HomeMy WebLinkAboutROLLINS LT AOnsite File
Lot A
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Municipality of Anchorage
Community Development Department Page 1 of 2
On -Site Water and Wastewater Program
4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181428 PID Number: 051-312-42 ❑ New 0 Upgrade
Name:
BRIGGHAM & SARA CHILDRESS
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
15509 HUSKY STREET
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
ROLLINS A
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
92.1
N/A
N/A
N/A
(E)
TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1250G,1.
Surface Water
100+
N/A
N/A
N/A
Material
Number of compartments
Lot Line
5+
N/A
N/A
N/A
STEEL
2
NA
Foundation
10+
N/A
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain50+
N/A
N/A
N/A
Gal.
Remarks* SEE WAIVER REQUEST
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank3034 Tank to
drainfield 3034
JR'S SEPTIC SERVICES
Drainfield CO/MT 3034
Inspector Pannone Engineering Services
BENCH MARK (Assumed elevation) 365.5ft
Inspections,
dates: 1 12/4/18 2"' 1/9/19
Location and description
3"' 41h
SE BOTTOM HOUSE TRIM
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval: Date
AQ TH
t'teven R: '15annone
Approved (����U Date
CE 8149
90,
Inspection Keport_1-1-12.doc
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PAMONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
ROLLINS LOT A
BRIGGHAM & SARA CHILDRESS
15509 HUSKY STREET -
EAGLE RIVER, AK 99577
PROFILE
SCALE: NTS
Date
2./8/2019
Scale
i' = 50'
P.I.D. NO
051-312-42
PERMIT NO.
OSP181428
Sheet
2OF2
Municipality of Anchorage
P.O. Box 196650 0 4700 Elmore Road
Anchorage. Alaska 99519-6650 a (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.org/Onsite
Develo2ment Services Department
On -Site Water and Wastewater Section
Waiver#: WR050013 COSA#: Permit#:OSP181428
PID#: 051-312-42
Legal Description: Rollins Lot A
Engineer: Pannone Engineering Services
Applicant: Briggham & Sara Childress
Your request for a renewal of the waiver of the required 100 feet horizontal separation from the
septic tank on this lot to the private well on this lot has been approved. The approved separation
distance is 90.0 feet. Renewal of the waiver is being granted because the original 1974 steel tank
was 90 feet from the well and water samples taken in 2005 showed no contamination.
This waiver approval applies to the septic tank installed under permit OSP181428 only. Any
future upgrade to the on-site wastewater disposal system will require all separation distances be
met or another approval from this department.
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Waiver is Granted: X Waiver is not Granted:
Date: 3 oc 9 � / Approved by: '
' Name of Reviewer
...................................................aa.....a....a....a.....aaa81
Pannone
noar
4 si eag ? t
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
February 12, 2019
Subject: ROLLINS LOT A
Request for Well Waiver
Design Narrative
This is a request for a separation distance waiver for a septic system upgrade for the subject property. Due to
existing conditions and available space on the property, the plan needed to be modified to enable it to confirm
with a majority of the required separation distances.
1. Waivers: We would like to request a waiver for separation distance for the septic tank to the well located
on the lot with the details specified below.
a. Septic Tank (E): A separation distance waiver between existing well on Lot A and the replacement
septic tank on the same lot. The distance between the septic tank and well is 92.0±, the well head is
also at a higher elevation than that of the septic tank so it is not likely that effluent would travel
toward the well head. We are requesting a waiver for the septic tank to the existing well for a
distance of 90' on Lot A.
L DEC Criteria: The well on Lot A is a private well and was drilled in 1974. The data is
summarized as follows:
LOT #
WELL
STATIC
YIELD
Well Data
H2O Test
Soil
Well
Nitrate
2.68
DEPTH
WATER
Date
Date
Characteristics
Log
Level
LEVEL
Data
Lot A
12S'
45'
0.5-1 gpm
02/14/1974
03/01/2005
Y
Y
<0.145
mg/L
The ground water in this area typically flows from the north to south. The soil cross-sections are similar across
the area and a homogenous cross-section was used to calculate the DEC criteria for all components. As outlined
under 18 AAC 80.020 and 18 AAC 72.021(a), I have calculated the following points:
Lot A Septic Tank to Well:
Distance from sewer system bottom to groundwater
5.70
Soil sorption below sewage system
1.81
Soil permeability below the system
2.00
Water table gradient
4.50
Horizontal separation
2.68
Total Points
16.69
"The sum of the above values could equate to the following conditions: 16-24 Almost sure to be free from any
form of contamination from household sewage." In my opinion, this waiver request meets the above criteria for
Page 2 of 2
approval and does not constitute risk to health. I hope the above information will assist you in determining that
the waiver should be granted.
Granting this waiver will not affect the future development of the surrounding or existing lots. If you have any
questions or concerns, please contact me at 754-8200.
Sincerely,
Q�ycanaa p 4
OF
Steven R. Pannone, P.E.
Owner/Civil Engineer
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MUNICIPALITY {]FANCHORAGE
On -Site Water & Wastewater Program
POBox 19GGsn 470DElmore Road
Anchorage, Alaska 99519-885O Phone: (3O7)343'78O4 Fax: (9U7)343-7997
Permit Number: O8P181428
Work Type: SepticTankUpgoada
Tax Code Number: 05131242000
Site Legal Address: R[)LL/NSLT A G:0653
Site Mailing Address: 1550gHUSKY ST, Eagle River
Owner: CH|LDRESSBR|GGHAMK8&SARA
Design Engineer: PANNONEENGINEERING SERVICES
This permit iafor the construction of:
El Disposal Field 0 Septic Tank Holding Tank Privy
Effective Date
Expiration Date
LotSize inSq Ft
Total Bedrooms:
12/4/2O18
12/4/20iS
El Private Well El Water Storage
All construction shall beinaccordance 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 (18AAC8O)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.G5.Provide notification bycalling (SO7)343-7QO4(24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall beeither:
o. Opened and Closed onthe same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: ]jn� a 111
Issued By: J
/ 7'/�// S/
Date:
Date:
I /
M
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-312-42
Property owner(s) Briggham & Sara Childress
Mailing address 15509 Husky Street Eagle River, AK 99577
Site address 15509 Husky Street
Day phone
Legal description (Sub'd., Block & Lot) Rollins Lot A
Legal description (Township, Range & Section)
Lot Size 40,598 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
(® all that apply)
Absorption Field ❑
Septic Tank
❑X
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
APPLICATION IS AN:
Initial
❑
Upgrade
❑x
Renewal
❑
TYPE OF DWELLING:
Single Family (SF) ❑X
(w/wo ADU)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Dis tance:
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: '/S
Waiver Fees:
Date of Payment: 12-LZZ2
Date of Payment:
Receipt Number: 0 T q36?
Receipt Number:
Permit No. 615,0012 ILIA --9
Waiver No.
Permit App_:•:•._. c:
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181428, Rebecca Carroll, 12/04/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181428, Rebecca Carroll, 12/04/18
?~---, MUNICIPALITY OF ANCHORAGE
DE~ .;ITMENT OF HEALTH AND HUMAN SERL .ES
,~ Environmenlal Health Division
~ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
'ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Na~.e DISTANCES
Nddress , TANK FIELD WELL
LEGAL DESCRIPTION ~ ~ //
Township, Range, Section
AS-BUiLT DIAGRA~ tShow Jocation of well, septic system, property hnes, foundabon,
~ I~ ) ~'~ ~J~ j ~X~ driveway, wa,erboOies, etc.)
TANKS i
~ SEPTIC ~ HOLDING
¢~ ~ ~ Compa~nts '
Material No. of '
. TYPE OF SYSTEM Cl.
~ TRENCH ~ BED ~W. DRAIN ~ OTHER r ~
Dept~ to p~pe bottom from Total depth from original grade ~ /
orlginalgrade ¢,¢ FT q,~ FT T, ~
FIJI added above original grade Gravel depth beneath pipe ~J / ~"
Total~absorptlon&~+. ¢ ~area ~QFT Distance between ii.es ~ FT ~
~ PRIVATE ~ OTHER ddentifvl
, SR B 196X cedily that this inspection was pedormed according to all
Municipal
and
Health Depadment Approval: ·
.['~IEI:::'ARTt"'tli:NT L., HEALTH AND E]',IVIF;.:OhlMEf',IT~L , ,q[)]"ECT~ON
;:~. I I":E:.k:. I ANCHORAGE, AK '::;~;)'::'"" 1
825 L. " ..................... , · .... ¢ -
,:,:.~: 4 ~ 4. 7,..-..(.)
....... t.,::./86
DON ROI..A..INS
P,,O,, BOX 140210
ANC]"tORAGIE .,, Al< 995 :L 4
688 '"" 928 9
t....L:!i:GFd... DESCR l F': SUBD I V I S I ON: NA LOT: 124 BLOCI<: NA
SEC"I'ION: 25 'fOWNSHIP: ;L5N RANGE: 2W
LO'I S i ZE:: 9()0:5? (SC,!. F"F,, OR ACRES)
I cer. t:Lfy that=
:J. ,,]. am ~ ami ]. iar v,]:J.'Lh thE, r(.::~,qLtii"em,:::.~r'Y[.s ~ or' ¢.:)n'""sit~e s~9~er's al~d t4E,~. ].!~ a~ set
f'cH-i:.h by the Munic.::i. pal&ty of An:borage (MOA) and the State af Alaska,
;2, i will ins:tall the ~:ystem in acc:cH"dance ~gi't:.h a].l MOA,cc:)des and r, egu].at~c)ns~
and :i.n compliance w:i. tl"~ the design triter:La oF 't'..h:~: perm:i.i:.,
:%, ]: w:i.$1 adher'e 'Lo alJ. MOA and State of Alaska Pequirements for the set
d:i.~'LarH::;es frc:)m ar'ly exist:i.r]g wel'.L~, wastewater' di~pos~], system or pub].:i.c
sewer'age system (:H"~ th:i.s of any ad:ac:e)nt or nearby ].ot,,
IF A I....IF:'T SI"ATION IS INSTAL..L..ED iN AN AREA COVERED BY MOA BUILDING CODES~
'l'HE]'q (1) AN ELECTR];CAL. PERMIT AND ZhISPEC'/T'I[)N MUST BE OBTAI. NED~' (2) AS-BLIII...TS
WILL. NO'f BE AF'PROVED WI'I"HOLYT' AN ELECTF;'.ZCAt... INSF'EC'T'ION RE]::q]R'T'; AND C:5) THE
ELECTRICAL WORK MUST BE: DONE BY A L. IC',ENSED ELEC]:RICtAN,,
, ......... ..........................
0
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Ii:]'.L...EiX.}I l::~ Z ,{3AL.. WC}I::;'.!<i Jvj!.JS"J' iE{Ei~ ]}(].')J\JJi!!~ ~{{V {.ti J.... '.[ CE]~.tE~E:D Ii!i:L..EE;"! F;~ '.[ C :[ ~.~!1\t.
DATE
'0
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HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
RtSPOSAL SYSTEM
z../ze
ROBERT A. SHAFER
December 7, 1985
CIVIL ENGINEER
694-2979
Mr. Don Rollin~
P.O. Box 140210
Anchorage, Alaska 99514A l
REFERENCE: Lot 124; Section 25; TIEN; R2W
Dea~ Mr. Rollins,
Reference our recent t~lephone conversation concerning the on-site waste
water disposal 4ystem upgrade installed on the referenced property by
RaSmusson Enterprises. As I expl~ned to you on the t~ephone, the
absorption area a~ installed and described by Mr. Rasmusson, and documented
on Municipality inspection report dated May 17, 1985 by u~ is deficient
in area to support a four bedroom residence. The following calculations
show the short fall and upgrade requirements for four bedrooms.
DRAINFIELD:
21 Ft. long; 10 ft. wide; 3 ft. S.R. depth
210 210
AREA = 21X 10 = -~- = 7- = 300 SF
w~1+-~T x100 I0+I+2(3) 100 = 70
REQUIRED AREA FOR FOUR BEDROOM
85 X 4 = 340 SF ~ 300 SF
Short 40SF
UPGRAGE REQUIRED:
21X12 = 340.5 340 OK
12+5
· % depth = 12+I+2~ = 74
Add 2 ft. to the width X 21 fe~t long with 3 feet S.R.;
I run of 4 inch perforated pipe; tied into the existing!u
distribution system
page
Lot 124; Seation 25; TI5N;
Anahorage and two inspection~ ~ill
has b~n accepted and approved
bedroom r~iden~e.
If we ~a~ be of ~th~r 6erring, p~se co~a~
Department of H~lth and Human Services
'O ·
· ~Z * 00£
~.' 00£
gA '0OS:
-"~00' ¢
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
NAME IPHONE
Absorption~oarea t I Dwellin~
%~ex..s~%_l Material~..~~
Inside length J [ Width
I~q-N EW
[~UPGRADE
NO.
PERMIT NO,
No. of compartments
Liquid depth
Dwelling PERMIT NO.
Material Liquid capacity gallons
in
ILEGAL DESCRIPTION
~ ~ DISTANCE TO:
~ [ Liq'lc~gall°ns IF HOMEMADE:
Well
DISTANCE TO:
Well
DISTANCE TO:
Top of tile to finish grade
Total leng~o~ lilies
Length
Type of crib
Nearesi ~lin.~
Trench v~idth
/'~(~inches
DISTANCE TO:
Material beneath tile '~,,P inches
Depth
:rib diameter
Well
PE RialTo_ N 0~,.~
Lo,
Distance between lines
Total effective absorpljon area
PERMIT NO.
Total effective absorption area
Nearest lot line
Distance to lot line PERMIT NO.
tank Absorption area(s)
DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
Z
APPROVED
DATE .,LEGAL
MESSAGE
REPLY
SIC
~T~c~ 4S 472
SIGNED
SEND PARTS 1 AND 3 INTACT -
PART 3 WILL BE RETURNED WITH REPLY.
DATE
POLY PAK (50 SETS) 4P472
L.. E E{i,.q J. }'Z:"::i: '.ii:;C I::;'. :[ !:::' :',
E;L..iii{;[]'t F;: ;[
F:?F:'L ][ []f,:~N'i' ::
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONiVlENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
SLOPE
DATE PERFORMED:
·
10
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER ~%~[
ENCOUNTERED? ' '~ ~ I~
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
)ERCOLATION RATE ~/~ (minutes/inch)
TEST RUN BETWEEN ,/,~-- FT
PERFORMED BY: ' r S'R~ 19~ ~ ~ ~
ROBERTA. SHAFER
December 7, 1985
CIVIL ENGINEER
694-2979
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Mr. Don Rollins
P.O. Box 140210
Anchorage, Alaska
99514
REFERENCE: Lot 124; Section 25; TI5N; R2W
Dear Mr. Rollins,
MUNICIPALITY OF ANCHOI~
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECI'IOI~
BEC g'lg85
RECEIVED
Reference our recent telephone conversation concerning the on-site waste
water disposal system upgrade installed on the referenced property by
RasmuSSon Enterprises. As I explained to you on the telephone, the
absorption area as installed and described by Mr. Rasmusson, and documented
on Municipality inspection report dated May 17, 1985 by us is deficient
in area to support a four bedroom residence. The following calculations
show the short fall and upgrade requirements for four bedrooms.
DRAINFIELD:
21 Ft. long; 10 ft. wide; 3 ft. S.R. depth
210 ~ =' 300 SF
AREA = 21 × 10 =7= .
% ~epth = w+1+2d ×100 10+I+2(3)
100 = 70
REQUIRED AREA FOR FOUR BEDROOM
85 × 4 = 340 SF ~ 300 SF
Short 40SF
UPGRAGE REQUIRED:
21X12 = 340.5 340 OK
.74 --
12+2 = 74
% depth = 12+I+2(3)
Add 2 ft. to the width X 21 feet long with 3 feet S.R.;
run of 4 inch perforated pipe; tied into the existingi'?
distribution system
SRB 196X EAGLE RIVER, ALASKA 99577
Lot 124; Section 25; TISN; R2W
Decem§er 7, 1985
A permit from the Municipality of Anchorage and two inspections will be
required at the time this upgrade is preformed. In the meantime, your system
has been accepted and approved by the Municipality of Anchorage for a three
bedroom r~idence.
If we may be of further service, please contact us.
AS/ss -
¢~: RasmuSSon Enterprises
Municipality of Anchorage
Depar~ent of Health and Human Services
~G£ ER ANCHORAGE AREA Bb ~"~JGH
~/]~/ Department of Environmental Quality
'~ 3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
L OC^T,ON
MAILING ADDRESS ~( ~-0~ ~'~)[~. /~e~ PHONE LEGAL DESCRIPTION ~ ~o~ IZc~ ~/' ~'-
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
NUMBER OF
MANUFACTURER ~/-~4~¢ fTl~E¢~. MATERIAL ~-~ CO NTS ~
INSIDE WIDTH LIQUID DEPTH __.LIQUID CAPAClTY~T~ GALLONS,
(
SEEPAGE PIT:
NUMBER OF PITS /
LINING MATERIAL
BUILDING FOUNDATION
ADDITIONAL ABSORPTION
CRIB SIZE: DIAMETER"~? DEPTH ~?¢ DISTANCE FROM:
NEAREST LOT LINE
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) -~ SQ. FT.
WELL:
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED _
NEAREST
SEWER LINE
REMARKS_
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK SYSTEM
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
PIPE MATERIAL.
LOT SLOPE:
R~EMARKS:
(/ G.A.A.B. --
. Use of Well '
': Location .(addze~s.,of: · To~ip, .l~mge, :Bect~o~,-L[ ~own; or di~t.a~ee mat~ road .'
S~e of cas~g 6 Depth of 'H61e 12~ feet Cased to '1'~ "feet"
Static wa~gr, iegel a~ : ~. ' ft. (~) (below) land surface. Fini~ of well (check one) open end (
-of drawdo~ from ata~ie level. _ .
REC[IVED
· ~ ~ ,'/- ..... '.
- ~ . ..~......~'...' ;.:.... :' . .
.TO "" ' · ....
" RE'CE
TO
.... ~ .~.. ~ .... ~ .:
· 2 ~ State
GrEaTEr ANr~,HORAGE Area BOrOUgh
'IRONMENTAL QUALITY
DEPARTMENT OF EN¥. ~,
3350 "C" STREET ANCH0.RAGE. ALASKA 99505
TELEPHONE 27~:~561
PERMIT NO.
SEWAGE DISPOSAL SYSTEM -- APPLICATION.
NAME OP APRLiCaNT
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
SEEPAGE Pit_ ~/ , DRAIN FIELD , OTHER
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINANCED THROUGH
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQU RED BACKFILLING O~' ANY sYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE Pit ~2~l DRAIN field.
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK ,SEEPAGE PIT , DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK ,SEEPAGE Pit
DRAIN FIELD ~
SEPTIC TANK,/~/~l~./j~]{~, SEEPAGE PIT /00 ,DRAIN FIELD
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND O[JT 0F SEPTIC TANK AND INTO CRIB CROSSING GAP OF
ExcaVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH ~lRTiGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO B~
REGULATIONS REGARDING INSTALLATION.
OR
LICENSED DESIGNER
_ SEEPAGE AREA SIZE TYPE
DIAGRAM OF SYSTEM
[ CERTIFY THAT I AM FAMiliar WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIb SYSTEM IS iN ACCORDANCe WITH SAID CODE.
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A S'INGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Lot~, Rollins Subdivision
Location (site address or directions) 15509 Husky'
Property owner
Mailing address
Rollins
Day phone 696-7089
270-3631 wk
Lending agency
Mailing addreSs
CITY MORTGAGE
Day phone
Eagle River, Alaska/ATTENTION: Mark Truskett
Agent Lola Pederson/JACKWHITE COMPANY Day phone 694-5500
Address 10928 Eagle River Road, Eagle River, Alaska 99577
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well xxx
Community well
NOTE:
Public water
If community well system, provide written confirmation from State AD£C attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: if community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA ~21
Sm
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 wa[er 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 Munici pal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Phone ~/-~-~7~
$ & $ ENGINEERING
Address 17034 Eagle Ri,vet' Loop Road Ne. 21)4
Fagle River, Alaska 99577
Engineer's signature
Date
D/~S SIGNATURE
Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
~ (~¢~'¢~ Date
By: /
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 pumhasers 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 o~ .Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91 ) Back MOA #21
Legal Description:
RECEIVED
Municipality of Anchorage ,~i~ )CT 1 4 1991
Department of Health & Human Services ~eCipality of Anchorage
HEALTH AUTHORITY APPROVAL CHECKLIST alth & Human Services
A. WELL DATA
Well type ~-¢,/'~c'¢
Log present J~/N) ~
Total depth \ '/..5 ~
Sanitary seal ~)'N)
if A, B, or C, attach ADEC letter.
Date corn pleted
Cased to ~,?-o '
FROM WELL LOG
Date of test
Static water level
Well flow '/1~
Pump level ~--
ADEC water system number
'¢' ~[ -'J ~ Driller ~/~- Xe-~
Casing height
Wires properly protected {~)'N) ...YMuNICIPALITY
OF
ANCHORAGE
AT INSPECTIONENVIRONMENTAL SERVICES DIVISION
o~ - "l~ -"l ~ OCT 14 1991
'57,2
g.p.m.
.[..CEIVE D
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot ~C) ~'~
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/c leanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed 1
Cleanouts (~/N)
High water alarm (Y~:)
Date of pumping
Nitrate
Collected by:
Other bacteria
$ & $ ENGINEERING
17034 lESlie River LOep Road Ne, ~04
Eagle River, Alaska ~$~"'/
Tank size \ '7-~'~.-~ Compartments
Foundation cleanout ~)/N) ~ Depression (YXJ~
J~ Alarm tested (Y/N) '"~J~
Pumper ~..~.- ~¢~5,¢oc) ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot \ DC> t~' On adjacent lots
To property line \ o Absorption field
Surface water/drainage ~ 0 C~ ~¥
Foundation
Water mai n/service Ii ne
Z-c) i
72-026 (Rev. 7t91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y~
.WefFon lot On adjacent lots
Manufacturer
Manhole/Access (Y/N) .~
.~'"'"'~'Pump off" level at
.~~Gycles tested
Surface water
D. ABSORPTION FIELD DATA~
Date installed
Length ~-I
Total absorption area
Depression ove~ field (Y~J~
Results(]~/fail)
Peroxide treatment (past 12 months)
Soil rating ~ ~/I~_
Gravel thickness ~ ~
Cleanouts present (~)/N)
Date of adequacy test
for l,~e~.~-'~' '~
System type
Total depth
~*d~J If yes, give date "'~l,~,
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot \~t~- On adjacent lots '~c~Ot~' Property line \~t~-
To building foundation '~f~ ' To existing or abandoned system on lot
On adjacent lots ~ ~ ~ Cutbank Water main/service line
Surface water ~ ~ ~ ~ Driveway, parking/vehicle storage area
u rtain drain ~
E. ENGINEERS CERTIFICATION ''
I ce~ify that I have checked, verified, or conformed to all MOA and HAA guidelines in ef~~ate of this inspection.
~. O~~' ,A~ ~.
$ & S ENGINEERING
~. , 17034 Eagle Ri~er L~p Road N~.
~,gnature ~ '
~5~d~ ~ver, Alaska 9~7~
Engineer's
Name
Date /~- 1/~( ~* ~
~;.. ..~
HAA Fee $ ' ~ Waiver Fee:
Date of Payment ~ ~/~- ~ ~ Date of Payment
R c i.tNu er )
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received October 12, 1976
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1:30 p.m.
10-15-76 Friday
Pratt
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
Lomas & Nettleton
4449 Business Park Bldv.
Carl A. Dashnaw
Phone: 274-7661
Phone:
3. Legal Description: T15N R2W Section 25 Lot 124
4. Location: Chugiak
5. Type of facility to be inspected Single Family
6. Well Data: Individual
A. Type
C. Construction
7. Sewage Disposal System:
A. Installed
C. Septic Tank: 1. Size
D. Seepage Pit:
E. Disposal Field:
8. Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
No. of bedrooms
1. Absorption Area
Total length of lines
B. Depth
D. Bacterial Analysis
On-site system
B. Installer
2. Manufacturer
2. Material
, Absorption area
, Other contamination
, Absorption area
, Sewer Lines __
C. Absorption area to nearest lot line
F0-~34 (1/74l P~nm 1 n{ fwn n~nm¢
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection~-~ CMRO VA '~//
2. Property Owner: ( ~ ~e-- ~-- .~, ~~)~)/7 z~)
Mailing Address:
3. Name of Buyer: c~-~,
FHA CONV
Day Phone:
Mailing Address: ~ Day Phone:
Name of Lending lnstitution: ~-~:::~,~'~/4._~ ~
Mailing Address: Phone:
5. Name of Realtor or Agent: ~'q,~O,~ (~ ~--'~ ~.,~
Mailing Address:~)~/-~, ,/~/~'~ ~ ~]~' Phone:
6. Legal Description:~O~ /~ ~ ~ ~ ~ -/ /5 ~
Locat on=
7. Type of Facility to be Inspected:
No. Bdrms.
Water Supply
Type of Supply: ~//
Public Utility.
If Individual, number of dwellings presently served
.Individual
/
If Individual, depth of well.
Sewage DisPosal System
Type of System:
Public Utility.
Individual (on-site)
If Individual, date of installation
72-003(3/76)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received July" ? " 1~, 19~6
~~0,~~ / ~ ~Z?~ c~' ~'~ '~ TD~~ ime :fi InspecTion 2-_~. m.. /~':~:~
~~L, ~ ~ ?~/~ ate 0 . n~pect'0n 7 6 Frida~
~ ~., ~ND~W~U~L SE~E~ ~ ~TE~ F~C~L~T~ES · ~eaZe
voa.
1. Approval requested by: U, nited Bank of Alaska
Mailing Address: 645 G Street
2. Property Owner: Carl A & Bonnie J. Dashnaw
4.
5.
6.
% Mat Sullivan
Phone: 278-9526
Phone: 688-3130
Mailing Address: Post Office Box 501, Eagle River
Legal Description: Lot 124 Section 25 T15N R2W
Location:
See map on back
Type of facility to be inspeCted
Well Data: Individual
A. Type
Single Family
B. Depth
No. of bedrooms 4
C. Construction
Sewage Disposal System:
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
D. Bacterial Analysis
On-site system
B. Installer
1. Size 2. Manufacturer
1. Absorption Area 2. Material
Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
, Absorption area /~
Other contamination
, Absorption area
, Sewer Lines
C. Absorption area to nearest lot line
D~.^ I ^-¢
Page, 2 of two pages - Red st for Approval of Individual .c '-~.r & Water Facilities
L~gal Description T15N R2W Section 25 Lot 124
Comments
Date
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)
o
~;' MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street,' Anchorage, Alaska 99503 -- ~1
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACI/LITIES
VA FHA
Type of Inspection:~_.
Mailing AddreSs: ~"0~ '"~-'~//
Name of Buyer: ~~ ~ ~~'~~'
Maili(g Address; ""~~
Name of Lending In.itutio~:
A r.s:
Mailing Address:
6.' Legal D~scri'ption: Lo'cation:
Type of Facility to be inspected:
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well .
No. Bdrms.
Individual
/
9, Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Individual (on-site) ,
EQ-037 (1/74)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FAC]L]T]ES
FOR
v.ao
Date Received
Time of Inspection
Date of Inspection
January 5, 1976
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
Spokane Mortgage
Carl A. Dashnaw
Post Office Box 501, Eagle River
Phone: 277-0543
Phone: 688-3130
3. Legal Description: Lot 124 Section 25 T15N R2W S.m.
4o LOcation: Chugiak
5. Type of facility to be inspected Single Family No. of bedrooms 4
6. Well Data: Individual
A. Type DR///~/]
c. construction
B. Depth A!~orox. 130'
D. Bacterial Analysis
e
Sewage Disposal System: On-site system.
A. Installed 7._~_ ~z/ B. Installer -/~/~/-
C. Septic Tank: 1. Size /ZS'~) 2. Manufacturer
D. Seepa§e Pit: 1. Absorption Area '~O 2, Material X ~/7~
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank ~-~ , Absorption area
Nearest lot line ~// , Other contamination
B. Foundation to septic tank ~
C. Absorption area to nearest l°tline __
Sewer Lines
, AbsOrption area
(1/74) Paae 1 of two oaqes
~age 2 of two pages - Re~ ;t for Approval of Individual ~ ir & Water Facilities
~Legal Description Lot 124 Section 25 T15N R2W
Comments
Approved
/~ Date
Approval Valid for one year from date sigq~n-e~~x~LyK//
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
~ccurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 'C" Street, Anchorage, Alaska 99503 - 274-4561
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH &
ENVIRONMENTAL PROTSCTION
JAN ,5 1976
RECEIVED
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER F~CILITIES
1. Type of Inspection: CMRO VA ~/ FHA CONV
2. Property Owner: ~')~-~__~L
Mailing Address: ~, ~ ~/ ~.
3. Name of Buyer:
Mailing Address: ~ ~, ~/~ Day Phone
4. Name of Lending Institution: ,~O~&
Mailing Address: ~~~hone
5. Name of Realtor or Agent: '~~
Mailing Address: ~~)"+~~~
6. Legal Description:
,' Location:
Type of Facility to be inspected:
No. Bdrms.
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
Individual
/
Sewage Disposal System
Type of System:
Public Utility
Individual (on-site)
If Individual, date of installation
EQ-037 (1/74)
Pgge 2 of two pages - Re st for Approval of Individual ! er & Water Facilities
L~gal ~escripti0n T15N R2W Section 25 Lot 124 S.M.
Comments
Approved _~/,/~,,~.~m~z~%-~ Disapproved
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 a'nd
accurate representation of~e subject sewer and water facilities and these facilities
are operating satis~actor/Jly.) t~
SIG~ED~/~//_'~/~/~?~-~---3 Da /,~ ~_
EQ-034 (1/74)