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Home My WebLink AboutT12N R3W SEC 33 LT 28 Permit Number: LEGAL DESCRIPTION WELL. ~ew El Upgrade Municipality of Anchorage Page / DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box ;196650 e Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report PID Number: .~ ~,~:,~j__L~ 1,-',~'~ -~ Wastewater System: ~ew [3 Upgrade ABSORPTION FIELD C[Y~'oep Trench [3 Sh~.llowTrench [3 Bed ~ Mound ~3 Other tram original grade: Grovel depth ber~eth pipe "TANK' SEPARATION DISTANCES ~.o ..~ Ho,ding (ii S.T,E.P, su,,~o , LIFT STATION Water ~/~0 '- Line Foundation ~ ~0 Drain Remarks: ~ o/Z'/' < BENCH MARt( Location oltd Oesorlptlon: ..eviewed and approved Heath and ~n~ai/, ~f)rvlces approval. ~10. Y/32.E PermitNo, ,~,~,J c/~o/?~ Page ....... of_ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. ~ox 196650 e Anchorage, Aleska 99519-6650 · Telephone: 343~4744 ' .QmB!t e ~.a~ewat ~~te~~~~ e PO rt al Description: ~ ~.~ L.I FT I 0'[,~ /0 5 ~ /ob 7 ENGINEER'S SEAL HO.:IT32-E Jun~ 2:~, 19~8 Constr~cting ~nginoe~s, SOILSLOG-~P£ROOLATIONTE6I PERFORMEO FOR: DATE PERFORMED: LEGAL DESCRIPTION; Township, Range, Section: 1 2 3 4 6 7 8 9~ ~3 14, 17~ 18 19 2O SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED;' IF YES, AT WRAT DEPTH? Reading ~0 Time Time Depth to Net Water Or{~ t. V~ ....... ~.(~/_ ........ ¢o/ ~' PERCOLATION RATE ~' ~ (m~nutes/~norlI PERC HOLE DIAMETER __ TEST RUN BETWEEN /0 ~' FT AND --,.('-.~.-~ FT PERFORMEO BY: C O~ ~gfi ~ -. I ~.~[~0~ CERTIFY THA~ THIS TES~ WAS PERFORMEO IN ACCOR~ANCRWI~HALLSTAT~ANDMUNICIPALGUIO~LINESIN~F~EC] ON THISDA~E, DA~: ~ ~ .TLIL 30 ' 9~, El?: 4:3i"I EiROHI'~ ~ ~Or,? ~'/C'~ SULLIVAN WATER 'WELLS P.O. BOX 670272, O~IU(~IAK, ALASKA 0~I~?. TELEPHONE DRA~ DOWN FT, L~GAL DESCRIFFIO~ Ended ~ GA~, PER HR ~.'- DA~E,StaRed ~ HENRY WILSON 9601 BUDDY WERNER DR.: ANCHOR^G[, AK 99516 (907) 346-2~H30 Constructing Engineers Engine%~g:,i Surveyors ,P,- /.zr,. ?',,z,t.,, Municipality of Anchorage Dept. of Health and Human Services P O. Box 196650, 825 Lst. Anchorage Alaska, 99519-6650 To wbomit may concern, REF: Permit # SW 950174 October 30, 96 During the summer of 1995, as per the Design Engineers recommendations, I discussed with On Site Services the requirements for upgrading the septic system I was building from a three bedroom to a four bedroom system. At that time I was told to follow the advice of the original Design Engineer, Hank Wilson, regarding size and design detmls for die larger system and that the larger system would be approved and recorded when the project was complete. This is exactly what 1[ did and now the system is done and ready to be put into use. I have been notified by Mr, Wilson that the As-Built Drawings, showing the completed four bedroom system, which were submitted to your office are in question of being approved. Plense call me if you need any additional information that would help speed the approval process along. Thank yon for your help. Respectfully, Thomas Tyler (owner) 428 2211 DBBP TI.~BNOH gY~TF.~ PL.,AN VI'DW -- 5OHE.,MA'rlo GEOTION ~END GOOPg: NE.W AB,,gOF2P""ION ~YSTE,M FOR A TdH~'DE,H3~ ~E. DF~OOM HOME., DY-,,~P T~E. NC, H WITH 6' OF'- ~P. AV~L.. $~L. OW TH~, PlP~, A$$ORPTION ARBA CAL..¢UL. ATION~: ,~/ MINIMUM RE. QUIRE. D: ~F~DF~OOM~ X ~50 ~PD/~DROOM :~50 ~PD CAPACITY ~01[-~ ~ATIN~ AT P~OPO~D ~Y~T~M - O,G ~PD/~F MINIMUM glZING = 450/0~6 = J-DO gF T~NOH WA&I_ AR~A LgN~TH : ~O'~F/12' =~4'FT IMPACT ON ADZAOa;NT &OTC: THB~E A~ NO P~IVAT~ W~LL9 WITHIN I00' AND NO PU~iO WB&&~ WITHIN ~00' OF '?MI9 A~O~PTION ~Y~TF.M, THg Pi~OPO~D A~O~TION ~Y~TgM HA~ NO IMPACT UPON ANY ADZAO&NT ~OT~ A~ ~HOWN ON THE, ATTAGTED GIT~ DIA~AM. Municipality of Anchorage Dept. of Health and Human Services P.O. Box 196650, 825 L st. Anchorage Alaska, 99519-6650 December 2, 1996 REC[IV[ D Attention Jim Williams REF: Permit # SW 950174 DEC 4. 199(~ Dept. Healtll & Human 8er~lo~e~ During the summer of 1995 I constructed a septic system in the city of Anchorage. This work was done prior to the construction of the proposed house. The design eugineer, Hank Wilson, and I decided to wait on drawing an as-built for the system until the house foundation was installed. This was completed in the spring of this year, 1996. The as-built was submitted to your office shortly thereafter. This is a brand new system that has yet to be put into use. The completion of the house is scheduled for early next year. At that time I am planning on using the system for the first time. If I can be of any further assistance please don't hesitate to call. Respectfully, Thomas Tyler (owner) 428-2211 Rick Mystrom. Mayor Mtmicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 24, 1996 Thomas H Tyler Margaret A Tyler 2247 East 86th Court Anchorage, Alska 99507 3403 Subject: T12N R3W Section 33 Lot 28 Permit ~SW950174, PID #018-181-13 The subject permit, single family well expired as of July issued July 21, 1995 by this office and/or on-site wastewater system, has 21, 1996. for a 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 this office for documentation of the close the permit. log must be sent to installation and to If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of constructJ.on completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. On-site Services enc: Copy of Permit cc: Constructing Engineers, Inc. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES PoE. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 995].9 6650 ON-SITE WELL AND WASTEWATER DISPOSAL, PAGE 1 OF SYSTEM PERMIT PERMIT NUMBER:SW950].74 DESIGN ENGINEER:CONSTRUCTING ENGINEERS, OWNER NAME:TYLER THOMAS H & MARGARET A OWNER ADDRESS:10012 NANTUCKET CIRCLE ANCKORAGE, AK 99507 INC. DATE ISSUED: 7/2]./95 EXPIRATION DATE: 7/21/96 PARCEl., ID:01818113 LEGAL DESCRIPTION: T12N R3W SEC 33 LT 28 LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: 3 TItIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRNCTION 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 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80) . 3° THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EAEH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343 4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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 RECEIVED BY: ~---- ISSUED 0 LOT ,5 L. OT A~[LA : 50,000 gF L-~.gg gETP~AOKg, WE. LL. RADii, BLUFF ARBA, A~E.A WITHIN ~00' OF O~V~D WAT~J~, D~IVUWAY AND HOUg~ FOOTPRINTg : 4~,860 gF AVAII_A~t~ FO~ ~P-FIO gYgTBM P Akl L.E.~AL.: LOT 28 IN NF. 1/zl, g3:5, TI2N, I~a4W OWN~: TOM 'FYL~E.~ PHON~,: ~4~"5240 DAT~: 6/I/35 SOALE: I' fO0' OON~T~UOTiN(~ &N~IN&~ ~4~--~000 I b601 ~UDDY W~N~ DRIVe. J J OP ~ ANOHO~A~E, A&A~KA 8~1~_ .. PI_AN VIeW - SOI'iKMATIO SF-.OTION f:K. ND VIBW) NEW A~9ORPTION SYgT~M PO~ A THRFo~ (;~} BF~D~OOM HOM~. TH~ gY~T~.M WILL DLLP T~LNOH W/TH 6' OF ~AVLL BELOW TIdE PlP~. A~O~PTION A~A MINIMUM ~OUI~I): ~ BED~OOMG X 150 ~PD/~D~OOM =450 ~PD CAPACITY ' ~O1~ ~A'FIN~ AT PROPO~BD GYGTbM = 0.6 MINIMUM GIZIN~ = 450/O.6 = YSO GF I'R~NGH WALL A~A P~O~A~Lg IMPACTS TO ADZAOENT LOT~: A~ ¢HOWN ON TH~ ~IT~ PLAN, ON THE AD'AGeNT A. WELLG ANP D. DI~ AI~HA~E TOM 'FY&~LI;~ PHON~L: D48-52,40 .~OAl~b: 346-2000 NO ~ OF 3. 3 4 7 8 9 10 ~3 14 15- 16- 19- Muniolpallty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Streel, Anchorage, Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST LEGAL DESCRIPTION: _ Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? Reading PERCOLATION RATE TEST RUNBETWEEN .---~?~ Drop 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 Parcel I.D. # CERTIFIC>,TE OF HEAL."FH AU'I'I-tORITY Ai-PROVAL F~.:R A SINGLE FAMILY DWELLING 01¢'- IZI - GF, NERAL INFORMATION Complete legal description Location (site address .~>r--C-i-re~{.iCris) / ~ /~.~_ ?-~/-~ u' 5) .(!_L~-_L~-, f~ oPr',D Property ownor Mailing address I_ending agency Mailing address__ Agent _ Address [)ay phone [)ay phone Unless otherwise requested, HAA will be held for pickup, NUMBER OF BEDROOM,S: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-.site Nolding tank Community on-site Public sewer NOTE: If community wastewater system, provido written confirmation from State AD£C attesting to t]e legality and status of system. 72~25(Rev, 1/91) Front MOA#21 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 Municipalify of Arrchorage files and from my investig,ation and inspection, the on-site water sup[~ly and/dr waetewC, ter disposal system is in compliar~ce .with all Municipal and State codes, ordinances, and f'egulations in effect on the date of this inspection. NameofFirm C0~J57'. ~AJ~ (~ Engineer's signature //~/~ Phone 6. DHHS SIGNATURE ....... ,- · ~ Approved for ¢ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 D H HS 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. 72-025(Rev. 1/91) Back MOA CY21 ENVIRONMENTAL ,SERVICE8 DIVt$/ON Municipality of Anchorage APR 0 8 1997 DEPARTMENT OF HEALTH & HUMAN SEF~VICES Environmental Services Division i1~ · ECl E VED L Street, ,eom . ^nc,erage. ^laska 99, O o Health Authority Approval Checklist LegalDescription: L~.8 ,.~ c ~'"'~ '~"l~/'J ~L,L) ParcelI,D,: ol ~- I~'1- 1'5 A. WELL DATA Well type ~'~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed Total depth Sanitary seal (Y/N) FROM WELL LOG Date of test ~ .. c~ ,.~ Static water level Well production '~ g,p,m. WATER SAMPLE RESULTS: Coliform Date of sample: B, SEPTIC/HOLDING TANK DATA Casing heigl~t (above ground) Wires properly protected (Y/N). AT INSPECTION Nitrate /1~, ~ ~) Other bacteria Collected by: g.p.m. Tank size I ~.-~ O Number of Compartments ~ Cleanouts (Y/N) ~ Depression (Y/N). /''J High water alarm (Y/N) /~/ Pumper Soil rating (g,p,d,/fF er'fl~/bdrm) O, ~ System type ~'~rE~ Gravel thickness below pipe (~,~l' Total depth Monitoring Tube present (Y/N) ~ Depression over field (Y/N) Results (Pass/Fail) -- For ~ bedrooms Date installed Foundation cleanout (Y/N) Date of Pumping /'J ~ ¢'J C. ABSORPTION FIELD DATA Date installed ~'- ~' ~ ~'~CN) Length ~S'I .Width Effective absorption area Date of adequacy test Fluid depth in absorption field before test (in,); C'~ Immediately after - gal, water added (in.): Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) ~ Absorption rate = -- .g,p,d. /'v/ If yes, give date ~ 72-026 (Rev. 3/96)* O. LIFTSTATION /JOT' (J,~D 0c2-~51~)~ (_.oF Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/heh~-tank on lot "¢' / o 0 Absorption field on lot -~/o ~ / Public sewer main -/- / 0 0 Sewer/septic service line ¢- / o O On adjacent lots -/- {o o On adjacent lots Public sewer manhole/cleanout Lift station +/o O 't-I00 SEPARATION DISTANCES FROM SEPTIC/HGLDH',~G TANK ON LOTTO: Foundation ~0 Property line .4- .:3 o Absorption field Water main/service line "/',,~-(~ Surface water/drainage "/' /o O Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -w ~ O / Building foundation '¢ .~ ~ ~ Surface water ¢- / co ~ Curtain drain ~/' O0 / F. ENGINEER'S CERTIFICATION Water main/service line '+ ..¢~ Driveway, parking/vehicle storage area '~ 2_. O ~ Wells on adjacent lots ~/o 0 / ~:~ ~ ,,/~ .,~ 5~0' I certify that I have determined thru field inspections and review in conformance with MOA HAA guidelines in effect on this date. Signature ~/~ '~'¢'~ ~ Engineer's Name Date ,~/'- 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number