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HomeMy WebLinkAboutROCKHILL BLK 3 LT 11Rockhill Lot 11 Block 3 #015-063-09 /~ MUNICIPALITY OF ANCHORAGE · . DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMEN'rAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT i L E G A L~D ES,'~:::H PTI O N LOCATION NO. 0 ~.[~ROOMS _v Well ~_? t w~, f. . DISTANOETO: /~O ' DwellingT~ PER~T~O~ ~ Manufacturer ~ ?~. Materi%~~ No. o~partments Liq. 9apacity in gallons Inside length Width Liquid depth ~0 ~ IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. 0 Z ~ Manufacturer Material Liquid capacity in gallons O Well Foundation ( Nearest lot line ~ PERMIT No. of lines ¢ Length facile Total ,.ffi~ Ii,es Trench ~dy~¢ ' ' ' ~ ~ Top of tile to finish grade ~ Material beneath tile i.ches Total effe~sorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line m DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPEMA*~7 ~ ~O I NSTA~ER /~ ,i APPR~ DATE LEGAL · Well 'Log ~o, ............ ~.~.~.r...z..5..L. ........ ~.q.~:.~.,9.: .f. .......................................................... Date m lete' d//~/.,.~.../. ~ ... . co p ct ............. f ...... t.. , .................. Depth of ~t~ ~ well . ' g ~"' Size of easin ~ / . Distance to water.. .~ . Distance to water while pumping .......... '¢~9 ..... at rate of . ..~.~6D. ............. gallons per hour. Formation j from J to I l I l I l I I I l l I ,,,~,~,~,rm~-T OF AiqCHO~AG [ DEP' OF HEALTH I I I L~T ii I~u~ 3 Driller DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE. ALASKA 99507 ILS !,~'~tLI ]"T' C,F Ftf-I,Z:pRB,BE DEPBRTMENT ~ HERLTH RND ENVIRONMENTRL .,~OTECTION 825 ~L' STREET, aNCHORBGE~ ~K. 9950i 264-4720 F'O B_,., t~.:~.-,.,~ =,0 STN FEF..MIT NO. ,'ol'""R'~-'''- l'..'-~ .) RPPLICaNT GOENTZEL BUILDERS INC LUL. RTIL N LONE TREE LEGRL L. tt B.~ ROCKHILL LAT SIZE SQUARE FEET~ . THE REQUIRED SIZE OF THE SOIL RBSOR. PTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET::' OF THE TRENCH OR ZHE DEPTH OF R ZRENCH OR. PIT I~ T~E DISTRNCE BETWEEN THE SIJRFR~kCIF UROLIND RN[:, THE BOTTOM OF THE E,.<C:R~,,RTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRR',,,'EL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL F"~ RND THE BOTTOM OF THE EXC:R',/RTION (IN FEET;,. PERMIT RPPLICRNT HRS THE RE=,PON_,IE, ILITT TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION IN=,PECTIUN_, OF RNY WELLS RDJRCENT TO THIS FR2PERT9 RND THE RE_,I£.,ENL. E=, THRT THE WELL WILL SERVE. NUMBER. OF ' ~' .... - Tt...IC~ ,:' <':' ':, I fI_.F E _-T I Of-dS. FIRE . ¢= . - '=-- -" - C I-~:E _r-!L! IRE[:. BRCKFILLII'.IG OF RNY =,'T_,TEM WITHOUT FINRL IN=PE_.] ION RND RPPROVRL E:V TFIIS DEPRRTMENT WILL BE '-$t tBJECT TO PROSEL':UTIC~N. MINIMUM DISTRNCE BETWEEN R WELL RND ANY ON-SITE SEWRGE DISPOSRL SYSTEM IS i00 FEET FOR R PRIVRTE WELL OR i50 TO 200 FEET FROM a PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET aND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. ' OTHER REQUIREMENTS MaY RPPLY. SPECIFICATIONS RND CONSTRUCTION DIaGRaMS RRE RVRILaBLE TO INSURE PROPER INSTaLLaTION. PERf-1 I T E.--...F I RES [)EC:EI'-IBEI~: 3:1.. 1 .... ~.i I CERTIFY THRT i: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN 8CCORDRNCE WITH THE CODES. 3: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. RPPLICRNT UOENTZEL BLIILDER~ INC PERFORMED FOR: 3- 4- 5- 6 7 8- 9 10- .-11 12 13 14 -15 16 17 18- 19 20 COMMENTS MUNI( DEPARTMENT OF HEALTH AND EN~ 825 L. Street, Anchorage, Alaska 995~1 264-472(I SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: SLOPE ENCOUNTERED? DATE PERI TEST Net~m~'--'~ to "'e'~ ' Gross Reading Date Time Time · Water ' Drop PERCOLATION RATE {minute~/inch) TEST RUN BE'FWEEN , FT AND , FT 72-008 (6/79) ParcelI.D.# MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, AJaska 99519-6650 (907) 343-4744 CERTIFICATE OF.HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 015-063-09 GENERAL INFORMATION Complete legal description ROCKHILL SUBDIVISION: LOT 11. BLOCK 5 Location (site address or directions)' 9900 LONE TREE DRIVE ANCHORAGE AK. 99516 Property owner. MARTIN NOVAK Day phone (907) 546-2950 Mailing address 6o2'1 w, TREE DRIVE ANCHORAGE AK. 99516 Lending agency Day phone Mailing address Agent. Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBEROF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide wdtten confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: ndividual on-site Holding Tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide wdtte~ confirmation from State ADEC lng to the legality and status of system, 72-025 (Rev, 1191) Front MOA #21 Computer Version 5. 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 indicatad herein. I further vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and i~sp 3Jion, the on-sita water supply and/or wastawater disposal system is in compliance with all M f/d State codes, ordinances, and regulations in effect on the date of this inspection. ! F ed to de a 'horeuah: .scie, Name of Firm ALASKAV Phone (907) 337-6179 Address 6901 DEBARR / / Engineer's Signature Date_ · / in conducting this evaluation, AWWC, In~.. scienflous engineering analysis of the system in accordance with ADEC and M~ ~ Guidelines & Regulations. The reported results described the performance of the system under the condllions ncoUntered at tlie time of the test, and eeparation distances measured to readily identifiable features. The ( )eraflonal life'of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the svaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects er encroachments. AJ44/VC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHH$. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or pedy is not authorized, nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE )(' Approved for 3 Disapprovect Conditional approval for bedrooms / OF,.. 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 DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not rasponsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91 ) Back MOA #21 Computer Veto[on Legal Description: A. WELL DATA Well Type PRIVATE Log present (Y/N) Total depth Sanitary seal (Y/N) RECEIVED Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVIC~T [ 3 Z000 ~ .... Environmental Services Division ~ 825 L Street, Rm 502 Anchorage, Alaska 99501 (907~,~il~ OF ANCH0~ ~NVIEQNMI~NTAL SEEVICES DIVISION Health Authority Approval Checklist ROCKHILL S,/D; LOT 11, BLOCK 3 Parcel LD.: 015-063-09 l'POSITIVE DRAINAGE AROUND WELL CASING] IfA, B, or C, attach ADEC letter. ADEC water system number N/A 60' YES Date completed Cased to 60' YES 6/16/B1 Casing height (above ground) *7" Wires properly protected (Y/N). YES Date of test Static water level Well production FROM WELL LOG 6/18/81 40' 40+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: 9/21 ,/2000 B. SEPTIC/HOLDING TANK DATA AT INSPECTION 9/'21/2000 42' 7.0 g.p.m. 4-.52 mq/L Other bacteda 0 Collected by:. A.W.W.C., INC. Date installed 8,/11/81 Tank size 1000 Number of Compartments 2 Cleanouts (Y/N). YES Foundation cleanout (Y/N) YES Depression (y/N). NO High water alarm (Y/N) N,/A Date of Pumping 9,/21,/2000 Pumper A+ HOME SERVICES C, ABSORPTION FIELD DATA **MT DOES NOT EXTEND TO BOTTOM OF FIELD (50.5" OF 72" IS USEABLE). SYSTEM ABSORBED AT LEAST 825 OF 1535 GALLONS ADDED. Date installed 8/11 ,/2000 Soil rating (g.p.d./ft2 or ft2./bdrm) 150 System type TRENCH Length 24' + 14' Width 3' Gravel thickness below pipe 6' Total depth 10.5' Effective absorption area 456 ft2 Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test 9,/21/2000 Results (paSs/Fail) PASS For 3 Bedrooms Fluid depth in absorption field before test (in.); Fluid depth 0 (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Computer Version **0 Immediately after 1535 gal. water added (in.): __ 0 Absorption rate = 600+ GPD NONE KNOWN If yes, give date --' .. L,,TsT*T,o. Date installed Manhole/Access (Y/N) ~~t~f~C-on" level at* "Pump off' level at*  .*Datum E, SEPARATION DISTANCES [*SEE Alq'ACHED WELL WAIVER REQUESTI SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100'+ On adjacent lots *92 100'+ On adjacent lots__ 100% Absorption field on lot Public sewer main _ N/A Public sewer manhole/cleanout N/A .... Sewer/septic service line 25'+ Lift station__ N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line 25'+ Surface water/drainage 100'+ Wells on adjacent lots 100'-.~.__ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main/service line. 25'+ Surface water 1 oo'+ Driveway, parking/vehicle storage area O' .__ Curtain drain NONE KNOWN F. ENGINEER'S CERTIFI(~A~IO,,N~/ I cerfify that I of Municipal rc'cord~ th~t~¥ Signature ~ Engineefs Nam~ Date~~ ~ld inspections and review systems are in conformance ~n this date. JEFFREY A. GARNESS Wells on adjacent lots 100'+ . ... HA.& Fee $ ,~"~ ¢-_~O, ¢ tim Date of Payment ///-,2 ~-! '5- ~ ~ Receipt Number O(¢',z~ I (_,_~'~'~l 72-028 (Rev. 3/96)* Computer Vets[on Waiver Fee $ Date of Payment Receipt Number George P. Wuerch, Mayor Mlm cipality of Anchorage Department of Health and Human Services 825 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us November 1, 2000 Jeffrey Gamess Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B Anchorage, AK 99504 Subject: Waiver Request for Rockhill, Lot 11, Block 3 Waiver Request #WR000089 Parcel ID #015-063-09 HA000518 Dear Mr. Gamess: Your request for a waiver of the required 100 feet horizontal separation from the private well on subject property to the septic tank on Rockhill, Lot 10, Block 3, has been approved. The approved separation distance is 92.0 feet. This waiver approval applies to the existing private well to septic tank separation only. Any fi~ture upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Services Waiver Review Worksheet WR#: WR000089 PID#: 0t5-063-09 Date Received: October 13, 2000 Legal Description: Rockhill, Lot 11, Block 3 HA#: HA000518 Permit: Engineer: Alaska Water & Wastewater Consultants, Inc. 690t Debarr Road, Suite 2-B, Anchorage, AK 99504 Applicant: Martin Novak Waiver Requested: 92 foot separation distance waiver between private well on subject property to septic tank on Rockhill, Lot 10, Block 3 Criteria: 1. Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2. Special Conditions: 3. Other: Total: Waiver is Granted: 'u~ Waiver is not Granted: List Conditions or Reasons for above: ~"¢F-- /')~7-/c'~(/Y~ [ ate: //- /- O0 Rec~: 06391 Amount: $625.00 Name of Reviewer Date Paid: 10113100 b/~q T- E~ T~f3L~ R, O, I 2.3 /.2 LOT 7, BLOCK 3 ~ LOT 9, BLOCK $ ~ LOT 10, BLOCK 3 5 ~ ~ .~oc~ ~ // -- 10/3/2000 :~_ ~::~ ..... ~t~, .~ ~ ~,~ o~w~ ~ ~. cousmTaNrs, ~UC. smc]:,, S.g.:;h Z;2~'L....~ ..... :.~..~ PREPPED FOR PHONE NUMBER: PAGE NUMBER: · .~ ........... MARTIN NOVAK (907) 546-29~0 1 OF 1 ffr ' ROCKHILL SUBDIVISION; LOT 11 BLOCK 3 "~--7953 ... SITE P~N FOR WELL WAIVER REQUEST ~ ALASI WATER & WASTEWATER October 12, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 9951%6650 Subject: Waiver Request for Rockhill Subdivision; Lot 11, Block 3 To whom it may concern: We would like to request that your department issue a separation distance waiver of 92 feet from the subject private well to the neighboring septic tank on Lot 10, Block 3. The following are some mitigating factors for the justification of the requested waiver: · The subject well is located uphill from the septic system, so it is impossible for surfacing effluent to migrate towards the well. The only path for contamination would be subsurface. The septic tank installed on Lot 10, Block 3, Rockhill subdivision is only about 92.4 feet from the private well located on Lot 11, Block 3. This encroachment has existed since 1981. Recent water samples from this well (copy attached) indicated no coliform bacteria and a nitrate level of 4.52 mg/L. Based upon the aforementioned facts, there appears to be minimal risk in granting the requested waiver (well to neighboring septic tank = 94.2 feet). If you have any questions, or require additional information, please contact me at 337-6179. Thank you for your assistanc~ and consideration in this matter. PredJetSi~ncerel~ i ~ 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Pr: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com \ /a..Ca~' ,/ ", 'N ~ LOT 24, BLOCK 2 ROCK HILL s/g ~'"~"~-.C.),~aNN~¥'/ / 10/3/2000 ~SI~ WATER ~ WAS'I EWA~I ER ~O~L~: .... :.~.:~ MARTIN NOVAK (907) 346-2930 1 OF 1 ROCKHILL SUBDIVISION; LOT 1~, BLOCK 3 ~PE OF WORK: ~POfess~OO~ SITE P~N FOR WELL WAIVER REQUEST ~;~ '~=~ 09-25-00 17:52 FRO~-CTE ENVIRONMENTAL 5615301 T-623 P.01/02 F-211 CT&E Environmental Services Inc. Laboratory Division 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 582-2343 Fax: (907) 561-5301 CT&E Ref. #: Client Name: Project Name: Client Sample ID: Matrix: PWSID 1005700001 AK Water 8, Wastewater Cons. n/a RockhUI Lot 11 Bk 3 Drinking Water Client PO#: Printed Date/Time: Collected Date/Time: Received Date/Time: Technical Director: nla 09/2§/00 17:45 09/21/00 16:00 09/21/00 17:23 Stephen Ede Released By: / Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Total Coliform (MF) 6 co~/lOO mi SM9222B 09/21/00 KAP Nitrate 4.82 0.5 mg/L EPA 3{30 10.0 09121100 SCi. ,i APPLI¢~"NT FILLS OUT UPPER HAL~'-'~ONLY PropertyO~mer Loye D. and Dawna L. Williams (Equitable Relocation Mgt.) Phone ~ ~ his k.263-3706 Maili~gAddress'' SRA Box 63-S~ Anchorage, AK. zIp~cQue 99507 hom~ 344-2876 Buyer Address Zip Code Lending Institution Phone Address Zip Code Realty Co. & Agent Phone Address Zip Code Legal Description Lot 11, Block 3, Rockhill Subdivision Street Location 9900 Lone Tree Drive Type of Residence ~ Single Family [] Multiple Family No. of Bedrooms 3 [] Other Water Supply )~ Individual . ,~ '~""'/ ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community~)~( ~ ' For wells drilled prior to that date, give welt depth (attach log if available). [] Public Utility Sewer Disposal ~ Individual Year Individual Installed: [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RECUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector inspector Inspector Inspector UB,O0 . Field Notes: {~ {~. O · ,MUNICIPALITY OF ANCHORAGE DEPT. OF ~,~/,LTil ~ ~~ ' NOV 3 RECEIVED (~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) D,SAPmOVED ( ) COND,T,~?ROVA~ Soils Rating Date ~wer installed Well To Absorption Area J O ~- Well Log Received ~-~ g-Il- ~ ~ ~,,,oT~,~ /~ ~e~.~T~,.~ .~ DArE RECEIVED DATE ~,~ ~- ?" ' DATE DATE ~ / , NSPECTO~...~ MUNIcIpALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI0r~PT. OF I-!EAL~;'{ & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P;~()[ ECTION ENVIRONMENTAL SANITATION DIVISION A[JI~ 2 0 '1981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S~E~ ~-J~cVLE[~S DIRECTIONS: Complete ali parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER , I PHONE VIAl LING ADDRESS PROPERTY RESIDENT (If different from above) ' ' PHONE 2. BUYER PHONE MAILING ADDRESS 3'. LENDING INSTITUTION I PHONE MAILING ADDRESS 4. REALTOR/AGENT~;' . I PHONE MAI LING ADDRESS 5. LEGAL DESCRIPTION L .r il 13/ t'( ;TREET LOCATION 6. TYPE OF RESIDENCE ~1~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Other [] Two [] Five /~ Three [] Six * 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 if available.) 8. SEWAGE DISPOSAL SYSTEM ,z'~' INDIVIDUAL/ON-SITE** /? ~'I [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79)