, 2003 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 22, Delucia Subdv. Narrative & Permit Application Dear Mr. Cross: The proposed septic system upgrade will have very limited impact on adjacent properties for the following reasons: 1. This is a replacement of a deficient tank only, there is no upgrade of the number of bedrooms. 2. Immediate neighboring septic systems are installed close to the lot line. 3. Drainage will not be affected and is not a major consideration in our design. We are requesting a waiver to 5' distance to the lot line adjoining lot 21 for our proposed septic tank location as this will allow us to place the new tank at +100' from the well and stay outside of the existing gas and telephone utilities avoiding a request for a 100' waiver to the well. This work will not affect the reserve area on adjacent lots as the adjacent septic system is already located with at waiver to our lot line and only 5' is required from a tank to any leaehfield. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \1997~03-039NA~.OOC 40' Z S 89'59'00" E / 81.30' S 89'59'~0" E 81.30' APPROXIMATE: EXISTIN(~ W~LL ~APPiOXIMA~ ,~/ EXIuS~ LOT 21 EXISTING HOUSE ABANDON EXISTING SEPI~C TANK EXIS'rINO LEACH FIELD o 'l~E INTO LEACH FIELD INSTALL NEW GAL I ~,~ SEPTIC TANK o I z N 89'59'00" W 81.30" N 89'59'00" W 81.30' NO WELL 100' o. --T-- -- BURIED TELEPHONE UNE -G- - BURIED GAS LINE NEEDLF. S LOOP · - MONITOR TUBE o SEWER CLEAN OUT ~- - WELL - - - EASEMENT 1. REPLACE 1000' GAL. SEPTIC TANK ~ - PROPOSED LEACH FIELD I - EXISTING LEACH FIELD 2. NO SURFACE WATER OR NO KNOWN CURTAIN DRAINS ~ DRIVEWAY E PLAN' GAL: LOT 22, DELUCIA SUBDIVISION .... ~x~.. .... ~ ~ND ~].-' )NTR~ 'OR: N/A ~-~9TH~ '"~'~ ,, , 'B~02 339WS/DATE: 10/05/051SCAL! 1 = 30 EAGLE RIVER ENGINEERINGSERVICES ~ ~ '~ P.O. Box 773294 ~ x (907) 694-5195 FAX: (907) o~. ~ LEGAL: OWNER: CONTRACTOR: N/A JOB#O3-O39WSi DATE: ~0/05/0~1 SCALE 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 SEPTIC TANK REPLACEMENT LEGAL: Lot 22, Delucia Subdv. 10/14/2003 A. GENERAL 1. The drawings shall be a part of this specification. 2. All materials and workmanship shall meet the requirements ofAnchorage Department of Health and Human Services Permit. B. SEPTIC TANK REPLACEMENT AND LEACHFIELD CLEANOUTS 1. Septic tank construction shall be a/'(~0~allon steel two compartment tank approved by the Municipality of Anchorage. 2. Septic tank is to be installed level on compacted base material. 3. A new connection is to be made to the house with new cleanout and piping to the tank all at minimum grade. All 'tank connections are to be made with caulder couplings. Tank and flow lines are to be insulated. 4. The existing tank is to be pumped, crushed and buried on site in it's existing location. 5. New tank to be provided with double cleanouts after tank and tied into existing leachfield. \1997~03-039tankrepspec.doc 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 ~-~EW [] UPGRADE LEGAL DESCRIPTION LOCATION NO. O~.~ D ROOMS Well 1~}~ (' ] Absorptio~ar? Dwelling_~.~,)t,,. PERMIT~.~,.~ ~ ~/C.)~_~s Ma n u fact u rer...~'~ /-~ IF HOMEMADE: Well DISTANCE TO: Manufacturer Inside length Dwelling DISTANCE TO: Well /~ No, of~.~ Le~Aofo~.~ '-- / (-~each line Top of tile to finish 9rade~ Length Width Type of crib Crib diameter Well Depth DISTANCE TO: Fou ndati o~:~---~ Total ,~gt,h~f lines Material beneath tile Depth Crib depth Building foundation Width :lass Building foundation DISTANCE TO: PI PE~/IATER IA LS so,, REMARKS Material Nearest I o~)n ~,, Trench W~,.~ inches _'~_ ~C~ inches Total effective absorption Nearest lot line Driller Distance to tot line OTHER Jo.~mpartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO~ ~;)_~/~.~ G Distance bet~es Total eff~:)~rpt)on area PERMIT NO. Sewer line Septic tank PERMIT NO. Absorption area(s) APPROVED / 72-013 (Rev. 3/78) DATE LEGAL O & E ENL,.,NEERING & DEVELO, 'MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: Name: Mailing Address: Legal Description: ,_/'~ ¢~- SOIL LOG Tel. No Earl Ellt~ 688-2280 Depth (feet) Soil Characteristics 2 3__ 6__ 7__ 9__ 10 PLOT PLAN 11__ 12__ 13 14__ PERC. TEST 15__ 16__ Ground Water Encountered: Yes.__ Proposed Installation: Seepage Pit No ~ If yes, what depth Drain Field J'/ Comments: Performed by: WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ Geophysical Surveys Dritling Permit No. LOCATION OF WELL (Please complete either la, lb or lc.) A.D.L, No. I~:llBorough Subdivision Lot Block I-~.I I/4qtr$. Section No. Township N[~ Range Em Meridian __of__of--of -- si-] ,c.ljDISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 5, OWNER OF WELL: Address: Street Address and Area of Well Location Feet Belo~ 4. WELL DEPTH: (final) 5. DATE OF COMPLETION 2. WELL LOG Surface ft. -- -- Material Type TopBottom ~ Auger ~ Jetted ~ Bored ~ Other: 7. USE; ~ Dome*tic ~ Public Supply ~ Industr~ ~ Irri~atlon ~ Recharge ~ Commerical ~ Te~t Well ~ Other: 8. CASING: ~ Threaded ~ Welded diam.~in, to~ ft. Depth Weight lbs./ft. J diam. in. to ft. Depth Stickup~ ft. 9. FINISH OF WELL: Type: Diameter: Slot/Mesh Size: Length Set between ft. and ft. Backfilling Gravel pack ~o. STATIC WATE. ~EVEL: ft. Date ~ Above or ~ Be~o~ land surface Equipment used: II. PUMPING LEVEL below land surface and YIELD ft. after hrs. pumpin~ g.p.m. I~IUINJ~IY~LiI ~ t~F ~tN~M~K~E ft. after hrs. pumping ~ g.p.m. ENVh: ~ ,~ F , J I~.GROUTING Well Grouted: ~ Yes ~ No Material: ~ Neat Cement ~ Other: ', . 1~ 13. PUMP: (if available) HP~ Length of Drop Pipe ft. capacity g.p.m. - RECEIVED ~ su,.. ~ Jet ~ CentrificaI ~ Other 14. REMARKS: 16. WATER CONTRACTOR'S WELL CERTIFICATION'. 15. Water Temperature ~o ~ F ~ C This well ~as drilled un~er my jurisdiction and this report is true lo the best of my ~nowledge and belief~ Registered Business Name Contrect License Number Address; Signed~ Date; Authorized Representative Form OZ-WWR {11/81) Copy Distribution; WHITE-State DGGS~ PINK-Driller~ CANARY-Customer HEALTH AUTHORITY APPFIOVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SiTE pLANS ROAD OESIGN SO&L TEST Mr. Eldon Young FEDERAL HOUSING AUTHORI2~ Department of H.U.D. 701 C Street Box 64 Anchorage, Alaska 99513 ROBERT A, SHAFER At]gust ].~J, ~,.988 R.~ERENCE: Lot. 6 and Lot 22; DeLucia. Subdivision CIVIL ENGINEER 694-2979 MUNICIPALITY OF ANCHOP~GE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 9 1988 RECEIVED Dear Mr. Young, The private wells on each of the referenced properties have been tested to determine their flow. Each of these tests were performed over a four hour period with the results showing that the well on Lot 22 will produce 26 9ph while the well on Lot 6 produces 20 gph. The owner of these two properties is prepared to install an approximate 1500 gallons of water storage on each p£operty. This will provide twice the quantity of water that would normally be required to produce 3 gpm over a four hour period. Water storage tanks will consist of ].50u gallon steel tanks, buried next to the foundation of each house with a heated n~%nhole over each tank. The n~nhote will house a jet pump and provide access to the float switch and timer which will be necessary to control pumping cycles of the submersible pump within the well casing. The jet pump will draw from the storage and pressurize the dlstribution system upon demand. These wells currently produce an adequate amount of water to satisfy Municipal Ordinance requirements. The Municipality of Anchorage has issued Health Authority Approvals on each of these properties and has no objections to providing addit$onal storage even though it is not necessary to satisfy Municipal requirements. requ~uem~ MECHANICAL I~,SPECT,O~S ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Request you ev~!uate this pro£.~sal and, u[.on completion of work, waive the ~nt for each well to produce 3 gpm. Water supply for the above properties is adequate to meet requirements established by Municipal Ordinance and the additional storage proposed will aid in ~meting instantaneous demands. ~u~i~ality o£ Anchorage Department of Health and Human Services 17034EAGLEHIVH~LOOP. SUITE204. EAGLERIVER. ALASKA99577 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) Location (address or directions) (b) Property owner 4/~)~'' ~' Mailing Address ~ Telephone'(home) Business (C) Lending InstitutioJ ¢''r/~' Mailing Address Telephone' (d) Real Estate Company and Agent Telephone ~ ¢ ¢¢ (e) Mail the HAA to the following address: (or check here [], if hold for pick up.) List contact person and day phone number below: 17034 Eagle River Loop Road No. 204 Ea~a R':v=r, ~!:-'k'- 9952T TYPE OF RESIDENCE Single-Family/~ Number of bedrooms WATER SUPPLY Well/~' Community [] Public [] Individual 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 flies 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 Address 17034 E-*~la River Loop Road No. 204 Eagte River, Alaska 99577 Date Telephone Approved for ~ bedrooms by Approved ;:><-- Disapproved .. Conditional Terms of Conditional Approval 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. 7/58) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Static Water Level Casing Height Above Ground Electrical Wiring in Condui (Y~_~) A. WELL DATA Well Classification /'~,/~--'/~-~',~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present~) : Date_Completed -'~-- /- ~ ~- Yield Total Depth32~'t'Cased to(~'.) Depth of Grouting -- ~ ///'~' ' Pump Set At /'Z t, ~ Sanitary Seal on Casing~) _ Depression Around Wellhe'e~d (Y~' SEPARATION DISTANCES FROM WELL: To Septic ank on Lot ! ;On Adjoining Lots ¢./'~) O To Nearest Edge of Absorption Fi ot [/~_.2~ ~ ·' , On Adjoining Lots //~ To Nearest Public Sewer Line e~/?%L To Nearest Public Sewer Cleanout/Manhole ,,x~//~ To Nearest Sewer Service Line on Lot ¢I;~~'- Water Sample Collected by 4d..~ / d ~ ; Date . Water Sample Test Results . ~ ,4--7/J-,,c:,,¢~c -z'",.~ / B. SEPTIC/HOLDING TANK DATA Date Installed ~._,~¢n --~'2 Size Depression over Tank (Y~ Pumping/Maintenance Contact on File (Y/N) Holding ~ank High-Water Alarm (Y/N) /~)/¢xT ~¢~¢--'~ No. of Compartments Air-tight Caps ~_j~N) : Foundation Cleanout(~ ~ ~ ~ Date Last Pumped /~-- /J"~t~ ~ · for ~// Temporary Holding Tank Permit (Y/N)/4/.///'~F- SEP/~RATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~ P~'- To Property Line .,~'~_~ ~''~ To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments %//r~ ¢_f To Building Foundation To Disposal Field 72-026 (Rev 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed .~'~ ,~o- Width of Field O / Square Feet of Absortion Area Depression over Field (Y~.~ Results of Last Adequacy Test Type of System Design Length of Field Depth of Field ~ ~ z./--,~ravel Bed Thickness Statndpipes Presen (Y~) Date of Last Adequacy Test -Ir SEPARATION DISTANCE FROM ABSORPTION FIELD: TO Water-supply Well J~::2~ r / To Property Line To Building Foundation ~,~-- r Lot /'"'////~' ; On Adjoining Lots To Water Main/Service Line ,/C9 //- To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course /'~oq r ¢_ To Driveway, Parking Area, or Vehicle Storage Area //dP " To Existing or Abandoned System on Comments D. LIFT STATION Date I nsta--ITed~ Dimensions Size in Gallons -'"'"""~_~~]/,..///Man,~ole/Acce~s (Y/N) "Pump On" Level at ~-~-~LI~./ /,/I _.~Pump Off Level at High Water Alarm Level at ! ~ Vent (Y/N) _ / Tested for ~equacy 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 17034 Eagle River Loop Road No. 20~ inspection. Signed Company Date MOA No. E~le River, Alaska 99577 Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Receipt NO. ,~d'?-'~,.,-~ Date of Payment /C~ - ~ d:, '- Amount: $ /','~-69-00~) 72-026 (Rev. 7/88) Back MUNICIPALITY OF' ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 1. GENERAL INFORMATION /MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal De.scription (include lot, block, subdivision, section, towns, hip, ,range) Location (address or directions) (b) Property Owner /i;~.~ F~ Telephone: Home Business Mailing Address (c) Lending Institution 'F~~t''~/~'"~-dZ_.~t~ .~t~-~ Telephone Mailing Address (d) Real Estate Company and~Agent (~/~~ ~;~ ~-~ Address /~ ~ ~~~~ ~ Telephone (e) Mail the HAA to the followina address: or: Check here~ if hold for pick up List contact person and day phone number below. S & S ENGINEERING 17034 Eagle River Loop Road No. 204 E=_2!e ~'_,ve.-, .~.!a-'?' TYPE OF RESIDENCE Single-Family,J~" Number of Bedrooms WATER SUPPLY Individual Welt j~ Community r-] 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 OnsiteJ~ 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 fRev 8/861 Front 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 & S ENGINEERING 17034 Eagle River Loop Road No. Address Eagie R;Ylr, ,-,,- Date Telephone DHHS APPROVAL ~.~ Approved for -~ bedrooms by Approved ~ Disapproved Conditional Date Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-025 fRev 8/861 Back ~ ~.~,G~.5~'~'~'~ ~)~MUNICIPALITY OF ANCHORAGE (MOA) ,~ .~ ~ HEALTH AUTHORITY APPROVAL (HAA) ~ .~O % ~ ~HECKLIST - FEBRUARY 1984 e4-4 44 Legal Description: WELL DATA Well Classification Well Log Present ~N) Total Depth "2'2 "~ ~ Cased to ~ '~' t Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~'N) Separation Distances from Well: To Septic/He~t/G.g Tank on Lot ~t~J~ If A, B, C, D.E.C. Approved (Y/N) Date Completed ~ - \ - '~:2'7.~ Yield Depth of Grouting Pump Set At L-)~/--~. Sanitary Seat on Casing ~) 7 Depression Around Wellhead (Y~. · On Adjoining Lots '~ · On Adjoining Lots To Nearest Public Sewer To Nearest Edge of Absorption Field on ~_ot ~ ~1 To Nearest Public Sewer Line ~c~/~. I Cleanout/Manhole ¢, To Nearest Sewer Service Line on Lot Water Sample Collected by ~'~'~-~ ~t-.~_~!r-~'~_...~L~(2_~,,,-~ . Date Water Sample Test Results ~/r~,~-'~'~¢.-,..¢' ~ ~'~"~-2~/~,¢~ ':~ ~---~¢~'~. Comments [_~ .~'~.~c:~L~ ~ '~ ~'~ - B. SEPTIC/HOL--D~G TANK DATA Date Installed Standpipesd~N) ~ Air-tight Caps ~[~:N) Depression over Tank (Y~[~ Pumping/Maintenance Contract on File (Y/N__)~) ~ r---/y-~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/l~ Tank: To Water-Supply Well ~'~r'~¢~ To Property Line \~-------~ To Water Main/Service Line \ Course I c.C~ "~ ""'~O-LS'7..-.Size ~, C)c:>t.~ No. of Compartments ~ Foundation Cleanout (Y4~) t~ , Date Last Pumped '-7 -- ~ ~ ~ '~--~{~ - · for [,~/~, Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026 ¢Rev g,'86~ Front Co ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well \ ~ ~ To Building Foundation ~ Lot To Water Main/Service Line Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Presen~N) Date of Last Adequacy Test 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 Cutbank (if present) Comments D. LIFT STATION Date I~ Size in Gallons %~ "Pump On" Level at High Water Alarm Level at ~'---~._ Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) dequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M/~A and HAA guidelines in effect on the date of this inspection. Signed ~ ~. ~ ENGINEERING Date ' - 34 Ea le RiYer Lo~p Road No. 2~ Receipt No· Date of Payment Amount: $ Page 2 of 2 72 026 IRev 8'86~ Back Municipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 28, 1988 Robert A Shafer, P.E. S & S Engineering, Inc. 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 22 Delucia Subdivision Waiver Request ~WR88-040, HAA~ 88-0285 Dear Mr. Shafer: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 95 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services DJR/ljw96 ROBERT A. SHAFER July 15, 1988 CIVIL ENGINEER 694-2979 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOiL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 22; Delucia Subdivision Request you issue the attached Health Authority Approval (HAA) and grant a waiver for the horizontal separation distance between the private well and the septic tank located on the referenced property at a distance of 95 feet. The septic system was installed after the well was drilled. The septic installation was inspected and approved by a Municpal Department of Health inspector on March 30, 1982. A previous HAA was issued for the property in October, 1983. A risk analysis has been performed and it appears that no bacterialogical pollution is possible from this source. Attached for your review are the following documents: 1. A plot plan showing relative distance between the well and septic system. 2. Risk analysis waiver worksheet. 3. The well log for the referenced well. 4. Coliform and nitrate analysis results of water taken from the well located on the referenced property. If you. r~qui~ additional information, ~sin~c~ ~RT A. SHAFER, P.E. /ss It is our opinion that the horizontal separation distance prescribed by 18AAC72.021 is not required in this case. please contact us. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99516 TELEPHONE (907) 562-2343 / _~r-i'-~"~i %, FEDERAL TAX ID # 92-0040440 ANALYSI2 REPORT BY SAMPLE for Work Order ~ 7740 Date Report Pnnted: JUL ii 88 ¢~ !2:24 Ci,~ent Sample ID:LT 22 DELUCCiA Collected 3UL 7 88 @ 12:35 Ret@Feed JUL 8 88 @ 10:$0 i~rs. Preserved with :4 DEGREES C Client Name Client ~cet P.O.~ VERBAL Req ~ Ordered By SNSENGP Analysis Completed JU~ 8 B8 Laboratory 3upe:¥iso~ :STEPHEN C. EDE Released By : ~ ~' ~ Special ADEC FOR~T lns~zuct. Send Repo~ts to: :)s ~ s ~NO~§EER:NG 2)ADEC Chemlab Rei ~: 1713 Lab Smpi I[:' i Matrix: Watez Allowable Parameter Tested tesuit/Unita Method Limits Sample ROUTINE SAMPLE te~azks: SAMPLE COLLECTED BY RJS. ........... ============ ...... ========= .....===== ....============== .... ==================================== Tests ?ez~ormed ' See S. peclal ~' ........ ' ~n~. ........ OhS Aoove UA=Uhava~iable None Detected '' See Sample Remarks Above ~.,~,.. Analyzed ~i=~ss Than, GT=Greatez Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER PRIVATE WATER SYSTEM Nam~ S & S ENGINEERING 17034 Eag;e ~;~er L~op Roac~ ~. ~O~i, Mailing A,.gidre, ss~. ., . .... eagle Klvert AlasKa y~31/ Phone No. City State Mo. Day Year SAMPLE TYPE: ~ J~Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose Zip Code [] Treated Water [] Untreated Water SAMPLE NO. LOCATION 2 I 3 I 4 I 5 I Time Collected Collected By TO BE COMPLETED BY LABORATORY Date Received Time Received Analytical Method: Analysis shows this Water SAMPLE to be: ~ Satisfactory [] Unsatisfactory [] Sampletoo long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* i / I ~ l I Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD ¥~ -'¢t_\ READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 'Membrane Filter. Direct Count ;Verification: LTB 'Final Membrane Fil~Resl~ts Reported By ..... Coilform/10Oml TNTC = Too Numberous To Count OB = Other Bacteria BGB ~) Coilform/lO0ml Time: / ~ a.m. PART I OF Z ~ EMAI~'{D??. TO FOLLOw APPLIC FILLS OUT UPPER HAL ONLY --~.~- ::/'. Phone ..... // / Mailing Addre~ ~" ~ ,- . . : ~., . ,_ _ .u,e, '-: :,/C/ .... Address ,' Zip Code Lending Institution Phone Address Zip Code ' '" ~ ~/,//'/'~ ~./. .,'~,,'~ ~. ~ , Phone RealtyCo.&A~nt /L; /L ," . ~ . ' ,, Legal Descript~n .~' Street Locati~ Type of Resi~nce ~. Single Family ~ Multiple Family No. of Bedroo~ .... ~ Other Water Supply ~ Individual A~ACH WELL LOG. A w~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 Year IndivMual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date X C' Inspector Inspector Inspector Inspecto~ Field Notes: C~J I~ ~ ~ ~ MUNICIPALI~ OF ANCHORAGE ENVIRO,N',M2NTAL PRO~EC[ION Soils ~ating Date ~wer Installed Well To Absorption Area / ~ ~ ~ Well Log Received ~ ~ ~ '- 3 0 ~ ~_ Well to Tank / 0 > ~ Septic T~k Size 72-023 [3t82) rTime Time ~e Date Date Date I nspectur Inspector Inspector Comments Conditional Approval Date Sewer Installed Permit No. Septic Tank Size ~ ~::)~..~ ~) ...- ~"~'t-~ Holding Tank Size Soils Rating Well To Absorption Area / ~ Well Log Received Well to Tank ~ ~ ~ APPLICANT FILLS OUT LOWER HALF ONLY Property Owner Buyer : Address Lending nstitution .~' ::~ /:~ ~,::;~ :.~T<~_.~/~ Phone Address - Realty Co. & Agent.? . ~ ..~¢ ~ ....... Legal Description ,,~- / '''~ -~"; Street Location · / / , / ' ' / ' " / " ' Type,gf Residence ~ Single Family ~ Multiple Family No. of Bedrooms ~ Other Water Supply ~ Individual A~ACH WELL LOG. A well log is required for all wells drilled since June ~ Community 1975. For wells drilled prior to that date, give well depth (attach log if ~ Public Utilit~ available.) Sewage Disposal -- ,' ~ Individual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. AS-BUILT I hereby testy that I have '~vveyed the following ment~ ~t~d, there~ not or.lap or e~osch to, ~at no ~rov~ents e~ roadw~f, ~an~on ~n~ .or omev v~o~e ememe~ said pro~y ex~ Da~fl at Eagle ~ver, Al~ka SCAL~ Register~ Land S~or No. 1' = ~ ' BOx 45~, Eagle River, Alaska Phone (~7) 6~2543-