HomeMy WebLinkAboutT15N R1W SEC 18 LT 124
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231263
Work Type: SepticTank Upgrade
Tax Code Number: 05117237000
Site Legal Address: T15N R1W SEC 18 LT 124 G:1155
Site Mailing Address: 18832 S BIRCHWOOD LOOP RD, Chugiak
Owner: GREGORI THOMAS WAYNE
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date:
Expiration Date
Q ,
111164 i 1,
Department
Lot Size in Sq Ft:
Total Bedrooms:
9/7/2023
9/6/2024
45738
9 Disposal Field Q 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
Special Provisions:
• Prior to construction, the field is to be located in order to endure that the required 5' separation from tank
1 to field is met.
C� �ie�� GVaJ a��e�' lv�Zs/L3
Issued By:
Date:
Date:
3
MUNICIPALITY OF ANCHORAGE
Development Services Department a Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-172-37
Property owner(s) THOMAS WAYNE GREGORI Day phone _
Mailing address 18832 BIRCHWOOD LOOP ROAD CHUGIAK, AK 99567
Site address 18832 BIRCHWOOD LOOP ROAD CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) T1 5N R1 W SEC 18 LOT 124
Lot Size 45,738 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field Initial ❑
Single Family (SF) IN
Septic Tank ® Upgrade ®
(w/wo AD U)
Duplex
Duplex (D) El
Tank ❑ Renewal El
Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes..
(Signature_of..property owrie� or authorized agent)
Permit/Rush Fees: Z �_ Waiver Fees: _
Date of Payment: 0�/ 5�_3 /�7f8�23 Date of Payment:
2
Receipt Number: _ 2-157 1C) Receipt Number:
Permit No. SP 7- 3 / 2 3 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
0 Co
Fr,rst Waler
- C O N S U L T I N G
�✓J�, TLP.I't: S-iE AifR
9UPP0RT PLANK NG
`�.� s:a•, Oxy-_---,.-,—�.:^�....-
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
October 16, 2023
Municipalities of Anchorage
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: T15N R1W SEC 18 LO 124
The property owner has requested we obtain a permit to upgrade the septic system that is
encroaching groundwater of the above referenced lot. We propose to install a pressurized septic
system with three shallow 6' -wide trenches to serve the existing 3 -bedroom house.
At septic tank installation, groundwater was encountered at 8' from existing grade that was
encroaching the 6.1' total depth of the existing 1993 septic absorption field and required that the
1530 -gallon Infiltrator septic tank be installed. S&S Engineering conducted the test hole "TH2"
on September 8, 1993, that was later monitored on 9/15/1993 and was dry. However, based on
recent observations, a total depth of 3.5' from grade with this absorption system is proposed. An
additional percolation test will be conducted at construction per the design.
The slopes are moderate at 0-5% at the proposed upgrade location. The lot and area are served
by private water. The design will not impact any of the neighboring properties. Please contact
us if you have any questions.
Sincerely,
0 ��
Curtis Huffman, P.E.
Frs�W�
"UYSULTIUC
S�TIVICES
'`
I"l_�`�
� Wdl Efl/WdSIEWAI Efl
�'� ';'
SOPPO]Ii PLANNING
DESIGN CALCS:
3 BDRM X 150 GPD = 450 GPD
450 GPD/0.6 GPD/SF. = 750 SF SAS
750 SF / 6'W X .78 RF= 98 FT. TRENCH
USE 3 TRENCHES - 33' (L) X 6' (W) X 1.5'(ED)
TOTAL DEPTH FROM ORGINAL GRADE: -3.5'
co -2r1
NO SLOPES >25% WITHIN 50'
OF PROPOSED FIELD.
NOTES: STAKE PROPERTY LINE, ESMTS, WELL RADII PRIOR TO CONSTRUCTION
/ LOT 103 S8A5'01 "E 271.82 COMP
(N90\00'00"E 271.82' R)
I
'APPROX
/100' WELL
RADIUS
o_
0 o
U_
I _ O
O
0 tod
In n
LOT 123 M
\ ODo
OD r-)
L(7 d.
\ N O
O p
OZ
\Q V
Z
WELL 3O
HOUSE /
a g0
36.1' `1' qe ? /
APPPRRLOX �2y� coq
G
Lam' o GRAVEL DRIVE
LOT 124 /
WST STAKE 100f VEM
M[M PMrn To CONST.
'S' - PUS,IC rTLU"`
REM TAM( SAT Ii
TO VTSTATION
WE A To � AT 70 f\
Oaaan ma w
STAKE ��
PROPERTY LINE yr uT / f�'�'
BEFORE CONST.
ANY BIGMAT OF EXISTING
FIELD WILL BE REMOVED TO G
PL- APPROX
100' WELL
pie \RADIUS
G
LOT 125
WITHIN 6 HORIZONTALLY m
OF PROPOSED
TRENCHES de MOA SAND sn
INSTALLED. TREES
ALL SEWER ROCK WITHIN 6',
MEASURED HORIZONTALLY, APPROX 1978
TRENCH/S.T.
FROM THE EDGE OF THE ABANDONED
NEW PROPOSED FIELD WILL
BE REMOVED. ALSO, REMOVE
ALL EXISTING BIOMATTED
SEWER ROCK BELOW THE
PROPOSED FIELD. ADD MOA
SAND & MAINTAIN 6'+
SEPARATIONS BEFORE
INSTALLING NEW 1.5' ED
FRf01VI--3:5-F-ROM EXISTING
'GRADE. \
APPROX / \
100' WELL NX0'00'
RADIUS
T1 5N R1 W SEC 18 LOT 124
ho a`10 VACANT - LOT
PARALLEL`b 126 (EKLUTNA)
TO MDM0
DESIGN PEE�1j"/OLDER 33' R.O.W. AND UTILITY ESMT
MDS DIGIry1ED ASB 107 )
do M A FILE �.�- (BK 302 PG AT SOUTH
LOT CORNER
V'W6.,4-;7r
3' R.O.W. AND APPROX
TILITY ESMT 100' WELL
BK 302 PG 107) RADIUS
SUPPORToSERVICES:
o
PREPARED FOR:
THOMAS WAYNE GREGORI
18832 SOUTH BIRCHWOOD LOOP °
CHUGIAK, AK 99567
FIRST WATER CONSULTING DATE: 10/16/23
13030 SUES WAY SURVEY: DMS
DRAWN: FWCS
ANCHORAGE, AK 99516 SCALE: 1" =60'
907-350-9566 FirstWaterAK®gmail.com PAGE: 1 of 2
OF A4�'
�*9TH*r
0jt�
` � rtis Huffman 100
4�CE 128991 "AAf
10/16/23 ems®
® �FESSIOTiA1'
CDS
DESIGN DETAILS:
A NEW 1530—GAL PLASTIC INFILTRATOR SEPTIC TANK WAS INSTALLED THAT NEEDS A PUMP
WITH THE PROPOSED THREE 33'L x 6'W x 1.5'ED TRENCHES —3.5' FROM GRADE w/
INSULATION & 2'+ OF COVER MAINTAINING 100' TO WELLS / SURFACE WATER, 10' TO LOT
LINE,.... INSTALL PER AMC 15.65, 15.55, & MASS... TANK BEDDING, SEPARATIONS,
MATERIALS,
0 r4-) WELL ' a'
LOC. �� -�
�Y
O� GRAVEL DRIVE
/
LOT 123 FCO LOT 124
O NO WELLS WITHIN /
MUST STAKE 100' WELL
\ 00 n 100' OF PROPOSED RADIUS PRIOR TO CONST.
Ln SEPTIC SYSTEM / �\
N O co X\ S c0 /
/ 7H1
\ 0 O DECOMMISSIONED EXISTING
S.T. & INSTALLED NEW
TH2
O z 1530-GAL PLASTIC INFILTRATOR
\ O SEPTIC REQUIREALIFT S NK THAT ATIONLL
DUE TO GROUNDWATER AT 8' DCO
I I & MONITORED AT 7.5'
OCTOBER 2023. MH
CONDUCT iD M
PERCOLATION o
TEST AT CONST. '� 0P
M®
STAKE -10'-
PROPERTY LINE MT m MT 10
BEFORE CONST. `'
0 Sew- Roc'k `J
ANY BIOMAT OF EXISTING`� ® MT
FIELD WILL BE REMOVED TO
WITHIN 6' HORIZONTALLY Co
OF PROPOSED 0 G
TRENCHES & MOA SAND S&S O
INSTALLED. --,TREES TH
�o
INSTALL TRENCHES
APPROX 1978 PARALLEL TO SLOPES/
TRENCH/S.T. O� ,
ABANDONED DESIGN PER/OLDER �� 33 R.
MDS DIGITJZED ASB �G� (BK 3(
I & A FILE
Lo
LOT Cc
T1 5N R1 W SEC 18 LOT 124 SUPPORTOSERVICES: __®®
PREPARED FOR: OF
THOMAS WAYNE GREGORI _
18832 SOUTH BIRCHWOOD LOOP TH
CHUGIAK, AK 99567
FIRST WATER CONSULTING DATE: 10/16/23
SURVEY: DMS 0# r', Huffman
13030 SUES WAY DRAWN: FWCS O � 10 12899123 /23
ANCHORAGE, AK 99516 SCALE: 1" = 30'
10/16/23 e
PAGE: 2 OF 2
907-350-9566 FirstWaterAK@gmail.com
OF •��>!� Go
�A Z�k
F rsr WarerS U L T IN G �• ••••-••
surPosracL,�;: �urCurtis Huffman • •:
13030 Sues Way - Anchorage, Alaska 99516 r� �'.• _.
Tel. 907-350-9566 firstwaterAK@gmail.com �� Fps • .CE
Tcc�FO� 0/33/23/23
SOILS LOG -PERCOLATION TEST �i ROFESS101A�
LEGAL DESCRIPTION: T15N R1W SEC 18 LOT 124 ,1
DEPTH
FEET OG SOILS
ORG/OL
1
2
3
SM/gm
4
5
6
7
8
9
10
BOH
11
12
13
14
15
16
17
18
19
20
PERFORMED FOR: THOMAS WAYNE GREGORI
TESTHOLE # 23-1 DATE PERFORMED: 9/25/23
GROUNDWATER ENCOUNTERED: YES
IF YES, AT WHAT DEPTH: 8'
DEPTH TO WATER AT MONITORING: 7.5'
DATE: 10/03/23
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
Reading
Date Gross Net Depth to
Time Time Water
Net Drop
10/3/23 30 min 6"
1 13/16"
30 min 6"
1 13/16"
30 min 6"
1 13/16"
PERCOLATION RATE 17 (MIN/ INCH)
TEST RUN BEWTWEEN 25 & 3.5 FT
PERC HOLE DIAMETER 6"
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH
PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 10/03/23
BASIS OF BEARING
00".E .271,81' (271-95' R)
33' R. 0. W. AN D
UTILITY ESMT
{BK 302 PG 107)
N89°59'24"E 6.47'
(N90*00'00))E 6.47' R)
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
BLM Lot 124
T15N RiW Sec18 SM BLM PLAT MAY/13/1955
SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance shool(
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lilies.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: DATE: SCALE.E--MAIL
OCT 19, 2023 1 "=50' schuller(Dak.net
23-102 DRAWN BY: 111HEOIED BY GRID NUMBER: BOOK AGE:
JAS N W1155 230318
F �® LA`
���'�
,,r44
111� O S �
,i 411y
oe
6�.•' 49TH
Cdr
�......... ............. ........ j�r
?A
�. .:......................� ...,
e •,JOHN L. SCHULLER.-
,, • • LS ---10408
�,� • • , . • • O 1831 Talkeetna Street
' 0, � ...` � ,,� Anchorage, Alaska 99508
A
�o fe a1 �.,.,'�' (907) 227--1455 office
kl ,l ssia`�„�•.�. (907) 274--4992 fax
Municipality of Anchorage Page of_
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
Na~ne: ~~ Wastewater System: ~ New ~Upgrade
Phone~ ~. ~ ~ o~rooms: ~ Deep Trench ~hallow Trench ~Bed ~ Mound ~Other
LEGAL DESCRIPTION so,,.~.~GPD/Sq Ft TotalDepthffomodg,nalgrade:
Lot: /~ ~ ~ ~: Depthtopipebottomfromoriginalgrade: Graveldepthbeneathpipe
Township:/~ ~ Re.ge ~ Seotio.:/ ~ ~ Ft ~ ~ Ft.
WELL: U New Q Upgrade eravelwidt~
~ / ~ ~ ~t.
Ciassd~on (Private, A,B,C) Total Depth: Cased TO: / ~tal absorption area: Pipe material:
~~ ~rilled: Static Water Level: Installer: Ddt s II
Yield: ~... ~GPM IPumpSet at: Ft ICasing Height AbOve GrOund:Ft TANK/'/
SEPARATION DISTANCES ~eptic U Holding U S.T.E.P.
To Septic Absorption Lif, Holding ~Priv~,.' ' '~ M~f%e;`
FFOB Taf, k Field St.tier, Ta.k Sewer Lines - /~
Surface I ~/~ LIFT STATION
L~:; /0 lot& ~ ~ l~p /~ [Highwatoralarmat:
Foundation ¢7t /¢ t ~/~ ~/~ ~/~ "Pump on" level at: o :
~0~ ¢ ~ O ~ ~ ~ Pump Make & Model ~ Electrical lnspecUons performed by:
Curtain
Drain
Remarks: ~%/~ ~D~/ ~/~ ~ /~ BENCH MARK
Location and Description:
Assumed Elevation;
S l S ENGINEERING
inspections performed by'. 17e34~=;!:Ri~,:r t~ ~e~,H~: 1st
Department of Hea th
d Human r~eo~ appro
Reviewed and approved by: ' Date: -
72 013 (Rev 9/91 ) MOA 25
Permit No. SW050313 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: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:LOT 124-. NECTION 18. T15N. RIW. SM. AK PID No.: 05117257
CO1
NEW
1000 GAL
SEPTIC
TANK
CO2
jFINAL
GRADE
~94,6' 94'9'~/
92.4'~/
HOUSE
WELL
MT C04
_~/~98.5'+
· 86., WATER FOUND 7/23/93
3 BDRM
72-013 A (2/91) MOA 25
SEPTIC
DBL CO
TRENCH
SCALE f' = 40'
GARAGE
ENGINEER'S SEAL
(ENGINEER'S SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
1
2
3
4
5
6
7
8
9-
10
11
12
13
14
15-
16-
17-
18
19
2O
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water A~ter~,~
Monitoring? ~ ~ Date:
D Gross Net Depth to Net
Reading ate Time Time Water Drop
r /
PERCOLATION RATE --
tminutes/inch) PERC HOLE DIAMETER --
$ & $ ENGINEERING TEST RUN BETWEEN ~ FT AND FT
COMMENTS ~7034 I~aalo ~1,...,
.........
Eagle fiiver Alas ca
PERFORMED BY: ~'
ACCORDANCE W[~H ALL STATE A~D MUNICIPAL GUIDELi~FECT ON THIS
DATE.
DATE:
72-008 {ReVl 4/~)
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930313
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:BREWER GEORGE W H
OWNER ADDRESS:18832 BIRCHWOOD LOOP RD
CHUGIAK, AK 99567
DATE ISSUED: 8/20/93
EXPIRATION DATE: 8/20/94
PARCEL ID:05117237
LEGAL DESCRIPTION: T15N R1W SEC 18 LT 124
LOT SIZE: 45738 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. 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
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
- DATE
ISSUED BY: /
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENS&ONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
August 12, 1993
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, Alaska 99501
REFERENCE: Lot 124, Section 18, T15N, R1W, SM, AK
Request you issue a permit to upgrade the septic system
serving the three bedroom house on the referenced property.
An adequacy test performed on the existing system on July 19,
1993, for Health Authority Approval purposes found the
absorption capacity of the existing system to be inadequate.
% test hole was excavated and percolation test performed in
:he area of the proposed upgrade. During excavation water
~as encountered at 11 feet and after seven day water
monitoring water was found at 13 feet. Attached is the
~roposed upgrade design.
~e do not anticipate any adverse effects on neighboring
properties by the installation of the proposed septic
upgrade.
If you have any questions or require additional
f~r y~view,_ please contact us.
rt A. Shafer, P.E.
tS/LSU/lsu
information
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
0
~o~
0~0
z
Municipality of Anchorage
DEPARTMENT OF HEALTH & HU~IAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE
LEGAL DESCRIPTIoN:LJ~[~; ~ I~_, 'T/~--J~J, ~o.~ 5.~, Township, Range, Section:
SLOPE SITE PLAN
I-
~,. ;r~'F~l %',,,
3
4
5
6
7
WAS GROUND WATER
1
0
ENCOUNTERED?
12 E
~ ~ ~ Depth lo Waler Alter / 2'
13 ~ HE,--/ ~10flit0ring? _ __ '_~_ _. late:
Reading Date Gross Net Depth to Net
Time Time Water Drop
.... ~ lo ~/~ ~/~"
~:¢~ ~o ~*/~" ~"
14
15
~ ~ ~,o,~-~,
17
18
19
20
PERCOLATION RATE ~0 (m~nutes/inch) PERC HOLE DIAMETER ~:~ r /
T EST R UN BETWEEN .~Z__...~-~ AN D ~ FT
PERFORMED ~Y& 5 ~.[~E~U~ I /~ CERTIFY THAT THIS TEST WAS PERFORMED IN
Eagle Ri , -
72-008 (Rev. 4/85) ~
VIUNICIPALITY 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
PHONE [~'N EW
NAME r~.. ~ ~/.~ ~ ~08~ ~ ~ ~.- E~ UPGRADE
MAI LIN~ADDRE~
LEGAL DESCRIPTION
LOCATIO~ NO. OF BEDROOMS
I ";O0/"e" Owel~g) / PERMITNO.
h Z Manufacturer
~ ~ Mat~ ~o. ~ompartmonts
biq. capacity in gallons Inside length Width Liquid depth
~000 IF HOME.DE:
, ~ Well Dwelling PERMIT NO.
Length ~e~ ~e Total ,e~h~nes Tre~ ~dth Distance between lines
~- No. oflines /~ ~ -~s ~i~absorption
~ ~ ~ Top of tile to finish grade ~ ~ Material beneath tile ~ / Total area
inches
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot line
m DISTANCE TO:
~ DISTANCE TO: Building foundation Sewer line Septic tank/0~ ~ Absorption area(s)
OTHER
PIPE MATERIALS
C~,
SOl L TEST RATING
/50 -
REMARKS
/
~Z
I ~ Lq
72-013 (Rev. 3/78)
Illqq ]
L O C I:;I ]" I 0 i",l
I1'",h111 1'1 NUMBER FF:' E,M)I;JJUt'I
'['HE LENC~TH [)IMEI'4E;ZON ZE; ]]"JIE LENGTH <IN FEET) OF THE 'TI~:ENC:H OR [',P.R]:NFZELD.
THE DIEPTH OF FI TRE]qCH OR PIT ]:E; THE DIE;TFtNC:E 8E'T'HEEN THE 'Ja;UP. FFfCE OF THE
GROI. JND FIND THE Eu])TTC)M OF THE EEi:'~CFIVFIT):ON (il",! F:'I:}.':ET).
THEI:;:E IS NO SET 14Z[)TH FOR TRENC:HES.
THE GRFIVEL I:)EF'TH ZS THE I'IZi",IZMUM [:'FPTH OF GRFIVIEI_ EIE:TI,!EEN THE OUTFFII.L. F"ZF'E
Fff',IE:~ THE: E:OTTOM C)F THE E::':',CFIVRTIOI",I (IIq FEET).
PEI:;~:MIT FIF'F'IJ:C:I::INT lilt. THIE I~.L_F .N_.I.E, ILI I ]"O INFORM THI.. r)EI:;:'I:r~F~'TMFI'.4 .....
· '. ' ...... I I H
! I -t.:, I t L,. ~I r ! ... I~I ]; 1',,1:'..-] F' E C T I C) i'.4 ',E; O I:::' Iq N ',F I.,I E L L, :E; Fi [:, J I:t C E N T' ]" O .... l-
iql. Ii','I[~:I!EF:i OF' RES Z DENCES THFIT' I'HIE HEI_L H i Lt...:,I:.I- -';'..'~'E.'
: .... ' :' '" ......... ' .... : ............
L. ".. I'-.I~ 1 L.!._ ]. N .:l O1:::' I::IN~'r' ..., r :, I [:J t H I 'T'HOUT F I NF:IL. .!.iq:. t EL. f
[:'EF:'Fq:~:Tt"IENT' H I M- E. E :,l_lB ] E..,. T 'T 3 F 1,,. J'-",f: CU I ! - t,l.
MII"~IMUM D1STFINCE DE"I'HEEN 8 HELL FIN[.'." FIN"r' ON-'SITE SEHRGE D]:SPOSF:IL. :E;'T'::!;'FEM '(S
::1..(3~:1 F:'EET' FOR I::1 F~F~:IVI::tTE HEL,.L...~ OR
::l'31;i~l TO ;;:~EI(~I FEET FRC)M FI PUBi...IC HEL,,L. DE;F'LEN[)]:N(~ii IJPON THE T'?'PE OF F:'UE:LtC HEll.
Oi"lqEl::( f;:EY;:!I..IIF'-".EMEN-I':~i; MFI"r'F'IPPL.'TL SI::'ECIFICf:ITZONS RN[) CC)N:~STRUCTZON [)IIqG!:;i]:::tI"I:~; laRE
Ft',/FIII.FiEH. E TO INSURE' PROPER INSTFIL..i_.FtTt;ON.
! CER"f'IF'~'r' 'T'FtI:::t]"
±; I FIM FRMIL. I'F:IF~: H].'TH "FHE REQUIREMENTS I::OF.: ON-:F;ITE SEHER:i:i; FIN[) HIEI~i.S
FORTIq B~'r' THE MLII",I ! O l PFIL Z T¥ OF
2: I 1.4II. J.. IN'_'3TFILL ]'HE '.~"r'STEM IN FIC(]:ORDF:tNCE HI'TH T'HE C:COES.
]J:: i UHDERSTF~ND THf::IT THE' ON-'E;I'T'E SEHER S"r'STEM i"lFt"r' REQUIRE ENIJ:ZlR(::iEMEi]",tT '!:r;:' THE
RESIDENCE I':; REMO[:,E]_E[:, T'O INCLUDE MORE THF:IN :::[: E!:EDROOMS.
..... [ .~1 ,ILl ................................
J_'ab
"0~ t~ I~ v~or~h a thousand n~inion~"
2204 Cleveland Anchorage, Alaska 99503
This ~orm Renorts Soils Lo~_~i~_ , Percolation T~st
neath
Feet
Soil Characteristics
10
14--
]6,
20--
Was ~roond Water Encountered?
I~ Yes, At what Deoth?
Readinq Date
Grnss Time
Net Time
Denth to H20
Net Dron
Percolation Rate Hinute
ProPosed Installation: Seeoaae Pit Drain Field
Oeoth of Inlet Deoth To Bottom Of Pit Or Trench
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. #
1. GENERAL INFORMATION
Complete legal description
CERTIFICATE OF HEALTH AU?HORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
T15Ni RIW; See. 18/ Lot 124
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
18832 South Birchwood Loop
Chu~iak~ AK
Eva Lokcn REMA× EAGLE RIVER
Day phone
Day phone
Agent
Eva Loken/ REMAX EAGLE RIVER
Address 16600 Centerfield Drive, Suite 201
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 2
TYPE OF WATER SUPPLY:
Individual well ~x
Community well
Public water
NOTE:
Day phone 694-4200
Eaqle River, AK
99577
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
XXX
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72*025(Rev. 1/91) F¢ont 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 inves~i_gation 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.
S & s EN61NEE,ING
Name of Firm 17034 Eagle River L~ad
Address ~l,, m,,,r~ ...... e/~/~ .~/~_.~
Engineer's signature /~ x.~ / Dar
DHHS SIGNATURE
/'"'"Approved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By:
. Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91 } Back MOA #21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription:~/2¢'- ~'/~/'~-/¢%'LJ/,''~/('0/ ParcelI.D. o~r't I"~'Z--
A. Well Data
Well type:/'~/c)¢¢(- /('
Log present (Y~).
Total depth ~.~-
Sanitary sea(~N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed /~'~ ZT~ Driller
Date of test
Static water level
Well flow
Pump level1 ~
SEPARATION DISTANCES FROM WELL TO:
Septic/l~ tank on lot /<:~2 ~'
Absorption field on lot ~
Public sewer main /L) ///~
Sewer service line :~) ( ~-
Cased to
FROM WELL LOG
'~ ~ C/,,~ng height
Wires properly protecte (~N)
AT INSPECTION
; On adjacent lots //4~ 43 -/-
; On adjacent lots /'¢:) ~ "7
Public sewer manhole/cleanout ~ //'~-
Petroleum tank ,'V' 0 ¢0 ~
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: :/~
B. SEPTIC/HOLDING TANK DATA
Collected by:
Other bacteria
/
Foundation
Water main/service line
Date,nsta,ed Tanks,zeCompa ments
Date of pumping ~' -.~'L./ ~/,-~ ~'~ Pumper ~ ///~ ~/
/
SEPARATION DISTANCES FROM SEPTIC/~ TANK TO:
Well(s) on lot /-"/(~ ~' On adjacent lots ,//~__.2 ~
To property line '"/¢ ~/~ Absorption field ~'- (
Surface water/drainage ~ L9/,.D- ~-~
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date insta"~'~lled_ Manufacturer
Size in gallons ~ ~ / /Manhole/Access (Y/N)
Vent (Y/N) "Pum~ump o~ff" Level at
High water alarm level ' ~ IcJyc~
SEPARATION .~A~CE FROM LIFT STATION TO:
Well on lot ~ / ~ -
D. ABSORPTION FIELD DATA
On adjacent lots
Date installed
Length ¢¢~ / Width
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y~_.~
Surface water
Soil rating (GPD/FF) /'~¢ ~ System tyj.~//
~- t Gravel thickness 2, ~ Total depth
Cleanout present ~N) Depression over field (Y~)
After test
Result~il)
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /,,//7Z / On adjacent lots
If yes, give date
To building foundation
On adjacent lots
Surface water ~ ~o ~ ¢ --~¢b~' ~) Driveway, parking/vehicle storage area
Curtain drain /'P/D /
Property line
To e~r abandoned system on lot
Cutbank ~ 0 ~J ~ Water main/service line
E. ENGINEER'S CERTIFICATION
Signature
Engineer's Name
Date
I certify that I have checked, verified, or conformed to all MOA and HAA
S & S ENGINE.ERIN~
// /
HAA Fee $
Date of Payment ~, '-~/~'
Receipt N umber ,-~-~/ ~z~ C,//¢
72-026 (3/93)* Back
waiver bee ~
Date of Payment
Receipt Number
DEPARTM[
825
#1: Time
MUNICIPALITY OF ANCHORAGF EAGLE
F HEALTH AND ENVIRONMEN ?ROTECTION
L Street, Anchoraoe, Alaska 99501
264-4720
Date Received: March 1~ 1978
RIVER AREA
~2: Time ~3: Time
Date ~ Date Date
Insp P~.~. Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Am~ac Mortaaae Cofppration
Mailing Address: 705 West 6th Avenue, Suite 201 Phone: 277-8588
Property Owner: George W. Brewer Phone: 688-2432
Mailing Address: Star Route Box 67C Chuqiak 99567
3. Legal Description: T15N R1W Sec~i0n 18 Lot 124
4: Single Family Residence: (x9 Number of Bedrooms: Two
Multiple Family Residence: ( Number of Bedrooms:
Well System:
Permit
Construction
Individual Well ~ Community/Public System ( )
Depth of Well &~l Well Log on File
Bacterial Analysis
~ )
6. Sewage Disposal System: On-site System ~ Public Utility ( )
Permit
Installed I~'~a~/,,~' Installer
Septic Tank Size
Manufac=urer
Absorption Area
Soils Rate
Material
Distances: Well to Septic Tank to Absorption Area
=o Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
,,UNICIPALITY OF ANCHORAGL
.~O~ Department of Health and Environmental Protection
~ 825 L Street, Anchorage,
Alaska
99501
//~'~ 264-4720
~'~quest for Approval of Individual Sewer and Water Facilities
Property Owner:
Mailing Address:
Name of Buyer:
Mailing Address:
George W, Brewer
SR Box 67C Chugiak, Ak. 99567
Phone: 6~__
n/a - refinance of land - modular unit purchased
Phone:
Lending Institution: AMFAC MORTGAGE CORPORATION
Mailing Address: 705 W. Sixth Avenue, Suite 201
Phone: 277 8588
Realtor/Agent:
Mailing Address:
J. A. Realty
3400 Mt. View Dr
Anch. 99504 Phone: - 279 2589
Sec 18 lot 124, TI5N R1W
Legal Description:
Street Location:
6. Single Family Residence: (X~ Number of Bedrooms: 2
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply: *Individual Wel! kxk
If Individual Well, well depth
If Community System, name of system
Public/CoMmunity System (
Sewage Disposal System: *~n-site System ~X~ Public System ( )
If On-site System, date of installation:
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
Rage'~wQ
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: T15N R1W Section 18 Lot 124,
Comments:
Affadavit Attached:
Approved:
Disapproved:
Department Worksheet:
( )
Letter Attached:
Date:
Date:
( )
1978
George Brewer
Star ~oute Box 67-C
Chugiak, Alaska 99567
Subject= T15N RIW Section 18 Lot 124
This department will grant'& temporary approval for the
sewer a~d water facilitiee, if~onies are escrowea to
complete the upgrade of the sewer system and well by
July 1, 1978.
The upgrade of the sewer system will incluae~ (1) 100 feot
separation between well, septig tank aha leach field~
(2) thirty-three(33) feet lenghh trench with seven(?) feet
o~ gravel below the per~orated pipe. A permit has been
iseued for tt~e upgrade.
The well is in a cement vault, but the casing is below ground
level. The casing will need to be extended twelve(12) in=has
above .¢~rouna-level to complete that protion of the upgrade.
If there are any ~urther questions, please contact this
of£ioe at 264-4?20.
Sincerely,
Robert C. Pratt,
Sanitarian
Amfac ~ortgage Cor~oration
705 West 6th Avenue 99501
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
CERTIFICATE OF INSPECTION
SEWER AND WATER FACILITIES
1, PROPERTY OWNER
MAILING ADDRESS
2, LEGAL DESCRIPTION
/,,:/ I,:~ ? ,5-~ ~' /:~ , .' > ,'~ ,.Ix ~ ~.
3. TYPE DWELLING
SINGLE FAMILY RESIDENCE
MULTIPLE FAMILY RESIDENCE
OTHER (Describe)
4. WATER SUPPLY
INDIVIDUAL
COMMUNITY/PUB LIC
5. SEWAGE DISPOSAL
INDIVIDUAL/ON-SITE
PUBLIC UTILITY
HOLDING TANK (Maintenance Required)
APPROVED FOR
BEDROOMS
' EZ3 CONDITIONAL APPROVAL (See Attached)
DISAPPROVED
SEAL
DATE
'12-014 (3/78)