HomeMy WebLinkAboutT15N R1W SEC 18 LT 62Onsite File
T15N R1W
Section 18
Lot 62
#051-171-29
A Right-of-Way Encroachment Permit is
required prior to future COSA approval
(for field located in ROW).
Municipality of Anchorage
On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211219 PID Number: 051-171-29
Dwelling: N Single Family (SF) ❑ with ADU R Duplex (D) El Two Single Family Project: El New MR Upgrade
Name
DONCHAK KIMBERLY & DONALD
0 -RP
A -RPTION FIELD
❑ Tr R Wide Trench El Bed F-1 Mound
Site Address
19219 Ganoe St Eagle River
�TrenchOther
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
13
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original g
�Ft.
Gravel depth beneath pipe
1-1 Ft.
Subdivision Block Lot
LT 62
Fill added above original grade
Ft.
Gra'vql 71th
Ft.
Township Range Section
T1 5N R1 SEC 18
Gravel width
Ft.
Beds: Number of Lines
Dista hce7betweenlines
Ft.
SEPARATION DISTANCES
TO
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between t�,
From
Tank
Field
Tank
Line
Ft2
Well
>100'
NA
NA
NA
NA
TANK ❑® Septic El S.T.E.P. F-1 Holding F-I Other
Manufacturer
greer
Capacity
1000 Gal.
Surface Water
>100'
NA
NA
NA
—
Material
Number of compartments
Lot Line
>10'
NA
NA
NA
NA
plastic
2
Foundation
>1 0'
NA
NA I
NA
LIF-X—STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Zie`clntailed by
11 d
Installer
Tank to 3034
PIPE MATERIAL House to tank 3034 drainfield
Whitters Excavating
Drainfield COIMT3034
Inspector
BENCH MARK (Assumed elevation) 100 ft
Inspection 1m 7/27/2021 8/17/2021
dates:
Location and description
2nd
3rd 4th
top, of concrete sidewalk by point B
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Z A
A] �!
Conditional Approval: Date
kk
. . . . ......... . .
?_4. . . . . . . . . . . . . . .
.
L. To end
Septic System
Approved Date 11 1012�t����yo�
N
ES
t
Note: this approval does not include well permit requirements.
AAA�J
I
LTJ
ry
U]I
LOT 61
EXISTING 85' x 30'' x 48"
SUMP EFFEC TI VE DEPTH TRENCH
l /
3 BEDROOM
HOUSE
CO A
DCO
NEIGHBORING SEPTIC IS > 10' r
FROM PROPERTY LINE I
i
8.1'
P4.4'--
4.5'
W o - - SCALE: 1" = 10'
0 o B W
0
<C TH#1 EXISTING 78' x 60" x 3.88"
CD I EFFEC TI VE DEPTH TRENCH
N
EXISTI G 4/ VER TER \ SL OPE < 1%
VA VE 7\
SUMP
MT
-- - — - - - - - - _\------- - - - - -- '---------
BIRCHWOOD LOOP ROAD
SCOPE OF WORK
1. REMOVED EXISTING SEPTIC TANK.
2. PLACED NEW 1,000 GALLON PLASTIC SEPTIC TANK AND TIED INTO
EXISTING ABSORPTION SYSTEMS. THE TANK WAS PROVIDED WITH MINIMUM
20" 0 MANWAY RISER SERVING THE FIRST COMPARTMENT. THE FIELDS
WERE LOCATED PRIOR TO INSTALL OF TANK.
3. ALL CONSTRUCTION TO BE IN ACCORDANCE WITH ALL REQUIREMENTS
SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65.
Record Drawings Prepared for
Don and Kimberly Donchak
19219 Ganoe St, Chugiak Alaska 99567
T1 5N R1 W SEC 18 LOT 62
EKLUTNA ENGINEERING, LLC DATE:
19162 MOUNTAIN ROAD DRAWN:
CHUGIAK, ALASKA 99567 SCALE:
(907) 406-1058
PID: 051-171-29
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719,579-51-
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
Pd Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.rnuni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP211219
Work Type: SepticTank Upgrade
Tax Code Number: 05117129000
Site Legal Address: T15N R1W SEC 18 LT 62 G:1155
Site Mailing Address: 19219 CANOE ST, Chugiak
Owner: DONCHAK KIMBERLY & DONALD
Design Engineer: EKLUTNA ENGINEERING, LLC*
This Permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms
n,ent
t S'
t�C:1)8 I' CriiCll C
7/19/2021
7/19/2422
47916
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
I. 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 (2417).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: Locate the edges of the fields to confirmthat the 5' separation between the
tank and field will be met.
Received B)
Issued By:
Date: 2—
Date: % Z
3
Munic
f l t
s
alityoragi
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 e (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
I>e pnrtm en
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV211048 COSA#: Permit#:OSP211219
PID#: 051-171-29
Legal Description: T15N R1W SEC 18 LT 62
Engineer: Eklutna Engineering
Your request for a waiver of the required 5 feet horizontal separation from the septic tank to the
absorption field has been approved. The approved separation distance is 4.2 feet.
This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ a ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ e ■ ■ ■ ■ ■ ■ ■ ■ s ■ ■ e e ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ I
Waiver is Granted: X Waiver is not Granted:
Date: /9 2 I Approved by:���i-r
Name of Revi
**** VARIAN C EIWAIVE R REVIEW ****
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-171-29
Property owner(s) DONCHAK KIMBERLY & DONALD Day phone
Mailing address PO Box 770626 Eagle River AK 99577
Site address 19219 Ganoe St Chugiak
Legal description (Sub'd., Block & Lot) T1 5N R1 W SEC 18
Legal description (Township, Range & Section)
Lot Size 47,916 Sq. Ft. Number of Bedrooms 3
LT 62
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single �'_�SF) ❑
Septic Tank
Upgrade 0
( wo /CDU)
Duplex (D) ❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the abovey.information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of
owner or authorized agent)
Permit/Rush Fees: I '� � -
Date of Payment: �:, .20 �2 1
Receipt Number: OS 9 2 H b
Permit No. 0 S P.211 `. 1
Waiver Fees: -0ZZ 5
Date of Payment:
Receipt Number:
Waiver No. 05 k/2 I '1 D 4 S
GADevelopment Services\Building Safety\On Site Water and Was tewater\Forms\Client FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211219, Deb Wockenfuss, 07/19/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211219, Deb Wockenfuss, 07/19/21
Li,
EL
bi
/ (fA5T
317.66' COMP)
,
- - - -
N 89059'43" E-317.69'
Lli
32.70' �.
4. 9'
+ ' ,
c,
v j
SNEO yy
56.7'
+14.6'
' K�'V AY 13.4' 25.4' ��ii�/�r' Z (), Q
W o G 0121V Two 5TO2Y ;'oe,� U; �
0 0 �
' ? 56.0' I N 23.9' WOOD FLAM
HOuS� Q
^z� LOT 62 •"%
Q n
i 3 0 26.2'
O v 3
�3 i MIS 1 vl I ^•3 , r
26.2' �/ o ^ �"
p o N I o l U �` 1 •�
4' r
O SW CORNER
LOT 60B
O
50'
WEST _ _ 243.97' cuLt/ERr
----33'-2- `T -OF" -WAY cuLVEerr---------- =�a ` ---- ---
NE 1/16 EDC,E OF ROAD ------- �'' Mer
CORNER PAVEO 120ADWAY
WEST 266.67' /
(WE5T —266.64 )
BIRCHWOOD LOOP ROAD
33'
1
I i n T —7 li
L_
NOTE
1. THE BASIS OF BEARING USED FOR
THIS SURVEY IS FROM THE NE 1/16
CORNER TO THE SOUTHWEST CORNER
OF LOT 606, POMEROY SUBDIVISION.
THE BEARING IS N84048'11'W AND
THE RECORD AND MEASURED
DISTANCES ARE 331.21' AND 331.20',
RESPECTIVELY.
2. THIS DRAWING SUPERCEDES AND IS
A REVISION OF THE EARLIER DRAWING
DONE ON 1-05-99. THIS NEW
DRAWING SHOWS THE EDGES OF
ROADWAYS.
�OF • Ad
��A
A : 49 M•. * 0
0 11
0 •1MLLIAM MCCLINTOCK • �®
0 ip, • No. LS 5480 .•C .
VA
0 25 50 75 100
SCALE
McCUNTOCK LM/D ASSOCIATES, INC.
11940 BUSINESS BLVD, SUITE 205
EAGLE RIVER, ALASKA 99577
(907) 694-4499
FIELD WORK DATE: 1-04 & 5-26-99 PARTY CHIEF: BM
DRAWN DATE: 5-27-99 DRAWN BY: JC
r'
LEGEND
FOUND BRASS CAP MONUMENT
FOUND REBAR
WATER WELL
SEPTIC VENT OR CLEANOUT
ov SEPTIC VALVE
XX XX XX MEASURED DATA
r
(XX XX XX) RECORD DATA PER BLM PLAT
OF DEPENDENT RESURVEY AND
r SUBDIVISION OF SECTION 18,
TOWNSHIP 15 NORTH, RANGE 1
WEST, SEWARD MERIDIAN, DATED
MAY 13, 1955.
(XX XX XX COMP) COMPUTED FROM RECORD DATA
AS -BUILT
I hereby certify that I have, or someone under my supervision
has, inspected the property described as:
BLM LOT 62, SECTION 18
TOWNSHIP 15 NORTH, RANGE 1 WEST
SEWARD MERIDIAN
Anchorage Recording District, Alaska
The improvements situated thereon are within the property lines
and do not encroach or overlap onto adjacent properties, nor do
any improvements from adjacent properties encroach or overlap
onto this property, except as indicated hereon.
No lot corners have been set. The property dimensions shown are from the record
plat and are not necessarily as we may have measured. The improvement locations are
approximate and have been determined only to the extent that enables us to determine
if there are any encroachments onto or off of the lot. Drafting and reproduction
may produce graphic inconsistencies; therefore scaling should not be attempted to
O determine unshown dimensions. This drawing is not adequate for additional
Z construction or for determining the exact location of property lines. Only
easements from the recorded subdivision plat noted above are shown hereon and it is
the responsibility of the owner to determine if any other easements, covenants, or
restrictions exist.
McClintock Land Associates, Inc. (MLA) 1999
This document is copyrighted and is authorized to be used for one real property
transaction or project only. Any copy is to be considered unauthorized unless it
bears an original surveyor's signature (usually in blue ink) or a stamp showing
recorder's office data. Copyright restrictions (but not re—use restrictions) are
waived if this document has been officially recorded. Lending institutions may also
nwke additional copies for their own records. Liability to MLA is limited to fees
received for this project.
FIELD BOOK: 9640-31 PLOT SCALE: 1"=50'
GRID: NW 1155 DWG NAME: AB99-156 JOB No: 99-156
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
Permit Number: ~u,.I,:IE:o~,G,_~' PID Number: ~l - I~1 -~
N~: Wastewater System: ~ New ~gr~
Address:
I~A~ ~o~ ~ ~u~,~ AIc~ ABSORPTION FIELD
Phone: ~ . ~¢~ INo.o*m oo ,: ~DeepTrench~ShallowTr¢~ UBed ~Mou.d ~Other
LEGAL DESCRIPTION ~o:l Rating: Total Depth from original grade:
Lot: ~ ~ Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath p~e
Fill added above original grade: Gravel length:
WELL: EXt~T,~ew D ~ Gravelwidth: ~, Numberoflines: IDistancebetweenlines:
Ciassiflcation (Private. A.B.C): ~pth: Cased To: Total absorption area:
¢~ ) ~ ~ Ft. Ft.
Date ins lied:
Driller: Date Drilled: I
SEPARATION DISTANCES ~ ~ .olU:ng ~ S.T.E.P.
TO Septic Absorption Lift Holding ~ubllc/PrivateManufacturer: Capacityin gallons:
From Tank Field Station Ta~k Sewer Li,es A~
Number of Compa~ments:
su,.~e LIFT STATION /
Lot ~ ~ I ' ' :
Foundation ~t~ J OJ ~ ~
OunainDrain ~ ~d~ ~
Remarks: ~ U~g h R~uc~,o~ F~o~ BENCH MARK
Location and Description:
Assumed Elevation:
Department of Health and Human Serwces approval ~;,, ' ~ ....'~L~
72-013 (Rev. 9/91) MOA 20
PERM,,~O~:'~UMB": AS ' BUILT DRAWING P^R~ 0' ~--0~ '° ~": --:~
~ UT'CO ~ / USED AS A ~ESERVE SITE. ~LI~ ~25.2 2~.411.5
~ ~ ~ ~ ~ ,/ ~ ~ 24.8
' ~ ~ - US AND ~Ti 43.0 27.3
I ~ ~ / i .~ NOTE: THE WELL ~DI
, ~ ~ -'-- THE ROAD RIGHT OF WAY
I ~ ~ ~ , / ~ ~SEMENTS WERE F~GGED
~ O I~N~ ~ / PRIOR TO CONSTRU~ION
I ~ I ~ SU~OR. ALL SEPA~TO
~ SEPTIC TANK~ ~'.', A ~weLL
I D~ ~z) u ~ / /
m ~ /
I - - · ,x~ i ~/
V J~ ~/ao ~ ~/ /~
o~ OOl x . / ' /
~ ', ~/ / ,,
BIRCHWOOD LOOP ROAD eom
~. ~f~ .
~S~ WA~ A~ WAS~WA~ CONS~T~S, ~C.
7320 E. CHE~ HEIG~ CJRC~, ~CHO~E, AK 9950¢
,., .,.., .,.,
,
PREPARED FOR: PHONE NUMBER:
CAROL OLIVER 688-6584
CURTIS AND
J.L.M. 1 = 40' 2 OF 2
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Dec 10, 1998
Expiration Date: Dec 10, 1999
Permit Number: SW980466
Legal Description: T15N R1W SEC 18 LT 62
Design Engineer: 0041 AK Water & Wastewater Consulta
Owner Name: CURTIS & CAROL OLIVER
Owner Address: 19219 GANOE STREET
CHUGIAK , AK 99567-9608
Parcel ID: 051-17%29
Site Address:
Lot Size: 47916 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field ~] Septic Tank ~] Holding Tank [] Privy
Private Well [] Water Storage
All construction must 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B - Anchorage ~ Alaska 99504
(907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
November 24, 1998
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic Design Upgrade for Lots 62, Section 18, T 15N, R1 W,
To whom it may concern:
The existing 3 bedroom house is served by a private septic system and a private well. The existing
septic system will not pass an adequacy test and must be upgraded prior to the sate of the house.
Comments regarding the proposed design are summarized as follows:
I. SOILS: Attached is a log which shows the soil profile, and the percolation test result. The
soils below the organic layer are a SM/ML material to a depth of 16.5 feet (bottom of the test
hole). No groundwater was encountered during the excavation of the test hole. A percolation
test was performed between the depth of 7.5 feet to 8.0 feet. The percolation rate was 24
minute/inch
2. TRENCH DESIGN:
a. Percolation Rate: 24 minutes/inch
b. Allowable Application Rate: 0.6 gallons/day/fi2
c. Number of Bedrooms: 3
d. Des!gn Flow: 450 gallons per day
e. Minimum Absorption Area: 750 f~2
f. TotalDepth: 10.5 feet (max.)
g. Effective Depth: 4 feet
h. Width: 5 feet
i. Minimum Length: 75 feet
j Effective absorption area = 750 f~2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: The topography of this lot is mostly flat. In short, there are no slope
We are unaware of any adverse impacts this installation would have on adjacem wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
Sincerely~
James P. W. illiams, P.E.
Civil Engineer
LOT 62, SEC 18, T15N, R1W
SERVED BY PRIVATE WELL AND SEPTIC /
f[ 'k~PROPOSEO SEPTIC UPGRADE" ! / /
'~ ~ (SEE DESIGN PAGE 2 OF 2),/ / / /
BECKY LANE '~-.. .~ ,' I
' BIRCHWOOD LOOP ROAD
[ '~ I LOT 70, SEC 18. T15N, RIW /
o !
ALASKA WATER AND WASTEWATER. CONSULTANTS, INC. _,~,~.'~_'~,,
PHONE; (gO7) 337-E17§/FAX: (ROT) 338-3246
LEGAL DESCRIPTION: . 49_TI
LOT 62, SECTION 18, T15N, RIW,
.............. i .... ,;'l'~ Fl':'"
SITE .L*. ..
PREPARED FOR: PHONE NUMBER: L'~" NO, 9608 .'
CURTIS AND CAROL OLIVER 688-6584. ~'~.~,~" .. C,E. , ..."~.¢~,,~'
11/24/98 J.L.M. 1 = 100' 1 OF 2
NOTE: THE CONTRACTOR SHALL HAVE THE ROAD
RGHT OF WAY EASEMENTS AND THE 100' WELL
RADIUS FLAGGED BY A REGISTERED LAND
SURVEYOR PRIOR TO CONSTRUCTON.
/--EXISTING DRAIN FIELD TO BE
USED AS A RESERVE SITE
~ / /~EXISTING SEPI'IC~'A~K'- ~
~ / /TO BE ABAN..DONED COMPLETELY ~.~.
/ . .,
L~J II , ,// \\
~XlSnNG / (' \ /
U~L ~'~ I~ ~ ~ EXCAVATE 10.5 FE~ DEEP / /
~ ............... ~ ~[~ BY 5 ~ WIDE BY 75 FE~ LONG. / /
~ ~ ~ ~,~ ADD 4 FE~ OF CLAN, WASHED / ./
x //
~ %%~ ROAD RIG~ OF WAY ~SEMENT
~ BIRCHWOOD LOOP ROAD
I
PHONE: (907) 337-6~79/F~: {907) ~3n-3246 · .
LOT 62, SECTION 18, T15N, RlW,
~[s~o~ o~ s[~c svs~[~ u~o~a~ ................
DATE: D~WN ~:' ' ~C~E: PAGE:
11/24/98 J.L.M. 1 = 40' 2 OF 2 I
ALASKA WATER & WASTEWATER CONSULTANTS' INC' ] ~!~ ~ ~:~ ~.~0
7520 E. CHEER HTS. ~I~CLE · A~HOEAOE, Al(. 99504 .........
PHONE (gO7) ~7-617~ * F~ (go7) ~B-~246
~SO~L LOG - PERCOLATION TE~T~
LEGAL DESCRIPTION: LOT 62. SE~ION 18, T15N. E1W. ~:.-:1.5~.:~.
PERFORMED FOR: CU~IS AND CAROL OLIVER WlLLIAM~t ,
DATE PERFORMED: 11/17/98 ~h~ ~ NO. 9608 ..'
[ I '""
TEST HOLE ~ ~ '~ ......
DEPT~ ~
12~ ORG~ICS
?~ SQIL C~SSIFICATIONS [SITE PLAN]
~: ~: ~ ~W ~ ORG L I" = IOO' J
GM CC ~
~ GC OL
B sP CH
, ~ S~ OH ~,STiN~ ~ ~ ~ ~
DEPTH TO DATE ) ~ ~EE ~ESi~N. ~*~E ~ OF
~ROUNDWATER
D~ 11/17/98 ~._
9 SM/MI o~ 1!/~8/9a ~ BIROHWOOD LOOP ROAD
I~llt~ DATE CLOCK NET TIME WATER LEVEL NET DROP
11
READING
TIHE (HINUTES) RE,lNG (INCHES)
..... 5 ~.:5~ ...... 6"
~i[ " 5:27 30 MIN. 4 3/," , 1/4"
15
B.O.H.
PERFOMeD bY A~ WATER · WAST.ATER ,. ;~ ~~ . CERTI~THAT
THIS WAS PERFORMED ~N ACCORDANCE WITH ALL ~'A] ~ND MUNICIPAL GUIDELINES IN EFFECT ON THiS
DATE. DATE: ~
DEPTH TO DATE
GROUNDWATER
DRY 1.1/!7/98
DRY 11/lS/gB
DRY 11/24/98
STATE OF ALASKA
DEPARTMENT OF ENvlRoNk~ENTAL CONSERVATION
CONSTRUCTION AND OPERATION CERTIFICATE
for
PUB LIC WATER SYSTEMS
A. APPROVAL TO CONSTRUCT
Plans for the construction or modification
public water system located
· Alaska. submitted In accordance with 18 AAC 80.100
_have been reviewed and are
(see attached conditions)·
FITLE
If construction has not started within two years of the approval date, this certificate Is void and new plans and
specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS
Change (con re~¢l order no, or desortpt[ve re/erenc~
Approved by Date
,18-0407 Rev. 11 83
section must be completed and signed by the
to the pubItc.
tlon of the t~'~'*~'~ j '~£' 1'· ~j '~ ~ ^' "~ .... '~
completed on ~]IJ~(~JO~V~
operate for 90 days following the completion date.
(date), The system Is he
TITLE
g the Interim approval perloa, or an Inspectlon~ by the De
~g to the approved plans. The system IS hereby
'l~./!'~;,3,~.~k' /~."/~? /~.,j~ ~,-,~ ~' ,.
TITLE
DISTRIBUTION: 1, WHITE. ~NGINEER (Complete 8eoflo~ Oi ' ; ~i 2. YELLOW. WATER SYSTEM FILE (eompt~te Section C)
3. PINK - ENGINEER/MUNI.BOROUl3H (Complete Seotlon C
4. GOLDENROD. MUNI.BOROUGH {Cornplele Seotl~n A)
DISPOSAL
~J New System
certify that the above information is correct:
Existing System
YeS ~] NO
IV, DIAGRAM (')F SYSTEM(Si ~ ~
INSTRUCTIONS FO[{ DIAGF{AM
1. In a plan view, locate and identify each of the following:
a) Well b) All Structures c) Septic Tanl< d) Soil Absorption Sys em
SOILS LOG
MUNICIPALITY OF 'AAICHORAGE
DEPARTMENT OF HEALTH AND ENVli?ONMENTAL PROTFC FION
825 L, Street, Anchorage, Ala:Jq~ 99501 2644720
SOILS LOG - PERCi.)L CNTION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
4
5
7
11
SITE PLAN
13
15
16
17,
18 - A.
19-
COMMENTS
............... (minutes/inch)
]'EST F~UN BETWEEN F[ AND® FT
GREA.,.R ANCHORAGE AREA BOR~,
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
~GH
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME:~:Z--0-~'--'--; ~A,L,NG ADDRESS S-~'~' __~ ...... ~.0.~ ~--~'~ '
LOCATION LEGAL DESCRIPTION ~/~r' ~/~ ~ 1~ C(~?~ ~'~
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
MATERIAL
· LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY__
GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINIS~
WELL:
TYPE _ _ COB,
BUILDING NEAREST
FOUNDATION____ LOT LINE
CESSPOOL .......... OTHER
APPROVED ..... DISAPPRO
WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN, ABOVE TILE IN,
__DEPTH ......
SEEPAGE
, SYSTEM
DISTANCE FROM:
DISTANCES:
INSTALLED BV:
DIAGRAM OF SYSTEM
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
Form LQ-032
0 8' E GEG
Russell Oyster
694-2774
Soils 8- Foundations
Performed for: Name:
Legal Description:
Depth (feet)
'CHNICAL Er DEVE~.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
SOIL LOG
~MENT CO.
Earl Ellis
688-2280
Land Development
Tel. No,
Mailing Address: ~,~.~.<.s~"~;~
Soil Ch)ractertsttc)
8
10,
11__
13
15
Ground Water Encountered:
Proposed Installation: Seepage Pit
Comments:
Yes___No__.__v'~'/If yes, what depth
Drain Field v'/
July 28, 1977
Dan Vicks
Star Route A Box 740
Chugiak, Alaska 99567
Subject: On-site Sewer Insta~lation at
T15N RIW Section 18 Lot 62
Dear Mr. Vicks:
This letter is to re-confirm our conversation on July 27,
1977 in regards to the above subject. In order to upgrade
your system to be in a~lian~e with our requirements, you
will need to ~e twenty five(25} fee~.ba~k~the line and
then add twenty-five(25) feet of per~r/ated~ipe per-
pendioular to this li~e.
The trench will need to be twelve(12) feet deep, twenty-five(25)
feet long with nine(9) feet of gravel backfill. Two ~nsgections
by this department will be required. The first m~st be after
the lengh~ and depth are excavated and the second after the nine(9)
feet of gravel is added and the twenty-five(25) feet of perforated
pipe is in place. You may allow one end of your trench to
tou~h your side lot line, but you must meLntain a one-hundred(l~0)
foot separation f~m your seepage trenoh to any well.
If there are any further qmmstions, please contact this office
at 279-2511, exten~ion 224 or 225.
Sincerely,
Cory Willis,
Sanitarian
C / jh
JUly 22, 1977
Dan Vicks
Star Route A Box 740
Chug~u~k, Alaska 995~7
SubJect~ On-site Sewer Installation at T15N RiW Section 18
Lot 62
Dear Mr. Vtske:
This department was recently made aware of the lo~ation of a
neigh~ring well seventy-five(75) feet from the end Of your
seepage trench. At the time the system was I~lt i~ Mr. Polyefko
said he was aware of the req~irements for on-site sewersaand
wells.
On July 20, 1977, Mr. Bob Pratt visited the Van Eck residence
and located a well inside Mr. Va~ Eck's gugage, which was
seventy-five(75) feet from the end of your trench.
The S~te of Alaska, Title 18 Environmental Conservatioa~Cl~apter
72.0~2, paragragh C Section 3 states "no person may construct
or ~natall a septic tank, Package plant or ~tl absorptionsystem
in such a manner as the water supply is ~n danger of be~om/ng
contaminated. Unless the department requi=es further separation
because of poor soil eondieions, the minimum spearation, lmeasured
horisontally, regardless of property li~es or ownership,;ib~twaen
a septic ta~k . . . or soil abeerp~ion system and (3)a private
well is one hundred(100) feet." It ia also in violation/of';:.the
Municipality of Anchorage Ordi~ance 15.64.040, paragraph A.:
This department will not approve ~oum new installation until the
one-hundred(100) foot separation fr~m the trench to any wells
ams met. If th&s system ia not brought into compliance within
thirty(30) days, 1&esl action will be taken.
If there are any further questions, please ~ntact this office
at 279-2511, exte~sien 224 or 225.
Sincerely,
Cory Willis,
Sanitarian
GREA.,:R ANCHORAGE AREA BON .uGH
Department of Environmental Quality
3330 C Street
AnchorBge, Alask~ ggS03
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEN~
NAME
LOCATION
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
~ DRAIN FIELD:
· INSIDE WIDTH
LIQUID DEPTH
NUMBER OF
_ COMPARTMENTS
LIQUID CAPAClTy~_0~)O GALLONS.
DISTANCE FROM WELL t 6~ ~ O ~'"~ I TOTAL LENGTH
FOUNDATION I~ _NEAREST LOT LINE I ~ OF LINES
NUMBER OF LINES ~ DISTANCE BETWEEN LINES N/~l~. TRENCH WIDTH ~1~ IN. TOTAL EFFECTIVE
ABSORPTION AREA ~ ~ ~--- SQ. FT. LENGTH OF EACH LINE ..... ~ t.~
DEPTH: TOP OF TILE TO FINISH GRADE ~:~ DEPTH OF FILTER
MATERIAL BENEATkl TILE__~ 0 ~--~ IN. ABOVE TILE__~.~ IN.
WE L ,~,,..~ ' ~ ', , ,.~ ,,~
TYPE .. CONSTRUCTION ,.,,~'~ l,'t ~ ~ DEPTH
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION__, LOT UNE .__ SEWER LINE TANK SYSTEM
CESSPOOL
OTI4E R SOURCES
APPROVED
DISAPPROVED_
--REMARKS.___
DISTANCE FROM:
DISTANCES: . _ /
INSTALLED BY: J t'~'-¥N
SEWER [.INE DEPTH:
PIPE MATERIAL:
LOTSLOPE:
REMARKS:
DIAGRAM OF SYSTEM
DATE APPROVED
S~UTHCE~ITRAL REGIONAL OFFICE
437 "E" STitEET, SUITE 200
AitCH(J~GE, ALASKA 99501
274-2533
June 15, 1984
~ir. Robert A. sharer, P.E.
S&S Engineering
St~J 196X
Eagle River, Alaska 99577
Dear Hr. Sharer:
Subject: BLiI Lot 62, T15N, RI~i, Section 18
(8421-FA-267) and (8421-DA-243)
In addition to tae infon,a:ion supplied in your ~iay 26, letter on the
subject property, you provided th~ follow,in§ verbal information to us
on dune 12 and 14, 1~4:
1. The area occupied by the property is flat.
2. The casing on the well l]as been extended to as least 12 inches
above ~jrou~]d level, a~)d the other well - upgrading measures referred to
on tile site plan included with your letter.
3. The existing septic tank shown adjacent to the west side of the
owelling has 17den pu~ped out and filled with sewer rock, and its assoc-
ciated seepage trench abandoned.
4. The well on the adjacent property 120+ feet to the west of the
seepage tre)')ch currently in use on the subject property serves a single
fondly residence.
5. The pul~Ip test perforh)ed on the uell indicated no drop in the
s~atic water level of 56 fee~ after several hours of pumping.
6. It was your professional jud~jement that, due to soil conditions
and well constructio)~, tile existing coudi:ions pose no increased risk of
cont~dF)ation of the well than if the l~dniF,~ul~i separation distance of
15U feet were ~laintained.
DasuU on the above infomation a~d the infon;]ation provided in you)'
luster, the separation distance of 117 feet Trom t~e septic tank to
the well and 137 ~eet fror;~ the seepage trench to the well is hereby
approved, a~d the waste~ater disposal syster,~ meets Department approval.
Fir. i~obert A. Strafer
¢
2
June 15, 'l~JJ4
A Certificate to Operate the well as a Class "C" water supply is attached.
To insure ti)au safe water is beiF~ proviued to the public'water syste~,
it is the policy of ti)is office to require r~nthly bacteriological testing
of th~ drinking ~a~er systel:-r for a period of 12 n)onths for Class "C"
watur syster,~s requiring a ~aiver of separation distances to operate. He
require tibet tile o~¢ner/operator contract with an approved laboratory for
tl~is testing for a perioO of 12 ~onths, and to supply u.s with a copy of
tire contract agreumunt. The public water system ident¥~ication nui~ber
we have assigned to the syster, i is listed on the operation certificate.
Sincerely,
..... Richard ('). Farnell
Environmental Engineer
Attach);len~s
cc: Robbie Robinson (i, IOA)
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. if
1. GENERAL INFORMATION
Complete'legal description
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Lot.62; Sec. 18;~'T15N; R1W
Location (site address or directions)
Property owner
Mailing address
19219 Ganoe Street
Chugiak, AK
Curtis & Carol Oliver Day phone 688-6584
19219 Ganoe Street Chugiak, AK 99567
Lending agency
Mailin. g address
Agent Cindy wilson/ Partners Real Estate
Address
Day phone
Day phone 694-4994
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
3
NOTE:
Individual well xx
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
XX
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-O25(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 cor~pliance with all Municipal and State codes,
ordinances, and regulations in effect on the date Chis inspection.
Name of Firm ~ WA'r~
Address ~
Engineer's signature ~
//'
6. D~/~/S SIGNATURE
Approved for
Disapproved.
Phone
Date.. /,/o~,/? ~
Alaska Water & Wastewater Consultants Inc., is to be paid
$2820.00 at closing for engineering services performed.
'
~ bedrooms. 'k- ~OCESS~9 ~
Conditional approval for
bedrooms, with thee following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
RECEIVED
I~/lunicipality of Anchorage ,lAN 0 ~ 1998 /~
DEPARTMENT OF HEALTH & HUMAN SE~b~l~i~i~y o~ ANCHOPAGE
Environmental Services Divi$ioi~NV~RONM~NTAL SERVICES DIVISION
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description:
A. WELL DATA
Health Authority~Approval Checklist
'~'~u,~J,,.;p~' ~;I-Ii Parcel I.D.:
Well type ~°~,l.JP.'r~' If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y~) ~ ~ Date completed
Total depth 8H'~-~ Cased to ~OI ~
Sanitary seal (~N) ~e~
Casing height (above ground)
Wires propeny protected (~)
Date of test
Static water level
Well production
FROM WELL LOG AT INSPECTION
,,
.f ~'g.p.m.
g,p.m.
WATER SAMPLE RESULTS:
Coliform ~
Date of sample: I ~Z/?..t
B. SEPTIC~N;I, TANK DATA
Dats Installed I ~/~o/=/~ Tank size
Foundation cleanout ~N) ¥=.5
Date of Pumping ~ ~
Nitrate O. ~ f'A_~/L- Other bacteria
Collected by: ~ .,,,al.v,3. ~, ~ I ~4..
IGoo Number of Compartments 'Z. Cleanouts ~TN)
. Depression (Y~) t,J o High water alarm (Y/{~) ~Jo
Pumper "-"----
ABSORPTION FIELD DATA
Dateinstalied '~./2.'~//~'~-'/"I/"R Soilrating (~or~)
Length -/~, Width
Effective absorption area "/(o~I~
Date of adequacy test t4 g. ~
O. (0 System type
Gravel thickness below pipe ~-. 'g,~5 Total depth
Monitoring Tube present (~) ~'r~ Depression over field (y,r{~
Results (Pass/Fail) ~ For ~ bedrooms
Fluid depth in absorption field before teat (in.); --- Immediately after -- gal. water added (in.):
Fluid depth (ins) Minutes later: Absorption rate = q.p.d.
Peroxide treatment (past 12 months).(Y/N)
If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date install~ Size in gallons
Pump o "level at*
High water alarm level at* ------~*Da~
E. SEPARATION DISTANCES
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot I I ~ ~
I
On adjacent lots 1 oo +
On adjacent lots I co [ +
Public sewer manhole/cleanout /'J/~
Lift station ! ool f.
SEPARATION DISTANCES FROM SEPTIC/I,~ANK ON LOTTO:
Foundation ~-u~t~ Property line ._2.~ Absorption fie d
Water main/service line Iot-t- Sudace water/drainage Joe I-f'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line . ~t ~ Building foundation Jo!
Surface water
Wells on adjacent lots Ioo~ 'f-
Curtain drain
F. ENGINEER'S CERTIFICATION ~//(
I certify that l h~det~n~ned/~fiel~ inspections and r
in conforman? wi~. ~~H 'de,~lin~ect on this date.
Signature ~
Engineer's Name
Date *'/~"/'~ ~
Water main/service line Io i+
Driveway, parking/vehicle storage area
· Wells on adjacent lots I oo~-P
Waiver Fee $
Date of Payment
Receipt Number
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
-,, NAA # ,-~'~- '~'-~ ('i~-1Z~
1. GENERAL INFORMATION
Complete legal description ~(,~' '7L //~'~ ~ ~-
Location (site address or directions)
Property owner
Mailing address
Lending agency
Day phone ~' ,'~"~ ' ~'tZ '~ /
Day phone ....~'~, -
Mailing address
Agent
Address
/
Day phone
/
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 DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
X
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 Healt~ 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
Address ~'/
Engineer's signature
Phone_"74 5-/110
l'mcr; A K
Date
,J
DHHS SIGNATURE
Approved for 2
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 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
MU~C~P^UTY O~ ^NCHO~E
ENVIRONMENTAL $1::RViCE8 DiViSiON
Municipality of Anchorage AU~ 05 199~,
Environmental Services Division R FeEl
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description: ~)l/~_o'JlL ~.~2, TIS/q ~l~J,$ecJg Parcel I.D,: O~ - I~J ~ ~..~
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
~ Date completed L[ f3 J~.
~A
Cased to ~0~
Casing height (above ground) ~V¢/' ~'~'
Wires properly protected (Y/N) Y
FROM WELL LOG
AT INSPECTION
Date of test
Static water level ~/~.
79'
Well production
WATER SAMPLE RESULTS:
~A g.p.m. 3.0 g.p.m.
Coliform ~ Nitrate
Date of sample: ~ - l ~ '- ~
.~;~ Other bacteria
Collected oy:
B. SEPTIC/HOLDING TANK DATA
Date Installed ..~-14-~ ~Tank size
Foundation cleanout [Y/N) Y
Date of Pumping ~-I-c~7
C. ABSORPTION FIELD DATA
J?o0~ ~ ~
Number of Oompartments Oleanouts (Y/N) 'Y
Depression (Y/N) ~ High water alarm (Y/N) ~'~
Date installed 5' -14-84 Soilrating (g.p.d./ff~o~) ~Z5 Systemtype Tro c¼ Width ~'~ ,~0" Gravel thickness below pipe ~ ~r Total depth
Effective absorption area ~o&~(J Monitoring Tube present (Y/N) ~" Depression over field (Y/N)
Date of adequacy test '7'- I~ -~'~ Results (Pass/Fail) ~ For 3
Fluid depth in absorption field before test (in,); ~.~ '~
Fluid depth 8 (ins) Minutes later: J ~ ~0
Peroxide treatment (past 12 months) (Y/N) ~,~
Immediately after~)gal, water added (in.):
Absorption rate = ~O g.p.d.
If yes, give date ~J~fi~
bedrooms
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N).
High water alarm level at*
Cycles tested
Size in gallons
"Pump on" level at*
*Datum
"Pump off" level at'
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main /~(MTC,
Sewer/septic service line
On adjacent lots .A/..~;/',~,,",",3
On adlacent lots ~~V¢.
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~0 / Property line ~',.5 '
Water main/service line /t)~ Sa #ace water/drainage ~/l~'/~
/00/
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~ CI v- Building foundation ,~.~O ·
Surface water /}//DT')E /L///,~/~ /'~"
Curtain drain //~/~07')~ ~ ~;,/-~ ~/'~c~/'/'~
F. ENGINEER'S CERTIFICATION
Absorption field /~ ~ ~ . _
Wells on adjacent lots ~'/~'/~///J/~)~.
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots/4/,~,~,~,,.',;,,~;./Vo w¢'/l_~/' ~'~"'~
I certify that I hays determined thru field inspections and review of Municipal record,
in conformanTwith M~OA HAA guidelines in effect on this date.
Signature//,,
Engineer;s Nade
systems are
HAAFee $ ~ '~
Date of Payment
.eoe,pt Numbar
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
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
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lot 62; See. 18; TI~N~ R/W; S.M.
Location (address or directions)
NHN Birc,~uood Loop ~ Ganoe
(b) Property owner 14. Ii .1). P~n,~/~.¢'~ 'D2x_?n/,J".in,~ Telephone: (home)
Mailing Address #111-025801 605 WeSt 4th. Avenue
(c) Lending Institution Telephone
Business
Anchor~'.qe~ AK 99501
Mailing Address
(d) RealEstate Company and Agent ASSOCIATED BROKERS Attn: Earl Mclone
Address 640 West 36th Avenue S~te #I, Anchorage, AK 99503
Telephone 563-3333
(e)
Mail the HAA to the following address: (or check here (~xif hold for pick up.)
List contact person and day phone number below:
S & $ ENGINEERING
17034 Eagle Ili,ver Leep Read Ne. ~
Eagle Rlver~ Alaska ~957~
2. TYPE OF RESIDENCE
Single-Family r~X Number of bedrooms
3. WATER SUPPLY
Individual We~(J~
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 B~XX 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
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 Firn'$ & _~ £NC4t~RING
17034 Eagle River L~p Road No. 204
Address ~.=¢,!_- ~!¥,.,*: Alaska 99577
Date
Telephone
6. DHHS APPROVAL
Approved for ,~ _bedrooms by
Approved _ ,~ ~)isapproved
Terms of Conditional Approval
Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only u pon 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
~/analyze data before a certificate is issued. The Mu nicipality of Anchorage is not responsible for errors or omissions
the profess ona engineer's work
72-025 (Rev 7/88) Back Page 2 of 2
A. WELL DATA
~ MUNICIPALITY OF ANCHORAGE (MOA)
....... ,~,~"%~ ...... Health Authority Approval (HAA)
DIV SION
RECEIVED
Well Classification ~;n~/~ '.'~ *'rd't lV
Well Log Present (Y/N) ~/~ _ Date Completed
Total Depth O/X/ Cased to~O~'' Depth of Grouting
Static Water Level "~
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot _
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot _
343-4744
Legal Description:
If A, B, C, D.E.C. Approved (Y/N) __
Yield ,~z~?/¥,~z~,,
(A., JJf~ ~ 0
Pump Set At L2 I~'
Sanitary Seal on Casing (Y/N) y
Depression Around Wellhead (Y/~
; On Adjoining Lots /
/ ~ ' 'lC ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
-~ 0 'Jr
B. SEPTIC/HOLDING TANK DATA
Date Insta,ed Si e ! Compartments
Standpipes (Y/N) __ ~ Air-tight Caps (Y/N)
Depression over Tank (Y/N) ~
Pumping/Maintenance Contact on File (Y/N) ~',)//~
Foundation Cleanout (Y/N) rd
Date Last Pumped _ ,~
_; for
Holding Tank High-Water Alarm (Y/N) ~J/.~. _ Temporary Holding Tank Permit (Y/N) ~/~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well_ / /
To Property Line _ / fO
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments _<, C..O -/~/o
To Building Foundation /
To Disposal Field / 0 ' "'~
J
72-026 (Rev 7/88) Front Page 1 of 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
SEPARATION DISTANCE FROM ABSORPTION FIELD:
TO Water-Supply Well I :~'
To Building Foundation
Lot ~_-~ c>
To Water Main/Service Line -.~ O ' ~
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System
Length of Field
Depth of Field (~
Gravel Bed Thickness ~
Statndpipes Present (Y/N)
Date of Last Adequacy Test
Design
/
To Property Line / (2
To Existing or Abandoned System on
; On Adjoining Lots ~/~
To Cutback (if present) ^~/~
/
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
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 guidelines in effect on the dat(J ~f this
inspection.
Signed S & 5 ENG~IFI~RING "~,~.~'~'*~'~.",., '~2'
Company 17034 Eagle Rl~er L~p Road No. 2~ ' ',-'
Date
~'/~ Waiver Fee: $
~ ~O/~ Date of Payment
Page 2 of 2
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
ENSTAR Natural Gas Company
VFW Dr,ve
P O [~ox 549
Eagle River, Alaska 99577-0549
(9O7) 694 9292
May ]0, ]984
Mr. Larry Burton
Eagle River~ Alaska 99577
Dear Mr. Burton,
Enstar Natural Gas Company has no objection to the Lcach Field that encroaches
in to the R/W on BLM Lot 62 located w~ithin the N.E. ]/4 Section 18 T15N. RIW.,
$.M. Alaska. '
If you have any questions please ca]] me at 264-3743.
Very ['~uly Your,~;,
Dan Westerve] t
R/W E~gineer