HomeMy WebLinkAboutGUDVEINA ESTATES LT 7Onsite File
Gudveina
Estates
Lot 7
#017-161-04
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201229 PID Number: 017-161-04
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
GREGORY FROSBERG &MARY CARY
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
15401 BLAIR VIEW CIRCLE, ANCHORAGE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invertfrom original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Fill added above original grade
Ft.
Gravel length
Ft.
GUDVEINA ESTATES 7
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
R'
Ft.
Well
100'+
__
25'+
TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1000 Gal.
Surface Water
100'+
__
Material
HDPE
Number of compartments
2
Lot Line
10'+
--
NA
Foundation10'+
__
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks Tank insulated,
Alarm location
Electrical installed by
PIPE MATERIAL Housetotank 3034 drainfied 3034
Installer A+
Drainfield CO/MT 3034
Inspector FWC
BENCH MARK (Assumed elevation) 100 ft
Inspection 1" 9/14/2020 2nd 9/15/2020
Location and description
3r° 4'"
TOP OF TANK MANHOLE
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
�1>a
Conditional Approval; Date
e., • •' `�
R-49 M��*���
® .. .....
•' .. .." ' ° " : • °
Septic System
Approved - La Lr 0�
All -nam �0?C�
.
�r �F'• Cudis
CE 128991 Huffman
Q�t`Fq o
4Z� Date �� �%
�pR2/10/2 H—+'ZI
Note: this approval does not include well permit requirements.
(Rev 05/02/18)
PI D: 017-161-04
PERMIT: OSP201229
A—C=73.1'
B—C=87.3'
A—D=76.3'
B—D=90.5'
A—E=81 0'
B—E=95 3'
A—F=831'
B—F=97.4'
MT
EFIELIDG\\\ INSTALLED NEW
10 WITH ANK
NEW DFCO & DCO.
FE
\ STAKED
g D
WELL RADIUS
PRIOR TO
DCO
CONSTRUCTION
36.9 �O
FCO
6, 6,
SEPTIC SECTION
SCALE: NTS
WELL I
GUDVEINA ESTATES LOT 7 SUHHUKI$StKVIctS: ' �'OF �N\
PREPARED FOR: ��A�y 1
GREGORY FROSBERG & MARY CARY )0
15401 BLAIR VIEW CIRCLEF�* 9 TI
ANCHORAGE, AK 99516
FIRST WATER CONSULTING DATE: 12/10/2020 /, � rtis Huffman /
SURVEY: KGL 2020r�, CE 128991
Of
13030 SUES WAY DRAWN: FWCS 11 121101202WOW
ANCHORAGE, AK 99516 SCALE: 1" = 30' A, ssioNev
907-350-9566 firstwaterAK@gmail.com \��
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201229
Work Type: SepticTank Upgrade
Tax Code Number: 01716104000
Site Legal Address: GUDVEINA ESTATES LT 7 G:3138
Site Mailing Address: 15401 BLAIR VIEW CIR, Anchorage
Owner: FROSBERG GREGORY A &
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
,��11LI]C
0
L)( hlll'CIII e11t
7/14/2020
7/14/2021
167435
❑ 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
Date:
Date: / �-7
3
MUNICIPALITY OF
•
Development Services Department
On -Site Water & Wastewater Section
Parcel I.D. 017-161-04
ON-SITE SEPTICM/ELL PERMIT APPLICATION
Phone: 907-343-7904
Fax: 907-343-7997
Property owner(s) GREG & MARY FROSBERG Day phone 9072230039
Mailina address 15401 BLAIR VIEW CIRCLE, ANCHORAGE, AK 99516
Site address 15401 BLAIR VIEW CIRCLE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) GUDVEINA ESTATES LOT 7
Legal description (Township, Range & Section)
Lot Size 167,435 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
0
(w/wo ADU)
Septic Tank
El
Upgrade El
(D)
El
Holding Tank
❑
Renewal ElDuplex
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
. 75 Waiver Fees:
Receipt Number: 7W40 3
Permit No. ns,071D 122 9
Date of Payment:
Receipt Number:
Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350 -9566 / firstwaterAK@gmail.com
July 6, 2020
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: GUDVEINA ESTATES LOT 7
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank outside any
deck supports to serve the existing 1-bedroom residence (3-bedroom system). The lot and area
are served by private water. The design will not impact any of the neighboring properties.
Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201229, Rebecca Carroll, 07/14/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201229, Rebecca Carroll, 07/14/20
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R.._/ MUNICIPALITY OF ANCHORAGE '~/
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~AME
PHONE
[] NEW
~r~.UPGRAD E
M~,I LING-ADDRESS
LEGAL DESCRIPTION
LOCATION
Ov DISTANCE TO: W'ell
"~'~I- Z Manufacturer
m Liq. capacity in galJons
~ ~ iF HOMEMADE:
I Manufacturer
1:3 We
,,_1, 3: I DISTANCE TO: I
m~O ~ No of lines ILenDth of each line
F- ~ ~ ~Top of tile to finish grade--
I Length Width
~ ' · m er
<~_ I T~Lpe/of crib Crib dia et
We,,
~ / DISTANCE TO:
"{, IClass Depth
~ ] Building foundation
DISTANCE TO:
NO. OF BEDROOMS
Dwelling
Foundation /
Total len§th of lines
Material beneath tile
Depth
Material
Nearest lot lipe
Trench width
~..~ ~ "/ inches
inches
PERMIT NO.
No. of comzJ~artments
Liquid depth
PERMIT NO.
Liquidcapacityingallons
PERMIT NO,
Distance between lines
Total effective absorption.~rea
PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Driller Distance to lot line PERMIT HQ.
Sewer line Septic tank Absorpt on area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
72-013 (Rev. 3178)
DATE LEGAL
I:)IERM I T NO ~
DATIE ISSUED:
APPLIGANT~
ADDRESS:
CONTACT F:'HONE:
L. EGAL DESCRI
LOT SIZE:
MAX BEDROOMS
I1'"'"II I]_1 Ih, II % CZ: ]] ~"zr,.~l~ L_ ]E ]F' %'" ~7:? F: ~:~, 4t L.] ~'-'~ ~7) E-.,:: ¢~ [.::~ ~:=..
DEI:::'AFUT'MEIqT OF I'-tEAI..TH AND ENVINDI4t~EN] AL F'ROTECTIC)N
825 L ~ 1F~:I:. I , ~.~F.h..IAOF~AL~I:., AK 9950:1.
;764- 4 '72 ()
BARBARA 'T' ,, ERSI'::.' I NE
154()1 BLAIR VIEW
ANCHORAGE,, Al":: 99576
3/-I. 5-.-:[92:3
SUBDIVISION: GUDVEINA
SECTION: 35 TOWNSHI F':
167435 (SQ,,F]'. OR ACRES)
LOT: 7 BLOCK: NA
RANGE: 3W
I_is'Lecl I::~elo~,..~ are the op'Lic)ns avai labIe te you in desj. gning yeur septic
system. Choose 'Uae opt ien that best f its yell? site.
"If" IF:;: E=-'- ~ ~7~ F-~ ]E.".~ EE ?Z~
DEPTH TO I='IPE BO'I"TOM (i:::T.) 4,, 0 4.0
GRAVEl.... DEI::"f'H (F"T.) 9.0 O. 5
'I"OTAL. J}EFm"t"H (F'T.) ].3,, 0 4.5
GRAVEL,. WID'fH (l:"f'.) 2.5 ],7,,0
GRAVEL L..EHqGTH (F'i'.) 2 1.0 34.0
GR'AVEL VOLUME (CU,, YDS. ) 18,, 5 2~,, 5
TANK SIZE' .(GALS) 1,000,,0 ~- 1,0()0.,0 '>s~
SOIL RA]"ING (SQ.FT,, /BR) ' :[25 :[25
¢,.'¢{. 'f'ANI< MUS'T HAVE A'I" LEAST TWO COMPAR't"MENTS
4.0
3.5
7,,5
5.0
4 ].,, 0
3() ,, 4
Z~()00.0 .~.~
:[25
I cer'LJ.{y fha'L:
],, I am f'ami].J, ar with the r'eqLlirement~.~i £ep on-site sewens,s and vcells as set.
Fen'Lb by the Municipality oF Anchorage (MOA) and the State of' Alaska.
2.,, I will insta].l 'Lhe' system in actor, dance ~,~i!'J"l all MOA co, des and regulatiens,
and in compliance with the des:i, gn critenia oF this'permit.'
3. :[' will adher'e 'Lo .all MOA and State of Alaska requirements fen the set back
distarices f'nom any existing ~e].]., wastewater disposal system op publ:i.c
sewerage system on 'Lhis or' any adjacent cm nearby lot,,
4. I ur'iders'Land 'Lhat this penmit is valid £or a ma;..'imum oF 3 bed. poems and
ar'ly enlargemer'rL ~,J,].l requJ, re ar", additional perm:i,'L.
IF; A LIF'T STA"FIOI',I IS INS'I"ALL. IED IN AN Al:REA COVERED BY MOA BUIL. DING CODES,
]'HEN (1) AN 1:7. LECTRICAL PERMIT AND INSPEC]'I[JN MUST BE C)BTAINED?, (;17) AS-BU!I_.TS
WILL: hiD']" BE APPROVED WITHOUT AFl E!...ECTRICAL IIqSF'ECTION REF'ORT; AND C::1) THE
EMEC;TRICAL WORI< MUST BE: DONE BY A L..ICIEIqSEED EL. EC'TRI[iIAN.
AF'PL LCAN'I"~ BAITBARA T ~ IERSI< ~NE
].,.~._,[JED J.: ,' D~-EE:
PERFORMED FOR:
5
6
7
8
9
10
11
12
13
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
SLOPE
WASGROUNDWATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SOILS LOG
[] PERCOLATION
TEST
14
15
16
17
18
19
2O
COMMENTS
PERFORMED BY:
72-008 (6/79)
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND FT
DeB
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 017-161-04
1. GENERAL INFORMATION
Complete legal description GUDVEINA ESTAES LOT 7
Expiration Date: O i r go
Location (site address) 15401 BLAIR VIEW CIRCLE, ANCHORAGE, AK 99516
Current property owner(s) GREGORY A FROSBERG & MARY C CARY Day phone
Mailing address
Real estate agent
15401 BLAIR VIEW CIRCLE, ANCHORAGE, AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $95-0
Date of Payment.
Receipt
ayment.Receipt Number F5 1 SOY 3
COSA # USG 22 / `SOD
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 815/2022
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. 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, quality of
construction (workmanship & materials), the water usage of the family being served by the �11���\
system and maintenance. The operational life of all well and septic systems are subject to �� Q� �4��,1�
these various and dynamic characteristics and are outside the control of the evaluator of the � �i
well and septic system. Therefore, any estimate of how long a system will function satisfactory awl& ' � � . !f'
for current or future occupants or guarantee that no unseen encroachments, deficiencies or g.' •:�
discrepancies exist can be given by First Water Consulting & FWGS *' TH • • ..�:* ��
6. DSD SIGNATURE • • " • '
Curtis Huffman
System #1 Approved for bedrooms ����F��sl , CE 128991��'�
�,Q • • ,x/5/22 , . • ��G r
System #2 Approved for bedrooms�l\�� o is'
Disapproved
Conditional approval for bedrooms, with the following stipulations:
BY Original Certificate Date: d �� Z
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
r 1 _
Legal Description: GUDVEINA ESTATES LOT 7 Parcel ID: 017-161-04
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
® Well log is filed with Onsite (or attached)
Well production at time of test 5+9 pm
Date drilled 8/7/1970
Water storage tank volume NA gallons
Total depth 127 ft
Well disinfected for coliform test? ❑ Yes ® No
Cased to 127 ft
® Coliform bacteria is Negative
® Sanitary seal is functioning correctly
Nitrate 0.273 mg/L E]Nitrate less than MRL (ND)
® Wires are properly protected
Arsenic ug/L ® Arsenic less than MRL (ND)
Casing height (above ground) 12+ in.
FW'C
S,,
Date of flow test for COSA 8/3/2022
Collected by � =
Static water level at beginning of test 42 ft.
Date of Sample 8/3/2022 ./
Comments NEW SANITARY SEAL.
Absorption rate 450 gpd
B. TANK DATA
Age of tank(s) 2 years
Tank type/material SEPTIC / HDPE
Measured operating fluid level in septic tank 50"
® Standpipes/foundation cleanout per record drawing
Date of pumping 8/2/2022
D. ABSORPTION FIELD DATA
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Which system tested (date installed) 9/9/1985
Adequacy test date 8/3/2022
® ALL standpipes present per record drawing
Results M Pass For 3 bedrooms
Total measured depth from grade 10.8 ft (max)
Fluid depth prior to test 1 in (SLUDGE / H2O)
Measured depth to pipe invert from grade 4.4 ft (min)
Water added 450 gal
❑ N/A — pressurized field
New depth 19 in
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 9' MOA IR — 8' ED SHOT
Elapsed time 1320 min
® Code -required soil cover over field
Final fluid depth 1 in (SLUDGE / H2O)
❑ System presoaked
Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced gallons
If yes, enter date
FM
MT / SECOND DCO AFTER TANK
AT GRADE. < ;;r
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
M Yes if No ft
Wells on Adjacent Lots:
Community Sewer Manhole/Cleanout > 100'
M Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' M Yes
if No
ft
Private Sewer/Septic Line > 25' M Yes
if No ft
Absorption Field on Lot > 100' M Yes
if No
ft
Holding Tank > 100' M Yes
if No ft
Neighboring Absorption Fields > 100'
Surface Water > 100'
M Yes
Animal Containment > 50' M Yes
if No ft
M Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ®Yes
if No
ft
M Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' M Yes if No ft Surface Water > 100' ® Yes if No ft
Property Line > 5'
M Yes if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
M Yes if No ft
Private Wells > 100' M Yes if No.
Water Main > 10'
M Yes if No ft
Community Wells > 200' M Yes if No.
Water Service Line > 10'
M Yes if No ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
M Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
M Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
M Yes
if No
ft
Private Wells > 100' M Yes if No _ ft
Water Service Line > 10'
M Yes
if No
ft
Community Wells > 200' M Yes if No
Surface Water > 100'
M Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I
certify that l have determined through field inspections and review AW. •' • ' •
of Municipal records that the above systems are in conformance �"°' •• •;57`¢
with MOA COSA guidelines in effect on this date.
.... .... . .........
.. .... ..'"�
Curtis Huffman Ps
¢� �'c{`••. CE 128991
��1`�I�r,` • $/23/22 •���,s
ll�>�®�pROFESSIO�P ..�
ft
Mt
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
264-4720
Application Date (~ ~ (~ -
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
(b)
(c)
Location (address or directions)
Applicant Name ~t~.^f~, ~c.¢).~1cl/,4 ~
Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain);
Telephone: Nome ~MS-t~'%_'t~ Business
(d) Lending Institution
Address
Telephone
(e) Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family ~ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well/~... 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 I of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
/
Name of Firm A~¢~1.' ~¢-~ -~_¢*,4 &-fkf -¢_L~-"~_J f'.~C-.Telephone ~{~ I~ [.--~ ~-~-
Address _( ~'(~ ~ //0. ,'1~'~ A¢.t,r~./ ~,-~O.,4'~A'O£;~..,, A((-.. ~;:~;)~. ~"O."~
DHEP APPROVAL
Approved for '/__,~','~.??bedrooms by
Approved ,X '' Disapproved
Terms of Conditional Approval
Conditional.
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 engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: I~o'r '~
I~NVIRONMENTAL PROTECTION
L P i o 1985
RECEIVED
WELL DATA
Well Classification ,T_ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) Y Date Completed ~ ""7 - '~ O Yield
Total Depth ~ Cased to ~ Depth of Grouting ~.~
Static Water Level ~ ~ ' ~6~ ~¢ ~ 8~ump Set At .A ~&~
Casing Height Above Ground ~ ¢4 Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line bi///&,
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments .~ $
Depression Around Wellhead
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
! O0 %
tt.q'
tq./,~ To Nearest Sewer Service Line on Lot
T, f2 e-6-Ab4 ; Date ~ - ~
SEPTIC/HOLDING TANK DATA
_
Date lnstalled ~-2_")- :~-Size
Standpipes (Y/N) %/ Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
HoldingTank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~. ~ ~
To Property Line ~ O
To Water Main/Service Line
Course O_ ~
No. of Compartments
Y Foundation Cleanout (Y/N)
Date Last Pumped b4
· for
Temporary Holding Tank Permit (Y/N)
To Building Foundation -~ ~
To Disposal Field -7
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 1~ ~.~;j
Date Installed ~'-~-'"/- ~'~-~
Widthof Field ~u'c.t,k~."; -'~ '~, t
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation /,~ O~ /
Lot ~'0
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments .~, r-_~-9
Type of System Design
Length of Field 0.[
Depth of Field I ~
Gravel Bed Thickness C~
Standpipes Present (Y/N)
Date of Last Adequacy Test
TO Property Line ~ O/-4-
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
:~'0 /-4-
LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date 0[ - ~ ~ ~ ~,~
Company.~_¢l:(~- [~/L~%y .~.~ MOA No. ..¢,,"(' ~'~ %~00 [
Receipt No. 3~'~ ~ ~
Date of Payment ~ - ~1~ ~%~'
Amount: $ ~ ~ ~
Page 2 of 2
72-026 (11/84)
Werner FITZE
P.O. Box 1007
Anchorage, Ak.
99510
DEPT, OF HEALTH &
EN~IRONMENI'AL PROTECT/ON
SEP
RECEIVED
August 30, 1985
MUNICIPALITY OF ANCHORAGE
Dept. of Health & Environment Protection
Att~ Susan Oswald
825 L Street
Anchorage, AkL, 99501
Re: LOT 7, GUDVEINA ESTATES
off Rabbit Crk. Road
Gentlemen,
This is to certify that in 1963, during the construction
of my loghome at above location, a septic tank and cess-
'pool system was installed, using concrete rings which were
covered each with a solid concrete top.
I also remember that a boom truck was used to install these
heavy elements.
Sincerely,
/,7 [./ L" /'''l×' CJi. l
Nerner Fitze
P~.T,PJ~E OF LIABILITY
Arctic Engineers, Inc. (AEI) was hired by Ms. Barbara Erskine in
August of 1985 to inspect an existing well, and to inspect installation of
a new septic
existing septic system which
Municipality of Anchorage
Protection.
system.
The septic system was installed to replace an
did not meet the requirements of the
Department of Health and Environmental
Without excavating to uncover the existing system, AEI was unable to
determine exactly what and where all components of that system were. We
received a letter from the original owner certifying his recollections of
the system structure and installation, which is attached.
Normally, AEI would require visual inspection of the existing system,
and proper abandonment prior to release of a Health Authority Approval
application. In this case we were relying on the previous owner's
certification. Our client requested that excavation in the vicinity of
the old septic system be avoided. ~
In consequence, Arctic Engineers, Inc. will not be held liable at any
time for any proble~ which may occur as a result of improper abandonment
of the old system. Such problems would include pollution of any water
resources, health risks due to collapse of any system components, or any
related problems. ~'
Barbara Erskine
PAGE 1 of 2
STATE OF ALASKA
THIRD JLDICIAL DISTRICT
THIS IS TO CERFIFY that on this /~)Z~ay of ~77. , 1985,
before me, the undersigned, a Notary Public in and for the State of
Alaska, duly sworn and commissioned as such, personally appeared Barbara
Erskine, who executed the foregoing instrument and acknowledged that they
executed said instrument as a free and voluntary act for the uses and
purposes mentioned therein.
WITNESS my hand and official seal the day and year in this
certificate first above written.
'PUBLIC in ~ fo~ Alaska.-
../ Commir~on
My Comn'd. ssion Expires: ^pril 1% 19S9
PAGE 2 of 2
MUNICIPALITY; OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing,
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
PHONE
MAILING ADDRESS
3. LENDING INSTITUTION ~ PHONE
MAILIN~ ADDRESS
~l Ul ~ ~DDR~SS Z77~ ~G
5. LEGAL DESCRIPTION
;TREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~ One ~ Four
~ SINGLE FAMILY ~ Two ~ Five
~ MULTIPLE FAMILY ~ Three ~ Six
[] Other
7, WATER SUPPLY
~ INDIVIDUAL~
[] COMMUNITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** **if individual/on-site, give installation date /¢:~ ~
If system is over two (2) years old an adequacy test is required
[] PUBLIC UTI LITY by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
I NSP ECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [~] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2, WATER sUPPLY PERMIT NUMBER
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or []Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
-~. DiSTANCESwELL TO: Septic/H°'ding Tank IAbs"rpti°n Area Se-~er' Line --l Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[~ DISAPPROVED
DATE BY (Title) - / /
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
July 28, 1978
Werner Fttze
% Kurt I~echt
~otem Realty
724 East 15th Avenue
~chorage, Alaska 99501
Subject-' Lot 7 Gud. veina Estates Subdivision
Before this department may process the request for sewer
and water approval, several items will need to be completed.
A one-hundred(100) foot separation between th~ well and
the leaching area is required. Either your well or leaching
area must be move~ to comply with state and local health codes.
The septic tank is fifty-six(56) feet from the well, which
is satisfactory. If the well is moved the sewer system will
need to be checke~ for adequacy. The firms in the Anchorage
area who performe~ the test are attached with the letter.
Before the test is performed, a four(4) inch cleanout must be
installed to the ~eepage pit. If the leaching area is moved,
a soil test will need to be obtained an~ prior to any construction
a permit ~ust be obtained from this office.
In ~e event the adequacy test performed on the existing
'system fails, an u~rade of the leaching area will be necessary,
Prior to the upgrade, a soils test must be obtaLned an~ a
permit must be issue~ by this department.
The septic tank must be pumped and the receipt should be
made available to the office.
If there are any ql.~estions, please contact this office at
264-4720.
Sincerely,
Robert C. Pratt, R.$.
Sani~arian
CP/ljh
DATE:
TO:
FROM:
SUBJECT:
MEMORANDUM
July 20, 1978
Sewer and Water Staff
Senior Environmental Specialist
Adequacy tests on existing on-site sewer systems
for loan approvals
Since 11/74 specifications of on-site sewer installations
were'changed to screened gravel backfill.
The adequacy test requirements for loan approval is
being changed to the following criteria:
(1) Untested systems over four(4) years old must be tested.
(2) Systems previously tested should be retested every two(2)
years when another department approval is requested.
- (3) Septic tanks in us9 over two(2) years must be pumped as
previously required.
oenior Environment~.l
LNB/ljh
78/9
91-010
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