HomeMy WebLinkAboutGATEWAY TO THE PARK BLK 1 LT 11Gateway To
The Park
Block 1
Lot 11
#067-601-03
• ., Municipality of Anchorage ;.
Development Services Department r tl :
Building Safety Division
�'
On -Site Water and Wastewater Program, 4700 S. Bragaw SL
P.O. Box 196650 Anchorage, AK 95519-6650 Page of 3
www.cianchorage.ak.us (907) 343-7SO4
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number S IA) QDO3t c PID Number. 067--601-O3
Nam•: i s /
0L;r1 R;,fidSOn
Wastewater System: 0 New pgrade
trans'
5///{)E-i/✓r� . `,, ! s , � ive i
' ,s% ABSORPTION FIELD
Prwrr. � i /✓ I 6 .8 cc Nwntra eebcan•:3
�//
0 peep Trench *seems TrmN 0 BW 0 Alma
0 ether
LEGAL DESCRIPTION
Sol Ratingaal
oet—"PGN
Depen baa di!Dadr g
Tlj
Deck:� La:" S�ti6visbm
fie
Ga1�tcYlY to 1 /Y :l✓�
DepmbN bottom tan original
F .
FI
Gravel deem benanl ow:
FI
TowmJip. Range: SeGat
Fa added above anginal gado /S+
V .
FI
Grave Lenppt
s7
/F,
Well: ❑ New ❑ Upgrade
Gravel witty rE FI.
Nurser a Snot
1
I Detente beaten lines:
�� rlDassifitetica .
jj.
Fk t 5 (T ten, B�%t `/
Taal Deem FI
Cased la Ft
Taal absapaon are: s I O FIs
70
h 5'rill 03o3y/FS
to
Devitt
Dale DM
SIMia Warn levet
rl.
rear
r
tAteedFxr rEn4
Date Metalled
41-7- ^�
U
Y:eid p Ser at
. Mon Craart
et
./
TANK
GPAI FL
SEPARATION DISTANCES
1 Septic ❑Holding 0S.T.E.P. ■ Other.
7o
From
Septic
Tank
Absorption
Field
Lift
tatiionn
Station
Holding
Tank
PutriciMandate.�'Mandate.
SevierLire e
T'
Capaerr.
Gal
al
Wee
a
10'
f4t
117'
JtTl_
ln
‘
urranranr.erls
&date Water
-I-
iooL
1 L
4...
LIFT STATION
Lot Line
ca39a9tas
39 1.1'
as
ze
Gal .Mend
we
Oaten Drain
..
1a 7
%
one
^3
Y
n;w w
—
'Pump an'level et
Pump Is 'L Vi . -
�PwrpMM. YT
aG
NO wafer �FaaG.zn
tet* t bseecbens ow^
j
Remade:
NEW TRe,tic!-/ /Aurre) uea J
•�-., .
BENCftMARK
Oto LiFr 3'R. P
7Gffee/ L�
Lesson and DescFbm Q, f --)J
i �Ol/ern oT 5,r do
. AJC vi'r AJK
Asea r, avascr.
er orrier a %, 100 Ft
ctsE•
''i N
Engineer's Stamp
er;1y° •. ••• 0'. r. ri•
j� 'Oaast ;i- G.
er c J •e ^'" `; .
a .• vj?t '. a .�i'-
� Sri A. t.%; :I. ..
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t.'
S-83KLT76a
17034 Eagle River Loop Road, No.204
Inspections performed by: EapleRIvor, Alaska 99577 Dates: 1" I a7-0.<
Development Se is -s Departm ji • t royal
Reviewed andby:/..--7-0G
approvede: ! 1
PERMIT NO SW020352
PACE 2 OF 3
Munic-ipalit of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
0 Box 196650 • pphone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM e, Alaska LAND/OR p1WELLeINSPECTION REPORT
LEGAL LOT 11, BLOCK 1, GATEWAY TO THE PARK
P.I.D. NO.
067-601-03
100' WELL RADIUS
(APPROX LOCATION)
DV (VALVES IN
A 10" PVC PIPE)
n
LOT
12
�— EXISTING
LIFT STATION
EXISTING
\1000 GALLON
SEPTIC TANK
TH♦
MT2
ENGINEER R AMP
VPr& 1.r j�.
...so*. ... i; ~5
vy r '•.g
,e7
PERMIT NO SW020352
PAGE 3 OF 3
DEPARTMENT Anchorage
SERVICES
ENVIRONMENTAL SERVICES DIVISION
PO Box 196650 •Anchorage, Alaska 343-4744
ON—SITE WASTEWATER DISPOSAL SYSTEM LAND/OR WELLeINSPECTION REPORT
LEGAL LOT 11, BLOCK 1, GATEWAY TO THE PARK
Pio. NO. 067-601-03
MT1=125.8'
MT2 =126.3'
FINAL GRADE
MT1=119.6'
MT2=119.7'
2" INSULATION
DIST. PIPE=123.7'
N. T. S
NO WATER FOUND
111.7' B.O.H.
P
11/4 441$1
.1.••
r otA
,n A. Shea
Ea. 1457-2 ¢'•y
?'.
� r
A
9
DV
49.0'
19.5'
MT1
36.0'
45.0'
MT2
54.5'
86.0'
MT1=125.8'
MT2 =126.3'
FINAL GRADE
MT1=119.6'
MT2=119.7'
2" INSULATION
DIST. PIPE=123.7'
N. T. S
NO WATER FOUND
111.7' B.O.H.
P
11/4 441$1
.1.••
r otA
,n A. Shea
Ea. 1457-2 ¢'•y
?'.
� r
Permit Number:
Legal Description:
Design Engineer:
Owner Name:
Owner Address:
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
SW020352
GATEWAY TO THE PARK BLK 1 LT 11
0003 S & S Engineering
Robin Richardson
32451 Eagle River Rd
EAGLE RIVER , AK 99577-0000
Date Issued: Sep 17, 2002
Expiration Date: Sep 17, 2003
Parcel ID: 067-601-03
Site Address: 032451 EAGLE RIVER RD
Lot Size: 43560 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
I Disposal Field ❑✓ Septic Tank ❑ Holding TankPri
❑ vY ❑Private Well 111 Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 (24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date'
\r 't Date: //i' %/oz
Mtttticipality or Anchorage
beVelopment Set-VIces bepartmeht
Building Safety bivision
On -Site Water and Wastewater Program
4700 South bragaw Si.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. —loot - O 3
Property owner(s) Rohm RI c\A CL" �
Mailing address (1) X2451 Eccc\c Rw SLL
Mailing address (2) ERSt- t&s\CA Zip Code S9 5 }
Legal description (Lot, Block & Sub'd.) Lp'\ 1± B\k A.) C�?s w1 o Si -1)
Legal description (Section, Township & Range)
Lot Size 4-3 -tteres/Sq.Ft. Number of Bedrooms
'/3 � St
THIS APPLICATION Is 1oR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade Lf
THIS PROPERTY CONTAINS:
Not Tub ❑ Jacuzzi ❑
Swimming Pool 0 Water Softening Unit 0
Permit Number SW O2035Z
bay phone 44 () 9 te' 5
Therapy Pool 0
1 certify that the above Information is correct. I further certify that this application is being made for a
Single Family bwetiing and Is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
S a S Fr:c1NEERiNG
17e,, i : t ogle Ricer Loop Road. tio.2a:
Route River, Alaska 99577
Permit Fees:
$-q co
Dale of Payment: *I'r 3 /0" -
Receipt Number: 0 3- ST a- Y
(Rev. 12/00)
Waiver Fees:
bale of Payment:
Receipt Number:
01
"Ilk "
E((G(neeR(ng
AQP
LEALTHAUTHORTY
APPROVALS
SLIVER WATER
STAIN EXTENSIONS
SEWERS WATER
PSPECTION
ENGINEERING STUOTES
AND REPORTS
WELL INSPECT/CH
S FLOW TEST
SITE PLANS
ROAD CESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL S
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
MISPOSALSYSTEM
MESION
August 15, 2002
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 11, Block I, Gateway To The Park Subdivision
ROBERT C. COWAN, PE.
ROBERTA.SI LAFER,P.E.
CML ENGINEERS
(907) 694-2979
FAX(907)694.1211
It is requested that you issue a permit to upgrade a septic system to serve the existing
three bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test was performed on 7/24/02. The
approximate location of the test hole is located on the attached site plan. Ground water
was monitored and after seven days the hole was dry as shown on the attached soils logs.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
obert C. Cowan, P.E.
RCC/jhm
Enclosure
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577
• SITE PLAN
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DESIGN
1
1" = 60'
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• SITE PLAN
DETAIL
1" = 60'
CCC'
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1
Performed For:
Legal Description:
1-
2-
3-
4-
5-
6-
7-
8-
9;
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
Depth
r
(Feet)
••••-
.4 ..
0..�
t. •.
•4.
,
COMMENTS
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519.6650
swow.ci.anchoraae.ak ug
(907)343.7904
Soils Log - Percolation Test
H -472-...S01--1
tar
t O/� Date Performed:
%or ; 9GGIG /,, GAW-6— 11¢N 'iv VW&
Slope
GM
SO H
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT DEPTH?
Depth to Water After
Monitoring?
/76
DRi
Date: 94/01
s
L
0
P
E
(-4'7
i
i
i
Reading
Dale 1
Gross Time
Net Time
Depth lo Water
Net Drop
�l k
P/402,
0
0
7P
.--
30
70
/O'
3
o
o3o
rr
10
o
4
PERCOLAT
ION RATE 131 (nryteeMcn) FERC HOLE D AMETER Y
TEST RUN BETWEEN .L? FT AND4 FT YY
PERFORMED 13Y: / // CJi+A7L�1 4-11/Z.LI1e1� CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCOf2DANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: I/ r7../o Z
Name
IVIur.Is..IrALI I 1 'Jr MIslafVrsAuc
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502. Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
/44¢NNi - 4 • SmA
AOmess
320/ G' sr .S`17J—,Ar-/co-IcE,41,C.
phone(s)
.rii-cpzw
LOt
Perms No NO 01 800Iooms
P9OTy3 3
SEGAL DESCRIPTION
// lawn 6-1/Cct/4y %z /A/4cK
TOwnsmp. Range. Racoon
T/JA/,Rit cgcricA. 9
LOT LINE
DISTANCES
SEPTIC
TANK
/03
3r/
ABSORPTION
FIELD
//0 /f
WELL
20'
FOUNDATION Zel 0 /
SEPTIC
Manuldcwter
MaIenal
TANKS
0 HOLDING
Capaofy In gallons
/100
No. el Compartments
Z
TYPE OF SYSTEM
0 TRENCH M BED 0 W. DRAIN 0 OTHER
Dep:R Io p,pe Dollum fnom
0119mal graoe
3
Pill ROCCO above Dogma' guav
—0—
Glave. tengtn
*7
Toul aosorpocn ilea
"4j
Numoer pt uses
3
Sal raring
/aQr
Ins:aner E..4 $�a1
/CAW— d- 1 74C Ii
PRIVATE
Llass,bcanurl IA 13 CI
Inslal4.
AS -BUILT DIAGRAM 'Snow Iocalo t 01 wen. sepias system. p10
anveway water booms. e!C 1
y lines. lounaal.on.
L
NT
t
i
Total Oupin Irom *stigma! graoe
3 a. FT
Glass oepm beneam p.pe
FT a 4 FT
Gravel sworn
FT /O FT
FT
Datanbe between Ines
SO FT
Pipe malenal
SO FT
G FT
?tic
Dale InsUuea
—Z -AS
WELLS
0 OTHER (Identify)
Tomo Depth
6/
Dale InsIalea
FT
i,c
0
scki
Caseo to
410f FT
/0 -24 - 83
REMARKS:
Scale: tVTS
Inspections Pertormea by
kJ a Lt y H—C w 4+e.
Date ti /Z/ey
(I/a/SI
ROP Ud Lr ''(t2 +1, certify that this uupeaion wu Wormed according to all
Municipal and Stale guidelines in effect an Ns dal /�////Jti- /7/o z. - es �j��j �r
` " 4; ! Date �/ e OCs.
Grte-Zv-
Health Department Approval:
72-013 (3/85)
sage ft9� AL
•OF,A gsgV;
v. 'E 9T M i �i •. *
•t••..? -
LE
•.
• 0 --I'll. Robart E. K• roe
No. 414 -E �/
3 OFESS `� •..'a'
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343-172W
417ry/7G�d
U N- S I T E SEWER P E R M I 1
Number: 880243
-1I, issued: 10/25/80
Upgrade
Engineer
Designed
Owner Name: F.N.M.A. Day Phone:
Owncr Address: 3201 C STREET, SUITE 505 561-0820
ANCHORAGE, AK 99503
Parcel Id: 001-011-03
Lot Legal: Subdivision: GATEWAY TO THE PARK Lot: 11 Block: 1
Section: 9 Township: 13N Range: 1E
Lot :117e 45000 (sq.ft. or acres)
Max Bedrooms: This Permit: 3 Total Capacity: 3
SEPTIC TANK: Minimum total septic tan{:: capacity: 1,000 gallons. Each septic
tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0
fec°t requires insulation over tank(s).
)r+• -TALI_ PEFt ENGINEERS ATTACHED DESIGN. NOTIFY DHHS PRIOR TO
EACH INJSPECTION BY THE ENGINJEER. TH1S PERMIT IS ISSUED FOR THE
1..x1ST1NU w. DEDIUUM RESIDENCE ONLY AND EXPIRES ON 12/31/88.
Ili:, •r THAI.
1. l am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
[ atI' 4alt the system in accordance with all MOA codes
and regulations.
,,,,id in compliance with the design criteria of this permit.
1 w1'1 L0 all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or am• adjacent or nearby lot.
' I:nrierstancj that this permit is valid for a maximum of 3 bedrooms. I
.'t,=c; understand that the capacity of the total system is 3 bedrooms and
any enlargement will require an additional permit.
(Owner) F.N.M.
1St.nr.d Ry:
DATE:
DATE:
Municipality of Anchorage
DEPARTMENT OF HEALTH 8 HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: FAQ! MI6 M A E
LEGAL DESCRIPTION: L04 11 r 1
D PTH erg, &a*Lx,„/ fl *I Pod<
(Fettr-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Q
EMD
Lt. Brn
m,r at/14
c ren.e/ -S�(
,✓/ Si /-F.
St,) -6M DL R,„
Crr.ve/wr4A 54„e.t
.IJ s- „„e s,/1.
S
No 6 r ,,.JA V.:, ler-
EnCcon is rc Gl.
p Sf!I�c,c!^„Nav
DATE PERFORMED: f (cJ
4 Ptl;
Township. Range. Section: Nr' tl '7 /et -
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
epth to Water Atter t
,a
Manithring7
Reading
/
4
Date
•
N
kJn
Dae
10 itt/06
„
,r
Groff
Time
$
L
O
P
E
J
f
N
LLI
r
L
PC.
A
1
Net
Time
/0..
/0,. ,,
10„
Depth to
Water
Net
Drop
. /�
• //
. /C
/0
.!0
PERCOLATION RATE 14. / 7 (minutev,nch) PERC HOLE DIAMETER 4; ”
/ // TEST RUN BETWEEN •' FT AND /4 .F1 r/` //
COMMENTSl; C✓—G 44 Set /S Le -1, r. ZI 4//4' pe! "I'PJ*ofa-f- rt-4vJ ct-/ /PC St'F`F/ Prir...
PERFORMED BY: S reek/ KrrCC I ,L //
RItFY THAT THI TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE IN EFFE �•N THIS DATE. DATE: ��Lyn.
72.008 (Rev. 4/85)
•TEENC H
DES IG h1
B'
i
VO7'
.0°. ti1133
i
• h1
/KIuG
652,4
Ta+
Nok
ce •
o•/
Peorostt
Sent./
tan
o 14 { Ct.
▪ '▪ gy▪ •
m\
Est. r Lic
4" Par P.pe
Set...ter tee- \
ac•
\
0
5 B9'$4.i,,v 70..06
7
3
des /4-11
cgex
(3 ga,-)ofsw,I.i;. =SSSse -rt &'. -+t 44)(6-5.: S'te„) = CASs, (i. et' ' 7'
SEWER SYSTEM LOCATION PLAN
or• �°Z,ee
f J ...• eee n Iti
!d ' •_ •......j.. •
of
J. Corwin W A
CE -5283 \:'d
A� _.
•......•
"�ore�sc .,.
NORTH
'LOGIC
1
SECTION TOwNSNIP/RANGE
1`IE l4 Cr 9 PIF
SCALE.
1"=50'
SUBDIVISION
6"AT£t.hijj -fn 4L. p,it
DRAWN eye /,
Jen./ C PFCr
NOTE.
THE ACCURACY OF LOCATION OF EXISTING
PROPERTY CORNERS, WELLS, AND SEPTIC
SYSTEMS INOICATEO 13 NOT EXACT,
DIMENSIONS INDICATED HAVE BEEN
DETERMINE° SY USE OF CLOTH TAPE APO
NOT BY SURVEYING TECHNIQUES.
PREPARED FOR.
FA AI,wr MAF t1 U3 cr,i
DATE' /0 //4 /", 1 SHEET I Of '
4X Jin.-tiax, b•.)x
Kt\
E1
Retrieval rope --N. l'4 I
Nil
i
3' tha collar
punpout
S'
S'dia
5
2:
Flap
check
4' 0'
pvt ,ccco
24 x 4 O' Culvert itaitho'a
1' flexea a Presaire lia,o ,
I' P V C Poo Typ
2' urethane loan (shop C pia:
with Toenec top cant
Adfastakle float Switch Assn-
Seal girth RAN-NEK or Egt.�l
J -bolt hold down
1 1/4' welded coupttt.
1/'J' train lack fila
4'pvc flow icdu_r_-
1 3/e' holes 6' CC
1/2' nrsh polyeihyleac screer
L oa x 37 high
112hp. lit LL^tee Si.bnen s'a
Effluent Pu-ip
Re.an...g aisles
500 GALLON LIFT STATI❑N
500 GAL
Reserve Capacity
above Alarm
111 gal
Capacity Between
Pump on E• Purtp off
DOSE
123 gat
Float Level
Set -tines
Above Vault
Batton
Center Float Cord Ai
Morn
39'
On/OPf
3L5'
LIFT STATION DATA
t
d
8gsatI$ggfaoa9o0§9
0 5 10 ,15 20 25.3 35
Gallons per minute
TYPICAL PUMP PERFORMANCE CURVE
r
• muNicIPALITY OF ANCHORAGE
NAME
• j as,
„(�
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
Si EVC Li-14KE(--,4"1�
MAILING
PHONE
oU
❑UPGPGRADE
ADDREC/ 0s tJ C C� `/ /1/4./e7= --4)/N `%y-Z�%�
LEGAL DESCRIPTION %
for :cK
1e art �t" 4•77,
LOCATION - -.
Sec
ci 7/3 n/ RIC / r
1 (K/ C.
NO. OF BEDROOMS
O Y
DISTANCE TO:
Manufacturer
Well 7
/ c�
Absorption ar
I� --
Dwelling - /
NOT //�
PERMIT NO. J77
Sc>�s
r2
F
/'~)
g:5(1--
f"ta�%ri-,4Lr_
l
No.
,u
l-/
Liq• lgalons
of compartments Z
25231
C/EiQ
IF HOMEMADE:6
Insidelength
Width
Liquid depth
bDZ
I-Ia
DISTANCE TO:
Manufacturer
Well N/
Dwelling
PERMIT NO.
,
Material
Liquid capacity in gallons
-I
iu =
W
DISTANCE T0: I
No. lines
WellFoundation
Nearest lot line
PERMIT NO.
i IT
H
of
Top of file to finish
Length of each firer'
Total length of lines
Trench width
inches
Distance between lines
cc
o
grade
Lens
Length
Material beneath tile
inche
Total effective absorption area
to
^
g �] /
T�
Type
W'dth
22 '
Dyq
i-�s 713 CC7" WA//S /L. c
I N
PE 11j
a /�
NO. 7
J
mW
of crib
Crib diameter
Crib depth
Total effective absorptiona�
w tl/
CD
777
ut
DISTANCE TO:
Class
Class
Well /
/AS—
/�
Builtl n Soundati
Va 9n
N
Nearest lot line /�
W
C
�]\' I `H1
Depth
/�
77
Driller
Distance to lot line
PERMIT NO.
DISTANCE T(}; —As
Sewer line
Septic tank
Absorption area Is)
OTHER
PIPE MATERIAL$�/,
■■■■■■■■■■■■■MI
SOIL TEST RATING
113 '4,2_
1
■
INSTALLER ,/ S?:
fI!IE!Ji!iII
REMARKS
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72 131Rev.3/781
I I LI t -J I C i F• n L I -re o r R t -d r I --I 0 IR FR G
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 995+1.
254-4720
C.t-4—SITE EWER F•EF:t•1 I T
PERMIT NO: 8400.57
DATE ISSUED: 03/15/E:4
APPLU=ANT• SSS ENGINEERING
ADDRESS: _RB 19EX
EAGLE RIVER, AK 95577
CONTACT PHONE: 694-2979
LEGAL DESCRIP: SUE:DIVISION: GATEWAY TO THE PARK LOT: 11
SECTION: 9 TOWNSHIP: 13N RANGE: 1E
LOT SIZE: 1.2A (SQ. FT. OR ACRES)
MAX BEDROOMS:
CLO
BLOCK: P_
LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IFJ DEIGNING YOUR SEPTIC
SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE,--
/
11-1REEC4C:1-1
ITE,.-
TfREt-JCI-1 ,EDEE) 14. C•RFi I t -J
DEPTH TO PIPE BOTTOM (FT. ) 4. 0 4. 0 4. 0
I GRAVEL DEPTH (FT.) 3.0 5 3. 0
TOTAL DEPTH (FT. ) 7. 0 4. 5 7. 0
GRAVEL WIDTH (FT. ) 5 I 22. 0
5. GRAVEL LENGTH <FT. ) L. 9. 0
113.0 »:»' 44.0 79.0 **
GRAVEL VOLUME (CU. YDS. ) 35. 5 35. 8 51..,
TANK SIZE (GALS) 0
1, 000.0 ** 1, 000.0 ** 1,000.0 **
_•OIL RATING (SO. FT. /BR) 225 212
22.,
y°* GRAVEL LENGTH > 75 FT. REQUIRE• MULTIPLE RU J" i EXCEED
* TANK MUST HAVE AT LEAST TWO COMPARTMENTS EXCEEDING 75 FT. EACH)
I CERTIFY THAT:
1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS.AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE <FIOA) AND THE STATE OF ALASKA.
I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATION=,
_ AND IN COI•IPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
_. I HILL ADHERE TO ALL MCA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
4. I UNDERSTAND THAT THIS PERJ•MIT IS VALID FOR A MAXIMUM OF 3 BEDROOMS AND
ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROy WITHOUT AN ELECTRICAL IN'PECTION REPORT; AND (3) THE
:ELECTRICAL WORM::. FIDS' -� 'ONE CY A LICENSED ELECTRICIAN.
CIGGNED
FIPPLICANT: :• r; ENGINEERING
ISSUE
DATE:
DATE :440i v---
Department' I HealthLand Environmenta'�rotection
25 L Street, Anchorage, AK. i9501
vacs) * 264-4720 0t2
Permit #
* * HANDWRITTEN PERMIT * * /�/
WEL ND/OR ON-SITE SEWER PERMIT
(�
Applicant-ZZ�pQ,T QdJ P-- Mailing Address- o cS'J(�j 12/1/
Location: Phone Number: Cqy 74%77
Legal Description: G// 6/7FG/wl i� �%/�1e:7 Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: _ Seepage Bed: X Holding Tank:
Maximum Number of Bedrooms: ' Soil Rating(sq.ft/br) 2/3 pj/1,Z
% he Required Size of the Soil Absorption System Is:
DEPTH # LENGTH d GRAVEL DEPTH 6:‘00,14=1 WIDTH 2)
CIO 1 OE al-tve
The length dimension 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
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = 000 GALLONS * •
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* 41.* TW0(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this departmen
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set f. th by the Municipality of Anchorage.
(2) I w 1 install e system in accordance with codes.
(3) I end- -rand t•- the on-site sewer system m require enlargement if
ce ,. remodeled to include more • at 3 bedrooms.
* * *
i
SignedMiliplicint
- L Issued b
Date:
SWP/024(1/81)
n
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: CSfl( 4....1.{- 2- K Ce:I\ I Sr
LEGAL DESCRIPTION: �`r l( (-7%F're,t° 74`tilt
1 E T 1
2
3
4
5
6
7
8
9
10
11
12
13
14
01261s -Ni I L
Zzs 04z A -o
213 .
WAS GROUND WATER
13c51'T041N ort j L ENCOUNTERED?
15 .;'p'c .• ..... 4 S!
�. %`i rt"
16 +. ••X.:`' '9J
ate
re
18 •
17
po
g.,b.n A. SI.,f : w�ce
-d • Nn. 1157{ ;' fir!'/
19 1 >; ; •.,.......• \'t;'.:
.."131.41114:4: r i
•
20
COMMENTS
PERFORMED BY: S % r E:1aINL-ERINQ
in.,ALE.RIVER. ALASKA £;577
PH. 6$¢297$
72-008 (6/79)
IF VES, AT WHAT
DEPTH?
0 SOILS LOG
PERCOLATION
TEST
DATE PERFORMED: 9 —!!v - 83
—1-77 -n-tt. 1p-1e—IC
SLOPE SITE PLAN
If
N L
5 �n
fc etc,
o 4
00
La
d
0
P
E
t
Reading
Date
Gross
Time
Ne
Time
Depth to
Water
Net
Drop
/
`I -11,-8i
I:35 p
1 1°
9 g
Z5
2.` OS P
Solana,
%y w
ZZ a
3'
zr15P
to �
it
•-�
z4 'zsP
(0
l .r
_,
r�
1
Z
5
zr.3Sr
lb 6t8
( w
-4s
a,
PERCOLATION RATE
z -o
4 c--(rrlinutes/inch)
TEST RUN BETWEEN FT AND J 17 FT
CERTIFIED B
DATE: 924e7--
:j I i •:� to :.;-s E':=
P.0. BOX 7M CHMIAK, ALASKA SO"
i
4t ;J
TELEPW)NE G
DErM OF WELL 6 0 s
STATIC LEVEL OF WATER FT. Jl
,r?!s r ft c
DRAW DOWN FT.
GALS-MRHR 900
KIND OF CASING 6 -Kao
I,
KIND OF FORMATMN:
F•aD Ftta117FLn.rf'C
_
AK3E
lnt & a
oFrr. of PLAIT"
Frm
Frew Ftto Ft
A r i's
pya_/eL F to S3 Ft
Ft. to Ft
-t-
roa,:r2 to- 6/ t
SAi.+O i�CtI.+PL.
p.. FL Ui---FL
•� ATFL
ptoa Ft to h
Frota FL to—Ft-
From—Ft.
o FtFpw Ft p ----Ft •
Ftoa FC to -----FL
Fpm -----ft to FL
From Ft to Ft
from
Ft.t.. F
AK3E
lnt & a
oFrr. of PLAIT"
Frm
FL loF
From
Ft. to Ft
...
Fpm
Fpm
Ft.to F
Ft -to FL
• RECEI VED-
Fran Ft to Ft
From -----FL tp Ft
Froom FL to ---Ft.
Frm_Ft to Ft
prom_Ft to Ft
From FL'" cr-• — - - FFRm
Ras Ft tom Ft pronl_FL to Ft
Fmm Ft tom Ft
Fem Ft to Ft
Fnm FLto__---FL
_FL a t • Ft
Ftm
1tSQ.II�ORNA770N:
Fpm Ftto Ft -
FNM—FL tort
From FL to_—Ft-
Fpa—t'lo Ft
llCrt 1 FF! rIt1YF
a
rd
1' 11_1 t•.1 1 C: I F• F=1 L_ 1 T' -r' 0 F' IR I -I Fi Ci
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET: ANCHORAGE, AK 99501
264-4720
C) E; I TE LSII=ISL F EE VI T
F'ERI'MIT NO: 84€079
DATE ISSIJED: 03/27/84
APPLICANT: WAK.ELAND CONSTR.
ADDRESS: SRFI BOX 2415
EAGLE RIVER. AF; 4957 r
CONTACT PHONE: 694-2661
LEGAL DESCRIP: SUBDIVISION: GATEWAY TO THE PARK LOT: 11
SECTION: 9 TOWNSHIP: 12N RANGE: lE BLOCK: 1
LOT SIZE: 4560 (SQ. FT. OF: ACRES)
I CERTIF'r' THAT:
1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MINJICIPALITY OF ANCHORAGE (MOR) AND THE STATE OF ALASKA.
2. I WILL INSTALL -THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS,
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
2. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK
DLSTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR AN'r' ADJACENT OR NEARBY LOT.
SIGNED
APPLICANT: WEIKELAND CONSTR.
ISSUED BY
DATE:
DATE : - 7/5' y
�5
Parcel I.D. #
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
nib -1 - tart -s�,2
1. GENERAL INFORMATION
Complete legal description
HAA441`
Lot 11; Bloch 1; Gateway to the Pante
Location (site address or directions) Mite 11.9 Eagle Riven Road, Eagle Rivet, AK
Property owner Jae Robin and Cherry! R.i_rhandson Day phone 694-7843
Mailing address HC83-2432 Eagle Riven Road. Eagle Riven. AK 99577
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
XXX
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
xxx
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-02S (Rev. 1/91) Froni MOA .21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm s s ° ”!G1vFVRnvn
17034 Eagle River Loop Road No.204
Address �,;e i;,�r, ..Ieeke 77577
Engineer's signature
Phone
Date IZ-11-412.-
• 0
d�
2+0,L. %'
6.1 feat .
i�—
Pa ; RCGER J. SHAFERi `s,
J too. *.a :`-:Si..
6. DHHS SIGNATURE
Approved for Dnr-a 'a' bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By. �l�•_�.� .._�-
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) Bed u0A nl
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 1-61.8 et- / &IrENAy 7b In: in" S/o Parcel I D
O&7- 6o/-03
A. WELL DATA
Well type PruVATE If A, 8, or C, attach ADEC letter. ADEC water system number ^/M
Log present IPN) YE3
-vo' S..
Date completed /0111/83 Driller 's cicL4OW WAITEf hirc,1_s
Total depth Cased to 10/t Casing height 21"
Sanitary seal (ON) VC Wires properly protected (9N) YES
FROM WELL LOG AT INSPECTION
Date of test /o/Z//fl /Z/!S /9z
Static water level 20/ Zeil
Z7
Well flow 16 gPm (o, (ogpm rncp
n
rn
Pump level UNKNOW/./ UrnatiO1U rn _,
co t^O
IC
SEPARATION DISTANCES FROM WELL TO:
rn N
Septic/holding tank on lot /00/+•On adjacent lots /OOrf S V
/1 y / 0
Absorption field on lot
/CO I+ On adjacent lots /00'/• 9 m
Public sewer main AbME PRESEur
Sewer service line Sb /t
Public sewer manhole/cleanout WPC PRESENT
Petroleum tank Nom KJ
WATER SAMPLE RESULTS:
Coliform �- Nitrate °Ian rife Other bacteria
Date of sample:
-- 14-4U—
Collected by 5'*S SOG/NEERJ,J&
B. SEPTIC/HOLDING TANK DATA
Date installed 7/28/ 84 Tank size /CbO Compartments Z
Cleanouts ON) Yes Foundation cleanout N V65
Depression (Y,(611) NO
High water alarm(ON) ties Alarm tested &N) YES
Date of pumping l 2/ 14/92 p JR S C ESSAJOL Pun-IP/A./6Pum Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlot /O3' On adjacent lots /00'l ZO /
1Foundation
Topropertyline 351 Absorption field 50t Watermain/serviceline lO/t
Surface water/drainage NONE PgE, ,ijr
72-026 (Rev. 7/91) Front
CONTINUED ON BACK PAGE
C. LIFT STATION
///z /88
Date installed
Size in gallons SOO
Vent6/N) YES
High water alarm level
"Pump on" level at
C.01
Manufacturer Attic -Hogs Thhu c
Manhole/Access (3 N) Yrs
6.e' • • 1' "Pump off" Ie'ei at 6. 9
Meets MOA electrical codes(PN) YES
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot /00 '1 On adjacent Tots
D. ABSORPTION FIELD DATA
Date installed II /2 / 28
Length 47 ' Width /S
re
Total absorption area g44
Soil rating
Cycles tested Z
10 0'l
/SS`s
Surface water An we PRSSS/r
Gravel thickness
Depression over field (Yi ND
Results
d
/fail) P,1SS
System type 136V
Cleanouts present ON)
Date of adequacy test
Peroxide treatment (past 12 months) (Y/N)
for 3
Total depth 35'
Yes
/z//S/4Z
/Wive KNoc-w If yes, give date N/h
bedrooms
SEPARATION DISTANCE.FROM ABSORPTION FIELD TO:
ZOi Property line 001
Wellonlot 119+
To building foundation rO�'
On adjacent lots
Surface water
ZO'/
On adjacent lots
ijoNE P' ECC,vt
Curtain drain NONE K-fowN
• r
To existing or abandoned system on lot 10 t
Cutbank t Water main/service line ZSt
Driveway, parking/vehicle storage area 1°‘e
A g' &r'r G44?746E5 5r4C i4S77't.4/s?Zo�4.
AID 51 -,Js of ar _oe- r 'v'—set—t $4-rra6
At174ou6H Dayu6HTt.JFa ills .4 Porer-snf'r-� r'r
is "for An-Inc7P/`rC-o.
E. ENGINEER'S CERTIFICATION
1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in el ffeCJ;j*4date of this inspection.
"II ••••• ••(7)7:111/170.10
0? RJ. HAFER Co
I4 s ti No.8 •S J ��
, it tk to R•O• FESSne Ot Jaaw
ar
jA\itwozsq-
Signature
Engineer's Name
Date
5 & S ENGINEERING
17034 Eagle River Loop Road No.404
Eagle xiver, Alaska YYD77
HAA Fee$ /7 el' v0
Date of Payment /2—if— 91- )
Receipt Number a-00 2-6' (se./5/
72-028 (Rev. 3/91) Back MOA 21
Waiver Fee* $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
Department of Health 8 Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I D# 081-011-03 HAA # t -IRR— c L« 0
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, secti ; township, range)
Location address or directions)
(b) Property owner Federal National Mortgtlgfhpoqik)on
Business
Mailing Address 10920 Wilshire Blve, Suite 1800, Los Angeles, CA 90024
(c) Lending Institution Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.)
List contact person and day phone number below:
FA �'ti) t Cr- /-1,A E /6-17- et -
3 2. 'G Si. S`eJ
14-,%-,CPr-th /,41c. LeijGj
2. TYPE OF RESIDENCE
Single-Family/EC Number of bedrooms _5'
3. WATER SUPPLY
Individual Well pi Community 0 Public 0
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 -sited Public 0 Community 0 Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legaiity and status.
72-025 (Rev. 728)
Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Fir nf —E roi.t/ r �/>scntTE Tele hone + �— V`�`//C
Address
Date
6. DHHS APPROVAL
Approved for 3 bedrooms by
Approved Disapproved
Terms of Conditional Approval
,at/a
Enter • igea8,t 000000q !i�
„5 ' ▪ `•t,r7 . 1:9730
000*
%ms ; Robert E. Kniefel4 ; $$
��
A J, % No. 4149-E ,i
�I
Ila:FOp,.
"•...«aa ;_-$"
r%ROFES5Ona.
Date '/�/O�.r�Hz
-jf%'
Conditional
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 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.
fl -025 (Rev. 7/881 Bach
Page 2 of 2
A. WELL DATA e
Well Classification If A, 8, C, D.E.C. Approved (Y/N)
Well Log Present ) %yrc Date Completed 'o -- ' ' '-a Yield
Total Depth f/ Cased toy' '74 -Depth of Grouting l�^-..,e,,---,.
Pump Set At U .✓
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY 1984
343-4744
Legal Description*
/.•
MUNICIPALITY OF ANCHORAGt
ENVICJNMEENTAL SERV.CES DIVISION
0 4 1888
RECEIVED
7 r 4_
Static Water Level 23
Casing Height Above Ground 3 Sanitary Seal on Casi
ng1�l)
Electrical Wiring in Conduit) /yc
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot VG 3
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service
e on Lot
/
71
Depression Around Wellhead V V/l"<
y
; On Adjoining Lots
/Z:.< ; On Adjoining Lots
/t<r
,e/T-2)..
Water Sample Collected by /T ).. - .= s ; Date 74- - ? -ees
Water Sample Test Results
Comments
To Nearest Public Sewer Cleanout/Manhole
B. SEPTIC/HOLDING TA K DATA
Date Installed Size /tc 0 NoofCompartments /
Standpipe (Y% ) 2e, Air -tight Cap`(Y/N) t, re Foundation CleanoutOn yf c
/ Date Last Pumped /' - '6' lee 24
Pumping/Maintenance Contact on File (Y/N) it/ zz • for -t/%,,,// ``
( )
Holding Tank High -Water Alarm Y/N �� Temporary Holding Tank Permit / ,4:.> / 'Y S
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well /0 3 / To Building Foundation /E
To Property Line -7,5- / --)--c) 7--iTo Water Main/Service Line
Depression over Tank (VS) 4/,
2
-- "
/ To Disposal Field
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front
Page 1of2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
/i- 2 -Z'r
Date Installed
Width of Field
Type of System Design /-&-'-5
AC -i'/
-57 -D /
Length of Field
Depth of Field
Gravel Bed Thickness
Square Feet of Absortion Area ,1 sF Statndpipes Presen ) ),,C-
Depression over Field 62 .4 .4
Date of Last Adequacy Test i/FId fy s%F-' 9
Results of Last Adequacy Test /17,c-ed4-'TfAe/
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well /76- -74- To Property Line
To Building Foundation
/lG /
Lot —<G) / '-7`-"- ; On Adjoining Lots
To Water Main/Service Line -n-% -7-- To utback (i res n
Aze r nFcfr�_
To Existing or Abandoned System on
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area --c-" i
4�,
Commentsg-�.s 7 a/ 4' M .s 44ns a 1/71) /8 g
D. LIFT STATION
Date Installed
Size in Gallons
)v r —f'c'
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Code
Comments
6o /
..0
Dimensions
Manhole/Acces (N) /
"Pump Off" Level at 6' g
Ven Y/ ) �/-{
Pumpi g Cycles during Adequacy Test.
"Check Permitted Bedroom Rating Against HAA Request" _'-•"•�‘
certify that t I have checked,verifi d or conformed to all MOA and HAA gu4 t♦vn®fingtfest'.,Qn the date of this
-
C ��41..• Is
Inspection . s' •. ,,, aS� )
% ^�
Signed
Company
Date
MOA No.
JLC
Receipt No. n 5-2D7??
/g/7
Date of Payment /('7/�d/X
Amount $ /20.00
ice:
**,?49TH
fn • Robert E. Knio`fel :a4J
0I �'. No 4149.E : e
+`, ��taa� O`er e =
•} *,I
!/ E�gineer's Seal
f l . •Ci s•
Receipt No
Waiver Fee. $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 Of 2
•
•
I
11
2
DATA SIIEE,
PRDJEcr: LoT 11 P,Lr 1
KtFWejAy . P1eCY _SAirtnA E
•LOCATION OF HELL (Legal Description):
WELL DEPTtf: /' FT.
CASING:
DATE DRILLING CO:IPLETEO:
DRILLER:
• STATIC WATER LEVEL (Top of Casing):
FT
FT
OF Tc"ST:Ac 88
SCREEN:
90
120 2 hours
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: r14NA1/L: /Ir A -
LEGAL DESCRIPTION: LOI // /,3t,/(, /
C—'1•'1�WAy Ta M ,04 -12K
Rco 5
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(FEET)
elf •
COMMENTS
Lr. Baow& 6vt4vety
M)MMR6 w/SiLr'
GW -G -M 044t 13R4wN
oitAraec w , tl{ S 4-4
A -NO 5: sat
v bVt.U,n".s 1^r4 -(GC 7S
•NW
• Robert E Kn(eflatr=.e�
f'. No. 4149-E 14(101
01,
ROFESS•ON�v
DATE PERFORMED:`\\1,1gr' �� �t�Cl
Township, Range, Section: NL31, / Set 9 T4/3.V 4,6
SLOPE SITE PLAN •
WAS GROUND WATER
ENCOUNTERED?
IF VES, AT WHAT
DEPTH?
S
L
7 S O
P
E
(legible Water Aller 7 r
Monitoring? Dalt /Ia /fl
Reading
/
2.
3
Date
/006
ri
Gross
Time
4-
)\
Net
Time
/0
/0
/0
/0
/0
f; --
Depth
r
Depth to
Water
Net
Drop
, /3
.//
,/O
, /0
,/o
PERCOLATION RATE /1/J(mmutv41
eu¢h) PERC HOLE DIAMETER
TEST PUN BETWEEN '1 FT AND / FT
Cw -6-,vi Sv«s &E72,. 1 3'-/c2'/ ac ins/P-4 4 ,<f?J , Z/ae,.fo.A,
PERFORMED BY: ..7 -66 -ti /*e f
CERTIFY THAT THIS TEST WAS PERFORMED IN
//'
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.
72.608 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
(a) Legal Description (include
Application Date
lot, block, su division, section, �t,yownsh , range)
tir
Location (address or directioons)
pr fra,0
Lc-)
(b) Applicants Name G wr�'I/ � Telephone - Ila �L Business C�.r� '
PP • c^•s� P
Applicants Address
(c) Applicant is (check one) Lending Institution
Buyer El ; Other CI (explain);
Owner/builder j�j ;
(d) Lending Institution
Address
Telephone
(e) Real Estate Co. & Agent
Address
Telephone
13/7 « — 44-r u.t
(f) Mail the RAA to the following address:
fOe_z_z4.--tHJ helo
2. Type of Residence
Single-Familypci Multi -Family [j Other (describe)
lis
993- 77
Number of Bedrooms
3. Water Supply
Individual Well[ [ ii Community ri Public FT
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite Public Community [L Holding Tank f
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]
anieSiimar
..sams: warn
5. En:ineerin. Firm Providin: Ins.-ction3 Tests File Search Data and Information.•
As certified by my seal affixed hereto and as of the validation date shown below, I
verify
my
Investigation this lth ity Approval
functionalwandhat the enforce
uate
the number of bedrooms and type of structure indicated herein. I furthereverif for
based on the Information obtained from the Municipality of Anchorage files and f that,
investigation and inspection, the on-site water supply and/or wastewater dis from my
system is in compliance with all Municipal and State codes, ordinances, and regual
la -
tions in effect on the date of this inspection.
Name of Firm
Address 1. 6 & EC191NEERINCI
Date
Telephone
(ENGINEER SEAL)
6. DHEP A_ n ai
Approved for, ti bedrooms
Approved Disapproved
Terms of Conditional Approval
or
Pik
Or
OF 44
li
,n 'Av
*abort A. Shofar 4; w
4 d• . No. 145744.4a'
: fy'
w Y
Conditional
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS LIVEN 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 NAMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/ej/D18
(Page 2 of 2]
7-19-94
A. WELL DATA
Well Classificatio
Well Log Present
Total Depth
Static Water Level
.+a
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Descripti
-`-.M =LITYc OF ANCHC.QAG:
ENVI.RONMENTAH.FALT`I
1 Fn.:T: Ci:OfJ
ISEP25
RECEIVED
_ic, 6/
/ /may y e a,
✓Y(/L/f� If A, B, or C, D.E.C. Approved(Y/N)
Date Completed /O // 3 :73... �P�
i� / Yield n, S`// ,
Cased to £O S Depth of Grouting //
Z O
Pump set At u c -r
Casing Height Above Ground /2.//oPc-
Sanitary Seal on Casing (Y
Electrical Wiring in Conduit&�/i) Depression Around Wbllhead
.Separation Distances frau Welll:
To Septic/Holelz,.g Tank cn Lot /17(3—/ ; On Adjoining Lots /DO 74
To Nearest Edge of Absorption Field on Lot�� / ; On Adjoining Lots /00 /
To Nearest Public Sewer Line
•Cleancut/Manhole
Water Sample Collected By .S b S Z - 7hlel" Dat S%/2/ ice
f79- To Nearest Public Sewer
Tb Nearest Sewer Service L ne on Lot ¢-O
Water Sample Test Results(71
is c ; r ez>7
Contents
B. SEPTIC/HOLDING TANK DATA
Date Installe• 7/PV
Standpipes
Depression over Tank
size / coo
Air -tight Caps
Date Last Pupped
Pumping/Maintenance Contract on File (YfN)'V/fl ; for
Holding Tank High -Water Alarm (Y/N) Nl1- Temporary
Separation Distances from Septic/Holding Tank:
/OS -
To Property Line 71 £b f To Disposal/
Field ��
No. of Compartments
To Water -Supply Fell
z
Foundation Cleanout 001
N(49 -
Holding Tank Permit (Y/N)1/4/14
To Building Foundation 20 //-
To Water Main/Service Line 3p -- To Stream, Pond, Lake, cr Major Drainage
Course ,J /�
Convents1
Receipt # 995,,Q d,?
q
Date Paid: _,2.5., y
Amount: if on
(Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
fig'
Date Installed
Width of Field
2/3 / Type of System resign 8:9
Length of Field 4;19/
7 /L
G"
Gravel Bed Thickness
Square Feet of Absorption
Depression over Field (Y
»ea
)
Results of Last Adequacy Test
746
Depth of Field
Standpipes Present
Date of Last Adequacy
Separation Distance frau Absorption Field:
To Water -Supply Well //C
To Building Foundation
To Property Line
2 0 ' To Existing cr Abandoned System cn
Lot A' 6 0- ; On Adjoining Lots 11/0 f'
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, cr Vehicle Storage Area 444 /-
Comments Co:ments
Test
f)
Netti •
wl�
3o 1- To Cutbank(if present)
D. LIFT STATION
i
Date Installed
Size in Gallors
"Pump On" Level at
High Water Alarm Level at
Tested for i
•*
I certifj that I;have checked, verified, or conformed to all MOA HAA Guidelines in effect
cn the date of this irspecticn. •OF At
Signed 8 a r E`:31c'.2ERIM!i Datz/�Y 91(�p ••10. ,9+
Coapanyl�c.,QLE t MO No .
•
ni�w ainstiA CST? , r e 49
KBl/d5/s
r Robed A. SMIu, j `3
No. l4S7-E . $? 0,
fv
Dinersicns
/. / Manhole/Access
/4,1`//mp Off" Level at
Vent (Y/N)
(Y/N)
Electrical Codes(Y/N)
Convents
Pumping Cycles during Adequacy Test. Meets ?CA
r+
Check Permitted Bedroom Rating Against HAA Pequest
(Page 2 of 2]
2-15-84