HomeMy WebLinkAboutT12N R3W SEC 33 LT 194T12N, R3W
Section 33
Lot 194
#018-331-07
Municipality of Anchorage Page I of '~'~
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
~d ~1~ ~/~,~ ~.~ c.'/-~ ~.'~ Wastewater System: ~ New ~ Upgrade
Address:
Phone: .% ~j /[ ~ ~ ¢ .~ ~ No. of Bedrooms:.~
¢~ ~'~ O .~J ~ ~ B Deep Trench B Shallow Trench BBed ~Mound DOther
Total Depth from original grade:j
Lot: JO~. Block: Subdiv~ion: Deplh to pipe bottom from odgiaal~de: Graver depth beneath pipe
T**,..:iX I~,n,: ,~ ~ ISection: ~ Fifladdedaboveoriginalgrade:~¢~.,Ft. Gravellength: ~0' Ft.
Number of lines: Distance between lines:
WELL: B New ~ Upgrade Gravelwidth: i-g' Ft. Z% I ~/..-~' Ft.
Classification (Private, A,B,C): Total Depth: Cased TO: Total absorption area: Pi e material:
Driller'
Da e Dr ed' S atio Water Level' Date installed:
Yield: ~ Pump 8~at: Casing Height Abo~e Ground:
SEPARATION DISTANCES ~s~p,ic u Holding U S.T.E.P.
TO Sepdc Absorption Lgt Holding '.,gc/Pd,a/e M~,faot,rer:~,~.~?~l/j Capacityi, gallon,= /OOO
From Tank Field Slatio. Ta.k Sewer Li.es n~-b~
~ ..... Material: ~' ~ Number of Compartments: ,
Surface ~
Water (~' ~00't', LIFT STATION
Lot
Curtain ~ I~ctri~llnspectionsperformedby: ~
('r ~ ~ 3 ) P ~& .~ ' ~ Location and Description:
Inspections performed by ~gle.iver, Alaska ~ Dates: ~st 2-11'-q*~
Department of Health and Human Serwces approval
72-013 (Rev. 9/91} MOA 25
PERMIT NO. SW990234 PAGE 2 OF 3
iV)u nicip, o, Li~. oF' Anchor'o, oe
DEPARTMENT OF HEAYLTH AND HUPfAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O, Box )96650 tAnchoro, oe, Mo, sRo, 99519-6650eTe~ephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LOT 194, SECTION 55, T12N, RSW P.].]). No. 018-551-07
PERMIT NO. SW990234
PAGE 3 . OF 3
Municip, ~i% o£ AnchoraGe
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.B, Box 196650 IAnchor-cge, ALcskc 99519-6650eTeLephone~ 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 194, SECTION 33, T12N, R3W
P.LD. NO. 018--331--07
FINAL GRADE
o~,~, C01MT1 / MT2 C02 , ,
GRADE
~FINAL GRADE
ST1 /ST2~-90'5'
%
·
NO WATER FOUND
69.0' B.O.H.
A B
FCO 30.0' 31.5'
ST1 84.0' 107.0'
ST2 90,5' 114,5'
DBL1 93,5' 117,5'
DBL2 95,0' 119,5'
C01 134,0' 167.0'
MT1 122.5' 157,5'
C02 124.0' 136.0'
MT2 135.5' 148.0'
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERPORMEO POR:
7
8
9
10
· 11
12
13
14
15-
16-
17-
18-
19-
20-
COMMENTS ?,5 ~"~
, I , ~CERTIFYTHATTHIS~j~ESTvZ~ AS PERFORMED IN
72-008 (Rev. 4/85)
IF YES, AT WHAT
DEPTH?
Depth Io Water AFter
Monilorino? Dale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
WAS GROUND WATER
ENCOUNTERED?
PERCOLATION RATE ~o ~ (m~nutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN ~ FT AND ~ FT
Township, Range, Section: 'l-'/.~.h,..[) '/~
SLOPE SITE PLAN
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6850
Rick Mystrom htr p://www.ci.a nchorag e,a k.us
Mayor
Permit Number: #SW 990234 Date of Issue: 7-29-99 Parcel Identification Number: 018-331-07
Date Started: ~-9-9 DateComl)leted: B'28.99 Is well located at approved permit location?~ Yes ~ No
Legal Descriptions; T 12 N R3 WSec 33 Lot 194
Property Owner'Name & Address: Newby Construction
12929 Tracy Way
Anchorage, Ak 99516
Borehole Data: Depth (ft)
Soil Type, Thickness & Water Strata From To
Stick-Up 0 2
silty gravel 2 37
gravelly silt 37 112
silty water sand & gravel 112 114
silt 114 t35
gravelly silt 135 147
silty water sand & gravel 147 150
Bedrock 150 190
Method of Drilling [] air rotary [] cable tool
Casing type: steel
Wall Thickness: .250 inches
Diameter: _6 inches Depth: 155 feet
Liner Type:
Diameter: __ inches Depth: __
Casing stickup above ground: _2 feet
feet
Static water level (from ground level): 63 feet
Pumping level: 190 feet after
_2 hours pumping 5 gpm
Recovery Rate: 5 gpm
Method of Testing: air lift
Well Intake Opening Type:
[] Open End [] Open Hole
[] Screened Start__ feet Stepped feet
[] Perforations Start 1t2 feet Stopped 114 feet
Grout Type: bentonite # 8 Volume: 1 bag
Depth: Start_0 feet Stopped feet
Pump: Intake Depth__ feet
Pump size __ hp Brand Name
Well Disinfected Upon Completion? [] Yes [] No
Method of Disinfection:
Comments: also pe/forated ]48 to 154 feet
Well Driller: Alpine Drilling & Enterprisesl
P.O. Box 110496
Anchorage AK 995t
T-h~41ter-shatl~provide~a-wdl logto~the-prc~pc,"'c/cwn~wvit-l~ 30-<ta~ys~f~completion and the property
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box '196650, Anchorage, AK 995'19-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Jul 29, 1999
Expiration Date: Jul 28, 2000
Permit Number: SW990234
Legal Description: T12N R3W SEC 33 LT 194
Design Engineer: 0003 S & S Engineering
Owner Name: Newby Construction
Owner Address: 12929 Tracy Way
ANCHORAGE, AK 99516-0000
Parcel ID: 018-331-07
Site Address: 003900 RABBIT CREEK RD
Lot Size: 82500 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
ROBERT C, COWAN, P.E.
July 14, 1999
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELLINSPECTION
& FLOWTEST
ROAD DESIGN
SOILTEST
PERCOLATION
lEST
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 194, Section 33, T12N, R3W
Request you issue a permit to drill a well and install a septic system to serve the
proposed three bedroom dwelling on the referenced property.
Two test holes were excavated and percolation tests performed. The approximate
location of the test holes are located on the attached site plan.
At the time of excavation, 6-5-99 water was not found. After seven days of ground
water monitoring, no water was found.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the
adjacent prop erties.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/bjj
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 ' EAGLE RIVER, ALASKA 99577
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3-
4-
5-
6-
7-
8-
9-
10-
11
13-
14-
15-
16
17
18
19
20
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
A
ca-sso /.472
Township, Range, Section: F- I ~-~ ~ ~c~.:~ r ~ J
WAS GROUND WATER
ENCOUNTERED?
SLOPE SITE PLAN
S
IF YES, AT WHAT ~
DEPTH? p
E
O,pl" tO Waler A~ter Oate: ~/! '~/~:~cj
Monitorin§? J~ P~ ~
/:-J-7t
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATD)N RATE __ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ ~/~- FT AND /f '/>, FT
fi '/~. '~
ACCORDANCE W~F-H~I.g[,~VT~I~I~'~I~'~PAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG m PERCOLATION TEST
PERFORMED FOR:,
LEGAL DESCRIPTION:
2
DATE PERFORME~:, (,
Township, Range, Section: ~' I ,~ ~/ ~ ]
SLOPE SITE PLAN
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
WAS GROUND WATER
ENCOUNTERED? ~/ ~
IF YES, AT WHAT -~ SL
DEPTH? pO
E
Monitoring? ~ ~"~/ 13ate:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE 4~0. (o (m~nutes/~nch) PERC HOLE DIAMETER ~"
TEST RUN BETWEEN ~ '/¢- FTAND ;-~ '~ FT
COMMENTS
1 ~034 Eagle River Loop I,[oar. i i~Jo. 2.0.;. I . ' ;'~-~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCECy~I::I [~£Ae$')'~1Ee~[~I~[~CIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE;
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Lot 194, T12N~ R3W~ Sectinn ~3
Location (site address or directions) 3900 Rabbit Creek Road
Property owner
Mailing address
Lending agency
Mailin. g address
Agent
Address
Newby Construction Dayphone 240-5312
12929 Tracy Way, Anchorage, AK 99516
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
3
individual well ×X×
Community well
Public water
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. 1191) From MOA ~!21
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 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
Address
Engineer's signature
17024 Eagle River Loop Road No. 204
Phone
Date
S,G.^TU.E
Approved for /~~j~-
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with th-e following stipulations:
Additional Comments
By:
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 pu rchssers 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
responsible for errors or omissions in the professional engineer's work.
(Rev. 1/91) 8ack MOA ¢21
Municipality of Anchorage /_~J~l~
DEPARTMENT OF HEALTH & HUMAN
.... D,,qVIRONM~[[ ALSERVICESNT " S
Env ronmental Serwces D~v~s~on
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description:;Lo'F I¢lq /
A. WELL DATA "'
,' 'T ~ ,'2 j .,t'$ ~ Parcel I.D.:
Well type /~21 ',/RTE_
Log present~.~N)
Total depth
Sanitary seal (..~)
If A, B, or C, attach ADEC letter. ADEC water system number
~Y~.J' Date completed ~ / '~3/ q 'I
) °t O ' Cased to 6' 3-
Casing height (above ground)
Wires properly protected ~'.'~)
Date of test
Static water level
Well production
FROM WELL LOG
AT INSPECTION
WATER SAMPLE RESULTS:
Coliform
Date of sample: )
B. SEPTIC/HOLDING TANK DATA
Date installed ~ /11 / ~ ~ Tank size
Foundation cleanout ~N)
Date of Pumping ~//~ - "J'~ Pumper
Nitrate O, 5' ~1 Other bacteria
Collected by:
ENGINEERING
17034 Eagle River Loop Road No. 204
Eagle River, Alaska ¢9512
//00 O Number of Compartments '.~-L Cleanouts(~N) Y'¢J'
Depresmon (Y/I~ ~,.' 0 High water alarm (Y,~ /v' 0
C. ABSORPTION FIELD DATA
Date installed ~ /11/ ~ ~rl
Length (O0 f Width
Effective absorption area c} co
Date of adequacy test N/,'~
Soil rating g~.p~or fF/bdrm) ~0, ~ System type /~¢ D
/
Gravel thickness below pipe I ' Total depth
~' i 't- Monitoring Tube present ON) Y4 J Depression over field (Y~)
~, k,' Results (Pass/Fail) For ~ bedrooms
Fluid depth in absorption field before test (i~iately-a-f~ gal. water added (in.~ ~-~
Fluid depth __~e:teTT.' Absorption rate = _ .g.p.d.
Peroxide.~trea~t (past 12 months) (Y/N) If yes. give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycle~
Size in gallons /-
''Pump on" level at* ~' level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot ) OO On adjacent lots ) O0 ~L
Absorption field on lot /oO -f'- On adjacent lots ? oo C-
Public sewer main /v/~ Public sewer manhole/cleanout zv//.)
Sewer/septic service line ~ ~ ~ Lift station "¢/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation (~ ,5 Property line ~ 3 Absorption field
Water main/service line ] 0 4- Surface water/drainage J°¢ -~ Wells on adiacent lots
'¢
)oo ·
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~ o Building foundation J I ~¢ Water main/service line / O '-
Surface water ) & 0 4- Driveway, parking/vehicle storage area ) O ''/-
~ o.,-, ~ .~ ,,~ o ~,¢ ,~ Wells on adjacent lots ?Od 4
Curtain drain
ENGINEER'S CERTIFICATION
I certify that l have determined thru field inspections and review of Municipal record, c~&~'Ch..?,~i~f#ms are
in conformance with MOA HAA Quldehnes in effect on this date.
En~lneera' 's Name __
HAA Fee $_
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number