HomeMy WebLinkAboutEAGLEBROOK #1 BLK 2 LT 7Eagle Brook #1
Lot 7
Block 2
#017-121-59
NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL ~NSPECT~ON REPORT
PHONE I E~J~ EW
MAI LING ADDRESS
LEGAL DESCRIPTION
LOCATION
DISTANCE TO:
Manufacturer
Liq, capacity in gallons
DISTANCE TO:
Manufacturer
DISTANCE TO:
No, of lines
/
Absorption area
//'
Inside length
IF HOMEMADE: --
Well Dwelllng
Top of tile to finish grade
Material beneath tile
Length Width Depth
Material
Nearest lot lin~z~/i
Trench width
72--. iQ~es
NO. OF BEDROOMS
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO,
g 3 o ~,~.~____
Distance between lines
Total effective absorption area
PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Depth Driller PERMIT NO,
DISTANCE TO:
Building foundation Sewer line
Distance to lot line
Septic tank
Absorption area(s)
OTHER
PiPE MATERIALS
b-. 2o3q
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED ~ u DATE
72-013 (Rev. 3/78)
LEGAL
PERMI]' NO. < 8]~0i96 )
FIPPL I CBNT L..EROY CABANA
LOC:FIT ~ ON
LEGAL L. 7 EAGLEBF.:OOK
[)EF'BF.'.TMEN]" OF HEALTH AND ENVIRONMENTFIL P~'OTEC]"ION /~/L,O/~ -CD
STREET., FIN']HF~RBGE, BK. 99 L
~,4 4, ,~..~:~
?50? GLENN HIWY ~124 99504
LOT SIZE 999999 SQUARE FEET
TYF'E OF SOIL FIBSORF'TION SYSTEM IS: TRENCH
MRXIMUtd NUME:ER OF E:E[:,R. OOMS = 4 SOIL RFITING (SL.] FT,."E:R)= ±45
THE: REI;~UIRE[:' SIZE OF 'THE SOIL RBSORPTION SYSTEM IS:
THE LENGTH DIMENSION IS THE LENG"FH ,::tN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF ~ TRENCH OR PIT IS THE DISTal'ICE BETWEEN THE SURFRCE OF 'THE
GROUND aND THE BO]"TOM OF' 'THE EXCRVFITION (IN FEET).
THERE IS NO SET WI[:,TH FOR TRENCHES.
'THE GRRYEL [:,EPTH IS THE HINIMUM DEPTH OF GRRVEL BETWEEN ]"HE OUTFRLL PIPE
F~NE:, THE BOTTCd'4 OF' ]'HE EXCR',,,'FITIC~N < IN F'EET).
PER}ti]~' FIPPLICRNT HFtS THE RESPONSIBILITY TO INFORH THIS DEPRRTMENT DURING THE
INSTFE_L. FtTION INSPECTIONS OF RNY I..IELLS FIDJFICENT TO THIS PROPERTY FIND THE
NUI'"E!4EF~: OF: RESI[:,ENCES THAT THE WELL. F.!ZLL. SE:RVE.
BFICKF:ILLING OF RNY SYSTEM NITFIOUT FINFIL INSPECTION FIND RPF'ROYBL BY THIS
DEPFd:;.':TMENT WILL BE SUBJECT ]"0 PROSEE:UTION.
MINIMUM [:,ISTF:tNCE BETNEEN R FIELL FIND Fff4Y ON-.SITE SENRGE [:,ISF:'OSRL. SYS'T'EH tS
i00 FEET FOR FI F'RIYRTE WELL GR ::L50 "FO 200 FEET FROM R PUBLIC WELL DEPENDING
UPO!,i TF!E TYPE OF PUBLIC WEL. L.
HTNIMUId DISTANCE FROM a PRI'¢WFE WELL TO a PRI',,,'FI'rE SEWER LINE iS ;]-]:5 FEET
]"0 FI COMMUNITY SEI..IER LINE IS '75 FEET.
WELL LOGS RRE REL.]UIRED FIN[:, MUST BE RETURNED TO TNE DEPFIRTMENT 1.4ITHIN ~:0 DRYS
OF THE WELL COMF'L. ETION.
OTHER REC4UIREMENTL=; MRY FIPPLY. SPECIFICRTIONS RND CONSTRUCTION DIFIGRFII',IS FIRE
FI',,,'RILRBL.E: TO INSURE PROPER INSTRLLRTION.
F' ~Z I;'.;.: tPl X T' bi .'>;; P 1: IR E :B [:, E: C]: E tt,1 B E $: :i-'.' ± .. :1_ :_=¢.. :=-}~.
I C:ERTIFY THRT
:'L: I BM FFIMILIRR WITH THE RE(;!UIREMENTS FOR ON-SITE SEI.4ERS RN[:, WELLS RS SET
FORTH BY THE MUNICIF'FILITY OF FINCHORRGE.
2: I 14ILL INSTFILL. THE SYSTEI'~I IN FICCORDRNCE WITH THE CODES.
ii:: I UNDERSTFIN[:, THRT THE ON-SITE SEWER SYSTEM MFIY REC!LIIRE ENLRRGEMENT tF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THFIN 4 BEDROOMS.
V4. 0
JNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska ~9501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
LEGAL DESCRIPTION:
1
2
3
?
14
H~
DATE PERFORMED: '"'~:'~' 7 - ~ ~ .
SITE PLAN
P
E
iF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE_
TEST RUN BETWEEN
COMMENTS
~_~.~_..~.,~ '~,, Z,~. 3~ ~-~.
PERFORMEDB~ /"~E~LA CERTIFIED
BY:
72-008 (6/79)
.ir.
,ATE:_
~ge Esmt,
I
54,256 S.F.
1.246 AC.
N 65°ll '22"E
0
6
50,588 S.F.
1.161 AC.
N89059'.r~"W 4'88.85' REC. P7T-34
N 89°59%.,, W 4'89.12'
378.82
25'
20' Te-~'Te. ~ Elec, Esmt.
25.00
?1.18
8
66,886 S..F
1.536 AC.
%
151,586 S.F.
:3.48 AC.
20' Drainage Esmt.
)o
I0' Tole. ~ Elec. Esmts,
5
50,240 S.F
1.153 AC.
50'Public Access Easeme
Automatically Vacated Wh
Access Becomes
North Of Lot 8
IO'Tele. & Elec. Esmts.
N
ARC = 78.12'
N2 I0' Tele.& Elec. Esmt~
BLOC 2 ~ I
4 lO' Tel!
¢~ 20' Drainage I
85,736 $.F. ~ Esmf,-~ J~
I. 968 AC. ~
3.012
I
N 3°30[13" E
j 2~.e4 \
\
N 65°5~' 07"W
AC. /.5~. 5~
Recovered 5/8" Reb~
2
Recovered
11.78
of Anchorage
Department of Health and Human Services ~t~-~-~)
Division of Environment,a? Services
On-Site Services Section 825"L Street Room 502
P.O. Box 196650 Anchorage, AK 99519-8650
www.ci.anchorage.ak, us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D, 017-121-59
1.
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
HAA # /'-~(.~"~-)
Expiration Date:
Lot 7~ Block 2 Eaqle Brook S/D'-¢
6100 Andover Drive
Current Property owner(s)
Mailing address
Lending agency
Lerov & Lori Cabana
6100 Andover Drive, 99516
Day phone 345-5827
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOIVIS:
4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding tank []
E~ Community On-site []
[] Public Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health
Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on propeAies served by a single family on-site wastewater
disposal and/or water supply system DHHS also issues HAAs upon request to home owners. CaAificetes of
Health Authcritv Acoroval'are valid for 90 davs from the date of issue for properties served by a private or Class C
wetl and may b'e r~'ssued with new water sa~ple resutts !ess than 30 days old. Certificates are valid for one year
for pron. erti~s served by Class A er ~ wells or a public water system. The Municipality of Anchorage is not
c. ATATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that mv investiaation
based on procedures outlined in the Health Authority Approval Guidelines for this ~eal[n
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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Enq. Svc.
Address P.O. Box 102954, Anch, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E.
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
Phone 272-8218
Date 6/11/2000
, '".;;-u-%
bedrooms. %~ ¢ .;, ............ >.: ~¢
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
VVell Flow Advisow
Et,'cirsucn Dste:
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
P, eissue Date:
.nJcipaliW of Anclhorage g (- g I V D
Department of Health and Human $~Hric'"'e!~'-- -
Division of Environmental Services .11
On-Site Services Section 825 "L" Street Room 50'~"
P.O. Box 196650 Anchorage, AK 99519-6650 ...... NCHORAGE
~UNI(JIpALU~
www. ci.anchorage.ak.us .vleC)NMENTAL SERviCES DiViS~
(907) 343-4744
HEALTH AUTHORITY APPROVAL CHECKLIST
Lot 7, Bock 2 Ea,q e Brook SID
Legal Description:
A, WELL DATA
Well type PRIVATE
Date completed 81511983
Total depth 310 ft
Parcel I.D.: 017-121-59
IfA, B, or C provide PWSID Cf__ Well Log _Y
Sanitary seal Y Wires properly protected Y
Cased to 310 ft Casing height (above ground) 15
FROM WELL LOG AT INSPECTION
Date of test 815/1983 6/10/2000
Static water level 260 ft 270 ft
Well production 8+ g.p.m 5+ g.p.m
Nitrate ~ mg/I
WATER SAMPLE RESULTS:
Coliform ~-'C~ '-- colonies/100 mi
Date of sample: 6/11/2000
B, SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Date installed 411811983 Tank size 1250
Cleanouts Y Foundation cleanout Y
Date of pumping 911511999
C. ABSORPTION FIELD DATA
in.
Other bacteria ~--o ~ coloniesll00 mi
Collected by: S.R.PANNC)NE
Pumper A+
gal Number of Compadments _2
Depression over tank N High water alarm
Date installed 4/18/1983 Soil rating (g.p.d./ft2 orff2/bdrm) 145 System type D'r
Length 50 ft Width ~ ft Gravel below pipe 6 ft
Total depth 12 ft Effective absorption area 600 ft2 Monitoring tube Y Depression over field N___
Date of adequacy test 6/1012000 Results (Pass/Fail) PASS For _4 bedrooms
Fluid depth in absorption field before test 22 in Water added610 gal.
Elapsed Time: 1440 min Final fluid depth 22 in
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N
(Rev. 11/99)
New depth3_.~8 in.
Absorption rate >= 600 g.p.d.
If yes, give date
LIFT STATION
Date installed.
"Pump on" level at ~
Size in gallons
in"Pump off" level at
Datum Cycles tested
sEpARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 102
Absorption field on 1ct 117.6
Public sewer main N/A
Sewer/septic service line 90
in
Manhole/Acces-~ .__
High water alarm level at in
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manholelcleanout
Holding tank 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation. 30
Water main N/A
Drainage 100+
Property line 40
Water service line, 90
Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 40
Water Service line 100
Curtain drain 100+
Building foundation 1§
Surface water 100+
Wells on adjacent lots 100+
N/A
Absorption field 11
Surface water 100+
Water main N/A
Driveway, parking/vehicle storage 75
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone, P.E.
Date 6-10-00
HAA Fee $
Date of Payment
Receipt Number
(Rev. 11/99)
Waiver Fee $
Date of Payment
Receipt Number
Pannone Engineering Services, LLC
Consulting Engineer
SEPTIC SYSTEM ADEQUACY TEST
Legal:
Owner:
Residence:
No. of Be&'ooms:
Septic System:
Lot 7, Block 2 Eagle Brook S/D,
Leroy & Lori Cabana
6100 Andover Drive, Anch. AK 99516
Four (4)
Tank Size: 1250 gallons.
Absorption System Type: Deep Trench
Date of Pumping:
Date of Test:
P.O. Box 102954
Anchorage, Alaska 99510
(907) 272-8218
Absorption System Size: 50x3x6'
Absorption Area: 600 s.f. Installation Date: 4-18-83Soii Rating: 145 sf/br
9-15-00 By: A+ Home Services
6-10-00
Test Procedure: System was inspected visually and measured. The tank was found to have 4 feet of
cover. Liquid depth was measured to be 50 inches. The drain field was found to have 68 inches of cover
and a total depth of 142 inches. There was 22 inches of liquid measured in the field's monitor tube. Water
was added from the well at a rate of five gallons per minute (GPM) into the monitor tube in the drain field.
Liquid depths were measured in the monitor tubes: The liquid levels rose 16 inches in the monitor tube with
the induction of 600 gallons of water into the drain field. After the water was turned off, the liquid level
returned to the original level within 1440 minutes. This system is able to absorb 600 gallons per day.
The well was tested in conjunction with the septic system. The static water level in the well was measured
to be 270 feet below the top of the casing. The water level in the well was drawn down to 300 feet below
the top of casing while the pump produced 5.0 GPM. It appears that the well is able to preduce greater than
5.0 GPM. The water was tested for bacteria and nitrates. The test results were not available at the time of
this writing, but will be forwarded when received.
TEST RESULTS: This system meets the code and operational requirements of Municipality of Anchorage,
Department of Health and Social Services for a four (4) bedroom house.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the
system in accordance with ADEC and MOA DHHS Guidelines & Regulations. The reported results describe
the performance of the system under the conditions encountered at the time of the test, and separation
distances measm'ed to readily identifiable features. The operational life of all wells and septic systems
depend on the local soil condition, ground water levels that may fluctuate during the year, and the water
usage of the family being served by the system. These conditions are outside the control of the evaluator Of
this system. All systems eventually fail and satisfactory test results do not guarantee future performance of
the system, nor do they guarantee that there are no hidden defecB or encroachments. PES can therefore not
provide any warranty for future performance nor give any estimate of how long the system will continue to
meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole
benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not
authorized nor will it confer any legal right whatsoever.
OB-18-O0 11:12 FROU~CT~ ==NVIRONVANTAL
,4~_- CT&E £nvlronmenlal 6srvieas Inc.
1002553001
P~none l~n~.
L7 B2 l~le Bmol¢ l~os¢ Bib
L7 ~2 EagIe Brook Hos~
Drir~g WaTer
0
Clien£ PO~
Pria~d D~e/Timc 06/16~2000 9:06
Collected Dace/time 06/11/2000 11;~
Reecivcd ~lme 06112/2000
Techoical Dir~ur ~ephen C. Ede
O.~OO u 0.§~0 n~I/L EPA ~O0.O 10i~9~ Q6/12/00
MUNICIPALITY OF /kNCHORAGE
DIVISION OF ESMRONMENTAL HEALT~
DEPARTMENT OF HEALg~{ AND FNVIRONMF, NTAL PROTECTION
APPLICATION FOR ~.,ALTH AUTHORITY APPROVAL CERTIFICATE
i o Ger~ral Inforn~tion Application Date __ <"~
(a) Legal Description (include lot~ block~ subdivision, s~)ction~ township~ range)
Location (add~ess or directions)
(b) Applicants Nar~ k-~~__C~ ....... ~.~.~ ho~ ~~_~
{c) Applicant is (che~ o~) I~nding Institution ~ ~ ~er~uil~r ~
Bul~r ~ ~ ~her ~ (e~lain);
(d) Isnding Institution Telepho~
Adt%~e ss
(e) t~al Estate Coo & Agent
Address
Telephone
2. ~? of I~sidenoe
$~ngle-~ amlly
Number of Bedrooms
3o Water_ Su_p~l~
Multi-Family
Other (~scribe)
Individual ~%11 ~ C~unity ~--~ Public
Note: If ~nity ~11 system~ ~st ha~ ~it~n ~nf~ti.on ~ the State
~pa~nt of ~viro~ntal Con~rvation attesting to t~ legality ~d status~
Is the ~11 ade~a~ fo~ the n~r of ~ s~cified in this
Onsite ~ Public ~ ~--Jnit. y ~ Holding Tank
Is ~e ~stewater dis~sal system adequate f~ the
[Page 1 of 2]
2-15-84
5~ [[~n~ineerinc1 Fi~m l~ovidin_g_In~ctions, Tests~. Data and Infor~tion
I cek~tify that I hav~ checked~ verified, o~ conforn~d to all MOA HAA ~uidelines in
effect on the date of this insp~ctiom
Signed by
( ENGINEER SFJkL)
Conditional
The Municipality of Anchorage Dapa~tment of Health and Enviror~rental Protection does
not guarantee the continued satisfactory p~rfcc~manee of the wate~ supply and/or the.
wastewate~ disposal system~ This approval indicates that, as of the validation date
shown above~ based on the data and info~mation furnished b~ an engineer registered in
the State of Alaska~ the wate~ supply and wastewater dispc~al system is safe and func~
tional for the numbe~ of b~droc~s and type of structure indicated°
(DHEP SEAL)
Mail the HAA to the. followino address.·
KB2/d5/s
[Page. 2 of 2]
2-,15~84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
Well Classification _.~~_~ If A~ B~ c~ C~ D.E.Co App~oved~
Well Log P~esent ~___ Date. Ccmpleted 8-~3 Yield
Total Depth ~/0__~__~__ Card to ~ ~Mow~ ~pth of ~outinG
Static Water ~1 ~Z~O ~$, ~ ~t At~
Casing ~ight ~ Gr~nd ...... ~/ ' Sanit~y ~al on Casing
Elec~ical Wiring in ~nduit ~ ~ession ~ound ~l~ead
Sep~ation Distan~s ~ ~11: ~ '
To ~ptic~olding Ta~. ~ ~% ~~_ __ ; ~ ~joining nots~
To ~arest ~ of ~so~tion Field on ~t~; ~ Adjoining ~ts
To N~est Public ~ Line ~ ~ _ To ~est ~blic ~r
Clean~t~a~ole ~ ~ ~est ~= ~rvi~ Li~ on ~t
Water S~le Test ~sults
C~nts ~ ~ ~
B. SEPTIC/HOLDING TANK DATA
Date Installed ~ Size ~ NOo of Compartments ~
Standpipes (~N) Air-tight Caps ~N) Foundation Cleanout _~)
~ession o~ Ta~ ~ ~te ~st P~d ~; ~~~~
P~ing~intenan~ ~n~act ~ File (Y~ ; for
Holding Ta~ High-Wate= ~a~ ~Y~) ~/~ ~ra~y Holdi~ Tank ~r~t JY~) ~/~
~p~ation Distan~s ~ ~ptiq~olding Tank:
To Water-Supply ~11 ~/ ~ To ~ilding F~ndati~ ~/ ~
To Probity Li~ __~ / ~ To Dis~sal Field ~ ~ / ~
To ~ter ~in/~rvi~ Li~ ~ To S~e~, Pond~ ~e~ ~ ~jor ~atna~
Co~ ~/~
[Page 1 of 2]
2-15-84
C. ~RPTION F,IE,LD raTA
Soils RatinG in Absorption Strata Type of System DesiGn
Date Installed LenGth of Field
Width of Field ~/~ Depth of Field
Gravel Bed Thickness
Square Feet of Absorption A~ea ~ Standpipes P~esent ~/N)
Depression ove~ Field (Y~ Date of Last Adequacy Test ~/~
Results of Last A~tequacy Test ~
Separation Distance f~cm Absorption Field: /
To Water-Supply Well ~ ' (~ , To P~operty Line ~/'7 . __
To Building Foundation ~ To Existing c~ Abandoned System cn
Lot ~/~ ; On Adjoining Lots ~' ~ /
To Wate~ Main/Service Line ~/~. TO Cutbank(if p~esent)
To Stream/Pond/Lake/c~r Majo= D~aina~e Ccu~s~~ , .
To D~iveway, Pa~kirg A~ea, c~ Vehicle Stc~a~e A~ea ~ ~ !
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
HiGh Wate~ Alaz~m Level at
Tested for
Electrical Codes(Y/N)
Con~nts
Dimensions
Manhole/Access (Y~)
"Pump Off" Level at
Vent (Y/N) .
Pumping Cycles du~ing Adequacy Test. Meets MOA
** Check Permitted Bed=o~n Rating AGainst HAA R~quest **
I certify that I have checked, verified, o~ confc~m~d to all MOA HAA Guidelines in effect
on the date of this inspection.
si ed Date
Company /~ ~-C Y , MOA NO.
KB1/dL/s
[PaGe 2 of 2]
2-15-84