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Home My WebLink AboutT15N R1W SEC 16 NE4 M/BT15N, RlW, Section 16 NE4, M/B #051-191-12 Municipality of Anchorage Page __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 Permit Number: ..,('/~J~)o~ PIDNumber: ~5'/-/q/- 12- Name: ~J~CoV~/~y' ~/OZ4fz Wastewater System: ~New D Upgrade *~d~,~: ~ ~O~ I//~// ~.~ ?~1( ABSORPTION FIELD Phone: No. of Bedrooms: ~ ~Deep Trench D Shallow Trench D Bed D Mound ~ Other Total Depth from original grade: LEGAL DESCRIPTION so,,~,,~:/.z ~,o~s~.~. ~. Lot:.~ ~ / ~BIock: Subdiv~ion: Depth Io pipe bottom~,~ +fr°m original grade: Ft. Gravel depth beneath pipe ~ Ft. ' ~ S~ctlon: Fill added above original grade: Grave~ length: Township: /~I Range: /~ /~ ~, ?' - ~, ~ ~t. Y3 .t. Number of lines: ~ Distance ~tw~n lines: WELL: ~New ~ Upgrade Gravel width: ~ Ft. ]~ ~ Ft. Classification (Private, A,B,C}: Total Depth: Cased To: Total absorption area: Pipe material: ~ ~ ~ Driller: Date Drilled: Static Water Level: Installer: Date installed: Pump Set et: ~sing Height Above Ground: ~: 3 ~.u ~ ~, ~. ~ ~. TANK SEPARATION DISTANCES ~Septic D Holding D S.T.E.P. To Sept,c Abso~tlon Lift Holding Publlc/Pflvate Manufacturer: ~ Capacity in gallons: /~ From Tank Field Station Tank ~wer Lines ' . . Wel~ /~l. /~'~ ~ ~ ~ Material: ~/ Number °f C°mpa~ments: SuHace w~t~ /~ /~' ~ ~ ~ ~ LIFT STATION Lot Size in gallons: Manufacturer: Line / 0 ~ /D I ~ -- __ Foundation /~,~/~,, _ _ -- "Pump on" level at:~leve, at: I High water alarm at: Cu~ainDrain /~/~ /~/> ~ ~ ~ Pum~ ~ Electrical Inspections pedormed by: Remarks: ~o ~.~m ~7~ ~ BENCHMARK Location and Description: Assumed Elevation: ENGINEER'S SEAL Inspections pedormed by: ~ E~'~ Dates: 1st P~'d/' ~6 ,"I~'-..-.~;~.~..-.,~-. 2nd?fi- ~z- ~ ~ ~..~ ~ Department of Health and Human Se~ices approval ~ ~',, Reviewed and approved by: ~~ ~ ~ate:/-//-~ 72~13 (Rev, 9/91) MOA 25 * AS 3UILT SYSTEM DETAILS/SITE PLAN Permit SWgSOaSS T15N, RlW, SECTION 16~ NE 174, M/B PI9~051-191-12 SCALE~ a-s=4o,a'~ ~~ ~ - ~ ~1250 GAL~ ~ 9ISCDVERY CBNSTRUCTIBN, INC, C~- ~ou~aRr: LANMARK ~O~sslO~ ~ 12/19/98 EAGLE RIVER, AK 99577-8?36 NW1159 a:~r>[,,a:9809&BWO oo~,o: 98098 {907}696-0111/FAX ~907}696-8111 STATE .~ ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT Loc^,,o, oP WELL. / /q 0 q /Z- WATE" WEL' ,ECORD ~URD .one,e, ME~O,^ ' O~ER. DEPTHS M~SURED FROM:~casing top ~ground sudace ~ BOREHOLE DATA: ~~ ft '~- .... . -7 ..... Depth Depth of casing:~ ft ~ ~ ~ Material TvPe and ~olor From To DEPTH TO STATIC WATER LEVEL: ~ -~ ft below ~] top of casing Date: [] ground surface METHOD OF DRILLING: ~] air rotary I-~ cable tool i-'] other Dept. CONTRACTOR INFORMATION: Signature of AuthEriZe~ "es~s;n'~tativa USE OF WELL: [] domestic [] irrigation [] monitor [] public supply [] other CASING STICK-Up: ~ ~ Casing type~:c~_.~ ft. Diem: .in. to, WELL INTAKE OPENING TYPE: [] open end [] perforated/~ open hole [] screened Depths of openings: to ft SCREEN TYPE: ,,.~a m: in. Slot/Mesh Size: ~ f--t GRAVEL PACK TYPE: Volume used:__ Depth to. top: GROUT TYPE: Depth: from ~ ft to ~ --.--___.___.__ ft DEVELOPMENT METHOD: ~ Duration: PUMPING LEVEL AND YIELD: hrs PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION?',4~ YES I-I N--"~O REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: DNRIDIVI$10N OF MINING & WATER MGMT 3601 C St, Suite 800 ANCHORAGE AK 99503-5935 Phone (9071269-8639, Fax (907)562-1384 MUNICIPALITY OF ANCHORAGE Department of Health end Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box '196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date issued: Aug 12, 1998 Expiration Date: Aug 12, 1999 Permit Number: SW989298 Legal Description: T15N, R1W SEC 16 NE4 M/B Design Engineer: -7-~ Owner Name: DISCOVERY HOME Owner Address: P.O. BOX 11141 ANCHORAGE , AK 99511-1411 Parcel ID: 051-191-12 Site Address: 023125 DOTBERRY DR Lot Size: 43560 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [~ SepticTank [~ 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. Date: --17--78 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 August 4, 1998 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: New sewer and well permit - Skyline View S/D, Block 3 Lot 7 Gentlemen: On ~uly 31, 1998, we excavated one testhole for the subject property. The results of this test and water monitoring are attached. We propose to install a 5' wide deep trench. The testhole indicated no water, and based on the surrounding area testholes we do not anticipate ground water in the testhole or encroaching on the system. Additional fill will be placed over the system to provide a minimum of 3' of cover when complete. This lot slopes from northwest to southeast at approximately 2-7%, which is away from the proposed house and any surrounding wells. There are no public or private wells within 100' of our proposed system location except as noted. There is neither surface water within 100' nor any known curtain drains within 50'. We do not expect that there will be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, Ii~ I~I ~]~ Engineering Kenneth M. Du~ff , P~.E. attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test IwELL WASTEWATER SKYLINE DISPOSAL SYSTEM VIEW S/I}, ]}LOCK 3, LOT SEPTIC :ANT LOT · YELL LOT 7 9BT]}ERRY Or' DETAILS/SITE 7 LOT 1 PLAN D DESIGN DETAILS 4 BORN X 150 GPO = 600 GPO 600 GPO/L8 GPO PER SQ, F% (8,0 MIN/IN,)= 500 SQ, FT 500/(8'(W) X 6'(D) (6,0' GRAVEL) - 41,7' FT, TRENCH USE 1 TRENCH - 48' (L) X 8' (W) X 6'(]]) Total depth o¢ system Is 9,0' 9rom omlglncl g~cde, Tot~ depth o9 gravel be[ow distmlbutlom pipe is 6,0' , NOTES~ 1, USE 1850 GALLON SEPTIC TANK, INSULATE TANK IF <4' COVER, 8, INSULATE TRENCHES WITH 8' HB BUR]AL FOAM, 3, CONTRACTOR WILL ENSURE MAXIMUM BY. SLOPE INTO SEPTIC TANK, 4, ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TD ACHIEVE HIN, 3' COVER IF REQUIRED, 5, CONTRACTOR TO VERIFY WELL AND SEPTIC LOCATIONS OF SURROUNDING LOTS PRIOR TO CONSTRUCTION, PREPARED FOR~ LEE BAKER DISCOVERY CONSTRUCTION, INC, P,O, BOX 111411 ANCHORAGE, AK 99511 FIELD BOOKS COMPUTED: 80UNDARY: LANMARK o~^wN: KMD ST^mO: LANMARK CHECKED: KMD DATE; 8/1/98 _.__ om: NW1159 Scc/e: 1'= 100' PAGE 1 OF 2 ASBUILT: LANMARK DWG FILE: ACA9 FILE: 98098.DWG 98098 ENGINEERING ~0441 PTARMIGAN BLVD. EAGLE I4IVER, AK 99577-8736 /907t696-6111/FAX t907}696-8111 WaSTEWATER DISPOSAL SYSTEM ]3ETAILS SKYLINE VIEW S/I}, SLBCK 3, LET 7 BT / ~ DISCOVERY CONSTRUCTION, INC, * ANCHORAGE, aK 995ii PAGE a BF 3 FIELD BOOKS COMPUTED: BOUNDARY: LANMARK DRA~: KMD ASBUIllT: LANMARK uat[: ~%2~9& _ EAGLE RIVER, AK 995??-8?36 DWO Ell'E: gZIZ: NWl159 *Cab FILE 98098lBWC JOB ~o: 98098 ~907)696-6Jtl/FAX ~907)696-8~tt ]..~ 1D ENGINEERING 204~I PTARMIGAN 13LVD. EAGLE RIVER AK 99577-8736 SOILS LOG - PERCOLATION TEST SEE ATTACHED SITE PLAN ]- /~ ,~.,~,~ FOR HOLE LOCATION 2- WasGround water encountered? /~ What depth? ff, Z~ 3-.-- ~{'~ Z~---. Depth to water after monitorh,,? _ ~_/_'~..___ DateB-l~2-ff?~ st'&(' 7- 8- 9- 10- 11~ 12- 13- 14- Il. 16- 17- 18- Reading Date GrossNet Depth to Net-- Time 'rime Water Drop / 7-~t-~/.'~; o .-- 9,, _ z /.'/o/o~,~ ~ ~' w~"' s ~ I.'/I~ 9. _ 4 I: zl1~,~ q' 5-" ~ /.' ~z /a~,~ ~' ~-~ 7 ~ I.'S~_ 7" ~ ~ I.'Y~/~ ~" ~" ? ~ l.'q4- 9~ -- /o l: ~4/~,~ q" 5" /~ ~ 1'5~ - ?" - 19- 20- Percolation Rate ~ (min/in) · ' " I crc Hole D~ameter~_ Test Run Between ~ feet and Z//. leer l, Kenneth M. l)uffus, certify that this lest was performed in accordance with all State and Mtu]icipal guidelines effect on this date: 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 GENERAL INFORMATION Complete legal description Location (site address or directions) Lending agency Day phone Mailing address Agent ,--¢NJ"¢~ ~)6k~W/~ Day phone Unless otherwise requested, HAA will be held for pickup. ,/ NUMBER OF BEDROOMS: L.~ TYPE OF WATER SUPPLY: Individual well 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: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~25 (Rev. 1/91) Front 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 /~'"////-~ ~/f'~'/Z/('~"¢"/'~/I'~ Phone ~;~ -~,'/// Engineerssignature~- ~._~/.~_..~/v',~--/ ..L~/~ ~.~ 7 Address,~-~¢L/¢'/ /~/-~;~'~/F'('~ <~/"'~/' ~r~' Date DHHS SIGNATURE ~' Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 responsible for errors or omissions in the professional engineer's work. APR 14 ,000 Municipality of AnchorageM,,~.~^L,v o~ t~.~u,^~.; DEPARTMENT OF HEALTH & HUMAN '51ER¥{~q~,w'~', ..... Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501, (907) 343-4744 Health Authority Approval Checklist LegalDescription: ~-/ ~,4,// pi/,t)/ ,~£~__.. /~ / ,f/_~//¢ / /¢//~ ParcelI.D.: A. WELL DATA Well type. ~ ¢',~ OZ'- Log present ~N) y Total depth ,,~¢'~'" Sanitary sea, N) Y Date of test Static water level Well production IfA, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ¢'~ / Casing height (above ground)_ Wires properly protected ~'N) FROM WELL LOG AT INSPECTION ¢.8 .t, .~ g.p.m. ~ g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate /,, ~ ? Other bacteria Collected by: //4'/f/'z~ Date installed ¢~4/ Foundation cleanout ON) Date of Pumping C. ABSORPTION FIELD DATA Date installed Length 7~/ Width Tank size /,,~ ~'--/~,.~ Number of Compartments __ Depression (Y~) /d// High water alarm (Y/N) Pumper ;~"f-,~ Soil rating ~r fF/bdrm) ~ 2- Gravel thickness below pipe Effective absorption area ~",¢¢,¢::;'-t.- Monitoring Tube present ~1) Y Date of ~deq~acy-t~t ~- Cleanouts~/'N) Y System type ~ / Total depth /~- ~ / . Depression over field (Y/~ For ¢ bedrooms Fluid depth in absorption field before test (in.); .,~1 ~mcmediately ~~ FI~ r. ate.:' g'P'' eroxide treatment (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* Cycles tested Size in gallons ~ "~level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot ,/~¢ Public sewer main /f//,4 Sewer/septic service line On adjacent lots //¢~/~ On adjacent lots /~b'/C- Public sewer manhole/cleanout .,~/,/~- Lift station ////,,~- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /~/"/' Property line //~/'¢" Water main/service line ,,,23" /~ Surface water/drainage ,,/,¢//"/- SEPARATION DISTANCE FROM ABSORPTIQN FIELD ON LOT TO: Property line Building foundation ,/~) /~z_ Surface water Driveway, parking/vehicle storage area Curtain drain Wells on adjacent lots /~,¢ /¢' ENGINEER'S CERTIFICATION HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Absorption field /~/'/- Wells on adjacent lots. Water main/service line ..~ ~/'/- in conformance with MOA HAA guidelines in effect on this date. - ,~'t,~(~oo..O~ ~...~'%~ ~ ,~1~)'~ ....... ~lgnature ~ ~~/~ '~'¢z ~ , ~'~'~ '-- '. Engineer's Name ~ ate Waiver Fee $ Date of Payment Receipt Number 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 GENERAL INFORMATION Complete legal description Location (site add ress or directions) Property owner Mailing address Lending agency Mailin. g address Agent Address Day phone Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~025 IRev. 1/91) Front MOA#21 o 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 investiga, tion 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 Phone Date DHHS SIGNATURE /~ Approved for ¢ Disapproved. Conditional approval for bedrooms. bedrooms, with th-e following stipulations: Additiona~ 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 DH HS 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICE Environmental Services Divisio~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)~]~J-4'~99~ Municipality of Anc De t, bore Health Authority Approval Checklist p Health & Human Se~v~ceea Legal Description: _7-/~, ./V t ~. /~)/ 2 E~.-/'~'/ ~E. ~/ / /.1/~ Parce D . A. WELL DATA Well b/pa Log present (WN) Total depth Sanitary seal (WN) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~/ Casing height (above ground) '~ Wires properly protected (Y/N) "/ Date of test Static water level FROM WELL LOG Well production WATER SAMPLE RESULTS: Coliform (~ Date of sample: / ~. - 2. ~ ~ B. SEPTIC/HOLDING TANK DATA AT INSPECTION g.p.m, g.p.m Nitrate /' / ~ Other baoteria. ~ Collected by: /~,/~ ~ ~-,~/~, ~'~' ,",~ Datelnstalled ~?'~/-'~ Tankslze //.~5-D Number of Compartments ~- Cleanouts(Y/N) ~/ Foundation cleanout (Y/N) ")/ Depression (Y/NJ ~ High water alarm (Y/N), ~ Date of Pumping ~ Pumper -- C. ABSORPTION FIELD DATA Date installed ~'~- ~Z - ~' Length ?~ ~ Width. Effective absorption area Date of adequaoy test Soil rating (g~ or fff/bdrm) /, 2. System type ~',,~ ~',~¢~ Gravel thickness below pipe ~' 'Total depth /-~, ~ ' Monitoring Tube present (y/N) "~ Depression over field (Y/N) ~ Results (Pass/Fail) For .---~bedrooms Fluid depth in absorption field before test (In.); Impaled (In.): .-~-'~'~sorption rate = g.p.d. Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) If yes, give date. 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at' Cycles tested Size in gallons ~ "Pump on" level at* ~vel at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELLON LOT TO: Septic/holding tank on lot / Absorption field on lot ,/~ Public sewer main ~-'/,4 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 ~? -~ ~- Surface water/drainage /~O /~- Wells on adjacent lots .?~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation /D /~' Water main/service line Driveway, parking/vehicle storage area ~-~' Wells on adjacent lots / ~ '~ ~ ~- F. ENGINEER'S CERTIFICATION I certify that in conformance withTOA HAA guidelines in effect on this date. Signature Engineer's Date HAA Fee $ ~,t~"f~,.,"~ Date of Payment Waiver Fee $ Date of Payment Receipt Number Ir ~ ~ ~ -- Receipt Number 72-026 (Rev. 3/96)*