HomeMy WebLinkAboutFIRE LAKE ADDITION 2 TR J-2Onsite File
Fi'* re Lake A ddi*ti*on 2
Tel
Formerly Fire Lake Lot 2 Tract J
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: ________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
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Municipality of Anchorage Page / of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~,~/ ~c~ O/~ PID Number: ~'/- ~.~-~'/~
Name:
~1, ~/~ ~ ~ ~IL B~T Wastewater System: D New ~Upgrade
Address:
/~ ~/~ ~ ~p., ~ 9957g ABSORPTION FIELD
Phone: NO. of Bedrooms: ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION s°~'""'~""~,45 GPO/S,.Ft. Total Depth fr~ ~riginai grade:
Lot: Oluvk. Subdivision: Depth to pipe bottom from original grads: Gravel depth beneath pipe
Township: /~ Range: /~ Sectio~ / Fill added above original grade: Gravel length:
Gravel ~h: Number of lines: Distance ~tween lines:
WELL: C New C Upgrade ~ ~/~ ~ Ft. ~ /~ ~ Ft.
Classification (Private, A,B,C): ~1 ~ ~sed To: Total absorption area: Pipe material:
Driller: ~ Date Drilled: Static Water Levek Installer: Date
installed~/
SEPARATION DISTANCES ~,~ic ~ Holding ~ S.T.E.P.
To Septic Absorption Lift Holding =ublic/Prlvat. Manufacturer: Capacity iT;,~s
From Tank Field Station Tank Sewer Line, AW~H
j Materiel: Number of Compa~ments:
su,.c. , LIFT STATION
Water ¢/~ ~/~ ' ~/~ ~
Line ¢/~ ~/~ , Size in gallons: Manufacturer:
Foundation ~/ ~/~/ ~> "Pump on" level at:,1~~~ mat:
Pump Make & ~'~lectrical Inspections pedormed by:
Drain ' ~/
Remarks: BENCH MARK
Location and Description:
Assumed Elevation:
ENGINEER~SS~AL
Inspections peflormed by: ~ ~ ~ ~ Dates: l st ~//~/95 * "''"~
~.~ 2nd ~//5/75 '~ ~ · ·
~[~ LOUIS A. Bulera
Department of H~~~~vices approval ~,~",
Reviewed and approved ~~ w,/~-~-~ Date: ~,~,~;,~
72-013 (1/91) MOA 25
Permit No. SW950103
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
Fire Lake
Legal Description:
Lot 2, Tract J
E
051-333-24
NO DEVELOPMENT WITHIN 75'
JUNCTION "i
349.50
N 69°52'00" W
SHED ti`1` SWING TIES: o
N N NEW TANK A-C = 32.7 'ii 01
D ��� B—C = 14.1 0 ^�
RIV oW A—D = 56.9 °~
EW/� y tim u B-D = 53.7
o C A-E = 44.7
ti B-E = 53.2
19 z BIB you B A—F = 41.4
T1 Sf a B—F = 59.4
- o tiw W
Fri
Fr7 0 0 3¢ o
F_ 2 4 TRACT J
e
(Tj 1 3
P
d �
M 293.50
N 89'52'00' W
SCALE 1" = 60'
® — TEST HOLE
— MONITOR TUBE
o — SEWER CLEANOUT
¢ — WELL
— LEACHFIELD
ELEVATIONS OIL TOP OF CONCRETE WALK — — EASEMENT
(NOT TO SCALE) ASSUMED ELEV = 100.0 -
m
❑RIGINAL =O
GROUND
LEVEL AT. m ENGINE SAL
V ADDED FILL TR2 985 = OF �,
�{ TR3 97.2
innIltfll TH 97.2
2 2" 35PSI INSULATION NO GWT � ��� v
49 TH t
TANK . • .
X98.7 6,5 TRl2 999766.755 TR]2 999765.755 00 0
TR3 95,2 TR3 95 2 0 ' ' ` . ... .
�I Fc LOUIS A. BUTERA
TRl2 9gg099.6SS1 �Jf CE-6736 �_
TR3 88,01 ��,Fpno * - Fri
72-013 A (2/91) MOA 25
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND H~ SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM
PERMIT NUMBER:SW950103
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:PHILPOTT WILLIAM KIM &
OWNER ADDRESS:14439 FIRE LAKE DR
EAGLE RIVER, AK 99577
PARCEL ID:05133324
LEGAL DESCRIPTION:
FIRE LAKE LT 2 TR
J
LOT SIZE: 52910 (SQ. FT.)
NUMBER OF BEDROOMS.: 3 THIS PERMIT: 3
(UPGRADE) PERMIT
PAGE 1 OF 1
DATE ISSUED: 6/05/95
EXPIRATION DATE: 6/05/96
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 ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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:
THE INTEGRITY OF THE EXISTING SEPTIC TANK SHALL BE VERIFIED
TO THE ENGINEER' S SATISFACTION.
I~ick Myslrom,
Mayor
Mmficipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
May 5, 1995
Lou Butera, P.E.
Eagle River Engineering Services
PO Box 773294
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 2 Tract J Fire Lake Heights S/D
Waiver Request ~WR950016, PID #051-333-24
Dear Mr. Butera:
Your request for a waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 2 feet from the leachfield to the north
property line.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Si~erely, ~
~om~rSa~r~aSnS~g~'-
On-site Services/Water Quality
ljw #7
MUNICIPALITY OF ANCHORAG~
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR~ WR950016 PID# 051-333-24 HA#
Date Received: May 23, 1995
Permit
Legal Description: Lot 2 Tract J Fire Lake Heights Subdivision
Engineer: Leu Butera, P.E., Eagle River Engineerinq Services
PO Box 773294 Eagle River, Alaska 99577
Applicant: William Kim/Pamela Ann Philpott
Waiver Requested: Lot line waiver of the leachfield to 2 feet to the
north property line;
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Waiver is Granted: Y Waiver is NOT Granted:
List Conditions or Reasons for above: ~ ~V~
Date:
Na~ df Reviewer
Rec #: 00918/3338 Amount: $ 115.00 Date Paid: May 23, 1995
Louis Butera, P.E.
Registered Civil Engineer
May 23, 1995
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re:
Fire Lake Heights, Lot 2 Tract J
Narrative for Permit & Waiver Application
Dear Mr. Cross:
On behalf of our clients, Mr. & Ms. Philpott, we are applying for an upgrade permit for the above
referenced property.
This lot presently has three wells with a combined total well yield sufficient to provide a three
bedroom dwelling. The wells were drilled, and it was determined that a leachfield upgrade was
required. Due to the severely limited reserve area, we are requesting an upgrade leach field be
installed at two feet to the north lot line and at a minimal distance to the existing trench, which
will be abandoned in place and at 10 feet separation between the new trenches.
We do not expect any complications from either locationai waiver for the following reasons:
The lot to the north has no development within 75 feet of the lot line, and there is
more than sufficient acreage to support several reserve areas on this lot.
The existing soil is not very permeable and leachate travel beyond the existing
trench is therefore minimal.
We will be utilizing a stepped trench system as there is a 10% slope to the west, and to take
advantage of more permeable soils near the surface. The first trench is to overflow to the second
and third, which will be evenly distributed through a tee shown as "junction box" on the site plan.
Financial consideration makes the requirement of a pressurized system impracticable.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\C:\V~PWIN60\WPDOCS\ 1995\95-029A.NAR
P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 · Fax (907) 694-3297
Louis Butera, P.E.
Registered Civil Engineer
June 2, 1995
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Fire Lake Heights, Lot 2 Tract J
Explanation of soil logs
RECEIVED
JUN 5 1995
Mumc,flatity ot Anchorage
Dept. Health & Human Services
Dear Mr. Cross:
The original soils log for test hole 2A and 2B on the above mentioned property, show a 1.5' layer
of non-native fill at the top of the test hole. This layer of fill is created from the driveway of the
residence on said property. The site for the test hole was chosen at the edge of the driveway pull-
off so as not to disturb the natural soil at the proposed system location.
This non-native fill layer is present only at the test hole, and is not present at the location of the
proposed system.
The system design shows the system to be built from 2' depth to 9' depth, however, this is not
taldng into the account the non-native fill layer. The proposed system will be built at a depth of
1.5' below the natural ground surface to 8.5' below ground surface. Disregarding the 1.5' fill
layer on the soil log because this layer is not representative of the surrounding area. This will
allow the entire septic system to be in the sandy gravel and silty gravel layers. Cover above the
system will be a combination of insulation and mounded fill.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\G:\WPDOCS\1995\95-029B.NAR
P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 · Fax (907) 694-3297
JUN-- 2--95 FR I 1:~ .' ;~c) E . R . ENIG I NEER I N~
0E,'-'0~-lgg$ l~4iPN FROM E.R. Enslneerin~ ~vo~, TO ~94745~
Reglste~ Civil Engineer
~ 2~ 1995
Jim Cross,
Managar, On-Site $.~rvices
Muaicipality of Anchorage
P.O, Box 196650
Anchorage, ~ 99519
Re: Fire Lak~ Heights, Lot 2 Tract
Explanation of soil logs
RECEIVED
JUN 5 1995
MOtuu,p,ahly OI Anchorage
Dept. Health & Human Services
Dear Mr. Cross:
The orlg~nol soils log for lest hole 2A a~d 2tt on the above mentioned pm~, show a 1,5' layer
of non-~ve ~ at ~e ~ of ~ ~I ho~. ~is hyer of fill Is c~ ~m ~e d~veway of the
~sidcn~ on ~ pw~. ~ ate for ~o ~ hole wm chos~ at ~e ~E~ of ~e driveway pu~-
off ~ as not m dis~b the nam~ s~ at ~e pm~sed zySt~ l~aflon,
This non-native fill layer is present only at th~ tt, s~ hole, and is no~ present a~ th~ location of the
proposed systcra.
The ~ystem design shows tl~e .~ys~em m be built from 2' d6pth to 9' depth, however, this is not
t~t%g into ~e a~uut the non-nagvo fill layer. Thc pro~s~ sys~m w~ ~ b~t at a dep~ of
1.$' below ~e natu~ ~ound surf~ to 8.5' below ground surfak, Dts~ga~di~g the 1,5' fill
layer on ~ soft log ~aum ~is lay~ is not r~n~Ove of ~e su~ounding ~. This w~
~low ~te ~&e mptk system ~ ~ in ae ~dy grovel ~d airy g~vel layer, Cov~ ~v~ ~e
sys~m ~1 be a con~b~a~on of ~sulafion ~d mound~ ~.
Ii: you have any questions plea~ call our office at 694~195.
Sincerely,
Louis B~tera, PJS.
~O~WPDoC~\ ! 9P~\9~-OZPI~,NAR
P.O gox ?73t~4 · Eaale Ri~r. Ala.~ka 9,9577
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL:
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
and State Department of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage, Department of Environmental
Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
1. The trench is to follow the natural land contour to maintain uniform total depth of
the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 9' at any point.
4. The sewer line is to replace the existing sewer line that leads to the existing
trench.
The trench gravel is to be covered with typar fabric material.
Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
The area over the trench is to be finish graded to prevent ponding of surface water
runoff.
The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
o
RECOMMENDED I,EACI-IFIEI,D DIMENSIONS:
TOTAL DEPTH = 9' GRAVEL DEPTH = 7'
TRENCH LENGTH = 71' TRENCH WIDTH = 3'
SOIL RATING = .45 GPD/ft2 BEDROOM CAPACITY = 3
SEPTIC TANK = 1000 gallons
Trench is to be stepped in three sections (see site plan).
Twenty-four (24) hours notice required for all inspections.
C :\WPWIN60\WPDOCS\1995\95-029B.RPT
', TRACT I -I'~-
II JUNs~nxo. NO DEVELOPMENT WITHIN 75'
~ ~ ~ ~ ~ /~ ~ m ~4950
h 89'5~'00' W
TRACI L
l~,,f~ ~ - TEST HOLE
· - MONITOR TUBE
o - SEWER CL~NOUT
+ - WELL
~- PROPOSED L~CHFIELD
m- EXISTING LEACHFIELD
EASEMENT
SEPTIC UPGRADE SITE PLAN
LEGAL: FIRE LAKE TRACT J OF LOT 2
OWNER: PHILPOTT
CONTRACTOR: N/A
JOB~ 95-029A~ DATE: 05/18/951 SCALE 1" = 60' ~'"~~~:'
P.O, Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:__
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15.
16-
17
18
19
20
COMMENTS
.7- Township, Range, Section: -'~'/.<--.~.. ,~I ~, .4~ -~/
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT L:
DEPTH? ~, ~,)/ pO
E
Depth to Water After ~,j /
Monitoring? Dale:
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
Z F-~r~ ~:~ D~ ~"" ~ '~* ~/1~'
PERCOLATION RATE ~'~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN -'q'- FT AND O'/ - FT
I ..,/---,4:~,-?'" ~*' ~ CERTIFY THAT THIs TEST WAS PERFORMED IN
PERFORMED
BY:
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELtNES iN EFFECT ON THIS DATE. DATE; --
72-008 (Rev. 4/85)
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:
LEGAL DESCRIPTION: /~-~_,~"~,
1
2
3
4
5
6
7
8
9
10
WAS GROUND WATER
ENCOUNTERED?
Township, Range, Section: ~'/j-..~, ~ / u.~ ~'~.¢, ~"t
SLOPE SITE PLAN
11
12
13,
14
15
16
17
18
19
20
COMMENTS
S
IF YES, AT WHAT O~
DEPTH? .
Reading Date Gross Net Oeoth to Net
Time Time Water Oroo
3 ~-2z-~ ii,.~y 3~...~ ~ ~llt r/ii"
PERCOLATION RATE ~
-- (m~nutes/~nch) PERC HOLE DIAMETER __
TEST RUN BETWEEN ~ FT AND /7/ FT
PERFORMED BY: ~'~"~ ~/~-'J I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. '~,/~ -z,."/.~3-
72-008 (Rev. 4185~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL D E SC R I PTIO N:,,/~_/,~ ,~,-~
1
2
3
4
§
6
7
8
9
10
11
12
13-
14
15
16
17
18
19
20-
COMMENTS
DATE PERFORMED:
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT L
DEPTH? ../t//.¢~ pO
E
Oeplh to Water ~4iter
Monitoring? M'r? f- /~ Dale:
TI~-.,~' /~ I ~ ~.~, 7/
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
2.. I--/.t-~r i$-..,~,~ 70 ,,.,, Y ~Z~ ~
PERCOLATION RATE ~'~ (minutes/inch) PERC HOLE DIAMETER 6' "'
TEST RUN BETWEEN t~ FT AND ~ FT
PERFORMED BY: /~ ~"~/--~J I --~;'~~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ,~//-~
72-008 (Rev, 4/85)
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 95-029
Calculated By: LB
Date: 5/22/95
Single Family 3 Bedroom Dwelling
Deep Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom -- 450
Percolation rate --
Wastewater application rate =
Required absorption area =
Trench width (W) =
Gravel depth (D) =
gallons
60 minutes perinch
0.45 gallons per day per square foot
1000 square feet
2 feet
7 feet
Required length = Required absorption area / 2 / D
Required length = 1000 /
Required length = 71 feet
Total Excavation Depth = 9 feet
2 / 7
SINGLE FAMILY ON-SITE WORKSHEET
ERES PROJECT NUMBER: 95-029 CALCULATED BY:
LEGAL DESCRIPTION: FIRELAKE LOT 2 TRACTJ
NUMBER OF BEDROOMS: 3
WATER USE PER BEDROOM: 150 GALLONS
PERCOLATION RATE: 60 MINUTES PER INCH
DEPTH TO GROUNDWATER: 13 FEET
DEPTH TO IMPERMEABLE LAYER: 15 FEET
ANTICIPATED DEPTH OF COVER: 2 FEET
MOUND OR BED SYSTEM
WASTEWATER APPLICATION RATE:
ABSORPTION AREA REQUIREMENT:
MINIMUM BED LENGTH
12 FEET WIDE BED
15 FEET WIDE BED
TRENCH SYSTEM
WASTEWATER APPLICATION RATE:
ABSORPTION AREA REQUIREMENT:
SHALLOW TRENCH OPTIONS
5 FEET WIDE TRENCH
EFFECTIVE
DEPTH (FT)
I
2
2.5
3
3.5
4
LB
0.3
1500
USABLE SOIL STRATA
TOTAL USABLE DEPTH:
USABLE SOIL STRATA DEPTH:
GAL/SQ.FT
SQ.FT
125 FEET
100 FEET
0.45
1000
GAL/SQ.FT
SQ,FT
DEEP TRENCH OPTIONS
3 FEET WIDE TRENCH
REQUIRED TRENCH EFFECTIVE REQUIRED TRENCH
LENGTH (FT) DEPTH (FT) LENGTH (FT)
175 4 125
140 4.5 111
127 5 100
117 5,5 91
108 6 83
100 7 71
8 NA
9 NA
DESIGN SPECIFICS
FIELD SYSTEM: D
GRAVEL DEPTH: 7
TRENCH OR BED WIDTH: 2
LENGTH: 71
TOTAL
EXCAVATION
DEPTH: 9
(B=BED, S=SHALLOWTRENCH & D=DEEP TRENCH)
FEET
FEET
FEET
FEET
PAGE 1 OF
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:SW950013
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:PHILPOTT WILLIAM KIM &
OWNER ADDRESS:14439 FIRE LAKE DR
EAGLE RIVER, AK 99577
DATE ISSUED: 2/09/95
EXPIRATION DATE: 2/09/96
PARCEL ID:05133324
LEGAL DESCRIPTION: FIRE LAKE LT 2 TR J
LOT SIZE: 52910 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
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 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:
DATE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME )/( / /)
MAILING AD[~RESS
LEGAL DESCRIPTION
l Well __, ' __ /,? Absorption areaz, (./
Manufacturer/'
pacity in gallons Inside length
~) L IF HOMEMADE:
DISTANCE TO:
Dwelling
DISTANCE TO: Well jL..,),.~-?
Length O',e.~ach~nez ~,
No. of lines / I Y': ·
Toper tHe,to/finish grade
Length Width
Type of crib
Crib diame~./
DISTANCE TO:
Class
DISTANCE TO:
Well
Foundation /,) (' ¥/
Total leng~th of line~
Material beneath tile
Depth
Crib depth
Building foLmdation
IPUON E .~F'N EW
/Y'/- ',', , I ' :DPGRA.E
Dwelling
Z
Widt~ ~7'~-
Material
Nearest lot line
Trench width
inches
NO. OFBEDROOMS ;~
PERMIT NO.
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
Distance bef'w~? ,in~', /)
/Toti~l; e~fective abso(ption area
PERMIT NO.
Total effective absorption area
Nearest lot line
Depth Driller Distance to lot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
)¢ (
INSTALLER
REMARKS
DATE LEGAL
7~-013 (Rev. 3~78)
PERMIT NO.
DEPRRTMENT 0,' HEALTH RN[:, ENVIRONMENTRL t r~.OTECTION
825 "'L"' STREET., RNCHORRGE, RK. 9D50i
264-4~20
,:: 81008~ )
APPL I CANT
LOCAT I ON
I_EG[~[_
ROBERT BENSON 26]:0 SBNCTLIARY [)R.
F I RELRKE
L.T. 2 TRACT J FIRELAKE S,.."D LOT SIZE
E;94-2:OB7
4~560 SQLIRRE FEET
TYPE OF SOIL ABSORPTION Sb'STEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING (SQ FT,.'"BR)=
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEF'TH= :1.2 L E I'~lr.2iT H = 82 ~2~ R R '...' E L_ [:,EP]'H=~. '7'
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OF.: DRRINFIELD.
THE DEPTH OF' A TRENCH OR PIT IS THE DISTRNF_:E BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE E',=..',CRVATION (IN FEET).
'THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIF:'E
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS 8[:,JACENT TO THIS PROPERTY AN[:, THE
NUMBER OF RESIDENCES THAT ]'HE WELL. WILL SERVE
TI..4C, ( 2 ) I I'-.ISF'EF:T I L--~I%IS; RI~:E RE _r-.!LI I RE[;:.
BACKFILLING OF FtN'-r' SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL. AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
±00 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC NELL.
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 THE DEPARTMENT WITHIN 3:0 [:,AYS
OF l"HE WELL COMPI..ETION.
OTHER REQUIREMENTS MAY RPPL~'. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
R',,,'RILRBLE TO INSURE PROPER INSTF~LLRTION.
F'ERF'I I T E."-~P I RES E:,EC:Ef'IBEF.: 31.. :1.'_:~.. 8::!_,
I CERTIFY THAT
t: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MI...INICIPRLIT¥ OF 8NCHORRGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
.S':: I UNDERSTRN[.', THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENL. RRGEMENT IF 'THE
RESIDENCE IS; REMODELED 'TO INCLUDE MORE THAN -_'.': BEDROOMS.
V4. 0
O & E ENG,,,~IEERING & DEVELOI-,vlENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Oyster
694-2774
A/in
Performed for: Name:
Mailing Address:
Legal Description: /---
Depth (feet)
0
1
2__
3__
4__
5
7__
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
SOIL LOG
Soil Characteristics
Earl Ellis
688-2280
Tel. No, ~'7
No ~ If yes, what depth
Drain Field
PLOT PLAN
PERC. TEST
Comments:
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COSA Checklist.docx
COSA Checklist
Legal Description: FIRE LAKE ADDITION 2 TR J-2 Parcel ID: 051-333-58
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA – WELL #1
Well log is filed with Onsite (or attached) Well #1
Date drilled 4/14/1981 Total depth 605 ft
Cased to 23 ft (INTO BEDROCK)
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA *8/1/2024
Static water level at beginning of test *20.9 ft.
Well production at time of test *0.5 gpm
Water storage tank volume NONE gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 1.02 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Sullivan Date 8/1/24 & 8/7/24
(Well #1 disinfected with subsequent neg coli)
Comments: *Per Sullivan’s flow, well number one had 0.5 GPM water production and was chlorinated. See attached. Per MOA, since well
number 1 produced enough water the other 2 existing wells only had CAN water samples taken – see attached test results. These other 2
wells are connected to the house, had 12” + casing height with sanitary seals, conduit and these well logs are in the MOA file.
B. TANK DATA
Measured operating fluid level in septic tank 50”
Date of pumping 7/15/24
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/16/1995
ALL standpipes present per record drawing
Total measured depth from existing grade 10.5 ft (max)
Measured depth to pipe invert from grade 3.6 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 7/15/24
Results Pass
Fluid depth prior to test 25 in
Water added 500 gal
New fluid depth 42 in
Elapsed time 1440 min
Final fluid depth 25 in
Absorption rate 450 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 84 in (MOA 7’ ED)
Effective depth used 25 in (Final Fluid Depth)
Effective depth (ED) remaining 59 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots &
appears approximate. As checked above, all standpipes of the record drawing were present & surveyor missed showing.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No *5 ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No **2 ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*TANK TO FOUNDATION MET CODE AT TIME OF INSTALL. **MOA WAIVER - #WR950016
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 8/7/2024
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
8/7/24
Flow Test
O DOC CO dba
�BILL 8c COLE
P-,ULLIVAN WATER WELLS
P.O. Box 674269, Chugiak, AK 99567 688-2759
Client:
Address:
Date:
Time
Brent Western
14439 Fire Lake Dr. Eagle River, AK 99577
8/1/24
Static Meter Gallons
GPM
Notes
2:47
20.9
4230
12.82
DD Start
2:57
98.5
4347
117
11.7
3:07
175
4461
114
11.4
3:17
243.9
4564
103
10.3
3:27
254.9
4658
94
9.4
3:37
254.8
4740
82
8.2
3:47
U N K
4811
71
7.1
3:57
U N K
4873
62
6.2
4:07
4926
53
5.3
Meter Swap
4:10
1667
4:20
1710
Stuck Meter
4:29
Dry
4:35
Bucket Test
Off
4:45
Off
4:47
6
0.5
Off
4:57
On
4:59
6
0.5
Off
5:09
On
5:10
6
0.54
Off
5:20
On
Well Yield
5:21
6
0.5
0.5 GPM
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Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater program
4700 South Bmgaw 6L
P.O. Box 196850 ~, AK 9g619-8650
www.d.andlol.age.ak.u~
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 051-55.3-24
1. GENERAL INFORMATION
Complete legal description FIRE LAKE SUBDIVISION; LOT 2, TRACT
Location (site address or dlrec~ons)
Current Property owner(s)
Malting address
I-~llng agency
Mailing address
Real F. stete Agent
Mailing address
14439 FIRE LAKE DRIVE * EAGLE RIVER, AK
JENNIFER & JEFF NELSON Day phone
14439 FIRE LAKE DRIVE: * EAGLE RIVER, AK 99577
Day phone ..
99577
696-3794
MARY D. FOX w/ REMAX PROPERTIES Dayphone
2600 CORDOVA DR~E * ANCHORAGE, AK 99505
257-0120
Unless ofhenafse requested, HAA ~ be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Wall ~11
Individual Water Storago
Community Class Well []
Public Water Si/i~m
[]
TYPE OF WA~ i ~'WATER DISPOSAt.:
IndMdual On~lte E]~
Individual Holding lank
Community On-~lte ~
Public Sewer
'2. ? ~, - 7 ~._77 y
up to one y~ar ~teT~iml~les.) Coates are valid for ~ne year for properties esnmd by Class A or B
wells or a public water s/stem. The Municipality of Anchorage Is not mspenslble for errom or omlssione In lhe
pmfesalonal engineer8 work.
4. STATEMEHT OF INSPECTION BY ENGINEER
for the number of bedrooms and type of sf~ucture ~ted hereln. I furS.a~ verffy ~hat based on U~e
on-sl~ water supply and/or wasmmter disposal aysa~n Is(am) In compliance wl~h all applicable Munldps]
and State codes, orr/IMm:es, and regulatlons in ef[ect at ~he #rne of instsllatlon,
NameofFInn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504 ~--/_l,
Engineer's printed Name JEFFREY ~ GARNESS, P.E. Date
Approved for
,Dtsappnwed.
Conditional approval for __
bedmoma, with the fllowlng stipulations:
Septic System Advisory
Well Flow Advisory
Manltensnce Agreements
Supplemental Engineers Reert
Other
Original Certificate Date:.
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 South Oragew St.
P.O. Box 196650 Anchorage, AK g9519.6650
HEALTH AUTHORITY APPROVAL CHECKLIST
A. WELL DATA
FIRE LAKE SUBDMSIONi LOT 2, BLOCK
Parcel ID: 051-3,35-24
Welltype PRIVAT[ IfA, B, orCprovldePWSID~ N/A Well Log (Y/N) YES
Date completed ~ - ~'
~' ' Il -~ ~-~! Sanlta, ~eal2_~(Y/N) YES ~Ires pm.dy protected (Y/N) YES
om~ oepth~lt. Cased to ~fL Casing halght (abev~ ground) 12"+ In.
FROM WELL LOG
AT INSPECTION
4/24/01 J 4/25/01
Wall pmductton 1.o J o. lo I o~8 g.p.m. 0.2, o.~
o.~ ~- ~ ~1 ~ ~2
WA~ ~P~ ~UL~:
4/27/~1
D~ ~ ~pla: · 5/~/2~1 ~ ~: A~C, INC.
WELl. ,3 w.~ NOT
~.~l~u. STAllC WATI~
ft. LEVEL W~ AT 99'
~ 4/24/~1,
B. 8EPTICfltOLDING TANK DATA
Tank Type.~latedal
Tsnk etze 1000 gal.
Founda~on claanout ~) ~
Dm ~ ~mpl~ 4/27/2001
~O~ON R~ DATA
~ ~ ~ ~a ~ ~~m)o.45
~ 72.7 (~T~)[ m 5 [
$1LEL
Number of Compa,'tments 2
Depression over tank (Y/N) NO
F'um~er
Date Installad 6/16/1995
Qeanoute (Y~N) YES
High water alarm (Y/N) N/A
JR'e PUMPING
MT2/MT3 - lr,~.:.u MIDDLE AND LOWER I~[NCHES ONLY
System type TRENCHES
Gravel below pipe 7 ft.
Totaldeplh ~o..~+/- ft. Eff. absorpfionarea 1017 Ifl Monitodngtube YES
Date of edequacy test 4/27/01 Re~utts (Psss/Fall) PASS
Ruld depift In absorpUon field before test .~.~ In. Water added 1500 gal.
Elapsed Time: ,250 min. Final fiuld deplh ~s'/42'
Any mJu~naUon ~atment (past 12 mo.) (Y/N
Depn~alon ov~r field NO
For 3 bedm
New dep~ 77'/4s' In.
In. Absoq~lon ate >- 450 -{- Il.P.d.
NONE KNOWN If yes, gtve date -
O. UFT STATION
E.
Date Installed, Size In gallons ~
· pump on' level at ~ High water_ale, tm ._k~l a.t In.
~ Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Sepfi= tanM~t staUon on k=t lOO'+
Absorpfion field on lot 100'+
Public sewer main N/A
Sewer/septic esn~ce llne 25'+
On adjacent lots 100'+
On adjacent lots. 1 oo'+
Publio sewer manhole/ciesnout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Watermaln 10'+~~) Watareswlceline 10'+
Welis on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION Fll=l i'~ ON LOT TO:
· Property llne *2' Building founc~fion lO'+ Water main
Water esn4ce llne 10'+ Surface water 10o'+
Curtain drain NONE KNOWN Wells on edjecertt lots. 100'+
Absorption field.
Surface water
5'+
100'+
*SEE WNVER ~WR950016
Odveway. peddng/vehlcie storage
F. COMMENTS
G. ENGINEER'~ CERTIRCATION
I certify that I have determined through field Inspecffons a. nd
review of Murdclpal records that the above ~ema ~ ~. .
conformance w~h MOA HAlt guidelines in effect on rn~s oa;e. '
Engtnee~'$Prlnt~dN/~me JEFFREY A. OARNESS
I/
Date ~
Date of Payment ~ '<~ -<:::) /
RecelptNumper /
Waiver Fee $
Data of Payment
Receipt Number
Dlvlsion~of Environmental Services' '" '~*~
· ' ' On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
':" ":?*'"" ': 343-4744 · '
CERTIFICATE OF HEALTH AUTHORIT~
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# Q51-333-24 HAA#
1. GENERAL INFORMATION ~:
Complete legal description
Fire Lake Lot 2, Tract J
Location (site ad~lress or directions)
14439 Fire Lake Drive, Eagle River
~ Mailing address '14439 Fi~e lake Drive. Eaale River. AK 99577
Lending age,n.~y 'Pacific Alaska Mortgage/Wendy Goldba~ay phone 258-7534
. Mailih~g address. 2600 Denal~ Street:,- s~ite' 702~ D~n~l{0~:a~e}}~~} 9'9503 . -.
· , ;-}. ,Agent vista RE/Chris Swires..'"~".. .... ~,DagPh0ne'~, ~w,~;~ ~273-7235'
. , ,.~ '. Unless otherwise requested, HAA w~ll be.held for p~ckup?,~...~:?~;~.;,.,~$~:~,~. ~, .,r __~...~
2. "'NUMBER OF BEDROOMS:',, 3 ... .....
:';'~' ' .... 3. ~;~L~"= "~=' WATER 'SUaa'v' .-~,~ :,¥, ';',L .......... : :'~.~.-~..':~., ":,, ,':-. ;, .:' ; ',~:,L:,'>;, I'~1 '~ ~., c
NOTE:If commu'nity well sYStem, provide written confirmation from S. tate Al
ing to the legality and statue of system. ' '"
4. TYPE OF WASTE'WATER DISPOSAL:
. i-,,.-, ~ , ;~,~.~ r''''--'Holding tank ?. , ..... ; .... ~
NOTE: If community waste~ater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
'O ix
=.g attest-
72-02~ (Rev. 1/913 Finn! MOA ~21
STATEMENT OF . INSPECTION BY ENGINEER : ..
As certified by my seal affixed hereto and as of the validation date shown beloW,. I:verify, that my;.:
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my inves.t~ation 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. Well flow rate is the
combined figure of three separate wells.
"' Name of Firm v Eaqle River Enqineerinq Services Phone 694-5195 ~
Address p.n. R~r 77q?q4_ Wm~]m ~,~'. AW
Engineer's signature · ~~-~
9q577
Date
6,.~?!.~ DHHS SiG NATU R E ?'~a?:'~:"i:~*, !-'
bedrooms.
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 satis~ certain federal and state reqbirements. Employees of DHHS do not
conduct inspections o~: analyze data before a certificate is issued. The Municipality of Anchorage is not
resPonsible for errors or omissions in the professional engineer's work.'? ' .....
WATER WELL ADVI$OR,Y.
HEALTH AUTHORITY APPROVAL NO. ~//~ ~,~,_4"~
During a recent Health Authority Approval on-site inspection a~
test of the p~table water supply well on Lot /,~ .~/'~~
of /~.~/~ L~L~ Subdivision, the well's productivity
was det'ermined to be ~_~_~ gallons per minute. The minimum well
productivity required by this department (AMC 15.55) for
a -~ bedroom residence is d2c~.~_ gallons per minute.
Although the subject well currently exceeds this minimum
requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of
noncritical water uses such as washing cars and Wat'ering lawns
and gardens may be required.
This advisory must be attached to all copies of t'he subject
Health Authority Approval,~
MUNICIP.,,~Y OF ANCHOP. AGF
Municipality of Anchorage ~.NVIRO~SERVICE$ DIVISION
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST ,.:~¢-~ 9 199,5
Legal Description: ~//Z'g: /~'/-~; Parcel I.D.
A. Well Date
Well type
Log present (Y/N)
Total depth /J /~o5/
Sanitary seal (Y/N)
~/Z I ~'/Y7/~ If A, B, or C, attach ADEC letter. ADEC water system number
)/~ 5 Date completed 0~//?/
-<" Cased to _~:'
Wires properly protected (Y/N) Y~..5
Septic/h(;L..'-~,.g tank on lot
Absorption field on lot
Public sewer main
Date of test
Static water level
Well flow
Pump level1 (//V~'/V 0 ~,/~/
SEPARATION DISTANCES FROM WELL TO:
/
~/ FROM WELL LOG AT INSPECTION
ZOO' 1~9 ' /~ ' ~. IO~' I~ ~ '
(~F H
l,O ~,la ~F~.p.m. I~,~ ~I:~ z~.~ ~.
Sewer service line
~ IO0
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank /~0~/~
· /-/OD /
/
/-/~
WATER SAMPLE RESULTS:
~1 /~z- /x~e ~I w~- ~z
Coliform -g) ~- ~ Nitrate ~, ~ O,~ ~ Other bacteria
Date of sample: ~/~¢ { ~&/~/~¢ Golloctodby: ~F~
B. SEPTICIfI{DL'BfNG TANK DATA
Date installed (7~/~/~? ~ Tank size ,/~)DO Compartments ~-
Cleanouts (Y/N) ~/£<~ Foundation cleanout (Y/N) Y~ Depression (Y/N)
High water alarm (Y/N) /~///~ Alarm tested (Y/N) /~//,~
Date of pumping /q//~ ~ ./~/C:/4.? Pumper /~///~
Well(s) on lot /-/Q(~
To property line 7/'/~) /
Surface water/drainage
SEPARATION DISTANCES FROM SEPTIC/t~DEtDtNG TANK TO:
/ On adjacent lots /'//.2~0 /
Absorption field /~) /
>//,4
72-026 (3/93)* Front
Foundation ~ /
Water []aai~service line '-/'-/~) t
CONTINUED ON BACK PAGE
c..FT ST^T O, >J/,4
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N) ~
Vent (Y/N) "Pump on" level at .-~¢b~p off" Level at
High water alarm level ./~ycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTA..NCE'~OM LIFT STATION TO:
Well °/J~¢~ On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed
Length ~-, '~ / Width
Total absorption area
Date of adequacy test /~//./J
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF) ('), .z/.~ System type Gravel thickness ~;
Total depth
Cleanout present (Y/N) k//_/¢~,~ Depression over field (Y/N)
Results (pass/fail) ~'~/~ ~ for
/4//~ After test /V/CF
/V//~ If yes, give date A///~
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation /-/~
/
On adjacent lots
/
Surface water
Curtain drain /'-///'¢
7z / ~) () ' On adjacent lots //DC '
To existing or abandoned system on lot
Cutbank ?~///~ Water main/service line
Driveway, parking/vehicle storage area ~ '
Property line
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in efCeqt on the date of this inspection.
Signature
Engineer's Name
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date.~.~-~
GENERAL INFORMATION
(a)
(b)
(c)
Legal Description (include/I.o.t, block, subdivision, section, township, range)
Location (address or d. irections)
.... ? ~, ~ '
Applicant Name~.?~.~ ~' :'~'~-'-'~:~-~-- Telephone: Home ~ Y~-- ~ 'X~ Business
Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other~(explain);
(d)
(e) Real Estate Company and Agent
Address ~?~' ~'~' '/7'"'f~(7
Telephone
(f) ..-.Mad the HAA to the following address:
Lending ,nstitutior~'~- ,~'~,~ Telephone
Address ~Z~-~ /'~-~' ¢'~' _~C,
L
TYPE OF RESIDENCE
Single-Family¢ Multi-Family I-I
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well'~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~ Public [] Community [] Holding Tank
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72.-025 01/84)
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 mve~t,gahon of this Heatth
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe f .~ct,onal and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the ~r~format~on obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-sde water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regbiabons in effect on
the date of this inspection.
Name of Firm
Address
Date
Telephone
DHEP APPROVAL
Approved for ~//4~:~z7' {/25~? beOrooms by ~-~-.4..-.~
Approved X Disapproved
Conditional
Terms of Conditional Approval
CAUTION
The Muncipatity of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authorily
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions an the
professional engineer's work,
Page 2 of 2
72-025 (! 1/84)
WELL DATA
MU.,C,PA',TY OF A.C.O.AOE (MOA)
HEALTH AUTHORITY APPROVAL (NAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
Well Classification
Well Log Present CN) /
Total Depth ~' O'-'~''
Static Water Level
Casing Height Above Ground '~(.~' '~
Electrical Wiring in ConduitS)
Separation Distances from Well:
To Septic/44~ank on Lot /~o /'/"
To Nearest Edge of Absorption Field on Lot /'~:).-v~' .
.~, ~' . If A, B, C, D.E.C. Approved (Y/N)
Date Completed ,~:)--//4-- ~ I Yield
Cased to
~-- '~ ' '~ Depth of Grouting ' -
Pump Set At ~ ~ ·
Sanitary Seal on Casing {~N)
Depression Around Wellhead (Y/.~
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Line /")/~ To Nearest Public Sewer
Cleanout/Manhole
Water Sample Collected by ~ ~g~ ; ~
Water Sample Test Results
Comments
B. SEPTIC/14~31.~N~ TANK DATA
Date Installed /~C~ ~ /
Standpipes~N)
Depression over Tank (Y(~
Pumping/Maintenance Contract on File {Y/N)
/
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/; ;o;d;,,g Tank:
To Water-Supply Well _ J ~ ~
To Property Line
To Water Main~ Line
Course / ~O I
Size /'~::~(~3 No. of Compartments ~ ---~--L~'. '-";
Air-tight Caps~N) Fou~i-ion Cleanout (~[?.__~//~),- (~
Date Last Pumped ~ - ?-'7
..J/,,~ ---,-
; for
Temporary Holding Tank Permit (Y/N)
/
To Building Foundation ~
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026¢1/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed / ~ ~'!
Width of Field -"'~::;)
Square Feet of Absorption Area
Depression over Field (Y~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
q;15,)~/.-~. Type of System Design
Length of Field ~:~-
Depth of Field /Z.
Gravel Bed Thickness ~,
Standpipes Present(~N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~
To Water.Ma~rZService Line /~:~ ~'-
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Cutbank (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
anhoie/Access (Y/N)
a ~ /"Pump Off" Level at
/r L,//~4 Vent
(Y/N)
/-
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all I~OA a~d HAA guidelines in effect on the date of this inspection.
Signed
omBa~ ' a, e ae e MOA No.
Amount: *
Page 2 of 2
72-026 (11/84)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTILITY'
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
-'] PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCESwELL TO: Septic/H°lding Tank [Abs°rpti°n Area ISewer Line INearest L°t Line
Absorption Area to nearest Lot Line
5, COMMENTS
[]~'/ APPROVED FOR --~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY ~j~
Charles and Pogany Development
Post Office Box 323
Eagle River, Alaska 99577
Subject: Lot 2 Tract J Firelake Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
(1
The water analysis report needs to be submitted to
this office from the Chem.Lab, 5633 B Street, for
our review.
(2
A well log submitted to this offence for review and
our files.
(3
(4
The depression around the well casing needs to be
filled in with impervious type soil so that it slopes
away from the well casing.
The well seal needs to be tightened so that it is
water tight.
Please notify this department for a reinspection when the
noted descrepancies have been corrected. If there are
further questions, please call this office at 264-4720.
Sincerely,
James S. Roberts
Associate Environmental Specialist
JSR/ljw
cc: Alaska Mutual Savings Bank
Post Office Box 1068 99577