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' �EPHRTMENT O� JEHLTH HND ENVIRONMENTHL F ,TECTION
STRFiET/ H14CHORHGE/ HK. 99501()(
279�2511 ��'
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PERMIT NO. ( 77641 )
J~yL 7 /�/}i��
HPPLICHNT L QW GENERHL CONT P O BOX 214 EHGLE RIVER 69428]2
LOCHTION ST` ^ -
LEQHL LOT 20 SCHROEDER S/D LOT SIZE 11700 SQUHRE FEET
TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH
MHXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BFR:-
THEE
REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS:
(3 Fu IV, KE-, 0 �. . . .����= �
THE LENGTH DIMEN5ION IS THE LENGTH (IN F:*EET) OF THE TRENCH OR DRHINFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE 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 MINIII11.31el DEPTH OF GRRVEL BETWEEN THE OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET). .
F-?. RE7. ����� C.1 fQ1 �3 f-1 p IL- V,H�
����~����0 Jf'�� V=F: F." L'.. f::,l 1�41 -11 C".) F'm 1:���
H PHCKHGE
PI HNT MHY BE INSTALLED HT THE PERMITTEE/S OPTION SUBJECT TO THE
FOLLOWING CONDITIONS:
1EITHER H CLHSS I QR II NSF HPPROVED PLANT MHY BE INSTHLLED.
2 H CONTINUOUS MHINTENHNCE HGREEMENT IS REQUIRED. IF H MHINTENHNCE
HGREEMENT IS NOT KEPT CURRENT YOU MAY 8E REQUIRED TO ENLARGE THE SOIL
HBSORPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION.
�_� JJ, ---q CH F" F-7--] -T T C-.) VA Fo F;�!! ]F�-E F,-� I-;"-'�� ~�~
BHCKFILLING OF AN,`5Y�TEM WITHOUT FIN�L INSPECTION HND HPPROVHL BY THIS
DEPHRTMENT WILL BE SUBJECT TO PROSEC'::UTION.
MINIMUM DISTHNCE BETWEEN H WELL HND AN' -r' ON-SITE SEWHGE DISPOSHL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL
WELL LOGS HF",!E REQUIRED HND MUST BE TO THE DEPHRTMENT WITHIN ]0 DI YS
OF THE WELL COMPLET�ON
OTHER NFT -r' APPLY. SPEC. IFICRTIONS HND CONSTRUCTION DIHGRHMS FIRE
HVFIT LHBLE TO INSURE PROPER INSTALLATION.
��iC 11-11 EE: IF
I CERTIF`-r' THHT
1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE
2: I WILL INSTHLL THE SYSTEM IN HCCO
]� I UNDERSTHND THAT THE ON~SITE SEWER SY�TEM �QUI�E E
HAY RNLHRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS
Tc�/|FD RY
-_� ... ..... ..... ..... ....
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[ON|
0 Et E GE -01 .-CHNI CAL & DEVELC 'MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 688-2280
Soils Et Foundations \ \ Land Development
Performed for: Name:�; W ��i®�����1. No.
Mailing Address: 77n(1k90�9?9
Legal Description:
De th feet
Lei
Soil Characteristics
1 \&\\... - 4. ��A �'`" ?: t..- W \,t %(\
2
3.�
4
I
9
Ground Water Encountered: Yes _ No �If yes, what depth
Proposed Installation: Seepage PitDrain Field
Comments:�—
Performed by:�
Date:-- 77
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL TAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date � D 5�
1. GENERAL INFORMATION
(a) Le/gal Description (include lot, block, subdivision, section, township, range)
1=. a t�a c_1vo e le S 1. l c�4 / (�� Al ,e .2 4v .Se_e_-_2
2. TYPE OF RESIDENCE
Single-FamilyMulti-Family 11 Other
Number of Bedrooms
3. !NATER SUPPL`!
Individual Well,Rr Community El Public ❑
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 Public ❑ Community E1 Holding Tank ❑
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 2-02sn1 sai
Location (address or directions)
_
(b)
Applicant NameT Jif_ S' 7
elephone: Home Business
Applicant Address_ _:_. f'� x , <=LY 1
? c /C L zn
- Ic y' S5"7�
(c)
Applicant is (check one):Lending Institution ❑ Owner/builder
0 ; Buyer E7 ; Otherpl
(explain); / E'Cly
(d)
Lending Institution-
_ _
Telephone
Address
(e)
Real Estate Company and Agent —_0_4:4
Address i3 ,,Y __77 G z_ y i /=;GL��
'S� 7
Telephone�LS
_s�✓�
(f)
Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single-FamilyMulti-Family 11 Other
Number of Bedrooms
3. !NATER SUPPL`!
Individual Well,Rr Community El Public ❑
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 Public ❑ Community E1 Holding Tank ❑
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 2-02sn1 sai
f.
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION �0
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Wealth
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 FirmJAGLE_RIVER ENC�NEf RING S_LRVICES _ Telephone
Address _ _ EAGLE RIVER, AK 99577
1 . W. UVA � / UGJY
Date �a eS' 6G4-5798 -------- --
m
A
Engineer's Seal
o=
6. DHEPAPPROVAL
Approved for _ bedrooms by `5 f�T �''.- '{T -",Date
Approved _ 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
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
CHECKLIST- FEBRUARY 1984 ENVIRONMENTAL PROTECTION
264-4720 t kV
Legal Description: &. 'YF Q"�'�' S c,x 1,
_ / v i✓ � mZ Gca _
A. WELL DATA k
Well Classification /1"71/"/"-� If A, B, C, D.E.C. Approved (Y/N) _ ti%A
Well Log Present (Y/N) — _Z Date Completed 1927 Yield * t'.'"l
Total Depth -SAV ' Cased to 5 r Depth of Grouting —11-11A
Static Water Level s'7+ 5 _ Pump Set At 8 y`
Casing Height Above Ground �f _ Sanitary Seal on Casing (Y/N) —
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
9-.1) ' .4.
Depression Around Wellhead (Y/N)
On Adjoining Lots _ IeO'71-
To Nearest Edge of Absorption Field on Lot 'L ; On Adjoining Lots
To Nearest Public Sewer Line tic"� To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot S'
Water Sample Collected by r` x,E ps+^ee _ Date 5 -
Water Sample Test Results S, f 9lJW1 y
Comments a,
A.,d o hrs,ti�t 511�/y r 7-A
B. SEPTIC/HOLDING TANK DATA
Date Installed J 2 _ Size _ /UOv G' / No. of Compartments
Standpipes (Y/N) Air -tight Caps (Y/N) Z Foundation Cleanout (Y/N) _y
Depression over Tank (Y/N) W---- Date Last Pumped .3-/l Y s -i
Pumping/Maintenance Contract on File (Y/N) ✓f± for
Holding Tank High -Water Alarm (Y/N) t1114 _ Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
T W t S I Wtea+
o a er- upp y ell
To Property Line /O -
To Water Main/Service Line
' •t
Course
Comments
Page 1 of 2
72-026(11/84)
To Building Foundation
To Disposal Field �3
7 e
�
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed If;? %
Width of Field us, A -.w o,�A
Type of System Design
Length of Field ah /rte o
Depth of Field AM, Y_
Gravel Bed Thickness "A lrH V4. ^/
Square Feet of Absorption Area c-25-5- Standpipes Present (Y/N)
Depression over Field (Y/N) _ do Date of Last Adequacy Test
Results of Last Adequacy Test Ye, 7-1r 7-r, c 7-�s, 71S�1_
Separation Distance from Absorption Field:
To Water -Supply Well To Property Line
To Building Foundation To Existing or Abandoned System on
LotJ'`� ; On Adjoining Lots
To Water Main/Service Line 'L To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area /0 /
Comments " Sar Zeci ySiJ G -4//-,X .4 .0 irPd 4v.; 7'c % le,;e
/e r e / ,/e-,.,% w . c2 4 r 6 e /i / 5 - 0.,, ,., u /e J
l
D. LIFT STATION
y/
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for _
Electrical Codes (Y/N) —
Comments
— Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and, HAAguidelines in effect on the date of this inspection.
Signed Date
Company .t' s r.,�ee., .5 ,,, MOA No. Y-5" T -.a e's-
Receipt No. 3 S V- L 05 Ale hq
Date of Payment - a-
Amount: ��S 00 �'„ a_e orf 3,, `r Engineer's Seal
u
("���5o.i0et�c�+vo-aca -ieac1
/1'�Su-nagainaoev aogaa noaoc +v 9�'��
fiq f,i o tnl; /',. ii UiCf CI ea 4,'E�°
Page 2 of 2 C>e <`n,°° CE 6i36
P/I0J6Q39aa�`l�\ }rte
FSS\ ,
72-026 (11184)1+,;.,.-�
.... a •<..--
DEPTOF ENVIRONMENTAL CONSEB"TION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
May 20, 1985
Mr. Lou Butera
Eagle River Engineering
Services
P. 0. Box 773294
Eagle River, Alaska 99577
SILL SHEFFIELD, GOVERNOR
274-2533
SUBJECT: Horizontal Separation Waiver Between Well and Septic Tank,
Lot 20, Schroeder Subdivision
8521 -WA -164
Dear Mr. Butera:
The department has reviewed the subject waiver request and hereby waives
the horizontal separation between the well and septic systems to 82 feet
on the subject property for a 3 bedroom single family residence only.
Sincerely,
Steve Eng,
District Engineer
SE/dd
MUNICIPAL 11Y OF ANCIIORACI�.
D -PAR i -MI -NI . OF HLALTH AND FNV1R0HMEI`H,- 1) 1 (VF -f
'3 2 1, S I-ect lichol: �mr, AL a a
Az64, 1 J
264 - 117 7 0
"I'ime 10:30 a.m. 42 . Time/ In C2
11=23-77 Wednesday Ila, C Date
Disp Pratt
REQUEST "OR APPROVAL 01,' INDIVIDUAL SEWER APD "iAl'Ell ),;'AC1J,[TJP;S
1111; i on United Bank Alaska
645 G Street 99501. 1111one. 276-1911
2.1
Propert-,) Ovines:-: L & W General Contractor 694-2832
maiji.liq Post Office Box 1107
3. Legal, De5crip-Lion; Lot 20 Schroeder Subdivision
4: R',�sidence: /X Of Pedrooms: Three
Multiple Family Rzesidence. J.\111111ber of j"-d.rooms:
5. Well System: Fildivictlial we]_ (X)
Permit. Depth of Vlell 76 Well 1"o-cl oil 1.1-J-10 (kj-
Cons LI-tiCIU-ion
6. Sewagcl Disposal On --site c1*ysL.,,ni (x) Public--, ULJJi-'L-Y
I L a 1. c,
Permit n,' I- a 1. 7, (�Ct 1977
Septic "Tank Manuf-acL-,urei-
Absorption At -(,.a S
I)oi'l R T c[te M a.),
c� t e 3
7, Distances: P1(211 to SepLi C 7.
1ank toAbsorj-,,Lion Arca
to Sewor Nea.Lef;t-- LOL lill(2
to Nea.rest Lot Lino
ya�je Two
DcpalrLmcot of 8oaIth and �ovirnnmcnta]� �cot�nrioo
Dcgoext J' -'()j- Approval Of Iodivi0ual and Cl.-WatFiici�iti,;
f,cgal Dpsoziytiuu: Lot 20 Schroeder Subdivision
Cummeut,:
MUNICIPALITY OF ANCHORAG,
hepar-tmcnt of IIeaIth and Environmental Pr.oLection
325 L Street, Anchoracle, Alaska 99501
264-4720
`Request for Approval of Tndividua Sewer and Water Eac7-litie:,
1. Property Owner:
=institution:-7—x-d�--
Mailing Address:
���U)l_ 1107
�-----------Phone:
�949
2. Name of Buyer:
Mai_.l-ing Address: Phone:
------ ---------- --------------
3. Lending
=institution:-7—x-d�--
Mailing
Address:
Phone:
4. Realtor/Agent:
nq C11 -Ss: --- -- ------ Phone: -----_..__
5. LecJal Desccr:i_uti.on :
t. r e c t Lo c ation : — --- ZO 7- "4� — 1 • / /%�G' IJ�S' �?�'---------------------
G. Sinc; ]_e family Resiclence: Numbc�r of )3ech-ooms.
gul_Liplc P'ami].y Residence: ( ) Number of
i. dater- Supply: ?ndi-vidual Wel]_ �, ( )
(?O i t b]_ic/Community System
If Indiai-dual Well, well depth
If Comnninit"/ Sysl,cm, ncl,ne of system
8. Sr'T'.age Disposal System: *'i)n-s1tC Sys Lem
� (}O 1 ubl-ic System ( )
]=12 On-si Le System, date of .iristal.lation: e%e/Ad '77
*NOTE: A well log is required on ALL wells drilled since 5/'75.
If on-si
to sewer system is over t:Jo Z
test i 1 by Lhi� department Scars old, an adequacy
rejuired s
fee of $2.5.00 must accompany cacti r.:�quest before processing
can he initiated.
3 /'% 7