HomeMy WebLinkAboutHUNDRED HILLS BLK 1 LT 1u,ndred HIU
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
DON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME ,.
J/Q-C., /J-1-' ,- r
PHONE
Li'NEW
❑ UPGRADE
MAILING ADDRESS R X ` „, t e , ,
LEGAL DESCRIPTION .2 17 / / / /�%�L//J /Pr.
LOCATION
NO. OF BEDROOMS
SEPTIC
TANK
DISTANCE TO:
Well
%ICJt
Absorption area
/�(Jt --
Dwelling
Z5 r
PERMIT NO. p
8 / es -o0
Manufacturer
Materia
No. of compartments
Liq. capacity in gallons
/Uv0
IF HOMEMADE:
Inside length
Width
Liquid depth
O Y
-T2
= z F
DISTANCE T0:
Well
Dwelling
PERMIT NO.
Manufacturer
Material
Liquid capacity in gallons
TILE
DRAINFIELD
TRENCH
DISTANCE TO:
Well t -f
/ZQ
Foundation t
20 i'
Nearest lot line r
�6
PERMIT NO. p
/L?,S'Oq ,,
No. of lines /
Length of each line j
Total length of lines.
Trench width 1-
inches
Distance between Jige
�//
Top of tile to finish gradei
el
Material beneath tile
6
Total effective absorption area
SEEPAGE
PIT
Length
Width
Depth
PERMIT NO.
Type of crib
Crib diameter
Crib depth
Total effective absorption area
DISTANCE TO:
Well
Building foundation
Nearest lot line
w
Lj
Class
Class,,
un'�'e
Depth
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption areals)
OTHER
PIPE MATERIALS
P/19.SL CI
SOIL TEST R ING
/ '10
f�
.r
_.j
1plls�
h
Pam
INSTALLER
/ai 1v-1 EXE-,
1
I
0II�
REMARKS _
4 l . . ,�1`_. .+
8'
4 o
i el,"1. 1 7« ., aa 7.13'
2.6
3
/
%%ten%. . ,/0v! /C`,.-vim"4 r "
a
�I
/2e4t .,._tv:,40e
APPROVED DATE LEGAL 2% ----I ! / \ .. ,� 7 /..1---g /1) itZe-f _ X /�-
Trr:ifirti Drilling4E11g
DOC bCyo. dba
SULLIVAN WATER WELLS
LCHUGIAK, ALASKA 99567 • TELEPHONE 688 2759
T_ / 4E/
DEPTH OF WELL
t
OWNER OF LAND
ADDRESS j. STATIC LEVEL OF WATER FT
LEGAL DESCRIPTIO
DATE - Started
Ended
DRAW DOWN FT
GALS. PER HR ‘,1 '1e2
PERMIT NUMBER KIND OF CASING • ,f
KIND OF FORMATION:
From Ft. to .2-.LiFt ," - t./t/ ..t.c., / f ,,,,t,...7,..r , „t From Ft to Ft
From Ft to Ft ' ', Ft to e PA t' c ,, ),,,,,,,..-c:, i From Ft
From Ft to Ft„.."-„,„, I From Ft to Ft
From Ft. to i i . i Ft - ,
, r e -`4,-. From Ft to Ft
From Ft. to Ft. A ' ..,";,t t,e <” .? R. + ' ., t..,/,Finm Ft to Ft
From Ft to /-.., Ft. ,-., , -,i„ ' , 14, From Ft. to Ft.
From - Ft. to , : Ft. 5 t: 1.,. ,•.. ,--;e .4,.... --...,< ,'Ittom Ft. to Ft.
From Ft to Ft.
) -°•°4 ' ,—Z Ft. to Ft. — ' "I``4r4O:ni
From Ft. to Ft From Ft to Ft
From Ft to Ft From Ft to Ft
From Ft. to Ft. From Ft to Ft
From Ft to Ft. From Ft to Ft
From Ft. to Ft. From Ft. to Ft
From Ft. to Ft. FromFt
Ft to
From Ft. to Ft. FromFt.
Ft. to
From Ft. to Ft. From Ft. to WNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
From Ft. to Ft. From Ft to rtitiVIRONMENTAL RoTEcooKi
MISCL. INFORMATION:
uuN 2 3 1981
RECEIVED
TIM TT T vrs9c. Al A RAE.
q n
FA T. c � C1f7" FR c:DEPARTMENT .HEALTH AND ENVIRONMENTAL JTECTION
^ ~ ' 825 /L' STREET/ ANCHORAGE: HK 99501 k�
264.-4720 •
~ �E�__ E) r-4 --r- ��1.4E7 FR • �EE. ��T
PERMIT N[i ( 810508 )
APPLICANT JACK HORNER BOX 594 EAGLE RIVER {iQSil 694~27r.09
LOCATION SOUTH FORK MILE 8 LOT SIZE 200@00 S{�UHRE FEET
LEGAL LOT 1 BLK 1 HUNDRED HILLS S/D
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 140
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
CHUEIL El E: r-4 •-rU�:�
(3 IRFi ET_ C> F" TIF -1,== IS
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHIMFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
f4.; CI ILJ I FR EE E> n5 EE F:" 1- I (2: 1- Firq V( E; I OIE == 0 EltD C3F41___ IL_ 0 V4 n5
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE
17440 <-2.7 ir4n5F•EEC:1-I(DP4E; F#FREE FZE:111.1_1IFREEE>
BACKFILLING OF•HNY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100. FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F° 1: F." IR': El �ia" E: F-7.!
::1_��:���
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SE
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODEa
3: I UNDERSTAND THAT THE 8N -SITE SEWER SYSTEM MAY REQUIRE ENLARGE
RESIDENCE Ir; REMODEL -D Tr INCLUDE MORE THAN 3 BEDROOMS
SIGNED:
9PPLICHNT JACK HORNER
ISSUED BY~
011.12'1
~
�~�
��
~
2 //4. L. 1/4„) // N a 7-12,c4
Russell Oyster
694-2774
Performed for:
0 & E ENC VEERING & DEVELC7 1ENT CO.
Name'
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
// // SOIL LOG
-� g C"/C N AJ E A
i
2/0
Tel. No
Earl Ellis
688-2280
Mailing Address* '' //
Legal Description. LOT /1 /j Lc�G/� % /7/0A1O Q/EL5 /I/LL 5 SUf3.
Depth (feet) Soil Characteristics
0
1 -5/4-T ✓ 0/2 5O/
2
3
/ 5
6
(k'7
11
12
13
14
15
16
/ 2 /6OL, 5/1 -AM 5)
PF /L
-1,0 404,2,
eoi7`eM 7 -
PLOT PLAN
/Jo 5e4c 4-
PERC.TEST
Ground Water Encountered: Yes No If yes, what depth
Proposed Installation: Seepage Pit Drain Field
Comments'
2—X1:&
Performed by: d/C/7 ;�
Date. 6/4/g/
['NUN L. MCPAGOS CONSITVIC7=1
V. O 0 0
'.;•--c`567
691.3-70:3T
sOLD TO
Al Lson - Rustic LOME: S
sTnEET &No.
. R ox 594
rciy
Sale Rjver, Alaska 9 9 5 7 7
EZELENVN
11\111010E
SHIPPED To
pi land Road.
& NO.
INVOICE NO.
[7
64
1611Mafrali261.ASIMIS_
30TIIMS
Yards Sewer Rock
Dolly ery
Ti 4 and 9 r TWAICIrALITY OF ANCHORAGE
-17E7176F-17717F1 c<
Delivery ENVIRONMENTAL PROTECTION
X/ 6/
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
•
4700 South Bragaw SL '
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us .
(907) 343-7904
••;:; IS .'I 6
AzzL
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A 51-NOLE FAMILY DWELLING" ---
Parcel I.D. 07,P— HAA# (7 S - (0
-Expiration Date: — /4 —0 4L
1. GENERAL INFORMATION
Complete legal description Iy '4 4' L 6'/GLS S/L , LOT / Rock t
Location (site address or directions) 74429 /'/L.¢n/ ,eDc
Current Property owner(s) JaffAJ i* SAiI //d Rr/Efe.
Mailing address
Day phone
to 1.
Lending agency • Day phone
Mailing address
Real Estate Agent . LOkaa
Mailing Address. PRtJOF�l1 IIJ 1L/Srf9
Unless. bther wise requested, HAA will be held by DSD for pickup.
Day phone 6c9 -6'F76
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY: ;
Individual Well
Individual Water Storage
Community Class Well
Public Water System
3
❑ .
0
' TYPE OF WASTEWATER DISPOSAL: .
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
0
The Municipality of .Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family cn-site wastewater 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 properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for 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 of the validation val date
Guteet nes for this application,v.verify
yt my i that he on.
based on'procedures outlined in the Health Authority App
.site water supply and/or wastewater.disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein.further
verify thdat t basedon on he einformation
fo s on -Site obtained
nedly and/or
Municipality. of. Anchorage files and from my.investigation
• wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation. .
_ JbRTrth44 -F (C, /4r6 •P,,,,,ii
Name ofFirm - .: `.�•'-""� -
Address
3 :F.: I • . C.l.e'-cif/.
Date
Engineer's Printed Name— • • • : •
OF A� it
::� :: 49 44.4.410e .
♦I Steven W•. Eng •. �'';
• �+.sJ :�• �' .' PE 6256.•°•�� Vim/
�� 4141. .
.' 7eROFESS07'• ••• •
5. DSD SIGNATURE.
Approved for.
• Disapproved. •
bedraoins, With the following ;stipulations: • .
Conditional approval for " ;;4141,.,:. •.: .
•
'Additional Comments'
Attachments:
HAA Checklist
• Septic System Advisory
• Well Flow Advisory •
By:
(Rev. 01102)
Maintenance Agreements ,
Supplemental Engineer's Report
Other
Original Certificate Date: 1
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.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
. Legal Description: &AM /2EA ///LLS 4/1)` LOT 6 saw/ Parcel ID: 07J /7/-02
A. WELL DATA
Well type P If A, B. or C provide PWSID #
Date completed C/P/ Sanitary seal (Y/N) Y
Total depth /CO ft. Cased to 6 7 ft.
FROM WELL LOG
Date of test
Static water level /60 ft.
Well production
WATER SAMPLE RESULTS:
Coliform V colonies/100 ml. Nitrate 0.139 mg./I.
Arsenic: mg./I. Date of sample: 0/71°-?
B. SEPTIC/HOLDING TANK DATA .41Q4 /Q ,t'pS
Tank Type/Material 6. rr e/ STEEL
Tank size /on6 gal. Number of Compartments 2
Foundation cleanout (Y/N) X Depression over tank (Y/N)
Date of pumping/CA/03
C. ABSORPTION FIELD DATA
Date installed elPf - 3/12 Soil rating ( 2 or ft2/bdrm) /1/0 System type -rR -A(//
Length 3C ft. Width 3 ft. Gravel below pipe ' ft.
Total depth /0 ft. Eff. absorption area 4Zft2 Monitoring tube y Depression over field .t(
Date of adequacy test /a//3/63Results (Pass/Fait) Al4i.f For 3 bedrooms
Fluid depth in absorption field before test24f in. Water added1{50 gal, New depth in.
Elapsed Time:/20 min. Final fluid depth 2I1 in. Absorption rate >= VS -0 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) flit'ketch...4V If yes, give date
/5 g.p.m.
Pumper c.91-,c/fTA./
Well Log (Y/N)
Wires properly protected (YIN)(_ 1/
Casing height (above ground) /2 in.
AT INSPECTION
/0%s/a3
/OG. 7S
ft. TO. C
g.p.m.
Other bacteria O
colonies/100 ml.
Collected by: i{ /01"-/-4P.rn E., •
Date installed 6/i// To 3//2,
Cleanouts (Y/N)
High water alarm (Y/N) A(Mt
yc`4'
D. LIFT STATION Af/,.
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at _ in "Pump off" level at _ in. High water alarm I el at in.
Datum Cycles tested Meets alarm & c' cuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot / 31 On adjacent lots /act
Absorption field on lot / /Ort
On adjacent Tots /O e
Public sewer main /1/4 Public sewer manhole/cleanout n!/4
r
Sewer /septic service line 70 *
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
�
Building foundation 2 % r Property line /Do 4' Absorption field
Water main A/At Water service line
4)6 it Surface water /00
Wells on adjacent lots /OG
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line/� Building foundation 1/ d 17" Water main ,///q
Water Service line PS 'i' Surface water /00 4' Driveway. parking/vehicle storage .30'#
•
Curtain drain [//t%rlou/,l Wells on adjacent lots /60 rt
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 Printed Name 7 V,' F,/6
Date
HAA Fee $
Date of Payment ' ( ' V
Number
Receipt ((( t �r
p � ( ( S
(Rev. 12/01)
- of 44q' 1
ice. '.T4
▪ * I
• •4
r'
-r,
c.
*;'49TH
so. ••s
¢ t
✓ Steven WL�c'fSg v✓
'4
f+ J.•• PE 6256 S• •:.o
SIS
Waiver Fee $
Date of Payment
Receipt Number
SGS,'
GS Refit
lint Name
'reject Name/it
:[tent Sample ID
7atrix
'WSID
ample Remarks?
1037245003
Nortt.Rim Engineering
Various
Location 3 /./VA16AC6 ifa.Z.JL g/
Drinking Water
0
=o- !C,E:o, . , C.
All Dates/Times are Alaska Standard Time
Printed Date/Time 11/12/2003 713
Collected Date/Time 11/07/2003 9:00
Received Dale/Time 11/07/2003 10:30
Technical Dim -. Stcphcj 'lEde
Released Hy
antneter
Results
PQL
Units Method
Tatars Department
Nitrate -N
ticrobiol'uy laborato.cy
Total Coliform
0.939
t:
Container ID ^d, r
.ible Prep nis
1 ii�s Ds,e Daae I: it
0.100 tnplL, CPA 300.0 13 (<-101 11/07,03 1113
con 00r1 S1118 9=2D A (<-'11 11/07/03 I KC