HomeMy WebLinkAboutEKLUTNA HGTS STEWART ADDN LT 20 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
Permit Number: <~Jq'to~(3 ' PID Number: o~'/(2G-TJx7
Name: , Wastewater System: D New ~ Upgrade
~y y. ~ T~/ ~, ~y
Addre88: ABSORPTION FIELD
Phone: ' Nc. of B~rooms:. ~Deep Trench ~ 8hallow Trench ~ Bed ~ Mound' ~ Other
LEGAL DESCRIPTION so, Rating: Total Depth from original grade:
~.~ GPD/Sq. Ft.
Lot: ~k: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe
Township: ~ Range: Section: Fill added above original grade: ~ Gravel length:
I
WELL:~ New ~ Upgrade Gravel width: Number of lines: Distance be~een lines:
~ Ft. / ~ Ft.
Classification (Private, A,B,C):~/E ~ Total Depth: Cased To: Total absorption area: Pipe material: F~/O P~
~IV~ /~ Ft. /~ Ft. ~Q. Ft. ~ ~O~ P.V,~
Driller: Date Drilled: Static Water Level: nstaller: Date installed:
Yield: Pump Set at: Casing Height Above Ground:
Z GPM ~ Ft. I I~'~Ft. TANK
SEPARATION DISTANCES ~Septic ~ Holding D S.T.E.P.
To Septic Absorption Lift Holding PubHc/Privat( Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~ ~~ ~
/ ~ Material: Number of Compa~ments:
we~ /O / /~/ Z~ '+ ~
Su,ac. ,+ ~+ LIFT STATION
Water /dO /~O ~
Lot / /
Line ~ /O -- --
Cu~ain ~ 0 ~ E ~O i J~ =ump Make & Model [ Electrical Inspections pedormed by:
Drain -
I
Remarks: BENCH MARK
Location and Description:
Assumed /~d.~O Ft.
Elevation:
'~ .~ 'EN~E~S SEAL
17~4 Eagle River Lo~ Road, No. 2~~~..~
Department of Hea~.~uma~~, appro~l~ ~ ~~
Reviewed and approved b ate:
72-013 (Rev. 9/91) MOA 25
Perr~it No.Sw940150
2 2
Page of
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
EKLUTNA HEIGHTS SUBDIVISION, LOT 20 05106557
Legal Description: PID No.:
N.T.S.
~01 COZ
NEW ..................
1000 GAL
SEPTIC
TANK
GRADE
A t~ C
FCO -- 18iO --
D.V. 21.5 21J5 --
~'i" "i'~i~' "i8'~6 .............
co2~v.o ~9~o --
co3--i~oio 8.5
C04 35.5I 40i0 --
MT1 39.5 36~5 --
MT1 C04
9~'.'0 ........................................................................
86.0
,~. 80;0.~...NO...WA~R..i~O ~ND .........................................................
WELL
LOT i20
T~E~Cn
SCALE 1" = 40' i
4
100' WEL!
RADIUS
10001 GAL.
SEPTIC TANK
SYSTEM
ABANDONED
72-013 A (1/93) *
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE
1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NIIMBER:SW940130
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:DREWRY JAY V & TERRI A
OWNER ADDRESS:HC 80 BOX 5928
CHUGIAK, AK 99567
DATE ISSUED: 5/17/94
EXPIRATION DATE: 5/17/95
PARCEL ID:05106337
LEGAL DESCRIPTION: EKLUTNA HGTS STEWART ADDN LT
20
LOT SIZE: 13370 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD 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:
RECEIVED BY:
ISSUED BY: ~~
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
April 30, 1994
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
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
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 'L' Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Eklutna Heights Subdivision; Lot 20
Request you issue a permit to upgrade the septic system serving the
four bec~ho~seonthereferencedproperty.
An adequacy test performed on the existing system for Health Authority
Approval purposes found the absorption capacity of the existing system
to be inadequate.
A test hole was excavated and a percolation test performed in the area
of the proposed upgrade. The approximate location of the test hole is
located on the attached site plan. The monitoring tube within the test
hole has been checked and found to be dry. Attached is the proposed
upgrade design.
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, contact us.
A. Shafer, P.E.
STRUCTURAL &
~,IECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
o
~Ox
"ld S,N3SO¥1AI
z ~
,OL
'~{IS 9918A¥~9
NYqd 311~
:ml¥Og
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE
Township, Range, Section:
1
2
3
4
7
8
9
10
.12
'13-:
14~-
17-
.18-
1¢-
20-
SLOPE
i/
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE PLAN
Monitoring? ~
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~_~minutes/inch) PERC HOLE DIAMETER g /! ~
T ST RUN BETWEEN -~T AND ~) FT '/
COMMENTS ~,s~ ~ ~/~ Z o. ~ ~ ~~
i~le River, Alaska 9¢~1Z ...... ".l ~ T ON THIS DATE
ACCORDANCE WITH ALL STATE AND MUNiuI~AL ~u~c~ N~/T or . DATE:
72-008 (Rev. 4/~) ~
ON-SITE ~£~AT~_a DISPOSAL SYSTEM
OONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
R~F~CE: Eklutna Heights Subdivision; Lot 20
1. The scope of this project includes the installation of a leachfield
trench to serve the three bedroom residence located on the referenced
property and excavation of the existing 1000 gallon septic tank to
verify its integrity. If the integrity of the existing septic tank is
poor the existing septic tank is to be excavated, pumped, crushed, and
abandoned in place and a new 1000 gallon septic tank installed.
2. 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.
3. The contractor shall be responsible for obtaining any necessary
underground utility locates.
4. Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling.
5. 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.
SF/:TIC TA~(INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
2. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
3. Ail standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
Page Two
Eklutna Heights Subdivision; Lot 20
April 30, 1994
Septic tanks installed with less than 4' of cover shall be insulated.
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' 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.
AS~(IIF~ION TR[9~C~/DRAINFTELD INSTALLATI(]~:
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 (roughed-up) before gravel (sewer rock) placement.
o
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.
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.
4o
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.
e
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.
MINI]~3]~ MAT~{IA~ SP~CIFICA~I(]~S:
1. Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
Page Three
Eklutna Heights Subdivision; Lot 20
April 30, 1994
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
e
e
o
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM FS10 (HDPE) Yes No
ASTM D2662 (ABS) 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 140/N, 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, its gradation
specifications must conform to current M.O.A. or D.E.C. requirements.
INSPEC~I(]NS:
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:
o
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.
3. The final inspection is to occur upon final grading of the property.
Page Four
Eklutna Heights Subdivision; Lot 20
April 30, 1994
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. The inspecting engineer will not coordinate,
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DAT~: ~tartea [/.~2
PE~IT NUMBER
by L
DOC Co. dDa
SULLIVAN WATER
P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
DEPTH OF WELL
o ~-K'-,-"r'"'~ /-/,"rJ
Ended ~/~"/
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION
From ,9 Ft. to jO
From ,-? Et. to C'~'~'- Ft.
From-'~ Ft~to ~
~n0m '~ Ft.~o ~
~ Fmm~Ft.' to--Ft.
'.From / ~OFt. to--Ft.
From. . .Et. to
~om~gt. to
From, Ft. to
From ' Ft. to
~Froni - .Ft. to--
From' Ft. to .....
.From Ft. to ,
From Ft. to
From Ft. to
From Ft. to
~ From · ...Ft. to
Ft.
Ft.
..Ft.
.Ft.
..Ft.
..Ft.
Et.
.Ft,
From Ft. to. _Ft..
From ..Ft. to_ .Ft.
From___Ft. to Ft.
From Ft. to Ft,
From- _Ft. to _Ft_
_,.q~ ~r~om .Ft. tO .Ft.
From_ Ft. to___ Ft.
From ___Ft. to_ Ft.
From .Ft. to
From___Ft. to _
From ~Ft. to
From _ Ft. to_
From__ Ft, to_
From .Ft. to
From Ft. to
From. Ft. to~ _Ft.
From__-Ft. to Ft
Ft. ·
~'~':o~'~x~'.." ,~,~,~'
Ft. Z~~O~ ' "~
Ft ~-'
Ft. ~~
Ft.
/ 5-a 7-~ /FY"'
DRILLER'S NAME -
DEF'FIF.:THENT OF HEALTH AND
,:,c,S "'L'" 5TREE% HNI_.HORHI~E., flK :.:~.-,~
~,4'="- --'4~'-'~, ~ : RNCHORRGE 6S~4="2~2~ : ERGLE RIN,'E~
Cor-~-b] IfE b~ibb PEa:fi I T
F'ER:f'II T NI]I.
RPF'L I CRNT: OBEt~:.T L. UNc, TR ,','.. [ E_ N F'HONE:
C H U Ii I FI K., FI I<: '.3 9 5 7 7
LEGFIL DESCRIPTION -.- SUB[:,I'¢I9ION: EKLUTNR FITS BLOCK:
,= ~ ,- , RRNGE: SECTION: -
LOT _,I~E ¢ =,6.. FT. TOL4NSHIP: - -
I UERT I F · TI.-.IRT:
1. I RH FFIMILIRF'. L,JITI-'I THE RE~I_IIREHENT¢ FOR ON-SITE =,E~4ER_, RN[:, ~4ELLS RS SET
FORTH B"r' THE I"IUNICIF'RLIT"F OF I~NE:HO~:RGE RND THE STRTE OF RLRSKR.
2. I L4ILL INSTRLL THE S'¢STEH IN FII]CI]~'BFINCE ~4ITH THE CO[:,ES'.RND HRVE RECEIVED
R COP'¢ OF THE C:O[:'E SUI"IflRR¢ FIND [:,IRGRRM FITTRCHr,IENTS ~,4HIE:H IS PR~'.T OF TH~5
PERH I T.
.... ~ .. RE ENLFI~:GEI'"IENT IF THE
~. I UN[E~=,THN[. THFIT THE uN--z, ITE SEFJER S'T'STEH HR'¢ ~'E; I '
RESI[:,ENCE IS ~EMOD, ELE[:,. TO INCLUDE f'IORE TI...IRN: ]: EEB, ROUfl_.
F'ERf'IIT RF'PLII]:FINT HH:, THE RESF'ONSIE:ILIT'¢ Till IHFORf'I FE~_,]NNEL DURING
THE INSTRLLRTION IN_,FEI_.TII_IN:, OF RN'¢ L,.IELLS R[:,JFtCENT TO THIS FRUFERT~ RND
THE NI_IHE:ER OF ~:Ec, I[.EN_.Ez, THFIT THE L4ELL P~ILL SERVE.
IF R LIFT '~TRTIFIN IS INz, T~LLEB., FIN ELE_.TRICRL F'ERr,IIT RN[:, IN=,FE_.TION MU=,T
BE OBTRINE[:,. I_ E, UILT_ CFINNOT E:E FiF'F'F'-',,,'E[:, ~,4ITHOUT RN ELEL. TRIE. HL INz, FE_.TION
REF'I]RT. THE ELECTRICFtL ~4OI~:K HLIST E:E E:,ONE 'B'¢ R LIUENz, E[ ELE_.TRICIRN.
S 16NE[:,:
RF FI._I ...HNT:
I .... I_IE[.,
OBEF.'fT L-:I]INST~: ~::
[:,RTE:
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
MAI LID~ g,J~ D R E,~ '
LEGAL DESCRIPTION
LOCATION
DISTANCE TO:
No. of linls
DISTANCE TO:
Absorption a~ea
zoo/
IF HOMEMADE:
Well
Width
Crib diameter
Well
Depth
Building foundation
Inside length
Foundation ~..~ ,/
Total len~li~..
Material beneath tiJ~6
Depth
Crib depth
Building foundation
Driller
Sewer line
[] UPGRADE
Dwelling~l
Materie~F~,~ C
Width
Material
Nearest lot
TrenchZl~ inches
inches
NO. OF BEDROOMS
PE.M,* N. po
No. of compass
Liquid depth
PERMIT NO.
Liquid capacity in gallons
"ERMIT NOT~','~?L'Ci'0
Distance betwe~ p/~
Total effective ~fbs. o, rption ar~ '
Total effective absorption area
Nearest lot line
Distance to lot line
PERMIT NO.
Absorption area(s)
Septic tank
OTHER
PiPE MATERIA LS,,~ ~
INSTALLER
~ ~~.~ ~.,~ DATE LEGAL
'2-(~-~3~ (ReVl 3/78')
PERMIT NO.
RPPL'ICANT SHARON ~ C/O P. O.
LOCATION MI 24 OFF OLD GLENN
LEGAL L-20 L~, ..... ILL ...........
TYPE OF GOIL RBSORBTION SMSTEH IG: TRENCH
.l-llJr.,,I ! C ' ]-"FIL T T"-r' OF ;'~I'-,IC:'/'~JR;":I.''~E
DEPARTMENT OF .HEALTH AND ENVIRONMENTAL PNOTECTION
825 "L" STREET., ANCHORAGE., AK.
264-4720
~3~4--S I T'E ~EL~ER PERf~ I T
BOX 5888 C. HUG~AK
LOT SIZE 15000 =,~LRRE FEET
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING ~.'~Q FT?BR)=
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[)EPTH= 12 LEr46T| |~":"' 2-c~ GRA~/EL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE ENCAVATION (IN FEET>.
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET>.
E:E(;-1LI I RF., [~ SFPT I C TI::II-,II< S I ZE= t E~D~':.4
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTRLLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
THO <2) I [-4SPECTIO[-IS ARE F:EL-41_IIRE[:.
BACKFILLING OF ANY SYSTEM WITHOUT FINAL IN~PE_.TION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
~-, ,c, IS
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL ~T_TEM
100 FEET FOR A PRIVATE WELL~ OR
i50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC: WELL.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'ERM I T E×P I RFS [:,EC:EI'IBER 3:St.. I 9';:'8
I CERTIFY THAT
l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
,APPLIC~4T S¢~RON ~
MUNICIPALITY OF ANCHORAGE ,
~? 5 ~ ~'4 Departmenf.~f Health and Environment,,~ P ectlon 825 ~ Street, Anchorage, AK. ~9 '
~ 264-4720
,1'~~,$.~. * * .*. HANDWRITTEN PERMIT * * *
Type of Soil Absorption System Is: ~)~//-~
Trench: Drainfield: Seepage Bed t Holding Tank:
Maximum Number of Bedrooms: Soil Rating (sq. ft/br)
The Requ~'red Size of ~he Soil Absorptio~ System Is:
' D~r,,, W~D~H
DEPTH LENGTH GRAVEL ~"
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(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 TM - 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 departmen
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fe~
for a 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 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 3 * * *
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.
I understand that the on-site sewer system may require enlargement if
(3) t~ residenc~ is rem°deled t° include m°r~that/3 bedr°°n~s'/ ~
Signe~:
SWP/024 (1/81)
Performed For
kenal Qescrintion:
This Form Renorts
' 2204 C- ireland Anchorage, .%]aL/"~ 99503'
° Date Performed 10-6-78
Sharon Spears
Lot 20 Block Subdivision Eklu_t_~na
Soils [Otl Yes peKcolation Ie~t
Perth
Feet ;,.'
Soil Characteristics
:18 ·
20 .-.
Was Ground
I· Yes, At
Brown Silty.Sandy Grave~ with
occasional Cobbles
Bottom of Test Hole-
F
Readinq
Water Encountered? 'No
what- Depth?
Date.
Gross Time Net Time Depth to H20 Net Dro
Percolation Rate !tinute
Froposed IostJllation: Seenaoe Pit
Deoth of Inlet
CA~i,E~S: 150 Sq. Ft. drainage a~ea required per be__ddroom,
Drain Field
Bottom Of Pit Or Trench
Test Performed By David Paul
Data
Certified ~:. CTL
Da t e: __10-6-78
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
1. GENERAL INFORMATION
Complete legal description
Lot 20; Eklutna Heights Subdivision
Location (site address or directions)
Property owner .
Mailing address
21644 Madsen's Plac6
Chuqiak, AK
Jay and Terrie Drewry Day phone
HC 80 Box 5928 Chugiak, AK 99567
688-4171
Lending agency
Mailing address
Agent Teresa Romines/ DON MCKENZIE REAL ESTATE
Day phone
Address 13135 01d Glenn Hwy. Suite 100 Eaqle River,
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3 '~
TYPE OF WATER SUPPLY:
Individual well ×XX
Community well
Public water
NOTE:
Day phone
AK
688-4171
99577
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:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72*025 (Rev. 1/91) Front MOA #21
J
5. 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 --~204 Phone
Address E,~,,, ,,,- ,
Engineer's signature
bedrooms.
D~.,~. SIG NATU RE
· Approved for '~
Date ~/~/~ ~/
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
'tiN[iii'Il
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
prof,~ssional 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
respunsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ,~'~1~1 ~'?--~f~ . Parcel I.D.
Wall Data
Well typ~~ If A, B, or C, attach ADEC letter. ADEC water system number ~'
Date completed
I
Cased to [ ~ Ca~ng height ~ '~
Wires properly protecte~)
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG
g.p.m.
AT INSPECTION
RECEIVED
SEPARATION DISTANCES FROM WELL TO:
I
Septic/.l:=:~l~ tank on lot / ~) / ; On adjacent lots
Absorption field on lot /~/ / ; On adjacent lots
Public sewer main --/~',/C~?'J ~' Public sewer manhole/cleanout
Sewer service line '~-~ / ~ Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~) Nitrate ,5~-. ~ ~-.~/Z.-- Other bacteria &
Date of sample: ~_ /' / ~'~,, ~"/" _
Collected by: -~ ~ ~ ~ / ~~
e. SEPTIC/HOLDING TANK DATA
Date installed~ & ~ ~ _~',~Z. Tank size /~ Compartments - ~-
Cleanouts (Y~) / Foundation cleano~N) ~'/ Depression (Y/~ ~
High water alarm (Y~.( ~ Alarm tested (Y/N) ~
Date of pumping ~/~ Pumper ~ ~ ~ [~.
SEPARATION DISTANCES FROM SEPTIC/I,I~E'D'~;~,,,~ TANK TO:
Well(s) on lot /~ / /
To property line
Surface water/drainage
On adjacent lots
Absorption field
Foundation
Water main/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
Manu~
rvl~a,~ole/Access (Y/N)
"Pump on" level at ~ "Pump off" Level at
High water alarm level ~ Cycles tested
Meets MOA electrical codes (Y/~"'"
SEPARATION DISTA~NC~E FROM LIFT STATION TO:
Well on lot ~ On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed ~2/~/~'~''
Length ~' ~ / Width
Total absorption area
Date of adequacy test /.~/,-f--~
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y~
Soil rating (GPD/FF)
~ ! Gravel thickness
Cleanout present'q)~// Depression over field (Y~
Results (pass/fail) ~ ~'7/'~_~/L~ for ~
/,_b/.~. After test .~//~
System type "~--/~C ~
Total depth /~__,2~-
If yes, give date /'--~/7~'
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots ,
Surface water
Curtain drain
On adjacent lots / ~;~-~ / Property line /~ /
//~ / To existing or abandoned system on lot /~ /
Cutbank /'-~/~'L~~ Water main/service line
Driveway, parking/vehicle storage area "~ '~
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, orCA and HAA
Signature S & S ENGINEER~c.// ~ ~
, 17034 Eagle~e~p R~ Ne, 204
Engineers Name. =.~,_ ~__/ /.,/./~__'__~- .....
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
06/07/c]4 12: ~ CTSF- ENU I RONHEIqTRL L~B SERU ICES HI]. 05~ ~02
'~t~I~ Commercial Testing & Engineering Co, ,
Environmental Leboratory Services
LABORATORY ANALYSIS REPORT
Clirmt Name S &, 8 ENGINEERING WOP, K Ord~ .9019
Printed D~tc 06/07/94 t~09:02 N~,
Ordered By R. SI'~BIt Colleetcd~e 0~/01/~4 ~ 14:30 Ns.
Project Nme ~cdv cd Date 06102/94 ~ 11:45 ~a,
Projcct~
PWg~ UA T¢ch~dc~d Dit'ec;o~' ~'FEpI~N C, EDE
Released~y: ~ ..... ~ ~
QC Ailow,<rble Ext. Anal
l'aramcter Results Qual l. Jld~s Metkod Limits Date Date Inil
, ............................... ~'~ ..................
--ht~;~-~- ..
: ................................................................... ' t IA: tJfiav a~,labl¢
* $~ Special Ins/nu~liolts Abov· NA: No I ,~.~lyzed
** Sc~ Sample K¢~ ~ove
Il = Un&t~te~ g~ot~ed vah~ i~ the In~ctical q[t~tfif~cafion limit. LT= I ~ss 'llta~t
D = Secom~y ~lution.
6633 8 Street, Anchorage. AK ~8518-I 600 -- Teh {907} 862-2343 Fax: (907) 661-5301
ENVIRONMENTAL FACILITIES tN ALASKA, COLORADO. FLORIDA, ILL!NOIS. MARYLAND, NEW J~[RSEY, OHIO, U'fAH, WEST VIRGINIA
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, tpwnship, range)
Lot
Location (address or directions)
(b) Property owner
Mailing Address
AHFC Telephone: (home) Business
AHFC'#5646'3
(c) Lending Institution
Mailing Address
Telephone
(d)
(e)
Real Estate Company and Agent JACK WHITE COMPANY/Kathi Olmstead
Address 10928 Eagle River Road, Eagle River, Alaska 99577
Telephone
694-5500
Mail the HAA to the following address: (or check here~ if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING/694-2979
17034 Eagle River Loop Road, Suite 204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family ~3 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.
4. 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
$ o c c~cc~[u,". Telephone
17034 Eagle RLver Loop Road No. 204
/, /"'/
Address
Date
6. DHHS APPROVAL
Approved for'7~/-?bedrooms by
Approved //~ Disapproved
Terms of Conditional Approval
Date
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 M unicipality 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
1.. c) ~9~9 343-4744
A. WELL DATA
Legal Description:
Well Classification ~,'l'~;;~J ~ ~?~ ~
Well Log Present (~N) ~/ Date Completed
TotalDepth I~o~ Casedto /~'~' Depth of Grouting
Staff? Water Level
Casing Height ,~bove Ground
Electrical Wiring in Conduit~N)
SEPARATION DISTANCES FROM WELL:
To Septic/HOlding Tank on Lot
To Nearest Edge Of Absorption Fiel,~jo,~ Lot
To Nearest Public Sewer Line
If A, B, C, D.E.C. Approved (Y/N) ..
Pump Set At
Sanitary Seal on Casing ~N) y
Depression Around Wellhead (Y~
Yield ~-,I
To Nearest Sewer Service Line on Lot
Water Sample Collected by ~,~¢ ~ ~--7-.~G;/.~J~/_.'~ ;Date
Water Sample Test Results '~:::~l,~:-~ ~ ~_____~¢
Comments
;On Adjoining Lots
/ DO /.~ ; On Adjoining Lots /
To Near/est Public Sewer Cleanout/Manhole ~,~
B. SEPTIC/HOLDING TANK DATA
Date Installed / //~ Size
Standpipes ~N) ~' Air-tight Caps,/N)
Depression over Tank (yu_.~
Pumping/Maintenance Contact on File (Y/N) ,/
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well / ~O /7L'~ To Building Foundation
To Disposal Field
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
No. of Compartments ~
Foundation Cleanout (~YN) ~'~
/j/Date/p Last Pumped //- [/~ -~' ~
; for ~
Temporary Holding Tank Permit (Y/N)
72-026 (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
Depression over Field (Y~N~
Results of Last Adequacy Test
Type of System Design
Length of Field -'~-~.~ /
Depth of Field I Z-~
Gravel Bed Thickness ~ ~ ~'~
Statndpipes Present(~YN)
Date of Last Adequacy Test
To Water-Supply Well
To Building Fou~n~d~tion ~ -
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
II - IXt' -
SEPARATION DISTANCE FROM ABSORPTION FIELD:
!
,/ ~ l./_ TO Property Line / ~
To Exis)ting or Abandoned System on
; On Adjoining Lots ~ ~-
[ ~ To Cutback (i.f present)
Comments
D. LIFT STATION
"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
g Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ~;
inspection. ,~.~ C, ~~.
~gnea 17034 Ea9;- ~;,,~ L~ ;~ No. 2~
Company Eagle ~ver~
Receipt No. /~5 --~/~ ff~ ~O Receipt No.
Date of Payment ~' ~ Waiver Fee: $
Amount: $ /~/~--~ Date of Payment
~2-02~ (R~v. 7/eS) ~.ck Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX ID # 92-0040440
ANALTSIS REPORT EY SAMPLE £or Work Order 9 12728
Date Report P~inted: APR 18 89 @ 08:59
Client Sample ID:L20 EKLUTNA NTS
PWSlD :UA
Collected APR 12 89 @ 16:40 h~s.
Received APR 13 89 @ 13:00 hrs.
Preserved with :AS REQUIRED
Client Name : S & S ENGR
Client Acct : SNSENGP
P.0.$ NONE REC'D
Req #
Ordered By : RJP
Analysis Completed :APR 14 89 Send Reports to:
Laboratory Super, v';~o~$TEPHEN C. EDE 1)S & S ENGR
Released By : ~ ~. ~,~ 2)
Special
Instruct:
Chemlab Ref $: 4890 Lab Smpl ID: 1 Matrix: WATER
Allowable
Parameter Tested Result/Units Method Limits
NITRATE-N 0.19 mg/1 EPA 353.2
Sample ROUTINE SAMPLE.
Remarks: SAMPLE COLLECTED BY RJP.
1 Tests Performed ' See Special Instructions Above UA:Unavailable
ND= None Detected ** See Sample Remarks Above
NA= Not Analyzed LT-Less Than, GT=Greater Than
APPLIC/-'IT FILLS OUT UPPER HALr""ONLY
P~'opertyOwner /-y/, .,E" ~Z,,.,.,.,.,.,.,.,.,~,'~ v . Phone
/
Buyer' ~ ~
Address ( [ ~ ~AJt~tJ.J~ / Zip Code
'~ Phone
Lending Institution ~: /~
Legal Descript~n /~ ~O ~//LUW~a
Type of Resi~nce :
Single Family
~ Multiple Family No. of Bedrooms
~ 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 wel~ depth (attach log If available).
~ Public Utility
Sewer Disposal
Individual Year Individual Installed:
Public Utility When Connected to Public Utilit?
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH
ENViRONM'=NTAL PROTECTION
0gT 1
RECEIVED
(,=~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
· ol~Wl.,7-7
--/--
/
BY: , /xJ-- -ca
Boils Rating Date Sewer Installed Well To Absorption Area
Well to Tank Septic Tank Size
72-023 (3/82)
DATE
MEGSAGE
REPLY
SIGNED
~T~---~'~"~J. 4S 472
SIGNED
$~ID PARTS 1 ~ID 3 WItH CARBON IN?ACT -
PART 3 WILL BE RETURNED WITH REPLY.
DETACH AND FILE FOR FOLLOW-UP
DATE
EXCAVATION
ROBERT A. SHAFER
WORK
CIVIL ENGINEER
694-2979
October 12, 1983
Today's Realty
ATTENTION: Joyce Gardner
P.O. Box 279
Eagle River, Alaska 99577
Dear Ms. Gardner
Reference: Lot 20; Eklutna Heights Subdivision
A sewer system adequacy test was performed on the system located on the
referenced property, as you requested. The septic tank was pumped and
verified to have a capacity of 1000 gallons. The absorption trench was
tested by a continuous flow of water over a period of 72 hours with an
adequate amount of water flowing through the system for a three bedroom
residence.
It can be concluded from this test that the waste water disposal system
serving the three bedroom home being built on this property is currently
functioning adequately. However, the system cannot be guaranteed
against subsequent failure.
If
we/B~7~be of further service please do not hesitate to contact us.
~rely
;s
cc: Municipality of Anchorage
Department of. Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA