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Home My WebLink AboutT12N R3W SEC 33 BLM LT 189B Municipality of Anchorage Page of. 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: _~*~/ ~0 /'72. PIDNumber: 0 /~.~ Name: Wastewater System: ¢~ew ~ Upgrade *~'~": ABSORPTION FIELD Phone: lNo. of~edrooms: ~ Deep Trench D Shallow Trench ~d DMound DOther Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION , ~ ¢,~/sq.~. ~,5 Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe ~ rill added above original grade: Gravel length: Number of lines: l~istance betwee~ lines: WELL: ~ New D Upgrade Grace[depth: ~ Ft. ,/~ ~' Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material; Date Drilled: 8taticWater Level: Installer: Date installed: Yield: Pump Set at: . ' Cssing Height Above Ground: SEPARATION DISTANCES ~eptic B Holding ~ S.T.E.P. To Septic Absorption Lift Herding P~blic/Pdvate Manufacturer: Capacity in gallons: Number of Compa~ments: S~,.ce LIFT STATION Water ~{00~ ~/Oo/ ~ ~ Lot Size in gallons: ~ Manufacturer: Bomarks: BE~GH ~K Assumed Elevation: ~.~ SEAL Inspections performed by: ~ ~¢~*~¢~ ::Micheel ~. Anderson ~ Department of Health and Human Serwces approval '~,, *"~:'C, *'4 ''~o ....... :¢.:ss~* Y~¢:'* 72-013 (1/91) MOA 25 Pe~,mif. No. ~ ~ ~ ~ ~) ,/~7 ~.. Page of 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 Legal Description: z~_//?~ /ZS'/o ,~ PID No.: 72-013 A (2/91) MOA 25 BY ........... DATE ........ CLIENT CHKD. BY ...... DESCRIPTION SHEET ....... OF .... JOB NO. -- ............. -From : RLPINE DRILL 90? 345 0202 LOCATION/SKETCH: DEPTHS MEASURED FROM~rCaSing top I-lground surface BOREHOLE DATA: Depth Material Type and Color From To Ru9,25.1992 11:05 RH P81 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD ~.'~!. ON i-lE Els WELL OWNER: WELl. DEPTH: DATE OF COMPLETION Depth of hole: ,~ ~' ft Depth of casing:...~ ~' ? ft ~ f.~"~l DEPTH TO STATIC WATER LEVEL: ~[~"~' It below ~top of casing [] grobnd surface METHOD OF DRILLING: ~[~.air rotary , [] cable tool [] other USE OF WELL: ~Cdomestic [] irrigation [] monitor [] public supply [] other Casing type: ~ ,, .in. to Jt WELL INTAKE OPENING TYPE: I-1 open end [] screened ~open hole Depths of openings: ~'/-/ ~'to ,~'~' / ft Slot/Mesh Size: Length: ft RAVEL PACK TY'~L~ Volume used: Depth to top: . GROUT TYPE: ~ , · Volume: Depth: from ~'~'~t to. ft DEVELON~ENT LEVEL AND YIELD: after / hfs pumping ? gpm PUMP INTAKE DEPTH: ft Horsepower: __ WELL DISINFECTED UPON COMPLETION;' ~ YES [] ~-0 ~ CONTRACTOR INFORMATION: Refliste/f~f~' Rusineaa Name Signature of Authorize§ Respresentatlve ~/- '. Date REMARKS: PLEASE MAU. WHITE COPY OF Ld'b TO: DNRIDIVISION OF WATER ' ~ PO BOX 772116 / ' EAGLE RIVER AK 99577-2116 GOV'T LOT 189B PAGE 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:SW920172 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:SIMPSON DONALD D ~ OWNER ADDRESS:P.O. BOX 203201 ANCHORAGE, ALASKA 99520-3201 DATE ISSUED: 7/08/92 EXPIRATION DATE: PARCEL ID:01828223 LEGAL DESCRIPTION: T12N R3W SEC 33 BLM LT 189B 1 OF 7/08/93 1 LOT SIZE: 46175 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 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 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: June 28, 1992 Municipality of Anchorage Dept. of Health & Human Services Environmental Services Division 825 "L" Street, Room 502 Anchorage, Alaska 99501 Subject: B.L.M. Lot 189/~ ~ Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: I have reviewed information available on lots adjacent to the subject property and have conducted an onsite investigation. The terrain of this lot gently slopes as shown on the attached site plan. Soils encountered in the testholes located on the lot were fairly consistent and acceptable for an onsite septic system. Distances to adjacent systems are noted on the attached area map. The system, if constructed as designed, will have no adverse impacts on the wells currently in use or to be placed in the future on lots located in the re'ea. The system, if coastructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space either surface or subsurface on located in the area. any lots The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. Sincerely, Michael E. Anderson, P.E. LOT ,? 3oq.86' SHEET NO. OF CALCULATED DY, DATE CHECKED BY SCALE /~.,--~- = z~ ,'~,,.,,//,,,~ --'. ~'. /~-~ - . q DATE /~ ~0 0 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 4 5 6 7 8, 9 10 12 13 14 16- 17 18 19 20 DATE PERFC / ~;~ Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN Reading Date Time //: /0 /1: Z~ Net Time Depth to Weter // ?¢" //7/,~,, Net Drop PERCOLATION RATE ~'"~ (minutes/inch) PERC HOLE DIAMETER .. ~ /~ A ....... ~-'R'i'/I"~THAT HIS T ST WAS PERFORMED IN CCORDANCE WITH ALL STATE AND MUN,CiPAL GUiDEL,NE$ iN EFFECT ON THiS DA-¢E. DATE:. 72-008 IRev, MunlcipalJly o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST '~¢{FORM E D FOR: L~AL DESCRIPTION: DATE PERFC ~ L.4'vl, ~-i- /~) Township, Range, Section: 1 2 3- 4 5 6 7 8 9, 10- 11 SLOPE / / SITE PLAN 0 N IF YI~S, AT WHAT SL Depth lo W,t,r Reed[ng Date Gross Net Depth to Net Time Time Water Drop [.jdg~. z..t5 -- ~ ,I-,_,, _ 14 15 16 18- 19- 20- PERCOLATION RATE e,~) (minutes/inch) PERC HOLE DIAMETER ~' // TEST RUN BETWEEN ~'~ FT AND .'~" I//Z.- FT ..... ~E~IFY THAT TH~ TE$~ WAS PERFORMED IN ;ORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: ~¢~ ~ Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST bRFORMED FOR;_ ~)~'--"~/~'~ ~ ~ J ~ JOD ~) DATE PERFOR~ LJ~GAL DESCRIPTION: ~:~L.)1~ ~o~' /& ~ Township, Range, Section: "; 1 2 5- 6- 7 8 9, 10- SLOPE WAS GROUND WATER .I . ENCOUNTERED? ~,J{~ IF YES, AT WHAT DEPTH? SITE PLAN 13 - ~/.~1,%/~:~i3,~:.,.,~, Oeplh to Waler After '1 MoAitoring? 14- 15 16 17- 18- 19- 20- Reading Date Gross Net Depth to Net Time Time Water Drop II:}~ f I1,t, ~, DOLATION RATE . (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND ~ ~ FI / (Rev. 41851 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Dan Roth Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: HAA Lot 189B PID 018-282-23 96-02-21 10:21 RCVD February 20, 1996 Gentlemen; Per your request one of the monitors for the septic system servicing this property was exposed and extended on February 21, 1996. A second monitor was not located in spite of being referenced with swing ties. Most likely the monitor is buried in the lawn. At this time, with frost several feet deep, a backhoe would be required to find this pipe. We request a conditional HAA be issued with the conditions being that the second monitor be found and extended after breakup. At that time the monitor can be found with a steel probe which will do minimal damage to the lawn. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services t '., On-Site Services Section .995~19:§65~-,,~.:, .,.~:.,,,,.-- , ,.,., . .. _ -,.,- .... P.O. Box 196650 Anchorage. Alaska -~i ~..,:'::;;,. .:; · ... .................... 343 47~ .... . .--~. _:.-: ...~.-,: , :~,.;.,.,,¢:;~.- . : TH AUTHO TY. ~: '- ,:iL :~j;:~;~'~j APPROVAL FOR A SINGLE FAMILY DWELLING- . :-',.':~ _ 1.'~,_GENERAL-INFORMATION ............. ~_,~ , ' " tlon · ' ' · ..... ' Complete!egal descnp - . ,.. , - t; ;-Location (s ~e aooress or Qlrec[ions) ........ , ~'.~ ~' Madm address- ~- ~ ~ ~ ,,, ~ ~:. · · -. ...... .- , . , - Da phone ;NOTE.. If ;~munity w~ii". )confirmation from State ADEC attes - : 'r~; ordinances, and regulations in effect on the date of this inspection. 6, DHH~ SIGNATURE ApproveC for 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 Autt' ority 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 furtherverif¥ that based on ihe information obtained from" the Municipality of Anchorage files and from my investigation and inspectior, the on-site water supply and/or wastewater disposa~ system is in compliance'~,ith all Municipal and State codes,. bedrooms. purchase~ bf h Legal Description: A. WELL DATA Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501. (907) Health Authority Approval Checklist LoT l~5qq~, ~_~_.C.~ Parcell. D.: OIt~..Z~39-~',,2--~ Well .type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) %/ Date completed Total dePth ,}2 ~ '~ t Cased to I ~ ~ I Sanitary seal (Y/N) V Casing height (above ground) Wires properly protected (Y/Iq) Date of test Static water level Well production FROM WELL LOG I AT INSPECTION WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate t~.-~)-/t44 ~///L Other bacteria ¢ Collected by: ~ .~ ~- B. SEPTIC/HOLDING TANK DATA Date installed ~/3c> ]q~?~ Tank size Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Dateinstalled mi30 ] Length ~ Ch I Width I u'~-C'~;> Nmnber of Compartments ~ Cleanouts (Y/N) Depression (Y/N) i'M. High water alarm (yfi'q) Pumper I Soil rating (g.p.d./fi2 or fi%drm) o /~ . System type '~ ~. ~t I Gravel thickness below pipe 1' Total depth Effective absorption area Date of adequacy test &//t Fluid depth in absorption field before test (in.); Fluid depth ~ (ins.) Minutes later: Peroxide treatment (past 12 months) (Y/N) Monitoring Tube present(Y/N) *~ Depression over field (y/N) Results (Pass/Fail) ~ For '~ bedrooms Immediately ~er ~Ogal. water added (in.): Absorption rate = '~ ~5- O g.p.d, If yes, give date D. LIIWF STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Panlp ofF' level at* High water alarnl level itt* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holdiug tank on lot I I ~ Absorptiou field on lot [ [ 0 [ Public sewer maili 1"'[/~ Sewer/septic service liue [ 091 -~ : On adjacent lots ; Ou adjacent lots Public sewer mardtole/clcanout Lift station SEPARATION DISTANCES PROM SEPTIC/HOLDING TANK ON LOT TO: Building foandation }-7/f-~ Property line I [3 ~F Abso.tion field Water ulain/service liue > I O Surface water/drainage ~[ ] O Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION HELD ON LOT TO: Building foundation 7C~ { Water main/service line Surface water N [-D Ctlltain draiu ~'~ [ O Driveway, parking/vehicle storage area I Wells O11 adjaceut lots "~ / ,~ ~9 t Property line ENGINEER'S CERTIFICATION .' I cot tify that i have detet mined thru field mspecttons and revtew ofMumctpal re?rctl~.that l}~ ~bo,~e~sy3't~.~ are m coaforntance wtth MOA H~ gmdelmes tn effect on th~s date. ~ :O .'" o¢ ? ~. . HAA Fee $ ~_"~f')~ ,. d~ Date of Payment Receipt Nun,bet / ~/ f~C"70~ / Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number .~j~, CT&E Environmental Services Inc. CT&E Re f.,.~ Client Sample iD Matrix PWSID 0 960353. 1017 LOT 189B. SEC 3310353-01 Drir,~ing Water Collected Date 02/01/96 Technical Director Released By Sample Remarks: OC Allowable Prep Analysis Parameter O/F Results Ouat RDL Units Method Limits Date Date Init Nitrate 1.0 .221 ,1 mg/L EPA 353.2 02/05/96 02/05/96 ELL TI~ 16:43 FAX 907 582 ~45§ VISTA I~AL ESTATE P' M LOT 16q~ tr~-~.) ~002 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. # _ 0 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 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 ~ 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. 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 Address Engineer's signature DHHS SIGNATURE Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 DH HS 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 engineer's work. 72-025 (Rev 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: 7"/ZM R3W $~ 3,.~ ~Lt¢/ ¢I~?¢ ParcelI.D. (~ h~Z(~ ZZ 5 A. WELL DATA Well type t~t~1~)RT~ Log present (Y/N) If A, B, or C, attach ADEC letter. Date completed Total depth ?-~ Cased to /~ 7 Casing height Sanitary seal (Y/N) y Wires properly protected (Y/N) ADEC water system number ~/2. ~/~ 2--- Driller /~/_.p/.4/~__. FROM WELL LOG AT INSPECTION Date of test ~/Z Z-/¢2~ ////7~ ¢'/¢ z- Static water level ~-7' cC ~/' /~" Well flow q g.p.m. /'/ Pump level ~c~T D'~'TTI~ R~ ~ ~ E.C, SEPARATION DISTANCES FROM WELL TO: /07' ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer servi'ce line WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed 7.//Z¢//¢'~' Tank size Cleanouts (Y/N) High water alarm (Y/N) Date of pumping /JE~ Compartments Foundation cleanout (Y/N) /V Depression (Y/N) /[////¢ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot { To property line Surface water/drainage On adjacent lots Absorption field >/~,c," Foundation ?,O/ Water main/service line 72-025 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer __ Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length .--Cot Width Total absorption area. I ~- Depression over fietd (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating ' '~ System type Gravel thickness / ' Total depth Cleanouts present (Y/N) Date of adequacy test ,4"£/,4; Co/~T,~Uc'F/ for ..2 bedrooms /f/.,~ If yes, give date W//¢ On adjacent lots >/~ / Property line To existing or abandoned system on lot )Jof4E ¢/u (_¢ T' Cutbank >/00 Watermain/serviceline Driveway, parking/vehicle storage area ~ O / SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot _ To building foundation On adjacent lots Surface water /~E //V Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. EngineeCs Name Date HAA Fee $ / ~:~ z ~ Date of Payment. / Z. --/--'~ ,-~ Waiver Fee: $ Date of Payment Receipt Number 72-O26 (Rev. 3/91) Sack MOA 25 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE S 61052 Chemlab Ref.$ 92.6541 Sample ~ 1 }datxix: WATER Client Sample ID PWSID Collected Received Preserved with TAP FROM WELL BLM LOT 189 UA 11/29/92 ~ 13:00 hzs, 11/30/92 @ 08:15 lu:s. AS REQUIRED Client Hame :MCFADDEN, MAYNE Client Acct :MCFA~CS BPOS : Rags : Ordered By :WAYNE MCFADDEN POS :NONE RECEIVED Analysis Completed : ll/30/92 Laboratory Supsrviso} :,STEPHEN C. EDE Released By Send Reports to: I)MCFADDEN, WAYNE Parameter Results Units Method Allowable Limits NITRATE-N ND(O.IO) n~/1 EPA 353.2/300.0 10 Sample ROUTINE SAMPLE COLLECTED BY: W. MCFADDEN. Remarks: 1 Tests Performed See Special Instructions Above UA=Unavailable ND- None Detected ** See Sample Remarks Above NAr Not Analyzed LT~Less Than, GT-Greater Than ~Sr~S Member of the SGS Group (Soci~t~ G~n~rale de S.rveilMnce)