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Home My WebLink AboutPETERS CREEK BLK 3 LT 11 NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 4~/¢,~rc~.j, IPHONE I,¢NEW MAILING ADDRESS LEGAL DESOR,PT, d; LOCATION - · . 7~-' Absorption ar¢~ I U v DISTANCE TO: I ~- Z I Manufacturer ~'~_ I~ I I ~ [ L i q ~,~Pb~ ~..,)g a I I ° n s IF HOMEMADE: Inside length Well Dwelling I D STANCE TO: Manufacturer D~STANCE TO:WeiCo No. of lines / ch bf tile to finish grade Length Width Depth Width NO. OFBEDROOMS No. of compartmented_ Liquid depth PERMIT NO. Material Liquid capacity in gallons inches width tile ~ ~_ ,~?_~'/~' inches '7 Distance bet w~.~i n e~s~ Total effective absZtion area PERMIT NO, Type of crib Crib depth Building Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Septic tank Absorption area(s) Well DISTANCE TO: DISTANCE TO: Building foundati( OTHER PIPE MATERIALS SOl L TEST RATI N~/~O INS ER /2o No, 72-bF (Rev. 3/78) DATE LEGAL PERMIT NO. DEP~RTMENT L HEALTH AN£~ ENVIRONMENTAL ,,~OTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 &-JELL Al-ID CB~-I--SITE SENEE: F'ER£-I IT ( 82tt67 ) APPLICANT LOCATION LEGAL BUCKHORN MOBILE HOMES Lli B} PETERS CREEK PO BO>( ii92 EAGLE RIVER LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [)EPTH= 1~ LEr-~]TH= ~--':0 6 ~-: R"-.-' E L [)EPTH= 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE TREr-~C:H &4I[)TH. IS 5. ~3~E1 ~-EET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ~:EL-;!IJ I ~."E[:, SEF"T I C: TAI'-II< $ I ZE= :1 ¢lOL---~ ~.3ALLCB~4S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTRLLRTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T&4C~ (2) I [4SPEC:TI BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AN[) APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR A PRIVATE WELL OR t58 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM R 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 ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIRGRAMS ARE AVRILABLE TO INSURE PROPER INSTALLATION. F'E~:N I T E:-<F' I RES [:,EL-:EI'-IBER _:--:iL, :1_982 I CERTIFY THAT l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. Z.':: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO I NCLU[:,E MORE TH8N ]: E:EDROOMS. - ,--:~ ............. _ .. -- , ~ . ~,~ RFPLIL:RNT E:LIC:KHOF~.~ MOBILE HOMES ,~ SOILS LOG PERFORMED FOR: LEGAL DESCRIPTION: ~2 3 4 5 7 8 9 SLOPE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O COMMENTS Robed A. 5haf~:r ~ (/,w- t ENCOUNTERED? -/ o IF YES, AT WHAT ( / P E DEPTH? !'.C, ,~':;~_,~ ~.,~!t~.: .,,', .~t~ ~ri:,~::~ ?m:.77 72-008 (6/79) Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND APPLI( NT FILLS OUT UPPER HA', ONLY Address Zip Code Lending Institution ~ /~ ~ ~_ Phone Address Zip Code Realty Co. &A~nt Phone Address Zip Code Street Locati~ Type of Resi~nce ~ Single Family ~ Multiple Family No. of Bedrooms ~ Other Water Supply ~ Individual A~ACH WELL LOG. A wall Icg is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal ~, Ingividual Year Individual Installed: / ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: iJ ( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED . BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72.023 (3182} CHEMICAL ~ LO L LABORATORIES 274-3364 _ £ ALASKA, INC. ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I'll I I I I · d'~ I N ~ Water System Name ' / Phone/No. Ciw ~'~/// State Zip Code I/121 Mo. Day Year SAMPLE TYPE: [:3 Routine [] Check Sample (for routine sample . . with lab ref. no. ) D/Treated Water /..~,~,, , ,'t~-e,',~c~al Purpose ~[Un~eated Water,. SAMPLE TI~ ,1 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [~[,,rSatisf actory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received [ ~ - '~ ? - ~''c~ Time Received ///~ ~ ~7 Analytical Method: [] Fermentation Tube Membrane Filter Lab Ref. No. Result* Analyst eNo. of colonies/100 mi or No. of Politive portions. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE_ 06-1220 (b) R~v. 1978 BACTER IO LOG ICAL WATER ANALYSIS RECORD Date Coll~ctM Sourcl .... Date Received Time RKelvM] ~, ~b, NO, Pre~mpt lye 10nfl 10mi 10mi 10mi I Omi 1.0nfl 0.1 mi 24 Hour~ 4a Hours ~onflr matory ~4 H~ar! ,4~ Hour~ EMB,,. Brotl~ 24 houri: Multiple Tube RM~ort: Membrane Filter: I)tmct Count .., verlflcat Ion: LTB ~ Final Membrane FNter Rmll~ /~ BrMh 41 houri: 1Omi Tubes PMItlvefrotli lOml P(wtlM~l bllf~rmll~l TlmeT 9 EXCAVATION ROBERT A. SHAFER WORK December 27, 1982 CIVIL ENGINEER 694-2979 Municipality of Anchorage Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Reference: Lot 11 and 12: Block 3: Peters Creek Subdivision This letter reports the findings and determinations of an inspection of the individual on-site well and waste water disposal system serving a three bedroom mobile home located on the referenced properties. This inspection involved the checking of horizontal separations between the existing wells on these properties and wells on a~joining properties and the on-site waste water disposal systems. At the same time the wells were checked to determine if grade around the casing was in compliance with existing codes. A water sample was collected in each of the mobile homes at this time. The water systems consists of six inch steel cased wells recently drilled by Jay Williams Drilling. The well on lot 12 had an adequate sanitary seal installed on the top of the casing and the wires were adequately protected by conduit. The sanitar~ seal on the well on lot 11 however had been broken and~ne"'"Conduit had Du%~.ed loose t-rom the cap allowinq the well wires to be exposed. This condition will require correction. The grade around ead~ of the casings was adequately sloped to drain water away from the well. A representative water sample was collected from the kitchen sinks in each of the mobile homes and submitted to Chem Lab of Alaska. The test results for total coliform bacteria were reported as satisfactory. A copy of the report is attached. The waste water disposal systems were installed by Metcalf Construction during late November and early December, 1982. These systems were '~ inspected by this office and copies of the inspection reports are enclosed. If we may be of f~ther service, / S in~'~ 1 . / cc: Buckhorn Mobile Homes please do not hesitate to call. SRB 196X EAGLE RIVER, ALASKA 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 1. GENERAL INFORMATION Complete legal description Lot 11, Block 3, Peters Creek S/D Location (site address or directions) 23222 Glen Court. Property owner Mailing address Lendin9 agency Mailing address Karen Anderson PO Box 670721, Chugiak, AK 99567 Day phone 688-2099 688-4939 Day phone Agent Caroline Streano/Aurora Properties Address PO Box 671973: Chugiak, AK 99567 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water ×x× NOTE: Day phone 688-4939 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer xxx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 72-025 (Rev, 1/91) Front MOA #21 D. LIFT STATION Date installed Size in gallons ---~----- Manhole/Access (Y/N) "Pump on" level at* _~--~ "Pump off" level at* High water alarm level at* _----~ *Datum Cyc~~'-'""-- E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots ~ Absorption field on lot ~nt lots Public sewer main .,..-..----~ ,)ublic sewer manhole/cleanout Sew~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation t~/'~ -'~ ~,~, ~,,~ /~,,, ,~ Property line '~ ~'' Absorption field. Water main/service line /o '-/- / .Surface water/drainage ) o 0 -~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ~-..(?¢,~ ~,v~'~, Building foundation p I~ Water mai~sewice line Prope~ line Sudace water / e e ~ ~ Driveway, parkin~vehicle storage area Cu~ain drain ~ o ~ ~ ~ ~ ~ ~ ~ Wells on adjacent lots ~ } 4 F. ENGINEER'S CERTIFICATION ~ OF 4/~ Engineer's Name ~0~ ~.~ F -~ ~0~ /~.[ ~o~, e. rowan Date i o { l U J ~ Y ~ q~ ....... Is ale HAA Fee $ ~-~ ~O. ~o Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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. S & S ENGINEERING Name of Firm Address Eagle Eiver, Ai~sk~ ~577 Engineer's signature Phone DHHS SIGNATURE Approved for TH R E£ 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. 72-025 (Rev. 1/91) Back MOA Legal Description: A. WELL DATA Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Health Authority Approval Checklist ~ ¢ ~' ~ P~-~/~ C,~ Parcel i.D.: Well type If A, B, or C, attach ADEC letter. ADEC water system number _Log present (Y/N) .... Date completed Total depth Cased to - Ca~(above ground) Samtary seal (Y/N) ..,,,,,~_ i"W~res properly protected (Y/N) FROM WELL LOG / AT INSPECTION Date of test Static water level / '"~. Well production / g.p.m. WATER SAMPLE~~TS: Coliform ~ hitrate Other bactena Da o{~f sample: ' Collected by: .. B. SEPTIC/HOLDING TANK DATA Date installed I ~ J/o / ~ 7. Tank size Foundation cleanout (Y/~) .. ~ o Date ofpumPing _ / o / cl ~ C. ABSORPTION FIELD DATA Date 'installed / Length' ~ ;~ _Width Effective absorption area g.p.m. Pumper / 0 o 0 Number of Compartments ~ Cleanouts(~/N) Y4j' Depression (y~ /,~ o High water alarm (Y/~ _ /-' o _ Soil rating (g.p.d./fF o~ _ Gravel thickness below pipe r Monitoring Tube present {~/N)_~ Date of adequacy test !0 ! / ~J//"q- I[ Results~s/Fail) /o,~$ $ Fluid depth in abso~tion field before test (in.); ~" ~ Fluid depth ~ ,, ~ Imm~iately affer~ ~ gal. water added (in.):. ~ ' ~ _ (ins) Minutes later: ~ ~ Abso~tion rate = ~ ~ o .~ g.p.d. Peroxide treatment (past 12 months) ~) ~ ~ ~ ~ ~ If yes, give date ~ 72-026 (Rev. 3/96)* 0 System type 7-,~ ~,,~ c~ Total depth z/ / Depression over field (Y~ ~v~ o For ~ .bedrooms