HomeMy WebLinkAboutEAGLES NEST BLK 1 LT 3BEagle's Nest
Block 1
Lot 36
#050-761-07
Municipality of Anchorage Page ] of 7--
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: -~ ~c~?¢2--~ PID Number:
Name[~:~y ~ ~07~ ~/C~ Wastewater System: ~New ~ Upgrade
Address:
/402 ~L~,~ ~r~ ABSORPTION FIELD
=~~ ~ ~op, -I"°'°'=~r°°~=:' ~DeepTrench D Shallow Trench ~Bed ~Mound ~Other
LEGAL DESCRIPTION so, Rating: /, ZGPO/Sq. Ft. Total Depth from original
Lot: Block: Subdiv~ion: Depth to pipe boEom from original grade: Grevel depth beneath p~pe
Township: - I Range: ~ Section:_ Fill added above original grade:/-~ ~Ft. Gravel length: ~ Ft.
I
WELL: ~ New C Upgrade Gravel width: Numar of lines: Disance between lines:
3 Ft. / ' Ft.
Classification (Private, A,B.C): ~ I~ Total Depth: Cased To: Total absorption area: Pipe material: ~/~ ~E~
~/V~ ~ Ft. Zz~ Ft. ~ SO. Ft.
Driller: Date ~rilled: Static Water Level: Ins~ller: Date installed:
Yield: Pump Set at: Casing Height Above Ground: TAN K
SEPARATION DISTANCES ~,p~,c ~ Ho~d,n, c S.~.~.,.
To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capaci~ in gallons:
From Tank Field Station Tank ~wer Lines ~01~ ~-- ~
Number of Compa~ments:
Sudace ~
Water /00 ~ /oo ¢ LIFT STATION
Lot ,~ s,*~ ,~ ~a"°~*: I ~nu'~ct~r~:
Line /~ ' ~ ~0 ~ ~
"Pump on" level at: ~evel at: I High water alarm at:
Foundation ~ ~ ~/~
I
Cu~ain - ~ ~O O E ~, )O ~ ~ ' Pump~ Electrical Inspections pedormed by:
Drain
Remarks: BENCH MARK
Lo~tion and Description:
Assumed Elevation:
S & S ENGINEERiN~
17034 Eagle River Lo~ Road, No. ~
Inspections pedormed by: ;a.l. River. Alaska ~5~ Dates: 1st 7-Zo-Wcl
Department of Heal~?uman Se--ices approval
Reviewed and approved by: ~ ~ Date:/~- ~- e+
72-033 (Rev. 9/91) MOA 25
Permit No.Sw940234
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
.... EAGLES NEST
Legal uescnpuon:
CO1 COg
NEW
1250 GAL
S.T.
N,T.S.
A B
FC0
CO1 3%01 40,0
CO2 43.5:: 48,0
COS 45.0=: 49.5
CO4 48.5i 54,0
C05 79.0:~ 87.0
MT1 80,0:: 88,0
SUBDIVISION; BLOCK ,
LOT 3B 05076107
PID No.:
(coo
(cog&
~T~)
82.7
(MT1)
CO1
C02
· 76,7' NO WATER FOUND
t25o Ge.
SCALE
/NEW ::TRENCH
;ULLll/A WATEII I,VRLL
ST4T~C L[VEL OF wA'/'ER F'lr. ~
~) DRAW DO~vN FT.
DATE- $tarttd ~ . Ended ~, GALS. P~R HR ~
PERMIT NI~MBER
KIND OF FORMATION:
fftNI) OF CASING
From__
Fromm_
Frolic_ FL !~ _Ft, ~rom
Prom_ ~fr.
........ Prom
MISCL INFORMATION,.
- --Ft, ro~., ...... Ft,_
-. Pt, to__FL
__Ft. lo_ ~Ft,,
__Ft, to~ _Ft,.
DRILLER'~ NA.~ ' ·
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:SW940234
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:BAILEY COY & RUTH
OWNER ADDRESS:1402 VALARAIN STREET
ANCHORAGE, ALASKA 99508
DATE ISSUED: 7/12/94
EXPIRATION DATE: 7/12/95
PARCEL ID:05076107
LEGAL DESCRIPTION: EAGLES NEST BLK 1 LT 3B
LOT SIZE: 217810 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / 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 AlkrD 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 343-4744 (24 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 PROVISIONS:
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
July 4, 1994
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
IN~ECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 'L' Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Eagle's Nest Subdivision; Block 1; Lot 38
Request you issue a permit to drill a well and install a septic syst~
to serve the proposed four bedroom house on the referenced property.
Test holes were excavated and percolation tests performed. The
approximate locations of the test holes are located on the attached
site plan. The monitoring tubes within the test holes have been
checked and found to be dry.
This property has enough area for a future septic upgrade 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.
If you have any questions, or require additional information for your
review,~ontact us.
U/jk
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
3'1¥~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
SLOPE LAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17,
18-
19-
20-
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
DATE PERF~~~
SITE P
Depth to Water
Moniloring?
-/
)/
/
/
/
/
Gross Net Depth to Net
Reading Date Time Time Water Drop
(. f/~l~.~ 3 ~ ,,., ~ 7" .___
~ ~/e ~ ~ ?"'
3; ~ ~ ~ E ~" z ~/~'
~/,/1. ~ ~ 7'
PE~COLAT,ON ~ATE ~ ~ ~ '~
__ (minutes/inch) PERC HOLE DIAMETER ~ I~
/
/ TEST RUN BETWEEN ~;~ ;T AND W "FT
PERFORMED BY: 17034 Ea~Je Riv~ I ~. a__~ .... I CERTIFY THAT THIS TEST WAS PERFORMED IN
EagJe River Ala -r .---. ,~, a
ACCORDANCE WITH ALL STAT[ AN~AL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRiPT,ON:/;4,, ~/ ~/, ~,~/ Township, Range, Section:
SLOPE
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER WO
ENCOUNTERED?
S
E
Depth ~ Water ~er ~- ~ -gr-q~
MoflimrinD7 Date:
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
TEST~UN .E~WEEN .
[ 170~ Eagle Riv~ L~ R~d ~. ~
PERFORMED BY: -- , =,
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DAT~:
PERCOLATION RATE
(minutes/inch) PERC HOLE DIAMETER
FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
72-008 (Rev. 4185)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: 1(i'k �')' (-"r" �y DATE
LEGAL DESCRIPTION: n
DEPTH
(FEET)
I - IY2 OverbvIrden(OL)
2 - I
1� v CIL, A,
6 -
7
8
9 -
10--
11 -
12- -
13 -
14-
15-
16 -
to
17-
18-
19-
20-
I
(coarse 5andl
Corave I (Gw)
85 S;/131 -
P1 ihVS
OF A
Jon M. Wick
CE -5838
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE
X SOILS LOG
El PERCOLATION
TEST
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
- to
PERFORmrDBY: AiLk 8 <Qe' 4 11?3 1( CERTIFIED
72-008 (6/79)
FT AND
(minutes/inch)
— FT
M, k" iGk ?�
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 19665C Anchorage, AK 99519-6650
www.cL anchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHOB TY~APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.':(:~"~ ~/'--~)~2 HAA#
..... ,.-- '-. --. Expiration Date:
1. 'G ENERAL INFORMATION
. .Complete' legal ~/
Cu~[ent ~j~.?d~.'9~her(s)~¢/, ~ ~/~ Day phone '"'~
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless othe~me requested, H~ will be held by DHHS for pickup. HAA picked up by:
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well .....
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
[~' Individual On-site
~ Individual Holding Tank
[-- .... Community On-site
Public Sewer
The Municipality of Anbhc)rage D'epartrnent 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 prCpert!es se(yed by.a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to ;dome owners.
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 less than 30 days old. 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.
72-025 fRev, 01/00)*
5, STATEMENT OF INSPECTION BY ENGINEER
As cedified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval
application show 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.
S & S ENGINEERING
1~'034 Eagle River L~op Road No, 204
Name of Firm 6agle P, iver, Alaska ~9~177 '
Address
Engineer's Printed Name
DHHS SIGNATURE
f/"_~' ,~pproved for ~ bedrooms.
Disapproved.
Conditional approva for __
bedrooms, with the following stioulations.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engin.eer's Report
Other
Expiration Date:
Original Certificate Date:
Reissue Date:
75-025 (Rev. 01/00)'
Legal Description: ~- ,~/~/' .~/~,/,
A. WELL DATA
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVIC~'-'~'
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501
mea~tn Autnority Approva~ unecKds~
,' ~~) Parcel I.D.:
Well type /'~///'~'~.
Log present.(Y/N) ~'/~5"
Total depth ¢ /
Sanitary seal ~;'N) {7'¢/~'~
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~/'~.
Cased to ,..~/-~ %,~'~ Casing height (above ground)
Wires properly protected (~}'N)
Date of test
Static water level
Well production
FROM WELL LOG
/
AT INSPECTION
g.p.m. / g.p.m.
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Nitrate
~', ~_~ Z, Other bacteria
Collected by: -~
of Compartments
Date installed ~{///~;~'~ Tank size /z~"'~ Number
Foundationcieanou~/N) ~ Depression(Y~ ~/~ Highwater~rm(Y/N)
Dateof Pumping ~O Pumper ~ f~
C. ABSORPTION FIELD DATA
Date installed ~/~¢~
Length ~ / Width ~ ~ Gravel thickness below pipe ~ / Total depth
Effective absorption area ~ Monitoring Tube presentCN) ~ Depression over field (Y~O
Date of adequacy test ~/~/~ Results (Pass/Fail, I~'~ For ~"~ bedrooms
Fluid depth in absorption field before test (in.); ~ Immediately a~er~/~ gal. water added (in.):
Fluid depth ~ (ins) Minutes later: /¢ Absorption rate = ~ _g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~W~ ~ If yes, give date
72-026 (Rev. 3/96)*
LIFT STATION
Date installed /~"'~ ~'~/
Manhole/Access (Y/N)
High water alarm level at* /
/
Cycles tested
Size in gallons
__ "Pump on" level at* _
*Datum
"Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON L.OT TO:
Septic/holding tank on lot
Absorption field on lot /¢:~'--~ /-¢'--
On adjacent lots
On adjacent lots
Public sewer main /...//,cF Public sewer manhole/cleanout
Sewer/septic service line 'zL ,,~,~'- / Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
FOundation ~ ~- Property line ~ ~ Absorption field
Water main/service line -/-,~.~"- / Surface water/drainage //~f-- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ,/'~¢~) ~ Building foundation /~) /'/-' Water main/service line
Surface water ,/~.r~ /./_ Driveway, parking/vehicle storage area
Curtain drain ~O~/~- /~/(/~)/k] Wells on adjacent lots / OO
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections
SignatureinC°nf°rmance~::~effect°nthisdate'
Engineer's Name
Date
HAA Fee $_
Date of Payment
Receipt Number ~'~~
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number