HomeMy WebLinkAboutT15N R1W SEC 18 LT 188B (GOVT LT) MUNICIPALITY OF ANCHORAGE
O, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
P~ONE
MAIUNGADDRESS //
LEGAL DESCRIPTION
kOCATIO~
~ / ~ ~ c ~ ~ d ~o. o~ ~o~
Well Absorption area/~ DwellJnB~
~ 2 Manufac r ~ No. of compartments
Liq.~y~ ,gens IF HOMEMADE: Inside length Width Liquid depth
~ ~ ~ Manufacturer/~1 [1/~14 Material Liquid capacity in gall~
~ Well//0 / ~ Foun~
No. of Hnes / Lengt~fx> I,; Total ,,n~,~
· . T ren~h E,~c)~ Disiance ~e~lil~
~ : Top of tile ,o~sh,rad~
" -- ri ) beneath~.~ , .~ ~ ~,~J Totaleffective,bsorption area
~ Length Width PERMIT NO.
~ ~ Type of crib Crib diameter depth Total effective absorption area
~ Well ~ Building foundation Nearest lot line
~ DISTANCE TO:
~ C~ass~. ~ ( ~pth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption a~ea(s)
OTHER
PIPE MATERIALS ~
~ ~,1 L TEST RATI ~
~EMAR
V
,,,
· [EFHF..TMEN1 HERL. TH RNE:, EN'¢IRONMENTRL OTECTION
,_,~5 "L ..~TREET., RNL. HUKHL:iE., RK.
, 264-4720
1t.4ELL II-.=-It~'-,~ E:, ,..~'4--q'S ]E 'FE-_- SE~...IER F"ERI'"I Z T
PERMIT NO. < 0~0726 )
RPPLICRNT
LOCRTION
LEGRL
LRRR'¢ WRIGHT
· c,,-, ~i~, Ti5 N RiW
LOT .I.,_,o SE] °"
SR:L BOX 22i5 CHUGIRK
LOT SIZE
999999 SQURRE FEET
TYPE OF' SOiL RBSORPTION SYSTEH IS: TRENCH
i'IRXIi"IUH NUHBER OF' BEDROOMS
SOIL RRTING (SQ FT/BR)= i00
THE REQUIRED SIZE OF THE SOIL RBSORPTION S¥STEI"I IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF' THE TRENCH OR DRFIINFIELD.
THE DEPTH OF' R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF ]'HE
GROUND FIND THE BOTTOH OF THE E',,<CRVRTION (IN FEETk
TFIERE IS NO SET WIDTH .FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRR',,,'EL BETWEEN THE OUTFRLL. PIPE
RND THE BOTTOM OF THE E;,'4CB'¢RTION (IN FEET).
PERI'lIT RPPLICBNT HRS THE RESPONSIBILITY 'FO INFORM THIS DEPRRTNENT DURING THE
INSTRLLRTION INSPECTIONS OF RN'¢ WELLS RDJRCENT TO THIS PROPERT'¢ RND THE
NUt'IBER GF RESIDENCES THRT THE WELL WILL SERVE.
T'i...iIC, < ;2S: :) ;i: NSF'EC]F ][ OI'-,IS RRE F.:EL~U Z RED, .......
BRCKFILLING OF RN'¢ S'T'STEI','I WITHOUT FINRL INSPECTION FIND RPPROVRL B'¢ THIS
[.,EPRRTMENT 1.4ILL BE SUBJECT TO PROSECUTION.
NINIMUi,I DISTRNCE BETWEEN R WELL RND RNa.' .ON-SITE SENRGE DISPOSBL. S'¢STEM IS
~00 FEET FOR R PRIVRTE WELL OF.'. ±50 TO 2~0 FEET FROM R F'UBLIC WELL DEPENDING
UPON THE T'¢PE OF PLIBLIC WELL.
HINIHUM DISTRNCE FROM R PRIVRTE NELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
T0 R COI'"II'RJNITY SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRE[:, RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 2.0 DR'CS
OF THE WELL COHPLETION.
OTHER REQUIREMENTS MR'¢ RPPL%.'. _,FEL. IFIE. MTILt4_,'= ' - -' -' '= RN[:, L._N=,TF. UL. TIoN'- ~ " " ' DIRGF.:RHS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
I CERTIFY" TFIRT
:L: I RI'4 FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SENERS BND WELLS RS SE]"
FORTH B~.~ THE I"IUNICIPRLIT'T~ OF' RNCHORRGE.
2: I WILL INSTRLL THE S'¢STEM IN RCCORDRNCE WITH THE CODES.
3.: i UNDER~TRND THRT THE ON-SITE SENE:R S'¢STEM f'lR~' REE~UIRE ENLRRGEMENT IF THE
RESIDENCE IS R~oDELE[:, ]"0 INCLU[:,E MORE THRN 3: BE[:,ROOblS.
~ SOILS LOG
TIVIE N PROTECTION [] PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
5~
6-
7
8
9.
SLOPE
SITE PLAN
11
13-
14~--
15-
16-
17
18
19-
20-
.~ ~,j .~ ~/~.COUNTERED~
£
Gross Net Depth to Net
Reading Date Time Time Water Drop
/
PERCOLATION RATE
(minutes/inch)
COMMENTS
PERFORMED BY:
72-008 (6/79)
BETWEEN FT AND -- FT
WAT, WELL DRILLING LOG
Dr13.3 ln~ Co.
Driller
I,oeatlon (address of, Township, Range, & section, ~f' known,
or dlst.nce from main road /-0 ~" /~F ~
Size of cas~nK. ,, ~ Depth of hole ~ feet. Cased to ~ .feet.
Stmt~c water level ~ feet (~) (be]ow) ]~-s~e. F~n~sh oF
well (check one) Open end (~), Screen (), Perforated
Describe screen or perforations
Wel~ pumoln~ test at ~J~ ~als. Der (i~ui) (minute) for / _
hOUr5
with-" feet of drawdown from static level.
Bem~rks /,3~,~ /mv ,/ ~, ,/-/,3 _ /7,/_.< .....
Depth ~n feet from
~round surface
Give details of formetlons penetrated,
size of m~terls]., colorand h~rdenss.
~/~' to '3"~
~__~I ....to
· --~---~--,- to ~ ~'
to
....... to
to
to
to
to -.,
to,
to,
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
~'),Z.%\ ...~ ~ _-~--~ HAA #
GENERAL INFORMATION
Complete legal description
Lot 188B; Sec 18; T15N; R1W
Location (site address or directions)
18220 Birch
Chugiak , AK
/' property ownei*'.' 'Larry Wriqht
.. ,'.Mailing address ~'
Lending agency
Mailing address
Agent
Address
18220 Birch Tree Street
Day phone 688-4060
Chuq~a~, AE qqR~7
Day phone
.Day phone .
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
3 ~
NOTE:
TYPE OF WASTEWATER DISPOSAL:
NOTE:
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.
Individual on-site
Holding tank
Community on-site
Public sewer
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/gl) Front MOA#21
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
Address
Engineer's signature
$ & S ENGINEERING
;/u~,~ Eagie kiver Loop ~oad No. 2u~
Eagle Rivej', Alaska ~577
Phone ~-~'-;~ ~ ?g
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
Conditional approval for
Additional Comments
bedrooms, with the following stipulations:
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 orderto satisfy certain federal and state requirements. Employees of DH HS 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
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
RECEIVED
MUNICIPALITt' Ol~ ANCHOP, AGE
ENYIRON/d~NI'/d. SERVICES DIVISION
Well type
Log present {~N)
Total depth
Sanitary seal(~)
If A, B, or C. attach ADEC letter, ADEC water system number
Date completed
Cased to q3 ~
! '/
Casing height (above ground) I/~ ~ 4,
Wires ~ropeny protected{~N) (~'E5
FROM WELL LOG
Date of test ¢//-'7'-/,¢'~
Static water level ~-~ ~
Well ~roduction ~
g.p.m.
AT INSPECTION
g,p.m.
WATER SAMPLE RESULTS:
Coliform 0 Nitrate
Date of sample:
B. SEPTIC/HOLDING TANK DATA,
Date installed
0,10
Collected by: ~]_%t:2
Number of Compartments _
Foundation cleanout~N) q1FS Depression (Y/~ ~ High water alarm (Y~)
'
Date of,'P, brnping ~ '~,~.~g~- ' Pumper
c. ,ABSeR'~'ION FIELD DATA
Date jhstalled
Length ~5' Width
Other 9acteria
$ & S ENGINEERING
17034 Eagle River Loop Road No. 204
Eagle River, Ala~k~ ~,77
2 Cloanouts. L'
Soil rating (g,p.d./ft= o ) /~t"J ~ ~ZSystem type ~
(~ ' ~ Gravel thickness below pipe .~ n Total depth /~)
Monitoring Tube present~) ~b% Depression
Effective absorption ares
Date of adequacy test CJ 'Z-/~ Results {~/Fail) ~45~ For "/'HEEE
Fluid depth in absorption field before test (in.)'; J'3V)4 Immediately after,¢0~ gal. water added (in.):
Fluid depth J (ins) Minutes later: ~ g m~ Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (Y(I'I'I~ ~0~¢ ~'~¢1 If yes, give date
over field (Y~)/lJ'C)
bedrooms
72-026 (Rev. 3/96)*
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
Size in gallons
"~:~n" level at*
E. SEPARATION DISTANCES
"Pump off" level at*
Wells on adjacent lots
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on Iol Ioo/+ On adjacent lots
Absorption field on lot !no ' On adjacent lots
Public sewer main ~ Public sewer manhole/cleanout
Sewer/septic service line ~+ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~'/* ~ ~+
Property line Absorption field
Water main/service line t0''~' Surface water/drainage I I~~+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation li~ '*' Water main/service line
Driveway, parking/vehicle storage area
~/h/o~J Wells on adjacent lots I bD ' ~'
Proper~y line {0'
Surface water lOC,
Curtain drain
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review
in conformance witb MOA J-IAA gui{;~lines in effect on this date.
Signature
Engineer's Name ~'~
Date
HAA Fee $ ~
Date of Paymen, ~
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL
During a recent Health Authority Approval on-site inspection
and test of the potable water supply well on Lot
e~==~ f~ of TIfN ~IW ]ECTI~N I~ Subdivision, the well's
productivity was determined to be .~6 gallons per minute.
The minimum well productivity required by this Department
(AMC 1.5,55) for a 3 bedroom residence is °3/ gallons
per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate, Restriction
of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This a~visory must be attached to all copies of the subjec~
Health Authority Approval.
M~Y-10-1998 ~0:01 CT&E ESI ~NCNOR~E 9075615~01
~'~ CT&E Environmental Services Inc.
CT&E Ref.# 952125002
Client Nnme S & S Engineenng
Project N~e/g N/A
Client S~ple ~ ~t 188B S~ 18 TI~N R1W
Matr~ Dr~ng Wa~er
Ordered By
S~caple R~.~ks:
Client PO//
Printed Date/Time 05/10/98 18:13
Collected Date/Time 05/06/98 11:57
Received Date/Time 05/07/98 13:30
Technienl Director: Stephen C, Ede
t~ethod
Aitowabte Prep A~aiysis
Limits D_Ote Date Init
3 ob/ ~00 mt/ No CoLi
0.100 u 0,100 m~j/L
TOTAL P. 0]
I: :msEnrc. COWAN, hE.
ROEIERTA. SRAFER RE.
ENGINEE~ING~IUDIEg
AND flEPOfll8
WELL INSPECIION
& FLOW ! ES !
WELL FLOW TEST DATA
LEGAL DESCRIPTION: /.er /fl~, ;~ I~.; 7~: ?F~k/
WELL DEPTR: ?0' CAS,.G DEPTB: ~ ~
DATE D.~LUNG COM.'ETED: ~/,/~'$DRILLER:
f /
~ISC. DATA;
CIVIL ENGINEERS
(gO?) 694-2§?g
FAX (gO?) 694-1211
TEST DATA:
DATE:
CASING tlEIGttT: I Z-" ~' SANITARY SEAL:
WIRES IN CONDUIt: , ~e , GRADING O.K.: '
BACTERIA AND NITRATE SAMPLES COLLECTED (date): ...q/~,/~',~
,
METER PUMPING DEPTH TO
CLOCK READING RATE WATER REMARKS
TIME (GAL) (GPM) (FT)
[RESULTS; WELL CURRENTLY PRODUCES0, 3G OPM WITH A ¢,;~ ' DRAWDOWN
TESTED BY: ~'
FLOW RATE NOT GUARANTEED-SUBSEQUENT VARIATIONS CAN OCCUR.
110,14 NORIll EAGLE RIVER COOP · SUITE 2114 · EAGI.E RIVER. ALASKA gg,~??
APPLIC! FILLS OUT UPPER HAL? )NLY
Buyer
Address Zip Code
Lending Institution ~( r~2~ ~
Address Zip Code
Realty Co. & Agent Phone
Address Zip Code
Type of Residence
~ingle Family
Indlvidua~ ATTACH WELL LOG. A w~l log Is required for all wells drilled since June 1975.
g Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time¢ ~)
Date Date
Inspector
Field Notes:
(~ APPROVED BEDROOMS ) DISAPPROVED
) CONDITIONAL APPROVAL*
DATE
'CONDITIONS OF APPROVAL
Soils Rating
72-023(3/82}
Date Sewer Installed
Well To Absorption Area / I (~'
Well to Tank t I 0
Well Log Received
Septic Tank Size