HomeMy WebLinkAboutPETERS GATE BLK 1 LT 16Onsite File
Peters Gate
Block 1
Lot 16
#051-541-01
Prior to future COSA approval, a letter
of non-objection shall be obtained from
MEA for bed located in easement –
5/10/21
2024 — 004437 — 0
Recording District 301 Anchorage cc
02/23/2024 09:11 AM Page 1 of 2
�II � I II IIIIIIII�I I I IIIIIIIIIIII I�I�IIIIIIII II I I IIIIIII� II IIIIIIII III II IIII
MATANUSKA ELECTRIC ASSOCIATION, INC.
LETTER OF NON -OBJECTION
Date: February 22, 2024
Anthony R. DeGange & Emily M. Davies
P.O. Box 671264
Chugiak, AK 99567-1264
Re: Letter of Non -objection for septic pipes located within the 30' MEA powerline easement on Lot 16, Block
1, Peters Gate Subdivision, Township 15 N, Range 1 W, Section 11, S.M., Anchorage Recording District
Dear Anthony R. DeGange & Emily M. Davies,
MEA has no objection to the septic pipes encroaching upon the 30' MEA powerline easement, within Lot
16, Block 1, Peters Gate Subdivision, Plat 74-146, Township 15 N, Range 1 W, Section 11, S.M., as
shown in the drawing dated November 4, 2021, on page 2, and subject to the following conditions:
1. The improvement will in no way restrict or limit the current or future ability of MEA to fully enjoy the
benefits of the easement for any and all utility purposes that it presently enjoys under the easement.
2. MEA will be held harmless by the landowner from liability for any and all damages or injury to any
person or property that may result from the existing and future use of the easement by MEA, its
contractors, or assigns.
3. MEA will be held harmless by the landowner for any and all liability arising out of or relating to any use
of the easement by others under a Letter of Non -Objection.
4. The landowner will be liable for any damages caused to MEA facilities by the improvement in the
easement.
5. The landowner will be responsible for any special construction costs incurred by MEA due to the
improvement in the easement.
6. The landowner will assure compliance with all applicable safety codes relating to the improvement in
the easement.
7. Use of this letter by the landowner, their successors or assigns will constitute acceptance of these
conditions.
8. Alteration of these conditions shall invalidate this letter.
9. This letter is not effective unless it is recorded in the Anchorage Recording District before ownership of
the referenced property is changed from the above -named landowner.
Sincerely,
Sarah Brandt,
Land Services Manager
STATE OF ALASKA) SS -
THIS IS TO CERTIFY that on this22'i`day of �Q�c�� 2024, before me, the undersigned, a
Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared
Sarah Brandt, Land Services Manager, Known to me and to me known to be the individual(s) named in
and who executed the foregoing instrument and acknowledged to me that he/she/they signed and sealed
the same as a voluntary act and deed for the uses and purposes therein mentioned.
tNotary
S `^ y E EOF, I have hereunto set my h n y icial seal 4f VINnd y r first above written
VV1� - $m.T l A
\\\\ Notary Public
Mmrt M. LpP¢t Jt.
My Comm. $xplres OU. 21, soa5
i anAI ska My commission expires
MATANUSKA ELECTRIC ASSOCIATION, INC. • P.O. Box 2929 • Palmer, Alaska 99645 • t 907.745.9300 • 1907.761.9368 • www.mea.coop
I
Lot 15 _
i7'45"E 24069' \
n
PECK � z26-4'.
Lot 16 i
4%825 S.F. I SEE Rot
- 4` GRAV`FI. DRIVEWAY "--
HOUSE DETAIL
Scales 1"=20'
Lang & Associates, inic (907)522-6476 Pita
(907) 522-462Faj
Professional Land Surveyors ken41angsurvsylom
I hereby certify that I havesurveyed the .following described. property:
LOT 16. BLOCK 1,, PETERS GATE SUBDIVISION (PLAT No. 74-146)
Anchorage Recording.: District. Alaska, and that the Improvements situated thereon are
within the property lines and do not encroachonto the property adjacentthereto, that
no Improvements on the property tying adjacent thereto encroach an the. surveyed
premises and thatthere am no roadways, transmimfon lines or other Visible
easements on said property except as Indicated hereon.
Dated this. the A-Tl" Day of . No Qm ?n 15F Zot.f at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictionswhich do not appear on the recorded subdivision plat.
el
e r—Hi E
30' MEA
EASEMENT
(Doc. No.
1984-074336-0)
10' UTILITY
EASEMENT
AECC963
Return to: MEA, PO Box 2929, Palmer, AK 99645
CT ID# 1901143
MEA EASE# _20240089
MATANUSKA ELECTRIC ASSOCIATION, INC. - P.O. Box 2929 • Palmer, Alaska 99645 • 1907.745.9300 ^ f 907.761.9368 • www.mea.coop
ULI'JIB'Illllllllll!`�!�I!IIIII'lll�ll'illll�:��!!�I'�Ilf�l�l�[IIGIIII'��II�
Page 2 of 2
301 -2024- 004437 - 0
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211056 PID Number: 051-541-01
Dwelling: Q Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade
Name
TONY DEGANGE AND EMILY DAVIES
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
25141 Sierra Mesa Cir Chugiak
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
3
0.8 GPD/SF
JTotal
2.6 - 3.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.6-2.0 Ft.
Gravel depth beneath pipe
1 Ft.
Subdivision Block Lot
PETERS GATE 1 16
Fill added above original grade
2.1 -2.7 Ft.
Gravel length
49' + 49' = 98 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
564 Ft2
2
6 Ft.
Well
>100'
>1 00'
NA
NA
TANK®Q Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1000 Gal.
Surface Water
>100'
>1 00'
NA
NA
Material
Number of compartments
Lot Line
>10'
>10'
NA
NA
NA
plastic
2
Foundation
>1 0'
> 0'
NA
NA
LLFT STATION
Manufac tree
Capacity
Gal.
Remarks 2" INSULATION OVER TANK
Alarm location
Elec ' 'stalled by
PIPE MATERIAL House to tank 3034Tank to 3034
drainfield
Installer
JRs Septic
Drainfield 3034 CO/MT 3034
Inspector Curtis Townsend
BENCH MARK (Assumed elevation) 100 ft
Inspection15r 10/13/2021 10/18/2021
Location and description
2nd
DOOR THRESHOLD OF SHED
Std 10/30/2 4r,,
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
�,�p�•''� �• :�`�'f'���
ym.. ...........00b*
... ,
Curtis L. T wnse d
-Q Dzte � • 1 � � Z�o�. rad
k�Fcsj No.cE719
FyF� • ... - `o
����PROFE�����
Septic SystemSSO
Approved __-- — Date 1h11,20,2-*_
Note: this approval does not include well permit requirements.
tnev un/uu.! o/
W THERE ARE NO STEEP SLOPES
Cj WITHIN 50' OF THE PROPOSED
Q� TANK.
U
W LOT 15 IS VACANT LAND, NO
WELL OR SEPTIC
Q
I�
SCOPE OF WORK
1. REMOVED EXISTING SEPTIC TANK.
2. PLACED NEW 1,000 GALLON TWO-COMPARTMENT
SEPTIC TANK AND TIED INTO EXISTING
ABSORPTION SYSTEM AND NEW ONE. ENSURED
NEW TANK WAS OUTSIDE THE 100' WELL RADIUS
AND 5' AWAY FROM EXISTING FIELD. TANK WAS
PROVIDED WITH A MINIMUM 20" DIA RISER
SERVING THE FIRST COMPARTMENT.
3. SOIL WAS MOUNDED OVER TRENCHES TO
PROVIDE MINIMUM OF 3' OF COVER.
4. ALL CONSTRUCTION WAS IN ACCORDANCE WITH
ALL REQUIREMENTS SPECIFIED IN ANCHORAGE
MUNICIPAL CODE CHAPTERS 15.55 AND 15.65.
I \
DESIGN PARAMETERS
BEDROOM: 3 (450 GPD)
SOIL PERCOLATION RATE: 7 mpi
APPLICATION RATE: 0.8 GPD/sf
AREA REQUIRED: 564 SF
SYSTEM TYPE: SHALLOW TRENCH
98'x 5' x 12" EFFECTIVE DEPTH
YIELDS 564 sf
MAXIMUM DEPTH OF EXCAVATION
WAS < 36"
/Ell
100' —
3 BR
HOME
GIS EL DRIVEWAY
C06 -; T6
C07 tifT = A
NEW 98' x 5' x 12"
\ EFFECTIVE DEPTH SHALLOW
TRENCH, BROKEN UP INTO TH
(2) LENGTHS OF 49'
\ A
LOT 6 SLOPE 58%
LOT 9
NEIGHBORING SEPTIC \
IS > 10' FROM
PROPERTY LINE
#2
GAR
TH #1
z C
w
zw C
z Q c1
w w
w
Cn
QJ
w
w D
x� o
lJ_I CO
—"�DI ERTER V.
I
BM
EXISTING 36' x 32'
x 6" EFFECTIVE
DEPTH BED
VSLCPE 3%
MT, TYP
Septic Record Drawing Prepared for 1
tt
TONY DEGANGE AND EMILY DAVIES114
. `P�� OF,...,��♦#
25141 Sierra Mesa Cir Chugiak, Alaska 99567�,.�''� �''!��
PETERS GATE BLOCK 1 LOT 16AW
9TH
OSP211056 CHANGE ORDER %........... 00
....
o.....�...,L ..............................0
EKLUTNA ENGINEERING, LLC DATE: 1/18/2022 08,?,CURTIS TOWNSEND: _•
19162 MOUNTAIN ROAD DRAWN: CLT
0,0.. a. X94�
CHUGIAK, ALASKA 99567 = �jC'Co���"•'•,� . .i
(907) 406-1058 PDA 5.1-541-01 SHEET 2 OF 3 ,,11�������••
MARK
A
B
SVI
49'-7'
26'-11'
SV2
45'-2'
22'-5'
DCO
43'-11'
20'-11'
DIV
VAL VE
42'-1'
19'-1
SV
35'-5'
46'-1'
C051UT5
47'-6`
61'-4'
C06/MT6
89'-2'
107'-7'
C07/MT7
87'-5'
108'-11'
C08/MT8
40'-11'
60'-5'
Lu
C05/6
J
W
0 o
J (V
U ,
90
Z
U N
Y
H
H O
2" INSULATION
OVER TANK
Septic Record Drawing Prepared for ....""�,',
TONY DEGANGE AND EMILY DAVIES .��P�E.OF q��s4,�♦♦
25141 Sierra Mesa Cir Chugiak, Alaska 99567 ' �' TH #
PETERS GATE BLOCK 1 LOT 16 ;
• 49—
OSP211056 CHANGE ORDER �..•..;:.""'"""�""""
EKLUTNA ENGINEERING LLC ���•�•••��•••��•••
DATE: 1/18/2022 j CURTIS TOWNSEND:'�
19162 MOUNTAIN ROAD DRAWN: CLT ♦♦j ,No. C1 904=CHUGIAK, ALASKA 99567.�SCALE: 1" = 10'
(907) 406 1058 PID: 051-541-01 SHEET 3 OF 3 Llk
C05/6
MT5/6
C07/8
MT7/8
0 - 105.4
OG
102.8 - 103.3
9 - 103.0
OG 100.2 - 100.6
EXISTING GROUND IS
101.7 .3
APPROXIMATELY 22% SLOPE 2.5'
ORG
TH#2 PERC
46% SLOPE
7.3 mpi
SM
92.7
NO GROUNDWATER
27'
IN JUNE
EXISTING GROUND IS
APPROXIMATELY 58% SLOPE
35'
PROFILE VIEW A—A
1. EXISTING GROUND ALONG THIS PROFILE LINE IS APPROXIMATELY 22%. THE
SLOPE DOWN GRADIENT OF THE SEPTIC TRENCHES WAS NOT DISTURBED.
ALL EXISTING VEGETATION ON IT WAS LEFT IN PLACE TO MEET 15.65.210
B.4.a.iii
2. SOILS IN THIS AREA HAVE A PERCOLATION RATE OF 7 MPI.
3. AN IMAGINARY LINE DRAWN AT 46% SLOPE, 2.5' ABOVE INVERT OF
DISTRIBUTION PIPE DOES NOT INTERSECT SLOPE OF EXISTING GROUND
FOR AT LEAST 35'.
4. THE EXISTING BED HAS BEEN IN PLACE FOR 37 YEARS. NO WASTEWATER
EFFLUENT HAS DAYLIGHTED DOWN GRADIENT. FOR THESE REASONS, A
WAIVER WAS REQUESTED AS THIS FIELD DOES NOT MEET THE STEEP
SLOPE PROVISIONS.
Septic Record Drawing Prepared for ....""�,',
TONY DEGANGE AND EMILY DAVIES .��P�E.OF q��s4,�♦♦
25141 Sierra Mesa Cir Chugiak, Alaska 99567 ' �' TH #
PETERS GATE BLOCK 1 LOT 16 ;
• 49—
OSP211056 CHANGE ORDER �..•..;:.""'"""�""""
EKLUTNA ENGINEERING LLC ���•�•••��•••��•••
DATE: 1/18/2022 j CURTIS TOWNSEND:'�
19162 MOUNTAIN ROAD DRAWN: CLT ♦♦j ,No. C1 904=CHUGIAK, ALASKA 99567.�SCALE: 1" = 10'
(907) 406 1058 PID: 051-541-01 SHEET 3 OF 3 Llk
i
I
Lot 15
� I I
/ 12.3'x16.3' SHED
�/ 6.0' DECK
Lot 16
49,825 S.F. I SEE H01.
DETAIL
HOUSE DETAIL
Scale: 1"=20'
DRIVEWAY
12.2'x16.2'
SHED
12.2'x20.0'
GREENHOUSE
l�
._`26.4'
WELL
I N
� z
SEPTIC C
PIPES i MANHOLE Q
I 6.6'x12.2'
GREENHOUSE E5
O
�I I
a)
mO
30' MEA
EASEMENT
(Doc. No.
1984-074336-0)
10' UTILITY
EASEMENT
DECK �
a
PLOT PLAN ___ AS BUILT _X_ SCALE 1" =50__ GRID __NW 1262__ Project No.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates inc. (907) 522-6476 Phone 0000� O
(907) 522-4625 Fax o00 Q
Professional Land Surveyors kenOlangsurvey.com o 9
0 A. �p
lonathanOlangsurvey.com O . ON
I hereby certify that I have surveyed the following described property:
LOT 16, BLOCK 1, PETERS GATE SUBDIVISION (PLAT No. 74-146)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on sold property except as indicated hereon.
Dated this the Day of Nv�/sw,�'Z6�� —_, _��_Z�_, at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
49TH
KENN H. ........U+n
�pp�PFd'
LS -520
04� OFfSSIONA� �o
AECC963
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: OSP211056
Work Type: Septic Upgrade
Tax Code Number: 05154101000
Site Legal Address: PETERS GATE BLK 1 LT 16 G:1262
Site Mailing Address: 25141 SIERRA MESA CIR, Chugiak
Owner: DEGANGE ANTHONY R &
Design Engineer: EKLUTNA ENGINEERING, LLC*
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
nye n t _ �,
G ��
f�
4 �
llepartiiserit
5/13/2021
5/13/2022
M • •
❑ 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
Received By: Date: _
Issued By:Q�etc_4i C�� C'(..('/j/J Date: J�ZI 3 ILA 0S
Municipality .,' Anchorage_
a a
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 a (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Department
On -Site Water and Wastewater Section
�)rcnt S,
� n
t)l'I)AI't IIIc lit
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV211026 COSA#: Permit#:OSP211056
PID#: 051-541-01
Legal Description: Peters Gate Block 1 Lot 16
Engineer: Eklutna Engineering
Applicant: Anthony Degange & Emily Davies
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to the excessive slope has been approved. The approved separation distance is 27.0 feet. See
engineer's waiver request and slope profile drawing for justifications.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater_ disposal system will require all separation distances be met or another
approval from this department.
............................................... ■ ............................. ■ 1
Waiver is Granted: X
Waiver is not Granted:
Date: J 3 �� Approved by: -Q -,UJ, LA
Name of Reviewer
............................................... ■ ............................. ■ t
**** VARIANCE/WAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
Ad
Development Services Department
Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-541-01-000
Property owner(s) DEGANGE ANTHONY & DAVIES EMILY
Mailing address PO Box 671264 Chugiak AK 99567
Site address Site 25141 Sierra Mesa Cir Chugiak
Legal description (Sub'd., Block & Lot) PETERS GATE BLIK
Legal description (Township, Range & Section)
Lot Size 49,658 Sq. Ft. Number of Bedrooms 3
Day phone
1 LT 16
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
Initial El
Single Fa ' (SF) []
,'I-
Db
v(A ;ACr
Septic Tank
0
Upgrade El
Duplex (D) ❑
Holding Tank
0
Renewal El
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
0--b5orreh'011 �e/o/ � skevc- S6010eDistance:- V 7
I certify that the above information is correct. I further certify that this is in accordance with
applicable/ unicipal Codes.
(Signatur( �of property owner or authbrized 'agent)
Permit/Rush Fees: $5,95 Waiver Fees: 9 0 � 5
Date of Payment: -3/q/ Date of Payment: 5 n t
7
Receipt Number: 0 32 1 '] 1b Receipt Number: 0 Ll (0 ?,-
Permit No. OSP211056 Waiver No. 0S \1 Q 11
GAIDevelopment Services\Building Safety\On Site Water and Was tewaierTorms\Client FormsTermit Application.doc
NNW
Eklutna Engineering, LLC
curtistownsend@gmail.com
June 25, 2021
Subject: Peters Gate Block 1 Lot 16
Septic Field Design Narrative
OSP211056
Waiver request for steep slope provisions and change order
The existing 3 bedroom house is served by a private well and septic system. The existing drainfield is full
of water and needs to be replaced. The existing bed will be left in place and a new field will be
constructed. The new tank will be connected to both fields via a diverter valve. Comments regarding the
design are summarized as follows:
1. SOILS: In October 2020, two test holes were dug. In June 2021, test hole #1 presented groundwater.
Test hole #2 that had previously been dug was percolated at 7 min/inch. Maximum depth of excavation
will not exceed 36". Soil will be mounded above trench to create a minimum of 3' of cover.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. TOPOGRAPHY: As can be seen on the attached drawing, the topography around the proposed
drainfield has a slope of 22%. Immediately downstream of the proposed field location the slopes are
22% for at least a distance of 27'. 15.65.210 B.3a states that deep trenches and wide trenches may be
installed on slopes less than 25%. This mounded wide trench is to be installed on a slope of 22%.
Let us consider the steep slope provisions. 15.65.210 B.4 a.iv The invert of this pipe is not a minimum of
36" below the top of the natural organic surface as measured on the downhill side of the trench. Please
see the field profile for justification as to why this system will not have adverse affects.
15.65.210 13.4 am The field will not be located a minimum of 100' up -gradient from slopes exceeding
46%. There is a slope of 58% within 100' of the proposed field. Please see the field profile for
justification as to why this system will not have adverse affects.
4. NEIGHBORING WASTEWATER SYSTEMS. Immediate neighboring septic systems are all 30'+ distant.
5. WELLS: This lot is served by a private well. The well is greater than 100' from the septic field and tank.
Neighboring wells are all greater than 100' from the system.
6. DISTANCE TO SURFACE WATER: There is no surface water within 100' of the proposed septic tank and
field. The proposed drain field upgrade will maintain at least 100' from all surface water and drainage
ditches.
The proposed installation will not affect the future developmen�t,,gLthis or the surrounding lots.
Sincerely,
Curtis L. Townsend, P.E.
OF A6'`,
C
:^. ....
Curbs L Tpimee d
Date U' 2.
No. C 119
��� �PRQFESSiCN���p
THERE ARE NO STEEP SLOPES
CD WITHIN 50' OF THE PROPOSED
QC TANK.
v
LOT 15 /S VACANT LAND,
NO WELL OR SEPTIC
Q
LIJ
SCOPE OF WORK
1. REMOVE EXISTING SEPTIC TANK.
2. PLACE NEW 1,000 GALLON TWO—COMPARTMENT
SEPTIC TANK AND TIE INTO EXISTING
ABSORPTION SYSTEM AND NEW ONE. ENSURE
NEW TANK IS OUTSIDE THE 100' WELL RADIUS
AND 5' AWAY FROM EXISTING FIELD. TANK IS
TO BE PROVIDED WITH A MINIMUM 20" DIA
RISER SERVING THE FIRST COMPARTMENT.
3. MOUND SOIL OVER TRENCH TO PROVIDE
MINIMUM OF 3' OF COVER.
4. ALL CONSTRUCTION TO BE IN ACCORDANCE
WITH ALL REQUIREMENTS SPECIFIED IN
ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55
AND 15.65.
�N \
DESIGN PARAMETERS
BEDROOM: 3 (450 GPD)
I
SOIL PERCOLATION RATE: 7 mpi
z
APPLICATION RATE: 0.8 GPD/sf
I w
AREA REQUIRED: 564 SF _
I Ln
SYSTEM TYPE: SHALLOW TRENCH
w
r
98'x 5' x 12" EFFECTIVE DEPTH
YIELDS 564 sf
MAXIMUM DEPTH OF EXCAVATION
o
TO BE 36"
I
� � 1
GARAGE'
I
100' z \
3 BR J
w
HOME ( w
��, < V
FCO i� �
I
------ J/
SPLITTER LVE
SLOPE 22%
C04
NEW 98' x 5' x 12"
\ EFFECTIVE DEPTH SHALLOW
TRENCH, BROKEN UP INTO
(2) LENGTHS OF 49'
A
Lor 6
Lor 9
NEIGHBORING SEPTIC \
IS > 10' FROM
PROPERTY LINE
SLOPE
MT A
w* 1
751TH #1 15,
5 TH 0 ` aIVERTE VA VE
C
I
` SLQPE 3%
EXISTI 36' x 32' s I
x 6° EF CTIVE MT, FYP
DEPTH BE I I
Septic Design Prepored for
TONY DEGANGE AND EMILY DAVIES
25141 Sierra Mesa Cir Chugiak, Alaska 99567
PETERS GATE BLOCK 1 LOT 16
OSP211056 CHANGE ORDER
EKLUTNA ENGINEERING, LLC DATE: 6/25/2021
19162 MOUNTAIN ROAD DRAWN: CLT
CHUGIAK, ALASKA 99567 SCALE: 1" = 40'
(907) 406-1058
PID: 051-541-01 SHEET 1 OF 4
�0 0
41 C_�: �®
AV 491-H
a.......... ? ............................
�..........�� �r::..............................�
� + CURTIS TOWNSEND �
®® No. CE 1/904 Vic®
®TQC `U �...... ;.....`Qr�r,'�C ®�
EXISTING GROUND IS —
APPROXIMATELY 22% SLOPE
46% SLOPE
EXISTING GROUND IS
APPROXIMATELY 58% SLOPE
to s
35'
MOUNDED SOIL TO
PROVIDE 3' COVER
1' NATIVE ORGANICS
2.5'
PROFILE VIEW A—A
1. EXISTING GROUND ALONG THIS PROFILE LINE IS APPROXIMATELY 22%. THE
SLOPE DOWN GRADIENT OF THE SEPTIC TRENCHES WILL NOT BE
DISTURBED. ALL EXISTING VEGETATION ON IT WILL BE LEFT IN PLACE TO
MEET 15.65.210 13.4.a.iii
2. SOILS IN THIS AREA HAVE A PERCOLATION RATE OF 7 MPI.
3. AN IMAGINARY LINE DRAWN AT 46% SLOPE, 2.5' ABOVE INVERT OF
DISTRIBUTION PIPE DOES NOT INTERSECT SLOPE OF EXISTING GROUND
FOR AT LEAST 35'.
4. THE EXISTING BED HAS BEEN IN PLACE FOR 37 YEARS. NO WASTEWATER
EFFLUENT HAS DAYLIGHTED DOWN GRADIENT. FOR THESE REASONS, A
WAIVER IS REQUESTED AS THIS FIELD DOES NOT MEET THE STEEP SLOPE
PROVISIONS.
Septic Design Prepared for
TONY DEGANGE AND EMILY DAVIES
25141 Sierra Mesa Cir Chugiak, Alaska 99567
PETERS GATE BLOCK 1 LOT 16
OSP211056 CHANGE ORDER
EKLUTNA ENGINEERING, LLC I DATE:
19162 MOUNTAIN ROAD
CHUGIAK, ALASKA 99567
(907) 4-06-1058
A'' ► \.
6/25/2021
CLT
SCALE: 1" = 10'
PID: 051-541-01 SHEET 2 OF 4
3'
3
1
2
3
4
5
6
7
8
9
ORGANICS
DATE PERFORMED: 10/5/2020
WAS GROUND WATER
ENCOUNTERED? NO
DEPTH TO WATER AFTER
MONITORING? NO
DATE: 10/17/2020
DEPTH TO WATER AFTER
MONITORING? 8'-1"
DATE: 6/15/2021
SOILS LOG — PERCOLATION TEST
TEST HOLE #1
NO.
DATE
CLOCK TIME
NET
TIME
(MIN)
WATER
LEVEL
READING
1
10/17/2020
13:33/14:03
30
6" — 3-3/4"
2
10/17/2020
14:04/14:34
30
6" — 4"
2"
3
10/17/2020
14:34/15:04
30
6" — 4 1/4"
1-3/4"
4
10/17/2020
15:04/15:34
30
6" — 4-1/2"
1-1/2"
5
10/17/2020
15:35/16:05
30
6" — 4-3/4"
1-1/4"
6
10/17/2020
16:06/16:36
30
6" — 4-7/8"
1-1/8"
7
10/17/2020
16:36/17:06
30
6" — 4-15/16"
1-1/16"
WATER READINGS ARE TO THE NEAREST 1/16 INCH.
PERCOLATION RATE: 28 MIN / INCH
PERC HOLE DIAMETER: 6"
TEST RUN BETWEEN 2 AND 3 FEET.
PERFORMED BY: CURTIS TOWNSEND. I, CURTIS TOWNSEND, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 10/17/2020
Septic Design Prepared for
TONY DEGANGE AND EMILY DAVIES
25141 Sierra Mesa Cir Chugiak, Alaska 99567
PETERS GATE BLOCK 1 LOT 16
OSP211056 CHANGE ORDER
EKLUTNA ENGINEERING, LLC DATE: 6/25/2021
19162 MOUNTAIN ROAD DRAWN: CLT
CHUGIAK, ALASKA 99567 SCALE: 1" — 40'
(907) 406-1058 —
PID: 051-541-01 SHEET 3 OF 4
491—
........................... . .....
® .
0 ...........
® : CURTIS TOWNSEND."'
®®0 No. CE 11904
1
2
3
4
5
6
7
8
9
ORGANICS
DATE PERFORMED: 10/5/2020
WAS GROUND WATER
ENCOUNTERED? NO
DEPTH TO WATER AFTER
MONITORING? NO
DATE: 10/17/2020
DEPTH TO WATER AFTER
MONITORING? NO
DATE: 6/15/2021
SOILS LOG — PERCOLATION TEST
TEST HOLE #2
�w I
_ I
----- Irk I
I I
I� (
rs I
TH #2
TH #1
NO.
DATE
CLOCK TIME
NET
TIME
(MIN)
WATER
LEVEL
READING
1
6/15/2021
19:30/20:00
30
6" —
0"
6"
2
6/15/2021
20:00/20:10
10
6" —
3 1/4"
2 3/4"
3
6/15/2021
20:16/20:26
10
6" —
4"
2"
4
6/15/2021
20:26/20:36
10
6" —
4 1/4"
1 3/4"
5
6/15/2021
20:37/20:47
10
6" —
4 1/2"
1 1/2"
6
6/15/2021
20:48/20:58
10
6" —
4 5/8"
1 3/8"
7
6/15/2021
20:58/21:08
10
6" —
4 5/8"
1 3/8"
WATER READINGS ARE TO THE NEAREST 1/16 INCH.
PERCOLATION RATE: 7.3 MIN / INCH
PERC HOLE DIAMETER: 6"
TEST RUN BETWEEN 2 AND 3 FEET.
PERFORMED BY: CURTIS TOWNSEND. I, CURTIS TOWNSEND, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/15/2021
Septic Design Prepared for
TONY DEGANGE AND EMILY DAVIES
25141 Sierra Mesa Cir Chugiak, Alaska 99567
PETERS GATE BLOCK 1 LOT 16
OSP211056 CHANGE ORDER
EKLUTNA ENGINEERING, LLC DATE: 6/25/2021
19162 MOUNTAIN ROAD DRAWN: CLT
CHUGIAK, ALASKA 99567 SCALE: 1" = 40'
(907) 406-1058
PID: 051-541-01 SHEET 4 OF 4
�16®S®%XJ1 JA ®
Q
49!H—
..............................
0............ 0. .........................
...................... ..�
0 C- CURTIS TOWNSEND:' �u
®®�i� No. CE 11904 AV
1 14
57/X 5-7 (p'e'k
L sFG, C
0
� f
Shy^
n
N a 7"E r
12t tr E s�.-d � ✓���--�� c� t'z -- t g -� t � ��c t.
_J11A
AS -BUILT I
I hereby certify that I /have surveyed the following described
property. Lyck jjf r
Ii T l -�J a R St ,
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no improvements on property lying adjacent thereto encroach
on the premises in question and that there are no roadways,
transmission lines or other visible easements on said property
except as indicated hereon.
Dated at Eagle River, Alaska
this_9!_L A day of Ay< f 19
ROBERT C. JOHNSON Z$.
SCALE: Registered Land Surveyor No. 80 -LS
Box 77-0456, Eagle River, Alaska 99577
Phone (907) 694-2543
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMEN'I'AL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NO. OF BEDROOMS~
LOCATION~'~C
~Z Manufacturer ~~ Ma3~ No. of compartments ~
~ ~ Liq. capacity in [allons ~ ............. Inside length Width
/~ O , ,r nu ....... ~c:__ ~ i Liquid d~.
9~ DISTANCE TO: Well (~/ Dwelling PERMIT NO.
~ - ~ Manufacturer/~ Material Liquid capacity in gallons
Q Well Foundation Nearest lot line PERMIT NO.
~ DISTANCE TO; ~t '
~ ~ ~ No. of lines Length of each line~ al length of lines Trench width Distance between lines
/ inches
~ ~ ~ Top of tile to finish grade aterial beneath tile Total effective absorption area
~ inches
~ ~ ~ Type of crib Crib diameter Crib depth Total effective absor~~
~ DISTANCE TO: Wel~
~ Class Depth Driller Distance to lot line PERMIT NO.
~ ~ ~ f ~ ~uit~i~g~u~tion Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOILTESTRATING~
i NS~ATLER
REMARKS
, ....
~'~ RIV~, ALAS~
~. ~H, 694~297~
72-013 (Rev. 3/78)
by
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 272. CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND
ADDRESS
N
LEGAL DESCRIPTIO ~.
DATE - Started
Ended ,- ,,, ~ ,.
PERMIT NUMBER
DEPTH OF WELL ':' ,: ~
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From (.' Ft. to Ft.
From :, Ft. to Ft.
From .? Ft. to / ,, Ft.
From__ Ft. to , Ft.
From_ Ft. to. Ft.
From__.Ft. to
From--
" c .,-,.,,; .... : From
,'- ,, / ,, · c ':: -,,:',', ~i,';-, ,.. From
"'~ , ,~ '--*-. "~:~ From
/j' .:..; .... , ,
Ft. '- -~, ' ". From
From . Ft. to ,, Ft.
From .. Ft. to' Ft.
From__FL to Ft.
From':~ Ft. to ' · Ft.
From
From
From
From
From~.Ft. to Ft.
From
From__ Ft. to Ft.
From
From , Ft. to ,.Ft,
From
Ft. to Ft.
Ft. to.__Ft
Ft. to__ Ft
Ft. to Ft,
Ft. to Ft.
Ft. to__Ft
Ft. to__Ft
MUNICIPALITY' OF ANC't-IOP. AOE
.Ft. toDEPT. OFIFEALTH &
ENVIRONMENTAL PROTECTIO[~
Ft. to Ft.
Ft. to JUL, g,. 1985
Ft. to__ ,Ft.
Ft. to ,, Ft.
Ft. to , Ft
Ft. to Ft.
Ft. to Ft.
.Ft. to ,Ft.
MISCL. INFORMATION:
DRILLER'S NAME .......
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS:
840644
07/31/84
BILL JEMIN
% S&S ENGINEERING
EAGLE RIVER, AK 99577
694-2979
SUBDIVISION: PETERS ~qTE
SECTION: 11 TOWNSHIP: 15N
62000 (SQ. FT. OR ACRES)
LOT: 16 BLOCK: 1
RANGE: 1W
Listed below' are, the' options available to you~in~ de,signing your septic
system. Choose the option that best fits your site,
DEPTH TO PIPE BOTTOM
GRAVEL DEPTH (FT.)
TOTAL DEPTH (FT.)
GRAVEL WIDTH (FT.)
GRAVEL LENGTH (FT.)
GRAVEL VOLUME (CU.YDS.)
TANK SIZE (GALS)
SOIL RATING (SQ.FT./BR)
4.0 4.0 4.0
4.0 0.5 3.5
8.0 4,,5 7.5
2.5 ~ 4.0 5.0
108.0 '~* 47.0 93.0 **
45.0 41.7 68.8
000.0 ~* t,000.0 *.~ 1,000.0 .~.~
287 250 287
GRAVEL. LENGTH ;::' '75 FT. REQUIRES MULTIF'LE RUNS (NOT' EXCEEDING 75 FT'. EACH)
TANK MUST HAVE AT LEAS]' TWO COMPARTMENTS
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality o~ Anchorage (MOA) and the State of Alaska.
~.c.,. I wi'il install the system in accordance with all MOA codes and regul, at. ions~,
and in compliance with the design criteria o¢ this permit.
3. I will adhere to all MOA and State of Alasl<a reqLtirements for the set,back
distances £rom any existing well, wastewat, er disposal system or public
sewerage system on this or any adjacent or nearby lot..
4. I underst, and that this permit is valid ~or a maximum of 3 bedrooms and
any enlargement will re. quire an additional permit.
IF A I_IFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODE;S,
TFIEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BU. ILTS
WILl_. NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
EI_ECTRICAL WORK MUST B~DONE BY A LICENSED ELECTRICIAN.
...... ..................................
PERFORMED FOR:
LEGAL DESCRIPTION:
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99§01 264-4720
SOILS LOG - PERCOLATION TEST
,j~PERCO LATION
TEST
13
14
15
16
17
18
19
2O
COMMENTS
PERFORMED BY:
72-0o8 (6/79)
ktOL E
NTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth toNet
Reading Date Time Time Water Drop
I ~t&,- l?m ¢," -
:~ ', i/q°t la ,, 8" //~ "
~ ,, I; ~ ~., ~ '~, ~,,
PERCOLATION RATE ~'"~ O (minutes/inch)
TESTRUN BETWEEN ~'~ FTAND ~ , FT
a, LASKA ENVIRONI~a=,NTAL
CONTROL SERVIC , INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO. OF
~A~C~LA'r~D
BY
DATE
CHECKED BY
SCALE
DATE
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
:??:~ i~'.i:~ , Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision/seCtion~.township, range)
Location (a,cldr~ss,ol~,~rections) ~:i,ri!r :,: i: ,!i' ,
(b) Appli~aht Name ~i~,,%, ~I~ Telephone: Home Business
(c)
(d) Lending Institution
(e)
Abplicant is (check one): ~,ending Institution 1-1. Owner/builder~[.; Buyer []; Other [] (explain);
Address
Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
Telephone
Page 1 Of 2
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of Bedrooms '~,
Other
WATER SUPPLY '
Individual Well~, Community I-I Public D !iiiiil, ii i' '!: .' ili
Note: If community well system, must have written confir~h~i~6n f~°m the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL :';:'i, . .
Onsite~, Public [] Community [] Holding TanE'er1 '; ::';:~:~. i ,
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. '~" ': "'
72-025 (11/84)
ENGINEERING FIRM PROVIDIN( ,SPECTIONS, TESTS, FILE SEARCH, DA' '~ND 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
Address
Date
Approved for ~ bedrooms by
Approved X Disapproved Conditional
Terms of Conditional Approval
Date
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given m paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work. ~,,~ .
Page 2 of 2
72-025 (11/84)
WELL DATA
Well Classification
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description:
Well Log Presentl~N)
Total Depth q~::)/' Cased to
Static Water Level /O~5" /
Casing Height Above Ground
Electrical Wiring in Conduit&N)
Separation Distances from Well:
If A, B, C, ;.D.E.C. Approved (Y/N)
Date Completed ~ 4-~4 Yield
~/" 4// Depth of Grouting /~'/~
Pump Set At ~-J/~
/, ~" / Sanitary Seal on Casing~N)
Depression Around Wellhead (Y(~
To Septic/Holding Tank on Lot ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /~"/ 'f' ; On Adjoining Lots
To Nearest Public Sewer Line ,, .W/'//~ To Nearest Public Sewer
Cleanout/Manhole W///~ To Nearest Sewer Service Line on Lot
Water Sample Collected by ~-"'~ ,/~, ~J/~-,4/ ;Date
Water Sample Test Results
Comments /~) ~/E'/J--/~/.~,~J "/~FT~. g)g~/f~/ /~-/~-g/. $~;~'~
!
B. SEPTIC/HOLDING TANK DATA
~Size /~'g'O No, of Compartments
Foundation Cleanouti~N)
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N)
Date Installed
Standpipes(~)N) ~ 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:
To Water-Supply Well ,//o
/o
To Property Line
To Water Main/Service Line
Course /~O
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
MUNICIPALITY OF
DEPT. OF HEALTH &
ENVIRONMENTAL P~CT~-CTtOh/
OCT
RECEIVED
72-026(11/84)
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
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes PresentgN)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
/
To Water-Supply Well
To Building Foundation /~'~" 1~'
Lot
To Water Main/Service Line /dO
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~ ~'~c'g"
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots /4)/''~
To Cutbank (if present) !
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
mansions
(Y/N)
,p Off" Level at
__ Vent (Y/N)
Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I~,~/~e/q~d, ~rifi~, d,~or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~ . /.,'t./~ Date /0 '-~'~ ~
Company ,/~5 MOA No. ~'~'4 - 0~/7
Receipt No.
Date of Payment
Amount:
Page 2 of 2
72-026 (11/84)
243-2302
ng
~reek
rater
~X~HXXX
DEAN THOMPSON
AAA
PLUMBING & HEATING
RESIDENTIAL AND COMMERCIAL.
3742 WEST 79TH AVENUE
ANCHORAGE, ALASKA 9950Z
243-2302
~X~XXX
October 1, 1986
TO WHOM IT MAY CONDERN:
AAA Plumbing & Heating did the plumbing
and Heating on Lot 16 Blk. 1, Peters Creek
Sub. On Dec. 10, 1984, we turned the water
on and fired the heating system.
Bill jemin was the owner.
Sincerley,
Dean Thompson (owner)
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONHENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. C~neral Information
Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
· 6 -
(b) Applicants Name ~/ZZ/3H -~H/~ Telephone- Home Business
(C) Applicant is (check one) Lending Institution ~; ~er/builder~;
(d) Lending Institution Z~/~ gMZ a/ ~d Telephone
Address >~. ~ ~7~0~ ~/Z~g ~,
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
~.~,.~x'*c ~x ~ , - -. , ~ ~ _ v-~., '
2. Type of ~es~cence
Multi-Family~
Single-Family.~,
Number of Bedrooms
3. Water Supp1[
Individual Well~
Other (describe)
Community~-~ Public~--~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. 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]
DHEP Approval
Approved for'~~bedrooms
Approved.~ Disapproved~
Terms of Conditional Approval
· ~ation
5. En~ineerin~ Firm Providing Inspections~ Tests~ Pile Search~ Data anC
As certified by my seal affixed hereto and as of the validation date ~ below, I
' the on-s.~, ite
verify that my investigation of this Health Authority Approval shows ~<~uate fe~,r
water supply and/or wastewater disposal system is safe, f~ction~ ~ verify t~hat,
the number of bedrooms and type of structure indicated herein. I f~,? .~ and frc~
based on the info~ation obtain~ from the ~nicipality of ~chorag~ ;.~.sposal
investigation and inspection, the on-site ~ter supply and/or ~stew~'~'.~.,~ regul~_
system is in compliance ~th ~1 Municipal and State codes, ordinanc?
tions in effect on the date of this inspection.
W~'..
~- %~..
By~a t e. Condition~
CAUTION
~ \,kL PROTEW'TION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OP HEALTH AND ENVIRON,~.' 'It': REPRE~;~_
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY U5'\, ,:,,;R REGIS ~:'i~R~'$m
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND ~\~'A BEFOi~E A
m~NTs, mFLOr~ES OP mEP O0 NOT CONDOCT I~SFECTIONS OR ANALYZ~,~ i','~' ~: ~O~ '~ORS
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPOI\~'
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19' ~4
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITy OF ANCHOP, A(~t~
HEALTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH &
CHECKLIST- FEBRUARY 1984 ENVIRONMENTAl.. PROT~.CTION
264-4720
Legal Description: ,Z..~"~ /~, ~UU~r-Z'I ~' '~985
Well Classification
Well Log Present'N)
Total Depth
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~'- Y-~'~ Yield
Depth of Grouting
Pump Set At /'/'/,'~
/,5'/ Sanitary Seal on Casing CN)
Depression Around Wellhead (Y~
Cased to
/~'/
Static Water Level
Casing Height Above Ground
Electrical Wiring in ConduitCN)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
//~/ ; On Adjoining Lots W///~
; On Adjoining Lots ,4/'/,~
To Nearest Public Sewer Line ,¢/,~ To Nearest Public Sewer
Cleanout/Manhole ~///~ To Nearest Sewer Service Line on Lot
Water Sample Collected by /~'g-~
Water Sample Test Results
Comments )~¢'tCSU~(tI~I~ '~ .,¢'/',~kJ~t~ES, --')
;Date
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes~N) Air-tight CapsON)
Depression over Tank (Y(~)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ,4/'//~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well //~' /
/
To Property Line
To Water Main/Service Line /'//,~'
Course
Comments ~E~#,~/~"~73; 7'~
Size /~13'0 ~,/~'/~ No. of Compartments
Foundation Cleanout(~N)
Date Last Pumped ,4//,~-- .
/'//,~ ;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field '~ ~-~'/
10.5
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 3''~ 7- ~'/
Width of Field
Type of System Design
Length of Field .~(o /
Depth of Field '~' ~'
Square Feet of Absorption Area
Depression over Field (Y~.
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot ,4/'/~
To Water Main/Service Line
/7-5' ' ~h
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Gravel Bed Thickness ~'
Standpipes Present ON)
Date of Last Adequacy Test
To Property Line
¥o Existing or Abandoned System on
; On Adjoining Lots "
To Cutbank (if present) W//
Comments
D. LIFT STATION
Size in Gallons __
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Man
(Y/N)
Off" Level at
Vent (Y/N)
Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I ha_v.e ch~cked,lverified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~--~..~ ~--4-~'~ - Date
Company ~-~4%.~ ~ MOA "0.
Receipt No. ~[ ~q ~ ~-
Date of Payment ~ ' t L~- ~
Amount: $ ~, OO .
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