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GRE/ ' 2 ANCHORAGE AREA
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION O'~X~ ~a ~ LEGAL DESCRIPTIONZ/~/,~¢~..~ /7~ 7~U
SEPTIC TANK: ~,~Ud
DISTANCE
FROM WELL '7~'~' MANUFACTURER .~T'.~{
¢¢~/~ NUMBER OF
MATERIAL /'"'- COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH __
.LIQUID CAPACITY /000 GALLONS.
SEEPAGE PIT:
NUMBER OF PITS I DIAMETER
LINING MATERIAL ~-0C~ CRIB SIZE:
BU,LDING FOUNDATION "7/r,
/7 X/E
OR WIDTH LENGTH DEPTH /O '
DIAMETER ~ DEPTH/~/ DISTANCE FROM:
TOTAL EFFECTIVE
NEAREST LOT LINE __
WELL ///~
ABSORPTION AREA (WALL AREA) ~:2'"'~0 SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
NEAREST SEPTIC
SEWER LINE TANK
REMARKS
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
REMARKS:
Form NO. LQ-D31
DIAGRAM Of SYSTEM
N
DATE ~/~ ~"2.~., /~7¢ APPROV ', P -
,:-.%
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
.... : (b)
GENERAL INFORMATION
(a)
(c)
Legal Description (include lot, blgck, subdivision, section,~township, range)
Location (address or directions)
Applicant Name ,~[¢C f~-[l%.~ Telephone:Home ,/0~)~ 'J~-"7~=~ Business
Applicant Address ~.~ (~* ~'~ ¢']~O C~ ~ t'~ ~.~ ¢_..,, 1¢~----~ _
Applicant is (check one)i ,Lending Institution []; Owner/builder [~; Buyer []; Other [] (explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
S & S ENGINEERING
SR B 196X
EAGLE RIVER, AK 99577
TYPE OF RESIDENCE
Single-Family ~. Multi-FaCnily r'l
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.
Page 1 of 2
SEWAGE DISPOSAL
Onsite [~' Public r'-i Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to th~ legality and status.
72~025 (11/84}
'ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal aifixed 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 a, nd 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 S & S ENGINEERING
Address SE B 196X
Telephone
Date
EAGLE RIVER, AK 99577
DHEP APPROVAL
Approved for
Approved ~ ' Disapproved
Terms of Conditional Approval
Conditional
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)
MUNICIPALITY OF ANCHORAGE (MO~)
MUNICIPALITY OF AI,~FF.~c~AUTHORITY APPROVAL (HAA)
DEPT. OF HEALTH & CHECKLIST - FEBRUARY 1984
~NVIRONMENTAL P2OT[CTION 264-4720
DEC 4 1986 Legal Description: ~.-o~ .~-~
WE,L DATA R E C E t V E D
Well Classification ~o F If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/~CI~ Date Completed ~.) ¢ /4_ Yield
Total Depth [ ~"~ Cased to /' ~'o Depth of Grouting
Static Water Level f ~_ 5~/ Pump Set At
Casing Height Above Ground [ ~ ~'' Sanitary Seal on Casing (~N)
Electrical Wiring in Conduit t~N) Depression Around Wellhead (Y,4~
Separation Distances from Well: I &¢0~.'¢ ~ /
To Septic/Holding Tank on Lot ~ ~ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ¢'0 ¢c¢ ; On Adjoining Lots
To Nearest Public Sewer Line hJ/~ To Nearest Public Sewer
Cleanout/M~,nhole ~ ' To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ~ ~ ~-- r~J ~., ~ ,~ ~,-_-'~w~ (~ ; Date / /
Water Sample Test Results ,_~/~ ~'"~t
Comments ~('~EL(.-t/~,.~Lb ~'~,~.>-r~O~,~t~~) O,~J /[-~,.~"cc~f'~ i,~¢"c.
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes Y~N) Air-tight Caps (?.~N)
Depression over Tank (Y~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
Size /~¢ No. of Compartments
Foundation Cleanout (YN~
Date Last Pumped ,// -
; for
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well '"~
To Property Line ! ~/'''~''
To Water Main/Service Line /
Course
To Building Foundation ~ 3
To Disposal Field ,~ ! /'¢~-'
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~'- Z.z - ?- '¢
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 / o~) ~ -/'
/
To Building Foundation :'7- /
Lot /~'~
Type of System Design
Length of Field / ¢' /
~,0,2 ) Depth of Field /O'
Gravel Bed Thickness CZ
Standpipes Present ~/N)
To Water Main/Service Line ( ¢ C./
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
/
/
Cate of Last Adequacy Test
To Property Line /©
To Existing or Abandoned System on
; On Adjoining Lots ~ ~' r~
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed S & S ENGINEERING
SRB 196X
c°mpaeYEAGLE RIVER, AK 9,9577
Receipt No. _~_~ /' ~'~ '~'~
Date of Payment
Amount: $ (¢~
Date
MOA
Page 2 of 2
72-026 (11/84)
P.O. BOX 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
December 8, 1986
Robert A Shafer, P.E.
S&S Engineering
SRB 196X
Eagle River, Alaka 99577
Subject: Lot 32, SW 1/4, Section 4, T15N, RiW, Seward Meridian
Waiver Request WR86-169
Dear Mr. Sharer:
Your request for a waiver of the 100 foot separation distance
required between the well and septio tank on the subject lot
has been granted. This distance has been waived to 79 feet.
This waiver is valid for the existing two bedroom single family
dwelling only.
Sincerely,
Stephen S. Morris
Civil Engineer
On-Site Services
HEALTH AUTHORITY
APPROVALS
SEWER&WATER
MAIN EXTENSIONS
SEWER &WATER
INSPECTION
ENGINEERING STUDIES
ANDREPOSTS
WELLINSPECTiON
& FLOWTEST
SITE PLANS
ROAD OESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
rNSPECT~ONS
ROBERT A. SHAFER
December 3, 1986
CIVIL ENGINEER
694-2979
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, Alaska 99501
MUNIc!PALi.~, OF
~wlAL p~.OTECTioN
4 1986
J' £C£1VED
ATTENTION: Steve Morris
REFERENCE: Lot 32; SW¼; Section 4; T15N; R1W
Request you issue the attached Health Authority Approval and grant
a wiaver of the horizontal separation distances between an existing
private well and the septic tank located on the referenced property.
The exisitng system was installed under Municipal inspection in May
1974 with a horizontal separation distance of 79 feet between the well
and the septic tank. In addition to the usual documents provided with
the HAA application we have included a copy of our waiver review work
sheet and a plot plan showing the relative location of the well and
on-site wastewater disposal system.
A well log for the well located on the referenced property has not
been located, however, the depth of the well is approximately 150 feet
with a static water level at approximately 125 feet. Attached is a
copy of a well log on the nearest adjoining property. The total depth
of the well is approximately the same and for purposes of risk analysis
we have assumed that the soils penetrated throughout the well are similar.
If we may be of additional service, please contact us.
Sincerely,
ROBERT A. SHAFER~ P.E.
RAS/ss
ON SITE
WASTEWATER
DISPOSALSYSTEM
DESIGN SRB 196X EAGLE RIVER, ALASKA99577
SCALE
MUNICIPILLIIY C? ,%'~CHOg,vSE
DEPARTMENT OF HEALYH AND EUMAN 5ERVICE£
WAIVER REV I !.:W WCKKSttEEI'
DATE RECEIVED:
KXGINEER:
196X
RIVER, Al( Fv~'
CRITERIA:
l) Geology: Potncs:
2)
3)
A. Water Table
B. Soil Sorption
C. Permeab£kity
D. Wacer Table Gradient
E. Horizontal Separation
O~hmr ;~
WAIVER IS:
granted, with conditions liated below:
~ot granted for re,'lsona iisi:ed below:
DATE:~,.'".
'SEB 196X C~MPUTATION SHEET
EAGLE RIVE~, AK 99577
SU~ECT:
DALE:
SmET / OF
BY
CKD
?9'
/ ¢"':5 '<"- '~ ) i r
SRB 196X
SUBJE~T..GL~ RIV~ A~(
C~MPUTATION SHEET
DATE:
SHEET ~ OF
BY
CKD.
000000000000
000000000000
Time ~ Time .ne
Dgte Date Date
Inspector Inspector Inspector
Comments Conditional Approval O~
(~A ~p?o,/~J Bedrooms
( )
- pproval¢
Date Sewer Installed Permit No. Septic Tank Size
~_ ~ ~ Holding Tank Size
Soils RatMg Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner ~/~ ~ ~ ~ Phone
Mailing Address ~ ~ ~ ~ ~ ~/~ ~~ ~7~
Lending Institution ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Phone
Address
Realty Co. & Agent ~ Phone
Address ~ ~
Typq~Residence
~ Single Family
~ Multiple Family No. of Bedrooms
~ Other
Wat~Supply
~ Individual A~ACH WELL LOG. A well log is required for all wells drilled since June
B Community 1975. For wells drilled prior to that date, give well depth (attach ~og if
B Public Utility available.)
Sew~ Disposal /~ ~
D Individual Yoar Individual Installod:
D PuBlic ~fility Whon Gonneeto~ to ~ubli~ Htilitg:
~ Holdin~ lank
EXCAVATION
ROBERT A. SHAFER
WORK
June 6, 1982
CIVIL ENGINEER
UUNICIPAH I~(~2~,~CHORAQ E
Edward Nixa
P.O. Box 9 5
Eagle River,
Alaska
99577
RECEI.V_ED
Dear Mr. Nixa,
Reference: Lot 3: S.W. z':: Section 4: T15N: R1W
A sewer system adequacy test was performed on the system
located on the referenced property as you requested.
The septic tank was pumped and verified to have a capacity
of 1000 gallons. The absorption trench and seepage pit
combination was tested by a continuous flow of water over
a period of 48 hours without any adverse effect on the system.
It can be concluded from this test that the waste water
disposal system serving the two bedroom residence located
on this property is currently functioning adequately.
.However, the system cannot be guaranteed against subsequent
failure.
If we may be of further service, do not hesitate to call.
si~e~, ///~/
~-/RO~ERT A. SHAF~R, P.E.
v s/ss
cc: Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA
DEPARTMENT oF HEALTH & ENVIRONMENTAL PROTECTION DEPT.
825 L Street ~ Anchorage; Alaska 99501 ~V[~O~MEHT,.~.
ENVIRONMENTAL ENGINEERING DIVISION FE~ Telephone 264:4720
R RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER ~,&~ ] PHONE
MAILING ADDRESS
PHONE
PROPERTY RESIDENT (If different from above)
2. RUYER
MAILING ADDRESS
PHONE
PHONE
3. LENDING INSTITUTION
MAI"E-I N G ADDRESS
4. REALTOR/AGENT ~ PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
~TREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four [] Other__
~- SINGLE FAMILY I~ Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7. WATER SUPPLY
[~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTILITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
;~ INDIVIDUAL/ON-SITE~*
[] PUBLIC UTILITY
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010(3/78) ,~.
· THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED '
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR iNSPECTOR
DIRECTIONS:
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 UTI LITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[~]INDIVI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[~]Septic Tank or []Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
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
I~t'""~APPROVED FOR . ~ BEDROOMS '
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ~
DATE B Y (Ti~e')..) // J
LEGAL DESCRIPTION
72-010 (Rev, 3/78)
7/
AS-BUILT
I hereby certify that I have surveyed the following
described proper~y: ~-z~ ~r~- ~ ~::_)
Anchorage Recording Precinct. Alaska, and that the
~mprouements situated thc'eon are x~thin the prope~y
lines and do nog overlap or encroach on the property
lying adjacent thereto, that no improvemen~ on prop-
erty lying adjacen[ thereto encroach o~ the premises m
queshon and thai there are no roadxvays, trangmisgion
lines or other visible easements on said prop~[y except
as inc~cat~! hereon.
Dated at ~agle River, ~aska
ROBERT C. JOHNSON
SCALE{ Registered Land Stlrveyor No.
1"= ~ ' Box 456 Eagle River~ Alaska
Phone 694-2543
24 HOUR SERVICE
SOOpE~ DOOpER POOPE~ PUMPER
GENE MC GOWEN
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection §/??/74
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location: ~'Rerg Fimld Rnad
5. Type of facility to be inspected
6. Well Data:
A. Type Drilled
VA
Alaska National Bank
Pouch 7-010 Anchorage 99510
Edward Nixa
General Delivery Eagle River
C. Construction Standard
7. Sewage Disposal System:
A. Installed 1974
C. Septic Tank: 1.
D. Seepage Pit: 1.
E. Disposal Field:
8. Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
Phone:
Phone:
Single
No. of bedrooms 3
B. Depth 150'
D. Bacterial Analysis Satisfactory
B. Installer Dick Sund
Size 1000 Gal 2. Manufacturer Stack Steel
Absorption Area 17'xl8'xlO'xlS! Material Lo§
Total length of lines
79' , Absorption area
, Other contamination
, Absorption area
111' , Sewer Lines __
EQ-034 (1/74) Page 1 of two pages
~PJ~ 2 of two pages - ReN~¢st for Approval of Individual S~,~er & Water Facilities
Legal Description Lot 32~ Sec 4~ T15N, R1W SM
Comments
Approved~/~ ~- Disapproved Date
Approval Valid for one year from date signed
Greater Anchorage Aria Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
5/30/7~
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
4.
5.
6.
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 3/20/74
Time of Inspection_ lO:O0 am
Date of Inspection 2/21!74
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Phone:
Phone:
Approval requested by:
Mailing Address:
Property Owner: Richard Sund
Mailing Address: Chugiak AK
Legal Description:
Location: Chugiak
Type of facility to be inspected
Well Data:
A. Type Drilled
VA
Area Realty
C. Construction
7. Sewage Disposal System:
A. Installed
C. Septic Tank: 1.
D. Seepage Pit: 1.
E. Disposal Field: Total
8. Distances:
A. Well to: Septic tank
Nearest lot line
P.O. Box 249 Eagle River AK
Lot 32, T15N, R1W~ Sec 4 SM
Well pit
B. Installer
694-9555
688-2296
No. of bedrooms
B. Depth 150'
D. Bacterial Analysis
Size
Absorption Area
length of lines
2. Manufacturer
2. Material
, Absorption area
Other contamination
, Absorption area
B. Foundation to septic tank
C. Absorption area to nearest lot line __
, Sewer Lines ,
EQ-034 (1/74) Page 1 of two pages
~age ~ of two pages - Req_.yst for Approval of Individual L ..~r & Water Facilities
~gal Description Well must be brought out of pit and funds stallation of approved septic sTstem before~'[~l,v 1. 1974
Comments
Disapproved Date
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
Date
SIGNED
EQ-034 (1/74)