HomeMy WebLinkAboutMOUNTAIN MANOR BLK 4 LT 3AOnsite File
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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: OSP191182
Work Type: Septic Upgrade
Tax Code Number: 05067152000
Site Legal Address: MOUNTAIN MANOR BLK 4 LT 3A G:0254
Site Mailing Address: 18826 STILLWATER DR, Eagle River
Owner: Gabrielson Lee
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Q Disposal Field 21 Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
enr .S'
f
LLT -
De PailtIII C'lir
7/17/2019
7/16/2020
63305
❑ 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 (2417).
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:
1, f/
4/�
Date: /
Date:
4
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
On -Site Sewer/Well Permit Application
For A Single Family Dwelling
_
Parcel I.D.
C/O WALLY BOSSERMAN
Property owner(s) LEE GABRIELSON Day phone 907-230-9199
Mailing address 18826 STILLWATER DRIVE, EAGLE RIVER, AK 99577
Site address 18826 STILLWATER DRIVE, EAGLE RIVER, AK 99577
Legal description (Sub'd, Block & Lot) MOUNTAIN MANOR: BLOCK 4, LOT 3A
Legal description (Township, Section & Range)
Lot Size Sq. Ft. Number of Bedrooms 5 (CURRENTLY 4)
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DEWELLING:
(®all that apply) Initial ❑
Absorption Field ®
Single Family (SF)
Upgrade ®
(w/wo ADU)
Septic Tank ®
El
Duplex (D) ElRenewal
Holding Tank ❑
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
DRAIN FIELD OVER TEST HOLE/ ABANDONED DRAINFIELD TO NEW DRAIN FILED Distance: 0 FEET / 6 FEET
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: '5_q5_ Waiver Fees: 'A R 15 -
Date
Date of Payment: 15771 '-71 Date of Payment: 51-t 2P
Receipt Number: 01D Receipt Number: Q-,,-yq DC7
Permit No. JSP 1 R G1'ya Waiver No. 66 y L g 1631
(Rev. 01 /11)
Municipality of Anchorage
On-site Water and Wastewater
F CODE COMPLIANCE
OSPi9�l 1 2 �becca Carroll, 07117119
Ruffaim-§ ,
.Ad"'w"Ccd F; c en,c,rd Svscc,�r,
A NESS ENGINEERING ROUP, Lt
ENGINEERING SALES CONSULTING
Revised — July 5, 2019
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic System Upgrade for Mountain Manor S/D; Block 4, Lot 3A
To whom it may concern:
The referenced property has a 4 -bedroom home on it that is served by a private well and septic
system. There is a detached garage on the east side of the property that has major foundation
damage caused by the November 30, 2018 earthquake. This garage currently has an upper area
that is currently being used for gardening per the owner. This garage is proposing to be moved
west of the existing location and a new foundation be installed. The septic system consists of a
1,250 -gallon steel septic tank and a deep trench type drainfield that were installed in 1981. We
have recently checked the liquid levels in the septic tank and the tank appears to be operating
below normal levels. This would lead us to believe the septic tank is of poor integrity. We have
recently checked the liquid level in the drainfield and found it operating just below the invert of the
distribution line. It was conveyed to us that a geotechnical engineer who assessed the property
for property damage related to the earthquake has recommend the drainfield be upgraded. Due
to the age of the septic tank and drainfield, the owners would like to upgrade the septic system.
A test hole has been excavated and we have designed the drainfield to be within the 30 foot
radius of this test hole. Attached is a design drawing showing the proposed septic system
upgrade. We are proposing that the existing septic tank be decommissioned per UPC and the
existing drainfield be decommissioned in place due to it encroaching on groundwater. We are
also proposing a new 1530 two-compartment Infiltrator tank septic tank, a new Infiltrator 500 -
gallon pump tank, and a new bed type drainfield be installed. Per the owner, the MOA accessor
office has recently assessed the property and determined the total number of 4 bedrooms for the
property is 4 bedrooms. We have sized the proposed drainfield to serve a total of 4 bedrooms.
1. SOILS: Attached is a soil log which shows the soils classification, percolation test data and
7 -day groundwater monitoring. The percolation test was performed between 4.0 to 5.0 feet and
had a percolation rate was 1.25 minutes/inch. We are proposing to use a 0.8 gpd/sq.ft. application
rate for this design with a bed type drainfield.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface water concerns.
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179' Fax: (907) 338-3246 * Website: www.garnessengineering,com
Page 2 of 2
4. TOPOGRAPHY: The topography is generally flat in the area of the proposed drainfield. There
is a slope that is greater than 25% over 50 feet downhill (south) of the proposed drainfield. In
short, there are no slope concerns with this installation.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you, ha e any questions, please contact us at 337-6179. Thank you for your
assistance.
Sincerely,
4
Jeffrey A. of Qss, P4".' M.S.
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246' Website: www, garnessengineering.com
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191182, Rebecca Carroll, 07/17/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191182, Rebecca Carroll, 07/17/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191182, Rebecca Carroll, 07/17/19
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NAME
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
PHONE
MAILING ADDRESS
LEGAL DESCRIPTION
Well
DISTANCE TO:
Manufacturer (~*' I~--~ ~-
LOCATION
Liq. capacity in gallons
DISTANCE TO:
DISTANCE TO:
IF HOMEMADE:
Inside length
No, of lines
Well Dwelling
l.~?'h °f 'a?_~n~7
Top of tile to finish grade
Length
Type of crib
Width
Dw~elling ! __
Material.~, *'
Width "' 't
Foundation
Total length of Hnes
Material benea{h til;a
Depth
NO, OF BEDRL..~OMS
PERMIT NO,
No. of compartments
Liquid depth
PERMIT NO.
Material .......... Liquid capacity in gallons
I Nearest Io~,~ PERMIT NO~_~
,~O. j Tr..ch w,dth inches
Distance between lines
Total effectiv.,e absorption area
PERMIT NO.
Crib depth
Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO..
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
DATE
LEGAL
PERMIT NO.
FIPPL I CANT
LOC:FIT I ON
LEGAL
[:,EF'FIRTMENT Or HEFILTH AN[:, EN',,,'IRONMENTFIL F't,::C]TECTION ~
,:,o~ "' L" ::,] REEF., RN':Hr]~'RGE., BK. ::_ :,~:. ~
264-4720 ~ S.
FINB, ERSON BROS CONST PO 80X J. 2La E.R. 9La577
ST [ L..LHFITER DR ~ ',,,'E
L3~ 84 HT M~NOR LOT SIZE 4]:500 SQLIF~RE FEET
TYPE OF SOIL FIBS-';ORPTION SYSTEM IS: TRENCH
MFIXIMUM NLIMBER OF BEE:,ROOM.S = 4
SOIL RFITING (SL.] FT',..'BF.':::,= t50
THE REQUIRED SIZE [DF THE SOIL ABSORPTION SYSTEM IS:
'TFIE LENGTH DIMENSION IS THE LENGTH ,'.:IN FEET) OF THE TRENCH OR [:,RRINFIELB,.
TFIE DEPTH OF' FI TRENCH OR PIT IS THE [:,ISTRNCE BETHEEN THE SURFFICE OF' ]'HE
GROUND FIN[) THE BOTTOM OF' THE: EXCR',/RTION ,::IN FEET).
THERE IS NO SET HI[:,TH FOR TRENCHES.
THE GRFIYEL DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETHEEN THE OUTFFIL. L. PIPE
AND 'THE BOTTOM OF THE EXC:FI',,,'RTION (IN FEET).
PERM:IT FIPPLICRNT HFIS ]'HE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTFILLR'rION INSPECTIONS OF FINY HELLS FIDJFICENT TO THI'S PROPERTY F~N[:, THE
NUMBER OF RESIDENCES THAT THE HELL HILL SER'v'E.
............... 'T t-.I ~'Z:~ ( 2 ) I ~-.! :_---. F' E C: T I El I%! '_.:.; A !:~: E--_ F,.' E: ~,:-:." L.I I ~,.': E: [:~ ...............
BraCKF'ILI_INC~ OF FINY SYSTEM HI]'HOU]' FINFIt_ INSPEC:TION FIN[:, FIPPROVFIL BY 'I'HIS
DE'F'RRTMEN'r HILL BE SUE:JEC:T TO F'ROSECUTION.
MINIMLIM [:,ISTRNCE BETHEEN A NELL FIN[) ANY (IN-SITE SEWAGE DISPOSFIL SYSTEM IS
]..00 FEET' FOR Ft F'F.'~IVFITE NELL OR ~50 TO ':200 FEE:T FROM FI PUBLIC HELL DEPENDING
UPON THE TYPE OF F'UBLIC HELL
MINIMIJM DISTFINCE FROM A PRI'v'RTE 14ELL TO FI PRIVATE SEHER LINE IS 25 FEET FIN[:,
'TO R COMMLff4ITY SENER L. INE IS 75 FEET.
OTHER REI;!UIREMENTS MFIY FIPPLY. SPECIFICFITII3NS FIN[.., CONS'I"RUC'FION DIRGRFIMS ARE
RYFIILFIBLE TO INSURE PROPER INS'rRLI_FITION.
I CERTIFY THFIT
:1..: I FIM FFIMIL..IFIR HITH THE REQUIREMENTS FOR ON-SITE SENERS AND HELLS FIS SET
FORTH BY THE MUNICIF'RLITY OF FINCHORFIGE.
2: I HILL INSTALL THE SYSTEM IN FICCORDRNCE HITH THE COB, ES.
]:: I UNDERSTRN[:, THR'r 'THE ON-SITE SEHER SYSTEM MFIY RE6!LIIRE ENLFIRGEMENT IF TFIE
RESIDENCE IS REMODELE[:, 'TO INCLUDE MORE THFIN 4 BEDROOMS.
S:' I iNEt'.':,: ...~_~_~_~ ................... :._.:__ ............. _. ...........
FIPPL-- I CFIi'.,FF /¢INE:,E:RSON'"'E, ROS C:ONST
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
DATE PERFO.~ED: /~ ? i~ I U_ Z.~' ~ i
LEGAL DESCRIPTION:
4
7-
SLOPE
SITE PLAN
10
15-
16-
17
18
19
20
11
12
~--~ 13
WAS GROUND WATER
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
~iPERCO LATIO N RATE (minutes/inch)
COMMENTS
TEST RUN BETWEEN ,, FT AND FT
PERFORMED BY:
72L008 (6/79)
MOON DRILLING
BOX 3370
PALMER, ALASKA 99645
'TELEPHONE 745-4071
FORMATION
PLEASE PAY FROM THIS iNVOICE
FORMATION
YOUR P O. NUMBER
TERMS . , t, ,,I ,,
DEPTH CASIN FORMATION
'211 ' '
=233 '
' 2~5
' 246
'268~ ~-~' ', '~ /
' 270 -' ~ '~ ....
' 272
AMOUNT
Parcel I.D. #
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
1. GENERAL INFORMATION
Complete legal description
Lot SA; Block 4; Mountain Manor Subdivision
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
18826 STill~ter Drive
Eagl~ River, AK
Howard and Fa~6 Simpson Day phone
18826 Stillwat6r Drive Ea~l~ Rivert AK
Day phone
694-5586
99577
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
4 ',4
Xxx
Public water
If community well system, provide written confirmation from 'State ADEC attest-
lng to the legality and status of system,
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
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 disposal system is in compliance .with all Municipal and State codes,
ordinances, and regulations in effect on the date of this~.
Name of Firm _~ & $ £NG!N_~:_~!N~ /'~ ~/Phone ~~'~
Address 17034 Eagle R. I, ve,r L_oo_p._R_oa~i I~ /
Engineer's signature ~-~ " ; ~'
o
DHHS SIGNATURE
Approved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
724725 {Rev, 1/91) Back MOA #21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
A. Well Data
Well type
Log present {j~) ",J
Total depth
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed C~ ~ ~1 c:) Driller ~¥--~
Cased to AbC)' Casing height j¢..~ Jr"
Sanitary seal ~1)
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot \
Public sewer main
Sewer service line
Wires properly protected ~1) ~
g.p.m.
AT INSPECTION
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~
Date of sample:
Nitrate
\. ~ Other bacteria
Collected by: ~ ~ ~
B. SEPTIC/HOLDING TANK DATA
Date installed Co ~<;'~ - '~ \
Cleanouts ~1)
High water alarm (YI~
Date of pumping
Tank size j ~..:'% c;::, Compartments
Foundation cleanout ~'N) ~ Depression
Alarm tested (Y/N)
--~;~ c~ /.( Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~ ~ On adjacent lots
To property line \ o Absorption field
Surface water/drainage ~ ~ ~ ~ ~-
Foundation
Water main/service line
72-026 (3/93)' Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N) ~
SEPARATION DIST~ANCL~ROM LIFT STATION TO:
WeE'~ lot On adjacent lots
Manufacturer
Manhole/Access (Y/N)
at
Sudace water
D. ABSORPTION FIELD DATA
Date installed L~'~%~J
Length [ .~"/ ~ Width
Total absorption area L~'"[ c~ ~
Date of adequacy test "/~ I ~
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y~
Soil rating (GPD/FF) I~ ~/~' ~ System type
"~.~-~ Gravel thickness Total depth
Cleanout present~b'q) ~/ Depression over field (Y~
Results~5~ ail) ~A--~ ~ for ~ Bedrooms
After test I
t~o~[,~ If yes. give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot l
To building foundation
On adjacent lots
Sudace water
Curtain drain
To ~xisting or abandoned system on lot
Cutbank ~1,~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
·
I cer~'~y that I have che~nformed to all MOA and HAA guidelines
Signature . / ~ ,r~ ~ .<~.~,..~ ~*~: ~.~;~. '~"
Engineers Na~E~ ~
Date Eag~v~ka 99577 ~~
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
WATER WELL ADVISQR~
During a recent Health Authority Approval on-site inspection and
test_of the potable water supply well on Lot JA . Block ~
of ~T~ /~o~ Subdivision, the well's productivity
was determined to b~ O.~O gallons per minute. The minimum well
prodqctivity required by this department (AMC 15.55) for
a ~ bedroom residence is~.~, gallons per minute.
Although the subject well currently exceeds this minimum
requirement, all part'les concerned are advised that the
production capacity of the well may fluctuate. Restriction of
noncritical water uses such as washing cars and Wat%ring lawns
and gardens may be required.
This advisory must be attached to all copies of t'he subject
Health Authority Approval.
CT&E Ref.#
Ciient Sarnple ID
Matrix
ClientName
Ordered By
Project Name
Project#
PWSID
Commercial Testing & Engineering Co.
Environmental Laboratory Services
LABORATORY ANALYSIS REPORT
94.3387-1
L3A B4 MOUTAIN MANOR S/D
WATER
S & S ENGINEERING
R. SHAFER
UA
WORK Order 80133
Printed Date 07/08/94 @ 13:32 hrs.
CollectedDate 07/05/94 ~ 15:00 hrs.
Received Date 07/06/94 @ 15:05 hrs.
Technical Director STEPHEN C. EDE
Released By: ~ ~.
Sample Remarks: SAMPLE COLLECTED BY: RAY.
QC
Parameter Results Qual
Units Method
Allowable Ext. Anal
Limits Date Date
Init
Nitrate-N 1.8
mg/L EPA 353.2/300.0 10
07/06/94 CMR
* See Special Instructions Above
** See Sample Remarks Above
U = Undetected, Reported value is the practical quantification limit.
D = Secon 'dary dilution.
UA = Unavailable
NA = Not Analyzed
El'= Less qhan
Gl' = Greater Than
5633 B Street, Anchorage, AK 99518-1 600-- Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 3; Block 4; Mountain Manor Subdivision
(b)
Location (address or directions)
18826 Stillwater~ Eagle Rive% Alaska
Property owner Freddie Mac Telephone '. (home)
Business
Mailing Address #29-64004-IC
(c) Lending Institution
Mailing Address
Telephone
(d)
,J~,? ~ COMPANWL~'nda Banner
RealEstate Company and Agent JACK '""-':
Address 10928 Ea~le River ~oad, Eagle River, Alaska
Telephone 694-5500
(e)
Mail the HAA to the following address: (or check here,~ if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING/694-2979
17034 Eagle River Loop Road~ Suit~ 204
~agle River, Alaska 99577
2. TYPE OF RESIDENCE
Numberofbedrooms 4
Single-Family []
3. WATER SUPPLY
Individual Well E:X
Ordered by Lynda Banner
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site~Z 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.
72-025 (Rev. 7/88) Page 1 of 2
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,~,~ MUNICIPALITY OF ANCHORAGE (MOA)
,(~'~r'~' ,/~'~¥' Health Authority Approval (HAA)
"' ',1 ?~~,~}~ CHECKLIST - FEBRUARY 1984
,,~, , ~ ,, ~ 343-4744
Leg De iptio
.:, ~ ",., al scr n:
A. WELL DATA
Well Classification
Well Log Present (~/N)
Total Depth ,.?...¢,~..i Cased to
Static Water Levet
Casing Height Above Ground
Electrical Wiring in Conduit ~'N)
Date Completed ~ ~ ~:~
Depth of Grouting
Y
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot \ ~C~I
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
IfA, B, C, D.E.C. Approved (Y/N) Gift'
Yield \ ,'7~ ~., ~'~1
Pump Set At t~""5 '~
Sanitary Seal on Casingd~/N) ~
Depression Around Wellhead (Y,d~)
To Nearest Sewer Service Line on Lot
Water Sample Collected by '~'¢~f'~'~ ~ Ir~r~ ; Date
Water Sample Test Results '~/"~'"1~\
Comments ~ ¢'q..~t~ ~ ~ ~.~ \~ ~ "B,~ .
; On Adjoining Lots
\ ~'~=~f ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
B. SEPTIC/HOLDING TANK DATA
Date Installed ~2-' ~" ~,1 Size
Standpipes ~/N) '7/
Depression over Tank
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
I'¢'~'~ No. of Compartments
Air-tight Caps~iyN)
Foundation Cleanout~,%~N) ~-./
Date Last Pumped [ ~
; for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well \
To Property Line
To Water Main/Service Line \
To Stream, Pond, Lake or Major Drainage Course
Comments
To Building Foundation
To Disposal Field
I.4-
72-026 (Rev, 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ -'
Width of Field '~-
Square Feet of Absortion Area
Depression over Field (Y~¢~
Results of Last Adequacy Test
~ '¢~//'"~¢-- Type of System Design
Length of Field (.~"7 I
Depth of Field
Gravel Bed Thickness
Statndpipes Present (~:TN)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundatio~
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line ~
To Existing or Abandoned System on
; On Adjoining Lots '?~¢~Jr
To Cutback (if present)
Comments
D. LIFT STATION
Date Installed
Size~
"Pump On" Level at ~
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
PumpingS.
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 th!.s
inspection.
Signed
Company
Date
MOA No.
ENGINEERING
Receipt No. 2 ('~ ~:2 // / ~/(~ ® ~ Receipt No.
Date of Payment ///-c~ ~ --'°c~' Waiver Fee: $
Amount: $ ./?¢ ~ Date of Payment
72-026 (Rev 7/88) Back Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX ID # 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order ~ 10523
Date Report Pxinted: NOV 21 88 @ 23:22
Client Sample ID:L3, B4, MOUNTAIN MANOR
PWSID :UA
Collected NOV 16 88 @ 16:10 hrs.
Received NOV 17 88 @ 15:15 hrs.
Preserved with :4 DEG, C
Client Name : S E S ENGINEERING
Client Acct : SNSENGP
P.O.{ NONE REC'D
Req #
Ordered By :
Analysis Completed :NOV lB 88 Send Reports to:
Laboratory Supervi~er~ .~:~33~PHEN C. EDE 1)S & S ENGINEERING
Released By : ~C.-~._ ~ 2)
Special
Instruct:
Chemlab Ref ~: 3483 Lab Smpl ID: 4 Matrix: WATER
Allowable
Parameter Iested Result/Units Method Limits
NITRATE-N 1.8 mE/1 EPA 353.2 10
Sample ROUTINE SAMPLE
Remarks: SAMPLE COLLECTED BY RP
1 Tests Performed ' See Special Instructions Above UA:Unavailable
ND= None Detected "See Sample Remarks Above
NA= Not Analyzed LT=Less Than, GT=Greater Than
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 tot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name J-~,rE./'L-~T"-.4 G,,~_. ~-'~.~,V~/felephone: Home ~r-d~" q °~°1L~ Business
Applicant Address
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution NZ,/£
Address
(e) Real Estate Company and Agent
Address
Telephone
Telephone
(f)
Mail the HAA to the following address:
S & S Englneerln~
SRB 196x
TYPE OF RESIDENCE
Single-Familyl~]..~Multi- Family
Number of Bedrooms
Other
WATER SUPPLY
Individual Well~ Community [] Public []
Note: If corem unity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite [~ Public D Community [] Holding Tank []
Note: if community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
Paoe 1 of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm $ & S Engineering
SRB 196x
Address EagJe ~,iver,
Date
Telephone
Approved for ~"~ .~ bedrooms e
Approved /~'/ Disapproved~/' '
Conditional
Terms of Conditional 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.
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
MUNICIPALITY OF ANCl"IORAJ~'
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
; E B 0 1986.
264-4720
Legal Description: ~-- ~'~'~ ~EIVED
WELL DATA
Well Classification "~(~.l. ~/~'~ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present~/NT~ Date Completed ~'~-~ ~' O Yield
Total Depth 7_..~"~" / Cased to
Static Water Level /oc~
Casing Height Above Ground
Electrical Wiring in Conduit
Separation Distances from Welt:
To Septic/Holding Tank on Lot ,/Oo /
/Z. Ii ~-
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line Cleanout/Manhole
Water Sample ColleCted by
Water Sample Test Results
Depth of Grouting
Pump Set At /'~'~' I
Sanitary Seal on Casing ,~/.N)
Depression Around Wellhead (,Y'~)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Comments
/oc~
B. SEPTIC/HOLDING TANK DATA
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Comments
Date Installed /-~-~"'f-~( Size /~"~ No. of Compartments
Standpipes (~N) Air-tight CapstANS' Foundation Cleanout(~bl,)'
Depression over Tank ~-Y~ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) '/'~" ; for
Holding Tank High-Water Alarm (Y/N) /'J'~- Temporary Holding Tank Permit (Y/N) "~'/_,4--
Separation Distances from Septic/Holding Tank:
~/z~o / ~ To Building Foundation
~ [ ¢'- To Disposal Field '-~
To Stream, Pond, Lake, or Major Drainage
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~;~ -,-.%~- ~ /
Width of Field ~::'~
Square Feet of Absorption Area ~¢~0
Depression over Field,~V~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field /
Gravel Bed Thickness ~"
Standpipes Present Y~.~;~I)
Date of Last Adequacy Test
To Property Line ~----~ ~
To Existing or Abandoned System od
; On Adjoining Lots ~'-~ t-
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 8, S £.gineering Date ~-~ -- ~:~'-'~ ~'
S~B 196x
Company ,,;,~]~
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
'1.
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 _/7/~'~,/
GENERAL INFORMATION
(a)
Legal Description (include lot, block, subd~wsion, sechon, township, range)
Location (address or directions) /
(b) App cantName~~_~ ..... ~Z Tolephone:~mo _;~-~f~/ Business
Applicant Address
(C) Applicant is (check one~. Lending Institution
(d)
(e)
Real Estate Company and Agent
Address
Tglgphone
(f)""'l~' the ~AA to the following address:
TYPE OF RESIDENCE
Single-Famil¢ Multi-Family [] Other
Number of Bedrooms ..... _~_ .........
WATER SUPPLY
Individual We,U,~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~ Public[] Community[] Holding Tank[]
Note: If community well system, must have written confirmahon from the State Department of Environmental Conservation
attesting to the legality and status.
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 invesbgation of this Hee th
Authority Approval shows that the on-site water supply and/or wastewater disposal syslem is safe, funchonal 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
Address
Date
Telephone
DHEP APPROVAL ,
APproved for //~'~¢-~'¢) bedrooms by
Approved /'~ Disapproved
Terms of Conditional Approval
Conditional
Date
CAUTION
The Muncipality of Anchorage Department of Plealth 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
C-
WELL DATA
Well Classification
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY '1984
264-4720
Legal Description: ,,~
Well Log Present(~/J~f~
Total Depth ,~o,¢" Cased to .
Static Water Level /~
Casing Height Above Ground
Electrical Wiring in Conduit{~/,t~
Separation Distances from Welt:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line /v/'4'
Cleanout/Manhole
If A, B, C, D.E.C. Approved (Y/N)
Date' Completed
Water Sample Collected by
Water Sample Test Results
Depth of Grouting
Pump Set At /
Sanitary Seal on Casing~/,~
Depression Around Wellhead
; On Adjoining Lots
,/de z ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Yield
: Date
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed (.¢'-'~"'-8 I
Standpipes ~/N,)' Air-tight Caps {~'/4~t)
Depression over Tank,4~j'
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well .,/~O
To Property Line c~o
To Water Main/Service Line
Size } "~ ~-C:~ No. of Compartments
Foundation Cleanout t~/-NT"
I~)ate Last Pumped
"~ ~'/,4,- ;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
Course
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed (¢2"~'~ ~'~
Width of Field ~'~ ~
Square Feet of Absorption Area
Depression over Fields
Results of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present {~')
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /~23~O ! ~
To Building Foundation ':~ I ~
Lot ~"~'
To Water Main/Service Line ~ / ¢'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~.~ ~ 4-
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
Man/ole/Access (Y/N)
~/'/Pump Off" Levet at ~//,,j,, Vent (Y/N)
//~'J¢' 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 M(~A and HAA guidelines in effect on the date of this inspection.
ComDan,v.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~UNICIPALITY OF ANCHORAOE
825 L Street - Anchorage, Alaska 99501 DFr~T ~ r
ENVIRoi4M :h ,A.,; .,~)4LCT
ENVIRONMENTAL E~GINEERING DIVISION
, ~ Telephone 264-4720 &~ ]~ g
DIRECTIONS: Complete all parts on page 1. Incomplete requ~ will not be processed. Please allow ten (10) dags for processing.
1.~OPERTYOWNER~ , , · _ ~ . ~ . PHONE
MAILING AQDRESS , ~' ' · , _
PBOPEaTY BESIDENT (If diffeTent from a~ve) ' ? -
2. BpYER . , ' ~ ~ PHONE
4. REALTOR/AGENT
PHONE
S. LEGAL DESCRIPTION
STREET LdCATIONs '
6. TYPE OF RESIDENCE
SlNGLEFAMILY
MULTIPLE FAMILY
[] One ~i~ Four
[] Two [~ Five
[] Three [] Six
Other
7. WATER SUPPLY
~, INDIVIDUAL* ' '
[] COMMUNITY
'1-'1 PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if availabl ~.)
8. SEWAGE DISPOSAL SYSTEM '~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
**If individual/on-site, give installation date
~,, s¥'stcm i~ ov~r t;;'c (2} 7eam-oNf~adequac,.y-te~t-~r~qui4~ed
by-this Del~m~
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
p' 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 UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
[~]Septic Tank or [] Holding Tank
Size: I ~-c~'-O If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area ISewer Line I Nearest Lot Line
WELL TO: ~/ cw
1
Absorption Area to nearest Lot Line
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
~'~)ISAPPROV ED
DATE BY (Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)