HomeMy WebLinkAboutGATEWAY TO THE PARK BLK 2 LT 2Gateway to
th
Park
lock 2
Lot 2
081-021
-17
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
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241226
Work Type: Septic Upgrade
Tax Code Number: 06761117000
Site Legal Address: GATEWAY TOTHE PARK BLK 2 LT 2 G:1005
Site Mailing Address: 32580 EAGLE RIVER RD, Eagle River
Owner: DENTER DEAN H & DEANN C
Design Engineer: ALASKA RIM ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
8/27/2024
8/27/2025
43560
Q Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: 12 Date:
Issued By: Date: 2
4
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 06761117000
Property owner(s) Dean &Denann Dent Day phone
Mailing address 32580 Eagle River Road, Eagle River, AK 99577-9751
Site address see above
Legal description (Sub'd., Block & Lot) Gateway to the Park, blk 2 1ot2
Legal description (Township, Range & Section)
Lot Size 43560 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
P-1
Initial El
Single Family (SF) ED
(w/wo ADU)
Septic Tank
El
Upgrade
Duplex El
(D)
Holding Tank
D
Renewal
Multiple Dwellings El
Privy
❑
(SF and/or D)
Private Well
D
Water Storage
0
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.
dal)6e
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment: Z��Z_'t
Receipt Number: 1031
Permit No. 0�;P2Lf ZZ
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GAIDevelopment Services\Building Safety\On Site Water and WastewaterTormsUient FormsTermit Application.doc
ARE, LLC
dba ALASKA RIM ENGINEERING
CONSULTING CIVIL ENGINEERS & PLANNERS
1920 Kentucky Derby Dr.
Palmer Alaska 99645
Telephone: 907.775.2347
Email: alaskarimengineering.llc@gmail.com
Professional Consulting --- Practical Solutions
ARE LLC, project # 2024036
August 7, 2024 Revised August 21, 2024
Municipality of Anchorage, D.S.D.,
On-Site Water and Wastewater Department
4700 Elmore Road, Anchorage, AK, 99519
Re: Gateway to the Park, Block 2, Lot 2
32580 Eagle River Road
Parcel ID 067-611-17
Subject: Septic System Replacement/Upgrade
Design Narrative and Permit Application
Dear Plan Reviewer,
The owners of the above 4-bedroom home septic tank would like to proactively replace their septic
tank and Field.
SOILS
Two test holes were excavated on June 27, 2024, and logged by Charles A. Leet, PE. The test hole
was advanced to a depth of 14 and 15-feet. The soils consisted of sand, gravels, and cobbles with
traces of silt. No groundwater was detectable after 10-day monitoring, see the attached soil logs.
PERCOLATION TEST
The percolation test was conducted near the test pit see site plan and soils logs. Based on the
percolation test the soil application rate 1.2gallon/day/square feet was selected, see the attached soil
logs.
TOPOGRAPHY
There are no topographical issues on the subject parcel. See the attached site plan for the topography.
SEPTIC TANK REQUIREMENTS
The existing septic tank is located near the driveway and within ten feet of the building foundation.
The new tank will be located near the existing tank and ten-foot away from the foundation. The new
tank will be 1250 gallon tank meeting the AMC Chapter 15.65.
The old tank will be abandoned in place, backfilled with sand and lime.
DRAIN FIELD DESIGN
We are proposing a 5-wide absorption field that will be constructed parallel to the existing field down
gradient from the existing field. The residence is a 4-bedroom dwelling with a design flow rate of
600 gallons per day. The prescribed application rate is 1.2 gallons/ft2. The required area is 500 ft2.
We are proposing a 5-wide trench with a 4-foot effective depth with a length reduction factor of 0.50,
with those dimensions the drainfield will be 50-feet in length for a total of 500 ft2.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241226, Curtis Townsend, 08/27/24
Gateway to the Park, Block 2, Lot 2 Page 2 of 2
August 7, 2024
Professional Consulting --- Practical Solutions
REPLACEMENT SYSTEM
There is sufficient area for a redundant/ alternate site to be installed within the 30 foot radius of the
test hole. See attached design drawing for the primary and alternate site locations and specifications.
SURFACE WATERS
There is no surface water within 100 feet of the proposed system. Drainage arrows on the site plan
indicate the slope and direction of stormwater runoff. (See attached site plan)
WELLS & DRINKING WATER
There are no water wells within 100 feet of the proposed system. The property is served by a private
well.
SURROUNDING PROPERTIES
We do not anticipate any adverse effects on the neighboring septic systems, reserve areas or drainage
patterns by the installation of the proposed wells and septic system.
Sincerely,
August 21, 2024
Charles A. Leet, P.E.
Principal Engineer
Attachments:
• Permit application
• Area Map
• Proposed site plan
• Trench detail
• Soil(s) log w/ percolation test data
August 21, 2024
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241226, Curtis Townsend, 08/27/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241226, Curtis Townsend, 08/27/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241226, Curtis Townsend, 08/27/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241226, Curtis Townsend, 08/27/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241226, Curtis Townsend, 08/27/24
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~, MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 2~720
~ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~ , ~HONE ~] ~EW
Liq~allons IF HOME.DE: Inside length '' Liquid d~pth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O Z ( Manufacturer Material Liquid capacity in gallons
Well Foundatio~/ Nearest Io~ ~ PERMIT~o~
,~e Trench
~ ---- ~ ~--~ ~~ ~ No. of lines/ Length~h. Total ~of~ nos . Distance~e~
~ ~ Top of tile toji~Sh ' Material b~eath tile
Length Width Depth P~RMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO;
~ Class Oepth Driller Distance to lot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
/ /''-
INSTALLER
REMARKS .... , ~J ~ .
APPR~ DATE LEGAL
~MUNICIPALITY OF ANCHORAGE~
Department f ~ealth and Environment~ Protection
825 L Street, ~nchorage, ~CK. 99501
264-4720
' ~//~ * * * HANDWRITTEN PERMIT * * *
Permit ~~v_ ~o WELL AND/OR 0N-SITE SEWER PERMIT
Applicant: /~/T~ ~/f~/~oT- Mailing Address: ~
/
Location: ~~ ~ ~~ Phone N~er: 3 ~- ~ ~ 7
Description: ~ ~/~ ~ /i~~~~~ Lot Size:
Legal
T~e of Soil ~sorption System .
Trench: ~ Drainfield: Seepage Bed: __ Holding Tank:
Max~ N~er' 'Xof Bedrooms: ~ Soil Rating(sq.ft/br) /~
The Required Size of the Soil ~sorption System Is:
DEPTH ~ 5 LENGTH ~ GRAVEL DEPTH ~'~ WIDTH
The length d~ension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
t~e bottom of the excEvation(in feet). There is no set width for trenches.
The gravel depth is the m~im~ depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
· * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~ GALLONS
Pe~it applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the n~er
of residences that the well will serve.
· * * TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Min~ distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minim~ distance from a private well to a private sewer line
is 25 feet and to a co--unity sewer line is 75 feet. Well logs are required
and must be returned to this department witnin 30 days of the well completion.
Other requirements may apply. Specifications and construction diagr~s are
available to insure proper installation.
· * * PERMIT EXPIRES DECEMBER 31, 1 9 * *
I certify that:
(1) I ~ f~iliar with the requirements for on-site sewers and wells as
set forth by the M~icipality of ~chorage.
(2) I will install the system in accordance with codes.
(3) I understand tnat the on-site sewer system may require enlargement if
S igne~:
the residence is remodeled to
~pplicant
S~rP/024 (1/81)
include more t~h.a~ 3 bed~s.
Issued by/~¥~--~
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
?/~i 7'1--/
SLOPE
/
Ty' G-/~f:t C/~(/**~/
DATE PERFORMED:
SITE PLAN
10
11
12
13
14
15
16-
17-
18-
19-
20-
WAS GROUND WATER
ENCOUNTERED? ~.~/O SL
O
P
E
IF YES, AT WHAT
~;~ ~ '7-77_.~/~? ~¥-"' DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
/
PERCOLATION RATE ~J / ~ (minutes/inch)
TEST RUN BETWEEN FT AND __ FT
COMMENTS
EAGLE RIVER,-ALASKA
338,5312 '.,~
OWN~.R c
ADDRESS
EAGLE ~ ~/:ER ALASKA 99577
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 06-J-611-iUr
1. GENERAL INFoRMATIoN
Complete legal:description
COSA# O%C..l/t DOq
Expiration Date: -//
L°cation (site address)
I
Current Property owne[(s)
Mailing address`
Lending agency
Mailing address
Real EstatbAgent',:.. ~o,,~. Flor;o
.l~illng Address ;,...
Un/ess othe~wi~'Nq~leste~li'C.OSA will be held by DSM for pickup.
NUMBER .0 F::,BED' dOoMs: L/
Day phone
Day phone
Day phone -/--H~ ~ HfiOO
TYPEOF WATER'SuPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well [~' Individual On-site
Individual Water Storage [] Individual Holding Tank []
Community Class. Well [] Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems ApprOval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSM also issues COSAs upon request to homeowners. Certificates of On-Site Systems 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. (Certificates may be reissued for a period of up to one year with valid water
samples.) Cedificates 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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my. investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 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(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Engineer's Printed Name
DSD SIGNATURE
~' Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone
Date
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
By:
(Rev. 11/05)
Arsenic Advisory
Maintenance Ag reements
Supplemental Engineer's Report
Other
Original Certificate Date: ~.~ ' ,.~, ~- 1/
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type
Date completed
Total depth | 2[ ff.
Parcel ID: 067--CJI- i~-
If A, B, or C provide PWSID # ~
Sanitary seal (Y/N) ¥
Cased to l?--~ ft.
Well Log (Y/N) "/
Wires properly protected (Y/N)
Casing height (above ground).
in.
Date of test
Static water level
Well production
FROM WELL LOG
,=~ g.p.m.
AT INSPECTION
g.p.m.
WATER SAMPLE RESULTS:
Coliform A~ colonies/100mL Nitrate I,~-~, mg/L
Arsenic: /VD ug/L date of sample: ~
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material ~.~-
Tank size 1'7-~O gal. Number of Compartments
Foundation cleanout (Y/N) ~ Depression over tank (Y/N)
Date of pumping ~1~/~[ Pumper
C. ABSORPTION FIELD DATA
Date installed 6,[t'~/l~H So,lratin9 {g.p.d./ft2or~~
Len9th "P.~ ft. Width ,.~
Collected by: /~ r.~ -~ ~ J~ nc,I
Date installed ~/IZl I~Jcg ~
Cleanouts (Y/N),
/X/ High water alarm (Y/N) /V'
Total depth ~ ft. Eft. absorption area f,~¢o ft~ Monitoring tube
Date of adequacy test Gl~/Zoll Results(Pass/Fail)
Fluid depth in absorption field before test ,~ in.
Elapsed Time: 13.0 min. Final fluid depth l0
Wate~ added (~00 gal.
in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type ~h~Jlo~ ~T~¢.c k
Gravel 'below pipe. .~ ~ ft.
Depression over field A/'
For ~ bedrooms
New depth ~0 in.
~00 g.p.d.
If yes, give date ~
D. LIFT STATION
Date installed /
"Pump on" level at ~
Datum J
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at ~
Cycles tested ~J
~l~anhole/Access (Y/N)
High water alarm level at ~
Meets alarm & circuit re rq~ements?
in,
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankJlift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
Animal containment areas .5o '
On adjacent lots I O0 ~
On adjacent lots ./o~)'
Public sewer manhole/cleanout
Holding tank /v/~
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 ~- Property line 5' 4-
Water main /v/A Water service line lO ~+
Wells on adjacent lots 1 O0 ~-/-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
!
Property line /0 -~ Building foundation
Water Service line JO t4- Surface water 100
Curtain drain SD"/' (~.) Wells on adjacent lots
Absorption field .~ !+
Surface water lO0 ~ ~A~, 0~
Water main A///~
Driveway, parking/vehicle storage
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name
Date
COSA Fee $.
Date of Payment
Receipt Number
-
II.
Waiver Fee $
Date of Payment
Receipt Number
(Rev. 4/10)
;ASDiENTS OF RECORD, OTHER THAN
'HOSE SHOWN:'~] THE RECORDED
bAT, ARE. NOT SHOWN HEREON,
' ' :tb'iiity ' " ! " '":" ' '""*
;-.. It ls'--:the respons of the owner ;to~ dete'rmf~ :"-":': '"';
the' existence of:any easements, covenants; .or. re.--L. :i --:':"~?
:. strictiO, ns which'do not.appear· on the-recorded'sub-:-'-- .... -
· ..'divisio'h plat, Under no 'circumstances s~ould anY',.~-''~:'~''~''
data-hereon be used.for construction or. for ese'ab~ !" '"'
" , resl~ons-i,b(lity for the i. nitjal transactibn only--:-:--'~ "" :"",
..~ ;.. " - LEGEND: - ~' · . *:- -" ' ':
. , , , ~-,-,-- ,.,. ! ' . . -.-: .-:.~
~ kO'i~ SURVEY CERTI FI.C_ATIOI~ ' ' ' $ .,,ss c,, .o.~.~' ..... : I , -'. ' .,- .,.' ,
)T ~ BLOCK ~ - . - :, ' : ' 1:3 ,u.x,.~.u. ~ ~r.c.''i': """'":":. ,/.F'" '/
~?.':./-'" 'i~'fi-,~l~:z: ."~-",~ ' ~I'~-~.";,~ -.'.-. l~,..~o~t I'-,~-' '
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 2, Block 2, Gateway To The Park
Location (address or directions)
Mi, 12.2 Eagle River Rd.
(b) Property owner T(eith Randt Telephone: (home)
Mailing Address P.O. Bn~ 774027, Eagle R'[ver, A~:- 99577
(C) Lending Institution Telephone
Mailing Addres~
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
~.~.,~_'~, t -~ !- \ '~ HAA# ~ ~"~,9~
Business
(d) Real Estate Company and Agent ~-~-~9~ R~al~- .g~nn~ ('n~l
Address 8~A0 R~gl~ R-~'~7p~ I~t .. ~gl~ p~7~-: A~. qqq77
Telephone 69~-499zl
(e) Mail the HAA to the following address: (or check here Q. if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family ~,X Number of bedrooms 4.
3. WATER SUPPLY
Individual Well ~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site;~ Public [] Community [] Holding Tank []
Note; If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 IRev 7/88} Page I 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 Firm Telephone
S & S ENGINEERING
Address 17654 ~.a.~!: R'.'~
Date Eagle River, AJaska 99577
6. DHHS APPROVAL
Approved for ¢
Approved ~-
/
.._ Disapproved Conditional
Terms of Conditional App, roval
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated 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 DHHSdo 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 7/88) Back Page 2 of 2
~ MUNICIPALITY OF ANCHORAGE (MOA)
(k~J~/~UTY OF AI, Elali#i~uthority Approval (HAA)
=,~AL SERVI(:~$'IB'(~(~I~T - FEBRUARY 1984
.... ~ 343-4744
Legal Description: ~
If A, B, C, D.E.C. Approved (Y/N) ~'~//--~
Yield '-~;>. ¢)
Pump Set At ~,~\L..~.
Sanitary Seal on Casingd~TN)
Depression Around Wellhead (Y/~,
JUN 7 1989
RECEIVED
A. WELL DATA
Well Classification
Well Log Present ,~'~TN) ~.~ Date Completed [4; -'Z~-
Total Depth ~'Z.-~ Cased ~.~, ~ I Depth of Grouting
Static Water Level
Casing Height Above Ground ~,
Electrical Wiring in Conduit~'/N) y
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
; On Adjoining Lots
~ \ ~_.~i .+ ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
Water Sample Collected by <:-~ ~' ~ ~"~-~ Ic-~-'~:::~'2,-~,,'~'d'' ; Date
Water Sample Test Results z'"~/~'~<:7 T~'/~'L-"~ ~ .~--t*~~~'~-
Comments-)/( "~-~.~.~'"~,.~.z~'~,_..~ '~_7~-"1~~ [~_~_~ ~ ~ ~ ~1 ~ /';~ ~/r //
B. SEPTIC/~ TANK DATA
Date Installed (~';~ ~"~' ~Aj Size !'~-~-~ No. of Compartments
Standpipes ~N) "f Air-tight Caps (~N) "/
Depression over Tank (Y/~ [-4
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
t~D~t~%.te Last Pumped (,~ ~ ~ '
; for
Temporary Holding Tank Permit (Y/N)
Foundation Cleanout {:~g~l) '~
To Building Foundation
To Disposal Field
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata \ '~::~-F---"~//~'~-A-- Type of System Design .'~-~,
Date Installed (¢~ .o- \'7~ -~_.~'~ Length of Field .-.~..~
Width of Field .~ ~
Depth of Field
Gravel Bed Thickness ~-~) .'~
~..--'~ L-;, ''~ Statndpipes Present~Y/N)
~ Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
Square Feet of Absortion Area
Depression over Field (Y~J~
Results of Last Adequacy Test
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
i \ r._?,d¢ To Property Line \t- ~ ~r
~->~-~ ~ To Existin~l or Abandoned System on
; On Adjoining Lots '-~; ~
,/,
\~_.~t cF To Cutback (if present)
\ c__~._, t,+
Comments
Date Installed
Dimensions
Size in Gallons
"Pump~
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Manhole/Access (Y/N)
"Pump Off" Level at
~% Vent (Y/N)
'""'~ng-- 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 effe~t~q~-~,t~
inspection. ~.~,"~-~.O, ~
Signed s & S ENGINEERING ~ '
Company ;~flle__ River. Alaska 99577 ~ ./:~,~,;.,
Date
Receipt No. ~ ~ '~// ~- Receipt No.
Date of Payment ~' ~¢H Waiver Fee: $
Amount: $ ~- ~ Date of Payment
~ o~e (R.v z/~) ~ck Page 2 of 2
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL ~r~ALTH
DEPART~NT OF ~EALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR F~TH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a) Legal Description (include lot, block, su~ivision, section, tg~shi~ raqge)
Location (address or directions)
(b) Applicants Name~///;
Applicants Address ~Z~L~
(c) Applicant is (check one) Lending Institution
Buyer ~ ; Other ~explain);
(d) Lending Institution
Address
Telephone - Home
Business
~-~ ; Owaer/builder~;
Telephone
(e) Real Estate Co. & Agent
Address
Telephone
(f)/~t~e HAA to the following address:
8 & ~ E."IGIHEERINR
2. T~pe of Residence
Single-Family~
Number of Bedrooms
Water Supply
Individual Well~l'
Multi-Family ~--~
Other (describe)
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
Onsit .e/.~ Public ~ ! Community ~ Holding Tank I J
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]
5. En$ineering Firm Providin~ 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 wast.water 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 wast.water disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm
Address
Date
DHEP Approval
Approved for ~g~u~- ~Z/) bedrooms
Telephone
(ENGINEER SEAL)
Approved . ~ Disapproved Conditional __
CAUTION
THE MUNICIPALITY OF ~NCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES ~ALTH AL~HORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY .~N INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF Ak~SKA. THE DHEP DOES THIS AS A COURTESY TO PURCF~SERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~D STATE REQUIRE-
MENTS. ~MPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
ae
MUNICIPALITY OF ANCHORAGE (MOA)
CHECKLIST - FEBRUARY 1984
Legal Description:
T~.T .r. []ATA
Well Classificatioj% ~/~/~/~ If A, B, c~ C, D.E.C. Approved(Y/N)
Well Log P=esent0/RD ' Date C~,~leted J~4A7 ~ Yield~f~4~.
Total Depth /~ / ' Cased to /'2]'--~,v~)/,~ Depth of Groutin(/
Static Water Level ~6) ' Pump Set At ~,(
Casing Height Above Ground ~( ;' Sanitary Seal on Casir~)
Electrical Wiring in Conduit (~ Depression Around Wellhead
Separation Distances f~cm Well: ~- L~'~-~ ~ ~': ~-~ ~ ~"~-'7~: ~'~ ~ ' ~ ....
To Septic/Holdir~ Tank on Lot /~ ~ /~ "' '~-' -~
; O~ Adjoining Lots
To Nearest Edue of Absorption Field on Lot //62 '~ ; On Adjoining Lots
To Nearest Public Se%~ Line ~ /~f- To Nearest Public Se~r
Cleanout/Manhole /~ /f~ To Nearest Se~r Service Line on Lot
Water Sample Collected By_~'-~ ~F/~4~//~; Dete /~/_~O/~&
Wate~ Sample Test Hesults '~' ~' ' '
B. SEPTIC/HOLDING TANK II~TA
Date Installed
Standpipes ~
Air-tight Caps Y~
Date Last-Pumped
No. of Compartments ~
Foundation Cloanout~)
Depression ove= Tank (Y~
Pumping/Maintenanc~ Contract on File (y~/4- ; for
Holding Tank High-Wate= AlalTa (Y/~//9~ Temporaz-f Holdir~ Tank Pe=ndt (Y/N~///~
Separation Distances frcm Septic/Holding Tank:
To Water-Supply W~ll /~
To Property Line /0
To Water ~n/Service Line
To Building Foundation /d)
To Disposal Field ~ /
To Stream, Pond, Lake, or Major Drainage
Cc~nents /0 0/,~ ~?
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD E~TA
Soils Pating in Absc~ption Strata
Date Installed 6/~ ~
Width of Field ~(~ "
Square Feet of Absorption A~ea
Depression over Field
Results of Last Adequacy Test
OCT 5 i
RFCEIV,ED _
~' Type of
Length of Field~
~p~ of Field
~~ Sta~ims ~e~nt
~ of ~st ~a~ ~st
Separation Distanoe frcm Absorptio~ Field:
To Water-Supply Wsll //~ ' ~ To ~ty Li~ /~ ' ~
To Building F~n~tion ~ ~ t TO Existi~ ~ ~nd~d Sys~m ~ '
Lot ~~ ; ~ ~joining ~ /~ ~
To ~te~ ~vi~ Li~ /O ~ To ~t~(if ~nt) ~ ~ ~ ~
To St=e~ond~ke/~ ~jo= ~ai~ C~ ~ O ~ ~
To ~i~way, ~ki~ ~ea, ~ Vehicle St~a~ ~a ~ ~ ~
C~nts ~ ~ ~ ~
D. LIFT STATION
Date Installed
Size in Gallor~
"Pump On" Level at
High Water Alarm Level at
Tested for
Elect~zical Codes(Y/N)
Dimensions
Manhole/access (Y/N)
~~, ,!.,/~Off" Level at
Vent (Y/N)
Meets ~DA
Computer, ts
** Check Permitted Bed~ocm Rating A~ainst HAA Request
I oe[,tify that I have checked, verified, c~ confc~med to all MOA HAA Guidelines in effect
on the date of this inspection.
MOA No.
