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HomeMy WebLinkAboutSIEFKER #2 BLK B4 LT 4 ,~ ~ .,~.~,\~ DEPARTMENT OF I-IF_Al:tH & ENVIRONMENTAL PROTECTION i ' ' ENVIRONMEN1'AI. ENGINEERI~G r)IVISION ~~ 825 L Street- Anchorage, Alaska 9,9501 Telephone 2.64-4720 - ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl. II\ISPECTION REPORT LEGAL ~ESCRIPT[ON DISTANCE TO: Manufacturer C~( DISTANCE TO: DISTANCE TO: NO, OF B~OMS Absorpt~oi~area · Dwelling Materia~'.,)_.~ (~/~, .o, of compartme~__ IF HOMEMADE: Inside length [~ Liquid depth Well Dwelling PERMIT NO. Liquid capacity in ~allons Top of tile to finish grade Length Width Type of crib ;rib diameter Well DISTANCE TO: Class Depth Building foundation DISTANCE -FO: Depth inches PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line S01)dc tank Absorption area(s) OTHER MATE IALS SOl L TEST RATING / INSTALLER REMARKS LEGAL_ WELL DRILLII IG ~,~' ~.o. ~oX ~-~42 Ec~ / A NCHORAGE, AK 99501 _ PHONE 34~-3';92 MUNICIPALITY OF ANCHORAGE DEPT. OF 14.>z, LH~ & I~NVIRONMENI'AL Pi. O OT 2 7 1980 .RECEIVED D R I L L E R'S N E L L L'O G CUSTOMER ~l(e !~a~ee LOCATION ~;!att }Nd off Jerome Rd (Ste£ker Subdv) SIZE H,, DEP~ 23n, CASING DEP~ 2~0~ GRO~ING DEP~ N/A YIE~ 'le-'~5 r::~L STATIC WATER L~EL 16F~' HOW TEST~ [~ir PUMP INSTALL~ 3/~ hp ~PE .75~'~I-.16A~, R~d ~ack~t FO~TIONS ENCOUNTER~ ~ APPROPRIATE DEP~S 1 TO 18 ,,, 11,'TO 97 97 TO 110 110 TO 228 22g TO 235 . .Hardpar ~o]ay with streaks of sand and ~ravel ~;and, ~.ravel~ boulders Gray el ay Sand'~ ~,rave]., 'boulders Sand, course gravel, water ~:~2t-15 gpm __ TO TO TO __ TO TO TO TO I'H!~f~ ['L; NO SE~ H~OfH f~OR t. LF, ON 'rl~ FYP~ 0t:' PIJ~L[O ...................................... / / -' (:,.)-- / ~i- ii~~..:~::.¥:-~:.?:<-' Department of. Environme ,ta~t:-Quali'~-~?ii?:'. . ~ , ~ .. 3330 .C Street ' ' a '" " ''- " ':' , : ~',,¢ ~ . .: ¢., hot ge. Alaska 99503 :.:..,.. [~lal P~cripti'on''L°f' ;;"~ 's~ 'r' ' Suud v'~i OI,.¢--;tNO~AG~-:::' ' .._ DePth Feet ..- .... fig ,SILT,FINS $AI.:O !'!1x(27~.) l Nas:i,ground water encountered? .. Reading Percolation rate Proposed installation: Date~ Net:Drop mi nu te, Seepage Pit ..... Drain Field '" Depth of Inlet ~ :, ., Dej?th to boi;tom of p'~:so~.ot¥~'~;h ...... 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 AU'T'HORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I,D. # 015-272-50 1, GENERAL INFORMATION Complete legal description Siefker #2 Lot 4 Blk B4 Location (site address ordirections) 3941 F~.att Road Property owner Michael L. Ba~tee Mailing address--P.o. P~× ].10495~ Anchnz::ag¢_¢ AK Lending agency Alaska Hcme Mortgage Mailing address.. P.O. Box 196850, Anchoraqe, AE Agent Address Day phone 428-0864 99511 Day phone 563-3033 99519-6850 ERA Crawford RE / Carolyn Christler Day phone 562-5592 3380 C Street, Suite 110, Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well x Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site × Holding tank Community on-site Public sewer ? NOTEi"' If community Wastewater system, provide written confirmation from State ADEC attesting to the legali~j~'~d s'tatus of systeml .... ' -· ' ' ' 72.025 (Rev. 1/91) Fronl MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~,~2E'c/d~/Z '¢' ~ Parcel I.D. A. Well Data Well type ¢¢~/ (//f ¢'¢ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) YE'5 Date completed /0//.)//¢~) Driller Total depth ~ ~ ~ ~ Cased to ~ '~('~ / Casing height Sanitary seal (Y/N) /v'~'~ Wires properly protected (Y/N) ~j- £/,/ /L / /,/ 5 FROM WELL LOG Date of test /0/~¢ Static water level /(~(~ / Well f~ow /~. /5 Pump level1 0/"/~/q~O,~ g.p.m. AT INSPECTION /57' g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/la4C,~ing tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots /,.//..4 Public sewer manhole/cleanout /I///4 -/-- ~O / Petroleum tank /~/0,A/~' ,/¢/'¢/::),'~,'~/"/~'- WATER SAMPLE RESULTS: Coliform Date of sample: /~//~/./?.~ El. SEPTIC/~G TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Nitrate O. ~,/"~/~//-'~ Other bacteria Collected by: Tank size /,~..~ P Compartments Foundation cleanout (Y/N) ~"~'.~ Depression (Y/N) ./,,.//,-4- Alarm tested (Y/N) /0//<)/~ L~ Pumper SEPARATION DISTANCES FROM SEPTIC/~G TANK TO: Well(s) on lot .~//~ / On adjacent lots 7~/('~ / TO property line ~ '~5 / Absorption field Surface water/drainage ,/k//~ Foundation Water 6'~Jn/service line 72-o26 (3/93)* Front CONTINUED ON BACK PAGE CT~E ENUIRONHENTgL LAB SERUICES - 907 694 ~? N0.025 [~ CX&EReS.# :94.5349-3 Clierr~ Sample ID :8XCF1{F~ t2 L4 BLK4 Commercial Testing & Engineering Co. Environmental Laboratory Ben, cos .... :-z_'----___' .... -_ ..... 5~33 ~ Stree~ RCPO[~ O~ R~C~[S Anchorage, AK 99618-1600 Tel: (907} 5~2-2343 Fox: {907) 581-$301 Ordel~d By :C,H. Sample Rev~rks: R~It~ S~f~£ CO~_.[.~.C'~ BY: UA. Collectecl ~e =10/17/94 ~ 14:10 ~. Allegeable Ext. Anal Units t~th~ Limits Date Date Init 0.51 ~g/C EPA 353.2/300,0 10 10/19 B = ~e~t~, R~ value IS ~he ~ic~ ~ificetim limit. LT = ~ ~ I=NVIRONMENTAL FACILITIES IN ALASKA. COLORADO, FLORIDA, ILLINOIS, MARYLAND. NEW JI~RSEY. OHIO. UTAH, WEST VIRGINIA 10z20/94 ~4:51 CT&E ENU[RONMENTPL LAB SERUICES - 90? 694 ~----O? ~'NVIRONMENT.aL I. AB OH ~,, r r.J H ¥ N0.025 GJ04 Drintdng Water Analysis Report for Total Coliform Bacteria ~P~ATB WA~ Year SA_MI>LE DATE' SAMPLE TYPE: "~ Rout/ne o Treated Water 0 Repeat Sample (for tontine sample 0 Untreated Water ~qth lab reL no. .) ' ~ SpeclaIPu~os¢ Time Collected S~LE LO~ON i C~[leeted By TO BE COIvlPLBIl/'D BY LABOiLATOKY A~mlysts shows rids Water SAMPLIZ to be: 3:a~' Satiff~¢mr7 [] Unsatisfactory [~ Sample over 30 hour~ old, rc~ult-q may · bo Unreliable CI StaJ~pla too long [n tra.n$1[; samplo should not be over ,[8 trouts old at examination l , [O indicate reliable msulu. Please send new ~a~ple via special~elivet D ate ~eech.'ed /0_ Time l~ceJ','ed Analys~s Began Analyfica[ Method: ,,.r]--'Membrane Filler 0 MMO.MUG * Number oeeolordedl00 ml. Lab gel No. Rrzult* Ag4i)'st ,5'~..ntto~.,u.l~;c. ~ Fbk.~ Jun Client rmtifi'ed of unsatisfactory re-sult~: Phoned Spoke ,Mth Datel Time: Comment~; BACTERIOLO GYCA~, WATER ANAJ~Y$I$ ltECOI~.D BGB (-~ ColoniedlO0 mi COLIFiKM Fecal Colifarm Confirmatlo? ._ Iriuat Membrane Ftlt,r Result: Colfform/l O0 mi TWO TO FOLLO ENVI~0NlaENT^L S-~,~',qCE~ IH ALASKa.. COLOraDO, UTAH. ILLINOIS, llXt~O, r,',~',~YLAND. "41e~T VIRGINIA. N=~.'¢ JERSEY· c-©UTE Louis Butera, P.E. Registered Civil Engineer November 14, 1994 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Siefker//2, Lot 4 Block B4 Dear Mr. Cross: We had previously submitted a Health Authority Approval application for the above referenced property, indicath~g a surcharged field condition existed which resulted in denial of the adequacy test portion of the application. Subsequently, the field was excavated into at the monitor end, and it was found that the tube was plugged with leachate. A new monitor tube was installed approximately 10 feet from the end of the trench by driving a four inch steel pipe to the full depth of the three feet of leach gravel. Cleanouts were installed by A Plus Home Services at the end of the trench and an after tank cleanout was also installed. On November 10 the field was tested again, and initial starting liquid levels were eight inches above the bottom of the trench. 600 gallons of water was added with an 8.5 inch rise in level, and then a subsequent reduction was recorded and a projected 600 gpd absorption rate was confirmed. This absorption rate corroborate with our previous test result of October 18. We recommend the system be passed based on observed conditions. A new data sheet is attached. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \C:\WPWIN60\WPDO CS\i 994\94-078A.NAR P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907} 694-5195 , Fax (907) 694-3297 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-272-50 1. GENERAL INFORMATION Complete legal description Seifker #2 Lot 4, Block B4 Location (site address or directions) 3941 Klatt Road Property owner .. Michael L. Bartee Mailing address P.O. Box 110495, Anchorage, AK Day phone 428-0864 99511 Lending agency N/A Mailing address_ Day phone. Agent Address ERA/Crawford Real Estate, Carolyn Ch~t~ne 3380 C Street, Suite 110, Anchorage, AK 99503 562-5592 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: NOTE: Individual well x .C°mmunity well ' Public water 4. TYPE OF WASTEWATER DISPOSAL: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Ind vdual on-site x 'i ' Holding tank ": " Community on-site Public sewer ommunity wast "NOTE: "If'c ewater system, provide written confirmation from State ADEC attesting to the legality and status of S~)stem. 72-025 (Rev, 1/91) Front MOA ~1 ×? Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D. 0/5 - 7~ 7 z Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number' V~ ,S Date completed /0/01./0¢0 Driller Cased to ?/~0 Casing height ~/£ ~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION /o/do /~' / 5 ¢' /~./5 SEPARATION DISTANCES FROM WELL TO: Septic/~u tank on lot Absorption field on lot Public sewer main Sewer service line Z //¢' /¢5' ~ 90/ .g.p.m. ,..T~-W ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /4//~/',/~ /¢PF/C /z,¢.'~/ 7- WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: 10/I ?/ ~ ~- O, ~/ ~&/~ Other bacteria Collected by: ~-,,V~/~/~ ~_ B. SEPTIC/I'I4~EBhNG TANK DATA Date installed Cleanouts (Y/N) I/~.-~ Foundation cteanout (Y/N) High water alarm (Y/N) Date of pumping /D// Compartments ~- ~-'~ Depression (Y/N) Alarm tested (Y/N) ,~///¢ Pumper /] g/t//¢ £ / SEPARATION DISTANCES FROM SEPTIC/H~L-~ING TANK TO: Well(s) on lot ~ //~, On adjacent lots 7~/~0/ To property line ~¢ ~' Absorption field ~/ :~-l~o~0"~ Surface water/drainage ~//,~ Foundation Water mai~-/service line "/- ~ / 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION /V/~, Date installed Size in gallons Vent (Y/N) "Pump on" level at Manufacturer Manhole/AccesS (Y/N) "Pump off" Level at High water alarm level Meets MOA electrical codes (Y/N~ SEPARATION DIST~ANC~' FROM LIFT STATION TO: Well.~n- olololo1~ On adjacent lots Cycles tested Surface water D, ABSORPTION FIELD DATA Date installed Length / 2~ % Total absorption area Date of adequacy test _ Water level in absorption field before test Peroxide treatment (past t2 months) (Y/N) Width "~0 Z~ Cleanout present (Y/N) //,///¢//¢ '-/ Results (pass/fail) /,//.4 Soil rating (GPD/Ft2) /¢2 ¢~' J/~ ( Gravel thickness System type Total depth Depression over field (Y/N) /P/¢.~._~_ for After test Bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~¢'/~ S / On adjacent lots To building foundation ~ / (~ / On adjacent lots -/~ ,~O ~ Surface water ./,//~ Curtain drain '/~/~ / Property line To existing or abandoned system on lot Cutbank /'I///4 Water mai~/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect o.~the, c~a(.e,, of this inspection. Signature ~~ Engineer's Name L _¢'~')/% ~¢~--¢~ /OLd, Date h//~-//~ ~-/ HAA Fee $ 3 0 ~')' ~ Waiver Fee $ Date of Payment 'f~/~/¢/~ Date of Payment Receipt Number O r0 ~ Z- C~ Receipt Number 72-026 (3/93)* Back 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 inves!Lgation 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 Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294, Eagle River, AK 99577 "' Engineer's signatu re ~'~'--~~ Date 6.' DHHS SIGNATURE .: r~"~Approved for Disapproved. Conditional approval for bedrooms. bedrooms With the following 'stipulations: Additional Comments · ';.,-'.The un[clpahty of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority -:; '~(~pproval Cerbhcate~' based only upon the representakons g~ven in paragraph 5 above by an indeoendent · .', pro, fession.al eng~,~r ~egmtered In the State of Alaska. The DHHS does th~s as a courtesy to purchasers of homes / ' ~"× do not an~ !he[r.:l~ndid~ }h.stlt'~tions in order to ~atisfy certain federal and state requirements. Employees of DHHS condUct:,lnsPectibns or analyze data before a certificate is issued. The Municipality of Anchorage is not -...:~,'.:','jc~7~;' '..' :' '. ...... . ..... ,. ..... .:~;...... : ...... ~ .. ..... .....,r ~-::,~. '/2-025iR~',~,'l~1).;BeCk MOA~2'I · :: '"' :';'. '! 'i.'i' .t-",.,,~ "2 :", C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DISTANCE F~ROM~IFT STATION TO: W~9.J¢~'~j On adjacent lots D. ABSORPTION FIELD DATA Width Manufacturer Manhole/Access (Y/N) Date installed Length / ~' .~ / Total absorption area Date of adequacy test J'~- ~-~evel at tested Surface water Soil rating (GPD/Ft2) /'~ Gravel thickness Cleanout present (Y/N) Results (pass/fail) ,~/~ ~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: System type ~/E~/Vd./.I Total depth _ Depression over field (Y/N) for -/;'PU/~_ Bedrooms Well on lot ~/~ / To building foundation On adjacent lots ¢-~ D ~ Surface water iV/lq If yes, give date On adjacent lots %/OO / Property line Z'/~ / To existing or abandoned system on lot Cutbank /'///'-) Water I~¢J~r/service line Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HA,4 guidelines in effect On the date. of this inspection. Engineer's Name L.Cu / S ~ 0 ¢'~t¢.~ ., Date /,* ~ ~ ~ - ~ ~v HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number' 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 inves.tLgation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, d~a~.,s, ar;t~,~gq,lations in effect on the date of this inspection. Name of Firm Eagle River Engineering Services Phone 694-5195 Address P.O. Eox 773294, Eaqle River, AK 99577 Engineer's signature ~ Date /~- ~ / - ~ ~ 6. DHHS SIGNATURE Approved for bedrooms: Disapproved. ": ..... '" / Conditional approval for 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 order to 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 prof,essional engineer's work. 72-025(BaY. I/91) Back MOA#21 . - · -'