HomeMy WebLinkAboutTONJESS ESTATES BLK 1 LT 7Ton jess
Estates
Block 1
Lot 7
#051-831-11
UBMITT,
Municipality of Anchorage AUG 11
Community Development Department Page
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP131150 PID Number: 051-831-11 ❑ New
1
2014
1 of 3
Upgrade
Name:
Lance Cluff & Gloria Grover
ABSORPTION FIELD
❑ Deep Trench ✓Shallow
❑ Other
Trench ❑Bed ❑Mound
Address
24821 Jesse Lee Court Chugiak, AK 99567
Phone
Number of Bedrooms
5
Soil Rating
1.2 GPD/SF
Total depth from original grade
7 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3 Ft.
Gravel depth beneath pipe
Subdivision Block Lot
Tonjess Estates 1 7
Fill added above original grade
1-3 Ft.
Gravel length
68 Ft.
Township Range Section
Gravel width
5Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total absorption area
680 z
Fl
Number of trenches
Two
Dist. between trenches
> 10 Ft.
Well
>100'
>100'
N/A
N/A
>25'
TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1,5000a1.
Surface Water
>100'
>100'
N/A
N/A
NA
Material
HDPE/Plastic
Number of compartments
Two
Lot Line
>5'
>10'
N/A
N/A
Foundation
>5'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Curiain Drain
None
Noted
Remarks Existing Septic Tank Decommissioned in
Pump on level at
in
Pump off level at
in.
High water alarm at
in.
Accordance with Municipal Code.
Punip make and model
Electrical Inspections performed by
Installer
Dean Construction
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
Drainfield HDPE CO/MT D3034
Inspector MEA
BENCH MARK (Assumed elevation) 100.0ft
Inspection 1st7/14/13 244 7!15/13
Location and description
Bottom of Siding.
3. 7/22/13 4"
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional Approval: Date
: O� 1
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es -*•:4918%\ •*}
t/ ! mama t. MOWN : 4 A.
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•-43$1 .•.�ill
. E 4••••• t
j[T ::Iti Eot s
Approves /
PP / v1/,1� at u / / L Date
nspection Repot] 1-1-12.doc
Permit Number: OSP131150
0
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P1
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Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
TONJESS ESTATES SUBDIVISION
LOT 7, BLOCK 1
51,440 SF
S 89'59'51"E 219.91'
Page 2 of 3
PID NO.: 015-831-11
J
N
N
(0
04
N 00'00'09"E
CLASS C
WETLAND
Qroximate Wetlands._.
Boundary _
ALTERNATE SITE
Advantex Treatment System with
Existing 25' Long x 5' Wide x 3.5'
Effective Depth Absorption Trench.
NOTE:
Existing Septic Tank
Decommissioned in
Accordance With Municipal
Code.
LOT 7
1.18 ACRES
N
A
SI
S2
C4
M1
05
C6
M2
C7
30.3'
32.2'
38.8'
39.9'
40.3'
58.4'
57.1'
56.7
B
35.9'
40.0
55.4'
79.5'
82.4'
65.8
87.8'
88.6'
S2 TH1
10' DRAINAGE
EASEMENT
/
/
/1
/
C6 /
/
N 89'59'51"W 168.10
!M2
/ 1
/
/
/
N
N
LEGEND:
TH — Test Hole
C4 — Clean Out
MT — Monitor Tank
M1 — Monitor Tube
FSV — Flow Splitter Valve
/ 51 — Septic Vent
O .
....
JESSE LEE COURT• 49th
MICHAEL E. ANDERSON /VI
•
I •r . NO, CE -4381 /AStfOFESSWr
PLAN AS BUILT
SCALE 1' = 40
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. OSP1311150
0
Page 3 of 3
PID No. 051-831-11
,500 Gallon
Se tic Tank
Finished Grade
92.0
94.7
U
Existing Grade
Geotextile Fabric
89.0
Grainfield Rock
85.0 —le
75.0
No Groundwater
7-22-2013
Finished Grade
34' (Trench Length)
90.0
91.3
r
U
Existing Grade
Geotextile Fabric
86.7
Grainfield Rock
82.7—""
75.0
No Groundwater
7-22-2013
34' (Trench Length)
PROFILE AS -BUILT
No Scale
89.0
86.7
DEPTH
(feet)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: Lot 7 Block 1 Tonjess Estates
PERFORMED FOR: Lance Cluff
DATE:
7/14/13 PROJECT No •
PARCEL ID#• TECHNICIAN- .1R
TEST HOLE 2
OB/OG
GW/SW
WELL GRADED GRAVEL
WITH SAND
B.O.H.
WAS GROUND WATER ENCOUNTERED'
IF YES @ WH.
DEPTH OF WATER AFTER MOt
DATE OF MO
SLOPE
No
........... 44.,,
•
• 49th
�7f
71/f"-1
MICHAEL HIE ANDERSON i
•I ea'., No. CE -4381•
vr
1N i
Professional Engineers Stamp:
SITE PLAN
See Site Plan
4T DEPTH" L
IITORING: None p
VITORING: 7/22/13 E
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRES
AKED PRIOR TO TESTING:
7/14/13
1
10:12
2.25"
2
10:42
30
9.50"
7.25"
3
10:43
2.00"
4
11:13
30
9.25"
7.25"
5
11:14
1.75"
6
11:44
30
9.00"
7.25"
PERCOLATION RATE:4 1 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 8/11/14
On -Site Wastewater Disposal System Permit
Permit Number: OSP131150
Tax Code Number: 05183111000
Work Type: Septic
Permit Effective Dates: June 25, 2013
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Design Engineer: ANDERSON ENGINEERING
Subdivision: TONJESS ESTATES
Site Legal Address:
Owner/Address:
to June 25, 2014
TONJESS ESTATES BLK 1 LT 7 G:1462
CLUFF LANCE ALAN &
GLORIA GROVER 24821 JESSE LEE COURT CHUGIAK AK 995675725
Site Mailing Address• 24821 JESSE LEE CT, Chugiak
Lot Size in Sq Ft: 51440
Total Bedrooms: 5
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: PRIOR TO CONSTRUCTION: New testholes shall be completed such that all
portions of the permitted drainfield are within 30 feet of a testhole. Any revisions will require an
approved change order to be obtained prior to construction. Testhole results shall be submitted
with the final inspection report.
Special Provisions: The permit includes waiver OSP131164 allowing the drainfield to be oriented
parallel to the slope.
6 � > 24..,;
Received By: ,`7 j - `� - Date:
Issued By:
i
tivAt
Date:
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage Alaska 99519-6650 • (907) 343-7904 S Fax (907) 343-7997
http://www.m un i.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP131164 COSA#: Permit#: OSP131150
PID#: 051-831-11
Legal Description: Toniess Estates, Block 1, Lot 7
Engineer Anderson Engineering
Applicant: Lance Cluff
Your request for a waiver of the required parallel orientation of the absorption field to the slope
contours has been approved.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
Z Adjacent properties are not affected by this waiver.
Waiver is Granted: X
Date: 6403
Waiver is not Granted:
Approved by,
Name of Reviewer
Rec#: 06756G Amount: $200.00 Date Paid: 6/25/2013
**** VARIANCE/WAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-831-11
Property owner(s) Lance Cluff
Day phone
Mailing address 24821 Jesse Lee Court Chugiak, AK 99567
Site address Same
Legal description (Sub'd., Block & Lot) Tonjess Estates, Block 1, Lot 7
Legal description (Township, Range & Section)
Lot Size 51,440 Sq. Ft. Number of Bedrooms Five (5)
APPLICATION IS FOR:
(E all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
APPLICATION IS AN:
Initial
Upgrade
Renewal
TYPE OF DWELLING:
Single Family (SF)
(wlwo ADU)
Duplex (D)
Multiple Dwellings
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Absorption Trenches Perpendicular to Contours of Ground.
Dis tance:
I certify that 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: 4(20 Pia
Date of Payment: 6 & h3
Receipt Number: O?9 '1-0 C7
Waiver Fees
Date of Payment: 4/as/ 73
Receipt Number: & '?5% Cr
Permit No. Oa° I S I I So Waiver No.
Permit App_9-1-12.doc
CUSPi3i 16741
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
June 15, 2013
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Subject: Lot 7, Block 1, Tonjess Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The existing house on Lot 7, Block 1, Tonjess Estates Subdivision has been expanded
to five bedrooms. We are therefore requesting a permit be issued for the upgrade of
the septic system to accommodate the five -bedroom home on. The attached Site Plan
and backup documentation identify the location and configuration of the existing and
proposed septic system. The existing septic tank will be decommissioned in accordance
with Municipal Code. The existing absorption trench will be left intact with the exception
of the northwest 5' which encroaches into the well radius. The remaining portion of the
trench will be the alternate site for future use as needed. Also identified on the plans
are the locations of the existing well on this and adjacent lots and adjacent septic
systems. No conflicts exist between the proposed septic system and the wells on this
or adjacent lots. Protective radii are shown to the adjacent wells. Drainage arrows are
shown indicating the current drainage patterns. The drainage patterns will be
maintained after construction.
The test hole placed on the lot indicated Well Graded Gravel with Sand (GW/SW). This
coincides with the original test hole placed on the lot for the original septic system. The
existing absorption trench is currently dry with no presence of septic effluent noted.
Groundwater was encountered at 10' below the surface. The percolation rate in the
soil was determined to be less than 5 minutes per inch. We have designed the new
trenches with an application rate of 1.2 gallons per day per square foot. We are
proposing to place 2-32' long by 5' wide absorption trenches with a 4' effective depth.
The total depth of the system will vary as the trenches must be placed parallel with the
slope due to the limited area available for the septic upgrade. The entire effective
absorption area will remain in the GW/SW soil layer. A flow splitter valve will be placed
Lot 7, Block 1, Tonjess Estates
June 15, 2013
Page Two
to insure even flow to each trench.
The ground surface on the lot slopes from south to north area of the absorption
trenches. The trenches will be placed parallel to the slope as shown on the attached
drawings. A waiver is attached to allow the placement of the trenches in this
configuration. A minimum of 100' will be maintained between all components of the
septic system and the proposed well and from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
1. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
1 / t
._ ,Zt-
Michael E. Anderson, P.E.
Attachments
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
June 24, 2013
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 7, Block 1, Tonjess Estates Subdivision
Absorption Trench to Ground Contours
Dear Onsite Services Engineer:
Very little area remains on Lot 7, Block 1, Tonjess Estates Subdivision to upgrade the
septic system. The lot is covered with heavy trees and brush and the surface slope is
very irregular. The most suitable area to place the new absorption trenches runs
perpendicular to the contours of the ground surface. The surface slope in the area is
5% to 10% in a south to north direction. The absorption trenches will be placed at 10'
below ground at the south end and approximately 7' below ground at the north end.
The organic layer in this area is approximately 1' in depth. The distribution pipe in the
absorption trenches will be below the peat layer, but totally in the gravel absorptive
layer. We therefore recommend a waiver be issued allowing placement of the new
absorption trenches to run perpendicular to the ground slope contours.
Sincerely,
--
E LEE COURT
\11
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\\ 1.3311S NO?JNOW i
TONJESS ESTATES SUBDIVISION
LOT 7, BLOCK 1
51,440 SF
13381S NOdNOW
tri
te
z
S 89'59'51 "E 219.91'
CLASS C Y
WETLAND / I
\ / /
\ / / /
\,___ Approximate Wetlands_. /
Boundary
ALTERNATE SITE 1
Advantex Treatment System with /
Existing 25' Long x 5' Wide x 3.5'
Effective Depth Absorption Trench. 1
LOT 7
1.18 ACRES
NOTE:
Decommission Existing Septic Tank
in Accordance With Municipal Code.
Decommission 5' of Existing
Absorption Trench in Accordance
with Municipal Code.
10' DRAINAGE
EASEMENT
�; 1
.\ \ Q� ryo� ryoa /1 O
N 4/ Iryof 1
1,500 Gallon 1g /
Septic Tonk 1
�MV ®H1 •_ pf E/
200 1" CO F4R o!
/
,GRAVEL
DRIVEWAY
168.00
0
0
NOTE:
Decommission
Existing Trench to
This Point.
N 89'59'51"W 168
I
JESSE LEE COURT
No Excessive Slopes or Breaks in Topography
Within 100' of the Propo ed Wastewater Systems.
SITE PLAN
SCALE 1" = 40'
N
—32' Long x 5'
Wide x 4' Effective
Depth Absorption
Trenches. Total
Depth 6' to 8'.
LEGEND:
TH — Test Hole
CO — Clean Out
MT — Monitor Tube
FSV — Flow Splitter Valve
SV — Septic Vent
,t1 .
•
.4 49th
:• MICHAEL E. ANDERSON ; �:
•1 Cl : No. CE -4381 r'1 "
LOT 7, BLOCK 1, TONJESS ESTATES SUBDIVISION
DESIGN FACTORS:
Five Bedroom Horne
Perc. Rate: 1-5 Min./Inch
Application Rate: 1.2 GPD/SF
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,500 Gallon Septic Tank
4' Drainfield Rock
5 Bedrooms * 150 GPD/Bedroom = 750 SF Absorption Area
750 SF/1.2 GPD/SF/5 SF (Width) '.5 (Red. Factor)= 62.5 LF Trench Length
THEREFORE: Construct 2-32' Long x 5' Wide x 4' Effective Depth Absorption Trenches.
Flowline Elevation to be 6' Below Original Ground Surface at the South End and 2' Below Original
Ground Surface at the North End. Flowline to be Level in Each Trench. Total Trench Depth to be
10' at South End and 6' at North End. Provide 3' of Cover Over Absorption Trenches and 4' of
Cover Over Septic Tank. Place Flow Splitter Valve to Insure Even Flow to Each Trench.
5'6"
5'
Geotextile Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION -
(NO SCALE) ��. �E OF y.♦
NOTE:
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock. •
Minimum 4' Separation From Groundwater. i
Minimum 100' Separation From Private Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.
a
♦'�
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MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
DEPTH
(feet)
1
2
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: Lot 7 Block 1 Tonjess Estates
PERFORMED FOR: Lance Cluff
DATE: 6/4/13 PROJECT No.:
PARCEL ID#: TECHNICIAN: JB
TEST HOLE 1
OB/OG
GW/SW
WELL GRADED GRAVEL
WITH SAND
B.O.H.
SLOPE
WAS GROUND WATER ENCOUNTERED° NO
IF YES T WHAT DERTFI?
DEPTH OF WATER AFTER MONITORING_ None 0
DATE OF MONITORING: 6/14/13
4
tVOF ,..
�4
1/41
49th W '.
V:p MICHAEL E. ANDERSON : z:
♦✓f NO. CE -4381 ti —
r'
Professional Engineers Stamp:
SITE PLAN
See Site Plan
Sas
DATE
READING
GROSS TIME
(RING -FES)
NET TIME
(MINUTES)
DEPTE TO
(INCES)
NG ERHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
6/4/13
1
12:05
6.50"
2
12:35
30
13.50"
7.00"
3
12:36
6.00"
4
1:06
30
12.75"
6.75"
5
1:07
6.25"
6
1:37
30
13.00"
6.75"
PERCOLATION RATE:4 4 (MIN/INCH) PERC. HOLE DIA. 12 (INCHES)
TEST RUN BETWEEN: 7 FT. and 8 FT.
COMMENTS' TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 6/14/13
t ( M MUNICIPALITY OF ANCHORAGE 1
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street • Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE''t SEWAGEpDISPOSAL SYSTEM AND/OR WELL. INSPECTION REPORT
NAME Q Dh / I S4 o t.
277- / /PHONE
EW
II UPGRADE
MAILING ADDRF,1Bb
LLI�--o / a 36 Ave.
LEGAL DESCRIPTION
L-7 6 / rO N . /ESS $/o
/ v
LOCATION
NO. OF BEDROOMS
SEPTIC
TANK
1 W7. a ( t
DISTANCE TO: V
Absorpt�arra.,,
..._
Dwelli.( .{..,
L—
M /
at r /
PEgIIT,t4Op7 z. 6
G
No. of compartments ea
Manufxmre,/fNC,/ v <
Liacit�yfi/jnaallons
q/
/q
IF HOMEMADE:
Inside length
Width
Liquid depth
. d Y
—i22
S? F
DISTANCE T0:
Well
Dwelling
PERMIT NO.
Manufacturer
Material
Liquid capacity in gallons
0
w
F 2
cc
o
DISTANCE TO:
Well (,�
/00 .�
Founda yy et
L,
Neareir. s fir
r
PEH plQ
Nay Z 6
No. of lines /
Lengty.eJ each4*L
O
Total }v eS of li s
✓J
Trench syiAth
CCJ Q inches
Distance tvk IiryZ
�f„(/ /tT—
Top of the fit all a
✓
7
"tete13er/ de
2/ (mss LU 5 # inches
Total elfec a�s�}w�e 'tea
SEEPAGE
PIT
Length
Width
Depth
PERMIT NO.
Type of crib
Crib diameter
C ib depth
Total effective absorption area
DISTANCE TO:
Well
B ilding foundation
Nearest lot line
J
3DISTANCE
Class
Depth
Driller
Distance to lot line
PERMIT NO.
TO:
Building foundation
Sewer line
Septic tank
Absorption weals)
OTHER
PIPE MATERIALS
`
SOIL If EST RA N
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T
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£
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Q'
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INSTTAA 'LER #C
,l'e4rr (ie. rads,
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%a see.'';” /
,
.#/ler J✓
"$
tiAilkibPPOW-
r1('7-}.r:et 41.1
APPH
/% DATE LEGAL 2466, V>'s'nv •&3AIU it
Z� �:>JNiHS3NIJt<� S'3 S
61 % ' 21,444-61- xc6>. N 0
7t01,i'(Rev. 3/78)
t1Ut*1 I C I F•AL I TY QF RFJCIA ORIRGE
DEPARTMENT SiA.I HEALTH AND ENVIRONMENTAL rOTECTION NO
825 't STREET, ANCHORAGE, AK. 99„01 1
264-4720
CrJ—SITE SEWER F•ERr1 I T
rERP1IT Na ( 820726 )
APPLICANT JOHN SHORT 401 E 36 AVE 99503 279-0491
LOCATION
LEGAL L7 81 TONJESS S/D LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING <SQ FT/BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
C'EF'TH= G. S LEF-4G11-1-1= 2S GRF1•ti'EL 1 EF'TH=
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT I5 THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET).
THE TREr-dcH WI CaTH IS -. B FEET_
THE GRAVEL DEPTH I5 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
RECIU I F_EP SEPTIC TFft-4I-C S I == 1O-+cuo UALLc.N15
' 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.
--- r140 1.-:2> I t4SF•ECT I Qr-JS BF_E G!U I FEC' ---
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.
MINIPMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE I5 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'ERt1 I T EKF• I RES C]ECEt1BEE FR: 2 S. S +L 2
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 THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED:_
APPLICANT JOHN SHOR
ISSUED BYSerg
DATE 7442- --- V4. 0
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
925 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG - PERCOLATION TEST
❑ PERCOLATION
TEST
PERFORMED FOR: 72;7;:ss /374h
Q / 2k [i`�% DATE PERFORMED: I/I Lfd�'7j`7��
LEGAL DESCRIPTION: ! On f CSS • `1� k / Lof !
VV SLOPE
1
2
3
4
5
6
7
9
F
RP
r
mar
10-
11
12
13
14
15
16
17
18
19
20
ebor/v graded
hof- much •Res.
gr .1/ hi I- •
COMMENTS
I
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
4b.
G
,-r pjs� E PLAN &pry.
F
Reading
Date
Gross
Time
Ne
Time
Depth to
Water
Net
Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN
commiond ''iu NP pc 40"
PERFORMED BY: J , CA
72-008 (6/79)
CERTIFIED BY:
FT AND
FT
rocx i
ATE:
Ctrs fifirb Urttting King
ur
DOC CO. dba
SULLIVAN WATER `YELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
OWNER OF LAND C ' !' f�/,q)ii�,c «DEI
rill DETII OF WELL J C r /4'
AXZ
7 a `>10 DKKE"C (O#.J 4Q A.40H 9 ? STTA IC LEVEL OF WATER FT SD
ADDRESS
LEGALDESCRIPTION L 7 aces y04'_'ESS
DATE •Started 7/F1 Ended %/tea
PERMIT NUMBER
DRAW DOWN FT
GALS. PER HR
KIND OF CASING
0900
;o0
:UND OF FORMATION:
From 0 Ft. to r; Ft. n JC g is c/.Pl1t o-% From Ft to Ft --
.'rom a Ft.to /0 Ft S-4 ai Q ! G.(.9✓05L From Ft to Ft
:rom /D Ft.to ad- Ft s'A"'' 64.4✓=e From Ft to Ft
from Ft to Ft CC6I 7)7 J err: <9 From Ft to Ft
''rom c)er Ft. to 4 Ft. s/< r `ra-Q.0 .SS/ From Et to Ft
:'rom Ft. to Ft. 644✓ei L From Et to Ft
.'rom'9'7 0 Ft te//1 Ft V t-ue Cc/47 From Ft to Ft
'rom 1/7 Ft to /a.i Ft SAw,O S! e.F'A✓cel•From Ft to Ft
"rom / r)2 Ft to P11 Ft Ste/n.)0 64,114.)674. Froni Ft.to Ft
:'rom Ft to Ft C &A' & '= AL From Ft to Ft
From Ft to Ft From Ft. to Ft
rom Ft.to ' Ft From Ft to Ft
.
:rom Ft. to Ft. From Ft. to Ft
From Ft. to Ft. From Ft to Ft.
:Tom Ft. to Ft Front Ft to Ft
:'rom Ft to Ft. From Ft. to Ft.
'rom Ft to Ft. From Ft to Ft
SISCL. INFORMATION:
1
DRILLER'S NAMEP
MUNICICRLIT'r or Rt-7C1-, r noe
DEPARTMENT OV HEALTH AND ENVIRONMENTAL PROTECTION
825 'L' STREET. ANCHORAGE, AK. 99501
264-4720
WELL P E R M I "1 -
PERMIT
PERMIT N0. ( 820910 )
APPLICANT SHORT CONSTRUCTION PO BOX 8AE 694-4994
LOCATION
LEGAL "L7 81 TONGESS ESTATES LOT SIZE 999999 SQUARE FEET
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I5
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
i 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 THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERMIT EXPIRES 17ECEME3ER 31.. 3952
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 THE CODES.
SIGNED:
APPLICANT SHORT CONSTRUCTION
ISSUED BYag
DATE y�/��. V4.0
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
Parcel I D # (1;1 — 9:2) - 1 1
1. GENERAL INFORMATION
Complete legal description
HAA# 1.iOPY21r1P.°12-)
Lot 7; Block 1; TonJe6e Estates
Location (site address or directions) 24821 32.46 Lee Count
ChugLak. aK
Property owner Lance CLu,(4 Day phone (W) 263-5244
(h) 688-6421
Mailing address 24821 Jesse Lev Count Chug-i.ah. AK 99567
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
XXX
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
12-025 (Rev. 1/91) Front MOA 121
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 b & s Ci i0if it..^:$ING
Address 17034 Eagle Rtvax nop R^;d No.
Eagle River, Alaska 99577
Engineer's signature
Phone 694f-2979
Date 677/9.--s°
„��-Da•0yty
p rn
:..eta
« : w...i:`
PX0 bill A. • a "'
4~
6. DHHS SIGNATURE '�' �`'
—f\ Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By: Ir
Date 6/74
CAUTION
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
respons;ole for errors or omissions in the professional engineer's work.
72-025 (Rar,1/91)_ Batt MOA m
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: i -'c'1 ¶1.4-t -‘21,,3SE95 E•r,
Parcel I D
A. WELL DATA 1
Well type�E^v ^ce 'iIf A, B, or C, attach ADEC letter. ADEC water system number `A
Log present 6/N) 1 Date completed 1 - 6.7- Driller SJwt %/pc-, s
Cased to 11-11 Casing height ti -1\
Total depth 11-11
Sanitary seal 6,/N)
Date of test
Static water level
Well flow
Pump level
y
FROM WELL LOG
- en -
Wires properly protected pm)
4° gpm
AT INSPECTION
Lo -8-`13r
"9.4 4-
u11- oV-
SEPARATION DISTANCES FROM WELL TO:
t oct
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
o 4s.
.1\s,
; On adjacent lots
• On adjacent lots
g p m
z
%0 c.
TTt c g
n In f;r1CO
Cc
rri w
o Eg
r
Public sewer manhole/cleanout
Petroleum tank 24S" t}
WATER SAMPLE RESULTS:
Coliform Nitrate 0.1c, Other bacteria O
Date of sample:
Lit --et5
5 & $ ENGINEERING
Collected by
Eagle River, Alaska 99577
B. SEPTIC/HOLDING TANK DATA
Date installed 8 - Z `j -13.1- Tank size XIS° Compartments Z
Cleanouts (6'/N) Y Foundation cleanout 6/N) 7 Depression (Y6 J
High water alarm (WS) ''i Alarm tested (Y/N)
t1^ .'v' t: •o' o.::.l .. ,.
Date of pumping Pumper • .-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot t o o ' On adjacent lots \ 00 14' Foundation is t
1 i-
Topropertyline to 14Absorption field Water main/service line \ Ot
Surface water/drainage 10 o l
72-026 (Rev. 7,91) Front
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at p off" level at
High water alarm level Cycles tested
Meets MOA electrical cod
SEPARAT
on lot
DISTANCE FROM LIFT STATION TO:
D. ABSORPTION FIELD DATA
Date installed
S -Z4 -61
On adjacent Tots • Surface water
Soil ratingB•' d ID F • System type PR -A-1 F' CIA)
Length r' 3
' 0 t Width C1 Gravel thickness 'y•r' t Total depth 1,5 1
Total absorption area �Sr 4 Clean -outs present STN) y
Depress on over field (Y6)) IP Date of adequacy test L.- S -93
Results,(.' ail) Press for "rat -t-- (-% bedrooms
- Peroxide treatment (past 12 months) (Y lXo, E-
1 -'1°d 4 If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot Po' } On adjacent lots u o t 4-
14tt
To building foundation
On adjacent lots
Surface water
Curtain drain
Property line
Nov
To existing or abandoned system on lot
:io
Cutbank all- Water main/service line I1::.3
(vot-F
ala
�oot1r—
E. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area'.
I certify that I have check., or conformed to all MOA and HAA guidelines in effect on tlsdat9.o(this inspection.
P G3
Signature O * t-
�c46.,1 A. sAary :
Engineer'
& S GINEERING
Eagle River, Alaska 99577
,• � Nn. 14 /-1
HAA Fee $17Q`ca)
Date of Payment 6. 9`?)
Receipt Number 21-77$
72-026 (Rev. 3/91) Elect MOA 21
7339
Waiver Fee•,$
Date of Payment
Receipt Number
r`}' 1'06%0893`;: 1
•
10:46 • CT&E'ENVIRONMENTRLLAB `SERVICES :.: :°;:EO.'064a `.:1702
•
COMMERCIAL TESTING & ENGINEERINGiCO.
ENVIRONMENTAL LABORATORY SERVICES .: •—
Chemlab'Ref.* 193.2583-1
Client Sample ID 0,7 Bi TONJE£S EST.
Matrix :WATER
Client Name
Ordered By
Project•Name
Project*
PWSID,
:S & S ENGINEERING
:RAY SHAFER
:UA
REPORT of:ANALYSIStr7
5633 B STREET
ANCHORAGE. AK 99516
TEL: (9071002-2343
FAR: 1707) 5615301
WORK Order -c',,-166844
Report Completed _!06/08/93
Collected •106/03/93 @ 12:30 hr:
Received :06/04/93 @ 16:15 hr6
Technical DirectorsS C. EDE
Released Ey :�.
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY.
Parameter
QC
Results Qual Units
Allowable Ext. Anal
Method Limits Date Date Init
.Nitrate -N
0.10 U
mq/L EPA 353.2/300.0 - 10 06/07 l.1.1
•
•
iisOitazix_zcsattftzaz=s=c=sittnuttazti=cclsitttzt zscacisittst
r
`" T"`SeeeSpecial.,InstrUCt�ionsrAbove`«`"
., **y1See:Sample RemarkstAbove t l r a 1 :+wnc
'U a:Undetected,;,Reported valuecisthe:practicalAquantificatio
'D`=xSecondary°dilutiori:., ..44,4,r.
- c 'A.
=itraaasttfttatiaaaaSSWRaaftalSat
" "d" CUA`'= Unavailable.
�t r.,,;., r NAie�NotiAnalyzecl�,
n m•LessfEhan;-*--
4V% 4, a GT.=.Greateri.Thanv
tw
1,4,t1",711.14 +; 1 « al)" 44SGS. Member`of Iho SGS orou'ISoc4t6♦GAi6ia+e'de Suh&II r( + ,"n° ,' zJ LL
P )� , +
t: • :EtNIRO1iblENTACSERVICES IN,ALASKA^COLORAp.♦ UT 1141CLINOIS. OHIO MARYLAND: WEST VIRGINIA NEW JERSEY SOU H CAROLINA),
t^i
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 9g _ ngao
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date 6/1/88
1. GENERAL INFORMATION
(a) Legal Description (include tot, block, subdivision, section, township, range)
Lot 7 Bik 1 Tonjess Estates T15NR1WSec.2
Location (address or directions)
(b) Applicant Name Lynda Banner Telephone: Home N/A Business 694-5500
Applicant Address 10928 Eagle River Road Eagle River, 99577
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 0 ; Buyer 0 ; Other &I (explain)' Pn -1t^r
(d) Lending Institution N/A Telephone
Address
(e) Real Estate Company and Agent Jack White Company— Lynda Banner
10928 Eagle River Road Eagle River, AK 99577
Address
Telephone
(1) Mail the HAA to the following address:
Pick—Up by Engineer
694-5500
2. TYPE OF RESIDENCE
Single -Family C$ Multi -Family 0 Other
Number of Bedrooms 3
i
I
3. WATER SUPPLY
Individual Well El Community 0 Public 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite €J Public 0 Community 0 Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
72.025 (11i84)
5. ENGINEERING FIRM PROVIDINI...4SPECTIONS, TESTS, FILE SEARCH, DAs.. AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection. the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm Eagle River Enaineerinq Serv;Wtone 907/694-5195
Address P.O. Box 773294 Eagle River. AK 99577
Date 6/1/133
Engineer's Seal
.. 11
A
6. DHEP ed for 7Z �_/�4 %'"!� — !� / / `rte
Approved for ,eri�bedrooms byDate /
Approved v` Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health 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 (11184)
'-.(OF'.•'"�tUNICIPALITYOFANCHORAGE(MOS..,I
11' HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
30\1 1 19� 264-4720
Legal Description•
ICS fa fe i
A. WELL DATA
ttcoo
Well Classification Pet ;As ie
Well Log Present (Y/N) i Date Completed
Let 7 ic*-/ .n ,esr
Tis .v
T/w s«.Z
If A, B, C, D.EC. Approved (Y/N)
7/4 -
Total Depth /n Cased to �� 7
Static Water Level 6-2'
Casing Height Above Ground +/'2 "
Electrical Wiring in Conduit (Y/N)
Depth of Grouting
Separation Distances from Well:
To Septic/Holding Tank on Lot */Do
.074
Yield
7.tco..
7&1e4 s-n3-sa
Pump Set At t 2 '
Sanitary Seal on Casing (Y/N) i
Depression Around Wellhead (Y/N)
• On Adjoining Lots
+/eo'
To Nearest Edge of Absorption Field on Lot -Nee ' ; On Adjoining Lots *neo'
To Nearest Public Sewer Line or,
Cleanout/Manhole evA
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot taS 1
Water Sample Collected by S $ r E...s'-.•e a -'.-r
Water Sample Test Results
Comments
Co / %F+. -.-.v. Fie
• Date S - /.2 - SY
ill' jtre >1 = Al
B. SEPTIC/HOLDING TANK DATA
Date Installed IT S2
Size /1reS1 No of Compartments —Z
Standpipes (Y/N) y Air -tight Caps (Y/N) '
Foundation Cleanout (Y/N)
Depression over Tank (Y/N) 4' Date Last Pumped S -7t8
Pumping/Maintenance Contract on File (Y/N) ns • for -nhE
Holding Tank High -Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well +100'
Temporary Holding Tank Permit (Y/N)
To Building Foundation
8�
To Property Line � To Disposal Field
i
To Water Main/Service Line t /O To Stream, Pond, Lake, or Major Drainage
Course i/o o'
Comments
Page 1 of 2
72-026(11184(
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata r.5"/trR Type of System Design 4 a,+, r4 e/o(
Date Installed /ft a.
s'4
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
N
Length of Field 30 11'4
Depth of Field
Gravel Bed Thickness
Sa re C74..
ya "A
Standpipes Present (Y/N) Y
Date of Last Adequacy Test
s -17 - 28
7 tie A6s..6t- -. .G se
Separation Distance from Absorption Field:
To Water -Supply Well -neeTo Property Line do '
To Building Foundation ao To Existing or Abandoned System on
Lot NS • On Adjoining Lots f 3c
To Water Main/Service Line oio # To Cutbank (if present) ^/fit
To Stream/Pond/Lake/or Major Drainage Course +100 '
1
To Driveway, Parking7re@. or Vehicle Storage Area ~7D
Comments q= ! / L=3e' '0cS1 1. ..T4 1...)4...,_fa„�..e,.���r../
-12:1 - 2G 7.1 ZGA I° ,o
D. LIFT STATION NA
d -ii'
amt re”
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
"Check Permitted Bedroom Rating Against HAA Request ..
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ��"'"+'^� Date 1/31/75'
Company
Receipt No.
1201 River Fnpinfw.y q..,m. e, MOA No. At - .245—
P. 0. Bac 773294
Eaple River, AK 99577
Date of Payment 694.5195 ( r o
Amount: $ 1 /7 O -
0 5 gc2.6 3 7i
Page 2 of 2
72026 (1Leo)
;Jr1•
rry •.'• it' •a '''.d. �;
� ` •°•e v�
d
11,61.1..:1447:P147-177, %-. is
Fe •. Art ..... ..•N1
1'. F : LouL• A. !mora �'
�, °�, A• CEa726 ".....41,„*".
T !"
i. �,-
k 'tar 0FESSt0''t'�z'
r
MUNICIPALITY OF ANCHCRAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY •
264.4720
Application Date b- I9- Gb
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Linn- •Tft,e, fir
Location (address or directions)
X11 et
(b) Applicant Name '&oiS Mit_-A E9 -T Telephone: Home to ee 2-0t03 Business Z?t" LCto
Applicant Address sf'-7- 'P'cK 14,141+1 GtioC-.IMl- Pei-, qel 5 67
(c) Applicant is (check one): Lending Institution 0 ; Owner/builder(; Buyer 0 ; Other 0 (explain).
(d) Lending Institution 'kV e. Telephone
Address t,isittez ' t:
(e) Real Estate Company and Agent 14 o. -I QlOri
Address
Telephone
(f) Mail the HAA to the following address:
54 5 ENGINEERING
-SR 8 196X
_____EAGLER1VER,..6.1C99577
2. TYPE OF RESIDENCE
Single -Family,- Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well 0- Community 0 Public 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite.T- Public 0 Community 0 Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
72-025 n 1/84)
(12.1
5. ENGINEERING FIRM PROVIDING ..4SPECTIONS, TESTS, FILE SEARCH, DM.. AND INFORMATION •
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is In compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
S & S ENGINEERING
Name of Firm —SR B 196X Telephone
Address EAGLERIVER, AK 99577
Date
6. DHEP APPROVAL
Approved for ..17/441 -)bedrooms by
Approved •Disapproved
Date / ��
Conditio al
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health 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
72-025 711/81)
A. WELL DATA
Well Classification
n
S,F
MUNICIPALITY OF ANCHORAGZ
DEPT. OF HEALTH g,
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 '71986
264-4720 6[� Q'
Legal Description. LI" rR FGE+V E D
Tont ,s trf
Well Log PresentQ$)N)
•
Total Depth X24 , 9
Static Water Level
Cased to
SO
If A, B, C, D.E.C. Approved (Y/N)
Alp
Date Completed 7/g=- Yield o•5-4Or^ -1—
r •
y 1-4..V Depth of Grouting
Casing Height Above Ground
Electrical Wiring in ConduitaN)
Separation Distances from Well:
To Septic/HeldiTTank on Lot
re"
(ov r
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line a1A
Cleanout/Manhole /b
Water Sample Collected by
Pump Set At Og
Sanitary Seal on Casing 4P/N)
• Depression Around Wellhead (Y/QI
l ao I -I -
Water Sample Test Results
Comments
• On Adjoining Lots
lao
• On Adjoining Lots .>Do 1'1"
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
S%S •Date
Sans
6 -19
Vie r -t. /iesl-c
TL'Sr ezteertoeco D.SGfir
B. SEPTIC/H9tDIRG TANK DATA
Date Installed e-7-4 --e t Size
1
'T
No of Compartments Z -
Standpipes CAN) Air -tight Caps ON)
Depression over Tank (Y.(6? Date Last Pumped
Pumping/Maintenance Contract on File (Y/N)f' •for
Holding Tank High -Water Alarm (Y/N) ' I Temporary Holding Tank Permit (Y/N)
Separation Distances from Septiclding-Tank:
To Water -Supply Well l 00r et
Foundation Cleanout (JN)
to -to - $b
To Property Line l u
lora
To Water Main/Service Line
aA
Course
To Building Foundation
To Disposal Field S
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 e:54' 164-- Type of System Design 1711--- r r tltn A
Date Installed
Width of Field
-- ?-'-r -8y
icon-
1.1"'
oo r t• -
Square Feet of Absorption Area
Depression over Field (Y/67
Results of Last Adequacy Test
25 S
Length of Field
Depth of Field 1 1/1-1
Gravel Bed Thickness
•
re t
0
Standpipes Present (tN)
Date of Last Adequacy Test
S/ t —3 e'rL_
to -t -t —ate'
Separation Distance from Absorption Field:
To Water -Supply Well 1 Oo IA- To Property Line
To Building Foundation 14'r
Lot
111
4
To Water Main/Service Line
l o tl–
• On Adjoining Lots
To Stream/Pond/Lake/or Major Drainage Course
To Driveway. Parking Area. or Vehicle Storage Area
Comments
0 1*
To Existing or Abandoned System on
3o I-1-
a
To Cutbank (if present)
A/he
too r.t�
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at"
�A "Pump Off' Level at
High Water Alarm Level at / ' Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
- Electrical Codes (Y/N)
Comments
" Check Permitted Bedroom Rating Against HAA Request •.
I certify that 1 have checked, verified. or conformed to all MOA and
SignedS & S ENGINEERING
SR B 196X
Compares MOA No. ary --cam
tAGIE RIVER, AK 99577 0 3'
Receipt No 3 9 0 7a to
Date of Payment 6 -97' 86
HAA guidelines in effect on the date of this inspection.
Date JU 2 6 ISCB
Amount: $ �op
Page 2 of 2
72-026 (11,84)
OF AC,;1
i�F1i71inaar'c gafYC �_ *
%' ties 14674 47 at:
- APPLICNT FILLS OUT UPPER HAh ONLY
Property Owner &Ade L. C. 7....C..//9 ne y/
Mailing Address s/. ,1) 1�pc (- ': G//,9 I< , I) Zip Code
Phone "��
�/ neS/• (/9�T�1'�
y
Buyer o Q. t Oe icicle {- T
Address CV.,/u, ' A K ,4 X Zip Code
Lending Institution ! �1.R �"9�i - - -.
r;,e.ST LW !9 5XII y.1
Address EA 9 [ p j . t ✓P /L Zip Code
Phone - -
Realty Co. & Agent
C . 2 / /'@ b,. 14ye //D.n,es
Address frig le ,P; s -p /(._ Zip Code
Phone
Legal Description 7
2 7 3 / TO .Ji --e cS
TTypeStreet Location CC Cte LP e Cr-
Typeof Residence
4 Single Family
O Multiple Family No. of Bedrooms
Date
❑ Other
Water Supply
❑ Individual
❑ Community
❑ Public Utility
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
For wells trilled prior to that date, give well depth (attach log 0 available).
Sewer Disposal
O Individual
❑ Public Utility
❑ Holding Tank
,
Year Individual Installed:
When Connected to Public Utility.
Inspector
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. -,
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
InsD:tor
Inspector
Field Notes:
EN ERT. C OF ANCHORAOE
ENVIROA,7vt CF L: -TH A
�r`1TAL PROTECTION
OCT 6 L ,,
RECEIVED
(3) APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDIT NALAPPROVAL'
DATEia �'/ 3
'CONDITIONS OF APPROVAL
BY -
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size
72423 IYatl
S & S Engineering
SRB 196X
Eagle River, Alaska 99577
October 3, 1983
Earl Chappell
Star Route Box 126
Eagle River, Alaska 99577
Dear Mr. Chappell,
Reference: Lot 7; Block 1; Tongass Estates
A well and septic approval requested on this property resulted
in -have the septic tank pumped and verifying its capacity to be
1000 gallons. The well casing was inspected and found to be
equipped with an adequate sanitary seal and all well wires
had been placed in conduit. The earth around the well casing
was adequately sloped away from the well. A water sample was
taken from the kitchen sink and submitted to Chemical and Geological
Laboratories of Alaska for total coliform bacteria analysis.
The results of this test were satisfactory.
If we may be of further service to you, please do not hesitate
tb contact us.
Sin
ERT A. H FER, P.E.
/ss
Municipality of Anchorage
Department of Health and Environmental Protection
'iA"��+•,en�. �L {.T.! VN..ase
APPLIrNT FILLS
OUT UPPER HAL'ONLY
Zip Code
Phone
Praperty Owner co H r S N 0-p-7
..
C
ME.
ailing Address PC 3 0 1 g A '
Buyer C H)9 PPe t L
Address 70 '-i O ID r Ckeiestra bk Zip Code 4PS0 V
Lending Institution
• /1L195/!q 07vrQ1/l l &A PC
Address Zip Code
Phone
,n
Realty Co.& Agent CeAo7toRy '/ NANCO P' Fell Lty
67-N A veZip Code
Address 4O i E.
Phone
�5'
Legal Description I O / T / %3 L i< 1 / l V
y
Street Location _ T e S S co C T
Inspector
Inspector
dd,�
MUNICIPAMfi' w ANICHf)RAf;E
..
/•// JT Q S s i [-- -�+ Zi-
Type of Residence
.s Single Family
❑ Multiple Family No. of Bedrooms
1CrLLL1 1
❑ Other
/L1'1
Water Supply Olab , V&1 1J 1 (fit
• C)
J•-LII
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).
...im Individual
❑ Community r • D [a.
❑ Public Utility
Sewer Disposal
.g Individual
❑ Public Utility
❑ Holding Tank
C v�
Year Individual Installed. / O
d /
When Comected 10 Public Utility.
Septic Tank Size 1 Z S"U
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Cir Aiczd P 4"t0
Date
Date
Date
Date
q-1 LI- 91(11 LCS
Inspector
Inspector
Inspector
Inspector
dd,�
MUNICIPAMfi' w ANICHf)RAf;E
` 1 ,r
Field Notes: O ' LV QO // Cf>T .r I . ; .0 ".
-L-I2-0 ,/rms/ ENVIF.�g.'.a:.a.!.OE.;I_.�
T 5 A f SEP 81982
RECEIVED
(3) APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL�APPROVAL'
DATE / �it.�{/
- 'CONDITIONS OF APPROVAL
P
BY: �L�/
Soils Rating
Dale Sewer Installed
Q- Q.t.-
Well To Absorption Area
Well to Tank
Weil Log Received I O
Septic Tank Size 1 Z S"U
72423 ball