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HomeMy WebLinkAboutJ & D LT 11 QPI<6 1- gS Municipality of Anchorage Page l of 4 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: �� `� PID Number: Nam Wastewater System: New ❑ Upgrade Ass� ABSORPTION FIELD Phone: No. of Bedrooms: eep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: ).-2-GPD/Sq. Total Depth from original Ft .rade:7 Lot: Subdivision: Block:yL, Depth to pipe bottom from original grace: Gravel depth beneath pipe j • �t L� I � Ft. Ft. Township: Range: Section: Fill added above original grade) 1 + Gravel length: 45 46 Ft. Ft. WELL: 1:1 New El Upgrade Gravel width: Number of lines: Dista�c between lines: Ft. Ft. 'ficati�on/ (Private, A,B,C): `V T•li Total Depth: FL Cased To: Ft. Total absorption area: ___5 SQ. Ft. Pipe�mat�erriifal: to Driller: Date Drilled: Static Water Level: Ins (ler: �-1 r`I Date inst ed: - 10 Ft. uSSa Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES 'Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private anufacturer: r��,^� 11 Capacity in gallons: /� �•�"1� ' A L_ From Tank Field Station Tank Sewer Lines L./ Well I2�5i r� Material� Number of Compartments: Surface Ilk I —ll� DU _ — LIFT STATION Water LotUf-{� IOt� Size in gallons: Manufacturer: Line Foundation r I �f 'Pump on" level at: "P off" level at: High water alarm at: Curtain 1 +,� �O Pump Make&M Electrical Inspections performed by: Drain �•l i� BENCH MARK Remarks: Location and Description: 0-_� Assumed Elevation: t Z�D ✓ Ft 44�,� ()t 4�1 o° Pi99999 ¢ YSG0,00 9 R� 0° S & S ENGINEERING ®B9s,°�°�'°° 170$4 Eag le River ioop Road, No. 204 1st�.®e�Arosea Inspections performed by: Dates: age ver, as 2 4 m °JJ 30C HAFT2nd! _ GiN16�'� Department of Health a H a Serv' es approval �a��� 6de00, ee©° C / C Date: Reviewed and approved by: 72-013 (Rev. 9/91) MOA 25 Permit No. G(�ZUIP� Page 7— of —0— 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 Leaal Descriotion:—A +r� ►'o"r I PID No.: o'er i�818�/ KL_ rT a_ l�orSs� �£� fal 72-013 A (Rev. 9/91) MOA 25 MOrd A GER J. kHAFEF No. 8215 e '*A®FESS�®�e Goo (f�5 �G A GER J. kHAFEF No. 8215 e '*A®FESS�®�e From Ft. to— From Ft to - Ft. _ FromFt.to, Ft. From From Ft to Ft. - -a• From Ft: to Ft. :' From Ftto Ft -; . <_ DOC Co dba SIJLLIVAN WATER WELLS P.O BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE688.2759 Iflzot OWNER OF LAND C is._R E& wJJC DEPTH OF WELL nn ADDRESS Z1 !tea K5 '7 % 3 9 STATIC LEVEL OF WATER Fr.:,. cK LEGAL DESCRIPTIOrL�oT J n SJl�A` DRAW. DOWN FT. " -- — . DATE - Started Ended GALS. PER HR K x{i PERMIT NUMBER KIND OF CASING ,,.j, - ,.41 :._: ., a ::.. . f •; - ss_-xzx'�^ x`xa_5^:�-'�ciK::- -t.. , KIND OF FORMATION: 'From Q —Ft. to c�Ft. C A 3t 6�� S << GKj !0 From Ft. to Ft. From_C4_Ft. to__J_Ft.; Q Q t P�rni From Ft. to Ft. FromA—Ft. toL(a----" Ft. S147 Y s41UQ t �j ,4,jz L From Ft. to Ft. FromL6—Ft. to,-3[—_Ft. S4^0 From Ft. to Ftp to --Ft. CLAi F �R�`1t �- From, Ft. to Ft From-2e—Ft, -3 -5 From to � Ft._s ' �� ���t` �" From Ft. to Ft. _Ft. From- 7_Ft. to Ft. • Qad61aC Al 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. t 5 From Ft. to Ft. From—Ft. to Ft.. From Ft. to Ft.'From -` Ft to Ft. From Ft. to— From Ft to - Ft. _ FromFt.to, Ft. From From Ft to Ft. - -a• From Ft: to Ft. :' From Ftto Ft -; . <_ 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:SW920183 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DRECHSLER JO S JR & OWNER ADDRESS:P.O. BOX 773594 EAGLE RIVER, ALASKA 99577 PARCEL ID:05128185 LEGAL DESCRIPTION: J & D LT 1 LOT SIZE: 40249 (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: PAGE 1 OF 1 arm -�-cls c �L Pi DATE ISSUED: 7/13/92 EXPIRATION DATE: 7/13/93 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: ONE(1) ADDITIONAL SOILS TEST WILL BE PERFORMED DURING CONSTRUCTION TO A MINIMUM DEPTH OF FIFTEEN(15) FEET TO COVER THE END OF THE UPGRADE TRENCH AND ORIGINAL TRENCH. ADDITIONAL SOILS TEST SHOULD BE SUBMITTED WITH AS -BUILT DOCUMENT. RECEIVED BY: awl DATE:- ISSUED BY: /` Gli/'At'/o- 0K. / Y° `17 - DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVILENGINEERS June 29, 1992 (907) 694-2979 FAX 694-1211 FQ CSF RIV E R. P" P HEALTH AUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street SEWER&WATER Anchorage, AK 99519-6650 MAIN EXTENSIONS REFERENCE: J and D Subdivision, Lot 1 SEWER& WATER INSPECTION We request you issue a permit to install a septic system to serve the proposed 3 bedroom house on the referenced property. ENGINEERING STUDIES A test hole was performed on the property. The approximate AND REPORTS location of the test hole is located on the attached site plan. The monitoring tube within the hole has been checked and found to be dry. WELL INSPECTION This property has enough area for future septic upgrades, &FLOW TEST which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. SITE PLANS If you have any questions, or require additional information for your review, please contact us. Sincerely, ROAD DESIGN Roger J.afer, P.E. SOILTEST RJS/LSU/lsu PERCOLATION TEST b/janddl STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 1 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 u 50' •SCALE 30 Q� rrr, y W �F Do m I Gs> D y z r 1 r L CLINE STREETrr O i co m ym� m Q PROPOSED y 2 0 m 1 A ~ o DRIVE y I y m Z — — m m r 0 z D NO Z N m o v 0 A Awl Orri �yOW V (n Ili COrri G7 Z�RI O n Li �C7rrl rn nl TT • pp I11 Gi T ®.a�9 mee a B eo.e -9 e A 14� rri pea R 1\� Q a o l4d ® J.� IMil e e rq a Irlcoo Poo Q $� municipality of Anchorage SERVICES , HpMAN 9 o VA GOA HEALTH & tdo• DEPARTMENT , nChora9e. Alaska 9950 TEST n�,*D 825 "L" StreetC, PER LATION % PR I SOILS LO CO DATE PERFORMED: PERFORMED FOR• s'9 LEGAL DESCRIFTI.D: �� DEPTH ti 2 ^^' 10 •L l 12 13 14 ° 15 15 17 18- 19 20 PERCOLATION RATE FT FT AND TEST RUN BETWEEN COMMENTS I S & S ENGINEERING Road No to River Loo GUIDEL(Nt� IN EFFECT ON PERFORMED BY. 17®34 Eag I T� ACCORDANCE WITH 72-008 (Rev. 4/85) - TTHISTESTWAn CERTIFY THA DATE. DATE. 1`C� Municipality of Anchorage o ea, e Development Services Department •'~'� Building Safety Division On -Site Water and Wastewater Program ` 4700 South Bragaw St. P.O. Box '196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak us (907)343-7904 CERTIFICATE OF HEALTH AU T HORi i t' Argy[AcvML FOR k blNGLE+AMiLY DWELLING _ Parcel I.D. D.5 /- 28/- �S HAA R ��� �>C S Expiration Date: / l - / Ll- - Q 3 1. GENERAL INFORMATION Complete legal description Location (site address or directions) 179-15 LOAXEfz 6/Z✓u,E Current Propertyowner(s) b4d ROCNE Day phone .7—el-5'17a Mailing address no. Rc>l 3221 Rlzm4e, i4k Lending agency Day phone Mailing address Real Estate Agent-5VA I—OREnr Day phone 6,ff- 6 y 7G Mailing Address P2QAnjTi,4L VjgrAl /6635 CEnlT�,eFi�td �2f✓ Unless otherwise requested, NAA wt71 be held by DSD for pickup. . 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site P Individual Water Storage ❑ Individual Holding tank El Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-famly on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 5. Additional Comments Attachments: HAA Checklist. X Septic System Advisory Well Flow Advisory ..r' rrr /�. . vyH�i I t WATER Maintenance Agreements Supplemental Engineer's Report .Other rn:! gy; Original Certificate Date: — 4�- a3 (Rev. 01=) STATEMENT OF INSPECTION BY ENGINEER As by hereto'and as of the validation date shown below, I verify that my investigation, • .,::•.: - certified my seal affixed based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater -disposal system is(are) safe, fdnctional 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 9nd)nspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all appC7ble Municipal and State codes, ordinances: and regulations in effect at the time of installation...:. ' Mame of•FirmfSIM_ �iS7Gle! FG%/q6: _., Address Engineer's Printed Name STE✓FDate •:.;:`;`:; .. .. .-. :�..' _ `arca:►..• �, � ..� �•• •o .. .. _ - iii �,: is �':::�.- :Y• .. i.�i .J ... ~- •, •( ,• • � V" . .� •. JIG: L•. �Y. f :, , •, DSD SIGNATURE . _: s"•. '.: �e a.�s. ; . r ' ' ` �� ✓icy'•' ' :.:.:.:, ''' '.r' .. ..: for bedrooms. '- Approved ._ {.� ; Disapproved.. ><'. :; :. :;': •r ;; �!`1�•.+ . Conditional approval for - Y ~' ibedrooins; with the -folio nimg'stipulations: • .. .. .. ,. ... - :',."• -..•moi iit-J - _.... u' •'r Additional Comments Attachments: HAA Checklist. X Septic System Advisory Well Flow Advisory ..r' rrr /�. . vyH�i I t WATER Maintenance Agreements Supplemental Engineer's Report .Other rn:! gy; Original Certificate Date: — 4�- a3 (Rev. 01=) i Municipality of Anchorage • "' Development Services Department Building Safety Division On -Site Water & Wastewater Program S ` 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: .! '� � -'1'� / �� Parcel ID: OS(- 2P!1- <Rr A. WELL DATA Well type -.L-- If A, B, or C provide PWSID # _ Well Log (YIN) Date completed Sanitary seal (YIN) Wires properly protected (YIN)_ Total depth _-Vqft. Cased to A-3—ft. Casing height (above ground) _[ in. FROM WELL LOG Date of test 92 Static water level .77 ft. Well production 2 ✓� g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate 4. S 7 mgJ1. Arsenic: mg./I. Date of sample: k4 0,? B. SEPTIC/HOLDING TANK DATA AT INSPECTION, z/l"Lo3 .2 -5,75 - ft. Tac. 7. S g.p.m. Other bacteria 0 colonies/100 mi. Collected by: e5A)c Tank Type/Material 46&60 Q _A - 7-AAt K Date installed Tank size 1a66 ,gal: Number of Compartments Z Cleanouts (Y/N) Foundation cleanout (Y(N) Depression over tan�kr(Y/N) _� High water alarm (Y/N) } Date of pumping O 3 ""'' Pumper C. ABSORPTION FIELD DATA Date installed V g�12- Soil rating (g.p.d./f? or -ft. en) e Z System type 4X6 r 7ieC,40b: Length ZIP s ft. Width 3 ft. Gravel below pipe _4 ft. Total depth , Z,� ft. Eff. absorption area �ft2 Monitoring tube Depression over field AL Date of adequacy test // a3 Results (Pass/Fail) A SS For 3 bedrooms Fluid depth in absorption field before test 3 in. Water added gal. New depth 6 in. Elapsed Time: 100 min. Final fluid depth -3 in. Absorption rate >= a-5-0_ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date I D. LIFT STATION NIA Date installed Size in gallons _ "Pump on" level at —in. "Pump off' level at __ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfift station on lot �zd r Absorption field on lot Public sewer main 1_�11i4 Sewer /septic service line U3 r Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements' in. On adjacent lots %00 ' r On adjacent lots /001 '` _ Public sewer manhole/cleanout ,A1 Holding tank A(IA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 ►+ Property.line 30.0' Absorption field Water main 1-114 Water service line /0 �r Surface water Wells on adjacent lots �t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property tine rt Building foundation _ /f? �t Water main _ N14 Water Service line /0 �* _ Surface water /OG ►� Driveway, parking/vehicle storage Curtain drain NSA Wells on adjacent lots L1�2 if - F. COMMENTS S�p,���ey �F� �lfCan/,crECTGd �-f}S S$�Jr'ii}r(� �F�tL 5ECo%/D14i%/ AA1AC7'1VIE W FLL /%BEETS ALL Sl�i4R�Tio/� vpEpclLk' �u �� QL G. ENGINEER'S CERTIFICATION y�P�'•"»••/;;•4S I certify that I have determined through field inspections and O �t� 49�►j '•ti *+j� review of Municipal records that the above systems are in • ••-••a... ».•.....„ conformance with MOA HAA ,guidelines in effect on this date. I / Engineer's Printed Name S7EV6 F_t.I G!♦s�� s�e:c,. W. ng .•r; �; � . PE 6256 Date �f2azC3 �f�0@?a' 2 HAA Fee $ 7� J _ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 12101).. 1 CB -11-03 03:2TAAI FKU-CU: ZIIViR0KL4VIIA, Sk1' SIDS, SGS Ref.0 1034826002 ClicutNamt NunhklmFngincettng Project Nameht NIA Client Sample IL ] 4 D Matrix Dtit:1ting Water P1N'SID 0 901°E15301 '-61E F.03/05 F-373 All Datestritaes are Alaska Standard Time PrIntedDate(rime OR/07/2003 i5:00 Collected Date/rlme 08/04/2003 9:W Received Datarrtme 08/04/2003 11.10 Technital Director�. Ssy n C. Cde _-^ Released ... �r — i4 Sample Rem=ty Arawable p Analysis PAT tMetef Qual:tien Results PQC Unim W-Iod CwWner ID L'units nate Date Irit Microbiology Laboratory retal Coliform 0 rnU100mL SMIS 9222B A (<=I) 06.'04/03 3S C7-15-03 05:13PM FROM -CUE EVIR0h5ENTAL SR6 SCS RCf.# 1034135001 ClIentName NorlLRimEngineming Project Name;p J & D. Lot I Client Sample ID J K 1), Lau 1 I►iatrlx Thinking Water PWSID U S.anple Rri arks: 907EE15301 T -3E5 F.02/02 All Datesll lines are Alaska Standard Tdue Printed Datt/1 hit 07;1512003 10:02 Collated DAWN= 07111/2003 13:00 Received Datefrime 07'1112003 14.05 Ter4nical Director ✓ i S� ear ' Ede Released B,y��r.-lir/�r— Alloble prep Analysts Parameter Qushrims Results PQL Units methM Contumer10 Luniu Dn�c Hatarts Department Nitrate -N 4.57 0.100 mg/L EPA 100.0 D (c-10) 07112103 JIB Microbiology Laboratory Total Coldo-m 100, No Coli OL G9 coV100-n1. SM1992?2B A (:^1) 0711110' JS C'.['&F, F.uvironmental Services 1)c- 200 W. potter Drive Anchorage, Air 99518-1605 Telephone: (907) 5612-2343 Facsimile: (907) 561-53D1 30' —.�+-ar-s �• r�> w ��yis A ' ASBUILT ""� -Ole SE6IARD & ASSOCIATES LAND SURVEYING 694-082 1 HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE: 4:0:36%,% FOLLOWING FOLLOWING DESCRIBED PROPERTY: -p'' F A oe 17-74e1 c%�' loT/ DATE= L.,9`S' AND THAT NO ENCROACHMENTS EXIST EXCEPT AS g�� �._• ' ,�- INDICATED. IT IS THE RESPONSIBILITY OF THE ; ;�:' TH~ OWNER TO DETERMINE THE EXISTENCE OF ANY. • • * E ..:... EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- 4 D• anw M114, swwa!6 ' � p VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB` 6� t+fir', IS -5910 k ANY DATA HEREON BE USED FOR CONSTRUCTION 9B- �� �;�� OF FENCE LINES, OR FOR ESTABLISHING BOUND-�'% ARY LINES. DRAWN '+. iia caI �•�✓,- *,�T,��„•b