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HomeMy WebLinkAboutSUNSET HILLS WEST BLK 1 LT 21OTest ~*11 O Other: 7. CASl)tG: [~Threaded ~]~elded PUMP: (~f available) Length of Drop Pipe ---- ft. ca.city g,p.n Type: []Submers~b)e [~Reciproca~ing Form 02-W~R MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D, # ~--._.~O--, -_.~C;.;~ - ;-'~. / HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (e) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) re / i::¢ c (b) Property owner '-7~J3Z2_m ¢,-~< 0(2---%~ [~14q ~_.~eiephone: (home)._3~-~'-,2 2~7 Business ~'~,~,/:~ Mailing Address / ~-'/ / ~' ~'~ e OC~ ~ ¢ I (C) Lending Institution Mailing Address (d) Real Estate Company and Agent Address (e) Telephone __ Telephone /(/7/,~ Mail the HAA to the following address: (or check here ~Id for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family [~/ Number of bedrooms --~ 3. WATER SUPPLY Individual Well B1/ Community [] Public [] Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4l SEWAGE DISPOSAL On-site [] Public I~' Community [] Holding 'rank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-02S(Rev. 7/88) Page 1 of 2 le^oJddv I~UO!1!puoC) jo suJJaj. I~UO!~!puoo peAoJdd~s!Q ,~ peAoJddv ~¥AOBS~¥ SHHa '9 //¢ / _ z:-~_c ~uo~d~ "~0~_~; ~ U,¢O'~JO'.~ ~,o~..N 'uo!joedsu! s!qi ~o elep 8L1~ UO joe¢J8 U! suo!l~JnbeJ pue 'seoueulpJo 'sepoo elelS pub Ied!o!unl~l lie LtJ!M eoUe!ldUJoO u! s! Lue~9/~9 leSOd9!p ~SleMSlSeM JO/pue/~lddns JeleM ell$-UO eql 'uo!~oedsu! pue UO!I~SIlSOAU! /~UJ UJOJJ pue Sell1 ebeJoqouv ,Io X~,!ledjo!unJAI ell1 uJoJ¢ peu!elqo uolleuJJoJu! eq~ uo pe9eq li~Lll/~,qJeA JeLJ~JnJ I 'U!eJeLI peleoJpu! eJnlonJls Jo ed/~l pu~ suJooJpeq 1o jequunu @ql Jot elenbepe pul~' leUO!jounj 'e,tes s! uJels/~s I~sods!p JeJ'BM~],SBM Jo/pu~ ,~lddns JeJBM 8JIS-UO 8L~ ~,BL~I SMOL~$ p3^oJddV /q!Joqln¥ qlleeH S!ql,tO uolleSllSeAU! ~LU ~eql XJ!JeA I 'MOleq UMOqS elep UO!~epfieA 8LJ~ JO Se pue oleJeq p@X!JJIB IIB@S/~UJ Xq pe!J!lJ@0 S'¢ NOIJ.~IINIJO4N113N~' ~fJ.~O 'HOB'ViS ~t'11=1 '$.L$~iJ. '$NOI.LO~clSNI ONlalAOIJd INHI4 IDNII'I2]~NIONq 'g MUNICIPALITY OF ANCHORAGE-' (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALi1Y OF ANCHOR/3~3'4744 ENVIRONMEN[AL SERVICES DIVISION ' Legal Description: Lo 'f t.ll. 1 a ].989 rR,,E,,f LYE D Date Completed A. WELL DATA Well Classification Well Log Present (Y/N) /,51ocA. / If A, B, C, D.E.C. Approved (Y/N) I J // ) -~'/~;2-- Yield_ f'~ - ~ J Total Depth ~-:~'2~ Cased to 2-'b2. ~ Static Water Level ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Depth of Grouting _ {.,(..F~k~o fA)r', Pump Set At ,.?~':b I ' 2-. ~ Sanitary Seal on Casing (Y/N) \/ Depression Around Wellhead (Y/N) SFPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field, on Lot To Nearest Public Sewer Line -~' ~' ~ '~( To Nearest Sewer Service Line on Lot ,~, Water Sample Collected by ~-~ Comments '~< 5~,6 '¢f16 Y ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date~n& at~?d Size Standpipes (Y/"~N)->~ Air-tight Caps (Y/N) _ Depression over Pumping/Maintenance Contact on F~e-~/...N) Holding Tank High-Water Alarm (Y/N) SFPARATION DISTANCES FROM SEPTIC/HOLDING 'CAN~: To Water-Supply Well To Bui~F~oundation To Property Line 'Fo Disposal Fie~ To Water Main/Service Line '%"'"~"-. No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Stream, Pond, Lake or Major Drainage Course Comments (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA So. Rating in Absorption Strata Date [~led __ Width of Results of Last Adequacy Test "~% SEPARATION DISTANCE FROM ABSO~R~ION FIELD: To Water-Supply Well ~ To Property Line To Building Foundation ~ To Existing or Abandoned System on Lot ; On Ad. ets To Water Main/Service Line Cutb"ac~r esent)To To Stream, Pond, Lake, or Major Drainage Course TOcommentsDriveway, Parking Area, or Vehicle Storage Area '""'"~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test Size in Gallon-~'---.. "Pump On" Level ~ High Water Alarm Level at %~"~._ Tested for ~ Meets MOA Electrical Codes (Y/N) ~----. Comments ~. led **Check Peril inspection//~ ~ MOA No. Dimensions Manhole/Access (Y/N) "Pump Oft" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. ""~--~.~..~.. effect on the date of this / Bedroo/~ R_~ating Against HAA Request** ~~nformed to all MOA and H/ Engineer's Seal Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGIC LABORAIORIES OF ALASKA, INC. 5533 B STREET ANCHORAGE,FEDERALALASKATAx ID #9951892-0p40440TELEPHONE (907) 562-2343 Date Report Printed: JUL 16 89 { 11:05 Client Sample ID:SUNSET HILLS WEST PWSID :UA Collected JUL 13 89 @ 12:00 Receiv.d JUL 13 89 ~ 12:30 Preserved with :AS REQUIRED Client Name : CORWIN & ASSOC Client Acct : CORWINP P.O.{ NONE REC'D Req f O=dezed By : Analysis Completed :JUL 14 89 Send Reports to: Laboratory Supo~v~sgr :~IEPNEN C. EDE 1)CORWIN & ASSOC Released By : ~~, ~ 2) Special Instruct: Chemlab Ref ~: 6287 Lab Smpl ID: I ~atri×: WATER Allowable Pa[ameter Tested Result/Units Method Limits NITEATE-N ND(O.lO) mE/1 EPA 353.2 LO Sample ROUTINE SA~LE Remarks: SAMPLE COLLECTED BT R.L. AND 3.R, I Tests Performed ' See Special Instructions Above UA-Unavailable ND- Hone Detected "See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-Greate~ Than MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONblENTAL }LFALTH DEPARTMENT OF HEALTH AND ENVIRON~fENTAL PROTECTION APPLICATION FOR }~ALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 12/17/85 (a) Legal Description (include lot, block, subdivision, section, township, Lot 21z B].ock 1~ Sunset HJl].~ W~st Location (address or directions) 14115 Hancock Drive range) (b) Applicants Name Lee Goodman Telephone - Hom~45-635~usiness Applicants ~dres's' Box 110897, ^nchorage, Alaska 99511 yer[l:j; Other2l] (s p ain); (d) L~nding Institution ' Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: ~._Call w_~h_en ~'ead__v 2. T_~ of Residence Single-Family~ Number of Bedrooms 3o Water S~_~~ Three Other (describe) Individual, Well ~ Community [__--~ Public ~-~ Note: If community well system, must have %~itten confirmation from the State Department of Environmental Conservation attesting to the legality and status° Sewage D ij!p~a_~l Onsite ~-~ Public ~ Community ~][ Holding Tank ~__-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status° [Page 1 of 2] 5. E_~q~:[neerin~ Fi~m ?roviding Ins~_~!:ion33 Test~s, File__ Sea_~rch_~_~ Data aad Information As certified by my seal affixed hereto and as of the validation date stm~.~a below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewager 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 ~anicipality of Anchorage files and from my investigation and inspection~ the on-site water supply and/or ~3stewater disposal system is in compliance with 'all b~nicipal and State codes, ordinances, and regu].a'~ tions in effect on the date of this inspection° ,Name of Firm D a t e___D e c em~ e~j~_j_~.8~ Telephone.~D~t-A~t~.%52~ (ENGINEER SLAL) Approved for.~/~.,~ edrooms Approv~5l ~ Disapproved Conditionsl Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIROnmENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY ~?PROVAL CERTIFICATES BASED SOI3',LY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPE~)ENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA° T}~ DHE]? DOES ~IIS AS A COURTESY TO PURCI~SERS OF HOMES THEIK LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE ML~ICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAl, ENGINEER*S WORK° (DHEP SEAL) RR4/e~/D18 [Page 2 of 2] 7'-19-84 A. WEIL DATA Well Classification Well Log P~esent .(Y/N) ~O~H~NV ~o Aill~n~pleted Total L~pth 231 ' Cased to 231 ' Static Water Level 71 ~ Pump Set At Casing Height Above G~,-ound 18" Electrical wiring in (~Dnduit ,(Y/N) Separation Distances f~om Well: TO Septic/Ho~d~ng Tank on Lot 986~8 ~ O~0 Leqal Description: Lot 21, BLK ~ Sg_~f, Hill We~t, Sub. Anchor~ Al~sk~ ___ p NOI~]IO~d 1VIN]WNO~A~B r~va~%m~v~~ ~.~ a, B, ~ C, D.E.C. Ag~o~d(Y~) N/A -- 11/15/82 Yield 6 G.P.M. Depth of G~outing Unknown Sanitary Heal on Casing (Y/N) Y Depression A~ound Wellhead {Y/N) N ; On Adjoining Lots 200'~ ~,~:-,' 'n.,TD Nea].~st E~ge of Absorption Field on Lot N/A ; On Adjoining ". ,-T · -- .... · ,~",-,.LT.,~: ,N,ea/,est ~bllc Sewer 'Line 5~' ~""~ To Nearest Public Sewer ' '(!~,/' ~'?~eanout/~anhole 73' v3~'~'~ / TO Neazest Sewe~ Service Line on LOt 60' ' ..'.' :,Wa~SamPle Collected By B. Looney ; Date___ 12-16-85 Wate~ S ,a~ple Test Besul~s Satis£actor¥ C(a[[~nts '4'WaiveP ~equi~ed on distance f~om well %o Public Sewe~ Line snd 5o Public ,'Sewe~ Manhole B. SEPTiC/HOLDING TANK DATA N/A Date Installed Size No. of Cu~k)a~tments Standpipes (Y/N) _Ai~.-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pla~ped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High-Water Alaz~m (Y/N) Temporary Holdi~x3 Tank Permit .(Y/N) Separation Distances f~om Septic/Holding Tank: To Water-Supply Well To P~operty Line_ To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, c~ Major, D~ainage Comments [Page i of ~2i 2-15-84 Co ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption A~ea Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes P~esent (y/N). Date of Lest Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To P~operty Line To Existing or Abandoned System on ; On Adjoining Lots .. To Cutbank(i.f p~esent) To Stream/Pond/Lake/c~ Major D~ainage Ccurse To D~iveway, Pa=king A~ea, o~ Vehicle Storage A~ea Con, rents D. LIFT STATION N/A Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes.!~/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at .. Vent (y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check P~rmitted Bedroc~ Rating Against HAA Request ** I certify that I have checked, verified, or conforr~d to all MOA on the date of this inspection. Siuned ~~ ~ ~Date 12/17/85 Core, any CRW ENGINEERING ~ROUP MOA No.5'[ 85 -~-~3 KB1/d5/s [Page 2 of 2] 2-15-84 P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY K, NOWLES, MAYOR DEPAR'I'IVIENT OF HEALTH & tiUMAN SERVICE8 December 27, 1985 David Yanoshek, P.E. CRW Engineering Group 3900 Arctic Boulew~rd Anchorage, Alaska 99503 Subject: Lot 21 Block 1 Sunset Hills West Subdivision Waiver Request WR85-064 Dear Mr. Yanoshek: This Department has granted your request for a waiver of the minimum separation distances required between the well on the subject property and conflicting comraunity sewer main components. The minimum separation distance to the well has been waived to 54 feet for the sewer line and 73 feet for the sewer manhole. This waiver is valid for the existing well only, Sincerely, Stephen S. Morris Civil Engineer On.-site Services SSM/ijw engineering groul j 18 December, ],985 MunieJpality of Auchorage l)cpartment, of }leal /'h and F, nvironmental Division of Environmental Health ~25 1, Street Anchorage, Alaska 99~01 Protect ion MUNICIPALITY OF ANCHORA(~[! DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION. DEC 1. 8 1985 RECEIVED Atta: Robbie Robiusan Separation Waiver Request, Let 2], Block 1 Sunset llills West Subdivision, Aachorage, Alaska We reques~ a horizontal separation wa:Lver between the private well on the above preperty and a community sewer main and manhole. P] ease consider' tile follow:ing: The cen:l'[icting relatively good sewer maln was :iustal]ed in 1980 and :its condition would minimize Lite potential of o Only two houses are served by [;he eonflicLing sewer main above where the separation d:Lst;ance is less than required. The ]ow flow in ~he sewer would make its c:onbamination potenLiul similar Lo IhoL o[' s private sewer lille which has a required separation distance to a well of only 25' The waler we'L] Ls eased to 231'. a sewer main to such a deep well wel I log), The contamination polenL:iul ['rom would be minimal (see attached o The well has never had any problem w:ll'h waker quality or quantity. o The direction of groundwater is generally dictaled by the lecal [opography, [['he property [n question is Located [ess lhun 600' from the edge of a bluff above the ocean and the ground slopes sosth toward the acean. Groundwater wJlJ roi[Low the fall Line of the slope and tend to fJow toward the south. Surface water will flow south toward 'l:he ocean also. The well i~; l. oca~ed aorth o:F the sewer main and manhole and both grsundwater and surface water wil] Lend i'o Flow away from the well and toward itbe sewer main. The local topography reduces lhe potential L'er well contamination from ground water' or surface water sources. o Les; N. Buchholz, Senior Environmental SpeciaJist (I)I1EP), approved the well in December 1981. 3900 Arctic Blvd.,Suite 203*Anchorage. Alaska 99503,(907) 562-3252 Robbie Hobinson 18 December, 1985 Page Twe. e The property owner is currently making arrangements to remove the exis%~ng undergt'ound fuel tank. Attached are Lhe comple[:ed "Health Au[horJty Approval[" forms as well as a diagranl depicting the lot, house, well, and conflicting sewer' line, ]if you have ally questions please fee] free I;o ca].l inyse]f ol? B t'ian Leoney. Sincere]y, CRW ENGINEERING GROUP David Yanoshek, P,E. P ¥/j b 3900 Arctic Blvd. Suite 203 Anchorage, Alaska 99503 (907) 562-3252 SHEET NO, CALCULATED DY ~,L~, L CHECKED BY OF¸ DATE SU~ S$-F I~LL~ 5 W E_$~F , ~,,~, ~ ~ECEIV~D INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR I NSP E(;TOR I NSP ECTOR MUNICIPALITY OF ANCHORAGE ) DEPARTMENT OF HEALTH & ENVIRONMENTAL P~Y O~ ANCHORAGE 825 L Street - Anchorage, Alaska 99501 DEPL OF H~ALTH ENVIRO~,MEiqlAL PROTECTION ENVIBONMENTAL SANITATION DIVISION Telephone 264.4720 ~[~ i 1981 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND DI RECTIGNS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PROPERTY RESIDENT {If different from abo e) PRONE Z~ P H 0 N E MAILING ADDRESS MAILING ADDRESS ,.LE ALDE,C,,PT,G, STREET LOCATION lq/lb 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four ~,~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six [] Other 7. WATER SUPPLY ;:~ INDIVI DUAL* * ATTACH WELL I-OG. A well log ~s reqmreo for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give wel [] PUBLIC UTILITY oepm (attach log i~ available, 8, SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SII'E** I ? ~"/ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUFST 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 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 UTILITY 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, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Aroa to nearost Lot Line 5, COMMENTS PPBOVED FOR BEDROOMS [] CONDITIONAL APPROVAL {letter must accompany certificate) [] DISAPPROVED 72-010 (Rev, 6/79)