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