HomeMy WebLinkAboutALPINE WOODS BLK 5 LT 7Al pi ne Woods
Lot 7
Block 5
#015-234-37
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: OSP251078
Work Type: SepticTank Upgrade
Tax Code Number: 01523437000
Site Legal Address: ALPINE WOODS BLK 5 LT 7 G:2738
Site Mailing Address: 6000 ALPINE WOODS DR, Anchorage
Owner: BOLLERUD DANIEL M &
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date
Expiration Date
Lot Size in Sq Ft
Total Bedrooms:
4/9/2025
4/9/2026
31604
❑ Disposal Field R1 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
5
Special Provisions: If the existing 1985 bed is to remain in service, letters of non -objection (LNOs) must be
gathered from the utility companies addressing the encroachment into the easement along the east property line.
Received B�
Issued By:
Date: 4/9/2Q25
Date:
MUNICIPALITY OF ANCHORAGE
Development Services DepartmentPhone: 907-343-7904
On -Site Water & Wastewater Section P_
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-234-37
Property owner(s) DANIEL BOLLERUD & JAN DODDS
Day phone
Mailing address 6000 ALPINE WOODS DRIVE ANCHORAGE, ALASKA 99516
Site address 6000 ALPINE WOODS DRIVE ANCHORAGE, ALASKA 99516
Legal description ALPINE WOODS BLOCK 5 LOT 7
Number of Bedrooms 5
Engineering Firm FIRST WATER CONSULTING
Building Permit Number
Not Applicable FK
APPLICATION IS FOR: APPLICATION IS AN:
(® all that apply)
Absorption Field
❑ Initial ❑
Septic Tank
® Upgrade
Holding Tank
❑ Renewal ❑
Privy
❑
Well
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Permit/Rush Fees: 225
Date of Payment: y 2 zS
Permit No. L5P 5%070
Waiver Fees:
Date of Payment:
Waiver No.
Distance:
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
March 31, 2025
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: ALPINE WOODS BLOCK 5, LOT 7
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install two 1000-gallon HDPE tanks per the
attached design to serve the existing 5-bedroom residence. The baffle of the first tank will be
removed and the effluent pump installed in the second compartment of the second tank.
No groundwater was noted in the MOA on-site file, but if groundwater is encountered during
installation an epoxy coated steel septic tank or other action may be required. The lot and
adjacent lots are served by public water with private wells to the south that are 100’+ away from
the proposed septic tanks. Any encroaching wells, easements, … must be staked prior to
construction. The design will not impact any of the neighboring properties. Please contact us if
you have any questions.
Sincerely,
Curtis Huffman, P.E.
74.1'
N 89°55'05''W 243.00'
N
8
°
0
8
'
3
0
'
'
E
1
5
4
.
9
5
'
30
.
0
30
.
0
74.1'
L = 160.82
44.0
S
2
0
°
1
2
'
3
5
'
'
E
1
8
1
.
6
5
'
28.0
20
.
2
FIRST WATER CONSULTING
NO WELLS WITHIN
100' OF PROPOSED
SEPTIC TANKS
ALPINE WOODS BLOCK 5, LOT 7
DESIGN DETAILS:
11
DR�vE
LP/n/c Alnnn.S
OF A�q�;�p
49 TH*
�� fiat
0 0
a SHANE A. HOLT
LS -6914
44a a o
\\"fessioW Loo
N 89°55'05"W 243.00'
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT
ARE NOT SHOWN HEREON, UNLESS NOTED.
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
ONLY VISIBLE IMPROVEMEMS ARE SHOWN HEREON
R SYSTEM PIPE
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 7 BLOCK 5 ALPINE WOODS SUB.
ANCHORAGERECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED
DA LED ATANCHORAGEA LASKA THIS 25 TH DAY OF
MARCH 2025
7179 77-53240-7
HOL T LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
223-8615
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: ~'IAJ o~ ~O ~¢::~ I PID Number: O/_~' ~
N~m~:~ ~ ~~ ~ Wastewater System: ~ New ~' Upgrade
~d'~'~:~O0 ~~~OS O~. ABSORPTION FIELD
~~ ~~ ~eepTrench~ ~ Shallow Trench ~ Bed ~ Mound ~ Other
~)il~ating:~
LEGAL DESCRIPTION I~ ~ ~1 0t~ U~GPD/Sq. Ft. Total~Depth~from ~°'riginall0'grade:
Subdiv~ion: Depth to pipe bosom from original grade: Gravel depth beneath p~e
Township/ [Range: ~ ISec~ Fill added above original grade:~, ~'~ Ft. ~Gravel length:~ ~ ~U''4 : ~0 ~t.
WELL: B New ~ Upgrad~ Gravel width:~ ~ Number of lines: I Distance be~eenlines:
~. ~ I ~'+
Classification (Private. A.B.C): /T°tal De~Ft. Cased To: Ft. Total absorpt~o~ ~ SO. Ft. Pipe materiaho~o.~ t
)filler: ~ Date Drilled: Static Water Level: Installer: ~
Ft. ~ + ~ ~1~Date installed:
'~~ I I TANK G',~~
Y~el Pump Set at: Casing Height Above Ground:
PM Ft, Ft.
SEPARATION DISTANCES ~ Septic ~ Holding ~S.T.E.P.
TO Septic Absorption Lift Holding Public/Private Manu~e~ ~~ Capacity in gallons:
From Tank Field Station Tank Sewer Lines ' . ~OO
Wel~ ~j, ~l+ l~(~ ~ ~ Material:~~ Number~ompa~ments:
Surface ~ i
Water {~ [~ ~ ~ j~ [~ ~ LIFT STATION
Lot Size in gallons: J Manufac~
Foundation j~l~ ~O ~ ~ ~' ~)~ ~ "Pump ~: I"Pump ~'~etat: I ~,arm at:
Cu~aJ~ ~[~ Pump Make & Model J Ele~rical Inspections p~dormed by:
Drain
Remarks: ~ ~~~ ~~ BENCH MARK
~~0~~. ~~ j~[~~ Location and Description: ~ ~ O~
~V ~ y~L~, J A,umed Elevation: 100~ Ft.
Inspections pedormed by: ~~ Dates: 1st ?/1~? ~
2.d
Depadment of Health and Human Se~ices appr I '~:~;'.. ~'~' ."-
'~ffOFESS~
a ,roved by: /o-
72-013 (Rev. 9/91) MOA 25
PERMIT NUMBER: AS :BUILT DRA' "ING PARCEL iD NUMBER:
SW980291 ' 0'15-234-37
/--APPROXIMATE LOCATION
OF' EXISTING KEY BOX ~,, ~ \
F-APPROXIMATE I.OC^TION ~ 'x \ \
~ OF EXI,gTING WATER LINE ~ '~ \ \ ~-LOCAI'ION OF EXISTING BED IS
1} C ~ ', ,,, \ /~,7UNKNOWN. DRAWING IS ASSUMED.
I ~~\ ',.S--~__.-¢¢:-~'\ ., ~', .~-.o'. ,~.~'"";
~g b BE~()OM J M~X ~ " -- 38,5' 52.7'
15' LJI'II,IIY AND EQ~JES'I'RIAN ~SEMEN]'
'~~~,,? · ~ / / ~,,~ /
~:' ',U' ~ 5~ ~: 'J
NORTH TRENCH SOUIH TRENCH
,L,I,Z WOODS. SU,mWSIO,, LOT
AS-BUrnT OF SEPTIC SYSTE~ UPGRADE ':JA~ES' ' ~i'"~
PREPARED FOR: PHONE NUMBER:
A B
s'rl 52.0' 14,0'
ST2 60.2' 25,9'
MH 62.0' 27,9'
MT1 44.2' 58,2'
Mr2 B1.5' 71,7'
MT:5 :~8.5' 52.7'
MT4 62,0' 78.7'
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
DATE PERFORMED/
' / ~ 9//'
Township, Range, Section:
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED?
SLOPE SITE PLAN
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring? ~'Y Date:
L
E
Reading Date Gross Net Depth to Net
Time Time Water Drop
~ :~/~ - /~o~ ~" / - /~"
~ :~o('s~ ~ //~ ~,, /,~z~', z~"
PERCOLATION RATE '~ (minutes/inch) PERC HOLE DIAMETER ~O ',~
72-00B (Rev. 4/85~ALL ~A_` ~:: AND:UNZCIPAL;UID~L,: ~-EFFECT O~: TH[~DAT~Z:E~, ~;7''
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 'I96650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 10, 1998
Expiration Date: Aug 10, 1999
Permit Number: SW980291 Parcel ID: 015-234-37
Legal Description: ALPINE WOODS BLK 5 LT 7
Design Engineer: 41 _~:~ ~,_~ ~ ~, LL~_~ite Address: 006000 ALPINE WOODS DR
Owner Name: WILLIAM DOSS Lot Size: 31604 SQ. FT.
Owner Address: 6000 ALPINE WOODS DR Total Bedrooms: 5 Permit Bedrooms: 5
ANCHORAGE , AK 99516-2467
This permit is for the construction of:
[~ Disposal Field [~] Septic Tank I~ Holding Tank [~ Privy
[] Private Well
Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By: ~
/,2. -F-~
Alaska Water & Wastewater
7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504
(907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
July 28, 1998
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental. Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref.' Septic Upgrade Design for Lot 7, Block 5, Alpine Woods Subdivision.
To whom it may co~ern:
The existing 5 bedroom house is served by a private septic system and a community well. The
existing bed will not pass an adequacy test and must be upgraded prior to the sale of the house.
Two test holes were excavated to the west of the existing septic system and one test hole was
excavated to the so~th of the existing septic system ~ ~Comments regarding' ~he propoSed upgrade
design are summarized as follows:
1. SOILS: Attached are the 10gs which shows the soil profiles, and the percolation tests results.
The proposed upgr~le is to be designed around a 30'feet radius 0ftesth01e #3. No groundwater
was encountered during the excavation of the test hole. One soil percolation test was performed
at 5.5 to 6.0 feet which perked . out .at a rate of <1 minute/inch. The insuti soils shouldact asa
sand filter.
2. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Allowable Appli0ationRate: 1.2gallon'/day/fi2
c. Number of Bedrooms: 5
d. Design Flow: 750 gallons per day
e. Minimum Absorption Area: 625
f. Effective Depth: .4 feet
h. Width: 2 feet
i. Minimum Length: 2 ~ 40 feet long each (80 feet total length)
j. Effective absorption area = 640'rtZ(5625 ~ft2 OK)
k. Maximum depth = 8 feet (on uphill side)
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: Attached is a topography site plan. The trenches will be installed parallel
to the contours, on o~lope of approximately 20% - 25%.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you
for your assistance.
Sincerely,
jSHO PROP "'1 - ----"--
/,,
ALPINE: WO0~ SU~IVISIO~. LOT 7. BLOCK 5
--. ~ _.~ . : -: '-'
E. HUFFMAN ROAD
I
I
] I
N 1/2, NW 1/4. NW 1/4, ~
I
NW 1/4, SEC. 26, T12N, RlW ~
5830 HUFF~ R~ ~
PRIVA~ WELL A SEPTIC ~ LOT 1, VICKE~
I PRNATE WELL · SEPTIC
NOTE: AL.L PROPERTIES IN ALPINE WOODS *
~ I
SUBDIVISION ARE SERVED BY COMMUNI~ ~
WATER AND PRIVATE SEPTIC;. ~ '
I I
I , , I
A_LAS WA R AND WAS WA R
PHONE: ~907) 337-6179/F~: (907) ~8-3246 '" ' ......
LEGAL DESCRIPTION:
~PE OF WORK:
PREPARED FOR: PHONE NUMBER:
BILL DOSS (541) ~"~ '~ ~ Ci~7953 ..'
ALPINE WOODS DRIVE .... - ......... ' .... ---~-
~XISTING BED SYSTEMS~
' ' TO BE USED AS A ALTERNATE ~,\
~--APPROXIMATE LO~llON RESERVE SEPTIC SITE. \X
\ OF WATER KEY BOX \ \
EXISTIN(; SEPTIC TANKS--~--~ COMPLETEL ~ '\\ ~ \\
TO BE ABANDONED
\ r--APPROXIMATE LOCATION ~ \ \ ', \ \
(SEE NOTES)
15' EQUSTRAIN & UTILITY EASEMENT
NOTES:
1. THE CONTRACTOR IS RESPONSIBLE FOR HAVING THE EAST PROPERTY LINE
FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION.
2. THE CONTRACTOR IS RESPONSIBLE FDR CALLING IN UTILITY LOCATES. OUR
SUGGESTION IS TO TEMPORARILY DISCONNECT SERVICE, INSTALL THE PROPOSED~-~_. HUFFMAN ROAD
TRENCHES, AND THAN RECONNECT THE SERVICE LINE BY REROLJTING THE LINE
AROUND THE NEW TRENCHES.
ALASKA WATER AND WASTEWATER
,,~,~.,,, ,~,~,~,~,,~-,-,o,..,: ,:.,.,o,,,,.: ,,o-,, .:,_-,-,-,,.,.,,¥,:.,,.,: ,,,o,, ~-~, ~,.~.~
ALPINE WOODS SUBDIVISION= LOT 7, BLOCK 5, ,..~.[.....~:[~.-.f.;~.~......'~...i,
/ I ~.~.r ~J. ~
TYPE ~3F WORK:
,:,,_,,,,, !.
PREPARED FOR: PHONE NUMBER:
(541 )858-9697
BILL DOSS ~1~?,,~"-.. ..... .';'~.~
DATE:7.28.9B/! DRAWN BY: SCALE: PAGE:
J.L.M, 1 = 30' 2 OF
DETAIL D~WING
P~OFILE D~W~G
PREPARED BY:
ALPINE WOODS SUBDIVISION; LOT 7, BLOCK 5,
DETAIL AND PROFILE OF PRESUURIZED TRENCHES
BILL DOSS (541)858-9697
J.L.M. N.T.S. 3 OF
ALASKA WATER & WASTEWATER^~. ~.o~ .~..~ o~ ~.L_~
~:o ~. ~.~ .~. ~,~o,. · ^~.o~.~, ,~r-..~ ..........
[SOIL LOG - PERCOLATION TEST] ,~I ~""49 -
LEGAL DESCRIPTION: ALPINE WOODS SUBDIVISION; LOT 7, BLOCK 5, F
PERFORMED FOR: BILL DOSS ~
DATE PERFORMED: 7/22/98 '(//~ ;. NO. 9608 ,:
//[}~. '-.. C.E. .."
DEPTH
I ' ............
FILL SOIL C~SSlFICATIONS [SITE PLAN ......
2 :..~ ~,,, ~ ~ I r'= IOO, I :~ ~/'
ORGANICS .?::..~~,, .............. ~ ~ / ..../ /.-...
DEPTHTO a**= I k~ I Y X / ',X
GROUNDWATER ~n'~ / ~~<~X/
/
9~ EXTREHELY DENSE E. HUFFMAN ROAD
Il 1 ~ ] ~ I I II SiLT WITH SOHE SW
Il llllll II HEAVY SME~IN6
12~i~tlllttl 7/22/98 1 3:50 7 --
1~ *NO PREI;OAK REOU RED
14 B.O.H.
15
16
I
17 -
lB
19 PERCO~TION ~TE >60+ (NIN,/INCH) PERC. HOLE DIA. 6" (INCHES)
2 TEST RUN BETWEEN 5.5 6.0 FT.
COMMENTS:
PERFOMED BY A~SKA WATER * WASTEWATER ../ ~ ~ /U~ . CERTI. THAT
~H,S WAS ...~0.~ ~ ACCO.~A<. W,TH ~qS1~" ~NO .UN,C,.A~ .U~UN.S .N ~.~C~ ON TH,S
Date. Date: i ~ &Ut ?~ [ /
DEPTH TO DATE
GROUNDWATER
_DRy _ 7/2.2/98
ALASKA WATER & WASTEWATER
~o ~. ~.~ .~. o,~o,~ . ^.o.o.~, ~. ~o~ ~%..~:.~.~ ~.
[SOIL LOG - PERCOLATION TEST]
~.: ............. '-~d'l/l':'"')
LEGAL DESCRIPTION: ALPINE WOODS SUBDIVISION; LOT 7, BLOCK 5,
PERFORMED FOR: BILL DOSS
DATE PERFORMED: 7/22/98
.... ....
[TEST HOLEm
DEPTH ~
(f~et) ~ORGANICS
FILL/ORG DEBRI SOIL C~SSIFICATIONS sITE PLA~
EXTRENELY DENSE
7-- I Ill IlVISU~LY RATED THE DEPTH TO DATE
9-- -~B.O.H. , .... E. HUFFMAN ROAD
10~
11 -[ DATE READING CLOCK NET TINE WATER LEVEL I NET DROP
TIHE (HINUTES) READING (INCHES)
14~
.... - ~o
18~ '
PERCO~TION ~TE >~0+ {~IN./INCH) PERC. HOLE DIA. ~" {INCHES)
19
~0 TEST RUN BET~EE~ -- ~T,~D -- ~T.
f
CO~E~TS:
PERFOMED BY A~SKA WATER & WASTEWATER I, j, ~ L J~ , CERTI~ THAT
THIS WAS PERFORME~ IN~ ACCORDANCE WITH ALL~TE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS
DATE. DATE:
DEPTH TO DATE
GROUNDWATER
. DRY 7/22/98.
ALAs WATER & WASTEWATER
- - '7320 E. CHEER H~. CIRC~' * ~CHO~GE, AK. 99504 ff~..'"~ ......
I SOIL LOG - PERCOLATION TEST I {
LEGAL DESCRIPTION: ALPINE WOODS SUBDIVISION; LOT 7, BLOCK 5, ~
{ ~.~ E[/E~ ..... ~..': Y~.~'ff~ ....
PERFORMED FOR: BILL DOSS '[? ~'~ES P. WILLIAMS:
DATE PERFORMED: 7/22/98 ~qfi~ '.. NO. 9608 .: ,~
TEST HOLE ~3 '~%~' .......
DEPTH ~
(feet) ~ ORGANICS
BONDED W/SILT SOIL C~SSIFICATIONS ~/~¢/
HL LENSE 6H CL
,o ~o*, SM OH
6 ~ o o% SC
7 ,~¢*,% SW I DEPTH TO DATE
~¢,¢,~ W/ GRAVEL GROUNDWATER
9 ~ ¢o%
%%% ..... ~ .... ~.I~gE- E. HUFFMAN ROAD
11 ; SW/SH DATE READING CLOCK NET TIHE WATER LEVEL NET DROP
TIHE (HINUTES) READING (INCHES)
12 7/22/98 - .WA~ER ~BSORBED A S F~T AS IT .V ~.. ADpEB% ........
15 .............................................
18
19 PERCO~TION ~TE <1 (HIN,/INCH) PERC, HOLE DIA, 6" (INCHES)
2 TEST RUN BETWEEN 5,5 AND 6.0 FT,
/./(/.
THIS WAS PERFORMED )N ACCORDANCE WITH ALL Sq ~E AND MUNICIPAL GUIDELINES IN EFFECT ON THIS
DATE. DATE: ~8{~
DEPTH TO DATE
GROUNDWATER
DRY 7/22/98
~-.~. ¢! ~ 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
NAME 'PHONE I []NEW
/~ ~[~'~r~ ~7~,~> ~c~ ~r~c"~,'~,9 ~ ~I ~PGRADE
MAILING ADDRESS
/
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
J Well J AbsorPtionar~a Dwelling 2~ PERMITNO.
DISTANCE TO: J ~)O~I
~ Z No. of compartments
- --r~iq'~a~c~Y~~gallOns~ IF HOMEMADE: Insidelengt, Width Uquiddept,
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
0 ~ Manufacturer Material ~ Liquid capacity in gallons
~ Well ~O~ Foundation ~ Nearest lot line/ '2 PERMITNO.
~ ~ DISTANCE TO:
~ No. oflines ~ Length of each line Total length of Jines Trench width Distance~et~een lines
N Top of tiJe to finish grBde 4 MateriaJ beneath tile Total effective absorption area
. ~ -- ~ inches
Length Width Depth PER MIT
'~o--
~ ~ Type of crib Crib diameter Crib depth TotaJ effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth DrilJer Distance to lot line PERMIT NO.
g DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER .
PIP'MATERIALS
SOl L TEST RATING
/~ ~'/~ ,m ,~.~.
o
d,~,,~ ~,~.f ~,',.-4 .~'----/o' i-,~ ~"~-~s.?-- ~. y ~r~
_
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
DEPARI'MEIxlT OF HEALTH ANI) ENVIRONMENTAL PROTECTION
825 I... ,STREE]":, ANCHORAGE, AK 995£)1
264-472()
F:'ERM 31 T NIl:
· C~(.~[ .. .
l) A'T' E I o,:~ J E D ,,
AF'F'L. I CAIxI'T':
ADDRESS
CON1ACI PHOIxlE:
I... E BLANKENSHIP CONS
P 0 BOX. 770087
EAGLE RIVER, AK 99577
694-56'~8
.C.~EWE]R F'EF(I'"! I ]-
LEGAl,,. DESCR IF':
L, OT SIZE:
L..O'T I,,.OCAT I ON:
SUBDIVISION: ALPINE WOODS
SECTION'. ,~..) TOWNSHIP: 12
lA (SQ.FT. OR ACRES)
ALPINE WOODS DRIVE
LOT: 7 BLOCI<: 5
RANGE: 5W
I certify that:
:1.,, I am familiar with the requir, ements for on-site sewers and wells as set.
forth by the Municipality o~ Anchorage (MOA) and, the, State o~ Alaska.
R. I will install the _~ystem in accordance with all MOA Codes and regulations,
and in compliance with the design criteria o£ this permit.
3. I witl adhere to all MOA and State of Alaska requirements ~or the set. bacl.::
distances from any existing well, wastewater disposal system or public:
sewerage system on this or any adjacent or.nearby lot. ~
IF A I....IFl" STA'T'ION IS INS'T'ALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN' (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUIL-TS
WII....I .... NOT. BE AF'PROVED WITHOUT AN ELECTRICAL INSPECTION REPORT;. AND (3) THE
EI....li":CTliICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
olGNED DATE: .~- ~ ~- ~ ~
APPLICANT: I .... E BLANKENSHIP CONS
Permit No:
Date Issued:
Applicant:
Address:
MUNICIPALITY OF ANCHORAGF
Departmen ~f Health and Environments Protection
Pouch 6-650, Anchorage~ AK 99502
264-4720
On-site Sewer/Water Permit
HANDWRITTEN
Legal Description: S/D: ~/.~z~2~.(~~ ~
Section: ~1~ Township:
Lot Size: /~
Lot Location:
Max Bedrooms:
(Sq. Ft. or Acres)
Lot: ? Block:
Range:
Listed below are the options available to you in designing your septic
system. Choose the option that best fits your site. . ~ ~
...................................... .................
TRENCH (J_~)_y. t~ ~ZED ~ ,W. DRAIN
Depth to pipe bottom(ft.) Z-J, 0~
Gravel depth (ft.)
Total depth (ft.)
Gravel width (ft.)
Gravel length (ft.)
Tank size (gal.)
Soil rating (sq. ft./br)
** Gravel length 75 feet
requires mu l~t ip 1~
** Tank must have at least two compartments
runs (not exceeding 75 feet: each)
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage(MOA) and the State of Alaska.
2. I will install the system in accordance with ali. MOA codes and
regulations, and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set
back distances from any existing well.~ waste~ater disposal system or
public sewerage system on this or any adjacent or nearby lot.
4o I understand that this permit is valid for the maximum number of bedrooms
stated above, and any enlargement or modification wi1.1 require an
additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN
(1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL
NOT BE APPROVED WITHOUT AN ELECTRICAl, INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED:
Applicant
ISSUED BY:
DATE:
DATE:
SWP/024 rev.1/85
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
NAME IPHONE
MAILING ADDRESS
LEGAL DESCRIPTION
NO. OF BEDROOMS
J Well , ~ Absorption area Dwelling PERMIT NO.
DISTANCE TO: ZOO ~I ~ ~ ~- ~,~- co ~
~<~ Manufacturer ~,~ Material /~.~ f No. of compartments
~ ~ Liq. capacity in gallons Inside length Width Liquid depth
/0 CO IF HOMEMADE:
~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ - ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest tot line ~-,~ PERMIT NO.
~_~ ~ No. of lines ~ Length of each lige Total length of ,tines Trench width Distance betwSen lines
of tile finish / Material beneath tile Total effective
Top
to
grade/
absorption
8rea
Length ~ Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER ~,~ 5
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED DATE LEGAL
72-013 (Rev, 3/78)
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:]!;,, ! ~,,.~:i.].:l. adh',:.i:-:re .!:..,:::.~ a:l.:l, t"IC)~:~ and EH::a'LE.'. ~.::).[' (~.~].a'..!~l...:a r',:.:.:..,qu:Li",:.:-.'.m~.-:.:..'.r'J'L.iii~ 'for' 'Ll'"..e ~ilu:.:.i!'!:.. b.:..'~u::::!.::
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· '.'.!.,, I L.u"'~c:l,?..:,r'::ilrL.:'..'..u"~d t..l"'~a'L 'l:.h:i.!![~. p,.:.::.:,r'rn:i.t.. :i...:i~- ¥.:':':t].:i.d (c:)r ,a. m.:::..':::.'.::i.n'u...m'i ,::::,{' :3 b,~.~:dr.'.:::x::uTuii~i .::::tnd
any eJ"~:l, al"g(.:-:.)~'[!e~"~'('.. ~.,,~J.].]. r'e.,:::i.,...~.:i.r'e an a:.:::ld:L'LJ.,::::,na], i::) e !" ,,".,'~ :i. 'l:. ,,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
- DATE P ER FORM E D :/~U~,~
I
SLOPE
SITE PLAN
lO
WAS GROUND WATER ~0 ~
11 ENCOUNTERED7
O
P
'12 IF YES, AT WHAT E
DEPTH?
13
Gross Net Depth to Net
Reading Date Time Time Water Drop
14
PERCOLATION RATE -. ' ~,~ ,' . ' ~; * r~' ~ '~' {r~i~uJes/inch)
TEST RUN BETWEEN I . i~T AND ~
COMMENTS
i
.~ . <...~,t~,.~.'~.-: ........... . .
72-00~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O, Box 196650 Anchorage, Alaska 99519-6650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
1. GENERAL INFORMATION
Complete legal description ALPINE WOODS S/D: LOT 7. BLOCK 5
Location (site address or directions) 6000 ALPINE WOODS DR. ANCHORAGE. AK 99516
Property owner
Mailing address
Lending agency
Mailing address
~)EFFREY AND CYNTHIA REED
6000 ALPINE WOODS DR. ANCHORAGE. AK
Day phone
99516
Day phone
(907/ 545-6148
(907) 261-7600
Agent KAREN FOSTER w? DYNAMIC PROPERTIES Day phone
Address 3111 "c" STREET ANCHORAGE. AK 99505
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual well
Community well xxx
Public water
NOTE: If community well system, provide wdtten confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding Tank
Community on-site
Public sewer
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
lng to the legality and status of system.
72-025 (Rev. 1/91 ) Front MOA ¢Y21 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $450.00 at,
or prior to, closing for the engineering services provided.
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 a~i State codes, ordinances, and regulations in effect
on the date of this inspection. /~///._ ,I
Name of Firm ALASKA WATER& WASTEV~ER CONSULTANTS, INC. Phone (907) 337-6179
/_ II i
Address 6901 DEBARR ROAD, ~U(T/./E'/2B/,~NCHORAGE, ALASKA 99504 . /
Engineer's Signature t..~...~'.~ ~ Date ~"~ ff./(::~
I, conducting this evaluation, AWWO, Inc//at~br~'~i~ed-- '---' to p~'rovide a thorough, conscientious
enginee'ring
/analysis
of
the
system in accordance w/th ADEC and MOA bHq~'~' Guidelines & Regulations. The reported results described the
performance of the system under the conditions '~ncountered at the time of the test, and separation distances
measured to readily identifiable features. The operational lifo of all wells and septic systems depend
on the Iocal solls condition, greund water levels that may fluctuate during the year, and the water ~,.~..~_~.,~ ,, ~
usage of the family being served by the system. These conditions are outside the control of
the evaluator of the system. Satisfacto~y test results do not guarantee future performance % OF A
of the system, nor do they guarantee that there are no hidden defects or encroachments. "~"~".~
AVVWC, Inc. can therefore not provide any warranty for future estimate of how long the ,~./~.~.//~..~....'1'"; .?.
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report is for the sole benefit of the owner listed above. Any ~"~4~' '/~'~':://? //-'[~
reliance upon or use of this report by any other person or pady is not authorized, ~y,~.,,,?,,~ n ess..'
( 6E-7~53 ." ~
· ..........
nor will it confer any legal right whatsoever.
6, DHHS SIGNATURE
P'"'"' Approved for ,~'-'
Disapproved
Conditional approval for
bedrooms
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. 1/91) Back MOA ¢Y21 Computer Version
RECEIVED
MAY 22 ~000
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICI~aP^u~
. ,, Environmental Services Division ~IVIRONMENTAI. SERVI(:~
825 L Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744
Health Authority Approval Checklist
Legal Description: ALPINE WOODS S/D; LOT 7, BLOCK 5 Parcel I.D.:
015-234-'37
A. WELL DATA
Well Type. COMMUNITY
Log present(Y/N)
Total depth Cased to
Date of test
Static water level
Well production
IfA, B, or C, attach ADEC letter~ ADEC water system number.
Date completed ~
~e ground)
Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
WATER SAMPLE RESULTS:
Coliform
Nitrate
Date of sample: .__
B. SEPTIC/HOLDING TANK DATA
Date installed 9/24-/98 Tank size
Foundation cleanout (Y/N)~ YES
Collected by:
2000 Number of Compartments 2 Cleanouts (Y/N) YES
Depression (y/N) NO High water alarm (Y/N) YES
Date of Pumping 5/18/2000 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA J *NEW SYSTEM, LESS THAN 2 YEARS OLD J
Date installed 9/16/98 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2
Length 80' (2 @ 40') Width_ 2.5' .Gravelthickness below pipe
**UPPER TRENCH DRY 5/18/2000
LOWER TRENCH 8" 5/18/2000
.System type TRENCH
7' Totaldepth 8.6' - 10'
Effective absorption area 1120 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N). NO
Date of adequacy test *NEW Results (Pass/Fail) For ~
Fluid depth in absorption field before test (i~added
(in.):
Fluid depth ~ Absorption rate =
~12 months) (y/N) If yes, give date
72-026 (Rev. 3/96)* Computer Version
D. LIFT sTATION
Date installed
Manhole/Access (Y/N) YES
High water alarm level at* 44"
Cycles tested N/A
9/24/98
Size in gallons 2000
"Pump on" level at* 40" "Pump off" level at*
*Datum BO'FI'OM OF TANK
40"
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic~holding tank on lot
Absorption field on lot
Public sewer main
On adjacent lots
~Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation. 5'+ Property line 5'+ Absorption field 5'+
Water main/sen/ice line. 10'+ Surface water/drainage 100'+ Wells on adjacent lots 200'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Building foundation 10'+ Water main/service line 10'+
Surface water
Curtain drain
F. ENGINEER'S CERTIF
I certify that Ih~e~l(
of Municipal r~cord~ i
with MOA H~A gui~
Signature ',.-~'
Engineer's NaJ/j
Date
100'+
Driveway, parking/vehicle storage area 10'+
NONE KNOWN
u field inspections and review
'e systems are in conformance
t on ihia date.
JEFFREY A. GARNESS
Wells on adjacent lots 20g'+
HAA Fee $
Date of Payment ~2L-(/~-- '-~'"~- -- ~' D
Receipt Number /J~'z'c'D~ 7/'1'''~/- .'~-)
72-026 (Rev, 3/06)* Computer Version
Waiver Fee $
Date of Payment
Receipt Number
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
01 5-234-37 HAA #
1. GENERAL INFORMATION
Complete legal description
Lot 7; Block 5; Alpine Woods Subdivision
Location(siteaddressordirections)
Anchorage,
6000 Alpine Woods Drive
Prope~y owner William Doss
Mailing address C/O Jack White Real Estate
AK
Day phone
Anchorage, AK
Lending agency
Mailing address..
Day phone
Agent Sallie Nickerson/Jack White Real Est. Day phone
Address '3201 "C" Street Suite 200 Anchoraqet 'AK 99503
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
563-5500
5
XX
72-025(Rev. 1/91) Front MOA#21
NOTE:
XX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
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 A]ask~, Water & Wa_st~ rater
Consut~ant~,_[~/~
Address . 7,?,20 ircle
Engineers signature ~o ~~ )~
ALASKA WATER & WASTEWATER CONSULTANTS
IS TO BE PAID $1150.00 FROM THE ESCROW
ACCOUNT #10-64628 FOR ENGINEERING
SERVICES PERFORMED.
DHHS SIGNATURE
I'/' Approved for
bedrooms.
Date ~ ~ r~
Disapproved.
Conditional approval for bedrooms, with the following stipulati(.,?~
Additional Comments
By: /¢,'/ Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #'21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERV, I~E.~ ~
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744
Legal Description:
Health Authority Approval Checklist
(,~,.~O~ L"~'~, ~P,-~ Parcel I.D.:
WELL DATA
Well
If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Date completed
Total depth
~ed to Casing he ground)
Sanitary seal (Y/N)
y protected (Y/N)
FROM WELL LOG
AT INSPECTION
Date of test
Static water leve
g.p.m.
Coliform ~ ~ -~
mple: Collected by:
SEPTICI~ TANK DATA
Date installed
Foundation cleanouti~N) J;~Xt$?,~&. Depression (Y/~.
Date of pUmping N/~j/~ Pumper
ABSORPTION FIELD ~ATA
Date installed ~ l/~/~ ~
Length~ ~,e ~0 ~ ~idth
Effective absorption area //~0 ~
Date of adequacy test ~
Fluid depth in absorption field before test (in.);
Fluid depth (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/~
Other bacteria
Number of Compartments ~;~ Cleanouts {~N) 'YE~'
High water alarm (~N)
Soil rating r.ftqbdrm) 0,~ VlSu,~-~.. System type
5 '% Gravel thickness below pipe .~ I Total depth
Monitoring Tube present~YN) y
Results (Pass/Fail) "~
· Depression over field (Y~
For ~11
Immediately after gal. water added (in.):
Absorption rate = '""' g.p.d.
If yes, give date
bedrooms
72-026 '(Rev. 3/96)*
D. LIFT STATION
Date installed c~/~.~ Size in gallons
Manhole/Access ~fll) Y/~.~ "Pump on" level at* /~0"
High water alarm level at~; !~ ~ *Datum _~',~'7-/dA,~ oF-
Cycles tested ~J/~ - ~//~/xtJ T,,~/VJ(
"Pump off" le~/el at*
'7'Fr~ r-,.
E. SEPARATION DISTANCES
Public sewer main ~
Se~
Lift station
SEPARATION DISTANCES FROM SEPTIC~ TANK ON LOT TO:
Foundation '~ ~ ' 1(- Property line ~' ~- Absorption field
.Water main/service line /,0 '4- Surface water/drainage ,/(-~'~' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line .~. tO ~ ~ Building foundation
Water main/service line
Surface water ~ 00 ' + Driveway, parking/vehicle storage area ~
Curtain drain ~'~o~- ~1~, Wells on adjacent lots ~00t~
F. ENGINEER'S CERTIFICATION ~ ~ ~v~Oc~ IS ~ T/~ ~ ~1~) ~ Y~ ~-
I ce~i~ that l ~ave determi~ thru field/inspectiOns and review of Municipal records that ~~~ are
in conformance with MOA ~ ~ui~el~s in effect on this date. ~. ~.
.
Engineer' me ~~ ~ ~ I~/~
HAA Fee $ ' Waiver Fee $
Date of Payment J~ /~ lq ~'
Date of Payment
Receipt Number ~ ~. . ~Z ~ Receipt Number
72-026 (Rev. 3/96)*
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~..~._~;;?,¢~r~5~.¢~ _ Telephone: Home ,.~2.-~_ Business
Applicant Address
(c) Applicant is (check one): Lending Institution []; Owner/builder,S" Buyer [] · Other [] (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
(f)
Telephone
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-FamilyJ~ Multi-Family []
Number of Bedrooms __
Other
WATER SUPPLY
Individual Well [] Community~ Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
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.
Page 1 of 2 72-025 (11/84)
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~C/~-
Address _J,,~
Date .... ~.~
Seal
DHEP AppROVAL
Approved ~, Disapproved
Terms of Conditional Approval
Conditional
Date
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the represent{~tions given in paragraph 5 above by an independent professional',
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements, Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72~025 {11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description:
Well Classification
Well Log Present (Y/N) ,~y.~,.
· Date Completed "~/,~ Yield
Total Depth A,I/~ Cased to A//~. Depth of Grouting
Static Water Level ~IJ/~4' Pump Set At
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
I1~t B, C, D.E.C. Approved~N) .~',~-.E-O(
Sanitary Seal on Casing (Y/N) ,~"'~
Depression Around Wellhead (Y/N) ~
· _-~?~/4= ;On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~; On Adjoining Lots
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
;Date
Comments
SEPTIC/HOLDING TANK DATA
Date Installed ~Size
~ No. of Compartments
Standpipes ~'N) Air-tight Caps i~N) Foundation Cleanout (~N)
Depression over Tank (Y,~ Date Last Pumped
Pumping/Mair~tenance Contract on File (Y/N) eJ/,~.- ; for
Holding Tank High-Water Alarm (Y/N) p~,l/~.... Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course ,~./oz~,
To Building Foundation ./~V ~.~
To Disposal Field /0/4' 4~
To Stream, Pond, Lake, or Major Drainage
Comments ~ ~ ~.~.:~.~:~ t~__~ (~. ~..~:~~ .
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field ./G/ t~ -i.
Square Feet of Absorption Area
Depression over Field (Y/¢
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation ~.,'~
Lot
Type of System Design
Length of Field ,_~ (.D
'~ ~(~ Depth of Field ~ ~
~ ~ Gravel Bed Thickness ~ · ~ ¢
~ + /~O ~ ~ Standpipes Present~/N)
Date of Last Adequacy Test
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ,"~',~
To Cutbank (if present)
D. LIFT STATION
Date Installed ~4,)/~_
Size in Gallons
"Pump On" Level at ~)/,4-
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 hCve checke~ verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed d~'_ ~/)~'~,~,/_~. ~Of-.~_~ Date
Com pan:'~.~ ~'~':~. - MOA NO.
Receipt No. '~C~'"~¢~1~
Date of Payment /~'~,~ '~-~
Amount: $ 4~,G .O'~
Page 2 of 2
72-026 (11/84)
Engineer's Seal
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA gg501
BILL ~FFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
To Whom it May Concern:
According to records on file in this office the
Water System is in compliance with the State Drinking
Water Regulations
Sincerely,
