HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES #1 BLK 3 LT 10
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl.. SYSTEM AND/OR WELL INSPECTION REPORT
LOCATION
OFF JtllAk~O I?~ AT ,ID~,~'/ ~.P
Well
~ ~ Manufacturer ~
~ ~Liq. capacity in gallons [ IF HOMEMADE
I 100o :
~1 DISTANCE TO:
Well
~ 2] I Well
~/
~/No. of ...~ ILength of each line
~-- ~ ~ TOp of tile to finish 9r~de
[ Length ~1 Width
(~ ~/ Type of crib Grib diameter
Absorpt~)~l~a Dwelling ~ I
IOI Material .~ T~, f~I
I nsid~%le n gt~h W dtt~,_.¢~
PHONE
2?2-IS'T/
Dwelling
Material
Nearest lot line
Trenc ~ width
Foundation
Total length of lines
Material beneath tile
Depth 4 _b 5'
Crib depth
Building foundation
Driller
inches
NO. OF BEDROOMS L,~
No. of compartments
Liquid depth .=.
J~.N EW
[] UPGRADE
PERMIT NO.
Liquid capacity in gallons
PERMIT NO, ~LO4.2.2.'
Distaace between lines
Total effective absorption area
Total effective absorption area
Nearest lot line ':LO'
Distaece to lot line
PERMIT NO.
Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS /
SOIL TEST RATING
INSTALLER
5', ~-%~.Y. O¢os'lr,:, HOAq~ F_X84- 088
REMARKS
V~ DATE LEGAL
72-013 (Rev. 3/78)
DEPARTMENT (IF' HEALTH AND ENVIR(31qMENTAL PF~OTECTIOIq
825 L. STREET, ANCHORAGE, AK 99501
264-4720
F:'ERM I 'l" Iq[',):
DATE: ISSUED:
AF:'PI,. I CANT:
(4DDRESS ."
CON"FACT F'HONE
I_EEGAL DIESCRIF':
LOT SIZE:
MAX BEDROOMS:
84 ]422
C~6106/84
JAMES M. RIF'F'EY, JR.
15.35 E. I'HJFrFMAN
ANI]HORAGE, Al'::: 995.~5
272- :[5'71
SLIBDIVISI[IN'.' MOUNTAIN VALLEY EST
SECTION: 33 TGWNSHIF'." 14N
94:.$47 (SQ. FT. (]R ACRE']S)
"&'-/ [. LUuI .....
RANGE: :tW
Listed be].c)~ are 'Lhe options available 'Lo you ir'{ d~s:i, gn:Lng your sep'Lic
system,, Choose 'Lhe op'Li~n that best Fits your site.
DEP]'H TC) F'IF~E BGT'I'OM (FT.) 4. c) 4.0 4.0
GRAVEL. DEPTH (FT.) 4.C) 0.,5 3.5
I"DTAL. DEPTH (FT.) 8. () 4,, 5 7,, 5
GRAVEl,.. WIDTH (FT.) 2.5 22.0 5.0
GRAVEl_ I..ENGTH (FT.) '75. () 4:1.. 0 65,, 0
GRAVE[.. VOLUME (CU. YI)S,. ) 31.2 '33" ql Z~[~. :[
TANK S I ZE (GALS) 1, 000' 0 '~'"' 1, 000'' 0 '~'~ ]., 000,' 0
SOIL RATING (SQ.FT. /BR) 200 :L97 2?00
ee TAIxII< MUST HAVE AT LEA.::,T TWO [,[)MF, AF~]MENT,~
I certify that:
],. I am familiaP with the r'equ:Lrements for ~,]'n-"si, tre s~wers and well~s a~ set
FoPth by 'Lhe Munici'pality oF Anchorage (MOA) and the State of Alaska,,
2,, I wi].l install the system in ac::c(:rdance wi{h all MOA cc]des ~'l(',:l regula'Lic)ns,
and in coml:)li~nce with the design cpiteP:i.a c]t' this permit,,
3. I will adhere 'Lc~ all MDA and S'Late c)f Alaska Pequiremel"rL~: Fc)r the se'L back
distances Fr'~m any existing well~, wastewa'Le:,r' d:i, sposal sys'Lem or' public
sewePage sys'Lem ()n {his ur any a(:JjacerrL or nearby ].cfi...
4. I Luqder~{al]d Ch~a'~. ti-lis per~'l~.t is va].id for a maximum oF ':3 bedrooms
any en].aPgement wi].], reqL(:Lpe an adcli'Libnal permi'L.
IF A L..IFT S"FATION IS INS'I'ALJ..,ED IN APl AREA COVERED BY MOA BUILDIIqG (](:)DES.,
THEN (1) AN EL..ECTIRI[]AI.... PERMIT AND ]:NSPECTtOIxl MUST BE. OBTAINED; (2)
WILl... NOT BE AF:'F:'ROVED WITHOUT AN EL. ECTRICAI~. INSF:'ECTION REPORT; AND (3) THIE'
ELECTRICAL WORK IqUST BE D[INIE BY A LICENSED ELECTIRICIAIxl.
~) I GNI:D DATE:
DEPRRTMENT OF HERLTH RND ENVIRONMENTRL PROTECTION
825 L STREET, RNCHORRGE, RK
264-4720
PERMIT NO:
[)RTE ISSUED:
RPPLIE:ANT:
ADDRESS:
CONTACT PHONE:
LEGAL DE$CRIP:
LO]' SIZE:
MAX BEDROOMS:
840422
06,/06,/84
ANCHORAGE., RK_.'a'=='~.~.Jt.., = .. ..
272-'157'1
SUBDIVISION: MOUNTRIN VALLE? EST
SECTION: ~3. TOWNSHIP: '14N
94-~47 (SQ; FT. OR ACRES)
LOT:
RANGE
BLOCK:
LISTED BELOW RRE THE OPTIONS AVRILABLE TO ?OU IN DESIGNING ?OUR SEPTIC
SVSTEI"I. CHOOSE THE OPTION THRT BEST FITS VOUR SITE.
DEF'TH TO PIPE BOTTOM (FT.)
GRRVEL DEPTH (FT.)
TOTAL DEPTH (FT.)
GRAVEL WIDTH (FT.)
GRRVEL LENGTH (FT.:)
GRAVEL VOLUME (CU. YDS. )
TANK SIZE (GALS)
SOIL RATING (SQ. FT,/BR)
T t.~.: E ~'4 £: H BEE:,
].'.. 5 ~:~ 4. 0 4.
2.5 Et5 2.0
6.0 4.5 6.0
2.5 iD.E~ 5. E~
98. 0 :+::+, Z~6. 0 E;~.
25. 8 25. 3 29.
000. 0 ~:,+: 1, 000. 0 :+,~: t., 0E~0. 0
tSE~ 25~ i50
~,~-,.DEPTH TO PIPE BOTTOM < 4. 0 F'T. MRY REQUIRE'] A LIFT STRTION
GRAVEL LENGTH..- "'' 75 FT. REC.,LIRE~_ MULTIF'LE R_N':;_ ,::NOT E>:,CEE[.ING ,'75 FT.
TANK. MUST HRVE AT LEEIST TWO COMPRRTMENTS
EACH)
I CERTIFY THAT:
2L. I AM FAMILIAR P]ITH THE REI..]UIF.:EMENTS FOR ON-SITE SEPIERS aND UELL=,, - '- Rs SET
FORTH B? THE MUNICIPRLIT'¢ OF RNCHORBGE (MOR) RN[:, THE STRTE OF RLBSKB.
c, =,¢_,[EM IN RE. CORBMNL. E P.IITH ALL MOB
~. I WILL INSTRLL THE ~" ~ .... ~ .... _.UDE=, RND REGIIRTIONS.,
RND IN CF~MF'L ,-
:. IRNCE WITH THE DESIGN CRITERIA OF THZ=, F'ERMZT,
2:. ~ WILL RDHERE TO ALL MOA AND STRTE OF RLRSKR REQUIREMENTS FOR THE SET BRcK
DISTRNCES FROM RN'~' EXISTING NELL, P4RSTEWR]'ER DISPOSAL S~¢STEM OR PUBLIC
SEWERRGE S'¢STEM ON THI~ OR 8NV RBJRCENT OR NERRB¥ LOT.
4. I UNDERSTRNB THAT THIS PERMIT IS VRLI~ FOR R MRXIMUM OF
RN? ENLARGEMENT WILL REQUIRE RN 8DDITIONRL PERMIT.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERE[:' B"r' MOB BUILDING CODES,
THEN (±) AN ELECTRICAL PERMIT AND INSPECTION MLIST BE OBTRINED.~ (2) RS-BUILTS
WILL NOT BE BF'PROVE[:' WITHOUT RN ELECTRICRL INSPECTION REPORT.~ AND (2;) THE
ELECTRICAL WORK MUST BE DONE B'¢ R LICENSED ELECTRICIAN.
SIGNED t~ [)RTE:
~FFLICRNT: JRMES ~ R. IPPEV., JR.
E;SUED B9
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~O~T~ Fo~Y~ ~O~STRC~CT~O~4
DATE PERFORMED:
SOILS LOG
PERCOLATION
TEST
/O
LEGAL DESCRIPTION: ~O~j~'~l''~, VALLey E~-~)LoT'.bt'~' I~L.~ 5~C;3~fi ,T~A-N, }~lV4
200 % F//13eOfioOtq
SLOPE SITE PLAN
lO
11
12
13
14
15
16
17
18
19
2o
k~ 0 WA'Fa~
WAS GROUND WATER k I S
ENCOUNTERED? I~'~ ~ L
O
P
E
IF YES, ATWHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
I%"
PERCOLATION RATE
TEST RUN BETWEEN
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
SLOPE
1
4
7
8
9
DATE PERFORMED:
SITE PLAN
10
11
14-
15
16
17
18 ~EPL OF HEALTH
PROT~ION
19-
rJUL 2 5 t984
WAS GROUND WATER S
ENCOUNTERED? -- ~¢1 OL
P
E
IF YES, AT WHAT
DEPTFI?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
20-
COMMENTS SI~
PERFOR.ED BY: ~ ¢ ~ CERTIFIED
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~'"~-. SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
5
6
7
8
9
10
11
12
13
14-
15-
16-
17
18
19
DATE PERFORMED:
SLOPE SITE PI/AN
Reading Date Gross Net Depth to Net
Time 'rime Water Drop
20
PERCOLATION RATE //~//,],~ (minutes/inch)
//'
TEST RUN BETWEEN / / FT AND ~ FT
COMMENTS ~,¢,,vr/-'¢~/,,/6 '7'-0~.~ 1~7~o~ ~ ,
72-008 (6/79]
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. #
050 641
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
5
HAA #
1. GENERAL INFORMATION
Completelegaldescription Lot 10; Block 3; Mountain Valley Estates
Location (site address or directions)
NHN Johnny Drive
Eagle River, AK
Property owner
Mailing address
Lending agency
Mailin. g address
Agent
Address
Abel Veldcamp
P.O. Box 770812
Day phone 440-7244
Eagle River~ AK 99577
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well XX
Community well
Public water
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
NOTE:
xx
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(R6v. 1/91) Fronl MOA#21
5. STATEMENT OF INSPECTION BY ENGIN~EE~R -
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 t inspection.
NameofFirm J~'l~L;d'~_TMI/~/C._. Phone -~.-77--~/
Address ~, o/0 / ~)~ -~ ) ,,~1~¢.~ ~
Engineer's signature / ~'/~ ~-~ Date
TO BE PAID AT CLOSING FOR ENGINEERING , "
SERVICES PERFORMED. ~,~,,, ..
6. D S SIGNATURE ~- '~V~['Z .......
Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with th% following stipulations:
Additional Comments
L4~ o~he -~ pality of Anchorage Department of'Health and Human Services (DHHS) issues Health Authority
~r --~pp~'_o,~l Certffmates based only upon the representations gwen in paragraph 5 above by an ~ndependent
k"~ ~prot~_~ional enginesr registered in the State of Alaska. The DHHS do~s this as a courtesyto purchasers of hom~s
~ an~tl~ir lending ]nsbtutions in order to satisfy certain federal and state requirements. Employees of DHHS do not.
L,Z,4 ~.~c~ c0~di;~ct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is nOt
~ cb r Le~..~nsible~. for errors or omissions in the professional engineer's work.
RECEIVED
Municipality of Anchorage DEC 2.9
1998
DEPARTIVIENT OF: HEALTH & HUMAN SERVIC:ES
MUNICIPALITy OF ANCHoP, AG
Environmental Serviaes Division I~N¥1RO.b/M_EblZAL~/~V, iCE8
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343:~/q.,+ D~¥1.SlON
Legal Description:
A. WELL DATA
Well type ~2~1V ~-r~'
Log present (~/~
Total depth (~b~
Sanitary seal (~lJ)
Date of test
Static water level
Well production
Health Authority Approval Checklist
~.-,0 "r IOI I~ I. OC.~
050-
IfA, B, or C, attach ADEC letter. ADEC water system number'
Date completed
Cased to Zo'H" (l~,-~_~_ Casing height (above ground)
3/~5, Wires properly: protected (~tlj~)
FROM WELL LOG ^T NSPECT,ON
/2L~ /& ~
~}.O g.p.m. 2, '7,~ +--,
g.p.m.
WATER SAMPLE RESULTS:
~Coliform / Nitrate
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed '7/"Z.H/~H Tank size Iooo
/
O, q';/~ ,~J~. Other bacteria
Collected by: j~, LO. u J, ,'~, ~ I ~J~
Number of Compartments ~- Cleanouts (5~/ti1~ ?'~_s
Foundation cleanout {~/~ '~,~ Depression ~'~) /~o High water alarm
Date of Pumping ~//~, Pumper ,~'/5'r'~ J-J~s No~ ~ ~/~z~
ABSORPTION FIELD DATA ~ E~eo --~¥~,-r~,~ ht~,s
Date installed -~/7,~/fl~/ Soil rating (~11~ or ~]~ 1~10 System type
Length ~Width 2. o
Effective absorption area
Date of adequacy test Iz/8- t o/~ ~
Fluid depth in absorption field before test (in.); O
Immediately after %fi' gal. water added (in.):
I I _ _.~1
Gravel thickness below pipe o..,~ _ Total depth
Monitoring Tube present (~t~ V[~ Depression over field (~/~
Results (L~'a-~F.~[tt) ~/~s For --~ bedrooms
Fluid depth 0 (ins) Minutes later: I m,,~u,r~= Absorption rate = ~o'~ g.p.d.
Peroxide treatment (past 12 months) (Y~ ~,~ ~N~w~ If yes. give date - -
72-026 (Rev. ~96)*
D. LIFT STATION
D~ Size in gall:ns
Manhole/Acce~ ~-
High water alarm level at* , ~ ~
E, SEPARATION DISTANCES
"Pump off" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/t'iolding tank on lot / o I On adjacent lots
Absorption field on lot lop On adjacent lots
Public sewer main I~/~ Public sewer manhole/cleanout
Sewer/septic service line ~5~' Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation No-~ ,~ ~' Property line lof-/- Absorption field
Water main/service line to~-+ Surface water/drainage lo-Ct- Wells on adjacent lots
SEPARATION. DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Propertyline ~ol+' Building foundation /'JOT ~,~ '~' Water main/service line IO~P'
Surface water I'oo~'+ Driveway, parking/~/ehicle storage area 7-5J +--
Curtain drain ~o~J~ ~N o~J Wells on adjacent lots
icertifythatlha~te/~i}~d/4h'~lspectionsandrev,ewofMun,c/palrec~'~ _' ' ·
in confo~an~ wit~ ~/ ~eline~ in effect on this date. ~~
Signature ~y~ ~~ ~}~
Engineer's NaJ ~ ~ ~~ ~ ~~
-- ~
HAAFee $ ~)~ '
Date°f Payment ~-~//~ 1 ~
Receipt Number ~ ~:~ Y ~ '~ ~--~ ~ ? >
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
~,.~.~__~ CT&E Environmental Services Inc.
CT&E Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Orderet~ By
PWSID
Sample Remarks:
987175001
AK Water & Wastewater Consultants Inc.
Mountain Valley Est.
Lot 10 Blk 3 Well Head
Drinking Water
Client PO#
Printed Date/Time 12/15/98 00:08
Collected Date/Time 12/10/98 06:15
Received Date/Time 12/11/98 12:30
Technical Director: Stephen C. Ede
Released By ~
Parameter
Results PQL Units
Allowable Prep Analysis
Method [.imits Date Date Init
Nitrate-N
Waters Department Analyses
Total Coliform
0.498
NEGATIVE
0.100
mg/L
EPA 300.0 10 max
12/11/98 12/11/98 SCL
SM18 9223B 12/11/98 RMV