HomeMy WebLinkAboutEKLUND #1 BLK 4 LT 9 Onsite File
Eklund # 1
Block 4
Lot 9
#050 - 531 - 13
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Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: 181310
PID Number: 05053113
Dwelling: X Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade
Name
Bickman
ABSORPTION FIELD
El Deep Trench [:1 Wide Trench El Bed El Mound
Site Address
431 dr Upper Kogru
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
- GPD/SF
- Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
- Ft.
Gravel depth beneath pipe
- Ft.
Subdivision
Block Lot
EKLUND#1 BLOCK 4 LOT 9
Fill added above original grade
_ Ft.
Gravel length
- Ft.
Township Range Section
Gravel width
- Ft.
Beds: Number of Lines
-
Distance between lines
- Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
- Ft2
-
- Ft.
Well
+100
+100
-
-
+25
TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1000 Gal.
Surface Water
+100
+100
—
_
Material
Number of compartments
Lot Line
+10
+10
-
-
NA
Steel
2
Foundation
+10
+10
_
-
LIFT STATION
Manufacturer
Capacity
Remarks old tank disposed of per moa code
-
_ Gal.
tank replacement only
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank 3034Tank to 3034
drainfield
Martin Construction
Drainfield unk co/MT 3034
Inspector Charles Balzarini
BENCH MARK (Assumed elevation) 100 ft
Inspection
15` 9/14/18
Location and description
3m
nd
4n
top of deck foundation nearest tank
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
Date
, is
*:49?H.. •:*rel
Septic Syste
CHARLES G BALZARIN
Approved
Date
�+ �<`' CE.13854 • �`��
�
Note: this approv
does not include well permit requirements.pROFE5S10N4�
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100' WELL RAQIU
APPROX.
NEW AFTER
TANK CLEANOUTS
ti:
9
�lmlcjllm
IN
NEW 1000
GAL TANK.
— +100.0' DECK FOUNDATION
A
AW.
CHARLES G BALZARINI
CE -13854
OPROFESSIQ*"
ORI V
W4 Y-' 1 4
•z E:W-iqLl gEmcm,
LEGEND
* CLEANOUT
* MONITOR TUBE
M TEST HOLE
IV
Q%,n cm m IW Le
LEGAL DESCRIPTION: EKLUND#1 BLOCK 4 LOT 9
C&M ENGINEERING SERVICES OWNER: SUSAN BICKMAN JDATE: 12/1/19 1 REV. I DRAWN: CB J VER
907-854-5558
SEPTIC RECORD DRAWING
SWING TIES
A B
C
26.2 17.9
D
28.8 22.6
E
25 25.1
F
23.9 26.8
G
25.4 28.3
ti:
9
�lmlcjllm
IN
NEW 1000
GAL TANK.
— +100.0' DECK FOUNDATION
A
AW.
CHARLES G BALZARINI
CE -13854
OPROFESSIQ*"
ORI V
W4 Y-' 1 4
•z E:W-iqLl gEmcm,
LEGEND
* CLEANOUT
* MONITOR TUBE
M TEST HOLE
IV
Q%,n cm m IW Le
LEGAL DESCRIPTION: EKLUND#1 BLOCK 4 LOT 9
C&M ENGINEERING SERVICES OWNER: SUSAN BICKMAN JDATE: 12/1/19 1 REV. I DRAWN: CB J VER
907-854-5558
SEPTIC RECORD DRAWING
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1 111`16
`ciPA"rY MUNICIPALITY OF ANCHORAGE zn
. • On-Site Water&Wastewater Program 10 �(^
PO Box 196650 4700 Elmore Road
i • , f r .
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
�'R http:/lwww.muni.org/onsite 16044 f
Dcpartmcnt
9A,CMOao'
On-Site Wastewater Disposal System Permit
Permit Number: OSP181310 Effective Date: 9/11/2018
Work Type: SepticTank Upgrade Expiration Date: 9/11/2019
Tax Code Number: 05053113000
Site Legal Address: EKLUND #1 BLK 4 LT 9 G:0702
Site Mailing Address: 4316 UPPER KOGRU DR, Eagle River
Owner: BICKMAN JAMES & SUSAN M Lot Size in Sq Ft: 42282
Design Engineer: C & M Engineering Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907)343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
ry
Received By: Date: 9YA/K-
,,,,,Issued By: SI. 11. , ` I Date:
?m E.
EPLARNIS
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 050 531 13
Property owner(s) Jim and Susan Bickman Day phone 240-0385
Mailing address 4316 upper kogru
Site address 4316 upper kogru
Legal description (Sub'd., Block & Lot) EKLUND #1 BLK 4 LT 9
Legal description (Township, Range & Section)
Lot Size 42,282 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF) IN
(w/wo ADU)
Septic Tank 0 Upgrade ►��
Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
none Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
C&M ENGINEERING
(Signature of property owner or authorized agent)
Permit/Rush Fees: c215 Waiver Fees:
Date of Payment: /q"/ Date of Payment:
Receipt Number: I(C) D Receipt Number:
Permit No. OS P 181310 Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
9/04/2018
RE: Proposed Septic System Modification for Eklund#1 Block 4 Lot 9
Dear Reviewer,
The above referenced property is currently served by a 3 bedroom septic system installed in 1980s. The
1000 gallon tank has failed and is in need of immediate replacement.
We are proposing that the existing tank be replaced with a new 1000 gallon tank constructed and
installed in accordance with MOA requirements. A polyethylene tank is recommended.
As shown on the plan, the tank will be greater than 10’ from the house foundation and greater than 5’
from the deck support posts..
The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover.
The repair shall be performed by a moa certified installer in accordance with MOA requirements.
The engineer will inspect the tank before backfilling.
Repair of the proposed system will not negatively impact adjacent lots.
Upon completion of the installation, a record drawing will be submitted showing the location of the new
tank, leachfield, well, and other applicable features.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini@gmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181310, Rebecca Carroll, 09/11/18
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NAME
'~ " 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 I [~I~E w
LEGAL DESCRIPTION
LOCATION
DISTANCE TO: ~t~T" .1__~\1
NO. OF BEDROOMS
PERMIT NO.
Manufacturer J.~R-,~ -C,'~
Liq. pacity in gallons Inside length Liquid depth
IF HOMEMADE:
Well Dwelling PERMIT NO,
DISTANCE TO:
Manufacturer
DISTANCE TO: Well
No. of lines Length of each line
Top of tile to finish grade
Length Width
Absorption areaMaterial Dwelling
W dth
Foundation
Total length of lin~s
Material beneath tile
Depth
Material
Nearest lot line
Trench width
inches
inches
No. of compartments
Liquid capacity in gallons
PERMIT NO.
Distance between lines
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 td lot line PERMIT NO,
Sewer line
DISTANCE TO:
Building foundation
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
REMARKS
APPROVED
DATE
72-013 (Rev. 3/78)
LEGAL
PERMIT NO.
DEF'RR]"MENT OF' H. ERLTH RND ENVIF'.ONMEN'T'RL F'ROTECT:f.'ON
8;2:5 '"L." STREET., FtNCHORFIGE, F!.K. 9950:.t
254-4720
< 8:.t:tOOE )
42000 E;E:!LIRRE F:'EET
MFqXIMUM NUME;EF..' OF BEDROOMS = }]:
SOIL RSTING (S6! FF,..'BR)= ±8]:
TFIE REQUIRED SIZE OF THE SOIL FIBSORPTION S'¢STEM IS:
THE L.E:.N(:~TH DIMENSION IS THE LENGTH (If",! FEET) OF THE TRENCH OR DRRINF'IELD.
THE [:'EPTH OF' R TRENCH OR PIT IS THE DISTF4NCE BETNEEN THE SURFRCE OF' ']"HE
L'~F.':OLIND FIN[:' 'THE: BO]"TOM OF THE E'XCF!VF4T!ON (IN FEET>.
THERE IS NO SET I.,!tDTH FOF:: TF.:ENE:HES:
THE GRFI',?EL DEPTH IS ]'HE MINIMUM DEPTH OF' GRRVEL BETNEEN THE OUTF'F4LL PIPE
FIND THE BO'TTOM OF THE] E:,.,;CF4'v'FCrlON (IN FEET).
PERMIT FIPPLIC:¢~NT HRS THE RESPONL:;IBILITM TO INFORM THIS DE:PRRTMENT DURING TFIE
I NSTRLLFITiON i NSF'ECTIONS OF FIN¥ NELLS RDJRCENT TO THIS PROPERT"r' RND THE
NUMBER OF RESIDENCES ]"HFFf' TFtE NELL. WILL SERVE
BF4CKFiLLING OF Fff',W S'¢STEM NI'THOLrT F'INRL. INSPECTION RN[:, F!PF'ROVRL BY THIS
DEPRRTMENT NILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R NELL RND Rf.,t'-? ON-SITE SENFfGE DISPOSRL S"r'STEM tS
:1.00 FEET FOR R PRIVRTE NELL OR t50 TO 200 FEET FROM R PUE~L. IC NE:LL DEPENDING
UPON THE T"r'F'E OF PUBL. ZC NELL.
MINIMUM [:'ZSTFff'4C:E F'R]M_ R F'RZ'v'RTE 1.4ELL ]"0 R PRZ'v'FFTE SEI.,.tER .LINE Z- ~..~, FEET RND
TO R COMMUNITY' SEWER L..ZNE ZS 75 FEET.
NELL LOGS RRE RE6!UIRED RND MUST BE RE"FURNED TO THE DEPRRTMENT NITHIN 30
OF THE NELL COMPLETION.
OTHER RE6:~UZREMENTS MR'¢ RPPL'¢. 9PECZFZCRTiONS RND CONSTRUCTION DZRGRF:IMS FiRE
RVRZLRE:LE TO INSURE PROPER ZNSTRL. LRTZON.
I CERTIF'¢ ]'Hf~T
±: I RM FRMILIRR WI'TH THE RE(-:.~UIREMENTS FOR ON-'SITE SENERS RP,ID P.IELL. S F~S SET
FORTH B"? THE MUNICIPRLITY OF RNCH(]RRGE.
2: I t.4ILL INS'rF~Li. THE SYSTEM IN RC:CORDRNCE NI]"H THE CODES.
3: I UNDERSTRND THRT ]"HE ON-SITE SE[,.IER S~.'STEM MR'¢ RE:(;!LIIRE ENL. RRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3 BEDROOMS.
f~,F F'L I C:FINT ~L t...~:S~-,I
'¢4. 0
PERFORMED FOR:
LEGAL DESCRIPTION:
/~ /'~ [] SOILS LOG
MUNICIPALITY OF ANCHORAGE ~/
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION/~ PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
1
2
3
4
5
6
7
8
9-
10-
11
12
13-
14-
15-
16-
17
18
19
2O
COMMENTS
PERFORMED BY:
72-008 (6/79)
Robed A.
No. 1457.E
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE /2-~ ~ (minutes/inch)
TEST RUN BETWEEN ~ FT AND ~/'~ , FT
Engf. neeri
by
DOC Co. ada
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99.567 · TELEPHONE 688-2759
OWNER OF LAND ~J//~/ ~[<~<~,,9
ADDRESS ~O~ 3~ - ~ /~
LEGAL DESCRI~ION < ~ d~ ~ ~
OATE-Sta,ed [ O/~/f/ Ended
PE~IT NUMBER ? { I ~ 0 $
DEPTH OF WELL ! O 5-
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From O Ft. to
From .~' Ft. to
From Ft. to Ft.
From ,~-] Ft. to
From Ft. to, Ft.
From t
From Ft. to Ft. ~ ~~ d~ ~ ~&~,
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft, to ~ Ft
From Ft. to ? Ft.
From Ft. to Ft.
From Ft. to Ft._
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft,
From Ft. to.__.Ft.
From Ft. to Ft.
From Ft. to Ft,
From Ft. to Ft
From Ft. to Ft.
From Ft. to Ft.__
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From - FL to
From__Ft. to _.
From Ft. to
From Ft. to
From Ft. to
From Ft. to
Ft;
Iv~ICtPALITY OF ANCHORAGE
DEPT. OF HEALTH &
IlbJylRONMENTAL pRoTECTION
Ft. ,,n~.~ ~ '~ IClR1
Ft.
F,. RECEIVF-O
MISCL. INFORMATION:
DRILLER'S NAME
MUNICIPALITY 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 FAC LITY
264-4720
Application Date July 23, 1986
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 9 Block 4~ W. klund Subdv. T14N R1W Sec, 32
Location (address or directions}
(b) Applicant Name Jim&Susan Bickman Telephone: Home 694-9694 Business
Applicant Address BOX 2117-233, Ea~le River, Alaska 99577
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
N/A
(d) Lending Institution Northland Mortgage
Address 400 W. Tudor Anchorage: AK
(e) Real Estate Company and Agent N/A
Address
Telephone
Telephone
(f) MailtheHAAtothefollowingaderess:
piakup by engineer
TYPE OF RESIDENCE
Single-Family [] Multi-Family []
Number of Bedrooms 3
Other
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If community well system, must have written confirmation from the State Departme r~t of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. ' .
72-025 (11/84)
Page 1 of 2
5., ENGR'~IEERING FIRM PROVIDING INSPECTIONSi':I'ESTS, FILESEARCH, 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 inspechon.
Name of Firm EAGLE RIVER ENGJ~£Egt,';S SERV!CE$ Telephone
Address ~J~,GLE RIVER~ AK 99577
Date ~/'~ 5-/<~.'g P. 0.80X 773294
694-5195
Seal
DHEP APPROVAL~--~'~ ~)
Approved for ~ bedrooms by
Approved ~,.~ Disapproved
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 § wen 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 nspections or
analyze data before a certificate is issued. The Munici pality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOLj
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
If A, B, C, D.E.C. Approved (Y/N)
Well Classification
Well Log Present (Y/N) y Date Completed ~'~ ~'-~ Yield
Total Depth ~ O(~ j Cased to i O~%- / Depth of Grouting ~///~
Static Water Level I ,<;-/ b~[o~ -¢-e,~ r'.,~ i~,~ Pump Set At J
~--~ ~ Sanitary Seal on Casing (Y/N)
y Depression Around Wellhead (Y/N)
Casing Height Above Ground
Electrical Wiring m Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot "]"
To Nearest Public Sewer Line
Cleanout/Man hole
Y
Water Sample Collected by
Water Sample Test Results
Comments
: On Adjoining Lots '"\
; On Adjo~mng Lots -/--
j~//A To Nearest Public Sewer
~/A To Nearest Sewer Service Line on Lot ff' '~""
~'4Zc://~ ~'1 [/P_,l- ~'-m~irl~P_.13'l~ Date
J
PAd
B. SEPTIC/HOLDING TANK DATA
Date Installed ~
Standpipes (Y/N) y Air-tight Caps (Y/N)
Depression over Tank (Y/N) /V
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
.Separation Distances from Septic/Holding Tank:
To Water-Supply Well I
To Property Line ~ I~ ~
To Water Main/Service Line Jr" J('.~
Course
Size ~ No. of Compartments ~
y Foundation Cleanout (Y/N)
Date Last Pumped ~//-']/~, ,,
Y
; for
Temporary Holding Tank Permit (Y/N)
To Buiiding Foundation [ ~ I
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
Date Installed
Width of Field
Type of System Design
Length of Field -72
Depth of Field
· /
Gravel Bed Thickness
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy TeSt
v
Separation Distance from Absorption Field:
To Water-Supply Well +' ! (')0 /
To Building Foundation
Lot
TO Water Main/Service Line -/'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Standpipes Present (Y/N)
Date of Last Adequacy Test ~,./~
To Property Line I ('~) /
To Existing or Abandoned System on
; On Adjoining Lots 3- ~.~ / :
To Cutbank (if present) /,-/~'~
I0'
LIFT STATION~
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
.Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I~.~~or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Sig ned~--~~~ Date O- ~°.3'- ~,,~
Company ~/~', ,'~, ~-~ J' · MOA No.
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Eagl# River Engineering Sen/Ices
P. O. Box 773294
Eagle River, AK 99577
694-5195
EAGLE RIVER
~.NGINEERING SERVICES
P, O. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
LETTER
SIGNE~~ :
[] Please reply [] No reply necessary
/'-%,
MUNICIPALITY 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
GENERAL INFORMATION
(a) Legal Description (inclu~lqt, block, subdivision, section, township, range)
Lot 9, Block.~lqf,' Ektund Subdv. T1/4N RiW Sec.32
Location (address or directions)
Eagle River
(b) Applicant Name Jim&Susan Bickman Telephone: Home 694-9694 Business N/A
Applicant Address Box 2117-233, Eagle River~AK
(c) Applicant is (check one): Lending Institution F'I; Owner/builder E]; Buyer []; Other [] (explain);
(d) Lending Institution Western Mortage
Address 400 W. Tudor, Anchorage, AK
(e) Real Estate Company and Agent N/A
Address
Telephone 694-7~.872
Telephone
(f) MailtheHAAtothefollowingaddress:
pickup by enxineer
TYPE OF RESIDENCE
Single-Family [] Multi-Family []
Number of Bedrooms 3
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.
4. SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank []
N~te: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 (11,84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixe~ hereto and as of the validation date shown below, I verify that n~y 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 Telephone
Address EAGLE RIVER ENGINEERING SERVICES
~'/ -/~/~/.__~, EAGLE RIVER, AK 99577
Date 4/ p. .nv ~n~
694-5195
.~r's Seal
ApprOved for '~7~'~_~_,. beOroomsb / '' "~,
Approved /' ¢1'/ 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 independen, t 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
MU NICIPALITY OF ANCHORAGE (MO~,,
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description:
\
MUNICIPALITY OF ANCHORAGE
DEPT. OF
ENVIRONMENTAL PROTECTION
WELL DATA
Well Classification /~,/~ ///,4- 7-_~- If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) ~' Date Completed ~P' - 'P ~ ~/ Yield
Total Depth //~ ~ / Cased to /o 5- /
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorpbon Field on Lot
To Nearest Public Sewer Line
Cieanout/Manhole
Water Sample Collected by
Water Sample Test Results
Depth of Grouting x'f~/.~
Pump Set At ~o ~7~,
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots ¢z¢¢ /
¢/,~ ' : On Adjoining Lots "-/~ /
To Nearest Public Sewer
To Nearest Sewer Serwce Line on Lot "'~ ~-
,~,3/~ ,IC.,~.~ ~s,~e~,~J ; Date ~/~/~
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed P//p/ size /~.,~ d~,/ No. of Compartments
Standpipes (Y/N) ,,,V' Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N)
Depression over Tank (Y/N) /¢2 Date Last Pumped ~/'-z' ,/o
Pumping/Maintenance Contract on File (Y/N) ,,~/,,4 ; for
Holding Tank High-Water Alarm (Y/N) /~//,4 Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /¢ ¢ /
To Property Line ~-/o '
To Water Main/Service Line :"/~ ~
Course '4"//'~ ·
To Building Foundation /7"
To Disposal Field "~ ~ /
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed / ~ ~t
Width of Field ~ /
Square Feet of Absorpti°~ Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ,/~)"
To Building Foundation TS-
To Water Main/Service Line ~'/'~ /
Type of System Design
Length of Field 72 ~'
Depth of Field ~c. /
Gravel Bed Thickness ~'/'~
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ¢ -~ /
To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Date
Company
Receipt No.
Date of Payment
Amount: $
F~kl~vtr ~l~'~'r~,,Ineer no Services
: ~P~ ~ gOX 773294
F-Jgle River, AK
694-519~~
Page 2 of 2
72-o26 (11/84)
MOA No.
Engineer's Seal
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 9, Block 4, Eklund Subd, Addition No. 1, SW 1/4, Sec 32 T1-4N R1E, Sb
Location (address or directions)
Upper Kogru Drive
694-9694 694-9694
(b) Applicants NameJim Bickman Telephone - Home Business
Applicants Address P.O. Box 2117-233, Eagle River, Alaska 99577
Applicant is (check one) Lending Institution ~-~ ; Owner/builder~;
(c)
Buyer F-----[ ; Other~--~ (explain);
(d) Lendin~ Institution Alaska USA Federal C.U. Telephone 694-5390
Address Pouch 6613, Anchorage, Alaska 99502
(e) Real Estate Co. & Agent
Address
<f)
n/a
Telephone
Mail the HAA to the following address:
Jim Bickman
P O Box 2117-233
Eagle River~ Ak 99577
2. Tzpe of Residence
Single-Family[~
Number of Bedrooms
3. Water Supply
Individual Well~I
Multi-Family~
Other (describe)
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
0nsite ~ 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]
5e
En~ineerin~ Firm Providin~ Inspections~ Tests~ Pile Sear.ch~ 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 regula-
tions in effect on the date of this inspection.
Address
Date
DHEP Approval ~
Approved fo r'~z-i~/PJ bed rooms
Approved .~ Disapproved__
Terms of Conditional Approval
Conditional
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 REQUIRE-
MENTSo 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.
(DHEP SEAL)
RR4/eJ/D18
[Page 2 of 2]
7-19-84
ae
MUNICIPALITY OF ANCHOP, AGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH A[YI~ORITY APPROVAL (HA~)
CHECKLIST - FEBRUARY 1984
Legal Description:
OCT 2 3 oo,
RECEIVED
Date Comgleted
Pump Set At
Well Classification
Well Log P~esent (Y/N) y
Total Depth /~ ~ Cased to
Static Water Level ~. ~r"
Casing Height Above Ground 2/
Electrical Wiring in Conduit (Y/N) .y
Separation Distances from Well:
To Septic/Holding Tank on Lot /~ ~
If A, B, a~ C, D.E.C. Approved(Y/N) /~/
/~/~/~/ Yield
Depth of G~outin~ ~/~
Sanit~y ~al on Casing (Y~)~
~pression ~ound ~l~ead (Y~)
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ,,~m ~-' ; On Adjoining Lots
To Nearest Public Sewer Line -~/~-~-- To Nearest Public Sewer
Cleanout/Manhole/z/z/TM-- To Nearest Sewer Service Line on Lot
Water Sample Collected By
Water Sample Test Results
C¢~-~o nts ~t~_// /~ ~._~_~
B. SEPTIC/HOLDING TANK DATA
Date Installed ~,/~/ Si?~ //~ ~-~/? No. of C~oartments
Standpipes (Y/N) ?/ Ai~-tight Caps (Y~) / .~Du~on C!eanout (Y~)
~p~ession o~ Tar~ (Y~) ~ ~te ~st P~
P~ing~intenan~ ~n~act on File (YAq)~/A ;~ ~
Holding Ta~ High-Wate~ Ala~ (Y~) ~/~ ~ra~y Holding Tank Pe~it (Y~)
Sep~ation Distan~s ~ ~ptic~olding Tank:
To Water-Supply ~11 /~ To ~ilding Foundation /
To ~o~rty Li~ /~ To Dis~sal Field
To ~ter Main/Servi~ Li~ /~ To S~e~, Pond, ~e, ~ Major ~aina~
.Y ..
Course
Comments
R~ceipt 9
Date Paid:
Amount:
[Page 1 of 2] 2-15-84
D®
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption A~ea
Standpipes P~esent (Y/N) y
4~ Type of System Design
Length of Field 7-7 !
Depth of Field ~ ~
Gravel Bed Thickness zw' /
Depression over Field (Y/N) /L~ Date of Last Adequacy Test
Results of Last Adequacy Test ~"
Separation Distance from Absorption Field:
To Water-Supply Well /~m ~- To P~operty Line
To Building Foundation
Lot /~/~ ; On Adjoining Lots
To Water Main/Service Line /~-/- To Cutbank(if p~esent)
To St~eam/Pond/Lake/c~ Major Drainage Co~se
To D~iveway, Parking A~ea, c~ Vehicle Stc~age A~ea /~-
Corauents
To Existing or Abandoned System cn
Date Installed
Size in Gallons
"Pump On" ievel at
High Water Alar~n Level at
Tested for
Electrical Codes(Y/N)
Dimensions
Manhole/Access ,(,Y/N )
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Con~ents
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inepection.p
Co. any ~~ ~p~/ P~ MOA No.
KB1/d5/s
[Page 2 of 2]
2-15-84
