HomeMy WebLinkAboutUPPER EAGLE RIVER ESTATES BLK 2 LT 4B
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
,a~,e DISTANCES
~ ~ c-~'-c-J~l'-~) DC'v- ~. ~. D. ~ ~n SEPTIC AOSORPTION
Addre~FROM~ TANK FIELD WELL
Phone{s) Pe,mit NO. NO. of Bedrooms WELL /~
~*~ ~SCa,.T,O. LOT LINE F~'
Township, Range, Section
AS-BUILT DIAGRAM (Show Ioc~tion o[ weJl, septic system, properly lines, [oundation,
I~ ~L~ ~. i~ driveway, waterbodles, etc}
· A. s ? N
~ SEPTIC ~.~ ~ ~ HOLDING h~
Manulacture~ Capacity in gallons
Material NO. of Compadments
TYPE OF SYSTEM =. f =
~ TRENCH ~ BED ~ W, DRAIN ~ OTHER
Depth to pipe bottom from Total depth from original grsde {
o.~9ina~ 9~ade / FT /. J- FT ~ ~ - ~
~7 FT ~ FT ~ ~P~
~ SQFT ~ ~ /~ ~ FT
wELLs "'
~ PRIVATE /~,.,~.~ ~ OTHER Ildentifv) ~
REMARKS: ~'/~ / ~
~// ~ ~ ~ ~ x'~ ~ ~ ~ ~ ~ ~ Inspections Pedormed b~: ~%~..~ "~' .~:~ -~,,~
Eagle River Engineering Se~ices
~ ~ ~ ~ ' ~ ~ ~ ~ Date: Eagle River, AK ~577
I ~~ cedily that Ibis inspe,i0, was ped0rmed according to all
-- ~ ~ ' ~. '~ , .xt~ ~-~
Health Depa,ment Approval: Date: ~ -/ ' ~
72-013 (3/85)
Da'Lc ]:SSL~ed:
Ovqn~r~
BOX N-64
Day i:::'h on e ,~
,=71
I:::'arcel Id: 050-781-17
I...o'L I....c.~gal'~ Subc:!ivisic;n~ UPPER EABLE: RIVER ES Lot:
Sec:t:Lon: 17 'l'ownslnip: 14N Range:
Lot Size zhBSCK) (SC:l.f't. or ac:pes)
Max Bedr. ooms: This Per'mi'L: 3 'T'otal Capacity: :3
4B Block: 2
SEP'f'IC TANK: M:i, ri:Lmum 'LotaI sep'L~c tank ¢.oac..J.t¥. J."3('~ gallon~,, Each sept:i.c
.~.J.)t ..I. 'Lank (S) '::] 4."
tank mus'L have at least 7.', compar, tments. Depth to 'Lop of ~'-~ ......
[ E.)(D't. I" ~2RLI :J. P E~S i I'"i~i~Lt ], at i L][] (gVfDl" '[_al'] J,:: (s) ,,
IIqF:'ORM :O.H=H.S. PRIOR TO !ST & ,?.ND Z[NSF:'I!~J]'YIONS BY EIqGIIqE!ER, IF:'
AF:'TI~:~]R OI::T:'ICE I"IOIJF:~S, C[)NI'ACT 34[3'-"q.~1~:~1 Alii]} LEAVE~: ~ MESSAGE.
CONS'TI:~'.UCT F:'ER EIqGtNEE~]:~S AT'TACHED APF'ROVIE:D DESIGN.
THIS I:::'EI:~d~'iIT EXPIF~ES :t.J~'./31/89 AND VAI..ZD FOR A SINGLE FAMIL,.Y HOME,,
~3 J. Ci n e d:
(Owner'
Issued By
CERT IF:Y 'l HAr:
for'th by ']:.hce Mur~:L(:::Lpa].~ty of Anchor'age (MOA) and the State of' Alaska.
:[:'.~,, I w:i, ll :~.ns'La].l the sy~;t(e~m ~.1] ac:c;opdance with all MOA [::ocle~ ~a~c] pegL~].a'L:Lclr~s~
and J.n compl:Lantze ~k~i'th 'the d~.~sign crit. ep:[f~ f::~f this peP[iiit,,
3,, I wL] 1 adh(..:H"e 'Lo al.! MOA and State of' Alaska p~qLtiPfZ~iiil. Z~lqtf~
d:[s'kanc[~s f r'om o.i"iy e)x J. st irqg we]. ]., ;9astet*~ater d J. spo~a].
4,, I under, stand that this permit is valJ. d fop 'a maximum c:H' :3
SI:[CFqETARY OF' H,, U,, D,
F
155_,06
SLDPE < 57.
~-~ BED 24x30
~o I I~qq~
,25' ABS
-LIFT STATION
~K
Ld
O0
Z
HOUSE
155,04
EASEMENT
EXISTING LEACH FIELD
NEW LEACH FIELD
CLEANBUT ~o
SCALEI 1' : 40'
WELL AN]] SEPTIC
LEGAL, UPPER E,R, ESTATES
DWNER, H,U,D,
CONTRACTOR: N/A
EAGLE RIVER ENGINEERING
PO BX 773294
EAGLE RIVER, AK, 99577
694-5195
SITE
SERVICES
PLAN
F./~LE RIVER ENGINEERING SERVICES
EA~LE RIVER, AK 99577
E · BOX 773294
'694-5195
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
SLOPE
PERCOLATION
TEST
DATE PERFORMED: ~l~/_e~,
7-
8-
9
10'
11
OEP1
R
PER(
ROUNDWATER ~'~'X
TERED?
LATWHAT ..~:~!
Gross Net Depth to Net
Reading Date Time Time Water Drop
i ,, ?.'a~/,,,, /a....~; 3"-.~ ,q,o I ~
.14
18
19
2O
COLATION RATE ¢/ (minutes/inch)
TEST RUN BETWEEN ~ FT AND ~ I FT
PERFORMED
72-008 (6/79)
Eagle River Engineering Services
r-. 0. uox z?3294
Eag/e River, AK 995;~7
69~-5195
CERTIFIED BY: ~~
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOT 48, BLOCK 2, UPPER EAGLE RIVER ESTATES
GENERAL
1. The well and septic plan are for a single family residence only·
2. The drawing and or site plan shall be a part of this specification.
All materials and workmanship shall meet the Anchorage Department of
Health and State Department of Environmental Conservation
requirements·
4. All soil tests are advisory to the design and are to be verified or
modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified or
modified in the field by the contractor to meet Municipality. of
Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits
or easements and to locate any adjacent multi-family wells.
?. 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.
BED
1. The bed is to follow the natural land contour to maintain uniform
total depth of the bed bottom.
2. The bottom of the bed shall be level, plus or minus 1.5"
3.. The total depth of the bed excavation is not to exceed 1.5' at any
point.
4. The sewer line is to replace the existing sewer line that leads to
the existing trench.
5. The bed gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth
of 4' or equivalent is to be placed over the leachfield.
7. The area over the bed is to be finish graded to prevent ponding of
surface water runoff.
8. The septic tank and leachfield must not be closer 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 = 1.5' GRAVEL DEPTH
Soil Rating = 159
Bedroom Capacity = 3
Septic Tank Size =
1000 existing
~NOTE:
***NOTE:
***NOTE:
1' BED LENGTH
= 30' BED WIDTH=
24'
LIFT STATION REQUIRED· PRE FAB 500 GALLON, ANCHORAGE TANK.· WIRING
BY LICENSED ELECTRICIAN TO M.O.A. CODE. PRESSURE LINE TO BE' BURIED
5' WITH DRAINBACK ~0 LIFT STATION. -
EXCAVATE TO 2' LEVEL AND PLACE~ BEFORE PLACING SEWER
gRAVEL AT 1,5] LEVEL. 2" INSULATION REQUIRED OVER BED WITH 2' SOIL
COVER. SEWER .LINE FROM TANK TO LIFT STATION TO 8E INSULATED.
BID TO INCLUDE FINISH GRADING OF MOUNDED SOIL COVER 4" TOPSOIL AND
GRASS SEEDING.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage. Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
MAi El N G '~ D8 ~SS~7.p
LEGAL DESCRIPTION
' I AbsorPtion area
~ IManufacturer ~~
~ ~Lq capacty nga ons~ ~ u~ ~** ~ ~ nsde ength
~ O,STA~CE TO:
~ ~ ~ Manufacturer
~ I DISTANCE TO: I
~ lTopoftiletofinishgrade ~1 Materialbene~thtile
OTHER
PIPE MATERIALS
)Jo. A%~-%c~ ¢ /~m,..'. dx' ~o
Dwelling
Materiai
Width
Material
Neares{ I ot~linle
Trench
PHONE
PERMIT NO. ( 0g~
Liquid depth
PERMIT NO.
Liquid capacity in gallons
[] NEW
[~[JPGRADE
PER T NO
Distance betwee Ir~/~
Total effective absor~n area
PERMIT NO.
Total effective absorption area
Nearest lot llne
Septic tank Absorption area(s)
Distance to lot llne PERMIT NO,
! ) (~"') [] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~ PERCOLATION
TEST
SOILS LOG - PERCOLATION TEST
,,, 10
11
SLOPE SITE PLAN
;OUNTERED? 0
P
E
YES, AT WHAT
13-
14-
15
16-
17
~8
19-
20-
COMMENTS
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN ~ FT AND v~ FT
GREA,FR ANCHORAGE AREA BOg jGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~/C'O
LOCATION
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
~,,~x~_ ,~/~/~(; ~./ , NUMBER OF
MANUFACTURER ' ~'~ MATERIAL /~/~'/ 7/'//~'~5COMPARTMENTS ~
INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY //~-~:~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER --
LINING MATERIAL¢)~?/~k~'/ CRIB SIZE;
OR WIDTH
DIAMETER
BUILDING FOUNDATION__
NEAREST LOT LINE
ADDITIONAL ABSORPTION
LENGTH,~t~, DEPTH /[~ /
DEPTH / DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~//~ ~ SQ. FT.
WELL:
TYPE
BUILDING
FOUNDATION --
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE
REMARKS
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK SYSTEM
DISTANCES:
INSTALLED BY:'~-F/~
PIPE MATERIAL:~ '~;~' ~
'OTSLOPE:
REMARKS:
DIAGRAM OF SYSTEM
DATE ¢- r.~.~'~-- "~ APPROVED~X¥~-2//~ //"?"~";~','~ ·
/) G.A.A./~B. ' ....
We~ Dwner I.~o ~andt ~' Use of Well
Location (address of Townshi ~ e, Section, if ~own; or dist~ce main road
: W g
~ock 2, Lo~ 4~Eagle ~iver Es~a~es
Size of casinf 6"
Depth of Hole 94 feet Cased to 93 feet
ft. {V'ab~) (below) land surface, Finish of well (check one) open end
(minute) for ! hours with 100%
Static water level 85
Screen ( ); Perforated ( -? ,~ )~_
Describe screen or perforation .....
Well pumping test at 12 gaI10n~:p~?~
of drawdown from static level.,_.'~.?
Date of completion 11/18/76'. "- -
..... _~: WELL LOG
Depth in f~et from ~------~ .:~. ~
ground surface Giv~ details of' formations penetrated, size of material, color and hardness.
S~tty~Gr&vel: Occasional cobbles
_.. : 0 TO .':;-2
'z - "--~2 TO:'' 3
-' - 3 TO 33
33 TO 50
50 TO 80
80 TO 89
89 94
TO
TO
TO
TO
TO
.TO
~0
X0,
.TO
S~lty' sand and graY 1
hard bani O~as=4~=] cobbles
Gra~elly hard pan
2 -- STATE
i','ii:::t::-:::[l',il_ll','t IqL.IP1E~E,~r OF' E:E[::,Fd::IO["i:~; :::// :ii~/ ':SEI :[ I_.. RFI'F:[i'.~Ei ,::ZI:;:! FT,.."E:E:,=::'L".~
/
, THIE I:;;:IE(;:!I._I ]: RED '_:.; :1: 2% Eft::' THE SO :[ LD-ClE:SOI::~:F'T ;[ ON :E;'.r'E;TEi'"I :( L:;:
' E::. iF_:EZ ii:::" "IF b.-ll :=:: :%. ~C'~] ~.... E2.: ~-.~ C3i -~'- I~--tt == 7~: "=~- CZ'~ F--:: FI~ ",,.." :F:.C IL. IU:, ET£ IF:*' 'a'"' ~'.41 =::=
'THE: L..ENG'FH [::,]:i','IEN:~::[ O1'.,I I S '['HE L. ENGTH ( 1[ N F'[::_ET) OF THE TRENCH OF~: DI:~:FI I Iqf I I~::L.[::,.
THIE DEI::'TH OF' R 'f'F4:EI'.,IC:H OR PIT ZE; TFIE DZ:E;'I"FINCE BETHEEN THEE SURFFICIE OF' THE:
GROUN[) FINE) THE E:O"I"TOI"I OF THE E',:.0Z:F:I',,,~RTIOI"~ (ZN FE:ET).
'THEI:RE ]:~; NO ZET HZE:,"['H FO~'. TRENCHES.
T'HE (3Fi:FIVE[. DEF'TH ZZ THE M]:NIPll...II'I I}EPTH OF GRFI',,,'EL BE'T'HEEI",I THE: OUTFFILL F:'ZF'E
RN[) THE BOTTCfl'fi OF THE E::'::CRVFITZON ,::ZN FEET::'.
E~Fff:::KF' ]: I..,.L :[ NG Eg:-" FII",t'¢ Z"r'Z]"Ehl [41 THOUT F I NFIL I N'.E;F'ECT I (IN FIND RPRF-".O',,,'RL E:'¢ TH I ~;
[,EF;'FIF~:TI'clENT 14ZI..L. [:':E; ~;LIE:..:rEC:T -FEI F'~:O':'SECIJT.~OI",I.
h'l:[NliqlJl'"i C, :[ :!i;]"lalqC:E [3[ETHEEIq Fi .b. IELL FIND FIN"r' OiM--'S]:TE: SEHRGE DIZF'OSFIL. S"r'STE['fl
::LE,ZI F:'EH;T FOR R F'F~:I","RTE HELL O1:;'. 2E~E~ FEE-F FO[;: FI F'UBLZC HELl
HEL. L. LOG:E; FtR'.E R:EQL.IZF;'.E[:' RND [fllJ2:T E:IE RE"I"UFe. NED TO THE DEF'FIRTHENT HZ"I"HZN
(Jr THE HELL. COPIPLETZON.
:~;~:'l~;C: I I::' ][ CFIT :[ ONS RND COIqZ'F~:LICT I ON D I IqGE'.Iaf'IS:; FIRE R',,,'R I LFIE:L.E -I-O I NS;UF~:E F:'I~:OPER
]; tq::~;'I'FtL L.I:::]T :[
]: CEFCF]:F"r' 'TFII::IT
t: ]: FIll FFIP'IILIFII:~: klll'H THE:: REQUZREHENT$ FOR ON'-:F_:ZTE E;EI. qERE!; FINE:, HELLE; FI:E;
F'OI:?.TH 13"r' 'FHE i"IUN]:C::[F'IaI..i[T"r' OF FINCHORREiE.
2: I I.,.lll....I._ INGTFIL. L. 'THE S~¢STEE["i I1'4 FIL';COR[:,I::Ii'.,IC:E; I.,.t):TI-.I THE CODES.
_'ii:: I UI'.,IE)EFi::ii';TFII'.,ID TFII::IT "I'HE ON-'-~;I-t"E SEHEF:'. S'¢S]"EPi hlFl"r' F;:EQI..IIF~:E ENLFIF?.GEI"IE:I",IT IF' '1"HIE
F'::ES:;];DE:NE:E~EI'"IEI[:,EL. ED TO :[I",]C:L. UDE f'IOF?.E' THFff',I 2]: E!~IE[::,F~:E~OI"1'-'E;.
' :
I:-~:"PL;[~._.flhlT LEO .:r E, KFli",I[::,T
MUNICIPALITY OF 7~CHORAGE
Department of Health and EnvironmenTal Protection
SOILS LOG
PERCOLATION TEST
Performed for Leo J. Brandt Date Performed
Legal Description Lot 4, Block 2, Upper Eagle River Estates
7/20/76
2
4
6
14
Red-brown, sandy silt (ML)
Perc rate = 275 ft.2/bdrm.
Very dense, gray-brown, silty sandy gravel
lesnes of well-graded clean gravel (GW)
Perc rate = 160 ft.2/bdrm.
(GM) with
Total Depth = 20 feet
No water table encountered. --~ ........
AVERAGE PERC RATE FROM SOILS LOG = 178 ft.2/bdrm.
Date NeC Ti~e Depth Net prop
7/19/76 -0- 6 in. .'-0-
2 min. 7 in. 1 in.
7/19/76
7/19/76 4 min. 8 in. 2 in.
7/19/76 __. 6 min. 8.5 in. 2.5 in.
7/19/76 12 min. 9.5 in. 3.5 ih.
7/19/76 87 min. 21 in_. 15 in.
Percolation Rate 5.8 minute s/inch = 135 ft.2/bdrm.
p~rf~rm~d By ~ ~ - /~--~ NORTHWEST EXPLORATION SERVICES. INC.
__~"~ ~'IUNICIPALITY OF ANCBORAGE ~L~
Depar[,m~nt of Health and Environmental !qotection
'~ Brandt
Perform. ed for
SOILS LOG *
78-9
Date Performed 4/4/78
Legal Description Lot 4, Block 2, Upper Eagle River Estates
lO
0 - 0.5~ - Orgsmi.cs
0.5- 2.0' - Red-gra~, gravelly, silt (ML)
250 ft.2/bdrm.
2.0- 4.0' - Gray-brown, sandy gravel w/some silt
(GW-GM)
120 ft.2/bdrm.
4.0-16.0' - Gray-brown, silty, sandy gravel (GM)
with boulders to one foot
180 ft.2/bdrm.
Total Depth - 16 feet
No water tabie encountered
'AVERAGE ABSORPTION AREA REQUIRED FROM LOG = 179 ft.2/bdrm.'
Test pit dug 100'~and 30'~ of ~property corner
*Inspection not to be used for septic system design
Date Net Time Depth Net Drop
Percolation Rate_~__ , ~ --~---minute
Perforrged By~/~-~, ~ ~__~.~ CHAM?___~I~0~N DRILLING COMPANY, INC.
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
(~,~,((") -~ RI - \'~ NAA#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Upper Eagle River Estates Lot 4B Block 2
T14N, R1W, Sec.17
Location (address or directions)
9712 Wren Lane
(b) Property owner H.U.D.
Mailing Address 605 W. 4th Ave.
(c) Lending Institution
Mailing Address
Telephone: (home)
Suite 081 Anchoraqe, AK
Telephone
99501
Business 271-2792
(d) Real Estate Company and Agent The Realty Store
(e)
Address 8040 OPal Circle Anchorage, AK 99502
Telephone 243-1022
Mail the HAA to the following address: (or check here [], if hold for pick up.)
List contact person and day phone number below:
Pick-~? by Engineer
2. TYPE OF RESIDENCE
Single-Family [] Number of bedrooms
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 []
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
~ ,to ~ @bed
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MLJ~jJ~y OFr~NuCI~(j~IAPr~LITY OF ANCHORAGE (MOA)
ENVI~(~L SERViCE~i~in~uthority Approval (HAA)
2 ]989 343-4744
Legal Description:
A. WELL DATA
Well Classification
Well Log Present (Y/N) ,,t/ Date Completed
Total Depth ~'~' / Cased to
Static Water Level 2~/,'~/~.~,~
Casing Height Above Ground ~-'~"
Electrical Wiring in Conduit (Y/N) )/
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot /,~..z."
To Nearest Edge of Absorption Field on Lot /'~¢
To Nearest Public Sewer Line
If A, B, C, D.E.C. Approved (Y/N)
Yield ?,¢ ~,",~ ,~,.,.-,,~.,.,L~ ~'/~'
Pump Set At '~ ~ /
Sanitary Seal on Casing (Y/N) J"
Depression Around Wellhead (Y/N) ,,M
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot ~5'-/
Water Sample Collected by ~""~""~"
Water Sample Test Results
Comments ¢~'¢// ,~
B. SEPTIC/HOLDING TANK DATA
Date Installed /~22~ Size
Standpipes (Y/N) /P' '
Depression over Tank (Y/N)
Pumping/Main!er~ance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) '~/¥¢-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
/~:~-'_-,~/ No. of Compartments ::~
Air-tight Caps (Y/N) ,,c- Foundation Cleanout (Y/N) )/
~ Date Last Pumped z'z/~' ~' ~'~ ~)
To Water-Supply Well /~' /
To Property Line /-~ /
To Water Main/Service Line ¢/~ /
To Stream, Pond, Lake or Major Drainage Course
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ` ~-/' :
To Disposal Field ,~.,~
Comments
72-026 (Rev. 7/88) Front Page 1 0f 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness ~"~-/
Statndpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot /,-<- /
To Water Main/Service Line ~-~- /
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
p-
To Property Line '~'¢
To Existing or Abandoned System on
; On Adjoining Lots ,¢P'~"
To Cutback (if present)
Comments
D, LIFT STATION
Date Installed ?/2?
Size in Gallons .z-C,*
"Pump On" Level at
High Water Alarm Level at
Tested for "¢'/-~
Meets MOA Electrical Codes (Y/N)
Comments ~,¢¢~- ,¢¢'~'~--~'~'.'~¢~ ¢' "~/".
~--.r & ~,¢-~ :-, /¢ r/,.,., S .
Dimensions -¢~'¢ %'¢//'~ ~¢~ ~
Manhole/Access (Y/N) ~
"Pump Off" Level at ~ ¢~
Vent (Y/N) ~
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA gu, idelLnes iR ,~,fect~ on the date of th~s
inspection.
Signed
Company Eagle Riv0r Engineering Se~lces
I'. O. 80x 173294 ~ ~~'~, Engineer's Seal
Eagle River, AK 99577
Date
MOA No. ~
Receipt No. Receipt No,
Date of Payment X '~ ~ ~- ~ ~ Waiver Fee: $
Amount: $ /~- ~ Date of Payment
72-026 (Rev. 7/88) Back
Page 2 of 2
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) Legal Description (include lot, block, subdivision, section, township, range)
(b)
(c)
Location (address or directions)
Applicant Name K ~'/~-~/~ _~'-~c,.~/ Telephone: Home h~-/.//.r/~- Business
Applicant Address Lc>O"~('~ ~¢~ ~1,,4~- ~1~-", ~-, ~,~L..,
Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
S & S Engineering
SRB 196x
E:.~!~' ti!vet, Aln,:~a 99577
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well ~ Community [] Public []
Note: If corem unity well system, must hav~ wr tten conf rmat on from the State Department of Enwronmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite ~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 (11184)
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 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 $ & 5 Engineering Telephone
Address
Date
E~gle River, Alask. a 9957~
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 profess!onal
engineer registered in the State of Alaska. The DHEP does this as a coudesy 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 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
Well Classification '--~¢~t ~,,~--'F'~__ IfA, B, C, D.E.C. Approved (Y/N)
Well Log Present~.N-~'_ Date Completed //~.,//~,. ~'~7~, Yield
Cased to ~-~ /
Depth of Grouting
Pump Set At
Sanitary Seal on Casing
Depression Around WeJJhead (,~
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (~/,N)"
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field
To Nearest Public Sewer Line r
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
; On Adjoining Lots
Comments
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
To Property Line
To Water Ms, i~,,'Service Line
Course
SEpTIC/HOLDING TANK DATA
Date Installed ~,~/4~ /~'7
Size /~ No. of Compartments
Standpipes ~N')~ Air-tight Caps ~/N~
Depression over Tank
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /'OC~ //''
Foundation Cleanout
Date Last Pumped ~'~
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-O26(11/84)
ABSORPTION FIELD DATA
Date Installed ¢)~ C-j~''
Width of Field
Square Feet of Absorption Area
Depression ove~ Field ~
Results of Last Adequacy Test
,qo4
Type of System Design
Length of Field ~
Depth of Field // r
Gravel Bed Thickness
Standpipes Present ~
/,¢,~ate of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water.Ma4cEService Line ~.~
To Stream/Pond/Lake/or Major Drainage Course
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots 'Z//O/¢"
To Cutbank (if present) N A
To Driveway, Parking Area, or Vehi/cle.~torage Area
Comments ~
D. LIFT STATION
Date Installed Dimensions
Size in Gallons
Manhole/Access (Y/N)
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
"Pu/np Off" Level at
//Vent(Y/N)
· 7/~ Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I h .a. ve checke4t, verified or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed SF(B 196x Date ~/~ ~ ¢
Company °~, ~
Receipt No. "~5 ~ ~ ~
Date of Payment ~ - lb -' ~'~_
Amount: $
MOA No. ~p ,)'--d.)~-~ .~ :,
Page 2 of 2
72-026 (11/841
· DA, E RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
o~ ~ 0
DATE DATE DATE
MUN~CIPALI~ OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~iRONMENTAL PRO~EC~ION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION JUN 3 0 I981
Telephone 264-4720
A...OVA. o.
DIRECTIONS; Complete all parts on page 1. Incomplete requests will not be processed. Please a~low ten (10) days for processing,
o,
MAILING ADDRESS ~ ~.~
I 'PHONE
PROPERTY RESIDENT (If differen~from above)
2, BUYER PHONE
MAI LING AD DR ESS
3. LENDING INSTITUTION PHONE
MAI LING ADDR ESS
4. REALTOR/AGEN~ ~ ] PHONE
MAILING ADDRESS
5. LEGAL D SCRIPTION
6, TYPE OF RESIDENCE '/ NUMBER OF~BEDROOMS
[~/ SINGLE FAMILY [] One [] Four
[] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
[~]/ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for ali wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give weJl
[] PUBLIC UTI LITY depth (attach Io§ if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or EZ] Holding Tank
Size: /O ~ 0 If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holding Tank Absorptio]~ Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
[~/ APPROVED FOR .~ BEDROOMS
[] CONDITIONAL APPROVAL {letter must accompany c~t)ficate)
E:~'~I~iSAPPROV ED--
DATE BY /)
72 010 (Rev, 6/79)
EXCAVATION
ROBERT A. SHAFER
WORK CIVIL ENGINEER
October ll,: ~± DE?L ur ~rO~;~cwlON
Robert McCoy
2533 Providence Avenue
Anchorage, Alaska 99504
RECEIVED
Dear Mr. McCoy,
Reference: Lot 4B; Block 2: Uppe~ Eagle River Estates
A sewer system adequacy test was performed on the system located
on the referenced property as you requested. The septic tank was
pumped and verified to have a capacity of 1000 gallons. The absorption
trench was tested by a continuous flow of 624 gallons of water over
a 24 hour period without any measureabte-'rise in the sump at the
end of the trench.
It can be concluded from this test that the waste water disposal
system serving the three bedroom residence located on this property
is currently functioning adequately. However, the system cannot
be guaranteed against subsequent failures.
If we may be of further service, please do not hesitate to call.
Sincerely, ~ .
~~S~' '~..~~R.~ 'p. E.
cc: Ralnle~ Mortgage
ATTENTION: Cathe Na~y
Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA
(907) 264~4111
July 8, 1981
GEORGEM, SULL VAN,
MAYOR
DEPARTMENTOF HEALTH AND ENVIRONMENTAL PROTECTION
Robert O. Mc Coy
% 2533 Providence Avenue
Anchorage, Alaska 99504
Subject: Lot 4B B10C~ 2 Upper Eagle River Estates Subdivision
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
(1) The water analysis report needs to be submitted to
this office from the Chem Lab, 5633 B Street, for
our review.
(2) The depression around the well casing needs to be filled
with impervious type soil so that it slopes away from
the well casing. This will need to be reinspected by this
office.
(3) The septic tank pumped with a receipt submitted to this
office.
(4) An adequacy test needs to be performed on the existing
leaching area. This test will determine if the system
is adequate according to National Standards. A listing
of private firms performing the test is enclosed. This
report needs to be submitted to this office for our
review.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw