HomeMy WebLinkAboutMILE HI #1 BLK 8 LT 4Mile Hi #1
Lot 4
Block 8
#050-201-51
r
Municipality of Anchorage Page of Z -
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' 91? -07_2Z. PID Number:
t / e 7 -4,4 -le- p iy
Nam 009
Wastewater System: - ❑ New ❑ Upgrade
Addr'R.og 27/777 E/9e7K_E
ABSORPTION FIELD
Phone:v Q /_ �.0 N°' of Bedr°°ma'
]
beep Trench O Shallow Trench ❑ Bed ❑ Mound ❑ Other
L7LD3ESCRIPTION
LEGAL
Sal Rating O' �15—
Total Depth from original grade:
GPD .Ft.
Lot: ♦/ Block: Subdivision:
Depth to pi bosom original grade:
Gravel depM beneath Pipe
i 122= T /T
Ft.
.Ft.
Township: /�
Range: .. 1 Section:
Lt_I 9
Fill added above original grade:
Gravel length: JO -
7
Ft.
I Ft.
WELL: ew ❑ Upgrade
Gravel width
37"
Number of fines:
ID" ia batweta kdr
—
Ft.
Ft.
Classification (Private. A.B.C): D
Total the
Cased To:
2-7
Total absorptlo arm
s o
Pt me :
L FL
FL
SO. Ft.
Driller:O
Date Drilled,
Slatiewaterleva'
Inst laGgv % G.
r
Datg,nE/—/' EL
�Er!.L+ I /
tJvG
t.
5Aboveerround:
/"j'
ph
Yield: Pump Seta`
Ca"Hei9M1-27
TANK
GPM Ft
FL
SEPARATION
DISTANCES
� �
ItgSepttc ❑Holding 0S.T.E.F.
To
septic
Absorption
un
Holding
b1WPdvste
�C�•7�/
M/T; c?4 ��
Cap c in lions:
From
Tank
Field
Station
Tank
Sewer Lines
Well-
/07,
1104-
--
--
+td
�
Mat e al:
�TEEt-
Number of Compartments:
�-�
Surface
Water
LIFT STATION
LotfS�
Size in gallons: Man rer.
Line
Foundation
f/�
4-10
"Pump on" level at:
"Pu 6
High water alarm at:
Curtain
u
/�
,�, 5%
Pump Make I
Electrical Inspections performed by.
rtai
V
BENCH MARK
Remarks:
Location and Description:
3 r✓ c 24 1Nc 7�0 P
E,VTrz e�cc.K,
Assumed Elevation:
foo.-
—.ENGINEER'S SEAL
At
�'/LSA Dates: tst��
age
Inspections performed by:
(�✓� �
arae! /o - //- g 9 2nd /o - f-
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"Department Health and Human Services approval
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of
Date: - /7-0 O
Reviewed and approved by:
_
72-013 (Rev. 9/91) MOA 25
q
Permit No. / Z `! Page 2- of 2 -
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 7 68 X� /(-E: -/-// PID No.:
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Gor
IVIn aicipality of Anchorage
Department of Health and Human Services ,e
825 "L" Street
Rick Mystrom. P.O. Box 196650 Anchorage. Alaska 99519-6650
Mayor
Permit Number Date Of Issue==_ Tax Identification Number--
Date
umber=
Date Started - Date Completed - 5 Is well located at approved permit location? X Yes ❑ No
Legal Description
Block
Lot
Property Owner Name & Address:
i4I'Zx -1- C, \/ i6i
�w S'EP-24-99 FRI09_,53AN Northern Bv%eS Comp Svcs 1 907 337 2987
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o- MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502 P� Yl
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Aug 19, 1999
Expiration Date: Aug 18, 2000
Permit Number: SW990291 Parcel ID: 050-201-51
Legal Description: 6 NWHI #1 $LK 8 LT 4
Design Engineer: 0011 Constructing Engineers, Inc. Site Address:
Owner Name: Alex Taylor Lot Size: 53092 SQ. FT.
Owner Address: PO Bix 7717777 Total Bedrooms: 1 Permit Bedrooms: 1
Eagle River, AK 99577 -
This permit is for the construction of:
7 Disposal Field Z Septic Tank ❑Holding Tank L] Privy ❑✓ Private Well ❑Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Date:
Issued By: �/� C Date: -9-1999
HANK WILSON
CIVIL ENGINEER
LAND SURVEYOR
CONSTRUCTING ENGINEERS
< J,
9601 BUDDY WERNER DRIVE
ANCHORAGE, ALASKA 99516
PHONE/FAX (907) 346.2000
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e +.r Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: 46 Ei 7—t* Got DATE
LEGAL DESCRIPTION: L 'y 139? M Ilt -/--/I Township, Range, Section:
z
5rdvej
3
4d 1 62 Aj
5
6
7
8
9
5
t0 WAS GROUND WATER N O
ENCOUNTERED?
11
IF YES, AT WHAT
12 DEPTH?
13 Depth to Water After _
Monitoring? este:
14
15
16
17
18
19
WOMEN I ME
6
■
13 00
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
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20 4 II
PERCOLATION RATE 1, (minutes/inch) PERC HOLE DIAMETER
_ TEST RUN BETWEEN Gr FT AND I_FT
COMMENTS V$� QIFEI' Ti ar AIG.14 TOL? !sRIQ'VEL 7'U 13E �I �•�.
�607'roAA §Rl�vc, G ro 13dot / l3 _
PERFORMED BY; �r/'t' + 9Wf450A) I _. 'el' 114 W14-4 "'ll CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 4? - 41` 47/9
72-908 (Rev. 4185)
t1
7H(A K
WILSON
CIVIL ENGINEER
LAND SURVEYOR
CONSTRUCTING ENGINEERS
tnnitE- 41
9601 BUDDY WERNER DRIVE
ANCHORAGE, ALASKA 99516
PHONE/FAX (907) 346-2000
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K 0 P S }/STEM ( 00" tT G) m N S I TL 7LA Iii.
Parcel I.D. 050-201-51
Municipality ol'Anchoragca;e,.�,
On -Site Water and Wastewater Progra
(907)343-7904
V',`
DEC 3 0 2O15
Certificate nfOn-Site ` SVst80S)p oval
j. GENERAL INFORMATION
Complete legal description MILE HI 11; BLOCK 8, LOT 4
Location (site address) 22005 Upper Canyon drive, Eagle River, AK 99577
Current Property owner(s) Laura Schue-& Charles Couvillion
Mailing address
Real Estate Agent
David Parks
2. TYPE OFDWELLING:
[� Single Family kw/eoAO0
F] Duplex
F� Multiple Dwellings (Single Family and/or Duplex)
3.NUMBER OFBEDROOMS:
f'�]
4.TYPE DFWATER SUPPLY:
0
Individual Well
[�
��
Individual Water Storage
�l
Community Class Well
El
Public Water System
El
Waiver/Variance request for: N/A
Day phone 907-782-9767
Day phone 350'0144
TYPE [}FWASTEWATER DISPOSAL:
Individual
f'�]
Holding Tank
0
Community �
[�
��
Public Sewer
M
Received b Date: 1-/q/16
COSAmbe released mthe engineer. unless mherviise requested by the engineer.
COSA Fee Waiver Fee $
Date of Payment b Date of Payment
Receipt Number Receipt Number
�S
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,
based on procedures outlined in the Certificate of On -Site Systems 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 Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179
Address 3701 E. Tudor Road, Suite 101, Anchorage AK, 99507-1259 /
Engineer's Printed Name Jeffrey A. Garness Date i '''�1 ?--
!n conducting this evaluation, GEG provided an engineering evaluation of the well andlor septic ckatt
system in accordance with the guidelines and regulations established by the Municipality of 44' CF
Anchorage and industry practices. The reported results describe the condition of the systemis on the �-0.h, „,.�,...;,,� 8 �
datels of the evaluation. Separation distances were measured to readily identifiable features. '�� R;•�' �''•.,o,
Hidden defects or encroachments may exist that were not identified during the evaluation. The r
operational life of all wells and septic systems depend on a variety of variables including, but notr/c::
limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of � I
construction (materials and workmanship), and the water usage of the family utilizing the systemis. •"""""/' =/'t_''x=•"*"__'•_«
These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
guarantee future performance of the s stem/s; therefore, GEG makes no warrant """' "" ° ` "'°"`_"__'"
9 A Y y (express or ±"t 1
implied) regarding the future performance of the well or septic system. GEG makes no 0k115r�/ �J ffrey A„ .`Garness
representation whether an alternative well or septic system can be installed on the property in the �{jk115�i�f iJf CE;7g53 ;
event either of the current systems fail. The content of this report is for the sole benefit of the
personfparty who retained GEG. Reliance upon the information provided in this report by any other'•
` .. � ;;.t.*
person or party, including but not limited to subsequent property purchasers, is not authorized. in
short, GEG disavows any legal duty to anyone other than the personlparty who paid for this report.� 4 VA ffi ESS\
6. DSD SIGNATURE
System #1 Approved for
System #2 Approved for
Disapproved
Conditional approval for _ -
bedrooms, with the following stipulations: -;_,r
Original Certificate Date: % 4Y_, IL2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA ChecklistNitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 9-1-12.doc
oo-sa
bedrooms = s
Vd xr,
bedrooms '.�
WA r, CIO
bedrooms, with the following stipulations: -;_,r
Original Certificate Date: % 4Y_, IL2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA ChecklistNitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 9-1-12.doc
Legal Description:
A. WELL DATA
Well type _PRIVATE _ If4,B.orCprovide PVVS|O# N/A
Date completed Sanitary seal (Y/N)YB
Total depth 142 ft. Cased to 27 ft.
Date of test
Static water level
Well production
FROM WELL LOG
9/4/99
53 �
3
If more than 1 septic system is on the lot:
COSAChecklist # of
Structure served bvthis system ___
Parcel |D: 050-201-51
Well Log (Y/N) YES
Wires properly protected (Y7N) YES
Casing height (above ground) in.
AT INSPECTION
12/8/15
54.2
1.8f
RM
WATER SAMPLE RESULTS:
Coliform _��'oo|oninm/1OO mi Nitrate mg./L. Collectedby: GEG. Ltd.
WID //
Arsenic: i�--�Ug�L. z�s— Dat�ofsannp|e�_I��V15__
B. SEPTIC/HOLDING TANK DATA
TankType/Matehs|
Tank size 100gal. Number ofCompartments 2
Foundation cleanout (Y/N) YES Depression over tank [Y/N) NO
Date ufpumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating rft2/bdnn) 0/45
Length 4ft. Width ft.
Date installed 9/25-10/4/99
Cleanout (YYN) YES
High water alarm (Y/N) N
System type DEEP TRENCH
Gravel below pipe
Total depth _*21_.2 _ft. Eff.absorption area 480 f2 Monitoring tube YES Depression over field NO
Date nfadequacy test 12 Results (Poaa/Fai|)_PASS �- For 1 bedrooms
Fluid depth inabsorption field before test _Z�2 in. Water added J2Ogal. New depth 41 in.
Elapsed Time: 120 min. Final fluid depth 34 in. Absorption rate >= g.p.d�
NONE
|fyes, give date ____—____
D. LIFT STATION
Date installed
"Pump on" level atn
Size in gallons
Manhole/Access
"Pump off' level High water alarm leve at n.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL DNLOT TO:
'
Sepdotank�iftsta�on on lot 1
00+
Absorption field onlot
Public sewer main 7'
Onadjacent lots '
On adjacent lots
Public sewer manhole/cleanout
Sewer /septic service line Holding tank '
Animal containment areas ' Manure/animal excrete storage areas 100,+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK C}NLOT TO:
Building foundation ' Property line ' Absorption field '
Water main ' Water service |i '
Wells on adjacent lots 100'+
Surface water
1OO'f
SEPARATION DISTANCE FROM ABSORPTION FIELD ONLOT TO:
Property line ^ Building foundation ' Water main 10'+
Water service line 10'+ Surfamswaher ' —Driveway, parking/vehicle storage '
Curtain drain NONE KNOWN Wells onadjacent lots _'�u/+�-
F. COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that / have determined through field inspections and
review ufMunicipal records that the above systems are /n
conformance with M(l4 C{}SA guidelines in effect on this
date.
Engineer's Printed N
Date / Z/
/ I C) / J.';
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES.
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650 t
343-4744 /
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
n
Parcel I.D. # 19 - Zc1I- 5'1 HAA # �3�(
1. GENERAL INFORMATION �!
Complete legal description
Location (site address or directions) E2'Y6- /2,&/e r /?y led-
dgo .Cz�ya� fir.
Property owner /-,flex 7"-Y/o" Day phone
Mailing address P 771777 CAycC/y�2 �¢/< Q9S7`J
Lending agency
Mailing address.
Agent
Address
Unless otherwise requested, NAA will be held for pickup.
2. NUMBER OF BEDROOMS: 0"1.5
3. TYPE OF WATER SUPPLY:
Individual well
Community well
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.1191) Front 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 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 furtherverifythat 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 CnsCr�GS cns, �a s Phone
Address 9'60/ ?✓ Y AA -f-
Engineer's signature
6. DHHS SIGNATURE
L-02
nt--
k� Approved for I bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date
e,4G -Z V -o
bedrooms, with the following stipulations:
Date %- 211- 6
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 cou rtesy to purchasers of homes
and their lending institutions in orderto 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.
U2 (R".1191) Back MOA#21
,«KEIVEU
JUL 21 2WO
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SEWt NALtfY SEANCN)RAGG
• � t AL SERVICES plvi"
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: Parcel I.D.: OSo - 201-5!
A. WELL DATA
Well type i� If A, B, or C. attach ADEC letter. ADEC water system number IV/ 'Or
Log present (Y/N) }� Date completed
Total depth 1 f ?- Cased to 21 Casing height (above ground) 7_ +
Sanitary seal (Y/N) y Wires properly protected (Y/N) Y
FROM WELL LOG AT INSPECTION
Date of test `! `� 4 N N ostu use t -e-
t
Static water level 5
r
Well production
WATER SAMPLE RESULTS
Coliform A1,�?
Date of sample: % —
B. SEPTICIHOLDING TANK DATA
g.p.m.
Nitrate 2.S9 Other bacteria
Collected by: 4w/ GE
Z—
Date installed `) ' 9 5 Tank size 1000 Number of Compartments I- Cleanouts (Y/N) i
Foundation cleanout (Y/N) i Depression (Y/N) ^I High water alarm (Y/N) tj
Date of Pumping — Pumper — (ti' cFciSYS c e-)
C. ABSORPTION FIELD DATA
Date installed q-97 Soil rating (g.p.d./ft' ) 0. s System type DC EP TIZEN c N
Length VO Width 3 Gravel thickness below pipe l Total depth /0
Effective absorption area V lro s eMonitoring Tube present(Y"i' Depression over field (Y/N)
Date of adequacy test A' A Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test (in.); hnmediately after gal. water added (in.):
Fluid depth Minutes
Peroxide treatment (past 12 months) (Y/N)
N Bw a 1-5 7E14A,
(in.) Absorption rate =g.p.d.
If yes, give date
D. LIFT STATION N ° / u S 6✓ D
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot Oto ° f O f / o'
Absorption field on lot t /00 '
Public sewer main * 700,
n ad'
"Pump off' level at*
jacent lots o
On adjacent lots -4-16
Public sewer manhole/cleanout
Sewer /septic service line t 9S Lift station t /pO
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 4 /o r Property line 45o Absorption field
Water main/service line + y° I Surface water/drainage t °o Wells on adjacent lots iv 0 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation +/0, Water main/service line Zo
t- Zoo '
Surface water t to o ' Driveway, parking/vehicle storage area
Curtain drain -t- too ' Wells on adjacent lots 4. /p0
F. ENGINEER'S CERTIFICATION
1 certify that I have determined thru field inspections and review of Municipal
in conformance with MOA HAA guidelines in effect on this date.
,�/A
Signature 4 U, "v\.
Engineer's Name /% /V W /�SoNi G oyS i. tiG S
Date 7- Z U -,)c2
HAA Fee $ Waiver Fee $ _
Date of Payment f p`Date of Payment
Receipt Number 4' /!% 7 l/ 7 Receipt Number
Rev. 8/95 OSS: haa.wk.doc
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