HomeMy WebLinkAboutPREUSS #4 BLK 7 LT 5n
Municipality of Anchorage Page / of ~--
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
Mamo: ~ ~, ~s,~s ~ Wastewater System: ~New B Upgrade
Address:
~oz~ ~oo,s ~ ABSORPTION FIELD
I No. o~ Bedrooms:
Phone: ~ ~/~ ~ ~ ~DeepTrench ~ Shallow Trench DBed DMound DOther
Lot: ~-- BIock:~ ~Subdivisi°n:~ Depth to pipe bottom~from~original grade: Ft. Gravel depth~,/~e~h, pipe Ft.
Township~/¢~ Range: ~ / ~ Section: ~ Fill added above original grade: Gravel length:
Number of lines: Dislance between lines:
WELL: ~ New D Upgrade iGravel width: ~ J Ft. / Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: ,/ Pipe material:
Date~rilled: SlalicWater Level: ~lnstaller SQ. Ft.
: Date installed:
Yield: Pump Set al; I Casing Heighl Above Ground:
SEPARATION DISTANCES ~Septic D Holding e S.T.E.P.
To Septic Absorption Mil Holding ~ubgc/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank S .... Lines ~ ~ / ~
Surface
~ LIFT STATION
LineL°t ]~ ~ ~ ~ ~ ~Size in gallons: Manufacturer~
Foundation ~ ~ ~ -- -- '"Pump °n"leve' at: I"Pum~°ff"level at: I High water alarm at:
CurtainDrain ~ ~ ~ ~ ~ ~Pump Make & Model Electrical Inspections perlormed by:
Remarks:~ ~L~ - ~G~c~,~ BENCH MARK
Location and Description:
I ~88umeO Bevation:
ENGINEER'S SEAL
Inspections performed by:
Department of Health and Human Services a~proval ~ ~.., ~-
Reviewed and approved by: ~ ~~ Date: / ~
72-013 (Rev. 9/91) MOA 25
Permit No.
Page ~' 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
LegalDescription: L.~-:~ P~c~-~ '~ ?/?--~-'C1~,5 5.(5 b,/*v,?,~ PIDNo.:
72-013 A (2/91) MOA 25
by
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688.2759
DEl'TH OF WELL
STATIC LEVEL OF WATER F'F.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
OWNER OF LAND
ADDRESS /°~d
[EG^L DESCRI~rION/-- ~7-'~ a~< 7
DATE - Started Ended
PERMIT NUMBER
!
77c..
3'~-7
KIND OF FORMATION:
FrOm ~ Ft. to ~ Ft.
From c~ Ft. to 4 Ft.
From ~C Ft. to ~2 Ft.
From_~2~Ft. ,o ~3 Ft. ~Y)4~O0 ff-~%.l~ /
From Ft. ,o Ft. / ~-~m , From
From 1~0 Ft. to_f__~_Ft.'~('t4~Jd .~' 6~14dE~ From~
~om / ffff ~,. ~o ~ ~. ~/mam~ ~om
From ~O~Ft. tot~t.-~ 5 ~ff~Oa~ From
From~Ft. to ~m Ft. ~?~ i ~t~4~ From
From ~ Ft. to ~% Ft. Tt6dF~t~T ~~ ~rom
From Ft. to Ft., ~ ~ff~6~ From~
vt. to
__Ft. to Fl.
Ft. ~o Fl.
FI. to Ft.
__Ft. to Ft.
Ft. to _Ft.
Ft. to.__Ft.
FI. to Ft
Ft. tO Ft
Ft. to__Ft
Ft. to Ft
Ft. to Ft.
FI. to__Ft.
Fi. totTECEi'v'ED
Ft. to Ft.
MISCL. INFORMATION:
Municipality of Anchorage
De,~t, Health & Human Services
DRILLER'S NAME
PAGE 1 OF 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:SW920142
DESIGN ENGINEER:DAVID R. DAYTON, P.E.
OWNER NAME:WEISS FRANK G III &
OWNER ADDRESS:10228 LOUIS PL.
EAGLE RIVER, AK 99577
PARCEL ID:05057235
DATE ISSUED: 6/22/92
EXPIRATION DATE: 6/22/93
LEGAL DESCRIPTION: PREUSS #4 BLK 7 LT
SEC 8, T14N, R1W, SM
LOT SIZE: 19600 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD / 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 (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
D. R. DAYTON, P.E., R.L.S.
HC 78 Box 1026 Chugiak, Alaska 99567
(907) 696-2417
DESIGN NARRATIVE
Lot 5 Block 7, Preuss Subd. Unit 7
The soils found in both the original system and reserve area test holes
were the same. The receiving soils are a silty gravel with a perc rate
of 2.5 minutes per inch which allows a loading of 1.2 gpd/SF. For a
4 bedroom home, the absorbtion area required is (4x150)/1.2 = 500 SF.
A 35' long x 8' effective depth.deep trench was selected.
The lot slopes slightly from South to North.
The lot will be served by a private well with required separation
distances being maintained from this and other wells.
The system will have no significant impact on future systems on adjacent
lots, reserved space/surface or subsurface, or on drainage.
Resp~ect fully,
David R. Dayton
I~ %0"
ii
David R. Dayton P.E,
HC 78 Box 1026
Chugiak, Alaska 99567
3
David R. Dayton P.E.
HO 78 Box 1026
Ciluglak, Alaska 99567
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
SOILS LOG --,PERCOLATION TEST
Township, Range, Section:
SLOPE SITE PLAN
10
11
12
13
14
WAS GROUND WATER
ENCOUNTERED?
16-
17
18
19
2O
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth lo Water After.., / ~
Monitoring? / t/o,a)~' Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
/ z: f¢,¢ /o W?z" ,¢
,/ ~,'/ s- /o /17¢ ,¢
_6- ~.'2 ~ /~ //.~,
PERCOLATION RATE __
TEST RUN BETWEEN __ FTAND __FT
COMMENTS ~4::~;:~- ~ ~¢~¢')¢~', (-~--
(minutes/inch) PERC HOLE DIAMETER __
CE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:
Township, Range, Section:
I
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Oeplh to Water After
Monitoring7 Date:
SLOPE SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
.~q7 o 7
PERCOLATION RATE ~)' ~'~'(minutes/inch) PERC HOLE DIAMETER ~
TEST RUN BETWEEN ~' FT AND ~'--'-' FT
PERFORMED BY: I AT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~
72-008 {Rev. 4/85) /'~¢ ~
1
2
3
4
5
6
7
8
9
10
11
12
13
14
16
17
18
19
20
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
fleplh to Water Ait,~.,f,/,~__
MonitorinD? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN __FT AND
COMMENTS
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
/
?2-008 (Rev, 4/85)
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
'~(~ - ~'~ '~ - ~,~ HAA #
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Day phone
Day phone
Agent
Address
Day phone
Unless otherwiSe requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
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 omsite
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. 1/91) 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 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 ~-'¢¢"'~ ~ ~-¢"0-4~-'~"~ ''~' Phone
Address ,¢~)~"~ ~-~J"¢~/]~-" , E~',¢~/-'/~-'< '/~
Engineer's signature Date //"~'N/~,~'~'
/
DHHS SIGNATURE
Approved for ¢
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
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 DH HS 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.
72~325(Rev 1191) Back MOA ~21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /-/'/~'~(~OP-~- Parcel I.D. ~/~-~) -
A. WELL DATA
Wel~ type i~/~ U/~'2~ If A, B, or C. attach ADEC letter. ADEC water system number
Log present (Y/N) '~?/ Date completed 7/~ 7_~ Driller
/
Total depth 97 ~-- Cased to '~ ~ ~ Casing height /"~' ~/
Sanitary seal (Y/N) ~/ Wires properly protected (Y/N)
FROM WELL LOG
71 '
Date of test ~
Static water level ,~ ~
Well flow ~/
Pump level ~L/~-
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot )'~ "~-'
Absorption field on lot /~ -~
Public sewer main '~/.~
Sewer service line
AT INSPECTION
g.p.m, g.p.m.
; On adjacent lots ';e~ ~'-
; On adjacent lots ) ~o ,~-
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ?,~ ~,,/_¢t~ ~o0,. Tank size /'Z~-'~ Compartments
Cleanouts (Y/N) ~ Foundation cleanout (Y/N) /V Depression (Y/N)
High water alarm (Y/N) /'~//~. Alarm tested (Y/N)
Date of pumping /q,,/z~,~) ~ ~-z,z,,,t Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /~'-5~
To property line
Surface water/drainage
On adjacent lots
Absorption field
Foundation
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Width 2~- '
Date installed
Length ~/~¢// /
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Soil rating /; ;~.¢/~//¢'.'¢
Gravel thickness ~"/_;¢
Cleanouts present (Y/N)
Date of adequacy test __
for
System type //
Total depth
bedrooms
If yes, give date __
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /' Y¢'-~
TO building foundation
On adjacent lots z-
Surface water
Curtain drain
On adjacent lots
Cutbank Z~,//cL Water main/service line_
Driveway, parking/vehicle storage area -~1~.
Propertyline_
To existing or abandoned system on lot
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name {~/h-/.//_n /'/~/'~/)-~-'--' ,z~)~.~
Date
HAA Fee $
Date of Payment
Receipt Number
72 026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
9511
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
Chemlab Ref .$ :93.0375-1
Client Samplo ID :L5 B7 PREUS$
~4atri× : WATER
Client Name :DAVID DAY~ON,
Ordered By :DAVID
Project Name :
Project~
PWSID :UA
REPORT of ANALYSIS
Collected :01/27/93 ~ 13:00 hrs.
Received :01/28/93 ~ 12:45 bzs.
WORK 0~de~ :62706
Report Completed :01/29/93
Technical Dizecto~ :STEPHE~I C. EDE
Sample ROUTINE SANPLE COLLECTED BY: D.R.D.
Remark~: ...
QC kllowable Extract Analy~l~
Parameter Result~ Qual. Units ~ethod Limits Date Date
t!iTRATE-N 0.10 U n~/1 EPA 353.2/300.0 10 01/29/93 01/29/93
See Special Instruot~on~ Above UA - Unavailable
See Sample Romark~ Above NA - Not Analyzed
Undetected, Reported value ~e the practical quan~lfi:ation limit. LT · Less Than
Secondary dilution. GT ~ Greater Than
