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HomeMy WebLinkAboutDRAKE BLK 3 LT 4B[)rake Block 3 Lot 4B #017-462-22 LOQ - 0 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 Permit Number: SIN 530065 PID Number: C51�y6�22 Name: O L N'SEFFREy T, Wastewater System: C4 New ❑ Upgrade Address: v tax 30 o NcN k 975X ABSORPTION FIELD Phone: No. of Bed oms: Deep Trench El Shallow Trench 1:1 Bed E] Mound 1:1 Other LEGAL DESCRIPTION Soil Rating: r Total Depth from original grade: GPD/Sq. Ft. Lot: Block: S divisjon:.� Depth to pipe bottom from original grade: t Gravel depth beneath pipe IK Ft. 4 Ft. Township: Ta Range: Section: �U Fill added above original grade: Gravel length: L r 1\, ,w �— Ft. V � Ft. WELL: tNlew ❑ Upgrade Gravel width: Number (lines: Distance b%b�tt eenlines: P r Ft. Ft. Classification (P It te, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. / Ft. SQ. Ft. Driller: Dat Drill d: %� Static Water Level: 70 Installer: Date installed: qq -��"l3 S ;L Ft. N field: 1(7 Pump Set at: I I Casing Height Above Ground: 1 TANK GPM Ft. Ft. SEPARATION DISTANCES XSeptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturegq 7411J Capacity in gallons: From Tank Field Station Tank Sewer Lines NCµ . K ,per Well )M tl ^� r� �v/ „`/� Y" ���� Material: ��� Number of Compartments: Water 06 4- (6 t4 - LIFT STATION Lot 1 {- r Size In gallons: Man urer: Line 0 �a Foundation 161 U Ac, r4- "Pump on" level at: "Pu " leve High water alarm at: Curtain Pump Make el Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Descri tion: 11t1 t 1 LOGIC Assumed Elevation: O ENQC EAL er f k ng S & S ENGINEERING a��3 Inspections performed W Dates: 1st Eagle River, Alaska 99577 2nd Department of Healtq and Hu Services appr val t Reviewed and approved by: `' Date: -I/Z+/?f 72-013 (Rev. 9/91) MOA 25 Permit No. GWASnn95 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: MAKE c BDIVI ION, I3L.00K 3, LOT 4B PID No.: 01746222 CO1 CO2 100' FINAL 96.8' l NEW 1250 GAL 75.6' SEPTIC TANK SCALE 1" = 10' A B COI 12' 33.5' CO2 20..5' 38.5' CO3 30' 45' C04 31' 46' C05 45' 67' MT 40,5' 42' C06 52' 40' C06 NEW TRENCH 4 BDRM HOUSE SCALE 1" = 40' 72-013 A (Rev. 9/91) MOA 25 .250 GAL TANK 00.13 ♦ 82.3' NO WATER FOUND C Well Log Alaska Now—Well/Vern's DrUlling 12241 Avion 01 Anchorage, Alaska 99516 PC q� (907) 345-4417 RECEIVED MAY 2 6 1992 Municipality of Anchorage Dept. Health & Human Services 4 C) Location Of Well Permit *SW910082 Borough I Subdivision I Lot I Block I Section No I Township]K I Range I E I I Merdian Anchora a jDrake 14B 1 3 _28112N , Isl 13W,Sewardm JWJ Well Log Ft. Below Surface Material Type Top Bottom gravely 0 7 gravely brn till 7 15 brn silty till 15 25 hardpan w/cobbles 25 65 seepage at 40' brown till w/lenses of sandy gravel w/1-120 65 82 WELL CASED TO 71'. Water shut off at this point. Drilled open hole to 82' and gravel fromation devielped with air. Water back in & clearing. Well producing 15 plus gallons per minute while blowing. Well Depth (ft) Date of Completion 82' Drilled 7 1 6/12/911 Drilling Method Use rotar domestic Casing Type welded Diameter (in.) Depth (ft.) Weight (lbs/ft) 6 to 71 17 to Finish of Well Type Diameter open end Static Water Level Level (ft.) Date 301 1612-91 Pumping Level Below T of C (ft.) After (hrs) Pumping (g.p.m) Grouting yNoes B Material�� Pump. H.P. Capacity Type submersible Setting (ft) Remarks This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief. Authorized Representative Date Vernon L. Nowell 1 6/25/91 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930065 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:POULSEN JEFFREY J OWNER ADDRESS:PO BOX 230206 ANCHORAGE, AK 99523 PARCEL ID:01746222 LEGAL DESCRIPTION: VR % 3 L'T 4B T12N, R3W, SEC 28 LOT SIZE: 50069 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 I�6Y1 DATE ISSUED: 4/22/93 EXPIRATION DATE: 4/22/94 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 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PR RECEIVED B ISSUED BY: DATE: q,3��j� DATE: Municipality of Anchorage • .. Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 May 6, 1992 Jeffrey J. Poulsen PO Box 230206 Anchorage, Alaska 99523 Subject: Lot 4B Block 3 Drake Subdivision Permit #SW910082, PID #017-462-22 The subject permit, issued May 6, 1991 by this office for a single family well and/or on-site wastewater system, has expired as of May 6, 1992. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional 'Engineer has inspected the installation of the on-site wastewater system, the original as -built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $200.00 for an on-site wastewater permit; $75.00 for a well permit and $275.00 for a combined on-site wastewater and well permit. If you have any questions, sincerely, r1.- hnmi , P. E.m Manager On-site Services enc: Copy of Permit please call this office at 343-4744. 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:SW910082 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:POULSEN JEFFREY J OWNER ADDRESS:PO BOX 230206 ANCHORAGE, AK 99523 PARCEL ID:01746222 LEGAL DESCRIPTION: DRAKE BLK 3 LT 4B SEC. 28, T12N, R3W, SM LOT SIZE: 50069 (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: PAGE 1 OF 1 DATE ISSUED: 5/06/91 EXPIRATION DATE: 5/06/92 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: RECEIVED BY:. 26"L4� 0/ 121E 451?s �� .)—;, DATE:— 6A ISSUED BY: ( �.c�� DATE May 1, 1991 ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694.2979 FAX 694.1211 HEALTH AUTHORITY APPROVALS Munic i.pa.Pity o6 Anchonage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L S-tnee-t P.U. Box 196650 SEWER &WATER Anchonage, Atka 99519-6650 MAIN EXTENSIONS REFERENCE: Lot 4B; Sec. 28, T12N, R3W, S.M. PERMIT REQUEST NARRATIVE SEWER & WATER INSPECTION The east pottion o6 the pnopen..ty whene .the pa.opoaed house and aeptic ay.6tem a,%e toca..ted i.6 a high, btat area. The pupen.ty gnaduauy dopa o 6 6 .towakd .the wea.t. ENGINEERING STUDIES The pnopoaed wett tocati.on i,6 as dezigna-ted on .the pta-t. AND REPORTS Since the tot6 in .thdz anea ane ,2ange, we do not boneaee any advenae e66ec,t.6 on neighboring pupen.ti.ea by the instaUation o6 the pnoposed a ya -tema . WELL INSPECTION & FLOW TEST SITE PLANS VIgm R, P.E. ROAD DESIGN t SOIL TEST i PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE h�p�iG v- �oo -; �• $ _ 'iso �" '���s� (40 . L-r,,� 4A ot . x 141ft lo I W �►.I. •d � � � u 4 A S_ �� tint e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: M ,G,�1-1 ExC.:.k r—� DATE LEGAL DESCRIPTION: f 'T Township, Range, Section:" 1 Oo;� 2 3 4 ..�, 5 —M ---� Depth to Water 6 �.: 7 8 9- 10- 1012 12- 13 13- 14 14 15 16 17 18- 19- 20 81920 ]_ COMMENTS WAS GROUND WAT ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE S L O _P E Depth to ... ar �3 per' Monitorinp7 Date: %E 13 A. 7 /FORM tD%y l 2tJ 1 3 t z8 SITE PLAN Gross ==I -- I Time —M ---� Depth to Water PERCOLATION RATE _LLJ—y (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEENFT ND 11�i— FT PERFORMED BY: 17034 Earle River Loo, Road llo 2I Eagle River, Alaska 99577 // ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELd 72-008 (Rev. 4/85) OP- %---' CERTIFY THAT THIS TEST WAS PERFORMED IN T ON THIS DATE. DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: k2n,c- - ����✓ I C7r+l DATE PERFORMED: LEGAL DESCRIPTION'Sr.;> Township, Range, Section: ' 17 r� Z -22\j S ,Z 8- 9 -c 10- 12- 13 012 13 14- 15 4 15 •: 16 y �• 17 18 19 SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water Aher _ Monitoring? �(��(— SITE RE PTH (F.Eer) Com)L 2 o L 3 r 5 ` 9 6 8- 9 -c 10- 12- 13 012 13 14- 15 4 15 •: 16 y �• 17 18 19 SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water Aher _ Monitoring? �(��(— SITE 20 –{ I 1 of lul PERCOLATION RATE `��'(.3�(�minutes/inch) PERC HOLE DIAMETER to TEST RUN BETWEEN A—A I AND FT COMMENTS S & S ENGINEERING PERFORMED BY: �1 Rk/R i*"- g 7� ACCORDANCE VPAlRiLLt�FX#AN6afv 97 IPAL GUID SI 72-008 (Rev. 4/85) V 000' 4 CERTIFY THAT THIS TEST WAS PERFORMED IN ECT ON THIS DATE. DATE: ..th . ... 1 Water _®®_®® 20 –{ I 1 of lul PERCOLATION RATE `��'(.3�(�minutes/inch) PERC HOLE DIAMETER to TEST RUN BETWEEN A—A I AND FT COMMENTS S & S ENGINEERING PERFORMED BY: �1 Rk/R i*"- g 7� ACCORDANCE VPAlRiLLt�FX#AN6afv 97 IPAL GUID SI 72-008 (Rev. 4/85) V 000' 4 CERTIFY THAT THIS TEST WAS PERFORMED IN ECT ON THIS DATE. DATE: r -- t -S Municipality of Anchorage • '� Development Services Department Building Safety Division r z 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 AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 01-F Alio HAA Expiration Date: 12-7— Q L 1. GENERAL INFORMATION Complete legal descriptionQt` P U d g Sk 1 - Location (site address or directions) I a(a3G Pf„tr��r< Stan} Current Property owner(s) Day phone 2y- Mailing address lX*3ie P;^ 1n k Sitrw A. L . _.... A is aQc . Lending agency Mailing address Real Estate Agent Mailing Address Day phone phone '240-LO68 391 W 7"(jj)r)e K� Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site (� Individual Water Storage ❑ Individual Holding tank ❑ 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-family 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. 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 Health Authority 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 `Tebbe_, S�r�1,1 r � � Phone ���" 31111, Address '2ta;�, 311 1541 e uae 29�> y4^A ocrg k `l`[SIA Engineer's Printed Name T0661,11 , $4rw ds 5. DSD SIGNATURE zApproved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: e Original Certificate Date: (Rev. 01102) lVlunic ' Developm .,_ _E SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON w i i U t foundation Property line—*710 i® P Absorption field Building - service line Surface water Water main1`iIA Water Wells on adjacent lots lam''` SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO l ..rir..=. J.mtwyaCbMda=.%7n& � .%31'Jf4W4=°kms-et�°:P -'Y.,LY'M C45 wYF�,,�'t-.Nn.'N.:ea.As:..%sx^zv.u:::9GJa: -10+ Building foundation Water main Property line �© Surface water A/06, C)h5 Driveway, parking/vehicle storage 3 Water Service line Curtain drain'on e ©day Wells on adjacent lots F. COMMENTS .. .... 8i{F',� Ak' AN f\�0 G. ENGINEER'S CERTIFICATION U,9 I that 1 have determined through field inspections and certify of Municipal records that the above systems are in review withMOANAA guidelines in effect on this date '• conformance ,• ••Ly y _ .:rs .n�7}i"" qq 1 x�"0g'EiiSrvJJ Yid/b Engineer's Printed Nam P, df 'Umnn +�l fir^ )• Date .a Waiver Fee $ HAA Fee _ 4 �' l b Date of Payment Date of Payment SGS/CT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria ° .READ INSTRUCMNS ON REVERSE: SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED. BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM IDR . PRIVATE WATER SYSTEM-- . ❑ Send RebWb 0 Send Invoke' .[� Send Res uas WaW aratem Nwr&rmp" 11 m caned Nan. P1en. Namber Fa Neter . mwmg City SYN zip Caa. SAMPLE COLLECTION: hvNln.Whr•NIYW mM MOS Le, ]OMM..,OM aYeYw Data:' is 'ow. Year /^'y Time: II �] pS (d AM/ PM Location: (� �d�v/1_ \fit �i L. T g . 200 W. POTTER DRIVE ANCHORAGE, ALASKA 99518 Tel: 907-562-2343 Fax:907.-561-5301 Lab Rd osend Invoke SAMPLE TYPE: ❑ Routine❑Treated.Water A1110 -peat Sample 'a M reated Water . Z --��-�y ---- (refer to lab no. t rSL❑ Special Purpose Transported to Lab W. Same as collector Other. . mn TO BE COMPLETED BY LABORATORY Sample Receiving: Date: -K- Sample over 30 home aM; ❑ RUSH SAMPLE Resuhs may be umNkbN. .. Time: 6120 Temp: 44j, ❑ 48 Hour Waiver Phone A: Delivery Method: ote L0C8!I0"' Fax # . Received By: in• Primed Name i Comments: .................................................................o.r...••.ro.aa...•........0f...........................•..ao....... Bacteriological Water Analysis Record EDteMM, : MMOJNUG (PIA) RESULTS: FBK JUN Analysis Began: 5112-1&1(1+M Total Coti<om: .. Analyst -t>iE Coit Analytical Method: Membrane Filter ❑ MMO-MUG (P/A) Reported By: y -(,9,✓ Slgnalure Sent to Client � Q rifi { MEMBRANE FILTER RESULTS: Phoned Faxed Direct Count (0 ( Coknies1100mL DaleJrxrre: Vecation: .. S ke win: rxeram. LTB: Bca: OR Satisfactory ED r.emwam{ : ED Unsatisfactory 11 TMC • Tao Nw,emu. to Caard Date/Time: SZ�V1I 11 qD oa.oe. Form # FW- 0053 12/17/03 08-19-04 01:47PM FROM -CUE ESI, SOS ENV SERVICES 9075815301 T-704 P.02/03 F-139 SOS RcLX 1044898001 Client Name Tobben Spurkland P.E. Project Name/# Drake, Block 3, Lot Q Client Sample ID Drake, Block 3, Lot 4B Matrix Drinking Water Semple Remarks: MI DatewTimes are Alaska Standard Time Printed DateMme 08/172004 11:41 Collected Date/Time 08/10/2004 14:25 Received 4:57 08/10?.e Technical Director 9taphe �f Released i'�l Pio. Reymty Allowehle Prep =is Units Method Container Al i_'oe M i Init Waters Departseat Narato-N, 3.76 0.100 =9/1. EPA 300.0 B (r_10) 08/10/04 JJB Microbiology Laboratory Total Coliform TNTC OB coU100mL SM209222B A (<=I) 08/10/04 DKC ¥ § a , PINTAIL STREET * � . .... ..»7 !` N 00,0612ir . 127.91' i 'IMM . -------------- ±' 2- a. ; z § ? : ■ dw GZTa ET09 e�.»,p�_ &m/ ! � , � / / j w \; m§ dw GZTa ET09 e�.»,p�_ &m/ ! � , �