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Home My WebLink AboutT15N R1W SEC 4 LT 22Onsite File T15N R1W Section 4 Lot 22 #051-072-19 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201221 PID Number: 051-072-19 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name RONALD D JR PREWITT ABSORPTION FIELD - ADVANTEX ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 22236 GLACIER ROAD, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1 GPD/SF 7 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft. Gravel depth beneath pipe 5 Ft. Subdivision Block Lot 22 Fill added above original grade VARIES 0.66 — 0.75 +/- Ft. Gravel length 2 @ 30' 60 Ft. Township Range Section 15N 1W 4 Gravel width 3 FL Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 600 Ft' 2 10+ Ft. Well 50'+ 50'+ 25'+ TANK Septic ® S.T.E.P. ❑ Holding ® Other ADVANTEX Manufacturer ORENCO / ANCH. TANK Capacity 1500 Gal. Surface Water 50'+ 50'+ Material Number of compartments Lot Line 10'+ 10'+ NA FIBERGLASS 2 Foundation 101+ 10'+ LIFT STATION — PUMP BASIN Manufacturer ORENCO Capacity (PER FLOAT SETTINGS) 40 Gal. Remarks Original system decommissioned per code. System insulated. Alarm location BASEMENT Electrical installed by DRS ELECTRIC Installer JRs PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection dates: 1s' 8/11/20 2�d 8/12/2020 Location and description 3'd 8/14/2020 4" 8/14/2020... BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Aw Approval: Date AMP,��.•.•'' TH `• r� ••••• •• ••••.....• Septic System Approved - Date a �••` Curtis HuffmanCE 1 91 .: TF�F�•1/22/21Aw � � . PROHS*Sti� Note: this approval does not include well permit requirements. �'��,®,�..� rpo„ nrinori ux PERMIT: OSP201221 PID: 051-072-19 GLACIER VISTA ROAD GRAVEL /W A -C=17,2' B -C=18.4' A -D=24.9' B -D=221' A -E=38.1' B -E=32.5' J -F=46.5' B -F=18.8' J -G=21.7' B -G=35.4' 50' ROW RESERVE BK 207 PG 118 , 8.0 GRAVEL TH2O-1 o PARKING MT MT PAVED c�i ❑ I H D /W SHED ,50' WELL RADIUS G EXISTING FIELD F MT MT DECOMMISSIONED WALK AY D30� 6 J �i B p NEW 1500 -GAL E m W�2PUMP BASINK MH ETING IsTNG �DXI MH MH FCO HOUSE 4E DCO A DECK x ExisT, COVERED I WALK GgR,j FG ^ i SCALEi 1' = 30 MT MT 92.64 AX20 POD MH 9292 MH 99'07 FINAL GRADE 99.04 MH 98.38 FILTER FABRIC INSULATION f & INSULATION ORIGINAL GRADE/ - TH2O-1 ORG/OL 0.5' 0.2590.09 6.38 96.38 8.85 1500 -GAL FAP SEWER ROCK SM/GM ADVANTEX PUMP 91.38 91.38 TANK BASIN J -H=35.1' SEPTIC SECTION B -H=44 2' SCALE: NTS J -I-55.7' T15N R1 W SEC 4 LOT 22 B -I=34.3' PREPARED FOR: RON PREWITT 22236 GLACIER ROAD CHUGIAK, AK 99567 FIRST WATER CONSULTING 13030 Sues Way Anchorage, Alaska 99516 (907)350-9566 firstwaterAK@gmail.com 99'13 MT FINAL GRADE MT 99.11 98.38 ORIGINAL GRADE/ - FILTER FABRIC GRND.WTR. f & INUSLATION 0 13' SEWER ROCK 14 x/1/2020 r38 96.38 84 38 BOH 91.38 SUPPORT$SERVICES: �� OF AL4 �� TH 9 c� * 0, DATE: 01/20/2021 , �" r Huffman SURVEY: JLS 2020 1 r� CE 128991 �`� DRAWN: FWCS 1 01 /20/2021' o SCALE: 1" = 30' \ 1'$OFRSSIO'0' 0 IL BASIS OF BEARING N89'59'00"W 329.93' (330.00' BLM) GLACIER VISTA ROAD I 54' Raw RESERVE BK 207 PG 118 a. �� •SEPTIC ■ PAVED VENT SFi GRAVEL .(typ) DWELL PARKING DECK CONC E}(i5%G M t yp7 "ter SausF x Z 44.0' CD 0 Z 4VEL DECK x ❑/W aC) GkRAcC COVERED wnLx o x L1 a l ws0•°' I � + x LW LJ O7 o i x 4::E x M -aM �x � l x fx�x M ccC rrt j LOT 22 I N89'59'59"W 329.81' (N89'59'00"W 330.00' BLM) ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: BLM LOT 22 T15N RI W Seco 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 should any information on this drawing be used For construction of fences, structures, improvements, or for establishing boundary lines. IEXCLUSION 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. OCT 16. 2020 1 1"=50' 20-042-2 onxwr MI. aEntm I Oen WAOt SOM70M JL5 NW1458 200227 LOT 1 A = FND MONUMENT Q = FND 518" REBAR fi .. F "AL S * Y 49TH _ 1 ......i JOHN L. SCHULLER .: o LS -10408 c� E� LAND to 1831 Talkeetna street Anchorage, Alaska 99508 (907) 827-1455 office (907) 274-4992 fax 7/22/20 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-072-19 RONALD & ANNE PREWITT Property owner(s) Day phon Mailina address 22236 GLACIER VISTA ROAD, CHUGIAK, AK 995667 Site address 22236 GLACIER VISTA ROAD, CHUGIAK, AK 995667 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T1 5N R1 W SEC4 LOT 22 Lot Size 108900 Sq. Ft. Number of Bedrooms 4 9078545292 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank X Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ 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 of property owner or authorized agent) Permit/Rush Fees: qq., 2 5 Date of Payment: % Za Receipt Number: 6670.0/2 - Permit No. 0 S P 20 1 )_21 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc FIRST WATER CONSULTING 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com July 10, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: T15N R1W SEC 4 LOT 22 PHYSICAL: 22236 GLACIER VISTA ROAD, CHUGIAK, AK 99567 The septic field has failed and the owner has requested we obtain a septic permit to upgrade the system on the above referenced lot. We propose to install two pressurized deep trenches with an Advantex system to serve the existing 4-bedroom residence. The design is based on the recent test hole conducted on June 23, 2020. The slopes are flat at the proposed upgrade location. The lot and area are served by private water. 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 OSP201221, Deb Wockenfuss, 07/20/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201221, Deb Wockenfuss, 07/20/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201221, Deb Wockenfuss, 07/20/20 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350 -9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: T15N R1W SEC 4 LOT 22 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/1/2020 DEPTH FEET OG SOILS 1 ORG/OL 2 3 SM/GM 4 5 6 7 8 9 10 11 12 13 14 15 BOH 16 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 6/24/20 30 min 6 12/16 30 min 6 12/16 30 min 6 12/16 PERCOLATION RATE 40 (MIN / INCH) TEST RUN BEWTWEEN 5 & 6 FT PERC HOLE DIAMETER 6 PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: 13 DATE: 7/1/2020 TESTHOLE # 20-1 DATE PERFORMED: 6/23/2020 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: RONALD PREWITT 7/1/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201221, Deb Wockenfuss, 07/20/20 about:blank 1 of 3 about:blank 2 of 3 about:blank 3 of 3 ---�7- -----' ------ ------ ------ ------ ------ -----' BASIS OF DF BEAR|NG N88^59'00"VV 329.93' (330-00' BLk4\ LOT 1 /\ ANCHORAGE RECORDING DISTRICT, ALASKA FND MONUMENT AS -BUILT OF: FND 5/8" REBAR BLM LOT 22 SURVEY CERTIFICATE: 1, John L. Schuller. Have conducted a O.F.. LAIV low physical survey of this property as shown on this drawing and that the *4W improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should 49TH /6_q any information on this drawing be used for construction of fences. structures, improvements, or for establishing boundary lines. PA.... ?A XL EXCLUSION NOTES: It is the owners responsibility to determine ?A -7.0- - I - RA -JOHN L. SCHULLER.' o the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 1831 Talkeetna. Street WORK ORDER NUMBER: DAIE: SCALE: E-MAJL- JUNE 23, 2020 1 92 =50' Anchorage, Alaska 99508 20-042 DRAW BY. CHECKED BY, GMD NUM : BOOK/PAGE- Ofessjond\ (907) 227-1455 office JLS NW1 458 200143 (907) 274-4992 f ax ..-~ MUNICIPALITY OF ANCHORAGE ;~"i ', · ' ~:!,. DE' ~TMENT OF HEALTH AND HUMAN SER\ £S ~ Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~a.~ DISTANCES Addre;s 'FROM~ TANK FIELD WELL Phone(s) Permit No No o~ B~d WELL ~O / ~rooms TANKS i ~ SEPTIC ~ HOLDING TYPE OF SYSTEM ~RENCH ~ BED ~ W. DRAIN ~ OTHER ~,~ ~tht°plpeb°tt°mfr°m ~ 3°taldepthf'°rnorigl~a'grade ~__~, ~ ~ orlginalgrade DFT ~¢O F3 ' - ~'- WELLS ~PRIVATE ~ OTHER (Identifv) REMARKS: Municipal and~le~uidelines m effect 0n this : ..... ~ 9 1~O~ 72-013 f3/851 F:%RMI] t4.], DF]TIE ISSUED~ CLINI-AC'i F'ldOlqE: Ei[:iLJ'I'I'"I F:ORK CI]NS'I-. % S&S E:NGINEEEF;~IIx!G SR'B 196X EAGI_..E RiVER~ Al( 99577 694-'~Z9 79 ~t I~':tl:) ]: V :[ S I ON:NA L..OT: .=:.,=:. SE..[. I IOI,I. 'f'OWI'qSHIF"~ :L5N RANGE." 1W ,,;..,,,t (S[;h,F:'l,, [IR ACRIES) 3 E LOC~ .... I~tA l..is'Led b~:.)]cw-~ ar'e 'l:.he optiop, s awa~ lab]e t.o you :Ln designing your ,s/st~.~;ni,, Cho,:)se 'Lhe opi:..ior'l thai:, bes!: lit~ your site. DEI,:'IH TO PIF:'E BOTTOM (F"I".) GRAVE]- .OEP'iH (FI,) fOTAI.. DEPTH (F'I'~ GRAVE:]- W]:DTH (I GRAVE. t... Ll]]q[:¥ill (F [ ,, ) GRAVIEI..,. V[)LI.JME ([]L.l,, YDS. ) TANK SIZE SO]:L., RATING (SD. F:"I',, /BI:i) s e p t i c .x-~ E;RAVEL. LENBI'H > .. F"I. RE..d].I.F*E¢~ UL.I ].FL.,.,:. RLII'4S (NOT E. XI.,EEDIlI(:~ 75 F:'T,. i.b I HAVE ~ I I-I::.~.lo f TWO COMF:'ARTMENTS .~.~ I"ANK ..... ' .... ' .... E.A[,r'I ) ]: cer, t. ify that: J,. I am £amiI:i. ar v, ci.i'.h the r. equiremen'Ls for (_3n-site sewers ancl ~x~etls as set For'.tl'~ by 'Lhe Hunicil::)a.Lity of Ar'tchol'age (MOA) and the State o/ Alasl<a. Z],, I v~;L].l insLa].:L the s'ys'Lem in actor'.dar'lEe with all MOA codes and ar'id ~.r-! comp].iaric:e v,,it.h the design c[,:Ltep:[a of this permit,, ::% i ~d.].t adher~:~ t.o all MOA and Statx~:, ut' Alaska ~equirement. s for t. he set back se~.,~er, age system on Lhis or ai"ly adjacent of i']~ar'by 4. I undePstand that this permit. :i.s valid {or' a max:Lmum o¢ 3 I:i~]dpol:il¢ls arid any en],argen~erYf:. ~4J, ll pE.)qLIiP8 an additional per'm:i.i:.. i,F:: ¢4 I..IFI SJ'I¢.~'IION J:',3 :[NSIALLED IN AN AREA COVERED BY MI]A BU]:t..DING CE)DES, IHEN (1) A!xl EI,.ECIRICAt... f-:'E:FiM]:'[ AND INSF'EC;I"!ON MUST BEE OB't"AIIqlED; (2) AEi-..-BUII.,.TS , .~ ~ .~. - · [:. : .-r.:, .~.- INSF;ECTION REF'OR]'~ AND (3) THE ~ .1. LL. 14L¢. BI:::. A~;~)¢E:(] N ]: 'IHOU'I AN _L.E[.. [, ]. ~.,AL. . __ BiE iE BY A I.....I.,L F:LI:::i i'RZ[;RI.. MI"RK ~' ~ ~ ........ S :[ G N E::[) ~ ~ D A TIE: AF::'I:::'L. :[ CAi'q'I; SOL!I'H i 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 _o ~ °,smA.cE TO:''~-~'" , '1Abs°r't'°' ~/y~C Material No. of compartments ~-- ' I~side length Width Liquid depth ~ DISTANCE TO: .. Well /~0 /¢, FounOatio,kc[~ Nearest lot l~ // No. of lines Length of ea~h/li~t Total length ,lines Trench width Distance between Tope tJeto inis gra Z~ [~ OTHER REMARKS 72-013 (Rev. 3/7 ETHEN COLCHiSKi GLFISER RD L::2:2 SEC4 T±SN R'U4 RF:'PL. i ,':]:FIN']" LOE:RTION I....EGFIL PO 8X 8-629 RNCH ~aS~SEI8 LOT SiZE 688-%547' 40000 SQUFIRE FEE]' TYPE OF SOIL FIBSORPTION SYSTEM IS: TRENC:H NFIXIMLIM NUME:ER OF BED'ROOMS = !:.'. '-:;OIL. RFITING (SQ F-F,.'"BR)= 250 THE REQUIRED SIZE OF' TNE SOIL. FIBSORPTION S'¥'S'T'EN IS:;: THE LENGTH DIMENSION tS THE LENGTH '.'.Ih! FEET) OF THE "FRENCH OR DRFIINFIELD. ]'HE DEPTH OF R TRENCN OR PIT iS THE D!STRNCE BETWEEN THE SURFFICE OF THE GROUND RND THE BOTTOM OF THE EXCR',,,'RTION ,::IN FE:ET). THERE IS NO SE]' k!IDTH FOR TRENCHES. THE GRRVEL DEP"I'N IS THE MINIMLIM DEF'TH OF' CiRFtVEL BETHEEN THE OUTFALL. PIPE BP,ID THE BOTTON OF THE EXCRVRT!ON ,::tN FEET). F'ERMIT RF'Pt_ICFINT HFIS THE RESPONSIBILITY TO INFORP'I TNIS DEPFIRTMENT DURING THE IN%TF]LLRT!ON INSPECTIONS OF RN'T' NEL. LS FIDJRCENT 'TO THIS PROF'ERT'-F FIND THE: NUMF.;ER OF' RESIDENCES TFtFIT THE HELL HILL SERVE. 8FICI<FILL!NG OF F!NY SYSTEM HITHOUT FINFIL. INSPECTION FIND FIPPRO',,,'F~L 8Y THIS DEPFIRTMENT HILL BE SUBJECT 'TO PP. OSECOTION. MINIMUM DiSTRNCE BETNEEN FI HELL FIND RNY ON-SiTE SEIqRGE [.',ISPOSFIL SYSTEM IS ±00 FEE]* F'OR R F'RIVFITE HELL OR 150 TO 200 FEET FROM FI PLIBLIC NELL. DEPENDING UP'ON THE TYPE OF PU[.::!-IC HELL. t'dZNIMUM DISTFINCE FROM Fr PR!VFITE I.,,~ELL 'TO FI PRIVFITE SEHER LINE [S 25 FEET FIND TO la CONi',tUNI'TY SEHER L..INE IS 75 FEET. OTFIEr~: REQUIREMENTS NFIY FiF'F'L.Y. SPECtFICF!TIONS FIND CONSTRUCTION DIFIGt~'.FIMS FIVFIILRBLE TO INSORE PROPER INSTRL. LFiTION. I CERTIFY TNRT ±: I FIN FFIMI!_IlaR HITH THE REQUIREMENTS FOR ON-SITE SEHERS FIND HELi..S FIS SET FORTH BY ]"FIE MUNIC!PFILITY OF RNCHORFIGE. 2: I P.!IL.L INSTFILL THE SYSTEM IN FICE:ORDRNC:E I,.!ITH TPIE CODES. Z:: Z UNDERSTFIND "f'HFfT THE ON-SITE SEWER SYSTEM MFtY REQUIRE ENLFIRGEMENT IF TFIE RESIDENCE IS REMODEt_EF.:, ]'0 INCLUDE MORE THAN l: BEDROOMS. F!F'PL ! ~FI?,IT ETHEN COLCH I SKI I SSI.JED . ............. £:,F!TE_ .--~.-~ ..... V4. 0 PERF0~ED FOR; LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720. SOILS LOG -- PERCOLATION TEST [] S~ILS LOG PERCOLATION TEST SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ~ert A. PERCOLATION RATE ~ (minutes/inch} TEST R . ETWEEN 4"-- 'ANO COMMENTS PERFORMED BY: 72-008 (6/79) // S & $ ENGINEERING SR B 196X. EAGLE RI¥~R, AK 99577 MAY 6 t986 GREI ~' ANCHORAGE AREA BOI~ "-~H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~;1/ LOCATION MAILING ADDRESS ~J~-~ ~70 ~?~-k ~7 PHONE LEGAL DESCRIPTION g~Z~-- ,~,¢~/1/ T/¢'l~lg SEPTIC TANK: DISTANCE FROM WELL---f001 INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL ~'d"~(--~e~'-kCOMPARTMENTsNUMBER OF LIQUID DEPTH I_IQUID CAPACITY I~)OO GALLONS. SEEPAGE PIT: NUMBER OF PITS r DIAMETER ~l OR WIDTH '~lf, LENGTH I'~1, DEPTH ~)! LINING MATERIAL ~'~r~,~ CRIB SIZE: DIAMETER q'DEPTH (~/' DISTANCE FROM: BUILDING FOUNDATION ~1~'1'~I NEAREST LOT LINE ~ TOTAL EFFECTIVE , , ABSORPTION AREA (WALL AREA) WELL q~-~' s~. FT. ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST ~ LOT LINE OTHER SOURCES DISAPPROVED DEPT. NEAREST SEPTIC SEWER LINE TANK REMARKS DISTANCE FROM: SEEPAGE I 70~' SYSTEM _ DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No, EQ-031 DATE 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. # I'~.~-~'~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions Property owner /-¢ {~' ~2 Mailing add~'ess Day phone Lendingagency M~iling address · Agent Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ Day phone Day phone TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer lng to the legality and status of system. If community well system, provide written confirmation from State ADEC attest- NOTE: If community wastewater system, provide written Confirmation from State ADEC attesting to the legality and status of system, 72-025 (Rev. 1/91) Front MOA ~21 5. STATEMENT OF INSPECTION BY ENGINEER· As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposaI system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Engineer's signatur Date DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 'The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer ragistered 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. .... ~;NMENT^L SERVICES DIVI$~,. FEB 1 z Municipality of Anchorage C E I V F DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist Legal Description: L~¢~-,/st¢~'C~ 4 '~/'55.Jr~ J/~ Parcd I.~.: A. ~LL DATA Well type ~9(~] ~ qT~__ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) /¥ Date completed Total depth SauitaW s~al (Y/N) Date of test Static water level Well production Cased to Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION FROM WELL LOG j~ox/ Y WATER SAMPLE RESULTS: Coliform (~)~ Date of sample: [.~ ~ ~<~?~ Nitrate 5 ~ ~>x ~__ Other bacteria Collected by: .J. D ? ~-~ B. SEPTIC/HOLDING TANK DATA Date installed ~ Tank size J O00 Number ofCompamnents'~--~ Cteanouts (YfN) Foundation cleanout (Y/N) '~ Depression (Y/N) /~ High water alarm (Y/N) DateofPumping-O~lq)~Y~\ Pumper _J~.~]~ ~C[~ffv/~i [Jx~~ C. ABSORPTION FIELD DATA Date installed 6~- Z. ~ ~'( Soil rating (g.p.d./ft2 or ff2podrm) ~¢ /g rS~stem type .0~ Length [ J ~ Width Gravel thickness below pipe ,c~ rf) Total depth. Effective absorption area ~O¢' Monitoring Tube present(Y/N) ~r Depression over field (Y/N) Date of adequacy test [2~"-~J"'~7 Results(Pass/Fail) ¢~,~ For ~ bedrooms Fluid depth in absorption field before test (in.); C_,D Immediately aftertD~gal, water added (in,); Fluid depth O Minutes later: ~- ' (in.) Absorption rate = ~ (--fi _,~ ~e~ g.p.d. D. LIFr STATION Date installed x ,, Size4n gallons "Pump off" level at* Cycles tested E. SEPARATION DISTANCES Septic/holding tank on lot Absorpfiou field on lot Public sewer main SEPARATION DISTANCES FROM WELL ON LOT TO: [ ] ~ '7 ; Ou adjacent lets ( 4'-' ~ t ; On adjacent lots /x,~/& Public sewer ~nanhole/cleanout Sewer/septic smvice liue / J 2--,/ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Fouudatiou /.~.~ Property lip_e 7 :~ Absorption field Water mare/service line Surface water/drainage Wells on adjacent lets SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Surface water ~(//(~ (~d05-5-5-5-5-5-5-5-5-~/~'(5t Driveway, parking/velficle storage area Curtaiu drain /"JOg ~- Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that i have determined thru field inspections and review of Municipal records thct(dhe~aO, ove systems are mconJbrmancewtthMOAHAAguMehnesmeffectonth~sdate. .,~,,; ,',,, ,~ -~:~ ............................................................................................................ L,~: ~ ...... HAA Fee $ ~ ~ ' ~ Waiver Fee $ Date of Paymeat ~ff/~ff~ Date of Payment Receipt Number ~ ~O/5) Receipt Number Rev. 8/95 OSS: haa.wk.doc WELL DATA MUNICIPALITY OF ANCHORAGE (MOAt HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~ 'Z--'7~-i ~'-~,, Well Classification '~,, If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/~ Date Complete~ :[~t~o~ ~--tq~' Yield Total Depth ~.[~,~ ' Cased to ')¢' Depth of Grouting Static Water Level ['?-~ ~ Pump Set At Casing Height Above Ground "~¢ Sanitary Seal on Casing~:YN) Electrical Wiring in Conduit~'N) Depression Around Wellhead (Y/~ Separation Distances from Well: To Septic/~"~Tank on Lot 1''~' ; On Adjoining Lots To Nearest Edge of Absorption Field oN Lot ~ ¢r~' i ; on Adjoining Lots To Nearest Public Sewer Line ~/'~ To Nearest Public Sewer Cleanout/Manhole ~ Water Sample Collected by Water Sample Test Results Comments To Nearest Sewer Service Line on Lot '~;:. ~-; '~.~'ttt,~-~--;,"~r~. ;Date B. SEPTIC.~ANK DATA To Water-Supply Well To Property Line To Water Main/Service Line Course Date installed 4:~ ..¢~,~,.-¢'~ Size Standpipes ~N) Air-tight Caps,)N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding ~-ank High-Water Alarm (Y/N) ~/,'~ Separation Distances from Septic/,~Crdi~ank: \~+ No. of Compartments ~ Foundation Cleanout ~.N) Date Last Pumped ~ ~ '~ ~ ~ ; for Temporary Holding Tank Permit (Y/N) /0///4 To Building Foundation To Disposal Field ~-~ ~'~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Stre)a ~'~q'~lPr~'~ Date Installed ~'¢'"'~'~/ (.l~"~)Ct,~ ~q8¢"~¢~'~ Width of Field 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 "22C2'(I '~- Depth of Field Gravel Bed Thickness Crt ~ (,¢ -~ Standpipes Present (~N) Date of Last Adequacy Test To Water Main/Service Line L C:~ f'"~ 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 Cutb. agk (if present) Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signed S & $ ENGINEEEING Date ~4AY I 9 !986 SR B 196X MOA No, ,~¢~,_.(--~(...~'0 ..~ Company ~,~t~(~iLl~ RIVI:R, AK 99577 Receipt No. '~ Date of Payment Amount: $ __ Page 2 of 2 72-026 (11/84) A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOAi HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPAUTY OF ANd--HORAGE DEPT, OF HEALTH & ~NVIRONMENTAL PROTECTION MAR 1. ? Description: Well Classification 1¢ 14.~ Ii A, B, C, D.E.C. Approved (Y/N) Well Log Present ¢f~ Date Completed "~'¢'"'-'1'~ [~ ¢'~" Yield Total Depth ~ ~ f¢ ~' Cased to ~c~' ~ Static Water Level I '~'4'~ Casing Height Above Ground Electrical Wiring in Conduit/~ Separation Distances from Well: Depth of Grouting Pump Set At Sanitary Seal on Casing~ Depression Around Wellhead To Septic/Holding Tank on Lot ~ ~-~=~ I ~-' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot [.l~:>c:> t.l-' ; On Adjoining Lots To Nearest Public Sewer Line ~ [,~'~ To Nearest Public Sewer Cleanout/Manhole ~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~ ~'~' ~--'/~'~I~''l"~-'t~'~/~',' ; Date '~'~ Water Sample Test Results ._~,A,-¢7 ~ Comments ~VIJIr~ .~t~'tt' t ~ ~;~¢~N.~t~/~! B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes Depression over Tank Size /~"*~"*~"*~"*~"*~"*~ ~ No. of Compartments / Air-tight Caps~' Foundation Cleanout ~N~' Date Last Pumped ¢,~" ~"""' ~ ¢'~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~'~'~-'/ ~ ; for ~'" Temporary Holding Tank Permit (Y/N) ~4¢~' Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water--/Service Line Course To Building Foundation . ~O t ~' To Disposal Field "~' ! ~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (4 Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation To Water'M,~h~'Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ¢~'"~=;~- /~'~Ple"r~;:~ t '~¢~ Type of System Design ~/~[."1~ ~ ,._ Length of Field ~, ~' 'Z- t Depth of Field Gravel Bed Thickness Standpipes Present.¢¢~ Date of Last Adequacy Test' ~" t'~"~"'"'~"" To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) ~. "Pump Off" Level at ,/Jk, l, I Vent(Y/N) '/ "ul.,~ Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84} -.~;~ D,~E R EC~IV~'D "' -' INSPECTION APPOINTMENTS.~ I~-' ~k ~ ~/ 7 ~.~¢L=~:~::,_ .... TIME TIME ~~' TIME DATE DATE DATE MUNICIPALITY OF ANCHORAGEMIl ~IPAL~ OF ANCHORAGE ~ ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 AUG 1981 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE~I~S~ D DI R ECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow ten {10) days for processing. 1. PROPERTY OWNER PHONE MAILING / PROPERTY RESIDENT (If differen~ ~rom abovel PHONE MAILING ADDRESS .- . PHONE 4. REAL~OR/AGENT ~ ' ~ ~ -- ' M~DDRE~S ~' ~ / ~ ~ ~ ~ 0. LEGAL DESCRIPTION STREE LOCATI, ON 9, TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four ~. SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~1' Three [] Six [] Other 7. WATER SUPPLY J~ INDIVIDUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled ' [] COMMUNITY since June 1975. For wells drilled prior to that date, §ive well [] PUBLIC UTILITY depth (attach Icg if available.) /~d'/' 8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** /~_~-~ YEAR ON-sITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [~] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~ Connection Verified INSTALLER []Sept c TAnk o~r [] Holding Tank Size: I ~2~)() IfTank ishomemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURERI. TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS [j~/~PPROVEDFOR ~ BEDROOMS [] CONDITIONAL APPROVAL letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79) 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) (b) (c) Location (address or directions) Applicant Name T'~M.-~_.. Applicant Address ,~---~ ¢_.~"~ Telephone: Home ~;4;~-¢2<~(~ Business Applicant is (check one): Lending Institution []; Owner/builder.l~.; Buyer []; Other [] {explain); (d) Lending institution Address (e) Real Estate Company and Agent Telephone Address Telephone (f) M~4Tthe HAA to the following address: SJL NGII tE JNG SR B 196X EAGLE RIVER Al( 99577 TYPE OF RESIDENCE Single-Family'" Multi-Family [] Number of Bedrqoms ,2~ Other WATER SUPPLY individual Well [~- Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attestin9 to the legality and status. 4: SEWAGE DISPOSAL Onsitej[~f- Public [] Community E] Holding Tank r-] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 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 hereia. 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 Address Date EAGLE RIVFI~AK 995?7 Telephone NAY I 9 1986 Approved for (-.,'¢f"/~¢~- bedrooms by/~"'"'~//-,¢'~ ,~/~ ~-'?_ ~--/z~ Approved ,,,,~ DisapproVed Cond,~..~/. Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations 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. MUNICIPALITY OF ANCHORAGE / OF HEALTH AND ENVIRONMENTAL PRO~"ECTION DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH/ CERTIFICATE OF INSPECTION FOR HEALTH AUTHORI/TY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~'~ ~' GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) (b) (c) Location (address or directions) I Applicant Name ~ ~o[.~S Telephone: Home ¢88-~S~ Business Applicant is (check one~: ~ending Institution ~; Owner/builder; Buyer ~; Other ~ (explain); (d) Lending Institution Address . ~,, (e) Real Estate Company and Agent Address Telephone Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ~2~025 (11;84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND I~NFORMATION 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 pumber 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 i,nspection. Name of Firm Telephone · & $ EnglneeH.g Date Eagle ~.iver, Alask. ~S77 · '~'--'",/'~"~'"~' Approved fo~ bedrooms by/ Approved /~ Disappryje~ 'Conditional Terms of Conditionlal Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health,Authority Approval certificates based solely upon the representations 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) EXCAVATION ROBERT A. SHAFER WORK September 1, 1981 CIVIL ENGINEER 694-2979 MUNICIPALITY OF ANCHORAGE DEPT. OF 14,EA,Lt'H & ENVIRONMENTAL FROTECIION Ethen Colchiski F;0. Box 8-629 Anchorage, Alaska 99508 Dear Mr. Cholchiski~ SI!.P 8 1981 RECEIVED A sewage system adequacy test was performed on the system located on the referenced property at the request of ReMax Realty. The septic tank was pumped and verified to have a capacity of 12150 gallons. The seepage pit was full of water and approximately 1000 gallons was removed. The crib was then refilled with fresh water and after a period of 24 hours approximately 58 gallons had percolated out of the crib. It can be concluded from this test that the septic tank is adequate~ for the three bedroom residence loceted on this property; however,, I regret to inform you thet the seepage pit will require upgrading before it can be considered adequate. A permit for upgrading the absorption area,.may be obtained from the Municipality of Anchorage, Department of Health and Ehvironmental Protection, 825 L. Street, Anchorage, Alaska. If we may be of further service, please do not hesitate to call. Sincerely, cc: ReMax Realty ATTENTION: Joyce Porte Municipality of Anchorage , Department of Health and Environmental Protection AfLaska-Eank of Commerce Eagle River Branch SRB 19BX EAGLE RIVER, ALASKA 825 "L" ~TREET ANCHORAGE, ALASKA 99501 (907) 264-41 ~ 1 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF REALTH ANO ENVIRONMENTAL PROTECTION September 9, 1981 Ethan/Angela Colchiskey % Joyce Porte Re/Max of Eagle River Post office Box 848 Eagle River, Alaska 99577 Subject: T15N RIW Section 4 Lot 22 The adequacy test performed on the.existing sewer system revealed the system is not adequate. Therefore, an upgrade will be necessary. Prior to the upgrade, a soils test will need to be obtained so that a permit may be issued from.this office. If there are any further questions,'please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska Bank of Con~erce Post Office Box 1185 99577 C ORAG ,ALASKA9 50 (~~ (907) 264-4111 '-¥ '~'/=')' ~' C/ R-E M LUVA (~'lL~--~ 1~--/~-~'/ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION August 12, 1981 Ethan/Angela Colchiskey % Joyce Porte Re/Max of Eagle River Post Office Box 848 Eagle River, Alaska 99577 Subject: T15N R1W Section 4 Lot 22 Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: 1) (2) The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. Exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes and must be encased in conduit. (3) The seal on the well needs to be tightened so that it is water tight. (4) 5) The depression around the well casing needs to be filled with impervious type soil so that it slopes away from the well casing. The septic tank pumped with a receipt submitted to this office. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this department for our review. · Ethan/Angela Colchiskey % Joyce Porte August 12, 1981 Page Two Please notify this department for a reinspection when the noted descrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska Bank of Commerce Post Office Box 1185 99577