HomeMy WebLinkAboutHIGHLAND TERRACE #4 TR 2A- -er r o_ee S/D
l MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SFWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME ' PFIONE
LOCATION NO. OF BEDROOMS
DISTA~C[ 10: ] ~ Absorotion area
~ qaPa(
~ ~ Liq. ca acity in gal~'~s Inside length Liquid depth
~ ~ IF HOMEMADE;
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
~_~ ~ No. of lines ~ Length_ of each~line. I Total length~[) '°f Ii,es Trench width~ O inches Distance between ~1i s __
~Q~ Top of tile to finish grade ~ / Material beneath tile ~ ~ ' inclles Total effective absorption~/area __
Length Width DePth PERMIT NO,
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
Class~ ~ Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
INSTALLER~
f:ff:'F'L I (:i:I:::IN"I .... . 'E TOH HOI'IEi E:O
L.. 0 C: F:I T ~[ O
t. E T ::'.; :[ ZE :~:~'~ '.~':~ S' :E,C!IJFIRE~ FLEET
'T"T'PE OF ':J;f" I L F:iE:fE;Edr~:pT I ON E;"?E;TEH :[ '.E:: TP. Ei",IC:H
I'"If:I;:.:;ZHLIH i'.,It...IHE:EhE~ OF E:E[::,F4:Eu3HE; =
E;OiL. F:'.Fl'*r']:Hr':'i (E;C:.! I:::'T',..*'E:F.:)= :1.4. O
THE: [:::l.'.::).T..¢J l F.:E:E:, :E; I ZE Eft:' THE ~::O Z I.... FiE: ':.J;OF.:F'T t ON '.'".;"r'::~'TEI'"I 1:5:
THE: L. EI",tGTH D Z HEI",I:"!; T. Ed'*4:1: :S THE L. ENGTH ':: I i'.4 F:'E:ET ::, OF THE TRF2.1",IE:H OF;: E.',f~:l::l ]: l',II::' ]: ELI;:,.
THE DEFq'H OF' R 'T'REI'.,ICH O1:~: I::'IT ]:Si; THIE D]:E;TI:INCE;. BETHEEN THE E;LIF;iFFICE: OF: THE:
GI?OUND FIND THE E~C)'f'TOH Ol:' THE EXCI::I',,,'I:IT]:Efiq ,:: :[1",1 FEET>.
TI4ERE' I':_::; NO ?.fi, ET H]:E:,TH FOI::;~ TF.:ENCHE:E;.
THE C. if~:Ia',,,'IEL E:,Ei::'TI4 ;['.E: THE H:[I'.4IHLIH DEF'TH OF EiF::FI',/EL E~E'T'HEEN THE E~I...tTF"FILI._ F'tF'E
FIND THE E',EFf'TOH Eft":' THE EXCFI',,,'RT ]: ON ,:; ]: I",l FEET ::,.
PE:RH :1: T FIF'F'L. I CFINT HFI:5 'T'HE F.:ESF'OI'.,I:::..; I D I L ]: Th.' TO I I'.,tFOf~:H TH I '.'-]; [:,EF'F. ff;;:THE:NT [, .. F'. '1' NG THE:
.I.I.,1::, [ fiLL 11 I O1'.,t ].' t'-,t:i.";F'E:C T Z ONE; OF' FII",I'T' I.,.IEL. L~E; FiD..:rFIE:Ei'.,IT TO TH I ':' c' :; "' ~' ~- ;: -" '
:., r · . r' ~ . · T l::ll",l[) THE
NIjHE',IE[;;: OF I:;;:E:L':]:E:'E:NC:E:E; THFIT 'I"I"'IE I.,.IELL HILL. ::'..:;IEF:',,,'E.
H I N :[ I"]UH E:, :[ E;TRNC:E; E:ETHE:EI'.,I I::1 I.,.tE:I_.L.. I::II'.,IE:, I:':Ii",I'T' ON'"::E'; I TE': LSEHF::IGE: I::, I :~,I::'OE;I::II... :~;"r'E;TEI"I :( E;
:]..EH;!~ F:'EET FCIF~ I::1 F'RZVtaTE HE:I....L OR ::l..SEI '1"O ;?.IDEI I::'EET I:::'F:OH I:::1 F:'UE:L.:[C I,.!EL.L DEF'ENDINC'i
UF'ON THE: T'T'F'E OF PLIE,'L.]:C [,.IEL. I ....
H ]: N ]: HI.JH I::, :[ ~']"F:IN(::E: F'RCff"I I:::1 F'F;: :!: VFITE I.,.IE~J._L TO F:I I::'F.: I ',,,'I::ITE ESEI.,.I[FR L. ]: I'.JE :[ S ;.:.?!5 F:'EEi:T F:IND
TO f::l E:Efl'"IHUN ]: T'T' t~i;[Et.'.IEF;: L. ]: NE I ~ 75 F:'EE:T.
HELL. L.OG:5 FI~:E REC!U:[F:E[> F:fl"JI]:' HU:!!!;'T' E',E RETURNED TO THE E:,EPF:IRTHE:I",IT HI:THIN ::.;::()E:,F:I'T".E;
OF' TFIE HELL.. COHF'LET]:ON.
O'lq"tEF: [;.:[EI:~.!I..I ]: F:ti.::HENT:E; htF!'T' I:::IPF'L."r'. :ii;F'EC I F 1[ CFIT I ON:E:: I:INI) C:CII.,I:E;TF;.:I...IC:T :[ 01",1 [) I I:IGF;:F:II"'I:i~; FIRE
I::I ',,,' FI I LI::IE',LE TO :[ I",i:L:,UFi:E: F'F:Cff:'ER Z his TFIL. L. FI"I" :!: 01",I.
]: CE:Fi:'1' ]: F:"T' THFIT
:L: ~ FtI'"i F'FtI'I]:LZFiF.: !.,.IZTH THE Fi:E.::~]:!I...IZI:E:Et"IE:I",I'i":.:.';
F'OF;:'['H B'T' THE HUN :[ C :[ F'RI... I 'l""r' OF:' 1'3NCHOF.:FIGI:JE.
Z:: ]: I.,.I.T.I..L. Zi",I:E;TFILL. TFIE: :.E,'T':E;'I"Ii!J'"I Ii",l FICCOF-'.E:'F!i",ICE': H:[TH THE: CODEE;.
.Ei:: ]: I..It"~DEF~:~;TI::II",I[::' THFiT THEE OI",I'""E;.1.'TE :iSE:I.,.IE.':Fi: '.':T,'T':E;TEH HFI'T' Fi:IEC!IJ ]: [;?.E E!J",IL.f:tF~:GIEI"tE:NT ]:F THE:
F.'.E"% t' DEf',ICE: :[ :E; F::EJ"'IODE:t..E[::' TO
f::IF'F'L.. :1: CI::II",IT CU?:,'T'OH HOHE f" O
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROT[-'CTION
825 L. Street, Anchorage, Alaska 99501 2644720
SOIt. S LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DEPTH
(FEE'T)
2
3
7
10
~3
~4
~7
1~-
SLOPE S PLAN
/
WAS GROUND WATER . / S
ENCOUNTERED? ,j~,/¢ L
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Nat Depth to Net
Reading Date Time Time Water Drop
COMMENTS
pER FO R M E D B y~,¢ _~.,_~
72-008 (6/79)
PERCOLATION RATE (minutes/inch}
TEST RUN/~ETWEEN FT AND ~. -- F'~
DATE:
./
0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVlCE-'S.
Division of Environrnentai 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
1. GENERALINFORMA'rlON
Complete legal description
Location (site address or directions) 11005 St¢¢pl6 D~v¢
Property owner
Mailing address
Lending agency
Mailing address
Gary Barl6son
4831 Old Seward Hwy Suit~ 109
Day phone
Anchoraq&¢
Day phone
AK 99503
Agent
Lori Crous¢/ REMAX OF EAGLE RIVER
Day phone
Address 16600 CCr~zr~i6.6d DrZv6 Eagle
Unless otherwise requested, HAA will be held for' pickup.
NUMBER OF BEDROOMS: 3
AK
694-4200
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
XXX
Public water
If community we//system, provide written confirmation from State/~DEC att¢~t-~ ! ~',
gality yst
ing to the le and status of s em.
XXX
·" ':i ;/-f t' '''''( '
Public sewer
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 feZ1
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,
ordina.nces, and regulations in effect on the date of this inspection.
S
&
$
ENGINEERING
Name of Firm 17034 Ea_~le River Loon Road No. 204 Phone ~ ~'
]Eagle River~ Alaska 99577'
Address ~ ~ --, --
6. DHHS SIGNATURE
· /...,c- Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Date
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 b~/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. ',.-. ' .... : ~:."!!:.;:.,,:::":.',?,..?:i~;i'!,:::.!
:'.', . .- ... - - .....
Municipality of Anchorage
Department of Health and Human Services
HFALTH AUTHORITY APPROVAL CHECKLIST
A. Well Data
Well type
Log present(~N)
Total depth 7.--40 '
Sanitary seal ~(~N)
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot \
Public sewer main
Sew, er service line
WATER SAMPLE RESULTS: '
Coliform ~P Nitrate
Date of sample:
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to I ~ ~ ?,-f..~/.o~___ .
uasmg height
~/ Wires properly protected ~_~_)_
FROM WELL LOG AT INSPECTION
g.p.m, g.p.m.
0¢.-~
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
/,/5'- Other bacteria
Collected by: ~ '/ `-,% ~-~-/4,,
B, SEPTIC/HOLDING TANK DATA
Date installed ~1 -' ~ - ~'~ Tank size \ ,.> ~ Compartments
Cleanouts Y~q) ,-/ Foundation cleanout (Y~J~ ,~ Depression,(YA~
High water alarm (Y~. ~ Alarm tested (Y/N)
Date of pumping ~- ~'q - ~ Pumper .~-~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot c~ ~ On adjacent lots \ ~_Q__.
To property line /~ ~ '/'' Absorption field /o /
Surface water/drainage j ~ r ,~
2-026 (3/93)' Front I
Foundation
Water main/service line
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N) ~
SE~w-eI, on lot ;::~jl:clri:o:ts
Manufacturer
Manhole/Access (Y/N)
.___~?.ump-d~Level at
~ tested
Surface water
D. ABSORPTION FIELD DATA
Date installed c~ .;Z~i ~, Soil rating (GPD/Ft2) / ~/EY.-~ System type
Length ~'"'/~ f Width. ;2-, ¢' Gravel thickness /-7/ '
' Total depth ¢, /
Total absorption area 'zl/'z~ ¢ ~) ~-4~c. Cleanout presentJ~l) ? Depression over field (Y/~
Date of adequacy test 1
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/.~
Results(~ail) ,,~,~5.s for .~ Bedrooms
43 '* After test
/.,~r~¢- /g~/J~,J,,--) If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /,¢O ~ On adjacent lots ./o~, ' '/''-- Property line
To building foundation /,:, ~ ,c To exis~g or abandoned system on lot
On adjacent lots 3'o f 4-- Cutbank 'J//',4- Water main/service line
Surface water ) b.O I .N Driveway, parking/vehicle storage area
Curtain drain ~"~/.4.
E. ENGINEER'S CERTIFICATION
I cerb'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SFf'E SEWER AND WATER FACILITY
264~4720
Application Date
1. GENERAl. INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
...
Location (address or d~ctions)
(b)
Applicant Address
(c) Applicant is (check one): Lending Institution
Address
Address
Telephone ~ _ ~.~Q~
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Fa mily/[~' Mulb-Family
Number of Bedrooms
Other
WATER SUPPLY
Individual Well,[~ Community E] Public E]
Note: If comm{ nity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAl.
~ Public E] Community [] Holding Tank
Onsite
[]
Note: If community well sy.'~tem, must havo written confirmation from the State Departrnent of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 ,-2-u;z5 (:~ ~,~
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SFARCH, DATA AND INFORMATION
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 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 ':.,
Date
Telephone
DHEP APPROVAL,
Approved for ~
Approved __. t~'
bedrooms by- '?-~~ ~'¢'/U~c''7~r'''~ ate
Disapproved ............ Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations gwen in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. Tt:e DI-IFP does this as a courtesy to purchasers of homcs and their lending
institutions in order to satisfy certain federal and state requirements. Ernployeos of E)HEP 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.
Page 2 ol 2
MUNICIPALITY OF ANCI4ORAG~
MUNI'CIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH
HEALTH AUTHORITY APPROVAL (HAA) ENVII~ONMENTAL PROTECTION
CHECKLIST - FEBRUARY 1984
264-4720 [,i/"~"[ 2 0 1985'
Legal
Description:
WELL DATA
Well Classification ~%~ ~ If A, B, C, DE.C. Approved (~
Well Log Present~ Date Compl~ed ~ ~ D -~ Yield ~6~ ~
Total Depth ~ ~0 Cased to Depth of Grouting
Static Water Level ~O6 ~ Pump Set At ~ ~
Casing Height Above Ground /~ ~ ~ ~
__ Sanitary Seal on Casing ~/~)
Electrical Wiring in Condui¢/~) Depression Around Wellhead ~
Separation Distances from Well: ~
To Septic/Holding Tank on Lot ~Oz /~ ~ ~
~ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ./~ f On Adjoining Lots ~b / ~
To Nearest Public Sewer Line ~/~ To Nearest Public Sewer
Cleanout/Manhole ~/~ To Nearest Sewer Service Line on Lot ~
Water Sample Collected by ~ ~~&~/t~ ; Date ~*~/~-
Water Sample Test Results ~/~ ~'~ ~ ~
Comments ~ ~ (- ~) ~ ( (J ~ ,~
B. SEPTIC/HOLDING TANK DATA
Date installed
Standpipes ~;)N-)~'. __ Air-tight Caps
Depression over Tank ~'~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from,Septic/Holding Tank:
To Water-Supply Well v)~
To Property Line _ ,~._~ /
To Water Main/Service Line
Course
Size /6~ ~ No. of Compartments
Foundation Cleanoutd~
. Date Last Pumped /k/'~
~///'¢~ ; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation _ ,,/O ~' ¢'
To Disposal Field /0 /
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~'///~ ~/~.~
Width of Field
Square Feet of Absorption Area
Type of System Design
Length of Field
Depth of Field
¢,,20 ~zGravel Bed Thickness
Standpipes Present ~1~
Date of Last Adequacy Test
Depression over Field
Results of Last Adequacy Test
Separation Distance from Absorption Field:
; On Adjoining Lots
To Cutbank (if present)
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
/dmp Off" Level at
/ ./., Vent (Y/N)
/~/~,,.,"//¢ Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ,~ ~. ~-~ ~'.',~4~INF_~_~t~I~ Date
Company. ~ ~'~ ALASK& ~95'¢~ MOA No
Receipt No. -
Date of Payment ~ ~
Amount: $
Page 2 of 2
72-026 (11/84}
BILL SHEFFIELD, GOVERNOR
~I~T. @t= ~N~FI~N~I~NTA~ CONSER¥~T~OI~
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
274-2533
May 17, 1985
Mr. Robert A. Shafer, P.E.
S&S Engineering
SRB 196X
Eagle River, Alaska 99577
SUBJECT:
Waiver Horizontal Separation between Well and Septic
Tank, Tract 2A, Highland Terrace Subdivision
Eagle River, Alaska (8521-WA-162)
Dear Sir:
The Department has reviewed the subject waiver request and hereby waives
the horizontal separation between the well and septic tank to 90 feet
on the subject property for a 3 bedroom single family residence only.
Sincerely,
Steven W. Eng~wq~.
District Engineer
SWE/msm