HomeMy WebLinkAboutFIRE LAKE LT 2 TR KFireloke
Tract K
Lot 2
#051-333-37
()
Municipality of Anchorage ..<, ..
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 S. Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650 Page ~ of ..~
~a~w.d. anchorage.ak, us (907)343-7904
O.-S~TE W^ST~/^TE. D,SPOS^L SYSTEr~ ^.O/O. WELL mSPEC~O. REPO.T
Permit Number. ~'~'00 f tO~)~ <~' PID Number:
"""": ~5~a~,Ot Jah~_~o,,~ WastewaterSystem: I'-]New ~'Upgrade
LEGAL DESCRIPTION
Well: ~ ~ew ~ ~p~mde . ~. I ~ ~.
v~: ~~ c~~ TANK
SEPARATION DISTANCES ~ septic ~ Holding ~ S.T.E.P. ~ Othe~
Tank Field Station Tank s~mel ~ x ,~/~ ~ tO00'~" :'" "-
.--- ,' ,6'... /5
"~: BENCH MARK
E '
- % .- ~...~ ~
Inspections pedormed Dy: ...... .,__,._ ~.~ Dates:
~,~..~_.-~ ~.~....~...,
Development Se~ices Depa~ent Approval
Reviewed and approved by: ~ :
PEE,'~IT NO $W010038 PACE 2 OF 5
Municip. oli~ oR .~.nG h.q r..~ .c).e'
DEPARTMENT OF HE~THAND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. ])ox 196650 e_Anchor~ge, A, LtcsN~ 99519-665,0~ Te.~.e. phone:. 343-4744
ON-SITE WASTEWATER DISPOSAL :SYSTEM AND/OR WELL INSPECTION REPORT
LEGAl. LOT 2, TRACT K, FIRE LAKE S/D P.I.D. No. 051-333-37
PERM[? NO SWO 10058 PACP. 2 OF 5
Munlcip. o, ti't oF .A,n~ h.o F g g.e,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.a. Box 196650 e_Ancho,"o, ge, AIc~sko, 99519-6650® Telephone~ 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
L£C^[. LOT 2, TRACT K, :., FIRE LAKE S/D P.I.D. NO. 051-355-57
PERMIT NO $W010058 PACE 5 OF 5
D ........ Mu_ni_cip.oti .t y_o. F .A.n£ h.o r.a 9.e.
bI~AI~/MbN/ UP HbAL/H AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.D. Box 196650 ~Anchor'o. ge, Atoske, 99519-6650~Tetephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 2, TRACT K, , , FIRE LAKE S/D P.I.D. NO. 051--335-57
DETAIL
DBL1 & DBL2-~ /
DIVERTER VALVE--~\ / ~ C
\\ 1 FCO/
/
I /I TBM A~/~
A B
FCO 27.0' 29.5'
ST1 25.5' $6.0'
DBL1 25.5' 59.5'
DBL2 25.0' 41.0'
DV 24.5' 42.0'
C01 91.0' 118.0'
MT1 95.0' 120.0'
C02 150.5' 179.0'
MT2 126.5' 175.0'
C05 25.0' 42.5'
C04 23.5' 45.5'
FINAL GRA~E/ "~
MT1 =75.~'/
MT2=75.8'
·
NO WATER FOUND
67.~' B.O.H.
CO1 =84.8'
.C02=85.9'
2" INSULATION ON
NORTH 1/2 ONLY
% CO1 =81.8'
002=82.0' .. T. s.
~,~ ROBERT C COWAN 1~
~. ~;~%, ...f,<~- ~
MUNICIPALITY OF ANCHORAGE
Development Sen/ices Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Mar 22, 2001
Expiration Date: Mar 22, 2002
Permit Number: SW010038
Legal Description: FIRE LAKE LT 2 TR K P-111
Design Engineer: 0003 S & S Engineering
Owner Name: Sara Johnson
Owner Address: 14430 FIRE LAKE ROAD
EAGLE RIVER, AK 99577-9232
Parcel iD: 051-333-37
Site Address: 014430 FIRE LAKE DR
Lot Size: 120900 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] 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:
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
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWEPJWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
ParcelI.D. 05-1 - ~3~ -37
Permit Number SW O I O0 3~
Property owner(s) ~c~r'~ L~O
Mailing address (1) IqffEO
Mailing address (2) ~'a.~ [e ~t'l/e/", ~ Zip Code
Legal description (Section, Township & Range)
Lot Size D,~ (~lSq. Ft.
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Dayphone ~-"~'739
Number of Bedrooms
Well Only
Water Storage
Water Softening Unit
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
$ & S £NGIN££,ING
~'~Z ~ 17034 E.te River Loop Ro.d No. :204
(Signature of property owner or authorized agent)
Permit Fees: ,.~ & O. ~ ~
Date of Payment: 3//~,/e ~
Receipt Number: O O J ~ ~ O
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
PERCOCATIO~/
TEST
ROBERT C. COWAN, P.E.
March 9, 2001
CML ENGINEEr~
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCIIORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 2, Tract K, Fire Lake Subdivision
It is requested that you issue a permit to upgrade thc septic system serving the
existing three bedroom dwelling on the referenced property.
One test hole was excavated and a percolation test was performed on 3/2/01. 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,
RCC/bjj
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUffE 204 · EAGLE RIVER. ,ALASKA 99577
B.J.J. R.C.C. ~-9-01 I OF 1
~'ri~ DESIGN CRITERIA:
$ BDRM 450 GPD PRIOR TO AN~ EXCAVATION
SOILS = 0.45 GPD/SQ.FT. woeK.
450/0.45 = 1000 SO.FT. REQ'D.
..o.. ,,o,,,,.-,,,. LOT H '"-"'
DRAINFIEL ) CRITERIA:
8.0' DEEP
6.0' EFFECTIVE ~
2.5' WIDE
84' LONG
/~.-"r't~',J~_ ~ .~ Municipality of Anchorage
[~) DEPARJ~ENT OF HEALTH & HUMAN SERVICES
~ · 825 L Street, Anchorage, Alaska 99502~50 ~~'"~_~
SOILS LOG -- PERCO~TION TEST ~"~"
PERFORMED FOR= ~0~ ~N DATE
I / SLOPE SITE PLAN
1
2
3-
4-
5-
6-
7-
8-
g-
10-
11
ENCOUNTERED? N 0
IF YES, AT WHAT ~'
DEPTH? -- pO
E
~i~r~? ' ~
13-
14-
15-
16
17-
18-
19-
20-
G Joss Net Depth to Net
Reading Date Time Time Water Drop
_o =. -
PERCOLATION RATE ~0 (m,nutes/mcl~) PERC HOLE DIAMETER
TEST RUN BETWEEN ~" FT AND ~- FT
COMMENTS
PERFORMED BY: *',~'~- ,'--~- n~..__, ___ ~,__ ~ ,%~G, ~..~1 ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCEWI~fE~ALGUIDELINESINEFFECTONTHISDATE DATE: 3//~/0 I
72-008 (Rev. 4/85)
ROBERT C. COWAN. P.E.
CML ENGINEERS
(907) 694-2979
FAX (907) 694-1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 2, Tract K, Fire Lake Subdivision
March 9, 2001
GENERAL:
The scope of this project includes the verification of the existing 1000
gallon concrete septic tank, installation of a 1000 gallon minimum septic
tank if required, and installation of a new trench to serve the existing three
bedroom residence located on the referenced property.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and
all applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary
underground utility locates.
Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling.
Contractors installing waste~vater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing
their own systems must also receive prior approval from the Municipal
Health Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4 cleanouts for pumping access.
17034 NORTH EAGLE RIVER LOOP · SUqTE 204 · EAGLE RNER. ALASKA 99577'
Page 2
Lot 2, Tract K, Fire Lake Subdivision
March 9, 2001
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank.
All standpipes on the septic tank shall extend a minimum of 12 inches above final
grade.
Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation.
In the line between the tank and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic tank). These cleanouts
shall be located on undisturbed soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be
to clean toward the septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
ABSORPTION TRENCIUDRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of
the excavation shall be within 2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer
rock) placement.
Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches ofcover over the pipe.
A silt barrier must be installed between the final gravel layer and the native soil
backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the
locations shown on the design, and extend a minimum of 12 inches above final grade.
The portion of the monitoring tube extending through the gravel shall be perforated
from the bottom of the trench to the invert of the distribution pipe. This is equivalent
to the effective depth ofthe gravel as noted on the design.
I~aga 3
Lot 2, Tract K, Fire Lake Subdivision
March 9, 2001
Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent the formation of a
depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
.Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F8 ! 0 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting
eng;neer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam iii or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco,
or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
When sand is being used as a filter material, its gradation specifications must conform
to current M.O.A. or D.E.C. requirements, which ever requirement applies.
Page 4
Lot 2, Tract K, Fire Lake Subdivision
March 9, 2001
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of
the wastewater disposal system. These inspections will occur as follows:
The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any grovel. A septic tank may be
set in place, but may not be backfilled before this inspection.
The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement ofany other backfill.
3. The final inspection is to occur upon final grading of the property.
ORen there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting
engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a
pre-construction meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and plans and in accordance with the attached M.O.A. permit. There will be no
contractual arrangement existing between the contractor and S 8: S Engineering. S & S
Engineering shall be the o~vner's representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the contractors work rests with the
o~er and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor
to carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
CONSTRUCTION AND OPERATION CERTIFICATE
FOR
pUBLIC WATER SYSTEMS
1999
A. APPROVALTO CONSTRUCT
P a,,s rot .the COnS Dt O, ?
F~ /('% '~ ~-'_,,e.~ ~ ~ ~ public water system located in
.~ , Alaska, submitted in accordance with 18 AAC 80.300
approved.
conditionally approved (see attached'conditions).
-tiTLE , . DATE
BY
If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must
be submitted for review and approval before construction.
B. APPROVED CHANGE ORDERS
Change (contract order number or descriptive reference):
Approved by: Date:
C. APPROVAL TO OPERATE
The "APPROVAL TO OPERATE" section must be completed and signed by the Department before t~his system is made available
for use.
The construction of the public water system was completed
on (date). The system is hereby granted interim approval to operate for 90 days following the completion date.
TITLE DATE
BY
As-bu|lt/record drawings, submitted to the Department, or an'inspection by the Depa~t.~ent, have confirmed that the system was
constructed according to the approved plans. The system is hereby granted f'mal approval to operate.
TITLE
BY '.."
DATE
Distribution: I. Retain original for project file
2. Make copies for disuibution
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
IPHONE I F~NEW
' --- / ' NO. OF BEDROOMS
.OCA , ,
Well ~ ~ ~sorption area
~ ~ Material No, of compartments
~ ~ L ~, capac ty in~llons IF HOMEMADE: Inside lengt(] Width Liquid depth
Well Dwelling PERMIT NO.
~ ~ ~ DISTAl - M~.ia - -- ~ c ~ach~n ga
O Foundation Nearest lot lin~ ~ ~ PERMIT NO,
Length of~ll~e Trench widN1
~ ~ ~ Top of tile to finish grad~ .... ~te,~ath til~ - ~
~ ~-- V ' ~ ~ Totaleffe~iveabsor~
Length Width Depth PERMIT NO.
~ Typ~' ~C~ ~b depth ~~T priori area
~ ~,STANCE TO ....... Bu~ ~eat:;,, i0~lin;
~ ~~ Depth Driller Distance to 1et line PERMIT NO.
~ DISTANCE TO: Building~,~tS~ Sewer~oline Septic tank.¢~O~ Absorption area(s)
OTHER
PIPE MATERIALS ~ Ol
SOILTESTRATING ,~ ~'7~F.~ .'
INSTALLER__ ..... ;0'O .... ~' --~ G~.~ ~ ~
~_ ~ _
APP~ ~ DATE LEGAL
72-013 (
Applicant:
Location:
Legal Description: .~ ~ ~5~
Type of Soil Absorption System Is:
Trench: ~/ Drainfield:
Maximum Number of Bedrooms: ~
HUNICIPALITY OF ANCHORAGE 6/ ~>'~-~'~
Department ' Health and Environmenta. 'rotection /~ ~J
825 L Street, Anchorage, AK. 99501 /~ ~ ~ ~
264-4720 ~[~ ~, ~
* * * HANDWRITTEN PERMIT * * * , LJ , ~-~,~)~
4,~:It~B~/OR ON-SITE SEWER PERMIT # /J]~ ~-,,~-~/
Phone Number: ~ ~
,ot size:
Seepage Bed: Holding Tank:
Soil Rating(sq.ft/br)
DEPTH
The Required Size of the Soil Absorption System Is:
LENGTH ~c/ . GRAVEL DEPTH C/Z WIDTH
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 outfalt Pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE TM /~O O 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.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any 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 100 feet
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 ~ 1 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
Signed, /~/~/~ ___~Q Issued by,
Date:
SWP/024<1/81)
O & E ENG~NE_ERING & DEVELO(T-'MENT CO.
Box 90, Davi~-St., Eagle River, Alaska 99577
694-2774 or 688-2280
Ruaaell Oyster Earl Ellis
894-2774 SOIL LOG 688-2280
Name: ,/)/~/~--, //0/)/./~ ~''~ ~0'~/~-~/~O
Performed for:
Legal Description:
Depth (feet)
Soil Characteristics
6
7
8
9__
10__
PLOT PLAN
11 --i
12__
13__
14__
15__
16~
PERC. TEST
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit__
Comments:
No
~ If yes, what depth
Drain Field
Performed by: ~_~-~:'-~
GAAB HD I
GI~r. ATER ANCHORAGE AREA BOROI'~,H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TA~K: f,'C~.C':~ \C
DISTANCE P~O,,,, WEL~
LIQUID CAPACITY /~:~ (('~ ~t~ GALLONS.
LEGAL DESCRIPTION ,,~ ,~'7'"'_ .,,/Jr'
(' (C2,~/_~,~'/~.,j '~ NUMBER OF
MATERIAL COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
SEEPAGE PIT:
OUTSIDE DIAMETER
NEAREST LOT LINE
OR W,DT. /'-% / LENGTH I'5-" /
, , DEPTH
DISTANCE FROM WELL ~ BUILDING FOUNDATION
C/ 't'l
"¢~: TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~"~ ~'~ SQ.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
, NEAREST LOT LINE_
TRENCH WIDTH
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
,~'~'J'~¢~. '~ lJ~ L';'?I~'~: DISTANCE FROM
-WELL:
'r','P E
DEPTH , BUILDING FOUNDATION
NEAREST SEPTIC SEEPAGE
LOT LINE , SEWER LINE , TANK , SYSTEM
IN. ABOVE TILE__
WATER ~J t~",)
SAMPLE ' '~,*~~ , NEAREST
OTHER
, CESSPOOL__ . SOURCES
DISTANCES:
/i.m: :%'
JJ ~ D'~
<1
DATE
APPROVED :~/~ HEaLtH AumorltY
GAAB-HD-2
GREATEi. ANCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
OROUGH
279-2511
Case No. q~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
MAILING ADDRESS ~:P~ ~' PHONE NO.
LOCATION OF INSTALLATION
SEEPAGE PIT. , DRAIN FIELD , OTHER.
FINANCED THROUGH ~ TO BE INSTALLED BY ,Z/L'~',,V'G~ ~-~'~¢~l,/a ~
PERCOLATION TEST RESULTS ,,'~"Z'~ ANTICIPATED DATE OF COMPLEte_. ~"'/~',~ ,,...~'"¢' /¢'/'" ~'o~TL~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT /,4k~ ,
THIS IS TO SERVE AS /~-~' /~&,t~0 , PERMIT TO INSTALL A
.. SEPTIC TANK SIZE.~'/OOE~ TYPE ~ SEEPAGE AREA~TYPE
DIAGRAM OF SYSTEM
DISTANCES:
ealth Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described~/t] ~¢system is in accordance with said code. ~~ -~. ~
DATE f~::~)¢.. __ APPLICANTS SIGNATURE '/- ' ~
I hereby certify lhat I Eave surveyed the ~ '~ ' - de:~cribcd
AH('hOFaJ:~ I~OCOIOIII,~ Pi'ecincl, Alaska, and t~lat the
meTds sittlaled {}lcrt'ol~ g~'~ w~ti~in the pz'ol)e:'tY ti~:e~ and do
not (~vm'lap or encroach ,m lhe property tyinll adjacent tEe;'eto
13:dod aL Anchorage, Alaska
ilI,{WITT V. I.oONSIIURY & ASSOCIATES
l{e~>:tcrt'd Stn~e l,and Surveym's
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-333-37
1. GENERAL INFORMATION
Complete legal description FIRE LAKE LT 2 TR K
Location (site address) 14430 Fire Lake Dr.
Current property owner(s) STROUSE WILLIS
Mailing address
Real estate agent
2. TYPE OF DWELLING:
F-1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Expiration Date: __7-30`21
Day phone 390-0174
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
F
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ sS-10 0-47 Waiver Fee $
Date of Payment �� 2 o Z Date of Payment
Receipt Number. O 1-1 b Receipt Number
COSA # CJS C Z 117— D2 Waiver #
Distance:
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, b
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows tha
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the numb
bedrooms and type of structure indicated herein. I further verify that based on the information obtained fron-
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastev
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulation
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitt
Name of Firm NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 4/26/21
IS'��f
Ar
* :49TM* * V
........ . .......
6. DSD SIGNATURE
2� } Ene Aa
System #1 Approved for 3 bedrooms If CE -62M �R
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
.`S\ �'tITY OF.a1(%f
INgs ER qNp M
PRO ' FR
By: r Original Certificate Date: -3o J
The Municipality of Anchorage Development Sernrices Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only up(
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The A4unicipality of Anchor,
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic Svstem Advisory _ Arsenic Advisory
Legal Description: FIRE LAKE LT 2 TR K
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1969
Total depth 104 ft
Cased to 40+ ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12 in.
Date of flow test for COSA 4/19/21
Static water level at beginning of test 14 ft.
Comments Well Casing & Depth From MOA file
B. TANK DATA
Age of tank(s) 52 years
Tank type/material $ol`.0
Measured operating fluid level in septic tank NA
Al Standpipes/foundation cleanout per record drawing
Date of pumping 9/14/20
D. ABSORPTION FIELD DATA 6/6/01
Which system tested (date installed) same
❑ ALL standpipes present per record drawing
Total measured depth from grade 9 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 051-333-37
of Structure served by this system
Well production at time of test 6+ gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 7.65 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L AlArsenic less than MRL (ND)
Collected by NRimEng
Date of Sample 4/19/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 4/19/21
Results Q✓ Pass For 3 bedrooms
Fluid depth prior to test 36 in
Water added 450 gal
New depth 44 in
Elapsed time 30 min
Final fluid depth 40 in
Absorption rate 450 gpd
Any rejuvenation treatment (past 12 months) no
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if loss than required or if community "Voll)
Septic TanklLift Station on Lot > 100'
�
Yes
Community Sewer Manhole/Cleanout > 100'
ft
Yes
if No
ft
V
r7
Yes
if No
ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private SewerlSeptic Line > 25'0
Yes
if No
ft
Absorption Field on Lot > 100' 2] Yes
if No
ft
Holding Tank > 1001
Yes
if No
ft
Neighboring Absorption Fields > 100'
Yes if No ft
Water Service Line > 10*
Animal Containment > 50'
Yes
if No
ft
Fv� Yes
if No
ft
ManurelAnimal Excreta Storage > 100'
Community Sewer Main > 75' El Yes
if No
ft
R1
Yes
if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
�
Yes
if No
ft
Surface Water> 100'
Yes if No ft
Property Line > 5'
Surface Water> 100* Q Yes if No ft
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q
Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
certify that I have determined through field inspections
Municipal
Yes
if No
ft
Community Wells > 200'
Yes if No ft
Water Service Line > 10*
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required
Building Foundation > 10' U Yes if No ft
If absorption field is under driveway comment below
Property Line > 10' [D Yes if No ft
Wells on Adjacent Lots:
Water Main > 10' P-1 Yes if No ft
Private Wells > 100' Yes if No ft
Water Service Line > 10' Fes] Yes if No ft
Community Wells > 200* Yes if No ft
Surface Water> 100* Q Yes if No ft
F. ENGINEER'S COMMENTS
OF 441
G. ENGINEER'S CERTIFICATION
certify that I have determined through field inspections
Municipal
andevr
...
of records that the above systems are in conformarlth
V,
w
MOA COSA guidelines in effect on this date.
I St.. Eng
CE -62M 9-J
JW
i 4'/ 2 2 C�T
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 211208
Subdivision: Fire Lake lot 2 Tr K
A water sample revealed a nitrate concentration of 7.65 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
z
Mailing �ldsiress PCO Box 196650* Anchorage, Alaska 99519 6650 *www murn
,s3.=T.w
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
�� Mailing Address £P O` Box 196650 * Anc�'orage, Alaska 99519 6650 *www muni org {
1
Of
The location of the structure(s)as
sho n this record drawing u
r�� 1
i {as uilt) co les with Title 21 -,*AMC.
Drate:
'z! f
f
E
AS -BUILT
I hereby certify that I have surveyed the following
described property
TJX
Anchorage Recording Precinct , Alaska, /and that the . #
itnprw' ements situated thereon are within the property f
i Sines and do not o,.}erlap or encroach on the property
lying adjacent thereto, that no impraveznents on prop-
erty lying adjacent thereto encroach on the premises in
question and that there are no roadways, transmission
lines or other visible ease
rrients on said property except
as indicated hereon.
Dated at Eagle River, Alasica
this_' day, of _L _:�:�. 39;;�_.
IIOBERT C; JOHNSON
SCALE: ,P,e istered Land Sarveyor No..880-LS
1" = (�O' Box 45t, Eagle River., Alaska
Phone 634-2543 }
Municipality of Anchorage
Development Services Department
Building Safety Division ' :
On-Site Water and Wastewater Program
4700 South I~ragaw St ..... ,.
P.O. Box 196650 Anchorage, AK 99519-6650 .. -
www.ci.anchorage.ak.us . . . .
(907) 343-7904
· CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FORA SINGLE FAMILY DWELLING '
Parcel I.D..'/")~'I - ~'~,3 - 39r'
;. ;, -D ',. ·
1. :JGENER~U INFORMATION
H~# HA
.Expiration Date: ~ ~/,~ -'~3 ~
' c0/-nplete legal ae~ription
Location (site addm~
Current Prope.rty.ow~er(s)
Lending agency
· Dayph°ne' ' ":: '"
Dayph0ne'' ~:..
Mailing address
Rea! Estate,Agent
Mailing Address
Un/ess othetwis~ requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
Day phone
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class .__
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[-I Individual Holding tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of AJaska. Certificates of Health Authority Approval are required for the transfer of
title (except baleen spouses} for properties served by a single fatuity on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C wail and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water sampIes.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality cf Anchorage is not respensible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As cedified by my seal affixed hereto and as of the validation date shown below, I verity that my Investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or waste~vater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated heroin. I further verity 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 ~[tec~'~ll~ .~'npliance with all applicable Municipal and Slate codes, ordinances,
and regulations In effe~-P..~t~'li~6f]n~rallation ......
. I/U,~ I;agle K~ver Loop Koaa r, lo. 204
', *Ea~le River, Alas~c~ 99577 '
Name of Firm 'Phone
Address
Engine. e~s Printed
bedrooms.
DSD SIGNATURE ,
~ Apprpve. d.for..~
Disapproved.
Conditional approval for
Date , (,//~//o /
· ~t~'~: ~ .......... ;%,? ~
bedrooms, wRh the followin~ ~tipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ~, "/~'" E:) /
Municipality of Anchorage
Development Services Department
Building ~afety Division
On-Site Water & Westewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(SO7) 343-7~04
HEALTH AUTHORITY APPROVAL CHECKLIST
WELL DATA
We, type '1~1
Date completed/J,~/
Tot dapth / ..
ff A, B, or C provide PVVSID # ~
S~ ~l (Y/N) ~_~
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~'~ colonies/lO0
Date of sample:
g.p.m.
Well Log (y~) ~,,! O
Wires propedy protected (Y/N) (~'-~
Casino height (above ground) /~--- ~ in.
AT INSPECTION
~. I g.p.m.
Nitrate ~'
mg 3.
Other bacteria ~ colonies/lO0 nd.
S & S [ENglN~Rlu~
17034 Eagle Riv~' Loop Ro~d No. 204
B. SEPTIC/HOLDING TANK DAT~ Eagle Elv~r, Ala~V.a ~577 ~../~
Tank .Typ eJM at e ~'~'~4/~/2~V',/~,~ Date instell~ ~
Tank s~ /~ gal. / Num~ of ~e.ts / Cleanou~ (Y/N) ~C~
Foundation cleanou~"'~N) ..~ Depression over tank (Y/N) ~.fO High water alarm (Y/N) ~'~//~
Dateinatalted ~_~/' So, rating (g.p.d./ft=or~/bdrm){~~''~ Systemtype ~:~
Length ~ ft. Width ~o ~'- ft. Gravel below pipe
Totaldepth ¢~ft. Eff. absorption area ~.l~..,~.,ft~ Monitoringtub,~._ Oepression over field
Date of adequacy test ~/~"'~ ~ ' For bedrooms
Fluid depth in absorption field before test_/ in. Water added gal. New depth in.
Elapsed Time: min. ~~_n~ fl~id depth in. Absorption rate >= g.p.d.
Any rejuvenation treatn'~(pest 12 mo.) (Y/N & type) If yes, give date
D. UFT STATION
Date installed ,'J/~-
'Pump on" level at in.
Size in ~allons
'Pump off' level at __
Jn.
ManholeJAccess (Y/N)
High water alarm level at
in,
Datum Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
Absorption field on lot
Public sewer main
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/l~on lot /~ !~
!
~.~.e.e.e.e.e.e.e.e.e~e~-/septic service line ~ ~' /~
SEPARATION DISTANCES FROM SEPTIC/H.~G TANK ON LOT TO:
Building foundation. ~ ~'-
Water main
Wells on adjacent lots
On adjacent lots / ~ /,c-
On adjacent lots /~O "~-
Public sewer manhole/cleanout
Holding tank /',,///~
Property line ~ ~ Absorption field ~ /4--
' I00
Water sen, ice line /~ ''~ Sur~ce water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line / O/.y-- Building foundation /O ~ Water main
Water Service llne /(~) r,/~. Sur~acewatsr /4~(D t~._ Driveway, paddng/vehiclestorege
Curtain drain/K/O~/C ~'/114/N' Wells on adjacent lots //~ /~
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through ~leld inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
Date
HAAFee $ '~C~O. e'
Date of Payment 3 !!(,.Jo I
Receipt Number ~) 0 I c,/i O
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
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
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY.'APp-R( VAL
FOR A SINGLE FAMILY DWELLING,.
Parcel I.D. O$1 - 333-3'7
1.
HAA#
Expiration Date:
GENERAL INFORMATION
Completelegaldescription t, ot 2, Tract K, Fire t, ake SuDd. ivision
Location (site address or directions) 14430 Fire Lake Drive
Current Property owner(s) Sara Johnson
Mailing address 14430 Fire Lake Dr.~
Lending agency
Day phone 696-7739
Em?lo R~vor. AK qq577
Day phone
Mailing address
15,eal Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be he!d by DSD for £ickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding tank []
I--~ Community On-site []
[] Public Sewer []
The Municipality cf Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authoribj Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
vaIid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
en.clneer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are} safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are} in compliance with all applicable Municipal and State codes, ordinances,
and regulations
· 17034 Eagle River Loop Road No. 204 Phone
Name of Firm ~g!: ~!...~_r. ~.!-.';~_ ~-~
Address
Robert C. Cowan, P.E. D~te
Engineer's Printed Name
Conditional Health Authority Approval is ~equested. Septic system
to be upgraded by June 15, 2001. ~here is no eminent health hazard
(no overflowing sewage) and there ~ill be no adverse e££e~-~--,~'~:-~.~k.
a result of granting Conditional HAA.
~L¢~-'.. ·'.jo_g~ i-~'~"~.~"z."~----~--~
OSD SIgNAtURE
~ ,.3 ~Jl~'OI/E
Approved for bedrooms. ~-~: WATERAND :
~io~ :o ~ ~u~ ~. ~=o~ fo= th~ ~mo~ o~;~~'h~h
of 3 bids from certified contractors to perfo~ the ~ork vursuant rathe at~che~ '-'
permit No.'SW010038. M~nev in e~crow ~h~11 nn~ h. v.l.m~d ,,n~l ~h4~ nff:ie, hm~
given final approval. The work shall be completed no later than 6-~5-01
Note:A'~k31~l~b~r~/~}~rtNjoperty meets existing State and Municipal Codes. There are nitrates
present. It is suggested that periodic testing be performed to insure the wells continued suitability.
Current nitrate enneentrnt,nn k 7 1:; ~no-fl_ FPA .................... .-d-r-atlon .. 19.0 mg/l. 5Iere
information on nitrates is available from the On-Site Sen'ices Program, at 343-7904.
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
(Rev. IZ~0)
Original Certificate Date:
Municipality of Anchorage
Development Services Department
BuUdlng Safety Division
On-Site Water & Wastewater Program
4700 South Bregaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(9O7) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~~ Parcel ID: O5-, - ~'
A. WELL DATA
Well type '~{
Date completed
**0 Total depth tObC ft.
If A, B, o;' C provide PWSID #
Sanitary seal
Cased to z~O4'ft.
FROM wELL LOG
Date of test
Static water level / ft.
Well production / g.p.m.
WATER SAMPLE RESULTS:
Coliform _.~ coionias/100 mL Nitrate ~./_,~" mg./L
Date of sample: "~ ] ! } O ! Collected by:
/
B. SEPTICIHOLDINGTANK DATA
Tank T~pe/Materiel ~~
Tank size ]~ gal.. Number of Compartments
Foundation cleanout~l) ~. Depression over tank
Date of pumpthg .urn.er
Well Log (Y~). /~,/' o
W,'es properly protected (Y/N) '~/~'~
· Casing height (above ground) [ ~' + In.
AT INSPECTION
tl 4 - ft.
~o t g.p.m.
Other bacteria ~ colonies/100 mi.
$ & S ENGINEERING
17Q~ Ea~le River Loop Read Ne. 204
Eagle River, Alaska 99577
Date installed ~'/~::~ ?
Cleanouts (Y/N) ~'/{_~ ~
High water alarm (Y/N) ~/~--
,'"' C..'ABSORPTION FIELDI3ATA
~ Date !nstalled/5 _~"~Soil rating (g.p.d./f~ ~r'~/(-~ System type, ~-~
~ Length /~'/.~'9 ft. W~dth /~"//~ fl. Gravel below p,p, '"~ft..
(~ Totaldepthl~//~--ft. Eff..absoq3fionarea~_~t= Moniteringtube ~/~'~ Depression over field
L Dateofadequa-~cytes, z/~'~t-I0! Results(Pass/Fail, /~,/..-' FO,' ~ bedrooms
Fluid depth in absorption field bef~e test in. Water added gal. New depth in.
i,~ Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
~......Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes. give date
O. LIFT STATION
Data installed \
on" level at ~'~.
~Pump
Datum
E. SEPARATION DISTANCES
· Size in gallons
'Pump off' level at in.
Cycles tested
ManholeJ,N~cess (WN)
High water alarm level at
Meets alarm & circ~t requirements?
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/tn station on lot !(30 14-
Absorption field on lot
Public sewer main
,,Se~eptlo se~ce line ,~.- ~"-/lt'"
On adjacent lots
On adjacent lots
too'+
Public sewer manhole/deanout
Holding tank N/ar
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~ ~/' ' Property line ~' '~' Absorption field
Water main AI/,,A. Water service line
· ~- Surface water
Wells on adjacent lots / OO /'~'-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Prope ,ina /
.4- Building foundation /0 ~ Water main
watar Serv~ine ID "+- Surfacewata'
Cu. ain d ain/I/ ,W on ad ace.t lo .
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guideflnes in effect on this date.
Engineer's Printed Name ~:~O,,~,,.~T C.
Date ~'//(~ / ~ I
HAA Fee $ ~ O O,
Date of Payment ~,/! &/o I
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
WFI I RECOVERY TEST DATA
~g.~Er~! C.~W~-H..It.E.
DOOER$' A. SI IAFER. 1! E,
WELLLOCATIOrJ(IeUal); L2; Tract K; Fire T.ake S/D
'lEST DAIS: 3/1/01 1ESTEb BY:
WELL DEPTH~ UNE~0~ I04' (+) WELL DI{ILLER:
CASINGDEPTII: 40' (+) DA1EDRILLED: 1969 (a~proxim~t~)
]EST PROCEDURE:
1) Dr~w waler down Io pump.
2) Shut pump oil !5~6 min.
-rtL:oral
3! Turn pump on. Drawdown.
Shul pump of L
~record lime
MISC DATA:
Casing Ilelght: 1 ' (+)
¢,.nitar¥ Seai~ YES
O~4l~ O.~.? YES
Pump Oepllt: []nk .
o.,,:
C, TATIC *,','ATE,"{ LE'~"~I.: Unk
TfllAL {{ . PUMP II ~,i~E .!1 r~ETE~ Il' O^UM,N. :
OFF
II ~ ow -
o~ 1238 152~6~.0· I
2 nu 1243 30.0C/1~-
I' 3
ri
II
[I o~ ,l__
J OFF
OFF
RESULTS; WELL CURRENTLY PRODUCES: 2.1 GP~
FLOW RATE NOT OUARANT~E;D-SIIRsEOIIF~JT UARIATIO~R P. aN O~,CUP.
*Backflov chanRed meter for iteration # 2. HJC
lOT{aL P. ~,:?.
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
HAA #
1. GENERAL INFORMATION
Complete legal description
Section Lot 21 Tract "K";
Fire Lake Subd~ision
Location (site address or directions) 14430 Firc_.J'.a/ze Driv6
Property owner
Mailing address _
Lending agency
Mailing address
Day phone
Eagl& Riucr~ Ak. 99577
Day phone
696-0064
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
XX
Community well
NOTE:
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
individual on-site
Holding tank
Community on-site
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front 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 ENGINEERING
Address 17034 Ea_ale River Loom gong
Eagle River, Alaska 99577
Engineer's signature
DHHS SIGNATURE
//~,__ Approved for ~
Disapproved,
Conditional approval for
bedrooms.
Phone
bedrooms, with the following stipulations:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Hearth 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) Back MOA ~21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B, or C, attach ADEC letter.
/"J Date completed
Legal Description.~-~'~'~ ~'d~'D ~'~'~"
A. WELL DATA
Well type ~.~',/Ix~-~
Log present (Y~
Total depth \ C~~
Sanitary seal ~TN) ~
Parcel I.D.
ADEC water system number
OV--- Driller
Cased to ~'~+ Casing height
Wires properly protected ~)/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
g.p.m.
AT INSPECTIOI~uNiCiPALiTY OF ANCHORAGE
~:) ..c~ ~c~ I ENVIRONMENTAL SERVICES DIVISION
e,' 9" DEC I 8 i991
R CEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line ?.,'~'
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank '~
WATER SAMPLE RESULTS:
Coliform 0 c-~ ~-~l~ow~j~' Nitrate
Date of sample: 1 ~- -~. '~- ~ct ~
B. SEPTIC/HOLDING TANK DATA
Date installed 5"~/'~ ~ L~°~
Cleanouts(~/N) "~
High water alarm (Y/~)
Date of pumping _
Collected by:
Tank size
Foundation cleanout (Y~
Other bacteria ~J0 ~ ff,-
$ & $ ENGINEERING
ii(~,i4 i;agie I~iver Loop I{Oad Ne, 2~4
Eagle River, Alaska 99577
Compartments ~
Depression (Y/~
Alarm tested (Y/N) "J//~
Pumper ,.'~-~ ~% tP'o o L--
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
72-026 (Rev. 7/91) Front
On adjacent lots
Absorption field
~oo
Foundation
Water main/service line
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Manufacturer
Manhole/Access (Y/N)
"Pump on" level at ' ~' level at
~'~~-3ycles tested
Meets MOA electrical codes~R~-~-
S~FROM LIFT STATION TO:
W"ell on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed .~'- ~,,~'//
Length ./5''/7,~' Width. /~''/,~'
Total absorption area 3 b,~/~,.7,Z
Depression over field (Y~) /,J
Results 4~;~fail)
Peroxide treatment (past 12 months) (Yt..~
Soil rating
Gravel thickness ~ ',//~ '
Cleanouts present ~.~/N)
Date of adequacy test
for "/"/-/¢~.-~ (3_)
If yes, give date
System type g-~t~
Total depth
/ Z -/$ -?/
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1oo )
On adjacent lots '10o / +'
Property Fine ..
To building foundation ~o ~ '~'
To existing or abandoned system on lot ~'/~/~
On adjacent lots "~ ~ ~- Cutbank ~/~ Water main/service line
Surface water loc,
Driveway. parking/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
' certify that, have checked, verified, or conformed ,o all MOA and HAA guidelines in e~f,~l~;~.a~o, this inspection.
Signature I *~ ,4 Eagle River Loop Road No. 2~ ~-A.
.. J .'i~ ~lver, Alaska 99577
Engineer s Name
.....
Date [~~- ~l
HAA Fee $ / ~ d~
Waiver Fee:
Date of Payment /~-/g -?/ Date of Payment
Receipt Number ~; ~ ~]~ Receipt Number
'
72-026 (Rev. 3/91) Back MOA 21
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
ANALYSIS RESULTS for INVOICE S 41034
Chemlab Ref.$ 91.6608 Sample $ 3 I~etrix:
WATER
FAX: (907) 561-5301
Client Sample ID
PWSID
Collected
Received
Preserved with
SECTION LOT 2 T~CT K FIRE LANE S/D
UA
DEC 12 91
DEC 12 91 ~ 13:00 l~s.
AS RE@UIRED
Client Name :3 & S ENGINEERING
Client Acct :SNSENGP
BPO! :
Req! :
Ordered By :RAY
POS :NONE RECEIVED
Analysis Completed : DEC 13 9i Send Reports to:
Laboratory Supervisor : STEPHEN C. EDE l)S & S ENGINEEI~ING
Released By : 2)
Parameter Re.ults Units Method Allowable Ltm/ts
NITRATE-N 6.1 ~/1 EPA 353.2 10
Sample ROUTINE SAMPLE COLLECTED BY: RAY.
Remarks:
I Tests Performed * See Special Instructions Above UA-Unavailable
ND- None Detected '* See Sample Remarks Above
NA- Not Analyzed LT-Less Than, GT-Greater Than
Member of the SGS Group (Soci{St~ G~niSrale de Surveillance)
· DATE RECEIVED
INSPECTION APPOINTMENTS ~~ '
r'IME TIME TIME
DATE DATE ~, S - ~-g~ DATE
MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF AN~O~AGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH &
825 L Street - Anchora~, Alaska 99501 ~[EONMENTAL P',:OTECTION
~ ENVIRONMENTAL SANITATION DIVISION APR 2 0 1981
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requ~ will not be proceed. Please allo~ten (10) days for processing.
MAILING ADDRESS
PROPERTY RESIdenT (If different fr~m a~ove) PHONE
MAILING A0~ ESS~ ~ /
~ 'MAI~[NG AdD~S8 ' ~ .....
.. I
MAILING ADDRESS
~ ~ LEGAL DESCRIPTION
TR E~E"I' LOC-AT[ON' ....
8. TYPE OF RESIDENCE
S
INGLE FAMILY
[] MULTIPLE FAMILY
7. WATER SUPPLY
INDIVIDUAL*
COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
NUMBER OF~BEDROOMS
[] One [] Four [] Other
[] Two [] Five
Three [] Six
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SlX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
E:]Septic Tank or []Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
Septic/Holding Tank IAbsorption Area
ISewer Line
INearest Lot Line
5. COMMEN'~S
DATE
FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 6/79)
V ( ~ ' AIA:-;I<A
' F'; ~IIA ;I 9)!/1!
(DO/) 26'I ,I I 1 i
Apr'il 24, ] )3].
Robert K./I,i. nd;~ }<. NeidJg
% Dick Bi-own
].021 West 25Lh Avenun
Anchorage, A].o s]<~ 99503
,qubjecL: I,ot: ') .....
.. I ,, .~ ]( Fire Lake Snbdivir:;:ion
Apurovnl :lTor Lhe i rid i v'i dua.l sewe]: and water: [fac:i 1 i [-ies
cannot he granl, d until the ['o]_'Lowinq :it.ems have been
comp] et:ed:
(I) The sept'.:ic tank pumped wi. th a receipt suhm:it:l:ed
to t:his of:lice.
(2
(5
An adequacy tost: needs Lo be per:[ormed in Lhe exi. sl:inq
leaching atr~.:t. This test: will det:erm:ine if the sysLem
:i.s adequabo accord_ing to National Sbanda~ds. A list:lng
of private engineex's performing the test. :i.s enclosed.
This reporh needs
OtlU rovJ ~JW.
Disconnect: water 1 ;i.nes to I .[ re I,ake. thl's Wglt,lU SO/1UCO-
is not c(>nsid(;red an approved supply.
Another wal:ur: .qamp].e wJl.] need to be dr:awn when tho
dJsconrlec[:Jon :is made from Fire Lake and the only
source of water' is from the well on l:he subject:
propel'ky..
Enclosed is a copy of the approval fYom l:h[s department
dated Augusl: 26, 1976. You wi.I_] note lhat I:horc
Ilo I~ell[Jon o[ wet. el: being otheu thai:n a pcival:e we] l.
drilled at 104 feat.
]?].ease not. ify this department for a veinspc,~ction when t.he
noted decrepancies have been completed. Iff there a~'e any
further quest.ions, please call this office at 264-4720.
Sincerely,
Robert C. P~-at:t, R.S.
Assoc:Lata SI?acia] isl:
DAVIDA. SLENKAMP
MECHANICAL ENGINEER
694-9055
ipril 25, 1981
Target Realty
ATTFJ~TION: Dick Brown
1021 W. 25th
Anchorage, Als aka 99503
Dear ~ir. Brown,
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
MUNiCJPAUTY OF ANCHORAGE
DEPI. OF 14EALZil &
ENVIROfqM~-NI'AI ?: ' i iCI iON
2 9 1981
Reference: BLM Lot 2, Track K; Fire L~ke S%~bdivision
Bob Nerdig Property
~ sewer system adequacy test was performed on the system located
on the reference property, as you requested. ~e septic tank
pumped and varified to have a capacity of 1000 gallons. The sepsge
pit was full of water and had to be pumped. Approwi~tely ]000
gallons of water was removed from the crib. The ,.~ystem was then
recharged with lOOO ~sllons of ~mter, and measurements taken after
a 2~ hour period, indicated that appro×immtely 155 gallons of water
had been removed from the crib.
It can be concluded from th~s test, that the septic tank is adequate
for your three bedroom residence, however, I regret to inform you
that thesepage pit is not adequate for more than 1 bedroom and will
require upgrading for the three bedroom residence.
If we may be of further service, please ~o not hesitate to contoct us.
Municipality of ~nchorage
Department of Health :~m't Environmental Protection
SRB 196X EAGLE RIVER, ALASKA
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received August 10, 1976
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location: See map
5. Type of facility to be inspected
6. Well Data: Individual
A. T~pe
C. Construction
Sewage Disposal System:
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
Voa.
Alaska State Veteran's Administration
507 West Northern Lights Blvd.
George Mayo
Tract K Firelake Subdivision
Phone:
Phone: 688-2942
1969
l. Size
1. Absorption Area
Total length of lines
single Fa~mily No. of bedrooms
B. Depth
D. Bacterial Analysis
On-site system
B. Installer
2. Manufacturer
2. Material
104'
8. Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
, Absorption area
, Other contamination
, Absorption area
C. Absorption area to nearest lot line
, Sewer Lines
EQ-034 (1/74)
Page 1 of two pages
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO
2. Property Owner:
Mailing Address:
FHA CONV
Day Phone:
3. Name of Buyer:
Mailing Address: Day Phone:
4. Name of Lending Institution: J~~ '=~-~'~ J~f'
Mailing Address: Phone:__
5. Name of Realtor or Agent:
Mailing Address:
6. Legal Description:
Location: _,~~~
7. Type of Facility to be Inspected:
8. Water Supply
No. Bdrms.
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of welt /'O~' !
Sewage Disposal System
Type of System: Public Utility
Individual
Individual (on-site)
If Individual, date of installation
72-003(3/76)
Page 2 of two pages - Ret ~t for Approval of Individual ~ ~r & Water Facilities
Legal 9escription Track K Firelake Subdivision
Comments
Approved ~ ~.~~ Disapproved Date ~AC~/~?<o
Approval ~Valid for' one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)