HomeMy WebLinkAboutPETERS GATE BLK 2 LT 7
(Kev ublu2ti u)
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211057
PID Number: 051-541-17
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New FO -1 Upgrade
Name
Al and Adele George
ABSORPTION FIELD
❑ Deep Trench A Wide Trench ❑Bed El Mound
Site Address
25112 Sierra Mesa Cir Chugiak
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
4 GPD/SF
1.5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1 Ft.
Gravel depth beneath pipe
0.5 Ft.
Subdivision Block Lot
PETERS GATE 2
7
Fill added above original grade
2.0 -2.1 Ft.
Gravel length
26 Ft.
Township Range
Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
AWWTS
olding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
130 Ft2
1
Ft.
Well
>100'
>100'
>100'
NA
>25'
TANK X Septic ❑ S.T.E.P. ❑ Holding Other
Manufacturer
Anchorage Tank
Capacity
1500 Gal.
Surface Water
>100,
>100,
>100,
NA
Material
Number of compartments
Lot Line
>10'
>10'
>10'
NA
NA
plastic
2
Foundation
>1 0,
>1 0,
>10,J
NA
AWWTS module
Capacity
Remarks
Anchorage Tank NA Gal.
Alarm location
in furnace room
Electrical installed by
907 electric
PIPE MATERIAL House to tank 3034 drainfield Tank to
3034
Installer
Richard Person Construction
Drainfield 3034 CO/MT3034
Inspector Curtis Townsend
BENCH MARK (Assumed elevation) 100 ft
Inspection
15' 6/7/21 6/8/21
dates:
Location and description
2nd
Yd 10/30/2d 41'
bottom of siding at shed
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
Date
f4•...... .
Septic Systema,
Approved
Date
_._
Note: this approval oes not include well permit requirements.
(Kev ublu2ti u)
VACANT LAND, NO
WELL OR SEPTIC
LOT 1
THERE ARE NO STEEP SLOPES
WITHIN 50' OF THE PROPOSED
TANK.
VACANT LAND, NO
WELL OR SEPTIC
L W y \off
w W JPS
Lzo_+j W '13
f � H y
Go -o w
L
/ w
Z n� I
LLI
� r
N m z W � 202'
Z � J
0_0
mv
n
/ z V) 0-1
i
=1, I
SCOPE OF WORK 1
1. REMOVED EXISTING SEPTIC TANK.
2. PLACED NEW 1,500 GALLON
TWO-COMPARTMENT TANK WITH ORENCO AX20
ADVANTEX FILTER POD AND TIED INTO
EXISTING ABSORPTION SYSTEM AND NEW ONE.
NEW TANK IS OUTSIDE THE 100' WELL RADIUS
AND 5' AWAY FROM EXISTING FIELD.
3. SOIL MOUNDED OVER TRENCH TO PROVIDE
MINIMUM OF 3' OF COVER.
4. ALL CONSTRUCTION IN ACCORDANCE WITH ALL
REQUIREMENTS SPECIFIED IN ANCHORAGE
MUNICIPAL CODE CHAPTERS 15.55 AND 15.65.
LOT 2
LOT 3
NEIGHBORING SEPTIC
IS > 10' FROM
PROPERTY LINE
I
Record Drawing Prepared for
DESIGN PARAMETERS
BEDROOM: 3 (450 GPD)
SOIL PERCOLATION RATE: 18 mpi
PROPOSED CATEGORY III
APPLICATION RATE: 4 gpd/sf
AREA REQUIRED: 112.5 SF
SYSTEM TYPE: SHALLOW TRENCH
26'x 5' x 6" EFFECTIVE DEPTH
YIELDS 130 sf
8 MAXIMUM DEPTH OF EXCAVATION
TO BE 18".
OSHED
100'
3 BR
HOME
SLOPE 1
CO3
SLOPE 14%
I
NEIGHBORING WELL IS LOT 6
> 100' FROM
PROPERTY LINE
AL AND ADELE GEORGE
25112 Sierra Mesa Cir Chugiak, Alaska 99567
PETERS GATE BLOCK 2 LOT 7
EKLUTNA ENGINEERING, LLC
19162 MOUNTAIN ROAD
CHUGIAK, ALASKA 99567
(907) 406-1058
OSP211057
DATE: 2/08/2024
DRAWN: CLT
SCALE: 1" = 40'
PID: 051-541-17 SHEET 2 OF 3
FCO
,)TANK MT
DV
'ORIGINAL BED
(I :z \l
EXISTING 35' x 18'Q
x 24" EFFECTIV
DEPTH BED
M T, TYP (n
NEW 23' x 5' x 6"
EFFECTIVE DEPTH
SHALLOW TRENCH,
INLET LINE ENTERS AT
MIDPOINT. NEW FIELD
MINIMUM 6' AWAY FROM
OLD BED.
UrAV q
•�:
•�
'•49TH0
.....::..1 ..................................
♦ �: CURTIS TOWN SEN D.
�jG�^: Y/C 11904
1500 gal TANK
W AX20 FILTER
Lzzlu
.0
i
L�
1 D�.4
FG 99.8 mo o� 99.7
OG 97.7 7 7
GROUNDWATER IN OCT 2020
WAS FOUND AT 93.8'
MARK
A
B
TANK MH
44'-0"
62'-10"
DV
51'-11"
69'-5"
CO3
51'-0"
73'-2"
MT1
104'-1 "
130'-2"
C01
105'-1"
131'-1"
MT2
125'-0"
149'-4"
CO2
125'— 7"
149'-10"
Record Drawing Prepared for `%1L1L1k
AL AND ADELE GEORGE �.�p.E 0� � 4*���
25112 Sierra Mesa Cir Chugiak, Alaska 99567 AF?° #,
PETERS GATE BLOCK 2 LOT 7 ; 4 TH * ��
.....::....... ....................::.....
OSP211057 %. .. 0
EKLUTNA ENGINEERING, LLC , ND-.
DATE: 2/08/2024 �j� t:CURTIS TOWNSEND: �
DRAWN: CLT ��'' No. CE 11 04
19162 MOUNTAIN ROAD — �Z /g�Z,i
CHUGIAK, ALASKA 99567 SCALE: 1 — 10' �� ajjL '1' •
(907) 406-1058 •4��-;;i••
PID: 051-541-17 SHEET 3 OF 3
Q m
o �
z m
O
N
00
W
N U0
L4
V O
O
ID
z
� A -• p p 0- w O N S
o
ro O
_ -• O' ro w p d -•'p
moo"=.ox`con-.m
� v p
op .�
- w
r.o v-oo I
-
o _ a o o
:Z___ vc
o a da � n�v
N o w ro
c o o ro� a rt
o-- -•-� o �o� Dm
N o ro fD m ro o a _.
• ro ? w O - d
p c N'-•,pccv-o
p do-
.0_
oE
_ o _ , -.
-ro va q
f«m o ro m m •poo �
0
Dyrov� Ow N�SS�
- ro O ro� ro p
0-
p _. q
�-
•-y
oa o '�o c o -• ro .-. o c n
-«o fwm mmm�gm
oro��� m�ro
=r = o
X
X
'x
X
o p
CSD
v =
x
X
_ ca
O N s
c'?
CD
CD 0-
=
X
x
x
sl
CD—
rt
CQCD -=
o
m
co
O: O
°
m
<
m ai t— to
o
CL -0 O a ;Ea Ji ®
CD
O
CD a m O
CD CL = m
zm
c'D ai 0 7, - Z —1 vJ
3
= m Co - crn7 ® M
, CD
-`zo s p �j r
G)
O
y
0
a
$ �, P <
r
m
D
D
-
;
n
P_
o
D
w
S
_
X
z
O
V
A
rn
=r = o
=- —
ui v = v c
o p
CSD
v =
O
c a
@ co
rt
_ ca
O N s
c'?
CD
CD 0-
=
aW. C
po c
m30
sl
CD—
rt
CQCD -=
s
w _ '4
m
co
O: O
�C
ccD nim
f*1
<
m ai t— to
o
CL -0 O a ;Ea Ji ®
CD
O
CD a m O
CD CL = m
O"
m y
c'D ai 0 7, - Z —1 vJ
3
= m Co - crn7 ® M
, CD
-`zo s p �j r
ID.
0 O +- CD r�DZ w
c
r~0 o
CD
$ �, P <
+c
o�uNN
fl p. yCD
P_
2.
O o =
_ =
se
0 < j
O
_
rn *
< D cn
m m D
S n --ir O
rn O
z
Z
m m
r -r
n o m
z
n C G)D
O,1;oz
zr> >
o
C0
M 01
;�rn0Z
Omc>
--I Ln
m O
�Op
:K -q
HD r
zm
ymD
rN�
ion
rDrn
�rn-Z
3
O�
r�
r0
-0 Or Z
D m0 O
M
z (n
O >O
m
3N
rn_
2�
m�
rnC
Ow
rn
0�
rn�
00
zz
W Z
Or-
Om
O �
N n
Q1
r
Dz
G)m
M
0�
t-+ �
- - - - - - - - 4- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
moffrill
IR W
v cn
00
-i W N
o -j
m
to N
0 0P.
O io
a; OD
--------NO* -41' 38"W 229.40'
--------
(NO-09'00"W 230.00')
µ t�y
O ,ry
� C
o 0
x
v
m
� i
m
Z I t1
m
z
Z
co
co to
m tp
m r
m Cil r 1
U) O (A oz
G) W Ln
-I > �— r n
o rn ®® U N m gni
41
a 0-
(n
cn cn o �'
j N 0 O P
w �F?•y.�,�
(A Sit to .. v
'o 0
(NO'09'00"W 229.48')
SO' 48' 15"E 229.12' p� ---
2Z 4
W p� ®�•—
O' ® -®® s® r s s® r
_ SIERRA MESA CIRCLE
o 9DGE Of /"AV9 997" q
(NO -09'00"W 229.42')
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: OSP211057
Work Type: Septic Upgrade
Tax Code Number: 05154117000
Site Legal Address: PETERS GATE BLK 2 LT 7 G:1262
Site Mailing Address: 25112 SIERRA MESA CIR, Chugiak
Owner: GEORGE ALLEN F JR & ADELE L
Design Engineer: EKLUTNA ENGINEERING, LLC*
This permit is for the construction of:
Effective Date
Expiration Date
Lot Size in Sq Ft
�1»cnt
o�
"AA
1I `�
L)ehartin n
Total Bedrooms:
3/22/2021
3/22/2022
54014
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
Date:
Issued By: G C/ Date: 2
3
6UIC,IALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-541-17-000
Property owner(s) GEORGE ALLEN & ADELE Day phone
Mailing address 25112 Sierra Mesa Cir Chugiak AK 99567
Site address 25112 Sierra Mesa Cir Chugiak
Legal description (Sub'd., Block & Lot) PETERS GATE BLK
Legal description (Township, Range & Section)
Lot Size 54,014 Sq. Ft. Number of Bedrooms 3
2 LT 7
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Fieldf
Initial ❑
Single Family_,(SF) El
(w/wo ADU)
Septic Tank
El
Upgrade ❑
~-- "J
Duplex (D) El
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the ab ve information is correct. I further certify that this is in accordance with
applicable Muni,-ipbal Codes. ,
(Signature of propeYty owner or authoriz6d ag
Permit/Rush Fees: $595 Waiver Fees:
Date of Payment: 3 y 020 Q f Date of Payment:
Receipt Number: OO 2 `i 1 Receipt Number:
Permit No.
OSP211057
Waiver No.
GADevelopment Services\Building SafetylOn Site Water and WastewaterTormsUient FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211057, Deb Wockenfuss, 03/22/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211057, Deb Wockenfuss, 03/22/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211057, Deb Wockenfuss, 03/22/21
N -F L�TCIPALM` OF ANCHORAGE
ADVANCED WASTEM-AT 1E.R. T REATMENT SYSTEM,
MMINTEN.4 NICE, AND
AG, REEIvE1NTT-beT =- "AG- REDNE-N—u-P Nuade zm3
entemd into as Gf thir. -'m Day of 61,
rof 20 2. 1 , b,,'2M. baweem
PJ4k. NNER ar--d
ina=3 vvubrat, -e b1z m 3 c 3 iii:
d --
Anchu
(AINIC) 15,65,365, In con (dersni cri. af-"6c muluid-ummmants
IhC pidll1--N-- Wl U:iS
The IN-lb-nicip4ily gra tspemissiclu Tw-fis-z
Ownwriv -pulli7c and. awralk, =, Advanced. Waslewalel. Trea it, I& item JAN -%71;),
dc,scribcdmi /' u1
lomted
e7l
I Itaifiteoftom'Repain fund Aber
(Owner J'S re-qw'rcxi to .id., =6 mtand and inillml mxbw-
Throughom the lerm of this � kgreemon-1, the OvmeT sliarl) mici into a, wrvimarrotrbcm
MILI an, AWA78 sendqe and Maimcmqno�t pro-vidcT a%-,-)mYvcd- by ibc-IMU03-c-lilp-0ilY aw the�
canditi n. carmblof poTfb,-7nin�T,.:R,.-; de -S3
an- -p XIM
wcm
gntdl d nA=Ih-
ti it fti pa
rdanmen wLffi -fes. PMM3 3 -Rp?rQlVVI!' &[ Gp -eM-001 i , the JAM
It shulE 'br- the reumm-bili.tv of the, Ck-vter durm',-_.-, the tefm cpf ito.AgrQcr---Yid -,- tai pa -v foj- P -J -T
rLe t c i'lnij 5- -
lAe-s aulannual Main-te c -a i I v S*4 QQ tra � 0 0)
L'mncr agrocs thoor-hr and
QT tw, mazdam-rcif s w-ppzxnratrec -m H in.9p. 33CT—MSM-�
MK- ELIb.amcm.
Fcpairs- -or p0mall ffim--,d Rlt="c..y'n-'q ta'a.c: Systc:z.
100 01 YAT-ir-r- ackvmrwrjexc:gcs that regulai muia.`l�rwnu,-- of u --q._ Vkr%rTS- teduc,� mbe pa -le -i -al
Fmilurt of tht sysL-,.m, wbir.b. u-ou L-1 i r la i3e. sewaee bacRv 3 widmmu'lN, re -a-Im.4 .0, r ciM-jMflv7Jd
p
Te p1l:10—e fftem 1.
Of3
Page I
Ti
gess that the lvlk3r&!pafky Ml Tr -M. 3c5l.rCcr-%TCS 433:111. kinkmunce an -d
.repm front to m—PDwift4aunr's r i tie tOT n=131121111nCe, Pfb%lidev-
C) um e r a c. kn rrivk- d g e s I h.% - tk: fits f -P.- r f. � it i, I ig lx ma: n 12 6 ri an a rcpai:r ; a a A), WWTS : vnay'be
assess.&I in, acccTdanci; wilb A -M -C 14.6i.11.0AI,
► Owueragrees ic, grant the h1midpably rinasomablQ .ac ss 'to-tutim'd inspect dw
AWWTS.- TheN.WiNci, IV
paliN� wiTI.
Dmier. agreers -tit wNithof a
y sal.`c OT b=-,B�r:Df tl'd.rGf fl3e JIMUP--*�.f WE --Wt 00=f 1 W D,,C%V
CWtificue: af On-SitD S.,v,,Mcnis ApprrivpJ.
I- -
Dvxmer agrees tbo dhc.-,.A.WVj-N and mmllAcnance Ttgurnt �-K, a -S. txcpvLd�
bie f1w. A*WW, TS -vcDdcr,-'Lpst-q.11cr anci apron n�l by d -m- Nlanil'pal'4, av- -lh:'
P. im [d e I i n as f b -r Tic oo w, 1 cr c%n,
--jcna g:nd.. L -f the 1T= `A AWNYT-s-
wwxi MOMr o
r
tai -t. wnuv3.-1,M-:g -af'lh--AWWTS as rNuif
r kp,:rccs to malTi In - - rc-mot
AWA7-q apprc-fvql,
The te-P-Tj nf thj,., Agr,merit slwll bct6n on lite val. by the
MunicipaRty to c�pvratc ft- instalfod, 5,vSX'M,,,OC UpOn: t=.ftr of tide, and. coli ;cim, linue
wlifle The AWWTS fsnp;-TTxJcinp.2 or- wn-jil Odd! is trangfegnbd.
ttj, NDTk%%%YNWj. 711C jf�jttvc - c TOM. 1.6pall al an)"fln to eilfbnce a
of fh - lv� I -q ft 3-
A fj r c, --m ma f: shah Jin ro, n M, N or in W, v., wk, - affcv
wwv cons6ftn- a -
U
ahe vah-A Agnent c(ramyI partro, or tea pTy
r-.vcTv prcnm Ion h-=af-
v
LkIlL nr.&
uft=-ril Aall only be mne-aded by c-ruhonized mpwsmmiv es of
the Owner asidINfumicipaRMy. Any:aftempt-to amend lhusccmcn! c� hc.an
unauffic)rjud reshabc
present4WIve U -r klm-M-11IO&W. ro-cals - ll -- void-
ch:Llife -rlf I -lw- Amy;AvJil O.W-Un aTi'sing-I'MM thais A me -La sh&H be.
W -ought in -Lhe Superior Co-unfortk.- Thirdludicial DistTi-AvEtbt Swe of Ma l= :L-
Arr
'Le
'hor., `hc
of -43%-c- an ig of tnf
!wq lhtStat.ervFAh.%kashal]., tie. Ls � d obli atkvn-s h
rig
cs under fh3is.A;-=Tc,-meat.
7. SeverabiLif.3.7 Atty -provision.-', Ofthis.Agneta-efft dwreed, inmalid by avcun,e� 00-M-petm
LmsdEction shat] :t inv-.-Aidale the D ii
nm',PTO-Osion-s of 'the Agrczm- cat
(�cvi,95A.&2018) Pue 2 0, f 3
OWNER:
By:hu A, J� (signature) Date:
Q� 0 f k -E (print name)
STATE OF ALASKA )
) 5S.
TH RD :iUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this a day of
f LISTATE flP ALASKA ,y
�01 LI2Y PUBC I OR A%, .SKS;
IOTf�E�YpEl?L!C
My Commission expires: 1 ODd4 Felicia R. Burst
F�+f CCRnipMSfOT: ExpiresV
:_W� INIC IPALI rY:
By: (signature) Date:2 21
(print name) Title:
(rev. 05/18/2018) Page 3 of 3
AS -BUILT
rik
v
m
I hereby certify that I have surveyed the following described
property: _ % C k 2— —
Sir �1 aqr! !/ , T1 P,
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the property lines and do
not overlap or encroach on the property lying adjacent there-
to, that no improvements on property lying adjacent thereto
encroach on the premises in question and that there are no
roadways, transmission lines or other visible easements on
said property except as indicated hereon.
Dated at Eagle River, Alaska
this 30 day of -5--' 4 1982
R013FAT C. JOHNSON 4
SCALE: Registered Land Surveyor No. 880 -LS
1" = q -O Box 456, Eagle River, Alaska
Phone (907) 694-2543
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC f"lON
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORTJ~NE
NAME ~ IPHONE
LEGAL DESCRIPTION
~LOCATION NO. OF BEDROOMS ~
IWell [ Absorption area Dwelling PERMIT NO.
O ' Material No. of compartments
~ ~ Manufacturer ~~ Width ~ T~ ~
~ ~ Liq. capacity in gBllons Inside length Liquid depth
~0~ 0 IF HOMEMADE:
Well Dwelling PERMIT NO.
~ ~ DISTANCE TO:
O ~ ~ Manufacturer Material Liquid capacity in gallons
~ DISTANCE TO: Well //~ * Foundation ~O .~ Uearestlotline~o~ PERMITNO.~~,T~ ~
Trench width Distance between lines
~ N°'°flines ~ Length°feachline~ O Total lengthoflin~o ~O I~ ~nches
~ Top of tile to finish grade ~ , Material beneath tile ~ inches Total effective ~o~ti~area.
Length Width Depth PERMIT NO.
~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer tine Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
~EMA~S
' / Ho
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
Permit
Departmen )f Health and Environment ~ec~io
825 L Street, Anchorage, AK. 9
264-4720
~ ~ * * * HANDWRITTEN PERMIT * * *
~- 'f~' WELL AND/OR ON-SITE SEWER PERMIT
Applicant: v~.~.,¢~
Location:
Legal Description:
Type of Soil Absorption System Is:
Trench: Drainfield:
Maximum Number of Bedrooms: ~
Mailing Address:
Phone Number:
~~ ~/~ ~.~/~), LOt Size:
~ ~ Holding Tank'
Seepage Bed: ·
Soil Rating (sq.ft/br)
The Required ~ize o~ t~he~.S~i~_~rp, tion,System Is:
LENGTH . GRAVEL DEPTH ~ ' WIDTH
DEPTH
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 = /~OO 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(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this departme
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fe
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, i 9 8 3 * * *
Z certify that:
(l) I am familiar with the requirements for on-site sewers and wells as
set forth by the Mun~pality of Anchorage.
!2) I will/~tall the~stem in accordance with codes.
3) I un~rs~d that/z~e on-site sewer system may require enlargement if
.//~ ~//////////////th~res~v~/~~led to include more the2 3~droz.~.~
S igne~: ~/~.//~.~ ~/ Issued
'~i~a~t Date:
SWP/024 (1/81)
1
2
3
4
5
6
7
8
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
/~ SOILS LOG
[] PERCOLATION
TEST
SLOPE
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
Robert A. ;had,er
No. 1457. E
PERFORMED BY:
ENCOUNTERED? O
P
IF YES, AT WHAT /
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
RATE
CERTIFIED BY:
DATE:
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
4 O
DEPARTMENT OF HEALTH AN ENVIRONI~I~NTAL PROTECTIO.I~..
~25 L. Stme~ A~-h~a~e. Al~ka ~5~1'
SOILS LOG - PERCOLATION TEST
!
[] PERCOLATION
TES~..:..
10
WAS GROUND 'WATER
'1 1 ENCOUNTERED?
12 IF YES, AT WHAT
DEPTH?
13
15
16
17
18
PERCOLATION RATE
Gro~
Time
Net
Time
Depth to
Water
_ (minutes/inch)
Net
Orol~
72-008 (6179)
by
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759
OWNER OF LAND '-.L3 &'~',g /C C? (; / '7-,:" DEPTH OF WELL ,,.; ·
? .... ~ ,..',a ~,( ._. 7 ~ c2 ,~ t; /~ ,. -,.,. STATIC LEVEL OF WATER FT.
ADDRESS ~/~ '
LEGAL DESCRI~ION z:..~ ~ ? /~:~k" ?t ,' ~: ; DRAW DOWN FT.
7 /, %,,.~: _" Ended '~ GALS. PER HR (:'
DATE- Started ~,: , - · ~/// 0/
PE~IT NUMBER KIND OF CASING L': 7f'~
KIND OF FORMATION:
From ,, Ft. to .,~' Ft,
From ,,, Ft. to / $~_. Ft.
From / ~i~ Ft. to ~:~' 7~ Ft.
From · ) Z, Ft. to t .~',:~Ft.
From ,' -: ~ Ft. to i ~ ~-
From Ft. to , Ft.
From_ ." ~ ' ~
From ,': ~;/~;i:', Ft. to/~ ~f ~ Ft.
From~Ft. to Ft.
From/i,': )~
From .:2.:. ~,, Ft, to ~ , ,~, Ft.
From~Ft. to Ft.
From ~ ~'?' Ft. to ~?~"'Ft.
From ' ', !:~.Ft. to ~)? ! Ft.
From__ Ft. to Ft.
From _/ / i Ft. to d~OFt.
From Ft. to _Ft.
From Ft. to Ft.
From Ft. to__ Ft.
From Ft. to Ft.
From Ft. to .Ft,
From. Ft to
From__ Ft. to FL
From Ft. to . Ft.
From Ft. to . Ft.
From Ft. to . Ft.
From Ft. to .Ft.
;Tgia"2"-?q'~ Cr'g~ . .Ft. to .Ft.
From Ft. to .Ft.
Ft. to Ft.
Ft. to.~Ft,
Ft. to Ft.
Ft. to Ft.
Ft. to ,Ft.
From
MISCL. INFORMATION:
DRILLER'S NAME
MUN CIPA'ITY OF ^.CHORAGE /
DEPARTMENT OF HEALTH & HUMAN SERVICES ~
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
H87-0576
Application Date
GENERAL iNFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 7 Block 2'Peters Gate Subdivision (T15N R1W
Section 14)
Location(addressordirections)
Sierra Mesa Cr.
(b)
Property Owner A.H.F.C.
Mailing Address 235 East
8th
Telephone: Home
Avenue, Anchorage
99501
Business
(c) Lending Institution lst'National Bank of
Mailing Address_ Eaqle River, Alaska 99577
(d) Real Esta[e Company and Agent Linda Malone, Re/Max
Address 16600 Centerfield Drive %201, Eaqle
River,
Alaska
99577
Telephone 694'4200
Mail the HAA to the followina address: or: Check here []~if hold for pick up.
List contact person and day phone number below.
S & S Engineering
17034 Eagle River Loop Road #204
Eagle River, Alaska 99577
(e)
.,
TYPE OF RESIDENCE
Single-Family ~x
Number of Bedrooms
three(3)
WATER SUPPLY
Individual Well I~x Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite ~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
72-025 IRev 8/86~ Front
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.
S & S Engineering Telephone 694-2979
Name of Firm
Address 17034 Eagle River Loop Road #204, Eagle River, Alaska 99577
Date November 21, 1987
NOTE:
Engineer's Seal
The mound system approved and installed on this lot was
designed for the sand fill layer and not the accepting
It appears to be functioning adequately at this time.
soils.
DHHS APPROVAL
Approved for three ( 3 ) bedrooms by
Approvee~XXXXXXXXXXX Disapproved
Terms of Conditional Approval
Conditional
.December 1, 1987
CAUTION
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.
Page 2 of 2 72-025 fRev 8/86) Back
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed "~ ""'7..~\ - ~;~"~
Width of Field
Square Feet of Absorption Area
Depression over Field (Y~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
t
To Water-Supply Well
To Building Foundation
/
Lot
"¢'"~ Type of System Design
Length of Field ¢7 ~
Depth of Field ~'
Gravel Bed Thickness (,/~-~
Standpipes Present~)
Date of Last Adequacy Test
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
Comments
Do
Date Installed
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
puVent (Y/N)
-~~~' Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have chec[~.e.d, verified, or conformed to all MOA and HAA guidelines in
~. S, &S ENGINEERiN~
~'g nea-- $4 E~,-;~ ~.~.---'- ['~PRea'4 N'"'' 2n~ate .~//'/¢-~/"~
Com~ Ri¥~;, Alaak' 995~9' MOA No.
Receipt No. ~ --O ~) / -- O (--.J ,/3
Date of Payment ..//f f 02 ._;;~ ~ ~7
Amount: $ /'O ~
Page 2 of 2
72-026 (11/84)
effect on the date of this inspection.
Src~'V~("c~MBA'~"'FR AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARy 1984
WELL DATA
2
Well Classification
264-4720
Legal Description:
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present ~N) y Date Com~/leted
Total Depth '~2.~/ Cased t~"~:>/~r' DePth of Grouting
Static Water Level .~[.,o~/~
Casing Height Above Ground
Electrical Wiring in Conduitd~J)N) y
Separation Distances from Well:
I
To Septic/~Tank on Lot
Yield
Pump Set At
Sanitary Seal on Casing ~N) y
Depression Around Wellhead (Y~;[~
· On Adjoining Lots
; On Adjoining Lots
To Nearest Edge of Absorption Field ~.~/~_ot ~ ~
To Nearest Public Sewer Line /J~' To Nearest Public Sewer
Cleanout/Manhole ~/.&' To Nearest Sewer Service Line on Lot
Water Sample Collected by ~--~' ~ ~:::~-~/-~.~.~,~¢~:9..~, ;Date \\~ \L~,.-
Water Sample Test Results ,~,,,~\~-~)~.~:~. ~ .....~,,.~~
Comments ~ '~¢ ~' \_ _~,....4.~ '~k--c~P ~ ~ ~ ~.\-"~\'"'~"/
B. SEPTIC/H~B~4~I'TANK DATA
Date Installed 'I//'?....~,/~
-/ /
Standpipes ~N) y Air-tight Caps(~N)
Depression over Tank (Y/~)
Pumping/Maintenance Contract on File (Y/N) //~
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic~ Tank:
To Water-Supply Well \ \~"~
To Property Line ~ c:, t ..~
To Water Main/Service Line
Course ! (:~l::;:>~ Jr-
Comments
Size t, ~ No. of Compartments
Foundation Cleanout(i~)
Date Last Pumped
t-5/jk ; for '-'--
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026(11/84)
APPLIC IT FILLS OUT UPPER HAL NLY
'r: :~ Zip Code
Realty Co. & Agent Phone
Address Zip Code
Type of Residence ' -' / '
SingleFamily
: Multiple Family No. of Bedrooms ..,'
: Other
Water Supply ~~
~:lndividual ~ ~-~' ATTACH WELL LOG A well log is required for all wells drilled since June 1975.
~ Community~CX'~;'~' For wells drilled prior to that date, give well depth (attach log if available).
: Public Utility
Sewer Disposal
~dndividual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
: Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Inspector I n s pect or,,~ ~__ Inspector ~, Inspector / ~
Soils Rating Date ~wer Inst~lled Well To Absorption Area ~ Well Log Received
__ ~ ~ ~ Z f": ~ ~ WelltoTank I [ 3 Septic T~k Size
72-023 (3182)
