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Home My WebLink AboutSUE TAWN ESTATE #2 BLK 1 LT 14 Municipality of Anchorage Page I 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 Name~v~ ~ ~1 ~ ~l ~~ Wastewater System: ~New D Upgrade Address: ~? ~ ~~, ABSORPTION FIELD Phone: NO of~e;ooms: ~eepTrench ~ShallowTrench ~8ed UMound ~Other Total Depth from original grad : LEGAL DESCRIPTION Soil Rating: I, ~ GPD/Sq. Ft. Township: I Range: ~ Section: Fill added above ori inal grade: Gravel length: Number of lines: I Distance between lines: WELL: Q New ~ Upgrade Gravel width: ~/Ft. II ¢~ · Ft. iDcation(Private, A,B,C): Total Depth: Cased TO: Total absorption area: Pipe materiah~ Driller: Date Drilled: Static Water Level:Installer: Date installed: Yield: GPM ~ Pump Set at: F, [ Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Hold[n9 ~ublic/Private M~ufacturer: Capacity i~ Well [~1 j~,~ ~ ~ ~ Material~ ~ ~ Number~partments: Surface Water I~'~ t~'~ ~ ~ _ LIFT STATION Lot Size in gallons: I Manufacturer: Foundation Iq' ~ ~ ~ / ~ High water alarm at: CurtainDrain ~ ~ )~ ~ ~ ~ ~ ~ ~ump Make ~ I Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: - Assumed Elevation: ~¢ ~, EN Department of Hea~nd Human Services approval ,~-~'.~_ 72-013 (Rev 9/91) MOA25 Page ~of ' ~- Municipality of Anchorage 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 72-013 A (Rev 9/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744 HAND WRITTEN PERMIT Permit Number: SW Date Issued: ~'~-~'~/~-~ Design Engineer: Owner Name: Owner Address: Permit Type: ~/eaJ Expiration Date: g-~--~3 Day Phone:~ Parcel ID: b ~{~A-bZ--~3" Lot Legal: Subdivision: ~ ~/~'~)~/~-RW~zpLLOt: /~B1ock: / Section: Township: Range: Lot Size:~ (sq.ft. or acres) Max Bedrooms: This Permit: ~ Total Capacity: ~ SEPTIC TANK: Minimum septic tank capacity: /7~-D gallons. Each septic tank must have at least 2 compartments, insulation is required if depth to top of septic tank(s) is less than 4.0'o Lift stations require an appropriate electrical inspection. WELL LOG: A copy of the well log must be sent to DHHS within 30 days of the well's completion. I CERTIFY THAT: I will install the on-site sewer system and/or well in accordance with all codes and regulations of the Municipality of Anchorage (MOA) and State of Alaska , and in compliance with the design criteria of this permit. 2. I will adhere to all MOA and State of Alaska requirements for separation distances from any existing well, septic system, or surface water on this or any adjacent or nearby lot. 3. I understand that this permit is va~id for a single family dwelling with a maximum of ~ bedrooms. I also understand that any enlargement will require an additional permit. I understand this permit is issued for 365 days and expires one year from the date of issue. I will notify DHHS prior to all inspections by the engineer or well driller. 4 o (owner/designee) ISSUED BY: ~ 0~a-o,7o~ db/ll5 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. August 7, 1992 CIVIL ENGINEERS (907) 694-2979 FAX 694-121~ HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL iNSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municl~)ality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 REFERENCE: Sue Tawn Estates #2, Block 1, Lot 14 We request you issue a permit to drill a well and install a septic system to serve the proposed 6 bedroom house on the referenced property. A test hole was excavated and a percolation test performed on the above referenced property. The approximate location of the' test hole is located on the attached site plan. This property has en6ugh~area for future septic upgrades, which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Sincerely, RJS/LSU/lsu 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION~--~-~--~ \ ~, 5 6 7 8 9 10 DATE PERFORMED: Township, Range, Section: SLOPE WAS GROUND WATER SITE PLAN 11 12 13 14- 15- 16- 17- 18- 19- 20- IF YES, AT WHAT DEPTH? Depth (o Waler~J~-~,~ Monitoring? Gross Net Depth to Net Reading Date Time Time Water Drop -' k ~l~I~'z- ~'.~.~ ~-- ~,~/~,, ~ a:~ (~1~~ ~" PERCOLATION BATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETEB PERFORMED BY- $ & $ ENGINEERING ~ ' ~--~ ¥-' · ~op Road No. 204 L ACCORDANCE WITH L~I~T~t~?~I~I~GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85} CERTIFY THAT THIS TEST WAS PERFORMED IN by SULLIVAN W ,ILR WELLS P.O, BOX 670272, CHUGIAK, ALASKA 99507 * T~L~PHONE $88,276~ OWNER OF LAND DATE Slatted .......................... Ended PEP, MIT ,c;l'&~ lC LEVEl. O;c %A]'f..P, Ff. _L3J. DRAW DOWN KIND OF FORMATION: F~om. O__n. to...~ ...... r.,,,,2.:~J_ From__.__ Fi, From .......... Fl. Frop~ ............ From /'/ .I ~ ..... .,.'/ DRILLER S NA,vlt,] 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 HAA# 1. GENERAL INFORMATION Complete legal description Lot 14; Block I; Suetawn ~stat~s #2 Location (site address or directions) 19144 M~ssa Lane Ohugiak, AK 99567 Property owner Mailing address Lending agency Mailing address Carl Disote~l /DISOTELL ¢0NSTRUCTI~ay phone P.O. Box 770210 Ea~l~ River, AK 99577 Day phone 694-5797 Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well XXX 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 DISPOS/~L: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 and from my investigation and inspection, the on-site water supply and/or waste?ater 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 Address Engineer's signature 5J~, s Ei~!GINEERING 17034 E~,gie River Loop Road No. 20z/ Phone DHHS SIGNATURE ~ Approved for ~_~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 professional engineer's work. 72~325 (Rev. 1/91) Back MOA 921 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descriptign:~-~" \'~ ~v4/-- I ~¢-_-C~5~t ~-r~c'?-~Parcel I.D. A. WELL DATA Well type 1~¢.~ >~-f._ If A, B, or C, attach ADEC letter. Date completed o~ .- ot ~ Driller Cased to '5 -z~-~' ~" ~ Casing height Wires properly protected (~)'N) Log present ~N) J Total depth '~"~ ~ ~:~ ~ Sanitary seal (~)N) ? FROM WELL .LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: \o c, Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ADEC water system number ~,~_~, g.p.m. AT INSPECTION / g.p.m, rtl ;~ 7- ,>- ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ c.~ ~-,/[~,,~. Nitrate Date of sample: ~ ~ /3 - '~ B. SEPTIC/HOLDING TANK DATA Date installed ~ - 2- ~' ~°t ~- Tank size Cleanouts (~YN) High water alarm (Y~) Date of pumping Other bacteria fJ'o Collected by: Foundation cleanout ~/N) ~' Alarm tested (Y/N) 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Compartments ~ Depression (Y~ ~/ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~5" ~ Onadjacentlots J~po ~--- To property line /O /4- Absorption field /c~ / ~' Surface water/drainage ~ .~undation Water mai'/service line L?' 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~ C~cles tested Meets MOA ele~ Manhole/Access (Y/N) Surface water D. ABSORPTION FIELD DATA Date installed Length '5-5- ~ Width Total absorption area Depression over field (Y,~ Results (pass/fail) /,./' ~ Peroxide treatment (past 12 months) (Y,~ Soil rating /_2 /~'~°//~-z System type Gravel thickness 7 / Total depth /~ / _ Cleanouts present ~(/N) Date of adequacy test for /L~:z-~r 7""-,../.4~,d' :2 /¢~ X' bedrooms ~ If yes, give date lo / -/-~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /¢ o I ~ To building foundation On adjacent lots -~ Surface water Curtain drain On adjacent lots /~o J ~', Property line / ~ / To existing or abandoned system on lot Cutbank ,,4'/.¢._ Water main/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 on the date of this inspection. $ & $ ENGINEERING Signature '17034 Eagle Rivet' Loop Road No, 204 [';ag e River, Alaska 99577 Engineer's Name Date "~ ~ I ~ ~' I~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91} Bac~< MOA 21 Waiver Fee: $ Date of Payment Receipt Number