HomeMy WebLinkAboutFIRE LAKE #2 BLK 2 LT 1Onsite File
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Municipality of Anchorage AU5 2 4 �01_7
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On -Site Water and Wastewater Program - (907) 343-7904 age 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171236 PID Number: 051-351-23
Dwelling.- 01 Single Family (SF) 1771 Duplex (D) 0 Multiple (SF and/or D) Project: F71 New RE Upgrade
Name:
WAYNE JOHN
ABSORPTION FIELD
RM Deep Trench R Shallow Trench [] Bed El Mound
Address
El Other
Phone
Number of Bedrooms
Soil Rating
JTotal depth from original grade
15
1.2 GPD/SFJ
13 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
5.4 Ft,
Gravel depth beneath pipe
7.6 Ft,
Subdivision Block Lot
FIRE LAKE #2, BLK 2,LOT 1
Fill added above original grade
0.5-1.0 Ft.
Gravel length
48 Ft.
Township Range Section
Gravel width
2,0 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
Toil Septic 1 Absorption I Lift Station Holding Sewer
I
Total absorption area
Number of trenches
Dist. between trenches
From Tank Field Tank Line
730 Ft,
1.0
Ft.
Well100,+ 1 '
1 100'+ 50 +
TANK [9 Septic [I S.T.E.P. 171 Holding E] Other
Manufacturer
ANCH TANK
Capacity
1500 Gal.
Surface Water 1 1001+ 1 1001+
Material
Number of compartments
Lot Line 10'+ j 10'+
STEEL
2
NA
Foundation10'+ 10'+
LIFT STATION
Manufacturer
Capacity
Curtain DrainGal.
UN UN
ti
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Tank to
PIPE MATERIAL House to tank 3034 drainfield 3034
Installer
MIKE N ANDERSON
Drainfield 3034 CO/MT aQ34
Inspector MIKE N ANDERSON, P.E.
BENCH MARK (Assumed elevation) 97.5 ft
InspectionLocation
1" 8-21-17 8-21-17
and description
dates: 2"
— th
3 IdZ4
GARAGE SLAB
7 7LM
I I
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
r
Conditional Approval: Date
7..
:4
V4?
,.O - MICHAEL N. ANDERSON
CE 94 9
7,
ApprovedDate
A
PROF[ SS1�30�
1
Inspection Report_9-1-12,doc
Permit No. OSP171236 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: FIRE LAKE #2 BILK 2, LOT 1 PID No.: 051-351-23
T'
1
,OLD SYSTEM DECOMMISSIONED
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1500 STEEL TANK
DRIVEWAY �
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ASBUILT
SCALE: 1 "=�"30'
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MARK
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25
42
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51
MT
52
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,OLD SYSTEM DECOMMISSIONED
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1500 STEEL TANK
DRIVEWAY �
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05
SCO C04 ;
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EXISTING ELL
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ASBUILT
SCALE: 1 "=�"30'
-car CO, ,-CD a F -cos �.c0e
/fire A
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SEPTIC SECTION'
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H\L,PAL, MUNICIPALITY OF ANCHORAGE �,
as e n
On-Site Water&Wastewater Program co S;,,
PO Box 196650 4700 Elmore Road 1
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
vk http://www.muni.org/onsite s r
Dy partnt(Ant
RkCHONAG''
On-Site Wastewater Disposal System Permit
Permit Number: OSP171236 Effective Date: 8/18/2017
Work Type: Septic Upgrade Expiration Date: 8/18/2018
Tax Code Number: 05135123000 tol-t $/Z,(/ I "I
Site Legal Address: FIRE LAKE#2 BLK 2 LT 1 G:0454
Site Mailing Address: 13937 SAVAGE DR, Eagle River
Owner: JOHN WAYNE W JR & CYNTHIA Lot Size in Sq Ft: 40511
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 5
This permit is for the construction of:
0 Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: 1( Date: � 9--
Issued By: RtlitteA C1 ,?9 Date: 017
MUNICIPALITY OF ANCHORAGE
• �e
Community Development Department : Phone: 907-343-7904
Development Services Division Fax: 907-343-Z997
On-Site Water& Wastewater Program 6 � �_`� 10 7�
,f
ON-SITE SEWERMlELL PERMIT APPLICATION `� RUSH
AUG 1 7 t.,Ji1
Parcel I.D. 051-351-23
t_
WAYNE JOHN it:
30 tun
Property owner(s) Day phone
Mailing address 13937 Savage Dr 2_01 6 9 i, g
Site address
Legal description (Sub'd., Block & Lot) FIRE LAKE #2, BLK 2, LOT 1
Legal description (Township, Range & Section)
Lot Size 40511 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑X Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade ❑x Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signatu e o property owner or authorized agent)
12t4-5h
)D
Permit/Rush Fees: $L(1 1 541 = 'ii ' Waiver Fees:
Date of Payment: g l?[Il d lalirliDate of Payment:
Receipt Number: a169)81 Receipt Number:
Permit No. CG P I1 )23co Waiver No.
Permit App_.- • :_.,c
4
Aug. 15, 2017
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: New Septic Permit
Legal: FIRE LAKE #2 BLK 2 LT 1
To Whom it may concern:
This is a request for a septic permit on the above referenced lot the old system has failed. A test hole was
excavated and found clean sandy gravel for the entire depth.The pert rate was found be 2 minutes therefore
a simple deep trench was designed with an effective depth of 7 feet. No water was measured in the test hole
during or after the excavation. The tank will also be replaced at the same time. The slope around the site is
flat with no cut banks within 100 feet.
This system will not impact any of the neighboring properties due to the lot layout.
Please call me if you have any questions.
o/c_Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
• DESIGN CRITERIA: I MOUND OVER
(T1-1i11) o• 11.21111GRADE
5 BDRM X 150 = 750 GPD 12 .ORG i W
SOILS = 750/1.2 = 625 GPD FILTER FABRIC
625 GA/14 = 45' sP 4° ��>+ 4"0 PIPE
(1) TRENCH SEWER ROCK
11.0' DEEP
7.0' EFFECTIVE 11'0
2.0' WIDE I 20' I
45' LONG 19
SEPTIC FIELD SECTION
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PROPOSED
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DRAINAGE FIELD
-BARNES AVE- ___ _'
— — — — — — — — I - I
TT
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, I EXISTING HOUSE I WELL° i PROPERTY LINE
II
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1_� EXISTING WELL
i 1 I 100'RADIUS
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Septic Design Prepared for __*AVM%IR iii,,'
WAYNE JOHN •.'<t•�•OF 44'f/S♦♦i♦
FIRE LAKE #2, BLOCK 2, LOT 1 ,i 49TH %\ •'•• '�♦�0
Eagle River, Alaska
•
Michael N. Anderson, P.G. DATE: 8/3/2017 ,0♦ •:,MICHAEL N. ANDERSON 4 1
4601 NATRONA AVE ♦ No. C 9469 /
•
DRAWN: DJR ♦1 14(��;•.•c
ANCHORAGE,ALASKA 99516 •1J.�••'''.•••....................... ....
(907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=200' 44b, �;='n...•••
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TING SYSTEM
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\ FIRE LAKE /
r \\ LOT 3,TRACT M / PER UPC
- 1 \ /
\ // NEW 1500 GALLON
•,` // STEEL TANK —
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`N _--_ PROPERTY LINE ,,/ \V r'‘'''
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x — __- 2 ..-2.1,,' <- ----i--ice -/ - '\ PROPOSED LEACH r
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II ® v""'" SEPTIC AREA IS FLAT NO SLOPE
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BLOCK 2,LOT 1 / I--
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Septic Design Prepared for 41011,11sig1,
WAY N E JOHN . '•♦�P�E OF q�� ��♦♦
FIRE LAKE #2, BLOCK 2, LOT 1 '• �- ��
• TH ' * t
Eagle River, Alaska 49— �� -• %
•
Michael N. Anderson, P.E. DATE: 8/3/2017 ♦0 a;MICHAEL N. ANDERSON.
4601 NATRONA AVE • No. C 9469 •
DRAWN: DJR �1� .�,, {{,,+
ANCHORAGE,ALASKA 99516 .;%.'„c„.•'••••..��s•�• ••• :�♦
(907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=50' 444, E;=. 4♦
•
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Municipality of Anchorage .4\rilVIINEE-'S EA•C -1*1
Development Services Department ; •.
: Nb. '.9fi`
\ Building Safety Division % *: 49TH •• rA
* On-Site Water and Wastewater Program
— 1 4700 Elmore Road ••• • • ......•.•.•.• a �
P.O. Box 196650 Anchorage,AK 99507 / •
I •I•A MICHAEL N. ANDERSON :Z25,::#4
/
www.ci.anchoraqe.ak.us
.,..__________/ (907)343-7904 CO,' C/9169 ..:47-:.�..
/
1ilF9F�,7161/9 ••$' . ..
Soils Log - Percolation Test tO ESSt`��=
Performed For: w 014 h C -3 v t-vo Date Performed: Wf ‘7). -
s/J
Legal Description: Fte, Z Y 7... V u r ( Township,Range,Section:
Slope Site Plan
Depth
(Feet) OAt,c
2 ? r-- ('( a✓i
3-
4-
5-
6- S ceAV
7-
5 I)SP
8-
WAS GROUND WATER
9- - /7---c v...) ENCOUNTERED? t (r 0
S .
10- L oret-v IF YES,AT WHAT DEPTH? L
0 . , .
Depth to Water After
11- 0-0-9L ! Monitoring? 0f1,, EP
12- Date- /L0,'Z
13-
14- Reading Date Gross Time Net Time Depth to Water Net Drop
15- SII 9- /v►,vti ti L A 5 "
16 U II � I(
17- L/i cj 71
18- Ga if
19- - G t( 5 "
20-
PERCOLATION RATE 'L (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 3 FT AND '...t FT
COMMENTS
PERFORMED BY: /\/I l I CERTIFY THAT THIS TEST VAS/
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: b/,L4072
GRE~[ER ANCHORAGE AREA BOKuUGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503 ,,,~,, - ~ _ ? / I _ ~__,
INSPECTION
LOCATION £/~ 2n/F*
REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRESS ~
~G~scm~o~ ~Z~ ~ J~ T / ~/~ Z4Y:.
SEPTIC TANK:
DISTANCE
FROM WELL/~]~'f' J/~'" ~--~ MANUFACTURER'~.~ 1~-~4 .~ ~- ~'- MATERIAL
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH __
NUMBER OF
?//t~ T/~ S COMPARTMENTS
LIQUID CAPACITY / ?:~'-g) GALLONS.
NUMBER OF PITS __ DIAMETER __OR WIDTH LENGTH DEPTH
LINING MATERIAL
BUILDING FOUNDATION
CRIB SIZE: DIAMETER__
NEAREST LOT LINE__
.DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE 7K
ABSORPTION AREA (WALL AREA)
ADDITIONAL ABSORPTION
SQ. FT.
WELL: /t/z/7- /~// L~b~{~'/dT'¢ 12
'TYPE h~/~'/("/') CONSTRUCTION
BUILDING NEAREST
FOUNDATION __ LOT LINE
CESSPOOL
OTHER SOURCES
APPROVED
DISAPPROVED
~'4/0¢ n~ ~ DEPTH fl~2 ~' DISTANCE FROM:
NEAREST SEPTIC SEEPAGE
SEWER LINE TANK SYSTEM
REMARKS
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:/~ZL ~"~S F
LOT SLOPE:_
Form No. EQ-031
DI ~AG_~I~O F SYSTEM
DATE
G,A.A.B.
GRE -'r ANCHORAGE AREA BO Jgh
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
PERMIT NO.
INSTALLATION LOCATI ~/X
LEGALDESCR,PT,ON 2 /--0Z--~' p I F~t~ /a/~ . ~__~y.
TYPE AND TO
SOIL T[ST E[SULTS
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL C)UALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DI~TAN~I'Z~. R~QUII~NI£NT$ DIAGRAM OF
O,NDAT,O" TO SEE? .CD¢
SEPTIC TANK TO ~.'.~-" ~T WALL
SEPTIC TANK ~-- ., SEEPAGE PIT
TO NEAREST LOT LIHE.
DRAIN FIELD
~EP~I~ TANK, GEEPAGE PIT
/~
, SEEPAGE P,T
/O~'
CA~T IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 ~EET INTO UNDISTURBED SOIL.
DATE /'r~ t ~'~':~--APPLICANT'S S,ON^TU.E
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ~/ Z ~ __//~ / /
GREATER ANCttORAGE AREA BOROU'"
Oepartment of Environmental Qb
3330 "C" Street
Anchorage, Alaska 99503
SOILS LOG - PEROI,ATION TEST
ty
Legal Description: ~1< .~ /c~t ~ ~_~ Icd~,~ ~oLo~.~
This form reports: ~-~i~ 1-~ '~ Percolation test
Depth
Feet
2-
3-
4-
5-
6-
7-
8-
Date Performed__fTy[- ?$ .
10 -
11 -
12 -
13 -
14 ,,
/~a~' ground water encountered?
If yes, at what depth? ....................
Reading Date Gross Time
Net Time Depth to Water Net Drop
Proposed installatlo'--~-n-:----~'e~a--ge Pit .................. Drain Field
........... Depth to bottom of pit or trench
:)epth of Inlet ...... . ..........................
COill'IENTS:
OTFfo~Fe~i-B~:~/LM~'-- .,.C~.,=~._. Certified By: ................................ UaLe: .............
EQ -040 (6/74)
• '-� Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 051-351-23
1. GENERAL INFORMATION:
Expiration Date: F_ k 10 , )_0� 2
Complete legal description FIRELAKE #2: BLOCK 2, LOT 1
Location (site address) 13937 Savage Drive *Eagle River 99577
Current Property owner(s) Brandy Tschoepl Day phone 382-0530
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
M Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
M
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $__.550 Waiver Fee $
Date of Payment/ -7941 Date of Payment
Receipt Number 07-3-Z-3 G Receipt Number,
COSA # 0 SC 211660 Waiver #
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,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: I i `• �-
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
System #1 Approved for 5 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
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#AECC884
OF ANctiO�
014"S��E
with the fi: lI inZ, VATq"i� R o -
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By: Original Certificate Date: 16 X02
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
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OF ANctiO�
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with the fi: lI inZ, VATq"i� R o -
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By: Original Certificate Date: 16 X02
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description:
�������� Checklist �
*���n��� "�wm���m����
FIRELAKE #2; BLOCK 2, LOT 1
If ;nore than 'I septic systern on lot: COSA Checklist # -of
A.WELL DATA
��Well log isfiled with Onsite (or attached)
Date drilled 11127/75
Tota|de[dh*82+ft
��O�
Cesad to`=,f
��Sanitary seal iafunctioning correctly
wires are properly protected
Casino height (above ground) 12+ in.
10/27/21
Date of flow Lest for COSA
Parcel ID: 051-351'23
StruCtUre served by this system
Well production attime oftest 10.3+ pm
Water storage tank volume N/A Aa||ona
infected for coliform teat? F� Yeo EMI No
oUformbacteria iuNegative
Nitrate IA m@/L [] Nitrate less than MRL (ND)
AreeniouA/L EvAmenio less than MRL (ND)
Collected by 11 GEB ' LTD
Date of Sample m000`
Static water level atbeginning oftest 57
_�/.2 �ft.
Comments *WELL LOG |NMOA DOCUMENTS |SBARELY LEGIBLE
B. TANK DATA
Age ofbsnk(s) 4
yaam
Tanktypehnatehu|
Measured operatingfluid level in septic tank 50"
J Stand pipes/foundetioncleanout per record drawing
Date oypomping
D. ABSORPTION FIELD DATA DEEP TRENCH
Which system tested (date installed) 8/21/17
ALL atondpipeapresent per record drawing
4
Total measured depth �m1
o
grade �,O ft (max)
Measured depth topipe invert from Qrode5_�.58 ft (min)
1_lN/A — pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective _r�__
# Code -required soil cover over field
FlSystem presoaked
(Required ifvacant for greater than 3Odays prior to
date oftest)
Gallons introduced N/A "a||uny
Comments/Deficiencies:
C. LIFT STATION
0Required maintenance completed
Age oflift station ____years
Lift station material
N/A
Comments:
Adequacy test date 10/27/21
Results [Z]Pass For 5 bedrooms
Fluid depth prior 0otest 23 in
Water added 1332 gal
New depth 64 in
Elapsed time 120 min
Final fluid depth 42 in
Absorption rate 750+ gpd
Any rejuvenation treatment (past 12months)
NA\
If yes, enter date ____
ME
E SEPARATION DISTANCES
Frorn Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station onLot >1UO'
El Yes
if No
Community Sewer Manhole/Cleanout >1OO'
M/ Yes
ifNoft
Property Line >5'
7Yeo
ifNoft
Neighboring Tank >1OO' Yen
ifNoft
Wells onAdjacent Lots:
Private Sewer/Septic Line >25'Yes
ifNoft
Absorption Field onLot >1OO' Yes
ifNoft
ifNoft
Holding Tank >1UO' Yea
if No ft
Neighboring Absorption Fields > 100'
Water Main >1U'
121
Animal Containment> 50' Yeo
ifNo ft
[71 Yes
ifNoft
E] Yes ifNoft
Water Service Line >iO'
ED
Yes
ifNoft
Manure/Animal Excreta Storage ^ 100'
comment below
Community Sewer Main > 75' P/71 Yes
ifNnft
��Yea
ifNuft
FmmSeptic/Hoiding Tank onLot to: (Please enter distances if less than required)
Building Foundations >1O'
El Yes
if No
°51+ ft
Surface VVater>1D(y
nlYeo ifNoft
Property Line >5'
�1Yao
Yes
ifNnft
Wells onAdjacent Lots:
VVoterK8ain>10'
Absorption Field >5'
��Yee
ifNoft
ifNoft
Private Wells >1O0' Yen ifNoft
Private Wells >1OO'
��Yea ifNoft
Water Main >1U'
121
Yes
ifNoft
Surface Water >iU0'
Community Wells >2OU'
E] Yes ifNoft
Water Service Line >iO'
ED
Yes
ifNoft
|fseptic tank ieunder driveway
comment below
From Absorption Field onLot to: (Please enter distances ifless than required)
Building Foundation >1O'
Yee
if No **
ft
|fabsorption field isunder driveway comment below
Property Line >10'
121
Yes
ifNoft
Wells onAdjacent Lo��
VVoterK8ain>10'
1771
Yes
ifNoft
Private Wells >1O0' Yen ifNoft
Water Service Line >1O'
111
Yes
ifNoft
Community Wells >2OO' Yeo ifNuft
Surface Water >iU0'
��Yea
ifNoM
F. ENGINEER'S COMMENTS
*MET CODE AT TIME OF INSTALL **3'TO SHED ON CINDER BLOCKS
G. ENGINEER'S CERTIFICATION
/ certify that / have determined through field inspections and review
ofMunicipal records that the above systems are inconformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
#AECC884
LA
'0
Z
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fn
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01
4.3' DECK
14.4' SHED
0
00
WELL -\"o
IAIN-UNK FENCE
6
Lot I
zo
16.0' x 16.4' DECK
30V
STAIRWELL
JV -_ , --j-,
8.0' x 9.0' DECK
-MORTGAGE SURVEY X SCALE 1 50 GRID NW 454 _Prolect No. 21-679LAM1
11500 Daryl Avenue. Anchorage. Alaska 99515-3049
Lang & Associates,(907) 522-6476 Phone
(907) 522-4625 Fox
I =P OF A/
Professional Land Surveyors ken0longsurvey.com ..........
jonothan*langsurvey.com
I hereby certify that I have surveyed the following described prop":
LOT 1. BLOCK 2. FIRE LAKE SUBDIVISION No. 2 (Plot No. P-515)
Anchorage Recording District, Alaska, and that this Mortgage Location Survey Is a
representation of the conditions that were found on the date the survey was performed.
This survey does not constitute a boundary survey and Is subject to any Inaccuracies
that a subsequent boundary survey may disclose. The Information contained hereon shall
not be useJ to establish any fence, structure, or other Improvements.
Iltll - tl�_�'L' t
Dated this the L -L_ Day of l
I , of Anchorage, Alaska
4 is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plot.
Paz 1, =0
No
'0
PIPES
fn
14.4' SHED
0
00
IAIN-UNK FENCE
6
Lot I
rn
40,485 s.f.
70
7r,
-MORTGAGE SURVEY X SCALE 1 50 GRID NW 454 _Prolect No. 21-679LAM1
11500 Daryl Avenue. Anchorage. Alaska 99515-3049
Lang & Associates,(907) 522-6476 Phone
(907) 522-4625 Fox
I =P OF A/
Professional Land Surveyors ken0longsurvey.com ..........
jonothan*langsurvey.com
I hereby certify that I have surveyed the following described prop":
LOT 1. BLOCK 2. FIRE LAKE SUBDIVISION No. 2 (Plot No. P-515)
Anchorage Recording District, Alaska, and that this Mortgage Location Survey Is a
representation of the conditions that were found on the date the survey was performed.
This survey does not constitute a boundary survey and Is subject to any Inaccuracies
that a subsequent boundary survey may disclose. The Information contained hereon shall
not be useJ to establish any fence, structure, or other Improvements.
Iltll - tl�_�'L' t
Dated this the L -L_ Day of l
I , of Anchorage, Alaska
4 is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plot.
Paz 1, =0
No
'
Mu�� ��.,
����K� ��]�����
Municipality �u Anchorage
On -Site Water and Wastewater Program �
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEms APPROVAL
P8rCe|i[). 051-351-23
1. GENERAL INFORMATION
Expiration Date:
Complete legal description FIRE LAKE 92, BLK 2, LOT I
Location (site address) 13937 SAVAGE DR. EAGLE RIVER, AK
Current Property owner(s) WAYNE JOHN Day phone
Mailing address —SAME
Real Estate Agent
2. TYPE C>FDWELLING:
�� �
�� Single Family kw/w/o/\OU\
F� Duplex
1771 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OFBEDROOMS:
4. TYPE OFWATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
WaiverNariance request for:
Day phone
`
5-
TYPEOFVVASTEVVATERD|SPC)SAL:
z
Individual
z
| |
Holding Tank
El
| |
Community
El
E71
Public Sewer
El
Distance:
uuu*moereeaoecimthe engineer, unless otherwise requested bythe engineer,
CDSAFee Waiver Fee $
Date of Payment Date ofPaynoent
Receipt Number Receipt Number
C[}G/\# VVaiver#____�
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,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm MIKE N ANDERSON, P.E. Phone 727-3564
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON PE Date 3/23/17
6. DSD IGNATURE
System #1 Approved for
System #2 Approved for
Disapproved.
Conditional approval for
-5 bedrooms
bedrooms
y^� �
A
+ 10" t i f (v c
p�aoo> r etoe acuocos� '��E
'1 h:ilCHA:L Pi. ANDERSO lotl`
CE 94'0
V"
bedrooms, with the following stipulations:
ON-SITE
ATER AND
PROGRAM
By: � 'E►. Original Certificate Date: � 3O ,20 7
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc
Ifmore than 1septic system ieonthe lot:
COSAChecklist # -of
___
Structure served by this system
Legal Description: Parcel ID:
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed j0-27-75 Sanitary seal (Y/N)�
Total depth _87'f� Cased to_82 ft.
FROM WELL LOG
Well Log (YYN)
Wires properly protected (YYN)y
Casing height (above ground) _24°±
AT INSPECTION
Date of test 10-27-75 8/7/2017
Static water level 64 ft� 61 ft,
WATER SAMPLE RESULTS:
Cn|honn NEG colonies/1O0mL Nitrate `
Arsenic: - ND uQ/L Date of sample: 8-22-17 Collected by: Mike Anderson
B. SEPT|C/HOLDINGTANK DATA
TankTypo/K8ateha| STEEL Date installed 812212017
Tank size 1500 gal. Number of Compartments 2 C|eonouta(\YN)
Foundation cleanout (YYN)y Depression over tank (Y7N) N High water alarm (YYN) NA
Date nfpumping NEW Pumper NEW
C. ABSORPTION FIELD DATA _198SSYSTEM TESTED
Date installed 8tD/Z8YT Soil rating (of/bedroom)1��_ System type DEEP TRENCH
Length 48 ft. Width _2ft. Gravel below pipe _Tfi_ft.
Total depth t3.6 -/""f Effabsorption area r,« *c Monitoring tube ,( Depression over field N
Date ofadequacy test NEW Results (Pass/Fei|)_NEW i_For J_bedrooms
Fluid depth in absorption field before tost__ in. VVateradded_ga|. New depthin,
Elapsed Time: ___min. Final fluid depth __ in. Absorption rate 8.pA
Any rejuvenation treatment (past 12mo.)(\?N&type) UNKNOWN |fyes, give date________
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size ingallons Manhole/Access (Y7N)
in. "Pump off' level skin.High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ONLOT TO:
Septiotynk/|ift station onlot
Absorption field onlot 1001+
Public sewer main
Sewer /septic service line
Animal containment areas
SEPTIC/HOLDING TANK ()NLOT TO:
On adjacent lots
Onadjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
Building foundation Propehyiino_1{y± Absorption field
Water main 1 Water service line Surfaoewahsr
Wells nnadjacent lots _10O'+____
ABSORPTION FIELD ONLOT TO:
Property line Building foundation _Y8 Water main
Water Service line _50y+Surfaoewoter Driveway, parking/vehicle storage _10.±____
Curtain drain Wells onadjacent lots _10K7±�__
F. COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that / have determined through field inspections and
review of Municipal o*cVndo that the above nyohenns are /n
conformance with MOA CO3Aguidelines /neffect onthis date.
Engineer's Printed Name MIKE N. ANDERSON, PE
Date 8/23/2017
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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
Completelegaldescription Lot 1, Block 2, Fire Lake Subdivisicn
Location (site address or directions)
13937 Savaqe Drive
Eagle River, Alaska
Property owner
Mailing address
Lending agency
Mailing address.
/riel Sather Day phone
13937 Savage Drive~ Eagle River~ Alaska 99577
Day phone
696-0017
Agent Mary Rea rdon
Address
Day phone 274-6142
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 5
TYPE OF WATER SUPPLY:
Individual well ×
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
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
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,
Address 255 E.
Engineer's signature
ordinances, and regulations in effect on the date of this inspection.
NameofFirm Gilfi l ian Engineering, Inc. Phone
Fireweed Lane, Suite 102 Anchorage, AK
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
277-2021
99503
Date 11/24/93
bedrooms, with the following stipulations:
Additional Comments
Date
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 p?ofessional engineer's work.
72-025(Rev. 1/91) Back MOA~21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription: Lot 1, Block 3, Fir~e Lake Sub. ParcelI.D.
A, Well Data
Well type Pr'irate
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Y
87'
If A, S, or C, attach ADEC letter. ADEC water system number
Date completed 10/27/75 Driller Sam Cot ten Dr~illing
Cased to 82 ' Casing height 24"
Y Wires properly protected (Y/N) Y
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG AT INSPECTION
10/27/75 11/23/93
64' 57' 8"
15 g.p.m. 6.5
764' 764'
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 100' +
Absorption field on lot 1 O0 ' +
Public sewer main NA
Sewer service line 25' +
g.p.m.
; On adjacent lots 100' +
; On adjacent lots 100 ' +
Public sewer manhole/cleanout NA
Petroleum tank 25' +
WATER SAMPLE RESULTS:
Coliform /Z} ~5 E~"~
Date of sample: 11/23/93
Nitrate /,! ~//;'!,~.//-, Other bacteria
Collected by: K. Sheet s
B. SEPTIC/HOLDING TANK DATA
Date installed 9/9/75
Cleanouts (Y/N) Y
High water alarm (Y/N)
Date of pumping
Tank size 1 ?50 Ga I . Compartments
Foundation cleanout (Y/N) Y Depression (Y/N)
NA Alarm tested (Y/N) NA
3 Pumper '~--/~), '..S /d~£ l/V ~'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 100' +
To property line 10' +
Surface water/drainage
On adjacent lots 100' + Foundation 10' +
Absorption field 5 ' Water main/service line 50,
None
72.026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed 9/9/75
Length 47 '
Total absorption area
Date of adequacy test
Water level in absorption field before test ( 1 )
Peroxide treatment (past 12 months) (Y/N)
Width
752 Cleanout present (Y/N) Y
11/23/93 Results (pass/fail)
= 82" (2) = 52"
N
Soil rating (GPD/Ft2) 125 sq. f t/BRSystem type
Unknown Gravel thickness 8 ' Total depth
T Pen ch
~0'
Depression over field (Y/N)
for 5
Aftertest (1 : 82"
If yes, give date
N
Bedrooms
(2) = 52"
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1 O0 ' +
To building foundation
On adjacent lots 50 ' +
Surface water None
Curtain drain NA
15'
On adjacent lots 100' + Property line 1 o ' +
To existing or abandoned system on lot NA
Cutbank NA Water main/service line NA
Driveway, parking/vehicle storage area 10 ' +
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effebt~~ of this inspection.
.....
Signature~~R~f'l' ~ ~ ~'~~~~~*"~'~'~'" '~
Engineer's Name er . ~ ~ ~ an, ~ .b. ~?'~:::~P~r': jj ~
Date 11/24/93 ~, ~, . ,. ~
H~ Fee $ ~ ~ ~ Waiver Fee $
Date of Payment ~- ~ ~ ~ ~ Date of Payment
Receipt Number ~7~ ~~ Receipt Number
72-026 (3/93)* Back
Gilfilian Engineering, Inc.
1800 E. Parks Hwy., Suite D-100
Wasilla, Alaska 99654
WELL FLOW TEST DATA SHEET
From:
Well Log ® Probing Measurements
ADEC Records
Well Depth: 82' ®
Static Level: 57' 8" (D
Physical / Sanitary Features: Sanitary Seal / Cap
Casing Above Ground Surface: __
Pump Wire in Conduit
Surface Drainage Away from Well:
Good ~f Poor
24"
Well Pump Specs:
Water Supply Line:
Size:
Drop Pipe:
Size: Type:
Depth to Pitless Adapter:
Storage / Pressure Tanks:
Type:
Time Time Interval Pumping Cumm. Static Comments
Minutes Rate (gpm) Gal. Level
11:25 -- 6.5 -- 57' 8"
11:55 30 6.5 195.0 57' 11"
12:20 25 6.5 357.5 57' 10 Y2"
12:55 35 6.5 585.0 57' 11"
13:30 35 6.5 812.5 57' 10"
Minutes TOTALS Average = Gallons Asl
125 125 6.5 812.5 3"
Time Time Interval Static ar Comments '
Minutes Level
1340 10 57' 8" 3"
LOCATION: Lot 1, Block 2, Fire Lake
CLIENT: Mel Sather
PROJECT NO: 93142
DATE: 11/23/93
BY: K. Sheets
WELLFLOW,GEI
.IUNICIFALIT~ OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF ~ALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR NR. ALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description (include lot, block, subdivision, section, township, rar~e)
Location (address or direc~io~)
(b) Applican~s Name ~o~er Telephone - Home~'~Z~usiness
Applicants Address
(c) Applicant is (check one) Lending Institution
uyer - ; Other Ci (. plain);
(d) Lending Institution
Ad~k~ss
~-~; Owner/builder~-~;
Telephone
(e) Real Estate Co. & Agent
Address
(f)
Telephone
Mail the HAA to the following address:
2. Type of Residence
Single-Family~
Number of Bedrooms
3. Water Supply
Individual Well~
Multi-Family ~-~
Other {describe)
Community~--~ Public C--~
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~-~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[~age 1 of 2]
5. Engineerin§ Firm Providin~ 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 regula-
tions in effect on the date of this inspection.
Address 1¥S30
Date /tO
Approved bedrooms
Approved
Terms of Conditional. Approval
CAUTION
TRE MUNICIPALITY OF ANCHORAGE D~PA/~TMENT OF ~.~LTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES ~-dLTH AUTHORITY APPROVAL ~ERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER HEGISTERED
IN THE STATE OF ALASKA. T~ DEEP DOES THIS AS A COURTHSY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO. SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DEEP 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)
Rl~4/eJ/nl8
[Page 2 of 2]
7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
WELL DATA
Well Classification ~r~v~. If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) ~' Date Completed jO/~,?/?,,)"' Yield
Total Depth ~-~ Cased to ~ ~ ~,' Depth of Grouting ,~,A,
Static Water Level ~-ye
Casing Height Above Ground
Electrical Wiring in 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/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
Pump Set At ~ ~"
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (y/N)
; On Adjoining Lots ~,
IO$' ; On Adjoining Lots ~,
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date ~ /~'~' ~'
N
B. SEPTIC/HOLDING TANK DATA
Date Installed ~/)/~"~
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~
To Property Line
Size
To Water Main/Service Line
Course .~ I00 ~
Air-tight Caps (Y/N)
No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped
; for N,.4.
Temporary Holding Tank Permit (Y/N)
To Building Foundation I~ '
To Disposal Field ~'~
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ /~/?,5'
Width of Field ~('~ ~
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
I Z$ ~'/~,~r,~ Type of System Design
Length of Field ~ ?'
Depth of Field ~ 3 '
Gravel Bed Thickness ~ '
"/~" ~. Standpipes Present (Y/N)
/~ Date of Last Adequacy Test
To Property Line ~-~'
To Existing or Abandoned System on
; On Adjoining Lots ~ 3~
To Cutbank (if present)
To Water-Supply Well
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 .~?~&em ~¢¢¢/~/~,~/ ~00 ~'~/(0,'~'
D. 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 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed .~'~r-~ ~. ~ Date
Company ~'1¢,~"~/~ /'~er.~4,~,! .~'vr..t' MOA No.
Receipt No. .-.-~,.~
Date of Payment ~.-II
Amount: $ (.,..
Page 2 of 2
72-026 (11/84)
Engineer's Seal
#1: ~ime
MUNICIPALITY OF ANCt'~ORA
DEPARTME, OF HEALTH AND ENVIRONMEI, PROTECTION
825 L Street, Anchorage, Alaska 99501
264-4720
Date Received:
November 9, 1977
10:30 a.m. ~2: Time ~3: Time
Date 11-10-77 Thursday Date Date
Insp Pratt Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
,ending Institution Request:
Alaska Bank of Commerce
Mailing Address: Pouch 7-012 99510
Phone:
279-5641
2. Property Owner: Richard L. Dickinson ,,, Phone: 272-3242
Mailing Address:
3. Legal Description: Lot 1 Block 2 Fire Lake Subdivision
Single Family Residence: (x)
Multiple Family Residence: ( )
Number of Bedrooms:
Number of Bedrooms:
Six
Well System:
Permit #
Construction
Individual Well (x Community/Public System ( )
Depth of Well Well Log on File
Bacterial Analysis
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System (x~
Public Utility ( )
Installed
1975 Installer
Manufacturer
Soils Rate
Material
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Absorption Area
Absorption Area
to Nearest Lot Line
MUNICIPALITY OF ANCHORAGE
Department of Health and Environmental Protection
825 L Street, Anchorage, Alaska 99501
264-4720 ,. ' ..., ,
'~equest for Approval of Individual Sewer and Water Facilities
Property Owner: /~/d~ {.~ ,4~-.~.z9 6,/~ f c/~z~J~c o~
Mailing Address: Phone:
Name of Buyer:
Mailing Address:
Phone:
o
Lending Institution:
Mailing Address:
Phone:
Realtor/Agent: ~
Mailing Address:~z/~/~ /~/~7--/~/u/ ~ Phone:
Legal Description: ~ ~.~Zf~ Z,f ~~ Z~ ~,
Street Location: ~ ~~~~,_~d~ /
Single Family Residence: (/ Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply:
If Individual Well, well depth
If Community System, name of system
* Individual Well (/Public/Community System ( )
Sewage Disposal System: On-site System
If On-site System, date of installation:
(/Public System
( )
*NOTE:
A well log is required on ALL wells drilled since 6/75.
If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 1 B1Qck 2 Fire Lak$ SubdSvision
Comments:
Affadavit Attached: ( )/~
Disapproved:
Letter Attached: ( )
Date:
Department Worksheet:
-'agle River Area
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received February 9, 1976
////0///_.,/?,..., I-~F3,~, Time of Inspection
_~ ~<~/~ ~/..D' Date of Inspection
~ .~ REQUEST FOR APPROVAL OF
/)/,/~,' INDIVIDUAL SEWERF~RWATER FACILITIES
Conv.
3:00 p.m.
February 11, 1976
Fred - Wednesday
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
First National Bank of Anchorage - South Center Branch
Post Office Box 4-2090, 99509 Phone:
Richard L. Dickinson
Phone:
Post Office BOX 113 Eagle River 99577
274-1521
272-7583
Legal Description: Lot 1 Block 2 Fire Lake Subdivision
Location: savage Drive
D
Type of facility to be inspected Single Family No. of bedrooms
Wel 1 Data: Individual
A. Type
C. Construction
B. Depth ~)~ /
D. Bacterial Analysis ~;~6'~ ,.
Sewage Disposal System:
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
~/q~_~ B. Installer
1. Size /~-~3 2. Manufacturer
1. Absorption Area ~b"~ 2. Material
Total length of lines / ~,t°~/¢~
A. Well to: Septic tank , Absorption area , Sewer Lines
Nearest lot line
B. Foundation to septic tank
,, Other contamination
'~' , Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA FHA
Mailing Address: ~('). /')~x'-:~ ~,~?~;/%F~.\~.~)i~q~ DayPhone
;
Mailing Address: '~.'~;~('~ ~ ~~k~y Day Phone
4. Name of Lending Institution: ?;'{ ¢:~J ~k~ ~O~ck
Mailing Address: ~.,. E)~V ~- ~-d)d~ ~ d~d)':;~) Phone
.5. Name of Realtor or Agent:
Mailing Address: Phone
Legal Description:
Location: ~
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply:
No. Bdrms. ~b
Public Utility
Individual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Individual (on-site)
EQ-037 (1/74)
Page 2 of two pages - Re st for Approval of Individual F ~r & Water Facilities
Comments
Approval ~Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)