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Home My WebLink AboutHOMESTEAD HILLS #1 BLK 3 LT 1Onsite File #015-173-23 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: OSP191477 Work Type: Septic Upgrade Tax Code Number: 01517323000 Site Legal Address: HOMESTEAD HILLS #1 BLK 3 LT 1 G:2636 Site Mailing Address: 11300 BEARPAW ST, Anchorage Owner: KIRCHER RICHARD S 50% & Design Engineer: C & M Engineering This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: Uepai,tr ent 11/4/2019 11/3/2020 36463 Q Disposal Field 0 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 3 Special Provisions: 1. A test hole is required prior to construction of the drainfield to confirm separations to impermeables and com `G�j seasonal high groundwater. In addition, percolation test(s) are required for the accepting soil. Locations are indicated on the site plan. If results require a design change, construction shall stop pending On-site review and approval of a change order. Please submit results with the inspection report (or change order, if required). 2. The updated as -built survey submitted after construction of new septic system is complete shall have correct legal address. change, Gr(Ae . to /1ect) Sot (5 t'�1 �v , 08/ 4' J Received By: // Date: Issued By: Date: � � / MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section --- Fax: 907-343-7997 ON-SITE SEPTICNVELL PERMIT APPLICATION Parcel I.D. 015 173 23 Property owner(s) Jessie Siira Mailing address Site address 11300 Bear Paw Day phone 223-0015 Legal description (Sub'd., Block & Lot) HOMESTEAD HILLS #1 Block 3 Lot 1 Legal description (Township, Range & Section) Lot Size 36,463 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field Fx_1 Initial ❑ Single Family (SF) ❑ (w/wo ADU) Septic Tank ElUpgrade 0 Duplex (D) ❑ Holding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well [ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: NONE Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: ?aC)-C)C) 1�( Date of Payment: N 101 �A_ \ Receipt Number: O u l 0 D Permit No. C)5 q 4-7 j Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc co -6--1 Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System replacement for Homestead Hills#1 Block 3 Lot 1 CHANGE ORDER #1 Dear Reviewer, The proposed change order #1 modifies the drain field design at the above referenced property due to changed soil conditions. A test hole was excavated, and a percolation test conducted to verify the design. The test hole was excavated to a depth of 18' and the soils encountered were found to be better than anticipated. Soils are well graded sand with some gravel and trace amounts of silt. No groundwater or impermeable soils were encountered. The percolation rate was 22=5 minutes per inch. The testhole was excavated on 11/21/2019 and 7 -day groundwater monitoring revealed no water in the Monitoring tube. Please do not hesitate to contact me at 907-854-5558 or by email cgbalzarini an"gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 12/01/19 OF "CHARLES G BALZARIW CE13854 AW �� PROFESS\QAI -:F C&M ENGINEERING SERVICES 907-854-5558 Septic Design Calculations Residence: Homestead Hills#1 Block 3 Lot I number of bedrooms 3 br Water usage/bedroom 150 gpd/br Water Usage 450 gpd CALCULATIONS ARE FOR REFERENCE PURPOSES ONLY USE DIMENSIONS SHOWN ON PLANS CALCULATIONS ARE FOR REFERENCE PURPOSES ONLY USE DIMENSIONS SHOWN ON PLANS Calc By: CGB Date: 11/25/2019 CE13854 . W4, R-3 '0 lb—PROFESSO type: shallow Application Rate 1.2 gpd/sqft required absorption area 375 sqft width (W) 5 ft minimum effective depth 4 ft below distribution pipe see narrative Trench Factor 0.5 Min Required Length: 37.5 ft MOA Sand Depth 0 ft MAX Excavation Depth: 12 ft TO BOTTOM OF ROCK Min Cover: 3 ft Insulation: 2" blueboard Effluent Pipe: 4" ASTM 3034 CALCULATIONS ARE FOR REFERENCE PURPOSES ONLY USE DIMENSIONS SHOWN ON PLANS Calc By: CGB Date: 11/25/2019 CE13854 . W4, R-3 '0 lb—PROFESSO LEGEND ELMORE / BRAGAW STREET CDS — 0 CLEANOUT 0 MONITOR TUBE NOTE: THE PROPOSED SEPTIC SYSTEM MUST BE INSTALLED GREATER THAN: UTILITY EASEMENT 100' FROM ANY PRIVATE WELLS 200' FROM ANY PUBLIC WELLS 100' FROM ANY SURFACE WATER 10' TO ANY PROPERTY LINE OR FOUNDATION 5' TO ANY TEST HOLES 10' TO THE HOUSE FOUNDATION RESERVE SITE SEPTIC AREA j P,r-R C f LOCATION o r— 1 ( OPTIONAL DIVERTER VALVE TO I OLD BED SYSTEM DUAL CLEANOUTS EACH SIDE OFiFANK DEMOLISH OLD TANK PER MOA REQUIREMENTS \0, _100_V`/)ELL RADIUS I HOMESTEAD ILLS #1 BLOCK 3 L T 2 I 1 � (1) 5'x40' SHALLOW TRENCH WITH 4' EFFECTIVE SEWER ROCK. MAX EXCAVATION DEPTH 12'. .I 0 O3 L —__oJ NEW 1000 GALLON POLY TANK W/ INSULATED RISER AT FIRST CHAMBER - INSTALL PER MOA AND MANUF'R REQUIREMENTS I � LOCATE AND REPLACE LINE TO HOUSE (RECOMMENDED) \ HOMESTEAD HILLS #1 BLOCK 3 LOT 1 �I "'n � OF Al q iloel * ; TH •• * 1 CHARLES G BALZARI9i (+�5qF�j•. CE -13854 ••��c`�A-' OF SS OLE #1 1'CONTOURINTERVAL I EXISTING WELL I DRIVEWAY C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION:HOMESTEAD HILLS#1 BLOCK 3 LOT 1 OWNER:SIIRA DATE: 9/30/19 1 REV: 0 DRAWN: CB I REF: SITE PLAN Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 ....... ........ www.muni.org/onsite G Ullt. T;iRINI (907) 343-7904 Soils Log - Percolation Test Performed For:la r kA Date Performed: Legal Description: OAEt7Te4 -�5�_ownship, Range, Section: Slope Site Plan Depth WAS GROUND WATER Date ENCOUNTERED?A/0 2- Depth to Water s 3- L Depth to Water After Monitoring? 4- 'q E, 5- 6- LJ 7- 8- 9- 10- 11- /� 12- 13- 14- U I 15- 16- 17- 18- 19- 20 - WAS GROUND WATER Date ENCOUNTERED?A/0 Net Time Depth to Water s IF YES, AT WHAT DEPTH?,A//A L Depth to Water After Monitoring? 0 luif 'q E, Date: Reading Date Gross Time Net Time Depth to Water Net Drop \J, LJ /� LO U I PERCOLATION RATE -,t , ) ' (minutestinch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT 2,f COMMENTS '45 1f0 k 6D Tp , _lj PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIP�_LIDELINES IN EFFECT ON THIS DATE. DATE: I;zm//2 C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System replacement for Homestead Hills#1 Block 3 Lot 1 Dear Reviewer, The above referenced property is currently served by an older failed bed system and steel septic tank. The owner wishes to replace the aged septic with a new septic tank and drainfield system. Our review of available documentation and field investigation show that this project will not adversely impact any nearby wells, wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. A new test hole will be excavated and a percolation test conducted to verify the design. Included with this letter is a permit application and design package, including plans, and calculations. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 10/15/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191477, Rebecca Carroll, 11/04/19 Lot 3, Block 1 Homestead Hills Subdivision 36,462 Sq. Ft. +/- 11300 Bear Paw Street 2 Story Wood Frame House With Attached 2 Car Garage T E N89° 53' 41"E 269.37S00° 06' 19"E 135.15 N89° 58' 42"E 269.43N00° 08' 00"W 135.54 S S S MB;;;;;;;;;;;;SS SLOT 2 ℄ BEARPAW STREET ℄ BRAGAW STREET ℄ TRAPLINE DRIVE30'R.O.W.30' R.O.W. 22.2 66.331.1 47.7 16.0 16.022.18.032.2 3.3 7.3 2.117.632.9 14.121.4 22.110' T & E EASEMENT 20'20'20' WIDE ANCHORAGE NATURAL GAS COMPANY EASEMENT 20' C.E.A. TRANS. LINE EASEMENT 100 ' W E L L R A D I U S 45.1W 30'R.O.W.CULVERT GRAVEL DRIVEWAYOHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP EDGE OF PAVEMENT 395 400400395 3953 9 0 399 398397396 394 393392 391391 394393392396 395 397 PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Frederic Wagner, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. September 12th, 2019. Legend:Scale 1" = 40'Gas Meter Electric Meter/Outside Power Deck Septic Telephone Pole Fence Mailbox Light Pole S G E Metal Post Lot 3, Block 1 Homestead Hills Subdivision General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Jesse Siira 19-371 09/13/2019 78-151 N/A E TMBW Elec. PedestalWater Well Tel. Pedestal Lot 3, Block 1 Homestead Hills Subdivision 36,462 Sq. Ft. +/- 11300 Bear Paw Street 2 Story Wood Frame House With Attached 2 Car Garage T E N89° 53' 41"E 269.37S00° 06' 19"E 135.15 N89° 58' 42"E 269.43N00° 08' 00"W 135.54 S S S MB;;;;;;;;;;;;SS SLOT 2 ℄ BEARPAW STREET ℄ BRAGAW STREET ℄ TRAPLINE DRIVE30'R.O.W.30' R.O.W. 22.2 66.331.1 47.7 16.0 16.022.18.032.2 3.3 7.3 2.117.632.9 14.121.4 22.110' T & E EASEMENT 20'20'20' WIDE ANCHORAGE NATURAL GAS COMPANY EASEMENT 20' C.E.A. TRANS. LINE EASEMENT 100 ' W E L L R A D I U S 45.1W 30'R.O.W.CULVERT GRAVEL DRIVEWAYOHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP EDGE OF PAVEMENT Frederic W. Wagner NO. L.S.-9946 PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Frederic Wagner, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. September 12th, 2019. Legend:Scale 1" = 40'Gas Meter Electric Meter/Outside Power Deck Septic Telephone Pole Fence Mailbox Light Pole STA T E O F ALA S K A49 TH ROYEVRUSDNALLANOISSEFORP DERE T S IGER 9/13/2019 S G E Metal Post Lot 3, Block 1 Homestead Hills Subdivision General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Jesse Siira 19-371 09/13/2019 78-151 N/A E TMBW Elec. PedestalWater Well Tel. Pedestal :-~--, MUNICIPALITY OF ANCHORAGE DL T.E.TOF.EA'T.A.D..MA. SE. Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Address Phone(s) I Permit No. No. of Bedrooms LEGAL DESCRIPTION Township, Bange, Section TANKS SE.T.C [] .OLD,.G Manufacturer Capacity in gallons Material CompaAments TYPE OF SYSTEM [] TRENCH ~. BED [~ W. DRAIN [] OTHER Total depth lrom original grade Depth to pipe bottom from original grade ~ ~'~ .~.~F~- Fill added above original grade Gravel depth beneath pipe ~ ~ FT Gravel length Gravel w~dth ~--"- FT /~' FT Total absorption area Distance between lines ~"7~' SO ET ~ FT Pipe material Date installed WELLS t~ PRIVATE [] OTHER (Identify) Classification (A,B,C) Total Depth J Cased to FTJ FT Installel Date Installed: REMARKS: &f~.~)~ DISTANCES SEPTIC ABSORPTION TANK FIELD WELL WELL LOT LINE FOUNBATION AS-BUILT DIAGBAM (Show location of well, septic system, property hnes, foundahon, driveway, water bodies, etc.) Municipal and State guidelines in effect on this date: Health Department Approval: Scale: r~' Inspections Performed by/' ,4~'~Y ,4. Date; certily that this inspection was perlormed according 1o all .........'f i .:*~:'(ii'i !' ~/~i¥1 :[ ]. ;i ~'~ I'~ ~.,~ ii. 'it, l"i ' ....... ~ ...... r'.e~qLi:i. ¥" Ei'f¥i((';'iI"I'~L !~i ~' (:1){" i::i{"i '""Ei ii. t ~:'~> ~iE'>i.~i'~:~ I" i~i ~:~tl"i(::l '~,~i~'~'.'"'~ ,i.~ ".. '.:~ ~!~i i ,..~t' ~., {:;)'~i' 't.:,h~i¢ ['"[t.U'i :i. (::::i,' {:] .:?i .~.~ ,l.: '"''(.. ). E)~' 12il'{EiI'iEil'" ~:i~C:, . (E' ,~ ,(. ['"[ ..... ;¢;tr' H 'iL {"i ({'}~ "'" '" "'" ii:If '" ..<:: ::, '..::: ,, ;~:'~ ,, [j~ ¢'~ ;i. I.I, .... 't. ii. i"u!irl;'..:'.ii ;{. ]. ':' ' ...... ~:.. ~iv'.~i~i!:... (~;.h'i'~ ii. n acc (::) ~" (:~' ~i:u'":c: (.:.~> ",..~, '~.,. ".. '"', ~ .~':i '.I. ;i. I"!Ci¢, (::: (:::,(::l(.~:~,~i ~;~n,:::J {" e(:.;l ~...~ ]. ii:vt., il.' c:)n !~ ~ EJ :i !i~. i.~l"iC;(~!~. ~ I'" Cilq ....~;?d" ~' (ii.)>( ';~. ~:" '~':.~ ~ ii. i'~[: ~h.~.~ 'i 'I ,, ,'.i~i/~:;'I'. , i::,i ~: 'iL (~.:,I" (:ii !.' ':::-I,~ L~'::::-~::~ .i.' ~i~4"EV~L (:!':'Ii! C)i'~ l:;)i..i~;:i ]. . .... ' ............. it. ,:::) i'.. !i~:,~;~,i,'..~(.:;.~ i" ~:', g El, !~ v !~!. '[' (.~> E)F'{ i"l .i.: o I" & }'1 '? ~:~ (;:J .~ ~;:i E: 6(.)i"i 'IL C) }' i 'i ,..ii, ~:!~ ~ i..~ ~,..' ,.f [ i'"t (::~h!l:':' PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: //~.¢~/~_~./ X.//~- T~wnship, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTER ED;) S L IF YES, AT WHAT O DEPTH? P E Depth to Water After ~'/D ~/~'7 MenDoring? ~)",' ~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE /'~' TEST RUN BETWEEN 2.. [m~nutes/~nchj PERC HOLE DIAMETER __.FTAND Z.f- FT PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN P --I0' PHONE ~ ELEC. ESMT. S aS ENGINEERS, (BO7) 274-9397 5610 SILV£RADO WAY, suITE' A'? ANCHORAGE , ALASKA 99502 , m · "- ' PLOT PLAN lAS-BUILT' zX' IGRIO: 2636 DRAWN BY:MDC ICHECKEO B : ~ ,CAL..I -,50 ' !, , ' t , , -- ~ .... ~ ' ' ' ' "' 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~WELL INSPECTION REPORT NAME PHONE ! ~,,,~ E W MAILING ~DDRESS LEGAL DESCRIPTION I Well bszpti~:a Dwelling PER MIT NO. ~ ~ ~ ~ Manufacturer ~ ~ Mater No. of compartments ~ ~ Liq. capacity in gall~s Inside length Width Liquid depth /~ ~. IF HOMEMADE: DISTANCE~ Well Dwelling /- PERMIT NO. Z OZ~ Manufa~~ ~ FMateria] ~t -- / y in gallons ~ D;;TANCETO: We,] jj¢ ,~ Foundation ~ Nearestlotline/~ PERMITNO. ~ No. oflines . Lengthofe~hlJne Totallengthoflin Trenchwidth / Distancebetweenlnes ;'~ Top of tile to finish grade ~~ }~ '~* /~¢¢ inches Total~f,tive absorption are, ." Material be~ath tile ~ -~ /~ ¢ ~ ~.~ Length Width ~ ~pth - m DIS~C[ TO: Well ~ Buildin~ foun~don ~earest lot line ~ ~ Class Depth Driller ~istance to lot line PfiBMIT ~O. ~ DISTANCE TO: Building foundation Sewer line Septic tanN Absorption area(s) OTHER PIPE ~ATERIALS SOl L TEST RATING _ /~ REMARKS I I' ~1~ DATE LEGAL F'ERMIT NO. ( ,~:l.~,~,c, ) APPLICANT ROBERT MILBY LOCAT I ON LEGAL LiB3 HOMESTEAD HILLS DEPARTMENT ~ HERLTH AND ENVIRONMENTAL ~:OTECTION 825" STREET., ANCHORAGE, '~ -' ~"-" Z T~ BO,':< 21t4 PflLMER ~'~ ~'" LOT SIZE 50000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR)= 85 7'HE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [aEF'TH= ~L2 LEI'-~GTH= :La-; G F-: R'..." E ~ , [;.EPTH= :9 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE RND THE BOTTOM OF THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS ±00 FEET FOR R PRIVATE HELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF RNCHORRGE. 2: I WILL INSTAL[_ THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. ISSUED BY_ __DATE .... ~ ..... V4. 0 ,~IUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-1850. Ancilorage. AJaska 99502 276-222"J SOILS LOG -- PERCOLATION TEST I'1 SOILS LOG PERCOLATION TEST PER FORMED FOR.'..~ ~ 8 LEGAL DESCRIPTION: SLOPE 3 4 5 6- 7- 8- DATE PERFORMED= lq A PR ~ / SITE PLAN 10- 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? I~r.~ L ' O P IF YES, AT WHAT E DEPTH? i _~.t t J Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) · -- ~T RUN B EEN FT AND/'''~y FT .~.~o.~, :"' ~ ' '/// // .,iUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch G-'GSO. Anchorage, Alaska 99502 276-222"~ SOILS LOG - PERCOLATION TEST SOILS PERCOLATION TEST L o-r ~'i SLOPE 1 2 3 4 5- 6- 7- 8 D^T~ P~.~O.MED: /5 A P" 8 / SITE PLAN Ii ./., ., 10 11 ~12 13- 14 15 16 17 18 19- 20- COMMENTS I WAS OROUNDWATE" ~/O s! ENCOUNTERED? ~) P E IF YES, AT WHAT DEPTH? * GroSs Net Depth to Net Reeding Dete Time Time Weter Drop PERCOLATION RATE ~p~.T ,UN .~p~EEN G W -- O K O-~v r--<,~<'----.-" ' PERFORMED CERTIFIED ]'his well is producing .__._._gallons OON DRILLING SR BOX 668, BOGARD RD. PALMER, ALASKA 99645 TELEPHONE 745-4071 I~ Btk. - Sub, CASIN FORMATION rater per hour. Set pump (P __ feet. iNVOICE NO.~ yOUR P. O, NUMBER ~ TERMS - ~ [~A[,ESMAN WELL LOG CAS~ FORMATION CASIN FORMATION PLEASE PAY FROM THiS iNVOICE p~rl~t AMOUNT ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 0/ -/73 23 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner "~'~/ ' ~'W~O Telephone: Home Mailing Address ?/.~4ro ,~P/~ ~ ,/¢~f. /4'~. Lending Institution" '~,/~.~4~/~'~/)~ ~/~/~/~'C~'Telephone (c) (d) (e) Business Mailing Address Real Estate Company and Agent Address ¢-~? O0 lelephone ~ q& ~ Mail the HAA to the followina address: or: Check here~, if hold for pick up. List contact, person and day p~hone number .below. ¢,p, TYPE OF RESIDENCE Singie-Family'l~ Number of Bedrooms 3 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. 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 72-025 fRev 8/861 Front ')tJOM S,~ggu!Sug leUO!SSgJOJd gq~ u! SUO!SS!UJO JO SJOJJg JOJ elq!suodseJ ~ou s! eDeJoqouv jo ,q!l~d!o!unlAI eqJ. 'pgnss! s! e~eo!j!~ao e g~oc. gq e~ep gZXleue Jo suo!~oedsu! ~onpuoo ~ou op SHHQ Jo see~olduJ=l 'slueLueJ!nbe~ e~e~s pug leJgpgJ u!elJeo ,~Jsp, es o~, JgpJo u! suo!~n~p, su! 5u!pugl ~!gq~ pue sauuoq jo sJaseqoJnd m,/~sgj~noo e se s!q~ seop SHHQ @q.L 'eHSel¥ ¢o e~e~S eq~, u! peJm, s!SeJ ~eeu!Sue leUO!SSejOJd lugpuedgpu! ue ,~q e^oq~ S Llde~ee~ed u! ue^!5 suo¢,e~uese~deJ gq~, uodn ,~lUO peseq se~eo!J!pg3 le^oJdd¥ /~poq~n¥ qllegH senss! (SHHQ} seo!^JeS UeLUnH pue q~legH jo ~u@uJpedeQ eSeJoqouv jo/~!ledp!unv~l gq1 NOIJ. nVo leUO!l!puoo le^oJddv leUO!l!puoo jo SLUJgl pe^oJddes!a '~¢ pe^oJdd¥ /{q suJOOJpeq ~ Joj pgAoJddv "lVAOldddV SHHa .g WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) ACi~C~Lt,~- FEBRUARY 1984 d ~ [\ [ ~ ~ ~64-4744 .... ~.~ Legal Description: ~/ Well Classification Well Log Presentt~N) Total Depth ' Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~_.)N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ,,d,//~ Cleanout/Manhole '~///q NOISlAIa S_TS!A~SS -3O¥~IOHDNV JO ,U. IWdl31Nn?~1 '~,~/Y'~ If A, B, G, D.E.C. Approved (Y/N) Date Comffleted Cq/~"// Yield Cased to c~)_-2/ Depth of Grouting /g'~ ' Pump Set At ' ,/J/~ _..~/, ~/'~,~,'( · Sanitary Seal on Casing(~) Depression Around Wellhead /0:~ ; On Adjoining Lots /~-~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Water Sample Collected by /¢~"~.~ ~. ~7~) ; Date Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~) .¢~ Air-tight Caps 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 /d'Y/O No. of Compartments Foundation Cleanout (~N) Date Last Pumped ;for Temporary Holding Tank Permit To Water-Supply Well To Property Line To Water Main/Service Line Course TO Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026 fRev 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/~.,~ Results of Last Adequacy Test /0/,4 Separation Distance from Absorption Field: To Water-Supply Well /'~ To Building Foundation Lot Type of System Design Length of Field -.~ ~ / '~ Depth of Field ~S'-~ 6' ' Gravel Bed Thickness :~-?~, z~' ..... Standpipes Presentl~N) Date of Last Adequacy Test To Property Line ; On Adjoining Lots To Existing or Abandoned System on To Water Main/Service Line /O ¢ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutbank (if present) D. LIFT STATION Size in Gallons % "Pump On" Level at High Water Alarm Level at ~ Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hav,,e~che,~,J~ed, ve)'ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ,~-~('~ ~C//¢-:"~ Date ¢''' ¢~I~ ? Company ~ MOA No. ~¢¢/ No. ' 0 0 9 Date of Payment ~ - O~ _~'~ ' Amount: $ [.~' ~ ~ Page 2 of 2 72-026 fRev 8/861 Back 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 Work Orde~ ~o. : SpeciaJ FEDERAL TAX ID # 92-0040440 ~ D~ .E RECEIVED , INSPECTION APPOINTMENTS ~/ LtK~LII Y L~' AM(~H(JNA~ mUNICIPALITY Of ANCHO~AG~ D~PT. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~~RONMENTAL P~OrECTION 825 LStreet-Anchorage, Alaska 99501 AU¢ =; I981 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 R E C E ! V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on pege 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. PHONE PaOPERTY RESIDENT (If diluent from able) PHONE PHONE MAILING AD.ESS 3. LENDINGINSTITUTIO?~X~, ~.~<~ >~O5 ~ IPHONE MAILING ADDRESS 4, REALTOR/AGENT ~ PHONE MAt LING ADDRESS 5. LEGAL STREET LOCATION 6. TYPE OF RESIDENCE S INGLE FAMILY [] MULTIPLE FAMILY 7. WATE R,~UPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four I~ Other~ [] Two [] Five ~.' Three [] Six * 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 available.) 8. SEWAGE DISPOSAL SYSTEM /~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. 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 E~]Septic Tank or C-IHolding Tank Size: ///'~'~ £J) 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 I t WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS E~ APPRovED FoR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED