HomeMy WebLinkAboutSCIMITAR #1 BLK 1 LT 1��5�-X32.-��
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF FIEALTH & ENVIRONMENTAl.. PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99.501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
IPFIONE [~-LN E W
NAME
MAILING ADDRESS
LEGAL DESGR]PTION
/ [ Well ~ [ AbsoH~tion area~
/ ~ ~ [ Manufacturer
~ ~ ~Liq caoacityin gallon~l .... ~ inside length
- '/& ,~ ~F HOM=,~,AD~:
A v I DIS~ W~ Dwelling
3~ , A~CE TO: I ~
~ ] ~Well ~ .~ ~ I Foundato~ 7:t-
~11~ L DISTANCE TO: I f ('/
~ ~:~ I No~Hines ¢ I Le.~th of each ii,2
~ :~L_ . I I .. .3~ ..... i_. . ,.~. -
~ [l'op~iletofinishgrade ¢/¢. [Mater,albeneatht,le
~ I~ngth Width J Depth
~ ~f~ Cri~er ~1~ Crib depth
~ ~ ::- t~/I] Buildingfo(~tion
l~ss Depth Driller
Dwelling
.¢- ££L.
Width
LM_aterial
NO. OF BEDROOMS
$
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in .~tallons
I DiStance I~e~,w~z lines
I Total effective a~ area
PERMIT NO.
inches
I -Fatal effectiv: abs~o_rption area
Nearest lot line
[ Septic tank [~-b~ror~t~onon area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
R EMAR KS
/?:? ////
TYPE OP SOIL ABSORPTION SYSTEM IS: TRENCH
MHXIMUM NUMBER OF BEDROOMS � ] SUIL RHTING (SQ FT/BR)� i25
THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS:
Nov K TO, 1- H
M. NEE L. TH
TVA VIA 1- PH 0:50:
oil Fit Q M YET L.. Q EYE Q 1- 0-1 wK
THE LENGTH
DIMENSION
IS THE LENGTH (IN
FEET) OF THE TRENCH OR DRHINFIELD
THE DEPTH OF
H TRENCH
OR PIT IS THE DISTRNCE
8ETWEEN THE SURFHCE OF THE
GROUND HND
THE BOTTOM
OF THE EXCHVHTION
(IN FEET).
THERE IS NO
SET RlDTH
FOR TREHCHES.
DEPHRTMENT WILL 8E SUBJECT TO PROSECUTIO�
THE GRAVEL
DEPTH I2V THE
MINIMUM DEPTH
OF GRHVEL BETNEEN THE OUTFALL PIPE
AND THE BOTTOM
OF THE
EXCHVHTION (IN FEET)
10@ FEET FOR H PRIVATE WELL OR
to! EYE �1-1 IF Y1. I::., R:��: m.-. , L VI.,: "I - W? TVA to! ����� 0-tv) too 91 oil L_ I_ fly TV o!�
PERMIT HPPLICHNT HHS THE RESPONSIBILITY
TO IHFORM
THIS DEPHRTMEW DURING
THE
IHSTALLRTION I�SPECTOF
HDJHCENT
TO THIS PROPEMY 1N0 TH2
NUMBER CF RESIDENCES THHT THE WELL
WILL SENk.
�-- 11- 1 , R Kim - � :22 3 1
A IY:
too Fit Q to! FYI pit R., :1 FQ fs� 47�
BHCKFILLING OF HNY SYSTEM NITHOUT FINHL INSPECTION
HND APPROVAL. BY THIS
DEPHRTMENT WILL 8E SUBJECT TO PROSECUTIO�
MINIMUM DISTANCE BETWEEN H WELL
AND ANY 1105I1E
SEWHGE DISPOS9L SYSTEM
{S
10@ FEET FOR H PRIVATE WELL OR
150 TO 200 FEET
FROM H PUBLIC NELL DE
ING
UPON THE TYPE OF PUBLIC WELL
MIIIPTUM DISTHNCE FRDM H PRIYHTE
WELL TO H PRIVRTE SEWER LINE IS 25 FEET
HND
TO H COMMUNITY SEWER LINE IS 75
FEET.
NELL I RND MUST
BE RETURHED TD
THE DEPH9TMENT NITHIH 18
DHYS
OF THE NELL COMPLETION.
OTHER REgUIREMENTS MHY APPLY
SPECIFICHTIONS
HND CUNSTRUCTION DIHGRHMS
HRE
HVHILULE TO IMSURE PRUPER IMSTHLLHTION
17"KITIM :1 "AF A: H`.� ".EY�
NET 4, 1140 Th
RAT Mt 11_, M.
I CERTIFY THHT
1 I HM FHMILIPR WITH THE REQUIREMENTS FOR OH~SITE
SEWERS HND HELLS AS
SET
FORTH BY THE MUNICTPHLITY OF HNCHORHGE.
2� I !�ILL INSTHLL THE SYSTEM IN
HCCORDHNCE NITH
THE CODES,
]� I UNDERS THHT THE OW -SITE SENER SYSTEM
MAY REQUIRE ENLHRGEMEHT IF
THE
RESIDENCE IS/REI: ODELED TO INCLUDE
MORE THRN ]
BEDROOMS,
x SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: / 11//" .+ L)ry1S% DATE PERFORMED: o'
LEGAL DESCRIPTION zr) f
SLOPE SITE PLAN
15
16 ell
17
81920 18-
19-
20-
L
COMMENTS
SIC�ND'y
ar-
WAS GROUND WATER S
1 ENCOUNTERED? =�U O /v
IF YES, AT WHAT E
DEPTH?
a
Robert A. Shafer .• �i
No. 1457•E +aFP
•doe
o•.ho.No 1\O�s
�OfESSt01� A� .r,►
PERFORMED BY: -
I,
r
72-008 (6/79)
Reading
Date
2
Net
Time
Depth to
Water
Net
Drop
3
vW
_,4
q
5
6
IE�:'
4 U
1
lk 7
9
V �
V. -A
11
Ile
12
13
14
15
16 ell
17
81920 18-
19-
20-
L
COMMENTS
SIC�ND'y
ar-
WAS GROUND WATER S
1 ENCOUNTERED? =�U O /v
IF YES, AT WHAT E
DEPTH?
a
Robert A. Shafer .• �i
No. 1457•E +aFP
•doe
o•.ho.No 1\O�s
�OfESSt01� A� .r,►
PERFORMED BY: -
I,
r
72-008 (6/79)
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATEV —(minute,/inch)
TEST RUN BETWEEN o® FT AND e FT
CERTIFIED B
DATE: S Lir-)
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological a Geophysical Surveys
N
r
0
0
z
0
Drilling Permit No.
LOCATION OF WELL (Please complete either to, Ib or Ic.)
A.D.L. No.
To Borough
Subdivision
Lot
Block
Ib. I/4 qt rs.
Section
No.
Township N ci
Range E
Merl dian
—o}.. of—of
Wo
I]TANDIS CE: AND DIRECTION FROM ROAD INTERSECTIONS
3. OWNER OF WELL:
Address:
Street Address and Area of Well Location
2. WELL LOG
Feet Below
4. WELL DEPTH: (final)
5. DATE OF COMPLETION
Surface
Material Type
Top
Bottom
6, Q Cable tool O Rosary D Driven Dug
-
❑ Auger 0Jailed ❑ Bored ❑ Other:
7.USE:-u Domestic Public Supply 0 Industry
Irrigation Recharge ❑ Commerical
Test Well Other: -
8. CASING 0 Threaded Welded
clam. - in. to It. Depth Weight Ibs./fl.
diom. in. to ft. Depth Stickup ft.
9. FINISH OF WELL:
Type. _�--__— Dlameter_ _
Slot/Mesh Sise:_ _ Length:__
Set between ft. and ft.
Bockfilling , _ Grovel pack _
ANCHOR
OF
10. STATIC WATER LEVEL: - ft.
ri_
E-
�
--._ �
Ej Above or Ej Below land surface Dote
if J, `
CNVIf
Equipment used:
I I . PUMPING LEVEL below land surface and YIELD
f
ft. after _ _hrs, pumping__ g.p.m.
--ft.
w
offer hrs. pumping __g.p.m.
niA
v
12. G R 0 U TI NG Well Grouted: Yes [] No
'
Material: Neat Cement u Other: _
13, PUMP: (if available) HP
Length of Drop Pipe ft. capacity g. p. m.
U:_Subm. CJ Jet ® Cenlrifical U Other
14. REMARKS:
—.
16. WATER WELL CONTRACTORS CERTIFICATION:
15. Water Temperature F Q -G'
This well was drilled under my jurisdlclion and this report is true to the best of my knowledge and belief;
Registered Business Name
Contract License Number
Address:
Signed: .- -
Dater
Authorized Representative
Form 02-WWR (II/BI) Copy Distribution: WHITE -Stale DGGS,
PINK-Drillor, CANARY -Customer
N
r
0
0
z
0
n
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 051-132-08" HAA If NL�1c��.
1. GENERAL INFORMATION
Complete legal description Lot 1, Block 1. Scimitar Subdivision No. 1
Location (site address or directions) 20036 Chugach Park Drive
Property owner Glenn & Joyce Baker. Day phone 688-1 236
Mailing address 20036 Chugach Park Drive Chugiak, AK 99567
Lending agency Day phone
Mailing address
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
Three (3)'
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water —
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xxx
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 MOAN21
5.
1
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.
Name of Firm Anderson Engineering
Phone 522-7773
Address-_ P.O. Box 240773 Anchorage AK 99524
Engineer's signaturetiaj- Date 1 /20/99
R
V+f,°?e a c1-
.1
1 e
DHHS SIGNATURE
—� Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Note: The well for this property meets existing State and Municipal Codes.
TherP a r P n ira}PG PX_es II:. TY j C11gge_ that pri ndir YPcri ng h
performed to insure the wells continued suitability. Current nitrate
eenee�ityq#4e4� is 5,76 mg/l. ffiamimufn eaneentrat ---4s 10,10 mg1z
More information on nitrates is available from the On-site Services Program,
Additional Comments
GAUTIC
Date 1— 2 9::99
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 acourtesy to purchasers of homes
and their lending institutions in orderto 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-M (Rw. iN1) Back MOA x21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICRT CEIVED
0* Environmental Services Division A_r�
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907)j.Rp-�3.4hq!)
Health Authority Approval Checklist Municipality of Anchompe
ept. Health I3, Human Services
Legal Description: Lot 1_Llock 1 , Scimitar No. 1Parcel I.D.: 051 -132-08
A. WELL DATA
Well type Private _ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Y __ Date completed _ 5 /5 / 8 2 _
Total depth 78' Cased to 78 Casing height (above ground) 2
Sanitary seal (Y/N) Y _ Wires properly protected (Y/N) _ Y
FROM WELL LOG AT INSPECTION
Date of test _5/5/82 8/5/98
Static water level 67' 7 0 '
Well production
WATER SAMPLE RESULTS:
Coliform 0
10
Nitrate
g.p.m.
5.76 mg/L
Date of sample:. 8/5/98_^ Collected by:
8.6
9 -P.M.
Other bacteria
T. Kimbrough
B. SEPTIC/HOLDING TANK DATA
Date installed 5/30/82 Tank size 1 , 250 Number of Compartments _ 2
Foundation cleanout (Y/N) Y __ Depression (Y/N) _ N
Date of Pumping 7/24/98 Pumper JR's Pumpinq^
C. ABSORPTION FIELD DATA
n
Cleanouts (Y/N) Y
High water alarm (Y/N) N
Date installed 5/30/82 Soil rating (g.p.d./ft2 or ftz/bdrm) 1 2 5 SF System type Deep Trench
Length 38' Width _ 50 Gravel thickness below pipe 61 _Total depth 10'
Effective absorption area -'.4 5 E SF Monitoring Tube present (Y/N)—X— Depression over field (Y/N) N
Date of adequacy test 8/5/98 Results (Pass/Fail) Pass For !---bedrooms
Fluid depth in absorption field before test (in.); 0 Immediately after_5 09 gal. water added (in.): 0
Fluid depth 0 _ (ins) Minutes later: 1 Absorption rate = _ >450 5J 0 _-g.p.d.
Peroxide treatment (past 12 months) (Y/N) N _ If yes, give date _N/A
72-026 (Rev. 3/96)*
D. LIFT STATION - None on Lot
Date installed _
Manhole/Access (Y/N)
High water alarm level at* ,
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at* _ "Pump off" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
>100'
>100'
On adjacent lots > 1 00
On adjacent lots >100'—
Public sewer mainry I A Public sewer manhole/cleanout
Sewer /septic service line __> 25'
Lift station
N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation > 5 1 Property line >5' ,_ Absorption field---! _5 ,
Water main/service line > 10 '—Surface water/drainage > 1 0 0 ' _ Wells on adjacent lots > .10 Q _
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >1 0' Water main/service line _ > 10'
Surface water > 1 0 0 ' Driveway, parking/vehicle storage area _> 10 '
Curtain drain _ _None on Lot Wells on adjacent lots >100'
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records
4sare
in conformance with MOA HAA guidelines in effect on this date.
✓�� �c�.'
Signature
Engineer's Name Michael E. Anderson, P.E.��°�
lI Hmr)N
Date 1 /Z0/99 � °kkl
o°
HAA Fee $ ���� Waiver Fee $ —
Date of Payment Date of Payment
Receipt Number n-14uR �`3 Receipt Number
72-026 (Rev. 3/96)*
�l� �� p
Tema ui�� ✓ n CSG c ��� ca7 es
Ls 0, 1,2.17
`
Date C 9 NCs C�
qy0 Date
�' _
Dale
a rl4f
Inspect Inspector Inspectors
._. � 11\\ l
Comnents
Conditional Approval
�.4
Permt o. ®�
Date Sewer Installed N
i Septic Tank Size t�
Holding Tank Size
,lolls Rating
Well To Absorption Area
Well Log Received
Well to Tank
�AL�
ei
__ APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner Myers ams— lon,
Phone
Mailing Address T'(? 351. Ghtzgiak, AK 99567 694-9633
BuyerTtT—
Address 4301 Aero Jp?., .Anchorage, AK 99503
Lending Institution
Phone
Address First Federal Savings & laan, 813 W. 17orthern Tlightt, Anch 99501 274--6565
—&
Realty Co. Agent' Ccu mnwealth `.lateen Realty, Inc.(J T1ttt ri �'���
Phone
Address PO Box 911, Lagle River, AK 99571
694-9494
Legal Description Lot 1, 1110C}c 11 �C tar SUk7C17 V] SiOn�p� ��
Street Location A] -N Poniard Drive
Type of Residence -
3 Single Family
3
❑ Multiple Family No. of Bedrooms
_
❑ Other
Water Supply
I* Individual ATTACH WELL LOG. A well log is required for all wells drilled since June
❑ Community 1975. For wells drilled prior to that date,
give well depth (attach log if
* Public Utility 4 available.)A�
Sawagge Disposal
CSF Individual Year Individual Installed: X1982 _
❑ Public Utility
When Connected to Public Utility:____
❑ Hoid�Tankt����
NOTE: THE INSPECTION FEE? MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN RIF INITIATF:n