HomeMy WebLinkAboutBROWN LT 2
Permit Number:OSP261193
Tax Code Number:01516359000
Work Type:SepticTank Upgrade
Effective Date:
Design Engineer:
Site Legal Address:BROWN LT 2 G:2640
Owner:VONHAFFTEN ALEXANDER H JR &
Site Mailing Address:11540 TRAIL'S END RD, Anchorage
Lot Size in Sq Ft:49375
Total Bedrooms:4
This permit is for the construction of:
Disposal Field Septic Tank Holding Tank Privy
Non-Public
Water 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. Coodinate with On-Site staff regarding preferred method.
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
7/2/2026
7/2/2027
PANNONE ENGINEERING SERVICES
Expiration Date:
¨þ ¨¨¨¨
Issued To:
Issued By:
Date:
Date:
7/2/2026
7/2/2026
PANNONE ENGINEERING SERVICES
Isatou B Njie
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
MUNICIPALITY OF ANCHORAGE
Development Services Department ' Phone: 907-343-7904
On -Site Water & Wastewater Section -
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-163-59
Property owner(s) VONHAFFTEN ALEXANDER H JR & MILLER KERSTIN
Mailing address PO BOX 230069
Site address 11540 N TRAIL'S END RD
Legal description BROWN L2
Number of Bedrooms 4
Engineering Firm Pannone Engineering Services, LLC.
Building Permit Number
Day phone
Not Applicable ❑■
APPLICATION IS FOR: APPLICATION IS AN:
(® all that apply)
Disposal Field
❑ Initial ❑
Septic Tank
❑ Upgrade El
Holding Tank
❑ Renewal ❑
Privy
❑
Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Permit/Rush Fees: 27-0
Date of Payment: 2l 245"
Permit No. OL b I t� S
May 2025
Waiver Fees:
Date of Payment:
Waiver No.
Distance:
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
1 July, 2026
Mailing: P.O. Box 1807 Palmer, AK 99645
Telephone: (907) 745-8200 FAX: (907) 745-8201
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, Alaska
Subject: BROWN L2
11540 N TRAILS END RD
TANK REPLACEMENT
This is a design narrative for a permit to install a 1250-gallon septic tank to replace an existing 1250-gallon septic tank
to be issued for this property. The existing tank is 33 years old and is likely perforated and leaking, it will be
decommissioned per code. Currently the lot is developed. The proposed replacement will be connected to the existing
drain fields. This lot and the surrounding lots are served by private wells. There are currently no wells within 100’ of
this upgrade.
1. Upgrade Tank Design.
A foundation clean out installed if needed.
The tank will be located: 5’+ from any property line.
5’+ from any deck/stair support.
10’+ from building foundation.
10’+ from any water line.
100’+ from any surface water.
100’+ from any private wells.
200’+ from any public wells.
The proposed installation will not affect the future development of this or the surrounding lots.
If you have any questions, please contact me at (907) 745-8200.
Sincerely,
Steven R. Pannone, PE, F. ASCE
Owner/Civil Engineer
1 July 2026
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP261193, Isatou Njie, 07/02/26
BROWN L2
BROWN L1
APPROXIMATE
LOCATION OF WELL (E)
FC (E)
(SEE NOTE 1)
11.4'
(10' MIN)
4 BEDROOM (E)
CO1 (E)
INSTALL MOA APPROVED 1250GAL
SEPTIC TANK(P)
INSTALL WITH NEW DCO AFTER TANK.
INSTALL WITH 20" MANWAY RISER ON
1ST COMPARTMENT OF TANK.
ENSURE 4' OF COVER OR 4'
EQUIVALENT W/ RIGID INSULATION.
DRAIN FIELD (E)
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20.7'
CO2 (E)
MT (E)
105.0'
WELL (E)
WELL (E)
100' WELL RADIUS TO BE
STAKED BY PROFESSIONAL
LAND SURVEYOR BEFORE
CONSTRUCTION
1250GAL STEEL TANK (E)
(DECOMMISSION PER MoA CODE)
PAVED DRIVEWAY (E)
DCO1 (P)
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NEW SEPTIC
DESIGN PARAMETERS
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 4(600 gpd)
TANK SIZE: 1250g
WATER LINE / WELL
RADIUS
ESMT/SETBACK
STREAM/DRAINAGE
WAY CENTERLINE
FLOW PATH
THE CONTRACTOR, AND OR THE PROPERTY OWNER RESPONSIBLE FOR THE INSTALLATION OF THE PROPOSED WASTEWATER TREATMENT SYSTEM SHALL NOTIFY PES A
MINIMUM OF 24-HOURS IN ADVANCE MONDAY THROUGH FRIDAY OF THE REQUIRED PRE-CONSTRUCTION INSPECTION. AT THIS TIME A REPRESENTATIVE OF PES AND THE
CONTRACTOR OR PROPERTY OWNER WILL
1. DISCUSS CONSTRUCTION PROCEDURES AND DESIGN REQUIREMENTS.
2. VERIFY SITE CONDITIONS CONFORM TO THE DESIGN PLANS AND PERMIT.
3. VERIFY THE PROJECT LAYOUT CONFORMS TO THE DESIGN PLANS AND PERMIT.
(Ref: AMC 15.65)
PLEASE REFER TO THE NOTES AND SPECIAL PROVISIONS PAGE FOR MORE INSPECTION INFORMATION.
PES SHALL NOT BE HELD LIABLE FOR INSTALLATIONS NOT MEETING THE REQUIREMENTS OF 18 AAC 72 AND/OR AMC 15.65 AND THE SPECIAL PROVISIONS OF THIS PERMIT AS
APPLICABLE IF THE CONTRACTOR AND OR PROPERTY OWNER FAIL TO GIVE PES PROPER NOTICE. PES WILL ATTEMPT TO DOCUMENT THE SYSTEM AND OBTAIN ANY NECESSARY
WAIVERS AT THE CONTRACTOR AND OR PROPERTY OWNERS EXPENSE. PES MAKES NO GUARANTEES THAT ANY NEEDED SEPARATION DISTANCES WAIVERS WILL BE APPROVED
BY ADEC OR THE MUNICIPALITY OF ANCHORAGE ONSITE DEPARTMENT STAFF.
ABBREVIATIONS
CO CLEAN OUT NO.
DCO DOUBLE CLEANOUT
DV DIVERTER VALVE
(E) EXISTING
FC FOUNDATION CLEANOUT
FS FLOW SPLITTER
MT MONITOR TUBE NO.
MH MANHOLE NO.
(N) NEW
NIC NOT IN CONTRACT
(P) PROPOSED
R.I. RIGID INSULATION
TH TEST HOLE
TYP TYPICAL
SHEET NOTES:
1. VERIFY LOCATION AND ACCESSIBILITY OF FC. IF INACCESSIBLE OR NONEXISTENT
INSTALL DCO BEFORE TANK.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP261193, Isatou Njie, 07/02/26
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1. GENERAL NOTES:
1.1. ANY MODIFICATIONS TO THE ATTACHED PLANS NEED TO BE APPROVED BY PES AND THE OWNER OF THE PROPERTY.
1.2. PES SHALL BE NOTIFIED A MINIMUM OF 48 HOURS IN ADVANCE BEFORE CONSTRUCTION OF THE PROPOSED WASTEWATER
TREATMENT SYSTEM.
1.3. PES SHALL BE NOTIFIED A MINIMUM OF 24 HOURS IN ADVANCE TO PERFORM A MINIMUM OF FOLLOWING INSPECTIONS:
1.3.1. A PRE CONSTRUCTION MEETING IS REQUIRED BY STATE AND MUNICIPAL REGULATIONS BEFORE A ONSITE WASTEWATER
TREATMENT SYSTEM MAY BE INSTALLED.
1.3.2. TOP OF SEPTIC AND OR HOLDING TANK (TANK IS SET IN PLACE LEVEL WITH ALL PIPING ATTACHED (CLEANOUTS, MANHOLES,
INLET AND OUTLET PIPING).
1.3.3. BOTTOM OF EXCAVATION OF THE DRAIN FIELD/S.
1.3.4. AFTER PLACEMENT OF FILTER SAND (IF NEEDED).
1.3.5. AFTER INSTALLATION OF THE DRAIN ROCK WITH ALL ASSOCIATED PIPING IN PLACE INCLUDING DISTRIBUTION LINES
CLEANOUTS AND MONITOR TUBES PRIOR TO INSTALLATION OF FILTER FABRIC AND INSULATION (IF NEEDED).
1.3.6. FINAL GRADE INSPECTION. ENTIRE SYSTEM IS INSTALLED AND BACKFILLED.
1.4. THE ENGINEER (PES) HAS NO CONTRACTUAL RELATIONSHIP WITH THE CONTRACTOR (THE INSTALLER OF THE SYSTEM) AND,
THEREFORE, HAS NO AUTHORITY, CONTROL OR RESPONSIBILITY FOR THE CONTRACTOR'S EMPLOYEES, THE QUALITY OF WORK,
THEIR COMPLIANCE WITH THE DESIGN DRAWINGS/SPECIFICATIONS OR THEIR MEANS/METHODS OF CONSTRUCTION. AT
APPROPRIATE INTERVALS, THE ENGINEER WILL VISIT THE WORKSITE TO OBSERVE THE QUALITY OF THE CONSTRUCTION AND TO
DETERMINE IN GENERAL IF THE CONSTRUCTION IS PROCEEDING IN ACCORDANCE WITH THE DESIGN
DRAWINGS/SPECIFICATIONS.THE ENGINEER WILL NOTIFY THE OWNER IF DEFICIENCIES ARE OBSERVED; HOWEVER, THE FAILURE OF
THE ENGINEER TO OBSERVE A DEFICIENCY WILL NOT RELIEVE THE CONTRACTOR OF THE RESPONSIBILITY FOR CORRECTING ANY
SUCH DEFICIENCY. THE ENGINEER WILL PREPARE RECORD DRAWINGS AND SUBMIT THEM TO THE REGULATORY AGENCY HAVING
JURISDICTION OVER THE WASTEWATER TREATMENT SYSTEM (ADEC OR MOA). FINAL APPROVAL OF THE WORK AND CORRECTION
OF ANY DEFICIENCIES IS BETWEEN THE OWNER, THE CONTRACTOR, AND THE REGULATORY AGENCY HAVING JURISDICTION OVER
THE WASTEWATER TREATMENT SYSTEM (ADEC OR MOA).
2. SCOPE AND SPECIFICATIONS:
2.1. ALL CONSTRUCTION SHALL BE AS SPECIFIED IN THE ATTACHED PLANS. CONSTRUCTION ACTIVITIES SHALL ALSO BE IN
ACCORDANCE WITH THE MOST CURRENT EDITION OF THE FOLLOWING CODES AND POLICIES AS APPLICABLE.
2.1.1. 18 AAC 72
2.1.2. AMC 15.65
2.1.3. AMC 15.55
2.1.4. MOA STANDARD SPECIFICATION FOR COMPONENTS PARTS AND MATERIALS.
2.1.5. ADEC ONSITE WASTEWATER SYSTEMS INSTALLATION MANUAL (OWSIM).
2.1.6. MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS).
2.2. SCOPE OF WORK: INSTALL SYSTEM IN ACCORDANCE WITH THE ATTACHED DESIGN AND SPECIFICATIONS.
2.3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF -- 11' BELOW EXISTING GRADE. IF AN APPARENT WATER TABLE IS
OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN -- 11' BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
2.4. STRUCTURES DEPICTED ON THE SITE PLAN ARE BASED UPON ONE OF THE FOLLOWING: CONCEPTUAL PLOT PLAN DEVELOPED BY
OWNER; A PLOT PLAN DEVELOPED BY RLS; OR A SURVEY AS-BUILT.
3. CONSTRUCTION SPECIFICATIONS:
3.1. ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE ENGINEER IF ACTUAL FIELD
CONDITIONS VARY FROM THOSE USED TO PREPARE THE DESIGN
3.2. EXCAVATE THE DRAIN FIELD. BOTTOM OF EXCAVATION SHALL BE LEVEL AND SCARIFIED. RECORD ELEVATIONS AT BEGINNING,
MIDDLE AND END OF TRENCH BOTTOM. CONSTRUCTION EQUIPMENT SHALL NOT OPERATE ON THE FLOOR OF THE EXCAVATION.
ANY MATERIAL COMPACTED BY THE OPERATION OF THE CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITH
NON-COMPACTED MATERIAL.
3.3. PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL OR SPOILS
FROM EXCAVATION. LEVEL ROCK SURFACE TO ±1" PRIOR TO INSTALLING THE PERFORATED PIPE.
3.4. ALL PIPE SHALL BE SCHEDULE 40 ABS AND OR PVC CONFORMING TO ASTM F628 AND ASTM D3034 AS APPLICABLE OR ENGINEER
APPROVED EQUAL.
3.4.1. ALL PRESSURIZED SEWER LINES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC CONFORMING TO ASTM D1785 OR ENGINEER
APPROVED EQUAL
3.5. FOR MOA PROJECTS THE MINIMUM SOIL COVER SHALL BE 3 FEET OVER SEWER LINES AND DRAIN FIELDS AND 4 FEET OVER THE
SEPTIC TANK. ONE INCH OF INSULATION MAY BE SUBSTITUTED FOR 1 FOOT OF SOIL COVER.
3.6. FOR STATE OF ALASKA (ADEC) PROJECTS THE REQUIRED SOIL COVER IF 4 FEET FOR ALL WASTEWATER SYSTEM COMPONENTS.
3.7. THE MINIMUM ALLOWABLE SOIL COVER SHALL OVER ANY WASTEWATER SYSTEM COMPONENT SHALL BE 2 FEET WITH 2 INCHES OF
APPROVED INSULATION.
3.8. ALL INSULATION SHALL BE 2" THICK DOW HI-40 INSULBOARD OR ENGINEER APPROVED EQUAL. CENTER INSULBOARD WIDTH OVER
SEPTIC TANK, DRAIN FIELD, OR SEWER LINES.
3.9. GEOTECHNICAL FABRIC SHALL BE TYPAR 3401 OR ENGINEER APPROVED EQUAL. LAP ALL JOINTS 2 FEET MINIMUM. GEOTECHNICAL
FABRIC SHALL CONFORM TO AASHTO M288 CLASS 3 AND HAVE THE FOLLOWING CHARACTERISTICS:
3.9.1. MINIMUM PERMITTIVITY (ASTM D4491) -0.5/sec
3.9.2. MAXIMUM APPARENT OPENING SIZE (ASTM D4751) - 0.20 TO 0.21mm (US SIEVE #70)
3.10. COVER THE DISTRIBUTION PIPE WITH A MINIMUM OF 2" OF SEWER ROCK AND COVER WITH GEOTEXTILE BEFORE PLACING
INSULATION AND BACKFILL.
3.11. MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS.
3.12. SLOPE ALL FILL MATERIAL TO DRAIN AT 2% MINIMUM SLOPE AND 3:1 MAXIMUM SLOPE AND IN SUCH A MANNER THAT PONDING
AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT AT 6" HIGHER THAN SHOWN TO ALLOW FOR
SETTLEMENT. SEED SURFACE AFTER COMPLETING INSTALLATION AS PER MOA CODE.
3.13. RECORD THE FINISH GROUND ELEVATION OVER THE BEGINNING, MIDDLE AND END OF SYSTEM.
3.14. MAINTAIN 5' SEPARATION BETWEEN PERCOLATION HOLE AND THE DRAIN FIELD TRENCH.
3.15. EXPOSE, PUMP AND FILL LOG DISPOSAL CRIB OR CONCRETE TANK WITH SOIL TO ABANDON IAW WITH MOA CODE IF NEEDED.
NOTES & SPECIAL PROVISIONS:
4. CONTRACTOR RESPONSIBILITIES:
4.1. THE CONTRACTOR SHALL FAMILIARIZE THEMSELVES WITH THE SITE CONDITIONS AND LOCATIONS OF
ALL LOT LINES, EASEMENTS, WELLS (E & P), SEPTIC SYSTEMS (E & P) AND SHALL MEET MINIMUM
SEPARATION DISTANCES OR AS NOTED.
4.2. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION
AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN
30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE
WORK.
4.3. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE
ATTACHED.
4.4. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
4.5. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK.
ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
4.6. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED
DRAWINGS AND SITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE
DESIGN.
4.7. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED-LINE AS-BUILT DRAWINGS
TO THE ENGINEER. THE RED-LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS,
PIPE ELEVATIONS, AND TANK ELEVATIONS.
4.8. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE
BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN-OUTS AND MONITOR TUBES INSTALLED,
INSTALLED TANK AND FINAL GRADING.
5. THE CONTRACTOR SHALL CERTIFY THAT ALL WORK WILL BE PERFORMED IN ACCORDANCE WITH THE
APPROVED PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS-BUILT REDLINES ARE TRUE AND
ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED.
BY ACCEPTANCE AND CONSTRUCTION OF THE ATTACHED PLANS THE OWNER, CONTRACTOR AND APPLICABLE
REGULATORY AGENCY AGREE TO THE PROVISIONS SET FORTH ON THIS PAGE AS APPLICABLE AND ANY
SUBSEQUENT SPECIFICATIONS (IF ATTACHED).
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP261193, Isatou Njie, 07/02/26
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, ~elephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
.am~ DISTANCES
//)'//~/¢,~'/_ t.7,¢~4,,,~/ c/~ J)&'$1,,c,~J5 I,~ I.,u'oo~ ____'~_ TO SEPTIC ABSORPTION WELL
^,,,r..,~FROM ~ ., TANK FIELD
~q~-~o~V J 8~OZ~I ~ LOTUNE ~ '
Z, I E~o~' FOUNOA~ON /~' Z~ ~'
Tow~i~ ~, ~ A~BUlLT DIAGRAM l~ow lation
TANKS
~ SEPTIC D HOLDING
':~,,, TYPE OF SYSTEM ~. ~, ~; o
,
~ TRENC'~~ ~ .ED ~ W. DRA~N ¢'~:.~.,' .........................
:iff ada~ a~ve ong~n~ grade ~a~ ~ptfl ~ealh pt~ I~ /
/ t
Tot~ a~rpt~on area ~ ~te li~ ..
Num~ of Im~ rating P,~ marcia ~ ~
/ /so so ~ ~o ~ q FY c ~/'
I~tall~ Date IffiJlffi , -~
~ PRIVATE D OTHER (IdenflN) L
FI FT
REMARKS: ............................ '
DE~. OF HEALTH &' ,
..... " -,'~ ~ /,,~ ~o'
':..:.::- ,,_...,%
72-013 (3/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
.ame DISTANCES
SEPTIC
ABSORPTION
L~o~ O~SC...~,ON LOT LINE
Lot ] Bloc~ ] Subdivision
Z, I E~o~ FOUNDATION
Township, Range, Section AS-BUILT DIAGRAM (Show location of well, septic system, properly lines, foundation,
TANKS
~ SEPTIC ~ HOLDING
Manufacturer Capacity in gallons
~aterial No. of Compadments ~
~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ~,~
Depth to pipe bottom from Total depth from original grade
°riginalgrade ~ FT ~ FT
:ill added above original grade Gravel depth beneath pipe
~FT ~ FT
Gravel length Gravel width
Total absorption area Distance ~tween lines
~0 SO FT ~ FT
~umber of lines I Soil rating Pipe material /~ ~ ~ ~
Installer ~ ,i~ ~ -} Date Installed
WELLS
~ PRIVATE ~ OTHER {Identify)
Classification (A,B,C) Total Depth ~ Cased to
FTI FT
Installer Date Installed:
REMARKS:
Health Depa~ment Approval: _ _ Date:
72-013 (3/85)
Owr"m.:,i" Name:,: M I Cl...If41ii!] ....BR[)Wiq
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Sect i c'.,n
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i'.'la::.( Bedl'.ooms~ ]"his l'.::'el'm:i,t: 4 To'La], [:];,~[:)at::J,'t'.,y~ 4
! ~i!,:. must h,':?'.'e aL :i, easi~'L ;7 cc)r, pal'~tments,, Dep'Lh to top o~ .septic 'Lank (s) .:::
! ,,-.';':! ;'; .... ; . : "?-' ~.].,:~'l',,iCd'i OvE:r~ 'l:.ai"'ik (s) .
must
· h:.:.i:, p \,, .~. (..-' ~.,,.'.:,,:'.., w i th :i. n :'.!!iC~ days o ~' we 1 1 c: omp 1 et i on ,,
I. N'..::::'! AI..I .... t:;:'tiii:t::~ EI"JG I I',tE::ERE~ AT't'ACHEi:D DES :1: GN ,, NC)T I F:'Y DHHS I;::'R I OR '1'0 EAC;H
:t:I".!~:~I::~E:.~; i .I.t)N. 'TF~ENC;H 1S ]"C/ BE ~ .........x .....
: .,Jl" t:,III:.D AND [',L..OSED C)N ]"HE SAME DA'Y, ,
L,iiqLEE~S t"II~:A"i" i S I:::'RCiV I DED,, T H I S I:::'EI;:(M I '1' ]: S :[ SSLJED FOR THE ::'L~ANIqED
4 BE. DROC~M SI. txlt':il..,t~: FAMILY DWI~!~:LI.,.IIxI[~)ONI.,.,Y AND _EX I:::'!RES [IN
A I',It~EW PERMI'T' WtI:L,.t .... BE IRI~ZC;!LJiRED AF:'T'ER 'I"HAT' DATI~ :1:1:::' THE~: SYSTEM HAS
['~ "' ' X o' ............
NO"i' .~..,E.t,I I Il~:~l
i ., I:: I'~ ~. F'Y 'T' t'"lt'.'::~ ] .'
:1.,, I am f'am:i.l:i.a['~ w:i. th tho requir'emen'Ls ~'or' on,...,si'Le sewers ar'id wells as se'l:.
f'or'Lh by the Mun:i. cipal:i, ty of Anchc)rag~ (MOA) and the Sta'Le of'
2.. i wi].l :i, nstall 'Lhe s'y'~t, em :Ltl ac::l:::or'dal"'lce with a].l M[](::i cc)c:les and reguia'L:i.c)r'~s~,
and :i,r'~ compl',i, ar'tce [~l]:i.'t'..J"j t,,he CJ~/~J,(~Jl"t c::r'~.'LeP:i.a (:)~ 't:.h:i.s per'mi'L,,
:]~,,, 1 will a(:Jhel=e 'k.o al, J. MOA al"lc:l State (::).l A].a~ka r. equ:Ll"emer'~ts (ol" the set
(:J ;i. ~"" ......... . .
.~.,~::~J ~..(.:e~]5 [ I" C)ll'i ~;~,l"i~k.' (~')'( :~, E~'[',, :J, I']C WE') t :I. ,, was'Lewater d i st:)osa ',1. system or'. pub :1 :i. c
E~?~w(.~.~l"-a~:j{~)~ ~B'y"~j't:,.ef[i Cil"~ 'Ll'"l~,~i c)f'- (i~i"~z ac:lj;~c:er'YL oP r]ear, by lo'L.,
t ur'~der, s'Lar~d fha'l:, this per'.m:i.t is raj. id for' a max:i, ml.,~m of' 4 bedr'ooms,,
also undersLand that 'Lhe capac:i, ty (~l"u.:~, total system ~,s 4 ~:){~)~c:Jl"~::)l::)~l~ and
any c~,"~].ar.c, emei~~ r'.equ:i. Pe ari~:~it:i, orl~]. ,::,errr, i'L ,,
.............. ............................................................ ............
(Owner') Mi[,.HAI~::] ....
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN.SERVICES
825 "L" Street, Anct~orage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: .~.r ~-~
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
Township, Range, Section:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTER ED;'
IF YES. AT WHAT
DEPTH?
~4~mtming?
Daze Gross Ne~ I Oeo;h to Ne~
Reading
Time Time/ Water Oroo
PERCOLATION RATE
(m,nute~,nctt) PERC HOLE DIAMETER
TEST RUN 8EI~WEEN ~ FT AND .
COMMENTS "~Zg/J)/Z'-/O/~/~/-- T'E,,~,"~ 1"/~/4~__ ~ ~0~~ /~E~
ACCOROANCE WIT~ ALL ~ATE AND MUNICIPAL GUIOELIN~S IN ~FECT ON THIS OATE DATE
72~ (R~. ~
THAT. THI.~ TEST WAS PERFORMED IN
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN.SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
2O
Township. Range, Section:
SIT~ ~LAN
SLOPE
WAS GROUND WATER
ENCOU NTER ED ? /k,/O
IF YES. AT WHAT
DEPTH?
It
Rla:ling Date Gross Net Deoth to Net
Time Time Water Drol~
PERCOLATION RATE
(mmutes/mc~) PERC HOLE DIAMETER __
TEST RUN BETWEEN FT AND FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DAT[ / '
72~ (R~. ~)
IN
PERFORMED FOR:
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN.SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRII~I'ION: ~.OT ~.
I
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
2O
,~ US~t Townst~ip, Range, Section: '-~ 2 '?- 7'"'/SA/ ~ ,~ ~J
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
. I
t
tl I
Re~:ling Date Gross Net / Oeot~ to Net
Time Time Wate~ Drop
!
PERCOLATION RATE __ (mmutes~,nc~) PERC HOLE DIAMETER
TEST RUN BE'DWEEN __ Fl' AND FT
IN
I
I
I I
I
7~
% ~ .'
FOUNDATION
~' DRAINAGE ARROWS
NOTES:
I. IT SHALL BE THE RESPOHSlSlLIT¥ OF THE BUILOER OR OWNER TO VERIFY THAT
BUILDING LOCATION SHOWN MEETS ALL SUBDIVISION COVENANTG AND ZONING
ORDINANCES.
~:. IT IS THE RESPONSIBILITY OF THE BUILDER TO VERIFY ALL ELEVATIONS WITH
RESPECT TO ALL UTILITIE$~B DRAINAGE.
3. THiS PLAT REPRESENTS THE PARCEL OF PROPERTY DESCRIBED BELOW TAKEN
FROM THE RECORDED PLAT DESCRIGING THAT PARCEL. INSTRUMENTS RECOROED
PRIOR TO OR AFTER THE FILING OF THE RECOROED PLAT ARE NOT SHOWN ON
-- --
d
I 30'
30'
EURVEYOR'~ CERTIFICATION
I HERESY CERTIFY THAT I HAVE SURyEylrO THE
PROPERTY D(S(:RIGEO ON THIS PLAT ANO THE
IMPROVEMENTS SITUATED THEREON ARI LOCATED
AS SHOWN ON THtG PI-AT. . ~
LEGEND
0 LOT
FOUNDATION
DRAINAGE ARNO
NOTES:
IT SHALL IE THE RESPONSIBILITY OF THE BUILDER OR OWNER TO VERIFY THAT
BUILDINI LOCATION SHOWN MEETS ALL SUIOIVISION COVENANTS AND ZONINg,
OROINANDES. ,
tT IS THE RESPONSIBILITY OP THE BUILDER TO VERIFY ALI. ELEVATIONS WITH
RESPECT TO ALL UTI~,ITIEEt & ORAINAGL
THIS PLAT REPRESENTS THE PARCEl. OF PROPERTY DESCRIBED IRLOI
FROM THE REDOROED PLAT DESCRIBING THAT PARCEL. INSTRUMENTS
FRIOR TOON AFTER THE FILING OF THE RECORDED PLAT ARE NOT SHOWN' ON
THIS PLAT.
THE INFORMATION ON THIS PLAT II FOR THE USE OF LENDING INSTITUTIONS
SPECIFICALLY TO SHOW ANY CONFLICTS IETWEEN EXISTING STRUCTURES
PLATTEO LOT LINES OR EASEMENTS ~ THE P~AT IS NOT TO IE USED FOR
~IITIONINi ADDITIONAL ITRUCTURES OR F~NCE8.
'~Z 0 T ~ZAW
2 ,
349-6451
DRAWN BY '- /~/')
CHK. BY,
BE$SE, EPP$ I~ POTTS
2220 E. 88'th. AVE.
ANCHORAGE, ALASKA 99507
344-1352
JDW~,
'~ '-".'~ '. · WATER WELL RECORD
· ;., STATE OF ALASKA
'~. ' · · - DEPARTMENT OF NATURAL RESOURES
· Division of Geologicol ~ Geophysicol Surveys
": '":'~': !' .-';'/:~' Drilling Permit No.
LOCATION OF WELL (PleDGe complete either lo, lb or lc.) ; "' ~'''~ - · A.D.L. No.
STANCE FROM ROAD INTERSECTIONS ~ .. '-, ~. OWNER OF WELL:
AND
DIRECTION
' '[ ';? "' :'J ";: ' addrea,: Designs In Woo,
Street Address end Area of Well Locoflon ". ,"~,~ ..... ',' ' ~oho~e
~ WELL LO6 Fief Below ...,. 4, WELL DEPTH: (flnol) 5. DATE OF COMPLETION
MQterlol Type Top 80ttom
.:J ~; ~ f~:,-~ ~ ~ 0 ~ 6, ~ Cobll tool ~ Rotary ~ Driven ~Dug
: TXp~: Dlomefer:
'~ Set between ff. ond ff.
,r . ",';. '1 Boekfllllng Grovel pock
.... I0, ~TATIC WATER LEVEL:
MUNICIP~IT~ ~ AR~, )~':'~ "" ":';'~' ~ Above Or ~ Below Iond ,urfoce Dote
_. F~VIR~NME ~T~ PR~E
' '?'r'' ; 1,.~ ;1 II:,PUMPING LEVEL below land ~urfoce and YIELD
' ',": ' '" "- ' Material: 0 Neof Cement 0 Other:
' ]4. REMARKS=
~ ~ , ,~ ..... · 15 Weter Tempereture o ~ F ~ C
This well ~as drilled under my )urlsdlcflon ahd this report]l j~:~:{~.:t~.'bilt of m~ knowledge ond be
Registered Business Neme ' :..,?'}~:;~:~ti~:, '-Co~lrect License Number
Form O~-WWR (11/81) Copy Distribution: WHITE'~f~fe DGG~ PINK"Driller, ~ANARY'CusfomIr
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-41 ! 1
TOADY k'/'vOWI_ES
~,.!A '," C: O
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 10, 1986
TO: Permit Applicant
Subject: Permit # 850246
Lot 2 Brown 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
SEO/ljw
enc: Copy of Permit
PER'MIT NO:
DATE ISSJEI:)::
05 / ..... / ...... '
· ... ~ .[ ~ (3 ~.J
C Ct N'T'A C T' I::' I'"10 I',t [!ii:
I....EE'h'::~I .... DESCF;,' I P ::
' L.[] T S I Z E ',:
L.E)T L. OCAT.I: ON::
MA X I'.:.qi.::;DRO0t'IS ::
,;:t AMIES M, I:,"tJI',IL. AF:'
.'.'.I. :1. 5 :L W '72NI:) AVENLtE;
(.-WqCHORA(i:.UE.~ AK 99502
2 Zl. 5 '"" '70 ./::, ':?
DEPTH TO F' I PE B(::!"I"'!"(::~!"'I (F'T ,, )
[':.) F:;'. ~::~ V El .... D I..'.]; F:'"I" i...1 ( F'"I" ,,
TO'I"A! ....DE]:::'TH (F'T.,)
G R A V E L I,,,J .1: D T H (F:'T,
(i~F;.'.(..~VEI .... L..EI'4E'YI'H (F::'T.,)
GI::;'.AVIE! .... MOI....UME (C.U, YDS,, )
'I"ANI.::; S :1: ZE ([).'i(.~L..S)
.SI:) Il .... I::;.:AT' I I',tG (SC!, !:::T ,, /BF';: )
For'i:..h by 't:.he Mur~:i.,:::::i.F~a].:i.l'..y [:).r-' Anchor'age (MOA) and 'l:..he E; !:. .~:,,, i'.. .,:.:.:.:, ,::>F {.:.~:l....?:'v..'~ka,,
2,, .'I: t,.,~:i. ]. :I. :i.n!s'l.'..al ]. 'l.'..hf.{'. '~.~y~..-.".i'('..6:.!.,'fi :Lr'i a'..'u[:: (::; ,:;::, i" d ,.'..'..'d"~ ,.;::: 6? w:i.'Lh at :t. h'1[;tA ,::::,:::x.i(.:.:..w..~ -:'..'..':nd r,:..?q:!u].a'!:.:i.,:::n'".,~,
and
:::.!;,, ! v,~:i.].! adh6:r'e t.o all MI:IA and S':a",:.'=; ,'::~¢ A1a..sl-'.:,.?..'~ r,:.:.:.~.,:::lU:i.r'c.:.:..'men'I:..s {c~.r' .Lh,:.i~ .~.~,..~:.~'i:.. ba',.,::::k
d:i.s't:.ance,.'i~; t:' r'c'.')/fl .:?:tr'ly g.:..~i.:: J.'..!?[L :i. ng t,,.~c..,.'t. 1 ~, '../,¢a":i~;~,:..,'.;,~-,~a.'l:..rE, r' d :i..i~.~t::)c::,i~ila]. ~i~y-~p.':..,:-::.:.m ,:::ir i::~J{:::,.:t. 1.,::::
'."ilP:')~',$':-:'."." r' .:T~.{~:J 6:, ,ziy'!..~FI.'.. 6::."f¥i cln '[:. l"i :J. '.:iii C} I" .:.'..':~I"! y .:'..':iCl .;j ?;:!C: E.H"i 'I.;. C} i': i"i ,.'.;.:..",~':'-'. 1" J;:) '.../ ]. C)'l& ,,
.q.,, I Lu"Ider"~E.'[atrld T..h.._'¢..'d:.. 'Lhi'..s l::.',c.:,r'm:i.'L is ¥.~':~].i(::I .~'oi" .:::i m.:':?.x:!.;¥iLu.'f',. ,'::.',,,'.' 4-l:tE.:,CJi"('::,,.'zh'¥?.;i:i .~':'.'.f"~(:.J
any
.l;l::: A LIF:"I' ?,.'l"A'l"IEd',l IS IN.STAi_LI.T:;D ]:lxlAB1 P.'F'?.IEA
........ ,' ,'¢ :::,. 't:,,'.., ;[ ' ~ ........ " .... "' "'
II h:.l',~(:1)~'..t~,~ iEL..!ii!;L';'T'FtICAI .... I E. :~1 "r' .......... ~!'",ID .1. N,:,.-[':.:.,1 ~.,...1~,! I'.'1~ q"r ;::.~::: [Xg'I"A]:I'",II!i!:D!I ............................ ') AS"-'!:::: "'1 '~"~:::
M I 1....I .... I"q[Tl" BE AF:'I:::'Fi'.EIVI'ZD M I 'I"H[)UT r:::',.'l',l lii..';l_r:i~.CTl::i'. I CAI
IEI....I!!i:C'I"t::;: :1: CAI .... t/,I ['.t F;: !<: IfiLIST' I'.":dE DONIE E",Y A I.... :I: CIEI',ISIE.f.) IEL. I.Ei.:iTF;.: I C :I: 2i!'",! ,,
AF:'F:'L. I CANT':,.'~.., ~....,~','~ c::.~"'"".::::, M. I)LINL..AP
ISSi!.IED BY
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~SOI LS ~OG
[] PERCOLATION
TEST
LEGALDESORIPTION: L~"~+ _~
SLOPE
SITE PLAN
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT ~
DEPTH?
P
E'
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND
5¢ f 5-0, CERT, F,ED BY:
FT
72-008 (6/79)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
DEPT. C / '
MUNICIPALITY OF ANCHORAGE , .,.. o,- ...... -.
DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION
TEST
Pouch 6-650. Anchorage, Alaska 99502 276-2224 f,:i/~¥'2
SOILS LOG - PERCOLATION TEST
i
SLOPE SITE PLAN
I i
'
10
12
13
14
15
16
17
18
19
20
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
77!
L
'--4 ....... ~ ..... i--4--d- ............. ?.--~---t .....
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch)
FT AND FT
· ......
CERTIFIED B , _
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
015-163-59
HAA #
1. GENERAL INFORMATION
Complete legal description Brown Subdivision ~ot 2
11540 ~'ail ~ztds Road
Location (site address or directions)
Property owner David J. and Marcia M. Lafferty Day phone 346-3809
Mailing address 11540 trail Ends Road, Anchorage, AK 99516
Lending agency
Day phone
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
X
Individual well
Community well
Public water
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OFWASTEWATER DISPOSAL:
Individual on-site
X
Holding tank
Community on-site
Public sewer
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 #21
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 Env-iror~enCa'l Mar~gement Thc. Phone 907 272-9336
206 E. Fir/~eed L~., f~ 201,
Address
Engineer's signa
Anchorage, AK 99503
bedrooms.
DHHS SIGNATURE
L/'"' Approved for
Date
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additiona! Comments
~'~"~~ L~,~~~. Date
By:/ ,
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 & 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 #
GENERAL INFORMATION
Complete legal description
'Br~n Subdivsion Lot 2
Location (site address or directions)
11540 Trail Ends Road
Property owner David J. and Marcia M. Lafferty Day phone 346-3809
11540 Trail Ends Road, Anchorage, Ak 99516
Mailing address
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickul
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual well X
Community well
Public water
NOTE: If community well system, provide written confirmation from State ,~um~, aauo~-
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
X
Holding tank
Community on-site
Public sewer
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 #21
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 Enviror~ental Hgt. Inc. //
Address 206 E. Fireweed/Ln~, ~chor~,//AE 99503
Engineer's >.~
6. DHHS SIGNATURE
Phone 907 272-9336
Date
/~ ~: 't, John Earl
/ / '%~ "~:.,,"..
Approved for
Disapproved.
Gonditional approval for
bedrooms.
bedrooms, with
the following stipulations:
Date ~',/Z.L~'//~g/"'
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 I¢21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Brown Subdicison Lot 2
Parcel I.D.
A. Well Data
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Private If A, B, or C, attach ADEC letter. ADEC water system number
Yes Date completed 03/28/88 Driller
75 ft. Cased to 75 ft. Casing height
Yes Wires properly protected (Y/N) ~s
3ft. 2in.
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG
03/28/88
47 ft.
6 ft.
.g.p.m.
74 ft.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
101 ft.
109 ft.
150 ft.
150 + ft.
AT INSPECTION
06/10/94
53 ft.
6
74 ft.
; On adjacent lots
; On adjacent lots
g.p.mt,-3 ~-
< -
150 ft.
150 ft.
Public sewer manhole/cleanout 150 + ft.
Petroleum tank N/A
WATER SAMPLE RESULTS:
Coliform 0 colonies/100ml
Date of sample: 06/13/94
Nitrate
1.2 mg/1 Other bacteria 0 colonies/100ml
Collected by: Chad Helgeson
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N) Yes
High water alarm (Y/N)
Date of pumping
12/30/88
No
08/13/93
Tank size 1250
Foundation cleanout(Y/N)
Compartments 2
Yes Depression (Y/N) No
Alarm tested (Y/N) No
Pumper Isaac' s Pumping Service
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 101 ft.
To property line 16 ft.
Sudace water/drainage
120
On adjacent lots
Absorption field
ft.
150 + ft.
6 ft.
Foundation 19 ft/
Water main/service line 100 + ft.
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed ']2/30/85
Length .57 £t.
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Width
600 Cleanout present (Y/N)
06/10/94 Results (pass/fail)
82 inches
No
Soil rating (GPD/FF) 150sq. ft./bd~m.
5 ft. Gravel thickness 4 ft.
Yes
Pass
System type W. Drain
Total depth
Depression over field (Y/N)
for 4
After test 83 inches
If yes, give date
No
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 109 ft.
To building foundation 29 ft.
On adjacent lots 110 ft.
Sudace water None Observed
On adjacent lots 150 + f~, Property line
To existing or abandoned system on lot
Cutbank None Water main/service line
Driveway, parking/vehicle storage area '16 ft.
ft,
ft.
1DO fr. +
Curtain drain N/A
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conf~rmed to all MOA and HAA guidelines in effect_~Gf this inspection.
HAA Fee * ~00' c~
- -
Receipt Number ~L~L~'~' ! ~f~
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
,3'-- / [¢ ~ - ,&-- c] HAA # ~ ~-¢ O / ~ ~;7
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lOt, block, subdivision, section, township range)
Location (address or directions)
(b) Property owner
Mailing Address
T. elephone · (home)
~'e$1~'
Business
(c) Lending Institution
Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here ,~"hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family'J~ Number ofbedrooms
3. WATER SUPPLY
Individual Well ~. Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site'[~. Public [] Community [] Holding Tank i-I
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev, 7/88) Page 1 of 2
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 bedro.oms 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 ,~/dDcl~o,,,J ~ u,J
Address ~O, '~0~ ~.'jO 773
Date ~/i~.~/~ ~
Engineer's Seal
6. DHHS APPROVAL
Approved for ~(~/-) bedrooms by
Approved X Disapproved Conditional
Terms of Conditional Approval
*f;T' I I Iff ~
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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. 7/88) Back Page 2 of 2
Well Classification
Well Log Present (Y/N)
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
,z:;',E'/¢//rg. If A, B, C, D.E.C. Approved (Y/N)
Date Completed 3//~--g~? Yield ¢ ~,~,w
Total Depth 7.5' Cased to ?..5" Depth of Grouting /,/o
Static Water Level /'/?' Pump Set At
Casing Height Above Ground /?" Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) )/ Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
; On Adjoining Lots /~¢ '
; On Adjoining Lots / 'Y'? '
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by ~4./. N~¢ -P'"A I:>c> ~ El
Water Sample Test Results %~T~5~Acr~ ~'~
Comments ~*,iELL, 15 ~,E~....I
,47/ 4: ¢"' ,~ To Nearest Public Sewer Cleanout/Manhole /~/~/~'"$
B. SEPTIC/HOLDING TANK DATA
Date Installed /Z- ~o-E8 Size
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Air-tight Caps (Y/N)
~J
No. of Compartments
k~ Foundation Cleanout (Y/N)
Date Last Pumped IJ~
~Et~q ; for
Temporary Holding Tank Permit (Y/N) /t///~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line
To Water Main/Service Line
/05 '
85'
To Stream, Pond, Lake or Major Drainage Course
Comments
To Building Foundation
To Disposal Field
!57
~-.0~ 5TIE. UCT' I 0 ~J
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /Z - $~- ~8
Width of Field
15o
Type of System Design
Length of Field ~, o'
Depth of Field ~
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Gravel Bed Thickness ~ '
Statndpipes Present (Y/N)
Date of Last Adequacy Test
Y
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot klO~E o~ LoT
To Water Main/Service Line c~ ~,
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments AE55oR. p'T-io~J ~'/E~_D /S /dEtJ~
To Property Line /~
To Existing or Abandoned System on
, ~-..-'
· On Adjoining Lots '7
To Cutback (if present) /,./o~./£ /c~4¢,5~'~7'
ATION Date I~ Dimensions
,Size in Gallons -""-~~ Manhole/Access (Y/N)
'Pump On" Level at '"'--..~ "Pump Off" Level at
High Water Alarm Level at ~ Vent (Y/N) _
Tested for ~~ Pumping Cycles during Adequacy Test,
Meets MOA Electrical Codes (Y/N)
Comments -"'"'"~ _.........~
**Check Permitted Bedroom Rating Against HAA Request**
M A "r'~
I certify that I have checked, verified, or conformed to all 0 an~;[~"'.4~t~tgu~l~_~ _~% in effect on the date of this
inspection. , ~~ ~ ~ .,....~.~.~
Signed ~ ~ ~"
Company ~~$O~ ~x~~ ~* ~9TM ~ .~.~
~, .,~,e,,~.;*~.l"~'~'**"~"~ ~'~
ate Sea,
MOA No. C~--~-OZ~ ~'%%~ ...... ~' ~.a~,~o~
_ ~ ~', 4381 ' E
Receipt No. 0 ~-- ~//O ~ Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
/ 7D. oc)
Waiver Fee: $
Date of Payment
Page 2 of 2