HomeMy WebLinkAboutHAMANN LT 19
i MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone ?64-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS ~ ~
LOCATION NO. OF BEDROOMS
Z
~ DISTANCE TO: IWell /~¢ /~ Absor~i~ea,~__ Dwelling %. PERMITNO.r, ~,
~'<N'Z~ Manufacturer ~ ~[¢ /~ ~E '~~: Ma~¢~ ~0. 0¢ oo~partm0nts~_
Liq, capacity in gallons Inside length Width Liquid depth
~O~ DISTANCE~O:~ Well ~ Dwelling PERMITNO.
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~:; DISTANCE TO: l 2--~ ,~ Foundation Near?¢ ,in~
2'. No. of lines ~ Length of n~ Total len li~es Trench wi Distance between lines
m incbos
~ ~ ~ F ~ Top of tile to finish grade
= ~ /~ inches
Length Width
~ ~ Type of crib ~rib diameter Crib depth Total effective absorption area
~m Well Building foundation Nearest lot line
~ DISTANCE TO:
~ ~ / //V~
~ ~ DISTANCE TO: Buildin~ foundation Sawer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
/ 206
INSTALLER
REMARKS ~ Z¢ ~ __
Permit ~
Applicant: ~/,~ ~ O~'X~-r---
MUNICIPALITY OF ANCHORAGE
Department ~f Health and Environmenta' Protection
825 = Street, A~chorage, AK. _~9501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
Location:
Legal Description:
Mailing Address
Phone Number:
Type of Soil Absorption System Is:
Trench: Drainfield: / Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br) ~3~
The Required Size of the Soil Absorption System Is:
--' /7%/ ! !
DEPTH LENGTH . ~c~ GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance 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).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~CO GALLONS * *
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) INSPECTIONS ARE REQUIRED * * *
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 well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER ~1~ 1 9 ~ 3 * * *
I certify that:
(1) 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 codes.
(3) I understand 'that the on-site sewer system may require enlargement if
the residenc~ is remodeled to include more that 3 ~drooms.
Signe~: Issued by: ~
Date: ---
SNP/024 (1/81)
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
PERCOLATION
TEST
PE'RFORMED FOR:
LI=GAL DESCRIPTION:
1
2
4
6
7
SLOPE
_/
/?
SITE PLAN
10
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading
PERCOLATION RATE
TEST RUN BETWEEN
COMMENTS
sy'[ , 8RD 19OX
PERFORMED
72-008 (6/79)
Gross Net Depth to Net
Time Time Water Drop
/0
1'0%
" /If L/
/ Z. z
Augu~ 3, 1977
~176624
Glen Hargan
Post Office Box 2160
~%ohora~3o, Alaska 99510
Dear P~'. Hargan:
A permit iosued by this depart~:~ent :for well and/or on-site
se%.~er installatiox~ on Lot 19 Hamm~% S~livision has expired
since the issue date exceeds one (!) year~
~h% the event you still plan to install the well and/or on
site se~.~er systoi!~%, a new i)ermit i~ ~uequire~t. The orl~final
soil test may be used to obtain a current
If th~ ~;ell h. as been drilled, a well log sho~ld be sent
%o ~hiS department to doo'tunent the installation date~
If you have any questions regarding the above matter~ please
do not hes£tate to con,act this office il~n]lediately at 279~.
2511, ~,~<ten~ion 224 or 225.
Sincer(~ly ~
Les
~anitarian
DEI::'I:::IF::'I"MI;!]",!T t. :"IE]:::IL'I'H f':ll",l[) I!i]",l'v' I I:,i:Ol",lMl!i]",!'l'FII FI'I!%;T I (]1",1
i~i:?.5;!.EI IZ. 'l"l..l[)lil;l~;i~ RE:,.., FII'.,ICI.II;]I:~:FI(:51;!i;., I::t1'(.
(;7;, li'"',,ll ....... ::i~ii;; ]!: "IF' I15!i7; :SE!;; 115~i~7 II.,,.!! I!!!:iE ~::;~i;: ~:::::" I{:E!i;; tt::;;;i:? 1l'=II % 'i
MI:::IXIMI..IM P.,ll.~lt"ll~:liii;l:;i'. f"F BF::[:,I:;iIE,~)MSil; = ,::1.
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TI-..I/:i; [;:,li~;~::"l"t.-I OF FI TI:~:E:NE:H (IR PIT .T.S
(;iil:;i:OLIl'.,ID I::II'.,ID THE: E~OT'I"OM OF THE
'f'HEt'~:lii:: I'51 I',,IO :~.'..iI~:::T I.,.II[:,TH
"1"1..1[~ GI'~FI',,,'Ii~;L. [:,EF'TH :[::il; THE MLIM
FII",I[:, "I'HI:~:~ lili:EITTOI"I OF THE ION
F¢lql;::l.::]::' I L.I... I i'.4G OF 1::11'4¥ 5:;'¢:~('1'1.E1','1 kl ;I; THOI21"I' ,
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;1.~:::.~O I:::'I!i]ET I::'Of;i: I::1 I:::'I:;.:I'v't:::tTE; I.,~{l:.!i]...I... OR ;:.?.OE~ FEET FOR FI I::'IjE~I_t[;: I.,.IEI..I
I.,.1~]... [... I...D G:i~;
O1::' THE P.IIEI 1
SPEC :[ I:::' ;i; Cl::f'l" I O1'.4S I:':II'.,!D E;(]I'.,ISTI:;i:~.I(]T_ I ON,fi.;:, ); FIGti:I;-~I',I'.5 F:II~:E l:::l'v'l::l I I.J:;:IE',I...E T() I I'.,ISI...If;:lii; Pl:;'.Of::'l!;I.;il
;[ Iq S TI:::ILI..FI'T'
]i [::EI:;iFI" I F"¢ TI'"II::IT
:1.: I I:::IM I:::'I::IMIL:I:FII:~'. I*!I'f'H THli!i: F4:EgK..ItI:,.".EMiEI',ITS FEd:;:: ON-".:~;I"I'i:':: :i!];lii:l.,.llEl:;i::!i!; I::t1",1[) I.,.IE[.l..'::i; 1'::15!; 5;I;:171'
F(]I';::TH I!?,'T' THE MI.]I',IIC]F'I::ILZT"r' [)1::' FII".!E:HORFIGI!::.
;:il: I t.,.I I I....I.... I N:!i;TFII..I_ THE S'¢STE]"I i N t:::ICCOF4:[:'I:;It",IE:E; ~'.11 '~'1"t TIE
:;ii:: I IJI",tDli~]:;::5;I'FII"4[:, THIr::I'f' 'f'l'"llili; Ot",I"-:E;ITE SE!-,.IER S"r'E;TIS]"I i-'lFl"r' F.':IEg!UZIq:IE ENLI:::IR[!it!ii;MIZI",tT ;!;I:: '!'I"IE
I%~!!;:!~;ID['ZI",IE:IE IS I:,;~EMODEiLEI)'T'O INE:I...LII],E I'"lO~:li~ THFII",I 4
I::11:: F::'L. I CI::II",IT Gl_ E]",I
Performed For Glen Hargen
Legal ~escrimtion: Lot 19 Block
This Korm Renorts Soils Low
~enth
Feet
2 __ TOpsoil
2204 Cleveland Anchorage, Alaska 99503
Date Performed_ 6/21/76
Subdivision Hamman Subdiv±s±on
yes Percolation Test
Eagle River
ground6__
water
level
@-9
10
Soil Characteristics
Silty Gravelly Sands (SM)
20---
Bottom of ~st Hole -
Yes, At what Denth? - 9 feet
I Readinq Date Grnss Time Net Time Depth to H20 Net Dron
Percolation Rate ~linute
Prnposed Installation: Seenaoe Pit Drain Field
Deoth of Inlet Denth To Bottom Of Pit Or Trench
(]mU!~ENTS: 225 Square feet Dra±nage area required per bedroom.
Test Performed By ///Q¢~ ~. ~/~Data Certified BY: CONSTRUCTION TEST
~ James D Mack Date: 6/21/76 LAB
s~ oomr~.~....:. '.~...-., .:../..'.?.:.,. ................................................ : ............................
Depth of well ...... :.x:'.'~.. ..............................................................................................
Size of casing ........................................................................................................
Distance ~,o water .... ~.~....~...~ .....................................................................................
Distance to water while pumping ......... .~.~...,~ ................................... at rate
of ...... ~.,<~..~. ................................. gallons per hour.
Formation from
to
8~1 GOLDEN
ANCHORAGE, ALASKA 99502
PHONE 344-065I
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.# O
HAA # ~ ; '-
1. GENERAL INFORMATION
Complete legal description Lot 19; Hamann Subdivision
Location (site address or directions) 24331 Wilma Circle
Property owner
Mailing address
Lending agency
Mailing address_
Suzi Spearman
9728 Di5aaka Duive
gaqle_River, AK
Day phone__6_96-2755
E~ AK 99577
Day phone
Agent
Address
Day phone..
Unless otherwise requested, HAA will be held for pickup.
,2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
XXX
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.
(Rev. 1/91) 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 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 ail Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm s & $ ENGINEERING
17034 Eagle River Loop Road Bio,
Add ress Eagle River, Alaska ?95_77
Engineer's signature ~--,/~
DHHS SIGNATURE
~ Approved for
Phone
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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 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.
72-025(Rev. 1/91) Back MOA¢I21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
025"L" Street, Room 502 · Anchorage, Alaska 99501 · (9(2)7) 343-4744
Health Authority Approva Checklist
LegalDescrip~ion: ~ ~ ¢/-,w--x~,c~\~ ParcelI.D.: O.>*5'ip ~,,,~ 0(~,
A. WELL DATA
Well type ~tv--vd ~_ If A, B. or C, attach ADEC letter. ADEC water system number
Log prcsent ~)
Total depth
SanitaD, seal ~N)
FROM WELL LOG
Casing height (above grouud)
Wires properly protected ~',I)
AT INSPECTION
Date of test
Static water level
irt
ff.. W,ell productiou
WATER SAMPLE RESULTS:
g.pm.
· .,~o 6ttt't°~J~
g.p.m, lU ~_~rntrcTev
Coliform ~)
Date of sample: /o? - t / ~
B, SEPTIC/ItOLDING TANK DATA
Nitrate /, ~3 7
Collectcd by:
Other bacteria O
S & $ ENGINEERING
· -~n~tal~ o giver Loop Road NO. 2~
Eagle RNer, Alask~ ~ ~:~/~
Date installed /f?$ Tank size ~GOo
Foundation cleanout (Y~) ¢ tJ Depression (Y~_ ~
of Pumping //-I~ ,Pumper ~ ~O~*J~
C. ABSOR~ION F~;LD DATA
Date installed [ q F 3 Soil rating (g.p.d./fl2 or fi2~drm)
Length ~ b ' Width ~ / Gravel thickness below pipe
Effective absorption area &/*~ ~ ~Monitoring Tube present~) ~
Date of adequacy test ][-17 ~1~ - q~ Results ~Fail) ~
Number of Compartments .,2. Clcanouts ~N) )/
High water ahum
o~o6, ~zg~-S_vsten't type
Total depth
. Depression over field [Y~g~) tv/
For ~' bedrooms
Fluid depth iu absorption field before test (in.); d) '
hnme&ately afle~d, oa gal. water added (in.):
Fhfid depth t9 (ins.) Minutes later: -.~,~2~,,/,/..5 Absorptioa rate = tit'~ 4' g.p.d.
Peroxide treatment (past 12 months) (YIn9 /O~,,Off,, /-A)O~dtOlfyes, give date
D. LllrlF STATION
Date installed
Manhole/Access (Y/N)
High ;wtter alarm level at*
Size in gallons
"Pump on' level at* ~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /09 / ,c
Absorption field on lot J o o
l
Public sewer main '~'/~
Sewer/septic service line ,,7 ~
On adjacent lots
On adjacent lots
Public sewer mauhole/cleanoot
Lift statiou
/oo ' 6
/oD
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ,'J/,0- Property line /O ~ Absorption field
Water main/service line /~ t-k- Surface water/drainage /,q2 t ~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water
Curtain drain
Water main/service line /o
Driveway, parkin~vehicle storage area
Wells on adjacent lots
Property line
F. ENGINEER'S CERTIFICATION
1 certiZb that l have detemnined thrufield inspections and review of AYunicipal records l~~ ~stems are
in conJbrmance witfi k[O~ HIM gu~elines in effect on this date.
Ii//~ //
EngmeersName I ~da/cF ¢., Co~
. ..
HAA Fee $ ~ O~ Waiver Feo$
Date of Payment 1~ '& 0 --~ ~ Date of Payment
ReceiptNomber /~e~ ~¢~ ~ ReceiptNumbcr
/
Rev. 8/95 DSS: haa.wk.doc
CT&E Environmental Services Inc.
Laboratory DiviBion
Laboratory Analysis Report
WATER
Client Sample ID L19 }IAMAh~
Client Name S & $ ENGINBERING
Ordered By ROBERT CO¥[A~
Project Na)~e
ProJeot~
PWSID UA
WORK ord~ 2014~
Printe~ D~to 12/15/9~ ~ 15:55
Co~lec~d Dab~ ~Z/~I/~5 ~ 12~26
~eceived Date A2/12/~5 ~ 15:2¢
Technical Director STEPHEN C. ED~
~ample Remarks: 8~PLE CO~/~CTED BY: RAY.
9C Allowable Ext. Anal
Parameter Re~ulgs QR&% Unite J4ethod ~it~lg~ Date Pat~
Nitration ~-87 m~/L EPA 300.0 ION 10 12/14/95
See Spocial ~[r~ionB Above UA = UnavaJ]abl~
S~o ~ample Remarks Al)DYe NA = Not ~alyzed
Secondary dilution, GT ~reater Than
200 W. Potter Drive, A~ch0rage, AK 99518-1605 ..... Tel: (907) 562-2343 Fex: (907) 561-5301
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