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HomeMy WebLinkAboutROCKHILL BLK 2 LT 23 Municipality of Anchorage Page l of ~.~/' 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 Permit Number: .~L~ ~'~O'~. cf ~. PlO Number: ~¢~ ¢~-- ~ Name: Wastewater System: ~New B Upgrade Address: ~1 ~~u~ ~e~ ABSORPTION FIELD No. of Bedrooms: Phone~ ~ ~ ~ ~DeepTrench ~ Shallow Trench B Bed ~ Mound ~ Other LE GAL D ESCR I PTI O N so, Bating: Total Depth from original grade: ~ ' ~ GPO/Sq. Ft. W ~ Lot: ~ ~ Block:~ ~Subdiv~i°n:~/~ Depth to pipe~boffom~from original grade: Ft. Gravel ~depth~ beneath~,~ pipe Ft. Township: ~ Range: Section: Fill added above original grade: Gravel length:~ I Gravel width: Number ~f lines: Distance between lines: WELL: ~New ~ Upgrade ~Ft. / // ' ~ Ft. ification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:/ ~A ~ ~ { Ft. ~ ~ Ft. ~ / ~ SO. Ft. ~/~ Driller: Dat~ Drilled: Static Water Level:Installer: Date installS: Yield:~ GPM Pump Set at: Ft. Casing ~Heightl Above Ground:Ft. T~K SEPARATION DISTANCES ~epti¢ n Holding ~ S.T.E.P. To Septic Absorption Lia Holding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~~ / Wel~ [ J~'~ [~,~ ~ ~ ~ Material:~~ Number°fC°mpa~ments: Sudace Water ~ ~ LIFT STATION Lot Sizein gallons: Manufacturer: Line ~ q~l - I // Foundation ~ ~ ~1 ~ "Pump on" level at:~ ~m High water alarm at: Cu~ain ~EI ed by: Drain /~ Remarks: ~~,~ ~ ~~ BENCH MARK Location and Description: Assumed Elevation: Inspections pedormed by: ~-~~¢-~ Dates: 1st ~[r~[~e Department of Health and Human So.ices approval ~,~t~~,~ Reviewed and approved by:~~ Date: [0'~' ~ 72-013 (Rev. 9/91) MOA 25 P,I,D, 015-063-80 A S- ]3 U I L T PERMIT WASTE~/ATER ABSORPTION SYSTEM LDT 23, BLDCK 2 RDCK HILL S/D DRAIN cn A "~.,,,T2 53,6 ]) ~Y~% 63,1 D£1 ~64,3 DC2 ~4,0 CP' 1~0,4 C3 7d~,6 M2 12~,8 / 50' SET-BACK -FROM CUT-BANK EXIST'G WELL I / 57,0 63,3 .......... 66,8 ~ ........ ~ ......... 71,1 ..~, ....................................... ~'"-.,.. 71,6 72,2 114,5 1143. 79, )C1 I,' SW980299 ~ ,~,~NEW WELL :~, :.:': L'.> \ :~. UNDE:VEE~PED DRAIN FIELD EXIST'G WELL \ \ NOTES, 1) PRIMARY & RESERVES SYSTEMS WERE INSTALLED AT THE SAME 8) A DIVERTER VALVE WAS INSTALLED BETWEEN THE TANK AND BOTH FIELDS, 3) INSTALLED ]]nTH FIELDS THE 100' WELL RADIUS FDR BUTH SURROUNDING LOTS, C,\Work\83-RRDKH,DWG / ....... / EXIST'G~ " SEPTIC ~ DESIGNI ~ PERC RATD 2 M/I APPLC'N RATD 500 SF RQ'D DEEP TRENCH 500 SF TOTAL PREPARED FDR~ Jim Reynoid~ 3751 Encore Circle Anchorage, AK 99507 (907) 563-5229 PANNDNE ENG, SVC P, D, BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 Phone & Fax )ATE, 9-~6-98 I AS-BUILT SCALD 1'=60' I 015-063-20 W ~w~ W~- AS-BUILT DETAILS ~ASTE~/ATER ABSDRPTIDN SYSTEM LDT 23, BLDCK 2 RDCK HILL 3Eni ~O£INDW PERMIT No, SW980299~ I,I M 1~0NW~93 C,\~/ork\l-HIGN$,clwg 1~0N¥39~ In0NW39O NDI£~NnO~ PREPARED FOR, Jim Reynolds 3751 Encore Circ[e Anchor~§e, AK 99507 (907) 563-5889 PANNDNE ENG, SVC, P, 0, BDX 142025 ANCHDRAGE, ALASKA 99514 874-0308, 272-8218 FAX ~ATE, ~es-~e J NOT TD SCALEI AS-BUILT · 1H$ MEASURED FROM:[~oasing top DATA~ ~t.Type and Color RECEIVED 28 1998 INFORMATK)~J: WELL DEPTH: DATE STATIC WATER LEVEL: ft below ~ top of casing DRILLING: ~:airrolary. [] OF'WELL: domestic I-1' irr'igation INTAKE OPENING 1;YPE: ,~0pen end [] goon hole Depths of openings: to i:SOREEN TY~: Diam: '.Slb~/~e~h Si~e: Length: GRAVEL Volume used: to ft tO METHOD: -, LEVEL AND hre pumplnt ~E DEPTH: ft Horseoower: UPON COMPLETION? ~ YE~ REMA~RKS: ~:~.~.'~.~:'. PLEASE MAIL WHITE COPY OF LOG TO:' ~ ~ · ONRtDIVISION OF MINING & WATER,MGMT ua~e 3601 CSt, Suite 800 ANCHORAGE AK 99603-$E3E ................. ~ .Phone (g07)259-~$39, Fax (g071562-138G ................... MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: Aug 12, 1998 Expiration Date: Aug 12, 1999 Permit Number: SW989299 Legal Description: ROCKHILL BLK 2~T 23 Design Engineer: 62 ~t.c~ (~.Jr~.~L~J_. Owner Name: JIM REYNOLDS Owner Address: 3751 ENCORE CIRCLE ANCHORAGE , AK 99507- Parcel ID: 015-063-20 Site Address: Lot Size: 49727 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: /r"-.~ , ~v Date: ,teven"' R. Pannone, P.~: Consulting Engineer (907) 272-8218 P,O. Box 142025 Anchorage, Alaska, 99514 (907)272-8218 Fax P~u~>ll~t 1~ lyyo Snbject: Gentlemen: l,,y ,irm was voma~tcd to design and install a ew s~ptic sys[e,,t ,u, me referenced lot. We conducted a field c cavated un omy ~o, s~o xo, a ut~ ~y~tcm ueslgff. ~]tu ~uh~ iqJurt and a percomtlun test l,Mlit l~ attawhuu. ~Om,u wmc~ was encountered. No bedru~, ~a~ envom,te, ed h, utc t~t ttuie. The lot is app, oxlmatcxy 0.96 acres hq size. Lot 23 slopes to the southwest at a rote of approximately 2-3 percent. The north eastern portion of the lot is steep. The proposed ins',allafion will be~u~at~u~ .... a un~- *~'me .......... wc~t,n, pmuun'~ ufuie" ,m.~' Both the primary and reserve drain fields will be installed. A diverter valve wili be installed after the tank to comrol me atrecl~on-o~th~e~uem.fl~v.. ~m- ~.__~-om~:wm oe-msuuw.~ me=~mverw~ valve. ~ ae:prc~posea location is greater than 100 feet away from the proposed well serving this property and 25 ~%et from the water service ........................ 4-The proposal nnes. ~he surrounamg weus.are tocaum grea~r-maa ~100:~,~mm,~hepropor~a-ms~__~ua[mn., · nsrananon will no[ affect [ne ~umre aevmopmem ox ~ne surrounding or existing lots. See the attached design. Please contact me at 272-8218 or 227-3522 if you have any questions about the proposed installation. Sincerely, Steveil R. Ptumone, P.E. Attacnmems: PROPOSE)) 1250 O ~EPT~IC_ TANK NEW ))RAIN LFxS'EFFx3'WI 9' TOTAL NOT WELLS WITHIN 100' DF PRDPDSEI) SYSTEM ~ DESIGN LnT 23, ~IL[]CK 2 RncK HILL S/]]~ 50' SET-DACK CUT-]~W~K EXIST'G WELL PERMIT ND, UN))EVELOPE)) WELL EX~Tg~ \,, WELL ..... ' ............................... '"'"EXIST' SEPTIC UN))EVELOPE11 NOT WELLS WITHIN 100' DF PRDPDSEll SYSTEM NOTES, 1> PRIMARY & REsERvES ~Y~TEMS WILL BE INSTALLED AT THE SAME TIME. 8> A DIVERTER VALVE WILL BE INSTALLED BETWEEN THE TAN~ AN)) BOTH FIELDS, 3) INSTALL )~DTH FIELDS DUTSII]E THE i00' WELL RADIUS FOR BOTH SURPJ]UNDING LDT.~ C,\W'ork\23-2RE~,~G PREPARED FDR~ Jim Reynolds Anchor~Qe~ AK gg507 (907> 563-5229 DESIGN, PERC RATE~ 2 M/I APPLC'N RATE, 1,2 125 SF/BR~ 4 ~8R'S 500 SF RQ~] ))EEP TRENCH 5' EFFx5OLFx3' 500 SF TOTAL )ATE, 7-86-98 ] DESIGN SCALE, 1'=100' PANNDNE ENG, SVC P, D, BDX 142025 ANCHDRAGE, ALASKA 99514 878-8818 Phone & F~x 'I'' "I~,I,,D, Nh, 015-063-e0 DE I N I)ET IL PERMIT NO, WASTEWATER A~SDRPTIFIN SYSTEM LDT 23, ~ILF1CK 2 RF1CK HILL w ~L~ W~ ]llIll ltDIINDN iRDNV39D lnDN~393 £~DN~'493 IRDN~390 inoNvZ'~o NOII¥~NAnJ C,\Work\llHIGNS,dwg PREPARED FDR~ Jtn Reynotds 3751 Encore Circle Anchorage, AK 99507 (907) 563-5229 I,I I I: N PANNDNE ENG, SVC, P, 0, ~DX 142025 ANCHORAGE, ALASKA 99514 274-0308, 272-S21S FAX DATEI 8-19-96 NOT TO SCALE DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE PERFORME LEGAL DESCRIPTION: Township, Range, Section: SLOPE -/ SITE PLAN 10 11 12 13 14 15 16 17 18- 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT DEPTH? ~ pO E Ilepth to Water~_~r~.~.~ Monitoring? ,L3~c ~ Date: Gross Net Depth ~ Net Reading Date Time Time Water Drop ~1z5[?~5 ~ : ~ ~ ~ fi,la,, PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER .. TEST RUN BETWEEN ~ FT AND PE.FORMED ~: ~ .~%--~.)~O~ ,-, --~. -- CERT,F~ T.A~ TH,S TEST WAS PERFO.MED,N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (~/~-~.~'~ ~'~.O HAA# 1. GENERAL INFORMATION Complete legal description /_¢,' ~ ~-~ ~3~c~Cl~ ~ Location (site address or directions) ;prOperty owner".---~t ~_~-'-d,~o ~ Mailing. address '-~;~-~--(' ~=~Jd'~-~'-'~Q~'~- ~ Lending agency' . Mailing address Day phone --~- '-~-- ~ Day phone Agent~,. Address Day phone Unless otherwise requested, HAA will be held for pickup· 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: ~ Individual well Community well Public water NOTE: 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 NOTE: 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 inves_ti_gation 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~L~/~- ~/~. ~'¢ Address Engineer's sig natu re_.----~~ '" DHHS SIGNATURE J Approved for /~'O L/~ Disapproved. Conditional approval for bedrooms. 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIC~.S~c,~^un ~ ANCHO~ Environmental Se~ices Division ,, ~,~,. ~v~c~,~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: ~z~"c Z'~: ~, ~- ~?c~c~{/-, t~1 L./~.~ Parcel I.D.: © A. WELL DATA ~11 typ~\d'~ Log present (Y/N) ~ Total depth ~1 Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ C~ -- If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~/~-//~ ~ Cased to ~' { ~ Casing height (above ground) Date of sample: FROM WELL LOG Wires properly protected (Y/N) AT INSPECTION g.p.m. g.p.m. Nitrate "~ ' ( ~ Other bacteria Collected by: ~:' [2-¥~ B. SEPTIC/HOLDING TANK DATA Date installed ~/'~'~C//~ Tank size Foundation cleanout (Y/N). Date of pumPing C. ABSORPTION FIELD DATA Date installed ['~-,.~=:) Number of Compartments ~ Cleanouts (Y/N) Depression (Y/N) /tM Hioh water alarm (Y/N) Pumper Soil rating ~r fF/bdrm) (, ~-- System type ~'~ Length .~O/.S-r__.~ Width .~/ ~ Gravel thickness below pipe ~"~-~'~ Totaldepth Effective absorption area ~O//~:~Monitoring Tube present (Y/N). c epression over field (Y/N) Date of adequacy test ~/(,~/~'~-,) Results (Pass/Fail)~-~; ~ For /-//' bedrooms Fluid depth in absorption field before test (in.);~/U Cr,.,t,) Immediately after ' gal. water added (in.): Fluid depth ~ (ins) Minutes later:. ' Absorption rate = .g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm event E. SEPARATION DISTANCES ~Pump off" level at* ~tum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line -.~_~- t On'adjacent lots On adjacent lots / C~c-~"~ Public sewer manhole/cleanout /~J (~' Lift station / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: F-'oundation -.~'-E~I Property line ~-~ ~'~ ~ Absorption field /~+ Water main/service line ~ Surface water/drainage /C~(~'-(" Wails on adjacent lots //o ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Building foundation '-~--~--~ Property line Surface water / Curtain drain / Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots /~:~ ~ /C~t I-'NGINEER'S CERTIFICATION -' '. .......... ! certify that I have determined thru field inspections and review of Municipal r~.~)~ds~~ms are Engineer's Name ~ ~ ~ ~Wo~ ~-~ :~" ~ : ~ ' : ~ Date /~/ ~[~ ~ HAA Fee $ '~ 0-0 , b~) Date of Payment Receipt Number Waiver Fee $ Date of PaYment Receipt Number 72-026 (Rev. 3~96)* T-400 P.02/03 ;-570 ¢lL~t PO~ Prilit~d Dar, e/']['Ime 11/06/98 10.47 CoUected D~ge/Time 11/03/98 19:00 R~x'ei~ed ~T~T~e I 1/~/98 10:15 T~ Di~o~ Sle~cn C. ~c unica coL/qO0~ O.lOO ALLoNabte Prep AaaLysjs 10 max I~10~198 11/0~/98 G:P