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Home My WebLink AboutLAKE HILL ACRES #2 LT 6A05'1 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904QU.BM1*P i;k«f ON-SITE WASTEWATER INSPECTION REPORTIJ JAN` 2 t 201 Permit Number: OSP181444 PID Number: 051-122-71 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: JOHN A. PEX ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 22623 MIRROR LAKE DR., CHUGIAK, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 -- GPD/SF -- Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade -- Ft. Gravel depth beneath pipe -- Ft. Subdivision Block Lot LAKE HILL ACRES #2 6A Fill added above original grade -- Ft. Gravel length -- Ft. Township Range Section Gravel width -- Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line -- Ft' -- Ft. Well 100'+ -- 100'+ __ __ TANK ® Septic ® S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1 1250 Gal. Surface Water 100'+ -- 100'+ -- Material STEEL Number of compartments 2 Lot Line 5'+ __ 5'+ __ NA Foundation 10'+ -- 10'+ -- LIFT STATION Manufacturer ANCHORAGE TANK Capacity 1250 Gal. Curtain Drain NA -- NA -- Remarks Existing septic tank decommissioned Pump on level at 44 in. Pump off level at 42 in. High water alarm at 48 in. per code. New tank installed & connected to system. Deep -Burial Tank. Pump make and model Franklin 2445040117 — 1/2HP Electrical Inspections performed by PIPE MATERIAL House to tank D3034 Tank to D3034 Installer Dean Construction drainfield Drainfield -- CO/MT D3034 Inspector ARCTERRA BENCHMARK (Assumed elevation) 100 ft Inspeection 1" 1/15/2019 1/16/2019 Location and description Znd ction 3`d 4'h 113ottom of Siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Conditional Approval: Datefi; OF A -A KENNETH tS. D tF v CE 7118 , G� Approved V CCDUU,"UDate l 0 3 /19— Inspection Report ST copy 3.doc O AS—BUILT SYSTEM DETAILS/SITE PLAN Permit OSP181444 LAKE HILL ACRES ADD, No,2 LOT 6A PID# 051-122-71 B—C=36,3' D A—D=39.1' x n n FINAL GRADE B—D=45.0' & A W250—GALY N EXISTING FIELD *: 9TH CE— ' E3SI0vl� PREPARED FORS JOHN A, PEX 22623 MIRROR LAKE DRIVE CHUGIAK, AK 99567 FIELD BOOKS COMPMED. DM*ft ST" N/A CHUM. A9MT- SLS DAIS: D. nm ACRD ME FILE I CD n SCALE, 1' = 30' SCALES NTS Its January 22nd, 2019 Rising Son Electric Services LLC. 36784 Eklutna Lake Rd. Chugiak, AK 99567 (907) 622-6777 Re: 22623 Mirror Lake Dr. Chugiak, AK 99567 Two whom it may concern: The lift station at the above referenced address has been wired in accordance with NEC and State/Local codes and is wired to the manufactures standards. Please contact Dakota Keller with Rising Son Electric Services LLC with any questions or concerns at (907) 622-6777. Thank you for your business. Sincerely, Dakota Keller, Owner Administrator License Number 2065 Specialty Contractor license Number 38497 (907) 622-6777 q 1 LOT 4A N87 -02'27"E O 3 P 0) m o LOT 6A I � U GRAVEL c) co • SEPTIC 0/W n )' VENT D� (typ) k A) A- • � k • MH46 /} • Js .0. '8s o�� ti yo�stic + F \ tiry .i60 ryo (SS Ss63 , ryry. 'Qe0J Ion ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: LAKE HILL ACRES ADD. No.2 LOT 6A PLAT 97-92 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. IEXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. JAN 16, 2019 1"=30 ' 19-UO3 BY: CNECKm BY GRID NUYBER BOOK A JLS NW 190102 5.00' 160.37' ® WELL �k U Q) .s CCIV O o Z OZ C' O o C, W O W � W O Z Co Wp O CC� ZO CJS �IO CSD ol t`b:�� NO 1 / � = ALUMINUM MONUMENT ® = 1" IRON PIPE / O = 5/8" REBAR W/ ALUMINUM CAP OF 4 of �. 49TH 1 / %JO HN L. SCHULLER.- +�0-0 -el LS -10408 c n \�o fessiono� �•r � �5 �G r V1 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax la - ME �`__—__ MUNICIPALITY OF ANCHORAGE anent S • On-Site Water&Wastewater Program ,�° ��, • /1 r PO Box 196650 4700 Elmore Road { 1111 Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 , ��s http://www.muni.org/onsite erartment NcH00.o On-Site Wastewater Disposal System Permit Permit Number: OSP181444 Effective Date: 12/28/2018 Work Type: SepticTank Upgrade Expiration Date: 12/28/2019 Tax Code Number: 05112271000 Site Legal Address: LAKE HILL ACRES #2 LT 6A G:1562 Site Mailing Address: 22623 MIRROR LAKE DR, Chugiak Owner: PEX JOHN A Lot Size in Sq Ft: 21123 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 Special Provisions: 1. The final record drawings and as-built survey shall show the 10 ft utility easement along the west property line. 2. The existing septic tank is shown inside the 100 ft well radius. If tank is to remain, a waiver will be required. If tank is replaced, it shall be located outside the 100 ft well radius. • Received By: Date: Issued By: R _ -2re,o - // Date: /02 <71b) ,Q6/k MUNICIPALITY OF ANCHORAGE r. .:�z;,`; Phone: 907-343-7904 Development Services Department \� . On-Site Water &Wastewater Section `'�r� Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-122-71 John Pex Dayphone Property owner(s) Mailing address 22623 Mirror Lake Dr. Chugiak, AK 99567 Site address 22623 Mirror Lake Legal description (Sub'd., Block&Lot) Lake Hill Acres#2 Lot 6A Legal description (Township, Range &Section) 21,123 3 Lot Size Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (E)all that apply) Initial ❑ Absorption Field CI Initial Family(SF)(w/wo ADU) Septic Tank ® Upgrade ® Duplex (D) ❑ 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 above information is correct. I further certify that this is in accordance with applicable Municipal Codes. /44,-,&• ./ .... ( ignature of property o,/ =%or authorized agent) Permit/Rush Fees: 421S, ob Waiver Fees: Date of Payment: 1212-111g Date of Payment: Receipt Number: 01226,P Receipt Number: Permit No. O n°1814141' Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc �FtCTE/ ^� m a ARC 1 ERRA I •• CONSULTING, INC 212 E.51St Ave,Anchorage,AK.99503 Office(907)868-3791,Fax(907)868-3793 •4, um wen•\•`On December 15, 2018 Municipality of Anchorage Development Services Department On-Site Water &Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic Tank Upgrade Permit-Lake Hill Acres #2 Lot 6A The owner has requested we proceed forward to obtain a septic permit to upgrade the failed lift station on the subject lot. The proposed upgrade will serve the existing 2-bedroom house. The subject and adjacent lots are served by private water as noted on the design. There is no surface water within 100' of the proposed tank. We do not expect there to be any adverse effect on adjacent lots by the development of this tank. If you have any questions, please contact me at 868-3792 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. WINO ' Ale h M. 0 .E. Kennet Attachments: On-Site Sewer Application Wastewater Absorption System Details/Site Plan 20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793 WELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN LAKE HILL ACRES ADD. No.2 LOT 6A a LOT 4A A 5.00' 160.37' ". 1 N87'02'27"E - 1 0 •I $ ':;h 3 � � h O m °'• LOT 6AI . .. v ho o, •'g 0 y NO5'05.41'W 30.98' • (N05'08'13"W 30.89' Rec) toe woi.mous oar.rein •• 'DECW.EXST. LS INSTALL +NEW 500-CAL STEP OR \MOON. NKALSO 0STALL NEW1250-GAL STEP. 0011014 4 , 6. '..?1,?6' RecJ �6 0 O1 .4, oio1 'Plu LOT 7 ' 4;7,1 arTIMu M.7►^_x^ FLAG PROPERTY LINES scale: 1'= 50' WELL RADII & EASEMENTS PAGE 1 OF 2 PRIOR TO CONSTRUCTION NO PUBLIC YELLS WITHIN 200' OF PROPOSED SYSTEM. DESIGN DETAILS NO PRIVATE WELLS VITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF 1. VERIFY INTEGRITY OF 1500—GAL CONCRETE TANK & INSTALL EITHER PROPOSED WELL EXCEPT AS NOTED A 1250—GAL STEP OR 500—GAL STEP W/ EXISTING TANK. 2. INSULATE TANK IF LESS THAN 4' OF COVER.. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 4, CONTRACTOR WILL ENSURE ALL SEPARATI❑NS TO ADJACENT —11b- il\ WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC...r ( OF Az• \or PREPARED FOR; lE S� 4:7 1 JOHN A. PEX oti Q�//��\�1 Pe� �.- 22623 MIRROR LAKE DRIVE r r+ TH /' di * CHUGIAK, AK 99567 `` / KENNETH �� • / FIELD BOOKS COMPUTED: D 11115113111111111111, _ CE— • 4Ia / BOUNDARY;N/A DRAW BMW �111211`L�` I \ �� STAIONG N/A a1ECKm: KMD `� �!1� .1�co .'1 /z,,� �� '/ ASBUILT: SLS DATE' 12/14/18 .i .''44c. �\\N'�/// 1 FESSIOT1 / DWG. FILE: GRID: NW1562 C G �1 11 \``:� ACRD FILE •JOB No.: �''/f.,SULTING '�56`� FILE 18-182 AK. 9957'7— WASTEWATER DISP❑SAL SYSTEM DETAILS LAKE HILL ACRES ADD, No,2 LOT 6A W 5.00' 1-11 N87.02'27"E 160.37' 'r !. 111r o • C .I.: co „c s>n■m 3 v n � (3). ,,,-, LOT 6A o0 , Q, . o Co N GRAVEL 4/O • D/W 6 O 100' WELL RADIUS ry \ /X-----'4-,. ., 'X`k� .120' A- k N) • EXST. FIELD • _ `% • Al H + 2 �, \ \\\\ OF //// ® WELL c )a8 • �c,° ti°2� -.1-/ 87/ T s , c + R y/O/4/ DECOM. EXST. LS & INSTALL �+ SF O`` NEW 500—GAL STEP OR \ ry" DECOM. CONCRETE TANKk Siff ALSO & INSTALL NEW (SS Ss6. • 1250—GAL STEP. T,p 1 7A� 9 C 7 `(9 7)9?826, ,�o oo Reel° c �C, wo DO. ,,c SCD. .�.4)\c FLAG PROPERTY LINES WELL RADII & EASEMENTS PRI❑R TO C❑NSTRUCTI❑N Scalei 1'= 30' �_` 1k PAGE 2 OF 2 OF AZ \ PREPARED FOR: CTE ��. •,.1,--- ..17 JOHN A, PEX °ti �� /*.A 9 TH 1\ * 22623 MIRROR LAKE DRIVE 3� / / CHUGIAK, AK 99567 1 a o KE ‘I'''- D ;//3 / FIELD BOOKS COMPUTED: x ' < .. CE— ,cy' ' I 9 UNDARY NSA DRAWN: 0MW z to ti$ � STAKING: N/A cNEaa:o: KMD � �:If ,�� k � ��/T/� / - .�..._. 'ik ssloll _ ASBULT: SLS DATE 12 14/18 9C! C 0 \`_+- D . FILE: GRID: NW1562 �'P'°A'SUI,TING l6`tr ACAD nil'FILE JOB Na: 18-182 R, AK.99577-''' .... MUNICIPALITY OF ANCHORAGE DEl .TMENT OF HEALTH AND HUMAN SER~ .S * Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 L/ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N a~"-'~2""~~ TI1 DISTANCES WELL Address FROM ~ TANK FIELD Phone(s) Perm,tNo. NO O~B ems WELL ~ O¢ LEGAL DESCRIPTION Township, Range, Section AS-BUILT DIAGRAM (Show Iocabon el well, septic system, property lines, foundation, C~¢j ¢ [~ ] +~. ~ O ...... y, waterboO,es, etc.) ~ SEPTIC ~ HOLDING Material No of Compadments ~ . ~TRENCH ~ BED ~ W. DRAiN ~ OTHER ~epth to plpe bottom from Total depth ,rom orl ,nalgrade ~l~ ~J ~' ' ' ~ill added above obgmal grcde ~avel depth beneat~ p~pe . I GraveilengtbTotalabsorpt ....... Grav~lw'dth ]"1 ~ I~ Number of hnes Soil rating Pipe matedal Installer Date Installed ~ ~ [~/&~ ~X., WELLS I al ~ .-. Class,f,cat~on~ (A,B.CI lotal Depth FI Cased to FT ~ ~¢ 5 & S ENGINEEEING I .~. -- J ~ ~ , ........ cedify tha~is inspcc~n was pcdormcd according to all Heallh Depadment Approval: Date: z .... M REPLY SIGNED SIGNED DATE ~~~ ,}~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICE8 ~~ 825 "L" Street Anchorage Alaska 99502-0650 ~~~ so, s - PERFORMED FOR: DATE LEGAL DESCRiPTiON~ ~' ~}~ ~/Township, Range, Section: ~, 1 2 3 4 5 6 7 8 9 10- 11 12 13- 14- 15- 16- 17 18 19 2O SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? s IF YES, AT WHAT ~) DEPTH? p E Dep[h to Water Alter ~ MonitoriflD? /Oate: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) ~R TEST RUN BETWEEN ~...~AND FT COMMENTS ~4~ ,, ~ ~/,/,.~.)'-'~',~ /__~¢._._~-'~:~:~ ~ / , ~ S ENGINEERING ~ ~ ~7034 Eqle R~ C~ R~d No. 2~ P.O. BUX 6650 ANC~O~A~=, ALASKA 9~502-0650 (~07) 2~4-4~11 TONY FNOWLES. DEPARTMENT OF HEALTH & HUMAN SERVICES January 10, 1986 TO: Permit Applicant Subject: Permit # 850596 Lot 6 Lake Hill Acres Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31~ 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. 0swalt Program Manager On-site Services SE0/ljw enc: Copy of Permit "SUBJECT: £~ ,vIPUTATION SHEET DA'IE: SHEET BY CKD OF SPECIFICATIONS ROBERTA. SHAFE CIVIL ENGINEEI 694-2979 FOR ELEVATED BED ALTERNATIVE WASTE WATER TREATMENT SYSTEM I. GENERAL A. Ail excavation & depths are advisory and are to be verified or modified in the field by an engineer. B. Ail materials.,& workmanship shall meet the requirements of Health and Environmental Protection permit. II. LIFT STATION A. The .stock material for the lift station shall be either galvanized steel (ASTMA-4444-76) or aluminum culvert capable of burial to 10 feet. B. The 36 inch pipe for the lift station shall have a welded water tight bottom of the same thickness & composite as the culvert. C. The top cap shall be rain tight & fastened with screws. D. All electrical fittings & connections in the lift station shall meet the requirements for a water tight service. The sump pump shall be capable of delivering approximately 10 gpm at a head of 20 feet. F. The sump pump shall be suspended not less than 6 inches off the bottom of the lift station with a " chain, or nylon line or set on a steel grate. III. SEEPAGE BED ae B, De The gravel for the bed shall be screened to sizes of ½ inch to 2½ inches. The berm around the seepage bed shall be constructed of impermeable material, and on a slope of 1 foot vertical per 3 feet horizontal. The bottom elevation of the bed shall be plus or minus 2 inches. The insulation required shall be dow extruded blue styrofoam insulation board of the 2.inch thickness, or equal. SR8 196X EAGLE RIVER, ALASKA 99577 SUBJECT: " ...... .vIFUTATION SHEET DAI~: SHEET BY__ CKD. OF PERI"! i T NO ~ DA']'E "J ,_,) J[ 1),,'::: cq :::'"" , DEPAI:RTMENT OF HEALTH AND !ENVIRONMEN]~AL. PROTECT].'OI',I 82.5 L.. STRIEIET~ ANCHORAGE, AK 9950 :~ 64"" 4'7 [-'? 0 3,.~(...,~ 9c, ENG I NEIEFRED DES I GN ()9 / 17/85 API:::'L ! CAN]" t: ADDRESS: CON'TAC'I" F::'HONE: LEGAL. DESCRtF': t...OT SIZE: I c:e~'tify 'Lina'L= HART ZELL.. S&~.:; IENG IIqEER I NG SRB i96X EAGL. E RIVER, AK 99577 694-2979 StJBDI'~ISION: LAKE HILL ACRES SEC'TtON~ ") '"' ' ~' ,= '10WNSHIF. . ..::,0~.-~ (SQ,, FT. OR ACRES) LOT: 6 I:~ANGE ~ 1W BLOCK: NA 1,, I am familiar' with '(:,he pe(,':tuit"emen't:,s fcH" On--sJ.'[e sewer's and ~x~e:l. ls a's set for'th by tl'~e Mun:[c:ipality of Arid]or'age (MOA) .ar'id the State of Alaska,, ;?.. ]: ~*~:i. 1]. ins'La].]. 'Lhe system J.r'~ acccH*dance ~,,¢i'Lh all MOA codes and r'egu].aL:[ons~; arid J.r'i compliance with the design cl*i't, ePia of this per'mit. '3~ I t.~J,].t adhere "Lo all MOA arid S'Late of Alaska r'equir'ements for' tlne set back diBtanE6:.:,S f'PC)nl any exis'Ling ~¢e],]., wastewater' d:i. sposal system oP pl..tb ]. :[ c: IF' A LIF']" c~F;.-tf].ON IS .~Nc.~]AL..[...I:_'... ]:N AN AREA COVERED BY MOA BLJtL. DING CE)DIES, TFIEN (1) AN LL.,...L,,RIU,-I... PERMIT AND INSPECTIDN MUST BE OBTAINED~ ) AS'""BUILTS ~,J~,L.I... hi(J] ~.,E AFr' ~OVI::.~ H~ lbO J[ AN E. LE. LtR1CAL .[N,~FE.C.,] 10N RE.F'Or*] ii AND (...:,. filE. EL. IEC'TRZCAL. WDRK MUS~Y BE DONE BY A L. ICENSED EL. ECTRIC:I:AN. APF'LICAN~ERING PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED: DATE LEGAL DESCRIPTION:[---~q~- f~ ~.Z~!4~__~ ~¢-I1~ /~-¢Z~Ownship' Range, Section:~ ~ ~1 ~' ~ ~, ~ ~ SLOPE 10 11 12 13 14 15 16 17 18 19 20- WAS GROUND WATER ENCOUNTERED? ~/~:~ S I L IF YES, AT WHAT 0 DEPTH? -I p E Depth lo Water Alter ~ ~ Monitoring? ;'~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop (minutes/inch) PERC HOLE DIAMETER __ PERCOLATION RATE . . TEST RUN BETWEEN __ FT AND -- FT COMMENTS PERFORMED BY:. ,.);, *'{l~ ~ '~' ,~///~ CERTIFY THAT 7HIS TEST WAS ACCORDANCE WITH ALL ST~'~N~CIPAL .......... ........ GUIDELIN~N EFFECT ON THIS DATE. DATE: ~ ~ ~5 PERFORMED IN ROBERTA, SHAFER CIVIL ENGINEER 694-2979 SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTE WATER TREATMENT SYSTEM I. GENERAL II, III. ae Ail excavation & depths are advisory and are to be verified or modified in the field by an engineer. Ail materials & workmanship shall meet the requirements of Health and Environmental Protection permit. LIFT STATION Ce The-stock material for the lift station shall be either galvanized steel (ASTMA-4444-76) or aluminum culvert capable of burial to t0 feet. The 36 inch pipe for the lift station shall have~ a welded water tight bottom of the same thickness & composite as the culvert. The top cap shall be rain tight & fastened with screws. Ail electrical fittings & connections in the lift station shall meet the requirements for a water tight service. Se The sump pump shall be capable of delivering approximately 10 gpm at a head of 20 feet. F. The sump pump shall be suspended not less than 6 inches off the bottom of the lift station with a "' chain, or nylon line or set On a steel grate. SEEPAGE BED A. The gravel for the bed shall/be screened to sizes of ½ inch to 2½ inches. B The berm around the seepage bed shall be constructed of impermeable material, and on a slope of 1 foot vertical per 3 feet horizontal. The bottom elevation of the bed shall be plus or minus 2 inches. De The insulation required shall be dow extruded blue styrofoam insulation board of the 2 inch thickness, or equal. SRB 196X EAGLE RIVER, ALASKA 99577 SUBJECT: C~'4PUTATION SHEEr SHEET BY. CKD OF , C~-~Y1FUTATION SHEET '~'~, DATE: S~EET BY SUBJECT: CKD OF mCtqTAL PROT£~rlON / x,/ I%I Anchorage Recto'ding Precinct, Alaska. and that the improvemenls situated thereon are within lhe property lines and do noi overlap or encroach on the property lying adjacent thereto, that no improvements on prop- mqy lying adjacent therelo encroach on the premises in ,.mestion and tl~at there are nu roadways, transmission lm~.~ m' other xqs~b!c easements on said property except ~s mdicaled hereon. Dawd at Ea~le River, Alaska ROB~,I{~ C J(IINSON ~, }{e~;islered I,and Surveyor No. I~O-LS ~:-~ ~I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT · ~'),[¢~ PHONE [~] NEW MAI LING ADDRESS LEGAL DESO~IPTION LOCATION ~ ~ T/,~ ~ ~ / ~ NO. OF BEDROOMS~ DISTANCE TO: Well Absorption area Dwellin~ PERMIT NO. ~ Manufacturer ~ / Material No. of compartments ~iq. capaciw in ~allons Insida lan~th ~idth Liquid depth IF ~OMEMAD[: ~ Well Dwel 9g PESMIT NO. ~ // ff //~ M ~ Manufacturor ~ No, oflines Lengthof~li~ Total length oflines Trench width inches Distance between lines ~ Top of tile to finish grade Material beneath tile Total effective absorption area ~ inches Length Width Depth PERMIT NO, ~ ~ Tgpe of crib Crib di t Crib depth Total effectiuo absorotion area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Clas~ ~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s} OTHER PIPE MATERIALS ~E~A~KS MUNICIPALITY OF ANCHORAGEs__ Department~'>f Health and Environment~~ ~Protection 825 L Street, Anchorage, AK. 99501 264-4720 Permit ~ ~~ ON-SITE SEWER PERMI Legal Description: ~.~r~3~~~ ~ Lot Size: Type of Soil ~sorp%ion System Is: ~'~c ~ ~PK Trench: Drainfield: . Seepage Bed: Holding Tank: Maxim~ N~ber of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED ~[~'~-T--i-C(HOLDING) TANK SIZE = o?~d 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 department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 * * I certify that: (1) I am familiar with the requirements for on-sit~ sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled tO include more that 3 bedrooms. . - ~ I /,,. · s /024 13-oo - BU bM De artment of Env ronmensa~ ~uan~ . ...... 3330 C Street , ..~ .... ..... ~ ........... ~ .... ..~:, ,,~:?,~?-~,,~:;~ ~-~ L :: -: Anchorage, Alaska 99503: ~: ..-~ ~, ~ F~-~'-:;.;[~P~CTI~ ~E~N-SITE ~W~E DISPOSAl ATION~ 'WELL'~ '. MANUFAcTuRER- r'_'MATERIAL ' ' ' INSIDE'WIDTH' ".'LIQUID DEPTFI "- '~ :-LIQUIDCAPACITY .... '"'" GALLpNSr - INSIDE LENGTH .... , ....... ?,-.,. ,. ],;:-.>:-~;;~:-~r*.'-'~,:-, '~:'' DEPTH'" D STANCE FROM:'"'-.WEL ': ...... NI , MATERIAL .... ' ..-. ¢,. : _ - .',. -. . -_-' ',..: ,,: . - -, ·-.; ..... : .' ',' .: ,¢ -'~,¢:','.'..'~4,~..~: ,. ~-..' :..:. ;.7.-.-,_.-~.?¢,,-.,?-: .... >:~.'::? ..:: ~ '. '. . ." -'; :, _ .: .:V? ' TOTAL EFFECTIVb,~:', ':. >:"" . :::..','.~:~.':?.',¢?¢~;~_,':F~ ' ...... ' ' 'NE '::' '" ?:'..-ABSORPTION AREA (WALL ARE6)' ". ':¥'".'.: ~'Z~'¢;'"-t. : . N' ' - NEAREST LOT L ~ .... _ .~ . - ~.~ > ..... ¢ . ..,_~ ¢~-~.~tF~:: .... NG ~ I O ..... ................... ~.~ ....... .. - _ - '.'_. · ~ .... ?. :¢' ~S+ANCE~RO~' _-. .CONSTRUCTION ~..~". P~ - . ..... '.:.;. .. N ' - ' LO~ LiNE -, 'SEWER LINE . ..:. "'- '> ?: OTHER 'SOURCES " "" '~:'. "": :?CESSPOOL ,:' - - · , - - - -: ..; ,.,.;'.~ ....... ~'..' ~PROVED-- DISARPROV ED -- REMA RKS~ .... '-% DIAGRAM OF SYSTEM ~ ~ISTANCES: ;:,?.~,:.~. ~-.~ ~.' ~.;~'~ ?/.,, · :~.,:. :'i.:'...-". :-...~,.~.,.~:.,.-~: ..:~ ~-:,~..:.:~.,..'.' ..:.. :.. ::.'~.:i~.~-~&..,~-.~!i,:.._.:,~?:":>~.i!'~?'~i~'~ '/!'-: .~ ~..~. - , ,,.:,: ,. -q~ -, .:?...,~.~, ~.:' ...?;':. -.. , /.?;:, -~.?:-,'. ,: .-.-...; .., . . .. ... . ._.., ~ ~.--~ ~ ..../.7~...,~/~¢~... _:, . . - . . , . - .. . - . , : ,., -; '¢(~ ~ .,";~:'- s;z'z~- ' "' '::" ': ":' '" ' ~ : I ' ""'~:'->: '--. : .. 4; ;;;:;;:U? ~:. LOT SLOPE: · . ~- ." ;.-'' .'.'-' .:-" -'"' ....... .... ;..'~.',: ~?': ZA,'.TM -- , :- ~',? ...,-:5,: '.;; ,~.? ?.'.,~;.'?. ,..:¢~:,~.;:~ 5 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES D ws oN OF E.WRONME.TAL SERWCES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date March 21, 1988 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) In,fl 6..- I_~.¢- Hi~J~- A~re_~ #2 Location (address or directions) (b) Property Owner ~ M~iling Address (c) . Lending Ihstitutio~ Mailing Addressl A .rIL~ F.C. Telephone: Home Business 56 I- 1900 570 F'. Telephone (d) Real Estate Company and. Agent Re/Max of Eagle River-- A1 Romaszewski Address ' I~00 ~rf~'~_t~d Dr. #201 Eagle River. Alaska 99577 (e) Mail the HAA to the followin~ address: or: Check here I'~, if hold for pick up. List contact person and day phone number below. S & S Engineering ~94-2979 TYPE OF RESIDENCE Single-Family Number of Bedrooms Three WATER SUPPLY Individual Well r'~ 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 I of 2 72-025 fRev 8/86~ Front ')~JOM s,Jeeu!bue leUO!SSejoJd chi u! suo!ss!uJo Jo 9JoJJ8 Jo] elq!suodsaJ lou s! eSeJoqouv jo X~!led!o!un!AI eqJ. 'penss! s! e~eo!j!pe3 e eJoleq elep az~leue ~o suo!loadsu! ]onpuoo lou op SHHQ jo see/~olduJ3 '$~ueuJeJjnb@J ele),s pub leJepe¢ u!e~Jeo At, sges ol Jap Jo u! suo!lni!lsu! 5u!puel qeqi pub seLuoq JO sJeseqoJ nd ol,~se~Jnoo e se s!q~ saop SHHQ eq.L 'e)lSelV ~o elelS eqi u! peJe~s!SeJ Aeeu!Sue leUO!SSe~oJd ~uepuedepu! ue /~q eAoqe ~ qde~6~,~ed u! ua^!5 suo!leju@seJdeJ eql uodn ~lUO peseq se~eog!Meo le^oJdd¥ ,~liJoqlnv qlleeH senss! (SHHQ) seo!^JeS ueuJnH pub qJleeH ~o lueuJIJedea eSeJoqou¥ ,to ,~l!ledio!un~ eq.L NOIJ. n¥o le^o~ddV leUO!l!puoo jo sWJel leUO!l]puoc) peAoJddes!a ~ peAoJddv ~ j ~¢/~(~ XqsuJooJpeq ~.i~¢^OUd,4V Jo, pe^oJddv SHHa .g _ ~.~C~ ..,~$\C~UNICIPALITY OF ANCHORAGE (MOA) .~?~,\~ ~O~,~\C[$~"~' HEALTH AUTHORITY APPROVAL (HAA) ~~ CHECKLIST - FEBRUARY 1984 ~N~O~ ~ 264-4744 ,~__~C~ Legal Description:. ~ ~ ~ ~ '~ WELL DATA Well Classification ~ I'-~1~/~/I ~)O~'~"L.-- If A, B, C, D.E.C. Approve(J (Y/N) . Well Log Present (Y~ t'-J Date Completed L~, Yield "~, ~ ~..~'t-'~ -Jr- Depth of Grouting Pump Set At Sanitary Seal on Casing ~)N) Depression Around Wellhead (Y/~ ! \ ~ ; On Adjoining Lots \ \ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Total Depth ~¢ ¢ Cased to '~"~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit(~N) y Separation Distances from Well: To Septic/H~ng Tank on Lot To Nearest Edge of Absorption Field on Lot To' Nearest Public Sewer Line Cleanout/Man hole Water Sample Collected by ~-~ ~/--~ ~, Ih'-~r--'~¢~ ; Date Water Sample Test Results ~~ ~ ~~, Comments ~ ~ ~, ~ ~ ~~~ B. SEPTIC~IOL-B~-NG TANK DATA To Water-Supply WelJ To Property Line To Water Main/Service Line Course Date Installed ~ '~'~'~- ~:~'"/ Size Standpipes ~N) '~ 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/l~ Tank: \ ~"~ No. of Compartments Foundation Cleanout~[~N) .,~D)~,~Last Pumped; for '"~ '" ~'- ~P--~"~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72~026 (Rev 8/861 Fronl ABSORPTION FIELD DATA Soils Rating in Absorption Strata \ ~ ~//'~ Type of System Design Date Installed q ~'2~2¢'- 8'/ Length of Field ~ } ~)~, Width of Field ~-~-.-. ~f~, "~.-~¢z5A0---''¢1-, Depth of Field /,O ~. Square Feet of Absorption Area '~"~ Depression over Field (Yd~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness \.C) ~ Standpipes Presentd~ZN) ~ Date of Last Adequacy Test To Property Line ~'~ To Existing or Abandoned System on ; On Adjoining Lots ~ ~-.~r To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at ~,'2--'~ '¢¢ High Water Al~ar/rn Level at Tested forI'~/~~- ~ ~ Electrical Codes~Z:N) y Dimensions '~'~ k'¢ K O'-.~ Man hole/Access ~N) y "Pump Off" Level at Vent ~N) 7 Comments g-- '~. Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Co~tr~l~CyEagle River Loop Road No. 204MOA No. Eagle River~ Alaska 99572' Receipt No. O(o (42 ~ Date of Payment ~//~q/~ Amount: $ / ~0 ¢ 0 Page 2 of 2 72-026 [Rev 8/861 Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ANALYSIS REPORT BY SABLE for Wo¢k O~der $ 5717 Date Report P~inted: t~R 24 $$ @ 12:44 Client Sample ID:L6, LAKE HILL ACRES ~2 ?W$ID :UA Collected MAR 22 88 @ 12:40 hrs. ReseiYed MAR 22 88 @ 15:00 hfs. '?~eseryed with :NONE Client Hame ; $ ~ S ENGINEERING Client Acct: SNSENGP P.O.8 NONE REC'D Req ~ Omdemed By Analysis Completed :MAR 23 88 Send Reports to: Laboratory $upe~yi~or. :STEPHEN C. EDEj 1)$ ~ S ENGINEERING Released By : ~ ~~ 2) Special Instruct: Chemlab Re£ ~: 9450 Lab Smpl ID: 1 Matrix: Wate~ Allowable Parameter Tested Result/Units Method Limits NITRATE-N ND(O.iO) mc/1 EPA 353.2 10 Sample ROUTINE SA}~LE. Remarks: SAMPLE COLLECTED BY R3A. 1 Tests Performed ' See Special Instructions Above UA:Unavailable ND= None Detected ** See Sample Remarks Above NA= }lot Analyzed LT=Less Than, GT=Greate~ Than ,- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL : ' ' '"'~-' . " OF ON-SITE SEWER AND WATER FACILIty .._~:~?.., Application Date ' --"" '(a) '_'Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ~,'r:~:-i'': ~';!.~: ""'~-'"~ t~ /~-- ' '-::~"~" ,,icant "ame ~-~'.~::(~L..~ Telephone: Home. Business :plicant is (che~;k ~ne): Lending Institution []; Owner/builder [~'; Buyer []; Other.[] (explain); ..... '~ - Institution Telephone '" IESIDENCE ._ -:-- ;...'~ ~ . ..... - · .... []-?Other ' '" "' 4.':.. SEWAGE DISF _~7 .,-.: o~site'~' 'Pdblic'• ;icomrmJhity [] Note: If community well system, must have written confirmation from the StateDepartment of Environmental Conservation attesting to the legality and status. ~ ...... .... system, must have written confirhna~tion from the State Depadment of Environmental ' Holding Tank ~ 72-025 11/84 Page 1 of 2 ~ ~LO ~ ')~JOM S,J@eU!~iUe leUO!SSe,toJd @qJ u! SUO!SS!LUO JO sJoJJe JOJ @lq!suodseJ jou s! e~eJOqgUV JO X~!led!o!un!AI eq/'p@nss! s! eleo!j!lJeo e eJo~eq m, ep ezAleue Jo suo!loedsu! lonpuoo lou op cI3HC] jo see,~oldLU3 '$1ueLueJ!nb@J ale,s pu~ leJepe~ u!~lJeo Xis!~s o~ JepJo u] suo!jn~!,tsu! bu!puel J!eq~ pub saLuoq jo sJeseqoJnd oj AselJnoo e se s!q~ seop cl3HC] eq.L 'e)ts~lV 1o elel$ eql u! peJels!eeJ J@OU!6ue leUO!SSalOJd ~uepuedepu! ue ,~q eAoq~ B qdeJ§e~ed u! ua^!6 suo]~mueseJdeJ aql uodn ,~lelOS peseq seleoy!lJeo le^oJddv ,~l!Joqlnv qJleeH sensS! (d3HO) uo!loe~OJcJ lelUeLUUOJ!AU-=] pue q],leeFI ~o jueLulJedeC] ebeJoqouv j,o /~!lBd!ounlAI 9ql NOIJ. rlvc) le^oJdd¥ leuo!lipuoc) ,to sLuJeJ. leUO!~,!puoo peAoJddes!a ~,,/~¢-' pe^oJddv ale " '" ' '~ Aq smooJpeq~ Jo~, peAoJddv euoqdela± oleo /-~66 e~lSelV 'ae/,R:l e16e9 'ON peo'~l doe'1 .~eAl~ elBe~ ~gOZL sseJpp¥ .~NiE.~.~NI~N~ ~ '~ ~ cuJ!4 ,to OLU~N · uo!~oedsu! s!ql jo elep eql uo ],oel,te u! suo!,telneeJ pue 'seoueu!pJo 'sapoo e,tm, Spue led?o!unlAI lie Lll[M eoueHdLuoo ~o/pue Alddns JeleM e,t!s-uo eq~ 'uogoedsu! pue uop, e~!lsa^u! ALU LUo],t pue Sel!,t aDe~oqouv peu!e~qo uo!leuJ]O,LU! eql uo peseq ~,,eql ~,t!Je^ Jaqlan~, I 'u!aJeq peleo!pu! eJnlon]ls ,to edA~ pue sLUooJpeq etenbepe pue leUO!~oun,t 'e,tes s! LUalSXS leSOds!p JmeMalSeM Jo/pue Alddns Je,teM e~!s-uo eq] leq~ SMOqS le^o~dd¥ X~poqtnv q~leeH s[q~ bo uo!lee!lSeAU! ALU ~eq,t ~,tlJe^ I 'MOleq UMOqS elep uoRep!le^ eql ¢o se pue oleJaq pexi~Je lees ALU Xq pe!,tfl~eo sV NOI.LVlNblO_-INI aNY YJ. VO 'HOt:I'~/::IS ':1'11:1 '$.l$:1l 'SNOIJ. O:IdSNI ~DNIOIAOJ::Id INl::ll.-I ~DNIM':I=INION:::I 'g MUNiCIPALffy OF ANCHo~,-~iO~/iCiPALiTY OF ANCHORAGE (MOA) ENVIRONMENTAL SERVICES D~,tH AUTHORITY APPROVAL (HAA) /~JG 7 1987 CHECKLIST- FEBRUARY 1984 264-4720 RECEIVED Legal Description: ~ WELL DATA Well Classification Well Log Present (Y/l~ Total Depth ~ * Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit(~/N) Separation Distances from Well: To Septic/,Me~ Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole /'~/~ If A, B, C, D.E.C. Approved (Y/N) ~'J//A Date Completed (-~/~-- · Yield ~ ~ I'Jr Depth of Grouting ,tO"C-L- . Pump Set At ut~ ' ~ ~ Sanitary Seal on Casing ~/N) Depression Around Wellhead (Y/~j~ J ~2¢ ; On Adjoining Lots /' / .~' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by '~ :~ 5 EI'J~/,"'J~-'~I?-'L,"J~I ; Date Water Sample Test Results ~~~ ~ ~ Comments ~ ~ ~, ~l~ ~ ~T 1~ B. SEPTIC/446LDtNG'TANK DATA Date Installed "~-7-~¢ ¢'~ Size Stand pipes(~/N) Air-tight Capsd:~N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N). ~ · Holding Tank High~Water Alarm (Y/N) Separation Distances from Septic/I,~Tank: To Water-Supply Well ! ~ / To Property Line /(,2 To Water Main/Service Line Course /62¢2 ~ Comments ~"/2. ~ ~_.~.,r--~5 No. of Compartments Foundation Cleanout ~)N) Date Last Pumped "~- Z- ~ ~7' ~//~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page I of 2 Square Feet of Absorption Area Depression over Field (Y~]~ Results of Last Adequacy Test ABSORPTION FIELD DATA Soils Rating in Absorption Strata /.~ '¢Z~(z-. Type of System Design Date Installed "7~?-.~r- ~"~ Length of Field ~-/---/.- Width of Field -Cz-I.. 5;./¢-.¢,~¢¢' /¢'J¢.¢. ,°EC~,e---/~ Depth of Field /,~ Gravel Bed Thickness .../7 ¢.. 4f~ Standpipes Present~TN) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot 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 ~o To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons %'7o ¢¢¢_..0~,o O,,)T~L.-_~.r- ~' "Pump On" Level at High Water Alarm Level at I/ Tested for / ¢2 d...-/,¢.:.~¢---~' Electrical Codes Dimensions Manhole/Access (~'N) "Pump Off" Level at f,z~. / Vent(~/N) "~¢' ,'¢-~Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MO)C, and/HAA guidelines in effect on the date of this inspection. Sign~ $ ENGINE_ERIN? ~ . Date 17034 Eagle ~i~er t.oop ~oad ~o. ~04 ~ _/ Co~ ~|v~r, A!=~,~= 9957~/ MOA No Receipt No. t/O (.2 ~' 0 O/ ~'~--'- Date of Payment ~'/ ~ Amount: $ ¢' ¢ Page 2 of 2 72-026 (11/84) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~,,,.~% FEDERAL TAX ID# 92-0040440 blot ~'' "~'~ ..... '" MU~ICIPALITY OF ANCHORAGE DIVISION OF ~IqVIRONMENTAL HEALTH DEPAR~.ENT OF .F~K~L~I%I AND ;ENVIRC~MENTAL ]PROTECTION APPLIC~ATION FOR h~_~r.TH ~J3THORITY_ APPROVAL CERTIFICATE 1. Ger. e~al Infor~lLation Application Date (a) Legal. Description (include lo,tI block, subdivision, section, tcwnship, range) Location (add~ess op dipecti0ns) {b) Applicants $~I ~[~[ Applicants Address (c) Applicant is (check one) Lending institution Buyer ~-~ ; Other ~ (explain); (d) Lending Instituticn Telephone Address (e) ~eal Estate Co. & Agent . . Address Telephone 2. T,_~of Pesidence S i ngle-Family~j~ Numar of Bedrooms Other (describe) 3. Water Suppl~ Individual W%ll~ Ccr~unity ~ Public ~[ Note: If cc~.~runity well system, must have written confirmatic~% from. the State Depar~nent cf Envircmrental Conservation attesting to the legality and status. Is the ~!1 adequate for the number of tedrocnm s~necified in this "HAA (~/N) 4. Sewage Dispcxsal . Is t~he wastewater disposal system adequate for the r,~,.mher of bedrcc3~s N) [Page 1 cf 2] 2-15-84 5. E~lgineering Firm Providing Inspections~ Tests, Data and Information I certify ~ h~ave checked, verified, c~ conformed to all MOA HAA Guidelines in effec~~~~~ inspection._ S i g~,~/_ ~/.~f~1~/_/ Date N~ ~of ~im~ ~ 5~ ~¢~,.~N~ ~ lepho~ Date 6. DHEP Approval Approved for Terms of Conditional Approval The Municipality of Ancho~.-age Department of Health and Environmental Protection dc~s not guarantee the continued satisfactory perfo¢r~nce of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validaticn date shown above, ~ased on the data and information furnished ~f an engi]~er registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrooms and type of structure indicated. (D~EP SEAL) 7. Mai]. the HAA to the following address: KB2/d5/s [Page 2 of 2] 2-15-84 ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification Well Log P~esent Total Depth~ f Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~Yy~ Separation Distances f~cm Well: To Septic/Holding Tank on Lot /~30 7g ; On A~_joini~g Lots ~ To Nearest EdGe of Absorption Field on Lot /~//~ ; On Adjoining Lots To Nearest Public Sewer L~n? /~/ /~ To Nearest Public Sewer Cleancut/Manhole /~Y//~ /To Nearest Sewer Service Line on Lot Wate~ Sample Test Results ~/~ --z~//~/~ ~-o ~c~ ~ Be g~OLDING TANK DATA Date Installe~ 7~>~/ Size ~0~ ~ No. of Ccr~pa~tm~n~s . .~ Standpipes ~) ' ~ ~i~-tight Caps ~ ~ F~ion. Cleanout ~ ~ ~ession o~ Ta~ ~ ~te ~st P~d l~/~ .... P~in~intenan~ ~n~a~ile~) _~; for ~/~ '~ ~5~<~-- Holding Ta~ High-water ~a~) ~ra~y Holdi~ Tank ~t~) ~p~ation Distance ~ ~pEic~oldin~ Ta~: ' - To Water-Supply ~11 /~ ~ To ~ilding F~ndation .~3 ~ To Property Line /~ '~ To Water Main/Service Lirm ~o -~ co se To Disposal Field / To St~eam~ Pond, Lake, c~ Major D~ainaGe [page 1 of 2] 2_15~84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption A~eat / ~ Standpipe s lh~esent (Y/N)Last Depression over Field (Y/N) te~ Adequacy Test Results of last Adequacy Test/ '~ / Separation Distance from Absorption Field:/ To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To thzoperty Line To Existing or Abandoned System on ; On AdjoiningLots To Cutbank(if present) To Stream/Pond/Lake/o~ Major Drainage Course TO Driveway, Parking Area, o~ Vehicle Storage Area Con~ents D. LIFT STATION Date Installed Dimensions Size in Gallons . / ! Manhole/Access (Y/N) "Pump On" Level at /h/ / ~ Off" Leve~a~at High Water Alarm Level at / I Q Vent (Y/N____J) Tested for Punting Cycles du~ing Adequacy Test. Electrical Codes(Y/N) Con~nents Meets MOA ** Check Permitted Bedrcxmn Rating Against HAA Request I certify th~~ _ch.ec~ed, verified, o~ conformed to all MOA HAA effect Compa~j/ / / MOA No. KB1/d5/s ~ ',' ~*~. ~"~,?'~' [Page 2 of 2] 2-15-84 JR'S CESSPOOL PUMPERS P.Oo BOX 77-445 EAGLE RIVER~ ALASKA 99577 CONTRACTUAL SERVICES AGREEMENT NAME: LONA SANTANA ADDRESS: STAR ROUTE 2 BOX 6380 PIONEER DRIVE CITY, STATE, ZIP: CHUGIAK~ ALASKA 99567 OWNER: LONA SANTANA LEGAL DESCRIPTION: LOT 6, LAKE HILLS ACRES #2 TANK CAPACITY: ~GALLON HOLDING TANK CHUGIAK ~ ALASKA The intent of this contract is to provide monthly scheduled services to the above described property beginning ~/1~/ ~ at the rate of $6~.00 load ha-s a 2,000 gal!~,n limit. per .l_~ad. and ending Eac~h .// Required pumping frequency to be / Payment in full for each pumping service shall be as follows: DUE AND PAYABLE WITHIN TEN (10) DA~S OF SERVICE RENDERED AND/OR BILLING DATE JR's Cesspool Pumpers and their employee's shall be held harmless from liability.of any nature or kind, including costs and expenses, for or on a9co~nt Of any and all legal actions or claims of any character whatsoever resulting from injuries or damages ~stained by any person or persons o~ property arising from its performance of this contract in any way whatsoever. ' The undersigned~ whethgr signing in an individual capacity or as a representative for a Principal, partnership, or corporation, hereby guarantees full and timely payment in accordance with the terms of SIGNA~U~ DATE JR' S CES~OL-PUMPERS ' APPLI ~NT FILLS OUT UPPER HA ~ONLY Property Owner LO ~ ih ('~ . ~ t'z¥ ~,.~)-i-)2{'i~) i~ ' Phone Mailing Address ~ i-~ ,~ [;";,OX ~.~'i ', ' - .. b ~s,~,(~ (~U~ L~C~ ~ ~ ~, zip Code */~;~ Buyer Address Zip Code Lending Institution Phone Address Zip Code Realty Co. & Agent Phone Address Zip Code LegalDescription ~.(~;~T ~> ~..tA~',d-. ~(L.(_ /j~i..'~.[-~. '~,~ ~ Street Location ~,'~,~, '~ i'~. ~,<-. (:~'., ~.- ~-~', ~, Type of Residence ~ Single Family [] Multiple Family No. of Bedrooms [] Other Water Supply ~i~ Individual ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. ' Community For wells drilled prior to that date, give well depth (attach Icg if available). Sewer Disposal Year Individual Installed: /~'/'] ~/- Individual Public Utility Whan Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time ,/,~ '~'-'- Date Date Date Dat~. Inspector Inspector Inspector Inspector ~,~ ~ / MAY 0 9 ~983 *CONDITIONS OF APPROVAL- ( ) APPROVED BEDROOMS (' ) CONDITIONAL APP~VA~ ~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received Well to Tank Septic T~k Size 12. 13. Locate and expose the cleanout to the seepage pit and/or leaching area for our inspection. This is to insure the minimum distance requirements are met between the well and sewer system. A four (4) inch cleanout needs to be installed to the septic tank. 13a. A four (4) inch cleanout needs to be installed to the leaching 81~ea. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs'to be submitted to this office for our review. 15. A maintenance contract for the Jet unit serving the sewer system ~eeds to be obtained from Consteel Company, 376-5919, and a copy submitted to this office for our review and our files. 16. The'permit for the installation of the on-site sewer system will expire December 31,198 . We have not received the as-builts of the installation in this office. If a private engineer inspected the system, please send us the report for our files and review. 17. The application shows the number of bedrooms exceeds the number the on-site sewer system was originally designed for. An upgrade will be required. Prior to any upgrade, a permit needs to be issued from this department. 18. An outside water tap was not available. Please Call this office to make arrangements to have an inspector to meet you at the site. 19. The depression over the sewer systems will need to be filled so that surface water drains away from the sewer .system. 20. The standpipe to the sewer system need caps on them. 21. The water sample could not be t~en due to silt content (turbidity). The well should be flushed clear by turning on a garden hose until clear water is evident over an extended period of time. Please contact this department for a resampling appointment. /~-@~%,~ " ¢ MUNICIPALITY OF ANCHORAGE Eagle River Area ~i' ' ~ DEPARTME ~ OF HEALTH,AND ENVIRONMEN ..... ,. PROTECTION gACf~;~)} P /~ ~. 825 L Street, Anchorage, A].as..a 99501 ...~ ~g .~ ~ - , ~?~'~, ~'/(~'~ 279-2511 ext. 224 or 225 ' .-'~ Date Received: ...~B~_e_.~ 1977 ~1: Time __~[~_~ .... ~2: Time ~3: Time Dahe ..~ ~ /~77 ~2~5. Date Date Insp ~'}~ ~}~ ~ Insp Insp RmQUES~ FOR APPROVAL OF INDIVIDUAL SEWER AND WATER ~ACII, IfI. ES Lending Institution Request:: Teamsters Federal Credit Union Mailing Address: 1200 Airport Heights Subdivision Phone: 274-6606 Property Owner: Mailing Address: 3. Legal Description: Robert Carleson Phone: 688-3350 Lot 6 Lake Hill Acres Subdivision, 2nd Addition 4: Single Family Residence; ~) Multiple Family Residence: ( ) Number of Bedrooms: Two Number of Bedrooms: Well System: Permit # Individual well (x) Cor[ununiEy/Public System ( ) Depr. n of Well Well Log on Fi.le Constructi on Bacterial Ana].ysis Sewage Disposal System: On-site System ~ Public Utility ( ) Permit ~! Installed __./F_7~____. Installer Absorptio}] Area Soils Rate Material ~'{o ~ ~ Well to Septic Tank ?...~.nance~: _ to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area l~ge ~wo ~. - Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 6 Lake Hill Aeres Subdivisio- Affadavit Attached: ( ) Approved: ~ Disapproved: Letter Attached: Date: Date: Deparu~]ent Worksheet ~""UNICIgA! ~' ' /~'"MUNICIPALITY OF ANCHORAGE Protection [/~,~\1 ' ' 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 ...... ~equest for Approval of Individual Sewer and Water Property Owner: Mailing Address: Phone: e Name of Buyer: ~O%J~ Mailing Address: ~[~ Lending Institution: /'~60 Mailing Address: Realtor/Agent: Mailing Address: Phone: Legal Description: Street Location: Single Family Residence: (~ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: e Water Supply: *Individual Well ~) If Individual Well, well depth If Community System, name of system Public/Community System ( ) 8. Sewage Disposal System: On-site System X) Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. 3/77 June 17, 1977 ~ , i . Te~nster's P~Aeral Credit Union 1200 Airport Heights ~mChorage, Alaska 99504 Subject~ LOt 6 Lake ~ill A~res SuBd~vision ~. : ,: ~ The sewersy~tem sErVing tho subjec'u prOPertY ¢on'Sists of an exp~rimontai hOldtank"trea~ont plant. This experimental design was requested by the homeowner and is not a standardized,design. While the existing s~wer system is not in viola~ton~ this ~epartment roquests tho potential buyer sign a let%er of acknowledgement of cortain maintenance re~aire~aents such as routin~ pumpin~ maintenance on the treatment DhB/l~ and electrical componot replaoemonto Xf th~e az'e any further questions~ plaase contact this office at 279-2511~ extension 224 or 225. Sincerely~ Les No Buchholz~ Sanitarian Mr. Les Buchholz, R. S. Sanitarian Dept. of Health and Environmental Protection 825 L. St. Anehorage, Ak. 99502 Sir; We are the potential buyers of LOT 6 Lake Hills Acres Sub- division, Mirror Lake. This letter is in response to the request in your letter of 6-17-77 to the Teamsters Federal Credit Union. We are aware of the nature of the holdtank-treatment plant on the property and its maintenance requirements. Sincerely, Barry W. Santana Lona R. Santana SRA Box 145-Y Anchorage, Ak. 99502 e Approval requested by: Mailing Address: Property Owner: Mailing Address: Legal Description: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR e 5. Type of facility to. be inspected 6. Well Data: ~. Date Received Time of Inspection Date of Inspection No. of bedrooms A. Type C. Construction 7. Sewage Disposal System: A. Installed ~--~ ~ B. Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area Nearest lot line , Other contamination B. Foundation to septic tank B. Depth D. Bacterial Analysis 2. Manufacturer 2. Material , Sewer Lines , Absorption area C. Absorption area to nearest lot line GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 274-4161 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIEs Type of Inspection: CMRO VA FHA _. CONV Property Owner: Mai-ling Address: ~/0o ~/~2~,¢ ~F~d~,~ Name of Buyer: CN~F~ ¥~F~) Mailing Address: 4. Name of Lending Institution: J~Z~$~'~ $-~ ~ ~'~r Mailing Address: 5. Name of Realtor or Agent: Mailing Address: $~ "~ ~ ~c~ .Day Phone Day Phone Phone Phone 6. Legal Description: Locati on: /'~rl:~/"2a,,4 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility No. Bdrms. ~- Individual If Individual, number of dwellings presently served If Individual, depth of well ~ / Sewage Disposal System Type of System: Public Utility Individual · If Individual,, date of installation {¢~ (on-site) ~.-'"~' EQ-037 (1/7~) .Page 2 of two pages - R(/ }st for Approval of Individual ~er & Water Facilities Comments Approved ~~.~~. Disapproved Date ~/~J~ Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are~operating satisfactorily. SIGNED Date EQ-034 (1/74)