HomeMy WebLinkAboutLOMA ESTATES BLK 1 LT 5I
4 caov o9awas
Municipality of Anchorage Page _I of
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
Permit Number: S W O 3 0 3 a6 PID Number: 10,20 05' a?
Name: /—/ F
Wastewater System: 0 New ❑ Upgrade
Address:
Pim
ABSORPTION FIELD
Phone:
yy� /
No. of Bedrooms:
O Deep Trench 0 Shallow Trench O Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
/Oa GPD/Sq Ft
/,0
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
Zer ,r ETrc 71e r
G.,r Ft.
or J- Ft
Township-.
Range:
Section:
Fill added above original grade:
Gravel length:
.2 - �3 Ft.
IOD Ft.
WELL' E❑ New ❑ Upgrade
Gravel width:
Numberones:
Distance between lines:
Ft.
/ b Ft.
Classification (Private, A,B.C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
FL
Ft.
SOVSO Ft
4XI-1 s ?o74''Ar'pse
Driller:
Date Drilled:
Static Water Level:
Installer: ir o 3 -06y 6
Date InstalleQ;
Ft.
/�7� �+. Ct-1'....�
_ 3
f-0
Yield:Pump
Set at:
Casing Height Above Ground:
TANK C- TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
19 Septic ❑Holding 0S.T.E.P.
To
Septic
Absorption
Lin
Holding
umic/Private
Manufacturer:
Capacity In gallons:
From
Tank
Field
Station
Tank
Sewer Lines
.4 � CJ.. rs, S G
/,ru
Well-/
�5� r
�•.ZQ /
/et p
Material:
free /
Number of Compartments:
:L
Surface
t/moo'
t/°r'/oe/
LIFT STATION N/A
Lot
Line
/
3J!
Lf0
3 y
Size in gallons:
Manufacturer:
Foundation
S /
oZ / /
D
"Pump on" level at:
Pump off' level at:
High water alarm at:
Curtain
Pump Make odel
Electrical Inspections performed by:
Drain
Remarks: a,, }0NeX
BENCH MARK
4� !!a Ota /N r•� 7'l�t•vL�
Location and Description:
�rl../iii/� of �i/r •s•J /�Cr-,r Pati 1< 07A
�p
YAI,✓e II /.rvG/ <i'Nil /G�G•!fi<�
Assumed Elevation:
/s7/! !Z:t Ft
//�7
e7rvO4 /r/!'w /h �ii..r w�.2. '' Gic .v0 rs/ /Slue ,6 ie rp/
ENGINEER'p SEAL
•+•(►s'�aiF
�.,aa.•a•aa " 41��
C� � ba Q
•'a
*d
Inspections performed by: Dates: 1st
*Oise
2nd -P-a F-O3
. s•»aa«»•••»»•»»•�•»
%a Louis X Butela
Department of Health and Human Services approval
�'���tia CE-6736;?��
��®�
Reviewed and approved by:Date: -1/-0
72-013 (Rev. 9/91) MOA 25
Permit No. SW 980005
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: Loma Est Lot 5 Blk 1 PID No.: 02009223
Lo13374 `i,�•%:i
s2
:SS.jov.
WELL n �• 1
I Z
1 0
LOT 5
N
SWING TIES
'c. Va. A—C = 81.6'
i yt W B—C = 25.9
.
B—D = 68.8'
T�j1 •,•., A—E = 86.1'
1R&� j" 4 B—E = 34.4'
pIV�RSION
VALVE
XISTING 1250 Gal
TH2 N D <<``'' Septic Tank
..• LA
THs
LEGEND
n g
'n B HOUSE N — TEST HOLE
• — MONITOR TUBE
E o — SEWER CLEANOUT
+ — WELL
NEW LEACHFlELD
— — — EASEMENT
------------------------
S 89'54 26" E 229.84
RV. SEPT. 8, 2003
ELEVATIONS ,TEIR Boat "CSH01D ENGINEER'S SEAL
(NOT TO SCALE) SAD °EA' 10000F D
Q..
aoaNAlOROUPID
LM AT.
91.7 TRI 49 ILL
av�P 'r 00
f 91.1 iR2
r4AMM xra NSULADON CWT 0 W.7 Q ••••••••••••••••••••••••• D
rAN,c
Louis A. Butero
aao +� ,.2 TRs oaM TTRIRs QQ cif' CE -6736 v�
oaam` �TR
90.1 TR2�?OFESSI��Q
0
00400d��
Sep. 8. 2003 8:55AM
N o . 0 0 2 8 P. 4
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
August 14; 2003
Jon & Denise Huf c/o
Remax Properties
2600 Cordova St.
Anchorage, Alaska 99503
Attn: Carol Butler
REFERENCE: Loma Estates Subdivision, Block 1, Lot 5. 5200 Davis Dr.: Well and
Septic System Evaluation.
Mr. & Mrs. Hut
Per the request of your agent, we inspected the well and septic system that serve your
property for the purpose of obtaining a MOA Health Authority Approval (HAA). A site
visit was performed on 8/13/03. Our findings are summarized as IbIlows:
WELL: Prior to the start of the flow test the water level was 35 feet below the top of the
well easing (BTC). The well is approximately 205 feet deep per the MOA records.
Water was metered from a hose bib at a rate of 1.8 gallons per minute (gpm) for 120
minutes. This causedthestatic water level to drop 114' to a level of 149' BTC. The flow
rate was then reduced to 1.2 gpm for 192 zpinutcs daring which time the water level in the
casing remained unchanged.
Based upon this data it was determined that the production rate of the well is
approximately 1.2 gpm. This exceeds the MOA requirements for a four (4) bedrtxrm
house (0.4 gpm).
WATER QUALITY: Vater samples were taken on 8112/03 and taken to a State
certified laboratory to be analyzed for nitrates and bacteria. As soon as the results are
available we will forward them to you.
SEPTIC SYSTEM: Upon inspection it was determined that the drain.field is completely
submerged in water. This is referred to as "surcharged" condition. Although the system
may be functional, it is by MOA definition technically failed and an upgrade will need to
be performed before you can transfer title (sell the property).
3701 E. Tudor Road, Suite 101 *Anchorage, Alaska 99507
Ph: (907) 337-6179' Fax: (907) 338-3246 6 Website: akwwc.evm
Sep. B. 2003 8:56AM
No -0028 P. 5
Unfortunately, due to our current workload, we are unable to assist you further on this
project. We recommend that you contact Eagle River Engineering Services cr 694-5195
or Flattop Technical Services @ 345-1355.
If you have any questions, please contact us at 337.6179. For more extensive information
on septic system te4ing and design, see our website at akwwc.com.
;z
M.S.
3701 E. Tudor Road, Suite 101 ' Anchorage, Alaska 99507
Ph: (907) 337-6179' Fax: (907) 338-3246' Website: akwwc.com
Sent By: Alaska Water and Wastewater Con; 907 338 3246; Aug -28-03 3:33PM; Page 214
./�./,� '
ACASKA-WA7ETZ F& WASTEWATER
Pubs.-pa.+NY*•wn.rullwrrn,u.xYX.Mwnnv..W�m CONSULTANTS, INC. •FPb9YP PIbMNJP+,Y1bIF�KMP>aY1bMP1. P"J111PP'PJPM.. L
WELL
�sFLOW
yy��TEST DATA
LEGAL DESCRIPTION: /� rJ .6-A / ze l'i:,'L
CLIENT:
NUMBER OF BEDROOM: _L
PHUNE NUMBER:
GALLONS PER DAY NEEDED:_
WELL: *SEE H.A.A. SITE VISIT CHECKLIST* DATE. OF TEST: 4g Z O
1. Casing Height (Above Ground): Z- �� _
2. Sanitary Seal: dE3? / NO (if "NO", describe in Comments)
3. Wires in Conduit: 0 /-NO (if "NO", describe in Comments) Y/ 0.
4. Water Samples Nceded. / NO (if "YES", date taken: 035050
5. Depression around Well: YES / (if "NO", describe in Comments
6. Does Well need Four Hour Flow est (FHA): YES
I
WELL PRODUCTION: Q� GPM ( 'J C u GALLONS IN 2 cj- 9'MINUTES)
iy
Signature: J! , 0/1 ,itt� Date:�T
Al -t- 001 W 0 Ph- 1Qn71117.6179 • Fax: (9071338.3246 • awwsQalaska net
ITTWI, I; MM
WELL PRODUCTION: Q� GPM ( 'J C u GALLONS IN 2 cj- 9'MINUTES)
iy
Signature: J! , 0/1 ,itt� Date:�T
Al -t- 001 W 0 Ph- 1Qn71117.6179 • Fax: (9071338.3246 • awwsQalaska net
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW030326
Legal Description:'LOMA ESTATES BLK 1 LT 5
Design Engineer: 0024 Eagle River Engineering Services
Owner Name: John & Denise Hui
Owner Address: 5801 Silverado Way
Anchorage , AK 99518-0000
X12, pl s:_�`DPm
Date Issued: Aug 25, 2003
Expiration Date: Aug 24, 2004
Parcel ID: 020-092-23
Site Address: 005200 DAVIS DR
Lot Size: 49989 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑✓ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑ Private Well ❑ Water Storage
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (1 BAAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
✓� c
Received By:
Issued By:
Date: C — .1S— 0.3
Date: zsD3
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program r�
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. OZo —097 —Z"? Permit Number SW030326
Property owners) J°NN Day phone 563— 7-2Sy
Mailing address (1) S�1tler4'clo z✓ay
Mailing address (2e-A4v�';s-P 'df" A` Zip Code
Legal description (Lot, Block & Sub'd.) Z' f"S /3//T / L C --� ti Z r A,�s
Legal description (Section, Township & Range) q ?ZO 1�) (1.V 6
Lot Sizeq q ,G�Acres/Sq.Ft. Number of Bedrooms 47'
THIS APPLICATION IS FOR:
Sewer Only ® Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: !! Waiver Fees: _
Date of Payment: t. Zo' of Date of Payment:
Receipt Number: -I b� 37 _lam Receipt Number:
(Rev. 12/00) �— 01 �9
Eagles River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
,A k5 i6
Jim Cross, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Loma Estates Lot 5 Blk 1
Narrative & Permit Application F9,- F�� r ►arr•�c J%
Dear Mr. Cross:
The proposed septic upgrade/well and septic system will have very limited impact on adjacent
properties for the following reasons:
1. The surrounding lots are large, 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. Drainage will be altered slightly by adding fill to the toe of existing slope in order
to maintain a 35' distance to the reserve area. ,
S We A . vC Ye w..#
If you have any questions please call our office at 694-5195. �` ""'� ""'"`"'� p�✓"'���
Sincerely,
Louis Butera, P.E.
\1997197-073-NAR.DOC
Skn, c ode,s.J t!
:Jrl.� I.+4 • .S4Te
NO WELL, 5EPTIC OR
_233,74 STRUCTURES +200'
F90P05E0
WELL � I
0
LOT 5 4 !
too,
\ ter t•r
LOT 4
o 0
P
Z v T� Maintain 10' separation
N o �T91 to leacktield, bury
.tom r0 X 4 / +10' and insulate.
N W
LOT 6A j a L TH2 1250 Gdl
5eptic Tank
i FELL +100
° O /
SEPTIC 6 �'>9 r �r•► . '
VENTS ��Q
�S'�,w- \� -3Gv it.G�
0 �
\� PROPOt�ED
HOU19E
60'
-----------------------
to• ut;rtr esmt. 5 89.54'26" E
229.84
5EPTIC
+ LOT 7 0—
VKN7S
0
0
NOTe: Area indicated to be filled
at time of construction of
reserve leach(eid. AWCHBOR
Total depth is t• from highest ekv. 0 — TEST HOLE FELL.
on trench, sod to be scrapes to s — MONITOR TUBE
.and Idter and leveled with sand,
<5% tino mateial. o — SEWER CLEANOUT
NO SURFACE WATER- + - - WELL EASEMENT
¢
NO KNOWN CURTAIN DRAINS - PROPOSED LEACHFIELD
WELL SEPTIC SITE PLAN 000���ooao
LEGAL: LOMA ESTATES L5 BLK 1 0 ��E•�F. A� NO
OWNER: JOHN HUF Z'`P•' •'9`r�90�/
CONTRACTOR: HAGMEIER G•* .49TH..•.:•*
JOB 97-078 10/22/97 J SCALE 1" = 60' Ge::eee
EAGLE RIVER ENGINEERING SERVICES -V/ V0% ••LOUIS A. BUTERA W
AP.O. Box 773294 G�Q,�•.••cE-6736••:
EAGLE RIVER, AK. 99577 �n ° •• o
(907) 694-5995 FAX. (907) 694-3297 ��0� pov��o�c�
Eagle(xdver Engineering ►services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
• SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LObIA ESTATES LOT 5 BLOCK 1
.10i17t97-
A. GENERAL
I. 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 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.
9. Any remaining open test hole excavations shall be filled.
B. SEPTIC TANK
1. Septic tank shall have a minimum capacity of 1250 gallons and be of MOA approved design.
C. TRENCH
I. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom.
2. The 5' wide trench is to be excavated down to natural sand material and scarified then an imported
sand material is to be placed so that the total depth of the trench excavation is not to exceed 1.0' at
any point.
3. The bottom of the trench shall be level, plus or minus 1.5".
4. The effluent line within the trench shall be laid level within 0.03'.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of Y or equivalent is to be placed
over the leachfield.
7. The area over the trench 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= 1.0' GRAVEL DEPTH = 6" under pipe, 2" over pipe
TRENCH LENGTH= 100' TRENCH WIDTH = 5'
SOIL RATING= 1.2 GPD/ft2 BEDROOM CAPACITY= 4
SEPTIC TANK = 1250
Twenty-four (24) hours notice required for all inspections.
\ 1997\97-073-spec.doc
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907)694-5195
ERES Project No.: 97-078
Calculated By: LB
Date: 10/20/97
Legal: LOMA EST. LOT 5 BLK 1 TEST HOLE 1,2,3
Single Family 4 Bedroom Dwelling
P4—ie^.- -5.c/r-
Shallow Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom = 600 gallons
Percolation rate = 1.15 minutes per inch
Wastewater application rate = 1.2 gallons per day per square foot
Required absorption area = 500 square feet
Trench width (W) = 5 feet
Gravel depth (D) = 0.5 feet
Required length = Shallow trench factor' Required absorption area / W
Shallow trench factor = (W + 2) / (W + 1 +2 D)
Shallow trench factor= 1.00
Total Excavation Depth = 0.5 feet
Required length = 100 feet
Design trench at 100' to compensate for
varying conditions.
of A Cgs�p�
...............................
LOUIS A. BUTERA
Jl • CE -6736
'oNPotip
Municipality of Anchorage Page f of 2
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
Permit Number: S� 980�s PID Number: OZC> 042 ;?-3
Name:
Wastewater System: ,XNew ❑ Upgrade
Address:
o Clcue/4.,r�r�vc ".2v/ �d 995/'7
ABSORPTION FIELD
Phone: No. of Bedrooms:
❑ Deep Trench Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
/ 2
Total fept�romoriginal grade:
GPD/S.Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
5- 1. LOMA Es Tort
e9,37- Ft.
Ors Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length: ,
�aV
"01 Ft.
Ft.
WELL: ONew ❑ Upgrade
Gravel width: �/
NumberHines:
Disla��tween lin Ft.
Ft
Classification (Private. A,B.C):
_f 7i V.0 Ire—
Total Depth:
Z'Ft.
Cased To:
Sy Ft.
Total absorption area:
-3'0O SQ. Ft.
Pipe material:
FS/O /�"
Driller: -
f4lP; H c Pr, /% u
Date Drilled:
6 -/o -y?
Static Water Level:
O Ft.
Installer:
�,e Co..sr
Date installed:
Yield: (�
/ GPM
Pump Set at: T
/Ydr __Z j7s/at. 1
Casing Height Above Ground:
3, Ft.
TANK
SEPARATION DISTANCES
�,/Septic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manu acturer:Capacity
2CA1. -7;_o,,(7
in gallons:
)-2-rU 4/
From
Tank
Field
Station
Tank
Sewer lines
Well
157 I
(2s'
N�
,f/A
! /o/
Material:
'el TEG[
Number of Compartments:
Surface
i
a ,oma
LIFT STATION
Water
Lot
I�
/
O
I
/
Size in gallons:
Manufacturer:
Line
Foundation
S/
15
t14
"Pump on" level at:
"Pu putt level at:
High water alarm at:
Curtain
Pump Make el
Electrical Inspections performed by:
Drain
N%}
BENCH MARK
Remarks: /uo F;// _e s r- Af
-
/ter t4 i/a �'/o>,.+ . /%rci..r,�•e./� !aced
Location and Description:
T t.s,4a/d l�.r c -c. �,r SC
Assumed Elevation:
00
ENGINEffL
..41.yIll
�* 49I�S
Inspections performed by: EPAF�S Dates: 1st 6"/7.95-L9"
``'�-Qb
NN"'•'••~•N••'« ..:...
2nd
„....».....«.......«
X Louts A, Butero
�1,�•ti. °esT�s
Department of Health and Human Services approval
.f•i
AW
wr
Reviewed by: 0"Date:
and approved
79.n191Rev 9/911 MOA 25
Permit No. --.$w
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: Loma Est Lot 5 Bilk I
PID No.: -- 197•0 017- Z-3
'10
WELL I
LOT 5
100,
SWING TIES
&A -C = 72.7'
.4 B -C = 19.3'
A -D = 10.7'
B -D = 69.4'
THI
0i
TH2 Q 1250 Gal
5eptic Tank
TH3 A NN
0
B HOUSE
® — TEST HOLE
C • — MONITOR TUBE
o — SEWER CLEANOUT
- WELL
- NEW LEACHFIELD
— EASEMENT
— — — — — — — — — — — —
5 —89°54'26"—
f-
229.04 SCALE 1 60'
June 17, 1998
ENGINEER'S SEAL
ELEVATION5 n RtAR DooR TH
RE5HOLD
(NOT TO SCALE)ooppp
100.00
OF A
0
.9
021UML
LeVEL AT:
QROUND 00 00,
91.7 49TH* `y*
app
!;� .....
................
SAM CM
/—Z" 35,P51 [N5ULATH) CHT 0 e6.7
.............
TANK �Oj, -,�Qh L 0 U I- S A. e
03.7 Bu ro
N1
95.0 4.7 91.2 91.2
CE -6736
IQ
90.7
SEP-11-2003(THU) 14:15 EAGLE RIVER ENGINEERING (FAX)907 694 3297
FPCH : J" HPWIRE CO. PHQE H3. : 24[r.A3J Tv . 19 1998 =LPH PL
STATE Le ALASKA
DWARTMEM OF NATURAL ALSDUlt=
DIVISION Cr wWnNG 6 WATER MGPAT
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P. 003/003
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW980005 DATE ISSUED: 1/12/98
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 1/12/99
OWNER NAME:BAILEY RAYMOND P
OWNER ADDRESS:5200 DAVIS DR
ANCHORAGE, ALASKA 99516
PARCEL ID:02009223
LEGAL DESCRIPTION:
LOMA ESTATES BLK 1 LT 5
LOT SIZE: 49989 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING rI
5. THE FOLLOWING SPECIAL PROVISIONS.
Wo,
��
SPECIAL PROVISIONS:
THE SAND USED IN THE FILTER LAYER MUST BE A CLEAN COARSE
SAND WITH 4% OR LESS PASSING THE #100 SIEVE AND 2% OR LESS
PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED
ON THE SAND USED OR OBTAINED FROM AN.APPROVED SOURCE.
RECEIVED BY:
ISSUED BY:
DATE: /-1`f-?
Z)awaNz - v DATE:/ " / Z -'%S
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 WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW980005 DATE ISSUED: 1/12/98
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 1/12/99
OWNER NAME:BAILEY RAYMOND P
OWNER ADDRESS:5200 DAVIS DR
ANCHORAGE, ALASKA 99516
PARCEL ID:02009223
LEGAL DESCRIPTION:
LOMA ESTATES BLK 1 LT 5
LOT SIZE: 49989 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING rI
5. THE FOLLOWING SPECIAL PROVISIONS.
Wo,
��
SPECIAL PROVISIONS:
THE SAND USED IN THE FILTER LAYER MUST BE A CLEAN COARSE
SAND WITH 4% OR LESS PASSING THE #100 SIEVE AND 2% OR LESS
PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED
ON THE SAND USED OR OBTAINED FROM AN.APPROVED SOURCE.
RECEIVED BY:
ISSUED BY:
DATE: /-1`f-?
Z)awaNz - v DATE:/ " / Z -'%S
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294
Eagle River, AK 99577-3294
October 17, 1997
Jim Cross, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Loma Estates Lot 5 Blk 1
Narrative & Permit Application
Dear Mr. Cross:
(907) 694-5195 tel
(907) 694-3297 fax
The proposed septic upgrade/well and septic system will have very limited impact on adjacent
properties for the following reasons:
The surrounding lots are large, 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. Drainage will be altered slightly by adding fill to the toe of existing slope in order
to maintain a 35' distance to the reserve area.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\1997\97-078-NAR.noc
i
10' Utility Esm{. —
_ 1
E — — — — — — — —
NO WELL, SEPTIC OP,
229.84
+00'
STRUCTURES +200'
SEPTIC
0� VENTS
_Z333
PQ0P05ED
LOT
7 0
WELL
0
NOTE: Area indicated to be filled
at time of construction of
reserve leachfield.
NEIGHBOR
Total depth is V from highest elev.
LOT 5 y
® —
TEST HOLE WELL
on trench, soil to be scraped to
sand later and leveled with sand,
too•
MONITOR TUBE
<5% fines mateial.
o —
SEWER CLEANOUT
I
NO SURFACE WATER
LOT 4
¢ —
WELL
¢
NO KNOWN CURTAIN DRAINS
(Vacant)
EASEMENT
—
PROPOSED LEACHFIELD
f�
roo
Z
�°� TH1
Mdintdin 10' sepdrdtion
to ledchfield, bury
.,aro
x l ®
+10' and insulate.
LOT 6A
o `/ TH2 P
1250 Gdl
5eptic Tank
WELL +100'0
/ Js
a }
SEPTIC
VENTS
$ ��Sn o `o fll
�—
10' Utility Esm{. —
— S 59054'26'
E — — — — — — — —
229.84
+00'
SEPTIC
0� VENTS
LOT
7 0
0
NOTE: Area indicated to be filled
at time of construction of
reserve leachfield.
NEIGHBOR
Total depth is V from highest elev.
® —
TEST HOLE WELL
on trench, soil to be scraped to
sand later and leveled with sand,
• —
MONITOR TUBE
<5% fines mateial.
o —
SEWER CLEANOUT
I
NO SURFACE WATER
¢ —
WELL
¢
NO KNOWN CURTAIN DRAINS
— — — -
EASEMENT
—
PROPOSED LEACHFIELD
WELL SEPTIC SITE PLAIN 0000000000
LEGAL: LOMA ESTATES L5 BLK 1 0��� OF„� q00° p
0
OWNER: JOHN HUF
,f:7
�Q,•'•
CONTRACTOR: HAGMEIER -v*;•49TH *?�
JOB 97-078110/22/97 1 SCALE 1 ” = 60' J
4• ••••.•.•••••.••••/J
EAGLE RIVER ENGINEERING SER VICES '•LOUIS A. BUTERA;'57
P. 0. Box 773294 44�'�^ —sass ••: �j�
EAGLE RIVER, AK 99577 o0 o
(90,7) 694-5195 FAX: (907) 694-3297 ��4poo�000Joo
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 97-078
Calculated By: LB
Date: 10/20/97
Legal: LOMA EST. LOT 5 BILK 1
Single Family 4 Bedroom Dwelling
TEST HOLE 1,2,3
Shallow Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom = 600 gallons
Percolation rate = 1.15 minutes per inch
Wastewater application rate = 1.2 gallons per day per square foot
Required absorption area = 500 square feet
Trench width (W) = 5 feet
Gravel depth (D) = 0.5 feet
Required length = Shallow trench factor" Required absorption area / W
Shallow trench factor = (W + 2) / (W + 1 +2 D)
Shallow trench factor= 1.00
Total Excavation Depth = 0.5 feet
Required length= 100 feet
Design trench at 100' to compensate for
varying conditions.
'�P��.�F••AZgs��0
�................ .........
. LOUIS A. BUTERA;
f'•, CE -6736
00��0 � PROFESSIONP��?d��
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294
Eagle River, AK 99577-3294
(907) 694-5195 tel
(907) 694-3297 fax
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOMA ESTATES LOT 5 BLOCK 1
10/17/97
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 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.
9. Any remaining open test hole excavations shall be filled.
B. SEPTIC TANK
1. Septic tank shall have a minimum capacity of 1250 gallons and be of MOA approved design.
C. TRENCH
1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom.
2. The 5' wide trench is to be excavated down to natural sand material and scarified then an imported
sand material is to be placed so that the total depth of the trench excavation is not to exceed 1.0' at
any point.
3. The bottom of the trench shall be level, plus or minus 1.5".
4. The effluent line within the trench shall be laid level within 0.03'.
5. The trench 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 leachfield.
7. The area over the trench 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 = 1.0' GRAVEL DEPTH = 6" under pipe, 2" over pipe
TRENCH LENGTH = 100' TRENCH WIDTH= 5'
SOIL RATING = 1.2 GPD/112 BEDROOM CAPACITY = 4
SEPTIC TANK = 1250
Twenty-four (24) hours notice required for all inspections.
\1 997\97-078-sp ec. d o c
- 1 r•.
men (ENG[KgER'+` GEA�)'r
e
_$v vas 78evx eree ii/itY y• :
Municipality of Anchorage
DEPARTMENT OF HEALTH i£ HUMAN SERVICES _t Laois s, a rrorc� ("
t 825 "L" Street, Anchorage, Alaska 99502-0650 ce-s7,U e,If
SOILS LOG — PERCOLATION TEST r"'•�.. _ ,�',; *�
PERFORMED FOR:. 146f F DATE PERFORMED:_
LEGAL DESCRIPTION: LOI412 EST L i
TNS DYFP-F
Cr (FEET)
1
2
3
U�
4-
C'
5-
6 6
J"
7
D
8
9 O;
v
10
11
12
13
14
15
16
17
18
19
1
CP -SP
faro
Township, Range, Section:
SLOPE
SITE PLAN
WAS GROUND WATER 11//
ENCOUNTERED? 7�S
S
IF YES, AT WHAT S' LL
DEPTH? u p
E S S o
Depth to Water After i
Monitoring? Date:
I
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
s�k�d
3x ?ti
20LJ I el
tui PERCOLATION RATE a lB (minutes/inch) PERC HOLE DIAMETER _
TEST RUN BETWEEN FT AND FT
COMMENTS �H' -Si �ro -f4.d� /h.c7L'ri �f/ ii y,n f1i / ,b erc .fit rC j'h e -e, f sp.r.✓ l/ej rT •ice
> s
� CERTIFY THAT THIS TEST WAS PERFORMED IN
PERFORMED BY: FiQES I 1
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: //'' Aw
LEGAL DESCRIPTION: .OM2 E-5% L t BCK / Township, Range, Section:
DEP SLOPE SITE PLAN
77.1 1
2 I FEET) f�
I I ' I
3 0
CP
4 Gvi 7Y7
5 O �7/�
!'a ✓c /
6
7 v
8
' •v
9
10
Fe T7,�, 0�/ T-11
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER I/cs
ENCOUNTERED? /
S
IF YES, AT WHAT i L
DEPTH? 1
P
E
ry
Depth to Water Alter 7' 0/ �d,_2 3 -'i?
Monitoring? Date:
ReadingDate Gross
Time
Net
Time
Municipality of Anchorage
Net
Drop
DEPARTMENT OF HEALTH 8 HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST{}/yL�;��;a,.
Y ea . +. .• ..++•.••+aer. •^.
s ' .ouj, A. 3ujara a;„
` h`eq cE-4736
r
oria�
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION: .OM2 E-5% L t BCK / Township, Range, Section:
DEP SLOPE SITE PLAN
77.1 1
2 I FEET) f�
I I ' I
3 0
CP
4 Gvi 7Y7
5 O �7/�
!'a ✓c /
6
7 v
8
' •v
9
10
Fe T7,�, 0�/ T-11
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER I/cs
ENCOUNTERED? /
S
IF YES, AT WHAT i L
DEPTH? 1
P
E
ry
Depth to Water Alter 7' 0/ �d,_2 3 -'i?
Monitoring? Date:
ReadingDate Gross
Time
Net
Time
Depth to
Water
Net
Drop
/e 5do
?,y 7-k
oria�
I 11%'79
211,
I vs7
z �I
z s
6
PERCOLATION RATE d-'23 (minutes/inch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN FT AND 3 FT --
COMMENTS Z'i'y ,S-, f( `I71i 7`C ria/ A1u.r ,71r� .O«G ea J� /nee ft .S+.v c� /•rr.5`'
_F't,rt,y
i5 'jq,+174" 7`z6e /v O/<tG ufeA mor GST rhpNi% 6' (fgT t7�/4YJ
PERFORMED BY: �J I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. fL /S 8
PERFORMED FOR:
Munlcipallty of Anchorage
DEPARTMENT OF HEALTH 8 HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
z
DATE PERFORMED: /a–/S--17
LEGAL DESCRIPTION: LO/W't EsT L - r BLIT / Township, Range, Section:
—rt/ 7 EPT SLOPE SITE PLAN
f7 7 SIF STV
2 N
3 c p /
4-
5
6
7
8
7-
�e Tow % fv
9
10 WAS GROUND WATER
ENCOUNTERED? Yes
11 S
IF YES, AT WHAT OL 10
12 DEPTH? P
E
Depth to Water After
13 Monitoring? S'S gate (v"o23�t i
14
15
16
17-
18
19
20
COMMENTS
Reading Date Gross
Time
PERCOLATION
Net
Time
5 e RS N•f.n 1A 1 tHY3tt
Net
Drop
{Pa CL -67a6
,6
t.p
DATE PERFORMED: /a–/S--17
LEGAL DESCRIPTION: LO/W't EsT L - r BLIT / Township, Range, Section:
—rt/ 7 EPT SLOPE SITE PLAN
f7 7 SIF STV
2 N
3 c p /
4-
5
6
7
8
7-
�e Tow % fv
9
10 WAS GROUND WATER
ENCOUNTERED? Yes
11 S
IF YES, AT WHAT OL 10
12 DEPTH? P
E
Depth to Water After
13 Monitoring? S'S gate (v"o23�t i
14
15
16
17-
18
19
20
COMMENTS
Reading Date Gross
Time
PERCOLATION
Net
Time
Depth to
Water
Net
Drop
rL -' ioo ci/
)s:ly
""Fp-
Zy„
6„
-z3—
3
PERCOLATION RATE %S (minutes/inch) PERC HOLE DIAMETER a
TEST RUN BETWEEN Z FT AND 3 FT
PERFORMED BY: I �OERTIFY THAT THIS TEST WAS PERFORMED IN
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Municipality of Anchorage
�•� Development Services Department
/ Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. .4_3- o - 0 5a2 - a. -7
1. GENERAL INFORMATION
HAA #_ � ?) Q ( D Z ---
Expiration Date: _j q / / - O 3
Complete legal description 4,2 74 B/oe-4- /,
Location (site address or directions) 5-�0 %� r,✓ /J, -..:t �J-rc.r��a
Current Property owner(s) .Te -v -V e:�7ewv-xe NN -1 Day phone 4-1-,1i —S-Y7i
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
'I'/lq Day phone
C4.,,i G r-Ae Day phone
Qf'•G.,. �.. %yri ��i � �lCd la.-alo,.,4 ,TT, ,yn��c.e.Sp
Unless otherwise requested, HAA will be held by DSD for pickup.
Z. NUMBER OF BEDROOMS:
l _
3. TYPE OF WATER SUPPLY:,
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or 8 wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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 Health Authority 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 in effe� at me 4me of irVallation.
it
agle ver n9ineering Services
Nemo of Firm-. P•O..Bo:773294. Ea0e Riya, AK 99M7.M ri lune 6Sy %l -i55"
Address
Engineer's Printed Name Date ;gg;;-y
.IlepVelr Fir, . t �-<. �r .,C �� 6 �� OF q���D
•�•,•....•••.0
(/ra✓Te o.a ! r 4-Vrs. /76r.,.j • �•• i�
� .�, we/i fi.... r•. � sv� fPiL'IB •,�9 1
,We f=•NYoes,&; ••N...i..•
%-GJt' rrPrrf- by /t /fL✓wG ♦ ..•• • •• •. •NN•••..
5. DSD SIGNATURE L'°� j era
1/ Approved for 1• bedrooms. �r �F��'"^....,.•..•'�
Disapproved.�'��'�
Conditional approval for bedrooms, with the following stipulations:
\\\��1 .••• •. 0 r
• ON-SITE
Additional Comments WATER
:WASTEWATER
- P�gGI}AA
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
'Well Flow Advisory Other
By: Original Certificate Date: 01-11-03
(Rev. 01=)
Municipality of Anchorage *A1
Development Services DepartmentBuilding Safety Division On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 40 f S- /dpl* / ,Lv.+, .c L5I'1' A --.r Parcel ID: O.2 u -G 91 - ? 3
A. WELL DATA
Well type - .4
Date completed
Total depth ;7 -JS- ft.
Date of test
Static water level.
Well production
If A, B, or C provide PWSID # *4 Well Log (YIN) y
Sanitary seal (Y/N) y Wires properly protected (Y/N) %
Cased to Sy ft.
FROM WELL LOG
v ft.
1V g.p.m.
Casing height (above ground) � Y in.
AT INSPECTION
9-13-G?
.3-5-
/'
s
/. ZX_
//OT
ft. Aj7.rsrL
yevt
g.p.m.
WATER SAMPLE RESULTS:
Coliform Y' colonies/100 mi. Nitrate a. / mg./1. Other bacteria _,Ir colonies/100 ml.
Arsenic: 11,44 mg./I. Date of sample:,F--i-o 3 Collected by: Ay �✓��� �' u'�f>�w^-*�
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Date installed % 8
Tank size /-2Jn gal. Number of Compartments Cleanouts (Y/N) y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/ti
I.
j Date of pumping 8 - i - e3 Pumper , No
C. ABSORPTION FIELD DATA
Date installed -/ 7 - Soil rating (g.p.d.e or ftZ/bdrm)/_1 System type S�.//.w µtai•/
Length ft. Nq-� Width S` ft. Gravel below pipe ���- ft.
Total depth /. ft. Eff. absorption area S&0 ftZ Monitoring tube i Depression over field N
Date of adequacy test /Wep^' � / a/ Results (Pass/Fail) f'" For It bedrooms
Fluid depth in absorption field before test 4> in. Water added 10� gat. New depth in.
Elapsed Time: U min. Final fluid depth = in. Absorption rate >= "G 4.W g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) '0V /wI If yes, give date -"
D. LIFT STATION /✓1, -
Date installed Size in gallons
"Pump on" level at in. "Pump off' level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots 7,/e4j'
Absorption field on lot /.;10 On adjacent lots ),"od'
Public sewer main IV14 Public sewer manhole/cleanout
Sewer /septic service line '` iso Holding tank N /A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation s Property line 3 5,' Absorption field ? r
Water main ?V)4 Water service line Surface water
Wells on adjacent lots -}ruvr
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ;,eO Building foundation cs;1 I Water main
Water Service line +/U Surface water f'/ed Driveway, parking/vehicle storage
Curtain drain *V14 Wells on adjacent lots
F. COMMENTS
We// eA k mss-. 1A& iC .� / 3 — a j
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name .Cct+ii k -,M;
Date 9 - 9 - e ?
HAA Fee $
Date of Payment U
Receipt Number
(Rev. 12101)
Waiver Fee $
Date of Payment
Receipt Number
in.
SEP-11-2003(THU) 14:14 EAGLE RIVER ENGINEERING (FAX)907 694 3297
Sent By: Alaska Water and Wastewater Con; 907 338 3246; Aug -26-03 3:34PM;
jai t:
SGSRcc# 1035050001
Client rUme AK Watcr & wastewater Coosullaau Int
PMJW Nuadx L5, B 1. Loma int. 5200 Davis
Cfieot Semple ID L5, 81, Lwow Eat. 5200 Davis
Mattis DdnVAC Water
P. 001 /003
Page 314
All DNtet/IBn s are Alaska Standard Time
?rioted 11aW ime
ORW2003 13.46
Collected DaWrise
08!1211003 11:34
Rteeived DatdT{tnt •
08/13/2003 9:10
Technical Director
Stepleo. Ede
Sample Rtmwks -
AlbwsLk hep AnsTysts
tatcmcw Q41aro rs itewlts FQL Uaiu Ut" Csms1por10 Lhnju D>Ne !nit
Waters Dapartaaent
Nitatc N 0.1001) 0.100 m8/L EPA 300.0 H (1C 10) 08/14/03 JIB
Microbiology Laboratory
Total Cchform D co11100ml. SM119222B A ("D 08/13/03 JS
m
MUNICIPALITY OF ANCHORAGE RECEIVED
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services JUL 1 3 1998
On -Site Services Section MUNICIPALITY OF ANCHORAGE
P.O. Box 196650 Anchorage, Alaska 99519-6650 ENVIRONMENTAL SERVICES DIVISION
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# Z'z3 HAA#i(V:19,nlSCr�
1. GENERAL INFORMATION
Complete legal description
Location (site: address or directions) SZoO py,; f Pr.
u.�
�H L IfOlO� �
Y
Property owner leu Day phone 3Ys = y3r�
Mailing address %'� '. dov //00 6 6 1�me-Aiorcoe AK 99s ii
Lending agency Day phone
Mailing address- -
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: y
3. TYPE OF WATER SUPPLY:
Day phone
Individual well
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
Holding tank
Community on-site
Public sewer
i�'K
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev.1/91) Front MOA421
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Eagle River Engineering Services
Name of Firm P. n. Rnx 77122
Eagle River, AK 99577
Phone
Address 694-5195
Engineer's signature - X25 ` Date �— >;— r •�'
6. DhIHS SIGNATURE
(� Approved for ! (' lQ bedrooms.
Disapproved.
Conditional approval for
Additional Comments
bedrooms, with the following stipulations:
Date %
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 courtesyto 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.
72-026(Rw. 1/91) Back MOA #21
A Municipality of Anchorage RECEIVED
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division JUL 1998 dhr15
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-47
Municipality of Anchorage
Health Authority Approval Checklist Dept. Health & Human Services
Legal Description: �oryQ GS%d%j LeT S /i 1 Parcel I.D.: D?�evq 2 Z 3
A. WELL DATA
Well type F ' vu Te If A, B, or C, attach ADEC letter. ADEC water system number 7A1,4 .
Log present (Y/N) k_5 Date completed g8
Total depth 2-e:95-- Cased to TY Casing height (above ground) Z y
Sanitary seal (Y/N)
Date of test
Static water level
Well production
FROM WELL LOG
6 -/d -y8
y g.p.m.
WATER SAMPLE RESULTS:
Coliform
O Nitrate
Date of sample: g- 2.q" f '
B. SEPTIC/HOLDING TANK DATA
Wires properly protected (Y/N) 7- z,57 //ems/
Ar /;,c UG �ws/ctrirrd
AT INSPECTION
/CLL
Other bacteria O
Collected by: Eoy/c /\''vim✓ �Ng✓'ti e -g-1,
Date installed G-0-99' Tank size / 7S0 9Q/Number of Compartments �- Cleanouts (Y/N) YeS
Foundation cleanbut (Y/N)' "%s Depression (Y/N) %Vo High water alarm (Y/N)
Date of Pumping Pumper /tl�4
C. ABSORIOTIQN FIELD DATA
Date installed 6 -/?-98 Soil rating (g.p.d./ft2 or ft2/bdrm) Z System type S!Ofll� ✓e x!�
Length 160 Width S Gravel thickness below pipe O.S Total depth
z
Effective absorption area . Soo r Monitoring Tube present (Y/N),K'r,,1_ Depression over field (Y/N) ltl�9
Date of adequacy test N — Results (Pass/Fail)
-A'�1
For /W bedrooms
Fluid depth in absorption field before test (in.); 1W Immediately afters gal. water added (in.):
Fluid depth (ins) Minutes later: /&/�� Absorption rate = � g.p.d.
Peroxide treatment (past 12 months) (Y/N) IV4 If yes, give date
72-026 (Rev. 3/96)"
D. LIFT STATION
A
Manhole/Access (Y/N)
High water alarm
E. SEPARATION DISTANCES
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot 2S
Public sewer main
— A-14 A-14 —
Size in
fl at*
On adjacent lots
On adjacent lots
"Pump off" level at*
Public sewer manhole/cleanout y"—
Sewer /septic service line 12-s ' Lift station Nw
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation .5-- Property line 3 6 Absorption field 3y >
Water main/service line +/o Surface water/drainage 4-/v ' Wells on adjacent lots _
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line y Building foundation 15-1 Water main/service line
Surface water Driveway, parking/vehicle storage area �y
Curtain drain /l�� Wells on adjacent lots hl�v
F. ENGINEER'S CERTIFICATION %,.+OF At.
I've�y,
I certify that l have determined thru field inspections and review of Municipal r r 40alI th•• is , kms
in conformance with MOA HAA guidelines in effect on this date. �i ••. '• 9 ��
*491H z
Signature
seerrrayf�Na•.••w.r.•rr•.u•�r •.,..
Engineer's Name*
Louis X tera
% CE -6736
Date 7
HAA Fee $ _ -i" f�
Date of Payment ��q U
Receipt Number 1),3;7 7
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
are
