HomeMy WebLinkAboutLAKE RIDGE TERRACE BLK 5 LT 7relTAIM-2m
v as
. . . . . . . . . .
#051 me 313 am 17
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP221044
Work Type: Septic Upgrade
Tax Code Number: 05131317000
Site Legal Address: LAKE RIDGE TERRACE BLK 5 LT 7 G:0653
Site Mailing Address: 17720 BLUE SPRUCE LN, Eagle River
Owner: LAIRD EMMETT P & KRISTY
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
CEJ Disposal Field C Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date:
�»cnt
Is,
No A .' .
i
n
i v
hepar tmeut
Lot Size in Sq Ft:
Total Bedrooms:
3/10/2022
3/10/2023
18700
❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: Submitted percolation test and percolation tests on file are not done in accordance with
current code (AMC 15.65.210C.5.c). An additional percolation test is required prior to construction of the
absorption field to confirm percolation rate. If results require a design change, construction shall stop pending
Onsite approval of a change order. Please submit results with inspection report (or change order, if required).
3
C'" 1 5'k� 4i < &Qz', wio � � � i � cid 4-b Gly
Ll * � rn �j ` J
�/3o%Zc� 2 Z
SW 1e- r'o-led oh �ru�le dW J sLkO(v�+kle'l Z/ fec.ora
Received By: Date:
Issued By: % Date:
ON-SITE SEPTICIWELL PERMIT APPLICATION
Parcel I.D. 051-313-17
Property owner(s) LAIRD EMMETT P & KRISTY Day phone 229-0159
Mailing address 17720 Blue Spruce Ln
Site address same
Legal description (Sub'd., Block & Lot) LAKE RIDGE TERRACE BLK 5 LT 7
Legal description (Township, Range & Section)
Lot Size 18,700 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
(M all that apply)
Absorption Field 0
Septic Tank
FxJ
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
APPLICATION IS AN:
Initial
❑
Upgrade
Fxl
Renewal
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
TYPE OF DWELLING:
Single Family (SF) E
(w/wo AD U)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
Distance:
certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(5lgnature of property owner or Nuthorized agent)
Permit/Rush Fees: k 59 5 Waiver Fees:
Date of Payment:3 Q O a 2 Date of Payment:
Receipt Number: O Q O(o a 4� Receipt Number:
Permit No. O S �? a 1 O `l Ll Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\FormsUient Forms\Permit Application.doc
SteveEng.com
Steve Eng, PE, PH
PO Box 770724, Eagle River AK 99577
907-694-7028
SteveEngPE@gmail.com
Date: 3/1/22 Number of Pages:
To: MOA On-Site Services
Subject: Lake Ridge Terrace Block 5 Lot 7
Septic System Upgrade
The subject property has been served by a septic system for a number of years. The STEP tank is to
be decommissioned and a new Advantex/Trench installed. The existing sand filter to remain for
possible future use. The entire subdivision is on private wells and septic systems. The terrain is
generally flat as indicated.
Please review the wastewater system design for the existing 3-bedroom home. I have included
design plans & specs, design guidelines. If there is need for additional information or clarification
please give me a call.
Thanks-Steve
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221044, Rebecca Carroll, 03/10/22
WAV
or-iTHI
NEERING
SteveEng.com
Lake Ridge Terrace Block 5 Lot 7
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 3 -bedroom, single family home. The
septic system is failing. The owner wants to upgrade the system to a Category III
Advantex. A design is submitted for a new trench & new Advantex w/Lift Station. The
neighboring lots are developed as indicated in the drawing; this upgrade will not impact
neighbor lots. Groundwater was recently reported @ over 6' depth. A 2' deep trench will
be excavated. The easements are located on the drawing and are not encroached upon. A
Category III application rate of 6 GPD/FT 2. Trench Length = 75 FT2/1.5'x 2 = 25'. No
bedrock was encountered. Old STEP will be decommissioned per UPC. Previous sand
filter left in place for possible future use. Advanced system allows 2' separation to
groundwater.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• Connect New Trench To Advantex/Lift Station. Watertight couplings, inlet & outlet
• 5' minimum between the tank and trench. 10' to property lines.
• 3' of cover is required for trench or add insulation board.
• Solid pipe must be set on well compacted, stable soil
• 4' of cover or insulation is required for tank; an equivalent of 1 " insulation for 1' foot
soil cover. Tank & solid pipe must be set on well compacted, stable soil.
• 4" diameter cleanouts with airtight caps are required 1' to 4' from foundation wall,
prior to any 90 degree bend in 4 inch line, in each tank compartment, and two
adjacent opposing cleanouts between the tank and the absorption field, not more than
10' from the tank positioned to provide cleanout access towards the tank and towards
the absorption field.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Trench to be placed level, minimum of 2' to groundwater, 6' to bedrock.
• Drain rock to be 1/2 inch to 2 inch screened. Drain rock to be distributed uniformly.
• Force main to be 1.25" Schedule 40 PVC or equal.
• Distribution pipe to be 1.25" Schedule 40 PVC w/ 1/8" orifice @ 15" on -center.
• Silt barrier (filter fabric) to be installed above the drain rock
• Smeared trench sides must be raked or scarified before drain rock placement
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661, PVC Schedule 40.
• Sewer Service Line is minimum 2% slope
• Septic Tank to be pumped every two years or when required
• Insulation board shall be extruded direct burial polystyrene (Dow Styrofm HI/equal)
O TH *'
Store Eng
CE -6256 24`=
6/25/22 `
DESIGN NOTES:
1. Install Anti—Floatation For Advantex.
2. Sewer Service Line minimum 2% slope.
3. Decommission Existing STEP Tank Per UPC.
Connect Advantex To New Trench.
4. Lots Served by Private Water Wells.
5. No Conflicts Within 200'. Mark 50' Well Radius.
6. Check Condition Of Sewer Service Line— Replace If Necessary.
7. Depth Of New Trench @ 2'.
8. Measure Separations Prior To Construction.
BLUE SPRUCE LANE
ASP�WEl /
DRIV Alf
GRA, L' /
.. 3 Bdr� Flat S(oPe /
Flat S(oPe '
LU old ST ST
/
v' h cOER UP DECK /
/ Lot 1
3 1i�l
Ac/v, qr) eX IAk lon /
Lot 6
New T enc ('oWlC(Pt Sfatlo
OTH2
and Mar /
THI /
Flat SIoPe
Flat SIoPe /
Lot 2
Lot 5 /
10' UTILITY
/ EASEMENTS
NOR THRIM �
P��`OF AV
Mhp4 LAKE RIDGE TERRACE i" = 41
ENGINEERING s* : 9�f DESIGN
SteveEng.com f•• ••••• •••• •... BUCK 5 LUT 7
Po Box 770724 f .... s �Ci9.
Eagle River, Alaska 99577 + CE- .. +$ WASTEWATER UPGRADE LAYOUT
can 7i� a Q 7n q q 6y25/2 n Tl \/ A N I T E- V I I D r D A Tl 1- Date: OEET: _
S
U
n1
z;
N
Z
C
OL
S
n
LL
c
CL
I
a
i
L
I
u
v
I�
y
U
O
d
L
A
W
n
U
'
U
> d
O L
3
d
W
I--
d
0_
U O
-C
Q
H u
x
M
— I
£
O
(y) U
c
N
X 0_
ry
U
o6 <
d
C)
W
W
0
a O
U1
> N
J
O
z0 O
�xQ
U
d LnN
d
L
p
0 :D
~ S-
c¢n
Hi
L,
a
-a Ln
s
U
to ��
)
3
E -1
0j
S
E S✓ O
+'
L ai
d a
W
n
O
N 0 W
_E
E d
~
L CU
0 d-4
=
x
tn
U
O �
W
U h -
ai
z
W
i-
z
N O
S 0-(-
UJ4->
Ln Ln N U
0)-C E N
N
>
L O_ pq
tAOL,J
-O
Q ,
N
L 0-
d � F -
CU
LZ 0UJ:3L
(4-
L01
3 dZiai
F' O L
ce)
OO 0�
U U U1
j
O
Odd
L, 0-
_I+'
3
I-
-f
:-
U d
- 4fU -N
> - - L
U
N
-P I L
O L
C�
LLIL
z o6
0
6) -- NME
ci -N
Ln O
p
z
4-x
0 ��H
N - U £
0-L (
--
< U1+'
N� ��
z
s L�
+' d d
L LM O-�
3 °' 3 CJ-
d
c
-P E -
d -I-' °+'
00
A<NC/13C�<�
ai 01
�D_r-LiAA
LA
LI
A
-4 CU
(Y) d" Ln I'D
I-
00 (7N
W
n
U
�ZON�
ZW
r
W
I--
nQ
Q
x
M
— I
OZ
IW^
V
In
lJ J
V
ry
0�
U
W
W
Q
I
pq
c
J
3
W
W'
\H
/
Hi
LL-
.L0
E -1
z
ry
W
W
n
f
i�
=
x
>-
U
W
C/)
z
W
i-
z
L
u
H
Q ,
n L
LTJ L
n
�ZON�
ZW
~W
W
nQ
2
x
M
OZ
0�
Z Lij
0
W
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221044, Rebecca Carroll, 03/10/22
0
0
n
Lot 6
Lot 5
BLUE SPRUCE LANE
/ S 89'53'E 183.10' _ 1
N -ASPHALT 1.4' CANT WELL 7
.DRIVEWAY
GRAVEL23 8' ,.
/ I
.. a h 1 n 26.4'
u 6 SPLIT—LEVEL
RESIDENCE ry /
19,1' is. s
sol'
N y � DECK co
o ♦ \ is.r^ Lot 1
vj SEP TIC$ /
I� PIPES MANHOLE
B•
r /
0 4j
Z
19,717 S.FLot.(COMPUTED)
18,700 S.F.(M.O.A.)
42.24' / /
N 89'53'W/ / Lot 2
UTILITY
/ EASEMENTS
PLOT PLAN ___ AS BUILT _X_ SCALE _11 _= 40_— GRID —AWN -53 Project No. _____L2—O!!0/L1----
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone 0000�p40
(907) 522-4625 Fax o
Professional Land Surveyors ken0langsurvey.com o �, of A44 k�
jonathan®langsurvey.com SOP
I hereby certify that I have surveyed the following described property:
LOT 7, BLOCK 5, LAKE RIDGE TERRACE SUBDIVISION (PLAT No. P-549)
Anchorage Recording District, Alaska, and that the Improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no Improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the __`Z�__ Day of S`�3p✓S-'_`L___, --"�_` of Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
49THlkr
`.
�c •. .....KH G. LA .: o
14p rFo'?s 5202.-
a� a .....1 O p
440oR�FE5SI0NAt• c�
�40000��
AECC963
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGRFENj ENT" made and
entered into as of thisDay of Mof 202 by and between
herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as
located at (legal description)
2 Maintenance Re airs and Aiterations.
(Owner is required to read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfiield
replacement.
(rev. 0511812018) Page 1 of 3
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24 -how notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void_
6_ Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 0511812018) Page 2 of 3
OWNER:
By: L—*(signature) Date:_ -)L-22.
— , 1 (��' (print name)
STATE OF ALASKA.
THIRD JUDICIAL DISTRICT
Theregoin instrument was a
20j by f
My Commission expires:
) ss.
)
ed before me this � day of
MUNICIPALITY -
By:
(signature)
�Ck./L � i L
(print name)
SHARON G. CRUZ
Notary Public
State of Alaska
L
ission Expires Sep 1, 2024
Date: /10 Zd 2 2 -
Title: Title:
(rev. 05/18/2018) Page 3 of 3
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page/ of 3
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: Sw6S0/3Z PID Number: O! �-� - )) ;- I .
Name P
—F fr(S G�
Wastewater System: ❑ New '4--hlUpgrade
Address:
7 72-
ABSORPTION FIELD
Phone: �7 / Number of Bedrooms:
El Deep Trench ❑Shallow Trench ❑Bed ❑Mound �' l [Other:
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
SF GPD/Ft'
Ft.
Block: Lot: / Subdivision:
S 7
Depth to ipe bottom from original grade:
2 SFt.
Gravel depth beneath pipe
L 1l loti-e—
Ft.
Township: Range: Section:
Fill added above original grade:
Gravel Length: /
�b
Fl.
Ft.
We II: tE , . ❑ w ❑ U rade
Gravel width:
Number of lines:75��2.
3
between lines:
/—Ft.
J Ft.
Classification (Private, A, B. C):
Total Depth:
Cased to:
Total absorption area:
Pipe Material:
FL
Ft.
(1 Ft'
SCH15Q (_)C.E0) /
Driller.
Date Drilled:
Static Water vel:
Instal r:
Date Installe �+
Ft.
O?/LoJ
Yield:
Pump Set at:
Casing Height A ve Ground:
! ��� 0l % TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
❑ Septic ❑ Holding S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
ublic/Private
Manufacturer.
Capacity:
From
Tank
Field
Station
Tank
Sewer Line
�C ff0(2.l �jJ �v
l2SOGal.
Well
/
/(
V�
0(9
/
( 0
Mat ial:
Number of Compartments:
Z
Surface Water
/00 '
X66'
a 0 'f
—
LIFT STATION
Lot Line
��++,,
(U I
/ !
l
/0 ,
V/G
Size: 7
s Q Gal.
Manufacturer. + /J 24 ,Q�YV /�
6 6 l-
Foundation
5 t
i�
/ Ll
� t
r
"Pump on" level at:
'Pump
Z_/ ( in.
"Pump off" level at:
'? S in.
High water alarm at:
Sin.
Curtain Drain
,(��
' �c
111A�111A-
N/�
Pump Make & Model
fS0 asf as ffff
Electrical Inspections performed by:
RSan F/ec,��,c-
Remarks:
BENCH MARK
Location and Description:
Assumed Elevation:
/ Q Ft.
Engine,�e�,s,Stamp
i+ lea
0.
Inspections performed by: I / Poo., Dates:
2nd 2 f g
to w
Developmet Services Department Approval
� • r r�
sy erten ��
Reviewed and approved by: LlXU �_ a'c:X Date:
12/00)
(Rev. � 11 y�r�Q
J it 1 r tAlA
C�'`L`,:7;•.;, 'j;
a.,� •i::
CONSTRUCTION NOTES:
1.
Total Depth of Trench is 2' @ T.H.
ro
Terrain Is Relatively Flat.
2.
Sewer Service Line minimum 2% slope.
3.
Trench is Minimum 10' from Lot Line.
4.
Lots Served by Private Water Wells.
5.
Air Compressor is Thomas Industries Model 5070
("Anchorage Tank").
6.
Air Line is 1/2" Diameter HDPE, Within Insulated
Sch. 40 PVC Pipe.
7.
S.T.E.P. Tank Meets Installation Requirements Per
"Anchorage Tank".
8.
Upper 6 Inches of Mound Consists of Top—Soil &
Vegetated.
9.
Existing Septic Tank Pumped & Crushed.
10.
Existing Seepage Pit Abandoned In Place. 10' Separation
From New Field.
SAND FILTER STRUCTURE MAINTAINED BY EARTHEN BERMS
>
Well
- L /11R100
F.C.O. /
A B
F.C.O. 2 36
zotc, Tank ecommis ne S.T. C01 14.5 25.5
1 STEP C 02 20 24
TM.T. o o STEP Riser 21 24
FV1 74 42.5
FV2 75.5 45
5-- -FV3 77 47
M.T. 60 40
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation Improvements,
11-01' Easemen
Bottomless Intermittant Sand Filter
New 1250 Gallon STEP Tank 1' = 40'
0 F
-4 S RECORD DRAWING
LAKERIDGE TERRACE
NOR THRIM J
49 Ili
ENGINEERING IPLAN
i 17237 Bear Pow Circ
LAYOUT
Ea le River, Alaska 9957; fi
907.694, 7028 gym4,� 1.
LOT 7) BLOCK 5
9/ of 3
6RE: 'ER ANCHORAGE AREA BOP:UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE
E.oM WELL / ~
INSIDE LENGTH
-- COMPARTMENTS ~
INSIDE WIDTH LIQUID DEPTH lIQUID CAPACITY /O<~) GALLONS.
SEEPAGE PIT:
NUMBER OF PITS I DIAMETER
BUILDING FOUNDATION
ADDITIONAL ABSORPTION
OR WIDTH/~-¢, LENGTH~/---~, DEPTH
CRIB SIZE: DIAMETER DEPTH. ¢ DISTANCE FROM: WELL ]///-7/~
TOTAL EFFECTIVE
NEAREST LOT LINE_. - ABSORPTION AREA {WALL AREA). t~E <~ SQ. FT.
WELL:
BUILDING
FOUNDATION
CESSPOOL _
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
DEPTH ~ ~) <:~
DISTANCE FROM:
NEAREST SEPTIC! '~/L SEEPAGE
SEWER LINE_ , TANK ,/-~r, SYSTEM. //¢
REMARKS
INSTALLED By:
LOT SLOPE:
Form No. EQ-031
DIAGRAM OF SYSTEM
DATE¢ -- Z 7- 7 y APPROVE ~ ~ L~,~.~..y '
G.A.A.B. v
GREATEr ANCHORAGE AREA BorouGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456 I
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
INSTALLATION LOCATION
INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT, ~
DRAIN FIELD OTHER
FINANCED THROUGH TO BE INSTALLED BY ~J~/~' ~ *
SOIL TEST RESULTS NOTE; THr~'~pERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE
TYPE.~
SEEPAGE Pit ../~)
ALSO CONSIDER AREA WELLS.
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATIon TO SEPTIC TANK ~
FOUNDATION TO SEEPAGE PIt ~:~O/
. DRAIN FIELD.
SEPTIC TANK TO SEEPAGE PIt WAll /~/
SEPTIC TaNK , SEePaGE PiT~) / . DRain field
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK /~0~ DRAin FIELD
WATER MAIN TO SEPTIC TANK .
DRAIN FIELD
TO RIVER, LAKE. STREAM.
· SEEPAGE Pit
· DRAIN FIELD.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION~'FEET into UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS· --~
SEEPAGE AREA SIZE / ~ ~/}~ /~ TYPE
DIAGRAM OF SYSTEM
3RAVEL BACKFILL
-~ONFORM TO BOROUGH ~:~EGULATIONS REGARDING INSTALLATION.
LICENSED DESIGNER
' Op~~/NCHORAGE Area BO~;~ORDiNANCE NO. 28.68 AND THAT THE
ESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ABOVE
~Te ~///~ 7/~ APPLICANT'S SIGNATURE --
DePa~';:ent 0f EnvJronmenta] Quality ....
' ' 3330 "C" Street ' '
Anchorage, Alaska 99503
kp9a, _Description: /~Z~ ~s~ --~ ~ ~--- performud
' '*= " . /~ercola~lon test
!)epth
Feet
2-
3-
4-
5-
6-
7-
10-
11-
12-
13-
14-
Was'ground water encountered?
Reading
' Date
Proposed installation:
~epth of Inlet
SOLVENTS:
~o' If yes, at what depth? .......
Gro~s Time
Net Time
Depth to H20
minute.
Seepage Pit ....... Drain Field .....
Dep~om of pit or t~nch -
Net Prop
'erformed By:~~i ~.~_~ ..¢~' Ce---rtified By:
MUNICIPALITY OF ANCHORAGE
'Lq Y OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PR(~IJ~-[~'i~,.~EF~, ,.~
HEALTH
&
DIVISION OF ENVIRONMENTAL HEALTH ENVIRONMENTAL PROTECTION
~ CERTIFICATE OF INSPECT ON FOR HEALTH AUTHORITY APPROV..AL~
OF ON-SITE SEWER AND WATER FACILITY
(inci~de let' bl0ck~ sUbdiVisi°n, Section, t0wn~ip; range):.
Location (address or direotions)
(e): Rea! EState ComPany and Agent
:-?-::: .-: Smgle~Family~,.~_ Multi-Family~ . Other' .'
3. WATER SUPPLY ' ; '--
Individual Well ~ Community D Public ~ ' '~"
Note: If corem unity well system, must have written confirmation from the State Depadment of Environmental Conservation
attesting to th~ legality and status.
4. SEWAGE DISPOSAL
Onsite,~ Public [] Community [] Holding Tank []
Note: If corem um[y well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 :..i'.': ' "". .... ~i. 7~'°.2$l~u~i '
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION -.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater d SPosa system s n compliance with ail Mun c pa and State codes, ordinances, and regulations in effect On ~
· :6. i DHEP
, : , . cAuTioN.
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. EmplOyees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Mbnicipality of Anchorage is not responsible for errors or omissions in the
professional engineer's workl
Paoe2of2 ": i ;': ·
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
MUNICIPALITY OF ANCHORA~=
DEPT. OF HEALTH '~
ENVIRONMENTAL PROTE&CTiON
1 9 1986
'Legal Description: ~---o"r q ~'D~,~'~' E ! V E D
Well Classification
Well Log Present..~Y~
If A, B, C, D.E.C. Approved (Y/N)
Date Completed "'"'" 1 ~j~r Yield
Depth of Grouting
Pump Set At U,~_
Sanitary Seal on Casing ~
Depression Around Wellhead .¢¢/~
Total Depth '""" ~/~l
Static Water Level '~ (2
Casing Height Above Ground
Electrical Wiring in Conduit (~'N~
Separation Distances from Well:
To Septic/Holding Tank on Lot
Cased to
; On Adjoining Lots
To Nearest Edge of Absorption Field on, Lot ~ [~"~ [ ; On Adjoining Lots
To Nearest Public Sewer Line ~ To Nearest Public Sewer
Cleanout/Manhole ~ To Nearest Sewer Service Line on Lot
Water Sample Collected by ,.~-~¢~ '~ ~]~.t,4 ~ ~/~ ; Date ~ ~ ~ ~
Water Sample Test Results ~ ~ ~ ~ ~o~
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed ~'~-~'~¢7I''/
Standpipes ~N~ Air-tight Caps~AN~
Depression over Tank ~'
Pumping/Maintenance Contract on File (Y/N)~t
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/~k:
To Water-Supply Well ~ ~ ~
To Property Line ~ O t ~
To Water~ervice Line
Size ~ O/.-) o No. of Compartments
Foundation Cleanout ~/.N')-
~Date Last Pumped
· for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field \ (,~'
Course
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field JCCd~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well t,{. L~,~
To Building Foundation "~'~
Lot rJ. "~
~. (::~ +-
To Water Mcan/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field ~
Depth of Field
Gravel Bed Thickness I I
Standpipes Present ~/N'~'
Date of Last Adequacy Test
t ~
To Property Line 1 D
To Existing or Abandoned System on
; On Adjoining Lots -'~ O ~ '~'
To Cutba~nk (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons ~
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
_ Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
certify that I ,ba. vg.c~nec, ked, yerified, or conformed to all M aA and HAA guidelines in effect on the date of this inspection.
5PR ~19~× Date ~-. - / ~"¢'~'/-~
MOA No. ~ ~"~Doj¢
Signed
Company
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ~"-//~-
GENERAl.- iNFORMATION
(a) Legald:::~.~...~Description,~/(include~to,, block, subdivision,,5.~_ ¢'~~.~.~secti°n' township, range) ~ ~-~ ~:ff~'-/,'~
Location (address or directions~ ~
(b) Applicant Name ~*/~ ~~ Telephone: Home ~ - qff~ Business -
Applicant Address
(c) Applicant is (check one): Lending Institution []; Owner/builder. J~; Buyer []; Other [] (explain);
(d) Lending Institution
Address
le) Real Estate Company and Agent
Address
Telephone
Telephone
(f) ..~ HAA to the following address:
TYPE OF RESIDENCE
Single-Family¢ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well/l~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status,
Page 1 of 2 ¢,, 72-025 (11,84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposa~ system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm _ ~ E[ ~ E.%"GINEERI~ Telephone
Address ~P,,.B ~gS~,
DHEP APPROVAL/ (~ //J ,
Approved for -- ,~f/-~bedrooms by _2r ~ //'?:-~z~-~/?~
Approved ~_ Disappro~ Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
anaJyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2 .,.
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal .Description: ~
Well Classification
Well Log Present (Y~)
Total Depth ''~ ~
Cased to
Static Water Level [.~,~_
Casing Height Above Ground
Electrical Wiring in ConduitS'N)
Separation Distances from Well:
To Septic/~g Tank on Lot
To Nearest Edge of Absorption Field on Lot
TO Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments P'~'
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~ I~J~/'~L' Yield
~1~ ~ Depth of Grouting
Pump Set At
Sanitary Seal on Casing
Depression Around Wellhead (Y~.,~.
; On Adjoining Lots ~ ~--;~
; On Adjoin!ng Lots J. C~:,L~
~5 jO. To Nearest Public Sewer
l,)/¢j To Nearest Sewer Service Line on Lot
-¢'~-~ ~ ~;;;;~-~lr~/~¢~/~"Y-~ ;Date ~¢, ~_~Z.J¢
B. SEPTIC/4C. OL-.t~.NG-TANK DATA
Date Installed ~-'~-~'q -'~ ~ Size ~ ¢ No. of Compartments
Standpipes (~) Air-tight Caps(~)'N) Foundation Cleanout4~N)
Depression over Tank (Y~) Date Last Pumped (¢ - ;~-¢.¢-
Pumping/Maintenance Contract on File (Y/N) ~[,~ ; for
Holding Tank High-Water Alarm (Y/N) t~/iA :l-emporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Ne~Tank:
TO Water-Supply Well ~ "~/-~ ~
To Property Line ~.~ t
To Water ~e~C~, Line
Course /~
!
To Building Foundation \ C)
!
To Disposal Field ~ ~
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ¢.~ ~."q"
Width of Field
.:j(2/~ Type of System Design
Length of Field '2~C-~
Depth of Field
Gravel Bed Thickness
Standpipes Present (~;N)
Date of Last Adequacy Test
Square Feet of Absorption Area
Depression over Field (Y~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well 1 t ~t¢ I
To Building Foundation
Lot
To Water Matfl'/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots "~'--~ ~"~
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump C)n" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/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 MOA and HAA guidelines in effect on the date of this inspection.
Signed ~'& ~ ~N~INg~Hi['~ Date
Company 8RB 196}~ .L
: ',~,, 31~ ~]VE~, A[J,~S~ '~a~ MOA No.
Receipt No. .
Date of Payment 1- I
Amount: $ ~5 ~
Page 2 of 2
72-026 (11/84)
Time
Date
Insp
'~ MUNICIPALITY OF ANCHORAFTM
DEPARTM~-,~T OF HEALTH AND ENVIRONMEN.,d~ PROTECTION
~ 825 L Street, Anchoraa~. Alaska 99501
264-4720
Date Received:
~'.~ ~2: Time ~'.~ ~ ~3: Tim~/ ~
~Q.-,~5/~ ~ Date ~~~ Dat
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER ~D WATER FACILITIES
1. Lending Institution Request: Alaska National Bank of the North
Mailing Address: 3301 C Street, Calais II
Phone: 278-4581
2. Property Owner: Robert Ohrt
Mailing Address: 401 East 36th Avenue 99503
Phone: 279-0491
3. Legal Description: Lot 7 Block 5 Lake Ridge Terrace Subdivision
4:
Single Family Residence: (x~
Multiple Family Residence: ( )
Well System:
Permit ~
Construction
Individual well (x)
Number of Bedrooms: Three
Number of Bedrooms:
Community/Public System ( )
Depth of Well 185' Well Log on File ( )
Bacterial Analysis
Sewage Disposal System:
Permit ~
Septic Tank Size
Absorption Area
On-site System (x) Public Utility ( )
Installed 1974 Installer ~f~[~.,;~J~.
/~ O Manufacturer
Soils Rate ~.~ Material
Distances: Well to Septic Tank i~Z~ to Absorption Area//~
to Sewer Line Nearest Lot line
Absorption Area
to Nearest Lot Line
Z' 4-- ~, - MUNICIPALITY OF ANCHORAGE - ~, ~C>~
~' .//~ .Denartment of Health and Environmental Protection ~'
~ ~ . 825 L Street, Anchorage, Alaska ,99501- ~-~ ~
279-2511, ext. 224, 22~5 ~'~ L ~-~-'~.~.~ ~ ~
~quest for Approval of Individual Sewer ~ W~.te~ Facilities
1, Property Owner: __ ~ ~~ ' "-'
Mailing Address: _~ ~/~'~ = $ Phone: ~-=~y.
2. Name of Buyer: ~ FX~ ~
4. Realtor/Agent: ~,C.k ~~-
Mailing Address: ~L ~ ~~ ' Phone: $~~Z)
Street Loaation: , b ~~.m
e ooms: )
Single Family Residence:
Multiple Family Residence:
( ) Number of Bedrooms:
o
o
Water Supply: *Individual Well (>~ Public/Community System ( )
If Individual Well, well depth __~__~
If community System, name of system
Sewage Disposal System: On-site System i~ Public System ( )
If On-site System, date of insta[Llation: ___~_~,~
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
Page ,Two .
' ' Department of Health and Environmental Protection
'Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 7 Block 5 Lake Ridge Terrace Subdivision
Comments:
Affadavit Attached:
Approved:
Disapproved:
Date:
Date:
Letter Attached: ( )
Department Worksheet:
(ep!s ~eqio caS) --O]OIAO~d 3998]AO3 tONVBflSNI ON 008~ m~o~ Sd
~ ~ ............................................... AINO 33553B00¥ Ol B3AI13
31VO 80 01 IN35
~8¥~150d
(e~elsod snld) ~SOZ--31¥1N C]31]11~133 a03 J. dl3O3b
