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HomeMy WebLinkAboutYERTON LT 126B -l--t~ MUNICIPALITY OF ANCHORAGE ,~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION {l~,~l~J ~1¢. ~11 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL ~ESCRIPTIg~ ~ __ ~ LOCATION / J - / / ~O, OF BEDROOMS ~ ] Well ~ /- ~ / ] Absorption a~ ( Dwelling '~ I ~ Z Manufact~ J ~ No. .~Z~ ' DISTANCE TO: Well~/' ~wellin~ PERMITNO. O Z ~ Manufacturer Material Liquid capacity in gallons Well- .--` FounOatio~o' Nearestlo~, ;!~ DISTANCE TO: /~ ~ / ~ Top of tile to finish grad~, '~ ..... Material beneath tile /O~ /'inches Totale~r~'area Length Depth PERMIT NO. ~ ~ Type of crib Crib diameter Total effective absorption area ~ Well Building foundation Nearest ~ot line ~ DISTANCE TO: ~ CJa~/ ~ ~ ~ ~ Driller D~stance to lot line PERMITNO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIP'MATERIALS 72-013 (Rev. 3/78) F'ERM I T' ,NC) ~. DA Tlii'] I SSLIED: A F"'Fi_ I CANT: ADDRESS: CON'TACT' PHONE,", I._EGAL. DESCR Il::': LOT S I ZE: U'"'ll IL.~ IN[ ][ L,. ::Hi F:~' ~:~ IL.... ][ DEPARTMENT OF:' HEAL.TH AND ENVIRONMENTAL PROTECTION , 825 L. SI"REET~ ANCHORAGE, AK 995()1 26 Zl.-.47 Z.'.~O ~11:::1~ Ih,,~ '-- ~!]]S ][ -IF lei ~ E: ~,,,11E~: F~ F"" E~: IR P"~ ::~: '"11'" 84" 9 :' R ~A~ 1 ../,:~:..::, 18 .I. ,.,~=~,~ ENGINLE,.R].I lb ~UBDIVIS]I:ON~ N1/2 LOT~ 126 ~LOCK: NA SEC'T'ION: 9 TOWNSHIP: 15N RAN~)E~ 1W 1,,25A (SQ.FT. OR ACRES) I c e r 'E i £ y :~,. :1: am t. hat: ~'am:i,'.l. iaP wit. h t,I]~ i',~i, qL~:i.l"c~mcel']'lLS ~'l:)l'~ Oi]~,..sj.t.~ ~wer~ and fc:mt.l"~ by t. he Municipality c)r Anc:hc~rage (MOA) and the State c:~f' Alaska,, I will ir~si',,all the system in ac:cc~rdance with aI1.M(,[iA c:c)de~i and :i.n cc)mpliance with the desigl"l ~:pitePia c)J' this per'mit. I wi].], a~dhel"e t,c~ ali. ffl[]~ and S'~.a'~(~ iii' Aia~;il.::a i',eq~.~:i.l'ellll~:~l'lt!~ J'~:)l" dist. ances f'pom any existing ~e:l.:l., wastewat, er dispersal sysi:em of public IF A I,..IFrT STAT'ION IS INSTALLED IN AN AREA COVIa:RED, BY MOA BUIL.,DING CODES, THEN (:1,) AN ELECTRICAL, F.'EF~MIT AND INSPECTION MUST BE OBTAINED; (2) AS-.BUIL, TS WILJ_ NOT BE APPROVED NI'THOUT AN EL, ECTF~ICAL INSF'ECTIDI~I IREPOF~T; AND C];) T'HE EI_EC, TF~I[::~L W[,1RK MUST BE DONE BY A i..ICENSli~D EL.I!~:C'TT~ICIAN. SOILS LOG MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTIVlENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST~ 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST/~ ~ / ~ ~/~'~ 2 4 5 6 7 10 15 16 17 18 19 2O COMMENTS ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~"~ ~ (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: 72-008 {6/79} 101 DIilLLING WAT£R WELLS W. H. Selby Sial R~. C, Box 8~ .~';'(.-'/ . Palmer, AK Name: ._ "; ~ , s:_. Lc~Z~ /2_~ Anchorage 279-1938 Palmer 745-3351 Glennallen 882-3413 Results oun~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmentar Services On-Site Services Section ~ P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AU'THORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 126B Yerton Subdivision Location (site address or directions) 20129 Upper Bowery Chugiak, AK ·' Property owner·" Mailing address Lending agency Mailing address Jack Anderson P.O. Box 671785 Chuqiak/ Day phone 688-1173 AK 99567 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Floral 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. $ & $ ENGINEERING Name of Firm ...... , Address Eagle River, Alaska 99577 Engineer's signature. ,~'~'?,v~ Phone _G _Date. DHHS SIGNATURE --~ Approved for bedrooms. Disapproved. -- Conditional approval for bedrooms, with the folloWing stipulations: Additional Comments 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to 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 errom or omissions in the professional engineer's work. 72-025 (Rev, 1/91) Back MOA #21 MUNICIPALITY 0F ANCHORAGE ENVII{ONMENTAL ~'½t~RVICE$ DIVISION Municipality of Anchorage dUN 0 DEPARTMENT OF HEALTH & HUMAN SEFIVIC~ff ~u ..... Environmental Services Divisien I~ ~ ~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-~NMEN'rALsE~WC~S Health Authority Approval Checklist LegalDescription: ~-Cr-j" I~-:/,_g~ L-I~'.~--Q'-73~-}<~lp Parcell. D.: A, WELL DATA Well type ~ ~ID,~t ~ ~'~-5/V'L~I_ f A, B, or C, attach ADEC letter. ADEc water system number Log present~)( \/~'/~-fr-~/¢/C'./-~at e corn plet e d Total depth ////.¢ ! Il Cased ,o~//¢~/~¢'~ z~C-P~¢./~Oasing height (above ground) FROM WELL LOG Date of test Static' water level Wires properly protected (~N) AT INSPECTION JUN 05 1997 Well production t:.) I/~- g.p,m. ~ -- WATER SAMPLE RESULTS: Coliform (/~ Nitrate ~, .~ ~' Other bacteria g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed Ir-'[~/~~/ Tank size //~)E2~) Number of Compartments ;'~ Cleanouts~---~l) V -- Foundation cleanout~J~) ~ Depression (Y~ ~/ High water alarm (Y/N) / Date of Pumping"' ~- ~- Z¢'Pumper '~, ~ Bate instai~ed' /~*¢ S,!(?ting (g.p.dJ*'or fF/bdrm)~// _ System type Width Gravel thickness below pipe _ Total depth Effective absoCption area _ ?~ Z/'~ Monitoring Tube presentc~) _ Depression over field (Y~) Date of adequacy test '¢;- ~ ¢~- ? Results~¢~ail). ~¢¢' For ¢ bedrooms Fluid depth in absorption field before test (in.); Immediately after~gal, water added (in.): Fluid depth L/~ r'¢ ' (ins) Minutes later: J ¢0¢ Absorption rate :: ~¢ g.p.d. 72-026 (Rev. 3/96)* LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pum~ "Pump off" level at* High water alarm ~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~ ~' '~ ~' ~' '~- Property line Absorption field Water main/service line bt A--- Surface water/drainage /oO \j~ Wells on adjacent lots SEPARATION 'DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation · Water main/service line Surface water ~ og) I. t~ Driveway, parking/vehicle storage area · Cur~tain drain. ~o ,~d~ ~'~ ~ Wells on adjacent lots ~.~ E~GINEER'S CERTIFICATION F in conformance with MOA, HAA auidelines in effect on this date. ~/~ ~ '%~ Signature ~ . Date ~/? ~-~ -- HAA Fee $__;~ ' ¢ Waiver Fee $ Date of Payment ~./~/~,Z Date of Payment Receipt Number ~/~ (~>r¢ /) Receipt Number ~/(~ Y 72-026 (Rev. 3/96)* Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "k" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 September 17, 1997 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 126B Yerton Subdivision Waiver Request #WR970052, PID #051-144-34, HA970223 Dear Mr. Cowan: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system anti a lot line has been approved. The waived distance is 5 feet from the leachfield to the property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744. Sincerely, Donna C. Mears Civil Engineer On-site Services ljw #7 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet 051-144-54 HA~ HA970223 Permit # Date Received: September 5, 1997 Legal Description: Lot 12 Yerton Subdivision Engineer: Robert C. Cowan, P.E., S & S Engineering 17034 Eagta River Loop Road, Suite 204~ Eagle River, Alaska 99577 Applicant: Jack Anderson Waiver Requested: Lot line waiver for 5 feet between the leachfield and property line. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: ~/ Waiver is NOT Granted: List Conditionslor ~easons for above: Date: 9' ~7~ By: '7~~ Nam~ of Reviewer Rec ~: #03201 Amount: $~ 115.00 Date Paid: Sept 5, 1997 ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS ENGINEERING STUDIES ANDREPORTS WELL LNSPECTION & FLOW TEST ROAD DESIGN SOILTEST STRUCTURAl& MECHANICAL INSPECTIONS September 4, 1997 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human P.O. Box 196650 Anchorage, AK 99519 Services REFEREN QE Lot 126B; Yerton Subdivision StP 5 1997 Municipality of Anchorage Dept, Health & Human Seryices Request you issue a Health Authority Approval on the referenced property and grant a waiver for the horizontal separation distance between the leachfield and the property line at five (5) feet. We do not anticipate any adverse effect on the adjacent properties. The property line is adjacent to Karen Avenue (see attached asbuilt survey). If you require additional information, please contact us. Sincerely, Robert C. Cowan, RCC/gk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 SEP-04-9? TtlU 10:13 RE/MAX OF EAGLE RIVER FAX NO, 9076960214 P. 02/02 t ~ ,R E h, I . /v ~°'5~' ~z"g ."- SEPTIC /o O~ A'C. /00,00' WEST /SG B ---- Lol , Blook ........ · Ancriorage Recording District~ Alasko LOT SURVEY CERTIFICATION /050 Date' Bro~ or Aluminum cqpp~d ~qnument recovored Iron pipe on,/or reb~r r~overed '.g X2 hub ~ tack reuovsfed 5/B"x~O"rebor sol this survey 'I~JVCE UNE (AF.:'P~OXo LOCA 7/OM) .... · . ~" Prepared by, / ($o~)~7~.~ao0. BUTTON 519 ~ ~/'~h/h ~v~, 000000000000 ~0~ 0 MAY-12-199? 16:51 CT&E ESI ANCHORAGE ~t~m~ C T&EEnvironmentalSe fyi c es In c, 90? 561 5301 P.05/~5 CT&E Rd.// Client Name Project Name./// Client Sample ID Matrix Ordered By PWSID 972256002 S & S Engineering N/A Lot 126 B, Yerton S/D Drinking Wamr Client PO// Printed Date/Time 05/12/97 13:05 Collected Date/Time 05/06/97 i2:00 Received Date/Time 05/06/97 16:00 Technical Director: Stephen C. Ede Sample R'~aarks: CT&E Microbiology Drinking Water Program certification ~tatus is provisional as of 4/8/97. ALtowab[e Prep Analysis Limits Date Dete init Nitrate-N 3.28 0.200 mg/L $Ht~ 4500-NO3F 10 max ~otal Cotiform 0 co[/lOOmL $M1§ 9222~ 05/07/97 JCl 05/08/97 RA14 ublect. [.ct 126B, :Yerton .Subdlylslorl:.."" . ' Well Casing Irlspection',,' · On Saturday, May n~e~ '~ th <'* '"" 24,,11997;.'~'we:'!i t~d e',well oq;[.Ot;-;126B Yerton Subdivision.,': At.the time of the. in~p¢~Ttion ,the. wel hbuse h'ad beer~ removed an~l', the.' :,,W. ell. Vcas ii'~' ha'd:i'l~ehi;~xp~'se'd .to:i~ bedr0.¢k;:, a ."depth' o~f aeproximately 'i5;.':' No ~ perfo~'~i ~nS.',".'or any oiher d~fd'~ma'tion (ir .oenetrafien of the casing,was,,noted?.~We Uid:':note however, the .well head did not have a:sanitary seal nor:,~was the,~'wiring exiting th~'::'well hea'd The purpose of .our inspection :;:Was,! to '.verify the well',-,cas ag was .not perforated Throdgh,careful observation,we are corivinced the well casing is no! perforated, ' Please advise' if;y6i~':have: add tiona qu'estions. Michael E. Anderson. PiE. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECIION FOR HEALTH AUTHORI] Y APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date March 27, 1986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 126~R_laE~on Subdivision Location (address or directions) North Birchwood and North Jay Hawk~d¢~ (b) Applicant Name Yerton Telephone; Home 688-2186 Business Applicant Address __~D~, R~x 670R5~. Chugj~k~ AK 9956_2 (c) Applicant is (check one): Lending Institution []; Owner/builder I~; Buyer []; Other [] (explain); (d) Lending Institution let Interstate - Anchoraqe Telephone Address (e) Real Estate Company and Agent Address Telephone (f) JCeil~the HAA to the following address: SRFI 19~x TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms J~3) ?h~ee Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding 'rank [] Note: If community well system, must have wrilten confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 z2-o25 (u/e4) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SI"ARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, ] verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, lunctional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on Ihe 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 regulatioes in effect on the date of this inspection. Name of Firm 'S ~ f, ,F.~z~.r, ec.~_~r~ SRR 1~ Address Date Telephone C,h" DHEP APPROVAL ..' ~/ . Approved for '~/f~"c~.~., bedrooms b _ ('~_~-~--'~k_~-__~ Approved ~ DisapprovCcY ConditionaP--' 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 (MO~j HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description:. ~,~¢" /,Z~,,. · yc:,¢.,r~ ,',.¢ 'r/c, WELL DATA Well Classification ~ ( '~.~,,.--~-~- If A, B, C, D.E.C. Approved (Y/N) Well Log Present .u~_ Date Completed ¢¢_2.X~ r-~ ,-~ Yield Total Depth ~"Z'J Cased to. OI 0 t ~-' Depth of Grouting Static Water Level /2? Pump Set At Casing Height Above Ground Sanitary Seal on Casing~(J~ Electrical Wiring in Conduit-'~;) ~"~-~ Depression Around Wellhead separation Distances from Well: To Septic/Holding Tank on Eot ' / ~ 0 I -~- ; On Adjoining Lots To Nearest Edge of Absorption Field on,Lot ~/p ~ /~' ; On Adjoining Lots To Nearest Public Sewer Line /'J'~'t.' To Nearest Public Sewer Cleanout/Manhole ~-- To Nearest Sewer Service Line on Lot Water Sample Collected by - '~---/-'~¢*-JG~l"/l~'c~J~¢ ;Date Water Sample Test Results Comments _~,~ '¢4(¢-'1-,4.~ ~-~O&~T~I'~ I ~ ~-~r~z_.4% ,!~ B. SEPTIC/HOLDING TANK DA'rA Size ~oc~ No, of Compartments Foundation Cleanout ,,,.,/?~Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) Date Installed Standpipes ~,N¢'. Air-tight Caps Depression over Tank ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: 1~ ¢- To Water-Supply Well To Property Line To Water.Maln/Service Line Course To Building Foundation '~%'-'*' To Disposal Field '.-'~/ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ..,~O *7cz ¢' Square Feet of Absorption Area Depression over Field,¢¢~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation /--//~ / Lot To Water'Mek~/Service Line ~; ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway. Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field / Gravel Bed Thickness Standpipes Present Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots .~42 / /~ To Cutbank (if present) _/,,~/~f~_ 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) "[~ump Off" Level at /d/' 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 I~AA guidelines in effect on the date of this inspection. Signed .~ ~' .S ~,~ineeHn~_ Date ~,Z'/...~ /,~ ¢ SRB 196x C°mpan~agle .~iv~, Reoe*pt No. Date of Payment Amount: $ MOA No. Page 2 of 2 72-026(11/841