HomeMy WebLinkAboutCHUGACH PARK ESTATES BLK 2 LT 10Chugach Park
Estates
Block 2
Lot [0
#051-481-05
.... ~ ,~,~)~.~!!~_m~l ITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF ," .LT; &
ENViRON.vi .:i.~.L . '- L!CT ON
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION k ";
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 i.;.~'l ~ I980
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
Well /
I DISTANCE TO: J /~ Z/.. '
Manufacturer ..~ _ ~--
Liq. capacity in ga Ions
/~ ~ F HOME.DE:
DISTANCE TO: Well
'Manufacturer '
J Well ,
~Z J DISTANCE TO: J /~ '
No. of lines Length of each line
Top of tile ,o finish grJde , '
J Length Width
J Type of crib Crib diameter
J DISTANCE TO:
JClass Depth
J Building foundation
DISTANCE
TO
I
JAbsorPtion area
2/
Inside length
Dwelling
Foundation !
Total length of lines
Material beneath tile
Depth
Crib depth
Building foundation
Driller
Dwelling
Material
Width
Material
Nearest lot line
Trench width
~ ~ inches
4/2 inches
Total effective absorption
Nearest lot line
NO. OF BEDROOMS
4
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
7~'~ ~-~Z
Distance between lines
Total effective absorption area
PERMIT NO.
rea
Distance to lot line
Sewer line Septic tank
PERMIT NO.
Absorpt on area(s)
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER
R EMAR KS
APPRO~ _
DATE
LEGAL
PERMIT NO.
MUN I C I F ~L I T¥ ,=mF
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 'L' STREET., ANCHORAGE, AK. 99501
2~4-4720
HELL AND
( 790_~54 >
ON--S I TE SEhJER PERM I T
RPPLICANT
LOCATION
LEGAL
KENNETH BOGGS
EAGLE RIVER
LiO B2 CHU~A~ PK EST
STAR ROUTE
LOT SIZE
694 2~94
54450 SQUARE FEET
TYPE OF SOIL 8BSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4
SOIL RATING (SQ FT?BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
E~EPTH= 12 LENGTH= 43 GRA~/EL DEPTH= 4
THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE E~CRVRTION <IN FEET>.
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFBLL PIPE
AND THE BOTTOM OF THE EXCAVATION <IN FEET>,
REQI] I RED SEPT I L~ TRNK S I ZE= 1250 ~3RLLFj~-~S
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF 8NY WELLS ADJACENT TO THIS PROPERTY 8ND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TWO ( 2 ) I ~SPEC-T IONS ARE REQId I RED
BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVBL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSRL SYSTEM IS
100 FEET FOR A PRIVATE WELL~ OR
i50 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL LOGS 8RE REQUIRED 8ND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS 8RE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM I T E×P I RES DECErIBER 31~ 1979
I CERTIFY THRT
l: I 8M FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2~ I WILL INSTRLL THE SYSTEM IN RCCORDANCE WITH THE CODES.
~ I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS.
R CRNT ~IN~TM BOG~S /,~-~
V_?.... 2
PERMIT NO.
r-1 LI I-4 I C: I F' I::]'L_ I T' %-' C! F I::t If-~ C: H C~ F,: fa C..~ E:
DEPARTMENT 0~- HEFILTH FIND EN',/'IRONHE. NTFIL F--"TEC:TION
825 "1 .... :STREET., AI'.4CHORFIGE, AK. E'~5,_.±
2 G 4 - 4 7 ;2 C~
L-~EL_L. F'EE."IPl I T
(79C~C~42 )
AF'F'LICANT EIOGGS KENNETH R
LFuZ:F:IT t lin ~ z..~ (_.. C/Z./.~,
LEGAl-L--id ~.-,::~. (_~-'~?z.~'~'/>~-~' /'/~ /,~':?Z,'/: LOT SIZE .~RaF'~.:l SL.':!UFiF.'.E I--E'ET
MINIMUM DISTANCE BE'FWEEN A WELL ANC, AN'-r' ON-SITE SEWFtGE [:,TSF'OSRL SYSTEM
'1. CIE1 FEET FOR A F'RI'v'ATE WELL.; OR
±50 TO 200 FEET FF.:OH FI PLIBL. IC [,]ELL [:,EPENE:,ING UPON THE TYPE OF PUBLIF: WELL.
WELL LOGS FIRE REL.]UIREr:, FIND MUST BE RETLIRI'-,IE[:, TO THE [:,EPFIRTMENT WITHTN 36.~ [:,FTYS
OF THE WELL C:OHPLETIOI'.4.
OTHER REQUIREMENTS HR"r' RPPtZr'. SPEC:IFIC:RTIONS RN[:' CONSTRUCTION E:,IAGRRHS FIRE
AVRILRBLE TO INSURE PROPEF.: INSTFtLLFITION.
F'EF-:r-11 T E,'=-::F' I F-:EL-5 E:,EC:Er.IE:EE: _-----::1_..
I CERTIFY THAT
t: I AM FAr,IILIAR WITH THE REC~UIREMENTS FOR ON-SITE SEWERS FIN[:, WELLS F~S SET
FORTH 8Y THE MUNICIPALITY OF ANCHORAGE
2' I WILL INSTALL THE SYSTEM IN FtCC:ORDANCE WITH THE CODES.
RF'PLIC:ANT 8].aSS KENNETF'I\ ~
F._[:,FITE ....
OWNER OF LAND
ADDRESS
LEGAL DESCaI~ION :~' ~ 7~ /'~ ~'~ ,~ C:~/,~,., ~ O~AW OOW~ ~.
~ '/" ~,/7 Q Ended j¢/~') 7/7p GALS. PER HR
DATE - Sta~ed ,, .~, .....
PE~IT NUMBER -?' ~:~' 'c; ::~ ~c),, KIND OF CASING
erfifieh Drilling o
---N >¢NIAL :~ -, c~lON
DOG Go.
SULLIVAN WATER WELLS
~. o. ~ox ~,~, c.~.~, ~s~ ~ · ~.o~ ~,~ RECEIVED
I
STATIC LEVEL OF WATER FT. .
KIND OF FORMATION:
From ,/ Ft. to
From / Ft. to
From · .~ Ft. to !,,,.~
From ," ·
From :
From Ft. to
From. . Ft. to
From Ft. to
From .
From
From , ' Ft. to ,: ~,~' (;: Ft.
From__Ft. to__Ft.
From ~ ".,,, Ft. to, '~' Ft.
From ,, Ft. to . "d"'ii' Ft.
From~Ft. to
From , ' Ft. to '
From Ft. to Ft._
From
From
From__
From --
From
From
From
From
)/' ~':: ~' From__
From __
From __
From
From
From
From
From
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.
Ft. to Ft.
Ft. to__Ft
Ft. tor Ft
Ft. to Ft.
Ft. to Ft.
Ft. to__Ft.
Ft. to .Ft.
MISCL. INFORMATION:
DRILLER'S NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6,650, Anch(wage, Alaska 99502 276-2221
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
PERFORMED FOR;
DATE PERFORMED:
LEGAL DESCRI~rIO.=
1
2
3
4
5
6
7
8
9
?IIR K
SLOPE
.Lo
SITE PLAN
10
11
WAS /V'O f.
'~G-I~'OU N O WATER
ENCOUNTERED~ Dp
E
13
15
16
17
18
2O
COMMENTS
PERFORMED BY:
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
, , (minUtes/inch)
PERCOLATION RATE ,
TEST RUN BETWEEN . FT AND
72-008 (7/76)
.~, . '' .~' -.~DATE RECEIVED ,
o ,- INSPECTION APPOINTMENTS - ~.~.~-,~L~,~_~-~
DATE DATE DATE
INSPECTOR
INS~ INSPECTOR[
,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PR~ OF ANCHO~
825 L Strut - Anchora~, A~ka 99~1 DE~. OF H~A, LTH &
~I~ENT~L PROTE~I~
RO.M .TAL SA. TAT O. mWS O.
Telephone ~4720 fl0V 2 ~ 1979
DIRECTIONS: Complete all parts on page 1. Incomplete requ~ will not be pr~. Please allow ten (10) days for processing.
MAILING ADDRESS
PROPERTY RESIDenT (If di~fe~n~from above) PHONE
MAI LING ADDR ESS
4, REALTOR/AGENT ~ PHONE
I
MAILING ADDRESS
5, LEGAL DE~CI~IPTION
6. TYPE OF RESIDENCE
~_[~. SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One 5~"Four
[] Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~J, INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVI DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or []Holding Tank
Size: If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AR EA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
THIS SIDE FOR OFFIG4AC I~.SE ONLY
NUMBER OF BEDROOMS
[] THREE [] FIVE
[] FOUR [] SiX
[] OTHER
[] ONE
[] TWO
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
MANUFACTURER
MATERIAL
Septic/Holdi ng Tan k
Absorption Area ISewer Line
Nearest Lot Line
FOR ~:f'"'~"7 BEDROOMS
[~PROV ED
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ,~¢~
DATE
72-010 (Rev. 6/79)
Municipality of Anchorage
Development Services Department
Building Safely Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 995t9-6650
www.ct.anchorage.ak.us
(907) 3J,3-Tg04
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-481-05
1. GENERAL INFORMATION
Complelelegaldescriptio'n Lot: 10; Rlnr~ ?.
Expiration Dale: ! - :~ ' ~ ~
Location (site address or d, irections)
C. urrent Properly owner(s.) Chris
Mailing address
Lending agency
19340 Chu~ach Park Dr. Eagle ~iver
Day phone
Day phone
Mailing address
Real Estate Agent
Mailing Address
Sharon Minseh / R~mm~ Dayphone 6Q/,-A?~O
16600 Centerfield D~. Ste 201 Eagle River, AK 99577
2. NUMBER OF BEDROOMS:
· Unless otherwise requested, HAA will be held by DSD forpickup.
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ~
Individual Holding tank []
Community On-site
Public Sewer []
The Municipality of Anchorage Developmenl Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer reglslered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for propedles served by a single family on-site wastewa{er 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 propedies served by a private or Class C weft and may be reissued with
new water sample results less Ihan 30 days old. (Cedilicates may be reissued for a period of up lo one year with
valid water samples.) CeHific'~[es are valid {'or 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 oJ' the validation da~e shown below, I verify Ihat my Inves{Igalion,
based on procedures outlined In the HeaIth Authorily Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for Ihe number of
bedrooms and type of struclure Indicated herein. I fudher verify (ha{ based on the Informafion obtained from the
Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply end/or
wastewater disposal system Is(are) In compliance with all applicable Municipal and Slate codes, ordinances,
and regulations in effect at Ihe time of Installation.
Name of Firm S &
Address17034 N.
Engineer's Printed Name
S En~ineerin~ Phone 694-2979
Eagle River Loop Ste 204 EaRle River, AK 99577
Robert C. Cowan Dale ~/~'/~-
[ ......
bedrooms. ~, h,~,~C~Z:S~:~,~~
5. DSD SIGNATURE
L/" Approved for
Disapproved.
Conditional approval for
bedrooms, with lhe following slipulations:
Additional Comments
By:
Attachments:
HAA Checklist
Septic Sys{em Advisory
Well Flow Advisory
X
Maintenance Agreements
SUpplemental Engineer's Report
Olher
Original Cedificale Date: /~)"
Municipality of Anchorage
Development Services Department ~.
Building Safety Division '~"
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(90?) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
FROM WELL LOG
ATINSPECTION
Date o,,.t 7/3'q
Static water level ~,~, I ft. ft.
Well production /(~ g.p.m. 'g~" ~ g.p.m.
WATER SAMPLE RESULTS:
Coliform ~_~c~onias/100 mi.
B. SEPTIC/HOLDINGTANK DATA
/ Oate, ,e,,
. Tank size ~ gal. Number of Compartments ~ ./Cleanouts (Y/N)
' f: Foundation deanoUt (Y~N) ~ Depression over tank (Y/N) ~ High water alarm (Y/N) ~//
.... ' " '/ '"'""-
Nltmt~,~.~mgJI. Other bacteria O. colonies/100 mi.
Total depth q ft. Eft. absorption area"~['ft~ Monitoring tube y
Date of adecluacy test J~/~'~ ~" Results (Pass/FaiO ?~'~,
Fluid depth in absorption field before test 0 iff. Water adde~gal.
Elapsed Time: (~_.. min. Final fluid depth ~ in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (YIN & type) f~
Depression over field ~
For + bedrooms
New depth. I in.
~1~0 g,p.d.
If yes, give date
..C. 'ABSORPTION FIELI~ DATA
Length '"TO ft. Width Gravel below pipe ft.
D. UFT STATION
Date installed
*Pump on" level at ~ in.
/
Datum /
E. SEPARATION DISTANCES
Size in gallons
'Pump off level at
Cycles tested
ManholeJAccess (Y/N)
in. High water alarm level at in.
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LO'I* TO:
Septic tankalft~;~afi"on on lot
Absorption field on lot
'.'" On adj. .,
/00 I,~. On adjacent lots / ~)(~) /'~
Public sewer manholeJcieanout
Public sewer main
S~/sepflc service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~"' ~L Property line
Water main /v//~4~r Water service line
Wells on adjacent lots ! ~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
eroperb/line / O '~'"' Building foundation ! 0 '~' Water main
Water Setwice line / O ~/' Surface water
Curtain drain ~fO~'~/~J~Wells on adjacent lots
Absorption field
Su cew=tar
Driveway, pa~ng/vehicte storage
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 Pdnted Name ~ d gr ~,,~ ;._ ~' - CO ~,~4 *-
Date ~/I '~/O '7--
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number