HomeMy WebLinkAboutSPRING BROOK VISTA #1 BLK 3 LT 7
Municipality of Anchorage
Community Development Department Page 1 of 3
On -Site Water & Wastewater Program
4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite - (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171210 PID Number: 050-091-08 R New E Upgrade
Name: RUSSELL & JULIE BOTT ABSORPTION FIELD
Address: 0 Deep Trench 17-1 Shallow Trench 0 Bed 0 Mound
12221 E. PRINCE OF PEACE DR., EAGLE RIVER, AK 99577 0 Other
Phone: No. of Bedrooms: Soil Rating: Total Depth from original grade:
694-9257 3 1.2 GPD/Sq. Ft. 9.12 (MAX.)
LEGAL DESCRIPTION
Depth to pipe invert from original grade:
Gravel depth beneath pipe:
SEE DWG. FL
1
6.0 Ft.
Fill added above original grade:
Gravel length:
Subdivision: Block: Lot:
SPRING BROOK VISTA #1 3 7
SEE DWG.
42
Ft.
Ft,
Township: Range: Section:
Gravel width,
Beds Number of lines:
Distance between lines:
2.5 Ft.
F,
SEPARATIONDISTANCES
Total absorption area:
504
Number of trenches:
Dist. between trenches:
Septic
Absorption
Lift
Holding
Public/Private
Tank
Field
Station
Tank
Sewer Lines
SQ. Ft.
Ft.
Well
PUBLIC
PUBLIC
25'+
TANK E Septic 0 S.T.E.P. OHolding 0 Other
Manufacturer:
G.P.ciry:
Surface Water
100'+
100'+
ANCHORAGETANK
1000
Gal.
Lot Line
5'+
10'+
N/A
Material:
Number of compartments,
STEEL
2
LIFT STATION
Foundation
5'+
10'+
Curtain Drain
NONE K
NOWN
Manufacturer
ca Y:
Gal.
Remarks: OLD SEPTIC TANK ABANDONED PER UPC PER CONTRACTOR.
'Pump on'level at:
High water alarm at
NEW DRAINFEILD IS 20'+ TO 40% SLOPE. WAIVER GRANTED. SEE
1:2!:]
Electrical Inspections performed by:
WAIVER #OSV171079.
PIPE MATERIAL
House to tank D3034 Tank to D3034
drainfield
Installer NORTHERN EXCAVATION
Drainfield D3034 CO/IVIT D3034
Inspector G E G, Ltd.
BENCH MARK (Assumed elevation) 106.25 Ft.
Inspection
Location and Description:
Dates: 1st 811812017 2nd 8118/2017
3rd - 4th -
BACK (GARAGE) DOOR THRESHOLD
Community Development Department Approval
ENGINEER'S SEAL
Conditional approval: Date:
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Approved: Date:
..............
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LICENSE
#AECC884
Inspection Report _1-1-12,doc
PERMIT NUMBER: PARCEL ID NUMBER:
OSP171210 ECO `IN
050-091-08
4J
/ 4
co
^ / f
NEW DRAINFI
/
/KEY
BOX
' �.._ :.•.-� ..: :
r
PHYSICALLY
DRIVEWAY.;' :;" •,
`.'''•
VERIFIED
A
LOCATION
r
.
/
/
EXISTING
3 BEDROOM
/
HOUSE
APPROXIMATE WATER
LINE. CONTRACTOR
VERIFIED WATER LINE
LOCATION IN CRAWLSPACE
DURING CONSTRUCTION.
A B
FCO 19.0 33.6
STI 24.2 42.5
ST2 30.0 44.8
DBL1 31.9 46.0
DBL2 32.6 46.3
BR 36.6 45.6
C01 43.6 52.4
MT1 43.5 1 51.8
CO2 52.9 1 86.8
MT2 52.5 T 86.6
-APPROXIMATE LOCATION OF 1997
TEST HOLE BY LOUIS A. BUTEW
BULL RUN (BR) VALVE
NEW 1000 GALLON
SEPTIC TANK
9
Ltd
ti GME & ENVIRONMENTAL ENGINEERS _ �•-
3701 E TUDOR ROAD, SUITE 101 ` ANCHORAGE, AK 99507 - PHONE (907) 337.6179 ` FAX (907) 338-3246' WEBSITE w ,garner engineeringmm
PREPARED FOR:
RUSSELL & JULIE BOTT
PHONE NUMBER:
694-9257
PROJECT/LEGAL DESCRIPTION:
SPRING BROOK VISTA S/D #1; BLOCK 3, LOT 7
TYPE OF WORK:
�. RECORD DRAWING OF SEPTIC SYSTEM UPGRADE
PAGE NUMBER:
20F3
DRAWN BY:
J.L.M.
DATE:
8/24/2017
DRAINFIELD
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LICENSE44411S��"� ®�
#AECC884 /
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PERMIT NUMBER: PARCEL ID NUMBER:
MIT UMB
0 OS
SP171210 RECORD DRAWING 050-091-08
FINAL GRADE = 101.33-102.05
STI ST2
TOP OF TANK 2" OF INSULATION TOP OF TANK
AT INLET = 97,34 PER CONTRACTOR AT OUTLET = 9732
NEW 1000 GALLON
INVERT OF BUNG SEPTIC TANK
AT INLET 96 73—/ (RATED FOR \—INVERT OF BUNG
10' BURIAL) AT OUTLET = 96.48
FINAL GRADE MT1 C01
99.82-10.0-6-4 MT2 11 CO2 ORIGINAL GRADE
LOUIS BUTERA, P.E. @ HIGHEST
TEST HOLE POINT= 99.46
2" INSULATION - PER CONTRACTOR
FILTER FABRIC
INVERT OF PIPE
9634
BOTTOM OF
TRENCH = 90.34
RELAT�VE ELEVAT�ON OF GROUNDWATER ON 4/2/1997 PER LOUIS BUTERA, P.E 83.96
RELAT VE ELEVAT ON OF BOTTOM OF TEST HOLE PER LOUIS BUTERA, P.E = 82.46 A
lq��swlakilak
S
VA
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AV
ARNESS ENG INEERIN(3 G"ROUP, Ltd .... 00
---CIVIL& ENVIRONMENTAL ENGINEERS 0
IT .. . ............
3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907) 338-3246 WEBSITE: �.gamessengineedng.com 10 .......... . � .. ............. ........
PREPARED FOR: HONE NUMBER: PAGE NUMBER: 0 ko-- a ess 4Z Ar
RUSSELL & JULIE BOTT 694-9257 3 OF 3
E-7951 AV'
PROJECT/LEGAL DESCRIPTION: DRAWN BY:
SPRING BROOK VISTA SID #1; BLOCK 3, LOT 7 J.L.M. .. ................ 4s,
TYPE OF WORK: DATE: oro,411411 E
LICENSE ya 1%k 1111L s
RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 8/28/2017 1 #AECC884
MUNICIPALITY OF ANCHORAGE
On-Site Water &Wastewater Program .s.• �
.�� PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http.//www.muni.orgionsite
10160,-
I <•partinc•nt
On-Site Wastewater Disposal System Permit
Permit Number: OSP171210 Effective Date: 8/8/2017
Work Type: Septic Upgrade Expiration Date: 8/8/2018
Tax Code Number: 05009108000
Site Legal Address: SPRING BROOK VISTA#1 BLK 3 LT 7 G:0252
Site Mailing Address: 12221 E PRINCE OF PEACE DR, Eagle River
Owner: BOTT RUSSELL D & JULIE I Lot Size in Sq Ft: 30489
Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3
This permit is for the construction of:
0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ 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
Received By: 4 Date: $ 7
Issued By: 1.L/X' 1.'. �RJvur Date: e 8 , 0
= Municipaily ofAnchoira ue116
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://www.muni.orq/Onsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV171079 COSA#: Permit#: OSP171210
PID#: 050-091-08
Legal Description: Spring Brook Vista#1 Block 3 Lot 7
Engineer: Garness Engineering Group
Applicant: Russ Bott
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to the excessive slope has been approved. The approved separation distance is 20.0 feet. See
engineers waiver request and profile drawing for justification.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
11 Adjacent properties are not affected by this waiver.
Waiver is Granted: X Waiver is not Granted:
Date: 6V/old T 7 Approved by: P...Lkt ameel
Name of Reviewer
**** VARIANCE/WAIVER REVIEW *'k'k*
MUNICIPALITY OF ANCHORAGE
Community Development Department i- / Ph. 7904y-
Development Services 7 : 9 -343-79 �p
On-Site Water & Wastewater Program 0_ AUS i h LL11
"
Mayor Dan Sullivan
ti
�6 'y
On-Site Sewer/Well Permit Application c5A
For A Single Family Dwelling 01 6 g L
Parcel I.D. 050-091-08
Property owner(s) RUSS BOTT Day phone 694-9257
Mailing address 12221 E. PRINCE OF PEACE*EAGLE RIVER,AK 99577
Site address 12221 E PRINCE OF PEACE*EAGLE RIVER,AK 99577
Legal description (Sub'd, Block & Lot) SPRING BROOK VISTA#1, BLOCK 3, LOT 7
Legal description (Township, Section & Range)
Lot Size Sq.Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING:
(®all that apply) Initial ❑ Single Family (SF) ix
Absorption Field ® (w/wo ADU)
Septic Tank ® Upgrade Duplex (D) ❑
Renewal ❑
Holding Tank ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE!WAIVER REQUEST FOR:
DRAINFIELD TO SLOPES>25% Distance: 20 FOOT
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5 401 Waiver Fees:
Date of Payment: gl ti f('i Date of Payment: .
Receipt Number: D 0x 61 6 Receipt Number: 01 B 3aS-%
Permit No. O5 PI \ 1 210 Waiver No. DSV I 1 b1 CI
(Rev.01111)
0 t' QuaniCs
GARNESS ENGINEERING GROUP, Ltd
CIVIL&ENVIRONMENTAL ENGINEERS Qealer
August 8, 2017
Municipality of Anchorage
Development Service Department
On-Site Water&Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic System Upgrade for Spring Brook Vista #1; Block 3, Lot 7
To whom it may concern:
The existing 3 bedroom house is served by a private septic and public water system. The
drainfield is in a state of failure and needs to be upgraded. We are proposing to install a new
1000 gallon septic tank and deep trench type drainfield. We are also proposing to utilize the
existing 1997 T.H. by Louis A. Butera, P.E. (attached) and the proposed drainfield is designed
within its 30 foot radius. Comments regarding the design are summarized as follows:
1. SOILS: See the attached 1997 logs by Louis A. Butera, P.E. which shows the soil
classification, groundwater monitoring, and the percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface water concerns.
4. TOPOGRAPHY AND WAIVERS: As can be seen on the attached topography drawing, the
average topography around the proposed drainfield is 20-25%. However, there are slopes
greater than 25% less than 50 feet from the proposed drainfield. Therefore, we are requesting
that your department issue a variance from the required separation distance of 50 feet to slopes
greater than 25 feet down to 20 feet. As can be seen on the attached profile drawing, a 25% line
drawn at 2 feet above the top of rock does not intersect within 50 feet of the existing grade.
We are unaware of any adverse impacts this installation or waiver would have on adjacent wells
or septic systems. If you have any questions, please contact us at 337-6179. Thank you for
your assistance.
- ely
- -re - . �. - �-.E., M.S.
Presii t
3701 East Tudor Road,Suite 101 *Anchorage,Alaska 99507-1259
Phone: (907)337-6179 Fax: (907)338-3246*Website: www.gamessengineering.com
W
EE
O
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Q
W
d SPRING BROOK VISTA#1;
BLOCK 1,LOT 5 Al
0
L11 SERVED BY
U AW�MJ WATER
Er-
a.
SERVED BY
AWWU WATER
SPRING BROOK VISTA#1;
BLOCK 1,LOT6-A1
Q�
�Qli SPRING BROOK VISTA#1;
BLOCK 3,LOT 6
SERVED BY <(� ��
AVVWU WATER max.•
SERVED BY
SPRING BROOK VISTA#1;
:1004-..•
4-
BLOCK
AWWU WATER
BLOCK 1,LOT 7 �Q
COULD NOT PHYSICALLY
\ LOCATE WELL;DRAINFIELD IS
GREATER THAN 100'FROM THE
NORTHWEST LOT CORNER
.
i
I /' � SPRING BROOK VISTA#1;
�i L�' BLOCK 5,LOT 5
i �
CJS A
SPRING BROOK VISTA#1;
\� BLOCK 3,LOT 8
SPRING BROOK VISTA#1;
G SERVED BY BLOCK 5,LOT 4
AVNMJ WATER
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/
/
N.
0
/� -- \\ ���
\\ 100' 1 Q-
I ApPRO s1US IGJQ
SPRING BROOK VISTA#1;/ I WELL \ I
BLOCK 5,LOT 3
. E.A(20 N
ppP • '.kus I /
\\ \NE1-1-'. I /
\ // SCALE:
1 \\ i 1
\ /' 1"=100'
GARNESS ENGINEERING GROUP, Ltd = *` .'1. - '•*
•
CIVIL&ENVIRONMENTAL ENGINEERS • ,�� 0
3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE.AK 99507'PHONE(907)337-6179'FAX(907)338-3246•WEBSITE www ♦
.garnessengineenrg.com •, •
,
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ♦ ' : 'I y •:�Ga ess J W IN
RUSS BOTT 694-9257 1 OF 3 ♦�J,'••• rC 79 '•_�
PROJECT/LEGAL DESCRIPTION: DRAWN BY: 9 i 9 •
SPRING BROOK VISTA#1; BLOCK 3, LOT 7 L.K.B. ♦1 "•,''•••••••.....•••`.. .,4.
•
TYPE OF WORK: DATE: LICENSE ,1�1v„S`lhlb4
SITE PLAN 7/31/2017 #AECC884
K" 7 / / \\
DESIGN CRITERIA: GEG,Ltd.HAS A 8 PAGE SPECIFICATION
LETTER THAT PERTAINS TO THIS DESIGN.TO NOTE:THE CONTRACTOR
NUMBER OF BEDROOMS:3 OBTAIN A COPY OF THE LETTER CONTACT
GALLONS PER DAY(GPD):450 GEG.BY PROCEEDING FORWARD WITH THIS SHALL HAVE THE NORTH &
PERCOLATION RATE/S:*2.3 MIN/INCH INSTALLATION,THE ENGINEER,WELL DRILLER, EAST LOT LINES FLAGGED BY A
PROPOSED APPLICATION RATE:1.2 CONTRACTOR AND PROPERTY OWNER AGREE REGISTERED LAND SURVEYOR
MINIMUM DRAINFIELD SQ.FT.:375 FT2 THAT THEY HAVE READ THESE PRIOR TO CONSTRUCTION.
`PER LOUIS A.BUTERA T.H.IN MOA RECORDS SPECIFICATIONS AND AGREE TO ACCEPT THE
TERMS AND CONDITIONS OUTLINED.
DRAINFIELD DESIGN:
MAXIMUM DEPTH: 9.5 FEET / !/. PROPOSED DRAINFIELD
WIDTH:2.5 FEET `,
LENGTH:40 FEET /. //
EFFECTIVE:6 FEET Q / � EXISTING DRAINFIELD TO REMAIN IN
ACTUAL SQ.FT.:480 FT' �•� / PLACE FOR FUTURE USE
/
v C.F
/ / �P 4` /// S��O
♦ �Q co���// ' /. APPROXIMATE LOCATION OF 1997
/ C• • . 2P/�ESTHOLE BY LOUIS A.BUTERA,P.E.
APPROXIMATE / /'O 44P/ M k ` '-
LOCATION OF KEYBOX / `V '
PER LOUIS A.BUTERA, �� ,`� // x\`1`10
PLS 11-2-98 SURVEY / /}\,` ‘,......,/,
/ �`�� 35% 5%.3,,...
♦ `C // 1`��;: SPRING BROOK VISTA#1;BLOCK 3,LOT 6
/ �Q
/ 11�� SERVED BY AWWU WATER
♦ ° M •
P :/.
•
D
FD
/ ° �. G • APPROXIMATE LOCATION OF TOP OF TOE;
° SLOPES SHOT IN WITH CLINOMETER
/ • IDRIVEWAY1 d• ��
/ / • • �� 12k FE
/ /1 °. .,
♦ A./ .a ` 55%
/ / EXISTING 1000 GALLON SEPTIC TANK
TO BE DECOMMISSIONED PER UPC
♦ PROPOSED 1000 GALLON STEEL SEPTIC TANK;
EXISTING 3 INSTALL DOUBLE CLEANOUTS AFTER THE TANK
BEDROOM HOUSE
*4 INSTALL FCO IF ONE IS
NOT PRESENT
j%/././ /
/Z,// /
//
/
. / // „`0/
PRIOR TO INSTALLATION OF THE \
SEPTIC SYSTEM;THE WATER //
SERVICE LINE IS TO BE //
PROFESSIONALLY LOCATED. /// �a4.
/ 5�
\, // G4P
`\� / •\�
// �.�G
// a� SCALE:
SPRING BROOK VISTA#1;BLOCK 3,LOT 8 /
/ 1"=40'
SERVED BY AWWU WATER
....4\\\ ' 1111
GARNESS ENGINEERING GROUP, Ltd ;
SCALE 1 " = 10'
EXISTING GRADE
CO MT 25%SLOPE AT 2 FEET ABOVE TOP OF
ROCK(DOES NOT INTERSECT)
10%
40%
9.5 FEET
6 FEET
25%
22%
-.-20 FOOT WAIVER REQUEST
oF Aqs,157
1;7i
, Ltd ;i
GARNESS ENGINEERING GROUP : 4. ,..; .
•
CIVIL&ENVIRONMENTAL ENGINEERS
37D1 E TUDOR ROAD,SUITE 101'ANCHORAGE.AK 99507'PHONE(907)3378179'FAX(907)336-3246•WEBSITE.wwwgamessengneerng.corn
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
RUSS BOTT (907) 694-9257 3 OF 3 �j�', y Ass
LEGAL DESCRIPTION: DRAWN BY: • .r C 79 r�
SPRING BROOK VISTA#1; BLOCK 3, LOT 7 D.J.G. •�j FO�O� Z,•"'
TYPE OF WORK: DATE 4444 RO ES":4
PROFILE DRAWING FOR SLOPE WAIVER 8/1/2017 J
•
■y •a.N - ••• ..
,.-t1.1:"''
Municipality of Anchorage 1'
-t .1+ DEPARTMENT OF HEALTH & HUMAN SERVICES .M � •• N•
825 "L" Street, Anchorage, Alaska 99502-0650 r0° Louis A. gutarn w
�,+. t:g-6736 .�4r
,40
SOILS LOG — PERCOLATION TEST 4�� '+•V iii •''•"`�
PERFORMED FOR: !/\.yJJ ": --
DATE PERFORMED: 3 -/3 -S•2
SPie7.v0.r iepuor ,/rP.R sz/
LEGAL DESCRIPTION. La f 7 4'/4- J Township, Range,Section:
SLOPE SITE PLAN
1
2 1111111111. N
3 -off ,
4 G/
5 ' SrNs�j G... w/t.it I 111`
lyleif. .,,r-e_ fr
6 -
8i w.,,,
7
4
$ O
9
)9- t0
, ` GROUND
ENCOUNTERED?WATER
YFI
11 O
IF YES,AT WHAT L
12 DEPTH? /6'/ P ter.
E
13 ‘? Oeplh to Waler Atter
Monitoring? /5:6 gale: `1-a--77
14 •-
p Reading Data Gross Net Depth to Net
15 Time Time Water Drop
`J 7'-.L v,."
16 io., ,no' 7 %.
6 a V 4//g.'
? r 2; 70
17 .2 : Yo /o .n..,; 7 /is r
18 G 04, '2'SI /0 7 '-6 -(7;4yJ44"
19
20
PERCOLATION RATE (minutesnncht PERC HOLE DIAMETER g.
TEST RUN BETWEEN 2 FT AND E FT
COMMENTS
PERFORMED BY: ........ c.___t CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: "a 5?
72-008(Rev.4/85)
1
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ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-082q
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE'd_ / ,�og,�,‘%
FOLLOWING DESCRIBED PROPERTY: _ _mmoatelommemmame_ .„,„-•. .., aF A L ��4
sa.Qlti, ')v -f /,,U/.--"/O,/zp7-z,'-.7- DATE- p � •- ' �i' t.
AND THAT NO ENCROACHMENTS EXItT EXCEPT AS ��/� 4V&
INDICATED. IT IS THE RESPONSIBILITY OF THE ` .1:..-'' '
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: i
EASEMENTS, COVENANTS, OR RESTRICTIONS ./2S2. 0l� �
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- --- 0. Duane Mark Seward k 0
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: , t �.•. 7.:riy." y
ANY DATA HEREON BE USED FOR CONSTRUCTION _ may'�7 •t `a`�•,- �54+*
•
OF FENCE LINES, OR FOR ESTABLISHING BOUND "' ' ' 'i '� �ft.'r- .,...0 4-
s‘,
ARY LINES. DI`2AWN= ��,,,.a
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
. On-Site Wastewater Disposal System and/or Well Inspection Report
Name:Wastewater System: ~ New D Upgrade
Address: ~ /o N ,
Phone: ~X'~ IN°'°fBedr~ms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other
LE GAL D ESC R IPTI O N S°il Raling: /, ~ GPD/Sq. Ft. Total Depth from original grade:~,~
Lot: Block: Subdivision: Depth to pipe botlom from onginal grade: Gravel depth beneath p~pe
Township: Range: Section: Fill added above original grade: Gravel length:
WELL: P~/'~ ~ New ~ Upgrade O~,e~w~dth: Number of lines: 0[stancebelweenlines:
Classification (Private, A,B,C): / Total Depth: ¢Cased To: Total absorption area: Pipe material:
Driller: / Date D Static Water Level: Installer: Date installed:
Yield: .~ PumpSetat: ~ Casing Height Above Grou;;: TANK
SEPARATION DISTANCES ms~i~ a Holding ~ S.T.E.P.
TO SepllC Absomllon LiII Holding Public/Private ~anufacturer: Capacity in gaJJo~s:
From Tank Field Station Tank Sewer Lines ~ ~ ~
~ Material: Number of Compartments:
Surf~c. , W/4 LIFT STATIO N
Water ¢/~ ¢/oo ' ~__ ~
LineL°t %¢ / / ~ f ~ % I Size in gallons:%~ufacturer:%
"Pump on" level at: ~ump off" level at: H~ter alarm at:
Foundation /~ ~ 5~ ¢ ~1% %
Curtain ~ ~ ~ Pump Make & Model Electrical~tions performed by:
Drain
Remarks: BENCH MARK
Location and Description:
Assumed Elevation:
Inspections performed by: ~,E,~, Dates: 1st s-/¢/¢~ ¢~,~~~~~
Department of Health and Human Services approval '~.,, *'~'~;,%,;;:
Reviewed and approved by: Date: ~
72-013 (Rev. 9/91) MOA 25
Permit No, --
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 545-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Spring Brook Vista .1 L7 BIk 3
PID No.: --
! 000 GAL
5fi, PT C TANr.
Garage /
LOT 6
SEPTIC PIPE
o
YX32'
SWING TIES
A-C = 26,3'
B-C = 36.5'
A-D -- 80.1'
B-D = 67.7'
o
o
SEPTIC PIPES
LOT 8
ELEVATIDNS
(NOT TO SCALE)
ORIGINAL
GROUND
LEVEL AT:
93.7~ TANK ~3,5~90.8 ~ ~90.8
~@4.8
~ - TEST HOLE
· - MONITOR TUBE
o SEWER CLEANOUT
+ KEYBOX
-- LEACHFIELD
EASEMENT
WATERLINE
SCALE 1"=50'
8/19/97
r ENGINEER'S SEAL
~^R^~E C0NC. S,,,~ /
/
~ ~P." 49 m ~. "..~,
/ '~'~':t~~ ......... :...
/~ ~b; N2<~ .......... ,
~== ~ "~ /~$". ~oui~ A. eut~,o ..'~
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALAStCA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970085
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:RUSSEL BOTT
OWNER ADDRESS:1830 E.PARKS HWY. #539
WASILLA, AK. 99564
PARCEL ID:05009108
DATE ISSUED: 5/07/97
EXPIRATION DATE: 5/07/98
LEGAL DESCRIPTION:
SPRING BROOK VISTA #1 BLK 3 LT 7
LOT SIZE: 30489 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
THE ATTACHED APPROVED DESIGN.
ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18A_AC72) AND DRINKING WATER REGULATIONS (18AAC80).
THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT}
FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABsoRPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
TOTAL DEPTH OF TRENCH MUST NOT EXCEED 9 FT. BELOW
ORIGINAL GRADE.
RECEIVED BY: A ~ ~ J [ ~
ISSUED BY: ~:"' ~ J
!
DATE: '7 ~
Ea le River En ineerin ervices
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
]~agle River, AK 99577-3294 (907) 69'[-3297 fax
March 17, 1997
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Spring Brook Vista #1 Lot 7, Block 3
Narrative & Permit Application
Dear Mr. Cross:
The proposed septic system will have very limited impact
following reasons:
1.
2.
3.
4.
If you have any questions please call our office at 694-5195.
on adjacent properties for the
The surrounding lots are large, allowing sufficient room for septic sites.
Immediate neighboring septic systems are all +30' distance.
Reserve space is adequate, due to absorption capacity, and public water supply.
Drainage will not be affected and is not a major consideration in our design.
Sincerely,
Louis Butera, P.E.
\ 1997\97-009A-NAR.DOC
] a le River En ineerin Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle l~iver, AK 99577-B29~ (907) 69~-B297 fax
LEGAL:
A.
1.
2.
3.
4.
5.
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
Spring Brook Vista #1 Lot 7, Block 3
03/17/97
GENERAL
The septic plan is for a single family residence only.
The drawing and or site plan shall be a part of this specification.
All materials and workmanship shall meet the Anchorage Department of Health requirements.
All soil tests are advisory to the design and are to be verified or modified itl the field by the engineer.
All excavations and depths are advisory and are to be verified in the field by the contractor to meet
Municipality of Anchorage requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any
adjacent multi-family ~vells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer
approval.
8. it is always recommended that a surveyor locate the nearest lot line position and the location of any
easements.
9. Any remaining open test hole excavations shall be filled.
B. SEPTIC TANK
1. Septic tank shall be a minimum of 1,000 gallons, and of MOA approved design.
C. TRENCH
1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 9' at any point.
4. The effluent line within the trench shall be laid level wittfin 0.03'.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed
over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface water runoff.
8. The septic tank and leachfield must not be closet' than 100' to any existing private well, 150' to any
Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 9' GRAVEL DEPTH = 6' under pipe, 2" over pipe
TRENCH LENGTH = 32' TRENCH WIDTH -- 3'
SO1L RATING = 1.2 GPD/SF BEDROOM CAPACITY = 3
SEPTIC TANK = 1,000 gallons minimum
Twenty-four (24) hours notice required for all inspections.
\1997\97-009a-spc.doc
rr6~/~ / "X LOT 6
/ .q,/ ~ .... T-~.4~-m. ~,x~, T~NC, .
o - SEWER CL~NOUT
PUBLIC WATER - NO WELLS / EASEMENT
NO SURFACE WATER
NO KNOWN CURTAIN DRAINS / PROPOSED LEACHFIELD
SEPTIC SITE PLAN
LEGAL: SPRING BROOK VISTA ~1 LOT 7 BLK 3
'
CONTRACTOR: N/A ~:~9TH~.,
EAGLE RIVER ENGINEERING ~ERV]CES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(~o7) ss4-s~s5 FAX: (SO7) SS4-SZ97
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 97-009
Calculated By: LB
Date: 5/7/97
Legal: SPRING BROOK VISTA#1 LOT 7 BLK 3
Single Family 3 Bedroom Dwelling
TEST HOLE
Deep Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom = 450 gallons
Percolation rate = 2.3 minutes per inch
Wastewater application rate = 1.2 gallons per day per square foot
Required absorption area = 375 square feet
Trench width (W) = 3 feet
Gravel depth (D) = 6 feet
Required length = Required absorption area / 2 / D
Required length = 375 / 2
Required length = 32 feet
Total Excavation Depth = 9.0 feet
/ 6
77
SINGLE FAMILY ON-SITE WORKSHEET
ERES PROJECT NUMBER: g7-00g CALCULATED BY:
LEGAL DESCRIPTION: SPRING BROOKVISTA #1 LOT 7 BLK3
NUMBER OF BEDROOMS:
WATER USE PER BEDROOM:
PERCOLATION RATE:
DEPTH TO GROUNDWATER:
DEPTH TO IMPERMEABLE LAYER:
ANTICIPATED DEPTH OF COVER:
MOUND OR BED SYSTEM
WASTEWATER APPLICATION RATE:
ABSORPTION ARE;A REQUIREMENT:
MINIMUM BED LENGTH
12 FEET WIDE BED
15 FEET WIDE BED
TRENCH SYSTEM
WASTEWATER APPLICATION RATE:
ABSORPTION AREA REQUIREMENT:
SHALLOW TRENCH OPTIONS
5 FEET WIDE TRENCH
LB
3
150 GALLONS
2.3 MINUTES PER INCH
15,5 FEEl'
16 FEET USABLE SOIL STRATA
3 FEET TOTAL USABLE DEPTH:
USABLE SOIL STRATA DEPTH:
0.8 GAL/SQ.FT
563 SQ.FT
10
7
47 FEET
38 FEET
1.2 GAL/SQ.FT
375 SQ.FT
DEEP TRENCH OPTIONS
3 FEET WIDE TRENCH
EFFECTIVE REQUIRED TRENCH EFFECTIVE REQUIRED TRENCH
DEPTH (FT) ENGTH (FT) DEPTH (FT) ENGTH (FT)
1 66 4 47
2 53 4.5 42
2.5 48 5 38
3 44 5.5 34
3,5 4O 6 31
4 38 7 27
8 NA
9 NA
D (B=BED, S=SHALLOWTRENCH & D=DEEP TRENCH)
6 FEET
3 FEET
32 FEET
DESIGN SPECIFICS
FIELD SYSTEM:
GRAVEL DEPTH:
TRENCH OR BED WIDTH:
LENGTH:
TOTAL
EXCAVATION
DEPTH:
9.0 FEET
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED: ~ -/-~ - ~" ?
Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
COMMENTS
SLOPE
WAS GROUND WATER
ENCOUNTERED? ,,(//~S
IF YES, AT WHAT
DEPTH?
Oeplh Io Waler Afl0r
Monitoring? ,),~"
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ,~-' ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN '~ FT AND ~' FT
PERFORMED BY: ,,~-~,~-J'*' I CERTIFY THAT THIS TEST WAS PERFORMED IN
2
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEL[NES IN EFFECT ON THiS DATE. DATE:
72-008 (Rev. 4/85)
' Municipality of Anchorage •
°`_ °° {
On-Site Water&Wastewater Program
\ll (907)343-7904 Y.
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-091-08 Expiration Date: 1 ? ��
1. GENERAL INFORMATION
Complete legal description SPRING BROOK VISTA SID#1; BLOCK 3,LOT 7
Location (site address) 12221 E. PRINCE OF PEACE DRIVE, EAGLE RIVER,AK 99577
Current Property owner(s) RUSSELL AND JULIE BOTT Day phone 694-9257
Mailing address 12221 E. PRINCE OF PEACE DRIVE, EAGLE RIVER,AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
• Single Family (w/wo ADU)
❑ Duplex
E Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual On-site
Individual Water Storage ❑ Individual Holding tank ❑
Community Class Well ❑ Community On-site ❑
Public Water System U Public Sewer ❑
WaiverNariance request for N/A Distance:
Received by: Date: f /(0 71-7
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ t(i Waiver Fee$
Date of Payment 1/ $1 `!"t Date of Payment
Receipt Number 0Receipt Number
COSA# 6 -3C-1e7-134C19 Waiver#
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, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. /further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE,AK,99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 143 )240,
Engineers Comments:
In conducting this evaluation,GEG provided an engineering evaluation of the well andlor septic system in accordance with the #41�11C t%k M 1
guidelines and regulations established by the Municipality of Anchorage and industry practices. OF The reported results describe the �4<
condition of the systemic on the date/s of the evaluation.Separation distances were measured to readily identifiable features. ♦�
Hidden defects or encroachments may exist that were not identified during the evaluation.The operational life of all wells and septic �r •"•,•,,,•••i �j
systems depend on a variety of variables including,but not limited to,soil conditions,groundwater levels(that may fluctuate during ��
the year),quality ofconstnrdion(materials and workmanship),and the water usage of the family utilizing the systernrs.These '411 A / '\ •;* '
conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee future performance of the �/ (Y/
system/s;therefore,GEG makes no warranty(express or implied)regarding the future performance of the well or septic system. i •
GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the f r 11r� � M
current systems fail.The content of this report is for the sole benefit of the personlparty who retained GEG.Reliance upon the •:r f '' tr~
• r^ 4�Je ,ey A. Garness : Lia
information provided in this report by any other person or party,including but not limited to subsequent property purchasers,is not � ,41"
authorized.In short,GEG disavows any legal duty to anyone other than the person/party who paid for this report. �* 172C E- 79531,1
<(/)),,,_••••., (6!2-43 .(, '''� ':
6. DSO SIGNATURE ��� '°ROFESSIA�4_�
LICENSE ,Mti�%is***
11
ttAECCBB4
System#1 Approved for bedrooms.
System#2 Approved for bedrooms.
Le
Disapproved. r � ri_Y i S i i-E
WATER AND ¶.
Conditional approval for bedrooms, with the following:lstipuiatG sifvn -E`: C
•
B 1111111MIEWOriginal Certificate Date: c ' S —I 7
The Municipality or Anchorage Develop,emt Services Division(DSD)issues Certificates of On-Site Systems Approval(COSA)based only
upon the represenalations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist Nitrate Advisory •
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
lRov 1N17/171
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: SPRING BROOK VISTA SID#1; BLOCK 3, LOT 7 Parcel ID: 050-091-08
A. WELL DATA SERVED BY PUBLIC WATER
Wel ••e If A, B, or C provide PWSID# Well Log (YIN)
Date complete. Sanitary seal (Y/N) Wires properly protect-c /N)
Total depth ft. Cased to ft. Casing hei.• above ground) in.
FROM WEL •G NSPECTION
Date of test
Static water level . ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RES :
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
A lc: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date installed 8/18/2017
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout(Y/N) YES Depression over tank(Y/N) NO High water alarm (Y/N) N/A
Date of pumping NEW Pumper -
C. ABSORPTION FIELD DATA I*BELOW FINAL GRADE
Date installed 8/18/2017 Soil rating p.dor ft2/bdrm) 1.2 System type DEEP TRENCH
Length 42 ft. Width 2.5 ft. Gravel below pipe 6 ft.
Total depth *9.5-10.3 ft. Eff. absorption area 504 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fail) - For 3 bedrooms
Fluid depth in absorption field before test - in. Water added - gal. New depth - in.
Elapsed Time: - min. Final fluid depth - in. Absorption rate >= - g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date -
INFORMATION ON 1997 TRENCH IS IN THE MOA RECORDS
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at .. wa er alarm level at in.
- -•• Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: SERVED BY PUBLIC WATER
Septic . . .. tation on lot On adjacent lots
Absorption field on lot On adjacent lo
Public sewer main '.e ' sewer manhole/cleanout
Sewer/septic service lin- Holding tank
.'••: ontainment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
..4•%_ OFlookism',1 IA111
G. ENGINEERS CERTIFICATION P.,.•••" z--.-:•1"...... z--.-:•11! 1♦
I certify that I have determined through field inspections and :;:\,19* �� ••* �•review of Municipal records that the above systems are inconformance with MOA COSA guidelines in effect on this ••• ''} - ttix
date. • Gney A. Gorness::c�!
Engineers Printed Name JEFFREY A. GARNESS • --- :% CE-795 •
Date .? '_ 'I -,- 11 PROFESS��P�•�
LICENSE 11�11%s"s���
#AECC884
(Rev. 10/12/12)
, •
6 A)51);11, . azst,
11/ id ;4/,. 0
1/v.
iI 1 ° J) r .. i::: -.St
s w
� It '
• \\*:11.r.-- •---
IQ/ �� ,IDZai, //
fig
z
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Zr del..
a 61..,
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g oh
,‘ ,,,,\ liv
7 �V� 11
\ A"
/-g 1/��G�� 29•7;--/L5-47
ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE=S0��$ a
� �
FOLLOWING DESCRIBED PROPERTY: J�D �
..5:4,1-;f.,-;.6:,--- t `/�7��,u ��D,/CoT7,BF ".- DATE- ,a�; .. .• S
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS ��O a�k . •' .:t.
INDICATED. IT IS THE RESPONSIBILITY OF THE �� r . 47" �1 ,'_ *4
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID= '`"" 4
EASEMENTS, COVENANTS., OR RESTRICTIONS '' ..5"Z "#.C €„� ;/ ,' d
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- p---- . Duane Mark Seward .-�
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD F&may'�� t ... Ls yS A$ � 4
ANY DATA HEREON BE USED FOR CONSTRUCTION _ r- `4,• ,5 4'
OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN: 1.'��r'i-e Skr.;t; . C.�,�'
ARY LINES. �,� ra•a.:l• i
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
Parcel I.D. # ~,~,~,Z-~'~ ¢~'-E~¢~//,¢ ~' HAA # ~.~
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Day phone
Mailing address
Agent
Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DIBPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-4)29 (Rev. 1/91) Front MOA #21
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 ]~agJe ]~{ver Eng~eez-j_a~' SerMces Phone
P.O. Box ~73294, Ea~le l~dver, AK 99577.32o~
Address
Engineer's signature
Date 11- ~-q-~'
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
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 DH HS 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 MOAf¢21
DEC 03 1998
Municipality of Anchorage MUNICIPALITY OF ANCHOP..AGE ~'~. ~
DEPARTMENT OF HEALTH & HUMAN SEL~I~I~NTALSERWCES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
~t./~
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to Cas~ t (h~above ground)
Wir~roperly protected (Y/N)
AT INSPECTION
FROM WELL LOG
Date of test
Static water level /
Well production ~
~/~iRmSAM P~'S TI~S: Nitrate
D~l~sample:
B, SEPTIC/HOLDING TANK DATA
g.p,m.
Collected by:
Date installed ~L--/,~ .-,~ ~ Tank size
Foundation cleanout (Y/N)
Date of I~"'u~Ping
g.p.m.
Other bacteria
/ ¢'¢"~.?~ / Number of Compartments ~ Cleanouts (Y/N)
Depression (Y/N) ,"¢/~' High water alarm (Y/N) ~¢/x,,,¢
Y
C. ABSORPTION FIELD DATA
Dateinstalled ~"--/~"~ _ Soil rating (g.p.d./ft~orft~/bdrm)/,?--
Length '~'~- ~ '~/
Width , Gravel thickness below pipe
Effective absorption area ~ ~z' ~-
............. Monitoring Tube present (Y/N) ~
Date of adequacy test /f-/'// Results (pass/Fail). ,/b,",,¢
Fluid depth in absorption field before test (in.);
Fluid depth ////"~ (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
System type
~' / Total depth
· Depression over field (Y/N)
For ,.'>/,,'¢ 4'~
Immediately after///,(gal, water added (in.):
Absorption ram = /~/~ g.p.d.
If yes, give date /~/,'~
/4,,/
.bedrooms
72-026 (Rev. 3/96)*
D, LIFT STATION
Date installed Size in~q~s'''''''~~
Manhole/Access (Y/N) ~~n~ ...... Pump off" level at*
High water alarm level at*__ ~ *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELLON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
On adjacent lots
~a~jaconi o s
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation [ j, i Property line ~-~' Absorption field
Water main/service line '~
Surface water/drainage
.~D
Wells on adjacent lots
Property line
Surface water
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
J ')-- ~ Building foundation ,4-~- '
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots ~/~
ENGINEER'S CERTIFICATION
I certify that/have determined thru field inspections and review of Municipal
in conformance with MOA H~ guidelines in effect on this date.
Engineer's Name
Date 11~
HAA Fee $ (,...~,¢L~ , .---
Date of Payment Y~
Recei pt Number ~ ~ ~ S~ ('7~=~)
72-026 (Rev, 3/96)*
Waiver Fee $
Date of Payment
Receipt Number