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HomeMy WebLinkAboutLot 01`' t�� • a13- ��I �o �r i �LiCCsv L Sy�Municipality of Anchorage Page of Z DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.U. Box 196650 • Anchorage, Alaska 99519-6650 te Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ��'� `� — PID Number: Nam %—I -- Wastewater System: ❑ New Upgrade Address: /0 320 G� ic! �[�l 5 !_G. _�S ABSORPTION FIELD --- — — Phone: No. of B Brooms: ❑ Deep Trench ❑ Shallow Trench ed ❑ Mound ❑ Other —��--a LEGAL DESCRIPTION Soil Rating: O,� Total Depth from original grade', —_ �dPD/S . Ft. c0 Lot: Block: — Subdivision: Depth to pipe bottom from original grade:) ✓ Gravel depth beneath pipe / ✓.S Ft. Township: � L Range: Section: Fill added above original grade: / Gravel length: c—�7 WELL: ❑New ❑Upgrade Grav Wlepth:-W ZA F1 Number of lines: Distance between lines: 4 1 6 Ft. Cl a fication (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: 7bl p — Ft. Ft. SQ. Ft. —f—— Driller: Date Drilled: Static Water Level: Installer: 0/ / Data installed: p Yield: Pump Set at: — GP=— F[. Casing Height Above Ground: Ft. 1/ // TANK L/�I—,/�t ice' �—� -- SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. ® To Septic Absorption Lift Holding Public/Private Manufacturer: -� -- Capacity in gallons/: From Tank Field Station Tank Sewer Lines -- - ' ! V - Material: Number of Compartments:Surface Water IrTD'+ 16a — — LIFT STATION Lot r ) Size in gallons: Manufacturer: Line Foundation �t� � cr _I'-' ,� — — _�— ___ _ "Pump on" level aC 'Pump off' level at: High water alarm at _ Curtain — — Pumpt�pktf&fM.ds12t1,c.I --�--- Inspections performed by: Drain t� r-1 ti�0 tJ Remarks: BENCH MARK Location and Description: — — Assumed Elevation: I o — N I UZ iOF so ® �g¢ 0 _ ®® S dr 5 ENGINEERING 17034 Eagle River Loop Road, No. 204 � Inspections performed by,gfo_Rfveo.aons77 Dates: /0"3'�/Z "¢¢°•°°°^^° °°" °•","�¢"" 2nd_i0.7' Z `o¢°° a° ° son "¢ °as Q/ha'3V R00RH SHAFER : ba v©tl� Department of Health and Human Services approval f;10 ap°p ' Z'' "9•° �,. Reviewed and approved by: _ Date: _ 72013 (1/91) MOA 25 U -t w b.x.3 O 1_ w Permit No. �kICtZ0�0� Page "Z-- of Z` Municipality of Anchorage 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 Legal Description�� L� 21 T�iZZu7) S�C� I L PID No.: 155!1k� '1'.10' N 72-010 A (Rev. 9/91) MOA 25 MT I -i�lvti G0-Nc;'E C6 I n bq 1-900 T -Bet b 1A 2 �ourf� a�0 co \ Nil (oq° (Po �• / r-ITv —rt -12 �1T2 gs5 �Zo .FaCl�f. l2� G(PV CiFi?Tl�'��`r1K— No. r') J <7 LU 'ce, Ye Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �IC�Y"Ff'�t' IJ �L=nn t7:1 DATE Pi LEGAL DESCRIPTION: Township, Range, Section: rt DEPTH � o, . a 2 t 3 4 5 �. Two" V M I I467F—�'fL-�� 6 8- 9 SLOPE 10 WAS GROUND WATER c , ENCOUNTERED? 11 ,' IF YES, AT WHAT 1, 12 DEPTH? Depth to Water Altggr' L" rrn'1 d "CN. I 13 Monitoring? tel— Date: 14 15 16 17 18 19 20 Bastion, Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERD HOLE DIAMETER TEST RUN BETWEEN FT AND FT PE.RFORMED BY: 17034 Engle River Loop Road, N0.2" CERTIFY THAT THIS TEST WAS PERFORMED IN Eagle River Alaska 99577 ACCORDANCE WITH ALL STATE QND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: 72-008 (Rev. 4/85) PAGE 1 OF 1 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 (UPGRADE) PERMIT PERMIT NUMBER:SW920307 DESIGN ENGINEERS & S ENGINEERING OWNER NAME:SLOCUM RICHARD W III & JILL M OWNER ADDRESS:10320 WILLIS DR EAGLE RIVER AK 99577 PARCEL ID:05027314 LEGAL DESCRIPTION: T14N R2W SEC 12 LT 2 DATE ISSUED: 9/23/92 EXPIRATION DATE: 9/23/93 2__T of �� / 6y G7j Fir ��✓ co LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 ( S L,O CLe-vv S THIS PERMIT IS FOR THE CONPRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. ENGINEER MUST PROVIDE ADDITIONAL SOIL TEST TO CONFIRM SOIL TYPE IN NE HALF OF BED THAT IS OUTSIDE THE 30 FT. RADIUS OF TH NO. 1 RECEIVED BY: DATE:��'�� ISSUED BY: `��f« of DATE:.z(2 ROBERT SHAFER. P.F.. ROGER SHAFER. P.E. September 17, 1992 CIVIL ENGINEERS (907) 694 FAX 694 1211 /JPW/lsu PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Municipality of Anchorage HEALTH AUTHORITY DEPARTMENT OF HEALTH AND HUMAN SERVICES APPROVALS 825 L Street Anchorage, Alaska 99501 SEWER & WATER MAIN EXTENSIONS REFERENCE: B.L.M. 2, Section 12, T14N, R2W, SM, AK SEWER & WATER INSPECTION Request you issue a permit to upgrade the septic system serving the referenced property. The existing system is encroaching groundwater. ENGINEERING STUDIES AND REPORTS A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. WELL INSPECTION &FLOW TEST We do not anticipate any adverse effects on the neighboring properties by the installation of the proposed upgrade. As can be seen from the attached site plan the property has enough area for another future upgrade. SITE PLANS If you have any questions or require additional information for your review, please contact us. Sincerely,/ ROADOESIGN �\ T g:7 Sha er, P.E. SOIL resr /JPW/lsu PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 u Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 " L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: .✓�'J� DATE PERF( 1 LEGAL DESCRIPTION: "'r2' Township, Range, section: Ti4r l , vfL 1 B" 2 � O. 3 4 5 e,t Or 6 0 7� 8 Y` 9/�- 11 ` v <0�0 12 13- 3 14 14- 15- 1516 16- �. 17�,'� .a; 4V 18 s: �!a 6 CFl rsttQ�'� 20 Q®' o R( 'o -e.. COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? f% S 1• IF YES, AT WHAT 1L�Y O DEPTH? 2,P E Depth to Water Aller Monitoring? — II 11 Date: �2 Reading Date Gross Net Depth to Net Time Time Water Drop ;0 0 :R ,. SHAFER No. 215 o`twr�7 0 tec o0 oc P 9 PERCOLATION RATE 1 (minutes/inch) PERC HOLE DIAMETER 49 �•" aa�' �i o 'gFCSutn( e_ae' TEST RUN BETWEEN FT AND FT I, -L PERFORMED BY: S & 5 ENGINEERING? CERTIFY THAT THIS TEST WAS PERFORMED IN 17334 Eagle River Loo Road No.R i,— ACCORDANCE WITHAI.ha IK7 .A�l lJJy1�l . GUIDELI IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES wry}{ 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 LD. # 050 2 731 4 HAA # 1. GENERAL INFORMATION Complete legal description B.L.M. Lot 2, T1 4N, R2W, Section 12 Location (site address or directions) 10320 Willis Drive, Eagle River 99577 Property owner Mailing address Lending agency Mailing address Agent Address Richard Slocum Same Unless otherwise requested, HAA will be held for pickup. 2. NUMI3ER OF BEDROOMS: 4 V 3. TYPE OF WATER SUPPLY: Individual well Community well Public water XX Dayphone 1-800-241-4131 #198E 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 XX 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 A21 5. Q 0 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 verifythat 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_t_7,4gq cage Rivet! Loon Road No 204 Phone Address Eagle River, Alaska 99577 Engineer's signature Date Dti S SIGNATURE 7 Approved for Disapproved. Conditional approval for Additional Comments bedrooms. UJITlr bedrooms, with the following stipulations: Date // 2 - 9 ;)� 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. 7M25 (Rev. 1/91) Back MOA 021 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST L -OT- ? t L<�ef_ I -Z_- Legal Description: 114t 1 i -IZZLU Parcel I.D. 0A5�t'-.-4' �5 [!1- A. A. WELL DATA Well type's U�✓i--t �i If A, B, or C, attach ADEC letter. ADEC water system number k) Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Date completed Cased to FROM WELL LOG SEPARATION DISTANCES FROM WEL ( Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE SULTS: Coliform Nitrate Date of s ple: Dril ht Wires properly protec d (Y/N) AT INSPECTION eei r" C VALITy OF CFi E ENVIRONMENTAL SERVICES DIVISION P. 14 v 9(�; i991 �VFD On adjacent lots ; On adjacent lots Public sewer manhole/cleanout tank Collected by: Other bacteria R. SEPTIC/HOLDtIINGG TANK DATA Date installed r �oI Tank size +% Z - Compartments Cleanout &N) Z Foundation cleanoutON) High water alarm (Y& I"A Depression (Y/ 1O IJ Alarm tested (Y/N) — Q ) _A, . Date of pumping �rt/�.t 15 1 ��Z� Pumper ����I �i 11 ISI L_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot I �I� • On adjacent lots i Foundation I D I— To property line iU r- Absorption field Water main/service line 10'4 - Surface water/drainage I 6D t - 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 Meets MOA electrical codes SEPARATION DIST Well on lot FROM LIFT STATION TO: D. ABSORPTION FIELD DATA On adjacent lots /Access(Y/N) "Pump off" level at Cycles tested Surface water _ Date installed lC>-� -rl 7 Soil rating O•S� �Z System type ) Length �J U Width 2A Gravel thickness O S Total depth Total absorption area 1267yta Cleanouts present6N) y Depression over field (Y( pJ Date of adequacy test _�.1�_• Results (pass/fail) t�:A &�-�O �� y� l ��11I for !" bedrooms Peroxide treatment (past 12 months) (Y/N If yes, give date ___�A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot IJ, Q On adjacent lots 16D -I- Property line �00 I To building foundation r ✓ To existing or abandoned system on lot 10/ On adjacent lots -r- Cutbank �O/ Water main/service line 10' Surface water 6V i Driveway, parking/vehicle storage area 4SO r Curtain drain js! n,_1 ILt_I UV -5t-1 E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect this inspection. & ®G'� �t(� � ��eeneoeae000pe®�h9,E/%i� 5 & 5 ENGINEERING: o ®® tlP 17034 Eage ver Loop Road No, 204 Signature lRiL Eat @ River, Alaska 99577 p enzeeoao9eseeooP enconll nod' Engineer's Name , n ; n a ioG _ IJARr r• � Date � �-� vl ®q ;, .. No. 8.16 ^ _ 4 HAA Fee $ t1(D . ULA Date of Payment Receipt Number a LI XN 72-026 (ReV. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number