HomeMy WebLinkAboutMAJESTIC VALLEY ESTATES BLK 3 LT 5
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: OSP221098
Work Type: SepticTank Upgrade
Effective Date:
Expiration Date
Tax Code Number: 05073119000
Site Legal Address: MAJESTIC VALLEY ESTATES BLK 3 LT 5 G:0363
Site Mailing Address: 25838 WHITE SPRUCE DR, Eagle River
Owner: HERTE KEITH M & JOYCE D
Design Engineer: NORTH RIM ENGINEERING
relent
s
IVY4 l
Department
5/4/2022
5/4/2023
Lot Size in Sq Ft: 54469
Total Bedrooms: 3
This permit is for the construction of:
❑ 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
Received B)
Issued By:
Date: -51LI / '-�
Date: S Z Z
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. 050-731-19
Property owner(s) HERTE KEITH
Mailing address 25838 White Spruce Dr
Site address same
Day phone 830-6911
Legal description (Sub'd., Block & Lot) MAJESTIC VALLEY ESTATES BLK 3 LT
Legal description (Township, Range & Section)
. _...._
Lot Size 54,469 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑ Single Family (SF) 0
Septic Tank
❑
Upgrade El (w/wo AD U)
pg
Holding Tank
❑
Duplex (D) ❑
Renewal ❑
Privy
❑
Multiple Dwellings ❑
(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.
6��
(Signature of property owner or authorized agent)
Permit/Rush Fees: 22 S Waiver Fees:
Date of Payment: ���2-� Date of Payment:
Receipt Number:Receipt Number:
Permit No. OSP22)0(% 3 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
SteveEng.com
Steve Eng, PE, PH
907-694-7028
SteveEngPE@gmail.com
Date: 4/26/22 Number of Pages:
To: MOA On-Site Services
Subject: Majestic Valley Estates Block 3 Lot 5
Septic Tank Failure
The subject septic tank has failed- a new tank will replace the old one. The existing seepage trench
appears to be working OK. Please issue a permit so the tank can be replaced. Please review as soon
as possible. This is a large lot with no nearby neighbor conflicts. Elevations are as depicted in Plan
view.
If there is need for additional information or clarification please give me a call.
Thanks-Steve
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221098, Deb Wockenfuss, 05/04/22
SteveEng.com Majestic Valley Est B3 L5
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: The current septic tank has failed- the seepage trench still
functions. This lot is fairly large and on private water well. No adverse impacts are
expected from tank replacement. Easements are presented on the lot. The slope is
indicated in the area of the septic system. No conflicts to neighbor properties.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
New 2- compartment, 1000 gallon septic tank. Watertight couplings on inlet & outlet.
5 minimum between the tank and trench. 5 to property lines & 10 to house.
4 of cover or insulation is required for tank; an equivalent of 1 insulation for 1 foot
soil cover. Tank & solid pipe must be set on well compacted, stable soil.
No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per
MOA- sand or pea gravel.
4 diameter cleanouts with airtight caps are required 1 to 4 from foundation wall,
prior to any 90 degree bend in 4 inch line, in 2 nd tank compartment, and two adjacent
opposing cleanouts between the tank and the absorption field, not more than 10 from
the tank positioned to provide cleanout access towards the tank and towards the
absorption field. Manhole Riser required in 1 st tank compartment.
All cleanouts must extend to at least ground level.
In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
Insulation must be placed over any pipe installed under driveways or parking areas.
Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
Sewer Service Line is minimum 2% slope.
Septic Tank to be pumped every two years or when required.
Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221098, Deb Wockenfuss, 05/04/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221098, Deb Wockenfuss, 05/04/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221098, Deb Wockenfuss, 05/04/22
�4NGl� o R
�J rsF24 f Q -4.7s azea �+
015"A
15"
(e)Cf6,
��57h"
AS -BUILT
I hereby certify that I have surveyed %the following described
property: h07— 'F l -0
rpt! �� �����X Es 742- - s
r/ �V- AA ' C f 1
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the property lines and do
not overlap or encroach on the property lying adjacent there-
to, that no improvements on property lying adjacent thereto
encroach on the premises in question and that there are no
roadways, transmission lines or other visible easements on
said property except as indicated hereon.
Dated at Eagle River, Alaska
this 1 day of O(Zy , 19
ROBERT C. JOHNSON 79F&—R,
SCALE: Registered Land Surveyor No. 880 -LS
1" = /gyp Box 456, Eagle River, Alaska
Phone ( 907) 694-2543
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: _ ,~LL%°~ ~r~c~ ~-~ PID Number: ~:;'~gP~-
Name: Wastewater System: ~ New ~pgrade
Address:
Wc ~ ~ /2'7~ ~ 9~¢2¢ ABSORPTION, FIELD
~ ~ D Deep Trench ~hallowTrench ~ Bed D Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION S°ilRating: ~,~ GPD/Sq. Ft.
Block: Subdivision: Depth to pipe boltom from original grads: G ravel depth beneath pipe
Township: ~] I Range: /~ Section: ~Z Fill added abov~r~in¢l grade: Gravel length:
Number of lines: Distance be~een lines:
WELL: ~ New ~ Upgrade Gravel~ WI~YR ~ Ft. / W/~ Ft.
Classification (Private, A,B,C): Total Depth: ~o: Total absorption area: Pipe material:
Driller: //~ Drilled: Static Water Level: Installer~6¢ Dale installed:
Yield: ~ Pump Set at: Casing Height Above Ground: ·
~ GPM Ft, Ft. ~X/~ iJ~ TAN K
SEPARATION DISTANCES ~Septic ~ Holding
TO Septic Absorption Lift Holding ~;5:::.'Private Manufacturer: ~city in gallons:
From Tank Field Station Tank Sewer Lines
Sudace
w~t.~ ~/~ ~ W/~ LIFT STATION
Foundation Lot ~/~ "Pump on" level at: Manufacturer:
Line r/~' F/~ / ~IP / Size in gallons:
Cu~ainDrain ~/A / ~ Pum~~ctrical Inspections performed by:
Remarks: BENCH MARK
Location and Description:
I Assumed Elevation:
-. .....
. · . o
Inspections performed by. ~ Dates. 1st / ~ ~ ~
_ . c,,,,
~ ~..... ....~ ~
uepar[ment of Hea~nd Human Services approval
Reviewed and approved by: ~~~ ~~ Date:/~ ~//-'
72~013 (1/91) MOA 25
Permit No, SW950293 Page 2 of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 545-4744
On-Bite Wastewater Disposal System and/or Well Inspection Report
Legal Description: MAJESTIC VALLEY LOT 5, BLK 3
PID No.: 050~731-19
SWING TIES~
A-C = 70,5
B-C = 44,6
A-D = 78,5
B-D = 97,4
A-E = lO0.i
B-E = 99,5
A-F = 127,8
B-F = 106,1
FXISTING
1000GAL
TANK
~XIs D[VERSfC]N VALVE
ELEVATIONS ~ TOP Or ~ELL CASINO
(NOT TO SCALE) ^SSUMrD ELCV =
ORIGINAL
GROUND 0
! LEVEL AT, F~
/ TRENCH 86 4
0-1' ADDED FILL ~ TH1 86,3
' 2" '~N~--
~ . ~ u,_.~ ...... ~tl- '- II./'
/ 1--96y MID 84,1 L~ 'EAST 84.1
-- XHrD 815
- MONITOR TUBE
- SEWER CLF_.AN OUT
- WELL
NEW LEACHFIELD
EXISTINO LEACHFIELD
EASEMENT
10/09/95
ENGINEEFI'8 SEAL
~.." 49 T~ ~ ,..?,
'(//),~"LLOUIS A. BUTERA
~,~;,'. ........... . .:' ~¢-
PAGE 1 OF 1
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW950293
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:ZARAGOZA PAUL J
OWNER ADDRESS:HC 83 BOX 1774
EAGLE RIVER ALASKA 99577
DATE ISSUED: 9/27/95
EXPIRATION DATE: 9/27/96
PARCEL ID:05073119
LEGAL DESCRIPTION:
MAJESTIC VALLEY ESTATES BLK
3 LT 5
LOT SIZE: 54469 (SQ. FT.
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
INSTALL DRAINFIELD NO DEEPER THAN 5.0 FEET BELOW
GROUND ~.
RECEIVED BY:
Louis Butera, P.E.
Registered Civil Engineer
September 7, 1995
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Majestic Valley Lot 5, Block 3
Narrative & Permit Application
Dear Mr. Cross:
The proposed three bedroom septic upgrade will have very limited impact on adjacent properties
for the following reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, due to absorption capacity.
4. Drainage will not be affected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\G:\WPDOCS\1995\89-103A.NAR
P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 . Fax (907) 694-3297
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Majestic Valley Lot 5, Block 3 - 09/08/95
1. The septic plan is for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
9. Any remaining open test hole excavations shall be filled.
1. The trench is to follow the natural land contour to maintain uniform total depth of
the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 6' at any point.
4. The sewer line is to replace the existing sewer line that leads to the existing
trench.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface water
runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
t~ECOMMENDED LEACHFIELD DIMENSIONS.:
TOTAL DEPTH = 6' GRAVEL DEPTH = 3.5" under pipe, 2" over pipe
TRENCH LENGTH = 81' TRENCH WIDTH = 5'
SOIL RATING = 0.6 GPD/ft2 BEDROOM CAPACITY = 3
SEPTIC TANK = Retaining existing
DIVERSION VALVE (optional) - Bull Run type
Twenty-four (24) hours notice required for all inspections.
G:\WPDOCS\1995\89-103A.SPC
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
9
10
11
12
13
14
15
18-
19-
20
COMMENTS
DATE PERFORMED:
Township, Range, Section:
SLOPE
S
iF YES, AT WHAT - ' L
DEPTH? /1,~.
Oept~ to Water After
Monitoring? //, 3,.. Oale: ~'- '~ ~ ~
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
gO/r/C ~/~U~) .s''
/ 7..: 57' ,.~ 6' /~///.,, I ~//u
PERCOLATION RATE P(~ (m,nute$/incn) PERC HOLE DIAMETER
TEST RUN ~ETWEEN ~ FT ANO ~' FT
PERFORMED BY: /~'-~./~' I __t~--,'~ ~ ~,~ ~5""~-~'~------/~' ~- CERTIFY THAT THIS '1':EST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. DATE? ~:~' "'"~'~'
72q}08 (Rev. 4/85)
* - MONITOR TUBE
o SEWER CLEANOUT
~, - WELL
PROPOSED LEACHFIELD
EXlSTINO LEACHFIELD
NO KNOWN CURTAIN BRAINS EASEMENT
SEPTIC S,TE PLAN
LEOAL: MAJESTIC VALLEY LOT 5, BLK 5
OWNER: ZARAGOZA
CONTRACTOR: N/A
JOBff 89-105A1 DATE: 9/7/95 I SCALE 1" = 50'
EAGLE RIVER ENGINEERING SER WCES
P.o. Sox ~7s~4
EAGLE RIVER, A~. 99577
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK 99577
(907) 694-5195
SHEET NO.
SCALE
OF.
Majestic Valley Lot 5, Block 3
3 Bedroom Single Family Dwelling - 09/08/95
3' Bedroom Capacity = 450 GPD
Soil Rate = 20 min/inch = 0.6 GPD/ft2 shallow trench system
Required Absorption Area = 450 + 0.6 = 750 ft2
750 ft2 x 0.54 reduction factor for 3.5' gravel depth = 405 + 5' width = 81' length
LEACHFIELD DIMENSIONS:
Trench Width = 5'
Gravel Depth = 3.5'
Gravel Length = 81'
Total Depth = 6'
G:\WPDOCS\1995\89-103A.CAL
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK 99577
(907) 694-5195
SHEET HO. OF
CALCULATED BY Z'~ff DATE
CHECKEDBY /J/-~ DATE
SCALE
Majestic Valley Lot 5, Block 3
3 Bedroom Single Family Dwelling - REVISED 09/26/95
3 Bedroom. Capacity = 450. GPD
. Soil Rate = 20 min/inch = 0.6 GPD/ft2 shallow trench system
Required Absorption Area = 450 + 0.6 = 750ft2
750 }'t2 x 0,54 reduction factor for 3.5' gravel depth = 405 +
LEACHFtELD DIMENSIONS:
Trench Width = 5'
Gravel Depth = 3.5'
Gravel Length = 81'
Total Depth =
5' width = 81' length
G:~WPDOCS\1995\89-103A:CAL
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Majestic Valley Lot 5, Block 3 - REVISED 09/26/95
1. The septic plan is for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
9. Any remaining open test hole excavations shall be filled.
1. The trench is to follow the natural land contour to maintain uniform total depth of
the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 5.5' at any point.
4. The sewer line is to replace the existing sewer line that leads to the existing
trench.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface water
runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
~' ' 3.5" 2"
TOTAL DEPTH = ~ .),P~//~ GRAVEL DEPTH = under pipe, over pipe
TRENCH LENGTH = 81' - ~ TRENCH WIDTH = 5'
SOIL RATING = 0.6 GPD/ft2 BEDROOM CAPACITY = 3
SEPTIC TANK = Retaining existing
DIVERSION VALVE (optional) - Bull Run type
Twenty-four (24) hours notice required for all inspections.
G:\WPDOCS\1995\89-103A.SPC
MLINICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
QN-SITE SEWAGE DISPQSAL SYSTEM AND/OR WELl_ INSPECTION REPORT
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
----/ ....-', 1PHONE . 'EW
NC. OF BEDROOMS
PERMIT NO.
Material
Width
No. of compartments
Liquid depth
PERMIT NO,
Liquid capacity in gallons
DISTANCE TO:
No. of lines
/
Top of tile to finish
Z~
Length
Type of crib
DISTANCE TO:
Class
DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
R EMAR KS
Material
~ear-~'~st ~ot line
Trench widd] ~'~
('¢'~ 0 inches
Well ! 00 z.~ [ Foundation .~()
JLengthofoochl.~e¢ ~ Totallongthoflincs,
'ade Material beneath tile
Width
Crib diameter
Well
Depth
B uildin g f ou n~--~' ~o~~
inches
Depth / PERMIT NO.
CI}~t'~-,~ -rotal effective absorption area
~Z<dation '--- Festlotline
Driller --- ] ~'~0 lot iine I PERMIT NO.
~"' (4'
~e~er li~--D ISeptic tank J Absorption,reals,
PERMIT,S) ~- __
Total effective absor~)tion a.~ca
LOCATION
DISTANCE TO; J Well Absorption area
_Ov Manufacturer / Z.o / ~ /'
~ L q. capacity in gallons
IF HOMEMADE: [ Inside len~.h
DISTANCE TO: Well ~ D~elling
Manufacturer -/ii
Dwelling
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O ~ E GE(::;
Russell Oyster
694-2774
Soils ~' Foundations
_:CHNICAL ~' DEVEL
Box 90, Davis St,, Eagle River, Alaska 99577
694-2774 or 688-2280
SOIL LOG
?MENT CO.
Earl Ellis
688-2280
Land Development
Performed for: Name:
Mailing Address:
Legal Description:
Depth (feet)
0 ,
2~
6
7.
8~
Soil Charac~eristic~
Tel. No.
Ground Water Encountered: Yes
Proposed )nstallation: Seepage Pit
Drain Field~
Comments:
Performed by: Date:
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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. #
050-731-19
CERTIFICATE OF HEALTH AUTHORITY
'APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete lega description
Majestic Valley Lot 5, Block 3
Loc~tion (site address or directions)
NHN Spruce Lane, Eagle River, AK
~,?Property owner Pa61 & Betty Za~agoza Day phone 694-5987
Mailing'address ~ R~ F~× 1774. Eagle River, Ak 99577
Lending a~ency city Mortgage/~n ~esser Day phone 277-0700
'Mailing address ~'P~O~ ~x 92810~ ~choraqe, ~ 99509-2810
Agent":': "' 'Gr~at Land Realty/C~dy L~dbl~ .Day phone 694-9125
Address 11411 Old Glenn H~, ~gle ~ver, ~ 99577
.... ":"NOTE: If community well system, r)rovide written confirmation from State ?..DEC attest,,
lng to the legality and status of system.
itt n c°nfirmat
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 ~agle Rive~ E~cj'ineerJ_nq Sea-vices Phone
Address p.o. Eo× 773294. Ea_ole River. AK 99577
Engineer's signature ~~
694-5195
Date
DHHS SIGNATURE
:x" Approved for 5 bedrooms.
, Disannroved. . ....... -. :.:-.: - ·
; Cokditional approval, for :' ' · ::: bedrooms, With'the'¥oiJswing'sti'PUlafionsi' 't;{i'
. . . %.?":: . ~ , '_ ..
Date
i~e Mu~ii~i ~ .... of Health and Human Services (DHHS) issues Health Authority
only upon the representations given in paragraph 5 above bY an independent
,gistered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
titbtions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct ~nspec~ons 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 SERVICES
Environmental Services Division
825"1_" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description:. /'U ~71~'-£1&-
A. WELL DATA
Parcel I.D.:
If A, B, or C, attach ADEC letterl ADEC water system lmmber
Log present (Y/N) _
Total depth
Sanitary seal (Y/N)
Date completed _
Cased to /[;Y7 /
FROM WELL LOG
0,5
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform '~
g.p.m.
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
,~0~~
Dateof ample:
B. SEPTIC~G TANK DATA
Date instaned
Foundation cleanout (Y~)
Date of Pumpiug
C. ABSOR~ION FHgLD DATA
Date installed
Length ~[4 / Width
Effective absorption area
Nitrate ifil'/£2 /"qO//& Other bacteria
Collected by: ~:~ ~,_~
Y~ Depression (Y/N)
Pumper
g.p.m.
Fluid depth in absorption field before test (in.);
Fhfid depth /k///4-__(ins.) Milmtes later:
Peroxide treatment (past 12 months) (Y/N)
hnmedialely after
Absorption rate =
. If yes, give date
Results (Pass/Fail).. /O/)~qoc For
--[~ bedrooms
__ gal. water added (in.):
g.p.d.
Soil rating (g.p.d./ft2 o~m)
Date of adequacy test
ff-)~ ~( Systein type
Gravel thickness below pipe_ .~2., C' Total depth
Monitoring Tube present(Y/N) /~-~Depression over field (Y/N)
Number of Compartments ~ Cleanouts (Y/N) /V~,.5
High water alarm (Y/N) /%/0
mo
Date installed
Mauhole/Access (Y/N)
High water alarm level at*
Cy~
SEPARATION DISTANCES
Size in gallons
"Pump o~
"Pump ofF' level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
; On adjacent lots
: On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTICFrI:6~PANG TANK ON LOT TO:
Building foundation 7c/t9 / Property line 7c'/t9 / Absorption field 5-?
Water~ervice line 'Tv/0 / Surface water/drainage A///4 Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation '/-//) / Water maqw'service line "/- /O
Surface water .A//4
Curtain drain
/
Driveway, parking/vehicle storage area 7L/~
/
Wells on adjacent lots '¢/~P/-) Property line
1 certify that I have determined thrufield inspections and review
in conJbrmance with MOA H~ guidelines in effect on this date.
Signature
Ellgineer's Name /~/5 ~f~ ~
...............................................................................................................................................
HAA Fee $ 3 ~d) t d/~
Date of Payment
Receipt Nmnber
/ ('>)
,/
Waiver Fee $
Date of Payment
Receipt Ntnnber
Rev. 8/95 OSS: haa.wk.doc
- APPLI \NT FILLS OUT UPPER HA :ONLY
Buyer
Address : Zip Code
Address t-, //~.~. ~/'.2~4 /~ Zip Code
Realty 'Co. A A~nt '/ '/ Phone
~ Zip Code
Address ~ ~
Street Loceti~ ..::. ,~ . ~ d~ '
Type of Resi~nce
~Single Family
~ Multiple Family No. of Bedrooms
~ Other
W~terSupply [~-, ~ ~SC
~ndividual LC A~ACH WELL LOG. A w~l log is required for all wells drilled since guns I975.
B Community~(XL ~J¢~/~Z'~'~ For wells drilled prior lo that date. give well depth (attach log if available).
~ Public Utility
Sewer Disposal ,- ~ ~ ¢~. ~
4~lndivldual ~ ~ ~.. Year Individual Installed:. -//__
~ Public Utility When Connected to Public Utility:
~ ~o~.,T..~ L~~)
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Date Date Date Date
,,----,,_
Insp~tor Insp~tor Insp~tor Insp~tor
-- : . MUNICIPALITY OF ANCHORAGE
(~) APPROVED BEDROOMS ~ "CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Ratjpg Date ~wer Installed Well To Absorption Area /¢~ / Well Log Received
72-023 (3182)