HomeMy WebLinkAboutALPINE WOODS BLK 2 LT 13Onsite File
Alpine Woods
Block 2
Lot 13
#015-234-21
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 4
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201252 PID Number: 015-234-21
Dwelling: Al Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade
Name
THOMAS M. WOODS
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
11821 MOOSE ROAD *ANCHORAGE, AK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-345-8908
3
*1.0 GPD/SF
2.25 (MAX) Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
SEE DWG. Ft.
Gravel depth beneath pipe
0.52 Ft.
Subdivision Block Lot
ALPINE WOODS; BLOCK 2, LOT 13
Fill added above original grade
SEE DWG. Ft.
Gravel length
45 Ft.
Township Range Section
N/A
Gravel width
.10 Ft.
Beds: Number of Lines
2
Distance between lines
5 Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
4.50 Ftz
'
- Ft.
Well
_
_
_
_
�,
TANK El Septic A S.T.E.P. El Holding [I Other
Manufacturer
INFILTRATOR
Capacity
1060/540 Gal.
Surface Water
*50'x-
*50'-{-
*50'-}-
_
Material
Number of compartments
I
Lot Line
5'+
10'+
10 , +
_
NA
HDPE
Foundation
10'+
10'+
10 1+
_
LIFT STATION
Manufacturer
Capacity
Remarks *CAT II AWWTS - OLD TANK DECOMMISSIONED
INFILTRATOR
540 Gal.
PER CONTRACTOR PER UPC
Alarm location
REMOTE MONITORING
Electrical installed by
CAPSTONE
�-
Tank to
PIPE MATERIAL House to tank D3034 dra'nfield D3034
Installer'
A+ HOME SERVICES �- \
Drainfield D3034 co/MTD3034
Inspe for DAVID GARNESS PE AND TIM ECKLUND J
BENCH MARK (Assumed elevation) 95.29 ft
Inspection 15' 9/24/20 9/24/2"0�
Location and description
dates: Zia
3,d9/25/20 4.h
TOP O F M H 1
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
6d
Conditional Approval: Date
4b'
U f 6y A Garness.- D
4 D
Septic System
Approved Date I `� a02�
0�9.�" C)-7-9- -2 Z �o
.
l e
4j� �' •LI � ��I'
�ur�
V�p4p,Ofess'100
Note: this approval does not include well permit requirements.
#AECC884
kmev UD/UL/ ILS)
��;s� t)t7/zr
PERMIT NUMBER: RECORD D RAW I N G PARCEL NUMBER:
OSP201252 015-233 4-21
O
O�
0
O NEW
�I
Ji
APPROXIMATE LOCATION OF
ADDITIONAL PERCOLATION TEST MT
NEW IM -540 INFILTRATOR SEPTIC TANK
TO BE USED AS RE -CIRCULATION TANK MT
CO
T1 ST
H2
VP2
P1,
S
Fn
NEW NS500
TREATMENT POD
EXISTING DRAINFIELD
ALL SWING TIES WERE TAKEN
FROM THE ATTACHED
SURVEY BY LCG LANTECH
WATER LINE WAS PROFESSIONALLY LOCATED (RETAINED BY
CONTRACTOR) AND SURVEYED IN BY LCG LANTECH' PORTION OF
WATER LINE NOT SHOWN ON SURVEY WAS 'TIED IN" BY GEG
APPROXIMATE LOCATION OF EXISTING
LINED POND (DRY); SEE ATTACHED
PROFILE DRAWING FOR ELEVATIONS
DRAINFIELD
—GEG T.H.#1
`NEW 1060 INFILTRATOR
SEPTIC TANK-
..
1
- rid sl,
'--DBL1&2 �l��rrl
r � Jlj�t t�
i 1
EXISTING HOUSE
<5
GARNESS N
ENGINEERING ; SALES CONSULTING
37CIP ,JD0RRC„D,S0,,TE101 ANCHORAGE AK 19507 PHONE (901) 337. 179 -FAX 07;..783 46 VLBSI-E1
PREPARED FOR: PHONE NUMBER PAGE NUMBER:
TOM WOODS 907-345-8908 2 OF 4
LEGAL DESCRIPTION: DRAWN BY:
ALPINE WOODS; BLOCK 2, LOT 13 D.J.G.
TYPE OF WORK: DATE:
SEPTIC SYSTEM RECORD DRAWING 11/�/112/2021
N
V=40'
�P..••••..... ISL+i
0 ............. ..... ...�........
0
"i .......... 0
0.�o : rey mar ss
�� F, •'••.. �73 AV
•••'' • �'�'.
LICENSE,1 �;\\S",���
#AECC884
SCALE 111= 10'
ORIGINAL GRADE 25% SLOPE AT 2 FEET ABOVE TOP OF ROCK
33% SLOPE AT 2 FEET ABOVE TOP OF
ROCK (DOES NOT INTERSECT)
BOTTOM OF LINED POND ELEVATION = 87.84
1.75' TO INVERT �� (0.6 FEET BELOW TOP OF SAND ELEVATION)
10.5 FEET .�
2.25 FEET OF SAND TOP OF SAND ELEVATION = 88.24 --�
OF
♦.
1-77 7777�7
LtdGA
RNIT
..... a
............... ...........
�MSALES ,� CONSULTINGa M .�,.. AA ( .... 0
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907)338-3246 - WESSIM -game gineemg � .. w SM+ .. . . e.......... • .
0 }} r
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: , rCt y Games® �l' �AV
TOM WOODS; BLCOK 2, LOT 13 907-345-8908 3 OF 4 �� �•. CE -7953 _�!
LEGAL DESCRIPTION: DRAWN BY: �♦ I ���
ALPINE WOODS; BLOCK 2, LOT 13 D.J.G. �Fp•'''•••.. ...•`�P�,.�4V
TYPE OF WORK: DATE: rrr \\ ��••
� RECORD DRAWING OF PROFILE FOR LINED POND 10/26/2020
Qilrci I ► ► •
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 335-3245' W BSI I t—gamessengmeenng—.
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: ALPINE WOODS; BLOCK 2, LOT 13
PERFORMED FOR: TOM WOODS DATE: 6/26/2020
DEPTH
(feet) PERCOLATION TEST PERFORMED IN THE CENTER OF THE NEW BED AT
"BOTTOM OF THE EXCAVATION" DURING CONSTRUCTION
1
7
8
9
10
11
12
13
14
15
16
17
18
DATE READING
CLOCK
TIME
SOIL CLASSIFICATIONS
WATER LEVEL
READING
NET DROP
(INCHES)
9/24/2020 1
1:36
'. •'
2
- IIIIIIIIIML
30
4.75"
1.25"
3
2:06
II�III!11 CL
6"
%/% NIIN •
2:36
30
4.75"
1.25"
5
:'.'SW111111111MH
6"
• CH
6
3:06
30
4.75"
1.25"
•
'.�SIC
7
8
9
10
11
12
13
14
15
16
17
18
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
9/24/2020 1
1:36
6"
2
2:06
30
4.75"
1.25"
3
2:06
6"
4
2:36
30
4.75"
1.25"
5
2:36
6"
6
3:06
30
4.75"
1.25"
PERCOLATION RATE 24 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
19
TEST RUN BETWEEN 4.5 FT. AND 5.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES E NO
SOILS LOGGED BY: N/A PERCOLATION TEST PERFORMED BY: DAVID GARNESS, PE
rnMMFNITq. PERCOLATION READINGS ARE WITHIN 1/16 OF INCH.
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PEjRFQIED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: / (� (2 ,7
10/02/2020 12:10 8686770 APLUS
Municipality of Anchorage
Developmen Services Department
P.O. Bax 191 650 - 4700 Elmore Road
Anchora! e, Alaska 99519-6650
Info and Help: (907) 343-8211
It SPECTIONS:
Voice: (907) 34 3-8300 Fax: (907) 249-7777
1o/1/2o2o
Inspection Report
Vicense[AP#:
RETROE2014E �
Parent AP#:
Inspection #:
631615
Type:
DPRETRO
Status:
Closed
Address:
11821 MOOSE RD
Parcel:
01523421000
Inspector:
N.Holland
Project:
Resp Party:
Descr:
New lift static I.
Inspection
Electrical (Ele ancal Inspection)
Item:
Evaluation.
Approved
Result Notes:
Electrical lift Station approved
PAGE 01
m
OU)
0 U)
U)
m
X
0
z
0
0 m
>
i
�pc c:
Z M
Z—
> r M
LA m
M ><
r
M>
< Ul L')
Z
0 m e -I
r)
m co m
r)
co m 0
< z
o r)
Z 0
4 Z Fn 0
ril M
VI -n
mcg
>
oC
A0-nLn
r- m
mGl >
ryl 0
0 Z
q 0
-n N m
7- z
4
> z
Ul
m
0
r- \
0
0
0
00
409a
C
m
O*t <
m
10
ol PA
M PW' .
A te, :
>
Ln VA >
m C: r -
K
m r—
>
0.10
m
319
.461
Ul
Z m
o
m Z m Z
;po
M
>
V)X
m LA
w
m r—
zz
7. C)
..... ......................
.............. ..
.............
.............
............
....... .......
I .... .......... .
....... ...........
..... ...........
*.,. ' .... : ...........
........ ..........
........ ... * ......
..........
...................
.................
..................
.................
.................
................
..............
.................
...........
.............
............
. . . . . . . . . .
C�q
0
0
0--
°c0 -Vp ;0
>
m
>
>
m F)
)� LA
r7
X
m
z
z
*
M
,
>;o 0 m 0:� r)
z '0 m
m z EZ z
-u
m
-0M-0 0
Z °oo>
x
Ln L A r) 0 - M-1 Z:�E
'M' A o < > z0
>
C>
O;v M ;o 0
0 m > * Z
>
z --q r
Ln Lr -rC
0
z
c- m
oo
;T3 313
=4 L12
--o 0 C) z
-u V > r)
r - z M;o
z �b. ;o z
0 U*) 0 Ul 0 >
-V r) V)
-n
0' ;0
;v c L" z m;00r)
G) 2Az
0
<D
(
ul 0 co m
m L/) -Tl 0
>;o > M C
co LA
z
00
(D
r- Z -4
0 71 m
-r' C)
00
1-.
r')
*0 z >
>0 --4 >
0)
m
c) r)-< M m --j
--4 ril Z r
> ;o r) M
cn
0 Ln 0
V -4 Z —
M > C) Z >
YJ0
C)
;o Z LA M -r
m
-n
co
:� rl) . --q :;:� un
m
V) m c
M ;o
w
00
c)
00
0. >
r- m M Ez
LA r*) m Z m <
-r --j z m
m -r x
0
cu
0 LA --I -<
m Ln
00
(D
0c0 m X -
F n0
X 0 z z --i
-r
-n > 0 r) m
0
-n
z
0
0 m
>
i
�pc c:
Z M
Z—
> r M
LA m
M ><
r
M>
< Ul L')
Z
0 m e -I
r)
m co m
r)
co m 0
< z
o r)
Z 0
4 Z Fn 0
ril M
VI -n
mcg
>
oC
A0-nLn
r- m
mGl >
ryl 0
0 Z
q 0
-n N m
7- z
4
> z
Ul
m
0
r- \
0
0
0
00
409a
C
m
O*t <
m
10
ol PA
M PW' .
A te, :
>
Ln VA >
m C: r -
K
m r—
>
0.10
m
319
.461
Ul
Z m
o
m Z m Z
;po
M
>
V)X
m LA
w
m r—
zz
7. C)
..... ......................
.............. ..
.............
.............
............
....... .......
I .... .......... .
....... ...........
..... ...........
*.,. ' .... : ...........
........ ..........
........ ... * ......
..........
...................
.................
..................
.................
.................
................
..............
.................
...........
.............
............
. . . . . . . . . .
C�q
0
0
0--
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201252
Work Type: Septic Upgrade
Tax Code Number: 01523421000
Site Legal Address: ALPINE WOODS BILK 2 LT 13 G:2738
Site Mailing Address: 11821 MOOSE RD, Anchorage
Owner: WOODS ANNA M FREE & THOMAS E
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date:
c °�
V f
r
Depai-tment
Lot Size in Sq Ft:
Total Bedrooms:
7/23/2020
7/23/2021
79624
❑ 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:
Date:
Issued By:(N Date:7/? zo
3
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On -Site Water & Wastewater Program
Mayor Ethan Berkowitz
On -Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 015-234-21
Property owner(s) TOM WOODS
Day phone 907-345-8908
Mailing address 11821 MOOSE ROAD `ANCHORAGE, AK 99516
Site address 11821 MOOSE ROAD *ANCHORAGE, AK 99516
Legal description (Sub'd, Block & Lot) ALPINE WOODS; BLOCK 2, LOT 13
Legal description (Township, Section & Range)
Lot Size Sq. Ft. Number of Bedrooms
3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DEWELLING:
( ®all that apply)
Initial ❑
Absorption Field ®
Single Family (SF)
Upgrade Z
(w/wo ADU)
Septic Tank ®
El
Duplex (D) ElRenewal
Holding Tank ❑
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
N/A
Distance: -
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: y L4 6.2 C009 Waiver Fees:
Date of Payment: `3 5 7�2 U Date of Payment:
Receipt Number: o � $ G Receipt Number:
Permit No. O✓f ZQ lZ 52 Waiver No.
(Rev. 01/11)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201252, Deb Wockenfuss, 07/23/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201252, Deb Wockenfuss, 07/23/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201252, Deb Wockenfuss, 07/23/20
m
cl,
0000;�Cze�
d.- 2
Lo
CL
l7beo
m
cl,
0000;�Cze�
Lo
ria
N
cn
nn
Iga
Lo
ria
N
cn
Cr4
Iga
Lo
ta
N
cn
Cr4
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201252, Deb Wockenfuss, 07/23/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201252, Deb Wockenfuss, 07/23/20
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this q7- Day of -:z LY of 20-,;20, by and between
—W 0NiQ5 �5 , W, , AA.3
M. pRF t,, ML`s_ , herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as Q L),�-N [ 0 5 L'147
located at (legal description)
2. Maintenance. Repairs and Alterations.
(Owner is required to read, understand and initial each section)
,a,(Aj . Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Qp�L Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Q�GJ . Owner acknowledges that regular maintenance of an AWWTS reduces thep otential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page I of 3
Q Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
,Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
atassessed in accordance with AMC 14.60.030.
o, Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Q 1pr�, Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
By: ignature) , . Date: Ml
A�lN�4 1'� pRE� bDl):S (print name)
STATE OF ALASKA. )
} ss.
THIRD JUDICIAL DISTRICT }
The foregoing instrument was acknowledged before me this i y day of SU i- V
202b) by E\( Ca►t�I . C�Sl�� k
-i eA"r��'c
OT I F ASKA
%Commission exp' es: �Eg, [9, 26211p�,.ta,
MUNICIPALITY:
By: (signature)
(print name)
OF
Date: ZO
Title:
(rev. 05/18/2018) Page 3 of 3
~-', Municipality of Anchorage Page / of
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: ~2'-,) c:~~f~)~z/~'~ ~ PID Number:
Name:~
/~ ~~ Wastewater System: ~New ~ Upgrade
Address:~/~/ ~~~ ~~, ~/~ ABSORPTION FIELD
Phone~ --//~ No.o rooms: ~ Deep Trench ~Shallow Trench ~ Bed ~ Mound ~ Other
Total Depth from original grade:
LEGAL DESCRIPTION S°i'"a~in~: /~ ~.~Sq.~t.
Lot: /~ Block: ~ Subdiv~ion:~~~ Depth to pipe~boffom~from original grade: Ft. G ravel~th~ath pipe Ft.
Township: ~ I Range: I SectiOn: Fill added above ordinal grade:/~__ ~ ~ Ft. Gravel length: ~ ~ F~;,
WELL~~/~ New ~ ~ Gravel width~ ~ Num~f lines: l Distancebe~een lin~:
Ft. ' ~ ~ Ft.
~epth: Cased To: Total ab~2~ea: Pipe material:
Classification (Private, A,~C): ~ Ft. Ft. ~ sa. Ft.
Driller: ~ Date Drilled: Static Water Level:Ft. Inst~ll~r;~~ ~~, Date~ ~~installed:
~GPM [ PumpSetat: Ft. Icasing HeightAb°ve Gr°und:Ft. TANK
SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P.
TO ~ptic Absorption Lift Holding ~ublic/Private M~ufacturer: ~ Capacityin gallons:
From Tank Field Station Tank Sewer Lin~ W~~&E
~ ~ ~ ~ ~ Material:j~ Number of Compa~ment,:
Well
s~ /~/ ~/ ) ~ ~ LIFT STATION
L~te /~ /~ ~ ~ ~ S'ze '~ g="°~: I Ma"uf=ct~r~r:
Foundation ~/ ~J ~ ~ ~ "Pump on' level ~off" level at:
Cu~ainDrain ~ ~ ~ ~ ~ ~Pump ~el ~ Electrical Inspections peHormed by:
Remarks: o~C,~ c~c¢~ ~ BENCH MARK
Location and Description: ,
E~ ..... -~_~L
Inspections pe~ormed by: s & s ~,~~ Dates: 1st ~-~-~ ~~~.~.~
E~le River, Al~sk~
Depaflment of Health and Human Ca.ices approval
Reviewed and approved by: ~ ~a~ ate: %'-~ Y-~/
72-013 (Rev. 9/91) MOA 25
PC. RMIT NO. SW960545
PAGE 2 OF 2
Munlclpalit;y oF Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O, Box 1966500 Anchorage, ALaska 99519-6650 O TeLephone~ 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEC/~ LOT 13, BLOCK 2, ALPINE WOODS S/D P.I.D. NO. 015--234-21
I///~ ~KEY BOX
TH#2&
~ ALT. SIT~ ~
NEW TRENCHx ~
MT2 / ~
NEW 1250
SEPIIC TANK
ST 1 ST2
NEW
1250 GAL
S.T.
·
TH#5
MT CO CO1 = 96.?'
92.5' INSULATION~
CO1 = 92.1'
C02 = 92.1'
MT1 = 90.0'__..--~
MT2 = 90.0'
·
WATER FOUND 8q.5'
83.0' B.O.H.
A B
55.0' 40.0'
53.0' 40.0'
45.0' 47.5'
43.0' 50.0'
42.5' 50.0'
24.0' 71.0'
23.5' 71.5'
94.0' 14.0'
93.5' 14.0'
NOTE:
GROUND WATER
MONITORING TUBE
LEFT IN PLACE.
/////// SCA~ 1" = 40'
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
Township, Range, Section:
DEPTH
(FEET)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
WAS GROUND WATER ~ ~j~
ENCOUNTERED?
S
L
IF YES, AT WHAT ~ O
DEPTH? p
E
SLOPE SITE PLAN
Depth to Water Alter, ~ ~/t.,//~/7
Monitoring? I i I/'~ Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
~ (minutes/inch) PERC HOLE DIAMETER
· FT AND ~' FT
17034 Eagle River Loop Road Ne. 20~ /"-~' -/ "" ~' '"'-
PERFORMED BY:
ACCORDANCE WITlaa~ ~/i"~TII~ .~l~t~~L GUIDELINES IN EFFECT ON THIS DATE.
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE: /
72-008 (Rev. 4/85)
l-�- - PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960343 DATE ISSUED:10/09/96 .
DESIGN ENGINEERS & S ENGINEERING EXPIRATION DATE:10/09/97
OWNER NAME:WHITE KYNA L
OWNER ADDRESS:11821 MOOSE RD
ANCHORAGE, AK 99516
PARCEL ID:01523421
LEGAL DESCRIPTION:
ALPINE WOODS BLK 2 LT 13
LOT SIZE: 79625 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK 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 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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
S. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
DATE: 10
DATE • / - //�
on
0
�. �'e �e w
CY
X ? ��
w
U f:f NeWzo
03 25
if p ao v,
Ea UU z
eN..e O0 ' r Y
pmF0 I J
C)
/ w Z U p O
O
4v=i 'ao
O oN 0ww
va Ana
1— -J Wwm���w
o a z�o
F- � rK,OY J NW9Z�Q�
>- m
-~ wv~-ii>nw0
_0 �^ yc� j \ \ M m�Z a
O�
VL) v� Z
wW.
/i w 7
N / OW wpm w
�i o a (n \ �/ r z I
d7 / V) 3iv o \ n 0 a � � F
O�� /��� COEr S Z O to
W > F j J A,\ / Sa"�.\al i \ to to ¢ �' F-- o
C Q — h J ~\
` x w
O
O� =OC d 0 � J
Z \
\o
`-, CL
�_� i ��3
0
Y
U
Iz
W o
\ 4s p Oc.) O cc in
eZ O W> vri
v
Ow w U
fzof w W F
-
�` y( Q - f w w d
t j�l LJ.rw
Cd o yr
-yo of
\ J a-J3N
LJ \
0 c) vi a � w
0 Dom) P,' LLIO�
>
w -� L
a-L�"WOGQ i
Ld LJck- LJ
I
an @)
�" (n
m—o �n O�
� �a•� p E- C?tn -Cf N '
h4 -DIS -CI
NIVId; 311S
G
L7 CT.F
E..GW
C6�
zr r� w
26 yE?a
O -7 p"w
31YOS
99 =
kk
ij
LL
OD
®• J
---d33G
N \
Z
O f.�
N O
ZCD
>� — \
� � Im �-
cra
F—
o rLLJ
oLL-
Q w
O a
w �o z
Z v —� N
a �
330 : -V-
-iN
<C I
U
LI l31bM 0Nnoao 01
z w O NM :fi
o �
� IJ
AC z
c� �W. w
c�
�S 6 o LLI
C -r)
W I O
31dos
s
a
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER& WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
S&S�
7 HeelzInG
ROBERTC. COWAN, P.E.
ROBERTA. SHAFER, P.E.
SeptenAber 20, 1996 CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AIC. 99519
REFERENCE: Lot 13, Block 2, Alpine Woods Subdivision
Reauest you issue a permit to install a septic system to
serve the proposed four bedroom house on the referenced
property.
Test holes were excavated and percolation tests performed.
The approximate location of the test holey are located on
the attached site plan.
At -the tine of excavation, no water was encountered in nest
hole #1 and water was encountered at 6 feet in test hole
;F3, After seven daV ground water monitoring, water_ was
found :in the moni.tori.ng tubes at B aeet in the test hole #.'
anal a-1:. v feet in test holt #3. After thirty day ground
:cater monitoring; water was found in the monitoring tubes
.at £;.5 feet in teat hale 01 and at 6 feet in - est hole #3=
T -Ii s property has Enough area for a future septic uIngrade
which can I:,e seen on the at *.ached site plan,
'.'his property is served by a Community
Water System.
i
We do not- anticipate any adverse effects on. rxei_ghbori.n.g
wells, septic systems or dra .na.ge patterns by the
installation of the proposed septic system .
If you
regU .re
additiona.-.
_i.r. (.,)ruiati_cn, please
conte cl:
us..
Sind r
lyj
Z/'"fIr?JtA)/,V
VV a
C)
U/2,W� �;
Robert �:. Cowan, I.E.. elaf
f
Enclosure
sv- . ;
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
s Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
.nu
�tN(Sj�A
�.• • ttll .. N.N�°f••C.�,
1� M�
r� L ROBERT C. COWAN d
CE - 8001
PERFORMED FOR: TON) t/ O 0 DATE PERFORMED: g. � /
LOT J3 A i o trt
LEGAL DESCRIPTION: Township, Range, Section:
DEPTH.S HvL z / SLOPE SITE PL
(FEET)
S N
1�2C
2
3 / L SI��
A.
4 N
5
6 .� S �%
/
7 S;L� Y
8 ti /a7 S,0 r O
��►�/��
10 WAS GROUND WATER N
�l ENCOUNTERED?
s
IF YES, AT WHAT L
O
12 DEPTH? p
E
Depth to Water After `
c
13 Monitoring? _ Date:4er,
7
f-
14-
15-
16-
17
4151617
18-
19-
Reading
819
Reading Date Gross Net
Time Time
Depth to Net
Water Drop
,p% s 0 q /(.
_
$ /y 96 7'- v c1-
7�/N
3
(�
5-
6 y� „
7
,7 ,.
20
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND 6 FT
COMMENTS
PERFORMED BY: 1/034 S Se S Eagle
gglNRiver Loop Road Na. 1J O b
'j„�`,�� CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITHi3446110WAAMW&W GUIDELINES IN EFFECT ON THIS DATE. DATE: � r / a 9L
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: TOM W O o l>
Lo -r 13 13 L o (,rt �L
LEGAL DESCRIPTION:
DEPTH/ SLOPE SITE PL
'
(FEET) E S T %7 d L i-
1 7�'C
(^ 11 d",SANG L S N
2 /3-
4
4 C% l oA . 0 A
�'ilIV/ c)G -
.�, - � Lr y
6
M1 ff = VX7
7
8
9 W F} T Z 2 SK ii .0
10 WAS GROUND WATER y i s
ENCOUNTERED?
11 S
IF YES, AT WHAT L
12 DEPTH? P
E
13 Depth to Water After /.A -7 /u b
Monitoring? �j Date: D / � 7
1. ROBERT C. COWAN4C
% CE -8801
r ^Y
DATE PERFORMED:
�J�P� N� w�cas • ,��
TnwncF,in R�nno Ccrtinn•
14
15
16
17
18
19
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
—
f
JG
3/& „
7,// 6'
c.
38-
S/
1. Mi ,•i
`/� �
Sly �.
20 i,
PERCOLATION RATE 'S' 3 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN S FT AND (�R FT
COMMENTS
S & S ENG!
PERFORMED BY: ®��g�r Loop
Read No 04 111 -t-W7 (_-• /1' W h -CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITHE 4 % IV.ARD'KTUiVi RT GUIDELINES IN EFFECT ON THIS DATE. DATE: a 7 / L
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Tom t^' DATE PERFORMED: l ':
LOT
13 A L 0 Gsc MLA 04- wdcas
LEGAL DESCRIPTION: - - Township, Range, Section:
F7 I
F
EPTHd L 3 SLOPE SITE PL
T�'£STF EE1
1- 2 0 /iwa.-+ c S
2-
3-
4-
5-
6-
7-
8-
9-
10-
11 -
12-
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
2-
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
17
S] z-7 Z 911 � ( q6
L S r L /—
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ( L
DEPTH? v O
P
E
Depth to Water After 5 ��7 / I`
6
L
Monitoring? jT— Date:
ROBERT G.
,®WAN
CE -88g]
Reading Date Gross Net
Time Time
Depth to
Water
Net
Drop
501 T
b' 33 1M1iJ
I13/k„
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
6
TEST RUN BETWEEN FT AND 5- FT
J C¢ J GIVVIItlGCKlltlt,7
PERFORMED BY: �® ��11 ®®�� ggqq��y7 h �! t � /�a/-✓ CERTIFY THAT`THIS TEST WAS PERFORMED IN
ACCORDANCE WIT&%' VX�'AN5SAb9j' 77L GUIDELINES IN EFFECT ON THIS DATE. DATE: / l
72-008 (Rev. 4/85)
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
P~'T~ ~ ANCHORAGE
NTAJ. SERV~ ;S DIVISION
SEP 10 199"/
RECEIVED
1. GENERAL INFORMATION
Complete legal description )..~ 7-
Location (site address or directions)
. Property owner
Mai!ing address
Lending agency
..Mailing address
Day phone
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
.Public water
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
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front BOA ~21
Sa
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.
S & S ENGINEERING
Name of Firm
12'U~4 I=agle River Loop Road No. 204
Address Eagle River, Alaska 99577 ~,
Engineer's signature . -. ¢'--- -
Phone
Date ~//c./ q ?
DHHS SIGNATURE
'~ Approved for
bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and'Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1,~1) Back MOA~I
N~UNICIPALITY ,OF ANCHO~
Municipality of Anchorage ~NV~RON~ENTA~ SERV~.S ~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division SEP 10
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 34,.3:_4744
'CEIVED
Health Authority Approval Checklist
LegalDescription: L~ T- I~ I~L~ ~- /}gP~,vVz ~¢e~-.J' ParcelI.D.: CI ~ -' '5;) ¥ - 7Z /
A. WELL DATA
Well type C.
IfA, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production ~
WATER SAMPLE RF_~S:
Coliform ~
Dat f~sample:
Date completed ........
Cased to Casing height (a~
Wires ~cted (Y/N)
FROM WELL LOG ~T INSPECTION
Nitrate Other bacteria
Collected by:
g.p.m.
B. SEPTIC/HOLDING TANK DATA
Date installed (- / ~ ~ / q ? Tank size
Foundation cleanout ~/N) ~ &; -~
Date of Pumping/v/~ ~ '~ "~ Pumper
C. ABSORPTION FIELD DATA
Length "/ 3 Width
Effective absorption area 5'-~ /
] ~_,[- (2 Number of Compartments '~ Cleanouts(~N)__
Depression (Y~ ~ e High water alarm (Y~ ~ o
Soil rating ~or ft2/bdrm) /
Gravel thickness below pipe
System type
Total depth
Monitoring Tube present {~/N)V~' £ Depression over field
Fluid depth (ins) Minu.~.te~r:
Peroxide ~t 12 months) (Y/N)
72-026 (Rev. 3/96)*
Date of adequacy test N//t ~ I~ ~ ~' Results (Pass/Fail) ~
Fluid depth in absorption field before test (in.); ~1'~after gal. water added (in.):
Absorption rate = g.p.d.
If yes, give date
bedrooms
Do
LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Size in gallons _...--~
"Pu~
"Pump off" level at*
J *Datum
Cycl es~t~'eE"'~'
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELLON LOT TO: ¢ u,~.~, ~- ,/ ~,-.-/
Septic/holding tank on lot On adjacent lots
Absorption field on lot
Public sewer main _ ...-.------- Public sewer manhole/cleanout
S~ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation 3'"- Property line ,~- 0 4- "Absorption field
Water main/service line / o -/ Surface water/drainage ) O o ~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
/
Property line ,~ G 4- Building foundation /0 Water main/service line
Surface water / 00 ~' Driveway, parking/vehicle storage area
Curtain drain ~' ~; :~ t ~ ,'~ ~:' ,~ ~ Wells on adjacent lots
/ o
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal
inconformance__...wit~M~AHAAg~f~inesineffectonthisdate.
Signature -/I,~j .~"~.
Engineer's Name
Date
HAA Fee $ ~') ' ~
Date of Payment
Receipt Number
Waiver Fee $ __
Date of
Receipt Number
72-026 (Rev. 3/96)*