HomeMy WebLinkAboutT12N R4W SEC 10 LT 17 N2
MUNICIPALITY OF ANCHORAGE
· DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720
o.-S,TE SEW^GE D,SPOS^L SYSTEM ^.O/O. WELL,.SPECT,O.
Address
~5~3 J~ ~ TANK FIELDWELL
Phone(st .er~l: NO. NO of Bedrooms WELL /~O
LEGAL DESCRIPTION
~/g ~, 5~Y/~ /~ driveway, water bodies, etc.)
~ -' /TANKS
~EPTIC : HOLDING
TYPE OF SYSTEM
F,II added above original.grade ~T Gravel depth benea.ho. ~plpe ~ ~
/11
WELLS
~PRIVATE OTHER fldentifv)
spections Peal rmed~y:
I ~C ~ ~ 1~ ceflily that Ihis inspection was peflormcd accordino
72-013 (3/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Ancl~orage, Alaska 99502, Telephone 264 4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
'/ '~TANKS
~SEPTIC [] HOLDING
DISTANCES
SEPTIC ABSORPTION
TANK FIELO WELL
WELL /~oi_/_ /1~ t
FOUNDMION 5 '''~ '~'-0 / ~C~/-f:'
REMARKS:
DEPT, 0I: HEALTH &
j~NVIRONMENTAL PROTECTION
OCT 19 t988
P, ECEIVED
[)epar, tment oF Health & Human Sepvices
d .... I... Str. eeL Anchc,"ace, Alaska 9950~ .~..-I.... ~
'f E S E W E R & S E F:' T i C T A N K
O~,~n er' Add P,x~ss:
Engioeer' i}es~ :!~ed
F'a~'cel id: 011-.161'-'19
Lot Legal.: E~ubdivisi. on: ..... L.o'L: "- Block: .....
Sect:Eon: 10 'Jownship: 1P.N Range: 4W
N 1/2 LO'I" 17
L..o'L Size 4950() (sq. ft. of acres)
Max Bedroorns~ This Per, mit~ 5 Tota! Capac:ity: 7~;
';bt:.'IJ]C TANK~ Minimum total sepLic tank capacity: 1,()00 oa].lons. Each
....... ~ . ABANDON EXIS'I]',NG CIs.L~'.. II01 [FrY
I.:.X ~ .(~ ........ I. ,=./..:, I. / ,:~8.
SINGLE F:'AMILV RESIDENCE C}NLY AND = z:' ':"Fc~ > ":" '~
I am 'f ami J, J. ap wJi'.h the r~ecjui pelflf!~n'Ls { c:)r on.,..c:iJ.'L6~ ~=~ewepss and weJ. ZLs as set
for"Lh by thc:) Mur]:LcJ. j]a.].ity of Arii=hot'ag~ (MOA) and thE, St~te
i: t4:i.].], irtstall Lt'ie tsyslLF~m J. Ii B(ZC:IDPCJaFIEE+ ~/~i~:.~'l b:i].l HOA c:odeS arid r, eguJ. atJ. on~
d:Jlcl :iAi I=OlilpJ. J, al'/Cf~ bJJ, t.J"i t'.h~ design cr, i'Eer'ia OJ this
i ~,dlJ. adher'e to al.l. MOA and 8'Late~ c:H' Alaska i-equil'emen'Ls for' 't..l-,e set bac:l.::
d;Ls't, ar)ces fr. om arry' ex is;[: ir',q ~el].~ Hast(:)l,~a'L%r disposal system or public::
sew(DJ"ag({~ E~y~B'~6)iii Oil L.h:Js ol' arly acJ.iacor'lt of I"IFJ~PIDy lo'L.
also under'stand that thf::e capacity of 'Lhe to'La], system is 3 be~dl"oofns and
SEW!
R SYSTEM LOCATION PLAN
NORTH
SEWER SYSTEM LOCATION
NORTH
PROPERTY CORNERS, ~KELt-s, ANO SEPTIC
sySTEMS INOICATEO IS NOT EXACT.
SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, ARchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~ DATE PERFOR
1
2
3
4
5
6
7
8
9
10
11
12
13
14-
15-
17-
18-
19-
20-
IF YES, AT WHAT
DEPTH?
I
Gross Ne[ Depth to Net
Reading Date Time Time Water Drop
(h, ~ c-~ . '1 ~:, ~ ,l_~ ' ' cO, ~ ~h. 4'
PERCOLATION RATE '~' ~ {m,nutes, mch) PERC HOLE DIAMETER
~ESY RUN BETWEEN ~, .~o FTAND I~
: 'f; ,f }'~(' ~ . * * ~ ..... _ Y ~,'z~ ',~ IFY THAT THIS TEST WAS PERFORMED IN
t2~;%%TITH AEL STAT E AND MU.IOIPAL O UIDEEINES/~TH%TE. DATE:
/
PLAN VIE~W --~-A
N.T.S.
S*pllc Ton~
.,Slope to
, - ~/ t~ ~
II~';.;L'.: . ... .......... ... ..... , ,... ~ I*~.
~~ i ' t ' ' 'l ~ i , . '. . .. ' ' ',' ,. :'x~J
~ Undislu~ed ~11~
N.T. S,
2. Four ~dr~ system]'
3. I~ted ~ fill tof*d o1150
~. 5~p~ic T~nE ~o be J~O00~l
Certified Well R
For ......................... .................................
L~cati~n~ [~/~ ~2~/~7~ ~.~d~d~(~b~ ...............
Depth of well ............................................................................................................
Size of casing ..........................................................................................................
Distance to water ............ : ......................... J. ........ --/----?--~- .......................................
Distance to water While pumping. .......................... --/---~---~----~ ................. at rate
o£ ............. ..~.._Q...~...~] ............. gallons;per h~ur.
Description of Formatloh,. ~531'. % _ from to
O,
!
~ ~.~...~: ...... .,. 177 /qq
I cer.3ify the' above true and correct.
DOTTEN DRILLING CO.
John's Road
SPENARD ALASKA
We advise you to attach this certificate to your deed.
4,.I
i"tLIi'.,IIIE::[F:'I::ILIT"r' OF F:¢..IC:}-~ ;IGE '~"x
,. ,[:,EF'F~IF::TML::NT C ~EF:ILTH FIN[:, EN',,,'IRONHE:NTFIL i: i'EE:TION
;ili:rl ::L Z1 E. TIJ[:,EIF: F:[:,.., ;'t ~£..HL F:.H .~_E., Fha:::.
~...~EEL_L. F'EZF:bl Z '"'ii
RPPL..);CF:INT GERf:.ILD C SEE:HF'.);E;'I~, 850Z-': J'F:IDE S'1"
LO(_-:F:~T .T ON O50'_~: .]FI[~,E: S'i'
L..EGFIL N :L,/2 OF L±';':' SEC: ::LO T:t2N R414 LOT SIZE
f"iINZi'"t:LiH D);SI'FINCE BE:1'NEEN R HELL F:hND Rl'.,!~r' ON-,SI-f'E SEi.4FI(3E:: I:::,:[SPOSFIL E;'?'STEH ~S
::LOO FEET FOR' R F'RI',,,'FITE: k!EL.L OR 200 FEET FOF:t Fl F;'UBL_:[C klELt
HELL bO(~iS RRB REfJRJif;::['-;:[:' FINE) PIUST BE RE'f'URNE[) TO THE DEPRRI"ME:NT I.,.tITF'IIN 2:0 DFI'-r'S
OF THE NEL:L. COHF'L. E1'IEIN.
SPECIFICFFI iONS RND CONSTRLIC'T'ION E:,iFIGRRMS RRE RVF:IILRE,'I....E 't"O INSURE PF:'.OPER
I NS'f'RLLRT I
~"3:560 SL:'gJFtRE FEEl"
I CER'I' :i:I.:'Y' THFFF
±: I Rf'i Ff:IHiLIRF:: ~,4I'TH '['FIE REQLIIREHENIS FOR ON-SITE SENERS RN[> .t4ELLS RS SET
F'ORTH P'¢ THE HUNIL":IF'RL:[]'~r' OF RNCHORRGE.
2: :1: b!!LL !'N'_'~;TFII..L. THE S'¢S'['E:H IN F:tE:CORDRNCE 1.4ITH THE CODES.
:'El I GNE[:,: ;~ ......... : ...............................................................
f:lf:'F'L I E:RN'F GEI:;:'.FILD C SECHR I
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Comple~:'legal description
Lot 17: T12N, Section 10
Location (site address or directions) 8503 Jade Street
Property owner
Mailing address
Lending agency
Mailin. g address
'Rosella Shones ,
20714 David Avenue
Day pgone 694-~B53
Eagle River: AK 99577
Day phone
Agent
Address
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE:OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
XXX
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
XXX
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.'
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 Ander.~on Rng~ n~r ~ ng Phone
Address p.o. Box 240773 An~h~r~g~ AW 99524
Engineer's signature '///~,~,4~c~ ~ ~ Date
522-7773
5/18/99
DHHS SIGNATURE
Approved for 7-/'//-/~'~/~'bedrooms.
Disapproved.
Conditional approval for
bedrooms, with th-e following stipulations'
Additional Comments
By:
////
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 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 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.
Legal Description:
A. WELL DATA
Welltype p~-{ v~l-~
Log present (Y/N)
Total depth ;~ (~ 5'
Sanitary seal (Y/N)
Municipality, of Anchorage O,.~c Fi I V 999E
DEPARTMENT OF HEALTH & HUMAN SERVICE9~ ~'""
Environmental Sewices Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3~474~
Municipality ol A~cnorage
Health Authority Approval Checklist Dept. Health & I~uman Services
N1/2, Lot 17, T12N, , S10 ParcelI.D.:. 011-161-19
If A, B, or C, attach ADEC letter. ADEC water system number
Y
Date completed 8 / 76 '
Cased to > 40 ' Casing height (above ground) ? ' +
Y Wires properly protected (Y/N) ¥
AT INSPECTION
FROM WELL LOG
8/76
Date of test
Static water level 1 90 '
Well production 1 0
WATER SAMPLE RESULTS:
Coliform 0 Nitrate
Date of sample: 5 / 1 2 / 99
B. SEPTIC/HOLDING TANK DATA
Date installed 9/28/88 Tank size 1 ~ 000
Foundation cleanout (Y/N)
Date of Pumping 5/5/99
C. ABSORPTION FIELD DATA
Date installed 9 / 28 / 88
Length 37.5 ' Width 1 8 '
Effective absorption area 675 SF
Date of adequacy test 5 / 9 / 99
Fluid depth in absorption field before test (in.);
Fluid depth 0 (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
5/9/99
91 .2'
g.p.m. 7.5 g.p.m.
.639 mq/L Other bacteria 0
Collected by: MEA
Y Depression (Y/N)
Pumper North] and
Number of Compartments 2 Cleanouts (Y/N) y
N High water alarm (y/N) N
Soil rating (g.p.d./ft~ or ff2/bdrm) _!_5_0_~LE__ System type
Gravel thickness below pipe
Monitoring Tube present (y/N) Y
Results (Pass/Fail) Pass
Bed
.5 ' Total depth 5 '
Depression over field (Y/N) __
For Three
Immediately after 502gal, water added (in.):
Absorption rate = > 450 g.p.d,
If yes, give date N / A
N
bedrooms
0
D. LIFT STATION - None on Lot;
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot ;, 100 '
Absorption field on lot > 100 '
Public sewer main N/A
Sewer/septic service line > 2 5 '
Size in gallons
"Pump on" level at*
*Datum
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
"Pump off" level at*
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~ .5 ' Property line ~ 5 ' Absorption field
Water main/service line
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Sun"ace water ~ 1 f) f) '
Curtain drain None on Lot;
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal
in conformance with MOA HAA guidelines~in effect on this date.
Signature"
Engineer's Name Hi ~h~] R Anc~,~, ? .--~.
Date 5/18/99
N/A
:'5'
Wells on adjacent lots > 10 fl '
Water main/service line
Driveway, parking/vehicle storage area > $ O '
Wells on adjacent lots > 100 '
HAA Fee $ ~°lF~), ~ ~ Waiver Fee $
Date of Payment {,-- \~ .~¢~ Date of Payment
Receipt Number f'/q~(r~% ( ~ ~'-'-~.'~/} Receipt Number
72-026 (Rev. 3/96)*
~Y-i?-g9 Og:18 FROU-CTE ENVIRON~NTAL
~i~I~.cT&EEn~ironmen,alServlces,nc.
T-781 P.OI/6Z F-787
CT&I~ Ref-#
Clien! Name
Proj~cl Name/#
Clien! Sample ID
Ordered By
PWS~
Sample Remarks
9920~1001
AndersOn Eng~n~ertng
N 1/2 Lol 17
N 1/2 Lo~ 17
Drinlong Water
Client PO~
Printed Da~e/Timc 05/17/99 09:02
Collected Da~e/Time 05/12/99 07:20
Received Date/Time 05/12199 08:00
Technic"ti Director; Stephen C. Ede
PQL
units
0.639
0.500 n~J/L EPA 300.0 10 max 05/12/99 05/12199 SCL
Received Time May.17. 8:I2AM
~UNICIPALI~ OF ~NC~O~A~
MUNICIPALITY OF ANCHORAGE D~PT. OF
DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO~ECTION~VIR~MEN~AL 825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION ~U~ 8 ~979
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing,
1. PROPERTY OWNER
MAI LING ADDR ESS
PROPERTY RESIDENT (If different from above)
PHONE
PHONE
PHONE
?_7
2. BUYER
PHONE
MAI LING A DDR ESS
MAILING ADDRESS
PHONE
MAILING ADDRESS
§. LEGAL DESCRIPTION
iTREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~-m J~ One [] Four
SINGLE
FAMILY
[] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUB LIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
'~ INDIVI DUAL/ON'SITE~
[] PUBLIC UTILITY
**If individual/on-site, give installation date
If system is over two (2} years old an adequacy test is required
by this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY · .
DATE RECEIVED
INSPECTION APPOINTMENTS
-IME TIME TiME
DATE DA'rE DATE
INSPECTOR INSPECTOR INSPECTOR
, DIRECTIONS:
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
[] 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 []HoldingTank
Size: If Tank is homemade SOILS RATING
give dimensions:
-rYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
~ DISAPPROVED
DATE BY {Title) ~
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
2 'I"Si'REI~i
,:',;,:(;} i()R/-Gt}, ALASKA 99501
{90/) 2f.;,i 4 l/'l
August: 14, 1979
Gerald C./Rosella E. Sechrist
8503 Jade Street
Anchorage, Alaska 99502
Subject: T12N R4W Section 10 N½ Lot 17
Approval for your individual
can not be granted until the
completed:
sewer and water facilities
following items have been
(1) The power to the subject property will need to be on
so that a water sample may be taken.
(2)
There is apparently no septic tank between the house
and the leaching area. A 1,000 gallon septic tank
will need to be installed.
(3)
A percolation test be performed on the existing leaching
area. This test will determine if the system is adequate
according to National Standards. A listing of private
firms performing the test is enclosed. If the test fails,
a soils test needs to be performed and a permit for the
upgrade issued by this department.
Please notify this department for any further questions you
may have at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Fred T./Sue M. Trimble
Box 4-488 99509
~,. MUNICIPALITY OF ANCHORAf~]
Departme~.~ of Health and Environmen%__l Protection
825 L Street, Anchorage, Alaska 99501
264-4720
uest for Approval of Individual Sewer and Water Facilities
Property Owner: Gerald C. & Rose E
Mailing Address: 8503 3ade'
;echrist
Dne: 243-4456
Name of Buyer: James C. &
Mailing Address: 9413 Canl
Lending Institution ~1 Bank
ATTN: Larry
Mailir Address: 7-025
Phone: 344-9019
.aska, Mort. Loan Production
99510 Phone:265-2882
o
o
Real Sherman
MailLn9 Addr~ 10--31 St. ~n~ Ak9_~1 Phone: 272-31~0
Legs ~Descr~ hion: BLM 17, Se~ ~,~0, T.12N., R.4W., S.M.
sere i~ion: ~50~ ~de stree~ ~
Single Fam~l~Res~nce: (X)~mber of Bedrooms-
Multiple F~Residence: (~umber of Bedrooms:
Water ~ ~/ *Individ~a W 1 20~) Public/Co~unit~ ~ys~em (
Sewage isposal System: *~n-site System (X) Public System
If On-site System, date of installation: unknown
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2)
test is required by this department. ENVIRONMENTAL PROTECT[ON
A fee of $25.00 must accompany each request before processing
can be initiated. ~Ui~,i ~O 0 IC~78
RECEIVED