HomeMy WebLinkAboutT15N R1W SEC 18 LT 147BT15N, RlW,
Secti o n 18
Lot 147 B
#051-232-75
MUNICIPALITY OF ANCHORAGE
DE. ITMENT OF HEALTH AND HUMAN SER' -"S
" Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264~4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Na,~e DISTANCES
'~ ~ ~y~r ~ SEPTIC ABSORPTION
~ o, l~,cK C,'"/OZ.~, ~ TANK FIELO WELL
Phone(s) ~ ~-- ~ ~// Permit~o//~~N° No of ~ooms WELL
LEGAL DESCRIPTION
AS-BUILT DIAGRAM (Show Iocahon of well, sepbc system property hnes, foundabon,
TANKS N
~ SEPTIC ~ HOLDING
TYPE OF SYSTEM
~TRENCH ~ BED ~ W. DRAIN ~ OTHER
original grade ~ FT ~ F~
WELLS /
/ L
~ PRIVATE ~ OTHER fldentifv)
RE~ARKS:
i ~1~ ~ ~ cedily Ihal this i,s~ection was peder reed accordino I~ ad
72-013 (3/85)
~o~ ~?
·
~vl~ ~li b,.m P.IL,R.L.9.
July 3, 1987
DAVID R. DAYTON, p.l-.
SR t Box 1026
Chugiak, Alaska 99567
(907) 688-2417
Municipality of Anchorage
Dept. of Health and Human Services
Division of Environmental Services
Attn: Mr. Steve Morriss
Re: Lot 147B, S18, T15N, R1W, S.M., Ak.
Dear Mr. Morrlss:
The new septic system has been inatalled on the subject lot to
satisfy your Conditional Approval dated 12/18/86.
The new system meets all M.O.A. regulations. The old well was
abandoned (filled, cemented & cut off 4' below grade). The old septic
tank and crib were pumped, crushed and buried in there original
locations.
During construction of the trench, differing soil conditions
were found in the Northern ½ of the trench. These were SW soils
with a 125 sf/br rating. No allowance was made for these better soils,
thereby creating a slightly oversized trench.
Please review the attached "as-built", soils log for differing soils,
Inspection Certificate, Health Authority Checklist.
The well test well log and water test results were submitted
previously at the time you issued the Conditional Approval.
Sing~rely,
David R. Dayton
264 "4 77.x}
:lliiiiig IEii!J: 1t,~.,311E!ii.: I1:;::;;:: IF:::" ~T 1[ Ir-Il ][: -11'
BEV BF:~'¥ AN T
I:::'0 BOX 6702:];()
O;I,,.It.~C I AK~ AK 99567
[ E:()AJ. DES!::;R]:I:::':: SUB)[}IMIS]:I]N:: N/A L. OT': BLM :1,47B BLOCK:
SECTIOI',h~ 18 'T'OWNSH:[I::?.~ :I. SN RANGE: :I.W
I.[]~ 13;I:;NE: 38.:/,8:1. (s6!,,t:::r,, OR
MAX BEDF~E)OMS: 4
iSR(!VE] )::)EP'JI,! (F'r.) 5,, 0 O. 5 ]. 0
Ii:Ii A~. DtEP'rt.I (i:.:) 9,, 0 ~f,, 5 5.0
GI::,'AVI L i,/~: D 11.t (l:: i ~ ) 2.5 ;:;:'.;:;i'. ,, 0 5 ,, 0
[~I;;X..~,;li:L I..ENGTH d:::"t'. ) 55.0 4 :~.. 0 105,, 0
I]..~I::,'AV~:L VUI..UI~tI::~: (CIL, YDS,, ) 28,, 1 33,, 5 2'.9,, ~::'
I'ANK S t ZIE (GALS) :1,250,, 0 '~ )~' :[ ~, 25(),, 0 ~'~' :1 ~, 250,, 0
~OII. RA't :I:NG (SQ,,F::I',, IBR) :i37 150
· ~'~ [I .:~,,t:1 I IENGrH ::~ ?5 1:::'1., Id..J..d.I b:.,: MUL.T:I:I:::'[.E I LIN, d',IEYT E!:XCI!ii:I!iiiDII',IG ?5 F"T,, IEACI'P
I ~[,ll.. MI!ST HAVI::; A'I I hA-: I IWO COMF:'ARTME:I'qTS
t,,xi'Lh Lhe r'el::lU:i.r'eme]'l'Ls ~(::H' I:)r'l,..s:L't:,e se~,~er'.s
i:or'th by the Mt,u"l :i c: :i, pal:i.t'.y (:)f Anc:l'",c)f'ag~(.;(, (Mt3A) arid the State
:[ ~,~:i. ] ] :ilH;~FLa.I ] 'Ll"l{e ~;i~y~;iik,,~,~,~[i~ :i,l'] ac::ccir'da~d'l(::(6) ~,~:i Lh a] :l MOA
:i: ~.,ci,],:i. adher'0¢~ I..o a:t. 1 MOA al',d ~t:.at6:) (::)~' A]a~!~;:a
(;:1 i.%'~', ~:UIE:F:*S ~ P OfT* al"~y C~)X :i s't: :i. I']~:J ~,-~E~ ]. ;!. ~. ~gas!yl:,,r;,~L,,~a'[,E,r' d :i, spE).ii]h:~3. !:~y~F~L6:,ffl
I l'"ll!i',[ I' 1 .) (:!N I'1::: I:::'l"'l"l::;: :I: C¢d.. I:::'EF:M :1: 1" AND :1: I',ISI:':'I!!:C f I 01',t MI,.!S I L,I. EiB] A :1: NI!!:D il Q::.'"; ¢:.x::~" ~:,,',! ,I t I <',::
:; :::, :; ,, ( '.:
IAI [I..I UE) I J:.'~l::: ~:~F:'I:::'I::~[:)~,.qED W:[ t HDUi AN !.L.I L, ~ h, I. UAt. ;I:NSF'IEC'I ION ~d.I ,.t, I ~, AND ~ fie
DAVID R. DAYTON,
SR '1 Box 'I 026
Chugiak, Alaska 99567
(907) 688-24'i 7
May 28, 1987
Municipality of Anchorage
Dept of Health & Human Services
Division of Environmental Services
Re: Lot 147B, S18, T15N, R1W SM
Attn: Mr. Steve Morriss
Dear Mr. Morriss:
The attached plan and calculations are for an upgrade of the septic
system on the subject lot.
The original system, installed in 1971, was a 750 gallon tank and
crib for a 2 DR house. Subsequently (sometime between 1971 & 1979)
the house was enlarged to 4 BR without enlarging the septic system.
Also, in 1981, a second well was drilled and the original well
disconnected.
The upgrade plans are for the 4 BR house, using a 1250 gallon tank
and appropriate absorbtion area. The old system is to be removed
and the original well filled.
Please review the plans and issue permit for the upgrade. If there
are any questions, please contact me at 688-2417.
Sinqerely,
David R. Dayton
P.S.:
The existing system was deemed inadequate by S & S Engineering
in December 1986. A conditional approval was issued by you
on 12/18/86.
David R. Dayton p.E.,R.I..S.
SR 1 Box 1026
O~uglak, AK 99567
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14-
15-
16-
17-
18-
19-
20-
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Deplh Io Waler After ·
Monltorlnu? ~ Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __
TEST RUN BETWEEN __
COMMENTS ~/~ O ~J P~f~. '~l"~ ~,~ ~M~,3"~q[ ~ ~
(minutes/inch) PERC HOLE DIAMETER __
-- FT AND FT
PERFORMED BY: ~h~'/~ ~ ~,~-~',.~,v' I ~"~'~ ~ ~)"¢~ ~/ CERTIFY TH, A~ THIS TJ~ST WAS/PERFORMED IN
AOOORG^NOE WITB ^'~ STATE AND MUNIOIP^' ~IDE~INES iN E~PEOT ON THIS DATE~ OATE~
72~008 (Rev. 4/85)
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
12
13
14
15
16
17
18
19
20
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT ~-
DEPTH? pO
E
Oeplh lo Waler Alter
Monitoring? Dale:
SLOPE SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER __
COMMENTS
TEST RUN BETWEEN FT AND FT
PERFORMED BY: ~ ~-'~) I T'~,¢o.o I~. ~-r0~J CERTIFY THAT THIS TEST WAS PERFORMED IN
72-008 (Rev. 4/85)
,/
SULLi' WELLS
P. O. BOX 27: .-'PHONE 688-2769
OWNER OF LAND
ADDRESS .~ ~
LEGAL DESCRIPTION
DATE - Stnrted _ ~,~.
PERMIT NUMBER __
Ended
DEI"I H OF WELL ~?,~. 0
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR ge) ~{/q~ ....
KIND OF CASING ~ ~ .
KIND OF FORMATION:
From-:,.~---Ft, to-, ~ Ft ....
From ..~ Ft. to_/_,c_..__Ft.__
From~__Ft. to._~,_a__
From =~ ,~__Ft. to ;?, ~ Ft .... ~ £~ .,-~ ...........
From-,~--Ft. to ~ . ,.~ Ft, -;
From
From
F'rom Ft.
From ...... Ft.
From ..... Ft.
From.,L~_'! ~ Ft. to_.LLd '~ .Ft.
Froot. =,"'i ~ Ft. to_L ~".7 Ft. .,Y~'":
From ,,vJ _Ft. to~/'~'~' Ft.
From Ft. to _Ft
Fmm~, )"" Ft. to,~ ,,, ~' Ft,~~%'~'
From Ft. to.__Ft. C,o,o
From Ft. to --Fl,-
From_Ft. to Ft.
From____Ft. to ._.Ft.
From__ Ft. to .... Ft.__
From Ft. to
From ....... Ft. to
From Ft. to
From Ft. to____
From____Ft. to
From_____Ft. to__
From ..... Ft. to
From Ft. to
From Ft. to ....... Ft ...................................
From ..... Ft. to______Ft .............................
Ft ......
Ft,
Ft .....................
Ft ...........................
__Ft ................................
From Ft. to ___Ft ............
From Ft. to .... Ft
MISCL. INFORMATION:
From F
....... t. to ....... Ft ..................................
From .... Ft. to ...... Ft
DRILLER'S NAME
~'~' ~.TER ANCHORAGE AREA BORe ~H
HEALTH DEPARTMENT ~T? ~ 3 ?
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
ADDRESS,~/%
LIQUID CAPACITY
COMPARTMENTS
GALLONS. INSIDE LENGTH .INSIDE WIDTH __DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIAl
NEAREST LOT LINE
TILE DRAIN FIELD:
__OR WIDTH // '~"- ,LENGTH / ~- , DEPTH ~'~ !
· DISTANCE FROM WELL /~;~-- ! , BUILDING FOUNDATION ~' ~ t
of, o' TOTALEFFECT'VEABSORFT,ONAREA(WALLAREA SQ. FT.
DISTANCE FROM WELL , FOUNDATION ,~-~/'~~ E . oFTOTALLINEsLENGTH
NUMBER OF LIN~/ DISTA~'I~'[E'~EEN LINES TRENCH WIDTH~H~ .... ' IN. TO
AB TkIO'~ AREA SQ. FT. LENGTH OF EACH LINE
EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL: TYPE ~--~T[. ~.-', //~r,j , DEPTH /~/ DISTANCE FROM /~ ~ WATER
, BUILDING FOUNDATION _SAMPLE , NEAREST
LOT LINE ( , SEWER LINE '~ , TANK , SYSTEM CESSPOOL , SOURCE~
DISTANCES:
z
CD~ ~'Z~
DIAGRAM OF SYSTEM
DATE
GREAi'ER ANCHORAGE AREA BONOUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3Lo0 TUDOR ROAD POUCH 6-6~O
PERMIT NO.
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
INSTALLATION OF: SEPTIC TANK ~ SEEPApE PIT ~ , DRAIN FIELD. ., OTHER
FINANCED TH ROUGH
TO BE INSTALLED BY
t? )./!,~"~',~ ,~,~'/, x..../ NOTEl THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
/-
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE ~U~[/~ TYPE SEEPAGE AREA SIZE TYPE ~
DIAGRAM OF $Y$TEM
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT DRAIN FIELD
SEPTIC TANK TO SEEPAGe P}T Wall
/
SEPTIC TANK ~ ., SEEPAGE PIT DRAIN FIELD
TO NEAREST LOT LINE.
WELLTO SEPTICTANK 6- 4 /
, SEEPAGE Pit .
DRAIN FIELD , ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, ~ ~/~ SEEPAGE PIT
TO RIVER, LAKE, STREAM.
, SEEPAGE PIT
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET into UNDISTURBED
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PET
FITTED WITH AIRTIGHT ~EMOVABLE CAPS,
GRAVEL DACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION,
LICENSED DES]GNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCR[SED SYSTEM ES in ACCORDANCE WiTH SAID CODE.
APPLICANT'~ SIGNATURE
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Sen/ices
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorage.ak,us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORIT' :iAppRoVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.O ~'1 ~ c~ g:2~o~ -- "7 ~'
1. GENERAL INFORMATION
Complete legal description Lot
Expiration Date:
147B, Section 18, T15N, R1W
'Location (site addres~or, directions) 18620 South Birchwood Loop
'Curr~ht propertybwne~(s) Robert Roles Day phoneNancy
Mailing add~:ess
688-8500
Lending agency
Mailing address
Day phone
Real EstateAgent Country Realty/Nancy Stably Day phone 688-8500
MailingA~dress PO Box 671925, Chugiak, AK 99567
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
4
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding Tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by
a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates
are valid for one year for propedies served by Class A or B wells or a public water system. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 01/00)*
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval
application show that the on-site water supply and/or wastewater disposal system is safe, functional and
adequate for the number of bedrooms and type ef 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
$ & S ENGINEERING
Name of Firm 17034 EagJe River Lan~ R_~=~ ,~o. 204
Address, Eagle River, AJas~ce 99577 --
Engineer s Printed Name "~'~/~,._/'Z .. ~/~/~.,-_.----
DHHS SIGNATURE
P//' Approved for ~ bedrooms.
Disapproved. ,:_
Conditional approval for __
Phone ~ ~ _ ~LC'/ 7 ~
Date
.....
~ ~ · ,O~*T C. COW*N /.~
~j,'<,~ _ · ............ ,
, bedrooms, with the following stipulations.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date: ~ - c~ - ~) O
Original Certificate Date:
Reissue Date:
75-025 (Rev. 01/00)*
I-CEIVED
Municipality of Anchorage MAR 0
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental ...... MUNLCiPALIJ Y OF ANCHO,~AGE ~.~
services IJiVlSlOn ~/tr~-IMENTAL SERVICES DIVI
825 L Street, Room 502 · Anchorage, AJaska g9501 · (g07) 843-4744
Legal Description:
A. WELL DATA
Well type
Log present
Health Authority Approval Checklist
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~" oc /
Total depth ~.~5 5'
Sanitary seal (~N) ¥
Date of test
Static water level
Well production
Cased to z2/~ /
FROM WELL LOG
O
g.p.m.
&" Casing height (above ground)
Wires properly protected ~N)
AT INSPECTION
,~- ,~ S-~O0
'7,0
WATER SAMPLE RESULTS:
Coliform O Nitrate
Date of sample:
B. SEPTIC/HoLDING TANK DATA
~, 5" Other bacteria 7
Collected by:
Date installed
L~-p.q. ~ Tanksize t1-'5'-o
Depression
Pumper ¢-i~-
Foundation cleanout (~)N) '~
Date of Pumping 7..--d 'l -~ c~
Number of Compartments -Z~ Cleanouts ~J4~4) t/
High water alarm (Y/N) ,,g L
C. ABSORPTION FIELD DATA
Date installed L~- ~. ¥~..-)
Length -'~'"¢ J Width
~ I Total depth 9' ? ~ I
Depression over field (Y~ ~
For ~ bedrooms
Soil rating (g.p.d,/fF or fF/bdrm)
'~' ~ Gravel thickness below pipe
Monitoring Tube present ~/N) ~/
Effective absorption area ,5'-<¢0
Date of adequacy test ,,.)-~ ~-~ c~ Result~ail)
Fluid depth in absorption field before test (in.); ~ Immediately af~te/720_ gal. water added (in.):
,
Fluid depth ~ (ins) Minutes later: '-'----- Absorption rate = ~¢2o g.p.d.
Peroxide treatment (past 12 months) (Y~ ~J6-~E- ~ If yes, give date
72-026 (Rev. 3/96)*
D, LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N) ~el-a*~-- "Pump off" level at*
High water alarm~ *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holdipg tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation lC) / '~ Property line ~c) //'~b'~sorption field /o
Water main/service line ~'~l ~ Surface water/drainage ,/~0 %L Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line ~:'~ ~--~,~ ~ Building foundation 1~ t~ Water main/service line
Surface water 1~ c:, ~ ~ Driveway, parking/vehicle storage area
Curtain drain r't'//~- Wells on adjacent lots [.o ~
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru
Signaturein conformance.~.)/...~..~/with MOA HAAzfluidelines~._in ~ffe~t~. on this date,
Engineer's Name ~~ '5'/~/~ r' ~", (~¢)~.~/Iv.J
Date :'J /2./~','
CE - 8801
HAA Fee $.
Date of Payment '~
Reca pt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
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
GENERAL INFORMATION
(e)
(b)
(c)
Application Date
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Applicant Name -~U, ~..~&~,H, ~' Telephone: .ornegOC~
Applicant is (check one): Lending Institution []; Owner/builder~; Buyer []; Other [] (explain);
Business
(d) Lending Institution Telephone
Address
(e)
Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address:
S & S ENGINEERING
Sgg, 196X
EAGLE kiVER, AK 99~77
TYPE OF RESIDENCE
Single-Family,,~ Multi-Family []
Number of Bedrooms '~
Other
WATER SUPPLY
Well~ Community[] Public []
Individual
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
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 1 of 2 72-025 (11/64)
ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA IA 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 arid 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 S & S ENGINEERING Telephone _/~ ¢'¢z_~.¢*~.~
SRB 196X
Address
DHEP APPROVAL
Approved for '~P'~'" O'S)bedrooms by ~ ~;~}' '"~ Date
Approved ' Disapproved
Terms of Conditional Approgal
Conditional
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 professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy 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
72-025 (11/84)
WELL DATA
MUNICIPALITY OF AN~~'I~PALITY OF ANCHORAGE (MO,~)
DEPT. CF HEAt. T~'IEALTH AUTHORITY APPROVAL (HAA)
ENVIRONMENTAL pROTECTI~[IECKLIST . FEBRUARY 1984
264-4720
0Efi 1 5 1986
Legal Description: L ~'T / ~/~1
RECEIVED ,z,,,.,
Well Classification
Well Log Present~)/N)
Total Depth ?, ~
Static Water Level
Cased to
Casing Height Above Ground
Electrical Wiring in Conduitt~/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
If A. B, C, D.E.C. Approved (Y/N) /~///~
Date Completed ~ ~ ~/ Yield .F~'~~g~
Depth of Grouting -
Pump Set At
Sanitary Seal on Casing l~'N)
Depression Aroun~ Wellhead (Y~I~
On Adjoining Lots
/O~ ' : On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~/~
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
Date /P-~- ,~ ~ - ,~'
B. SEPTIC/HOLDING TANK DATA
Date Installed /~2~,~-
Standpipes ~/N)
Depression over Tank (Y~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
Size ~'<:~ No. of Compartments /'
Air-tight Caps (Y~] ~ O Founoauon Cleanout (Y~J~
Date Last Pumped -~
: for
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course ~'//2j
To Building Foundation ~':~ /
To Disposal Field ,~ /t
To Stream. Pond, Lake or Major Drainage
Comments
'5
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~'~
Date Installed /L~- 7.~ - ~-/
Width of Field / ?.
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
Square Feet of Absorption Area ~--- ;~ ~ '~
Depression over Field ~/N)
Results of Last Adequacy Test ~
Separation Distance from Absorption Field:
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~ ~1 &~ t 5 Fu~ ~ w~c~
Type of System Design
Length of Field /~__/
Depth of Field /.~
Gravel Bed Thickness
Standpipes Present{~/N)
Date of Last Adequacy Test ,--~
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~O
To Cutbank (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test, Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection,
/ /
SignedsR ~ ~;,~, Date
Compa~l~C~.~ ~.,~.~,, ~, ~ MOA No.
~ H~l~H ~O '~G ~,~
72-026 {11/~4)
ROSERTA. SHAFER
December 18, 1986
CIVIL ENGINEER
694-2979
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, Alaska 99501
ATTENTION: Steve Morris
REFERENCE: Lot 147A; Section 18; T15N; RtW
This letter provides information that you requested to supplement a
conditional Health Authority Approval requested for the referenced
property. The existing on-site wastewater disposal system appears
to be functioning in a way that does not create any health hazard.
There is no evidence that sewage has surfaced anywhere throughout the
system and we do not anticipate that it will during the interim period
between now and the time the system is upgraded.
If we may provide additional information, please contact us.
Sincere~
/~'lt~AS/ss
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
SRB 196X EAGLE RIVER, ALASKA 99577
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date ~-'~-Y '~,, ,~,¢i~,
GENERAL INFORMATION fMUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property Owner :~g' 8/z-~,,c,~Jr Telephone: Home
Mailing Address t°~o, /~; 67 O"~,~ ~) ~
(c) Lending Institution Telephone
Business
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the followinc~ address: or: Check here E~, if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Family,~
Number of Bedrooms
WATER SUPPLY
Individual Well]~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite,~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 fRev 8/86/Front
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.
NameofFirm -~,zl'~'z~ ~7, ,/~/2'a~J / ~, Telephone
Address ~ I ~ ~0~ C ~el~ ~
Date ~ ~/ 4~1
DHHS APPROVAL
Approved for -"P-o',~'- ~'~-'~) bedrooms bg.~~'~ ~' "~o.-~.-~..~ Date
Approved ~ Disapproved Conditional.
Terms of Conditional Approval
Engineer's Seal
CAUTION
The Municipafity 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.
Page 2 of 2 72-025 IRev 8/861 Back
MUNtCIPAU'fY OF ANCHORAQ£ MUNICIPALITY OF ANCHORAGE (MOA)
ENVi~,ONM£NTAL SERVICES DIVI$1OI',HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
JUL 6 1987 264-4744
Legal Description: ~'~'
RECEIVED
WELL DATA
Well Classification
Well Log Present (Y/N) ~/C~.~
Total Depth ;~.-.E, :~' Cased to
Static Water Level 4'7
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
If A, B, C, D.E.C, Approved (Y/N)
Date Completed ~,~/~/ Yield
~ Depth of Grouting
Pump Set At
~/~ Sanitary Seal on CasingS/N)
~'~ Depression Around Wellhead~
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments ~
; On Adjoining Lots /~o' "~-
To Nearest Public Sewer
Nearest Sewer Service Line on Lot ,'/~ '~
; Date /.27/~/~
$. SEPTIC/HOLDING TANK DATA
Date Installed ~'/~'/
Standpipes (Y/N) ~/~ ~'
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /~ 7
To Property Line
To Water Main/Service Line ,'/~'
Course
Size ~t ~.~"O No. of Compartments
Air-tight Caps (Y/N) ~/~" -~ Foundation Cleanout (Y/N)
Date Last Pumped ~'/E~u,J
; for
,/t//(¢ Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026 (Rev 81861 Fronl
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field ~--~¢~
Square Feet of Absorption Area ~""'~
Depression over Field (Y/N) /V'¢
Results of Last Adequacy Test ~'~--'-~
Separation Distance from Absorption Field:
To Water-Supply Well ,/¢'~ /
To Building Foundation ¢'~' !
Lot /'-¢"' !
Type of System Design
Length of Field
Depth of Field ~' /
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Water Main/Service Line . /~¢ ! '¢'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line ~-¢ /
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
2o/
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** 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 date of this inspection.
Signed Date
Company MOA No.
Receipt No. //~ O / OCD//
Date of Payment 7- ~,~ ~"~
Amount: $ ~,¢/'(-~ ~
Page 2 of 2
72 026 fRev 8/86) Back