HomeMy WebLinkAboutSUE TAWN ESTATE #2 BLK 1 LT 1Sue Tawn
Estates #2
Block 1
Lot 1
#051-471-23
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page ( of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: 05P /JC5/0,w PIDNumber: DS✓'"I t —23
Dwelling: Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑ Upgrade
Name:
ABSORPTION FIELD
❑ Deep Trench E3 Shallow Trench ❑Bed .Mound
Address
❑ Other
Phone
Number of Bedrooms
Soil Rating�ee
Total depth from original grade
15—
V e� GPD/SF
— l . '57— Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
-1 /, Z) Ft.
Gravel depth beneath pipe
D r Ft.
Subdivision Block Lot
t
N 2 W � %ly-Z LUJ-(
Fill added above original grade
15', CFt.
Gravel length
Ft.
Township Range Section
Gravel width .
3)(, rS Ft.
Beds: Number of Lines
1 3
Distance between lines
1 3 Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
/ �`j P C Ft'
f
Ft.
Well
�(�t/
.!
f'O�rT
J� /
0101
TANK Septic ElS.T.E.P. El Holding El Other
F
Manufa rer // Capacity
In ` 4n �
Surface Water
��
��Qt.F,
'15,0(� Gal.
Material /
Number of compartments
Lot Line
(0'-k
NA
Foundation
S �t
v�
LIFT STATION
Manufacturer
Capacity
Gal.
f
Curtain Drain
(�, h
Np
Remarks
Pump on level at
Pump off level
in.
High water alarm at
in.
Pump make odel
Electrical Inspections performed by
Jit? C`�
PIPE MATERIAL House to tank 3 U$q Tankto
073
Installer r
�C
drainfield
r t
Drainfield'j V 2 Lf CO/MT 031
Inspector A if .ir ! r �M �,����r
f •� „\
BENCHMARK (Assumed elevation) 10j,�ft
Inspection ,i
dates: 1 -t,1 5- Zn LC
Location and description
r
L
3b e
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
n ..
F
t.
Conditional Approval: Date`
yfJ
?� ` IDIICHAEL N. ANDEP,,Ctq
Approved Date %"off /S
�'k
Inspection Report _9-1-12A fC
Permit No. OSP151034 Page 2 of 2
Municipality of Anchorage
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
Legal Description: SUE TAWN ESTATES #2 BILK 1, LOT 1 PID No.: 051-471-23
T002 6 60 —
Cpp4 0 63
CO5 0 64
C 6 2 63
C 8 80 131 I'MT10 • TH#11
C 9 5 96
� MT9MT610 7 98 1
C61 8 100 / — /✓ / 1
C 12 1 5 114 / / / fff l M 1
Co 3 1 6 115 MT / / \ / \/�c✓6 l! / /
CO 4 1 9 121 C9
CO 5 1 135 / _ / _J
C01 12
CO1 12
138
144
TH#1 T�
— — — —
MT1 \ 96
94
C(
MT2 100
MT3 64
103
69
�
\/
N€6 1500 GALL�ON-TAN&OT11
MT4 \ 65
MT5 105
82
112
/
MT7 58
125 /
BENCH AT STAIR LANDING----.
MTS \ 61
1
MT9 123
T10 133
1
4
2 11Y2 1/131
\ \I
\ II
\ t \
\
mu cora
SRFL TANK
SEPTIC SECTION
N.T.S.
TC01 �, EXISTING TANK PUMPED
C04
01 \
L�11B
1 \
1
CRUSHED
OF
FORIC • 49 TH •
1.8 H MG
88
Gw/m
IAEL N.
No,CE
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP151034
Tax Code Number: 05147123000
Work Type: Septic Upgrade
Permit Effective Dates: March 20, 2015 to March 19, 2016
Design Engineer: ANDERSON CONSTRUCTION &
Subdivision: S U E TAWN ESTATE #2
Site Legal Address: SUE TAWN ESTATE #2 BILK 1 LT 1 G:1160
Owner/Address: STEEBY DALE DEAN
1088 SOUTH TRENSCH CIRCLE WASILLA AK 996549604
Site Mailing Address: 19519 SUE TAWN DR, Chugiak
This permit is for the construction of:
Lot Size in Sq Ft: 74239
Total Bedrooms: 5
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
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 (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received Bv:
�- a
Date: o
Date: ��
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D.
Property owner(s) V)
Mailing address fo
C)S!-Z4?l - 2-3
Day phone
Gtr
Site address
Legal description (Sub'd., Block & Lot) S u v -� C3 W t✓l J� ,eja k -e S 0-2- 81 `v'- C
Legal description (Township, Range & Section)
Lot Size .'? 4 23 q Sq. Ft. Number of Bedrooms
APPLICATION IS FOR:
(® all that apply)
Absorption Field
Septic Tank
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
APPLICATION IS AN: TYPE OF DWELLING:
Initial ❑ Single Family (SF)
Upgrade Is (w/wo ADU)
Renewal
Duplex (D) ❑
F-1
Multiple Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
of property owner or
agent)
Permit/Rush Fees: S -(o q Waiver Fees:
Date of Payment: / Date of Payment:
Receipt Number: 4;'5-[q { t? Receipt Number:
Permit No. r—�?rj C---- (fl Waiver No.
Permit App_::L.:c
Michael N. Anderson, P.E.
Civil/Structural Engineering & Construction
4640 Shoshoni Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
Feb 10, 2015
Municipality of Anchorage
Department of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Re: Sue Tawn Estates #2 S/D Lot 1 Block 1
To Whom it may concern:
This is a request for a new 5 bedroom septic permit upgrade on the above referenced lot. The lot
is currently services by a failing four bedroom system and the owner is requesting a 5 bedroom
system. From the MOA file the soils consist of GP/GW with water at 5 feet on the north side of
the lot. A new test hole will be excavated prior to the bed installation to verify the soils and the
water table again. Abed system has been designed with an application rate of 0.8 gallon/sf/day.
The slope is semi -flat with a 5 to 10 percent slope running from the east to west. This new system
will not impact the surrounding properties or limit their future development.
If you have any question please call me at 345-3377
Sincerely
Michael Anderson, P.E.
SEED & VEG
DESIGN CRITERIA: MOUND OVER
3:1 SLOPE MIN.
GRADE
5 BDRM X 150 = 750 GPD
SOILS = 750/0.5 = 1500 GPD (TH#1) (THp2) +1.0 44 RIC EROCK 1500 GA/15 = 100' 6'®D 1 IN
1.5 ORG 1.5 ORG _1.5
15.0' MOA FILTER SAND
(2) BEDS � GW/GP GW/GP
+1.0' DEEP
0.5' EFFECTIVE
15.0' WIDE
50' LONG 5 s
ESM SM
12 11 SEPTIC FIELD SECTION
\GREAT LAND ESTATES $3 GREAT LAND ESTATES #'3 —
BLOCK 6, LOT 1 BLOCK 6M LOT 2
—
CREEK ROAD—
Septic Design Prepared for
DALE STEEBY
SUE TAWN ESTATE #2, BLOCK 1, LOT 1
Anchorage, Alaska
Michael N. Anderson, P.E. DATE: 3/17/2015
4601 NATRONA AVE DRAWN: DJR
ANCHORAGE, ALASKA 99516
(907) 345-3377/ FAX: (907) 345-1391 SCALE: 1"=100'
PROPOSED
"'�'
PROPERTY LINE
DRAINAGE FIELD
� I
=
t
EXISTING SEPTIC
EXISTING WELL
i
100' RADIUS
\EXISTING
5
\
\ I
BEDROOM
J i
WELL
HOUSE
\
LI
SUE TAWN ESTATE 12
BLOOK 1, LOT 2
\
I
I
\ \i
APPROX
LOCATION OF i
I I SUE ESTATE B2
----- `F
T&E EASEMENT
BLOCKCK 2 2, TRACT B
�� \��
SUE TAWN ESTATE #2
BLOCK 1, LOT 1
\ �'
\
PROPERTY LINE
1
,'
S1 E TAWN ESTATE #2
\
I
;
BL 1. LOT 7
Septic Design Prepared for
DALE STEEBY
SUE TAWN ESTATE #2, BLOCK 1, LOT 1
Anchorage, Alaska
Michael N. Anderson, P.E. DATE: 3/17/2015
4601 NATRONA AVE DRAWN: DJR
ANCHORAGE, ALASKA 99516
(907) 345-3377/ FAX: (907) 345-1391 SCALE: 1"=100'
PROPERTY LINE - C R E E K R 0 911
Mei �
SECONDARY SYSTEM TO BE CLASS III 5t i�
SYSTEM W/ APPLICATION OF 1.OGPD/SF \\ i
SIZE 15' X 50' IN THE SAME LOCATIONS
NOTE: NO SLOPES > THAN 25% WITH 100' TYP-�
1 -
\ i
i
i
i'
i
r
r
\ it
i
i
1 _
\ G
\ 9 �
\ \O
\ \F\
SUE TAWN ESTATE #2 \ \
BLOCK 2, TRACT B \
\
\ \1
Septic Design Prepared for
DALE STEEBY
WELL
V
EXISTING
GARAGE
SUE TAWN ESTATE #2, BLOCK 1, LOT 1
Anchorage, Alaska
EXISTING
"OUSE
SUE TAWN ESTATE #2
BLOCK 1, LOT 1
Michael N. Anderson, P.E. DATE: 3/17/2015
4601 NATRONA AVE DRAWN: DJR
ANCHORAGE, ALASKA 99516
(907) 345-3377 / FAX: (907) 345-1391 SCALE: 111=50'
OLD LEACH
FIELD TO BE
REMOVED
NEW 1500
GALLON TANK
TYP.
OLD TANK WILL
BE PUMPED
AND CRUSHED
PER THE UPC
�- EXISTING WELL
i
100' RADIUS
i
L9il4
SUE TAWN ESTATE #2
BLOCK 1, LOT 2
SUE TAWN ESTATE #2
BLOCK 1, LOT 7
Performed For:
Legal Description:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchoraae.ak. us
(907) 343-7904
GINEEW SEALY/_ fi?I
*°LF!bi
°
SoilsLog- Percolation Test I-
-/t z L f !1 Date Performed:
`C
0 C' ! etwn S 6 1-4 Township, Range, Section: _
V'E' Slope
I _ r T1 I ' I I—
Depth]
C)U'9j r
3-
4_ ��14 P
5-
1
1
17-
18-
19-
20-L
COMMENTS
7-
1S-
19-
20-
COMMENTS
PA
r ............. ...
MICHAEL N. ANDERSOi««`
CE -9469 <�
Site Plan
Reading
Date
Gross Time
`
WAS GROUND WATER
Net Drop
ENCOUNTERED?
i
T j ef�()y/
IF YES, AT WHAT DEPTH?
Depth to Water After
S
L
d.�.
Monitoring?��f/.V
s� P
E
Date:
'SIII! Jfj
PA
r ............. ...
MICHAEL N. ANDERSOi««`
CE -9469 <�
Site Plan
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
�s
z:3a
M
io,„
(�3
cif
/3
/f
PERCOLATION RATE Z (minuteslinch) PERC HOLE DIAMETER to
TEST RUN BETWEEN t, S FT AND ?r �_ FT
PERFORMED BY: t -A A JA I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 3476!E_
Municipality of Anchorage
Development Services Department
Building Safety Division
.� On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchoraoe ak.us
(907) 343-7904
Soils Log - Percolation Test
i •srLravonvr.c aacM�q�:e': ,...
•.��• e6•..........�
Performed For: Vot 1P, Ci y . Date Performed:
Legal Description: 5 W't hoW #L C, Township, Range, Section: _
L ( a ( SITo,e rte rr�r
Depth
16-
17
18
1
WAS GROUND WATER
(Feet)
ENCOUNTERED?
I-
-2-
IF YES, AT WHAT DEPTH?
S D
2-
Monitoring?
3-
3-4-6-
4-
6-
SM
7-
8-
9-
��
it25'•r
10-
11-
1 -
�Oi�pyrt JI'
13-
16-
17
18
1
WAS GROUND WATER
Date
ENCOUNTERED?
Net Time
IF YES, AT WHAT DEPTH?
S D
Depth to Water After
Monitoring?
Date: 4W
V-.*, . . . . . . . . . . . . . .
ICHAEL N. ANDERSOi:;',�<.
CE -9469
P,1Z../G
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
��
it25'•r
PERCOLATION RATE,
(minuteslinch) PERC HOLE DIAMETER (O
TEST RUN BETWEEN FT AND °L FT
n
PERFORMED BY: M NJ, , I CERTIFY THAT THIS TEST WA
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /
e Municipality of Anchorage Page of Z
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4144
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW 9/03(0(0 PID Number: 051 - //7/ "Z3
Name
i�HFC
Wastewater System: ❑ New Xupgrade
Address:
520 15 347-H, An/CH0&&,E 99503
ABSORPTION FIELD
Phone:
Slvl - / 900
No. of Bedrooms:
TOTAL �t
❑Dee Trench ❑Shallow Trench
p ,Feed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
"�� �-P GPD/Sq. Ft.
40
Lot: Block: Subdivision:
Depth topipe bottomfrom original grade:
Gravel depth beneath pipe
SUE * Z
015 Ft.
Ft.
Township:
Range: /
/ Section:
S
Fill added above original grade:
Gravel length:
/.8 Ft.
.37- Ft.
WELL: ❑ New Ez/SI'Ik 3 Upgrade
'
Gravel depth:
Wf9'✓ H
er
Numboflines:
Distance between lines:
Ft.
/0 Ft.
Classification (Private, A,B,C):
P,eIV416
Total Depth:
Cased To:
Total absorption area:
Pipe material:
Ft.
.��----^'Ft.
/g8 SG. Ft.
45TH 5034
Driller:
D e
Static Water Level:
Installer:
Date installed:
FL
4/X/DCV50,!/ 312,
O/ 92
Yield:
Pump Set at:
I
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
XSeplic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
I
Lift
Holding
PubliclPrivale
Manufacturer:
Capacity In gallons:
From
Tank
Field
Station
Tank
Sewer Lines
. I;_
/2 5 O
Well/00
/Ob
//op
4 r
^�
(o(n5
Material:
TEES
Number of Compartments:
Surface
Water
J/A
"M
A//4
N A
/
A114
LIFT STATION
LotSize
Line
j%
/0,
3 S
in gallons:
Manufacturer:
Foundation
O r
/. / v
A//A
/1/.4
/V A
"Pump on" level at: 'Pum evel at:
High water alarm at:
Curtain
'A114
/' / A
/// Q
n/ A
Pump Make
Electrical Inspections performed by:
Drain&
Remarks:
BENCH MARK
Location and Description:
/1/5 PG/lADL FOR Z ffc ,200/
230 /-1 CK ST it
Cx/jT/n/: ^� ST J' L�ED/200M�
7d 7i L 4 z9,ED20 /-/ -
Assumed Elevation:
/0:7.0
D/�( 5 t.� %a.✓/r Ren,�vrc� u,.rol ye /G�eA
�`xetlt�R'Sa$,i�A6
Inspections performed by: f= oz �0
H�l�/�'E�Dates: is D/
o�RO0V1Y
®e.aOO
2nd 0.112119
`
,3,w zi�/r�9s fRo
�' Louis A. Butero
�® N�•eaa CE-6736
Department of Heal!and Human Services approval
Reviewed and approved by:
acute Orutl Moa ze
Permit No. SW 910366 Page 2 of 2
' Municipality of Anchorage
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
Legal Description: Sue Tawn #2 Lot 1 Blk 1 PID No.: 051-471-23
d`W
SWING -TIES
A - C ='57.5'
}
A - D =
:109.0'
B - C =
_ 51.0'
B -D='•.101.0'
(NOT TO SCALE)
.5' COVER J,
TAMC 91.791,
u.41794.1' 1991 TIELB
72-0I3 A (2/91) MOA 25
249.55
W R
6' X 32' ADDITION
n BO'kp BACK STAIR \
V ASUKB ELEV . 1mv
35 PSI i
ISOLATION 0
il01RAL
oEL
:VEL 1922'
�BVT ears
■4M
TH
EXISTING SEPTIC
\ SYSTEM
SCALE 1' = 60'
_..® ..� _ 1 _. _...........
TH e2
® - TEST HOLE
• - MONITOR TUBE
0 - SEWER CLEANOUT
- WELL
ENQ)NEEIR S SEAL
714
`aK r
__. �. ea.aoe�! a ower•
!7 Amo Louis A. Butera W
�A �n. •. CE -11736
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910366
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:ALASKA HOUSING FINANCE CORP
OWNER ADDRESS:520 E 34 TH
ANCHORAGE, AK 99503
PARCEL ID:05147123
LEGAL DESCRIPTION: SUE TAWN ESTATES #2 BLK 1 LT
1
LOT SIZE: 74239 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 1
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED:11/20/91
EXPIRATION DATE:11/20/92
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED
ISSUED BY:
BY : DATE: /71
DATE:
�� IlQ ° Il�IC�� ��� Il�i1C (0TJUP S(PNTACQIO
Louis Butera, P.E.
Registered Civil Engineer
November 19, 1991
John Smith, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Sue Tawn #2, Lot 1, Block 1
Narrative
Dear Mr. Smith,
The proposed septic upgrade will have very limited impact on adjacent properties for the
following reasons:
1. The area has large lots 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. Surface drainage will not be effected 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.
P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 6945195 • Fax (907) 694-3297
EAGLE RIVER
ENGINEERING SERVICES
P. O. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
JOBSue Tawn #2, Lot 1, Blk 1 91-089
' SHEET NO OF
CALCULATED BY L. B. DATE 11/19/91
CHECKED BY DATE
Existing 3 Bedroom System
Require 4 bedroom total, or l bedroom addition l '
Soil Rating = 2,1 min/inch
61 wide bed ;design with 6" gravel
150 GPD — 188 square feet required additional area
0.81
_.
Bed dimensions = 6' wide x 32' long
._..... ...
1_total depth
_
OF ' `V
P
gl, s�q,
U
,..
d... 4 (n .
4
�! 1 d
..... i..... ,
Cl'•736 ��...
p1�01-�aS10`�1P��p�10
®� c�
PBOGRT AN IM =.� 1rt. Gip.. Mao OEM.
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOT 1, BLOCK 1, SUETAWN tit
A. GENERAL
1. The well and septic plan are 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
and State Department of Environmental Conservation 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 or modified in the
field by the contractor to meet Municipality of Anchorage, Department of
Environmental Conservation 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.
B. TANK
1. Remove and properly dispose of existing septic tank.
2. Replace with 1,250 gallon tank to code.
C. BED
1. The bed is to follow the natural land contour to maintain uniform total depth of
the bed bottom.
2. The bottom of the bed shall be level, plus or minus 1.5".
3. The total depth of the bed excavation is not to exceed V at any point.
4. The effluent line is to be connected into the existing leach line to allow effluent
overflow to the upgrade leachfreld.
5. The bed 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 leachfreld.
7. The area over the bed 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:
TOTAL DEPTH = V GRAVEL DEPTH = 6" below pipe
BED LENGTH = 32' BED WIDTH = 6'
SOIL RATING = 1.2 min/inch BEDROOM CAPACITY = 1 additional, 4 total
SEPTIC TANK SIZE = 1,250 gallons
Leachfield may require imported sand material to install at proper level
Twenty-four (24) hours notice required for all inspections.
----------------
CREEK ROAD
PROPOSED
6' X 32' ADDITION
TU EXISTING �J ® TH
LEACHBTI /�/
1 NEIGHBOR'S WELL
-200'
EXISTING SEPTIC
SYSTEM
EXISTING SEPTIC
TANK TO SE REMOVED
AND REPLACED W/I25D GAL
SEPTIC TANK OUTSIDE WELL
APPROX.
NEIGHBOR'S
SEPTIC
APPROX.
WELL
LOCATION
PROPOSED
REPLACEMENT
AREA (1028 S.P.)
®
— TEST HOLE
•
— MONITOR TUBE
o
— SEWER CLEANOUT
— WELL
SEPTIC SITE PLAN
LEGAL: LOT 1, BLOCK 1, SUE TAWN ADD. 2
OWNER: AHFC
CONTRACTOR: NIA
JOB # 91—D891 DATE: 11/19/911 SCALE 1" = 60'
ui
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX.- (907) 694-3297.
SOILS LOG
c
MUNICIPALITY OF ANCHORAGE
P9PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:_AL.AhKA 14000f2(r(fJWC'F— DATE PERFORMED: Z41 CIL. 91
LEGAL DESCRIPTION: Sul' —TAWN1A
�.__ •/ SLOPE SITE PLAN
VDFP)rV.1 U—' )�
6 �•=C
7
s
10
it
12
13
14
15
16 +
17 is
•� ti
18 �! `c
yE
19
t`t—�iC'�
To b"
WAS GROUND WATER S
ENCOUNTERED? -�•� L
O
,G P
IF YES, AT WHAT
DEPTH?
Reading
OMEN
Gross
Time
Net
Time
Depth to
Water
Boom
SobK
2G �uLyl
■■■�i■■■IGH■
Y P
I
2��u�91
I:oo:�5
to rlitj
3-y a
ME
111111ion
WAS GROUND WATER S
ENCOUNTERED? -�•� L
O
,G P
IF YES, AT WHAT
DEPTH?
Reading
OMEN
Gross
Time
Net
Time
Depth to
Water
Boom
SobK
2G �uLyl
■■■�i■■■IGH■
I
2��u�91
I:oo:�5
to rlitj
3-y a
ME
111111ion
If
■INN
M■■E.011
I/
■liil■■
!1■■■6:i
■■■■iE��J■■EN
■■■■■iii■ONE
0
ON
MEN
■■■■■■■MEN
WAS GROUND WATER S
ENCOUNTERED? -�•� L
O
,G P
IF YES, AT WHAT
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
SobK
2G �uLyl
I
2��u�91
I:oo:�5
to rlitj
3-y a
I
If
li
I/
29 I a
IL JI PERCOLATION RATE 2.1 (minutes/inch)
TEST RUN BETWEEN 2, - -- FT AND 3' y FT
PERFORMED BY: �F J CERTIFIED BY'.2; DATE:
72-008 (6/79)
` - [,% MUNICIPALITY OF ANCHORAGE l ,
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
040 ENVIRONMENTAL ENGINEERING
DIVISION
' 825 LStreet -Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
NAME
PHONE
EW
, e,0 4 %� X L V s�
❑ UPGRADE
MAI LI GADD
l OC
LEGAL DESCRIPTION �
Cs'
� � A;4,
� 4 e
i
- LOCATION .
NO. F Bel Rr7nMS
DISTANCE
Well !;
Absorptar „�
Dwelli (,�[
P M O.
S%j
Uy
n Q
Manufacturer /
lee
No, of co rtments
=5
y
Liq. SagaGityjnellons
G6f�
IF HOMEMADE:
Inside length
Width
Liquid depth
a
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Joz
= Z H
Manufacturer
Material
Liquid capacity in gallons
a
DISTANCETO:
Well
Foundation
Nearest lot line
PERMIT NO.
w=
ul E z
No. of lines
Length ofe c line
Total length of lines
Trench width
Distance between lines
Z w
—
inches
< ¢
Top finish
Material beneath rile
Total effective absorption
�
of rile to grade
area
a
inches
w
Length t,,4 Width / l .
3g !�
Depth j f
"j /rII.SCCtGA7lJ 2 COL)-Lf
M T NO.
PEVV,-516
V .fir/ 6
Type of crib Crib diameter
Crib depth
Total effective bsortgtjn
a
owQ.
w
1°
rn
We /,�
DISTANCE TO: v
Building, u date
Nearest to e -!If—
J
Class` D tr G r,�
Driller
Distance to lot line
PERMIT NO.
J
( �
w
�
DISTANCE TO: Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
Lop
I
SOIL TEST ING
2.,
INSTALLER
o
a-
REMARKS
/./99
U
t
.
fCd
<, a
U
A. St ?
APPRO DATE LEGAL
�/�
- QQqq ��iiyy��q qq�1
f.In'
✓( J
ii d-ry R`J \lFS 0".4
8Y.SA' ZCJ
i-jt
CGr:
0.�.
72Wj�(Rev. 3/781 ` I'Fei`sare•�•,' PH. E71 ..G,:reM
Y G ' d,.; I LJ r -,j n_9 F� F1 PA Ea F' 9--Y0
DEPARTIE,IT ur4.HEALTH AND EdVIRC Ni''iENTAL FFOTECTI=ihd %Wb
-
825 'L.' :STREET, ANCHORAGE.- HF:::.
264-4720 -1
T 74=r _" E; �. va En "_ F" = & tl 117
PERMIT NO. 1 810516
APPLICANT RAYFORD E. BRA ;TON 632E_1 MINK AVE. 694-2566
LOCATION as 99 _.QUARE FEET )-._
LEGAL LOT 1 ELF:: 1 SUE—T BEST. ADD LOT SIZE 9 - a f
TYPE OF SOIL. ABSi_RPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS _ SCOIL RATING <SQ FT/BR)= =:5
V "Z
THE REQUIRED SIZE OF, THE. _,OIL ABSORPTION SYSTEM IS:
_ � 21 C3 F' iF A Er. E_ E> E= F` _FV- l = 04 -
THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRAINFI:ELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION 0N FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE E<:CAVATION <IN FEET).
F: E_ �-® 9_w � F. E_ E -a ^° F_ F` —8 � x_. T &-i ��7 � = - _" � ` E_ _ _� ®_ � e-�e a. -e e:� 1-'! � �_ w�a 9"-•d
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCE= THAT THE WELL WILL SERVE.
I �_Pe: T_" A FEE FEE E 6_ I FE_ Ea
�
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 I'S,
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE. OF PUBLIC WELL.
MINIMUM DI'S•TANCE FROM A PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY _EWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. _•PECIFICATIONS AND CONSTRUCTION DIAGRAM'_ ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
:f== E~ F&I ivy a -7- E=7 KS F° Im F° Eo On Eo E-= (7 E=7 1-1 F; E<F° : �.° � ij E3=
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENT._ FOR ON—SITE SEWERS AND WELLS AS SETT
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
°: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON--'S•ITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
IGNED: � T RFi F 1 -----------
AP=L. OF:G E. E'FaY<ITOtd ��hm�c
ISSUED B'r' DATE �S� _-- V4.0
VL
E oc
P&-) 6-650
ANCHORAGE. A=_J�SI<.;, 1)9502-0650
(907) 26 t-" I 1 ?
lYOR
D@PART:MENT OF JIEALTH AND ENV I RONMENTAF PROTECT. O IJ
<Permit $: 820874
January 31, 1983
TO: Permit Applicant
Subject: Lot 1 Block 1 Sue Tawn Subdivision
A permit issued by this department for an individual well
and/or on-site sewer system has expired as of December 31,
1982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the -
on -site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely
�C.T,�-
Robert C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCY,'ljw
enc: Copy of Permit
SWP/057
MUNICIPALITY OF ANCHORAGE
Department: Health and Environmental Protection
825 Street, Anchorage, AK. A501
264-4720
# # # HANDWRITTEN PERMIT # #
Permit # (�o ocl Lcc
Wfi�=A-;:D/QOR�ON-SITE SEWER PERMIT
Applicant:— ding Address: /„-�p
Location: `(� Phone Number: ;- (/ (Y 3 h
Legal Description: L / 6 )
Type of Soil Absorption System Is:
J a"Tik-, Lot Size:
Trench: 1-�_Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: � Soil Rating(sq.ft/br) b'
The Required Size of the Soil Absorption System Is:'
DEPTH LENGTH GRAVEL DEPTH CZ WIDTH
The length dimension is the length(in feet) of the trench or drainfield. 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 and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE _ / � GALLONS # #
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.
. * * * TWO(Z) INSPECTIONS ARE REQUIRED # # #
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 100 feet
for a private well 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 this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 2 * * *
I certify that:
(l)
I am familiar
with the requirements
for on-site sewers
set forth by
the Municipality
of Anchorage.
(2)
I will install
the system in
accordance with codes.
I understand
that the on-site
sewer system may equire
the re 'd e
is remodeled to
include more tha bedIr
/
Signe
`
Issued by:
Applic t
�
Date: 7/
SWP/024(1/81)
and wells as
enlargement if
oms.
Rayford Braxton
6320 Mink Ave.
Anchorage, AK 99504
Permit # 810736
225 "L" STREET
ANCHORAGE, ALASKA 99501
,907) 2611 4111
f1ORGE1117. suLIIVAN,
dIAYOR
,:IOI -EC i N
January 4, 1982
Sub'ect: Lt 1.Blk 1 Sue Tawn Est. S/D
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 1981.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent to
this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for our
files.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
C5;,4 cs��
Les N. Buchholz R. .
Program Manager
Sewer and Water Program
Enclosure: Copy of Permit
F"°"F FAF T41 1 Ate: 1: 'Fol L_ I ..T x-rx ED F_ 10144 C7 V2 I M FA C3 EE
DEPARTMENT �HEALTH AND ENV IRONME•aTAL-k:OTEC T IOP -I
82 'L.`' 'ETF:EET: � :tom,-l�-t��F:H.' AK. 99501
61 FET IL__ IL.- 0=1141p s CAP -41. — No, L=.I'll E=7Inc F="FoiIV? t1 1 -or
PERMIT NO. K :=10736 )
QetsvGl
APPLICANT RA'TFORD BRAXTON 6320 MINK: Aw
LOCATION ON MT N RD
LEGAL L.T. 1 BLK:. 1 SUE TAWN EST. S/D LOT SIZE 74000 SQUARE FEET
TYPE OF 'OIL ABSORPTION SYSTEM I S : TRENCH
MAXIMUM NUMBER OF BEDROOMS - 4 SOIL RATING (SO FT/BR)= 140
THE REQUIRED SIZE OF THE SOIL. ABSORPTION SYSTEM IS:
^_A L_ E-- rA aC -r 1-4 15- CD Ci FQ FA % E- L_ ILA EZ F° 717 VA _ :� 4..
THE LENGTH DIMENSION I_ THE LENGTH (IN FEET) OF THE TENCH OR DRAINF'IELD.
THE DEPTH OF A TRENCH OR PIT IS. IQ Th CIE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THEM ,-- ON FEET).
THERE i' NO SET WIDTH FOR TRE C:HE�'
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
F_= E� C -F LJ I F._ E= Em "° EO FF -"T"11 A_ _f=1 PA I'=-: TC = E: _-F_ AN My KA C3 FA L_ L_ ED 44"03
PERMIT APPLICANT HAS THE RESPONSIBIL_IT'T 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.
— -- — -'r j °.q P._A'
x_. �, -° ..n I T441 Su to" E07 A_: T- I ED T -"l As F=F M E0
F' T ME 97! F—F
I
FP' E--- Ii --x
BACKFILLING OF
ANY
SYSTEM WITHOUT FINAL INSPECTION AND
APPROVAL
BY
THIS
DEPARTMENT WILL
BE
SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY CAP? --SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 'loci 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 _EWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED ANDMI I T F:�,.,--FETUF:PSE [' TO THE DEPARTMENT WITHIN :Fi DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENT' MAY APDL' . 4 AF EC :I F i CAT I ONS• AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER IP+I'_TALLATION-
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WEL_L.S, AS. SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
: 1 WILL INSTAL (_ THE SYSTEM IN ACCORDANCE WITH THE CODES.
: 1 UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT" IF THE.
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED:=__^ Q
AF'F T R*H:"
OP+I
I'_ _,EIEC; ----------- —DA T E_v4�_�nQ �� V4.0
- XJ SOILS LOG
MUNICIPALITY OF ANCHORAGE
• +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: ze'f L N DATE PERFORMED:/ �l
LEGAL DESCRIPTION: ae
SLOPE SITE PLAN 1
1
EPTH v
En
e)i /l
�L
�
� �
2
Net
Drop
3
4
6
1+ u
1�)O.
.. --
16-
5
�V `.
CGS! _ CSO'Wer 411
b
.1•.
A00 Xyle
7-
18
8 8
r
% ••+�•
19
� e
0 u..
9
�I • j
10
'
11
.S/I/Vo c/ ,I/� T WAS GROUND WATER
ENCOUNTERED?
12
s
✓`
��Z�
IF YES, AT WHAT
DEPTH?
13-
3
Date
Gross
Time
Net
Time
14-
141515
Net
Drop
15-
16-
°
a�F A F
AV,.......
b
.1•.
18
r
% ••+�•
19
:d Robed A. Shafer
No. 1457.E
-f—&T
& f' S
O
P
E e q
12,
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
b
i
20 ,� FqF •e1 .1' 1 X
�h� PERCOLATION RATE
TEST RUN BETWEEN FT AND FT
PERFORMED BY: Snctxneenncl CERTIFIED
72-008 (6/79)
DA
fi
z
z
0
o
Z
0
G
-L
U
Z F -
Ca
to,
C9
coo
0 z
0000
C-')
.00
o
❑
z
Z
fi
z
z
0
o
C9
0000
Z
LL
fi
z
z
0
o
C9
0000
fi
z
z
0
o
0
Z
0
0
pGE
• Municipality of Anchorage =�
On -Site Water and Wastewater Program 4
(907) 343-7904. n
CERTIFICATE OF ON-SITE SYSTEMS APPR ` ALP'" L a 'LU'�k
Gretchen Stuffier
Parcel I.D. 051-471-23 Expiration Date: f�
1. GENERAL INFORMATION Z f R v� 14! y
�
Complete legal description SUE TAWN ESTATES S/D BLOCK 1, LOT 1 J{
Location (site address) 19599 SUE TAWN DR, CHUGIAK, AK
Current Property owner(s) DALE STEEBY Day phone
Mailing address SAME
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Z Single Family (w/wo ADU)
a ✓(/y� w
❑ Duplex
gQ,S
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
��c q7 f,
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ®
Individual
Individual Water Storage ❑
Holding Tank
❑
Community Class Well ❑
Community
❑
Public Water System ❑
Public Sewer
❑
Waiver/Variance request for:
Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ gogq.690
Date of Payment
Receipt Number 4�O2J
COSA#
■ . - MAWA�
Waiver Fee $ _
Date of Payment
Receipt Number
Waiver #
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,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations ih effect at the time of installation.
Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON, PE Date 06/24/15
6. DSD SIGNATURE
System #1 Approved for jr� bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
d
MICNAH h (sNDFRS0Ne
9-b9_
tfpF.
bedrooms, with the following stipulations:
OF
WATER AND
StK, N'iAN'
By: Original Certificate Date:
The ici of rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the re resentations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist # _of _
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
�2
Legal Description: SUE TAVir1V ESTATES S/D BLOCK 1, LOT 1 Parcel ID: 051-471-23
A. WELL DATA
Well type Private
Date completed 1017/1980
Total depth 219 ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID # _
Sanitary seal (Y/N) Y
Cased to 128 ft.
FROM WELL LOG
101711980
68 ft.
2 g.p.m.
WATER SAMPLE RESULTS:
Well Log (Y/N)
Wires properly protected (Y/N) Y
Casing height (above ground) 191NCHES
AT INSPECTION
611212015
ft.
2.2 g.p.m.
Coliform NEG colonies/100 mL Nitrate 2.5 mg/L
Arsenic: ND ug/L Date of sample: 611512015 Collected by: Stuart Gillbert
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC 1 STEEL Date installed 3121/2015
Tank size 1500 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) N
Date of pumping NEW Pumper NEW
C. ABSORPTION FIELD' DATA 1985 SYSTEM TESTED
Date installed 3121/2015 Soil rating (g.p.d.M2 or ff/bdrm) 0.5 System type BED
`33'1x f3
Length 33E3 ':ft. _ Width 15 X 3 ft. Gravel below pipe 0.5 ft.
TotaCdepth Eff. absorption area 1500+ ft2 Monitoring tube Y Depression over field N
Date of adequacy test 'NEW Results (Pass/Fail) NEW For 4 bedrooms
Fluid.depth.in absorptjorf field before test NEW in. Water added NEW gal. New depth _NEW in.
Elapsed Time: NEW min. Final fluid depth NEW in. Absorption rate >= NEW g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes, give date
D. LIFT STATION
Date installed
"Pump oh" level at in.
Datum
Size in gallons Manhole/Access (Y/N)
"Pump off' level at in.High water alarm level at _ in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES.
WELL ON LOT TO:
Septic tank/lift station on lot 1004
Absorption field on lot 1001+
Public sewer main 75'+
Sewer /septic service line 504
Animal containment areas 1001+
SEPTIC/HOLDING TANK ON'LOT TO:
Building foundation 51+ Propertyline 54
On adjacent lots 1004
On adjacent lots 1004
Public sewer manhole/cleanout 1001+
Holding tank NA
Manure/animal excrete storage areas 1001+
Absorption field 51+
Water main 100'+ Water service line 10'+ Surface water 1004
Wells on adjacent lots 1004
ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 101+ Water main 104
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 104
Curtain drain 50'+(None Known) Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
t certify that 1 have determined through held inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name MIKE N. ANDERSON, PE
Date 0612412015
COSA canary sheet 2-6-15.doc
1
r P��•QF At,,
r
* 49T=H *1
... ..........
MICHAEL N. ANDERSON ;
•• Ci% 94
i
4'
lel 0'
#�joo
k
N
h
ee, y8
lee N
ASBUILT-NO CORNERS SET THIS DATE. SEWARD & AS! 4566
1 HEREBY CERTIFY THAT 1 HAVE SURVEYED THE SCALE.
FOLLOWING DESCRIBED PROPERTY: 1"=40' s+ pF 4%TA
Sue Tawn Estate,Addn. No. 2t l Blk. 1 DATE=
.......
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 3-24-92
.► 4` �S o
INDICATED. IT IS THE RESPONSIBILITY OF THE *�%' TH'..•�.,*Sp
OWNER TO DETERMINE' THE EXISTENCE OF ANY GRID= ••• •• ••••• ••••-•®
EASEMENTS, COVENANTS, OR RESTRICTIONS NW 1060 4 0
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: 1! .a • M s.....a •'
thf tAF
ANY DATA HEREON 8E USED FOR CONSTRUCTION 27-16 d �,;_ y,�/�•'y� �
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES. DRAWN=
DMS
i •
d
i
' .
'.
#�joo
k
N
h
ee, y8
lee N
ASBUILT-NO CORNERS SET THIS DATE. SEWARD & AS! 4566
1 HEREBY CERTIFY THAT 1 HAVE SURVEYED THE SCALE.
FOLLOWING DESCRIBED PROPERTY: 1"=40' s+ pF 4%TA
Sue Tawn Estate,Addn. No. 2t l Blk. 1 DATE=
.......
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 3-24-92
.► 4` �S o
INDICATED. IT IS THE RESPONSIBILITY OF THE *�%' TH'..•�.,*Sp
OWNER TO DETERMINE' THE EXISTENCE OF ANY GRID= ••• •• ••••• ••••-•®
EASEMENTS, COVENANTS, OR RESTRICTIONS NW 1060 4 0
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: 1! .a • M s.....a •'
thf tAF
ANY DATA HEREON 8E USED FOR CONSTRUCTION 27-16 d �,;_ y,�/�•'y� �
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES. DRAWN=
DMS
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. #051-471-23-000
1. GENERAL INFORMATION
Complete legal description
HAA# Q2)'14�',LLiIr",
t a_' ,1. �-,3
Lot 1, Block 1, Sue Tawn'k#2
Location (site address or directions) 19519 Sue Tawn Drive
Property owner Matt and Melissa Hickey Day phone 694-2699
Mailing address
19519 Sue Tawn Drive
Lendingagency Northland (Trish Kastner) Day phone 694-7872
Mailing address 11421 Old Glenn, Eagle River, Ak. 99577
Agent C. Rolf Milton, Jack White Co. Dayphone _694-5500
Address 11823 Old Glenn Highway , Eagle River, Alaska 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well _ X
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rw. 1191) From MOA 921
5.
C�
0
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 forthe number of bedrooms
and type of structure indicated herein. I furtherverify 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 ���T�G2titl t Phone `o1 0
Address
Engineer's signature
DHHS SIGNATURE
X Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date �—
bedrooms, with the following stipulations:
Date Z12–/9—F-
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.
72-025 (Fay. 1N1) Back MOA e21
ro
Legal Description:
A. WELL DATA
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist o
Lot 1, Block 1, Sue Tawn #pa 051-471-23-0� -A
rcel I.D.: Q�
O
Well type i n d i v i d u a IfA, B, or -C, attach ADEC letter. ADEC water system number l C1% V0
Log present (YIN) Y Date completed 10-16-81 ^
Total depth 219' Cased to 128' Casing height (above ground) 22"
n
Sanitary seal (Y/N) Y
Date of test
Static water level
Well production
FROM WELL LOG
10-16-81
120'
9
WATER SAMPLE RESULTS:
Coliform -0- Nitrate
Date of sample: 5 0 c t 95
Wires properly protected (Y/N) Y
AT INSPECTION
10-10-95
68.3' Below Top of Casing
g.p.m. 2
1
Collected by:
Other bacteria
Stuart Gilbert
g.p.m.
B. SEPTIC/HOLDING TANK DATA
-21-92 7 -As
Date installed 44--l- — Tank size -10') 9- Number of Compartments 2 Cleauouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression (YIN) N High water alarm (YIN) N
Date of Pumping 14 O c t 9 5 pumper J. R.
C. ABSORPTION FIELD DATA
✓ -2/-g2
Date installed 10-15-83 Soil rating (g.p.d./ft'orfr`/bdrm) 85 System type bed
32 6 6, °'
Length 38' Width --12' Gravel thickness below pipe 12 n Total depth 24"
to
Effective absorption area 44 s 4 . NlotSitoring Tube present(Y/N) Y Depression over field (YIN) N
Date of adequacy test 10-10-95 Results (Pass/Fail) Pass For B e d r o ombsedrooms
Fluid depth in absorption field before test (m.); dry Immediately after7 0 gal. water added (in.): -dry-,
Fluid
ry-
Fluid depth D jy (ins.) Minutes later: 5 Absorption rate = GT 600 g,p,d,
Peroxide treatment (past 12 months) (Y/N) No evidence If yes, give date
D. LIFT STATION
Date installed None
Manhole/Access (YIN)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
"Pump off' level at*
Septic/holding tank on lot 100' to C . 0 . ; On adjacent lots GT 150'
Absorption field on lot GT 105' ; On adjacent lots GT 150'
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 65'
Lift station N / A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 49' Property line GT 80' Absorption field GT
Water mainlservice line GT 60 Surface watcddrainagc GT 150 'Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation _ GT 60'
Surface water GT 150'
Water main/service line GT 60'
0
GT 150'
Driveway, parking/vehicle storage area GT 100'
Curtain drain no evidenvice Wells on adjacent lots GT 1.50'
F. ENGINEER'S CERTIFICATION
Property line_ GT 40'
I certify that I have determined thru field inspections and review of Municipal recol t Vih ,C` A4ns are
in con%rmAii,ith I H.IA guidelines in effect on this date.66Signature * . 4.9 TH / t 1,Engineer'�• • •1
/p�• UOUAS T. I(t:NLEY ,<: r
DateG�� T`��'1S �1�'Jj,• CE6176
HAA Fee $ j),
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
ME Environmental Services Inc.
-Ak Laboratory Division v� ��.�®�wa���g�a•�ar���'s���e�®®®.�s�rs�e�e
CT&E Rtt.# 95.44"-1 Laboratory Analysis Report
Matrix WATER
Client Sample ID 1/1 SUE TAWN EST k2
C-1 Lent Name SU TECHNICAL WORK Order 18749
ordered By STUARD GELBERT Printed Data 10/13/95 1) 09:17 his,
Prolecc Name Collected Date 10/09/95 % 1o:00 hro.
Projeetd Received Date 10/09/95 t& 12:00 hre.
PWSID UA
Technical Director STEPHEN C. EDE
Released By
Sample Remarks: SAMPLE COLLECTED BY:T.5TUART.
QC
Allowab2e Ext.
Anal
parameter Results Qual
Unita
--'--
McLhod
-- —-------
Limits Date
--------
Date
Init
rnto-N 3.59
mg/L
EPA 3$3.2
—--------- ....................
10.
10/11/95
CMR -
v .... ......
A.. .,
..................._,........~•^•.........v..a«aP==i...... •.....
SeaSpacf.strutLiona.Unavailable
++ qee Sample Remarks Above NA - Not Analyzed
p Undetaoted, Reported value is the pvaetical gaahriricatiou lim.tt. LT . Legs Than
j,. Secondary dilution GT - Greater Than
200 W. Potter Drive Anchorage, AK 99518.1605 — Tel: (907) 562-2343 fax: (907) 561-5301
ENVIRONk:VNTAI- FACILITIES L. ALASKA, (CALIFORNIA FLORIDA, ILLINOIS. MARYLAND, MICHIGAN, MISSOURI, NEN• JERSEY, )HIO, WEST VIRGINIA
cis X69 'UFJ T'–;0T 95/2 T:: 0 T
]2-025(Rev.1/91) Front MOAN21
Ij
Date
i.
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.
72-025 (Ra, 1M) Back MOA N21
Muhcipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 51)r 7A10/�/ *2 LOT !3/K / Parcel I.D. 05/"
/5/,/ /3/141 $EGTiDN /5
A. WELL DATA
Well type ��/y/>T�
If A, B, or C, attach ADEC letter. ADEC water system number NYS
Y&
5 Date completed /01/014' / Driller -TAy 102LMAI
S
Log present (Y/N)
Total depth 2/9
Casedto /Z9 Casing height
Sanitary seal (Y/N)
Y65 Wires properly protected (Y/N) y� 5
FROM WELL LOG AT INSPECTION
z
/�� gl 0411�192
x
oz
Date of test
Static water level
2
P"
Z7
m v
D
9'0
r1n
N
Well flow
g.p.m. 9 -P.M.
o
0
Pump level
2 / ori �� v i
F7`I
,`'
<
y =Z
®
00
SEPARATION DISTANCES FROM WELL TO:
y G)
C)
Septic/ding tank on lot
kid
ia o ; On adjacent lots ��°°
z
Absorption field on lot
his / ; On adjacent lots fiat/
Public sewer main
NZA Public sewer manhole/cleanout
0, pfibn sewer service line
6� Petroleum tank �' osdP«P ✓�
WATER SAMPLE RESULTS:
Coliform 0 Nitrate �/ Other bacteria d
Date of sample: 04,//5 92 Collected by: Ir- N6/NEC b
B. SEPTIC/14GVDMG TANK DATA
Date installed D//2219Z Tank size
/250
Compartments
Cleanouts (Y/N) X`65 Foundation cleanout (Y/N) i Depression (Y/N) ^�
N�A Alarm tested Y/N N1A
High water alarm (Y/N) ( )
Date of pumping ,vew T" Z"
SEPARATION DISTANCES FROM SEPTIC/HeIL-EHNG TANK TO:
Well(s)onlot 1'412 On adjacent lots -/-/ Foundation Soy
To property line 3.)Absorptionfield5-1
Surface water/drainage
Water main/service Ii
72-026 (Re, 3/91)Front MOA 21 - CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) — "Pump on" level at
High water alarm level A
Meets MOA electrical codes (Y/
Manufacturer
Manhole/Access
SEPARATION DIST7 CE FROM LIFT STATION TO:
Well
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off" level at
Cycles tested
Surface water _
h 1 CPO
Date installed O�Lgll92 Soil rating X5 6 •''System type A
/
Length S2 / Width /Z/ Gravel thickness 6 Total depth 3
Total absorption area 4 5(0 10 X38 O� Cleanouts present (Y/N) %f S
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 montl,$) (Y/N)
Date of adequacy test 0yz-
for
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 115- On adjacent lots
To building foundation 61
On adjacent lots yj� Cutbank
Surface water
Curtain drainWA0 C /IPA4e-6s/ �
E. ENGINEER'S CERTIFICATION
f/av �
bedrooms
If yes, give date n//A
--Property line 1157
To existing or abandoned system on lot -/4
N/4
Water main/service li
Driveway, parking/vehicle storage area -
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the°datp of this inspection.
Signature
Engineer's Name
Date
HAA Fee $
r1. / T
Date of Payment
Receipt Number 2-34-2-V6700
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
APR 20 '92 09:42 NORTHERN TESTING, ANCHORAGE
P.1/2
NORTHERN TESTING LABORATORIES, INC.
33$0 INDUSTRIA. AVENUE FAIRBANKS, ALASKA 99701 (907) 456.3116 • FAX 456.3125
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277.8378 • FAX 74.9645
Eagle River Engineering
Report Date: 04/20/92
p.o. Box 773294
Date Arrived: 04/16/92
Eagle River AX 99577
Date sampled: 04/15/92
Time Sampleds 1645
Attn: Louie Butera
Collected By: JB
MDL = Method Detection
Limit
Flag Definitions
Our Lab: A116950
B = Below Regulatory Min.
Location/project: -
M = Above Regulatory Max.
Your Sample ID: Sue Tawn 02 1/1
E = Below Detection Limit
Sample Matrix: Water
Estimated Value
Comments:
Date
Method Parameter
Unite Result Flag MDL Analyzed
----'---------------------------------------------------------------------------------
EPA 353.3 Nitrate -N
mg/1 0.8 0.1 04/16/92.
r1
Slerorted By:
Microbiology
MUNICIPALITY OF ANCHORAGE
• Department of Health &Human Services
DIVISION OF ENVIRONMENTAL SERVICES M--
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel 1. D. # nLSl — x-111 — Q HAA # 4A P\9 � C_)cn Lo
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 1; Mock 1; Sue Tawn Ezt teh Subdivision #2
Location (address or directions)
19519 Sue Tawn Dni,ve, Chug.iak, AtAuka
(b) Property owner. _eu_ �,_, C 41111983 Telephone: (home) Business
W.A.#89814
Mailing Address
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent GREATLAND REALTY Attn:
Telephone 694-9125
(e) Mail the HAA to the following address: (or check here#, if hold for pick up.)
List contact person and day phone number below:
C R C FNGINceolNG
17034 Eagle River Loop Road No. 204
2. TYPE OF RESIDENCE
Single-FamilyKk Number of bedrooms 3
3. WATER SUPPLY
Individual Well OX 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 Q( 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
5. 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 b w b "'� 1ia-�F211JG Telephone 6!2�-
4 Eagle River Loop Road No. 204
Address Emile River, Alaska 99577
Date J — /2-
`I
.+1'� .....moi.
_
DHHS APPROVAL
Approved for 3 bedrooms b Date R �91
Approvedy Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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.
72-025 (floe. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA) `fid
1 Health Authority Approval (HAA)
0�SNCHECKLIST -FEBRUARY 1984
343-4744
Legal Description:
A. WELL DATA _II'
Well Classification -r v Jb,a 0 A L_ If A, B, C, D.E.C. Approved (Y/N)
Well Log PresentON) Date Completed \0-\L- 16\ Yield 2.5 1-%f>r1
Total DepthtiAI�'' Cased to \7—g' Depth of Grouting
Static Water Level L -:>
Casing Height Above Ground 1Z�
Electrical Wiring in Conduit (Y)N)
Pump Set At
Sanitary Seal on Casing(ZN)
Depression Around Wellhead (Yo
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot \ paC k" ; On Adjoining Lots
To Nearest Edge of Absorption Field
�o1/n-Lot �� 00` ; On Adjoining Lots \t tnl',-
To Nearest Public Sewer Line r. j�A To Nearest Public Sewer Cleanout/Manhole r4'A
To Nearest Sewer Service Line on Lot
Water Sample Collected by Date
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Size \bt(p No. of Compartments Z
Standpipes O/N) \1 Air -tight CapsON) Foundation Cleanout&y N) -4
Depression over Tank (YA! r4 Date Last Pumped t
Pumping/Maintenance Contact on File (Y/N), \/ for --
Holding Tank High -Water Alarm (Y/N) � Temporary Holding Tank Permit (Y/N) —
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK.,
To Water -Supply Well laa `'` To Building Foundation 50` }
To Property Line 10 "r To Disposal Field 5 ��
To Water Main/Service Line \
To Stream, Pond, Lake or Major Drainage Course lobe
Comments p�M��� 3� t � � C`sasPC> F�JHP )'4L -A
72-026 (Rev. ]/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata OQ/3V Type of System Design 3«
Date Installed \5-83 Length of Field
F _
Width of Field
Depth of Field
�1 Gravel Bed Thickness C11 -;>
Square Feet of Absortion Area Statndpipes Present/N)
Depression over Field (YOI Date of Last Adequacy Test
Results of Last Adequacy Test C_v " FDR—
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well I cxt> Fr To Property Line \O
To Building Foundation `5Dk r To Existing or Abandoned System on
Lot "),5� On Adjoining Lots
To Water Main/Service Line 1 0 % To Cutback (if present) `-A
To Stream, Pond, Lake, or Major Drainage Course o o kt
To Driveway, Parking Area, or Vehicle Storage Area `I45 +-
Comments t -C D\.Y51;
D. LIFT STATION
Date Installed
Size inn �a14 s
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electodes (Y/N)
Dimensions
Manhole/Access (Y/N)
*'Check Permitted Bedroom Rating Against HAA Request"
Vent(Y/N)
Pumping Cycles during Adequacy Test.
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on
inspection.
t i r �?57�IL"'t;adEi
Signed
Company ! r)I�Elvct L`laslca ?)`J'.i7:/ r.c
Date 3 - ('2 -
MOA
2 -
MOA No.
i
Receipt No.
Date of Payment
Amount: $
Receipt No
Waiver Fee: $
Date of Payment
72-026 (Rev. ]/88) Back Page 2 of 2
FF
3i eer's Seai
CHEMICAL & GEOLOGICAL ,LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING
6633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 5G2 2343 FAX: (907) 561-5301
ANALTSIS REPORT RT SAMPLE for WORKorderk 32459
Date Report Printod: MAR 12 91 4 07:39
Client Sample ID:LS Al SOL TARN RST 32
FWSID :UA
Collected MAR 7 91 i 16:00 his.
Reatired MAR S 91 4 12:45 hit.
P19e61red with AS REQUIRED
Client Now :S 11 9 ENGINEERING
Client Aoat .SNSENGP
EPO i PO f NONE RECEIVED
Req f
Ordered E7 A. SKATER
Analysis Completed :MAR S 91 Send Ropotte to:
Laboratory Supervisor :SILPNEN C. LDL 09 & S ENGINEERING
Roleesed By !q" L, 2)
(............................................................................................
Chonlob Rof 9: 910837 Lob Smpl ID: 1 Metrix: WATER
Pstemetet Totted
NITRATE -N
Sample ROUTINE SAMPLE COLLECTED 81: RAT
Asmarks:
Result Un1ts Method
------------------------- --- -
1.5 mg/I EPA 359.2
Allowable
Limits
10
............................n....................................... .-............. I ..........................
1 Tests Potfatmod Sea Special Imstructione Abovo UA-Unersilable
ND- Mons Detected •' See Sample Semerks Above
NA- Not Analyzed LT -Less Than, GT-Gtaeter Than
Time
APPLIC FILLS
OUT UPPER HAI.1®NLY
SNIT
Property Owner ��
1S , -f •, ., ;'�,
Phone
Mailing,Address
�.,,,., �,. ;, \
;{',,; Zip Code
Date hh_
Buyer
Inspector
Address
Inspector
Zip Code
Lending Institution
,. �. , ill .. j
-.,_ i�
Phone
Address > � , t\
... ,7.. . L - ._ - _ ,....
,. J ;- i Zip Code
LT J
Realty Co. ,& Agent
_ -
Phone
Address
O T /Ud
Zip Code
Legal Description
Street Location .. ..
._ _ ,,.(.. (... tr: t
•-. :.,-... --�
Type of Residence
Single Family
RECEN ED
❑ Multiple Family
No. of Bedrooms -�
❑ Other
CONDITIONS OF APPROVAL
( ) DISAPPROVED
Water Supply
5�L' Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑ Community
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
BY:
S
Sewer Disposal
-
Individual
Well To Absorption
Year Individual Installed: J
Public Utility
Received
When Connected to Public Utility:
❑ Holding Tank
�!� - (s U
-
Well to Tan
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
T'e
(7, 36
Date
Date
Date
Date hh_
Inspector
Inspector
Inspector
Inspector
LT J
Field Notes:
(� (L �y-Q�x Coxc'I- r
MUNICIPALITY OF ANCHORAGE
O T /Ud
r l� LAr� CEPT. OF HFi!_i-.
ENVIRO\�.4Ci�TAL P6.OTECTION
RECEN ED
3) APPROVED BEDROOMS
CONDITIONS OF APPROVAL
( ) DISAPPROVED
� fes, C7�
( ) 0NDITIONAiAPPROVAL*
'� 1 7'
DATE CS
BY:
S
Soils Rating
Date Sewer Installed
Well To Absorption
AreaWellLog
�LLk
Received
Septic Tank Size O 6 CT
✓
�!� - (s U
-
Well to Tan
'Roza lXffiI -- J 1 -
G� � fY l
/(�
December 16, 1983
Rayford B. Braxton
6320 Mink avenue
Anchorage, AY. 99504
Subjects Lot 1, Block 1, Sue Town, Estates, 12
Approval for the individual sewer and water facilities cannot
be granted until the following items have: been completed:
>M 'i'he water facilities were not turned on at the time of the
scheduled inspection, please call this office for another
�appointrient.
Expose the well for our inspection to determine proper
MY construction, also to insure minimum distance requirements
are beet between the well and sewer system.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264--4720,
Sincerely,
Cory Willis, R.S.
Acting Sewer & Water
Program Manager
3 ► -'8
< <�
tdac".