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HomeMy WebLinkAboutSOUTHFORK WEST BLK 6 LT 2 Municipality of Anchorage Page I of Z__ 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: 5W'c~c/O$~¢ PID Number: OT~d-~/// Name:~'¢(P~'/~F¢)~¢:::~ ~'~D ~O. Wastewater System: ~ New ~ Upgrade Address: ABSORPTION FIELD ~ I No. of Bedrooms: ~Oo~ /~¢P~ %s, ~ 72¢971 ~ ~ Deep Trench ~ Shallow Trench ~Bed ~Mound BOther Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION /. z ~/sq. ~t. , ~ ' Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe ~ ~ ~¢~F~ ~ ¢ Ft. , ~ ' ~t. Township: Range:, Section: Fill added above original grade: Gravel length: - ~/ - ~,~ Ft. ~ Ft. WELL: ~ New ~ Upgrade ~rave~ width: ~¢ Ft. Number/of lines: I Ois~ance.~beiween lines:Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~/V~~ ~ ~ Ft. ~0 /~ Ft. ZJZ~ SQ. Ft. Dril~ ~ Date Driged: ~taticWater Level: Installer: Date installed: Pump Set at: Casing Height Above Ground: Yi.,d: ~.0 ~,~ u /~ F~. ~ /W ,t. TANK SEPARATION DISTANCES ~ septic ~ Holding ¢ S.T.E.P. To Septic Absorption Lift Holding Public/Prlvate Manufacturer: Capacityin gallons: From Tank Field Station Tank Sewer Lines ~HO~ ~ Material: Number of Compartments: web /~.~ /~.~' /~.~' ~ 2~'~ ~%~ S.~f.ce LIFT STATION Water 200 ~ {00 ~ /00 ~ Lot ~ Size in gallons: Manufacturer: Line /0 ~ /0 '¢ /0 'W )~SO ~MCHO~ "Pump on" level at: "Pump off" level at: High water alsrm at: Foundation ~./ ¢ ~7.7' 29./ qz" Pump Make & Model Electrical I~spections performed by: Remarks: BENCH MARK Location and Description: T~- TOP OF FOU~D~T/O~ AT Fco I Assumed Elevation: ENGINE~'S SEAL 17034 Eagle River Loop Road, N~. 204 Inspections performed by: [,,~.. m,,,_. A~,,~, ~¢s~7 Dates: 1st_ /o -?¢ -e4 Department of Heal.and Human Services approval Reviewed and approved by: Date: 1~ -~-¢~ 72-013 (Rev. 9/91) MOA 25 Permit No.Sw940385 Page 2 of 2 Municipality of Anchorage 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 Legal Descriptio~OUTHFORK WEST SUBD., BLOXK 6, LOT 2 PID No.: 07803111 /.1~.8'~ ~-1/~9.1' FINAL GR~,DE~. M~2 \ ~?~T ] ~Ti 94 4'/ L 116.0'~ ~ ' All0.!' WATER FOUND ::~ 7-14-94 MT1 FCO' i"¢:fi--13.0 .... CO1 31.8 41.3 C02 46.4 36.0 MH 48.Q 38.0 MTi 104i0 80.4 MT2 142i8 126.( HOUSE i1250 GAL. S.T.E~P. MT2 SCALE i" = 40' 72-013 A (1/93) * PRESSURE DISTRIBUTION DRAINFIELD C. COWAN CE - 8801 FROM DE0.20.~4 3:lSPM P.001 ED'S ELECTRIC INC. 3138 COMMERCIAl. DRIVE, ANCHORAGE, ALASKA 99501 VALDEZ ANCHORAGE (~7) 27~4591 ~x 2~205 DI~CI~V~BBR gO, 1994 SOUTH FORK CONSTRUCTION lZZ$0 SPRING BROOK DRIVB BAGLB RIVER, AK 99~77 LIPT STATION AT JOHN 'tHOMPSON 175~5 SANTA ~aIA DRIV~ EAGLB RIVBR, AK AN BLBCTRICAL INSPBCTION WAS IX)NB ON SUBJBCT PROJBCT 12/19/94 THB WIRING WAS INSTALLED IN ACCORDENCB WITH NgfNICIPAL CODE~ AND NBC. STANDARDS. THBRB WBRB NO OODB VIOLATIONS OBBRSBVBD AT THIS TIMB. BD STROUT OPERATIONS MANAGBR "( erlifiei Drilling . · · DOC Co~a · · ~ SULLIVAN WATER ·WELLS .. P.~.BOX6~0272;C"UGIAK, A'ASKA99567. ' ~ :' ~' 173~ ~,,o7~ ~xt~ i;.-fi ~ STATIcLEvEL OF WATER FF. AD OWNER ADDRESS LEOAL DEs'cR~PT]ON~ L~- ~ ~-/< .!: . ~. DATE - Started v Ended PERMIT NUMBER (O ,~.'.~ q 3"H- t~OA~ t<. DRAW DOWN FT. ']L~/qq " GALS.'PER HR KIND OF CASING KIND OF FORMATION: From O Ft. to' From <:~ Ft. to From ~ Ft. to From ~.5 Ft. to From ,q~Ft. to From Ft. to From_ Ft. to From Ft. to From Ft. to From Ft. to From Ft. to.- From ......... Ft.'tO From Ft. to.__ From Ft. to From Ft. to Ft. From Ft. to Ft. From Ft. to .Ft , Ft. Ft. Ft Ft. Ft From. From From From. From From From From Fron~ __ From From From From From From Ft. to Ft.. Ft. to Ft Ft. to Ft. Ft. to Ft, Ft. to Ft Ft. to Ft. Ft. to Ft Ft. to Ft __.Ft. to Ft Ft. to Ft .Ft. to Ft " ~t. to ' ~ ' Ft. to Ft. to Ft. Ft. to. Ft. Ft. to Ft. Ft. to_ Ft. MISCL. INFORMATION: 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:SW940385 DESIGN ENGINEER:DAVID R. DAYTON, P.E. OWNER NAME:SOUTHFORK LAND CO OWNER ADDRESS:P.O. BOX 3892 SOUTH PADRE IS., TEXAS 78597 PARCEL ID:07803111 LEGAL DESCRIPTION: SOUTHFORK WEST BLK 6 LT 2 LOT SIZE: 87129 (SQ. FT.) NIIMBER OF BEDROOMS: 3 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:10/06/94 EXPIRATION DATE:10/06/95 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 343-4744 (24 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: BY: ID. R. DAYTON, P.E., R.L.S. 202'10 Donalar Ohugiak, Alaska 99567 (907) 696-2417 Lot 2, Blk 6, Southfork West Subd. ~ ~i .;The proposed septic system will serve a 3 BR home on..a~ 2?acre::lot.~ The lot slopes from SW to NE at 1 3%. The water table is relatively high. The system will be a mounded trench located in the SW corner of the lot. There is adequqte area for the system as well as alternate sites. The system '~ill have no impact on neighboring properties. There will be no measurable impact on reserved areas or on drainage, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION; /-..-Z r'~ ~'o0..~,N- ~ 1 7 DATE Township, Range, Sectiofi~ ~c SLOPE SITE PLAN 10 11 12 13 14- 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? '~/~'~ $ IF YES, AT WHAT DEPTH? PF Oeplh. onitorino?t° WaLer After ~,%. ~' DaLe: Gross ' Net Depth to Net Reading Date Time Time Water Drop & //,,¢~ /o~,~ I1" S~ PERCOLATION RATE ' ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN I FT AND /;//Z..-., FT COMMENTS 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 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~' Z- ~;;~ %~.1.1-~ ~'z~c/..,0C--~¢-T°wnship' Range, Section:. ~__~ SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? P ?,Ct E Depth Io Water After,~-) ..,. ~ ~5-~c~ ~, C PERCOLATION RATE /"~ {minutes/inch) PERC HOLE DIAMETER Z.~'~- FTAND TEST RUN BETWEEN -- Gross Net Depth to Net Reading Date Time Time Water Drop / '~/~-/~Y It'.~;~ 7,~ !~', ~" COMMENTS PERFORMED BY: ~-~O, O j~. ~)~'IZ~ p~' CERTIFY THaT THIS TEST WAS PERFORMED IN - ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DA . : 72-008 (Rev. 4/85) · Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST LEGAL DESCRiPT,ON: /'Z 6& 1 2 3 4 6- 7 $ 10 12 14 15- 16 17 19 20 Township, Range, Section: WAS GROUND WATER ENCOUNTERED? ~/~'"'~ IF YES, AT WHAT ~ DEPTH? '~ / SLOPE SITE PLAN nepth to Water After ~'?-.~ ' Monitoring? ~, Gross Net Depth to Net Reading Date Drop C//2~/~;~ Time Time Water / ~'- ~+/ ~o ~"/~ ~,'~ PERCOLATION RATE ~'~ 7 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN (~2 FT AND ~ FT COMMENTS David R. Dayton P.E. · CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: Chuglak, Alaska 99567 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: . 72-008 (Rev. 4/85) DEPARTMENT OF HEALTH & HUMAN SERVICES ,,. SOILS LOG PERCOLATION TEST PERFORMED FOR: ~ ~ ~/Z~ DATE PERFORM~&~:¢~ LEGAL DESCRIPTION: ~0¢~'~ ~~ Township, Range, S~ction:~¢z SLOPE SITE PLAN DEPTITI U-Er'Ti) 1 2 6 7 9 WAS GROUND WATER 10 ENCOUNTERED? S L 11 IF YES, ATWHAT ~ O DEPTH? ~;O~ P 12 E 9e~lh ,~ water A,er~' Date~ 13 ~oniloring? Gross Net Depth to Net Reading ¢~/~,~ Time Time Water Drop 14 15- 16- 17- 18- 19 PERCOLATION RATE ¢n~,-,~'"'"' (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~" FT AND 3 FT COMMENTS PERFORMED BY: 20210 Donalar St. i CERTIFY THAT THIS TEST WAS PERFORMED IN Chuglak, Alaska 99567 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) TO FROM David R. Dayton P4L 20210 DonaJar St. Chugia~ Alaski 99567 MESSAGE DATE I"~_~.~:~ 4S 468 POLY PAK (50 SETS) 4P468 carbonle~s J~JNo REPLY NECESSARY SIGNED J-~ REPLY REQUESTED - USE REVERSE SIDE :"{' '"-"~%~¢'¢~?~ P~.:P~T?'}~p./-?~iTM }',~,?~}-Ofi;Si~'S~ices Sebti0~'~-'?-":i'/:?''' ....... T,,,~ ":'.'~? %??' ?:~ ?'i P.O.' aox lg~O Anchorage. Alaska A ' " ,:-, "'~4~ ~ ?~i~;~~ :~;g':¢J/-].X'-"' ;~"~:~':B¥~'~rr - ~ " ' ......... ~"~;.'~t.~i~'f~ ~?: ~ '%~.~k~"~:~.~?~;;. , -.~ ¢- -':> -'. ,~ ..... ,7,, ~-~*' "."U~:; - .~,.~.,...,/-, ~ . , ~ ~..., r~-;.--5.:~;~, ,.":p'-,i;i. '~ ~,Z:. . .-~13 APPROVAL FOR A S NGLE FAM LY DWELLING . _,.. ~. . .~ .... ~ = , ,':::: ?'~??~:':..~ ' _.. -' ' / ,/ .:~;-'?'.:" ':-L..'i.', '.' '~ ~ '.~ ' '~ ldi:lress or directions) ,'; :~,.P .}:. , , owner Mailing address ~g agency 'John Thompson ~7343 Santa Maria Driv~ Day phone 696-5070 "'" ' EAGLE Riv~r~ AK 99577 Day phone ' -'~ 5. S'rATEMENT OF INSPECTION BY ENGINEER As certified by my saai affix(ed' he~et~) ~h'd as'*of the validation date Showh below, I verify that my investigatiO~l~r of this Health' "Auth~rlty'"'" ....... 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_,qation and inspection, the on-site water supply and/or wastewater d!sposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. l:70~/~,.'.!!e River Loop Road No, 204 . . . . Cond~tional approval,,for...,. .... · ........ bedrooms, with the follow!ng,.,stlpulat~on~. Additional Comments De'part~n~m o¥ Health 'an'd Human' 8e~j~' (D~JHS)ISS'~Jes H~aJt~;'.A~il~i~Y~?}'' '.' only dPon the'~epreS~ntations gi,~en'.~in;:paragraphi5 above· b~ 'an'lr~'~penaent"' 'v:, :ed in'the sta~'~;f'~laska': The DHHS d°es'ihi~ as'~ b'~ur;tesy'to purchasers bf in'd~:der ~(~'~tisf~ ~e~;tair{ federal and ~tate ~equirem~t~: Employees'of OHHS'd~ 'MUnicipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~Crl'H/¢Otzt= /des~- .~"~'D.; ~,: £2 Parcel I.D. A. Well Data Well type /'-?~/V4,7~- If A, B, or C, attach ADEC letter. ADEC water system number Log present (~N) ¥£ ~ Date completed / o /4 ,-/ Driller ..c Total depth (o '7 / ~ Y- Cased to z¢ o Casing height Sanitary seal ~N) y~:$ Wires properly protected (~N) Y~ FROM WELL LOG AT INSPECTIO~ Date of test / o /~1 ~ Static water level Do / Well flow ~- ¢ .g.p.m. Pump level1 ~ /K / SEPARATION DISTANCES FROM WELL TO: Septic/~tank on lot /¢2.2 ' ; On adjacent lots Absorption field on lot /~. ?' ; On adjacent lots Public sewer main 7s- ~+ Public sewer manhole/cleanout &~ '~ Petroleum tank Sewer service line WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: I '~ //~ / ~ ~ Collected by: Other bacteria B. SEPTIC/H~L-DtN~ TANK DATA Date installed ?/_/_ c/z/ Cleanouts ~1) YES High water alarm (.Y~N) ~'~--S Date of pumping Tan k size / 2. 5'0 Foundation cleanout (~N) Compartments Depression (Y~ Alarm tested (~N) Pumper SEPARATION DISTANCES FROM SEPTIC/I ICLDINC TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y~_ High water alarm level Meets MOA electrical cedes (~N) "Pump on" level at Manufacturer Manhole/Access (~'4) 2. .... Pump off" Level at 32." Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot_ ?~ ?.?' On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length 75-' Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y(~ ,L)O ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: //. /. c) ~/ Soil rating (GPD/Ft2) /. 2. Width 5-' Gravel thickness Z/-2.~ ¢ Cleanout present (Y~ /U© Depression over field (Y/~ __ ~/~ ^)e t,¢ s,fsq-~ Results (pass/fail) ~ .~~A~e r test If yes, give date System type ~,. ~.~u ~z /' Total depth /?. ,,t./,~ Bedrooms Well on lot /~-Z. To building foundation On adjacent lots Sudace water Curtain drain On adjacent lots /¢~/¢- Property line 'TT,'~ ' To existing or abandoned system on lot >J.//m Cutbank S'd) '4- Water main/service line /~ '+ Driveway, parking/vehicle storage area /o~ ' /~/JO E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name HAA Fee $ ~(~---~ ~- Date of Payment Receipt Number 72-026 (3/93)* Back I~ ~ ~ ROBERT C COWAN t~ Waiver Fee $ Date of Payment Receipt Number CT&E Ref,~ Client Sample ID M~trix Commercial Testing & Engineering Co. Environmental Laboratory Services I~BO~ATO~Y ANAk¥$1$ 94,6123-i SOUTH FORK WE~T BL~6, LOT2* Ordered By JACK FrOnted Da~= 12/19/94 Projec~ Name Collect~ Da~e 12/~4/94 % 10:~0 h~e. Project~ R~eiVCd Da~ 12/14/94 ~ 1~=1~ hrs. DWSID UA Te¢~nioal Directo~ BTEP~EN C, EDE Sample Remarks~ SAMPLE COLLECT~D BY: S&S EN~INEERIN~ WITNEeB BY JACK. * TAKEN FROM 0UTBIDE HOSE BIB. QC Allowable EXh. ~kal Defame=er Results Qual Units Method Limits Date Date In~t Nitra=e-N 0.19 mg/L EPA 353.2 10_ 12/16/94 C~R * See Epecial Inshruotions Above UA - ~navailable ** See Sample Remarks Above NA - Not ~lalyzed ~ U ~ Uncle=ac=ed, ReFor~ed value is ~he ~ D = fleconda~ dilution. GT - Greater Than £0d ~6E'0N [IE[~69A06 * 9NI±SBI q~13~]NW03 00:L~ ~6/6I/EI