HomeMy WebLinkAboutWOODED HOLLOW LT 6
NAME
MUNICIPALITY OF ANCHORAGE
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
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
DISTANCE TO:
Menu tacturer
gallons
NO. OF BEDROOMS
Absorption area Dwelling / PERMIT NO,
Material No. of compartments
ngth ~th
IF HOMEMADE:
Dwelling
DISTANCE TO:
Manufacturer capacity in gallons
Well Poundation / Nearest lot lin PERMIT NO
DISTANCE TO: __~/ '~ ~ ~
~ line~ Length of each lipe Total length~of li~ es Trench_~owidth inches Distance be
~op of tile to finish I ption area
Width PERMIT NO.
Type of crib Crib diameter ption area
Building foundation Nearest lot llne ~
Class Depth Driller Distance to lot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(si
DISTANCE TO:
OTHER
PIPE MATERIALS
INSTALLER
REMARKS
APPROVED DATE LEGAL
'I~ 72-013 (Rev. 3~78)
P.O. BOX 6650
ANCHORAGE, ALAS,KA 99502-0650
(907) 264-4111
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 10, 1986
TO: Permit Applicant
Subject: Permit # 850528
Lot 6 Wooded Hollow Subdivision
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If a private engineer inspected the installation of the on-site sewer system
the original as-built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan E. 0swalt
Program Manager
On-site Services
SEO/ljw
eric: Copy of Permit
DE~F:mAR]'MEN'f' OF IqlF.:AI...TI] AND IL"IxlVIf::;[]IqMIii:I',!TAL.
82.5 I.. ,u..'FI'T~[EET', ANCH[IRAGE, At::'. 99501
:.:?.6 4,..,4 7 2 ()
I I,F I lll Ixl[l~ 8, (~m8
DA'I'E I EiSLIED: SEil/:..?2/8[~
APPI..I CANT: S'T'ONES EXC,,
ADDRI~::SS'.' I:::',, 0. BOX 773272
EAGLE RIVER, Al<
CONTACT I:::'I'"IONE ~ 688'"<:?9 15
99577
L.I::.bAI.. D[....I(.,,~.I.I .... ~IJ}>:D[VI,~][.)N. WOODED HOIJ_CIW LJ]T:
,.mE.L,F .[011. 10 T[]WNf.~HIF:': :ISN F~ANGI!E~: 1W
MAX BEDR[IOH~:
I::I...[IL, I-,.. NA
L.z..,Lc.,d b~:,:.~].ow ai"e 't. he opt. loins available t,c) you :i.n clesJ, gning you1- sept,:ic:
sys'L~:~m. (]hoo~e the optic~n 'Lhat best f'its yc)ur site,,
.~...., L..L,k ~,~ , .L ~ ~. ~.-~ .~: ~',,.~
DE[F:"I"I,I TO F:' :1: PE BOTTOM (1:;:"1' ,, ) 4.0 4 ,, 0 4 ,. 0
I'.:;F~AVEI.. DIL!F'T'H (F"I".) 7,, 0 0,, 5 3,, 5
I'OT(~I,, DEF:'TH (I::'T ,, ) 11 ,. 0 4., 5 7.,
C~}RAVEI._ WIDTH (F'T.) ;~:2.5 17.0 5.0
GF~AVEI.., LENI:..YT'H (F:']'.) 27.0 34,, 0 4 1,, 0
GRAVEl..., VOLIJME (CI.I,, YDS..) 18.8 21.5 30.4.
TANK S I ZE (GALS) ' 1 ~t 0(?0.0 '~'r~ 1 ~ 000,, () -~"~' ]., 000 ~ 0 '~"x'
SOIl_ RA']'IIqG (S[;h.l::'"l",, /BI::~) 125 :1.25
-~!..x. TANK HL,I!~iT I'IAVIE AT I.Z::,A,::~I TWO COMF'AF?]'MEI~ITE~
cert, i fy tl"lat:
fDr't,h by the Municipality of AI"IchI3P~XgE~ (MOA) and tl~e State of Alaska,,
2. I wJ.].:l. :i. ns'Lall t. he system in ac:ccH~darlce wi'Lb all M[3A c:c:)df~)s and regular, it)ns,
f~l"id aft {:CHIip].i~FII::[2 ~Lt.t't 'Lhe d¢~sJ, gn crit, eria of' th:is peptllit..
3, I will alJhl~H',et t. fl a],~ MOA ar'id Bt. ate of Alasl::a r'~]qLl:[r't:~lllc.~ftt, s FOP the set, back
dis'Latices f'rc~m any e:.~$~t.~ng ~e:l.~. ~asl'.e~ater disposal system or public
f~ew~:H~ag¢~ ~yste~l ~:)n 'Ll'li~ oP arly ad.jac:erH'~ or near'by
4. I LU]depst. ar]d 'Lha]t Lhi~'~ permit, is valid for a rnat<:imum of' 3 bedpoclms al]d
any (~]l"l][~ll-~]~efn(}L~rl'[:, will, Pi~qLtJ. l"e an aclditic~rlal
IF: A I.,..IF'T S"f'A"I'ION ,I..,~ .[N,:,IAI.,..LI~.D IN AN AIxI_A C'OVERli':"D BY MOA EUILDING CODICES3,,
THEN (1) AN I=LFLL,]RII,,AL I-I.l~HIl AND IN.~IZL, F1UII MU,ST BIE OBTAINED; (,::.)
NII,.L, NOT BE Al ...... FRO?ED~ - NITHOUT AN E,I.:.EC]~xZE,~L-'~' ' '"' ' 1N,.)F[!:b]IDN' ~'"'"" ..... REPOF/T~ AND (3) THE
~i:,L.I:L,I[d.I,,AL. NORI< MUST BE DONE BY A LICEI~ISED [..I_LCIt.IL,.I, AN.
~ ]. bi ,K:,D
AF F LI(.,AIII .
DATE:
DEF:'AFTTMEIqT OF HIiF:AI_'TH AND IE:IqV:I:RONMENTAL F'ROTECTION
825 L ST'I:~:EIFZT, hNCI-IORAGE, hi-::: 99501
:~:'.64 -4 ¥ 2.0
PE:]:~M :!: T NO: 8~:~ ()5:];'7
DATE
APPI_ I CAIqT':
ADDRESS
CON]'ACT PI"K)Nli~: ."
S'I"ONE:E~ EXCAVATING.
F:', [:),, BOX 7'7327R
EA(aLE RIVEI::~, AK 99577
688-29 15
LI~'.G Al... DESCI::~ t F:':
L,[)T SI
MAX BIZDRO(:)IqS:
SI.)BD I V ]:S ]:[)NI: WOODED HOI_I...,[)W LOT." 6
SECT I(]l',l~: 10 'TOWNSH Il:::': 15 RANGE: :IW
4C)C)44 (SQ,, F']',, [IR ACRES)
3
BLOCK: Nh
L:i. st.c:,d below are t, he c)p'Lic)ns availal:)le 'Lo you in designing ye)ur septic:
system. Chc:)(:)~e t.h~:? Ol:)t:i. or~ ti]at best fits yOLU" si'LB.
-IF" F~'. ~Z: ~'"4 ~:::~ II--'~ :E3; ~:: Z:) ~',,~ .. ~:], F;','. ~ ]:: P',dl
l:)l~i:l:::q*H 'TO P I F'IL-: B(:)FI"[:)M (F:'T'.) Zl.~ 0 4,0 4. C)
GRAVEL DEPTH (FT.) 7,,2, 0,,5 3,,5
')'[H'~L DI~:F:']"H (I:::'T.) ~ 11 ,, ;~'. 4.5 7.5
GF~AVEI. WIDTH (FI'.) ;:',,:~ 17,,0 5.0
(SI:~AVEI.. I...EIxlI~FT'I'I (FT ,, ) 2.4 ,, 0 :31.0 38 ,, 0
GRAVEL,. VI::)LI,.IMI~ (CU,, YDS,, ) 17. ~] :1.9.6 '28.
'T'ANK S I ZE (I~}AI..S) 1, ()00.0 '~-'~ 1, ()()0,, 0 ,~..x, 1,000.0
S(3IL, RhTING (SI:~.F:T. /BR) 1:[5 1 t5 115
~'~t "I'ANI< MUST HAVE AT LEA~]'F TW[) COMI::'AI::UFMI:~:NTS
certify that:
1. :t: am familiar wit[~ the reclu:i, rements t'c)r on-s:i.t.c.~ sewers and .we:L:Ls aer~ set.
for'[.II I]y t, he Munic:i, pality oF Ar:lchcn'age (M[IA) and the State c)t' Alaska.
2. I ~:i.l:l. inst. a].l 'Lhe system in acc:(:)rdance wit. h all MCJ~ codes and regulat,:ions,
and in compl:i, ance ~it.l'~ t, he,<::h.~igr~ criteria c:,f th:i.s perm:i.t.
3,, ]: wi].] a(:lheme '~'.~ a:l,]. MOA and St, at, c.) (::)t' Alaska re~quirem[mt.s t'c)r the set back
[BC~e&VE.H",T~g~;)) ~ay~'[,e)lll (:)1] thi!~ (:)1" any ad.jacent clr nearby lot,,
any [:~rl].ar'gemlent. wi:L:l, r~:aquir'e ar] addJ. t:i.c,"ia:[, i::)el"m:i.t.,,
I F A
THEN
IZI.J~ECTRI(:;AI... WORK MUS'T BE DONE BY A [,.]:CENSED ELEC]'R]:CIAN,,
S :1: (:"I,IIS:D
DATE:
API:::'L, :t: [;ANT:' ' ......... ~ ....................................................
STONES EXCAVATING
'~"'< ~ ~ ~. <~ ~,~ ,
]. ,::),:>U[::.I} BY
I_:I:FT STATI(:]Iq ]:S :[NSTAI..L,ED :[1\1 AN AI:~I:~:A (]:]V[.::RED. BY MOA BLJII_D ING []()DES,
(1) AN ELECTI:r4ICAL. PERMIT AND IIxI<L"';F:'IFJ:C:"I']:ON MUST EIE OBTAINED; (2) AS-BI.I:I:I....TS
NC)T BE AF'PI:;~OVED WITHOLJT AN EI_ECTR:[CAL INSI::'I~:C]"ION REF'OR]'~ AND (3) THE
MUNICIPALITY OF ANCHORAGE
DEPARTIVIENT OF HI:ALTH AND ENVIRONMENTAl. PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
4-
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
bd 0 0 p b-~ I't~
S/t-i'-/
COMMENTS
DATE PERFORMED: .~/ ~iC/~ (~.~
SLOP
SITE PLAN
ENCOUNTERED? . NO i i .~f .
IF YES, AT WHAT
DEPTH?
Reading.~ ~..-~'~,~ Gross Net Depth to Net
~'~-n~' ,(1~ ~ Time Time Water Drop
PERCOLATION RATE.
TEST RUN BETWEEN
/~rJ~~ (minutes/inch)
FT AND -- FT
72-008 (6/79)
by
DOC CO, dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TI:LEPHON E 688.2759
OWNER OF LAND
ADDRESS "=;
""~
LEGAL DESCRIPTION
DATE-Started __'//
Ended
PERMIT NUMBER
I)EPI'tl OF %'ELL --4 r,:,
STATI(' LI%'EI. OF W:\I'I£R F ¥.
DRAW DOWN FT.
GAt. S. PERHR __ ~/'!3
KIND OF CASING
KIND OF FORMATION:
From ;'~ Ft.
From , ':' Ft.
From,?,,' Ft.
From Ft.
From ~,~;'' Ft.
From/~ "," Ft.
From~_ Ft. to {/:__ Ft. ' r ~ rff~:r~ ~: : ' ' ~r r
From Ft. to__ _Ft ....
From__ _Ft. to__ Ft.
From__. _Ft. to__ Ft.
to '] --Fl, h ~ ~ ! :/:/ '.-¢' ' ;~, ~,;':'~ From.____ Ft. to ..... Fl
to ,,' (~Ft.~fv¢,<,4! ~/,, ~ / From Ft. to Ft
to i ~Ft. ''.~ '/ (, ,'c~[ _. ~ From ........ Ft. to Ft.
to Ft. ;'~.~ d,', ~ :','~ _ From [:t. lo _~_Ft._
to~; * ~Ft ~.~_~ ,' 4~' From Ft. lo ..... Ft
to~:;~(~Ft. )'~ I~,.,/I ' Y"3'J~ /':~__ 2',:/'i~J From ....... Fi. lo_. Fl.
From_ ~Ft. to ...... Ft
From
From
From .... Ft. to.___
From___ Ft. to .... Ft.
From Ft. to____Ft.
From Ft. to .... Ft.__
From Ft. to ...... Ft.
From_ __.Ft. to .... Ft._
From Ft. to. __Ft,
Frmn___ _ Ft, to Ft.
From Ft, to Ft,
Frmn __Ft. to
MISCL. INFORMATION:
DRILLER'S NAME :' ' r
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEAILTH
CERTIFICATE OF INSPECTION FOR HEALTI-I AU-FHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264~4720
Application Date August 5, 1986
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 6 Wooded Hollow T15N R1. W Sec. 10
Location (address or directions)
(b) Applicant Name Wi}bu:e Dittbrende~-i'elephone: Home 688-~.~319__. Business
Applicarlt Address S.R. 2 Box 412
(c) Applicant is (check one): Lending Insgtution
(d) Lending Institution ....... Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
P ic kup_~by applicant
TYPE OF RESIDENCE
Single-Family ~ Multi-Family []
Number of Bedrooms ....
Other
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite ~] Peblic E'_I Community [] Holding Tank []
Note: If corn munity well system, most have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
I;..'NGINEERING FIRM PROVIDINg, iNSPECTIONS, TESTS, FILE SEARCH, D.~.,.~ AND INFORMATION
As certified by my seal affixed hereto and as of the validation (:late sirown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastew~ter disposal system is safe, functional and adequate
for fl~e number of bedrooms and type of structure indicated herein. I further vedfy that based on tbe 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 ~unicipal Qnd Stero codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm ' -EA~E~IVE[~GIN~I~E~ Telephone
Address
Date ~' ~- ~ P.O. BOX 773294
Approved for ,~'~d,'/ bedrooms by
Approved _ _ ¢/_k__, ....... Disapproved
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorago Department of Health end Environmental Protoction (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 ti'tis as a courte, sy to purchasers of homes and tbeir 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
Legal Description: ,L~, t-
Iv~Ui,!iCIPALIT¥ OF ANCIIORAGE
DEPF. OF HEALTH &
ENVIRONMENfAL PROTECT/ON
' 1986
WELL DATA
Well Classification .,,~/~ ! ¢~//7-~- If A. B, C, D.E.C. Appro~zed (Y/N)
Well Log Present (Y/N) .'Y Date Completed ,~¢~'/~- 5-- Yield
Total Depth _ /¢// / Cased to /~';/
Static Water Level /~ ~' ¢
Casing Height Above Ground /~-/o /'
Electrical Wiring in Coaduit (Y/N) )/
Separation Distances from Well:
/
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Depth of Grouting
Pump Set At ~o
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots ~'/6o ¢
//~- / ; On Adjolmng Lots ~"f'oo '
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
~'~5 g~- ~,~ /~'~¢~'~ : Date ~-¢- ~
Comments
B. SEPTIC/HOLDING 'rANK DATA
Date Installed ~_;~_._-~¢._5] . Size /¢¢¢ .,~'/ No. of Compartments
Standpipes (Y/N) /v- Air-tight Caps (Y/N) ,,v- Foundation Cleanout [Y/N) _
Depression over Tank (Y/N) /¢ Date Last Pumcea
Pumping/Maintenance Contract on File (Y/N) '~/"~ : for
Holding Tank High-Water Alarm (Y/N) _
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /~ .5-- /
To Property Line /7 /
To Water Main/Service Line ,'-/o
Temporary Holding Tank Permil (Y/N) >"~
To Building Foundation
To D sposal Field ?"
To Stream. Pond. LaKe. or Major Drainage
Course /t//,~
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata //5-
Date msia,ed
Width of FieJd ~o //
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field ,-~ 7"
Depth of Field /.-~.-, ~ 8
Gravel Bed Thickness ~rT'z::r~' /
'~ ~'~.,¢: Standpipes Present (Y/N)
./V Date of Last Adequacy Test /~' ~"~'~
Separation Dislance from Absorption Field:
//~-/
To Water-Supply Well
To Building Foundation ./¢ /
Lot ~//~
To Water Main/Service Line ¢_/~ z
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line / ~ z
To Existing or Abandoned System on
; On Adjoining Lots ¢- 3~ /
To Cutbank (if present)
Comments
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 Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~--~"~ ~~ Date
Company
Receipt No.
Date of Payment
Amount: $
MOA No.
Page 2 of 2
72-026 (11/84)
Eagle River Enginaerio! Services
P, O. aex 7732~4
Eagre RlyeE AK 9!577
Seal
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
Environmental Health Division
CASE[ REVIEW WORKSHEET
CASE NUMBER: DATE RECEIVED:
S-7953 December 26, 1984
SUBDIVISION OR PROJECT TITLE:
I~ts 2A, 3A, & 4A
l'~I:l°°ded Hollow Subdivision
--( ~[!/PUBLIC WATER AVAILABLE
( i''~ ) COMMUNITY WATER AVAILABLE
(~/[~ ~) U LIC SEWER AVAILABLE
" /
71-014 (Rev, 5/83)
WASTEWATER DISPOSAL
Public Sewer
CHECKLIST
SUBDIVISION REVIEW
Subdivision
Community Onsite Sewer
Soil tests stamped by engineer, signed, dated, identified, etc.;
Sufficient soil tests to characterize minimum of 50% of subdivision
in probable absorption field areas;
Soil test locations accurately identified;
Perc test data adequate; 30
Groundwater monitored for Re days, with last month occurring
between Junel and: October 15;
Accurate topographic map;
Slope <25% in general region of original and replacement sites;
D.E.C. approval of community system plans (if applicable);
Bedrock outcroppings or shallow depth to bedrock;
Sufficient setback from creeks, major drainages, other water bodies;
Sufficient setback from cutbank or bluff;
Sufficient setback from probable private well locations;
Sufficient setback from community well(s);
Sufficient setback from curtain drains;
Curtain drains installed and ground water monitoring results shown;
Thorough site visit (walk-through) completed;
Minimum proposed lot size meets with DHEP and Zoning criteria;
One original plus two replacement sites delineated for each lot,
while maintaining all separation distances between replacement
sites, property lines, water supplies, water bodies, probable
building structure location, cutbanks, bluffs, etc., and in areas
having less than 25% slope;
WATER SUPPLY
ublic Water
_<':
/~.' :ommunity Water l/single-family Wells
D.E.C. approval of community water supply;
Known water supply problems in the area;
Water rights applied for from DNR for community wells;
Meets all separation distances;
Sources of contamination identified (dumps, chemical storage sites,
etc.;
Adequate water supply and acceptable water quality;
Review conducted by
KB5/eJ/D18
Date