HomeMy WebLinkAboutPETERS GATE TR 1APeter's Ga'te
Tract 1 A
#051-551-11
try
Municipality of Anchorage
(- Development Services Department : fs;�'Yy:
Building Safety Division +•
Onsite Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ckanchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW030490 PID Number: 051-551-11
"aa"'
Van Mitchell
Wastewater System: ❑ New E Upgrade
Address:
19495 Kollander Dr. Chucilak. AK, 99S67
ABSORPTION FIELD
Phone: Number of ltedmoms:
O Deep Trercfr IM shallow Tmhcn O Bee O Mound O Oer.
LEGAL DESCRIPTION
sodRa•g:
7" De" frontoriginal pros:
0.8 GPDrF?
6.0 FI.
Blot*: Ld: Subei"ie"n:
Depth It, Pipe bosom from ongnei grade:
Gravel depth beneath pipe:
Tract 1 A Peters Gate
2.0 Ft.
4.0 FL
Townanhp: Range: setaon:
Fe added above ongnel grade:
Gravel Length:
0.68-1.23 Ft.
57 Ft.
Well: ❑ New ❑ Upgrade
Gravel ehdm:
Nenoer of "es:
(Mu noe between ""•:
5.0 Ft.
1
- FL
Cleselbcation (Private. A B. C):
Total Depth:Gsee
b:
Total aeeoP"rpuon an":
PMatenal:
Private
Ff.
Ft
563 Fe
D3034 & Sch40
Driller:
Date DNed:
Static Water Level:
ln% a :
Date nsuand.
Ft
Dean Const.
5/5/04
yield
ftp Set at:
casing Hoot Abw• Drnnd:
TANK
GPM
Ft.
Ft
SEPARATION DISTANCES
®Septic ❑ Holding O S.T.E.P. ❑ Other.
To
Septic
Absorption
Lift
Holding
PubltUPn vat
"h"r "'tuna.
wudv.
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1250 cel.
Well
100'+
100'+
NA
NA
25'+M•Inul.
Steel
Nunnbarel uonpamhenu:
2
sudaoswaler
100'+
100'+
NA
NA
LIFT STATION
Lix une
5'+
10'+
NA
NA
1250 Gel.
Orenco
Foundation
$'+
10'+
NA
NA
ump an
44"
' ump o "vel at.
42"
Hhyb wemr aW. at.
48"
In.
ti.
in
Ndain Dram
NA
*50'+
NA
NA
A""p 1i1ak•b:doI
Franklin 24
Ebcuhw InsPeobons P«tanhed by:
5040117-1 /2h BR/ KS �ZEC.
Rem"As:
*none known
BENCH MARK
Lo uun and npuun.
field Insulated
Top of gas gauge
Aswm•d E"vaum:
100 FL
Engineers stamp
e'E OF A ��►
• •a. '17,�
.I�
.• a ••. •N•e•• •N••
Inspections performed by: KND Eng nl eerinp. Inc.Dates: 1 st 5/5/04�V
2nd «Kenna W�
..Du'
Development Services Department Approval s :• CE 7116
Reviewed by: Date:IOl9Fpa'••••••••''••v�e�
and approved
i� PIROFESSON'�'�'
(Aa. lzgel
IAS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW030490I
PETERS GATE S/D TRACT 1-A PID# 051-551-11
A -C= 73'
COWNT D:
B -C= 58'
DRAW:
A -D=111'
IB -D= 88'
w <96.3'
D
A-E= 81'
DAM 11/18
B -E=57'
DRO: NW116
A -F=72'
d�
B -F= 48'
:d
SCALE, NTS
Aw OF ALqTE
*:.
CE 71
FESSIO'0' -
' OLD FIZD
lk SCALE, 1' = 50'
NwTcR�FINAL GRADE
nmr�
SEWER ROCK
PREPARED FOR:
VAN MITCHELL
P.O. BOX 671228
CHLIGIAK, AK. 99567
(907) 688-6506
FIELD BOOKS
COWNT D:
B MY.
DRAW:
srM.�a
acam KIAD
wssn�r.
DAM 11/18
M ME
DRO: NW116
At"D ^`E 03103.DWG
" N' 03103
SCALE, NTS
0
2.6
M�1\1 11) ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
FROH : Dean Construction FRX HO. : 6949117
FROM : B~ICK'S ELECTRIC Y FAX NO. : 770--~3~
Ma~. 10 2004 07:22RH P2
~aw, ~ 20~4 06:09~1 P2
1.1425.~lvion ,$'tree~ A nchot'age, .&K 99526
5-I0-04
To who it may e, oucem:
Brick's Electric has performed aU wiring necessary for the Orenco septic syst~a at the fol-
lowing location:
TR lA
P~ter's G-ate Sub'd
Sullen's Rd.
Eagl~ Riv~, AK
All work pe~form~l as per em-rent ~ationaI EI¢¢trica~ Codo
Sincerely,
William Brickwell ~~_
Phon~: 907..345.2923 * Fax: 907.770-2953 * 011:440-9351 ·
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water& Wastewater Program
4710 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW030490
Legal Description: LPETERS GATE TR ...1A 7
Date Issued: Nov 25, 2003
Expiration Date: Nov 24, 2004
Parcel ID: 051-551-11
Design Engineer: 0070 KND Engineering Site Address: 019495 KOLLANDER DR
Owner Name: VAN MITCHELL Lot Size: 165964 SO. FT.
Owner Address: 19495 KOLLANDER DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
CHUGIAK , AK 99567 -
This permit is for the construction of:
❑✓ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907)343-79G4 ( 24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and dosed on the same day.
B. Covered, seated, and heated to prevent freezing.
Received
Issued
Date:
� 2 c/03
Date: Z S 03
Municipality of Anchorage
Development Services Department
Building Safety Division %
On -Site Water and Wastewater Program •�"� ��"
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. _01::� I :E� 1— I I Permit Number SW 0.70490
Property owner(s) VAN MITCHELL Dayphone 688-6506
Mailing address
Legal description (Lot, Block &
Code Ff-f-W
Legal description (Section, Township & Range)
Lot Size QY Acres/Sq.Ft. Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only
Sewer and Well
❑
Water Storage
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
Swimming Pool
❑
Water Softening Unit
Therapy Pool
❑
certify that the above Information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
of property owner or authorized agent)
Date of Payment:
Date of Payment:
Receipt Number: yy,72.Ir Receipt Number:
(Rev. 12100)
KINM ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
November 17, 2003
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Septic Upgrade Permit — Peters Gate, Lot 1A
Gentlemen:
The subject property septic system has been identified to be in failure and the owner
has requested we proceed forward to obtain a septic permit to upgrade the system. On
November 6, 2003 we performed one testhole for the proposed system. The results of
this test are attached. The general slope of this lot is from west to east at a grade of
approximately 5-107o, with steep southerly slopes greater than 25% in the central
portion of the lot.
We have designed our system utilizing the existing testhole that was excavated for the
existing 3 -bedroom house. The lot is served by an individual well, located on the
northern portion of the lot. We propose to install one 5' wide shallow trench. Water
was not encountered during the excavation or monitoring.
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111 /FAX 696-8111.
Respectfully submitted,
KH D Engineering, Inc.
Kenneth M. Duffut,
Attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
Owner/ Contractor Specs
WELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLA
K�D
PETERS GATE S/D TRACT I -A
DESIGN DETAILS
3 BDRM X 150 GPD = 450 GPD
450 GPD/0.8 GPD PER SO. FT. (5.7 MIN/IN.)= 562.5 SO. FT
(562.5/5'(W)) X .5(RF) (4.0' GRAVEL) = 56.25 FT. TRENCH
USE 1 TRENCH - 57 (L) X 5' (W) X 4.0'(D)
Total depth of system Is 6.0' from original grade.
Total depth of gravel below distribution pipe Is 4.0' .
PRESSURIZED DISTRIBUTION SYSTEM HOLE SPACING DESIGN
1. RESIDUAL HEAD = 5'
2. HOLE SIZE = 3/16' = 1.00 GAL. PER HOLE E 30 PSI
3. 30 GALS (PUMP DELIVERY)/1.00 GALS./HOLE = 30 HOLES
4. 57 LF LATERAL/30 HOLES = 1.90' SPACING PER HOLE
NO PUBLIC VELLS WITHIN 200' Q 5. ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS.
NO PRIVATE
SYSTEM NOTES
NO PRIV"TE WELLS EXCEPT
200' TOr E
PROPOSED SYSTEM S VITH AS MOTE0.
NO SEPTIC SYSTEMS VIININ 200• Or 1. USE 1250 GAL S.T.E.P. TANK W/ DUAL OUTLET, INSULATE IF <4' OF COVER.
PROPOSED WELL EXCEPT AS NOTE& 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM.
3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK.
4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE
MIN. 3' COVER IF REQUIRED.
5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
-low14 WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS.
.Aw,q,�s 1 PREPARED FOR:
VAN MITCHELL
P.O. BOX 671228 Scale: 1'= 100'
/ * : 9 / CHUGIAK, AK. 99567
^• • • • •\-. 4 (907) 688-6506 PAGE 1 OF 2
CE -71 a
A�/
Ab' FESS100 -w
FIELD BOOKS
CdMUTCD:
BOtMD"RY:
DRAM:
STAR(
CMEam KMD
"SBLXIT•.
DAM 11/18
DWG. rLL
CRO. NW116
"A' "' 03103.DWG
''DB MR' 03103
ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
9'
'Fo
WASTEWATER DISP❑SAL SYSTEM DETAILS
PETERS GATE S/D TRACT 1—A
GL®FE=FLAT
-1
51'
5-1
Tm
0
12'
EXISTING
3 E®RM HOUSE
SL®EE=0-5%
EXISTING FIELD
TO BE RECONNE
PREPARED FOR:
VAN MITCHELL
P.O. BOX 671228
CHUGIAK, AK. 99567
(907) 688-6506
FIELD BOOKS
co~m.
eomo t
purr
0cCcm KMD
Amuir.
DAR 11 18
Dm ME
Oro: NW116
ACAD ML 03103.DWG
""' 03103
0
X100° wC
Scale, 1'= 20'
PAGE 2 OF 2
LL1dV LW ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
% 7777711
(907)696-6111/FAX (907)698-8111
JK D ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
SOILS PERCOLATION TEST
Performed for: Van Mitchell Date Performed: 11/06/03
Project: Peters Gate, Lot 1A TEST HOLE It 03-1
Depth
(Feet)
ID-
16-
17-
18-
19-
20-
ORG/OL -black/red overburden
S W/sm — med dense, gray, with
tram of silt
GP/gm - gray, mod. dense, tram
of silt, damp &
occ. cobbles to I'
B.O.H.
HOLE PRESOAKED
PRIOR TO TEST
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Groundwater encountered? NO What depth? NA
Depth to water after monitoring? DRY Date? 11/13/03
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
11/06/03
1:00
6"
-
2
1:10
10 min
315/16
21/16"
3
1:11
6-
4
1:21
10 min
41/16"
115/16-
5
1:22
6"
-
6
1:32
10 min
44/16"
112/16"
7
1:33
6-
8
1:43
10 min
44/16"
112/16-
9
1:44
6"
-
10
1:54
10 min
43/16"
113/16-
11
1:55
6"
-
12
2:05
10 min
44/16"
1]2/]6"
'
Water
Added
Percolation Rate 5.71 (min/ in) Perc Hole Diameter_ ""_
Test Run Between 4 feet and r fec
1, Kenneth NI. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
r,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street. Anchorage, Alaska 99501 Telephone 264-4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
•�
NAME
P E
NEW
���
❑ UPGRADE
MAILING ADDRESS ` � •—���; � � �. ����
U /
LEGAL DESCRIPTION
f � S
LOCATION
NO.OF BEQ$pOMS/
DISTANCE TO:
Well O
n r _
Absorptl e. .7r.
DwellmgJ O �, f
No le
u
PERMIT
(�
—Y
62Manufactur
M .r
No. of com ents
W F
Ci
Llq. Ions
IF HOMEMADE:
Inside length
Width
Liquid depth
fi te
DISTANCE TO:
Well
Dwelling
PERMIT NO.
�Z2
_ —
Manufacturer
Material
Liquid capacity in gallons
I
DISTANCE TO:
Well
Fou ti
Nearest I me7in.
PERMIT
2
No. of lines
Length l'
Total orli
Trenchyyd
Distance b t e 11'p�'
'u
Uh �
in
!� inches
� y
H
Top of file finish . !
eWal fx h rile F
S
Total affective absorption at
6_
L. /� in t
3
Length Width
Depth
MFPN
W
d s-
Type of crib Crib diameter
Crib dap
Total effective absorption area
ud
a
DISTANCE TO: Well
Building fou lation
Nearest lot line
Class p
Driller
Distance to lot line
PERMIT NO.
.r
Building foundation
DISTANCE TO:
Sewer line
Septic tank
Absorption arealsl
OTHER
Pit
PIPE MATERIALS
D Ile,
SOI L TEST RATIN
INSTA E
RE A KS
t�
�11�awy7
r 7 •,9D
v 4..
\
Aab.rt A. Shokir
^
2 dt••.•
�f��>VY
C � FES �wPe
AP VE ATE LEGAL ' - + SRU '19CX 10cly •••"^
`JGW
AL'+S:Vt £:577
7 �1riuLE.RIVER.
PH. G04-2070
71-113 (Rev. 3/78) /
MUNICIPALITY OF ANCHORAGE
DepartmentjHealth and Environmental~
rotection
825 'L Street,
26Anchorage, AK. 9y501 4-4720 p cFF
Permit # I * * * HANDWRITTEN PERMIT * * *
N WELL AND/OR ON-SITE SEWER PERMIT
Applicant: 0 tn,ia w % Ili%/yo Mailing Address: /'O. /?e x 77 0J -f P
J NV
Location: %/Q/9C%/-�/pKs Phone Number: l
Legal Description: �%�fitS 0 p �- /�%/C Lot
Type of Soil Absorption System Is:
Trench: i Drainfield: __ Seepage Bed:
Size:
Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br) L L��
The Required Size of the Soil Absorption System Is:
DEPTH LENGTH 2 9 . GRAVEL DEPTH 4 - WIDTH
The length dimension is the length(ih feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet). �� �)
* * REQUIRED SEPTIC(HOLDING) TANK SIZE _ _ L" GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of -residences that the well will serve.
* *.* TWO M INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection and approval by this departmen-
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 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 system in accordance with codes.
(3) I understand that the on-site sewer systemmay equire enlargement if
the residence is remodeled to include more th t edrooms.
Signed: /&d Plexi - /D�--�-"sued
Applicant
Dater d 3
SWP/024(1/81) /
_ O & E ENCA JEERING & DEVELO" ENT CO.
dox 90, Davis St., Eagle River, Alaska 89577
694-2774 or 688-2260
Russell Oyster ' Earl Ellis
694-2774 SOIL LOG 688-2280
Performedfor. Name:-`�gE�Ty—Tel. No.
Mailing Address: �' �d Y, 4JA02,4 ST• �ogr. 1,F_/!/i
Legal Description: / 'e'4GT Z ,, Re =- S (�;14r== �F577ATc s
Depth (fest) Boll Characteristics
0
1 ML 5/c7- %ori
2
3
a 5P Srl�✓DJ (//V/Fo 2/lf faE ro
5-
6 6
7
8
9 / /PLAN
10— SfI�(/DY� LOd/3L✓ / NoT�cAo¢
Ti�f�C,� m F S/LT, DCcAJ',
�- 11 — ..
�dUGDE,2.5 To /�
12-
13-
2-13_ //D ,1/8 42, PERC.TEST
14
�DTTa/t'l l�iT 00q�>>►
.15—jo
(%,......,�q �1
p.:
Ground Water Encountered: Yes—No—!:L'—If yes, what depth : • Earl P. Ellis•
Proposed Installation: Seepage Pi_ Drain Field 1 sr�.• No. t74SE
Prot
' �'"•
P1. F •._ _.•'_•1V i
Performed by: /� ��+o Date-
V-� St lfir BrittinglEgg, OF ANCHORAGE
by OF HEALTH R
ENVIRONMENTAL PF.OTECTION
DOC Co. do&
SULLIVAN WATER WELLS JUL 10 1981
P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 RECEIVED
,
OWNER OF LAND DEPTH OF WELL _� J
ADDRESS �' '' " ' ^ STATIC LEVEL OF WATER FT. /
LEGAL DESCRIPTION 14'
DATE • Started '1 / ' r Ended 4 /,T -
PERMIT NUMBER t / i' I `t
KIND OF FORMATION:
From
Ft. to '
Ft.
j �r : iJ,� . n,.;I
n< c i..'.,r_'C "'�rom
From
FL to I _7
Ft.
r
From
Ft. to
Ft.
Ft.
From
Ft. to
Ft.
From
Ft.to
,
From
Ft. to
FL
From
Ft. to_:.*_
'"` " :. ✓ 7'
From
2 Ft. to
Ft.
c i1 ` i A:7 ice c
From ? Ft. to ! "" Ft. . ?e t r c .` Y/
From Ft. to f'/ Ft. S
From ' ' Ft. to Ft. % % .. r SN ,do
From / Ft. to—Ft.—Cc.9 L%ate=L
DRAW DOWN FT.
GALS. PER HR 4 i _
)
KIND OF CASING Fc r,
From -� Ft. to 3" Ft. I' A:-, 'f `; : - t. •
From 7 / F' Ft. to
From n Ft. to �� Ft.
From '�4Ft. to + 7-' Ft. ! cC '. .. /
From!q'M Fl. to llcll Ft
From Ft. to r� ("E_Ft. 1)
From Ft. to Ft. �=
From Ft. to Ft.
From'S �) S Ft. to �Ft. " r '-
From '+ .✓ Ft. to K" 7- Ft. ' "
From Ft. to Ft.
From Ft. to Ft.-
From
t.
From Ft. to r' ` Ft. c. r` From Ft. to Ft.
From ' Ft. to Ft. LEI c ft From Ft. to Ft.
From Ft. to__2_�LFt. From Ft. to Ft.
From
Ft. to ?`r 1.
FI,
i �; %1
n< c i..'.,r_'C "'�rom
Ft.
From
Ft. to
Ft.
L ' ,d ^' T Z
�7N
! oa From
Ft.
MISCL. INFORMATION:
DRILLER'S NAME
MUt.I I C I'r`FiL I TY QF FItJCH�"`F2F�GE
w.
DEPARTMENT HEALTH AND ENVIRONMENTAL 1 OTECTION
825 'L' STREET, ANCHORAGE, AK. 99501
264-4720
LJEL.L F=*EF:ZM I T
PERMIT NO. C 810104 >
APPLICANT HOWARD M. ERICKSON SR BOX 9030 qq4i671 688-9280
LOCATION SULLINS DR.
LEGAL TRACT 1A, PETERS GATE SUB LOT SIZE 130680 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
14ELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER. INSTALLATION.
F}EFtM I T EXP I FZES E>ECEMBEFZ :lL 981
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 SYSTEM IN ACCORDANCE WITH THE CODES.
SIGNED
APPLIcArrT HOWARD M. ERICKSON
ISSUED
.V4. 0
Development Services bepartment
Building Safety Division
4E- B4
On-Site Water A Wastewater Program
4700 Elmore Street -
P.O. Box 196650`
Mark Begich Anchorage, AK 99519-6650 s r E r r
Mayor www muni.ora/onsite
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW_ Date of Issue:
Parcel Identification Number: Replacement Only: YES NO
Legal Description
TR 1A, Peters Gate
Property Owner Name & Address:
Steve Msdorj
1302 IV. 41st
Anchora e,AK. 99503
Pump Installation Date: 1013112008
Pump Intake Depth Below Top of Well Casing: 273 feet
Pump Alanufacturer's Name: Alyers
Pump Model: 2NFL10-12-2
Pump Size I hp
Pitless Adapter Burial Depth: 12 feet
Pitless Adapter Manufacturer's Name: N/A
Pitless Adapter Installer: unknown
Well Disinfected Upon Completion? ® Yes ❑ No
[Method of Disinfection: Recirc
Comments:
Pump Installer Name: Aarow Pump & IVell Service LLC
PO Box 110496,Anchorage, AK. 99511
(907) 346- 9355
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
.�rrn4 "S16-jq
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0-511-5,S11-1111 HAA
Expiration Date:
1. 'GENERAL INFORMATION
Complete legal description PETERS rATE TRACT 1 A
— —Location (site address or directions) 19495 KO 1 AND R DR. rHIIGA" AK 991;67
J •
Current Propertyowner(s) Charles_ & Tammy Dra_kp Dayphone GAR -7077
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
p
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer ❑
The Municipality of Anchorage Devolopment Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional
civil engineer registered in the State of Alaska. Certificates of Healih Authority Approval are required for the
transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal
and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health
Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well
and may valid
reissued with new water sample results. (Certificates may be reissued for a period of up to one
year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or
a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineees work.
4. 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 Health Authority 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 KNn rNGINEFRING, Inc- Phone (CI07) G96 -61-V
•.. lm N arm,71r.TTAIN:1. ..
.Name .. Duffils Date kTi1`1zIT1k
Engineer's Comments:
This investigation was completed In compliance with
ADEC and MOA regulations. The assessment of the
condition of the well and septic applies only to the
conditions as of the day tested. The flow and absorption
rates may change due to subsurface conditions that
may not be observed from the surface, changes in
land use, local soil characteristics, groundwater levels
that may fluctuate during the year and the water usage
of the family being served by the system. The operational
life of all well and septic systems are subject to these
various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system.
Therefore, KND can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
O
ON-SITE
WATER AND
WASTEWATER
�.,• PROGRAM
Maintenance Agreements
Supplemental Engineer's Report
Other
By: ��. Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division I
On -Site Water & Wastewater Program • • .
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: PETERS GATEF TRACT 1A ParoeIID: 051-551-11
A. WELL DATA
Well type rlvate
Date completed 4/1981
If A, B, or C provide PWSID #
Sanitary seal (Y/N)_y_
Total depth 580 ft. Cased to 144 ft.
FROM WELL LOG
Date of test 4/1 9 81
Static water level 162 ft.
Well production 0.5 9 -p -m
WATER SAMPLE RESULTS:
Well Log (YIN)Y.
Wires property protected (Y/N) y_
Casing height (above ground) 1 8 •
AT INSPECTION
7 b-% ft.
0.46 g.p.m.
Coliform -0--colonies/100 ml.Nitrate 1.50 mg.p.Other bacteria
_0_colonies/100 ml.
Arsenic: JA mg -A- Data of sample: 5/12/04 & 11:2105 Collected by: KND Engine
ering
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTICISTEFIL nate Installed 5/5/04 Tank size 1250 gal.
Number of Compartments Z Cleanouts (Y/N).Y
Foundation cleanout MINI) Y -Depression over tank (Y/N) N High water alarm (Y/N) Y
Date of pumping NA - NEK TANK Pumper
C. ABSORPTION FIELD DATA
Date installed 5/5/04 Soil rating (g.p.d./ft or ft /bdrn)_U System type _TRENCH
Length 57 ft. Width 5 ft. Gravel below pipe 4.0 ft.
Total depth ¢ ft. Eft. absorption area 191ft Monitoring tube Y Depression over field N
Date of adequacy test -_NA - NEW SYSTEM Results (Pasa/Fail) PASS For 3__ bedrooms
Fluid depth in absorption field before test n. Water added gal. New depth—in.
Elapsed Time: min. Final fluid depth in.
Absorption rate
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
'm
D. UFT STATION
Date installed 5/5/04 Size in gallong1250 Manhole/Access (Y/N)Y
'Pump on" level atm in. -Pump off" level at 42 in.Hlgh water alarm level at -4d in.
Datum Bottom of tank Cycles testees_ Meets alarm b circuit requirements?—Y
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAlft station on lot 100'+
Absorption field on lot 100'+
Public sewer main 75'+
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/deanout 10 0'+
Holding tank 1 00'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line S ' +' + Absorption field S ' +
Water main 10'+ Water service line 10'+ Surface water 10 0'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation1 0' .+ Water main _ 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10 ' +
Curtain drain 50'+ Wells on adjacent lots1 00'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION rl/* # gym
I car* that I have determined through field inspections and see •"• »�• ••
review of Municipal records that the above systems are in t/ .... •�••� •,
conformance with MOA HAA guidelines in effect on this date. , to- xm
Engineer's Printed Name Kenneth M. Duffus /.�,
Date R/30/Or
i� pROFES510 �i
HAA Fee S430.00
Date of Payment 31311015
Receipt Number �D
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
• Development Services Department `•-
Building Safety Division
On -Site Water and Wastewater Program s
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.aLus
(907)343-7904
Water Well Advisory
Health Authority Approval # 050126
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block Lot of Peters Gate, Tract
IA subdivision, the well's productivity was determined to be 0.46 gallons
per minute. The minimum well productivity required by this Department
(AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute.
Although the subject well currently exceeds this minimum requirement, all
parties concerned are advised that the production capacity of the well may
fluctuate. Restriction of non-critical water uses such as washing cars and
watering lawns and gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
Municipality of Anchorage
Development Services Department ;
Building Safety Division y
On -Site Water and Wastewater Program
4700 South Bragaw St. " "•
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLIlN`-IGII ''
Parcel I.D. 0.;1-551-111 HAA # ') 0 Z.
Expiration Date: g — ' O 4
1. GENERAL INFORMATION
Complete legal description PETERS GATE TRACT 1A
Current Propertyowner(s) VAN MITCHELL
Dayphone ARS
-6506
Mailing address POR 67129S
SHt MAK
AK 99567
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD
for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY.
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
CommunityClass Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer :
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional
civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the
transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal
and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health
Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well
and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one
year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or
a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the
professional engineer's work.
4. 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 Health Authority 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 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.
Engineer's Printed Name Kenneth M. Duffim Date 5/18/04
Engineer's Comments: OF 41-
This
C
This investigation was completed in compliance with
� �'�r •..-
ADEC and MOA regulations. The assessment of the
01
condition of the well and septic applies only to the
00* ?49Y_W
"•L
conditions as of the day tested. The flow and absorption
rates may change due to subsurface conditions that
•• ...,�,
may not be observed from the surface, changes In
m ; Kenneth
land use, local soil characteristics, groundwater levels�1;
sl:• cE
that may fluctuate during the year and the water usage
4 Eq'••.e..
44zloOF
of the family being served by the system. The operational
,
life of all well and septic systems are subject to these
various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system.
Therefore, KND can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
4���9ieli►tl�I.7
_IC Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X Maintenance Agreements
Supplemental Engineer's Report
_ Other
is
ON-SITE
fATEB AND
kSTEWATER
BOGBAM
By: AZ 0 ` a-t%� Original Certificate Date: , V' O 7
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Sita Water 6 Wastewater Program •'
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
A. WELL DATA
Well type private
Date completed 4/1981
If A. B. or C provide PWSID #
Sanitary seat (YIN)Y_
Total depth 580 ft. Cased to 144 ft.
FROM WELL LOG
Date of test 4/1981
Static water level 162 ft.
Well production 0.5 9 -p.m
WATER SAMPLE RESULTS:
Well Log (YM) Y
Wires property protected (YIN) Y
Casing height (above ground) 1 8'
AT INSPECTION
165 ft.
0.46 g.p.m.
Collfonn -k colonies/100 ml.Nitmte _1.5.Q_mg./I.Other bacteria _0 colonies/100 ml.
Arsenic: _HA mgA. Date of sample: 5/12/04 Collected by: KND Engineering
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 5/5/04 Tank size 1250 gal.
Number of Compartments.2 Cleanouts (Y/N).Y
Foundation cleanout (YIN) Y—Pepression over tank (Y/N)N--High water alarm (Y/N) Y
Date of pumping NA - NEW TANK Pumper
C. ABSORPTION FIELD DATA
Date installed 5/5/04 Soil rating (g.p.d./fe or fe/bdrm)-M System type TRENCH
Length 57 ft. Width 5 ft. Gravel below pipe 4.0 ft.
Total depth 9 ft. Eft. absorption area ,,§§,}fe Monitoring tube Y Depression over field N
Date of adequacy test NA - NEW SYSTEM Results (Pass/Fail) PASS For J-_ bedrooms
Fluid depth in absorption field before testn. Water added gal New depttLin.
Elapsed Time: min. Final fluid depth in
Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N 6 type) If yes, give date
D. LIFT STATION
Date installed 5/5/04 Size in gallons 1250 Manhole/Access (Y/N)Y
"Pump on" level atm in. "Pump ofr level at 42 in.High water alar level aL4A In.
Datum Bottom of tank Cycles tested. Meets alarm b circuk requirements9_y
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 75'+
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots _ 100'+
Public sewer manhole%leanout 10 0'+
Holding tank 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line -5' + Absorption field S' +
Water main _10'+ 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 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+
Curtain drain 50'+ Wells on adjacent lots 10 0'+
F. COMMENTS
OF q
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through fleld inspections and •'� �'
review of Municipal records that the above systems are in ,�•� ,,,,,
conformance with MOA HAA guidelines in effect on this date. t ;
�'' 6 711!
Engineers Printed Name Kenneth M. Duffus
Date 5/18/04
HAA Fee Waiver Fee $ _
Date of Payment S125 5Q�f
qDateof Payment
Receipt NumberS i Receipt Number.
(Rev. 12111)
Municipality of Anchorage
• Development Services Department �, •• "?%°;
j' Building Safety Division '
•u srr
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Water Well Advisory
Health Authority Approval # 040192
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block , Lot of Tract IA Peters
Gate subdivision, the well's productivity was determined to be 0.46 gallons
per minute. The minimum well productivity required by this Department
(AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute.
Although the subject well currently exceeds this minimum requirement, all
parties concerned are advised that the production capacity of the well may
fluctuate. Restriction of non-critical water uses such as washing cars and
watering lawns and gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
�r
-_Nr-rc If 161
on tro
; �-"Xw :an tro, resnim
Itvm*miuion orts
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MUNICIPALITY OF ANCHORAGE v
DEPARTMENT OF HEALTH b HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL PI Sg- Ine1 is
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date Manch 12, 1988
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot. block, subdivision, section, township, range)
PeteA'6 Gate Subdivision, Tnaat 1A; Section 14
Location (address or directions)
Sutten6 Drti0e.
(b) Property Owner Shondat Telephone: Home 688-3847 Business
Mailing Address P.O. Box 670012, Chugiah, Ata6ha 99567
(c) • Lending Institution Telephone
Mailing Address
(d) Real Estate Company and AgentREMAX OF EAGLE RIVER - Launet C4ou6e
Address 16600 Ce;tvt6ietd Dnive, Suite 201, Eagte Riven, ALa6ka 99577
Telephone 694-4200
(e) Mail the HAA to the followino address: or: Check here 6. if hold for pick up.
List contact person and day phone number below.
S & S ENGINEERING1694-2979
17034 Eante Riven Loop Road Suite 204
Eagle Riven Atasha 99577
ondeAed by Launet Crouse
2. TYPE OF RESIDENCE
Single -Family (Q)(
Number of Bedrooms -
3. WATER SUPPLY
Individual WeIVU Community ❑ 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 ❑ 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 72 075 Moo 8'061 From
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 sale, 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 _S4,S-ENGINEERING Telephone
Address 17034 Eagle River Loop Road No. 204
Eagle ituver7AItuilkwV957.7
Date
�4PP•(Tr-�...... •! ori
�
�,`•�•� t�
a.+t
1 %
*'
6. DHHS APPROVAL
Approved for ' �bedrooms by Date
Approved Disapproved Conditional
Terms of Conditional Approval
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.
Page 2 of 2 . 77-025 ins, 8881 Pack
n
n
MUNICIPALITY OF ANCHORAGE (MOA)
MUNICIPAIM OF ANCMHW AUTHORITY APPROVAL (NAA)
SERVICES DIVI CKLIST - FEBRUARY 1984
EµVtROWJ,Ept(AL
264-4744
Legal Description: �E—�— V ` \ _p`
A. WELL DATA RECEIVED
Well Classification t�04`liw� �, If A, B, C. D.E C. Approved (Y/N) 04
Well Log PresentV?N) Date Completed q 8 Yield 'JO (-AQ" =
Total Depth Cased to Depth of Grouting
Static Water Level 111i'2-7 Pump Set At 01�=
Casing Height Above Groun Of
Sanitary Seal on CasingP/ 1) �
Electrical Wiring in Conduit! J) Y_ Depression Around Wellhead (Y/8)
Separation Distances from Well: I
I
To Septic/Hekkag Tank on Lot t d�� ; On Adjoining Lots
To Nearest Edge of Absorption Field or) Lot ��%o r ; On Adjoining Lots c -E
To Nearest Public Sewer Line
Cleanout/Manhole —
Water Sample Collected by _
Water Sample Test Results _
Comments
B. SEPTIC/HOLDING TANK DATA
_ To Nearest Public Sewer 2� 1
To Nearest Sewer Service Line on Lot
Date Installed Size ) G2t5t:2 No. of Compartments 'L
StandpipesdVN) y Air -tight Caps Foundation Cleanout (AN) !-/
Date Last Pum
Depression over Tank (Y($� Ped
Pumping/Maintenance Contract on File (Y/N) 0 ; for
Holding Tank High -Water Alarm (Y/N) 'A Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Flekding Tank: r
To Water -Supply Well \� ' To Building Foundation tis
lar ...............:.
To Property Line loe� !'F To Disposal Field .
To Water Main/Service Line \ y_-, r"- To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-M rRr 81861 From
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 1(��l� Type of System Design
Date Installed
Length of Field 28 r
Width of Field Z r
Depth of Field �� f
Gravel Bed Thickness �nf
Square Feet of Absorption Area J�p Standpipes Present
Depression over Field (Y&P 1J
Date of Last Adequacy Test la - BB
Results of Last Adequacy Test S1S%/1
��(L—•
Separation Distance from Absorption Field:
To Water -Supply Well Ngo
To Property Line :o0 f�
1
To Building Foundation
'
To Existing or Abandoned System on
Lot
; On Adjoining Lots,
1
To Water Main/Service Line
To Cutbank if present)
( I k
To Stream/Pond/Lake/or Major Drainage Course
�
To Driveway, Parking Area, or Vehicle Storage Area
12n f
Comments
D. LIFT STATION
Date In
Dimensions
Size in Gallons
Manhole/Access (Y/N)
"Pump On" Level at
"Pump Off' Level at
High Water Alarm Level at
Vent (Y/N)
Tested for
Pumpin es during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
•• Check Permitted Bedroom Rating Against HAA Request •a
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signe &75-FWNEliRJNG Date
Comp37�3A Fe Ie River Loop Rad No. V6A No. oe 7-�0 3 �� G° •, : "..I rc.
Eapla River, Alaska 377—
Receipt No. Qa7- O 2 N �`' "• +•
Date of Payment 3 -�
a
Amount: $ r1 SK
s` Ltr
oS �o2da�o,6
Page 2 of 2
72-M IR6v 8861 Safk
PROFFSSt�<..��
rAW
MUNICIPALITY OF ANCHORAGE
n
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION1 1'�n'9b
DIVISION OF ENVIRONMENTAL HEALTH _ I ^� Js'a
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
2644720
Application Date2/3/8
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
(address or
GCi
(b) Applicant
Applicant Address
'� c✓4
O .Telephone: Home Business
,V - 67Z70 / Z �itCk
i
(c) Applicant is (check one): Lending Institution 0 ;Owner/builder O ; Buyer 13 ;Other ❑ (explain);
(d) Lending Institution k_�"7 194nQ,
Address
(e) Real Estate Company and Agent _
Address
Telephone
(f) Mail the HWg tbe.fnlipyviA(yfoss:
2. TYPE OF RESIDENCE
Single -Family Multi-Family[3 Other
Number of Bedrooms
Telephone
3. WATER SUPPLY
Individual
Individual Wel,,/Community O Publico
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,L9 Public O Community[3 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 72-025 (11184)
5. ENGINEERING FIRM PROVIDINv 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 regulations in effect on
the date of this inspection.
Name of Firm S & S ENGINEERING Telephone �9�1'Z-f
Address SR B 196X
Date
AK 99577
of at.4o.
we'd A. skefor
►a- lu7a
1.
6. DHEP APPROVAL �>
Approved for bedrooms by to
1 approved Disapproved Conditio
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 engineers work.
Page 2 of 2
72-5111/8,)
MIJOCf►AUTY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE (MOA) DER. OF HEALTH 3
BiVIROWMEMAL PIEOTECTIOW
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 SEP g
284-4720
Legal Description:
A. WELL DATA
Well Classification ONA VkN& If A. B, C. D.E.C. Approved (Y/N) N.%!
Well Log Present {yid) Date Completed N'il?�f Yield r9.6 &PN
Total Depth ��� Cased to y y �r Depth of Grouting "—
Static Water Level ( t; 4 r Pump Set At u • )�
r�
Casing Height Above Ground yc Sanitary Seal on Casing (2)N)
Electrical Wiring in Conduit N)
Separation Distances from Well
Depression Around Wellhead (Y/&
r
To Septic/Holding Tank on Lot /n60 * ; On Adjoining Lots ACV +
To Nearest Edge of Absorption Field on Lot _/� r `f ; On Adjoining Lots 1 Ga I - f
To Nearest Public Sewer Line VA- To Nearest Public Sewer
Cleanout/Manhole 04a To Nearest Sewer Service Line on Lot
rT'
Water Sample Collected by 5 d S BfJbUJd��ZiAlb ; Date
Water Sample Test Results S An 9F4C'TyRy
Comments WA;LL YftIL1b 16Si 5J/0W4b THA yNSU- TD ALPPLACF
I .1 Aums v M. S b;>M
B. SEPTIC/H'". TANK DATA
Date Installed 11-11-785 Size ZED No. of Compartments
L
Standpipes 6)N) Air -tight Caps &N) Foundation Cleanout &N)
Depression over Tank (Y,® Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) N.%t
Separation Distances from Septic/Holding Tank:
To Water -Supply Well /no, :f To Building Foundation b0 +
To Property Line 104-4- To Disposal Field lyrf-
To Water Main/Service Line /C i + To Stream, Pond, Lake, or Major Drainage
Course rl A
Comments
Page 1 of 2
72-0261111641
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Lip �� Type of System Design %MJ%44,N
Date Installed f-4 -83 Length of Field
Width of Field
Square Feet of Absorption Area
Depression over Field (YAS) _
Results of Last Adequacy Test
� r
Depth of Field
Gravel Bed Thickness
_31. IS Standpipes Present (5N)
Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well /r?a r + To Property Line /Orf
r
To Building Foundation t'o� + To Existing or Abandoned System on
Lot — NrA ; On Adjoining Lots Ab "4 -
To Water Main/ Service Line /p• f" To Cutbank (if present) N`
To Stream/Pond/Lake/or Major Drainage Course NIA'
To Driveway, Parking Area, or Vehicle Storage Area /00 1 IL
Comments
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
•' Check Permitted Bedroom Rating Against HAA Request ••
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
I certify th§ LhJLvE necked verified or conformed to all MOA and AA guidelines in effect on the date of this inspection.
Signed S - e1VGUVE Date 8'-
Compan*AeRIVER, AK 99N7 MOA
Receipt No. -14 001 • e0 L%
DateofPayment Q-Q•g�
Amount: $ (A S
Page 2 of 2
72-016 (1 1,84)
&WWI A. sbtiw
Ivn. 1467.4
7;
n MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
2644720 D
Application Date Z G o
1. GENERAL INFORMATION
(a)
(include lot.
s
"I -C A.0
I soh
I If
(b) Applicant Name Ct J_Qrk Telephone: Home 69�6'�EfBusiness
Applicant Address • M
014 e4110
(c) Applicant is (check one): Lending Institution O ; Owner/builder O ; Buyer ❑ ; Other(explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent A *E s2:br&-=1x
Address le
Telephone
a—O
(f) VzW the HAA to the following address:
Telephone
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms 13
3. WATER SUPPLY
Individual Well Community O Public O
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
Onsit� Public O Community O Holding Tank O
Note: II community well system. must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 7s-025111,14)
5. ENGINEERING FIRM PROVIDING ,rISPECTIONS, TESTS, FILE SEARCH, DAI.. AND INFORMATION
3
As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm _
Address
Date u
Telephone
DHEP APPROVAL
Approved for '14bedrooms by
Approved— Disapprove Conditional _
Terms of Conditional Approval
CAUTION
OF At
S 1
w ti or tet,..•. ..,•� 0
ra r
t ban A. Shakr % w/
`• No. W7 -E c r
�+ a •. �
c
Date
The Muncipality of Anchorage Department of Health and Environmental Protection (OHEP) 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 engineers work.
Page 2 of 2
72-025 (11184)
MUNICIPALITY OF ANCHOUGE
MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH 4
HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMEMAL PROTECTION
CHECKLIST - FEBRUARY 1984
3 01%5'
Legal Description:
Dun s C=ro-rr'_ '
A. WELL DATA
Well Classification SAF' If A, B, C, D.E.C. Approved (Y/N)
a 1A,
Well Log Present (2>N) Date Completed 4 - g I Yield - S raT'r_k+
Total Depth Sgo� Cased to t Z� Depth of Grouting
Static Water Level \ 15-11 Pump Set At V .K
Casing Height Above Ground A'>a Sanitary Seal on CasingdJDN)
Electrical Wiring in Conduit®N)
Separation Distances from Well
Depression Around Wellhead (Y9A
too�F
To Septic/HolAing Tank on Lot 1 ea ' �- : On AdjoiningLots
To Nearest Edge of Absorption Field on Lot lt' t : On Adjoining Lots laD'4
To Nearest Public Sewer Line `7 A To Nearest Public Sewer r
Cleanout/Manhole C To Nearest Sewer Service Line on Lot
Water Sample Collected by sA S CS�rNW--^x ; Date q -2-15-155
Water Sample Test Results SL�T1sf &Nnn +.r
Comments tl''' Sdra a_ 'n`ST s
B. SEPTIC 009DWG TANK DATA
Date Installed I\ -1 Size I oars No. of Compartments Z
Standpipes oMON)
Air -tight Caps ON)
Foundation Cleanout<MN)
Depression over Tank (Y/tDate Last Pumped q'u" e�c
Pumping/Maintenance Contract on File (Y/N) : for
03
Holding Tank High -Water Alarm (Y/N) IJ A Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/We" Tank:
To Water -Supply Well (
ot�r4 To Building Foundation (� Sir
t
To Property Line ) o ir''" To Disposal field 1 t
`'+-
To Water Main/Service Line
Course
Comments
Page 1 of 2
72-026(1 li84)
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata t o '8+L- Type of System Design __rR15Y lA
Date Installed L\' I'1-83 Length of Field _LB 1
Width of Field Z4:' Depth of Field I I I
Gravel Bed Thickness 17.
Square Feet of Absorption Area 33 Standpipes Present (DN)
Depression over Field (Yo Date of Last Adequacy Test'I �Z-�44L
Results of Last Adequacy Test
A
Separation Distance from Absorption Field:
To Water -Supply Well __ I � I+ To Property Line 1014 -
To Building Foundation V7 I t To Existing or Abandoned System on
Lot IJ /p ; On Adjoining Lots D �f-
To Water Main/Service Line
i To Cutbank (ii present)
To Stream/Pond/Lake/or Major Drainage Course
r
To Driveway, Parking Area, or Vehicle Storage Area t co t
Comments
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons anhole/Access (Y/N)
"Pump On" Level at "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for
Electrical Codes (Y/N)
Comments
•• Check Permitted Bedroom Rating Against HAA Request ••
Pumping Cycles during Adequacy Test. Meets MOA
I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed 88Ag INEERIx_ Date ,�/Z Ile
Compawy.=Aol $•ALASKA V")77 MOA No. B2JrQD3
S
Receipt No.
Date of Payment ri �j- '•.'fes
Amount: $ al 6
.!
v
:rm
R.b.rt.A. Shl:f•r• � Wr•
Page 2 of 2 def No. lu7•E :�K0
72-026 (It, B41
-
APPLICANT FILLS OUT UPPER HAC�ONLY
Time
e
TI
C
7(j_
VrJ/ y O,.per S%�C l /� � �p,c/ST//L>C' T /G'N
Phone
Date
dt
o - % Zip Coda
/ o� t
a6
Mailing Address/,)
C,Y S ( -T- .30
Inspector
Inspector
Inspector
•7/
Buyer /7, //
/%t r'V e
v.
Address
Zip Code -
Lending Institution���'/I
A-tr !r �+� d/p N,O
Phone
,sr•�Y
Address k //r/F .r //i>/t- %Jr f(/f/i•/� Zip Code
Realty Co. tt Agent
>� v ���v r % ,f' rc/7%/f ^/� �fQ v/y
Phones
^7
Zip Code
( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
Address
�' 3 t
Legal Description
�-,Y/y r- //S+- %�� rr,r's e-
Street Location
DATE_•�-- I S —
Type of Residence
ingle Family
�/� � I
44/16
❑ Multiple Family No. of Bedrooms
Solis Rating D to Sewer Installed Well To Absorption Area
❑ Other
CO l i —� 83 Well to Tank d
Water Su0
divldual
v
ATTACH WELL LOG. A well log Is required for all wells drltletl since June 1975.
El Community
For wells drilled prior to that date, give well depth (attach log It available).
❑ Public Utility
Sewer a
Individual
Year Individual Installed:
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
TI
C
7(j_
Date
Date
Date
Da
v /
Inspector
Inspector
Inspector
Inspector
•7/
v.
Field Notes: a 1��tvw•.� o -'h.
L C7
( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONALAPPRO AL'
g'
DATE_•�-- I S —
BY:
Solis Rating D to Sewer Installed Well To Absorption Area
Well Log Received
CO l i —� 83 Well to Tank d
Septic Tank Slze
v
72 ozs roma