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
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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)