HomeMy WebLinkAboutT12N R3W SEC 33 LT 142 W115 '
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: ,.~W~'7~) ~ PIDNumber: ~/~ ~¢2 ~
~m~: ~ ~.~ Wastewater System: ~ New ~ Upgrade
Addre s:
~ ~0¢¢ ~:~ ~ ABSORPTION FIELD
Phone: ~5 ~ ~ 7~~ NO o~ Be,drooms:~ ~ Deep Trench :~ Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION so,..,i.~: /'~ GPD/SR Ft Total Depth from odginal grade~
Lot: Block: Subdiv~ion: Depth to pipe bottom ~rom original qrade: Gravel depth beneath pipe
.ow..,,,.: 1 ¢ W Section: ~ 5 Fill added above Grig'hal grad~ FI ,ength: ¢~ Fl
WELL: g New ~ Upgrade Gravel width: ~ F~ Number of lines:/ Uista~ce between linesFt
Classification (Private. A.B,C): Total De : Cased To: Total absorption area: Pipe materiah ~/~
Driller:t ~' ~l* Date Drilled: ;ratio Walor Level:Ft. Inslage[:~/~¢ ~¢~** ~¢/ Date installed:,. ¢~ ~ ¢~,
~EPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P.
From Tank Field St6tion Tank Sewer Lines ~;~:~ ~
t , Material: ~¢~I Number °' O°mpadment':z
s.~c~ ' LIFT STATION
LOt ' I ' Size in gall°ns: [Monufacturor:
Foundation /~ ~ /O I¢ ~ ~ ~ "Pump on" level at:~¢level~
~emarks: ~" 5ot;~ ,~;D~ ',~%¢~[(~ BENCH MARK
Assumed Elevation:
ENGINEER'S SEAL
Department of Health and Human Services approval
Reviewed and approved by'. ~_~,~ Date: ~ ''~0FES
72 013 (Rev 9/91) MOA 25
AS-BUILT SYSTEM DL-TAILS/SITE PLAN PeP~t sw9703~
t ~/ 115% LEI'I' 14~, SBiC 33, Ti~N, R3~/ PID~O18 aga 03
PB~CUPINE T AIL DRIVE
LET 7A ~
A-D=39.8' ;~TIC ~ ~ I X -
49.1'
.... ~ existing system ~b~ndo~ed in pl~ce
F=80,8' ~ ~
G=94.8' W 115'
c~ 7'H6 ,¢ ~ PREPARED FBR~ I<ND ENGINEERING
fl II]H LAKE EAGI E RIVER, AK, 99577
~O~sstO~b~ :~000 PBRCUPINE II, AIl (907)696 6ttt/~ax (907)GgG 8HI
~~ ANCHBRAGE, ALASKa 995)0 gATE, H/B~/9z ]I)R~W~N6 ~f
PAGE 1 OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALAS[CA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW970322 DATE ISSUED: 9/18/97
DESIGN ENGINEER:KND ENGINEERING EXPIRATION DATE: 9/18/98
OWNER NANE:BROWN AUDREY L
OWNER ADDRESS:2800 PORCUPINE TRAIL RD
1 q
PARCEL ID:01829203
LEGAL DESCRIPTION:
T12N R3W SEC 33 LT 142 Wl15'
LOT SIZE: 36300 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
THE ATTACHED APPROVED DESIGN.
ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AZC72) AND DRINKING WATER REGULATIONS (18AAC80).
THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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 SANE DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: _~ DATE:
ISSUED BY: //'/~7{/{~C ( . DATE:
K
D
WASTE~/A1ER DISPBSAL SYSTEH?SITE
W 115', LOT 142, SEC 3(}. T1BN, R3W
LO'[ 114
W 11%'
LOT 115
C 115'
LI3T 115
SEPTIC
E 115
LO"f
SEPTIC
PLAN
PBRCUPINE TRAIL ]}RIVE
SEPTIC
SEPTIC
LET 146I}
LOT 14lA
]}ESIGN CRITERIA
NIl FI-.S:
PREPARED FBR: I<N~ ENG~EERING
~0441 PTARMIGAN BLV]]
[uu L~i<E EAGLE RIVER, Al<, 99577
'~[~.~ ID ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696~6111/FAX (907)696-8111
September 14, 1997
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: West 115', Lot 142, Sec. 33, T12N, R3W - Septic Upgrade Permit
Gentlemen:
Following a request from the owner, we conducted an investigation of the existing
undocumented septic system for the subject property. Based on those observations
and conversations with the buyer of the referenced property we were requested we
proceed with an upgrade of the septic system. On August 30, 1997 we dug one
testhole for the proposed upgrade. The result of this :test are attached. The lot is
served by an individual well.
The proposed upgrade system will be placed approximately 58' north of the existing
house and the piping will be rerouted to come out of the front of the house. As
indicated on the site plan the house can be served by a gravity system. The existing
tank and field will be abandoned in place. There was ground water observed during
monitoring of the testhole at 5' from the bottom of the testhole.
As indicated by the site plan drainage arrows, natural drainage is away from this site
and will be maintained after construction. There is no surface water within 100' of
the proposed installation. There are no known curtain drains within 50' of the
proposed installation. No private wells exist within 100' of the proposed installation
and no community wells exist within 200' of the proposed site. This upgrade should
have no adverse effect on development of adjacent lots.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
li~_'lxl !D Engineering
Kenneth M. Duffus, P.E.
attachments:
On-Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRiPTiON: ~/ //~ '/..0~,',','/ //~...~..~,3 ~'/,,.~/ Township, Range, Section:
1
2
3-
4-
5
6
7
8
9
10
11
12
13
14-
15-
16-
17
18
19
2O
SLOPE
WAS GROUND WATER ,/
ENCOUNTERED? __ .
DEPTH?
E
Depthto Waler Alter / / /
SITE PLAN
OOM~ENTS /~ o le
ReadingDate Gross Net Depth to Net
Time Time Water Drop
/ ~'~-77 //.' ~-c~ -- /~" -
Z /z.'z;o /,~;n -~'/~" ,~,~8"
~ ~ lZ;o/ ~ ~"
I~ .'/I /0~,~ ~ Y~" ~ ?/~"
~ ~ /~.'/~ , _ ~-,,
~ /~.~z' /~,.~ ~" ~ ~',
IZ :~ /b~/~ Z ?/~ "
P~.RCOLATION RATE -,~' ~' (mmuteshnch) PERC HOLE. DIAMETER
TEST RUN ~ETWEEN _ 7.5 _ ~ AND ~ ~ ~
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SEFIVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
~/~- ~ ~' NAA#
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) .P~co '/¢o,¢~_c~.io/~
Property owner
Mailing address
Lending agency
Mailing address.
Day phone 3'-/~%- c/'76-q
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup,
NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual well .x
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 I'e. gality and status of sysfem.
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 arid from my inves!i_gation 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.
Address
Engineer's signature
Phone '~ ~-/~""~ ~ .~ 7
Date
DHHS SIGNATURE
4/ Approved for ~
Disapproved,
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By: 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 orderto 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 engineer's work.
Legal Description:
A, WELL DATA
Well t~/pe ~--~1.
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
~unicipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3~3-~744
Health Authority Approval Checklist
Static water level
Well production
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~ ~ ~2' ~2
Cased to ¢r/o /'t- Casing height (above ground) -¢-/ ~
Wires properly protected (Y/N) y
FROM WELL LOG AT INSPECTION
g.p.m. ~. 2 g.p.m.
WATER SAMPLE RESULTS:
Coliform
Date of sample:.
B, SEPTIC/HOLDING TANK DATA
Date installed ~ ~- ~'~-' G*-/Tank size
Foundation cleanout (Y/N)
Date of Pumping
Nitrate
Collected by:
Other bacteria '~"~
/r,¢o ¢ Number of Compartments -.D. Cleanouts (Y/N) ~/
Depression (Y/N) A// High water alarm (Y/N) ~--
Pumper
C. ABSORPTION FIELD DATA
Date installed
Length ~'/-¢ ~ Width
Effective absorption area
Date of adequacy test A,/
Soil rating (g.p.d./fF or fF/bdrm) /
Gravel thickness below pipe
Monitoring Tube present (Y/N) \/
Results (Pass/Fall)
;L. ,¢ ! Total depth ~ ~
Depression over field (Y/N) ~
For .bedrooms
Fluid depth in absorption field, es! (in.);
Fluid depth /..(ir~) Minutes later:.
Peroxide~ (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
Immediately after,,,---"~gal, water added (in.):
D. LIFT STATION
Date installed
Manhole/Acce~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot / 0
Absorption field on lot
HAAFee $ ~ ~ ' ~
"Pump on"level at* ~
Size in gallons
On adjacent lots
On adjacent lots
/ODI
Public sewer main ¢v//] Public sewer manhole/cleanout
Sewer/septic service line ,¢--~ / ~ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK ON LOTTO:
Foundation ~' 8 ¢ Property line /O / ¢- Absorption field
Water main/service line ,¢_¢~'t y- Sudacewater/drainage /¢¢/'~Wellsonadjacentlots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Prope~y line ZJ% ~ Building foundation ~ ~ ¢ Water main/se~ice line ~,~-/->
Sudace water / ~¢ ~ ¢ Driveway, parking/vehicle storage area /~ /
Cu~ain drain / ~ ~ r ~ Wells on adjacent lots /
ENGINEER'S CERTIFICATION
I ce~ify that I have determined thru field inspections and review of Municipal records that~¢~%~s are
in conformance with MO~ H~ guidelines in effect on this date. ~ ~ ..... ?~.
Date of Payment ~ /2~('~/~ 7
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
,"/ . DEPAR~31ENT OF
DlVlSION OF LAND
APPLICATION FOp, ..W. ATE. R R!G_I4~T,', ..
· . You wi I need (1) a map showing the locatio~'°,f your ,our'o¢ of water.and the area of use,
· Instrucuons.. .......... tn,, document i.e. deed, patent, lease ap..reement or an easement
(2) a copy o/ your prOperty u'~-,-,o,-v , . ,
agrecmen~ if you do Bot own the property bwolvefl,'(3) a copy of your driller s well log, if application
is for an existing well, (4) Statement of Beneficial Use Of Water (Form 10-1003A) if this is an existing
water use, and (5) Application for Permit to Constmat or Modify Dam (Form 10-1015) if you will be
constructing a dam over 10 feet high or over 50 acre feet of storage. Ple~4e type or print in ink.
t. Full legal name of Appticant(s) ~ ~,jzL_~..2L ~ ....
3. Source of Water Supply:
(a) ~11
~dlled ~ Hand Driven
If existing well, attach copy of driller's well log.
If existing well, and n~..~supply all known ~fo~ation
Total depth ~~; Drawdown
Inlake Depth ~_. J~ Screened Ve~ No ~Unkn°wn- .
S~adc level ~~.
(b) ~ Surface Water
~ Stre~ River~ ~e ~P~'
Give geognphic n~e (if unn~=d, ~tat:
S'l ATE OF
~,. ,o,~., ~ u~OEST ~ND AND WATER MANAG~L~" . ~ .
Please complete A, B or C~ as required, and return to your District Offico.
Permit No.
STATEMENT OF BENEFICIAj. USE OF~WATE~R
ii-,.
'~mq ructiou o1' qructure,$ authorized under the above numbered Permit to Appropriate Water. of which I
the lawlul holder, have been completed and be~cficial u~ of wa~r is bcmg made. I hereby request that
C~rtificate of Apptophadon be issued to me. I ce~ify thai I ~v* complied with ~ conditions on the
llnetly describe the structures for withdrawing and conveying water to the point o{' u~ (if a well. please
attach copy of we'll log): _be2%._ ~ ? ~._ t.cg~_~ , F/~e ~_ ~- ~
I ce~ify under penalty of pe~u~ that the f~gotng i~ a tmo ~cl l~tl~I~ ataromont of th* extent to which
the above water u~ has b~en developed.
SUBSCRIBED AND sWORN TO befor~ me
, .- -
IhiS~.~ day of _~/~..dd,...~.<~ ~ , I~.
~pl~rmit'Holder)
DATE . --
PLACE
1~I003A