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Home My WebLink AboutCENTERPOINT HOMES TR 1Onsite File servedLot is by public • Formerly•pel Blk 3 Lots 8 & MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsit0 e ell Decommissioning Lo Legal Address: Subdivision 'W 6�-- p i �� Block Lot T R Section Lot On-site Water & Wastewater Section certified contractor performing the well decommissioning: Name: � C f Signature: l Cqmpa�y, y Well decommissioning date r3� Method of decommissioning: AMC 15.55.0601-1 a. ❑ b_ ❑ C. Location: Use the space below to provide a drawing of the property showing the following items: • North arrow • Decommissioned well location • Location of other water wells on the property • Two separate swing -tie distances for each well shown on the drawing Note: The swing -tie distances shall be measured from either permanent structures or the property corners. �v 0 f� ti G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Well Decommisioning form.doc ' ~J' 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 ,~ PHONE '~ ' ~AILING ADDRESS NO. OF BEDROOMS LOCATION ~ ~t ~ ~ Manufacturor Mato ~o. of compartments /~dO IF HOME'DE: ~ DISTANCE TO:, Distancebetwe~z~, Material beneath tile ~ ~ Topoftiletofinish grade~ / ~ / Total effective absorption area a Class D~ ~. Depth Driller Distance to lot line PER~IT NO. OTHER PIPE MATERIALS p/~ ~ REMARKS ~ l . ,/, / ( 72-013 (F ~ PERMIT NO. DEPBR. TMENT ~.':.,~'/HEALTH AND ENJ"IR_NMENTHL'F - ]~CTELT_LN" B25 '"L'" STREET, ANCHORAGE., AK. 99501 264-4728 FIPPL I _-:ANT LOC:AT I ON LEGAL JIM MONI"RGUE El,ID _ TEEET ~, B B W.G. PIPPLE S,-"D PO BO:."~ S~tl 4.:.._,~,~4 SL.]LIRRE FEET '-- - "='- ' ' ' '-'"- IS: TYPE OF _-,uIL HB_,uRFTIuN ='r,=TEM TRENCH MR;,.',IMLIM NUMBER OF BEDROOMS SOIL RATING '"q-' -" '"- ,,._l,:,. FT,~ BF.. - 100 '- '~' ':'- __ "~'"-- 'IS THE REQUIRE[:' =,I,::.E OF THE -,uIL RB':;-,nRF'TION _-r._,TEi'l : [:'EF'TH= "-' --' - .=. LE~-~3TH= --'"- b: ~3 F-: fFq %'~ E L DEF'TH= 4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR 'TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN 'THE OUTFAL. L PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F.:E _F-~L~ I F.:EC, SEP]- ][ C: TFt[-~:-'. .=. I ZE= IOEii----"i L-~NLLL~r~ PERMIT APPLICANT HRS THE RESPONSIBILITV TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY ]'HIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL. AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC: WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE PROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICRTIONS AND CONSTRUCTION DIRGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT 1: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTRLL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. SIGNED: .......................................... RPPLICRNT JIM MONTAGUE ISSUED BY_ .............................. F-:'ATE - &L- .... PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 ~ 4 8 9 10- 11 13- 14 15 16 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST D^TE PERPORMEO: [] SOILS LOG WAS GROUND WATER t ENCOUNTER ED? pO E IF YES, AT WHAT DEPTH? [] PERCOLATION TEST 17 Robert A. 18 19 ,, ;, : , ' ~,.-: :~.: 20- Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN * FT AND FT / .~ -- .~ COMMENTS EJ'.~,~ ~"/~'~'~" ~''~'-J""~'~"~"~' /'''~ ~ ~'~'~"'~"~''~ ~ ~' ~¢2 ~//,~ 72*008 (6/79) MUNlaPAnTY OFANCH,ORAG = DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date /~/~1(~ GENERAL INFORMATION · Ia) Legal Description (include lot, block, subdivision, section, township, range) xtion (address or directions) (b) Appli'c~nt Name ~ (F bb Telephone: Home Busino88 ~pplicant Address (c)' Applicant il (check one): Lending Institution []; Owner/builder []; Buyer []; Other [z~r (explain); (di Lending Inst[tuti'on Address Telephone (e) Real Estate Compar~y and Agent Address Telephone (f) Mail the HAA to the following ad, dress: TYPE OF RESIDENCE Sir~gle-Family ~]"/Multi-Family [] Number of Bedrooms --~ Other WATER SUPPLY Individual Well ~j~ Community [] Public [] -% Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: It community well system, must have written confirmation from the State Department of Environ mentai Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION A'S cedified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval 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 S 8, S Er~'i~l~d~ Telephone Address Date 6. D.EP^PPROV^L Approved for bedrooms by Date · Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes'and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Legal Description' .... I:1 Vi-I) WELL DATA Well Classification ~¢.Ak~ ~ If' A. B, C, D.E.C. Approved (Y/N) Well Log Present~l~ '~- Date Completed "'~(zv,>rz-"C~ k~ Yield Total Depth [~l Cased to. L~ Depth of Grouting Static Water Level ~:::~ Pump Set At ~ ~'~ Casing Height Above Ground ~ Z~ t.~- Electrical Wiring in Conduit~,.N]' Separation DJ'stances,~ from Well: ~¢ ~)~t To Septic/Holding Ta.nk on Lot Sanitary Seal on Casing Y~>F~ Depression Around Wellhead ; On Adjoining Lots To f~earest. Public Sewer Line Cleanou~anhoIe Water Sample C, ollected by To ~earest Edge. of Absorption Field o~jl~ ~ 0 ~, ~ ; On Adjoining Lots To Nearest Public Sewer Water Sample'Test Re'suits Comments ~ '-~¢'[~¢~ SEPTIC/HOLDING TANK DATA Date Installed ;~'~'~'--~1 Standpipes~C~,N'~ Size /006) No. of Compartments Air-tight Caps~)/,N'~ Foundation Cleanout Date Last Pumped Depression over Tankx(~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~t'~/~ Separation Distances from Septic/Holding Tank: TO Water-Supply Well '~ ~:~0 ' To Property Line ,~'d~ ¢'~ To Water. Mafrl/Service Line ' ' "~ "~- Course f-'//¢.--- ; for ~-- Temporary Holding Tank Permit (Y/N) To Building Foundation /-'/~ ! ~ To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~,-~ ,.~'~ ~'5 Width of Field '~ ~(.~ ~ ~¢o Type of System Design Length of Field ~(5 Depth of Field Square Feet of Absorption Area Depression over Field JCY""~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ,,/z2,/ ~' To Building Foundation z~/r(_..,) Lot '~"~/t~ Gravel Bed Thickness Standpipes Pres e nt~,N')' Date of Last Adequacy Test To Water k4em/Service Line .~<~-~, ,c_ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~O? ¢ To Cutbank (if present/~4 D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Bequest ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~ ,~ ~ [~In~n~l~ Date ~ ~/,/~,~'-~' . Company ~.~e ~er, ~.~ ~ MOA No. ~o~ Receipt No. '~'~'7~ ~ Date of Payment ~ -/~-~ Amount: Page 2 of 2 72-026 (11/84) p.o. B '. 1966 0 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES March 21, 1986 Robert Shafer, P.E. S & S Engineering SRB 196X Eagle River, Alaska 99577 Subject: Lot 8 Block 3 W.G. Pippel Subdivision Waiver Request, WR86-038 Dear Mr. Shafer: This Department has reviewed your request for a waiver of the separation distance required between the septic tank and well on the subject lot. The 100 foot separation distance required by 18 AAC 72.021 will be waived to 80 feet pending an inspection of the septic tank to ensure that the tank and wasteline couplings are in good condition and are not a source of contamination. In order for this waiver to be considered valid, an inspection report verifying the integrity of the septic tank shall be submitted to this Department prior to June 15, 1986 by an engineer registered in the State of Alaska. This waiver is valid for a three bedroom single family dwelling only. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER OISPOSALSYSTEM DESIGN ROBERT A. SHAFER March 1 I, 1986 CIVIL ENGINEEH 694-2979 Municipa~ty of Anchorage Department of He~h and H~man Services 825 L Street Anchorage, Alaska 99501 JVIUNICIPALITy OF ANCHORAGE DEPT. OF HEALTH & ENVJRONMENTAL PROTECTION RECEIVED ATTENTION: Susan Oswalt REFERENCE: Lot 8; Block 3; Walter G. Pipple Subdivision Request you issue the attached Health Authority Approval and grant a waiver for the horizontal separation distance b~tween the private well and septic tank of 80 fe~t. The well on this property was installed prior to 1970, however, the on-site wastewater disposal system was upgraded from a cesspool to provide a Municip~y approved system in 1981. At the time the new on-site wastewater disposal system was insta~ed the Municipality granted a waiver for the septic tank at 80 feet and the Municipality did grant a Health Authority Approval. It is our opinion that the horizontal separation distances prescribed by 18AAC72.021 are not required in this case. The topography in the area is generally level and the w~l is known to have a depth in excess of 130 feet. There is no water table evident from soil analysis that leads to a depth of 13 feet and the static water level in the well casing is approximately 30 feet below the surface. All septic tanks insta~ed in 1981 were required to have mechanical seals and since this system was inspected by Mr. Les Buckholz, senior sa~tary engineer for the Municipality, it is assumed that the tank was properly installed. Risk analysis performed by us indicates th~ no bacterialogical pollution from this septic system of the private w~ on this property is possible. If we may provide additional information, please contact us. ~T A. SHAFER, P.E. ~AS/ss SRB 196X EAGLE RIVER, ALASKA 99577 TIME" TIME TIME ~NSPECTOS ~ HSPECT{~,(.~ . ~UNICIPALI~ OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~viRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION FEB 2 0 1981 Telephone 264-4720 D~rEI~IC~ ]1R~CTIONS: CompleJe all i)Brls oil j]age 1 . Incomplete reque~ls wig nol be progessod. Please allow ~en (10) days for processing. 1. pROPERTYOWNER PHONE ~08 _JOH~ & ~RY F. DAVIS 625-0906 - MAILING ADDRESS ~N End Street, Eagle River, Alaska 99577 None ~n~,~ C: 5 ~_B~r 349-3888 ~AI[ING ADDRESS PO n~ ln-/.97 ~,,~ c~ A~ ~K 99511 3 L~*GT~STJ?0T~N ............ ' o - - ' - PHONE MAILING ADDRESS 20~ ~. 36t~ Ave. ~ ~cho~a~e~ ~ 4. SEALTOS/AGENT J PHONE Totem Realt~.I~c/Jim ~qntague ......J 694-9494 Box 911~ Eagle River, ~ 99577 ~PLEASE CONTACT JIM MONTAGUE PRIOR TO INSPECTION 5. LEGAL DESCRIPTION Lot 8._B~_~k--3~ Pipple_SJahd/v~sion ;TREET LOCATION NHN End Street~ Eagle River~ AK G, TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY NUMBEH OF,BEDROOMS One [.7 Four Two [] Five Three [] Six [] Other 7. WATES SUPPLY INDIVIDUAL' [] COMMUNITY PUBLIC UTI LITY INDIVIDUAL/ON-SITE'' [] PUBLIC UTILITY ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log il awdlat)le.) ~]ot Avai l, YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONlY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY I_J ONE L~J THREE U_} FIVE [~J OTHER [] MULTIPLE FAMILY [~] TWO L-'] FOUR [] SIX ~2, WATER SUPPLY PERMIT ~ INDIVIDUAL DEPTH OF WELL ~ COMMUNITY ~ PUBLIC UTILITY Connection Verified ~ LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PeRM~ NUMBER ~ INDIVIDUAL/ON -SITE DATE INSTALLED ~PUBLIC UTILITY Connection Verified ~SoplicTank or [~HoldingTank Size: _~ I[ Tank is homemade SOl LS RATING give dimensions: 4, DISTANCES Septic/Holding Tank WE L L TO: 5. COMMENTS ~ ~ C~PROVED FOR ~ BEDROOM~ , ~eONDIT,ONAL APPROVAL (letter mUl~/co~pa,w ce,lifica/e) ~ DISAPPROVED ~ Q ~/.,~t~