HomeMy WebLinkAboutEAGLE CREST #1 TR A LT 7, 8Eagle Ceest
T act A
Lots 7&8
#0§0-303-04
MUNICIPALITY OF ANCHORAGE
"· DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
'~ ENVIRONMENTAL ENGINEERING
DIVISION
~ . --- 825 LStreet- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
~ J
LEGAL D[SCRIPTION
kiq.~i~lo.l IF HO~E: In~id~ length Width Liamd depth
. Type of crib Crib diameter
~ DI~TANOE TO:
~ Class ~ [a/)e~ [~ V IDriller Distance to lot line PERMITNO.
~ DISTANCE TO: 8ui(dln~ foundation Sewer line Septic tank Absorption area(si
OTHER .
PIPE MATERIALS
SOl L TEST RATING
72-013 (F. v. 3/78)
PER,II T NO.
~UNI C I PAL I T~' OF R~CHORRGE
DEPRRTMENT F'-~.HERLTH AND ENVIRONMENTRL/"~3TECTION
825 'L STREET, RNCHORRGE, AK. 99~dl
224-4?20
O~--SITE SEWER UPGRADE PER£dIT
< 810774 )
APPLICANT
LOCATION
LEGAL
BOB MONICA % SRA BOX 19~X ~9577
4TH STREET
LOTS ? & 8 B 0 EAGLE CREST LOT SIZE
694-9299
Z2504 SQUARE FEET
TYPE OF SOIL RESORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4
SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= ::LB LEI'~iGTH= 47 GRFI~..'EL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAI~tFIELD.
THE DEPTH OF A TRBICH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND 8ND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GR~VEL DEPTH IS THE ~IINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
RE~..U I RED SEPT I C: Ti~II'-~ ~( S I ZE= 1250 GI::ILLOI'~IS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORF~ THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TJ~iO ( 2 ) I I'~I_'~.PECT I Obis liRE REI~.I_I I RED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTIO~I.
MINI~IUM DISTANCE BETNEEN A NELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE NELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIVATE NELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMU~IITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. BPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER I~'ISTRLLATION.
PERM I T E×P I RES DECEMBER ~..~ :L.,
I CERTIFY THRT
l: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND NELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I NILL INSTALL THE SYSTEM IN ACCORDANCE NITH THE CODES.
~: I U~JDERSTRND THAT THE ON-SITE SENER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE ~IORE THAN 4 BEDROOMS.
SIGNED'
APPLICANT BOB MONIC8 ~ ~.~d~
ISSUED B'¢ .............................. ...... V4. O
F'~UNICIPALITY OF ANCHORAGE/"%
-Department~: Health and Environmental .,rotection
825 L Street, Anchorage, AK. 99501
264-4720
* * # HANDWRITTEN PERMIT # ~ ~
~ ON-SITE SEWER PERMIT-
Phone Number:
Applicant:
Location: ~% ~
Legal Description: ~ 7 ~ ~ ~-~ ~j~ ~
Type of Soil Absorption System Is~:
Trench: ~-" Drainfield:
Maximum N~er of Bedrooms:
LOt Size:
Seepage Beds Holding Tank:
Soil Rating(sq.ft/br) /4~O
DEPTH
The Required Size of the Soil Absorption System Is:'
LENGTH ~["7 GRAVEL DEPTH & WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE: /~2-,~'-~) GALLONS # *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
' * ' TW0(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this departmen'
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 $1 *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set.fo~h by the Municipality of Anchorage.
(2) I wi~l~f ~nstall th~§ystem in accordance with codes.
(3) I~de~nd t~e on-site ~ewer system may require enlargement if
· . ~~z/~/~~///~///~modeled to ~nclude more that__ bedrooms.~ ~
S[gne~//..~. ~/~/~////~/.~_/ Issued by: %~, ~.~'~c.4x~~''''
SW'P/024 (1/81)
PERFORMED FOR:
LEGAL D~SCRIPTION:
1
2
3
4
5
6
7
8
9.
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
PERFORMED BY:
72-008 (6/79)
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 Lo Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
[] PERCOLATION
TEST
SLOPE SITE PLAN
WAS GROUND WATER /PL~0 SL
pO
E
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
CERTIFIED
FT AND FT
hy
DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588
DEPTII OF ',YELL '~__~'- o
STATIC LEVEL OF %VATER FT.
C~'rJf~ ~[TR..XV,' DO¥,'N FT.
GALS. PER IIR
KIND OF CASING
/
KIND OF FORMATION:
l'rom _.D__.._ Ft. t n I Ft. e'"' ~'~ '~",~ ~ ~°o~ From__.F,. to
From i Fi. to {nTt Ft._.g'.'Vra~9 ¢' ~'~ c,¢/~, Ft. to
From~ .Ft. to 1~ Ft. C~ ~<~d~q ~ ~ot ~rom .Ft. to
~From /~ Ft. to ~ Ft. ~O ~6~d'~g' From~.Ft. to
:rom Fl. to ' FI.. ' ' 'From FI. to
?rom Ft. Io.. Ft._ From Ft. Io
:rom Ft. lo Fl . From__FL to
Front FI. Io Ft. From__Ft. to
Front Ft. to Ft. From __ Ft. to
From_ Ft. to~Ft. From __ Ft. to
from-- Ft. to Ft. From Ft. to
Ft.
Ft.
Ft.
Ft,
Ft.
Ft.
Ft.
Ft.
Ft.
Ft.
Ft.
Ft
Ft
Ft.
Ft.
Fi,
:IISCL. INFORMATION:
I)RILLER'SNAME {Z~c-'~4e -J-~;":':--"-"
PERMI1
MUNICIPALITY OF ANCH'ORAOE
DEPARTMBIT OF"~IEALTH A~ID ENVIRONMENTAL P"'~TECTION
825 'L' STREET, ANCHORAOE, AK. 995bi
264-4?20
780932 )
HFHLICHNF
LOCATION
LEGHL
ROBERT T MONICA 160 CITATION
CITATION ST EAGLE RIVER
L ? IRRCT R EAGLE CREST
LOT SIZE
694 ~299
17800 SQURRE FEET
MINIMUm DIS]HNCE I~ETWEEN A WELL AND R~Y ON-SITE SEI4RGE DISPOSAL SYSTEM IS
10~ FEE] I-'OR A PRIVATE WELL; OR
150 ]U 2~k~ FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL LUGS HRE REQUIRED AND .MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS
*OF THE WELL COMPLETION.
, OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIRGRRMS ARE
HVHILH~LE *1'0 1N$URE PROPER INSTRLLHTION.
PERM I 1' EXP 1 RES DECEMBER ~L.-
! UERIIh¥ IHH[
1: I HM FHr~ILIHR WITH THE REQUIREMENTS FOR ON-SITE SEI4ERS RND WELLS RS SET
FUK[H BY THE MUNICIPHLIT¥ OF ANCHORAGE.
~': 1 WILL INSTALL ]HE S~TEM IN ACCORDANCE WITH THE CODES.
SiUN U ............ ............
ROBERT T MONICR
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak, us
(9O7) 343-79O4
CERTiFiCATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-303-04
1. GENERAL INFORMATION
Complete legal desc~ption
Expiration Date: ~:~/Z/ /o $
/--
Lots 7 & 8, Tract A, Eaclle Crest S/D, Eaqle River
Location (site address or directions) 19252 Citation Drive, Eaqle River, AK 99577
Current Property owner(s) Christooher Clemens
Day phone
Mailing address
19252 Citation Drive, Ea(lle River, AK 99577
Lending agency
Day phone
Mailing address
Real Estate Agent Colin Roth/Re Max Day phone 727-1191
Mailing Address c~"¢'(3 ~C~'~r~,/~ ~'~ ~ /~, ~~ ~
Unless othe~se mquested, H~ ~11 be held by DHHS ~r pickup. H~ picked up b~
2. NUMBER OF BEDROOMS:
4
o
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTE'WATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Cammunity On-site
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with
new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A
or B wells or a public water system. The Municipality of Anchorage is not responsible far errors or omissions in the
professional engineer's work.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for 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 bedreoms and type of structure indicated herein. I further redly that based on the
information obtained frem 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 applicable Municipal and
State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Ency. Svc. Phone 272-8218
Address P.O. Box 102954, Anch, AK 99510
Engineer's Pdnted Name Steven R. Pannone, P.E. Date
Engineers Comments: In conducdn8 an adequacy test, !attcmpt to provide a thorough, consc/entious
engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. Thc
reported rczults descfibo the porronnuncc of the s)~tcm under the candifions cncoumcred at the time of
thc te~ and separation dis~nces me;~surod to readily identifiable f~turos. The oporafional life of all
wells and septic .systems dep. md on the local soil condition, ground vaater levels ~at may flactuate
during [he year, and the water usage o£the family being served by ~e s)~tem. The~e conditions ~
outside the control ofthe e~aluator oftkis system. All s)~tems eve~mally ~ and satisCactory test
results do not ganran~'e future perform=co of the system, nor do they guarantee fluat ~ere are no
hidden defi.'cts or uncroachments. PF_.S can therefore not provide any ',~ ~"ran [7 for fiiture porformancc
nor give any e~timate of how long the system will continue to meet the operational requirements of the
ADEC or MOA DSD. The content of dais report is for the sole benefit of the ov,~or listod above. Any
reliance upon or use of this report by any other pomon or party is not authorized nor will it confer any
legal fight ~'hatsoevor.
6. DSD SIGNATURE
t,,'"" Approved for ~ bedrooms.
Disapproved.
Conditional approval for __
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Certificate Date:
Reissue Date:
Legal Description:
A. WELL DATA
Well type AWWU
Date completed
Total depth
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bregaw Street
P.O. Box 196650 Anchorage. AK 99519-6650
wvnv.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Lots 7 & 8. Tract A, Eaele Crest $/D
ft
If A. B. or C Ixovide PWSID # __
Sanitary seal
- Cased to It
FROM WELL LOG
Parcel I.D.: 050-~0:~4
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mi
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Omer Steel
It
g.p.m.
Well Lng
Wires I:N~pedy protected
Casing height (above ground)
AT INSPECTION
iff.
Nitrate
Collected by:
g.p.m
mg/I Other bacteria colonies/100 mi
Date installed 91111981 Tank size t250
Cleanouts :2 Foundation cleanout Y*
Dare'of pumping 71~2002 - Pumper JR'$ Pum9in<3
C. ABSORPTION FIELD DATA
Date installed $/'1f1~181 Soil rating (g.p.d./ft~ or It=/bdrm) ,t40
Length 47 ft · , WKtth 40" It
Tote{ depth 9.3 It Effective absorptk~ area ~ It2
Date of adequacy test 7/2~2002 Re~uits (Pass/Fail) . ,.
Fluid delXh in absoq~ion field before test .~ in
Elapsed Time: 45 min Final fluid deplh 0 in
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N
(Rev. 11,~)
gal Number of Compartments :2
Depression over tank N High water alarm
System type Trertcl~
Gravel below pipe 6 It
Monitoring tube Y Depression over field N
' For4 bedroom~
Water edded600 gal. * New deplh,~ in.
Absoq~ion rate >= ~00+ g.p.d.
If yes, give date
D. UFT STATION
Date installed
'Pump on' level at
Datum
Size In gallons
in'Pump off' level at
Cycles tested
tn
Manhole/Access'
High water alarm level at __ in
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absoq~tion field on lot
Public sewer main
Sewer/seplic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 24
Water main
Drainage 100+
Properly line t0+
Water service line 25+
Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 25
Surface water 100+
Wells on adjacent lots 100+
Properly line 10+
Water Service line 25+
Curtain drain 100+
F. COMMENTS
Foundation Cleanout located in laundry room.
G. ENGINEER'S CERTIFICATION
review of Municipal records that the above systems are in
conformance v~th MOA HAA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone. P.E.
Date ,
Date of Payment ~ (~/C~ Z
Receipt Number ~ ~'~*'~ ~0
(Rev.
Abserpiion field $
Smface water 100+
Water main 25+
Driveway, pan~ing/vehicle storage
Waiver Fee $
Date of Payment
Receipl Number
I I
I
..7,0
MUNICIPALITY OF ANCHORAGE ~
~. Department of Health & Human Services
· DIVISION OF ENVIRONMENTAL SERVICES
~ ,?.. , 343-4744
,CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
'ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
HAA # ~~~ ~ ~ (~)/~ ~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
19~5~ C.Ctz~t.J. o ~
(b) Property owner Ab~.~u~z, Telephone: (home)
Mailing Address 18550 F,~6h
(c) ~.ending Institution Telephone
Mailing Addres~
Business
99577
(d) Real Estate Company and Agent Re/Max- Al Roma6z~,~
Address 16600 Ce~'.~.fZe.~d Dr., E~q~e RZu~, ~6~
Telephone 694-4200
99577
(e) Mail the HAA to the following address: (or check here~, if hold for pick up,)
List contact person and day phone number below:
$ & $ ENGINEERING
17034 Eagle Rivm' L?ep Read No. 204
E~gle River, Alaska ~577
2. TYPE OF RESIDENCE
Number of bedrooms
Single-Family E]
3. WATER SUPPLY
Individual Well I~
4
Community D Public CI
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ~ Public E] Community I"1 Holding Tank r~
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
Page I of 2
Name of Firm
Address
Date
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by'my seal affixed hereto and as of the validation date shown below, I verify that my 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 typo of structure indicated herein. I further verify that
based on the inf~)rmation obtained from the Municipality of Anchorage files and from my investigation and
inspection, the ~m-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.
Telephone ~'4,:~/'/~- ~--~' ~'-'~ ~'
$ & $ ENGINEERING
17n34 Eaale Rlve~' Loop Road No. 204
Eagle River, Alaska 99577
6. DHHS APPROVAL
Approved for
Approved ~
Disapproved
Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 error? or omissions
in the professional engineer's.work.
Page 2 of 2
, (_~IU.N~--~' oFM~LITY OF ANCHORAGE (MOA)
~' ,1 ~liF,.,~' NI[N. THHealth Authority Approval (H~)
~~~O~KLIST - FEBRUARY 1984
~' ~ ~ ~.~ 343-4744
. ' FEB 5 . .
~ '. ' ~.~ ' Legal Description:
RECE! ED
A. WELL DATA
W~II Classification [,L~u t ~;::),--~='~1~- If A, B, C, D.E.C. Approved (Y/N)
Well Log Present~;~N) ~ Date Completed ~.~ - ~ - '"/~:, Yield
Total Depth~__..~.~Cased to ~c'~'~ Depth of Grouting
Static Water Level. '7....,~ ~[' i Pump Set At ~/-'-
Casing Height Above Ground
Electrical Wiring in Conduit4~'/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge,of. A~$orption Field ~n~ot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Sanitary Seal on Casing (:~)
Depression A~'ound Wellhead (Y/,~p
' ; On Adjoining Lots ~
~ ~ ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
Water Sample Collected by ~; Date ~,, -
h
Water Sample, . ~ " ~:~ -
Test Results
Comments ~
B. SEPTIC/HOLDING TANK DATA
Date Installed '~- ~-~1 Size
Standpipes ¢i~'N) ~ '
Depression over Tank (Y~
Pumping/Maintenance Contact on File (Y/N)~
· r
(Y/N) t4--/~
Hild!ng Tank High-Water Alarm
~'Z''~c:) No. of Compartments
Air-tight Caps~'/N)
¥ Foundation Cleanout (Y/~Fp
· . Date Last Pumped ~.-
; for
Temporary Holding Tank Permit (Y/N) '//A
To Water-SuPply Well
To Property Line
To Water Main/Service Line
To Stream, Po~d, Lake or Major Drainage Course
C'(~mments '"~'~-~: ~_.,~-~oc:,~-. ~)'~"'~ ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
~ To Building Foundation
~ ~::'~"¥' To Disposal Field
Page ! of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~:~ ~ -- ~-~
, Width of Field
Square Feet of Absortion Area
Depression over Field (Y/~
Results of Last Adequacy Test
Type of System Design
Length of Field.
Depth of Field i \ ~=~
Gravel BedTh~ckness ~ 1 I . ~ ,
Statndpipes Present(~N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ~, c:'~" ~ To Property Line' \ <=,t ~
To Building Foundatk~n '~"~" . To Existing or Abandoned System on
Lot "~ ~' ; On Adjoining Lots '"%~.' 5¢
To Water Main/Service Line ~.~=-~ A- ~/~
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course ~ .c:~:~ ~
To Driveway, Parking Area, or Vehicle Storage Area ' '~C;:~ ~
Comments
D. LIFT STATION ,~ ]
"Pump On" Level at
Dimensions
Manhol'e/Access (Y/N)
"Pump Off" Level at
High Water Alarm Level at ~' Vent (Y/N) -
Tested for ~ ~ 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 a'nd HAA g~idelines in effect on the date of th[s
inspection. ~ "'
Signed
Company
MOA No.
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
Receipt No.'
Waiver Fee: $
Date of Payment
"/~ CHE~IICAL & GEOLOGICAL LABORATORIES OF,4L,'ISKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
FEDER^L TAX ID, ~2-0040440
ANALYSIS REPOR! HY HAWPLE fo{ Wozk O{de~ ! 11681
Date Report FEinted: FEB 13 89 ~ 15:15
Client Sample ID:L/ & 8. EAGLE CREST
FWSID :UA
Collected FEE 13 89 ! 09:10
Received FEB 13 89 e 1l:30 hz,.
Frete{ved with :NONE
Client Name : $ & S ENGR
Client Ject: HNSENGP
P.O.! NONE REC'D
O~deEed By = R~$
Analysts Completed :FEB 13 89 Send Repogtm to:
Laboratory Supe=T[mo~ :$'IEFHEN C. EDE 1)S & S ENGR
l~tguct:
Chemlab Ref l: 4225 Lab Smpl lO: I Watztx: WATER
Allowable
Fazamete~ ~etted Retult/Unttt Method Limttl
NITRAYE-W ND(O.IO) mg/1 EPA 353.2 lO
~mple ROOTI~ SAJ~LE.
ReMake: SA)~LE COLLECTED BY
I Tettt FeEforMd ' See Spoclal Inst~ucttona Above UA-Unavailable
ND- None Detected "See Sample Reuagks Above
HA- Wot inaly~ed LT-Lete Than. GT-GEoateE Than
!
f ~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
I. GENERAL INFORMATION
Legal ~escription (include lot, bl.o.~, subdivision, section, township, range.)
Applicant Name~ ~ ~ Telephong: Home ~ ~ ~ ~ Business
(c) Applicant is (check one): Lend~ng Institution ~; Owner/builder ~; Buyer ~; Other~(explain);
(d) Lending Insfilulion ~~ ~~ Telephone
~eal ~tata Compan~ and ~ent
Address
Telephone
(f) ~ttht~e HAA to the following address:
2. TYPE OF RESIDENCE
Single-Family.J~ Multi-Family 1-1
Number of Bedrooms
'. III I1~
Other
3. WATER SUPPLY
Individual Well J~r Community I'1 Public r-I
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 [] Community [] Holding ~l'ank []
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 t2-o2s o~,~
' FILE SEARCH DATA AND INFORMATION *" ·
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, ,
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 F!rm
Address
Date
Telephone
6. DHEPAPPROV/~L ':" ~'
. bedrooms by ~
AD~roved ' ~ ' ' ~Disa'~roved
Terms of Conditional ~A~pproval
\\ ,.
:1 ~\\ ''
""~/~'"~ Date
Con~nal
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 ~f Anchorage is not responsible for errors or omissions Ir~ t~e
professional engineer's work.
Page 2 of 2
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
&~UNICIPALI~' OF
DEF'i'. OF HEALTH &
F~','V 17.O N~.4 E NT.~j. PRCT£CT;ON
Legal Description:
Well Classificatior{
Well Log Present (k~N)
Total Depth "'~ "ze"
Static Water Level
Casing Height Above Ground
Electrical Wiring in ConduitS/N)
Separation Distances from Well:
To Septic/bie~lf~J'Tank on Lot
*~ '~"' If A, B, C, D.F-C. Approved (Y/N)
Date Completed tc>"a~' ~'~ Yield
Cased to ~C;)lJr Depth of Grouting
'Z~:~:~' Pump Set At
~-'4'j'~'' Sanitary Seal on Casing~l)
Depression Around Wellhead (Y~)
¢C~iO ~r ' ; On Adjoining Lots
To Nearest Edge of Absorption Field on ~ot ~ c:~ ; On Adjoining Lots '[ ~C;>
To Nearest Public Sewer Line ~.3 ~,, To Nearest Public Sewer t
Cleanout/Manhole J~l~ To Nearest Sewer Service Line on Lot ~
Water Sample Collected ,,3LE ~VEP~ ALA~I"~ '~e.~7~'
Water Sample Test Results ~3~7~ ~ 7/~ ~ ~ ~.~
co nts *
B. SEPTIC/~IQL-Dll~ TANK DATA
Date Installed ~"t-~ -~' ~
Standpipes ~)N) Air-tight CapstaN)
Depression over Tank (Y~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic.~ Tank:
To Water-Supply Well ¢~ ~ I
To Property Line
To Water Main/Service Line
Course I,b
Size ~,~,~:::~ No. of Compartments "Z.-
Foundation Cleanout (Y/,.~.
~3.~. Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11,84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date !nstalled. '
Width of Field
Square Feet of Absorption Area
Depression over Field (Y{~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well I/~
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present ~lN)
Date of Last Adequacy Test
To Property Line .j {;:~t.~.
To Building Foundation '~'
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Existing or Abandoned System on
; On Adjoining Lots ~ [4-'
TO (~utbank (if present) 1'3/~
Comments
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
~lanhole/Access (Y/N)
r '~ / ~"Pump Off" 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 certi fv__t hat ]_have cb.ecJ~d .y.e ri fled. or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Sign~. ~ 1~
Company~~ MOA N~-- 00~
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
November 6, 1985
Robert A. Sharer, P.E.
S & S Engineering
SRB 196-X
Eagle River, Alaska 99577
Subject: Waiver Request WR85-049
Lots 7, 8 Tract A Eagle Crest Subdivision
Dear Mr. Shafer:
This Department has approved your request for a waiver of the
required minimum 100 foot separation distance between the well
and septic tank on the subject lot. This waiver is valid for
the existing septic system only. Future upgrades must meet
separation distance requirements.
Sincerely,
Stephen $. Morris
Civil Engineer
On-site Services
ssM/lJw
ROBERTA, SHAFER
October 26, 1985
CIVIL ENGINEER
694.2979
HEALTH AUTHORITY
APPROVALS
SEWER A WATER
INSPECTION
SYSTEM DESIGN
WELL INSPECTION
& FLOWTEST
SITE PLANS
ROAD DESIGN
SOIL TEST
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, Alaska 99501 ~;~,'~
A~'~'~NTION: Susan Oswalt
REFERENCE: Lot 7 & 8; Tract A; Eagle Crest Subdivision
Request you issue the attached Health Authority Approval and
approve a waiver to the horizontal separation distances between
the septic tank and the well for the referenced property.
The on-site waste water disposal system was installed in September
1981 under a waiver issued by the MOA. At that time the MOA
issued a certificate of inspection and approval for a four
bedroom residence. The septic tank for the on-site waste water
disposal system was installed using mechanical water tight
seals. The existing well log shows that the well penetrates
several layers of clay and gravel from 12 feet through 346
feet. The static water level measured to be 245 feet from
the top of the well casing. The topography in this area is
relatively flat.
The risk analysis performed by this office indicates that the
well is almost sure to be free from any contamination from
household sewage, therefore, it is our opinion that the horizontal
separation distances prescribed by 18AAC72 are not required
in this case.
~~ of further
~S/ss
service, please contact us.
SRB 196X EAGLE RIVER. ALASKA 99577
TIME TIME TIME
DATE DATE DATE
,NSPECTOR ,NSPECTO. .NSPECTOR
MUNICIPALITY OF AN(HOP, AGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
// DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI~N~IRONMENTAL
825 L Strut · Anchor~, Al~a ~1
ENWRONMENTALSAN TAT OND WS ON SEP 1981
TMe~e ~7~
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIE~
Ol RECTIONS: Complete all parts on page 1. Incomplete r~u~ will ~ot ~ pr~. Please allow ten (10) days for pr~sing.
1. PROPERTY 0~~/
MAILING ADDRESS
PROPERTY RESIDENT (If d,fferent from ebon) I PHONE
2. B~ER PHONE
MAI LING ADDRESS
i~ LENDING INSTITUTION ~ PHONE
I
MAILING ADDRESS
4. REALTOR/AGENT
B. L E G A L D E SC R I PT, ON (.._.~...,,~).~1//~;2.
STREET LOCATION
6. TYPE OF RESIDENCE
[~'"~SI NG LE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS (i £J~
[~ One ~"Fo~r -- [] Other
[] T
~e g FiveSix
7. WATER SU~
~ INDIVIDUAL*
r-I COMMUNITY
[] PUBLIC UTILITY
· A'I-I'ACH 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.)
8. SEWAG.. EE ~J~OSA L SYST E M
~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
· . THIS SIDE FOR OFFICIAL USE ONLY -
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
I--'1 SINGLE FAMILY- f--] ONE I-'1 THREE r-1 FIVE [] OTHER
[] MULTIPLE FAMILY I-1 TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE )ATE INSTALLED
I--Ipu BLIC UTILITY
Connection Verified NSTALLER
[]Septic Tank or r-] Holding Tank
Size: ' If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES WELL TO: Septic/Hold'rig Tank IAbs°rpti°n A~'ea ISewer Line INeares' LOt Line
Absorption Area to nearest Lot Line
5. COMMENTS
[~"~APPROVED FOR ~ BEDROOMS
f--I CONDITIONALAPPROVAL (letter mus~accompan¥ certificate)
'- [] 'DISAPPROVED
72-010 (Rev. 6/79)
/v unicipalitYo
Anchorage
825"L"STREET
ANCHORAGE, ALASKA 9950!
(907) 264-4111
September 3, 1981
Robert F. Monica
160 Citation
Eagle River, Alaska
99577
Subject: Lot 7 Tract A Eagle Crest Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
(2)
The water analysis report needs to be submitted to
this office from the Chem Lab, 5633 B Street, for
our review.
The inspection report of the upgrade of the sewer
system needs to be submitted to this office if a private
engineer has inspected the installation.
If there are any further questions, please call this office'
office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
-
MUNIC/PALI~Y
MUNICIPALITY OF ANCHORAGE DEPT: OF HEALTH
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~O~ENTA/ P~OTE~ION
825 L Street · Anchore~, Alaska 9950t
ENVIRONMENTAL ENGINEERING DIVISION NOV 2 1 19~
Telephone 2~720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~E~L~
DIRECTIONS: Complete all parts on page t. Incomplete requests will not be preceded. Please allow ten ~ ' processing.
:~TY OWNER
--r-' tY' o : C o._.
, MAILING ADDRESS
E$1DENT (If different from above)
tT- /-/
2. BUYER
MAILING ADDRESS
3. LENDING INSTITUTION
MAILING
PHONE
4. REALTOR/AGENT
6. TYPE OF DENCE
~ S ~IGLE FAMILY
' [] ' M LTIPLE FAMILY
[~' ViDUALo
[]
[] : UTI LITY
SEWAGE DISP
~ INDIVI
[] PUBLIC UTI I
DROOMS
One [] Four [] Other
I-2 Two I-3 Five
[] Three r-I Six
)G. A well log is required for all wells drilled
since Jura lied prior to that date, give well
depth (artec If available.)
", f ind'v'dual/on-s tee give installation date F~ / 0~. ~O
if system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-0t 0(3/78)
/~ THIS SIDE FOR OFFICIAL
USE
ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
iNSPECTOR INSPECTOR INSPECTOR
)IR ECTIONS:
1. TYPE OF I~I~SI_~ENCE NUMBER OF BEDROOMS ,
[] SINGLE FAMILY [] ONE r-'l THREEnj ,1'--I,.. ;Fly?.. , . ;[] OTHER.. ~
[] .MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER - -
2. WATER SUPPLY
[] INDIVIDUAL ' DEPTH OF WELL
[] COMMUNITY DATE DRILLED .... ,, . , .
[] PUBLIC UTILITY _ "'(' "~ '";"" ' '" ' - ~ .... '~-' '"
Connection Verified LOG RECEIVED , , ~ ~
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER . ·
[]INDIVIDUAL/ON *SITE , DATE INSTALLED
[]PUBLIC UTILITY ,r
Connection Verified INSTALLER
['-)Septic Tank or []Holding Tank
~ Size: If Tank is homemade SOILS RATING ~..
Absorption Area to nearest Lot Line
5. COMMENTS
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
r-I DISAPPROVED
DATE 13Y (Title)
LEGAL DESCRIPTION
72-010 IRev. 3/78)