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Home My WebLink AboutELMORE #2 BLK 7 LT 10 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231201 Work Type: SepticTank Upgrade Tax Code Number: 01817249000 Site Legal Address: ELMORE #2 BLK 7 LT 10 G:3036 Site Mailing Address: 4351 E 145TH AVE, Anchorage Owner: MORAN JEAN M Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: Ment S N_ 0 G G v Depal'tment 7/17/2023 7/16/2024 39520 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: I (—`' "`-'� Date: Issued By: Date: 7--// � Z 3 MUNICIPALITY OF ANCHORAGE Development Services Department `Y' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 018-172-49 Property owner(s) JEAN M MORAN Day phone Mailing address P.O. BOX 112111 ANCHORAGE, AK 99511 Site address 4351 E 145TH AVENUE ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) ELMORE #2 BLOCK 7 LOT 10 Legal description (Township, Range & Section) Lot Size 39,520 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) AD U) Septic Tank ® Upgrade(w/wo ® (D) ElRenewal Holding Tank El Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS. APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify thaf'the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Z 2— Waiver Fees: Date of Payment: 2 D 2 Q Date of Payment: Receipt Number: 0/ v e Z y Receipt Number: Permit No. OSP 2- % Z(!:j f Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! July 7, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: ELMORE #2 BLOCK 7, LOT 10 The owner has requested that we obtain a septic permit to upgrade the existing aged 500-gallon steel septic lift station tank on the above referenced lot. We propose to install a 1500-gallon epoxy steel septic tank per the attached design to serve the existing 3 -bedroom residence for future flexibility. Groundwater was noted in the MOA on-site file & the existing concrete tank integrity will be inspected at construction. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231201, Curtis Townsend, 07/17/23 FIRST WATER CONSULTING ELMORE #2 BLOCK 7, LOT 10 DESIGN DETAILS: NO PRIVATE WELLS WITHIN 100' OF PROPOSED STEP SEPTIC TANK Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231201, Curtis Townsend, 07/17/23 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage. Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report ~~ ~. ~ ~ ~ ,~ Wastewaler System: D New ~pgrade ~ ~. I~ ~ ABSORPTION FIELD Soil Rating:~ LEGAL DESCRIPTION ~ ~,~,~ ~, /.~ WELL: Q New ~ Upgrade Gra~e, wld,h: ~.~ ~, ~,. TANK Surface Cu~ain Remarks: BENCH MARK ' ENGINEEr'S gEAL Department of He--nd Hu~ Se~ices appr~al ~.~'~ ~eviewed and approv ~ate: ~N Old :uo!ld)JOSOO le6O9 6t'ZZ[91.0 OI 10'I 'Z, 330'I{~ 'B~ 'Na(]Y '(lflfiS .qao~rl.q podell uo!loedsul Ileh~ Jo/pue mals,(s lesods!o Jele~alse3A olls-uo t~t~Zt,-Ct~ :ouoqdolOl · 0999-6Lg66 e>iselv 'o§moqouv · 09996[ xofl 'O'd NOISIAIQ Sg31Aa3S qYJ. N:;I~NOI~IAN:J S391Al:EIS NvI~nH ONV HlqYgH =!0 1NillAIJ. tlVdilO o§eJoqou¥ jo ,q!led!o!unlAI lo ~§ed ZDOO~6AAS 'ON. IImJad · INSPECTION REPORT MUNICIPALITY OF ANCHORAGE, BUILD .- - , ,~ . lNG SAFETY DIVISION 3500 EAST TUDOR ROAD INSPECTIONS (907) 5~3-3464 . INFORMATION (907) 788-821 NAME __ .... . / PERMIT NO. __ STREET ADDRESS '" ~ ." / /,. , ', * / PHONE LOT / __. BLOCK / ~- SUBDIV / DATE ._._...__._._ FOOTING ---------.- FOUNDATION BOND BEAM __ FRAMING __ INSULATION - SHEETROCK __ STRUCT. FINAL ELEC. SERVICE ,~., r'l PLBG. ROUGH ~ ELEC. ROUGH [] GASTEMP· __ Itl ELEC. FINAL __ [] GAS __ _ OTHER __ l'"] MECHANICAL I'-I MECH, FINAL _ FIRE FINAL __ . F'~ PLBG, FINAL ~ r'l OTHER [] ZONING.__._______ J'-I OTHER.._.___._._._. [] ~ NO NONCOMPLIANCE OBSERVED r-i CORRECTIONS ESSENTIAL AS EXPLAINED BELOW ' DATE WHEN CORRECTIONS ARE MADE, ~LEASE CALL FOR INSPECTION_______._.__.___._. ~-~l".,.,,~,~ DO NOT REMOVE THIS NOTICE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L' STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930087 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:JENNISON BRENT W OWNER ADDRESS:4351 E 145TH AVE ANCHORAGE, ALASKA 99516 DATE ISSUED: 5/06/93 EXPIRATION DATE: 5/06/94 PARCEL ID:01817249 LEGAL DESCRIPTION: ELMORE #2 BLK 7 LT 10 LOT SIZE: 39520 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 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 (ISAACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ROBERTSHAFER. PE RCGERSHAFER. PE. May 2, 1993 CIVIL ENGINEERS (907) 694.2979 FAX 694 '~211 SOIL TEST Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Elmore Subdivision #2, Block 7, Lot 10 Request you issue a permit to upgrade the existing septic system on the referenced property. An adequacy test was performed on the existing system in August 1992 and was found to be inadequate. Two test holes were excavated and a percolation tests performed on April 9, 1993. Ground water monitoring tubes showed water at 6 ft. on April 19th and at 4 ft. on April 30th. We do not anticipate any adverse effects on the neighboring properties by the installation of the proposed septic upgrade. If you have any questions, or require any additional information for your review, please contact us. Sincerely, 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 JJames P~ams PERCOLATION TEST A. Shafer, P.E. 1" = 40' UPGRADE DP~VE N.T.S. :BC, ALE DETAIL/PROFILE o I~ ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE= Elmore Subdivision #2, Block 7, Lot 10 4351 E. 145th Avenue GENERAL= The scope of this project includes the installation of a 500 gallon wastewater lift station and a pressurized absorbtion bed. The existing tank was excavated on April 9th, 1993 and was found to be in satisfactory condition. 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. e Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be resposible for ensuring a satisfactory vegetation growth over the mounded area. Se Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALL]~TION= A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 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. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. Page two Elm.re Subdivision $2, Construction Practices Block 7, Lot 10 ® A foundation clean.ut 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 clean.uts (unless an effluent pumping system exists within the septic tank). These clean.uts shall be located on undisturbed soil not more than 10 ft. from the tank. The first clean.ut, in line, shall be to clean toward the leachfield. The second clean.ut 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. PRESSURIZED MOUND SYSTEM INSTALLATION: 1. Any peat or organic matter must be removed from the elevated mound site. The bottom of the basal bed area as well as the top of the sand filter is to be within two inches of level. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. The side slopes of the top layer of the mound system must not be steeper than 33% (3:1). The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion. The distribution pipes are to be embedded in sewer rock. Care should be taken to backfill in such a way as to prevent damage to the piping system. Silt barrier material 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. 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. Page three Elmore Subdivision ~2, Construction Practices Block 7, Lot 10 MINIMUM MATERIAL SPECIFICATIONS= Any septic tank proposed for installation must be constructed by a Municipally 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 F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 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, it's gradation specifications must conform to AMC 15.65.060D. INSPECTIONS~ Typically there will be a minimum of three (3) inspections required during the installation of the wast,water disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. Page four Elmore Subdivision #2, Construction Practices Block 7, Lot 10 me The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR= 1 2 GU3 3- 4 6w/~w 5 6 7 8 9 10 - 11 14- SITE PLAN WASDROUNDWATER ENCOUNTERED? . IF YES, AT WHAT C}I DEPTH? ~Depth~W~erkiter I~nimring/ Dat~ , 15- 16- 17 18 19 20 PERCOLATION RATE ~"l (m,nuteshnch) PERC HOLE DIAMETER ~"~" ,! , TEST..RUN BETWEEN ~ ~..~FT COMMENTS UL~e- PERFORMED [~le .1~, AII~i ~5~ ~ / ~ THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUlDEUN~E~ ON THIS DATE. DATE: 72~ (R~. 4,~) Munk:lpallty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERF LEGAL DESCRIPTION: ~q~' ~/O, _,'~J,~, /~7/Or~-f~T"~wnship, Range, Section: 3 4 5 6 7 SLOPE SITE PLAN 8 10 - WAS GROUND WATER ENCOUNTERED?_ 12 - t DEPTH? 14 - ~ Gross Net OeDth to Net Reading Date Time Time Water Drop 18 19¸ 20- PERCOLATION RATE (m,nutes/,nch) PERC HOLE DIAMETER TEST RUN BETWEEN .~.-.~..~1~ AND FT COMMENTS PERFORMED BY: ~ ~ ~ Al.~. ~S~ ~ ~/ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WI~H ALL STATE AND MUNiCiPAL GUiDE[i~ ECT ON THiS DATE. DATE: 72~ (R~. 4,~) G~RF~TER ANCHORAGE AREA BORO~I~ HEALTH DEPARTMENT ' 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: MA,L,NG /'~OX /o/~- ~C/~/-- ADDRESS !~'1,,~ th ~'7" PHONE LEGAL DESCR,PT,ON '7/ Z.--,' DISTANCE FROM WELL /C ~'/ MATERIAL (~'J'~ NUMBER OF COMPARTMENTS ~/ Cld'°n~f'-"~Z L,ou,D LIQUID CAPACITY /~ GALLONS. INSIDE LENGTH INSIDE WID[. DEP,. SEEPAGE SYSTEM: SEEPAGE PIT= ~ .,l...I ~' ~./ NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH // , LENGTH / ~'' , DEPIH. LINING MATERIAl ~ DISTANCE FROM WELL //f / , BUILDING FOUNDATION NEAREST LOT LINE ~~ TOTAL EFFECTIVE ABSORPTION AREA ~ALL AREA) ~'~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSO. RPTION AREA ,, FOUNDATION ~ /-- . DISTANCE.~T.W'~N LINES TRENCH WIDi]H _..//~SQ. ET. LENGTH OF EACH LINE TOTAL LENGTH · OF LINES IN. TOTAL EFFECTIVE DEPIH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TY/~ ~/'"////~ 4 DEPTH ~ '~/ LOT LINE ~~ . SEWER LINE ~ ~' ~.TANK DISTANCE FROM , BUILDING FOUNDATION. //~ ~" / SEEPAGE · SYSTEM WATER /G//~ SAMPLE . NEAREST Or. ER CESSPOOl / , SOURCES DISTANCES: []-7(3 =//$/ DIAGRAM OF SYSTEM DATE /~//~/~'1~ APFROVED -GREATEIx ANCHORAGE AREA f" ROUGH Ca. No. ItEALTH DEPARTMENT 327 Eagle St. Anchorage, Ala~k~ 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT ~)~' ~ ~1~/~ MAILING ADDfiESS~ ~ PRONE N 0~[~ RESIDENCE ADBfiESS ~/~.~ ~ LOCATION OF INSTAL~TION. .LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~ /'~ '/,, SEEPAGE PIT '/~ , DRAIN FIELD TO BE INSTALLED BY .~"c-'~// · ~TEST RESULTS ANTICIPATED DATE OF COMPLETION. :',~.~-,/~",3 y~,(_ ~0,~ BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT , OTHER THIS IS TO SERVE AS /~'. J~)O gL ~, , PERMIT T0 INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED. · SEPTIC TANK SIZE./,o~o TYPE. ~-~'"/--' SEEPAGE AREA DIAGRAM OF SYSTEM TYPE LO3 DISTANCES: -/-o I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above des crib ed system is in accordancewith said code.s SI~GNAT~U ~Z~ ~'~DATRR ANCHORAGE AREA BOROUGH~ H~ALTH D.,Ak.,,DAT 327 EA~L~ £T~EET AKCHORAG~ ALA~KA'9950~ · Performed For Robert H. Ruble Legal Dcscrip:ion: Lot IO ~lock Th{s rcrm Re~o~ts a: So~-"~'~-bog Tee: Soll Charac:eris: Da:e Performed Oct. I0, 1969 Subdivision E]more Sub~, JvJsion ~ ~.- ~ -"?ercola:ion Location Sketch .. ][ i ~as Ground Water ~*ncoun%ered?,, ' Reading Da:e Gross Time Net Time Depth To H20 Ket Drop Prc.~o&,.~d Instal~$eepage P~t V Drain r~eld Dep:h Of Inlet ALASKA GEOLOGICAL CONSULTANTS October 27, 1969 Mr. WilliamE. Christy, Jr. Box 4-1633 Spenard, Alaska 99503 Re: ' Soil percolation characteristics for Robert H. Ruhle property, Lot 10, Block 7, Elmore Subdivision .t! ~ Dear .Mr. Christy: This letter is to certify that an investigation of the soil percolation characteristics has been conducted on the above-mentioned property It was dete.rmined at the time of the investigation that a percolation test was not necessary and the information enclosed herein reports the soil characteristics for the proposed sewer system. The location of the septic tank and cesspool excavation are shown on the attached Greater Anchorage Area Borough Health Department form. This investigation was made in accordance with the Greater Anchorage Area,Borough Health Department specifications. Respectfully submitted, JAH:Js ALASKA GEOLOGICAL CONSULTANTS s A. Hamilton Eno, cc: Greater Anchorage Are,a Borough Health Department I OilL¥ DRILLING DEPORT' DATi& FORMATION FORMATION 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 · Parcel I.D. # CERTIFICATE O~ HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING OI ~ -i'-~. -- ~ HAA# GENERAL INFORMATION Complete'legal description . Lcd- Id" ~Loc~ 7 ,rCEIVt: dUN 0 1999 .,,UNICIPALI'[Y OF ANC~O.:{AGE .:NVIRONMENTAJ,. SERVICI:S DIVISION Location (site address or directions) Property owner 3' u .~ 't-;,.. ,[. Do ~-, ,v A y Mailing address '~35' I A,~ sT /,.-/j-- ''-''/ Lending agency /vo~'~/~.,~,..~3 - ~,,,¢~'~.,~,~c.~ Mailin. g addres's. Agent b~- p.~'.o,.,~ ~ ~',,..,~,,,< Address Dayp.hone 2 (,~--?Y77 Day Phone Day phone ~ ~- 3~1 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- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. e 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. $ & S ENGINEERING Name of Firm ixo.~4 I=aole Elver L~op Aoa~; ;,;~. ~-v,~ Phone ~ q ~ ' ~-q '7 c~ Address Eagle River, Alaska 99577~ /~/c/7z-~-~ ./~*'7./---.__. Date ~ / 3. / ~ ~! Engineer's signature Se DHHS SIGNATURE / Ap. proved for -F"~-h~J~ E bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional comments By: Date 'The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to pu mhasers 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. ,< Cl lVl:u De Municipality of Anchorage JUN 0 ~ ~)99 ~k DEPARTMENT OF HEALTH & HUMAN SERVIC~N~'~"'~" ~ ~ Environmental Services Division .,vaKa, e~a~ ~.ev~c.~s ~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: WELL DATA Health Authority Approval Checklist LoT'/o Gt, oc< '7 ~/./v~o,~.,WZ.Parceli. D.: 01<~ Date of test Static water level Well production WATER SAMPLE RESULTS: If A, B, or C, attach ADEC letter. ADEC water system number Date completed q ] I ~, / ~ ol Cased to (~ % Casing height (above ground) ~ ~' $ Wires pmpen'y protected (~N) AT INSPECTION FROM WELL LOG g.p.m. I I. $~ Coliform 0 Date of sample: ~'/'3- o SEPTIC/HOLDING TANK DATA Date installed "._?~ I~t ~ Tank size Foundation claa~out ~YN) ~ t 5 Date of Pumping ABSORPTION REM3 DATA -: Date installed -/ / ~ ~' ! q 3 Lengm ~f ~ w~c~ ,' Effective absorpfion area (e~' Date ot adequacy test ~'/~ / q '1 Nitrate Other bacteda $ & S ENGINEERING Eagle Rh~r, AIi~i / 0 ~ O Number of Compartments I Cleanouts ~).__ Depression (Y~ ~ 0 High water alarm (Y4~ r~ o Pumper Soil rating ~or fff/bdrm) O. 7 System type /~ou ~'D Gravel thickness below pipe O. ,~ Total depth Monitoring Tube present (~/N) Y~ J Depression over field (Y~[~ Results~Fall) P/~ $ For ~ Ruid depth in absorption field before test (in.); 13 '/,~" Immediately after ~'(~'gal. water added (in.): Fluid depth ~ (ins) Minutes later.'. '7 '7 ~' Absorption rate = /V .S' 0 + g.p.d. Peroxidetmatmant(psst12moofhs)(y/N).~'~,(~ J~e~,,v' Ifyes, givedate ~ y~ J' ~0 72-o26 (Rev. D. UFT STATION Date installed Manhole/Access I~N) High water alarm level at* Cycles tested 3 Size in gallons "Pump on" level et* (; / 0 $00 "Pump off' level at* (~ %/" .*Datum TeA E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: t Septic/holding tank on lot ) O O Absorption field on lot Public sewer main On adjacent lots / O ~) On adjacent lots Sewer/septic service line IOO J~ ]oo '4- Public sewer manhole/cleanout ,~//,e Lift station / o d ¥- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ,.C' 5- Property line :~ 0 Absorption field ~' / Watermaln/sewicellne. /0 '4 Surfacewater/dralnage 2oo ~ Walls on adjacent lots /00 ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line / ~. ' Building foundation ~ ~' Water main/service line Surface water ! 0 o / -F Driveway, pmldng/vehicle storage area ) 0 / +' O / Curtalndraln. ~/o~,' ~. t<~/o~/ __ Walls on edjasent lots ~ ,/ <20 ~- __ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal am in conformance wffi~ ~fOA._t.IAA guidelines in effect on this date. - - CE- om HAA Fee S ."~O 0 ' Date of Payment Receipt Number ~6 (R~. ~6)* Waiver Fee $ Date of Payment Receipt Number 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 CERTIFICATE OF HEALTH AUTHORITY · ' APPROVAL FOR A SINGLE FAMILY DWELLING ~" 1, GENERAL INFORMATION Cb~ple{e'leg~l'description -Lot 10~ Block 7~ E~a, or~ Subc~u.~6lon Location (site address 'or'~irections) Property owner Day phone :AK :,99509 $46-~500 Lending agency -"~.-~ c;,:' ;~'.'.; :~!~',~.'T~..~ ;"' "· .T" .... · ....... . ;~!.. ~' ,':~ . · Mailing address Agent Address Day phone Day phone e Unless otherwise requeste, d, HAA will be held for pickup. NUMBER OF, BEDROOMS: ~ TYPE OF WATER SUPPLY: :'"" ' ..... NOTE: Individual well Y. XX Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, !,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.ti_.qation 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 ' ~ Phone ~[;;;>4~'- ~.~ '~ ~ S & .5 ENGINP. I=I41r~ ~" Address 170~4 Ea~[ a R;¥e~' L° ° p R,'Oa~'cl l'~'' 204r/ '~ Eagle Rlver~ Alaska 9~~ Engineer's signature /// /~/;~ Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following st~pulat'ons: Additional Comments By: '..._~O (~ ~/~4 (/"H' Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer rag stared 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 o! 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. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERV CES 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 Parcel I.D. # ~',° ~"~'-~-L~.c~ HAA# ~('~'~Lt~,, 1. GENERAL INFORMATION Complete legal description Lo~ 10; Z~.oek Locat'on (site address or directions) t Property owner Mailing address ' Lending 'agency Mailing address Day phone Day phone Agent AS$OCIATEO BROKERS ATTN: Sandu ffie.b.6,f3zd 640 (~t $6,tt~ AveJ~¢ Su.~e #! Address Unless otherwise requested, HAA will be, he~d for pickup. NUMBER OF BEDROOMS: 5 Day phone 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. e 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 attesting to the legality and status of system. 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. ame oT firm i~os4 D~;, ~.;, ;~_--~ No. 2o4 Phone Address Eagle R~ver, A1~9957~ ' DHHS SIGNATURE ~. Approved for ~ bedrooms. ~ ' Disapprbved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~,,~/~' Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of. Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type .~ Log prese~{~N) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number .Date completed ~/("/~'-[~'7 Driller ~b,~_.~,~'.~ Total depth Sanitary seali~l) Date of test Static water level Well flow Pump level1 . ~'~' / Cased to F~OM WEtL LOG (.~ ~'/ Casing height Wires properly protecte(~N) AT INSPECTION I~UNlClPALITY OF ANCHORAGE ENVIRONM, ENTAI~ S ERVIC£S DIVISION "', 271993 .g.p.m. 7- g.ii CEIVED SEPARATION DISTANCES FROM WELL TO: Septin/holding tank on lot //,~- / Absorption field on lot /Z~ / Public sewer main /'-/~ ~'-*/~' Sewer service line /~ *''/'' ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ' 'g~ '. Date of sample: Nitrate Collected by: Other bacteria / · B. SEPTIC/HOLDING TANK DATA Date installed '/~/~' f Cleanout~'(~N) y High water alar~)F Date of pumping %/~-~ ~* Tank size / ~:~**"~*-*~) Compartments Foundation cleanout/~N) ~ Depression (Y/I~ Ala~ leste~) · ~ Pumper ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot J ( '~- ! On adjacent lots To property line ~ I Absorption field Surface water/drainage t ~::~"~ '~1~ Foundation ~"~' ~' I Water main/service line 72-026 (3/93)° Float CONTINUED ON SACK PAGE C. UFT STATION Size in gallons ~"4~"~ Ven~/N) ~ 'Pump on' level at High water alarm level ~ ~! Meets MOA electrical cede~N)y SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot I ~-'~:~ ! On adjacent lots Manufacturer -t~q-.~,L~ ~ Manhole/Access~) y ~' # 'Pump off' Level at Cycles tested ~ Surface water D. ABSORPTION FIELD DATA Date installed ',~- ,""~('~.~ '~ ' Length .,~- ~z~/ VVidth Total absorption area Date of adequacy test s.-[/.~.. Water level in absorption field before test Peroxide treatment (past 12 months) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: ',,X~oil rating (GPD/FF) ~. ~ /~'/"7~y~eem type .l"~-J~ . Grovel thickness /~.~' Total depth Cleanoutpreson~N) y Lr~"/-"~Depressionoverfleld~Y~ J Results (pass/fail) ~ ~--'~-/~----~'T*'"~'f'~for ~ Bedrooms After test L) If yes, give date ~_)/ Well on lot I ~ To building foundation On adjacent lots "~"2 ¢ Surface water t Curtain drain ~--~.'"'"'"'"'"'"~ On adjacent lots I Z~ ~-3c''' Property line To existing or abandoned system on lot Cutbank f...J o ~1 ~ Water main/sewice ina. Driveway, parking/vehicle storage area ~.- E. ENGINEER'S CERTIFICATION I cerb*[y that I have checked, verified, or conformed to all MOA and HAA guidelines in effect Signature O0 HAA Fee $ Date of Payment ~'-~ ~_~O.__~ Receipt Number Waiver Fee $ Date of Payment Receipt Number. 72-028 [3~93)* Back 08:58 CT~E ENUIROIq'E~AL LAB SERUICES ~D. 93S DO~ Client Name tS & $ ENGIN~i~ING WORK Order :68622 Ordered Sy :R. SHAFf~ Report Completed :07/27/93 Project Name : Collected :07/21/93 8 11:00 hfs Pro~ectt : Received :07/22/93 @ 14:20 hr~ Technical Director:STEPHEH ~. EDE Sample Remarks: RoUTiNE SA~°L£ CObLECl~TJ ~-T[GF-e SRN:~RD. OC Allowable Ext. Anal Parameter Results Qual Units ~ethoct Limits Date Date Init Nitrate-N 0.10 u mg/b EPA 353.2/300.0 10 07~26 [.,L{ * See Special Instructions Above UA = Unavailable ** See Sample Re~=ks Above HA = Not Analyzed U - Undetected, Reported value is the practical quanti~icetion limtt. LT - Less Than D - Secondary dilution. GT = Greater Than Eh~iRONMENTAL Sm. RVICE$ IN A[ASI'~A, COLORADO, UTAH. ILLINOIS, OHIO. k;ARY~AND, WE~T VIRGiNiA, N[W JERSEY, SOUTH CAROLINA Legal Description (include lot, block, subdivision, section, township, range) ....... , ' , t 't cW-: Location addressor directions) . . '.: :. ,' . . :' - ' ' ;'. .(b) Applicant Name '~'c'~,~-~' ~lt', ~Ot~. Telephone:Home "~,t,~;_ I~q7 Business : Applicant Address '[:~t=:,~. ! t C) t 133.. ' .~,-~,C_.,t't.~3~.t,.~'~_~ . Jk't~--, ~'~1 ~ I (c) Applicant is (check one): Lending Institution I-I; Owner/builder~, Buyer I-I; Other I-I (explain); (d) Lending Institution' ~,"~f---. ~ ~ '"'~,~" Telephone Address (e) Real Estate Company and Agent (f) Address Telephone Mail the ~H&~tENGII~R [~ tess: SR8 19~Y EAGLE RIVER: AK 99577 2. TYPE OF RESIDENCE , ~ Single-Family~ Multi-Familyr'l Other' Number of Bedrooms ' -0 3. ',*WATER SUPPLY '~' ,.;. .,: . .... ., ~., "Individual Well{~ Communtyr'l Pub cfl-'. Note: If community well system, must have written confirmatior~ from the State Department of Environmental Conservation attesting to the legality and status. "'-- . ... ': ' ' ' -~" ';" ~::'-' "'"' ';~ ' ;..:'i - , 4.' SEWAGE DISPOSAL , . - . Onsite,~'. Publi~[] Commurlity[] ' Holding Tank[] ". ' ~ :" ~ "'"" .?',,i' ' .... Note: If community well system, must have written confirmation from tl~e State Department of Environmental Conservation attesting to the legality and status. '-. ' Page 1 of 2 ~ .., ,' ! 7'. ' 72-025 f11/84) · :,. 5e ENGINEERING FIRM PROVIDING INSPECTIONS"TESTS; F LE SEARCH, DAT. AND NFORMATION'~- ~* t '~? ~ "! ' ,' '* '- ,;: 'As certd~ed by my seal afhxed hereto and as of the vahdabon date shown below, I verify that my investigation of this Health., '* · · ~'i !'Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate *9'* ;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-~ite 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 ,~*-~.~J~J~-~Jrr~e Telephone Address ' SRB 196X '" E~:" n Date ~GLE RIVER, AK ~5~ ;' -, ' - .' 6. ~DHEP APPROVAL Approved for .3~.__ Approved Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues ~e~Ith Authority 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 in the professional engineer's work Page 2 of 2 72-025 (11/84) A. WELL DATA Well Classification Well Log Present~/N) Total Depth "7.5' ' Static Water Level Casing Height Above Ground EleCtrical Wiring in Conduit Separation Distances from Well: MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: ~- I "~ *i~. If A. B, C, D. EC. Approved (Y/N) Date Completed ~_ - I ~, - ~ gt Yield Cesedto' ~3' Deplh of Grouting Pump Set At tJ~' Sanitary Seal on Casing ~)/N) Depression Around Wellhead (Y/,I~ To Septic/He~ Tank on Lot "'i ! C:)~'' ; On Adjoining Lots To Nearest Edge of Absorption"Field on. Lot J/S" ; On Adjoining Lots To Nearest Pu. blic Sewer Line ~ To Nearest Public Sewer CleanouVManhole ~,~ To Nearest Sewer Service Line on Lot Water Semple Collected by ~ ~ ~ /~5~'~/,"0~'~3'Z-/~"-3~ ;Date CommentsWater Sample~Test Results B. SEPTIC/t'N~.=~fRG TANK DATA Date Installed/Z> - ~o ~ (,,'~ Standpipes~N) Air-tight Caps~N) Depression over Tank (Y.~ Pumping/Maintenance Contract on File (Y/N) _,! Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/l~flm3 Tank: Size / ~O~ No. of Compartments / Foundation Cleanout (Y~) Date Last Pumped ~° '~-' ~" ; for Temporary Holding Tank Permit (Y/N) To Water*Supply Well To Property Line To Water Meln/Service Line Course* To Building Foundation To Disposal Field /~ / TO Stream, Pond, Lake. or Major Drainage Comments Page 1 of 2 72-026{ 11/84) C. ABSORPTION FIELD DATA / Soils Rating in Absorption Strata Date Installed ,/~"~O~' ~/ Width of Field Square Feet of Absorption Area 'Z.-~' '~ Depression over Field (Y.~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ I ~ ' To Building Foundation Lot /'~ Ib. To Water Main/Service Line ~ o i ~_ To Stream/Pond/Lake/or Major Drainage Course Type of System Design ,.~r' ~'~, ~/" Length of Field / 2.. Depth of Field '~ Gravel Bed Thickness ~' / Standpipes Present ~N) Date of Lest Adequacy Test 7- ~'' ~&' To Property Line { C~ t 4" To Existing or Abandoned System on ; On Adjoining Lots To Cutbpnk (if present) To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions j~anhole/Acc= (Y/N) ~.~ /~ "Pump orr Level at / ~ Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t,~.~'c~.. ~N~J~d, or conformed to all M~nd I-~elines in effect on the date of this inspection. Signed SR B 196X Date Compar~G!1: RIVER, AK 99577 MOA No. Receipt "O, ~Z~"~ ~'~(~ (~ Date of Payment ~ - I O-~ Amount: $ ~ ~ Page 2 of 2