HomeMy WebLinkAboutEKLUTNA HGTS STEWART ADDN LT 8Eklutna Heights
(.Stewart Addition)
Lot 8
#051-063-25
7/15/2022
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-063-25
Property owner(s) FRED GRAUBERGER Day phone
Mailing address 21654 BEAR VIEW PL, CHILIGIAK, AK 99567
Site address 21654 BEAR VIEW PL, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) EKLILITNA HGTS STEWART ADDN LT
Legal description (Township, Range & Section)
Lot Size 8500 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
�
Initial 0
Single Family (SF) El
-XI
(w/wo ADU)
Septic Tank
I
Upgrade M
Duplex (D) El
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
El
THIS APPLICATION
INCLUDES
A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
re of property owner or authorized agent)
Permit/Rush Fees: 't 5 1 t> Waiver Fees:
Date of Payment: � I I s I '? 0)� —
Receipt Number: 013 -1 bIj
Permit No. QS? O� ( I �to
Date of Payment:
Receipt Number:
Waiver No.
GAIDevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client FormsTermit Application.doc
13021 Montego Circle, Anchorage, AK 99516
907-350-9566 / FirstWaterAK@gmail.com
June 14, 2022
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: EKLUTNA HEIGHTS STEWART ADDN LT 8
PHYSICAL: 21654 BEAR VIEW PL CHUGIAK, AK 99567
The septic field has been found failed and we request a septic permit to upgrade the system on the above
referenced lot. We propose to remove existing field / biomatted material and replace with a shallow trench,
and install new Advantex system to serve the existing 3-bedroom residence with MOA sand as required. The
design is based on the existing soils of the site and adjacent lots that will be verified at the time of installation.
The slopes are flat at the proposed upgrade location and there are no slope issues with this upgrade. The lot
and area are served by private water. The design will not impact any of the neighboring properties. Please
contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221196, Deb Wockenfuss, 07/14/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221196, Deb Wockenfuss, 07/14/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221196, Deb Wockenfuss, 07/14/22
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this Day of j L& of 20.2'--, by and between
,.herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as
located at (legal description)
fewA,-
2. Maintenance, Repairs and Alterations.
(Owner is required to read,. understand and initial each section)
oughout the term of this Agreement, the Owner shall enter into a service agreement
with*an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
t shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
—i includes an annual maintenance fee (typically $400 to $600).
-—Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018)
Page 1 of 3
Owner acknowledges that the Municipality may request records of maintenance and
re airs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
caner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred..
41. Nonwaiver. The failure of the Municipality at any time to enforce a.provision of this
Agreement shall in no way constitute a waiver of the provisions, nor. in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
By __'7(signature) Date: O 0
Fr ���IZ4Pr (print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT161
)
The foregoininstrument was acknowledged before me this / day of ,
20,:90, � G
G. Kl �2oi
NOTAR P BLIC FOR ALASKAN
OT
My Commission expirerwa c . /D, aaco
�N� pUB.L cY:
MUNICIPALITY:
BY t/ (signature) Date: / 2
(print name) Title:
(rev. 05/18/2018) Page 3 of 3
LOT 7
LOT 9
I ANCHORAGE RECORDING DISTRICT, ALASKA
AS—BUILT OF:
EKLUTNA HEIGHTS SUBD STEWART ADD
LOT S PLAT 63-I0
SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance shoul4
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: DATE: SCALE:E—MAIL
22-045
� r� MAY 20, 2022 1 "=20' schuhrftk.net
L 2 --- O 4 5 DRAWN BY: CHECKED BY GRID NUMBER: BOOK AGE
JLS NE1460 220174
@) = FND 5/8" REBAR
Io
0
D
D
D
7
AW OF r\ r�
AW Ao� 0
1 � L N D
/ .•
49TH •.7
..............................
PA
a G)l1
ro �•.J N L. SCHULLER.-* o
. .• LS --10408
Of
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274--4992 fax
i MUNICIPALITY OF ANCHORAGE
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
[] UPGRADE
LOCATION ~ 3 ~/~, G/ ~ NO. OF BEDROOMS
DISTANCE TO: IWe200 / Absorpt~a , Dwelling , PER~T~~/
I L~c~ll~allons____~v IF HOME,DE: Inside length. Width Liquid depth
~OZ~ DISTANCE TO: Well 7nY/ '4 PERMITNO.
0 Z ~ Manufacturer Material Liquid capacity in
. O Distance bet~ lin
~_ No. oflJnes/ Length off, liner Total lengt~es Trench wi~o inches ~
to~ ~ iinchest Total effec~ve~a~o rptip n
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter ~ri Total eff~tive absorption area
m Well BuilBing foundation Nearest lot line
~ DISTANCE TO:
~ Clas~ ~ [ ~.~ ~ ~ Driller Distance to lot lJne PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line : Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
INSTALLER
REMARKS *' ~ ~. /
724~13 (Rev. 3/78)
MUN I C~?AL I TY OF ANPOR;~SE
DEPARTMEN. OF HEALTH AND ENVIRONMENTA- PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
ON--SITE SEWER & WELL PERMIT
PERMIT NO:
DATE ISSUED:
840651
07/27/84
APPLICANT:
ADDRESS:
CONTACT PHONE:
IRA KRUGER
% S&S ENGINEERING
EAGLE RIVER, AK 99577
6942979
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS:.
SUBDIVISION: EKLUTNA HTS. LOT: 8
SECTION: 5 TOWNSHIP: 15N RANGE: 1W
8400 (SQ. FT. OR ACRES)
5
BLOCK:. NA
Listed below are
system. Choose the option that best £its your site.
the options available to you in designing your septic
TR~..NC| | BFD
DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0
GRAVEL DEPTH (FT.) 4.0 0.5
TOTAL DEPTH (FT.) 8.0 4.5
GRAVEL WIDTH (FT.) 2.5 19.0
GRAVEL LENGTH (FT.) 57.0 56.0
GRAVEL VOLUME (CU.YDS.) 23.7 25.5
TANK SIZE (GALS) 1,000.0 ** 1,000.0
SOIL RATING (SQ.FT./BR) 150 150
. 4.0
~ 5.0
'~ .56.2
\ l, ooo. o
~ 150
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
5. I will adhere to all MOA and State of Alaska requirements fop the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 5 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
APPLICANT: IRA
ISSUED
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264~1720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5-
6
7
8
[] PERCOLATION
TEST
10-
11
12
13
14
15
16
17
18
19
20
COMMENTS
PERFORMED BY:
DATE PERFORMED:
SLOPE
SITE PLAN
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN FT AND
(minutes/inch)
__ FT
72-008 (6/79)
! MUNICIPALITY OF ANCHORAGE
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
NAME/~_ IPHONE
~ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
Well Absorption area ~ Dwelling~ , PERMIT NO.
~ ~ DISTANCE TO:
Material No. of compa~ments
Liq. capacity in gallons Inside length Width Liquid depth
~ ~ 0 IF HOME,DE:
~ ~ DISTANCE TO: Well DwelHng PERMIT NO.
O Z ~ Manufacturer Material Liquid capacity in ~Hons
Q Well ¢ Foundatio~ / Nearest lot line PERMI~ NO.
No. of lines Length of each line Total length of lines Trench ~ vI Distance ~ lines
~ / ~ Material beneath~ tile . inches
~ Topoftiletofinishgrade~
area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth TotaJ effecti~ absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller ' Distance to lot line PERMIT NO.
m Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
SOl L TEST RATING
INSTALLER
w -Jill
M-W DRILLING, INC.
DRILLING LOG
Well Owner Alan LaPage Use of Well Dom.
Location (address of: Township, Range, Section, if known; or distance main road
Lnl- g F, klu~r.~ Height.~ Subdivision
6" 155.8
Size of casing Depth of Hole 320 feet Cased to feet
Static water level ] 25 ft. (]{l~x) (below) land surface. Finish of well (check one) open end (
Screen ( ); Perforated ( xx ).
perforation~-~0.~.. Shot perforations from 150-153'
Describe
screen
or
Well pumping test at ] gallons p/er (F~XI~) (minute) for 1 hours with 1007o
of drawdown from static lev~.
Date of completion 6 / 20 / 78
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 TO_ 2 Casing stickup
2 TO
TO
TO
TO
TO_
TO
TO
_ TO
TO_
TO
1'O
_ TO
TO_
_TO
);
18
48
60
95
119
120
122
154
18
48
60
95
119
120
122
158
154
320
Silty gravel
O3AI333
Loose gravel: cobbly
Sandy gravel
Loose gravel:
cobbly
NOIID~IO~d ]¥1N~WNO~IAN::i
'~ HIq¥3H JO
30¥'dOHDNV JO AlllVdlDINn~
Sandy gravel
Damp sandy gravel
Damp sandy gravel
Silty hardpan
Sandy water gravel
Bedrock, water seeps
in sporadic fracture~ t~hroughout
YC. /-'//-'
CurLi[i~atc No's. e, 973
PERr,II T NO.
Ir.lblr-~ I ~-: T F'RL I T'-r' ,"-iF RI'-J~E:HIL~F.'R~-3E
DEF'RF':TMENT OF HEALTH AND EN',,,'TRONMENTRL F'F.:OTECTIE[N
825 '"L" STREET., RNC:HOF':AGE., AK. ~50'1
264-4?20
~--~t-~--S I TE SEL.~EE' F'EF-'r-1 I T
780637 )
APF'L I E:ANT
LOCRT I ON
LEGAL
ALLEN LA PFIGE
LAF'RGE LN
LT. 8 EKLIJTNR HTS.
S,.'"[)
SR E:X li29 CHUGIRK
LOT SIZE
GE:E:-2~.?~
9000 SQLIRRE FEET
TYF'E 0F SOIL 8E:SORBTION SYSTEM IL-q: TF.:ENCH
MAXIMUM NLIMBEF.'. OF BEDROOMS
SOIL RATING ,::SQ FT,'"E:F.:>= 275
THE REQUIF.:E[.', SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[:,EF' TH= i~Z~ L E I'-.I,3 T H = :_---:2. :-:'~ I] F-: R '-.-' E L C, EF'TH= (5
THE LENGTH DIMENSION IS THE LENGTH ,::IN FEET) OF THE TF.:ENCH OF.: DRRINFIELD.
THE DEPTH OF R TF.:ENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GF.:OUN[:, AND THE E:OTTOM OF THE E,*<CR'v'RTION <IN FEET).
THEF.:E IS NO SET HIDTH FOR.: TRENE:HES.
THE GF.'.A'..,'EL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EX¢:R',,.'ATION ,::IN FEET:..'.
E: E i_--_! I_1 I E: E [:, ':]- E P T I C: T A N K '= I Z E = 1 ~_-1 [-_--1 ~.7_1 l_~j R L L C, !'-,!_ S
F'ERMIT APPLICFINT HAS THE RESPONSIBILITY TO INFEIF.:M THIS [:,EF'ARTMENT [:,IJF.iING THE
INSTALLATION INSPECTIONS OF ANY [,JELLS ADJACENT TO THIS F'ROPEF':T"r' AN[:' THE
NOMBER OF RESIDENCES THAT THE [,JELL WILL SERVE
T I---I C' ':: 2 1:' I r-.I S F' E £: T I C~ r-.I '---- A F-: E F-: E L--:! LI I F-: E [:,
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPEC. TION Ar.J[:, APF'RO'...'AL BY THIS
[:,EF'RRTMENT WILL BE SUBJECT TO PF.:OSEE:UTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
t00 FEET FOR.: R F'F.:I;,,'ATE WELL; OF.:
t_50 TO .';'00 FEET FROM A PUBLIC: HELL DEF'EN[:,ING LIF'ON THE TYPE OF PUE:LIC: WELL.
OTHER.: F.:EQUIREMENTS MAY APPLY. SPECIFICATIONS AN[:, C:ONSTRLICT!ON [:,IRGF.:AMS RF.:E
A',/R!LABLE TO INSURE F'F.:OPER INSTALLATION.
F'EF-:r-1 I T E.'-'-::F' I F-:E$ [:,E,]:Er-IE:EF-: 3:t_. 197:E:
! CERTIF"r' THAT
t- i AH FAfqlLIRR WITH THE FREg!UIF.:Er. IENTS F]R ON-SITE SEHEF.:S AN[:, WELLS AS SET
FAF.:TH BY THE MUf4ICIF'RLITY OF ANCHORAGE
2: I [,JILL INSTALL THE SYSTEM IN ACC:ORDANCE WITH THE CO[)ES.
]: I UN[:,ERSTRN[:, THAT THE ON-SITE SEHEF.: SYSTEM MAY REQUIF.:E ENLRRSEMENT IF THE
RESI[:,ENCE IS F.:EMODELE[:, TO INCLU[:,E MOF.:E THAN 2: 8E[:,ROOMS.
O Et E GEO. ECHNICAL Et DEVEL,,~PMENT CO.
Russell Oyster
694-2774
Soils Et Foundations
Performed for:
Legal Description:
Box 90, Davis St., Eagle River, Alaska 99577
694-2T/4 or 688-2280
Ma t 1 lng Address:
Earl El~is
SOIL LOG
Land Development
Depth (feet)
Sotl ~heractertsttcs
o
1
2
4
6
7
9
lO
11
12
16
Ground Water Encountered: Yes__No ~/ If yes, whit depth
Proposed Installation: Seepage Pit Drain Field
Comments: ~ A-r~-/t ~¥-A,~ ~ ~ ~,~
i
Performed by: ~d/~~ ~~-~-~
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L' Street Room 502
P.O. Box 196650 Anchorage, AK 995'19-6650
www.ci.anchorage.ak.us
-. (907) 343-4744
CERTIFICATE OF, HEALTH 'AUTHORITY APPROVAL
FoRA SINGLE FAMILY DWELLING
Parcel I.D. 0512063-25
1:
GENERAL INFORMATION
,Com
Lo~,ation (site address or,
Mailing address
Lending agency
Mailing address
Expiration Date:
Real Estate Agent
Mailing Address
AK ·
Dayphone 688-7334:
Day phone
Day phone
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS:
3, TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
[]
Well []
[]
Individual On-site
Individual Holding tank
Community Omsite
Public Sewer
: TYPE OF WASTEWATER DISPOSAL:r:
The Municipality of Anchorage Depadment of Health and Human Services (DHHS) Issues Certificates of Health
Authority Approval (HAA) based only upon the representations g~ven in paragraph 5 by an independent professional
civil ehgmeer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer ·
of title (except between spouses) on propedies served by a singte family 9n-site wastewater disposal and/or water
supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for propedies served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. Certificates are ~,alid for one year for properties served by Class A
or B wells or a publi~ water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
(Rev, 11/99)
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 investigatior
based on procedures outlined in the Health Authority Approval Guidelines for this Health Authority Approval
application shows that the on-site water supply ~and/or wastewater disposa~ system is safe, functional and
adequate for the number of bedrooms and type of structureindicated herein. I further verily 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 ~n compliance with all applicable Municipal and State
codes, ordinances, ano'regulations in effect at the time of installation.
Name of Firm ,Nh I:::nr~ir~;inn
Address _204_44 Pf~rrni~? I::n~l~ River, AK .q.q~77
Engineer's Printed Name .J.(~rtn~fh rhlffllR
DHHS SIGNATURE
Approved for
Disapproved.
Phone
Conditional approval for
Date _~)9/25/2000_
STAMP
bedrooms, with the following stipulations:
Additional 'Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Expiration Date:
(Rev, 11/99)
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: / ~)-
Reissue Date:.
Municipality of Anchorage ~
Department of Health and Human Ser~c~C E I V E
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box '196650 Anchorage, AK 99519-6650 SEP[ 5 200D
www.ci.anchorage.ak.us
(907) 343-4744
MUNIClPALII¥ OF ANCHORAGE
SEBVICE$
OIVlBlO~l
HEALTH AUTHORITY APPROVAL CHE(~'VI~.~I~~m'AL
Legal Description:
A. WELL DATA
Well type private
Date completed 6/20/i978
Total depth 320 ft
Date of test
Static water level
Well production 1
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi
Date of sample: 8/24/2000
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Eklutna Hei~lhts Sub. L8
Parcel I.D.: 051-063-25
IfA, B, or C provide PWSID #__ Well Log y
Sanitary seal y Wires properly protected y
Cased to 155.8 ft Casing height (above ground) 24 in.
FROM WELL LOG AT INSPECTION
6/20/1978 8/24/2000
125 ft 126 ft
g.p.m 1.5 g.p.m
Nitrate 4.09 mg/I
Collected by: KND
Date installed 9/1/1984 Tank size 1000
Cleanouts y Foundation cleanout y
Date of pumping 7/18/2000 Pumper JR's
C. ABSORPTION FIELD DATA
i~/~//,~/ Soil rating (g.p.d./ft2 or ft2/bdrm)150
Date
installed
Length 40 ft Width 5 ft
Total depth 7.5 ff Effective absorption area 370 ft2
Date of adequacy test ~//2.~ Results (Pass/Fail)
Fluid depth in absorption field before test dry in Water added450 gal.
Elapsed Time: i min Final fluid depth ~ in
Any rejuvenation treatment (past 12 mo.) (Y/N & type) yes- TERRALIFT
(Rev. 11/99)
Other bacteria 0 colonies/100 mi
gal Number of Compartments 2_
Depression over tank _n High water alarm na
System type trench
Gravel below pipe 3.5 ft
Monitoring tube y Depression over field n~
pass For 3 bedrooms
New depthd~.r.ry in.
Absorption rate >= 450+ g.p.d.
If yes, give date 7/i8/2000
D. LIFT STATION
Date installed
"Pump on" level at __
Datum
Size in gallons
in"Pump off' level at
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot Inn'
Absorption field on lot inn'
Public sewer main 'mn'+
Sewer/septic service line tnn'+
lin
Manhole/Access
High water alarm level at in
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacentlots lnn'+
Public sewer manhole/cleanout 1on'+
Holding tank 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation t0'+
Water main ~.~'+
Property line 10'+
Water service line ~-~'+
Absorption field 5'
Surface water 100%
Drainage ~nn'+ Wells on adjacent lets Inn'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~O'+
Water Sarvice line ~.~'+
Curtain drain inn'+
F, COMMENTS
Building foundation 10'+
Surface water inn'+
Wells on adjacent lots Inn,+
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 HAA guidelines in effect on this date.
Engineer's Printed Name I~nn~_fh 1311ff~l~
Water main ?,5'+
Driveway, parking/vehicle storage
Data NA/~RI~NNN
HAA Fee $ '~
Date of Payment
Receipt Number
(Rev. 11199)
Waiver Fee $.
Date of Payment
Receipt Number
MLqqICIPALITY OF ANCHORAGE
DIVISION OF ENWIRO~MENTAL HEALTH
DEPARTMENT OF h-E~ALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. Ge~.-_'al Info~ation
Application Date
(a) Legal D~_cri~ion (include lot, block, su~~, section, township, range)
Location (address or directions)
Applicants Address
Telephone - Home
Business
(c) Applicant is (check one) Lending Institution ~--~ ; Ow~er/builder ~;
Buyer ~ ; Other~ (explain);
(d) Lending Institution
Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the ~A to the following address:
2. Type of Residence
Single-Family.~.~
Number of Bedrooms
Multi-Family. ~
Other (describe)
3. Water Supply
Individual Well, .~ Community I i 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
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]
5. Engineering Firm Providin~ 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 ~rater 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
(ENGINEER SEAL)
Telephone
DI~P Approval
Approved fcr~ , bedrooms By ~-~'~ '
Approved Disapproved Conditional
Terms of Conditional Approval
CAUTION
THE I~UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRO~tENTAL PROTECTION
(DHEP) ISSL~S 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 FEDER~ AND STATE REQUIRE-
MENTS. ~IPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR .~NALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. Td~ MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGIh~ER'S WORK.
(DHEP SEAL)
RR4/eJ/D18
[Page 2 of 2]
7-19-84
ao
Be
~ELL ~%TA
MUNICIPALITY OF ANCMDRAGE (MOA)
HEALTH arCHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
MUNICI~ ..... _-
SEp g ,' ig84
gECE VED
Well Log P=esent ~Y~)
Total Depth ~ ~)~1% f Case,d, ~o
Static Water Le~/~/7 '~
Casing Height Abo~ Ground ~ ti
Electrical WirinG in Conduit ~Y~)
Separation Distan~s f~cm Well:
To Septic/He~9~ Tank on Lot //O O
Set At ~ ~
Sanitary Seal on Casirg~)
Depression Around Wellhead (Y~
; On ~djoining Lots /~ '
To Nearest EdGe of Absorption Field on Lot /d~3 ; On Adjoining Lots
To Nearest Public Se~a~r Line /~ /~ To Nearest Public Se~r
_,/_
Cleanout/Manhole ~//g- To Nearest Sewer Servioe Line on Lot
Water Sample Collected By '~; Date
Water Sample Test Results ~9~_~ .
-
SEPTIC~ TANK II~TA
Holdin~ Tank High-Water Alarm (Y/N) ~)~ Tem~ora~-y Holding Tank Permit (Y/N)
Separation Distanoes frcm Septic/~ Tank:
To Water-Supply Well /~O
To Property Line /O 7L
To Water Main/Se~vic~ Line ~ ~
To Building Foundation
To Disposal Field
CcxnTse
C~(~nts
TO Stream, Pond, ~mke, c~ Major D~ainaGe
Receipt ~
Date Paid:
Amount: ~
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD E~TA
SOils Rating in Absorption Strata
Date Installed ~/~/~ ~
!
Width of Field ~O ~'
Squaze Feet of Absc~ption.~ea
Depression over Field (Y~N3Z
Results of Lest Adequacy Test
Separation Distance frcm Absc~ption Field:
To Water-Supply Well /~D To Pr_operty Line
To Building Foundation -~O ~ To Existing or Abandoned System cn
Lot /~/[ ~9- ; On AdjoininG Lots /%/
TO Water Main/~ervice Line ~ /- To Cutbank(if ~esent)
To Stream/Pond/Lake/or Major Drainage Coumse
To D~iveway, Pazking A~ea, or Vehicle Storage A~ea ~
/~ Type of System Design
Length of Field ~(-Q
Depth of Field ~ ~
Grail ~d ~ick~ss ~Z
Stan~ims ~e~nt ~Y~)
~te of ~st A~a~ ~st~~
C~u'~nte
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electzical Codes(Y/N)
Dimensions
/j/ Manhole/Access (Y/N)
/ l~Pump Off" Level at
f [ ~-- Vent (Y/N)
Pumping Cycles durinG Adequacy Test.
Meets ~DA
CCaL~L~nts
** Check Permitted Bedrocm Rating A~ainst HAA Request **
I ~ertify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
' '
Company
KSl/dL/s .....
[Page 2 of 2]
2-15-84
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 5/14/74
Time of Inspection
Date of Inspection__EW~)2~~
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
~--=ld t,4,.,Idt
Phone:
Phone:
3. Legal Description:
4. Location:
5. Type of facility to be inspected $1mm~le
6. Well Data:
A. Type %~t~i~mal i~llmml
Be
C. Construction Stmm#lm~l
Sewage Disposal System:
A. Installed 1974
C. Septic Tank: 1. Size
D. Seepage Pit:
E. Disposal Field:
No. of bedrooms
B. Depth i~4)m
D. Bacterial Analysis
1. Absorption Area
Total length of lines
B. Installer
l( mlm 2. Manufacturer ~ )mi
Material mM
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
· Absorption area
, Other contamination
, Absorption area
C. Absorption area to nearest lot line
Sewer Lines ,
EQ-034 (1/74) Page 1 of two pages
· Page 2.~f two pages - R~est for Approval of Individual
Legal Description Lot 8D, Eklut~a I~t~t~ ~'~d!Y!~!e~
~wer & Water Facilities
Conlnents
Approve~Disapproved Date $/13/74
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage· Alaska ggS03 274-4561
Date Received S/14/74
Time of Inspection ~
Date of Inspection $/14/74
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACXLITIES
FOR
Fmfmmm ilemm A~mtntsttmttm
Approval requested by: ~t ~ _e~_lt~
me, zn chu t
~m~ald S~k~ld'c
Lot 8~) Fr. klutnm tklic~hts ~h,~tvtlten
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location:
Phone:
Phone:
5. Type of facility to be inspected
6. Well Data:
A. Type Drtlled
e
C. Construction
Sewage Disposal System:
Be
A. Installed
C. Septic Tank:
D. Seepage Pit:
Stngle
1. Size
1. Absorption Area
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
No. of bedrooms
B. Depth
D. Bacterial Analysis
B. Installer
2. Manufacturer
· Absorption area
Other contamination
2. Material
, Absorption area
, Sewer Lines ,
EQ-034 {1/74) Page 1 of two pages
Page 2 of two pages - Re~.._Jt for Approval of Individual ~ Jr & Water Facilities
Legal Description
LOT ~) ~&)gt3)l Helgld:S ~JDCllVlSIOII
Comments
Approved~~ Disapproved
~// .... Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
Date~_2.1~7_4~
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
,.1uae ~:$, 1974
;ir. Leslie L. ~rat~atn, P.E.
Tryc~, ~ym~n & ii,yes
740 "I" Street
A~¢horage, Alaska g9~1
SU~ECT: ~ter [~~ts In EK1u~ ~tg~ Su~ivtst~, Lo~ ~'
dear Hr. Bra~t~tn:
T~e Gr~ator Anchorage Are~ Borough Department of £nvtronmnLal Oual i ty hms
receiwed and reviewed t~he engineering plans for t~e w~ter ext~mston to
terwe propertY owned by Mr. Ronald Scnuldt. Our review shows t~t these
plans m~et with all conditions wtt~ watch Lr, ts department is concer~ed.
We will expect to receive as-builts on tJds project once it is completed.
Should you have questions reg&rdtng our review of t~e projact, please
contact t~qe understDmd.
Sincerely,
~elf Strtckland, R.S.
Chief Santt~rl&n
lW