HomeMy WebLinkAboutCHUGACH PARK ESTATES BLK 1 LT 13
GREt.,,ER ANCHORAGE AREA BOR ,t]GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY.__
INSIDE LENGTH
GALLONS.
DISTANCE FROM WELL /O~"--~'FFOUNDATION
NUMBER OF LINES / DISTANCE BETWEEN LINES
ABSORPTION AREA _,~ ,_~--~--
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LE NG.T.~
NEAREST LOT LINE ,,~--'d OF LINES -~_~'~ /
TRENCH WIDTH~(~ IN. TOTAL EFFECTIVE
FT. LENGTH OF EACH LINE
~.~[ DEPTH OF FILTER
MATERIAL BENEATH TILE q~/ IN. ABOVE TILE q IN.
WELL:
CONSTRUCTION
DEPTH
DISTANCE FROM:
BUILDING NEAREST
FOUNDATION LOT LINE_
NEAREST SEPTIC / SEEPAGE
SEWER LINE (~( , TANK /~)~, SYSTEM /~-
CESSPOOL OTHER SOURCES
APPROVED / DISAPPROVED
DISTANCES:
INSTALLED BY:
,,_
SEWER LINE DEPTH:
PIPE MATERIAL:
-.t
LOT SLOPE:
REMARKS:
REMARKS .
DIAG RAM3~F SYSTEM
Form EQ-O32
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F'ERMIT
RPPLICRNT SPECIRL SERVICES
LOC~TION PETERS CREEK-CIRCLE DR
LEGRL [_i~ Bi CHUGRCH PRRK EST
E:OX :Bi [,]RSILLR
LOT SIZE 42000 SQURF.:E FEE]'
MINIMUM [)ISTANIZ:E BETWEEN R WELL RND ANY ON-SITE SEWAGE C, ISF'OSRL SYSTEM IS
100 FEET FOR R PR I',,,'RTE WELL OR 200 FEET FOR R PUBLIC WELL.
WELL LOGS RF.:E REQUIRED RN[:, MUST BE RETURNE[:, TO THE DEPRRTMENT WITHIN Z.:O DR'T'S
OF THE WELL COMPLETION.
SF'EC:IFICRTIONS RND CONSTRUCTION DIRGRRf'IS RRE R',/RILRBLE TO INSURE F'F.:OF'EF.:
I NSTRLLRT I ON.
F'EF4-:i--1 T T "-..'RI._ :[:. [:. F,Z,F.~-: ,],I"-.IE "T"ERi;:~-: F I~-:,],i-'1 I ~-;.?.-:; L# IE-_:
I _.EF..T I F ¢ THRT
±' I Rf'l FRMILIRF.: WITH THE REC!UIF.'.EMENTS FOR ON-SITE SEWEF.:S RN[:, WELLS RS SET'
FOF.:TH BT THE r,IUNI_.IFMLITT OF RNCHORRGE.
2' I WILL INSTRLL THE S'T'STEM IN RCCOF.'.[:,RNCE WITH THE CO[:,ES.
RPF'L Z CRNT ~EC~L SER~,,~ CES
MUNIClPAU~TY OF ANCHOR~Or-
o Lgeriifieh rillin
APR 1 i 1977 by
A & L DRILLING COMPANY
RECEIVED ~X 97, EAGLE RIVER, ALASKA 99577 . TELEPHONE 694-25~
ADDRESS
LEGAL DESCRIPTION Z,:,T
DATE-Started '~// ~/7 (.
PERMIT NUMBER '-~
Ended 1~// ~/7~
i
DEPTH OF WELL ~ c~ O
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR ~ 0
KIND OF CASING ~ -~'00
t
i~o
t
KIND OF FORMATION:
Fr°m O
From ~
From ?~f'
From ~)~ c~
From~ / / ~
From /~
From /7 ~
From
From i C( ~
From Iq ~'-
Ft. to
__ Ft. to.__
Ft. to
Ft. to
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
From Ft. to Ft,
From__Ft. to Ft,
~ ~.~r~',~. 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
MISCL. INFORMATION:
I 7"o I go t
DRILLER'S NAME
MUNICIPALITY OF ANCHORAGE
Department of Health and Environmental Pr~nection
SOILS LOG
PERCOLATION TEST
Performed for Tim Swan Date Performed
Legal Description Block 1, Lot 1{ - Chugach Park Estates
2/23/77
0
4
.14
16
18
2O
0 - 1' - Soil and organics
2'- 3' - Gravel with some silt - GP-GW
Square feet per bedroom = 110
3'-10' - Clean gravel, some coarse sands - GW
Square feet per bedroom = 85
Hole could not be dug any deeper due to
sloughing. There is no indication of ground-
water.
AVERAGE SQUARE FEET PER BEDROOM = 90
Date Net Time Depth Net Drop
Percolation Rate__.less thmn 4
Performed By~~
minutes per inch - estimate
CHAMPION DRILLING COMPANY, INC.
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
5/.Z ~3~ ' ,.~, .. HAA # ~'~ ~'~C:~'-'l ~~
~oL ~3; B~ock ~; ChUgach ~a~ EsLaLes
Parcel I.D~ #
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) 2~i271 ?latsek Dr±ye
Chug iak, AK
pf~)l~e~tv:.oWn~.r~.;,''' Lee Stevens
/,Mailing-address. ; , '$/.p'SAurora . ,' ~ropert ~.es
Day phone
P.O. Box 671923 Chugiak, AK 99567
Lending agency
'~'Mgiling address / '~'
¥'; "~ :'" NanCy' S~ahley
A, gent.,
/ Aurora Properties
Add'ress "~
Day phone
Day phone
688-4939
Unless otherwise requested, HAA will be held for pickup.
3~'
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
XXx
NOTE:
If community well system, provide written confirmation from Sta.t~'.A'DEc attest-..
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
,, .... Holding tank _.:,
Community on-site
Public sewer
NOTE: 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
Se
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. * ~
S & S ENGINEERING
Phone ~ c~ q - ~..-~ '/~
Name of Firm :7~3~ ~--..!e _u!,,~, "~ ~oad #o. 204
Eagle RDer, Alaska 99577
Address
Engineer's signature ,,~.~,,'/Z, ~ Date ;3./1 ~/~7
DHHS SIGNATURE
' K Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
. "~.~;.:- ~ ~;
"-. ~.,,~?'""*.,;... , ,,"'t
,',.. ,- ! ' ,4- 1/
/
"The: ~c~i~i'"tSali,ty 0{'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 of' omissions in the professional engineer's work.
72-025(Pav. 1/91) Ba~c MOA~IY21
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
Municipality of Anchorage FEB 2 199
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division J
825 L Street, Room $02 · Anchorage, Alaska 9950'1 · (907) :34
Health Authority Approval Checklist
Legal Description: ~o'r 13, "1 I~,~cg J ,, C-,RUGAct-i Parcel I.D.:
A. WELL DATA
Well type ~)~,~,~/¥1-~ If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to
.~/,?/~-?
FROM WELL LOG
Log present (~)
Total depth ~- o
Sanitary seal ([~;IN)
JJ
Casing height (above ground) 12 ~-
Wires properly protected {~)'N) Y/~ ~
AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed 2 - ~5''~-t Tank size
Foundation cleanout (Y/~)
Nitrate
Collected by:
Depression (Y/~} /Jo
Other bacteria ~
$ & $ ENGINEERING
i~1~.~4 u. agie I~iver Lo,sp !:~-~ad, Nc,. 204
Eagle River, Alaska 99577
Number of Compartments ~ clean°uts (~N) _
High water alarm (Y~) N o
Date of Pu~ping J :- 6.~q7' Pumper I~,o'r0 -
C. ABSORPTION FIELD DATA
Date ins. tailed ~ - ~$--/-I . Soil rating (g.p.d./fF or~
Length ~'7, Width .
Effective absorption area ;Z~ ~
Date of adequacy test / - Z 1 - ~1 '1
Fluid depth in absorption field before test (in.);
I!
Fluid depth <2 (ins) Minutes later: -
Peroxide treatment (past 12 months) (Y/~) ~ o
~5" System type *'F*g~.
Gravel thickness below pipe ~ Total depth
Monitoring Tube present~'N). Ye~' Depression over field (Y~).
Results (Pass/Fail) ~/~5~ For -%
Immediately after ~/5ogal. water added (in.):
Absorption rate = L~-~O~ g.p.d.
If yes, give date ~ ~
bedrooms
II
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
~CycfEs tested
E. SEPARATION DISTANCES
Size in gallons
~ "Pump off" level at*
*Datum ~
F,
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot Io oI '1' On adjacent lots t oo~ +
Absorption field on lot ~oo ~{-- On adjacent lots J ooJ ~
Public sewer main ~/A Public sewer manhole/cleanout ~/~,
Sewer/septic service line 7~5~ +' Lift station ~/A'~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation .~ ~ 4- Property line ~ o 14- Absorption field
Water main/service line Jo ~ {-- Surface water/drainage I o ot -+ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
Building foundation Io L/.
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots
ENGINEER'S CERTIFICATION
in con~rmance with MOA H~ guidelines in effect on this date
Signature
Engineer's Name' ~ ~'~'~ ~ ~
Date ~ 11~/~7
HAA Fee $ ~/~'~3 , ~
Date of Payment ~'~--/'~---/~/~,,.P
Receipt Number ~"~;;~ C~'"-/7//7// )
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
Eagl~ River Area
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received February 25, 1977
Time of Inspection 10: O0 a.m.
Date of Inspection 2~25-77 JK
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
ConY.
1. Approval requested by:
Mailing Address:
Phone:
2. Property Owner: Timothy W. Swan
Phone: 745-4094
Mailing Address: Post Office Box 82, Wasilla 99687
3. Legal Description: Lot 13 Block 1 Chugach Park Estates
=4. Location:
Platser Drive
e
e
Type of facility to be inspected Single Family
Well Data:
A. Type
C. Construction
Individual
Sewage Disposal System:
A. Installed 1977
No. of bedrooms 3
B. Depth 320'
D. Bacterial Analysis
On-site system
B. Installer
1. Size 2. Manufacturer
1. Absorption Area 2. Material
Total length of lines
, Absorption area
, Other contamination
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
, Absorption area
, Sewer Lines
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
Page~2 of two pages'- Re( ~t for Approval of Individual S )r & Water Facilities
.Lega~ DescriPtion Lot 13 Block 1 Chugach Park Estates
Comments
Approved '~~~~sapproved Date~ -- ~' _~ ~
U
Approval .,Va~'~ for one year from date signed
Greater Anchorage Area B%¥ough, Department of Environmental
DIAGRAM OF SYSTEM
Quality
certify that the infomation contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
DEFi'. OF HTA/~
- MUNICIPALITY OF ANCHORAGE ENVIRONIVlENTAL PkOTECTION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 FEE :3 5 1977
REQUEST FOR APPROVAL OF R E C E l_ _V_ E D
INDIVIDUAL SEWER and WATER FACILITIES --
1. Type of Inspection: CMRO VA FHA
2. Property Owner: I"-~J~"/'~/ (-'/~. c~t,) ~ ~
Mailing Address: ~ ~. ~N g~ {~1~ Day Phone:
3. Name of Buyer: L~E ~U~) ~
CONV
Mailing Address:
4. Name of Lending Institution:
Day Phone:
Mailing Address:
Name of Realtor or Agent:
Mailing Address:
Legal Description: L I ~
Location: PL f:~'T~ ~c-~
Phone:
Type of Facility to be Inspected: ~//t)~ J£
Water Supply
Type of Supply: Public Utility.
If Individual, number of dwellings presently served
No. Bdrms.
If Individual, depth of well
Sewage Disposal System
Type of System:
Public Utility
If Individual, date of installation o~*-,~-- '~'~'
Individual
Individual (on-site)
72-003(3/76)