Loading...
HomeMy WebLinkAboutUS SURVEY 3043 LT 14 T10N R2E SEC 18 (2)US Survey 3043 Lot #075-092-17 Tom Fink, Mayor Municipality ot Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 January 10, 1991 James and Faye Duchanin PO Box 1138 Girdwood, Alaska 99587 Subject: T10N R2E Section 18 Lot 14 Permit #900131, PID #075-092-17 The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as of December 31, 1990. A new permit must be obtained from this office for a well and/or on-site wastewater system mot installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to'this office for review, approval and documentation. All inspection reports must be submitted within 30'days of construction completion. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 a combined on-site wastewater and well permit. for If you have any questions, Sinc~e~, J j// Prc~j r am Manager On-site Services please call this office at 343-4744. JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" Ci~..,w~ep Name: 0ANi!:..:.S & F"AY!i!: DLfCHAI,,i~N ('-] ]: F;',;}!.,.JOC)D !, AK 9951~I 7 arid [-lumo. n Sf?.-'pv:ic¢.~::?~ i~ithir'* ::50 day,:~, i:if ~,..~el]. COml:il¢fH:.:Lon~ !:F!~[AI L F:'ER A'!'I~'-~C:I"IIiitD SI FE F:'LAN,, PR:IVY "l'[:) BE ('di),AN.0OIxIED Al' T]:I"IIS: N!~..LI.. AN)} S[5:WE']::?. ZI',IST~q.J....EiD,, NOTi[FY .0HHS PRI[)R FI) Ai...]ERINE') I!;IELI... I.OCA I' I ON ,, 'IH 1S [:'ti!i]::;.'l"l I t !: S I SSLt,~ii:'0 FOR ]'Hiii. EX :[ SI' I NG OI,.iE B['::DROOM S]:NI~LIS: F:AMI:LY DWE!:LLIhlG C)NI....~,' AND EXF:':[RI:i:S ON I~?./3:1./90,, {or"t'.h by thc0 ldunic:ipali't.y of' Ar'tchopa(]e (MOA) arid Che State of' A]a. ska,, cJJ.~yl'.al'ic:~.~)s~ (p(:]m any exis'Llr'~g t,~e].i, ~aa~Cev. sater, dispo~[~aI sysCem (::w pub:L:Lc: s~,:w~e~i'age sys'L~::em on this o1' any adjacent i::)t" n~sar'by lot,, ]] L.u'icJ[epstal]{::} that {:.J'iJE~ per'mit :J.s valid {'c)p a. ma~.:Jmum cH' :l. l')edp(:)oms,, i a:l.~(:) und(~,:,pstar~d tha'L the capac:[.ty o'[' the '~.o'~..a! ~W~'~.em :Ls ]. t::)edpc)c~ms and any er~:~.apg~az~ment wi]] peclL.~.pe an add~/~.i(:)nal pepmit~ ,~0o I MU.,C,.AL,T;' DP A.C.ORAGE WASTEWATER 90 0214 CONNECT PERMIT DATE OF~APPLICATIO" "'5' ~: ~ SCHEDULED COMPLETION DATE ~ SINGLE FAMILY WATER & WASTEWATER UTILI~ ~ MULTFDWELUNG 401 W. [NT'L AIRPORT RD. No. APTS_ PHONE: 564-2762 ~ COMMERCIAL LOT/TRACT 14 BLOCK SUBDIVISION ~10 ~ R2E S~ 18/19 TAX CODE 075-092-17 GRID STREET ADDRESS ~[.~F-~'A ROAD OWNER J~4ES DUCH~NI~ El REPAIR EXISTING SERVICE O MAIN TAP- TO PROPERTY LINE ONLY MOA er State Row Permit recurred) MAIN TAP & ON PROPERTY CONNECT MOA Or State Row Permit reouired) R-O-W NO. AS-BUILT No. PHONE GIRD~OOD AK 99587 ~SSESSMENTS To be levied upon connection ~ Improvement District (~'~-~ Main extension agreememf' ~£.~ Extend connect agreemem Pending Paid CONNECTION SIZE ~'~ CHARGE $ INSPECTION FEE $/~5.50 PERMIT FEE $19.50 REIMBURSIBLE NUMBER DEPOSIT $ TOTAL $~. OO 3ERMIT ISSUED BY: CATH~ ~ PAID ~ CASH ~ CK# INSPECTED BY: DATE: REMARKS: PERMITTEE (Please HAVE READ THE CONDITIONS AND REGULATIONS ON THE REVERSE SIDE OF THIS PERMIT AND AGREE TO COMPLY WITH THEM. PERMITTEE SIGNATURE POST IN A CONSPICUOUS PLACE AT THE JOB SITE 31-122 {Rev. 11/89) CUSTOMER 1201 Ramona St. 99515 ~NCHORA~E~ ALASKA SIX INCH WATER WELL DRILLED ......... OUT TO THE DEPTH OF 1 i~] ?eet. DRILLED AT THE RATE OF PROPERTY OWNER.~ameS:.,'-. ~ Ix~.ye S. PER FOOT. Steel casing seated out to the full depth of 131' Duchanin. P.O. Box ]138 Girdwood AK LOCATION OF WELL SITE Lt. lY+ ~erxie ~ ...... s of F'ampart DRILLER US Survey 3043, ?tilling Works. WELL LOG: 0 - i7' A sandy gravel ~'~th 25~ clay binder. i7 - 39' Pine gravel. 15% silty material. ~lrdwooo.; FEB 2 2 1991 Municipality of Anchorage r).pf_ H~lth & Human Services 39 - 71' A silty gravel. 40...~, clay binder. 71 - 73' Silty sandy wet fine gravel producing a minimal amount of water. 73 - 106' A hardpan material. Cemented gravel. 106 - ]29' l~et coarse gravel with ~0% clay. 129 - 131' Fine water bearing gravel, going into a coarse water bearing gravel at 1.31 feet. Water recovery is back to 5~ feet of surface. ~;Mter yield shows 10GoM+ pumping five feet off bottom. Full pumping capacity shou] hold at near 15 GPM. Submersible pump, however, should be installed at seve~ or eight feet off bottom. (3/~ horse) The quantity of water is very good ~< we guarantee the quality of water, eve: withstanding an initial glacial sediment present in the gravel aquifer. ~(atural screening of the fine ~ coarse water bearing gravel should filter out any fine sediment after minimal pumping. Less than a 24-hour time frame. No mobilization cost or set up cost included in drilling cost. Total bill of f22.00 per ft. x 131 feet: $2,882.00 Paid in full. Ck ~ 1701. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPL~ION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ~NI~ ~ O~ ~'~? ~I~I~ WO~ DATE ,.June 12~ 1990 SERVIC~ CHARGE OF 1V~% P~R MONT~ WILL ~E ASSESSED ON PAST DUE ACCOUNTS. Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 RO. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ©'1 5 - e q 3 -17 1. GENERAL INFORMATION Complete legal description Expiration Date: US Survey 3043, Lot 14 Location (site address or directions) NHN Alyeska Highway Current Property owner(s) Michael & Kathie White Day phone 783-2490 Mailing address PO Box 832, Girdwood, AK 99587 Lending agency Mailing address Day phone RealEstateAgentRamax A]yeska: Dav~ Bauer Dayphone 783-20]0 Mailing Address PO Box 1029, Girdwood, AK 99587 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: ~ NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: individual Well individual Water Storage Community Class Public Water System Well 3 TYPE OF WASTEWATER DISPOSAL: [] individual On-site [] [] Individual Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by CIass A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72 025 ~Rev O! 00/' 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 based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 verity 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & $ NameofFirm 17'; ' ' ','L,;cpRoaaNo. 3Oa Phone Address ~a(~i~ ,~i,.,er, A,,.~,¢a 99577 Engineer's Printed Name '~0¢¢(:,~r C. DHHS SIGNATURE ~ Approved for -_~ bedrooms. Disapproved. Conditional approval for ~--- 0 ~,.,~ 4 ~, Date '7/3/00 s '.. bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: / ,D. --~ ' c, ~ Original Certificate Date:_/-7- ~ - ¢ o Reissue Date: 75 025,Rev 3~ 00~' Municipality of Anchorage i~ [~ C ~ ~V ~ D //~ Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 JUL 0 ~ ~(~00 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us MuNICIPAU~ OF ANCHORAGE (907) 343-4744 "~mr~NMENTAL $SP'VICES DIVIS~ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Parcel I.D.: Well type 1'4~ v,T4. Date completed Total depth ~ ;~ ft If A, B, or C provide PWSID # Sanitary seal ¥¢-~ Cased to ~oH- ft FROM WELL LOG Date of test / Static water level 0/[~ fl Well production / g.p.m WATER SAMPLE RESULTS: Coliform (P colonies/100 mi Date of sample: ~/;;L '~ /0 ,3 Nitrate~P, f,4f¢ mg/I Collected by: Well Log ~, o Wires properly protected 3,~$ Casing height (above ground) I;~+ in. AT INSPECTION re/ /oo 7./-/ g.p.m B. SEPTIC/HOLD!NG TANK DATA ~u&L, c ,~,~¢,~ Tank '~ype/M~teria!. Dat~!nStalled :~ ~ '-. Tank size gal Number of C~ Clean°uts Fbundation cleanout __ Depression over~-~' High water alarm Da.t~:bf Pumping ~ __ P~ __ _ C. ABSoRpTI°N FIELD DATA ~ Date installed. _ __ Soil rating (g~ or ft2/bdrm) __ System type _ Length ft Width ,~ft Gravel below pipe ft Other bacteria o colonies/100 mi S & $ ENGINEERING 17034 Ea,.';!e ~,~ver Loop Roa({ NO. 204 Eagle River, Alaska 99577 __ Depression over field__ For bedrooms __ gal. New depth Absorption rate >= __ If yes, give date __ Total depth .ft Eff~ption area _ft2 Monitoring tube Date of adequacy~__ Results (Pass/Fail) _ __ Fluid d~orption field before test __ _ in Water added El~me: _ __ min Final fluid depth in Ad~tion treatment (past 12 mo.) (Y/N & type) in. g.p.d. 72-026 (Rev. 01/00)* D. LIFT STATION Date installed ~ize i~~Access "Pump on" level at in Pu¢¢e at in High water alarm level at __ in Datu m.~....-~-~ ~ Cycles tested Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/4 On adjacent lots Absorption field on lot ~ /4- On adjacent lots Public sewer main ! oo '-~ Public sewer manhole/cleanout Sewer/septic service line ;~ ~ /'¢- Holding tank ~v SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation. Property line Absor~n-field~- Water main Water service line ~S~rface water Drainage Wells on ad~ SEPARATION DISTANCE FROM AB~IELD ON LOT'fO: Properly line ~..BC'Sing foundation__ W~fer main _ Driveway, parking/vehicle Water Service line / Surface water storage Curtain~ Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date 7/3/00 HAA Fee $ Date of Payment?/~/~/~) Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00)* Parcel I.D. # 1. 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 075-092-17 NAA# '~ GENERAL INFORMATION Complete legal description USS 3043,~ Lot 14 T10N, R2E, Section 18/19 Location (site address or directions) NHN. Alyeska Highway'; Girdwood Property0wner .Tam~s N. & Fay~ S. Duchanin Dayphone 783-2439 Mailing address P.O. Box 1138, Girdwood, AK 99587 Lending agency City Mortqaqe/Verl Taylor Day phone 563-0700 Mailing addres~ P.O. Box 92810, Anchorage, AK 99509-2810 Agent N/A Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 2 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. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer x 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 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 Eagle River Engineering Svcs. Address P.O. Box 773294, Eaqle River, Engineer's signature ~-'?=~ Phone 694-5195 AK 99577 Date o DHHS SIGNATURE )</-..._Approved for ~--~ 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 apd 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. 72~25 (Rev, 1/91) Back MOA g21 ; Municipality of Anchorage \ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /-.O¢- /~, 'O55 $Oz¢~ Parcel I.D. C~;~-' O2~ ~/'2 ~-lO/Z ~£ "5~e~/~N /~1~ A, WELL DATA Well type P£1~/47"&; Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number YE- ~ Date completed ~(~//7,-{ ~0 Driller /,~t Cased to ]',,~/ Casing height -~-) ~- Wires properly protected (Y/N) )/~ 5 Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION ~ /~. ~ g.p.m. /~ g.p.m. ~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /,//,~4 Absorption field on lot Public sewer main 7~ ~/~ ' Public sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: Collected by: Other bacteria To property line / S~rainage 72-0~6 (Rev, 3/91) Front MOA 21 B. SEPTIC/HOLDING TANK DATA Date installed Tank size Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) ~Y/N) High ~vater alarm (Y/N) ~ed (Y/N) __ Date of Pumping ~ _ SwEe~.~Ii~tN DISTANCES~~G TANK TO: Foundation Absorption field .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 ~~s Meets MOA electrical codes (Y/N) SEPARATION~TATION TO: W~ On adjacent lots D, ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) off" level at tested Surface water Date installed Length Width Total absorption area Depression over field (Y/N) Results (pass/fail) Soil rating . System type Gravel thickness Total depths... Cleanouts present (Y/N) Date of ad~ for "'/If yes, give date Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORP~ Well on lot _ __..~,~jacent lots Property line To building foundation ~ To existing or abandoned system on lot On adjacent lots ..'/ Cutbank Water main/service line Surface wat~./'/' Driveway, parking/vehicle storage area ain bedrooms 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. Signature ¢"~ ~'"~'~'~ -' Engineer's Name Date HAAFee$ /'~,¢ · Date of Payment Receipt Number "~ ~¢/,~ ~'/'~'¢~ 72-O26 (Rev. 3/91) Back MOA 21 Date of Payment Receipt Number