HomeMy WebLinkAboutGLEN EAGLE BLK 1 LT 3A
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: ~wq~Ol~'2- PID Number:
Name: Wastewater System: ~ New ~ Upgrade
*~"~: ABSORPTION FIELD
~ /~2~
~o~6: I No. of ~drooms:
~ ~ IV~ m ~ ~q~7 7 D Deep Trench ~Shallow Trench D Bed ~ Mound D Other
LEGAL DESCRIPTION so, Rating: ~. ~GPD/Sq. Ft. Total Depth from original grade:~ .~--,
Lot: Block: Subdiv~ion: Oepth to pipe bottom from original grade: Gravel depth beneath pipe
~ J ~ ~ ~ ~ ~Ft. J Ft.
Township: Range: J Section[ Fill added above original grade: Gravel length:
I
/ Ft. /~ Ft.
WELL: ~ New ~ Upgrade Grave~ width: Number of lines: Distance between lines:
~ Ft. ~ /~ ~t.
Classification (Private, A,B,C); ~/~ Total Depth: ~ Cased To: Total absorption area: Pipe material;
Driller: Date Drilled: ilaIic Water Level: Installer; Date installed:
Yield: ~ GPM Pump Set at:/~ Ft. Casing Height Above Ground:~ Ft. TANK
SEPARATION DISTANCES a Septic ~ Holding ~S.T.E.P.
To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~~ ~E ~
Material: Number of Compadments:
su~.c~ , LIFT STATION
Water /O~ ~ ~ I~ + I~0 ~
Lot Size in gallons: Manufacturer:
"Pump on" level at: I "Pump off" level at: I High water alarm at:
Cu~ain Pump Make & Model Electrical Inspections pedormed by:
Remarks: BENCH MARK
Location and Description:
Assumed
Elevation:
ENGINEER'S SEAL
Inspections pedormed by: 1703,4 Eagle Elve~ Le~ E~d, Ne. 2~
Dates: Ist 7-~ - ~
~ 2nd 7-7
Department of Heal and H n Se~ices appr~al/
Reviewed and approved by' , . Date:
Permit No. SW940182 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
GLEN EAGLE SUBD., BLOCK1, LOT 3A 05060128
Legal Description: PID No.:
CO1
CO2
/-FINAL GRADE ] 19.4~ M?4
MH MT2 114,5'
INSULATION
NEW
1250 GAL
S.TE.P,
SYSTEM
12.2'
N.T.$
/ ~ / · 107.2' WATER FOUND 5/30/94
~ MTll88.0190.0 ]
/
--~NEW 1250 GAL.
Si.T.E.P. SYSTEM
72-013 A (1/93) *
ED'S ELECTRIC NC.
3138 COMMERCIAL DRIVE
ANCHORAGE. ALASKA ~9501
VALPEZ
ANCHO[~AG
(907) 272-4591
JULY 12, 1994
S ~ S ENGINEERING
17034 NORTH EAGLE RIVER LOOP RD.
EAGLE RIX/ER, AK 99577
SUBJECT:
ELI{CTR].CAL INSTALLATION Ok'; LIFT
AT LOT 9A 'BLK 1
(~LEN EAGLE SUB.
].NC.
ED STROUT
OPERATIONS b[iNACEtl
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 (UPGR3~DE) PERMIT
PERMIT NUMBER:SW940182
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:KING MICHAEL W
OWNER ADDRESS:SRA 1629
EAGLE RIVERf AK 99577
DATE ISSUED: 6/21/94
EXPIHATION DATE: 6/21/95
PARCEL ID:05060128
LEGAL ]DESCRIPTION: GLEN EAGLE BLK 1 LT 3A
LOT SIZE: 44134 (SQ. FT.)
NUMBER OF BEDROOMS: 2 THIS PERMIT: 2
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHOR_AGE 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 343-4744 (24 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:
RECEIVED BY:
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SQIL TEST
PERCOLATION
TEST
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E,
June 06, 1994
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 'L' Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Glen Eagle Subdivision; Lot 3A; Block 1
Request you issue a permit to upgrade the septic system serving the
two bedroomhouse on the referenced property.
Test holes were excavated and percolation tests performed. The
approximate location of the test holes are located on the attached site
plan. At the time of excavation water was encountered at 8 feet in
test hole #1 and after seven day ground water monitoring water was
found at 7.5 feet in both test holes. Attached is the proposed upgrade
design.
We do not anticipate any adverse effects on neighboring properties by
the installation of the proposed septic system.
If you have any questions, or require additional information for your
review, please contact us.
A. ShaX~..E'
'LSU/jk
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
o
re'OX
SflI([V~[ qq[~ ,00[
30¥80d I"1 ]
NVId Ills
,0c5 = ,,L
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Glen Eagle Subdivision; Lot 3A; Block 1
1. The scope of this project includes the installation of a 500 gallon
septic tank effluent pumping (S.T.E.P.) system and two five foot wide
drainfields to serve the two bedroom residence located on the referenced
property. The existing septic tank is to be excavated to verify its
integrity. If the integrity of the existing septic tank is poor the
existing septic tank is to be excavated, pumped, crushed, and abandoned
in place and a new 1250 gallon septic tank effluent pumping (S.T.E.P.)
system installed. The existing leachfield is to be abandoned in place.
2o Construction shall be in accordance with the approved site plan and
design drawings, Municipal permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater Disposal
Regulations.
3. The contractor shall be responsible for obtaining any necessary
underground utility locates.
4. Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling.
5. Contractors installing wastewater disposal systems must be certified by
the Municipal Health Department for system installations. Owners
installing their own systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
1o A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
2. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
Page ~o
Glen Eagle Subdivision: Lot 3A; Block 1
June 06, 1994
Septic tanks installed with less than 4' of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the
building foundation. In the line between the tank and the leachfield
there shall be two adjacent cleanouts (unless an effluent pumping system
exists within the septic tank). These cleanouts shall be located on
undisturbed soil not more than 10' from the tank. The first cleanout,
in line, shall be to clean toward the leachfield. The second cleanout
shall be to clean toward the septic tank.
Final grading over the septic tank shall be such that a positive slope
exists away from the septic tank.
ABSORPTION TRENCH/DRAiNFIF. LD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The
bottom of the excavation shall be within 2 inches of level. If the
sidewalls of the excavation become smeared, they must be raked or
scratched (roughed-up) before gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to be installed
level with the perforations faced downward. Gravel is then to be placed
over the distribution pipe to provide a minimum of 2 inches of cover
over the pipe.
A silt barrier must be installed between the final gravel layer and the
native soil backfill. Ensure the silt barrier covers the entire gravel
surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter and installed
approximately in the locations shown on the design. The portion of the
monitoring tube extending through the gravel shall be perforated from
the bottom of the trench to the invert of the distribution pipe. This
is equivalent to the effective depth of the gravel as noted on the
design.
Backfill over the final gravel layer must not be less than twenty-four
(24) inches. Insulation must be installed when the backfill depth is
less than thirty-six (36) inches. The finish grade over the trench must
be mounded to prevent the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
Page Three
Glen Eagle Subdivision; Lot 3A; Block 1
June 06, 1994
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Type of Pipe Perforated
Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the
inspecting engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal)
must be installed between the final leachfield grave[[ layer and the
native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened grave].
with less than 3% passing the #200 sieve.
When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C. requirements.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the
installation of the wastewater disposal system. These inspections will occur as
follows:
The first inspection must be conducted after the excavation of ditches,
pits, trenches, or beds and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled before this
inspection.
The second inspection must be conducted after the placement of the silt
barrier, gravel, distribution lines, standpipes, cleanouts, and
insulation, but before the placement of any other backfill.
Page Four
Glen Eagle Subdivision; Lot 3A; Block 1
June 06, 1994
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required, especially with the
installation of multiple trenches, sand filters, pressurized distribution
systems, etc. Thus, the inspecting engineer is to be contacted at least 24
hours prior to the start of construction. If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractor's activities.
The owner shall contract with the contractor to perform the work outlined in
these specifications and plans and in accordance with the attached M.O.A.
permit. There will be no contractual arrangement existing between the
contractor and S & S Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to document the
contractor's activities. Final acceptance of the contractor's work rests with
the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or
omissions of the contractor or any other persons performing work on this project
or the failure of the contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer will not be
responsible for the construction means, methods, techniques, sequence,
procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG t PERCOLATION TEST
PERFORMED FOR:
· kG., DESORIPTiON/&'
DATE PERFOR~
~-~"/t,/ E/C/(~'~ Township, Range, section:
(ENGINEER'S SEAL)
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
SLOPE
WAS GROUND WATER
ENCOUNTERED?
/~,
IF YES, AT WHAT
DEPTH?
Monitoring? / · ~' _ gate:
SITE PLAN
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE (m~nuteslmch) PERC HOLE DIAMETER
'lEST RUN BETWEE D ? FT
COMMENTS
Eagle
EiYer.
Alaska
99577
~ESA~E~E~T N THIS DATE DATE
ACCORDANCE WITPTALL STATE ANDMUNICIPAL GUIDELI~xI~EFF~T O . :
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
~- 3
5
6
7
8
9
10-
11
12
13-
14-
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG M PERCOLATION TEST
16-
17
18
19-
20-
O£
(ENGINEER'S SEAL)
DATE PER FORM E'¢':..~'~/~,~i~.'/¢ ~ ;"
~'/. ~'AJ E~.L.~Township, Range, Section:
SLOPE
WASGROUND WATER
ENCOUNTERED?
SITE PLAN
£ s
IF YES, AT WHAT (~ / L
O
DEPTH? (~) p
t E
Depth t0 Water Alter ¢'/ ~' / //~ /,m//
Menitering? 1~'"'" Dale:
PERCOLATION RATE __ (m~nutesnnch) PERC HOLE DIAMETER
TEST RUN BETWEEN --~ F7
Reading Date Gross Net Depth to Net
Time Time Water Drop
COMMENTS .. ~, ;, !~; ...,,.,~RI,~C
~ .., ;3 ~ ,. ,,lie River Loop Road No. 204
.;~:~:,~ ,:iver, Alaska 9¢~77
PERFORMED BY:
ACCORDANCE WITH ALL STATE AND MUNICIPAL
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
FECT ON THIS DATE. DATE:
MUNICIPALITY OF ANCHORAGE
DE~ .iTMENT OF HEALTH AND HUMAN SER¥, .iS
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Address
LEGAL DESCRIPTION
TANKS
SEPTIC [~ HOLDING
DISTANCES
~ TO SEPTIC ABSORPTION
._FROM ~ TANK FIELD WELL
WELL ['~-'gg) ' / L~ I%
LOT LINE ~ c~ 4- ~ ~ ~'
FOUNDATION ~' ~ 'W~ .... -
AS-BUILT DIAGRAM ~Bhow Iocahon el well. sepbc sy$iem properly hnes loundahon,
TYPE OF SYSTEM
IJ~ ~ BED .:~..W. DRAIN [~ OTHER
ol,gmalgr~de Z FI ~" FI
J FT
(~'~) FT
l dial absorphorl area
"~ FT
WELLS
~'~FIIVATE
ClasslflCallon
REMARKS:
[] OTHER fldentifv)
FT
Sca[e:
Inspecbons Per~prl~ed by
~,PA-~_ [ to-~
I _ ~'" ~~., .... ~ ce[lily Ihal Ihi[ i~]~p~lio~ was perlo[md a~c~rdi~ Io all
Municipal and Slate g~l~ttjn~t[~[~ Ihis date: ~_.
Health Depadment Approvak Date ~ 2 ~
6 ()
:1.9
AI:::'F'L I CAN"r:
A D D R E S S:
C:ON"I"AC]' F:'HONE:
I.,,EG~.~L, DE:SCRIP:
L.E}T SIZE:
MAX BEDROOMS',:
NOF;:MAI',I C [1N~i:; 'T' F;:U C'1" ]: [) r'.l
I:::' ,, [] ,, BOX '77051iili3
(:'~ N Ij] H [:) I:~ A G li:~:, Al<: 99577
694-.-9 :t. 4.4
SUBD): V I !:31CIN:~ GLEN EAGLE
SECYI" I [::)iq ',', :1. 5 T OWNSH I F:': :t. 4N
44:1.34 (!:3Q,, F'T,, OR AC, RliLS)
EOT, 3A
RANBE: 1W
Bt...OCl<i 1
I...is'Le~d I:::,e:l. ow are ti'u.s,, q:)'L:i.(::)ns ava'~i:l, able 'Lo you Jrl'i (:les:i.(.:lrh:i.n~:J your sept:i.c:
~.~ys'Lr.:..u'n. Chc~osr),, the opi'.:i, on that best fr:i,'~..~rl ye)ur site,,
]B Ii/G:: I]D·
DEPTH "lC) F:' ]: F::'Ei: BOT"I"OH (I::'T.) .,':1.,,0
li.)l::;ff.:~VI.i!]_. DE~]::q'H (i:::'T ,, ) 0 ,, 5
TO'I"AI.... ).}EF:'I]-..I (1:::"I' ,, ) 4.5
GRAVIiii]... W :1: D'H"'I (1:::"1" ,, ) 1'? ,, 0
GR(:~VEL.. I...ElxlJ'{)'I"H (I::"T'.) 38. ()
GI::~AVEI... V[:)l...t.Jl'"'lliii: (CLI ,, YL')S ,, ) ,?.6 ri i!!]
'i"Al',ll'::: S :1: ZE (GAI....S) 1, Cx)O ,, 0 '~"~'
SO:I:L. R~Z'fl'II',l[:.') (S(:;1,, FI",, /BR) 239
.~..x- GI;?AVEI.. l..r. lEi]\l(}:'i"l"H :::' '75 F:'T ,, I:::tlF:QU i RE,r:~ MUL'I" I F:'LE I:RUI'.IS (NOT EXCEEI) I NG 75 F:T ,, lEACH )
.~..x. 'T'ANK MUS'f' HAVE AT Llii!:AS]' TWO C(]MI::'ARTMEN"I-S
]: cam'L i fy 'Ll"la'l:.:
2. ]i w:i,].]. :i. nsta].], the syst~):xi~ :i,n ac:c:(]rdan(:::(:.:) ~:i.t.l'~ all MOA codes and requ].at:[c)r~s~
%cet,~!l.~:.H"at~:l(,:.~ !sy!5'LIDIiI (31=1 'l'.,l"lJ.s C)p ai'ly ~ll:l 'jac:iDFIt [:il" i](~.)i:';tl"l:]y ll::lt.
4,, ]: LU'iCh.:.:H'"SI:.aI'H::I tt'iat. 'LI-~:i.s - ' ' :i.s
any Gtr]].aw'gelill.:~)r'it w:i. ]. ]. I'I.~.)ClI.iiPtL~ ~'~/['l ach::t~.tJ, cil]a], l:)~rm:i.t,,
, ':~
]:F:' A I....:I:I:::T STATIDI'q .I.~ INSTAI....L. IED IN AN hl".l:;:A COVIERED BY MOA B!.IIL. DZII[.':~ CODES,
...... , ........ , .......... ,..
'I'HEI'q (1) AN E.[...I:=[~ I1'~ I .,AI~ 1' I.I~PI.I. AND INSPEC"t"I(::Ilxl MtJST
W]:I..L NO"I' BE: AI:::'F'I::iOV[~[D I4~THEIU'T' AN I=.L.I:.L, II~.I.L, AL. .I. t lM'[.I..,I :l:l::)lxl I:?IEF'OFCT; AND (3) 'I'I'"IE}:
IJ~:I..I~Lc'r'I::RICAL. WORK HLIST BE i:)l:lltll~: BY h L.:ILCENSE~D I~L.IECTRICIAN,
~::
.))NED
~'. T::.i)CAN'I': ~-Jxll::)l~,l~ CO ', i "'FRUCYT' I ON '
MUNICIPALITY OF ANCHORAGE
DEPARTIVlENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, A~aska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
SLOPE
10
11
12
13
WAS GROUND WATER S
ENCOUNTERED? ~t~,~ L
-- 0
P
IF YES, AT WHAT r
E
DEPTH? \,'~
SITE PLAN
14
15
16
17
18
19-
20-
COMMENTS
Gross Net Depth to Net
Reading Date
Time Tirrle Water Drop
PERFORMED BY:
72-008 (6/79)
PERCOLATION RATE ~-'~? (minutes/inch)
TEST RUN BETWEEN /Jr' FT AND ~ FT
/ .
SUBJECT:
( .vlPUTATION SHEET
DATE:
SHEET OF
DEPT. OF HEALTH &
ENVIRONME ;F~PROTECTION
Du,~bi~ DR,,.{iN( Co.
,Time Drill Lo~l Casing Mile 1.2, Lucas Road .~-~
P.O. Box 871348 It~w
(907) 376:2305 ~i:, .... -'~ -~[
Name:
Address:
City: Pl~one:
dob
Location:
Crew:
Date:
Notes:
.... ~'~r/~LITy OF A~,~,
meNTAL PROTt:
RECE.'IVF)
Depth Well Log
Tom Fink,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
June 18, 1993
Michael W. King
HC 83 Box 1629
Eagle River, Alaska
99577
Subject: Lot 3A Block 1 Glen Eagle Subdivision
Permit #SW920139, PID ~050-601-28
The subject permit, issued June 18, 1992 by this office for a
single family well and/or on-site wastewater system, has
expired as of June 18, 1993.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as-built inspection report must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $200.00 for an
on-site wastewater permit; $75.00 for a well permit and
$275.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Si~/erely, ~ /~
YOn_/rr°sg ,~cem Service~anager s
enc: Copy of Permit
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 WELL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW920139
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:KING MICHAEL W
OWNER ADDRESS:HC 83 BOX 1629
EAGLE RIVER, AK 99577
DATE ISSUED: 6/18/92
EXPIRATION DATE: 6/18/93
PARCEL ID:05060128
LEGAL DESCRIPTION: GLEN EAGLE BLK 1 LT 3A
LOT SIZE: 44134 (SQ. FT.)
NUMBER OF BEDROOMS: 2 THIS PERMIT: 2
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL 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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: /~C~4-&,
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, rangez)
Location (address or directions)
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
(b)
(c)
Applicant Name~_]¢
Applicant Address
Applicant is (check one): Lending Institution L-]; Owner/builde.r~[~; Buyer []; Other [] (explain);
Lending Institulion __ _/'J- //-~ Telephone
Address
(d)
/
(e) Real Estate Company and Agent _._ /L/ //-'~'
Address
Telephone
(f) "ff;~Ni'the HAA to the following address:
TYPE OF RFSIDENCE
' Single-Family/L~ Multi-Family []
Number of Bedrooms -~'~-~
Other
3. WATER SUPPLY
Individual Well,Z]..,, Community [--] Public ~ '. ·
Note: If community well system, must have written confirmation from the State Department of EnvmaI?mbr~taFOOnservation
attesting to the legality and status.
SEWAGE DISPOSAL ,, ,
Onsite/r~ Public [] Cornmunity L-'] 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 ~11.84)
ENGINEERING FIRM PROVIDIN .NSPECTIONS, 'rESTS, FILE SEARCH, DA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that ray investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adeq date
for the number of bedrooms and type of structure indicated I)erein. I fudher verify that based on tile 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 Jn effect on
the date of this inspection.
Name of Firm . . ;. ', > Telephone
Address ___ _ . :~ ~..~,~.__~,~,.;:.~_~.~.,:
Date : '?~ "~': ": '"
DHEP APPROVAL
Approved for ~'~-'~¢ bedroornsby _/~%~~'
Approved ¢'~"~- Disap/~ved Con~nal
Terms of Conditional Approval
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
engiaeer registered in the State of Alaska. The DFIEP 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. Tile Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work,
Page 2 of 2
72-025 ( 1 ~'84)
_MUNICIPALITY OF ANCHORAGE (MOA)
MUNICiPALiTY OF ANCHOf'U~
.... EAL'fH 8,. HEALTH AUTHORITY APPROVAL (HAA)
~l~/,~.~f,~,,,,....__ ?RoTEC'ftON CHECKLIST-FEBRUARY 1984
264-4720
6 98b Legal Description: ~- ':~
Well Classification .~..~/(..,/4:~
Well Log Present ~N) Date Completed_
Total Depth /~ ~ Cased to
Static Water Level ~~
Casing Height Above Ground
Electrical Wiring in Conduit (~N)
Separation Distances from Well:
To Septic/Ne~6+~Tank on Lot
Depth of Grouting ¢/-.v' ,///~.
Pump Set At
Sanitary Seal on CasingS)
Depression Around Wellhead (Y(~
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line /~//'~ To Nearest Public Sewer
Cleanout/Manhole
Water Sample Collected by ...:'~" ' i .~" ~' ' ; Date
Water Sample Test Results
Comments ~ -~' '~ !
/
B. SEPTIC/J=t:i~:L-~NG, TANK DATA
Date Installed //¢-/-'~ ~ Size /*'~-~ ' No. of Compartments
Standpipes(~) Air-tight Caps~N) Foundation CleanoutCN)
Depression over Tank (Y/I~ Date Last Pumped '"~ ~ *~"
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High.-Water Alarm (Y/N)
-
Separation Distances from Septic/+~Tank:
To Water-Supply Well ,/'4¢~;) ~'-z4 ·
To Property Line _
To Water M~ccCService Line
/.U'//,¢ ;for
Temporary Holding Tank Permit (Y/N) ~//~
To Building Foundation
To Disposal Field ,~
To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~-- (-~
Date Installed /~)
Width of Field ,-¢~ !
Square Feet of Absorption Area
Depression over Field (YN~_
Results of Last Adequacy Test
MUNICIPALITY OF ANCHORAGE
EPT. OF H
Type of Syst,e~,,~,s,~,,'~,~¢~-~ ~/~'~,
Length of Field ~' (.~
Depth of Field
Gravel Bed Thickness
Standpipes Present~
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ,,/~c~ rTZ-
To Building Foundation ~"--~-- ¢¢'
Lot /'~ //~'
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Water M~itCr~ervice Line )'o ¢.;,~-
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Cutbank (if present)
D. LIFT STATION
!
Datelnstalled ,/~) __ f/C-- ~"~'- Dimensions
Size in Gallons --~"''~2C~/ ,~ // Manhole/Access(~N)
"Pump On" Level at ~'~ ~ "Pump Off" Level at '~/
¢,,.
High Water Alarm Level at /-'//~ Vent (Y
Tested for /,.)/]¢r ,'""~ ¢"'f")' ' Pumping Cycles~ during Adequacy Test. Meets MOA
1
Electrical Codes ~Yi/~ /L.,r c~ -r- /' ¢--~'~,,.,¢¢~ c: 'z",'~,,¢ //..J ~'-~.-//_¢ ,,'~_..
** 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 :.~ ~ ~ :;i '~-"'ti¢i'¢~?i;i;i'',hi Date
Date of Payment )/~'- %¢
Amount: $ ~.
Page 2 of 2
72-026 (11/84)
