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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: S~/7o3Z! PiD Number: .~_~o
"~': Vi. cc ~c~ Wastewater System: D New O Upgrade
~ ~-~S~ ~,vc ~.~.,A~ ABSORPTION FIELD
P~one: No. of~¢~ms: ~ ~pTrench ~hallowTmnch ~B~ ~Mound DOther
WEL~ ~ New D Upgrade Grail wldlh:
SEPARATION DISTANCES ~¢~ ~ Holding ~ S.T.E.P.
Sudace
Water .~/~ /;~ % .... LI~ STATION
Remarks: BENCH MARK
ENGI~L
~ ~'..- .
Inspections peflormed bT: ~ ~2~ Dates'lst~?~/~ ~'":~"'""~"':
Reviewed and approved by: Date: ~-~-
AS-BUILT SYSTEM DETAILS/SITE PLAN Permit S~/9703e!
PID#050-321-77
CARIBOU SUBDIVISION, LOT
icCRATY t ", ' ~ · WELL
~ [ PRIMARYSYSTE
1
$~gLD 1' ~ ~0~
~-c:e.8' ~ ~ i
S-~:38,0' B~ ~
A-E=35.5'
I
~ ~000 GAL k
S-E=56.6' m / I SEPTIC A ' ~
A-F=49.5' N / ~ANKq
B-F=39.0'~~ ~ ~ J
~ '" ~ ' ~ VINCI ~R[~ t~. .~
12111 HOR~SHD~ 9RIVE, fi3 ~.~ .,_
EAOL~ RIVER, AK 99577
~ .... ? (907)696-1226 '" -'
' FIELD sooxs
'~ *~: SEWARD
~~ ,c~nL[:97064.DWG ~,o.: 97064 (907)696-6111[FAX (907)696-81ll
by
Su UvA
OWNER OF LAND ~__=_.C ~.. /¢'/~C~Jc, ~
ADDRESS I~1! ~"~/~ ~)~,dE-d.~ IT
LEGAL DESCRIPTION ~-,~4( I~ ~(~'7" ~"~'
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 665-2759 0c'r 2 7 ~997
Municipality o! Anchorage
BORE HOLE DATA DepL Health &Human 8ervlcea
DEPTH
PERMIT NUMBER~70.~ ~ Date of Issue ~ -
TAX INOENTIFICATION NUMBER ~)~'O .,~.7,
Is well located at approved permit location? ~;~f~s [~ No
Method of Drilling: ~r rotary {~ cable tool
Depth of well: /~ ~
inches
feet
Casing Type ,~'T'.~t. Wall Thickness
Diameter fo/! inches, depth
Liner Type: ,
Well Intake Opening Type: {~'~n End [~ Open Hole
[~ Screened; Start feet Stopped feet
[~ Perforations Start ~- fe~t Stopped * feet
GroutType: ~z~-"7~ ~/~oJlume -°S'O
Depth: from L~ feet. to ~ feet
Pump Intake Depth: feet
Pump Size hp Brand Name
Well Disinfected Upon Completion? (;~t~es [~ No ~ .
~lethod of Disinfection: ,~)"O ~/P/-v"l ' ..
Casing Stickup Above Ground: 07 feet
Static Water Level (from ground level): Z~_~ feet
Pumping level: feet after hrs. pumping gpm
Recover Rate: [~:0~ gp~tJ, i'~
Method of Testing: ,~1/~
Comments:
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Departm&nt of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
Municipality of Ancho .rage
Department o! Hesaa t. kh' as tHuman Serv,ces
Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor hltp:!lwww.ci.anchorage.ak.u s
343-4744
September 18, 1998
Vincente Forrest French & Cobie Rae French
8751Beachwood Drive
Anchorage, Alaska 99502 5177
Subject: Lot 2 Caribou Subdivision
Permit #SW970321, PID #050-321-77
The subject permit, issued September 18, 1997 by this office for a
single family well and/or on-site wastewater system, has
expired as of September 18, 1998.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as-built inspection report must be sent to this office for
review, approval and documentation. Ail inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
P.E.
er
On-site Services
eric: Copy of Permit
cc: KND Engineering
~K3NICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970321
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:WRIGHT LARRY
OWNER ADDRESS:12111 HORSESHOE DRIVE #3
EAGLE RIVER, AK 99577
PAGE
I OF 1 7J_%.g8
D TE ISSUED: 9/18/9 Qt '%-Ae-°f
EXPIRATION DATE: 9/18/98
PARCEL ID:05032177
LEGAL DESCRIPTION:
CARIBOU LT 2
LOT SIZE: 50140 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
~HIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION I~JST 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:
ISSUED BY:
DATE:
DATE:
O~
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
September 9, 1997
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: New sewer/well permit - Caribou S/D, Lot 2
Gentlemen:
Following a request from the owner regarding the proposed development of the
referenced property, we dug two testholes for the proposed system and replacement
field. The results of those tests are attached. The lot will be served by on-site well.
The system will be placed on the southwestern portion of the lot outside the 100'
well radii. As indicated on the site plan there is sufficient grade to maintain a
gravity system. A 1000 gallon tank will be installed in anticipation of a 3 bedroom
house being constructed. There is also sufficient area and grade to maintain a
replacement gravity fed field.
As indicated by the site plan drainage arrows, natural drainage is away from this site
and will be maintained after construction. There is no surface water within 100' of
the proposed installation. There are no known curtain drains within 50' of the
proposed installation. No wells exist within 200' of the proposed installation. The
system has been placed outside a 50' setback from any slope that exceeds 25%.
Additional re-grading of the site is anticipated in connection with the construction
of the house and driveway. Development of this lot should have no adverse effect
on development of adjacent lots.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
~I(71'] ~b Engineering
attachments:
A~UJTqlCJPAMTY OF ANCHORAGE
EI~/II~F,k~.NTAL SE~IC~S DIYISION
SEP 09 1997
RECEIVED
On-Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
VASTE /ATER DISPOSAL SYSTEM/SITE PLAN
CARIBOU SUBDIVISION, LOT 2
K
LOT 3A
D
LOT 3B
GORDEN V. McCRATY
HOMESTEAD
GORDEN W. McCRATY
HOMESTEAD
VACANT
LOT 1
LOT 3
VACANT
DESIGN CRITERIA
NO SEPTIC SYST£NS WITHIN ,~OO' Dr
pRI~.~J]S[D ~dCl. I~ £xCJ:pT AS NJ~TC~ l. 3 BEDROOMS X ]50 GAL./DAY/BEDROOM m 450
~ P, IVAT[ ~ ~lC VCLLS ViTH~N ~' ~ ~. SOILS RATING' 13.33 HIM/INCH : APPL. RATE O.B GP~/SF
~s~D SYSTC, ~XCCPm AS
3. 450 GPD/O.8 GPD/SF : 562.5 SF
,.,,-- ,~.~ ............. ..?,~ ~
:
,~.~ ~/~7~~ ~' c~-*uo .-.~ ~ ~ PREPARED FOR:
EAGLE RIVER, AK 99577
~~ (907)696-~E~6
4.(562.5 SF /5'(~/)) x 0.50(RF) = 56.B5'L
5. MIN. DESIGN SIZE = I TRENCH - 56.25' LONG x 5' ~/IDE x 4' DEEP
6. DEPTH OF GRAVEL DELOS/ PIPE IS 4'.
7. TOTAL DEPTH DF SYSTEM IS 6.0' FROM ORIGINAL GRADE.
NOTES:
TIE INTO TRENCH AT NIDPOINT.
INSTALL 1000 GALLON SEPTIC TANK. INSULATE TANK IF <4' COVER.
INSULATE TRENCH ~/ITH E' HD BURIAL FOAM Ir <3' COVER.
CONTRACTOR VILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK.
KND ENGINEERING
P0441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
J (907)696-6111/F~× (907)696-8111
PERFORMED FOR:
LEGAL DESCRIPTION:
3-
4-
8
'1 !
12
14-
18-
20-
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
~plq .
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
E
Depth to Water ~er'
I~tenitoriag?
Gross Net Deplh to Net
Reading Date Time Time Water Dro~
~ ~:~ /~,~ ~ - ~/~,,
PERCOLATION RATE ~ {minutes/tach! PERC HOLE DIAMETER
TEST RUN BETWEEN ~- FT AND ~' FT
. · / ~ d .
PERFORMED FOR'
LEGAL DESCRIPTION
!
2
3--
4--
5
6
7
8
9
10
Municipalily of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage. Alaska 99502-06S0
SOILS LOG -- PERCOLATION TEST
Townsh,p. Range. SeC.OR.
SLOPE
WASGROUNDWATER
ENCOUNTERED?
SITE PLAN
'l I
12
13.
14.
16-
'17-
18-
19-
20-
IF YES, AT WHAT
DEPTH?
E
~p~ t~ WMU ~er '
)~onitori~g?
Gross Net Depth to Net
Reading Date Time Time Wate~ Drop
~. /.'1_; /D.~.;, //~ Y.~" ~"
5 Y; I:/'-/ ~ Y~"
t" I : z ,,/ /D ,.,,,,',~ / ~ .~R " ,~ ?v "
~' ? ~- I.'~ ~ Y~"
7 *-~: I.'.,~ ,.~Yz"
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P,O, Box196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
"~2.'1 ~ '7 '7 HAA # ~'~
1. GENERAL INFORMATION
~'- Complete'legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailin. g address
Agent
Address
Day p~one
Day phone
'Day phone
e
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC ·
attesti.ng to the legality and status of system.
Se
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 cor~pliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address'
Engineer's signature ~-~~ ~"~
DHHS SIGNATURE
~' A.p. proved for ~.~
~ Disapproved.
~ Conditional approval for
bedrooms.
bedrooms, with tee following stipulations:
Additional Comments
By: z ' ~
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given In paragraph 5 above by an Independent
professio nal engineer registered in the State of Alaska. The DHHS does this es a courtesy to pumhasers 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.
Munlclp~lity of Anchorage MAR 0
DEPARTMENT OF HEALTH & HUMAN SERVICES ~UN c~l
Enwmnmental Services Division ~NWRON~a~r~. S~WC~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
PamalI.D.:. DS'~- .~2.1-' '7'7
A. WELL DATA
well ~e P.-; -,* -/~
Log present (Y/N)
Total depth /~ / /
ff A, B, or C, attach ADEC letter. ADEC water system number
Date completed / ~// //, 7
Cased to /o~ / ' Casing height (above ground)
Wires property protected (Y/N)
FROM WELL LOG AT INSPECTION
Sta,c water lew~ ~/ ~ / J
Well production ~) g.p.m. J
g.p.m.
WATER SAMPLE RESULTS:
of.mple:
B. SEPTIC/HOlDING TANK DATA
~ ~ ~ing
Nitrate
Collected by:
Other bacteria
Depression (Y/N) ,~ High water alarm (Y/N) '""-
Pumper
Ce
ABSORPTION FIELD DATA
Soil rating (g.p.d.flff or tt't/bdn'n)
Gravel thic~ below pipe
Effecfiveabsomfion ama S'~'gduf- ManttoringTube pL'~e~e__m (Y/N) ~ Depressinno~r field (Y/N)
Date of adequacy west Results (Pass/Fall) For
Rutd depth in absofl~on field before test (in.); ~r added
(in.):
Fluid deplh (~ Absorption rate - g.p.d.
Peraxtde treatment (~2 months) (Y/N) If yes, gh~
UFT STATION
Date installed
Manh~e/Aceess (YAd)
High water alarm level
Cycles tested ~
'Pump on' level at'
Size in gallons
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absoq~tion field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
Off adjacent lots
Public sewer manhole/cieanout
SEPARATION DISTANCES FROM SEPTICA-IOLDING TANK ON LOTTO:
Foundation /o / ~- Property line /o *~-' Absorption field
Watermaln/sewicellne 2 5'/Y- SurlacewaterldraJnage /~/~- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Proper'o/line
Surface water
Curtain drain
/0 / ~- Building foundation /D / ,c Water maJn/sewlce line
/~ ~ /-/- ,Driveway, peddng/vehic~e storage area
/~6 ~ ;- - ~'~-~ ~*~,--- Wellson adJacentlots
/aa //--
.te p. .ot / /? ?'
Waiver Fee $
Date of Payment
Receipt Number
72-~26 (Rev.