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Home My WebLink AboutSUE TAWN ESTATE #2 BLK 1 LT 5 . Municipality of Anchorage :. Page DEPARTMENT OF HEALTH AND HUMAN SERVICES. · ' ENVIRONMENTAL SERVICES DIVISION " P.O. Box ~196650 e Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Name: ~ ~~ ? Wastewater System: ~New ~ Upgrade Address: ~0, ~ ~ Z5 IO ~/~, ~¢~7 ABSORPTION FIELD .. P~ne: ~_/~ ~No;ofBedr~ms: ~eepTrench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL D ESCR I PTI O N sol, Rating: Total Depth from original grade: Lo~ B]oc~: Subdiv~ion: :Dep h o p'pe bo om f om o 'g'na grade Gravel depth beneath pipe Township: -- { ' " ~/~ R?ge~)~ Section:I~ Filladded above originalgrade:/~ ~ ~ ~Ft. Gravel[ength: ~ Ft. Number of lines: WELL: ~New ~ Upgrade 'Gravel width: ~ Ft. ~ Ft. Classificatlon (Private, A,B,~): Total Depth: Cased TO: Total absorption area: Pipe material: P4~ Casing Height Above Ground~ SEPARATION DISTANCES ~s~pti~ ~ Ho]~ing ~ S.T.E.P. Material: Number of Compadments: Sudace Water /OO~ l~ ~ ~ LIFT STATION ndation ~ O ( ~ ..... "Pump o." 1eve, a,: J~um~ ~' level a' t: I High water alarm at: FOU CudainDrain ~ ~ ~ Pump Make & M~e[ ~ Electrical inspections pedormed by: ~ BENCH MARK ENgiNEER'S SEAL Reviewed a d a rovedb ..Dat~: ...... 72-013 (Rev. 9/91) MOA 25 Permit No. ~'V¥ c)f/~.~ _: Page ~- of "?-- i Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONM.ENTAL SERVICES DIVISION P.O. Box 196650 o Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site 'Wastewater Disposal System and/or Well Inspection Report LegalDescription: /~--~' P~--~I ~-.~-~c=. ~'z. PIDNo.: ENGINeErS SEAL PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940065 DESIGN ENGINEER:DAVID R. DAYTON, P.E. OWNER NAME:MCGP-ATH JOHN P & KARIN D OWNER ADDRESS:P.O. BOX 672310 CHUGIAK, AK 99567 DATE ISSUED: 4/07/94 EXPIKATION DATE: 4/07/95 PARCEL ID:05147127 LEGAL DESCRIPTION: SUE TAWN ESTATES #2 ELK 5 1 LT LOT SIZE: 71066 (SQ. FT.) K53MBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHOP~AGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: iSSUED D. R. DAYTON, P.E., R.L.S. I~1~~ Chugiak, Alaska 99567 20210 Donalar (907) ~ 696-2417 April 4,1994 Lot 5, Block 1, Sue Tawn Estates Septic System The proposed septic system will serve a 4 bedroom home. The system will be an a large lot (1.5+ acres) which slpoes from South to North at approximately 5%. The proposed system will have no measurable impact on wells or wastewater systems on adjacent lots. There will be no significant impact on reserved space or drainage. PERFORMED FOR:__ 2 3 4 5 6 7 8 9 10 11 Municipa ity of Anchorage ~25 E Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 13 14 15 16 17 18 19 20 IF YES, AT WHAT pO DEPTH? E Depth to Water Alter. ~ ,.,_ ~,~/~./~¢e~ I~oflitoring? ,A/~ ,'~r.~_ Date: Reading Da e Gross Net Time Time Depth to Water Net Drop PERCOLATION RATE -~" ~'~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN --/~ .FTAND J _FT COMMENTS ' ACCORDANCE WiTH ALL ,STATE AND MUNICIP / ' [-- 72~08 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL D ESCRIPTION:~-~ 2 3 4 5- 6- 7 8 9 10 11 12 13- 14- 15- 16 17 18 19 20 ~;~"'- Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Monitoring? /(~o~ Dale: S Gross Net Depth to Net Reading t/a~t~/~ ~/ Time Time Water Drop / ' iz:,,) - i.~., ~ ~,,, _ rz... ~.', ~_ /~-,'zz - iz~ ,.~' /~,. -/z- ~', PERCOLATION RATE . TEST RUN BETWEEN -- (minutes/inch) PERC HOLE OIAMETER FTAND. ~ FT COMMENTS pERFORMED BY' ~'~ ~--' ~'~'~ ~ ~'~ ' /(,~,~/~'C'-ERTIFY THA~T ~HI/S ;EST WAS PERFORMED IN · EFFEOT O" THIS DATE OATE' ' ACCORDANCE WITH ALL STATE AND ' ' 72-008 JRev, 4/85) 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. # 1. GENERAL INFORMATION complete legal description -~"~- ~-- CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Location (site address or directions) Property owner Mailing add tess Lending agency Mailing address Agent Address ~,~,~ :~, ~_.~'~ Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~L TYPE OF WATER SUPPLY: Individual well .......... O~mrnunity well ..... Public water'' ...... NOTE:If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. , '~,~,, !')1,/.~ 4. TYPE OFWASTEWATER DISPOSAL:' Individual on-site "~ n~sit ' ·" - communityo e ....... ..... ; Public sewer,· . .. NOTE: . If community wastewater system, provide written confirmat~o from State -:'" ' ' - attesting to the legality and status of system. · . · · ...... ' , 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 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 Address Engineer's signature David R. Dayton P.E. Chugiak, Ala~ 99567. Phone Date 6. DHHS SIGNATURE ,/~" Approved for bedroomsl Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments .,By:' ~'!,~/¥--,-~ .~--~. :. ~,: ,~z ,---' /~ Date ~', ., ',~' ~ , '~he Mumc~pah~ o{.~nchorage Depa~ment of Health and Human Se~ic~ (DHHS) ~ues Health Author ~,Ap~oval.~;.;~;.~.,___,_~: ~_.,___,_.___.._.~_ ~._._Ce~ff{~ .based only upon the representations given 'n paragraph 5 above by an independent -..--..-----..-...-...~...-,.~--...~-~, .-~.,-' ' g" .... ~,~-,,~,' ralandstater~uirements. Employ~sofDHHSdonot conduct ~nspections or anal~e data before a ce~ifimte is l~ued. The Municipali~ of Anchorage is not resPonsible for errom or omi~ions in the prof~ional engin~fs work. '2 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: (-~7- ~- ~ I ~ ?--- Parcel I.D. o..~/'-Y-7 / ~ ? A. Well Data Well type Log present (Y/N) "/ Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Cased to If A, B, or C, attach ADEC letter. ADEC water system number Date completed Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION ~ g.p.m. X / Casing height Y g.p.m. Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout /~/'//'~'~ Petroleum tank WATER SAMPLE RESULTS: Coliform o Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ,,,~Z/~ ,¢'/¢,.~ Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Nitrate /~ ~-~ Other bacteria ,~//z~,/~ Collected by: Tank size / ¢ ~ Compartments Foundation cleanout (Y/N) ?' Depression (Y/N) Y~/'//~ Alarm tested (Y/N) /f.//~ ~V'S~ /¢¢~,¢ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot / -~'*~ To property line /~ Sudace water/drainage On adjacent lots /*o0 ¢- Foundation / ~ Absorption field ~' Water main/service line ~- 72°026 (3,93)° Fro~lt CONTINUED ON BACK PAGE C, LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water ". ABSORPTION FIELD DATA Length ~ 5- Width Total absorption area _5-4,/~d Cleanout present (Y/N) Date of adequacy test /f~/4~'c~ ~'/5,"~ Results (pass/fail) Water level in absorption field before test ~ - Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) /. 'Z ~ .~'2_ / Gravel thickness System type ~. ,~ Total depth Depression over field (Y/N) for After test .If yes, give date /L,/ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / z/~'O To building foundation On adjacent lots Surface water Curtain drain Cutbank On adjacent lots / ~ ~ Property line /5- To existing or abandoned system on lot /"?".~ Water main/service line ~ ~-- Driveway, parking/vehicle storage area .5'-- E. ENGINEER'S CERTIFICATION I ce~'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect p/7.~fi.e..~.a~pf this inspection. David R. Dayton P.E. Signature 202'10 Dona]ar St, Chugiak, Alaska 99567' Engineer's Name HAA Fee $ ~ ¢ ~ Dateof Payment /D ~' /,~ ~,~/- Receipt Number ~/r~ "7 ~-7~c~ / 72-026 (~)* ~ck Waiver Fee $ Date of Payment Receipt Number SULLIVAN WATER WELLS P.O. BOX 6702?2, CHUGIAK.'AI~ASKA 99567 · TELEPHONE 688-2759 ~'St~fted DEPTH OF WELL ~'~O~ ! T ~------~- STATIC LEVEL OF WATER FI. DRAW DOWN FT KIND OF CASING From Ft. to Et. From . Ft. to Ft. Ft. to F From .Fi:' to ' Fi. , , , From ' ~t to': FI __ Ft. ,, __.Ft. From Fi. to . Ft. From . FI: From Ft. lp. Fl. Fi, to Ft. '- ~ Fi. to Ft. From FI. to Ft. DRILLER'S NAME CT&E Ref.# Client Sample Matrix Commercial Testing & Engineering Co. Environmental Laboratory Services ~~,c>',~-zT~-~-,~',~ LABORATORY ANALYSIS REPORT 94.3683-1 LOT 10BLKI SUE TAWNEST WATER Client Name DAVID DAYTON, P.E. WORK Order 80624 Ordered By DAVID DAYTON PtintedDate 07/25/94 ~ 15:15 hrs. Project Name CollectedDate 07/20/94 ~ I4:00 hrs. Project# Received Date 07/21/94 ~11:35 hrs. PWS1D UA Teclmical Director STEPHEN C. EDE Sample Remarks: ROUTINE SAMPLE COLLECTED BY: PD. QC Allowable Ext. Anal Results Qual Units Method [;units Date Date Init Nitrate-N 1.33 mg/L EPA 353.2/300.0 10 07/22/94 CMR * Sec Special Instructions Above ** Sec Sample Remarks Above U= Undetected, Reported vaine is thepractical quantification limit. D = Secondary dilution. UA = Unavailable NA = Not Analyzed LT= Less Ittan GT= Greater Than 5633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA Drinking Water Analysis Report for Total Coliform Bacteria READ IiVSTRUCTIONS ON REVERSE SLOE BEFORE COLLECTING SAMPLE Commercial Testing & Engineering Co. 5633 B Street Anchorage, AK 995'i8-1600 Tel: (907) 562-2343 Fax: (907) 561-5301 .MUST BE COMPLETED BY WATER SUPPLrER [] re, Lie wATER SYSTEM I-D. I Illlll [] PRi'VATE WATER SYSTEM Month Day Year SAM2r'LE TYPE: ~ Routine [] Treated Water [] Repeat Sample (for routine sample ~ Untreated Water ~Sth lab reL no. ) [] Special Purpose Time Collected SA1V[PLE LO CATION Collected By TO BE COMPLET~ED BY LABORATORY Analysis shows tiffs Water SA_bEaLE to be: ~ Satisfactory' [] Unsatisfactory Sam le over 30 hours old, results may [] P . - be mnrehable [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. _V-zI -qd Date Received Time Received Analysis Began Anal.~ntical Method: ,.-[]~embrane Filter [] MMO-MUG * Number of colonies/100 ml. LaB Roe hr,, Sent to A.D.E.C. Result* Time: Client notified of unsatisfactory results: Phoned Spoke~ith Dale: Time: Faxed BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Resutt: Total Coliform E. Coli Membrane Filter: Direct Count (~ Colonies/100 nd Verification: LTB BGB COLIFIRM Fecal Coliform ConFirmation Final Membrane Filter Results/~ /' Reported By , Coli£orrrdlO0 ad PART ONE OF TWO: REMAINDER TO FOLLOW ENVIRONMENTAL FACILITIES IN ALASKA, CO ...... u, ruu~luA. ILLINOIS. MARYLAND. NEW JERSEY, OHIO. UTAH, WEST VIRGINIA