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HomeMy WebLinkAboutHUNDRED HILLS BLK 1 LT 1u,ndred HIU s/D LI, PSI 6`l�- 11 \' p2' 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