HomeMy WebLinkAboutROLLINS LT BOnsite File
Rollins
Lot B
#051-312-43
u. u. li ii u. m N m
cN M O N CD
o o M.LX 00
C:) d. d* t
LO
n c c N 3 p
c n c d co
z H 2 U / � IJ
m O a p� N N t O m V J 7 Colo, (
0 (D m CL 0
> > N U U ` I
a m m c ai m m m M M �Y�i• �' U •�
U � r a =3m a) O O �C • �c. �'
1 N ca o U o U z U w M M 4� • '`•-C�.i
o M d - LL mLO N E a z U J {`1 T`
j r c J o c (1) `N\,�`�1�
a �, > p c- z d Q I— Q m a)
� m _w O co 0 m� m z C = J O _ ; 2 �p
ca LL LL
� aC) 0 � N
rn p Z W ro Lo a Q I_- z W a Y LL J
��V � ° _ �� fir- � v, ° Y w a pa
L O W .° F- 0 a.a� O Q ° ® O O F= O c U � > rio c
� j Q. � p m a >o a) o `o � z H m ¢ Q cu Q O O E
Cf)Q a.
Z p ~ fn ❑ c a m m Y `° W m Q m >m V o ~ a p
❑ _ n m > Z � (U � > d z cu �-- cu Q
W d p^ Q U) o u_ c� F°- Fa-��� _I� ¢ a m � m Z
�m + Q F-
D- � O ur 3 c ED U O
v ° E 0 N z � W Q
W p o r�yy -
o~ m M J W U CY � W
co Cl) ❑
Q p ct o to o Fm- CO Q
N L p it Lu � n _ F- F -U- v
O C Z m o } W IL
N cy) ui O
W � i i i i O d m
O Z ❑ U, rn a= Z Q z to co N
LL
O
O Q m � N d z a
� � N
N W W .Q-0 + + + W X Q Q >
Tl--
; z Z �)LL Lr)O LO O Z Q W Q
Co Q ° H Q O > C� co N N H n
M Q (0
COLL a� W J a _ + + + + Q W o "' >
_ _ w o
O O U z ~ LO F w -1 � M c~n Q-
L Z o
z UEn Q J o Z Q - c 0 -1 0 LL .2 c C (� «
a pp J a m .D Q O U
•o M Q U c Y a) g`
m�-' Q00 c 0 -J c a m 0 m U) U m II Q u
O �Q -2 1- L w -0p 3 w o i° E Z N o. � c U Q c
a_ p z� to V o J to � Fm-' U) tL � c c U CO Q
-VL'002 M„6Z,L040 S
b
(6
V
,CL -00C 3„0C,9 L.00 N
co
V-
1
(oLO
� Q
O 4-
a _I
N
N
F
H
W
O
J < zm�wn
I I
I
3
Z a N^N\��
2
o O
m
m
� o 0
/ M
F,
0
0
E
O
U
F
O Mtn
2' a?
ma
moo
Y O
' m
6.0' 34.5
F F-
rn
m
0
W USz NW z 2
��nzx�v'3z'nIQ-
N
U
Z
U�> QZOQ °�O
W
m
28.0'
w m
tY
0
E O
0
o =o
�
U
o c� $°d
,CL -00C 3„0C,9 L.00 N
co
V-
1
(oLO
� Q
O 4-
a _I
N
N
F
H
W
O
J < zm�wn
I I
I
3
Z a N^N\��
2
o O
m
m
� o 0
/ M
F,
0
0
E
O
U
r
2g'3
V a 0 O W
a?Wx`ao¢+Y
N
�-- �
m
0
W USz NW z 2
��nzx�v'3z'nIQ-
O_
W
U
U�> QZOQ °�O
(%)
Z
F W Q 3 C-1 ln� 2 N
(/1 2 D O
0
IWi
z
w o o Z.c ¢ ¢
o c� $°d
wm s��t- o
�/
U)
O
C',
z
Z¢ W M W¢ 0 0
ONN-M,-
X Q
3
,-
- < 0=
U
ZNe
Mz,
a
LL
=
NZS~�
O UCkf 0
W
m WO
o�Q�mW^0,
N
” m
,CL -00C 3„0C,9 L.00 N
co
V-
1
(oLO
� Q
O 4-
a _I
N
N
F
H
W
O
J < zm�wn
I I
I
3
Z a N^N\��
2
o O
m
m
� o 0
/ M
F,
0
0
E
O
U
o
Z
C
m
0
�
o
�
Y
o
o c� $°d
�/
U)
-0
D
aY�
m i5-
Z
3
,-
0
o rt== no
W
n
U
4—
m WO
U
= LLJ (7)LL
N
UaY
W
rn
m
m
I--
FY� Q
�—
Q Y c0
0
OQQ
�¢�
6N
J
>(nWL
WQ'�W60
d d "t (Y) M d' d' lf')
Z
Q }- Ib
��n
� � �
II II II II II 11 II 11 II II If II
UUPPW WLL-L, CIO==
-.1
_j
n W
WZCOCD
vJ
�
00M
. r
I I I I I I I 1 I I 1 1
Qf�QPgQWQWQWQW
O
ry
�Wt"Q
W��W
LL
OUB
to z
z
0
r �
a W
W
T W (/I
T I � 4QJ
� W
J
o � m
fV Q
W �
O
CD Y
w
w
b o ,0'£6
p26.'
J T
/ � J
-VL'00£ M„6Z,L0.00 S
J�
O J
J
\ W
fit!
U
\ 1�
Q
h
W `
a
34.5' C n
r= d
a a �p
� w
00 L'I
N * O
x
28.3' a
Lu
r U z
z W
Y
F -
.4.
x¢ z_
U Q
O� U
,£L'00£ 3„0£,91.00 N
,9'OVL
00
d 0
co N
z T
J
00
Q
:o
W
in
0
v
11
Ow
w
x
w
U
( I I
N
x
N
,0'0£
(
N
O
0
00 L'I
N * O
x
28.3' a
Lu
r U z
z W
Y
F -
.4.
x¢ z_
U Q
O� U
,£L'00£ 3„0£,91.00 N
,9'OVL
00
d 0
co N
z T
J
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT ; 907-343-7904
On -Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Well Decommissioning Lo
Legal Address: �yr.Key
Subdivision IC)��I �S B1ock Lot
T R Section Lot
On-site Water & Wastewater Section certified contractor performing the well decommissio 0 g:
Name�
14- Signature: // �
Com, Pad I i uc Wa'w
Well decommissioning date 5(J dJ_ Method of decommissioning: AMC 15.55.0601-1 a. ❑ b_ ❑ c. rVI
Location: Use the space below to provide a drawing of the property showing the following items:
• North arrow
• Decommissioned well location
• Location of other water wells on the property
• Two separate swing -tie distances for each well shown on the drawing
Note: The swing -tie distances shall be measured from either permanent structures or the property corners.
CCN
G:\ueveiopment 6erwcesu3widing Satety\On Site Water and Wastewater\Forms\Client FormstWell Decommisioning form.doc
a°" "Pp"``�• MUNICIPALITY OF ANCHORAGE
i
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
t,
Anchorage, Alaska 99519.6650 Phone: (907) 343-7904 Fax: (907) 343-7997 ll a hUpJ/vAvw.muni:.org/onsite
�icea ' s
On -Site Wastewater Disposal System Permit
Permit Number: OSP221211
Work Type: Septic Upgrade
Tax Code Number: 05131243000
Site Legal Address: ROLLINS LT B G:0653
Site Mailing Address: 17838 ALMDALE AVE, Eagle River
Owner: HOPE PATRICK R &
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Disposal -Feld- O Septic Tank ❑Holding Tank ❑ Privy
Effective Date:
Expiration Date:
711/2022
7/1/2023
Lot Size in Sq Ft: 49439
Total Bedrooms: 3
Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either.
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
r Special Provisions:
• Provide the Well Decommissionng Log with the IR.
Received By:
Issued By:
CI IZO�ZZ
7/1/22
Date:
Date: Z
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-312-43
Property owner(s) WENDY WATKINS & PATRICK HOPE Day phone
Mailing address 17838 ALMDALE AVENUE, EAGLE RIVER, AK 99577
Site address 17838 ALMDALE AVENUE, EAGLE RIVER, AK 99577
Legal description (Sub'd., Block & Lot) ROLLINS LB
Legal description (Township, Range & Section) _
Lot Size 49,439 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
Fx
Initial El
Single Family (SF) El
(w/wo ADU)
Septic Tank
Upgrade 0
Duplex (D) El
Holding Tank
❑
Renewal
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
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 59 5 Waiver Fees:
Date of Payment: 4,/ 17 h 0 0 Date of Payment:
Receipt Number: t Receipt Number:
Permit No. 0 S R�� I a I ( Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
CD �j
0
First Water
..
®-- CONSULTING
..� WAIERJ"NASIEWAIER
SOPPORT 8PEA UNING
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
September 8, 2022
Municipalities of Anchorage
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT — OSP221211
LEGAL: ROLLINS LOT B
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank and system on the above referenced lot. It was discovered that the groundwater levels have
changed since the original permit submittal and we propose to install a 1500 -gallon Advantex
system per the attached design to serve the existing 3 -bedroom residence. The existing system
will be decommissioned in place and a new leach field installed per MOA required code. The lot
and area are served by private wells and the septic upgrade area has 5% slopes or less along the
toe of the hill. The design will not impact any of the neighboring properties. Please contact us if
you have any questions.
Sincerely,
i
Curtis Huffman, P.E.
First
W d le v
ccwscuil+c SERVICES
C � WAIEA/WASIIWAIER
SLPPO➢1E Pl ANNI40
GO
DESIGN CALCS:
3BR X 150 GPD = 450 GPD
450 GPD/3 GPD/SF = 150 SF SAS
150 SF / 5'WIDE W/ (0.5'ED) = 30 FT. TRENCH
USE 1 TRENCH - 30'(L) X 5'(W) X 0.5'(ED)
TOTAL MAX DEPTH FROM EXISTING GRADE: -2'
ADD INSULATION AS NEEDED & USED REDUCED NO DOWN SLOPES >25% WITHIN
SOIL APPLICATION RATE.
50' OF PROPOSED FIELD.
NOTES: STAKE PR❑rNTY LINE & WELL RADII PRI❑R ❑ MO RUCTI❑N
AMY AVENUE
O� SO' BW RESERVATION
M
S 89'491 E 1 .00' 20' T&E EASEMENT
n/
12.9' z 15.7' SHED DECOMMl WELL SSIONED %aL
NO (LONGER EXISTS
{ •• THI 3 IS AN ADVANTEX (AX20 POD)
SE TIC SYSTEM. MAINTAIN 3'+
\ TO DBSERVED (9/7/22)
GRAVEL GROUNDWATER PER DESIGN.
DECK MA TAI 2'+ TO ANY
t.D OB ERVED GROUNDWATER IN
_ _ANCHOR ADVANTEX N OC OBER.
3 BED y,g'
TANK AS REQUIRED HOUSE
WITH 4CY OF CONCRETE. 1�
Lot A ,s- Lot B Lot 123
m 49.439 e.f.
t]1 SL
tYEOiH a t Re01D.,6r,WAN o
9a3 NLT AtmYID ADYAM
zo ANC" W r A1¢o rto
AxoM NWACr.M N
�®ot �� ; r/ oto AM
WCROA N >EDI1t REID RAT
A9 R91ARD PEA CCLE
w
SEPTIC ADDS PNP ,tea,„
RASH AA Ax TAP MWELD
To mm RtE3D.
AVP,eDac
ItoA"R L
� Txa—t
tW MLRAous �
mAi¢ eo' 0 RAL
=AM
roRL
AL
0 WELLS WITHIN /
50' OF PROPOSED _
ADVANTEX " W4a49184.79 DEBASED ON LANG
SEPTIC SYSTEM. ASB DWG & MOA DATA.
Lot 129C SEPTIC I Lot 130
SUPPORT SERVICES: _
ROLLINS LTB � ®®®®
AZ
PREPARED FOR: % �� OF<Q�
WENDY & PATRICK HOPE /��'
17838 ALMDALE AVE F� �* 9 TH
EAGEL RIVER, AK 99577 / I
FIRST WATER CONSULTING DATE: 9/8/2022 tis Huffman
13030 SUES WAY SURVEY: LANG CE 128991
DRAWN: FWCS 1 9/8/2022�
"
ANCHORAGE, AK 99516 SCALE: 1 = 60' ®®ossiozz�'
907-350-9566 FirstWaterAK@gmail.com PAGE: 1 of 2 ®®®�
DESIGN DETAILS:
INSTALL NEW 1500—GAL ADVANTEX TANK SYSTEM WITH AX20 POD. MAINTAIN 10'+ FROM
FOUNDATION, 50' TO WELLS, 50' TO SURFACE WATER, 5' TO FIELD & DECK SUPPORTS WITH
4' OF COVER OR INSULATION. ADD INSULATION & MOA SAND AS NEEDED ... & INSTALL NEW
30'L 5'W 0.5'ED TRENCH AT 2' MAX FROM EXISTING GRADE. INSTALL PER AMC 15.65,
15.55, & MASS... TANK BEDDING, SEPARATIONS, MATERIALS,...
GRAVEL
\ DECK
6.0'
�� rn
�9 N
o�Gs I 3 BED 4.9'
I -n
I HOUSE
d -
O
O
FCO
r�
W FENCc ECK
Lot B
Lot A o FOR 49,439 s.f. N
(O DCO- —
MH i DECOMMISSION EXISTING S.T.
O 1985TH o & INSTALL NEW 1500—GAL O
p S&S °Q FULLY ASSEMBLED ADVANTEX
2.0 3-4BR TANK W/ AX20 POD O
ZOR WITH 4CY OF
Neu 20�} DCO CONCRANC PER MANUFACTURER (n
SPE & MOA CODE
DECOMMISSION EXISTING
W/ DCO BE RE & AFTER TA
ENCROACHING SEPTIC FIELD �� CO FLAT
AS REQUIRED PER CODE. q
MT
SEPTIC IF D ANCHORED
REQUIRE,
BASIN AFTER AX AP 2.0 M�NM�M %
TO NEW FIELD. MT WELL
CO
_ APPROX.
/ 100' WELL RADIUS
\TH22-1
100' WELL RADIUS
NO PRIVATE WELLS VVITHIN STAKE 50' WELL RADIUS
50' OF PROPOSED A ANTEX PRIOR TO INSTALL
\
SEPTIC SYSTEM. \
ROLLINS LT B SUPPORT®SERVICES: F ®®®
PREPARED FOR: ® �`S� AZ4
WENDY & PATRICK HOPE
17838 ALMDALE AVEC ®* 9 TH \Y*EAGEL RIVER, AK 99577
0 tiKj�O
FIRST WATER CONSULTING DATE: 9/8/2022 tis Huffman
SURVEY: LANG f
13030 SUES WAY DRAWN: FWCS CE 128991
' 9/8/2022 eAr
ANCHORAGE, AK 99516 SCALE: 1" = 30' e
PAGE: 1 of 2
907-350-9566 FirstWaterAK@gmail.com ®®®®0 ,a-
0
F�rs[ Wafer
..
CONSULTING
,�-WATER/YJAST EI AIfR
. SUPPORT E PLANNING
13030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL:— ROLLIN LOT B
DEPTH
Depth to
Water
Net
Drop
FEET
OG
SOILS
1
6"
5 5/16"
2
6"
ORG/OL
"
6"
5 4/16"
3
6"
4
6"
5
6
GM/GP
7
8
:.'•
Silt increasing w/
9
depth
10
11
12
13
14
15
16
17
18
BOH
19
20
CO
ASW
TH
I..
�.• .
Curtis Huffman
CE �(���al�cq•.9 8/22991•.������/
OpROFEWQAA
PERFORMED FOR: PATRICK HOPE
TESTHOLE # 22-1 DATE PERFORMED: 6/17/22 1
GROUND WATER ENCOUNTERED: YES
IF YES, AT WHAT DEPTH: 9'
DEPTH TO WATER AT MONITORING: 8'& 5'
DATE: 6/27/22 & 9/7/2022
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
Reading Date Gross Net
Time Time
Depth to
Water
Net
Drop
6/18/22 10 min
6"
5 5/16"
"
6"
5 5/16"
"
6"
5 4/16"
"
6"
5 4/16"
"
6"
"
6"
PERCOLATION RATE 2 (MIN / INCH)
TEST RUN BEWTWEEN 4 & 5 FT
PERC HOLE DIAMETER 6"
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16 TH
PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 9/8/2022
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR GREEME T, Dein the "AGREEMENT" made and
entered into as of this a ODa of of 20 and between
tween
P -0 h rein 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 AN ADVANTEX SYSTEM
l�r�+nA �+ (�crr�l rjconrir�+innl
u,�vu a.a_� `lvsu.l uv.a valN oval)
ROLLINS LOT B
2. Maintenance, Repairs and Alterations.
cxOwner is required to read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
i;nth- ta'i A111YTe service amd. m.-iYrov;&r apYr,a:'edby the Municipality or - ie
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.
It shall be the responsibilityof the Owner durin the term of this Agreement
g to pay for all
repa.r(s), maintenance, .'.�j;5t;::e^t(S), iel»iluvviiiviit ;sus, u'a'a'uj :':'13YS:1�".n�✓�st.. T}:is
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.
S!i
AIIII7iT` r�»r e ihn nn+nnti a)
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
-L 1 Vf 3
�� Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
wner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance vdth AN4C 14,60.0 0.
wner agrees to grant the Municipality reasonable access to test and inspect the
11 laAWWTS. The Municipality will give at least 24-hour notice.
y", Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
0.wner agrees *,hat the AEVWTQ. i„ tallutii.„,1,1 and maintenance requirements, u,. 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.
2 Tnrm Tho +Arm of K.1 s -Ag e-ea?:r...T3t shall begin Lei': the -date -of appmval 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.
4. 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 purr hereof or the right of the Munici.pulity
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.
5. .T',:: iydieticn : C.".Dice of L.- .v. _ y �i3.,il action. a:isirg fay: this Agreement shall >3e
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
jurissd.ct.on, shall net in validate the remaining provisIons-of the �� g.Pe:::ent.
"V a
(rev. 05/18/2018) Page 2 of 3
ature) Date: Jl�
l �
name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this—�L day
(�.A- � , An A !( i vm vtj/ " (
NOT'RY PUBLIC FOR ALASK r
My Commission expires: n 0(
MUNICIPALIT
,Y
:
By: IN J::(signature)
(print name)
MORGAN HUMMEL
Notary Public
State of Alaska
My Commission Expires Jan 1, 2026
Date: q 2 Z Z
Title:
(rev. 05/18/2018) Page 3 of 3
Lot 113 / \ i Lot 114A
-- ----- f- ----- - I
AMY AVENUE
� .. I 50' BLM RESERVATION
O
M /-- — $ 69'49'0 "E 16 .DD' \,�-20' T&E EASEMENT
12.9' z
Lot A
�p/E 0/E. p/E — D/ p/E p/E — 0/E p p/E \
1
.1' SHED WELL
O
X00' I
1 RST
h�C l
GRAVEL .
\ - DECK
6.0 N
43.5 56 4 3.3' m N
j 3.8' p _
I 1 STORY 4.0' q9'
1 a RESIDENCE / 46,9 \
n I /
p 28.0 \
M 11.9' % 24.3'
CARPORT ..
SEI
Lot B
49,439 s.f.
WELL
(n
Lot 123
\ O
N 89'48'49"W 164.79' \ /
I
I
Lot 129C Lot 130
I
PLOT PLAN AS BUILT 2 SCALE —11= GRID NW 653 Project No. 22-356/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, i n C , (907) 522-6476 Phone 000Op�OO
(907) 522-4625 Fax o 0 F q X04
Professional Land Surve ors kenOlangsurvey.com
Y F............. q 4
jonathanOlangsurvey.com
o�,�Q'• •.'r -DO
I hereby certify that I have surveyed the following described property: O* 49TH Q
LOT B. ROLLINS SUBDIVISION (Plat No. 86-119) r/Q
Anchorage Recording District, Alaska, and that the Improvements situated thereon are """"'..... '
within the property lines and do not encroach onto the property adjacent thereto, that
G
no Improvements on the property lying adjacent thereto encroach on the surveyed �'A KENN H LA G r
premises and that there are no roadways, transmission lines or other visible O n G
easements on said property except as Indicated hereon.�S-5202
, yJ 00
O
Dated this the 2� Day of Tui -L Zo22 at Anchorage, Alaska �44�QRO�SSIONA&�o�
It Is the responsibility of the owner to determine the existence of any easements, ��Opoo�a
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
~-~ MUNICIPALITY OF ANCHORAGE-=~-'~S
DE ITMENT OF HEALTH AND HUMAN SER
: Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
' ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~,~ DISTANCES
^--dd .... [-'~hJ_ ~l ~ ~ ~ SEPTIC ABSORPTION WELL
~, ~ ~ ~, _~q~ TANK FIELD
LEGAL DESCRIPTION
~ Subdiwsion
.or ~ ~,~ ~,~ el~ FOUNDATION
Township,
Range,
Section
[~ AS-BUILT DIAGRAM tShow Iocabon of well, septic system, property eries, foundation,
' ~ )~ ) ~ ~ . ~ ~ ~ d ...... y, waterbodles, etc)
T,. S .,... N
Manulactu[er · Capacity in gallons
TYPE OF SYSTEM
~ TRENCH ~ BED ~W. DRAIN ~ OTHER
D~pth to p~pe bottom from Total depth fro~riginal grade
or,gin~, 9~d~ ~, ~FT ~ ~ FT
Fdl added above or[gmal grade Gravel~ depth beneath p~pe
Gravel length Gravel w,dt~
~O,O ~T ~0 FT ~ ,
Total
Distsnce
bet
....
lines
Number of hn~s ~oH ratm~ P~pe material
InstalJer Date Installed
WELLS ~-- ~
C PRIVATE ~ OTHER {Identilv)
Class~hcatlon (A,B,C) 3otal Dep[h Cased to
REMARKS:
,,
Scale: I Il~
I '-~' cedilv that this inspection was peflormed according to all
Municipal and State guidelines in effect on Ibis date: 5R B 19bX
,.
Health Oepa.ment Approval: ~ ~GLE RIVER, AK 995~ D.te~AY
.
~-x. MUNICIPALITY OF ANCHORAGE~-~h
Departmen~ ~f Health and Environments Protection
Pouch · =
6-6.~0, Anchorage, AK 99502
264-4720
On-site Sewer/Water Permit
HANDWRITTEN
Permit No:
Date Issued:
Applicant:
Address: ~ ~'
Legal Description: S/D: ~ff~
Section:
Lot Size:
Township:
(Sq. Ft. or Acres)
Lot: f~ Block:
Range:
Lot Location:
Max Bedrooms:
Listed below are the options available to you in designing your septic
system. Choose the option that best fits your site.
TRENCH BED W. DRAIN
Depth to pipe bottom(ft~)
Gravel depth (ft.)
Total depth (ft.)
Gravel width (ft.)
Gravel length (ft.)
Tank size (gal.)
Soil rating (sq. ft./bt)
** Gravel length 75 feet requires multiple runs (not exceeding 75 feet each)
** Tank mnst have at least two compartments
I certify that:
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.
3. I will adhere to all MOA and State of Alaska requirements for 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 the maximum number of bedrooms
stated above, and any enlargement or modification will require an
additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN
(1) AN ELECTRICA~P~-~MIT AND INSPECTION MUST BE OBTAINED; ~(2) AS-B~ILTS WILL
NOT BE APPROVE~t~WIT~OU~ - ~ AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICA~I~/ ~ LICENSED ELECTRICIAN.
SIGNED: K~~ _ DATE:
Applzc n~--/~
tSSUED B~y: -~~ ~ ~-~-~ DATE. ~ ~--~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~'~ ~'~'~Z-~ ~--~-----~P~
LEGAL DESCRIPTION: Lo1'- ~*~,,¢¢~
1
2
3
5
6
7
8
9
12
13,.
14-
17-
18-
19- No, 1457-E
20-
DATE PERFORMED:
Township, Range, Section:'~\~¥~ ~. ~. ~..~
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
L
IF YES, AT WHAT O
DEPTH? P
E
Depth to Water ADer ?,- ~
Monilorino? ~l/ Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN __ FT AND FT
PERFORMED By: ;;;~;~'~eer'P~J ~/~~--/_ ~'~ CERTIFY THAT ,HIS TEST WAS PERFORMED IN
ACCORDANCE W~"~%~T~~AL GUIDELI~ EFFECT ON THtS DATE. DATE:
N.00 ~6' $2"E !330.72'.'
300.72
300.7.~
300.74'
.74. ~._.
$ & S Engin~erlng
s~ ~96x CL~NIPUTATION SHEET
Eagle ~ver, A[as~ce 99577
DATE:
SHEET
BY
CKD
/OF
DATE:
s.~r 7_ o~
BY
CKD
Tom Fink, 825 "L" Street
Mayor P.O. BOX 196650 Anqhorage, Alaska 99519-6650
343-4744
January 9, 1989
Donald J. Rollins
PO Box 140210
Anchorage, Alaska
99514
Subject: Lot B Rollins Subdivision
Permit #880029, PID ~051-3t2-43
A permit issued by this Department for an individual well
and/or on-site~ sew.er system~has expired as of December 31,
1988.
Permits are issued on a calendar year basis by authority of
Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system
not installed, by the expiration date.
If you have drilled the welI, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as-built inspection report
(three-part form) must be sent to this office for review and
approval, and for documentation.
When applying for a new permit, the fees are: $90.00 for
an on-site sewer permit; $50.00 for a well permit; $140.00
for a combined sewer and well permit.
If there are any further questions, please call this office
at 343-4744.
Sincerely,
Daniel J. Roth
Acting Program Manager
On-site Services Section
DJR/ljw
enc: Copy of Permit
~Z. '00£
~o ~]L'0££ '3,,g£ ,91 oO0'N
':JA~? "' 93J/VNO8
T
WELL LOG
Wheaton Water Wells, Inc.
M MnPAUTY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
Box 1218 - Wasilla, Alaska 99687 - 376 - 2041 JAN 2 � 1989
RECEIVED
OWNER Don Rollins DEPTH OF WELL _ 400'
ADDRESS P. 0. Box 140210, Anchorage, AK 99514
WELL—SITE Rollins Subd.�
LOT 4-2Z5 C 1
STATIC LEVEL 41'
GALS. PER MIN.
SCREENED
BLOCK PERFORATED
No
DATE 4/20/88 SIZE OF CASING _ 61,
KIND OF FORMATION:
142
143
Soft Green Rock
FROM
0
Ft,
to
4
Ft Topsoil/Humus
FROM
143
Ft.
to
156
Ft.Bedrock
156
157
Soft Rock Water
FROM
4
Ft.
to
8
FtGravel/Loam
FROM
157
Ft.
to
267
Ft.Bedrock
267
276
Soft Green Rock
FROM
8
Ft.
to
42
Ft Hard Pan
FROM
276
Ft.
to
308
Ft.Bedrock
FROM
42
Ft.
to
53
Ft. Hard Pan/Mud
FROM
308
3V7
Ft.
to
317 Sandstone
—FtgQdr-o k
53
92
Ft.Bedrock
364
366
'187
Soft Black Rock
FROM
Ft.
to
FROM
36h
Ft.
to
Ft- Bedrock
FROM
92
Ft.
to
93
Ft Shale
FROM
387
Ft.
to
389
FtSandstone
FROM
93
Ft.
to
142
Ft Bedrock
FROM
389
Ft.
to
400
Ft Bedrock
Ntti
orn
rnrn
ch c+ i
rnrn
ll
Q^i Cb
co L
E
CL
O
>
00
A
O
cu
0
z
o a
U
0
.O
LL
Z 0)
J (1)
N
W C.
Z
W 0
C9 U
T—
U)
U
ca
a)
U
c
O
U
O
J
A
U
N
0
cu
cm
c
C
N
cu
co
U)
a�
N
T-9
X
Q
0
0
c
cu
E
_ cu
LL
Z N
n 0)
Q
'O
z c D
J LL N
J N N Q
W �
Q
LL
W ® ❑ ❑
a.
H
N
MI
C
00
W
In
LL
w
W
m
Z
M
Q
O
M
CO
w®❑❑❑
W
J
�
W
m
W
W
>
Q
W
J
❑
Z
W
W
Q
=
LL
LLZ
>
LU
J
E
Z
.2-
I
LL
O
co
CO
z
o a
U
0
.O
LL
Z 0)
J (1)
N
W C.
Z
W 0
C9 U
T—
U)
U
ca
a)
U
c
O
U
O
J
A
U
N
0
cu
cm
c
C
N
cu
co
U)
a�
N
T-9
X
Q
0
0
c
cu
E
_ cu
LL
Z N
n 0)
Q
'O
z c D
J LL N
J N N Q
W �
Q
LL
W ® ❑ ❑
a.
H
N
MI
C
00
W
In
LL
w
W
m
Z
M
Q
O
M
CO
w®❑❑❑
a)
�
L
a
a.E
W
(6
O
a
❑
E
Z
.2-
I
LL
O
0
mc
O)
L76_
O
m CO
E
LLQ
CL
'C
O
=
O
U d
I—
>
J
�
L
a
a.E
O
LL
>(1)
>Q)
(6
O
a
❑
E
Z
.2-
I
W
>
O
LL
0
E
U
Wa.
>
0
U)
CD
6
2
CD
iI
m
a�
LL
CO
0
N
c�
O
N
cu
0
�
L
D
O
LL
>(1)
>Q)
(6
O
a
❑
E
Z
.2-
I
iI
m
a�
LL
CO
0
N
c�
O
N
cu
0
0) = 0 L a)
E30
c o E
C cn cu
cu 3tc 3 co
)L C ,c LO " c
:Y cn +� \
�
�o�CC
c>o0 E
a) c (n O`
.V 6 OU
Q M Q c
Co—CU cL .0 o L c .-...
cn ca a)�
O 'c
L L >
>°ns aa)o
a) 0 0 c o °i
-.r- O O cn
ma)O�a)-(1)
US Q� = LF
c 7 u U)
6 m ca cu '>
> � -C >,
O a) Fu ca
CLa)'vQi.o E
cu Q. L i U
� < CU a) �
0C)
s_ cn
} E' on3�a)
c�a)E-L-
n a) O c I?
> U) �- CU V c
WOOS �.QO
W U) cu - a O :
zoco2>O�
oc=O
Q cl,
Z D p O O E a)
W �0 3
}O0a)O
m O U (6 .0 O U c
Y
4= � U
c
Z a) .� O c6 0
CCU:
I-- O 3: N Ec
Ua)=CD ,U - O UO
W X+ O2I-
d � `n a) co
U)
cu . CCU: 0)- ca
O ca c
cn a) t -
`. y
O — Q Q U cn O
E O c=n — < a)
E
Z-0 a) L C O :5—
LU cn
c () 5, a)
LD -O cn — cn
LU nz
a��i-n
C: a)
WQ o o.��� a)
ui
� o
U-
4--
0
a)
m
z
cn
O
a)
..O
Eo
90
r
• = N rn• w O
c Q mID``� HORA rri
__ �o�o GF r%
`° `
�� �0� 0.N aNi`� tioin
•�
N E•C m a 7 N
Q) N U a) u) 7 \ `
aa)) 3 0 a6i a) m R+ �.
a)D) c tL dr FE
30=ovC-
`P `i �c` :
n
ar
X42 ao TO �Q 5��.0
a�
�Lv
3E�o-0L��mJ�/Jl���P1111111\�
c 0 0 0 V m a) O a) _
co
na=ia>3LW 3L0MwE E�- Z m :3- O ! ,
c
U u) a N E.U. m N O c O
N ..U. L m 1p O (0 U L L L
(D cll
.O. O L to a) — m N 'D "O
U N
E~ (u cn.-15 c T•` O p >
U 'Oto m a) .�75 m LL
Q
NooEm°'o�aimnT
Q Q�
m m 3 m O cv
3EmLcEr 4> Q Q a) c6
O V) _= O� Q~ L) L m m >
m m .o o m ._ Q (D W i O
m U O p N V) U E U= I L. E E �-
cnUcc�mm=E�ca a) a) O
> m o o ,N E c a° O U O c
CL a) a� a`; Y ° -o T2 N Q `>^, ll>^, O O
'O TrOnt ="O O Q`O N
w C C L U O= •O U
Om2 F= cc fn
O N N .O > N C d
O -C Q 7 U O >. a) a) U ycl
U m my 3:12 •v
N
a)
co
0
a)
cu
U
a)
co
c
P
O
S
m
En
6
H
z
W
U
F-
a
ti
O
U)
a)
ou
0
U)
Y
U
a)
L
U
Q
O
Q
Q7
Q
a)
I
I
E
0
C)
E
E
0
0)
0
W
E
as
0
z
X
cu
0
cm
cu
E
to
0
C:
(n
ZI
uo
0
0
a)
"
z
'NJa
-j
co
>1
QI
(L
to
IN
1
(D
0-
_j
>,
z
WC
Z
w
o
cu
— 0
4—
0
CY)
<
x
Z
<
>
m
E 6
CL
1
,L=m
CU
C
W
(1) >
C
CL
0
-0
U)
m
a)
�
o
C
0
O
0
4—
0
.2-
a
-0
C:
—
U)
E
z
W
Z
<
zi
CL
E
=
a
4—
0
0
coo
"
cm
C)
m
0
0
E
a)
(D
0
-Fo
0
0
-0
0
4—
0
0)
cu
C:
n
cu
CY)E
CD
>
0
to
(1)
E
0
C
C13
0
o
>0
ch
v
co
_0
CL
CL
0
0
04- a) 0
0
w
0
0 N
0>
O)a
-0
1— 0 a
cu c
U)
a)
(1)
CL
-0
�o
E
w w
G
❑(n
o m -0 C.)
w 0 0
E
0-
(D
Cl U)
(D>
-0
0
Er
a) cu
o- a
U)
co
-0
cn CO
4—
E -o ID
>,
rn
tm
c
a)
C:
0
0
0 -Fu E
U)
cu z
0
:E -0
C)
U) 07 a)
El
M
El c."
E
S 00
E
>
2
cn
U)
a)
E
Co
Z
>1
(n
—
4—
OE00
a)
N
An
z0r;l
0
U0
>
CU
m
a)
2.1
C:
co
—
t
a)
off
a)
(D
oa)—a).cOE
U)
0)
co
0
E
=3
a
O
C
OC/)
co
0
U)
.(n
C
a)
=3
NO
a)
E
0
U)
0
a)
a)
co
a)
cn
0
D)
L)
a)
L)
<
U)
2!,
OU
U
O
+
04
0
U)
4i
0
O
004
CN
0
-0
04—
cm
a)
0)
0
c
-0
w
E
(n
C:
C:
C:
:3
<
-E
0
0
00
.2
2
0
u)
to
co
—
a
cm
0
-0
CN
CD
cn
CL
>
o
p
c0
CD
+
.—
—
0
-0
v
Lr-
=
Cc
L-
CL
(n
>
0)
<Q)
U)
C)—
_j
0
=
N
-0
-0
W
(D
0
q—
Co
4-
0
0
co
O
(n
ca
CUc
C f)
U
E
,
C)
co
!t
ED
0
0
()
0m
U)
E
0
C)
E
E
0
M-
U)
E
0
2
_0
a)
J 'O)
LU
C:
W 0
Z LL
a)
-0
— m 0
U) n '=
CL
El
Q -
a) co
-0 a)
< W U-
E
E -0
CU a)
-:R
31104
(1)
co
_0
0)
Q1
W
E
as
0
X
cu
0
cm
cu
E
to
0
C:
(n
ZI
uo
0
0
a)
"
W
F—
Cl)
'NJa
-j
co
>1
QI
(L
to
IN
1
(D
0-
> -
U)
>,
z
WC
Z
w
o
cu
— 0
4—
0
CY)
<
x
Z
<
>
m
E 6
CL
1
,L=m
CU
C
W
(1) >
C
CL
0
-0
U)
m
a)
�
o
C
0
O
0
4—
0
.2-
a
-0
C:
—
U)
E
z
W
Z
<
zi
CL
E
=
a
4—
0
0
coo
M-
U)
E
0
2
_0
a)
J 'O)
LU
C:
W 0
Z LL
a)
-0
— m 0
U) n '=
CL
El
Q -
a) co
-0 a)
< W U-
E
E -0
CU a)
-:R
31104
(1)
co
_0
C
Q1
W
E
as
0
X
0
cm
cu
E
to
0
C:
to
z
'NJa
-j
co
>1
QI
-0
to
IN
1
- a)
Ma
>
w
-0 cc
-0
"
.
m
"
cm
C)
m
0
0
E
a)
(D
0
-Fo
0
0
-0
0
4—
0
0)
cu
C:
n
cu
CY)E
CD
>
0
E
0
C>
0
o
>0
ch
v
vi
_0
CL
CL
0
0
04- a) 0
a)U)
w
0
0 N
0>
O)a
-0
1— 0 a
cu c
U)
a)
(1)
CL
-0
�o
w w
G
o m -0 C.)
w 0 0
E
0-
(D
Cl U)
(D>
-0
0
Er
a) cu
o- a
U)
co
-0
4—
E -o ID
>,
rn
c
C:
0
0
0 -Fu E
U)
cu z
0
:E -0
C)
U) 07 a)
El
M
El c."
E
S 00
U)
W
U
z
FQ-
cn
25
z
O
4
Q
CL
W
rn
R
+1 +II
0 0 0 0 0 0 0 0 3 0 0:
o z Z z z Z z Z Z c Z z
Al N U? cn N N to • N O
a) O a) a) O N N O a) p to to rn
0 ® ® ® ® ///
U N cu m
Al 70
Lnco C) c N
m Al �' o -a w o Al LA -�
O N O O O O cn
LQ O a) U O –� O Al n to J Y z
a) a) — W c c -a c n l W
COCO aa)) Al m cuan`�I Al cn 4- m i _ W
Q °
° coi O o o O E W o
E 3
E .>_ o c o o a m d U W ro
U) z Zj
� O
= 0c
O
Lo
p
co
LO
II I I I I I I I Q ZoCo
o
z z° z z z °n' O O O O o o 0 0 ° O Q
cu z z z z z a, z z z z z CL Q) c
v= a
� o
U) U) cn to to C to to O to to °� to U) w to to o : v
_" N Q)
nl❑ ® ❑ AI® ® ® ® ® ® ® ° ® ® ® ® ® U O m c
6 0 o in c
C o a) Z W U tzCc
O n l u- n l m o C o W �- m, a)
con l c Q. 2 c c Cn n l ii Al n l o O W W mots)
"J �C ° O L 'a 0 n I a) C O _O N CD V ~ U a) U Q
I� as Q o = nl Q a nl nlco w
a O
L
o ii 0) cn o °CD
U- ni U L c ni 0 a) W X W
c c c c Q O c c `O p J c to W W z =' O
H c O .c c a) u- O m as ,� LL o a) z I--
0 + c
0 0 °n c to o C n cA Q cn as O z C9 g
U L c Q] L L L c U L L U Q z
CL0 cu cu
v> o a 0 0) a) E a Q 0 c� W > W o S
U) z Q z U ca co 0
nu m !i Q ti m 0- u)
\
Lot 113 / / \ Lot 114A
-- -----f--------------- — I
o AMY AVENUE �--------
• ..• I 50' BLM RESERVATION
S 89'470'�16 .00' I �-20' T&E EASEMENT
0
Lot A
T
TOR7DENCE
11.9' X 2CARP
SEF
Lot 129C
Lot B
49,439 s.f.
/ 46.9
/ h
m
28.E cV
n
O
b
O
164.
to
WELL -
\
Lot 123
I
(
Lot 130
I
PLOT PLAN _ AS BUILT X SCALE 1" 440' GRID NW 653 Project No. 22-356/A1
Daryl Avenue, Anchorage. Alaska 99515—
�30,
94s9Lang & Associates, inc (907) 522-6476 Phone
(907) 522-4625 Fax "oQ�Okl
Professional Land Surveyors aoF q
o44
Jonathanolongsurvey.com
1 hereby certify that 1 have surveyed the following described property:
LOT 8, ROLLINS SUBDIVISION (Plat No. 86-119) p '. 49TH 4p
Anchorage Recording District, Alaska, and that the Improvements situated thereon are """"�
..............
within the property lines and do not encroach onto the property adjacent thereto, that Q
no Improvements on the property lying adjacent thereto encroach on the surveyed Q • • •
premises and that there are no roadways, transmission lines or other visible Q r, KENN 6�
easements on sold property except as indicated hereon. Q (p�Zo`ZZ
520.
Dated this the 20 Day of T,>w-at Anchorage, Alaska Q •• o'`Jc��
It is the responsibility of the owner to determine the existence of any easements, DOpppao�
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
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 SINGLE FAMILY DWELLING
3"1 -- ~1 '~- -- L/ _~ HAA# I~--~C~,Q,/"~,~"-'}(''~!
GENERAL INFORMATION
Complete legal description
Lot B, Rollins S/D
Location (site address or directions) 17838 Almdale
Property owner
Mailing address
Lending agency
Mailin. g address
Agent
Address
Cheryl Rolland Day phone 267-1313
PO Box 230316, Anchorage, AK 99523
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
3 ~
Individual well XXX
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
XXX
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
S & S ENGINEERING
Name of Firm ~.7o3d E.-.g~¢. 2;;~, L~, ~,,,,d N-. ~ Phone
Eagle River, Alaska 99577
Address
Engineer's signature
D~/HS SIGNATURE
Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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.
Municipality
of
Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVIC,E?~,~,~ ~ .~i ~".~'.~,'~u~~l
Environmental Services Division ~.~.~ ~:~¥~S DIV~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description: L_ ~ 'T-- ~ ~ 0 ~.~ ,~ .~' Y '//~) Parcel I.D.:
A. WELL DATA
Well type ?R ~ ,,/~ T~._
Log present (~N) ~ & ~ Date completed
Total depth L/ o 0 Cased to L/O ~-
Sanitaryseal~/N) ~f'4 ~ ~ u~,,~,~, c,~)
If A, B, or C, attach ADEC letter. ADEC water system number ~
Casing height (above ground)
Wires properly protected ~/N)
Date of test
Static water level
Well production
FROM WELL LOG
g.p.m.
AT INSPECTION
g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: / e/*/'f / O ~
B, SEPTIC/HOLDING TANK DATA
Date installed 5- / / -/ //~? (~ Tank size J 0
Foundation cleanout (Y/~ I~ c/~,~,~ Depression (Y/~
Date of Pumping ~ ct / ~ ~'/~/~' Pumper
Collected by:
Other bacteria
$ & S ENGINEERING
~,703~ c_:?~!= Rh;-_r ! _-'~'~ ~=~1 No. 204
Eagle River, Alaska 9~577
Number of Compartments ~L Cleanouts ~N)__
,v 0 High water alarm (Y/I~. /v 0
V¢ J'
C. ABSORPTION FIELD DATA
Date installed ~ /I 7 / ? G
!
Length · ~ o Width
Soil rating (g.p.d./~ ~. j 15'" System type
Gravel thickness below pipe ~ Total depth
Effective absorption area ~J q 5'- ~ r Monitoring Tube present ~/N)''/~ $ Depression over field (Y/~
Date of adequacy test ct ~ ;)-';~ I °i ~' Resul~Fail) /~/~ ~'~ For
Fluid depth in absorption field before test (in.); ~ ~ 7' Immediately after/¢ 77 gal. water added (in.):
Fluid depth '~ ~ (ins) Minutes later: '~/~ Absorption rate = /'i/.~'O 'Y .g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~ ~'~ ~. w~ ~, ~,~ If yes, give date --
bedrooms
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles t.'est_.Q.d~
Size in gallons
"Pump on" level at* ~at*
E. SEPARATION DISTANCES
F.
SEPARATION DISTANCES FROM WELL ON LOT TO:
/
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
/0o
!
IOo +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
I I
Foundation ~' +- Property line ~' ''~ Absorption field
Water main/service line ! o -/- .Surface water/drainage / o ,~ ~ Wells on adjacent lots
/O -/-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
!
/ 0 + Building foundation / 0 Y-
Property line
Surface water
Curtain drain A) o ~ ,g
ENGINEER'S CERTIFICATION
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent hots / o o
I certify that I have determined thru field inspections
inconformance~th~O~Tguid~esineffectonthisdate.
Signature '~/'~ - ~~
Engineer's Name ~ ,I/3 ~.,~ 7- ~-. ~'~'c~ ~
Date ~o //~ / ~ ~
HAA Fee $. ~ E~)g~. .4~ O
Date of Payment
Receipt.umber
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site ~address or directions)
Property'owner 'Do~
Mailing address
Lending agency
Mailing address
Agen't, .., ..
17838 Almdale
Ea~l~ River, AK
Eaqle River~
Day phone
AK 99577
Day phone
Day phone
696-5686
Ad dress
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~ ~
TYPE OF WATER SUPPLY:
Individual well ×XX
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XXX
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
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my inves.tigation 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 ~ ,t
17034 E~gle River Loop R~d No.
Address E~:~ ~:v~~~ '/
EngineeCs signature
Phone
Date
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
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 purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-4325 (Rev. 1/91) ~ack MOA ~21
Legal Description:
A. WELL DATA
Well type ~¢-~qr~rfz~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744
Health Authority Approval Checklist
If A, B, or C, attach ADEC letter. ADEC water system number
Total depth
Date completed 4 ~ 2.o -~ t~
Cased to 4o [ ¢ Casing height (above ground)
Sanitary seal {~q)
FROM WELL LOG
Wires properly protected ~
AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 Nitrate ~, [t2> Other bacteria
Date of sample: ~ -' \ ~ ' °l~'-
B. SEPTIC/HOLDING TANK DATA
Date installed ~"'-'V'/-~3 I... Tank size
Foundation c[eanout(~)N) q 2~' Depression (Y~ r~ High water alarm
Date of Pumping ~/-9.-I-4'1~ Pumper
C. ABSORPTION FIELD DATA
Date installed ~-~ I~/-~8 L~
Length' ~ ' Width ,5--/ Gravel thickness below pipe / t Total depth
Effective absorption area ~t/5"~( Monitoring Tube present'q) ~ Depression overfield (Y~
Date of adequacy test ~ ~ t ~ 9 5-- Resul~ail) ~,~-~$ For ~ bedrooms
Fluid depth in absorption field before tes! (in.); ~ ~ Inunediately after ~8o gal. water added (in.): /3"
Fluid depth 2 5~ Minutes later: 7, (in.) Absorption rate = /~tor~ ~' g.p.d.
Peroxide treatment (past 12 months) (Y~) r.[oM& t/-~otdt4 If yes, give date
Collected by: $ & ~ ;;NGiHP;g~NG
17034 Eagle River Leap Road No. 204
Eagle River, Alaska 99577
Number of Compartments 'Z-- Cleanouts ~ ~./
Soil rating (g.p.d./ft2 or ft2podrm) //~'~/~& System type
D. LIFT STATION
Date installed
Manhole/Access (Y/N) "Pump on" level at*
High water alarm level at* ~-~~atum
Size in gallons
~'~l~ump off' level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank ou lot I c>C~ ~ lc ; On adjacent lots
Absorption field on lot \ C>c:;>~ ; On adjacent lots
Public sewer main t~/,~ Public sewer manhole/cleanout
Sewer/septic service line ~Z~' ~ ~ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~ ~ 4--- Property line I c> ~ Ir- Absorption field
Water main/service line / o I ~ Surface water/drainage / o o t 7--Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water
Curtain drain
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
! certify that I have determined thru field inspections and review of Municipal rect~~. ~systems*;re
in conformance with g/IqA ~[AA gg!delines i~ effect on this date.
Engineer's Name / I 6 o g ~ / . O ~ ~
~ g~.,..~;., x~ ~;....~
.................................................................................... ~_~=~k2~ _.
HAA Fee $ ~ ~ ~ ~ W~ver Fee $
Date of Payment ~ - / F~ 7 b' Date of Payment
Receipt Number / ~ [ ~
Receipt
Number
Rev. 8/95 OSS: haa.wk.doc