HomeMy WebLinkAboutCHARLICE TR A-2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
c,,,~--......~T0 SEPTIC ABSORPTION
Address
TANK FIELD WELL
,hum ~
Phone(s) I,e~m,, No. IND. of ~edrooms WELL
Lot I Block I Subdivision
Township, Range, Section
A~BUILT DIAGRAM (Show location of well, septic system, properly hnes, foundation,
~/~ ~ /~ ~ ~ driveway, waterbodles, etc.)
TANKS N
~ SEPTIC ~ HOLDING
Manufacturer Capacity in galtons
TYPE OF SYSTEM
~ TRENCH ~ BED ~ W. DRAIN ~ OTHER +'~"
Depth to pipe bottom from Total depth from ongma, grade
Fill added above original grade Gravel depth beneath pipe
Gravel length Graver w~dth
~ FT /o FT
Total absorption area Distance between lines
~Q FT ~ ~ FT
Number of lines ] Soil rating P~pe material
Installer Date Installed
~ PRIVATE ~ OTHER fldenUfv)
Classification (A,B,C) Total De~th ~ Cased to
FT~ FT
Installer Date Installed:
~le: ENGINEER'6
I ~- cedily th~ this inspe~ion was pedormed ac~rding
72-013 (3/85)
To
EAGLE R~VER ENGINEERING SERVICES
P.O. Box 773294 ............. a .....,'*~ ' "~'~"
Phone 694-5195
LETTER
Date
Subject
SIGNED
[] Please reply [] No reply necessary
1'0
EAGLE RIVER ENGINEERING SERVia, ES
P.O. Box 773294
*EAGLE RIVER, ALASKA 99577
Phone 694.519§
FOLLOW-UP DATE
?
.19
Subject
/~ Please reply
[] No reply necessary
To
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 77,3294
EAGLE RIVER, ALASKA 99577
Phone 694-5195 Date
..C.*-~, ~',~ ,,,~. ~,~. Subject
LETTER
Please reply
[] No reply necessary
unicipality of Anchorage
Department of Health and Human Services
Tom Fink, 825 "L" Street
Mayor P.O. BOX 196650 Anchorage, Alaska 99519-6650
January 8, 1991
Arlene Voehl
HC 83 Box 212
Eagle River, Alaska 99577
Subject: Tract A-2 Charlice Subdivision
Permit #900177, PID #067-011-02
The subject permit, issued by this office for a single family
well and/or on-site waste~ater system has expired as of December
31, 1990.
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 needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation of the on-site
wastewater system, the original as-built inspection report
(three-part form) 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: $90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
J¢~4n Smith//P.E. V
P~og _r am Manager
On-site Services
JW/ljm: 200
enc:
Copy of Permit
"KidsAre Our Future"
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
SLOPE
/.5-0
SITE PLAN
Louis A. ~utera
CE-6726
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH? J O. ~
S
L
O
P
E
Gross Net Depth to Net
Reading Date Time Time Water Drop
~/~4 ~/~/~/~ o
g'% I
~ :~'.oo ,, ~%~ j
PERCOLATION RATE "'~' ~ {minutes/inch)
TEST RUN BETWEEN ~ FT AND ~-' FT
q~ 1~2 o
PERFORMED BY:
72-008 (6/79)
Eagla I~lver Engineering services
P. 0. Box 773294
Eagle River, AK 99577
$94-5195
CERTIFIED BY:
DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
SLOPE
SITE PLAN
1
2
3
4
5
6
7
8
9
10
WAS GROUND WATER
1 ENCOUNTERED?
I IF YES, AT WHAT
DEPTH?
S
L
O
P
E
Gross Net Depth to Net
Reading Date Time Time Water Drop
~:~,~ J< ~,1~,1~o
q: z C ~ ~//~ 7}1
~ I" o~ ~ z% 2
1
15
16
17
18
19
20
PERCOLATION RATE ~ (minutes/inch)
TEST RUN BETWEEN ~'- FT AND ~ FT
COMMENTS
Engineering Services CERTIFIED BY: ~ DATE:
Eagle
River
PERFORMED BY: ~ ~ ,, .........
Eagle River, AK 99577
6~-5195
72-008 (6/79)
LEGAL: TRACT A-2 CFJ%RLICE:
A. GENERAL
The well and septic plan are for a single family residence only.
The drawing and or site plan shall be a part of this specification..
All materials and workmanship shall meet the Anchorage Department of
Health and State Department Of Environmental Conservation require-ments.
All soil tests are advisory to the designandare robe verified or modified
in the field by the engineer.
All excavations and depths are advisory and are to be verified or modified
in the fie!dbythecontractor to meetMunicipalityofAnchorage, Department
of Environmental Conservation requirements.
It is the responsibility of the owner to obtain all necessary permits or
easements and to locate any ad3acent multi-familywell.
The excavation is to be exactly in the area shown on the site plan, any
deviation requires engineer approval.
It is always recommended that a surveyor locate the nearest lot line position
and the location of any easements.
DRAINF!WI.D
The drainfield is to follow the natural land contour to maintain uniform
total depth of the trench bottom.
The bottom of the drainfield shall be level, plus or minus 1.5".
The total depth of the drainfield excavation is not to exceed 3.5' at any
point.
The sewer line from uphill field is to invert to the downhill field.
The drainfield gravel is to be covered with typar or fabric material.
Soil or combination of soil and extruded board insulation to a depth of 4'
or equivalent is to be placed over the drainfie!d.
The area over the drainfield is to be finish graded to prevent pondin~ of
surface water runoff.
The septic tank and leachfield must not be closer than 100' to any existing
privatewel!, 150' to any Class "C"well, or 200 feet to any community wel!.
~AL DEPTH = 3.5'
GRAVEL DEPTH = 2.0'
DRAINFIFr.D r,RNGTH = 58'
DRAINFIW. LD WIDTH = 5 '
Soil Rating = 138 avg.
Bedroom Capacity= 3
Septic Tank Size = 1,250 tank w/lift
***NOTE: Lift station required. Anchorage tank preapprovedwith flanged lids.
***NOTE: Pressure line to uphill field to be 1 !/4" P.V.C. buried 5' deep with
positivedrainback to tank. Invert with siphon break at leachfield. Field robe
contoured to slope to allow uniform total depth.
I!
~,oo
C3
-1
I
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1
I
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DI
gertifiei Dri[[ittg D
by
DOC Co. dba JAN 14 19~1
SULLIVAN WATER
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2~!~pt. Health & Human Services
OWNER OF LAND
LEGAL DESCRIPTION
DATE-Started Ended
PERMIT NUMBER
DEl'TH OF WELL ..~:~ f;
STATIC LEVEL OF W-~TER FT. "~ ~
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From -' Ft. to '" Ft.
From :2~ Ft. to ::[ .... Ft. -
From__Ft. to Ft.
--~rom ~ Ft. to i ,,' Ft
from ! Ft. to .,g~ Ft.
-':' ~-~"' Ft.
From ~ ,' Ft. to
From :<
~ Ft. to I /~Ft.
From//_~' Ft. to !,.f~ Ft.
From ;~ ~ , Ft. to /~ fl" Ft.
f~ Ft. to x'P,', Ft.
From /
From Ft. to__Ft.
From .x /: Ft. to--Ft.
From '-':-g-~'~ Ft. to
From,,.") ~ Ft. to :.. ] Ft.
From Ft. to Ft.
From 4) ) Ft. to 4~]lI ~'~ Ft'
From Ft. to Ft,
From
From
From
From
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. lo Ft.
Ft. to Ft
Ft. to__Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to__Ft.
Ft. to Ft.
Ft. to.~Ft.
Ft. to .. Ft
Ft. to Ft
Ft. to Ft
FLto Ft.
Ft. to Ft.
Ft. to__Ft.
MISCL. INFORMATION:
DRILLER'S NAME ,. , <--~ ? '
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# 067-011-02
1. GENERAL INFORMATION
Complete legal description Charlice. Tract A2
T14N R1W Section 23
Location (site address or directions)
NHN Spruce Lane, Eagle River
Property owner Arlene
Mailing address HC 83,
Lending agency N/A
Mailing address
Voehl
Box 212, Eagle River,
Dayphone 694-8716
Ak 99577
Day phone
Agent
Address
N/A
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
2
NOTE:
Individual well X
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site x
l....-Holding tank
Community on-site
Public sewer
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
2'
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 Eagle River Engineering Services
Address P.O. Box 773294, Eagle River, AK
Engineer's signature '~~~"~~
Phone694-5195
99577
Date ~/-~ 2/~ n_
DHHS SIGNATURE
~ Approved for
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: ..~OH-N ,~"¢'~ t 5-Wr Date
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 DHHS 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 engineeCs work.
72-O25 (Rev. 1/91) 8ack MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~H~/~Z/~
-~'/4~/V
A. WELL DATA
Well type/D)~?/~,'/~-~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter.
Date completed
Cased to LZ~, J~/
ADEC water system number
~ '2/~D Driller
· /:~,~Casing height
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
/,/
SEPARATION DISTANCES FROM WELL TO:
Septic/h~l~l~ tank on lot
Absorption field on lot
Public sewer main
g.p.m.
AT INSPECTION
/
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Sewer service line / ~ /
Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate
Date of sample: (~//~/~ ~
Collected by:
Other bacteria
B. SEPTIC/H~L=BINEI TANK DATA
Date installed /9 C~/~ Tank size /000 Compartments z~
Cleanouts (Y/N) ~'~ Foundation cleanout (Y/N) ~ ~ Depression (Y/N)
High water alarm (Y/N) /V/~1 Alarm tested (Y/N) x41/~
Date of pumping ,/~/~ (J / Y/.~E ~/_) Pumper /,/'//x4
SEPARATION DISTANCES FROM SEPTIC/HOL-OtNG TANK TO:
Well(s) on lot /,~ '~ ' On adjacent lots 7 ?~) O / Foundation
To property line /' / ~ /
Absorption field ~ ~
Water ma4~/service line
Surface water/drainage ~'//,4
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N._~
SEPARATION DIST~iCE~ROM LIFT STATION TO:
Well on Iot~''~''~ On adjacent lots
D.~ION FIELD DATA
Date installed /~ c)0
Length '~/~ / Width
Total absorption area
Depression over field (Y/N)
Results (pass/fail) /DR ,~ ~
Peroxide treatment (past 12 months) (Y/N)
Manufacturer ~
Manhfll~/~~~~
"Pump off" level at
Cycles tested
Soil rating/3
Gravel thickness ~)' '~ /
Surface water
System type
Total depth ,.Z/. !
Cleanouts present (Y/N) )/~
Date of adequacy test/~O/VD/U~vU,~E_~
for ~- bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
On adjacent lots ~- /~)~) ! Property line
To building foundation To existing or abandoned system on lot
On adjacent lots 7~,..~O / Cutbank ,~///~4 Water ma~t/service line '~ ~/~ /
Surface water "~//'~ Driveway, parking/vehicle storage area / ? ~) /
Curtain drain ,~,//A
Well on lot /'/'~ 5/ ¢-/D /
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effegt o;~t!~te of this inspection.
Signature :"i; ?~ ,?.~,m ~ · '
Engineer's Name
Date
HAA Fee $ ~/-~D~:r'~)
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
OWNER OF LAND
ADDRESS ~ C
LEGAL DE~CRIPIION
DATE - Started
PERMIT NUMBER
( er, ifie Drilling. og
by
DOC: Co. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
/?~/~/~ U~ ~¢/"//-... DEPTH OF ~ELL ~ O
~ ~ (~1~ ~ ~ 5TATIC LEVEL OF WATER Fr. ~
Ended 7/qO GALS. PER HR 70
DOFCASI O
KIND OF FORMATION:
From
Ftl t;~:Ft:'~l/~/~ ~/~tOL} ~,,t~ft~"~/ /,x,~/ From
- ., ~ .~ ,..,/': . ': .,
'From Ft. to '~"~7~i'~"~'~OR~ From
Fmm~ Ft. to~ Ft. ~~lC ~~ From~
F~~Ft. to--Ft. ~e~ ~~ From
Fmm~Ft. to--Ft. ~O ~ ~(~ From~
'From Ft. to , Fl. ~ ~ ~ From
F,Om ~l~ Ft. to'Ft. ~ 0~ ~~(~ From
!
From Ft. to___Ft
From
From
From
From__
From
Ft. to,, , Ft.
Ft. to Ft.
Ft. to Ft.
__FI. to FL
FI. to , FI
FI. to Ft.
FI. to , Ft.
FI. to Ft.
FI. to__Ft.
FI. to Ft.
FI. to Ft.
FI. to Ft.
FI. to Ft
FI. to__.Ft.
~Ft. to Ft.
FI. to Ft.
FI. to__FI
MISCL. INFORMATION:
' I! "r'oT,~'~. ~ '/
JUH 1~ ~92
10:25 MORTHERM TESTIMG, AMCHOP(AGE ':"-:~ ..... - ...... "~~....~ ~~. 3/~"-::':~'~ ~""
~30 INOUSTRtA£ AVENUE FAIRBANKS, ALASKA *J~701
2!~0S FAIRBANKS STREET ANCHORAGE, ALASKA 99503
NORTHERN TESTING" LABORATORiES, INC'
907.456-3116'
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY CLIENT
PRIVATE WATER SYSTEM
NAME ........
City, Stile, Zip Code
'-M01 "Day Year
Purchase Order No.
[] Treated Water
~ Untreated Water
[] MPN -- Moat Probable
Number
tats, into./ Raf. Ne.
SAMPLE DATE:
SAMPLE TYPE:
~ Routine
[] Special Purpose
[] Cheek Sample (for original contaminated
~ sample with lab reference no.
METHOD OF ANALYSIS:
k~MF Membrane Filter
/0
S~mple 'rime
No, Loe~on Cellaret
~ ~-~,t,,f ~',4,~,~/,~ /'//~-~.,,
4
5
6
7
8
Signature of Representative
c,Mt~-.t M IW
FOR LABORATORY USE ONLY . ,,
Date Received
Time Received
Date Analyzed
Time Ana. lyzed
TO BE COMPLETED BY LABORATORY
Received at.'-~-'~: Anch. [] Fbksi
A
Next Sample Due
COMMENTS:
SATISFACTORY .
UNSATISFACTORy
RESAMPLE
OTHER BACTERIA
TOO NUMEROUS
TO COUNT
U
R
OB
TNTC
DiM Final
R~ul;* Comments
VefifiG,tion
BGB:
JUH 18 ~9£ 10:2~ HORTHERH TESTIHg, AHCHORA~E P.1/3
~1 2S05 FAIRBANKS STREET
Eagle River ~ngineering
P.O. Box 773294
Eagle River AK 99577
Attn: Louis Butera
Our Lab #:
Locati0n/P~oject:
Your Sample
sample Matrixz
Com~ntsz
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALA,~KA 99701 (90~' 4~6.3118 * FAX 456-$125
ANCHORAGE. ALASKA 99503 (9071 277.8378 4. FAX 274.9645
Al18184
Traot A Charlice
Water
Method Parameter
EPA 353.3 Nitrate-N
Report Dater 06/16/92
Date Arrived~ 06/15/92
Date Sampled~ 06./15/92
Time Sampled~ 1316
Collected By= LB
MDL m Method Detection
Limit
Flag Definitions
B ~ Below Regulatory Min.
H a Above Regulatory Max.
g - Below Detection Limit
Estimated Value
Unite
mg/1
Date
Result Flag MDL Analyze~
<MDL 0.1 06/16/92
Reported By= susan C. ~ifental
Microbiology Supervisor