HomeMy WebLinkAboutSEACLIFF BLK 1 LT 14OWL
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Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW `12o 3g3 PID Number: O //Z Z // a5-
Name:
Wastewater System: 9'�lew El Upgrade
E"niTE-7 � ` rpt '��
Address:
ABSORPTION FIELD
Phone: No. of Bedrooms:
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 09,6ther
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
i z t.
�, _�;
Lot: /t/ Block: / Subdivision:
`ltAz
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
j —5 r-
5 Ft.
Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
U Ft.
JETf".- Ft.
WELL: 11 New ❑ Upgrade
p9
Gravel depth:
Number of lines:
Distance between lines:
wr IDT-9 Ft.
— Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption are
Pipe material:
C'O o A/ / T
Ft.
Ft.
500 � SQ. Ft.
0--303-1
Driller:
Date Drilled:
Static Water Level:
Installer:
Date installed:
Ft.
Yield:
Pump Set at:
I
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
EB'S`eptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
G.e� rz.
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
/ 2 �7O
Well
>500'
>Sb®'
A11
P14
>,5oa'
Material:
sTs45
Number of Compartments:
Surface
Water
i /DO'
`y /00'
/I/��
/V1A
> 500'
LIFT STATION
LotSize
Line
22'
30
AI,1/
>50
in gallons:
Manufacturer:
Foundation
�
13
� 1 '
N/A
NA
,,5,,,
"Pump on" level at:
"Pump off" level at:
High water alarm at:
Curtain
�/
N
Pump Make & Model
Electrical Inspections performed by:
Drain
AloAIE IN
AREA
fI
Remarks:
BENCH MARK
Location and Description:
Assumed Elevation:
ENGINEER'S SEAL
No3 acs�a 6 a`d[s�
cr
ga
o°
Inspections performed by: ��, MC �Ar�n�,y Dates: 1 st
0000° o
2nd
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�h„I'�el
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`Anderson o
Department of Heal a Hum vices a r/oval
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4381
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Reviewed and approved a3
t,a
72-013 (1/91) MOA 25
Permit No. SW 9203 113
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: L / y 8/- / SEA C L / FF PI D No.: 0//Z2 / /
Page of
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72-013 A (2/91) MOA 25
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+``Michael E. Anderson
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW920343
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:QUIGLEY ENTERPRISES INC
OWNER ADDRESS:9340 SHORECREST DR
ANCHORAGE AK 99516
PARCEL ID:01122115
LEGAL DESCRIPTION: SEACLIFF BLK 1 LT 14
LOT SIZE: 19500 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF 1
DATE ISSUED:10/09/92
EXPIRATION DATE:10/09/93
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ENGINEER MUST NOTIFY DHHS AT LE77 2 HOURS PRIOR TO EACH
INSPECTION.
RECEIVED BY:
DATE: 112 % Z
ISSUED BY: Jc)t 'r4 ya2 m+- DATE: 1 O /y2, . ct2_.
ON SITE SYSTEM IMPACT
L 14 Block 1 Seacliff Subd.
Installation of an on-site wastewater system for this lot should have little, if any,
impact on surrounding properties since:
1. The lot has sufficient reserve area for the wastewater drainfield system
and a future system. The systems will not interfere with required well
separations since the subdivision is served by a community well several
hundred feet away.
2. Installation of the on-site system will not effect the lot surface or sub-
surface drainage in the general area.
If you have any questions please contact me.
Yours Truly,
✓ jL� a..
Michael E. Anderson, P.E.
viP Sg ¢eaooc o. a�q-' �t-i
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e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PER FORMED FOR:
111-11q 7-,—Z CO Al 57-
Gross
Time
DATE PER
Depth to
Water
Net
Drop
LEGAL DESCRIPTION:
I-lqS/ SC-A,eLlrp-
Township, Range, Section:
FI—DE—P—TH-1
S p
SLOPE
1
(FEET)
Pon�L�j CiPADED `r IJ_�
�An1Q� I -1
FF
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
CP
PoORLi
C,l2AOeo
(PCA)
SP
%moo k L V
C /'�DaD
SA til 05
not)
WAS GROUND WATER
ENCOUNTERED? N 0
S
IF YES, AT WHAT L
DEPTH? O s P
E
Depth to Water After
Monitoring? M) WATER Date:
,,tf151;C)NI�ER'S SEAL)
E, Anderson
SITE PLAN
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE -2- (minutes/inch) PERC HOLE DIAMETER ('a
TEST RUN BETWEEN 'V FT AND FT
COMMENTS qj 1nA
PERFORMED BY: `s'^' r Yt� f'-�"`�•-� I r ice' G6RTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
ER'S SEAL)
orE �F �t
:s �t,9 ®ne ae np 'f9 bj
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES �e ok ar
825 "L" Street, Anchorage, Alaska 99502-0650 �p0 ,�93 °o'E^oa p9°9''pO pp9O
SOILS LOG — PERCOLATION TEST �1
4381-E
PERFORMED FOR: f7A127—,541 COA)SM DATE PER
v 3-" PRO1
1'wGp`l`r
LEGAL DESCRIPTION: G / y 134l SjGA 61 / rF' Township, Range, Section:
DEPTH SLOPE SITE PLAN
(FEET) S F
1 P60RLt(
CRAD✓rC) TH _2 N
2 SANDS
3 C1 ra
4 P0o2Lt/
r?/LA 0 I -V p
5 62AY6I-V
6 (P CA)
7
8
9
10
11 SIP
12 POORLy
C,PAD h D
13 `aAt-Iba
14
15 j I e0 14
16-
17-
18-
'91
6171819
20
COMMENTS
61
WAS GROUND WATER
Gross
Time
ENCOUNTERED?
/old
Net
Drop
S
IF YES, AT WHAT
L
O
DEPTH?
P
y
E
Depth to Water After
Monitoring? No WATECLDate: L3 29 R2
I
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
/ %% z8 9
8, S"
y
P" -
PERCOLATION RATE(mmutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND q FT
PERFORMED BY: W , PA tr l I %r{L,f,�,a4L-Cr (�I�K.Lt
- Y THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: //� /9 Z"
72-008 (Rev. 4/85)
O
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
flop
rSV iib` OCSG mS�sOm
M'ichoel E. Anderson
A381 -E
//��11 v °ao�E s�n��,�w
PERFORMED FOR: I /W7 -E 41 �Q?1/ 5 % DATE PERFOR a�.,r_ eJ�
LEGAL DESCRIPTION: ZI'y ��. S�.Q�, L / �� Township, Range, Section:
DEPTH C SLOPE SITE PLAN
(FEET) S
1 Poo RLy
en PAbEP IF 1 =11-j.-11-4
4
3 � I C- P
4 P00RLy
6 /-2 A D E -b
5 G12'AvE-LS
6 (N (--'- 4)
7
8
9
10
11
12-
13-
14-
15-
16
213141516
17
18-
19-
20-
COMMENTS
81920
COMMENTS
WAS GROUND WATER
ENCOUNTERED? IIID
SP S
IF YES, AT WHAT L
PO O P L -\r DEPTH? _ O
P
GRAD rz:E D E D
Depth to Water Atter D
'2A N D S Monitoring? pio WATF1ZDale: B 29 9y
Bo F1
2
2 -
Reading
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
FT AND -5- FT
O
G
z
3
`f
/0
3.5
17, S'
5
3.�
3.5
/8's"
/'
PERCOLATION RATE+
(minutes/Inch) PERC HOLE DIAMETER
u
�0
TEST RUN BETWEEN
FT AND -5- FT
PERFORMED BY: w M� ('` nr� r� IEa—Y THAT T/71ST ST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /� � Z�
72-008 (Rev. 4/85)
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. # 0 11 Z Z // S HAA # —0 C)i9
1. GENERAL INFORMATION
Complete legal description Z_ /5/ 6Z / SFA CL!
Location (site address or directions) __ q 3'20 SNo,eE c2EST
Property owner U 16 l EV EM71E>z 2IsFS Day phone
Mailing address
Lending agency
Mailing address.
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well 11�
Public water
Day phone
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
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 H21
5.
6.
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 furtherverify 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,j0A Phone
Address JP
(). fo x ZY017 Y AN cal 6 qA G A1L q i sz-v
Engineer's signature
-ft✓jcLLn,,t E_ am,tel Date 2/i(alq3
0
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.
°E�n aoeeo�� �• ��
�� t5 michaol E. Anderson
r% �! ° .
DHHS
SIGNATURE
Approved for bedrooms.
Disapproved. 7
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 Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: �`? BL / Si=AGt/Fc Parcel I.D.
A. WELL DATA
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed
Total depth Cased to
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot _
Public sewer main
Sewer service line _
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Nitrate
Driller
Casing height
Wires properly protected (Y/N) —
AT INSPECTION
MUNIC'MUTY OF ANCHORAGE
LNVIRONMENTAL SER\`ICES DIVISION
EB 17 1993
g.p.m. g.p.m.
RECEIVED
_ ; On adjacent lots
On adjacent lots _
Public sewer manhole/cleanout
Petroleum tank
Collected by:
Other bacteria
Date installed X11319 3 Tank size 1250 Compartments 2
Cleanouts (Y/N) Foundation cleanout (Y/N) y Depression (Y/N) of
High water alarm (Y/N) NJA Alarm tested (Y/N) 1(111,4
Date of pumping A/EW 00057, Pumper OCCgzq,Jcy EXOeCTEA 31193
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot A/o'Ve oN Lar On adjacent lots /00' t Foundation
r �
To property line Z 2 Absorption field 6 Water main/service line_�is
Surface water/drainage /00/
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N),
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off" level at
Cycles tested
Surface water _
Date installed /� �93 Soil rating 112 System type TREIJcH �5
Length 145 51/' -1 -Width Gravel thickness 3' S Total depth R,S
Total absorption area 500 SF Cleanouts present (Y/N)
Depression over field (Y/N) fJ Date of adequacy test N Ew CoIJ s% _
Results (pass/fail) PASS for bedrooms
Peroxide treatment (past 12 months) (Y/N) hi If yes, give date _
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot Norte ON G01_ On adjacent lots > i00 Property line 30, _
To building foundation a1 To existing or abandoned system on lot No Ne otic Lo 7 -
On
On adjacent lots 75 Cutbank 13s` Water main/service line Coo
Surface water > ioo Driveway, parking/vehicle storage area �b
Curtain drain NONE !N AREA
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect p�,te, d, to of this inspection.
„ �,
p �
Signature
Engineer's Name Nj,
Date /
i;
HAA Fee $ Waiver Fee: $ —
Date of Payment7
�-yl? Date of Payment
Receipt Number - T �` `/& J/_ — k 9/1 Receipt Number
WALTER J. H/CKEL, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE (907) 349-7755
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
February 5, 1993
Mr. Wayne McFadden
SUBJECT: Seacliff Subdivision
Class "A" Public Water System, PWSID 210485
Dear Mr. McFadden:
I have completed a review of this office's files concerning the monitoring status of the
above -referenced Class "A" Public Water System and found the following:
1. The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on January 20, 1993. This does meet the provisions of
18 AAC 80.200(a), of the State Drinking Water Regulations.
2. The last inorganic Chemical Contaminants Sample results were submitted
to this Department on April 7, 1992. This does meet the provisions of 18
AAC 80.200(a), of the State Drinking Water Regulations.
3. The last Radioactive Contaminants Sample results were submitted to the
Department on October 20, 1992. This does meet the provisions of 18 AAC
80.200(a), State Drinking Water Regulations.
4. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC)
were submitted to this Department on May 27, 1992. Based on analysis of
the previous VOC samples results have been satisfactory. This does meet
the provisions of 18 AAC 80.200(a), State Drinking Water Regulations.
Issuance of this letter does not imply that the above -referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations.
If you have any questions on the above information, please do not hesitate to contact this
office at 349-7755.
Sincerely,
*ij144
Michael Lu
Environmental Eng. Asst. II
.0
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