HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 7 LT 10 Municipality of Anchorage Page 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: ~uo ~ 01I;'~ PIDNumber: ~'5o'-/q I( O N~,:Wastewater System: ~New ~ Upgrade Address: ABSORPTION FIELD Phone: No, of Bedrooms:~ ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound Q Other LEGAL DESCRI PTIO N sci, Rating:l, ~ GPD/Sq. Ft. Total Depthll from, --°riginal~ ~ ~ grade: Lot: Block: Subdiv~ion: Depth to pipe bottom Irom original grade: Gravel depth beneath pipe Township: ~ Range: Section: Fill added abov~riginal grade: Gravel length: WELL: ~ New ~ Upgrade Gravel width: ~ Number of lines: 0istance between lines: Classification (Private, A,B,C): Total Depth: ~a~d To: . Total absorption area: P~ ~aterial: Static Water Level: D~er: Date Drilled: Installer: Date installed: Yield: Pump Set at: ¢ 4~ Casing Height Above Ground: SEPARATION DISTANCES ~Septic B Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private ~anufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~, ~¢ ~, I~ O Material: Number of Compadments: Sudace ~ t . _ Water ~OO ~lOO +_tOO'~...LIFT STATION Line 5 ~' /~ "Pump on" level/~4~at: "Pump off ig;water al : '~H arm at Foundation i ~ ( i~ ~ Cudain Pump Make & Model Electrical inspections pedormed Drain ~ OD ~ ~O ~0~ Remarks: ~,_ ~ ~¢~¢~ BENCH MARK Location and Description: Assumod Elovation: ' ENGINEER'S SEAL Reviewed and approved b /m~ 72-013 (Rev. 9/91) MOA 25 ~ ~'~ 1 ~,D_ ~ + Page ~ of .~__ Permit No. Munig~)a~ilty,p~f 4¢cl~Rr~_ ~e DEPARTMENT OF HEALTH AND HUI~AN 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 72-013 A (Rev. 9/91) MOA 25 96-0~-12 ~1:28 IEage ~ of.__~,~ 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 724)13 A (Rev. 9/91) MOA 25 96-01-12 ~1:28 IN OWNER OF LAND ADDRESS (:! LEGAL DESCRIPTION DATE - Started PERMIT NUMBER (gerlifiell riliing Eog DOC Co. Oba SULLIVAN WATER WELLS P.O. BOX 679272, CHUGIAK, ALASKA 99567 · TELEPHONE 688.2759 Ended :/, I)EPTH OF WELL , ; r' ~ ST-\ FIC LEVEL OF WATEI{ FT. ),:./, i,., ~r ~ : DRAW DOWN FT. GALS. PER HR KIND OF' CASING KIND OF FORMATION: From- · Ft. to ' Ft. From Ft. to i .... Ft. From ~ Ft. to . -: Ft. From : Ft. to / ."" From" Ft, to .; · ' From: ' Ft. to ; From · ~, Ft. to/ / ~ ) Frc, n'~. Ft. lo _ From From: ' Ft. to Ft. From - r ' Ft. to_ Ft. r From /" Ft. to ' :Ft. - ~;; ' : From Ft. to ': ~ Ft. "' From ~ : Ft. to ., "Ft. ' ' ' From Ft. to__Ft From__Ft. to Ft From__Ft. to Ft. From_ Ft. to__Ft, From Ft. to__Ft Ft. [o Fl. [o Ft. t. Fro~ll Ft. to From Ft. to From__FL to Frmn Ft. to__ '., : Frolll ' 'From . Ft. to_ F1 [o Fi. Ft Ft._ Ft. F~ Ft. Ft. Ft Fl, Ft. Fl. Frmn Ft. to Ft From Ft. to Ft. From Ft. to Ft From Ft. to___Ft. From Ft. to96-0~'F[13 10:38 From__ Ft. to__ Ft, MISCL. INFORMATION: 96-01-12 11:28 IN DRILLER'S NAME ' "r PAGE 10P 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 WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950184 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:PULLEN SARA & OWNER ADDRESS:317 A STREET #402 ANCHORAGE, ALASKA 99501-2537 DATE ISSUED: 8/01/95 EXPIRATION DATE: 8/01/96 PARCEL ID:05079110 LEGAL DESCRIPTION: RIVER VIEW ESTATES BLH 7 LT 10 LOT SIZE: 40000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL 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 (iSAAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4o FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISION~ RECEIVED July 5, 1995 CMM General Contractor Gill/Pullen Residence Lot 10, Block 7, Riverview Estates Septic System Sizing - $ Bedrooms Percolation Rate: 1.5 minutes/inch From MOA Regulations - Soil Application Rate: 1.2 gpd/sf Absorption Area: 3, bedrooms * 150 gpd/bedroom = 450 gpd 450 gpd/1.2 gpd/sf = 3,75 sf Length of Deep Trench Absorption Trench: Assumed depth to groundwater: 17 ft Less burial depth of pipe: 4 Less depth above groundwater: 6 ,Aft Effective depth 375 sf/,l~'ft/2 sides = ~0~8-ft Use ~ fl for length of trench Reserve area will be the same as the absorption area. Other Information: Septic tank will be a steel, 2 compartment, 1250 gallon tank. Burial depth for all pipe will be 4 feet. No surface water was present within +250 feet. The lot is .91 acres with a vacant lot on the left and a residence on the right. The resident on the right indicated that his well was over 200 feet in depth. $~u~.o~,~,~a,~r Proposed well location is + 108 feet and + 200 to the well on ~ot 11. Calculated By: PaulaR. Ma~inelli ~~ ¢¢6 ~4~7~ Reviewed By: Jack F. Fulle~on ~' ........... / Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ,ZL-DT"/~, -~/~/L~_ ~/ ~)l/mZ~//l~ Township, Range, Section: SITE PI.AN t~..,~ T~ 7-~--,~ S LO P E / / WAS GROUND WATER ENCOUNTERED? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O IF YES, AT WHAT DEPTH? Oeplh lo Walsr Alter Meniloring? ~ O m ~ Dale: Gross Net Depth to Net Reading 7~t~e'-' Time ~h.~;~? Time Water Drop PERCOLATION RATE /, ~ tm~nutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN ~"~ FT AND Z~ FT PERFORMED BY:~'~, ~4~/~ ~1 I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: w'~ 72-008 (Rev. 4t85) 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. # ___f')~-_D~ !l ~ HAA # "'~\'":, '", .: - [ '(~- 4'-'/ GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address ¢£~-~-¢.5,~4rc" 1°.O ,8,--~! ¢ ~ ~ I~ /EJ~/c--~m¢-~c~.. /~//-- ~/~l.~ Agent ~-'.(~-:Z'r<~'. ~'¢ YbL l'Vk. ('~ ~ .,-. r v'o-~,. ¢ ~%t~'~'_,.l~- Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~:~ TYPE OF WATER SUPPLY: Individual well ,tX/ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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. 1191) Fronl 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 c r~-site water supply and/.or.wastewater disposal system is safe, functional and adequate fort'he number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Munici pality of Anchorage files and from my investigation and inspection, the on-site water supl~l~/'and/or wastewater dis posal system is in corn pliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ,.?'Engi~:~:~r;~'Si'gnature : ~ ':, '. . . ....-,.... .~.~... .~, :.,,.-..- ' "-~?,'.:,';. V~'~ .'. * ' ''r bedrooms. .' ";,7,' ~ ~' .-'~2~-:. " . ~, -. ,. ' ,2 ,-'~' ".'.':'L ;= 'V · ,'~:t~.s:¢~ 2:~ .'-..,~:.b~f-;,:~,',' .,...: ... :. ,,..r_._ ; ..' ', of Anch0r~'g~'De~ment of Health and Huma~ sewi~ '(5'RHs)'iS~ 'Health Authori~ based only upon the representations given in paragraph' 5 abOv~ by an independent ~¢ istered in the State of Alaska. The DHHS does this as a c0u~esyto ~urchase~ of homes . [¢ and'thSi'¢i&" i g institutions in order to satis~ ce~ain federal and state requireme~'ts::Employees of DHHS do not ','; conduct 'in~ec~[ons or analyze data before a ce~ificate is issued. The. Municipali~.0f Anchorage is not ',,:; ~; responsible for e?rors or oral,ions in the profess cna eng n~(s work.'. . '".: . ;L-~ ' ' :-" '"::': "' '" ' 72~(R~.1~1) B~k MOA~I Legal Dcscriptioo: A. WELL DATA Well type_"? v' Log present (Y/N) V _F, % Date cotnpleted I Total depth ,~_(~(D Cased to ZTLO. Saoitary seal (Y/N) FROM WELL LOG 96-01'12 11:28 IN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist If A, B, or C, attach ADEC letter. ~EC water system nnmber Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Date of test Static water level '"~ Well production ~. ~:3 g.p.m. ~ [2'''4g ,_.~. c~ ~ . g.p.m. ~/o~ Coliform O O~l o ~,6s ( ~ 0-O m [ Nitrate __ Date of sample: /Z~Z~-~' ~ "5 B. ~OLD1NG TANK DATA D, 1{~) m~!/'" Other bacteria (") Collected by: c~h ]/~/pt~?~//d d~5~d~A~-] Gravel thickness below pipe Dateinsta!led q/~50/q..~ Tanksize /.SC~'O~{.NumberofCompartments¢-~ Cleanouts(Y/N) ... Foundation cleanont (Y~) ~ Depression (Y~) ~ O Highwater alarm ~) ~ O Date of Pulnping ~/~C ~ Pulnper C. ABSOR~ION F~LD DAT~ Date installed ..~/DO ~ ~ Soil rating (g.p.d:/a2 or aZ~drm) Len~h ~-~ Width ~ System tFpe c'-'l ~o w~,,,')'~D / -q~ t Totaldepth /[,~! Effective absorption area % '~ ~ Monitoring Tube present(Y/N)~,a Depression over field (Y/N) p'(() Date of adequacy test p~)~_>~'-'~ Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); .I Immediately after gal. water added (in.): Fluid depth. (ins.) Minutes later: Peroxide treameut (past 12 months) (Y/N) Absorption rate = If yes, give date g.p.d. D. LIFT STATION Date installed'X.., Size itl gallons Manhole/Access (Y~) ~'~'~/~/~ r "Pump oil" level at* "Pump off" level at* High water alarm level tit' Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank oil lot Absorption field oll lot Public sewer nlain ~ Sewer/septic se~ice line ; On adjacent lots ; On adjacent lots Public sexver ma,fl~ole/cleanont Lift station /~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ] ~) Property line .~_ '~ r_~ Absorption field Water main/service line .~ 55' Surface water/drainage 4-1 O(.) Wells oil adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water -D Curtain drain ~ Water main/service line ~ t~ Driveway, parking/vehicle storage area ~ ~, Wells on adjacent lots -q' [ © (~ Property line F. ENGINEER'S CERTIFICATION m coq/brmance with ~ ..guidelines in effect on this (late. ...................................................................................................... HAA Fee $ ~.~D~ Receipt Number,/'~"~ ~- ('/'q'F~9°/' Rev. 8/95 OSS: baa.wk.doc Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc. ~' Laboratory Division ~ ---- ---~- -' ~ .... ~- o,,B ~o=.~~..-~-~ Laboratory Analysis RePort Clienb ~am~le ID L10 DI~7 ~IV~RVIE~ ~TATB~ CI~eRU Name C~~CO~CTOR Reoetve~ DaCe 30616 01/03/96 ~ 11:2~ h~m, 13/28/9~ ~ 17t30 b~=, Sample Romarks= MAMPSE CO~b~C~D BY: ~.H. ~ 3ce 8pe~£el ~Czuo~ion~ Above N~ = ~o~ AnalyZe~ " 200 W. Potter Orive. An~g~, AK 98518-160~ --Teh (907} 562-2~ Fax: (907} 661-530~ ~N~RONMENT~ F~I~I85 IN A~S~, ~LIFORN~ FLORIDA, ILL~01S, MARY~NO, MICHIGAN, MISSOURI, N~ JERSEY, 0RIO, WEST Vi~GINIA