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HomeMy WebLinkAboutLAMPERT ESTATES BLK 2 LT 1Lampert Estates Block 2 Lot 1 #051-791-02 Municipaltty ai Anchorage Community Development Department On -Site Water and Wastewater Program 4700 Elmore St, • P,O, Box 196650 Anchorage, AK 99519.6650 * httpf/www muni orgfonsite ° {007) 343-7904 ell Decommissioning Log Legal Address Subdivision nritY 5' 1e Block T R Section L oSl -1G11 oa Ori -site er at er Pmgrantcmtiedconflc pr perfpnning JoLiti..:f) 11: rii ` n eUdecomnssiani ethud of decommissioning. AMC 155 ovation Liss thespace befow:ro provide ad of the property showing theieltowing items; • Nurth arrow . • Decommissioned Well, • ©cher water wells onine propofty, • Two separate swing -Ire distances tar each wes shoo/non-the dr Note the swing.he distances shall be measured from either corner immunity DevefopmentDevelop Sent Services\Bullditg Satety\On.S and Wastot4ate'J or lien Forms; WeII Decommisioning fomi.doc Municipality of Anchorage Page / of Z— DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: -SW 94 oz -51 PID Number: ' %9/ -O 7 _j5/ Name: Wastewater System: ❑ New )8:( Upgrade Address: 0/0 Po Box 73.;99` � ./1‘-e ,�ivP� ABSORPTION FIELD Phone (p I L - 5/ 95 /tiPSC„ No. of Bedrooms: ❑Deep Trench 0 Shallow Trench8ed 0 Mound ❑Other LEGAL DESCRIPTION Soil Rating: OA GPD/Sq. Fl. Depth to pipe bottom from original grade: 3, ,f Fl. Total Depth from original grade: 4'r0 Gravel depth beneath pipe �/ Fl. Lot:/ Block Subdivision: i i� 1-/%/�% �%Zi E 7 Township: , / /5A Range: J / W Section: Fill added above original grade:ra 0 -- /• J FL Gravel length: 57 Ft. WELL: ID New ❑Upgrade Gravel width: Z/ Ft. Number/of lines: —T Distance between lines: '/ J Fl. Classificalt n (Private. A.B.C): Total De .• •. Ft. Cased To: FL Total absorption�oarea: // / /'7 SO. FL Pipe material: liC trv) 3a s y t eOpe. re.< yo Driller: i Dale Drilled: Static Water Level: Ft. Instal er: getiv G, C, Date installed: 09 9174 Yield: GPM Pump Set at: FL Casing Height Above Ground: Ft. TANK /�/ SEPARATION DISTANCES ❑ Septic ❑ Holding E.P. To From Septic Tank Absorption Field Lin Station Holding Tank aeblw1Private Sewer Lines Manufacturer: Capacity in gallons: Well 1C,//4 f, Zoog 7,-0 r G!/ 2x �//-4 M/A Material: Number of Compartments: Surface / r /A LIFT STATION WaterL tI Linen 3p t 7/0 l ZZnn f-30' T -10 / /Z - gallons ns: Manufacturer: 1n H 7/9/1e t2/ 'Y —C dr �, 'off" Foundation p / a LLL / . J Ci ` O NlA 'Pump on" level at: 4f3' "Pump level at: /1 High water alarm at: � ,7 Curtain e //4 Pump Make & Model 6,52_1_,2,5179i Electrical Inspections performed by: ,//e2pFT . 20',p_j BENCH MARK Drain /Y Remarks: `J/ -Ci' S/9//o Icid0141 Q S 46. 74 CON7720L- P /VeZ • OS / S• Si FT Location and Description: 7 PRoL'/PP T/ILS" ApS/NG. TD/0 Of /co)NDM-770/'/ e tNDUT Assumed Elevation: /OD. O Ft- ENGINEEE SSEAL i! L a'eY"" "` °a"=" " ` 4 ®-. :dross. ,,.° , y r;.- p I.cu)s A. lSu!rra a 4/e: f T °° C[-6736 4 �F°° , > :" Gn, P-` 44 C`��d�e ' ,r Zi n'd fl c Inspections performed by: e-,eGS Dates: 1st 09/ZG1 2nd d9/28/9if i Department of Health ark luma fvices approval Reviewed and approved by: 4-6 Date: �� ' Date: )0/% `�/ 72019 (Res. 9791) MOA 25 Permit No JW 9y o 2S 7 Page Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 s Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LQnnpePT 5;TaTe. f for / 9/a k 2. ❑BERG R❑AD PID No.: DS"/" 79/ -oZ DRIVE 3 Oo o •' 0 o� N L, In UTIL. EASEMENT 90.00' LOT 1 HOUSE A o_ 9.9 9 9 D Ind GAL TAM V/LIrr • IID Mrs VOX,. 9' OF VAICA UNE. 4111• V2A11211 NFPARAt1IX 59 \P\I I\VL 20X 2' PVC 9t A 3 13 45 4513 VP LRfAAI b e ee•E ELEVATI❑NS s TOP DF FDN CLEANOUT (NOT TO SCALE) ASSUMED ELEV s 100.0 92.0' 0' 1.5' ADDED FILL TAN 1.8 92.9' 1 1 70.00' N 89°58'50' W S14E0 Il.l 00 U o 0 ° (V o (U z LAMPERT CIR ORIGINAL GROUND LEVEL ATI N END 96.4' S END 94.12' TH-1 99.25' 35PSI INSULATION 92.9' SE MT 92.1' NV NT 92.1 m x 0 m GVT @ 86.25' 82.8' SWING TIES A - C = 27.2 B - C = 14.8 A - D = 53.5 B - D = 71.2 A - E = 99.8 B - E = 105.5 SCALE 1" = 40' • - MONITOR TUBE o - SEWER CLEANOUT KEY BOX 11111 u - PROPOSED LEACHFIELD - EASEMENT E %' "I EAL ,r,N `I-- • s * .-49 TH �" * �i F i. 'J . LOUIS A. BUTERA cue.,00 1A% CE -6736 g i IIA PROF %•- ✓-5--- "5y r TQ 10/04/94 16:10 0 a 90077699(f//66{1005 161 ISW INVOICE NO. 2 0 4 9 2 JOB PHONE QUALITY SAND & GRAVEL P;O, Box 1450 Palmer. AK 99645 Pit: (907) 373-5211 1-800-478.5213 Evenings: (907) 746-0235 LOCA N�MILE � 37'h PARKS HWY. / JOB NAME /LOCATION P.01 r f .. % LABOR I,IOLI RS RATC AMOUNT TOTAL MATERIAL TOTAL LABOR I ROHR Of1O[R[O m PATE 0:040.1.0-10 0 TAX l0000TURE 0 fro at+p'w• I+ rYMMY ...91 .6 a1.Ed. ow.e.4..4.f PAY THIS AMOUNT --1.. P.01 put / / /1 / Cl' `, < n., re 5.F,j(27/c 1' TC,It L,qVII PEgT ESTI? T !%/9L/ Lor , BLock 2 -/r c 7` Y i c / c(.i c, / 5 7 c� /� e' r.0 a ck leo (,) /r.y .J /t,c6t !ro;-) /0-3- qy . /,-,/ec /vIcC2 / ch' /60, -r:r7L. f'x • t..1/l / VU 7/poi o1 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE I r2 �2-(f�C,itw DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940257 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:SECRETARY OF VA OWNER ADDRESS:21529 OBERG RD CHUGIAK, AK 99567 PARCEL ID:05179102 LEGAL DESCRIPTION: LAMPERT ESTATES BLK 2 LT 1 LOT SIZE: 19459 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 7/22/94 EXPIRATION DATE: 7/22/95 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) . 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 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE : DATE :7/Z Z -4 j Eash Raw re EngiallQewll g SenyIlizz Louis Butera, P.E. Registered Civil Engineer July 13, 1994 Jim Cross Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lampert Estates Lot 1, Block 2 Narrative Dear Mr. Cross: The proposed septic 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 community water supply. 4. Drainage will not be affected and is not a major consideration in our design. We are requesting a variation from the code required 15' maximum bed width, as we have a special site condition that makes a 20' bed width preferable. Due to a water line that is located mid -lot, we cannot place the bed across slope, and need to limit the length to reduce mounding. To offset this width factor we will install a lift station effluent system which, in effect, delivers air to the bed during each pump cycle. We also propose to activate the lift pump on a regular 30 minute cycle for a 35 second duration, allowing for 450 gallons per day discharge, which would spread out effluent loading and increase air delivery. This system is presently in use in the intermittent sand filter systems. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \C:\WPWIN60\WPDOCS\1994\94-030A. NAR P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 • Fax (907) 694-3297 OBERG ROAD S 89'58'50' E 3 p o N 0 0 ° N p DRIVE 90.00 LOT 1 HOUSE SHED 4.444 I I I I I I PCPLACCIENI TNN VIM LIFT EXISTING TEST HOLE 914.e 15 lJ 3 dbbb 1/2" REBAR —Cr EXISTING TANK APPROX. EXISTING SYSTEM CROSS Al S9• VI111 110 JOINTS VIININ 9' 01 1+41ER LINO. 412' VERTICAL SEPARATION I[D \I I/l'\ C : ': E' PVC �Y �7A1 \ �Ztr \1/1' LATERAL \\ \\ \ \ 1 \ 70.00'\ W 0 o lL O O 0 e 0 N z LOT 2 SEPTIC FIELD +30' —�- N❑ WELL COMMUNITY WATER N 89°58'50' W LAMPERT CIR NO WELLS +100' NO SURFACE WATER NO KNOWN CURTAIN DRAINS H+HIIWI — EXISTING PERC BENCH TEST HOLE MONITOR TUBE SEWER CLEANOUT KEY BOX PROPOSED LEACHFIELD EASEMENT SEPTIC SITE PLAN LEGAL: LOT 1 BLOCK 2 LAMPERT ESTATES OWNER: VA CONTRACTOR: N/A JOB # 94-030 DATE: 6/22/94 SCALE 1" = 40' EAGLE RIVER ENGINEERING SERVICES I P0. Dox 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 n o ..• .. -' Louis P,. , Q a SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Lampert Estates Lot 1, Block 2 A. GENERAL 1. The septic plan is 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 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 requirements. 6. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 7. Elevations are to assigned datum of 100.00 at top of existing foundation cleanout. B. THE SEPTIC TANK 1. Septic tank construction shall be a 1,250 gallon steel two compartment tank with lift station approved by the Municipality of Anchorage. Pump is to be OSI 05-HHF, wired to code by licensed electrician with receipt provided to engineer. 2. Pump controller is to have Orenco digital pump duration and pump cycle controllers installed, 3. The existing tank is to be pumped, removed and properly disposed of, or opened and abandoned in place. Hole is to be backfilled with a base of pit run gravel to prevent settlement. B. BED 1. The bed excavation is to follow the natural land contour excavating and removing to below original topsoil layer to GM soil, approximately 4' depth. 2. The bottom of the bed excavation shall be level, plus or minus 1.5" and soil scarified. 3. The 4' separation to estimated groundwater is to be achieved by an imported clean sand fill placed without mechanical compaction and level to +0.1'. Sand source is to be approved by engineer prior to construction. Elevation of top of sand is 92.25', assumed datum A.7. 4. The drainfield gravel to a depth of 1' is placed on sand layer and is to be covered with typar fabric material. 5. Pressure effluent pipe to field is to be buried at +3' and covered with 2" burial foam. 1-1/4" PVC effluent leachpipe is to be installed 2" below top of gravel layer and is to contain 1/8" holes spaced at 3.0' (36"), facing up with orifice shield installed. Pipe ends are to contain cleanouts buried just below ground level with rebar markers. 6. The bed gravel is to be covered with typar fabric material. 7. A combination of 2' soil and 2" extruded board insulation is to be placed over the Ieachfield, and sloped 3:1 beyond leachfield at edges. 8. The area over the bed is to be finish graded to prevent ponding of surface water runoff. The entire leachfield mound is to have 4" topsoil and seeded. 9. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any class "C" well, or 200' to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: GRAVEL ELEVATION = 2' (92.25) BED LENGTH = 57' SOIL RATING = 0.4 GPD/ft2 SEPTIC TANK SIZE = 1,250 gallon with lift station GRAVEL DEPTH = 12", 6" under pipe BED WIDTH = 20' BEDROOM CAPACITY = 3 Twenty-four (24) hours notice required for all inspections. C:\WPWIN60\WPDOCS\1994\94-030A.SPC 1 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST (ENGINEER'S SEAL) PERFORMED FOR: V. DATE PERFORMED: 02, — �Y LEGAL DESCRIPTION: LGrG.1.r 1 / `%-7.'-ts LJ /5.� Township, Range, Section: 7-7,5-4/ // (,v .x,• y / SLOPE SITE PLAN Ne,,, - Nel - 41. 77P; or�freb.7/ T"Pf"r7 ohne. oryr�n /C T'prr////3ro...ier art.„"c 'lop y; 54 Np J/2.,/ Y i/T7v/ /gers7 6../cy r/✓q ✓e- / Afel -r( C"/e..""-j -6✓c), Very pe,rs< 4-3 .. ( ma y.{ �J 44iM1. '1.�.4gy fi f�A jiy-�f ea f J ', WAS GROUND WATER 115 ENCOUNTERED? j S IF YES, AT WHAT t' O DEPTH? 8 P E Deplh to Water"lAlter Monitoring? S ale. 6 - 3O- 36 N Sete /.r Reading- Dater Gross Time Net Time Depth to Water Net Drop — — yam k .. 1 6-23 /y /v,'3--7 tr-,,,,, gy s ” ., 'h/76" a. „ )r. /3 ).f 3 , !s'.2.7 /5"1r 15-441”783 IS -" 83 c." e ii" N „ /) PERCOLATION RAT (minutes/inch) PERC HOLE DIAMETER 6 rr TEST RUN BETWEEN T, FT AND 6 _ FT COMMENTS GwT 'G,Jrr Cq.rr,bd �'.�`m..5 '/+op c7`�..)...vde, tu,:„-r Cc�, PERFORMED BY- �1�"^" /e "1-7-.:0`(..-:- CERTIFY THAT THIS TEST WAS PERFORMED IN 6 -JJ' 91/ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Rev. 4/85) PERFORMED FOR: V - Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST LEGAL DESCRIPTION: Lawfc/%' 2- 3- 4 5- 6- 7- 8 -- 9- /1/4 p= � G,'5 Es 7-4 7(.4 (ENGINEER'S SEAL) DATE PERFORMED: ' :23 -?Y Township, Range, Section: TI 5`N A . SLOPE SITE PLAN WAS GROUND WATER 10 - ENCOUNTERED? NSA 11 - 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS 7Z,3 s« s71 p/ IF YES, AT WHAT DEPTH? S L 0 P E Depth la Waler Alter Monitoring? Dale: N Reading Date Gross Time Net Time Depth to Water Net Drop SaAk ----. — ) 6 -23-9' /v'5-'/ is ..„„ _7 .9 " 217X-4. 5-6 1-yb --T6" I +1, dL 'r 15-' to 1S- A6 150-„ 15- ...,;, 3 1 '1 /1 ) 5 j:- 0---,,, s7 4" "/s „ PERCOLATION RATE / 7 (minutes/inch) PERC HOLE DIAMETER Z. TEST RUN BETWEEN // FT AND S FTt -7.5 7 wo.5 rC>n on Mc 74 e-rn %h t .2 X,S aJG Pyr' 6 c .>t hest PERFORMED BY: ERFS I 5"."1ie.'r .: ' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 6-2,3 -7 ?/"/-i`Y 72.008 (Rev 4/85) EAGLE RIVER ENGINEERING SERVICES P. 0. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 JOB SHEET NO. OF CALCULATED BY L.B. DATE L.B. 07/13/94 CHECKED BY DATE SCALE Lampert Estates Lot 1, Blk 2 07/13/94 BED SIZING- 3 IZING3 bedroom single family dwelling = 450 gpd Soil perc rate = 30 min/inch = 0.4 gpd/ft2 Absorption area required = 450 _ 0.4 = 1,125 ft2 Site conditions dictate a 20' width, or 20' x 57' PRESSURIZED SYSTEM SIZING Flow rate from lift station = 28 GPM 8 laterals from one central manifold 3.5 GPM per lateral Lateral length = 25' Lateral distribution holes will be 1/8" (orifice) Q = 0.42 gpm 3.5 GPM per lateral requires: 3.5 GPM = 8 holes per 25' lateral @ 3.0' spacing along lateral pipe 0.42 PUMP CYLCE/DURATION 450 gpd loading rate, or 9.5 gallons every 1/2 hour Pump capacity = 28 gpm Squirt time = 9.5 gal/28 gpm x 60 sec/1;min = 20.3 seconds Estimate 15 seconds to fill pipes Pump duration time set at 35 seconds C •1WPW IN60\WPDOCS\1994\94-030A, CAL PP.ON;1fill Ngi�s IK. Cr ., Van 01111 Pia yo 3�Q3 s LJ J < U J J <C <I ULJ 0 CK W C7 i1 >L_ Uel N 2 O 8oC oC CC6 E aI W V Eza (2 N er-J a' c° r,� p± 2..‘t s p 1 o y. ° a o n (y • U v ii] L WATER LEVEL 8625 J U NOIIVUNO0J UNV 3SfDH VA ER ,I�FVEi Q6 5' BLOCK 2 LAMPERT ESTATES 0 J 0 J OWNER: VA z CONTRACTOR: DATE: 7/13/94 O V) O co W 0 W � V C.5 O W L� 4a c3) co f24 O N N C5O(O W QL, W TO 62 ✓lee/L�Yi,s Q ff ri c-7" � M f1 C SUBJECT L./ i3 MESSAGE DATE C7 /!j /6'-_}` A e (L-6(' c� ,-t-c-d-c. ;t€4_,11 .r- . hi 64� t.a.ak__ / 0 'il , f. i A/ . C vk__ ; (/cm /c z y.. -)---e - 1 f/^(,i.., - y,-_ _ . L-- A i (-_• (;) ,_.. e --A.,4 ,(14_, '/i ( 4' 1�_... , _.e ,;L_.��(- 'yam -t '/` 4-.f a -4_6-0-e_, - ("P -/ ._- Lu r(' ce _-x; /1 --y REPLY SIGNED i_G t . 4-d--,1 -,1.. _ ,G7.� I l CThC,,C.C�_ (ffEDrFDRM)® 4S 472 SIGNED SEND PARTS I AND 3 WITH CARBON INTACT - PART 3 WILL BE RETURNED WITH REPLY. DETACH AND FILE FOR FOLLOW-UP DATE / PIXY FAX (50 5E15) 411472 ALASKA CC1vIfl011411TAL COIITkOL S6 engineering & Enuironmenlal Studies 2/21/83 EDDIE BALLARD ANCHORAGE AK 999'503 SELLER — WAMTA A5H BUYER— SUBDIVISION—LAMP ORT SUBDIVISION BLOCK -2 LOT -1 ADEQUACY TEST FOR SEWER SYSTEM 1U1(,6S, I1C. THE TYPE OF ABSORPTION SYSTEM -FS A UNKNOWN WITH AN UNKNOWN ARA. THE SYSTEM IS CAPABLE OF ACCEPTING 960 GALLONS OF WATERER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 9e' GALLONS. .� BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC _TANK WAS PUMPED_ON 2/21/83 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK —VOLUME THIS 3 BEDROOM HOUSE. v.4%;'p ••Nvx n;.L.7ts, 441p • f) N•3°• 9° ;0i �.�v*csri • L ° •ff� go. Leroy ' : Rold, Jr. ; t �•,p It s N' 2251.E1) . 4'e/':%.** ..... ‘Q pROFE&,����`� 4.1111 OOP OF 1000 IS ADEQUATE FOR s• e r 411110 1200 UJes1 33rd Auenue. SuileB • Anchorage, Alaska 99503 • (907) 276-1361 a 411 P w M 410 060 Wt. Parcel I.D. # 051-791-02 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # n P" qCL iii 1. GENERAL INFORMATION Complete legal description Lampert Estates Lot 1, Block 2 Location (site address or directions) 2.1529 Oberg Road, Chugiak Property owner Secretary of the VA Day phone 694-5195 msq Mailing address -c/o P.O. Box 773294, Eagle River, AK 99577 Lending agency N/A Day phone Mailing address Agent AllStar Realty/Pat Arnett 561-7827 Day phone Address 2207 E. Tudor Road, Suite 53, Anchorage, AK 99507 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water x NOTE: tb a:xft exasttestx 1" ` t" 'Vv.. :1S :914e.§(2kateac 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer x 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 MOA 521 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. Name of Firm Eagle River Engineering Services P.O. Box 773294, Eagle River, AK 99577 Engineer's signature Address Phone 694-5195 6. DTrIS SIGNATURE \ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By' Date / ° - S to °oF ootsopea� s ai -' 49TH Ov °..gk. ..••.a,. Orf r cr` iouis A. Butercs • °°, CE•6736 •?�+4 % pROFccgiO'"' � Additional Comments Date / 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. 72-025 (Rev. 1/91) Back MOA *21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /4/4/Pte 6S��7 E A. Well Data Well type "7_ / Vic/' z Parcel I.D. 05/ 29/ -0z_ ADE -G -t 4te ADEC water system number %s% 0(P Log present (Y/N) Date completed Driller Total depth Cased to Casing heigh Sanitary seal (Y/N) Wires properly protected (Y/ M FROM WELL LOG AT INSP- TION 2 oz XI o Eci m <� r v t zD ri <D. n g.p.m.... r�o, rn m ° .o -z M '• i a P a o SEPARATION DISTANCES FROM WEL 0: rn G) O rn z Septic/holding tank on lot ; On adjacent lots Absorption field on lot ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank Date of test Static water level Well flow Pump levell WATER SA E RESULTS: Colifor Nitrate Other bacteria D e of sample: Collected by: B. SEPTIC/HOLDING TANK DATA D/9 ON %rgNk-//'I'L/V OZ /00 > �� Date installed 9/9i-/ Tank size 12 50 IN/ 4-/G7 Compartments 7✓ / t -/p -r Cleanouts (Y/N) I Foundation cleanout (Y/N) Ycs Depression (Y/N) No High water alarm (Y/N) Y Alarm tested (Y/N) y Date of pumping /V/4 Pumper SEPARATION DISTANCES FROM SEPTIC/IietetNG TANK TO: Well(s) on lot 1 % O° On adjacent lots /00 / Foundation a To property line 73O 1 Absorption field 35' Water raair4Aservice line /0 / .* Surface water/drainage /V/i4 No )2, J /N15 jt'/1H/t/ / 0rji1 . L/,kJ / /S'` ye77c- 4 SEPni 4T/ON 72.026 (3/93)' Front hi- will -6 le 5 vim/ 56,,✓E,. s V C C ,,,,a5p,,,,C-, . CONTINUED ON BACK PAGE C. LIFT STATION Date installed D 9l � / Manufacturer /live/T/ 7-1,94' / Og6/v-'O Size in gallons /-66, Manhole/Access (Y/N) Y65 Vent (Y/N) /GS "Pump on" level at 4 3 "Pump off Level at ‘710 High water alarm level I/11 Cycles tested AV/1 - NEw Meets MOA electrical codes (Y/N) YES _ CGEC%/ /J /'/s geTi6/P7 117-740,0E") SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot Ni/% On adjacent lots /` ZOO Surface water /V//i D. ABSORPTION FIELD DATA Date installed D 9/Z 8/911 Soil rating (GPD/Ft2) O. 4 System type BCD Length 5/2 Width ?-/ Gravel thickness/v (D Total depth A , Total absorption area /i / ' 2 Cleanout present (Y/N) Y6$ Depression over field (Y/N) 0 Date of adequacy test /V/// - A/CA' Results (pass/fail) ins S for `�" Bedrooms Water level in absorption field before test Nh✓a After test N/14 Peroxide treatment (past 12 months) (Y/N) A// 1 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N//q On adjacent lots If yes, give date /`// /4 Property line -74 Jo To building foundation q To existing or abandoned system on lot /5-1 On adjacent lots f 30' Cutbank N/14 Water main/service line /Oi Surface water /t///9 Driveway, parking/vehicle storage area /0 Curtain drain /`///q E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect op tl7'e Signature Engineer's Name 1-00/ 5 /art Date /o ac f `e ejf'tlil�inspection. e HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back /O 11 7;17 36 7 Waiver Fee $ Date of Payment Receipt Number