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HomeMy WebLinkAboutSWANEE SLOPES #1 BLK 1 LT 3wanee Slopes #1 Block 1 Lot 3 #051-221-32 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL ~STEM AND/OR WELL INSPECTION REPORT O, I F HOmEMADe: Inside length W dth Liquid depth DISTANCE TO: Dwelling Material ManufacturerDiSTANCE TO: Foundatio~ /~ Nearest lot line No. of lines / Tota~8~h o(lin~- Tre.~?tl~ [ ~ inches Top of tile~.~ finish_ ?el benea '~ ~.~ ~)(.,,,.~ inches Length Width Depth Type of crib Crib diameter Well DISTANCE TO: [] NEW ~IPGRADE Building found DISTANCE TO: OTHER NO. OF BEDROOM~.~ PE MIfF NO. No, of compartments .~= PERMIT NO. Liquid capacity in gallons PERMIT NO. b depth Total effective absorption area 3uilding foundation Nearest lot line Driller Distance to lot line Sewer line Septic tank APPROV b 72 013 - (Rev. 3/78) DATE LEGAL pERM,I'F N6 RPF'L I CRNT LORR]' I ON LEGRL ~tlL. tlHEL k. E, EUk. HN ¢1 ~¢A '~]'- F_~T OFFICE BO% 54L LOT ~ BLOCK & SWRNEEAS,/D LOT SIZE &~Be8 SQURRE FEET T'T'PE OF =,OIL HB=,L~FTIuN S"r'STEM I=,. DRRINFIEL[:, MR;*~IMLIM NJflEEF. OF E:EDROOMS = ':"' =,uIL RRTING '-.=,Q FT,. BR,- 85 THE REg!UIRED =,I~E OF THE =,lJIL ~ '-'1'' I-I '=' HB=,~RFT.I_N SYSTEM I_,. [:, EF' T ~'4 = 6 LE~-~,3Tt4 =..:=---~ ~=."- L~ E'R'-.-'E L [:'EF" TH= 2 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF ~ TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SLIRFBCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). T~-4E TRENCI4 !-.~ I [:.T~'-g I S 5. E~CZ, O FEET. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE E%CRYRTION (IN FEET). · F-:E~']~L[ ]: F.:EK"a '---' ' -" PERMIT BPPLICRNT HFS THE RE_PJN=IEILI]~ TO INF~RM THIS DEF'RRTMENT D IRING I Nh. '~ r~ ~ ~ -' '- =~RLLRTI_N IN=FEL. TION=, OF RNV WELLS RDJFICENT TO THIS F'ROPERT'¢ RND THE NUMBER OF RE_,IDENCE_, THRT THE ~4ELL ~4ILL _,ERIE. THE T~-g~Z",..." .=-'~:' .'.., I ~'4 ~--; F' E l:: T I ,---~ t'-4 =.¢- RRE REi;,g_. _n I RE[:-, E, ML.k. FILLIN~d OF BN'¢ _,~_,TEfl WITHOUT FINRL IN_PEL. TIuN RND RFFR_ ~RL 8'¢ THIS DEF'RRTMENT WILL BE=,UE, JEcT'- ' -' TO PROz, EL. LITION.'' '- -' MINIMUM DISTRNCE BETWEEN R WELL RND RNV ON-SITE SEWRGE DISPOSRL SYSTEM IS ~00 FEET FOR R PRIVRTE WELL OR %50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TgPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MR¥ RPPLg. SPEC:IFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PERF~ ][ T E~-~P I F-:EL-] ['¢EE:EI"IBEF~: 3:2L.. :~[ ~.=.~l I CERTIFY' THBT · : I RM FRMILIRR WITH THE RE~.UIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH B'¢ THE MUNICIPRLITV OF RNCHORRGE. 2: I WILL INSTRLL THE S'¢STEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTRND THRT THE ON-SITE SEWER SVSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN } BEDROOMS. ........................................ RF'PLICRNT MICHREL K BROKHN V4. 0 I'-lbll'-.-! I C.: ]C PRL I T"r' . DEPRRTMENT qF HERLTH RHD ENVIRONMENTRI c-'ROTECTION 825 k,~Z' STREET, RHCHORRGE~ Rr-.l£:, Or-~---~ .~. TE _"'~;-.EL.4E F-: PIEEF~:I--1 ]: T lc, LOT SiZE / ~ DD~ SIal]ARE FEET SOZL RAT~HG THE REQUIRED SiZE OF THE SOIL ~RBSORF'TION~.~V,S,.TEM IS: [:,E-_-F'TH=: ~zO LEh~]TH:~~,]F<R%-'EL. [:'EPTH=:~ THE LEHGTH DIHENSION IS THE LENGZH (IN FEET) 0F THE TRENCH OR DRRINF[EI_D. THE DEPTH OF R TRENCH OR PIT I5 THE ~?~STRNCE E:ETNEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO ~ET NIDTH FOR TRENCHES '~ ~' THE GRRVEL DEPTH IS THE MINIHUH DEPTH OF GRRVEL BETNEEH THE OUTFRLL PIPE RHD THE BOTTOH OF THE EXCRVRTION (~N FEET). PERMIT RPPLICRNT HRS THE RESPONSiBILITV'TO INFORM THIS DEPRRTHENT DI..IRII4G file ~NSTRLLRTION INSPECTIONS OF RNY NELLS RD.YRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE HELL NILL SERVE. 'TI.,.I[~ ( 2 ) I t-4SPECT I 0~4S RRE RE6)LI I BRCKFILLIHG OF RNY SYSTEM NITHOUT FINRL INSPECTION RND RPPROVRL BY THIS DEPRRTMENT NILL BE SUBJECT TO PROSECUTION. MINZ~UM DISTRHCE BETHEEN R NELL RND RNY ON-SITE SENRGE DISPOSRL S'¢STEH 18~ FEET FOR R PRIVRTE HELL OR 158 TO 28(~ FEET FROM R PUBLIC HELL DEPEH[:,ING UPOn] THE TVF'E OF PUBLIC NELL rqIHIMUM [:,[STRNCE FROM R F'RIVRTE HELL TO R F'RI'v'RTE SEHER LIHE IS 25 FEET TO R COHMUNITY SEHER LIHE IS 75 FEET. HELL LOGS RRE REQUIRED RND HLIST E:E RETURNED TO THE DEPRRTMEHT NITHIH 3:8 DRV$ OF THE HELL C:OMF'LEI'IOf-L OTHEF: REQLIIREMENTS MRY RPPLY. SPEC:ZFICRTIONS RN[:, CONSTRUCTION DIRGRRfq% RF:E R'VRILRBLE TO INSLIRE PROPER INSTRLLRTION. I CERTIFY THAT 1: I BM FAMILIF¢;: 14ITH THE REQUIREMEHTS FOR OH-SITE SEHERS RND HEt_LS AS SET FORTH B',r' THE MUNICIPRLITY OF RNC:HORF~GE. 2: I HILL INSTFILL THE _S'.r'STEPI IN RCCORDFINCE HITH THE CODES. Z: I UflE:,E-RSI'RN[:, THAT THE ON-SITE SENER SYSTEH HR'¢ F:EQLIIRE EHLRRGEHEHT IF THE RESIDENCE IS REPIODELED Ti3 INCLI.IDE MORE THRN L( E,'EDROOP1S. S I GNED: ........................................ RPF'L I C:RHT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6~50, Anc-~orage,,,~lask~ 99502 276-')22I · SOILS LOG-- PERCOLATION TEST SLOPE 3 8 -~' SOILS LOG [] PERCOLATION TEST SITE PLAN 10- 11- 12 13 14 15 16 17- 18- 19- 20- WAS GROUND WA ENCOUNTERED? Gross Net Depth to Net Reading Date Time Time Water Drop ~' (minutes/inch) PERCOLATION RATE TEST RUN BETWEEN __ FT AND FT PERFORMED BY:. ~" CATE RECEIVED '* INSPECTION APPOINTMENTS DATE DATE ' ~ DATE LO MUNICIPALITY OF ANCHORAGE D~PT, OF H~ALTH  825 L Street- Anchorage, Alaska 99501 ~U J~ ~ ~ I~ ENVIRONMENTAL SANITATION DIVISION ,e.hon R[CEIV D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES ~ ~ ~ ~ 0 ~ PHONE 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four XSINGLE FAMILY ~ Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ,,~ COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** ] P qG (~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY E] ONE [] THREE E~ FIVE [~ OTHER' [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE iNSTALLED []PUBLIC UTI LITY Connection Verified INSTALLER []Septic Tank or [~Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) 825 "1_" ST ftE~-!l ANuI'IORAG~, A ...... K/~ c arvn (907) 264-411i June 17, 1981 David P./Donnita S. Mumby General Delivery Chugiak, Alaska 99567 Subject: Lot 3 Block 1 Swanee Slopes Subdivision Approval for the individual sewer and water facilities cannot be granted until tile following item has been completed: (l) A cleanouh to the septic tank needs to be znsta.~.]_ei. This will need to be reinspected by this office when it has been corrected. If there are any further questions~ please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska Statebank 310 East Northern Lights Boulevard 99503 Chnshana Jamieson % Post Office Box 646 99510 DATE RECEIVED INSPECTION APPOINTMENTS DATE DATE DATE INSPEOTO. INSPEDTOR INSPECTOR,,.,  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. O~ H~ALTH & ~ ~ 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION ~ ENVIRONMENTAL SANITATION DIVISION OCT ~ Telephone 264-4720 DIRECTION~= Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow ten (10) days for processing. 1. PROPERTYOWNER ~ PHONE PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILIN~ ADDRE88 MAILING ADDRESS 4. REALTOR/AGENT STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [] Other [~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY [] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ~ COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8, SEWAG~E DISPOSAL SYSTEM .~ INDIVIDUAL/ON-SITE** ~O YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX )ERM~T NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 'ERMIT NUMBER 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified NSTALLER []Septic Tank or [] Holding Tank Size: 1~)OC~ IfTank is homemade SOILS RATING give dimensions: TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: I Absorption Area to nearest Lot Line 5. COMMENTS /. : PPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter m~t accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) Municipality of Anchorage *A. • -� Development Services Department Building Safety DivisionOn-Site Water and Wastewater Program4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D._032 HAA #H/9 0!05319 Expiration Date: f - 1 /- O �. 1.` GENERAL INFORMATION Complete legal description 'Lot 3; Block 1; Swanee S/D Location (site address or directions) 18542 Bending, Birch Chugiak, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Sharon flinch / gpTi,r Dayphone 694-4200 16601 Centerfield Dr. Eagle River, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. L f`tn. /6/11/01 2. NUMBER OF BEDROOMS: 1 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class G Well © Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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 on-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 less than 30 days old. (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 date shown below, I verify that my Investigation, based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on-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. 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 ts(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. 5 & 5 ENGINEERING Phone Name of Firm 17034 age /ver Loop Road No. 204 Address Eaalk 99577 b_ /0 / It 0/gr/! T C COw�f� Date `i Engineer's Printed Name ` OF A, ROBERT C. COWAN 5. DSD SIGNATURE °�, CE•ecol V Approved for bedrooms. rtt ` < _ Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By. � V 2E2=t Original Certificate Date: (Rev. 12/00) Municipality of Anchorage • Development Services Department Building Safety Division On-Ske Water d Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L�o� LDL/L r 4w*1C/:E '9l' Parcel ID: D S/- 2 q I A. WELL DATA Well type Zd WMUN 17 If A. B. ooC mvide PWSID # / Well Log (YM) Date completed _ Total depth ft. Date of test Static water level Well production San" seal (Y/N) Cased to FROM WELL L / ft. r g.p.m. WATER SAM19t E RESULTS: Wires property protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Coliform O colonies/10o nd. Nitrate 0 • S mg.A. Other bacteria 0 colonies/100 ml. Da sample: 9 1 1 �� 0 1 Collected by; S i S ENGINEERING ap • van Loop Road No. B. SEPTICIHOLDING TANK DATA Eeyle River, Alaska 99577 Tank Type/MateDate installed Tank size gaL t1Number of Compartments Cleanouts (Y/N) Foundation cleanout (YAC 7 Depression over tank (YM) High water alarm (Y/N) Date of pumping 3 Pumper rs C. ABSORPTIOI Date installed a Length 3b , ft. Width Total depth 5 R. q . absorption area -VD R Date of adequacy test / I3 U I Results (Pass/Fail) System type ��W T2��✓�/Y ft. Gravel below pipe Z- ft. n3tube%/& Depression over field /V P Fluid depth in absorpti field before test L— In. Water added gal. Elapsed Time: �0min. Final fluid depth 4 in. Any rejuvenation treatment (past 12 mo.) (YM & type) N O For / bedrooms New depth3�n. Absorption rate >= / 57D g.p.d, If yes, give date — D. LIFT STATION Date installed _ `Pump on" level at Datum !ZA Size in gallons E. SEPARATION DISTANCES Manhole/Access (YIN) "Pump off" level at _ in. High water alarm level at in. Cycles tested Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Iitt station on lot Absorption field on lot Public sewer main Sewer /septic service ^- 1A On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation �7 / % Property line /70'- / Absorption field S /} Water main / fl i Water service line / D Surface water /.00 t Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r f Water main I Property line 1 � 'F Building foundation 1 ' I�f•- Water Service line j Surface water /+e � Driveway, parking/vshicie storage Curtain drain Al Os,1 Wells on adjacent lots / UU 3T IS F. COMMENTS G. ENGINEER'S CERTIFICATION*, Vg ' 1 certify that I have determined through field Inspections and; 9t review of Municipal records that the above systems are in conformance with MOA HAAguidelinesIn effect on this date. t� Engineer's Printed Name ,` dot+t; COwA�/ 4 �� c COWAN CE • 8801 Date `I J(a 6 /01 'QF HAA Fee $ 3 O Waiver Fee $ Date of Payment °l a lot Date of Payment Receipt Number 0 1 0 6 fO a Receipt Number (Rev. 12100) _