HomeMy WebLinkAboutCHANDELLE ACRES LT 25Chandelle
Acres
Lot 25
#051-822-04
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP151190 PID Number: 051-822-04
Dwelling:
•
Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New
•
Upgrade
Name:
Lynette Weinzirl
ABSORPTION FIELD
Address
23807 Chandelle Dr, Chugiak, AK, 99567
❑ Deep Trench ❑ Shallow Trench IN
❑ Other
Bed ❑ Mound
Phone
907-244-0530
Number of Bedrooms
4
Soil Rating
0.4 GPD/SF
Total depth from original grade
5.64 Max Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Gravel depth beneath pipe
Subdivision Block Lot
5.14 Max Ft
0.5 Ft.
Chandelle Acres; Lot 25
Fill added above original grade
Gravel length
Township Range Section
See profile drawing Ft.
50+ Ft.
Gravel width
Beds: Number of Lines
Distance between lines
SEPARATION DISTANCES
30+ FL
5
6 FL
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total absorption area
1500+ Ft2
Number of trenches
1
Dist. between trenches
N/A Ft.
Well
N/A
N/A
N/A
N/A
N/A
TANK ❑ Septic • S.T.E.P. • Holding ■ other
Manufacturer
Capacity
Surface Water
100'+
100'+
N/A
N/A
Anchorage Tank
1250 Gal.
Material
Steel (10' burial rated)
Number of compartments
2
Lot Line
5'+
10'+
N/A
N/ANA
Foundation
5'+
5'+
N/A
N/A
LIFT STATION
Manufacturer
-
Capacity
- Gal.
Curtain Drain
N/A
N/A
N/A
N/A
Remarks No foundation or curtain drain known.
Pump on level at
Pump off level at
High water alarm at
Old tank was removed and disposed off-site.
- in.
- in.
- in.
See attached confirmation perk results.
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank D3034Tank to D3034
drainfield
A.R.M. Services
Drainfield D3034 Co/MTD3034
Inspector AK Rim Engineering
BENCH MARK (Assumed elevation) 100.00 ft
Inspdffiion es: 1•t 7/16/15 2"" 7/17/15
Location and description
3`d 7/18/15 4'^ -
Door threshold, East end of North wall.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional Approval: Date
Engineer's Stamp
sinklani t
ible
est! ?,!!4;%�•'y,
_'7--2-z—Iy 1
�� „ CMrNt *. tnt :4,..
s., CE10410 ••It.,�►
,1t,,,, ... 5fON;�..=
l
Approved��AI Pere--il— Date 8 / % /
Inspection Report_9-1-1
SWING TIES
A B
FCO 6.8 43.8
ST1 13.8 38.7
512 21.5 30.6
DBL1 23.2 28.7
081.2 24.1 27.7
M1 20.4 51.7
C1 21.1 54.7
C2 27.8 57.6
C3 32.7 60.0
C4 38.8 63.6
05 45.7 68.0
M2 46.4 67.4
M3 60.8 38.0
06 63.8 40.9
C7 59.8 34.2
08 56.2 29.3
C9 53.0 22.4
010 51.3 17.2
1,14 50.3 16.9
NEW 30'+x50'+ DRAINFlELD
�C6
2015 ALASKA RIM
ENGINEERING I LS I HOLE 1
<M2
C5
08
C9
010
M4>
C\
7/17/2015
CONFIRMATION
PERK TEST
NEW 1250 GALLON
SEPTIC TANK
4
4
4
•
*,fit gtAL,4, #x,
• &.s
• et .
1 •
4L •• Minkel A. LNI. •4af
.>�. 0E10460 •. •.e=
sP
RECORD DRAWING OF SEPTIC UPGRADE
L¢9ol
Description!
CHANDELLE ACRES S/D; LOT 25
ENG
P.O. BOX 2749
PALMER, ALASKA 99645
PHONE: (907)745-0222
FAX: (907)746-0222
Alaska Rim Engineering, Inc. Date 7/21/2015
PAGE 2 OF 3 1"=20'
CO
0
ANAL GRADE = 99.28-99.38
CO
TOP OF TANK AT
INLET = 94.89
INVERT OF BUNG
AT INLET = 94.24
TOP OF TANK AT
OUTLET = 94.89
NEW 1250 GALLON
SEPTIC TANK
(10' BURIAL RATED)
INVERT OF BUNG
AT OUTLET = 94.09
EXISTING GRADE 97.39
INVERT OF PIPE
= 92.25
TOP OF SAND
MT CO
0
co co
FINAL GRADE =
96.58-98.03
CO
CO
FILTER FABRIC
= 91.75 M:O:A: FILTER- SANG •
BOTTOM OF EXCAVATION 0 DEEPEST POINT — 89.90
EXISTING BOTTOM
OF BED = 91.70
30' MINIMUM WIDTH
RELATIVE ELEVATION OF
BOTTOM OF TESTHOLE B
= 82.89 (TESTHOLE DRY)
AK RIM
ItbIHOLE /1
PROFILE DRAWING OF SEPTIC UPGRADE
Legal
Descrcctlan'
CHANDELLE ACRES S/D; LOT 25
rw
S
RIM
ENG EE:_ .,t . INC.
P.O. BOX 2749
PALMER, ALASKA 99645
PHONE: (907)745-0222
FAX: (907)746-0222
Alaska Rim Engineering, Inc. Date 7/21/2015 PAGE 3 OF 3 N.T.S.
Performed For:
Legal Description
Depth
(Feet)
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
COMMENTS
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchorage.ak.us
(907) 343-7904
Soils Log - Percolation Test
LA-vicIG Ue t, t.lr I
C4cincicl/e 4cres toitZS
Slope
P4
(44-4uvid
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT DEPTH?
Depth to Water After
Monitoring?
Date:
Date Performed: /
Township, Range, Section:
5
L
0
P
E
Site Plan
cam
a
draw
bks
Id -
11-1
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
1tf-cc
7l17j,r
v
6'''
12n -S
-3.o,�d
3�%4,
Zt1�
I z :SS
1•7.99
�D�
3�r
3 f/ -.
z l --
i�zs
Via
�3/�,%'�
PERCOLATION RATE 13,3 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN f t) FT AND tiro FT
PERFORMED BY:
1%4e) ICItAQJIPj�.�e
CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STAT AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7- L2—t S
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP151190
Tax Code Number: 05182204000
Work Type: Septic Upgrade
Permit Effective Dates: June 29, 2015 to June 28, 2016
Design Engineer: ALASKA RIM ENGINEERING
Subdivision: CHANDELLE ACRES
Site Legal Address. CHANDELLE ACRES LT 25 G:1560
Owner/Address:
WEINZIRL LINETTE L
23807 CHANDELLE DRIVE CHUGIAKAK 995675565
Site Mailing Address: 23807 CHANDELLE DR, Chugiak
Lot Size in Sq Ft: 51200
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation, The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions:
1. The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a
percolation test. The Engineer needs to do an additional percolation test prior to the construction
of the septic field. Please submit stamped and signed results with the As -built Inspection Report.
If the results require a design change, construction of the system will stop pending On -Site review
and approval. AMC 15.65.060.6.3
Received By:
Issued By:
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage. Alaska 99519-6650,5 (907) 343-7904 • Fax (907) 343-7997
http://www.munlorolOnsite
Development Services Division
On -Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP151190 COSA#: Permit#: OSP151068
PID#: 051-822-04
Legal Description: Chandelle Acres Lot 25
Engineer: Alaska Rim
Applicant: Linette Weinzirl
Your request for a waiver of the required maximuml5 feet
approved bed width is 30 feet.
de bed has been approved. The
This waiver approval applies to the proposed absorption bed only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
Z Adjacent properties are not affected by this waiver.
Waiver is Granted: X
Date: £/ZW,/S
Waiver is not Granted:
Approved by:
Name of Review
**** VARIANCE/WAIVER REVIEW ****
•
OUBMITTAI
MUNICIPALITY OF ANCHORAG JUN 18 2015
Gretchen Stuller
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-822-04
Property owner(s) Linette Weinzirl
Mailing address 23807 Chandelle Drive, Chugiak, AK, 99567
Site address 23807 Chandelle Drive, Chugiak, AK, 99567
Day phone 244-0530
Legal description (Sub'd., Block & Lot) Chandelle Acres S/D; Lot 25
Legal description (Township, Range & Section) -
Lot Size 51200 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
( all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
APPLICATION IS AN:
Initial
Upgrade
Renewal
TYPE OF DWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D)
Multiple Dwellings
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Bed Width Waiver Distance:30'
E
No Fee-. %N1/
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: 6(0q
Date of Payment:
Receipt Number:
Permit No.
Permit App_:;
(0l1ijL6 e>L
psPisliad
Waiver Fees: /UIiA'
Date of Payment: //��,/j///�///
Receipt Number: c 455 le//iq'
Waiver No. V 15 O&
ALASKA RIM ENGINEERING, INC.
ENGINEERS — PLANNERS — SURVEYORS
9742 E. Frontage Road
Palmer, Alaska 99645
Telephone (907) 745-0222
Fax (907) 746-0222
Online at: www.alaskarim.com
June 16, 2015
Municipality of Anchorage, D.S.D.,
On -Site Water and Wastewater Department
4700 Elmore Road, Anchorage, AK, 99519
Attn: Jay Crewdson, P.E.
Project: Chandelle Acres S/D; Lot 25. 23807 Chandelle Drive, Chugiak, AK, 99567.
Ref: AK Rim Engineering Project #: 15-00371
Mr. Crewdson,
The subject property is served by a community well and a private septic system consisting of a
1250 gallon septic tank and a bed type drainfield. The septic system is in a state of failure and
needs to be upgraded. We are proposing to excavate the contaminated material, build up to the
same elevation with M.O.A. approved filter sand and rebuild the drainfield in place. The
original 1983 testhole does not appear to be near the existing septic site. A new testhole was
excavated on 6/8/2015 as close to the existing bed as feasible (within 30' of the proposed
upgrade site). The testhole justifies the rebuilding of this drainfield. The design narrative is
summarized as follows:
GENERAL SITE PLAN AND SEPARATIONS: All surrounding properties are served by a
community well on Chandelle Acres Lot 15 (PWSID #213807). The well is over 200 feet from
the proposed septic upgrade. There are no adjacent surface waters within 100 feet of the
proposed septic upgrade. The drainfield is over 10 feet from the property lines as well.
SOIL CONDITIONS: See the attached soils log and percolation test data. Based upon the
percolation rates, observation of the depth of the existing system and the 5/17/1983 soils log, we
are proposing an application rate of 0.4 gpd/ft2.
DRAINFIELD DESIGN: The existing drainfield is stated to be 31'x50'(+/-) on the 5/30/1983
inspection report. Based upon visual observation of the vegetation and the testhole location, it is
unlikely that the drainfield is actually sized as such. We are proposing to replace the tank in a
new location and rebuild a 30'x50' bed as shown in the following design drawings.
For an alternate site, the existing bed could be rebuilt in place again in the future. Also, the soil
conditions encountered in the 2015 testhole provides for an alternate site using advanced
treatment.
WAIVER: The proposed width is over 15 feet. We request you waive the bed width
requirement from 15 feet to 30 feet. Care will be taken during construction to keep the
Chandelle Acres, Lot 25. Septic upgrade narrative.
Page 2 of 2, 6/16/2015.
equipment from driving over the drainfield footprint. Also, because the system was originally
permitted and approved this way, we request that you waive the fee associated with this waiver.
TOPOGRAPHY: The topography in the direct area of the existing bed is 0-5%, sloping from
southeast to northwest. The proposed drainfield upgrade will be over 50 feet from a cutbank on
the property. In short there are no slope concerns.
In short, the proposed septic upgrade will not adversely affect the surrounding properties. If you
have any questions, please contact us at 907-745-0222.
Principal Engineer
Attachments:
Site plan drawing
Existing plan view drawing
Detail design drawing
Soils log w/ perk test data
NOTE: ALL SURROUNDING
PROPERTIES ARE SERVED BY PUBIJC
WATER SYSTEMS. NO PRIVATE WELLS
ON ADJACENT PROPERTIES.
200' CLASS
'A' WELL
RADIUS PWSID
#213607
%%%%%%%%4
Qseir1/40
•; is
• Legal
Si • _ /DescrlPtlmi
•
b•
4+ •• Charles11:Leet
t , CeiEtOt00
4•• OpROFESSOCsse
111%%%%%%%
PROPOSED SEPTIC UPGRADE
SITE PLAN
CHANDELLE ACRES S/D; LOT 25
P.O. BOX 2749
PALMER, ALASKA 99645
PHONE: (907)745-0222
FAX: (907)746-0222
Alaska Rim Engineering, Inc. Dare 6/16/2015 PAGE 1 OF 3 1"=100'
2015 ALASKA RIM
ENGINEERING TESTHOLE
efrvatiril
S
7 ai�ye eCEio4�she,.ea+�.S
i 'F ZY ta•• i'
�it, A4nrcclC0**:.
PROPOSED SEPTIC UPGRADE
EXISTING PLAN VIEW DRAWING
Legal
Descrlp<Ioni
CHANDELLE ACRES S/D; LOT 25
P.O. BOX 2749
PALMER, ALASKA 99645
INC. PHONE: (907)745-0222
FAX: (907)746-0222
Alaska Rim Engineering, Inc. Dere 6/18/2015
PAGE 2 OF 3 1"=20'
ALTERNATE SITE: CAT III
ADVANCED TREATMENT,
6.0 GPD/FT', MAX
DEPTH 2.5', WIDTH 5',
LENGTH 20+', TOTAL
AREA 100+ FT'
(?to d 0€ heel 15 COt.
#✓'o,' 2s%4- c/lnj'C, A.6 -
4' CLEANOUTS (TYP.)
SITE
ITERIA:
NUMBER 0 :EDROOMS:
GALLONS P Y:
PERCOLATION TE (MIN/IN):
APPUCATION RA .-
MINIMUM DRAMA �•
AREA
DRAINFIELD CR ERIA:
MAXIMUM DEPTH: BOTTO
LENGTH:
WIDTH:
EFFECTIVE DEPTH:
SAND FILTER DEPTH:
REDUCTION FACTOR:
DRAINFIELD AREA:
4
600
3.5 & 30
0.4 GPD/FI'
1500 Fr'
OF CONTAMINATED MATERIAL
50+ FEET
30 FEET
0.5 FEET
NEEDED TO REBUILD
TO •RIGINAL ELEVATION
A
00+ Fr
PROPOSED REBUILT DRAINFIELD
2015RIM
ENGINEERING
TE TESTHOLE / e�
> 3 /
/ ,AIS'
`T$ PROPOSED 1250 GALLON
to SEPTIC TANK
4' CLEANOUTS (TYP.)
4
4.
• c °F 4/
••• •4 Legal
•".iP "Jr wI Description
4911 '\ . ` .t I,
• 41''Ili ,•a„
�Wy
-' •
Charles A. Leet
/ *xi•• CFIOe86 • CTer
•
PROPOSED SEPTIC UPGRADE
DETAIL DESIGN DRAWING
CHANDELLE ACRES S/D; LOT 25
P.O. BOX 2749
PALMER, ALASKA 99645
PHONE: (907)745-0222
FAX: (907)746-0222
Alaska Rim Engineering, Inc. Date 6/16/2015
PAGE 3 OF 3
1"=20'
Performed For:
Legal Description
1
2-
3-
4-
5
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
Depth
(Feet)
•
-1
er
lei
COMMENTS
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchorace.ak.us
(907) 343-7904
Soils Log - Percolation Test
Line/fit Ue)hz,r,)
AOR(,%e v c. -r5 L0+t5
Slope
4rywksc5
St 94r tit
cr, e 5b+,
Sm 42ify
�f�r 56-14-te/
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT DEPTH?
Depth to Water After
Monitoring?
Date
Wee "!
•
•
•
17. 'r
.•ta'c
,tett r�C
y •. ••
Fo
1�t ` 6/SS r
Date Performed:
Township, Range, Section:
5
L
0
P
E
Site Plan
4
ce
le
4
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
9:oo
6/44
o
6 "'
rto
to
10
Z'^
�
g=20
z�
10
v''s/y'
3'/�"
(:39
'3(9
3
�=�0
'to
to3%'
2'/F'
gLf,7
5)
5)
l0
3 Ys'
a/y�
glob
Go
60
3 16'-
2. -74
PERCOLATION RATE ej- r (minuteMnch) PERC HOLE DIAMETER
TEST RUN BETWEEN 2-0 FT AND le -0 FT
G7
THAT
PERFORMED IN ACCORDANCE WITH ALL STATE AN/D MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.DATE:S TE iit
Performed For:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.cl.anchoracie.ak.us
(907) 343-7904
Soils Log - Percolation Test
L �kryN-t 1>.7 e -Z bo r
(�G f
Legal Description: G /f e / ^ -6,-c 5 lc f2 -.S— Township, Range, Section:
Slope
Date Performed:
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
Depth
(Feet)
COMMENTS
9 -et Pc c I
�pp 1
c! cvv%4i; fzc494o SS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT DEPTH?
Depth to Water After
Monitoring?
Date:
CQWCr rj Vii•, -G
S
L
0
P
E
Reading
Date
Gross Time
Net Time
Depth to Water
NetDrop
9x09
4M c----
0
O
‘'
g:3d
30
'3-8
5'
tT
01zoo
GD
3o
SI
i'-
aa36
to
3a
S-
r
PERCOLATION RATE 362 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN gee, FT AND l-(0 FT
L.)
PERFORMED BY: /411 ott 3 G r^(A,�j I (• �" CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL S#ATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: (0• +)• ( S
•\ MUNICIPALITY OF ANCHORAGE
\
f r
► , ,
\/
/
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAM�; C� v1Jffc/%I- (7/./h ,/ )
C ! �/
67, Zf /r
UPGRADE
MAILING ADDRESS
/ r_ ie
LEGAL DESCRIPTION
G- 2-S— CII4-A4 1, 4:, -e -'f
LOCATION
NO. OF BEDROOMS
SEPTIC
TANK
DISTANCE TO:
Well
Cc/71/ k A/Jir
Absorption rea,
{
Dwelling S / ±
PERMIT N �J
"
ManufacturerMaterial
kt, 12
� C£
No. of compartments
el
Liq. capacity in gallons
IF HOMEMADE:
Inside Igngth
Width
Liquid depth
-
1 --1
Y
J,0Z
O z Q
Z -H
DISTANCE TO:
Well /\/
Dwelling
PERMIT NO.
Manufacturer
Material
Liquid capacity in gallons
TILE
GRAINFIELD
TRENCH
DISTANCE TO:
Well
�%
Foundation
Nearest lot line
PERMIT NO.
No. of lines
Length of each lin" e' /^
Total length of lines
Trench width
inches
Distance between lines
Top of tile to finish grade
Material beneath tile
inches
Total effective absorption area
SEEPAGE
`Pff-
cf>
Length �b /• f-
Width 3/ j „A
Depth 5.z. f
PERMIT N/'—Qrie
Type of crib
Crib diameter
Crib depth
Total effective sorption
a
o
DISTANCE TO:
Well N/44
/-�
Building foundation
/ S
Nearest lot line 4.
-_ '� ,
W
Class
(: -,,17,11
Depth
LI /V /7 y
Driller
_.r S7Z /k
Distance to lot 'line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption areals)
OTHER V
'
1//Z
N
PIPE MATERIALS
1 y�.(_
N
SOIL TEST RATING
29 (3eI4jio.
INSTALLER
'/7c ( C'I/3i3S (--XC1
_-
IS
t
_.__
�j
i
----
Q
REMARKS
-arils_? 117DG/` 11 A
T
T
j
T
b /(/y cc,1J.�/t.1
f
crz
efl,«,�
,
I
T..
Ap-..
1
1-
eD
��`�1Nviu
��
stober' A. ;.raf*• . ,4'
��. " No. 1451-E :�',
G -.le �
-i(:) •o.¢°;tit; S.
iJ 'tar qc` 4•`.4f
'..
., k
". vacs; .*%•••.
APPR• 'D / DATE LEGAL
,� / (-i� J�
72-613 jkev. 3/78)
Permit #
Applicant:
Location: Phone mber:
Legal Description: [ ;;ae,{_,,. r
Type of Soil sorption System Is:
Trench: Drainfield: Seepage Bed: 24
JNICIPALITY OF ANCHORAGE
Department of Health and Environmental Protection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL'AND/OR ON-SITE SEWER PERMIT
Mailing Address:
Size:
Holding Tank:
Maximum N `,e of Bedrooms: Soil Rating(sq.ft/br)
DEPTH
Xql
The Required Size of th00911 Absorp ion S Is: e
alJ 1)4
LENGTH(
GRAVEL DEPTH ' 4c7 /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 th ou fall pipe and
the bottom of the excavation(in feet).
* *REQUIRED SEPTIC(44! 1t3) TANK SIZE = 7deW7717GALLONS * *
permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
>f residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
3ackfilling of any system without final inspection and approval by this department
till be subject to prosecution.
linimum distance between a well and any on-site sewage disposal system is 100 feet
`or a private well or 150 to 200 feet from a public well depending upon the type
)f public well. Minimum distance from a private well to a private sewer line
.s 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.
)ther requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 * * *
I certify that:
(1) I am familiar with'the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the s stem in accordance with codes.
(3) I u••- tand that � e on-site sewer system may require enlargement if
t - - ` . nce i ,emodeled to include more that 3 bedroonyt .
Signed ip /%
-�/, Issued by:
li ant
Date:
SWP/024(1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: iJ (,ay/% -e /
LEGAL DESCRIPTION:
10
11
12
❑ SOILS LOG
• PERCOLATION
TEST
DATE PERFORMED: 45-' / 7 -- C' 3
zzc 4/e -cf.
OR CNIN c_
S/LT y' 5t4N1
5/L 5I J
G L, �yty
22W 1972-
13 ,—.•1 r viA t -(z
14
15
16
17
18
19
20
COMMENTS
PERFORMED BY:
72-008 (6/79)
lute, -i A. .`;hJEeh,
No. 1457•E s•'.` -rt
401.
40 fiY4'
SLOPE
WAS GROUND WATER n1 S
1 �1 L=
0
P
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
E
SITE P
TEST
Pet_
4-5
_S
E
z
pc
r
r
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
.
I
7 - i -6'3
7 : 2 5
r,
1)
_ -----
-
�:
Z
7 ; 6- 5
3z.. iti i N,
3 4
/ 1
3 ti
,./
/
`, C.
!L' r lnl,
I r'
/ 3 i
J 4
9
l}
' 15-
1 �' }7l I ).f,
_1 �i
13
3 r.r
F IrZ- S
1C I'm h/,
/ ,
1'1 E
1 14
`-
PERCOLATION RATE
TEST RUN BETWEEN
8 &1GIg EERING
;i1.E,RiVER, ALASM y!57t
PH, 604-2970
A6-"
1
CERTIFIE
(minutes/inch)
FT AND Z FT
DATE:( it
Parcel I.D. 051-822-04
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Expiration Date:
7 18_/.7
1. GENERAL INFORMATION
Complete legal description Chandelle Acres; Lot 25
Location (sit address) 23807 Chandelle Dr, Chugiak, AK, 99567
Current Property owper(s) Lynette Weinzirl Day phone 244-0530
Maiiing`addrAss " `
23807 Chandelle Dr, Chugiak, AK, 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
Multiple Dwellings (Single Family and/or Duplex)
x
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class A Well
Public Water System
Waiver/Variance request for:
4
n
x
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
Community
Public Sewer
x
n
Distance:
7`Y"
COSA to be released to the engineer, unless otherwise requested by the engineer.
natcg
COSA Fee $ r9 b -Waiver Fee $
Date of Payment ti) 121 15 Gk 310& Date of Payment
Receipt Number J� Receipt Number
COSA# 0�5i 152- 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.
Name of Firm Alaska Rim Engineering
Address 9131 Frontage Rd, Palmer, AK, 99645
Engineer's Printed Name Charles A. Leet
6. DSD SIGNATUREIG
‘System #1 Approved for 4 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
By:
Phone 907-745-0222
Date
SP.•
OF A(4,
ipt • Charlie A. Leet
cetaaeo .C!
bedrooms, with the following stipulations:
`,\pQ�\YY OF%»,,
=%�� n ah'
NSfTC
WATER AND m=-
WASt1_WATER z
SEftVIC,e'C
J���f,ltltico))1
o,
/4/
The Municipality ofge Development 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.
Original Certificate Date: 8-17- rJ
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_c
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: Chandelle Acres S/D; Lot 25 Parcel ID: 051-822-04
A. WELL DATA
Well type Class A If A, B, or C provide PWSID # 213807 Well Log (Y/N) -
Date completed -
Total depth - ft.
Sanitary seal (YIN)= Wires properly protected (Y/N) -
Cased to - ft. Casing height (above ground) - in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. - ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform - colonies/100 mL Nitrate - mg/L
Arsenic - ug/L Date of sample: - Collected by: -
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 7/16-18/2015
Tank size 1250gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) i
Date of pumping New Pumper -
C. ABSORPTION FIELD DATA
7/16-18/15 2 x
Date installed Soil rating (g.p.d./ft2 or ftlbdrm) gP System type Bed
Length 50+ ft. Width 30+ ft. Gravel below pipe 0.5 ft.
Total r�s othi�:�it✓o . absorption area 1500+ft2 Monitoring tube Y Depression over field N
Dat�44 tdegfl tot ;i Results (Pass/Fail) - For= bedrooms
Flu. depth in absorption fiel.:efore test - in. Water added - gal. New depth - in.
Flar i Tirtp.,g; 7,, �j, _ Final fli iiiri dapth - in, Ahgnrntinn rata >- 600+ g p A
Any re1WjenMtion.treatm , (past 12 mo.) (Y/N & type) New If yes, give date -
/Amini
D. LIFT STATION
Date installed - Size in gallons -
"Pump on" level at -
Datum
in. "Pump off' level at -
Cycles tested -
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot N/A
Public sewer main N/A
Sewer /septic service line N/A
Animal containment areas N/A
SEPTIC/HOLDING TANK ON LOT TO:
Manhole/Access (Y/N)
in. High water alarm level at -
Meets alarm & circuit requirements?
in.
On adjacent lots N/A
On adjacent lots N/A
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas N/A
'+ '
Building foundation ' + Property line 5 Absorption field 5 +
10'+10'+
Water main Water service line Surface water 100' +
Wells on adjacent lots 200+
ABSORPTION FIELD ON LOT TO:
Property line 101+
Water Service line 101+
Building foundation 101+
Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
Water main 101+
Driveway, parkingNehicle storage 10 +
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA CO A(l�guidelines in effect on this date.
Engineer's Printed Name GtOU\et k 1
Date -2-z-I C
COSA brown sheet 10-10-12.doc
moi✓ eXCX.r-
ASBUILT-NO CORNERS SET THIS DATE.
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY: Lot 25,
Chandelle Acres Subdivision
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT 1S THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SEWARD & ASSOCIATES LAND SURVEYING 688-4566
SCALE:
1" = 40'
DATE:
6/6/91
GRID:
NW1460
FB:
21-27
DRAWN:
DMS
A
ttt QF. A!4t0
Af.sle
Duane Mark Seward
LS 6 18
f,fr(c,?te• " x/det i
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# 1-Ct-A HAA# c,+1�
1. GENERAL INFORMATION
Complete legal description
Lot 25; Chandelle Acres
S/t/r, '2
Location (Site address or directions) 23807 Chandelle Drive
Chugiak, AK
Property owner Roland & Carrie Kay Day phone 688-5292
Mailing,address 23807 Chandelle Drive Chugiak, AK
Lending agency Day phone
Mailing address
Agent Jean Kay/ Remax of Wasilla Day phone 376-4515
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well xxx
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:
Individual on-site
Holding tank
Community on-site
Public sewer
XXX
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 MOA121
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my invest9ation 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 S & S ENGINEER+NG Phone 6 y - `;/ 7
17034 Eagle River Loop Roar! No. 204
Address Fag!- River A! k7
Engineer's signature ��2F1r►�/ (L?+^��"�
Date 7/4'4'7
......-...•It . ..... t.... y....
�. ROBERT C. COWAN
tc,., CE - 8801 r �w
6. DHHS SIGNATURE htt4 FA'p*;''{." j1".-�
1/ Approved for Li bedrooms.
t�Z�~wZar"��~
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By.
Additional Comments
Date rzz/97
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA .121
MLIORgG@
Ems► 0t UNIC►PgENTgITY SERVOFgNCyICES OR
4�
Municipality of Anchorage JUL 75 1997
DEPARTMENT OF HEALTH & HUMAN SERVICES R
Environmental Services Division r 1VE �C
825 L Street,9
Room 502 • Anchorage, Alaska 99501 • (907) 343-� 4 V l
Health Authority Approval Checklist
Legal Description: LLT 25 C rrd.ell,e- Au^Ph Parcel I.D.:
A. WELL DATA
Well type
If A, B, or C, attach ADEC letter. ADEC water system number d l 3 F303-
Log
303'
Log present (Y/N) Date completed
Total depth Cased to Casing height (above ground)
Sanitary seal (Y/N) Wires properly prote - • /N)
FROM WELL LOG AT ' ECTION
Date of test
Static water level
Well production
WATER SAMPLE RES
Coliform
g.p.m. g.p.m.
Nitrate Other bacteria
Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 5-3051 Tank size 12-50 Number of Compartments Z Cleanouts ON)
Foundation cleanout r( t' N)Q¢, Depression (YO High water alarm (YJ 140
Date of Pumping / 1 / Or Pumper TJ 'S
C. ABSORPTION FIELD DATA
ATT
/ {t1
Date installed fJ/ 30/95 Soil rating (g.p.d./ft2 or ft2/bdrm) 380 pSystem type 13
Length 57 i Width 31 Gravel thickness below pipe 0. 5 ir Total depth 4j
2
Effective absorption area /5r5 -e2 - Monitoring Tube presenteN)CiS Depression over field (YO 00
Date of adequacy test /1/0(97--(/)(9?ff Results ail) 065 For Dui. bedrooms
ej
Fluid depth in absorption field before test (in.); 1 V► Immediately after teri gal. water added (in.): q
//
Fluid depth (ins) Minutes later: /0 Absorption rate = + 600 g.p.d.
Peroxide treatment (past 12 months) (Y/N) Alive Xv If yes, give date / 6
72-026 (Rev. 3/96)*
QS
D. LIF
Date installed Size in gallons
Manhole/Access (Y/N) mp on" level at* "Pump off" level at*
High water alarm level at* *Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot ZOO' +
On adjacent lots
On adjacent lots MIA
Public sewer mai. Public sewer manhole/cleanout
wer /septic service line Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 6"P Property line i0/1- Absorption field 61+
Water main/service line 04 !+ Surface water/drainage 1W/ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
R ►4
F. ENGINEER'S CERTIFICATION
t4 -
Cd
Building foundation I0 + Water main/service line IO
+
OU
Driveway, parking/vehicle storage are50
ae
Wells on adjacent lots
1 certify that 1 have determined thru field inspections and review of Municipal records tigairs are
in conformance with M.A HA,1 guidelines in effect on this date.
Signature.—
Engineer's Name l@0/ €,2,— (.. Co c✓.�,�
Date
• . *
k ROBERT C COWAN j .
,- CE -8801 f�'r
HAA Fee $ CD "
7
Date of Payment 7 // r/!
Receipt Number u l �/t 22
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. #
1. GENERAL INFORMATION
HAA# 60C1 111/D
Complete legal description Lot 25; Chandelle Acres
Location (site address or directions) 23807 Chandelle Drive
Property owner Daryl and Jeanne Waters Day phone 688-5292
Mailing address Roland and Carrie Kay (tenants)
Lending agency NORDSTAR MORTGAGE Day phone
Mailing address ATTRNTTON: Jnrg n'Hnyt
Agent Melinda/ALPEiA GROUP (229-1729 mobile) Day phone 563-3242
Address 5600 B Street, Suite 203, Anchorage, Alaska 99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
4
XX
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
xx
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 021
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Phone 6.9+-0979
j.:.;tIV+1•-•-•••
Address
�' Eagle Rive; Loop Road No. 204
"`
Eagle River, Ala- a :'577 /
Engineer's signature Date F� �'% q/
6. DHHS SIGNATURE
Approved for [ -� 4' bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
f 2., '9 ..s4'1} �i 6..
PT 4.
rs a
'R"3 *yrs
Additional Comments
By ,a n/(5
Date 610
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21
Legal Description:
A. WELL DATA
Well type
Municipality of Anchorage
Department of & HumanHEALTH AUTHORITY Hea(th APPROVAL CHrELIST'99
�oT Zai G-N�,�l>E L,1�� A - Parcel I.DR E C L
rtrillnk
•'i=
If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed Driller
Total depth Cased to Casing height
Sanitary seal (Y/N) Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG AT INSPECTION
gpm
gpm
SEPARATION DISTANCES FROM WELL TO:
1-
Septic/holding tank on lot Zp; On adjacent lots
4 -
Absorption
Absorption field on lot Znv ; On adjacent lots
Public sewer main Public sewer manhole/cleanout
Public sewer service line Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample: Collected by
B. SEPTIC/HOLDING TANK DATA
Date installed 6---5"t'.-
Tank size 1?AO Compartments Z-
Cleanoutsc}N) `� Foundation cleanout& N)
High water alarm (Y(l
4
Depression (Y0 4
Alarm tested (Y/N) 0‘14,
Date of pumping to- 8-�1 / .T,e- e-gssPoPL P✓161 r^I I')
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Zoo
`
Surface water/drainage
72-026 (Rev. 3/91) Front MOA 21
On adjacent lots
rlf)3
Foundation
10`}
Absorption field Water main/service line
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at "Pump off" level at
High water alarm level Cycles tested
Meets MOA electrical code
SEPARATIO
STANCE FROM LIFT STATION TO:
We on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed
3a-83
Soil rating 360 14•
System type F3E 2)
Length SO Width 3/ Gravel thickness D,S 11 Total depth 4
/Sj 0 ¢ Cleanouts present (9/N)
`--- Date of adequacy test Q - 7 -9/
Results4l1P/fail) PA- SS for k) FD✓G bedrooms
Total absorption area
Depression over field (Y.0
Peroxide treatment (past 12 months) (Ydrj
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
i -
Well on lot Zo 0
On adjacent Tots
If yes, give date
Property line 101
%
To building foundation l O +-
To existing or abandoned system on lot t-1.✓�
On adjacent lots 30* Cutbank #-LJAr Water main/service line 1c)14 -
Surface
ot}Surface water Icy/o' ar Driveway, parking/vehicle storage area 5DI .t. -
Curtain drain I -1/A -
E. ENGINEER'S CERTIFICATION
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect Qn•-thedate4of.this inspection.
`EiRl pay
Signature si,v River Loon Road No. 204
r adia klivor, Alaska 99577
Engineer's Name
Date //q/
HAA Fee $ // 4
Date of Payment -10
6
Receipt Number Pd- 74, 3 Ck `'- ('
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee. $
Date of Payment
Receipt Number
2F L.-_Itt'l\\SE/Lii)_,I\
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
FOR: S & S Engineering
Ray
June 5, 1991
PWSID 213807
WALTER J. NICKEL, GOVERNOR
563-6775
My review of the records on file in this office reveals that the Chandelle Acres Subdivision
Class A Public Water System, is in compliance with the provisions of 18 AAC 80.060, State
of Alaska Drinking Water Regulations.
Sincerely,
Keven K. Kleweno
Lead Engineer
prfr, leu urs rec�i: t,„t, • ,:rr b y
1
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
/
Application Date - (71. 9, /jYY
(a) Legal Description (include lot, block, subdivision, section, township, range)
'N EL QA)"
Location (address or directions)
,, 2Z
(b) Applicants Name 7 ,S//t. e Telephone - Home. -2(k2 Business
Applicants Address 4'ri.9x' J//4; e�t-
(c) Applicant is (check one) Lending Institution ; Owner/builder
Buyer ; Other (explain); /`ewe / C s 7y7P '/ e_,,
(d) Lending Institution = //,24T
Address tr-Ace,k, 7e/
ihTQf S7d> 2. '--B6141 jee Telephone 33 %—
.� c; ..-4- e C) c.•
(e) Real Estate Co. & Agent %1 -e -,-7i a
i
32.3 3
Address Y (1 .itScl )( 8'
Telephone 04/ —
(f) Mail the HAA to the following address:
to f » yd'
/c>
2. lype of Residence
Single -Family L
Number of Bedrooms
3. Water Supply
Individual Well
Multi -Family
Other (describe)
Community { x 1 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
1 [
Community
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]
e
•
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 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 regula-
tions in effect on the date of this inspection.
Name of Firm
Address
Date
J/ Y
6. DHEP Approval
./amu.)
Approved for i %bedrooms
Approved i Disapproved
(ENGINEER SEAL)
By
Telephone
0
Terms of Conditional Approval
Conditional
rt
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
A. WELL DATA
Well Classification
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
9
If A, B, cr C, D.E.C. Approve
crY))4
Well Log Present (Y/N) Date Completed
Total Depth Cased to Depth of Grouting
Static Water Level Pump Set At
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances frau Well:
To Septic/Holding Tank on Lot 2a9 ; On Adjoining Lots ZOO /-
Yield
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
To Nearest Edge of Absorption Field on Lot 200 ; On Adjoining Lots -Zoo ---
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected By
Water Sample Tes Resul s
Comments , d f
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Date
B. SEPTIC/HOLDING TANK DATA
Date Installed/3a
;g)
size /ZSb
Standpipes %. r ` Air -tight CapsO/!
No. of Compartments
Z
Foundation Cleanout %(y)NP}
Depression over Tank ( Date Last Pumped e�
#1/1-; for
Pumping/Maintenance Contract on File (Y
Holding Tank High -Water Alarm (Y/N) "
Separation Distances from Septic/Holding
c To Water -Supply Well 204.0 ,-
To Property Line /0
To Water MaWService Line � 1
Course AJ
Comments /V er-
Temporary Holding Tank Permit (Y/N)W'
Tank:
To Building Foundation �r
To Disposal Field 9
To Stream, Pond, Lake, or Major Drainage
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorpti Strata .3F 4 A//' Type of System Design ,' 1
Date Installed 5 /v /83 Length of Field 4572
Width of Field
Depth of Field
4ir
Gravel Bed Thickness
Square Feet of Absorption Area l37,s7b11, Standpipes Present (YMI
Depression over Field (Y' j) Date of Last Adequacy Test w(24/
Results of Last Adequacy Test ' [ /
Separation Distance from Absorption Field:
To Water -Supply Well 200 To Property Line /0 IL
To Building Foundation Air -/-A- To Existing or Abandoned System on
Lot f?/ / ; On Adjoining Lots -‹0 9
To Water /Service Line 504- To Cutbank(if present) f'`iz/14
To Stream/Pond/Lake/or Major Drainage Course /v d
To Driveway, Parking Area, or Vehicle Storage Areal p' -
Comments AV 8 w
D. LIFT STATION
**
Date Installed
Size in Gallons
Dimensions
Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Comments
j 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
on the date of this inspection.
Signed sae EA1I0 X R1NCi Date /
Company i' 31:E MPH, .9 A 9A tSzn MOA No.
conformed to all MOA HAA Guidelines in effect
KB1/d5/s
`ch
[Page 2 of 2]
2-15-84