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HomeMy WebLinkAboutT15N R1W SEC 18 LT 91A MUNICIPALITY OF ANCHORAGE DE RTMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT L.---~'~--- '~, ~..~;'~,.5,/=-,~._~ DISTANCES ....~. TO SEPTIC ABSORPTION TANK FIELD WELL ~¢'O ~ ~ ~ ~'' [¢, i AS'BUILT DIAGRAM (Showiocat,on ol well, septic system, property I,nes, foundat,On,drweway, water bod,es, etc, TANKS IN ~ SEPTIC [] HOLDING __ TYPE OF SYSTEM ~RENCH ~ BED ~ W. DRAIN ~ OTHER grade ~OFT ~0 FT ~, ,] ~ ~ ~ ~ -- ....... ~~ F~ .......... ~ '~ FI ~p~ SOFT ~/~ FT WELLS ~RIVATE ~ OTHER Hdentifv) I 17034 E.gI. Ri,er L.p Ro.d No. 2, 72-013 (3/85) C) N ..... S I T E B E W El; R P E R M I T F:'er'm~,t Number I:, 88()()75 Da't',,(,:,~) ]:~.Bf,41uedl~ 06/()7/88 Up§fade (]wrier Addr Day Phc:)r~e: 688-'76B 1 Parc::el Id Lo't, Legal Fi,ax Oe~tl~n~: 18 '~'w~iiP:~, Range~ Z,W, ~ 46998 (sq. ft. or acres) Tl"ti~ I:::'erl~J.t: 4 T'o'Lal (,apac...i. ty, .: I: ,WI:=K SYS'II"EMS ~ Depth to f::'ipe Bot'Lom (f't,.): 4. () [¢l"avel Depth (ft) ,~ 6,,0 Total Del]th (Ft) ~ :LO.C) [~Paw~l Width (ft): 2.5 Gravel Length (ft)~ 67.0 '~',~' Gravel Volume (c:ubic: yds): 40.4 So:Lt IRa{ir'u;~ Used (sq ~'t/bpm)~ 200 des;:Lgnir;g your ,~..~. (3raw(,>~l ler~gth > ,50 fe;e.t requires multiple soils 'Le~sts,, I_IFT STA'I"ION~ If a lif't station is installed, a hic]h water alarm mus'L be C:OT]f]O)?Ct(~'d t,(::) 'LJ"It-D ,::>b:,f' I.I,L TANK: Min:i. mt.un 'l:.otal !~i~el:)t,i(:: tank ~',E~(?'IL P(.DCJL.I:[P~i J.i"i~LI].a~(:)l") QVt~I'~ 'Lmnl-,: (s), capac::i'Ly." 1~,:.,,,~) gallon~. Each sept:i,c: [)epth to tap of septic 'Lank(s) < 4.() IN,.:~I~I-L. PEFi: ENGINEER!~ DE,.:d, GI"I SH(]WN ABC)VE., NOTIFY DHH,:~ t, EF'UFd::. 1 .~. /o 1 /8 8. 1S]' & 2',I\iD IIxI!!iPEC'T'IC)N!~. ]H.I.~ I:":'IZRM):T IEXF:'IRE. S I CIERTIF'Y 'I"F'IAT." 1,, :1: am familiar' with the r, eqt,t:Lr~merl'L!~ for' (::)I']-'S:['(,E~ sewers and wells as set forth by the I%mic:il:)ality of AnchoPage (MOA) and 'Lhe S~ate oF Alaska,, 2. I ~:i,l]. :i,r'~['t..a].;I. the system in accc)pdance with all MOA codes and r'egula'Lic)r~s, arid J.n compl:i, anc:e w:L'Lh the design c:riteria c:~f thi~ permit,, 3. :1: will adl"~er'e 'Lo all MOA and St. ate of Alaska requirements rcm t. he set back d:i,s'(,ar]6:es from any exi~tir~g we].l, ~as'LewateP disposal system or, sewepage sys't',.em on '(.hi!ii~ (::)P any adjacent or nearby lot. 4,, I ur~der, s'Land that this permit :i.s va].id fop a maximum c)f 4 bec:h"ocmls,, :1: a:l,~o ur~del"B'[.artd 'Lha'L the clapac:i,t.y of '[,he to'La], !Bys[e~ is 4 be(::h"oofJHi; and any er'~].argemerl't'., will requ:[r~ an addit.:i, or~al per'talC. (Owner) Issued By,', DA lei:: I)(4 f rE ,, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 5 6 7 8 9 10 11 12 13 14 15- 16- 17- 18- 19- 20- Township, Range, Section: SLOPE WAS GROUND WATER ~ ~,,,,~, ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Waler After Monitoring? Dele: SITE PLAI~ s :IPALITY OF ANCHOI~GIE OF HEALTH & PROTECTION JUN 1 0 1988 EIVED / PERCOLATION RATE ¢, ,~ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ~Z~ FT AND ,~ FT ACOORDAN~%",'".~ ~**"¥E AND MUN,CIP^~ GU,DEL,N~',?_'?~EO~ ON T.,~ DATE. 72-008 (Rev. 4/85) Reading Date Gross Net Depth to Net Time Time Water Drop 6- ,L ~". ~ ~ I~ ~ ~ ~" ~/~'~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGA. OESCR,PT,D.: Z ?/,~- 3- 4- 5- 6- 7- 8- 9- 13- 14- 15- 16- 17- 18- 19- 20- '5. Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Monitoring? / S L O Reading Date Gross Net Depth to Net Time Time Water Drop COMMENTS PERFORMED BY: Eagle Rlver~ Aieaka ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE~.f/N-Ed~ECT ON THIS DATE. 72-008 (Rev. 4/85) 17034 Eagle River L~op Road No. 20~ o ;:7 erlff[ei lr[llhtg A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 OWNER OF LAND ADDREss LEGAL DESCRIPTION Z PERMIT.NUMBER DEPTR Or WELL ~t ' ~ '~ STATIC LEVEL OF WATER FT. DRAW DOWN FT.. '~ ! GALS. PER HR /?o ~, KIND OF CASING ~ 50 KIND OF FORMATION: From ~9 Ft. to / Ft. From [ Ft. to q Ft. From c~ Ft. t6~' Ft. From ~' Ft. to ~-o~ Ft. From 4~'") Ft. to ~,-O -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 From Ft. to Ft From Ft. to Ft From__ Ft. to Ft. From ' .Ft. to Ft. From Ft. to Ft. From From From From.__ 7'O'eF r o m _ From Frmn From From From From_ From From From From From From _ _Ft. to Ft. Ft. to Ft. Ft. to Ft. __Ft. to __Ft, Ft. to____Ft. __Ft. to___Ft. __ Ft. to___Ft. Ft. to Ft. _Ft. t o~..~: I~_. _Ft.to ~,~____Ft. ~'. . ~ Anchorage Dept. H°a"'- Ft.~o Ft, Ft. to FL, ~.Ft to Ft. ~.~t to ~t. Ft. to Ft. MISCL. INFORMATION: DRILLER'S NAME ( erlifie Irillt g · & L IHIILLING COMPANY BOX97, EAGLE RIVER, ALASKA 99577 · TELEPHONE694*2588 OWNER OF LAND ADDRESS PE~IT NUMBER DE~TH OF WELL / OD STATIC LEVEL OF WATER FT. DRAW DOWN FT. ' · 0 GALS. PER HR ~' KIND OF CASIN~~ ~'~ O KIND OF FORMATION: From,C? From ~ Ft. to tO~ From /o] Ft. to ~' Ft. From ,,.~' Ft. to '~'0 Ft. From ~'a Ft. to ~'~" Ft. From ~-~ Ft. to ~ Ft. From ~ Ft. to From ~ FLto /oo Ft. From Ft. to. Ft From Ft. to From Ft. From Ft. to From Ft. to~ From Ft. to Ft. From __ Ft. to Ft. Fromm. Ft. to Ft. MISCL. INFORMATION: From From Ft. From~Ft. to__Ft Fro~Ft. to Ft Fr~Vf Ft. to__Ft From ~ Ft. to Ft From Ft. to__,Ft From Ft. to__.Ft._ From Ft. to Ft_. December 31, 1979 Louie Edwards Star Route Bex 695 Chugiak, Alaska 99567 Permit ,~ 790362 Subject: T" ='~ A permit issued by this department for well. and/or sewer system has expired. 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 should be sent to this department to document the installation date. If an enginee~ has inspected on-site sewer system, please for our files. the installation of the have them send us the If there are any further questions, please contact office at 264-4720. Sincerely, Les N. Buchholz, R.S. ~ Senior Environmental Speci~a2z~st LNB/ljw as-builts this enc: Copy of Permit PERMIT NO. i'(IIJ~ICIF ]L IT'¢ OF F~i~H( DEPARTMENT O~ HEALTH AND ENVIRONMENTAL P~dTECTION 825 'L' STREET, ANCHORAGE, AK. 264-4720 ON---SZTE SEHEF; PERr"I APPLICANT LOCATION LEGAL LOUIE EDWARDS ADRIAN LANE WEST LgiR NEI?4 Si8 TiSN RiW TYPE OF SOIL. ABSORBTION SYSTEM IS: SR BOX 695 CHUGIAK ~O/~>,~j, ~ ~)~ LOT SIZE TRENCH 4~000 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT?BR>= 148 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [)E-'PTH= 12 LENGTH----- --~8 ORA"eEL C~EPTH= 8 THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIEL. D. THE DEPTH OF A TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET>. RED SEPT I C TANK PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO (2) I NSPECTICmNS RS:E F~E;QLIIRED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELD OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERMIT EXPIRES DECEMBER --?--l. i~7~ I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON'~SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. ~ Steven A. Johnson Box 76 Chugiak, Alaska 99567 Phone: 688-3085 Performed for Legal Description Louie B. Edwards Lot 914 in the NE~ of Sec.18, 90' E and 85' N SW property corner Soils Log Percolation Test Date 9/5/78 T15N, R1W SM Test Pit Location 2 6 l0 12 14 16 ~L GW red brown gravelly silt w/organics (~L) 275 ft2/bdrm gray brown silty sandy gravel with cobbles to six inches (GW-GN) 14Q ft~/bdrm grading less silty from 6' to 9' 9'- 16' gray brown sandy gravel w/some silt (GW) 120 ft2/bdrm no water table encountered Total depth this test 16 feet AVERAGE ABSORPTION AREA REQUIRED FROM SOILS LOG = 148 ft.2/bdrm. NET TIME (Min.) NET DROP (In.) PERC P~Tn~in) Percolation rate Signed minutes/inch 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 91A; Section 181 T15N~ RIW; SM Location (site address or directions) 19433 Adrian, South Birchwood Loop Property owner Mailing address Louis and Dorothy Edwards Day phone 688-2632 Lending agency Mailing address Day phone Agent Ja~ie 01son/ERA PROFESSIONAL REALTY 2702 Gambel, Suite 200, Anchorage, Alaska Address Day phone 278-2776 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: *~ `% TYPE OF WATER SUPPLY: Individual well X Community welt 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: X 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 #2I 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 E'.,~G~NEERING Address 17034 ~a~le River Loop Road He 204 Eagle Riyer~ AJasEa Engineer's signature Phone Date / / DHHS SIGNATURE Approved for ~ Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: --~ ©t4 [~t ~Y~I~ Date 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 abgve by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to pu mhasers 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. 72~025(Rev, l/91) Back MOA#21 Municipality of Anchorage Department of Health & Human Services · HEALTH AUTHORITY APPROVAL CHECKLISTEN Legal Description:~-¢,~ c~ ~/3, ;~e.~ ~, ~-~'~'~.~: ~,J~,.~l~ Parcel I.D. If A, B, or C, attach ADEC letter. \/ Date completed A. WELL DATA Well type Log present (~N) Total depth Sanitary seal ~/N) MAY ? 199[ RECEIVED ADEC water system number ~ J ~- ?-.~o-7~' Driller A'~ L Z~,/a..c~,J~. ~.~. Cased to "~'¢~ ' ~ Casing height / 2. ' ~ ~' Wires properly protected ~N) V Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION '~..'~'. C' g.p.m. ~ ,~ ~ g.p.m. Absorption field on lot Public sewer main Public sewer service line SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ ~O ~ ~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ cc~'>~/m> ~- Date of sample: '~ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts gN) High water alarm (Y~ Date of pumping Nitrate t~ ~ ~, d~E)~. ~"~/¢ [ Other bacteria S & S ~GINEERING Collected by: ~7534 ~agie ~iver L~p ~oa~ ~o. ~ ~ngle River, Alaska ~577 Tank size / ~_~'-c~ ~A'/--. Compartments Foundation cleanout (~N) ~' Depression (Y,~ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot IC) (~)~'~' On adjacent lots IOc~ ~ ~ TO property line ~0~ ~'~ Absorption field Surface water/drainage ~ Dc> Foundation Water main/service line 72-026 (Rev, 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA ele~t~ ~OM L I F~ nS aT,j: Ic0e nNt :c~: , Manhole/Access (Y/N) Surface water D. ABSORPTION FIELD DATA Date installed [.,, Length I.~ ~ Width Total absorption area ~'~ Depression over field (Y,~. . Results ~fail) Peroxide treatment (past 12 months) (y/~l Soil rating '?~c='c::~l/i~-. Gravel thickness ~.0 Cleanouts present Date of adequ ,acy test for ~'c,~ f~.. u~No ~ If yes, give date System type Total depth ¥ bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot I ~:~:::, ~''' To building foundation On adjacent lots bar--- Surface water Curtain drain E. ENGINEER'S CERTIFICATION On adjacent lots ~:> t*" Property line 't ~ ~ '*- To existing or abandoned,system on lot Cutbank ~ ~' Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on ~ of this il3spection. Signature ~ r& ,~ ENGINE, ERHgG 17034 E~gle River Loop Road No. 204 Engineer's Name c~.l,. ~;,,ar. Ala~ka 99577 Date ~//~/~' t/ HAAFee$ /.~ O d_ Date of Payment '-~--"-7''-~ / Receipt Number ~--~- ~2 ~ '~ 72~026 {Rev, 3/91) Back MOA 21 Waiver Fee: $. Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301