HomeMy WebLinkAboutSANDHILL LT 9Sand Hill
Lot 9
#050-522-11
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191087 PID Number: 050-522-11
Dwelling: ❑� Single Family (SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: ❑ New ❑j Upgrade
Name:
Brandon Frazier ABSORPTION FIELD
Address 12 Deep Trench E Shallow Trench ❑ Bed ❑ Mound
24910 Hamann Road Eagle River, Ak 99577 ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
947-2311 3 0.8 GPD/SF 1.9 / 1.5 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot t4 / 1.0 Ft. 0.5 Ft.
Sandhill 9 Fill added above original grade Gravel length
Township Range Section 1.2 / 1.5 Ft. 2 @ 57
Ft.
Gravel width Beds:Number of Lines (Distance between lines
SEPARATION DISTANCES 5.0 Ft. Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Lift Station Tank Line 5570 Ft2 2 >6' Ft.
Well N/A >100' N/A N/A >25' TANK ❑Septic ❑S.T.E.P. ❑Holding ❑Other
Manufacturer (Capacity
Surface Water 1 N/A >100' N/A N/A Existing Tank Gal.
Material Number of compartments
Lot Line N/A >10' N/A N/A
- - -- NA
Foundation N/A >10' N/A N/A LIFT STATION
Manufacturer ((Capacity
Curtain Drain I None Noted
111 f Gal.
Pump on level at Pump off level at (High water alarm at
Remarks Absorption system only replaced under
this permit. Existing absorption abandoned in.1 in. in.
& aboveground pipe removed. 2 " insulation Pump make and model (Electrical Inspections performed by
placed over each trench.
PIPE MATERIAL House to tank Exist. Tank to D3034
Installer drainfield
Wilco Contractors Drainfield D3034 CO/MT D3034
Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft
Inspeection ction 151 4/29/19 2'd 4/30/19 Location and description
Std 4`^ Bottom of siding on South wall of house.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
.••'��F q NI._
Conditional Approval: Date IPS •' •.
I
. 49th \ ;* 1O
•
li VA MICHAEL E. ANDERSON d Li a
tv.-cp NO. CE-4381 J �:
�. �F 5/8/19 ...•''���'�
Approved w- (^ Date 7�� �*��o pR�FESS�• P:�•.
Inspection Report_9-1-12.doc
SAN DH I LL, LOT 9
PERMIT # OSP191087 PID # 050-522-11
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iiiiiiiPGE[MING // \\ \,
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.�-\E „k '�� 200 81.2 46.0 CO CLEANOUT
•. \>,...'"• "••\. MT1 82.0 45.9
f _i_ s •t PLAN AS-BUILT C01 83.8 47.7 200-DOUBLE CLEANOUT
�•�•4sth iN tzt t� MT2 90.1 109.6 FCO FOUNDATION CLEANOUT
� '� CO2 92.3 112.0 FS-FLOWSPLITTER VALVE
MICHAEL E.•ANDERSON/41,i: 0 MT3 91.9 59.1 MH-MANHOLE
•i�%'s� NO. CE-4381 �l �� 50 100 CO3 92.1 60.2 MT-MONITORING TUBE
•-e ••.•ti���s/3i19 moo••c� ''• FEET MT4 100.0 121.3
1 PeCO4 101.6 122.9 SV-SEPTIC VENT
t4h11 FE55���:•�� 111=50' TH-TEST HOLE
FS 102.8 61.6
SAN D H I LL, LOT 9
PERMIT # OSP191087 PID # 050-522-11
OE- TRENCH #1 1-0
U2 2U
89.9 FINISH GRADE 88.7 ORIGINAL GRADE
l
-n i fti 2" INSULATION
87.3 -r!" i �� i a,� .s� 4 � r � " 1. r„fl�INF16Lfi1 R4)�'r f `v w d�); t i.yam"yet}:�•r! ..
86.8 87.3
85.8 86.0 86.8
57'
\—
GROUNDWATER @ 82.2 4/23/19
78.7
1—
TRENCH #2
OF 1-0
U2 20
j" 86.0 FINISH GRADE 84.5 ORIGINAL GRADE
l \
83.5 —, ' `i ': .r;r' ti.r`.• fii l5+q,4; a r z , w.' ;*.:.,. .'.:� i l:� : ' 2" INSULATION
83.0 83.5
\\—
82.7 82.6
GROUNDWATER @ 78.0 4/23/16 57
74.5
II-
.•'-% OFgC $,
irai • 49th ' • •
' •�
j Z is
• MICHAEL E�ANDERSON i,kJ=
GE PROFILE AS—BUILT No. CE-438, r'=.
ENGINEERING
(NO SCALE) ••44pROFESS� �:•��
100/0 goiA
F nc S.
— 0° On-Site Water &Wastewater ProgramMUNICIPALITY OF ANCHORAGE
Elmoa Road
(
PO,Box 196650
343 7997 :>
h
Anchorage,Alaska 99519�6t P ilw Phone:(907)
Fax (907
De NI rtmeht
i'• System
Permit
N��oA Disposal y
On-Site Wastewater thsp
Effective Date: 4/11/2019
Permit Number: OSP191087 Expiration Date: 4/10/2020
Work Type: Septic Upgrade
Tax Code Number: 05052211000
Site Legal Address: SANDHILL LT 9 G:0262
Site Mailing Address: 24910 HAMANN RD, Eagle River
Lot Size in Sq Ft: 56755
Owner: FRAZIER BRANDON B 3
Design Engineer: FORGE ENGINEERING
Total Bedrooms:
•
This permit is for the construction of:
Disposal Field FJ Septic Tank 0 Holding Tank 0 Privy
0 Private Well 0 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
1 /Vine? CO# ` ni w fou^�ukCle✓ - �rc.tCA1 CI ccla,y,A.•
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Received By: a-6119--py.4_, Date: 7/
Issued By: (Xi Date: '17
EPt4tvs
MUNICIPALITY OF ANCHORAGE
Community Development Department -_ Phone: 907-343-7904
Development Services Division '— Fa . 07-3z13-2799-7
On-Site Water& Wastewater Program \
RU\5\f__
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 050-522-11
Property owner(s) Brandon Frazier Day phone 947-2311
Mailing address 24910 Hamann Road Eagle River, Ak 99577
Site address Same
Legal description (Sub'd., Block & Lot) Sandhill, Lot 9
Legal description (Township, Range & Section)
Lot Size 56,755 Sq. Ft. Number of Bedrooms Three (3)
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(E)all that apply)
Absorption Field AXI Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑ Upgrade IXl Duplex (D) ❑
Holding Tank ] Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well
Water Storage
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
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: `"'Isa Waiver Fees:
Date of Payment: LI 1511(31 Date of Payment:
Receipt Number: 601-603b Receipt Number:
Permit No. 05P 19 Ita4 Waiver No.
Permit App__-. :_..k
Muni opal ity of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE CONPUANCE
OSP191087,Deb Abckenfuss,04/11/
Now
GE
E N G I N E E R I N G
PO BOX 240773
ANCHORAGE,AK 99524
522-7773 677-7766(FAX)
April 5, 2019
MOA Development Services Dept, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Sandhill, Lot 9—24910 Hamann Road
Septic System Design
Dear On-Site Services Engineer:
The absorption trench on the subject lot has failed and must be replaced priorto the sale of the lot.
We are submitting this permit application for the construction of a new absorption trench to be
utilized in conjunction with the existing septic tank. The septic tank will be exposed, inspected
and verified suitable for continued use. It will be replaced if found defective. The attached site
plan identifies the location of the home and the existing well and septic system along with the
proposed absorption trench. No conflicts exist between this proposed system and any other well
or septic system on this or adjacent lots.
The groundsurface on the lot in the areaof the absorptiontrenchslopes to the southwest. Contours
are shown on the site plan indicating the grade and directionof flow. Stormwatendrainage will not
impact this septic system.The new trench will be constructed parallel to the slope as much as
possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100' from all
wells and surface water, and more than 5' away from the septic tank.
Please refer to the attached test hole log and plan and profile sheets for the septic design. If this
design is followed, there will be no adverse impacts to adjacent properties.
Sincerely, ��++•� n.
04,77,
Michael E. Anderson, PE a ITTTT 49th _
sewesgep
S N •NN.N••MNN•N•N•N•..N:
1. MICHAEL E. ANDERSON IL,•
, .r 1. No. CE-4381 'rar
�•,4. •..�•4/5/19 emir
SANDHILL, LOT 9 Coi
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EXISTING WELL.
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\ EXI. i.IG 1,250 G�L�EPTIC
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\ \ ='LACE IF NESkSSAR`? —�\ ` FC• TRENCH. H A�CNOT B SED
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illeftGE NOTE: / \ ‘ 1
_os.OF siii+' NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND
+++JP" -.,......,gC,9 .. PROPOSED SEPTIC SYSTEM
CO-CLEANOUT
�••• .•k. •i 2C0-DOUBLE CLEANOUT
4 : •o 4-t ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
�� • • FCO-FOUNDATION CLEANOUT
i• L »•49th ..�•
� �` i PROPERTY ARE SHOWN.NO CONFLICTS WITH WELLS OR SEPTIC
. �` M SYSTEMS. FS-FLOWSPLITTER VALVE
c.o +MICHAEL E. ANDERSON : •,• MH-MANHOLE
•�r s No. CE-438T 1,.t � 0 50 100 MT-MONITORING TUBE
J •1
�,F,e,, .••••4r2Nrt N•�,,,.�� '++ FEET SV-SEPTIC VENT
%1/2R0FESS\ ::• 1"=50' TH-TEST HOLE
•
SANDHILL, LOT 9 C o .-=f= I
DESIGN FACTORS: SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW 5' WIDE TRENCH SYSTEM
PERK RATE: 6-15 MIN/IN VERIFY INTEGRITY OF EXISTING 1,250-GAL.
APPLICATION RATE: .8 GPD/SF SEPTIC TANK. REPLACE IF NECESSARY
450 GPD / .8 GPD/SF /5' WIDE *1.0 RED. FACTOR = 112.5 LF TRENCH REQUIRED (114 LF SPECIFIED)
BOTTOM OF TRENCH: 1.5' BELOW GRADE
FLOW LINE ELEVATION: 1.0' BELOW GRADE
TOP OF TRENCH: 1.5' ABOVE GRADE
PLACE 4" OF TOPSOIL AND
REVEGETATE MOUND
1 — =ISI11I I III II — 2" INSULATION
=III=III—� Ill=I�I=I�I=I�I=
1'-6" =1 I I—III=111=1 I I=III=III—III—III—III=I I
I 11=111-111=1 11E-111E111=1 11=1 1 I=J 1=J.=I —I I I
=1 1 1-1 1 1=1 11=1 11-1 11—I I I-I 1=I 11E111=111= _111E-111E1
— —I 11=1 11-1 11-1 11-1 11-1 11-111=III= —I I I=
6" I f I=.L=III=11 I=I l I=f-I 11 :: 1 1-11 ORIGINAL GROUND
6" :•.:-..:-..:::::::::::::•:•.:-. :•:.;- .:;::: ::::•
4" PERFORATED PVC (HOLES DOWN)
5'
-1 DRAINFIELD ROCK
t ,
- ..
GE
:o. E N G I N E E R I N G
TYPICAL TRENCH SECTION .� ••,is
(NO SCALE) .4, ..G��'• ��, ••i•
•
•
NOTES: ° •
1. GRADE AREA OVER TRENCH TO DRAIN AWAY i az .h
•
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK. OR 2' ��=;AIICHAEL •E ANDERSON r �
WITH 2" OF INSULATION taCja%..,� No. CE-4381 .mit
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER QF.p'•••.,,•"?3'19 ....... '4
THAN PREVIOUSLY OBSERVED. CALL ENGINEER IMMEDIATELY �•h�f �E„�0:4'
CV
SOILS LOG AND PERCOLATION TEST
r -. S
ilifiiitGE re
49th N s �•
0tTMICHAEL E. ANDERSON fg
t.p'b No. CE-4381 4,.'..
LEGAL DESCRIPTION: SANDH ILL, LOT 9 -.1.*,..,.. 4/23ns�� ,r'k�,�
PERFORMED FOR: BRANDON FRAZIER
N(<20 1.i4pF;gw 0�••
111
DATE: 4.-I6-19 PROJECT No.:
PARCEL ID#: 050-522-11 TECHNICIAN: J. M I LLE T T E Professional Engineers Stamp:
DEPTH TEST HOLE A
(feet)
1 • • 1' OB SLOPE SITE PLAN
3
4
5 ' 1 ••," , SEE SITE PLAN
6 • t."r'..:
7 ;•. .; ' : SILTY SANDY GRAVEL •
8 ,: f`` GM
9 .
10 ' _ • • WAS GROUND WATER ENCOUNTERED? YES
IF YES WFIAT DEPTH? 6.5' S
1 I DEPTH OF WATER AFTER MONITORING: 6.5'
DATE OF MONITORING: 4/23/19
12
GROSS TIME NET TIME DEPTH TO NET DROP
13 DATE READING (MINUTES) (MINUTES) WATER (INCHES)
(INCHES)
14 4/16 TEST HOLE PRESOAKED PRIOR TO TESTING:
15 1 4:30 6
16 2 5:00 30 10-7/16 4-7/16
17 3 5:03 6
4 5:33 30 10-6/16 4-6/16
18 5 5:35 6
19 6 6:05 30 10-5/16 4-5/16
20
PERCOLATION RATE: 7 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 1.5 FT. and 2.5 FT.
COMMENTS:
A S B U 1 L7 SEWARD & ASSOCIATES LAND SURVEYING 694-0829
r HERESY GERT(FY THAT I HAVE SURVEYED THE SCALE-
FOLLOWING DESCRIBED PROPERTY Al
DATE=s• r( ..
AND THAT NO FNCRO4CHMENTS EXIST EXCEPT AS 'r�fi
INDICATED. IT IS THE RESPONSIBILITY OF THE -4
* 43rd
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID- '`...... .•.�,. ..
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- �•�`
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB` 68 /9 0"v °i°^� µArk Seward
ANY DATA HEREON BE USED FOR CONSTRUCTION ��
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES. DRAWN; '� Nrlsvak
��s
Municipality of AnchoragePage of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW WP O08 % PID Number: _ ��✓� $ ZZ ��
Name:
Holding
Tank
430/1/7E
Wastewater System: KNew ❑ Upgrade
Address:
Ca aciFrom tY m gallons:
J 5 Hfxoe CR - ER 995 7 7
ABSORPTION FIELD
Phone: , C�/ -
5
No. of Bedrooms:
13 Deep Trench }'Shallow Trench ❑Bed ❑Mound C3 Other
LEGAL DESCRIPTION
Soil
Total Depth from original grade:
Lot: Block: SMSub�.d/ivision:
SAN ///�•L
GPD/Sq. . Ft.
Depth to pipe bottom from original grade:
21.5
S r S
Gravel depth beneath pipe
Township: Range: Section:
Ft.
Ft.
Fill added above original grade: Gravel length:
0!
/
Ft. �/.O / Ft.
WELL: Whew ❑ Upgrade
Gravel width: Number of lines: Distance between lines:
Classification (Private, A,B,C): Total Depth: Cased To:
Bel✓A7S 500 Ft. I7*
Ft.
Total absorption area: Pipe material: - Ft.
-1
Ft.
Driller: / '6 A, Date Dri led: Static Water Leve l:
`i N 7 %
so. Ft. ASTM
Installer. Date installed:
r�ityfi Ft.
ANN 8' 0 -2%�a
Yield: p Pump Set at: Casing Height Aboye Ground:
GPM — Ft. t/Ti
TANK
Ft.
%a FrAnffl-11 wIr U1110 1 AIVL.G,
I XSeptic t.
❑ Holding ' ❑ S.T.E.P.
Inspections performed by: E2E-S
Tank
Absorption Lift
Field Station
Holding
Tank
rivate
SewerDnas
Manufacturer.
/V H
�^//�P
Ca aciFrom tY m gallons:
ITOSeptic
WeIFZ0i
Services approval"'`�'nrs�,�<
[1OMaterial:
Reviewed and approved
pp
` Date: ��
Number of Compartments:
WatrSurface100
72-013 (Rev. 9/91) MOA 25
N/A
LIFT STATION
Lot6
Line
0!
//D/
�/O
Size in gallons:
Manufacturer.
Foundation
—_t��
NIA
"Pump on" level at: 'Pu level at:
High water alarm at:
Curtain
Drain
I`r
�/^
Pump Make el
Electrical Inspections performed by:
Remarks:
BENCH MARK
Z �/ 3S
Location and Description:
I T0P 06 WELL GAS/NG!
TAssumed
G
9� R�
a a aV `,
Inspections performed by: E2E-S
091,96119!0
Dates:ls�;p,'.........`'
eanutAaensASSGseg•aa exanxeua ._,
2nd �2 &1
w•ww
l Louis A, 81001"A
Department of Heaj#i Hu
•d'p G CE -6736 °• mat
and
Services approval"'`�'nrs�,�<
Reviewed and approved
pp
` Date: ��
72-013 (Rev. 9/91) MOA 25
Permit No. -- SW960087 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 9 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: SANDHILL LOT 9
PID No.: --050-522-11
A ti
oC \MgNN
Is' .9
0,8
\ N
413
T
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1250
SEPTI
4p6j B SWING TTFS
A -C = 264.3'
B -C = 118.8'
A -D = 348,9'
B -D = 156.6'
LOT 9
ELEVATI❑NS n TDP OF WELL CASING \/
(NOT TO SCALE) ASu SDRED ELEV = I0
0
.00 /
ORIGINAL s
GROUND 0
I LEVEL AT,
V ADDED FILL 90.9 rn
2' I
2•
' 35PSI INSULATION GWT 2 80.4
TANK 77.9
89.7 9.4 88.4 ``� 88A
`85.4
IF
SCALE 1"=60'
i • — MONITOR TUBE
o — SEWER CLEANOUT
-0 — WELL
— — — EASEMENT
— LEACHFIELD
8/9/96
ENGINEER'S SEAL
0 OF
A
�o............ .I
49 TH
. LOUIS A.
BUTERA_-
O JT•. CE -6736
Z4G`
�NOROFESS1CNPo
(�rrtifir� Driffing ung
by
DOC Co. dba
SULLIVAN WATER 'WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
OWNER OF LAND k!'J 47 '/,(/4 R., J % E DEPTH OF W[LL �6 i f{
ADDRESS 7 ��q- K r.��J 1 l�7`I /yI� Og IE'<STATIC LEVEL OF WATER FT. / by
LEGAL DESCRIPTION !'oT 9 .Fej jo l rJ j
DATE - Started Ended
PERMIT NUMBER
DRAW DOWN FT.
GALS. PER HR 1 D
KIND OF CASING O
KIND OF FORMATION:
From O Ft. to�_Ft. __C A c/J� � i � C cJd From Ft. to Ft.
From OZ Ft. to__J Ft. 0 tJr712 A From Ft. to Ft.
From Ft. to Lo Ft. s41R 11 p/`3 ej From Ft. to Ft.
From4L:,a_Ft. to Ft. C .�- t,4 `e
.� `' �� /� From Ft. to Ft
Fromm .3Ft. toat�V C�ii�_Ft. &W c-) 911 4 From, � Ft. h.! Ft
Erom. 9SF t. r Ft. 6,44 Q ZC r /j G K Fr m Ft. to - Ft.
From_ U1 Ft. to JI] Ft. ieCY)&Cz)c C From Ft. to - Ft.
From!Q Ft. to?�Ft. _ .�%Qv �/C �� v{L /� 'VFrrm2 t� F1. toYjj
�' From Ft. to Ft.
From_JK ZFt. to�LS Ft. -
From-1-4f:Ft. to���`-�Z� Ft.
From Ft. to—4q-3 T v Ft.
From Ft. to Ft.
Aft?LiQC �R � 7 tit From Ft. to Ft.
d 49L C � 6R � % From Ft. to Ft.
From4ALI_Ft. to -!SLP Ft.
Fromlr
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MISCL. INFORMATION:
RECEIVED
SEP 9 ]996
Municipality of Anchorage
Dept. Health & Human Services
DRILLEWS NAME
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE n �C `?LI)
DEPARTMENT OF HEALTH AND HUMAN SERVICES LyLi> ��Lv
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960087 DATE ISSUED: 5/23/96
DESIGN ENGINEER:EAGLE,�RIVER ENGINEERING SERVICES EXPIRATION DATE: 5/23/97
OWNER NAME . P, ri��� ����
N 55�� ,a to
OWNER ADDRESS: -n ^ n^ 6?±282
CHUGIAK, ALASKA 9996:�—
PARCEL ID:05052211��
LEGAL DESCRIPTION:
SANDHILL LT 9
LOT SIZE: 56755 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL 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 (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
'SPECIAL PROVISIONS:
TOTAL DEPTH OF DRAINFIELD MUST NOT EXCEED 6 FT.
RECEIVED BY:
ISSUED BY
DATE • S� ?- r;2 6
DATE: OS -2-3-76
Eagle River Engineering ,Services
Louis Butera P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
May 14, 1996
Jim Cross, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Sand Hill Lot 9
Narrative & Permit Application
Dear Mr. Cross:
The proposed well and septic system will have very limited impact on adjacent properties for
the following reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, due to absorption capacity.
4. Drainage will not be affected and is not a major consideration in our design.
The owner is electing to install an oversized, 1,250 gallon, septic tank. If you have any
questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\1996\96 -023A -NAR
SPECIFICATIONS FOR ON-SITE SYSTEM
LEGAL: Sand Hill Lot 9
05/16/96
A. GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and/or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health (MOA-
DHHS) requirements.
4. All soil tests are advisory to the design and are to verified or modified in the field by the
Engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
Contractor to meet MOA-DHHS requirements.
6. It is the responsibility of the Owner to obtain all necessary permits or easements and to
locate any adjacent multi -family wells.
7. It is the responsibility of the Contractor to secure all utility locates prior to construction.
8. The excavation is to be exactly in the area shown on the site plan, any deviation requires
Engineer approval.
9. It is always recommended that a surveyor locate the nearest lot line position and the
location of any easements.
10. Any remaining open test hole excavations shall be filled.
B. SEPTIC TANK
1. Septic tank shall be 1,250 gallon, MOA approved tank.
C. LEACHFIELD
1. The leachfield is to follow the natural contour to maintain uniform total depth of the
trench bottom.
2. The bottom of the leachfield shall be level, plus or minus 1.5".
3. The total depth of the leachfield excavation is not to exceed 6' at any point.
4. The effluent line in the trench shall be laid level within 0.03'.
5. The leach gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is
to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface water runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private well,
150' to any Class "C" well, or 200' to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH= 6' GRAVEL DEPTH = 3' under pipe, 2" over pipe
GRAVEL LENGTH= 66' GRAVEL WIDTH = 5'
SOIL RATING= 0.8 gpd/ft2 BEDROOM CAPACITY= 3
SEPTIC TANK SIZE = 1,250 gallons - OVERSIZE TANK
Twenty-four (24) hours notice required for all inspections
\1996\96-023a-spc 05/16/96
� y
o� \MANN
1
QTY
LOT 9
Sass
0
9,oA
z
sp +d
106;,
PROPOSED
N JLC WELL LOCATION
VACANT
LAND
kr3tjs CI
1250 GALLON
SEPTIC TANK
L9
C9'!T
® - TEST HOLE <142)
• - MONITOR TUBE
a - SEWER CLEANOUT
- - WELL
- — - - EASEMENT
- PROPOSED LEACHFIELD
- EXISTING LEACHFIELD
NO SURFACE WATER
NO KNOWN CURTAIN DRAINS
LINE TO CONNECT
IO LEACH PIPE
16' FROM END OF
TRENCH O`•
,, 1 ,2
\w h
NEIGHBOR
9 MMT m
TH2 SEPTIC SYSTEM
/ o
L I
�r
� o
ra �r
Jy
O -
WELL SEPTIC SATE PLAN �E F q,����
LEGAL: SANDHILL LOT 9 �•
�
OWNER: LABONTE �Pl '""'•��5�1A
CONTRACTOR: N A * :49TH
JOB 96-023A DATE: 5/2J/96 SCALE 1" = 60' ..• .�
RAGLE RIVER ENGINEERING SERVICES • • A
P.O. Box 773294 I,� Tom'. LOUIS A. BUTERA• V
�s '. CE -6736 _/
EAGLE RIVER, AK. 99577 ���Fo
(907) 694-5195 FAX: (907) 694-3297 ,1�%yAlk �w4b,
7 t.
Ty
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
11 #1 ey$
=q(•fifVGIN� R'S SEAL)r:; V�
I
�4
S 086 OQ Ye DOEapena •••-'�]
Louis A. Butero
C= E7 640
aJ
PERFORMED FOR: Zzleaw;r6 DATE PERFORMED: S'% -9_d
LoT 9
LEGAL DESCRIPTION: �N/� Township, Range, Section:
�p Ji SLOPE SITE PLAN
(FE T) TOfsoII
t
2 -- `�1ry Tvnd Cs") N
3
5
0
4-
6-
7
7 Q:.
8 -Ili
9
10-0
I.
0:.
13 �
6o77a.y ¢ Ty
141 I
15
16
17
18
19
WAS GROUND WATER
ENCOUNTERED? YGS
S
IF YES, AT WHAT L
DEPTH? p
E
Depth to Water After
Monitoring? 'd�2 halt
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
5 �tL a:oq
51'/6"
a:a5
16 M,�
532#r
3
5o
5�
D ri•n
5'-I �1
3
l6 '
3:350
5 O1
20 „
PERCOLATION RATE (mmutesnnch) PERC HOLE DIAMETER
TEST RUN BETWEEN L� FT AND tl I LY/b FT
COMMENTS
PERFORMED BY: �2G1' ICERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIOELINES IN EFFECT ON THIS DATE. DATE: •_—/'fir `/ 6
Municipality of Anchorage
DEPARTMENT OF HEALTH 8. HUMAN SERVICES
825-L:' Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
�srry ..e
fw x''ti4 •9aayaas7uetL �,i
. - o iN `..EER•S SEAL) >:
#ye4 ce.as�acm au aaaocm=--
�$ u ma qem aua oecauaau e., <:
t.� u Louis A. Pwora �A
CE -6736 a
an°®
.14
•��S-4/Logan n+tr :.y
PERFORMED FOR: z'#& / DATE PERFORMED:
LEGAL DESCRIPTION: HL 971 -11L -L- E5 Township, Range, Section:
SLOPE SITE PLAN
772 ,!FEET 7?tai I -
j V
2-
3 3 `
G"
4-
6-
6 c 'D
7 b.
9 b0
10
11
12
13
14
15
16
17
18
19
WI -r-4 <11T
WAS GROUND WATER ytf
ENCOUNTERED?
S
IF YES, AT WHAT ' / L
O
DEPTH? P
E
Depth to Water Attar ' , �6
Monitoring? �� Date: S- r
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
I36
428 M'n
,
3
L)
3'34
i L
I�
iu M,n
'75 'a y�•
X7.1 �4�i
rT
� 110:•
I: o0
I D
i8 yl C.
17
9:oa
77
20 PERCOLATION RATE '5� .33 (minutesiinchl PERC HOLE DIAMETER
TEST RUN BETWEEN IZ71 FT AND FT
COMMENTS UTi•/ ze.( 1*.;2 iro2 TyB<' fe C.rilT/Nb TESD �u���• /��/'l�iP.✓
pC rc 24 f.e G.v e( Sd / / 14 /7ri Go f'ii i✓ _
PERFORMED BY: ,Y 2>r�J _ I CERTIFY THAT THIS TEST WAS PERFORMED IN
_____ _ ccccnT n., TWIC nerc naTF .5--/,{' -.9'r
ki
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK 99577
(907) 694.5195
x
11
z
FREE 1 SW2115%180
SHEET NO.
OF
CALCULATED BY 1r6
/-
DATE OS /9�
CHECKED BY
DATE
SCALE
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ENNIS
P, LIsht
MUNICIPALITY OF ANCHORAGE11M
�-
Development Services Department K Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 050-522-11 Expiration Date: 7- / 7
1. GENERAL INFORMATION
Complete legal description Sandhill Lot 9
Location (site address) 24910 Hamann, Eagle River, AK 99577
Current property owner(s) Brandon Frazier Day phone
Mailing address 24910 Eagle River, Anchorage, AK 99577
Real estate agent Edward Davison Day phone (907) 313-8871
2. TYPE OF DWELLING:
ly I Single Family (w/wo ADU)
Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Three
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well ❑ Private Septic I x
Water Storage ❑ Holding Tank ❑
Community Well ❑ Community n
Public Water System ❑ Public Sewer ❑
Waiver request for Distance:
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ ` l a,o,t 32e= LII( Waiver Fee $
Date of Payment JT'J(01 tq Date of Payment
Receipt Number 01 te), p D Receipt Number
COSA# OALl'-i
XI(OBJ Waiver#
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, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503
Engineer's Printed Name Michael E. Anderson, P.E. Date 5/6/19
ant 4
Sr
6. DSD SIGNATURE i 49tH
System #1 Approved for 3 bedrooms • t"'" ,SEL E S_
00 as No. CE-4381 .�
System #2 Approved for bedrooms co" 5/3/19 �,,r� ..
Disapproved !�+�w ���;;:••+•
Conditional approval for bedrooms, with the following stipulations:
ON SITE
WATER AND
IC WASTEWATER o:,
�4 PROGRAM sG1
% O0i FNT SERv�� ��
1)))1)111 •,
By: Original Certificate Date: f
The Municipality of Anchorage Develop 'ent Services Division (DSD) issues Certificates of On-Site Systems Approval(COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: Sandhill Lot 9 Parcel ID: 050-522-11
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
❑■ Well log is filed with Onsite (or attached) Well production at time of test 1.8 gpm
Date drilled 6/1996 Water storage tank volume N/A gallons
Total depth 500 ft Well disinfected for coliform test? ❑ Yes % No
Cased to 174* ft ❑■ Coliform bacteria is Negative
II Sanitary seal is functioning correctly Nitrate mg/L 0 Nitrate less than MRL (ND)
❑■ Wires are properly protected Arsenic ug/L 0 Arsenic less than MRL (ND)
Casing height(above ground) 21 in. Collected by Forge Engineering
Date of flow test for COSA 4/1/19 Date of Sample 3/26/19
Static water level at beginning of test 180 ft.
Comments *Casing depth is recored to be 174' on COSA from 1997 (Eagle River Engineering Services).
B. TANK DATA C. LIFT STATION
Age of tank(s) 23 years ❑ Required maintenance completed
Tank type/material Septic/Steel Age of lift station years
Measured operating fluid level in septic tank 49 Lift station material
❑■ Standpipes/foundation cleanout per record drawing Comments: N/A
Date of pumping 4/2/19
D. ABSORPTION FIELD DATA Shallow Trench
Which system tested (date installed) 4/30/19 Adequacy test date New Construction
ElALL standpipes present per record drawing Results ['Pass For bedrooms
Total measured depth from grade 3.1/3.0 ft(max) Fluid depth prior to test in
Measured depth to pipe invert from grade 2.6/2.5 ft(min) Water added gal
❑ N/A—pressurized field New depth in
❑ Monitor tubes go to bottom of effective. If not, state Elapsed time min
depth into effective
❑■ Code-required soil cover over field Final fluid depth in
El presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months)
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100'
-✓ Yes if No ft M Yes if No ft
Neighboring Tank > 100' 2 Yes if No ft Private Sewer/Septic Line > 25' 0✓ Yes if No ft
Absorption Field on Lot> 100' 2 Yes if No ft Holding Tank > 100' ['Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment> 50' ❑✓ Yes if No ft
2 Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' E Yes if No ft Q Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0✓ Yes if No ft Surface Water> 100' 0✓ Yes if No ft
Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' I=1 Yes if No ft
Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft
Water Service Line > 10' 1=1Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below
Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots:
Water Main > 10' 0 Yes if No ft Private Wells > 100' ID Yes if No ft
Water Service Line > 10' E Yes if No ft Community Wells > 200' 0 Yes if No ft
Surface Water> 100' 0 Yes if No ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION r��P�. .......� .QS'��
1 certify that I have determined through field inspections and review i 63\e.
`.1� �\'•t .j
of Municipal records that the above systems are in conformance with i /\ * t
MOA COSA guidelines in effect on this date.MOA
..,K4.4...ri......ats....„....... at S•
•
, MICHAEL E. ANDERSON r
tri
••.%�,.. No. CE-4381 '.,'c�:
•'••.. 5/3/19 ..•'' Ft�it
COSA Checklist yellow sheet ♦�,co .............. �, 4
•%fir\ ESs\C •4.
MUNICIPALITY OF ANCHORAGE
c---;------
DEVELOPMENT SERVICES DEPARTMENT 1 • , 907-343-7904
On-Site Water and Wastewater Section `� Fax: 343-7997
www.muni.org/onsite •_�
Septic Tank Advisory
Certificate of On-Site Systems Approval #0SC191145
Subdivision: Sandhill Lot3
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 23 years old. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
A , 1
r' Yp 9�
41 44:41 4a4 ,"'. ,E:
liw
. tai
1* qtr 444-�i
-.,''''Iiii,7;' :: .,„017 4,,.3, it,rr ,„,44,,,,.._:,0.,,„„, .,....,,, . . , . ,timpir .,
- ` !Zi..x:16 '9,„22
is w -' •Y.'�:d
Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
.'\' ..: ai---- \,. _._.., '-'" . -
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,c2N�G
ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829
I HEP•EBY CERTIFY THAT I HAVE SURVEYED THE SCALE' /
FOLLOWING DESCRIBED PROPERTY: .,'""=":,-.C-- , OF A! ,
s_s---9,1/.<7.... ---Z. sU� DoT 9 DATE: A �.C . d''
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS eV/, ° !� -_
INDICATED. IT IS THE RESPONSIBILITY OF THE r * ••4 9! i .
Municipality of Anchorage°o
On -Site Water &Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-522-11 Expiration Date:
1. GENERAL INFORMATION
Complete legal description SANDHILL S/D LOT 9
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
24910 HAMANN ROAD *EAGLE RIVER, AK 99577
KURT & JEAN LABONTE Day phone
24910 HAMANN ROAD *EAGLE RIVER, AK 99577
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Day phone
830-9175
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
N
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
Received by: Date:
COSA to be released to the lineer, unless otherwise requested by the engineer. F
COSA Fee $-_ QU
Waiver Fee $
Date of Payment _7a�/3
Date of Payment
Receipt Number _ Q ���
Receipt Number
COSA# _ �cSiyira�J'a o
Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, t verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 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 andlor wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK
99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date t l3
Engineer's Comments:
bedrooms. OF 41V,
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
`\\``°\Q����u
`_ Q
conscientious engineering analysis of the system in accordance with ADEC and MOA
The described the of the
J ON-SITE
DSD Guidelines & Regulations. reported results performance
0006�Op�O4
o OF
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
O�/��. • • �,.-9�;4�
septic systems depend on the local soils condition, groundwater levels that may
�Oj�Q' •' ' . �- DO1
fluctuate during the year, and the water usage of the family being served by the system.
O
4 g T.�* V
These conditions are outside the control of the evaluator of the system. Satisfactory test
* :.. I
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
�l
6
any warranty or future estimate of how long the system will continue to meet the
.... •
r Gar es.. G
s.
operational requirements of the ADEC or MOA DSD. The content of this report is for
Q P '.
'.
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
40 9s 179Ps .• �`�O
4 r< � 13
6. DSD SIGNATURE
Original Certificate Date: 3
'r�.Municipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev. 11105)
System #1 Approved for
bedrooms.
ltltlt(((((((f
System #2 Approved for
bedrooms. OF 41V,
Disapproved.
`\\``°\Q����u
`_ Q
J ON-SITE
Conditional approval for
bedrooms, with the following stip j2WATER AND
�9 WASTEWATER n;
Original Certificate Date: 3
'r�.Municipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev. 11105)
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: SANDHILL S/D LOT 9 Parcel ID: 050-522-11
A. WELL DATA *ASSUMED
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 6/96 Sanitary seal (Y/N) YES
Total depth 500 ft. Cased to *174 ft.
FROM WELL LOG
Date of test 6/96
Static water level 168 ft.
Well production 0.83 _9_13 M.
WATER SAMPLE RESULTS:
Coliform lO colonies/100 ml.
Arsenic: ND ug./L.
B. SEPTIC/HOLDING TANK DATA
Nitrate tom^' mg./L.
Date of sample: 4/15/13
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
4/15/13
212 ft.
1.27 g.p.m.
Collected by: GEG. Ltd.
Tank Type/Material SEPTIC/STEEL Date installed 8/6-7/96
Tank size 1250 gal. Number of Compartments E Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping r %3 Pumper
C. ABSORPTION FIELD DATA
Date installed 8/6-7/96 Soil rating (g.p.d./ftor /bdrm 0_8 System type SHALLOW TRENCH
Length 66 ft. Width 5 ft. Gravel below pipe 3 ft.
Total depth *7.58 ft. Eff. absorption area 569 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 4/15/13 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 8 in. Water added 5100 gal. New depth 116 in.
Elapsed Time: 220 min. Final fluid depth 14 in. Absorption rate >= 450+ g. p. d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date -
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off"
E. SEPARATION DISTANCES
Manhole/Access
water alarm level
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankA'rft station on lot loo ,+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main
Sewer/septic service line 25'+
Animal containment areas 50'+
Public sewer manholetcleanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Properly line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that l have determined through field inspections and
review of Municipal feconis that the above systems are in
confomrance with MOA COSH guidelines in effect on this
date.
Engineers Printed Nam JEFFREY A. GARNESS
Date s/f Ta
(Rev. 11105)
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I HEREBY
FOLLOWING DESCRIBEDTHAT
PROP RTYI HAVE RVEYED THE
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AND THAT NO MRO46WENTS EAOST EXCEPT AS
INDICATED. 1T IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
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WHIM ISIO DO NOT UNDER
VISION PLAT. UNDER NO CIRCUMSTANCES SHDULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
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MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
a"' r!1wcNOKace
&�FALSERVICESDIVISION
On -Site Services Section �-"'
P.O. Box 196650 Anchorage, Alaska 99519-6650
0` 1997
343-4744
S E P
CERTIFICATE OF HEALTH AUTHORITY
:IV ED
APPROVAL FOR A SINGLE FAMILY DWELLING\\
Parcel I.D. # Z - // HAA # ��J �°11
L1(�i"A
1. GENERAL INFORMATION
Complete legal description '44
Location (site address or directions)
Property owner Day phone
Mailing address /8:5-3-ae
Lending agency Day phone
Mailing address
Agent' N/4 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
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: WiNICIPALITY OF JNN(AURAGE
ANVIRONMEN1Al5ERVICES DIVISION
Individual on-site
Holding tank SEP 48 1997
Community on-site RECEIVED
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA *21
S. 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 Eagle River Engineering Services
ox Eagle 'ver, 9 77-3294Phone
Address
Engineer's signature Date'
k
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6. DHHS SIGNATURE
Approved for R bedrooms.
T Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By:
bra Date q,?. % /
auTlc
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.
72-M(Rev.1/91) Back MOAp21
t MUNICIPALITY OF
Municipality of Anchorage EwV1'O'\'MENTALSEEU� CHUNg1
DEPARTMENT OF HEALTH & HUMAN SERVICES ES tly
Environmental Services Division SEP 04 1937
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
rCEI I&
Health Authority Approval Checklist
Legal Description: ��,t r.9r✓ra��I�L CS74'wsparcel I.D.: LASy
A. WELL DATA
Well type If A, B, or C, attach ADEC letter. ADEC water system number IV14
Log present (Y/N) y Date completed 451/96
Total depth So o ` Cased to /7z/ ` Casing height (above ground) 7' /
Sanitary seal (YIN) y Wires properly protected (Y/N) y
FROM WELL LOG AT INSPECTION
Date of test 6'�9�
Static water level Q4-7
/
Well production Q, it 3 g p m a, R
g.p.m.
WATER SAMPLE RESULTS:
Coliform Nitrate O , / m tt/ Other bacteria
t>;
Date of sample: `! 7 �'" �� Collected by: % .v;,,,jee, Z��,F
B. SEPTIC/HOLDING TANK DATA
Date installed 9/ Tank size Number of Compartments a Cleanouts (Y/N) J'
Foundation cleanout (Y/N) _Z Depression (Y/1) i✓ High water alarm (Y/Nj
Date of Pumping ^) /4 "le" Pumper
SEP 08 1991
C. ABSORPTION FIELD DATA RECEIVED E C E I� Yr C D
Date installed ?/ 5i 6/ Soil rating (g.p.d./ft2 or ft- t) !9, System type
G4 F e /Q
Length 66 Width S-` Gravel thickness below pipe :3 Total depth S,S"
Effective absorption area S`6 9 Monitoring Tube present(Y/N) X Depression over field (Y/N) �✓
Date of adequacy test Results (Pass/Fail) For -- bedrooms
Fluid depth in absorption field before test (in.); — Immediately after= gal, water added (in.):
Fluid depth (ins.) Minutes later: — Absorption rate =
g.p.d.
Peroxide treatment (past 12 months) (Y/1) /'//4 If yes, give date
I
D. LIFT STATION vll
Date installed
Manhole/Acces /N)
High wa r alarm level at*
tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at* "Pump off' level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot / �z� z ; On adjacent lots
Absorption field on lot ; On adjacent lots y`-.
Public sewer main Al lA Public sewer manhole/cleanout
o'
y
Sewer /septic service line //S' Lift station N /A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation !Si– Property line %S ' Absorption field 7
Water main/service line t/!7 r Surface water/drainage Y /vaI Wells on adjacent lots >�e�vD'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation ao I Water main/service line —4 -lo
Surface water tIodDriveway, parking/vehicle storage area
Curtain drain i✓ /,/ Wells on adjacent lots Property line 36 '
F. ENGINEER'S CERTIFICATION
1 certify that have determined thru field inspections and review of Municipal reco YI&t b ee ')&des are
in conformance with MOA FL4A guidelines in effect on this date.
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Signature
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Engineer's Name _ �a7c v4
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Date x'1315 7
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HAA Fee $ Waiver Fee $ _
Date of Payment 7 Date of Payment
Receipt Number / 69r) Receipt Number
Rev. 8/95 OSS: haa.wk.doc `