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Home My WebLink AboutT12N R3W SEC 22 NE4NE4NE4SW4 RIC,1� 0.2 � Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number:.OSP241204 PID Number: 015-203-02 Dwelling: M Single Family (SF) F] with ADU [I Duplex (D) El Two Single Family Project: El New 0 Upgrade Name KEVIN D CALLAHAN ABSORPTION FIELD - EXISTING n Deep Trench n Wide Trench n Bed n Mound Site Address 11620 OUR ROAD, ANCHORAGE El Other Phone Number of Bedrooms Soil Rating depth from original grade 3 JTotal GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot NE4NE4NE4SW4 Fill added above original grade Ft. Gravel length Ft, Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. T12N R3W 22 SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 I Ft. Well 100'+ 25'+ TANK 0 Septic E] S.T.E.P. [I Holding El Other Manufacturer GREER Capacity 1250 Gal. Surface Water 1001+ Material HDPE Number of compartments 2 Lot Line 10'+ NA Foundation 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks Deep Burial Tank & Tank insulated. Alarm location Electrical installed by Tank PIPE MATERIAL House to tank 3034 drainfieldto 3034 Installer NORTHERN EXCAVATION Drainfield CO/MT Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspectes:tion 151 8/9/2024 n1 9/18/24 Location and description da2 3rd 4`h ITOP OF MH RISER ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date V1,11 iL Curtis Huffman CE 128991 Septic Sy7 Approvedste 7// low Date .1 /8/2025. )'ROFESSOO Xote: this approval does not include well permit requirements. (Rev 05/02/18) PID: 015-203-02 PERMIT: OSP241204 EXISTING 1994 APPROx PIPE LEANT❑ TRENCH LOCATIONS OF TRENCH \ U7 & CRIB. EXISTING �,0 NOT LOCATED TRENCH NEJ NEJ NEJ SWJ BAN ONRED SHED T12N R3W Sec22 S.M. IN PLACE. ' 12.0' 1p,0' M DECOMMI ZONED EXISTING S.T. APPROX. LOC. & INS T NEW 1250 -GAL OF EXISTING S TIC TANK. DCOs BURIALPE DEEP CRIB THAT o GRN CHSE REC NECTED TO 1994 FIELD. WAS ABANDONED IN PLACE. GRAVEL\ �X STAKED 100' D W 18,0' 0' DCO I O H WELL RADIUS � PRIOR TO /k W CO CONST. xrX_X l ¢ o F Jl � 14.2' N WELL k VERIFIED & MAINTAINED A 5'+ SEPARATIONS TO ANY FIELDS PER THE (CRIB & �— x DRAWING, A DIVERTER EXISTED 1' FCO Z k/ TO CRIB & FIELD. PER OWNER'S / DIRECTION, THE DIVERTER WAS k REMOVED, NO OTHER PIPES 4 ' WERE LOCATED & THE NEW �C f TANK WAS RECONNECTED TO fit/ V k THE 1994 FIELD. THE CRIB & ' k OTHER FIELD WAS COMPLETELY Z A / ABANDONED IN PLACE x B I /k A -C=66,3' FCO C0 DGO B -C=81,7' w9t� Go A -D=62.3' 95.89 B -D=78,3' INSUL A -E=58.3' 95.31 1,250 -GALLON 55.14 DEEP BURIAL D OSTING 1994 REM B -E=74,5' HDPE TANK A -F=53.1' B -F=69,8' SEPTIC SECTION SCALE, NTS SUPPORT SERVICES: T12N R3W SEC 22 NE4NE4NE4SW4 .►'�"�'�\ PREPARED FOR: OF KEVIN D CALLAHAN 11620 OUR ROAD * 9 TF ANCHORAGE, AK 99516 FIRST WATER CONSULTING DATE: 1/8/25 �+ is Huffman #.400 SURVEY: JLS , CE 128991 Ao 13030 SUES WAY DRAWN: FWCS 1/8/2025 ANCHORAGE, AK 99516 SCALE: 1" = 30' 907-350-9566 FirstWaterAK@gmail.com ��°`+ 1 = 50" Ll N89°58'45"W 329.53' N89°58'00" 329.75' R • SEPTIC PIPE (tyB) NEj NE1 NEJ SW' T12N R3W Sec22 S.M. LEANTO SHED G 12.0' JUMAR AVE 1G 00 - QR7 / GRAVEL l D./'W �Z� WELL 105.7' tU U $ v cs� 2� 0• r N89°58'42"W 329.55' (N89-58'1 3"W 329.75' R) ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: NEI/4 NEI/4 NEI/4 SWI/4 T12N R3W Sec22 S.M. SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shouh any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DALE: eM 1 F E -+ac AUG 14, 2024 1 „=50' schullerak6gmoii.cort 24-080-2 DRAWN BY: ctEcxm ByGRID NltueEa: oK BoAoE: JLS SW2736 240306 a0 ro ` 49TH tt s %x l s JOHN L SCHULLER —10408 Qj I k®a°fessi0nat Cr SUR V 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax I F1 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: OSP241204 Work Type: SepticTank Upgrade Tax Code Number: 01520302000 Site Legal Address: T12N R3W SEC 22 NE4NE4NE4SW4 G:2736 Site Mailing Address: 4936 Jumar AVE, Anchorage Owner: CALLAHAN KEVIN D Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft Total Bedrooms: 8/6/2024 8/6/2025 109049 ❑ 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 R4Geiv4d-By: :r 55LIke A to /1WC_ Date: Issued By: ( l Date: r 3 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-203-02 Property owner(s) KEVIN D CALLAHAN Day phone Mailina address 11620 OUR ROAD, ANCHORAGE, AK 99516 Site address 11620 OUR ROAD, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T12N R3W SEC 22 NE4NE4NE4SW4 Lot Size 109,049 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank ® Upgrade ® Duplex (D) ElHolding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (signature ..f.property owner or authorized agent) Permit/Rush Fees: 272 5 - Date Date of Payment: / 5 1 -w 2 i / Receipt Number: �' I �'/ Z U Permit No. osi>Z�IZay Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! July 24, 2024 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: T12N R3W SEC 22 NE4NE4NE4SW4 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 a 1250-gallon HDPE tank per the attached design to serve the existing 3 -bedroom residence. We would recommend a 1500-gallon HDPE tank be installed for current functionality and future consideration or flexibility. Groundwater was noted in the MOA on-site file and if shallow groundwater is encountered during installation an epoxy coated steel septic tank or required tank anchoring for buoyancy or other actions may be required. The lot and area are served by private water and 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. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241204, Deb Wockenfuss, 08/06/24 FIRST WATER CONSULTING T12N R3W SEC 22 NE4NE4NE4SW4 DESIGN DETAILS: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241204, Deb Wockenfuss, 08/06/24 Municipality of Anchorage Page I 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: ~WqqOZO0 PID Number: ~l~'2030~-- Name: Wastewater System: [] New ."~Upgrade Address: //~zo 0¢~ ;~-o,~. ABSORPTION FIELD /~.~)C,'~O~.,'~C~. ~ ~/G~ ~ Deep Trench D Shallow Trench ~Bed ~Mound DOther LEGAL DESCRIPTION sog Rating: Total Depth from original grade: ' Range: ~ Township: Sectio Fill added above original grade: Gravel length: Number of lines: Gravel width: WELL: Q New D Upgrade Classification (Private, A,B,C~'~A/~ Total Depth: Cased To: Total absorption area: Pipe material: ~/~ Yield: Pump Set at: Casing Height Above Ground: TANK Ft, Ft. GPM SEPARATION DISTANCES ~Septic ~ He,ding ~ S.T.E.P. From Tank Field Station Tank Sewer Lines ~ ~ /~ Su,ace '+ '~ LIFT STATION Water /O~ /~0 Drain Remarks: BENCH MARK /Od. O0 Ft. ENG!NE~t~-~EAL 17034 Eagle Eive~ Le~ Lead, Ne. J~ (; Inspections performed by: ,~.~ m~._a~.k~*~s~? Dates: 1st ~ ~ 7-~q ~ Department of Hea es ap I "''~ ..... " .... Reviewed and approved b . Date: 72-013 (Rev. 9/91) MOA 95 Permit No. sw940200 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:T12N' RSW, SEC.22, NE4, NE4, NE4, SW4 PIDNo.: 01520502 CO1 ,~ C02 I] /-96.9 i H NEW / / / / / / / ~E FU~RE / ii i A B ~C0 2t.0.... t.0 ....... iC01 56.0 18.0 ~02 64,0 ~5.5 ~).V, 66,0 ~7.0 ~C03 123.0 L21,5 ~204 ~L56.0 i67.0 iMT 23.5 [22.5 1000 i GAL. TRENCH ff [MAY BE USED IN THE ~J]IJRE SECi 22 M? C03 80.9 · 73.9' 1~0 WATER FOUND WELL N SEAL PAGE 1 OF 1 MUNICIPALITY OF ANCHOP~AGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 0N-SITE WASTEWATER DISPOSAL SYSTEM PERMIT NUMBER:SW940200 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SCHNEIDER KARL BURTON & OWNER ADDRESS:il620 OUR ROAD ANCHORAGE, ALASKA 99516 (UPGRADE) PERMIT ~- ~?DC~ DATE ISSUED: 6/24/94 EXPIRATION DATE: 6/24/95 PARCEL ID:01520302 LEGAL DESCRIPTION: T12N R3W SEC 22 NE4NE4NE4SW4 LOT SIZE: 109049 (SQ. FT.) ~ER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: ROBERT SHAFER, P.E, ROGER SHAFER, P.E. June 11, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& ~ECHANICAL INSPECTIONS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: NE¼, NE¼, NE¼, SW¼, Section 22, T12N, R3W Request you issue a permit to upgrade the septic system serving the three bedroc~houseon the referenced property. An adequacy test was performe~ on the existing system on May 25, 1994. From this test it was concluded that the system is in a state of failure. Test holes were excavated and percolation tests performed in the area of the proposed upgrade. The approximate locations of the test holes are located on the attached site plan. The monitoring tubes within the test holes have been checked and found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review~tact us. ,~SU/jk ON SITE WAS'I'E WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP ' SUITE 204 ° EAGLE RIVER, ALASKA 99577 N¥'ld 3118 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street. Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: , DATE PER LEGAL DESCRIPTION: ~ t/~_/, / C../¢,. Township. Range. Section: SLOPE 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER p ENCOUNTERED? 0 IF YES, AT WHAT ~' DEPTH? pO E "egtht°WaterAIter/E'U-'"' Dale: ~//'~'/?? ~/'~"',~H ' Monitoring? t~t'~ SITE PLAN COMMENTS PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN 72-008 (Rev. 4/85) PERCOLATION RATE ~1~ (minutes/inch) PERC HOLE DIAMETER ~*' · TEST RUN BETWEEN~ FT AND ~ FT / / 17034 Ea~le River ~~CERTIFY THAT THIS TEST WAS PERFORMED IN Eagle River, Alaska 99577 N~FFECT ON THIS DATE. DATE: Gross Net Depth to Net Reading Date Time Time Water Drop :fro ~o~,~ ~V~" ;~o Io" ~' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION:TI~"~t [~ i c~-C~9't J~Y~/t JR'i/z/' Township, Range, Section: ,/~)~=.l/w ~ ~"~ ~./V~., SLOPE SITE PLAN 1 3 4 7 8 9- 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS '~/~-I, I N k ----- WAS GROUND WATER ENCOUNTERED? S L iF YES, AT WHAT -- O DEPTH? P E Depth to Water After ~' Monitoring? L~ Date: PERFORMED BY: ACCORDANCE WlT~e/~ ~I~XeF~A~J~JI~J~'~- GUIDE 72-008 (Rev. 4/85) Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN $ & $ ENGINEERING 17C=4 ~'.~jie i~iver Loop Road No, inutes/inch) PERC HOLE DIAMETER .. CERTIFY THAT THiS TEST WAS PERFORMED IN ON THiS DATE. DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES ~' Environmental Health Division 825 "L" Street. Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~dd ....FROM~ TANK FIELD WELL Phone(s) Permit NO. NO of Bedro .... WELL [~ /~ FOUNDATION gO TANKS ~ SEPTIC ~ HOLDING Material NO. of Compe~ments ~F B-CLEANDUT3 ~-NDNZTD~ TU~E TYPE OF SYSTEM " FT L-) FT gx/~mG C~lb Conc~te i Total absorption area Distance between tines ~v ~eep T~nk % I Number of hnes Soil rating Pipe material ~ PRIVATE ~ OTHER (Identifv) -- FT REMARKS: -- Public ~q~ 72-013 (3/85) Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~ "~.~ (~V~ 3 ' 4- 5- 7 ML I 9 ~0 13- 14- 17 18 20 Township, Range, Section: SLOPE COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Waler Alter Monitoring? Date: ENGINEER'S SEAL) DATE PERFORM.ED: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE l~"t"~ ~' VI& U A' L ~ (minutes/inch) PERC HOLE DIAMETER -- TEST RUN RETWEEN --% ~A.~ ~ $$Nbl~ T~I ~O~L ~N T~g [ PERFORMED BY: '"~ ,,"~ I ~CERTIFY THAT THIS TEST WAS PERFORJ~D IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFE/ON THIS DATE.~DATE: ~~ 72-008 (Rev. 4~85) / \ O~.~n~x,i', l',Ixrr,~..~ I<AI::;J..,. SC, H!',!E)XOIEF~ Day F'Pll::)ne~ Add !" ,.-i N C.I'-~i..II:', A b t .... SEP'I :!: E: 'T Afql::: ;: M 'J. r'~ i mum 'LoC a ], seF) t. i c: t. an I:: iNSTAL. I_. 50' (:iF 'FF~ENCH PE~:R EIxlGI!qI~EERS DESIGN. I::'FROVIDE SEI::'ARA'F:[C)N D]:STANE:EE) FF~:E)kl ALL CE)MF'CINANTS Ell:= Dep!.l'~ t,i:~ ~.cq::~ c:~¢ rs<~-l:d:.ic tank (~) '::: 4,," f'c:m't.h 13y l:.h~) JqLln:i.c:~paii'Ly c)[ Ancl"tc:~r'ag~, (MOA) and Che:, Si. aLe ~ae)~.,Ic~l"age .[~;y's'Lc,~)m cH"~ 'l'.his (}r' any acljac:~nC oP neaPl::)y ]J t.U"~¢:JE~l"~L~:.a~l-id 'Lha'L t.h:Ls [:)~Prflil:. J. JB valid f'ol" a maximum c]f' '.3 als;c, ur~der's~'t.and 'Lha'L 'Lh,;.~ (:apac:iCy (Jr' Che) 'LoCal. si}/[~C~zem is 5 b~x::h'cx::uns and any [i~n!ar'gement. ~,~il]. r'(¢quiPe an a.d~:li'kit~nal (Eh~n~er') KARL, 5E,hlNE~:)tER ': , ):)ATE u 338 N[TTE~ ,~, ~,_,4~..~ ~ dELL._ WZTNIN NO RESIDENTIAL WELLS ~ViT~ I 50' ~F/TRENCH Concr6~ 1000 ~ Cr~b- ~, L ~ C~ncrt~ ~ C'ompa~tm~n~ B5 0 B5 50 75 100 150 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 3- 4 7 ~0 11 12 13 17 18 19¸ Township, Range, Section: T'~, ~l\l ,, ,~ ~' ~ WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN IF YES, AT WHAT DEPTH? lie,Ih l0 Watar A~tar ~.~',~ Monitoring? Iq Date: Gross Net Depth to Net Reading Date Time Time Water Drop // _ a,/~/~ - 20- PERCOLATION RATE J {~ (minutes/inch) PERC HOLE DIAMETER TESTWN.ETWEE. ~I~FTAND ( FT COMMENTS PERFORMED BY: ~ I ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFE~T ON THIS DATE. DATE: 72-008 (Rev. 4/85) Gr"~'~TER ANCHORAGE AREA BORO"'-~-=,H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM N? 190 NAME s- LOCATION SEPTIC TANK: DISTANCE FROM WELL 7///8 LIQUID ~APACITY //~'}~:} :Z~" zZ~'~ ~ MATERIAL GALLONS. MAILING ' _~Z~'~ ADDRESS ~' ~' LEGAL DES - - NUMBER OF ,~ ~ ~/~'~U~ COMPARTMENTS / I~$1D~ L~TH ~SI~ W~TH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER -/~" OR WIDTH ///.;.~ ~ "~ / · LENGTH ~:> ~ , DEPTH ........ ~'~ '' ,/'//~ / , BUILDING FOUNDATION LINING MATERIAl ~-y) rj/(~//~ ~/ . DISTANCE FROM WELl NEAREST LOT LINE .~/~ ~ ~ /~'~ . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~/ ~ ~' SQ, FT, TILE DRAIN FIELD: _--_-- -- ~ TOTAL LENGTH DISTANCE FROM WELL ~- /~ ~'~'-"~ AREST LOT LINE , OF LINES NUMBER OF LINES ~/ DISTANCE BETWEEN LINES '~RENCH WIDTH .... IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN, ABOVE TILE -- ~ DISTANCE FROM ~ .) WATER WELL: TYPE .~.4/~'-/~/-'~--'~_'7:'' · DEPTH ' , BUILDING FOUNDATION~-': ~' / SAMPLE -/g//) NEAREST NEAREST // SEPTIC ~/.~ ' ./? / SEEPAGE / // OTHER LOT LINE //~/ :':~ . SEWER LINF TANK SYSTEM _~/'/~ , CESSPOOl , SOURCES DISTANCES: ¥ DIAGRAM OF SYSTEM DATE APPROVED Certified Well Forl ... C a~l..Sd.'nneidez~. ..................................... Location. ........Oun..Bo, ad 2_[.. Depth of well :i ~[l~ Ee~fl-..:.:.-..: ....................................... : ...... SOMNtERVILLE WELL DRILLING Star Rt. A, Box 1773 Anchorage, Alaska - We advise you to attach this certificate to your. deed. GREATEh ANCHORAGE AREA , ')ROUGH Case N0. HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT RESIDENCE ADDRESS ~ ~::~/v%~_ LOCATION OF INSTALLATION ~_ M t.'") ~(~ ,/~ LEGAL BESEB PT ON F__[~ ~ } ~ ~ N ~ ~ ,~:~ APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PIT_ ~ ,DRAIN FIELD. ,OTHER TO SERVE THE FOLLOWING FACILITY ~ ~'c~ FINANCED THROUGH ] ~ ~(~ N,~ TO BE INSTALLED BY ~1~ ~'~ ~XC-, ~ TEST RESULT~ ANTICIPATED DATE OF COMPLETION ~ ~ ~%~ $~g~ BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS T0 SERVE AS ~t/\ ~, g c¥~ ~ e-, '~ ~ ~;-, PERMIT T0 INSTALL A g ~ ~..,] ~.A_ ?-~-~-~-~-~-~-~-~ ~ ~ ~ 'v',, AS DESCRIBED BELOW. SIZE OFUNIT. TO DESERVED '~}~ . SEPTIC TANK SIZE ~O0~ Typ~ ~ SEEPAGE AREA~x~y~ TYPE DISTANCES: I HE~H AUTHOR DIAGRAM OF SYSTEM 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. ~' l~ ~ APPLICANTS SIGNATURE b1 '~l/l~l Feet 7~ Was Ground Water Encountered? ........... If Yes~ A~ ¥~l';at Depth ........... Reading Date Net Drop 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 Parcel I.D. # (")~/~- GENERAL INFORMATION Complete legal description T12N, R~W, S¢C. 22, NE~, NE~, NE~, SW~ Location (site address or directions) Property owner Mailing address Lending agency Mailing address 11620 O~r Road A~chora~¢, AK Karl and Mary Schneider 98oi Buddy W~_rner Rd. Anchorage. Day phone AK 99516 Day phone 346-1872 Agent Mary Cox/ REMAX PROPERTIES Address 2600 Cordova Street, Suite 100 Anchora.qe~ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Day phone 276-2761 AK 99503 NOTE: Individual well XXX Community well Public water If community well system, provide written confirmation from State ADEC at,est- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site 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 MOA #21 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 . ~ Phone .~/~'~ Address 17034 Eagle R~ver Loo~oa~ No, 2~ EngineeCs signature / ~ ./~ Date /// 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 indepondent 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 7'/2/J,,/~. S~c.22.; '. ' ~' ,u~= .~-~,u ~;~u~arcel I.D. A. Well Data Well type Log present ~)N) Total depth Sanitary seal ~)N) Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number .7~s Date completed ~, - ? -7o Driller -~-o~ Cased to //~' Casing height V-c5 Wires properly protected (~N) FROM WELL LOG AT INSPECTION /V[UNICIPALI]Y OF ANCHORAGE (o - ~ ~ 7o 5- - 2 ~' - ?c/ ~NvIRONMENTAL SERVICES DIVISION 4,?' ~.o' ,:UL 1 9 lB94 /~ 'g.p.m. ~-, 7 g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /Od ' Absorption field on lot /~0' Public sewer main 2,~- J + Sewer service line z~- ' ~- ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform d Date of sample: ? - /~ Nitrate ~.ql Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ? - ? -q ~/ Cleanouts (~N) yes High water alarm (Y/N) Date of pumping Tank size /~)~ ~',~, Compartments Foundation cleanout L~N) Y~z Depression (Y/~ ,U.J,,9--~ Alarm tested (Y/N) /p,/~ Pumper ///~ ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /o~ ' On adjacent lots /d)o ' * Foundation ,~'~'/ To property line /0 ~ + Absorption field ~ 3 ' Water main/service line ~'-o Surface water/drainage /0o ' ~- 72-026 (3/93)* Frcnt CONTINUED ON BACK PAGE C. LIFT STATION Size in gallons ~ Manhole/Access (Y/N) Vent (Y/N) ,,~ _ ~t High water alarm level ~les tested Meets MOA electrical codes (Y/N) ~ ~ SEPARA~TATION TO: ~ yY. etFor~ot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed '7 - ~ - 94 Soil rating (GPD/FF) ~.z¢~- System type Length ,PS ' Width -7 ' Gravel thickness ~.,s' ' Total depth /,2 ' Total absorption area /, e 79 .-~,. err/. Cleanout present (~N) V~-¢ Depression over field (Y/~/ Date of adequacy test ~ Results (pass/fail) ._.~o~ ~ Bedrooms Water level in ab~re~t~ After test Pero~nt (pa ts 12 months) (Y/N) If yes. ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /(~o ' On adjacent lots /dJo / ¥- Property line To building foundation /zO J To existing or abandoned system on lot On adjacent lots 5'0 ' -*- Cutbank s"o ' +- Water main/service line Surface water /oo ' *-- Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, ve~f~2:~nformed to ail MOA and HAA Signature Engineer's N a~e~-S~ ~-~E ~,~1. N.~w, F,,,,~ ;,;~, ,~,.,~ guidelines in effec!,?, t~he~¢at¢ of this inspect/on. · ~':;'~ ' "' i:': .. HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number 09/15/94 i?:18 CT~E ENUIRONMENTRL LRB SERUICES N0.621 ~05 CT&E Kel~# Cli~mi Sample Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 94.3520-3 NE1/4 NEll4 N'~E1/4 SWI/4 8EC22 '1'12N R3W* WATER ClientNante S & 8 liNt' INI312RINt3 WORK Order 80343 t, ) ' }'rite.ted 1)ate 07/15/94 (.q; 17:1. 1krs, Ordered By P,.. SHAFER collected lYate 07/13/94 C~ 06:45 tms. I'roject Name Recelv e,t lYai¢ 07/13/94 ~,~ 12:40 lu's. Project# I'WSID UA Teclmieal Director STEPttEN C, EDE Qc Aliowable Ext. Anal l'm'ameier Results Qua[ Units Mi:thod Limits Date Date Init --~4~,.;~7,q ................................ --~7)~ ............ 7,~-~;C ......... i~/; 7G-_s-5 ;2-/} b~ .- 6- ...... q5 ............. ~ig/5~/-~T - -~5]§~ * $c¢ 8poq;ial It st 'actions Above NA e Not .41~alyzcd ** $~.,¢ Sample Remarks Above ~ U = Un&tecte4 Rc~oaed val~ is ~e practical t~miificatio~ limit. LT= ~ss 'lhtm ~ D = 8c~on&~ry ~l~ion- C~ ~cai~'lllan ~': ~33 B Street, Anohorage, AK 9~ 8-1600 -- Tel: (907) 562-2343 Fax: ..... {907} 501,5301 ..........