HomeMy WebLinkAboutSCIMITAR #1 BLK 2 LT 12(a
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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
�— PHONE {JEW
NAME
❑ UPGRADE
c-,zrn�c;:lrar
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MAILING ADDRESS
LEGAL DESCRIPTION 1
LOCATION
N0, OF BEDROOMS y�
F Well Absorption area Dwelling -�
DISTANCE TO: 11(x; .r Cr lCs-X l r
Uy
H z Manufacturer Material
PERMIT NO.
No. of compartments 2_
-Lic. rapacityin gallon Inside length Width _
9 �' -
Liquid depth _
I IF HOMEMADE: •--�--��"
,•— -
Well Dwelling
DISTANCE TO: �•f _
Material
PERMIT NO.
_ _ _
Liquid capacity in gallons
0 ? a Manufactures.
p -
J
iu T
- u—U
Well �-7
DISTANCE TO: , '?j L�
—
No. lit es Length of each bine
Foundation ` Nearest lot li e
��1` 1 r—�. \ C7". r't`-��"s`•r-'
Total len�-ytl7 of lines Trench with
PERMIT
1
Distance bet�Een i, s
u
si w
of
�-
"S ' inches
�'� Cr
h
__ _ -
Top of tyle to finish gradeN
Material beneath isle-
O
'"1� inches
--
Total effective ab orpx area
bs h' !"
I_
D
Z- \�•I=1_T{� 1!�<7JL.!_>"�1
�.`_� �
_
Length Width
D pth
PERMIT N0.
w
�
_
Q F
Type of crib
Crib diameter ice-
r a depth
Total effective absorption area
p o'.
w
- —
Well
—
Building foundation
Nearest lot line
rn
DISTANCE TO:
CI3ss� _
Depth
Driller
Distance to lot line
PERMIT NO.
a
w
Building foundation
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
�®
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLEn
REMARKS
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le
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Mo. 1457-4
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APPROVED' `e "''"`'1"`' DATE
LEGAL
Jo
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
LE8AL �ESCRIP:
LOT SIZV,:
MAX BEDROOMS:
11 11 DE JE 11. O!7!h 11[ . ..... 11' 1E.11 11:1= OIL pq I W K -1 oil lot OIL W 1H
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGEr AK
264^4720
Es J[ , 0 13 1I.Am ETZ FR". IF-` F;;:! P1 .I[:�
850507
08/15/85
PERRY VANN
% S&S ENGINEERING
EAGLE RIVER, AK 99577
694~2979
SUBDIVISION: SCIMITAR
SECTION: 10 TOWNSHIP: 15N
44512 (EQ"FT" OR ACRES)
3
LOT: 12 2
RANGE: 1�
Listed below are the options
available to you
in designin�
your septic
system" Choose the best fito youy
1.3 jl:::p
WW. X.,:p�������
DEPTH TO PIPE BOTTOM (FT")
4.0�
4"0
4"0
GRAVEL DEPTH (FT")
8"0
0,5
3^5
TOTAL DEPTH (ITT. )
12"0
4,5
7"5
GRAVEL WIDTH (FT")
2"5
25.0 �
5.0
GRAVEL LENGTH (FT,)
57.0
47"0
97.0 **
GRAVEL VOLUME MLI. YDS.
44"9
43^6
71^9
TANK SIZE (GALS>
1,000.0 **
1,000"0 **
1,000,0 **
SOIL RATING (BQ.FT"/BR)
299
257
299
** GRAVEL LENGTH > 75 FT"
REQUIRES MULTIPLE
RUNS (NOT EXCEEDING 75 FT" EACH>
** TANK MUSl HAVE AT LEAST
TWO COMPARTMENTS
I certif*y that: '
1. I am familiar with the requirements 401- on-site sewers and wells as set
forth by thig Municipality of Anchorage (MOA) and the Stat(w) ofl, Hlaska.
2^ I will install the system in accordance with all MOA codes and regulationsv
and in complianc� with the design criteria o[ thi� permit°
vjill adhere to all MOA and State of Alaska the set beck
dist�nces ��o� any existing wastewater disposal system or public
sewerage system on this or any adjacent or ne�rby lot.
4^ I understand that this permit is valid for a maximum of 3 bedro�ms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL9ERMIT AND INSPECTION MUST BE OBTAINED; (2) AS�BUILTS
WILL NOT BE APPROVED WlTHOUT AN ELTCTRION REPORT AND (3> THE
ELECTR I MUST 8E DDNE BY A LICENGED ELECTRICIAN"
SIGNED
APPLICANT: PER�N ~_
\J
ISSUED 8Y DATE: ��� \_�
/ ~ll/ " ~`�... ..... ...
❑ SOILS LOG
_ MUNICIPALITY OF ANCHORAGE Yr
PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: �1 �l�'t� t`-�� DATE PERFORMED:
LEGAL DESCRIPTION: ('�
SLOPE SITE PLAN
SnN1
2
3
Y�Y
r
4
a'
5
6
8 ` �•�
9
10-k ice
11
12 U`
13
42
14 J �, 0
15 r
16
N'Op✓�S�Ie �Ias�e aye " J�6�VJJ
I �J. e. LOa e•I* T,
1I R*tQrl A. Shaiar
o Plo. 1457-E
C-�'7 rLV - E tc
17
18-
19
20
COMMENTS
GROUND WATER (n�
OUNTERED? `�-�p S .
O
c E
YES, AT WHAT
EPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop_
114 ..
1ONllls
7
PERCOLATION RATE_
TEST RUN BETWEEN �— FT.
to }jr i` �'`dC'rIIV�I:NIIVt�
PERFORMED BY: 5RR 196X J57f CERTIFIE
S.r Ynn � I •ll - •A
604.2079
79.002 (6/791
(minutes/inch)
FT
DATE:
,Permit 0: 820331.
;January 31, 1983
TO: Permit Applicant
Subject: Lot 12 Block 2 Scimitar Subdivision
A permit issued by this department for an individual well
and/or on --site sewer system has expired as of December 31,
1982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the
on --site sewer system, please have.them send us the as-builts
for our files and documentation.
if there are any f_ur_ther questions, please call this office
at 264-4720.
Sincerely
I� C
Robert C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCP/ljw
enc: Cop,, of Permit
SWP/057
����������,� �� ���������
DEPHRTMENT r� HEHLTH HND EIVIRONM£NTHL ~ROTECTION
825 SlREETHNCHORHGE, 8K 9' 1
264-4720
PERMIT I'd ( 820] ]1 )
HPPLICHNT PERRY VHNN
LOCHTION TULWHR RD
LEGHL L12 B2 SCIMITHR S/D
2962 GLHCIER STREET
LOT SIZE 4]563 SQUHRE FEET
MINIMUM DISTANCE
BETWEEN H
WELL HND
HNY ON~SITE SEWHGE DISPO5RL SYSTEM IS
100 FEET FOR
H PRIVHTE WELL
OR 150
TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE
TYPE
OF PUBLIC WELL
MINIMUM DISTHNCE
FROM H PRlVHTE
WELL
TO H PRIV8TE SENER LIHE IS 25 FEET HND
TO H COMMUNITY
SEWER LINE
IS 75 FEET.
WELL LOGS
HR
�E�UI�ED HND
MUST BE
RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS
OF THE NELL
COMPLETION.
OTHER REQUIREMENTS
MHY HPPLY�
SPECIFICHTIONS
HN� CON5TRUCTIOM DIHGRHMS HRE
HVHILHGLE
TOIMSURE
PROPER
INSTHLLHTION.
��������
I CERTIFY TIF! T
1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON—SITE SEWERS HND WELLS HS SET
FORTH BY THE 1', 1UNICIP8LITY OF RNCHORRGE
2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES
SIGNED�
HPPLICHNT PERRY VHNN
MUNICIPALITY OF ANCHORAGE
° DEPARTMENT OF HEALI H & HUMAN SERVICES c?.
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 ✓�L
Parcel l.D.# �� I 131 'ate HAA #
1. '` GENERAL INFORMATION
Complete legal description Lot 12; Block 2; scimitar I#1 _
Location (site address or directions) NHN Tulwar Drive
Chugiak, AK
.Pro perty owner Paul Bergeron Day phone 688-6388 _
Mailing address P.O. Box 671347 Chugiak, AK 99567 _
Lending agency Day phone
1
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well XXz
Community well
Public water
Day phone
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 MOA $21
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.
Name of Firm S & S ENGINEERING Phone G �! _ -7
age rver Loop Road No. 204
Address Eagle River, Alaska 577 /
Engineer's signature — Date
6. DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
Additional Comments
0
bedrooms.
M
NuTle
bedrooms, with the following stipulations:
Date /2-/7-%%
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 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.
72-025 (Ftev. 1/91) Back MOA N21
3RONMENTAG SFPVIC:F.S DIVISIt-
Municipality of Anchorage OEC Q „
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division (( tl
825 L Street, Room 502 • Anchorage, Alaska 99501 • ,(907) 34��E4'
Health Authority Approval Checklist
Legal Description: L.oT 17- Sc 'wit. 111 Parcel I.D.: p S f— 3
A. WELL DATA
Well type ?F ivAT M If A, B, or C, attach ADEC letter. ADEC water system number
Log present0N) Date completed _
Total depth ��'C _ Cased to ._ _ Casing height (above ground) I?_
Sanitary seal �Y 1) _ ?fi _ Wires properly protected ICY)N) j!b
FROM WELL LOG
Date of test �j 5
Static water level _ 1
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform
0 Nitrate
0.I
Date of sample: 11,15 9 Collected by:
AT INSPECTION
�q}
Other bacteria o
�SgS ENGINEERING
agle Rover Loop ID-Nfa. 204
Eagle River, Alaska 99577
B. SEPTIC/HOLDING TANK DATA
Ivy _
[Foundation
te installed ��Tank size F000 Number of Compartments �_ CleancutsJ)
cleanout ftly- Depression (Yl� N0 High water alarm (Y/N).te of Pumping �tJ _ Pumper )J IovJ
C. ABSORPTION FIELD DATA
Date installed (� `��✓ Soil rating (g.p.d./ftz qfft2frm��_ System type TR_E�N(.14 _
I it 0rI
Length _Width _ 36 Gravel thickness below pipe_ Total depth 10"Z _ �,
Yl
Effective absorption area -� Monitoring Tube present QY N)� Depression over field (Y� too- CZy y�i
Date of adequacy test Results (Pass/Fail)
For _ bedrooms
Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.): _
Fluid depth (ins) Minutes later: Absorption rate =. _g.p.d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION J�
Date installed
Manhole/Access (Y/N)
High water alarm level at* _
Cycles tested _
E. SEPARATION DISTANCES
Size in gallons
"Pump -on' --level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
"Pump off" level at*
Septic/holding tank on lot 1001 On adjacent lots __Ion
Absorption field on lot _ 100' On adjacent lots 1DD' -}
't Public sewer manhole/cleanout _ too,+
Public sewer main �'S —
Sewer /septic service line 6' 1- Lift station tCFO
'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation P Property line 15 Absorption field_
Water main/service line Ib Surface water/drainage I(�o' )' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
� 1
Property line I D Y Building foundation ID � Water main/service line
Surface water t Ob
_� Driveway, parking/vehicle storage area t b
Curtain drain NbNE _K)4owrJ Wells on adjacent lots —
F. ENGINEER'S CERTIFICATION
I certify that f have determined thru field inspections and review of Municipal
in conformance with MOA
%HAA uideli� effect on this date.
Signature-----�-�-�'
Engineer's Name Aoe CoW.4.L)
Date
HAA Fee $ 2 Z
c
Date of Payment I -Z-1F
/�
Receipt Number � `- ��
72.-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
,IJ"j KWDUKI .."'
'� ' Ck • 2801
'It �.9„ ......u,•,' 1.
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