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Home My WebLink AboutNORTH SLOPE #1 BLK 3 LT 5Slope Block 3 Lot 5 #050- 511 - 14 Developmen{ Services Department Building Safety Divislon On-Site Water and Wastewa{er Program, 4700 s. Bragaw St. P.O. Box196650 Anchorage, AK 99519-6650 Page j of~ www. ci.anchorage.ak, us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ~(/'~0"'~01 ~'7 PIDNUmber= "'r~':~);501L~¢i/ ~I~..~"/F~E¢/pz/7 LL~- WastewaterSystem: ~New ~UpgraUe LEGAL DESCRIPTION so,,..,~: ~.OGpO/Fl. TotalDepthff=originalg.de; OFt. T~ship: Range: S~,,.= Fillad~daboveo,gi.l~de: ~2F,~ Grav. LenC,: ~0 Ft. Well: ~ New U Upgrade i ~ Num~line,: Dis,=. be enlines: ClassiE.tion{Pdv ABC: 360 "" .' eMcterieh . SEPARATION DISTANCES ~SepUc ~ ~olding ~ S.T.E.P. ~ Other: Tank Field Station Tank S~r Line ~ ~¢ ~ Inspections performed Dy: ......... ~. ~ Dates: ~ -~--O~ ',"P~~~ .... Reviewed and approved by: ~ ~ Date: 0 9 O~ PERMIT NO. SW020197 PAGE 2 07 3 Municip,~ti~ oP Anchor~oe DEPARTMENT OF HE~_TH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION PO. Box 196650 eAnchopcge, Ataska 99519-6650eTelephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 3, NORTH SLOPE #1 P.[.D. NO. 050-511-14 TH#SA /--NEW FCO ,~F TH#lA, . ST~T2 /~.TH#4 NEW 1000 GALLONff ~ NEW 550 GALLON HDPE SEPTIC TANK L-F~.T ALBERT S.T.E.P. TANK I.D.S.F. LOT 6 '- ?" UNDEVELOPED J ~ ~. ~. ~. ROBERT C. COWAN CE - 8801 PERMIT NO SW020197 PAGE ,.t OF 5 Municip. o, Ut; o~' Anchor"o. ae DEPARTMENT OF HE,~,~TH AND HUIv'fAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,B, Box 196850 IAnchorcge, Atoskc 99519-6650eTetephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 3, NORTH SLOPE #1 P.LD. bi0. 050--511--14 GRADE 90.8'~ ELECTRICAL CONDUIT 87.1' NEW 1 00 GAL. POLY. TANK DISCHARGE PIPE 86,9 550 GALLON FAT ALBERT WITH PUMP ASSEMBLY GRADE -MT1 =105.3' MT1 INSULATION GRADE DIST. LINE=102.9 MTl=102.6! A B C FCO 8.5' 22.5' - ST1 27.0' 40.5' - ST2 30.0' 45.0' - TMT 27.0' 42.5' - MH 56.5' 49.5' - FV1 71.5' - 86.0' FV6 79.5' - 101.0' MT1 81.0' - 102.0' · GROUNDWATER AT 98.6' 92.6' B.O.H. I~,i~ing' ~on ~.L~ric, Inc. 14916 \~/o4Lancl Priv~ (9~ 622-6~ May 23, 2003 Re: Lot 5 Block 3 North Slope To Whom It May Concern: The lift station at the above referenced property has been wired in accordance with NEC and State/Local codes, Thank you, . Kevin S. Hornbuckle, Owner Administration License Number 1284 Specialty Contractor License Number 27285 by DOC CO. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 * TELEPHONE 688-2750 OWNER OF LAND: ~/50'''~4''~ C.,~,,.,J,..? I ADDRESS: LEGAL DESCRIPTION: ~,~O~.~'h~' ~P~ ~ i PERMIT NUMBER: ~ /~ate of _ Is well I~ated at approved permit location? ~ D No Method of Drilling: ~otaw [2 cable tool Depth of well: / D I Casing Type ,.~' ~*~ Wall Thickness ¢ ~ ~ inches Diameter ~ t~ · inches depth / ~ I · feet _iner Type: ~O~ ~ Casing Stickup Above Ground: ¢,~ ' · feet Static Water Level: ~ 0 feet Recover Rate: ¢ gpm Method of Testing: ,~ Y¢'~ ' Well Intake Opening'Type: ~),.od"~n end E~ open hole ~J Screeneo; Start feet Stopped feet LIPerforations Start · . feet Stopped feet Grout Type: 1~t~.'~, 7~ ~ ~'1~"~ Volu~m?t ~"~'0~p Depth: from - ~") feet, to ,~ 0 feet Well Disinfected Upon Completion? fC~es (2 No Method of Disinfection: Comments: BORE qOLE DATA -DEPTH From To Driller's Name ATI-ENTION: It is the responsibility of the property owner ~o submit a cony of the well Icg to the proper author ty. Mun c pality of Anchorage: Department of Health & Human Services and/or DeDartment of Environmental Conservation. MatSu Borougn: Deoartment of Environmental Conservation. MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Renewal Date Issued: Jun 27, 2002 Expiration Date: Jun 27, 2003 Permit Number: SW020197 Legal Description: NORTH SLOPE #1 BLK 3 LT 5 Design Engineer: 0003 S & S Engineering Owner Name: Disotell Construction LLC OwnerAddress: PO Box 770210 EAGLE RIVER, AK 99577- ParcellD: 050-511-14 Site Address: Lot Size: 43260 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division OmSite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci,anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 05-O Permit Number Propertyowner(s) ~'~'l'~'-.~/I ~--.,~-~'~-'/;',nT/ ~Z-~... Dayphone Mailing address (1) ~). C0` ¢O~ Mailing address (2) ~/} 5-~.-~z~ ,~z v~ ,~. f .4 ~' Legal description (Lot, Block & Sub'd.) L 0 T S / Z¢/---¢ o ~ Zip Code / Legal description (Section, Township & Range) Lot Size ? . O Acres/Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool [] Well Only [] [] Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. 17034 Eagle River' Loop Roa~l Ne, 204 ~le River, Alaska 99577 (Signature of property owner or authorized agent) Permit Fees: ? / 0 0-0-.% Date of Payment: ~/2.,¢/o 7_. Receipt Number: O '~, i 73 '~ (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 995;'9-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Jun 27, 2001 Expiration Date: Jun 27, 2002 Permit Number: SW010210 Parcel ID: 050-51'1-14 Design Engineer: 0003 S & S Engineering Site Address: NHN KUPARUK AVENUE Owner Name: JUNE C. KEEN Lot Size: 43260 SQ. FT. Owner Address: NHN KUPARUK AVENUE Total Bedrooms: 3 Permit Bedrooms: 3 EAGLE RIVER , AK 99577- This permit is for the construction of: [] Disposal Field [~ Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either; A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: __ Issued By: / ,/ / / Date: ~ Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D.O.~0'- ~'/ ! -'/4 Permit Number SW 0 Property owner(si P [EOJF~ il ~/oin ¢~'r~4~.'j"'[Oi"l Day phone Mailing address (1) P, (~, ~oX --/"~l~'""~ JO ¢ ITE : Jtl~J~lV 1¢1,4P,~,~141~ l~vElul~E, Mailing address (2) ~"¢t ¢) j~ Gl Ye F/ /¢/~ Zip Code ~ ~ ~"~ 7 Legal description (Lot, Block& Sub'd.) LO-J- .:~,~ ~JO~ .~? ,J~)o('fJq 5'iop Legal description (Section, Township & Range) Lot Size ~:~ ~Sq. Ft. Number of Bedrooms 3 49, 2 THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool [] Well Only [] [~ Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. S & S ENGINEERIN6 17034 Eagle River Loop Road No. 204 Ea~te River; Alaska 99577 (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: ROBERT C. COWAN, P.E. April 23, 2001 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 ENGINEERING STUDIES AND REPORTS SOILTEST MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 5, Block 3, North Slope #1 Subdivision It is requested that you issue a permit to install a well and a septic system to serve the proposed three bedroom dwelling on the referenced property. Test holes were excavated, and percolation tests performed. The test holes' approximate locations are located on the attached site plan. At the time of excavatim~, 8/24/00, water was found at 4.5 feet. After ground water monitoring, water was found at 3 feet. C r, a >~ ) We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, obert . Cowan, P.E. RCCPojj Enclosure '17034 NORTH EAGLE RIVER LOOP · SUffE 204 · EAGLE RIVER, ALASKA99577 1"=50' SCALE / / / / / / / / / / / / / / / / / / ~'.~+ / / 1 / 1 / / / / / / / / / / / / / / / / / / / / / DESIGN / / / / iI/1~ SITE-PLAN N. T. S. SCALE DESIGN PROFILE Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~OPE 3 4 5 6 7 8 9 10--- 11 13- 14. WAS GROUND WATER ENCOUNTERED? tF YES, AT WHAT DEPTH) Oeplh to Water Monitoring? SITE PLAN Reading Date Gross Net Depth to Net Time T~me Water Drop 14- 15- 16 17 18 19 20 PERCOLATION RATE __ (mioutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN __ F~.~D FT COMMENTS , /"/ 9."/ 72~008 (Rev. 4/85) bI~HA~ItM~Nt ob H~ALTH & HUMAN BEIWiCEs B25 "L" Sltee{, A~ichoiagle, Alaska §95LI2-0650 SoiLS LOG -- PERCOLATION TEST 1 2 4 § 7 10- WAS gROUND WATER SITE PLAN Dale Gross Net Deplh to Net Ttme Time Waler Drop I . ,, 7" kERcoLATioN J~Ai~ ~//~ [mmutes/,nchl PERC HOLE DIAME'IER I~-StRUNBETWI~EN //'~' ~TAND ~';7,,~-' THAI ?ti~6 TE,~ WAS PERI:gRIllED IN bEI~ARtMENt OF HEALTH & HUMAN SERVICES ~25 "L" Slree(, Adchorage, Ai~iska g9502-0050 SOiL:B LOG -- pERCOLATiON TEST LEGAl_ DESCitlP'I ioN: 4 5 7 g 10 12 lg- SLOPE SiTE PLAN 1- Dr°ss Net Time Time Water Net Drop I~[hbbLA/ll3N J~A1E ~/~' ~ immures/tach) PERC HOLE blAMEIER ~' tJ:~ ~UN b~WEJ:J~I / FT AND ~ I:T PROPERTY OWNER AGREEMENT FOR THE MAINTEN~CE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated June 1,3, 2001.~ is made between the Municipality of Anchorage Department of Health and Human Services (DHHS) and the property owner(s) of: Lot 5, Block 3~ North Slope Subdivision; Anchorage Recording District This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owners agree lo th, e following: Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation statement from a registered professional engineer. This inspection and operation statement shall verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any deficiencies have been repaked and that the system is functioning as designed. (Signature) Signature~fl Carl A. Disotell, Co-Mgr. Disotell Construction, L.L,C. (Printed Name) Kelly E. Wright (Printed Name) (Notarize Here) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 RUSH CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-511-14 1. GENERAL INFORMATION Complete legal description Expiration Date: Lot 5; Block 3; North Slope #1 Location (site address or directions) Kuparuk Ave. Current Property owner(s) Carl Disote] I Day phone 694--$797 Mailing address PO Box 770210 r,,~1¢ River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class__ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority 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. Name of Firm S & S Engineering 17034 N. Eagle River Loop Ste. Address Robert C, Cowan Engineer's Printed Name bedrooms. 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for Phone 694-2979 204 Eagle River, AK 99577 Date ~/6/0~ bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Repod Other Original CerLificate Date: ~ - / 0 - 03 (Rev. 12/001 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~O 3- A. WELL DATA Well type/°/~4'r~ Date completed c}/o~ ~ Total depth / o~ ff. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ¢ colonies/t00 mi. Ars~ B. SEPTIC/HOLDING TANK DATA Tank Type/Material If A, B, or C provide PWSID # Sanitary seal (~/N) ~'~ .r Cased to /0/ ft. FROM WELL LOG ft. g.p.m. Nitrate O. i mg.fL Date of sample: HOP/z_ Tanksize ]OOO gal. Number of Compartments Foundation cleanout~N) ~,,~,r Depression over tank (Y/~) Date of pumping ,~/'-~ -- ,~ ~.-~' Pumper Parcel ID: O~'O -- 5'//- I ~ Well Log (~N) Y ~ Wires properly protected (~N) Casing height (above ground) AT INSPECTION g.p.m. Other bacteda I colonies/100 mi. Collected b~ & $ ENGINEERIN~ 17U~,~ Icagie kiver Lm:p ~ NO, ~ E~le River, Alaska 995~ D~te installed ~/~/o ~ Gle~nouts ~N) ~ e ~ C. ABSORPTION FIELD DATA Date installed c~/.,~.~ Soil rating~rft2tbdrm) '~.O Systemtype /. ~ $'-~--' Length c~ O . ft. Width ) S? ft. Gravel below pipe ~ ,z~ ff. Total depth ,¢.. (to ~r*~, ~,~ ~;~ ) ..~ ,- ft. Eft. absorption area -.~ bo ft2 Monitoring tube ¥" J' Depression over field Date of adequacy test M/4 -,","f,,,¢ Results(Pass/Fail) ~ For ~ bedrooms Fluid depth in absorption field before test ~dded . gal. New depth in. Elapsed Time: ~depth in. Absorption rate >= g.p.d. An~tment (past 12 mo.) (Y/N & type) If yes, give date LIFT STATION Date installed ~ "Pump on" level at ~¥ in. Datum /3~r~,~ Size in gallons ~-5" O "Pump off" level at 5 ~' in. Cycles tested ~- Manhole/Access (~) Y'~ J' High water alarm level at ~ Meets a arm & circuit requirements? in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ) ~ $~ Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots ) o o "/- /do '%/-- On adjacent lots Public sewer manhole/cleanout ~v/4 Holding tank /¢//~) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '~1 ~' Property line O~ ! ' Water main ~ Wells on adjacent lots Water service line Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ ~-" Building foundation. ~5" Water Service line )o -/-- Surface water /oo Curtain drain ~vo~,~. zc~,o~,,,, Wells on adjacent lots .)~¢-) Water main ~//g Driveway, parking~'ehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date HAAFee$. '}-/5". -/- /$-o Date of Payment Receipt Number (Rev. 12/01) 03 b7 Waiver Fee $ Date of Payment Receipt Number ENGINEERING 907 694 1211 P. 02/02 'I hereby Certify ~t I ~a~ ~u~eyed the foIlow~g de~b~ ~chg~Se .R~o~d~g ~t, Ala~k~ a~ ~a~ the ove~]ap,o~'e~oach ~ ~e p~o~ I~8 a~jacem t~e, that ~ansm~ lines, oe o~r v~ easement~ on said ex.pi as ~ca~ed .Da~ed b~ E~gle ~ver, Abska _O ERT C, JOHNSON. ~. TOTAL P.