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HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 4 LT 13 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 Name: ~OH~ .-5 ~ ~~t~ ~ .~~ -Wastewater System: ~ew ~ Upgrade Pho~/ NO. of Bed. s: (~1 ~ / ~-- ~ DeepTrench ~ ShallowTrench~ed ~ Mound ~ Other LEGAL DESCRIPTION so,, ..,,.g: l. ~GPD/Sq. Ft. To,alDepthf~orig~l~rade: Lot: Block: ~ Subdivision: Depth to pipe boltom from original grade~ Gravel depth beneath pipe Township: Range: Section: Fill added above_ odgin~i~de:~ Ft. Gravel length: ~/Ft. WELL: ~ew D Upgrade Gra~e~~,__~ Ft. Numberoflines:~ IDistancebetweenlines:~'~ Ft. ~tio.~,C): Total Depth: Cased To: Total absorption area: Pipe material~, ~ ~ Driller: Date Drilled: Static Water Level:Ft. ~~[nstaHer: ~~''Date insta~ ~ ~ ~ Yield: GPM~ Pump Set at: Ft. Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES ~ eptic D Holding ~ S.T.E.P. To Septic Absorption LiE Holding )ublic/Private ~anufactu rer: ~ Capacity in gallons: From Tank Field Station Tank S .... Lines ~ ~~ / / Material: Number of Compartments: Surface Line Foundation ~ I j ~ I ~ ~ ~ "Pump on" level at: "P~water alarm at: CudainDrain ~~ ~ ~ ~ Pump Make & Model Electrical Inspections peflormed by: Remarks: BENCH MARK Assumed Elevation:~ ~ EN ~ ~S_ SEAL Department of H Huma ices approval ..... :" .... 72-013 (1/91) MOA 25 'Permit No. ~ ~ L~:~"~::~--P Page ~ of ~ Municipality of Anchorage 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 Legal Description: -~.~Z' , .~C-~ 1_~4~r~ t~ PID NO.: ~:)~Jl~'~-~ 72-013 A (2/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERM I T NUMBER: SW910200 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:BENNETT JOHN J & CATHERINE M OWNER ADDRESS: 0511332600088 PARCEL ID: 05113326 DATE ISSUED: 7/17/91 EXPIRATION DATE: 7/17/92 LEGAL DESCRIPTION: GREAT LAND ESTATES #3 BLK LT 13 LOT SIZE: 104108 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 (18AACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVI~z Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~_:/~'~ ,~~>~t~'~ DATE PERFORM~:[~; LEGAL DESCRIPTION:Z/3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O ~wnship' Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCODNTERED? /%/e DEPT.? P E Date: ~ Deplh to Water AItJ~'),~L/ Monitoring? .p,,-r,..-/7 / '~rossj Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RA~E / (minutes/inch) PERC HOL£ DIAMETER '~ ROBERT SHAFER, P,E. ROGER SHAFER July 14, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORtTY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE pLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Muni~pality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 13; Block 4; Great, and Estates #3; PEI~IT REQUEST NARRATIVE Request you issue a p~rmit to drill a w~l and install a septic system per the attached design dated July 14, 1991. The GW soi~ on this property will require a sand filth. The ~ached design is for a seepage b~d system with a 2 ft. sand filter. There is adequate soils information available within this area to indic~e that the GW soil is consistent throughout th~ area above th~ bluff. Therefore, a s~cond soil test was not performed within th~ alternat~ site as shown on th~ attached sit~ plan. Even though this is a large lot (2.39 acres) much of thc lot li~s b~low a bluff area leaving only a littl~ more than on~ half acr~ av~labe for dcv~opmcnt above th~ bluff. A 50 ft. set back from th~ bluff was to establish thc area to d~v~loped for the absorption bed. W~ls on adjoining prop~rt~s that would b~ affected by th~ d~v~opment of this property already exist. We do not anti~ipat~ any adverse effect on neighboring properties as a result~ of this dev~opme~. If w~ may b~ of furor s~rvice or you requir~ additional information for your~ew, please contact us. -~ / ~S/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 his we!;is producing ~ gatlons of wat~ MOUH DRILLlt G hour BOX 3370 PALMER, ALASKA 99645 T~LEPHONE 745-4071 Set pump@_~_~ iota. Static It- TOTAL DEPTH OF WELL PERFORATED DEPTH -- FT. FT. 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 CERTIFICATE OF HEALTH AUTHORITY GENERAL INFORMATION Complete legal description Lot 13; Block 4; Greatlamd Estates #3 Location (site address or directions) 19748 Chugach Park Drive Chuqiak, AK op'erty · .:.. Pr owner 'Mailing address Lending agency Mailing address Agent ·-Address Catherine Bennett Day phone 745-0135 19748 Chugach Park Drive Chugiak, AK 99567 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 ~J TYPE OF WATER SUPPLY: Individual well XXX Community well Public water RECEIVED APR 2 5 1997 Municipality of Anchorage Dept, Health & Human Semites 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 xxx 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. ..... 72-025 (Rev. 1/91) Front 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. S&S ENGINEERING ~¢l Name of Firm ......................... , ...... Phone Add ress Eagle River, Alaska 99577 Engineer's signature ~'~"'~",~/~/~, - .~,~-¢. , Date By: DHHS SIGNATURE · /~ Approved for ~,LI~, . Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that a periodic testing be performed to insure the wells continued suitability. Nitrate concentration is 5.37 mg/1. EPA ma×imum concentrm~inn i~ 1D.N. mg/]. Mnra infnrmmr~nn mn n~r~mte~ available from the On-Site Services Section at DHHS, 343-4744. Additional Comments ,_ ~~!"~! /~// ~ ~J,A///~i~ D at e (~P--E//~ .~/,q'~ If.*lllll [e]~ 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 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. 72-025 (Rev. 1/91) Back MOA ¢Y21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type Log present,N) Total depth / Sanitary sea~N) Health Authority Approval Checklist ~-, ¢5, Cased to Y Date of test Static water level Well production WATER SAMPLE' RESULTS: Coliform 0 If A, B, or C, attach ADEC letter. ADEC water system number ¢'~ Date completed ~"~ ~ / /'~2 / ~O -,,°'t/ Casing height (above ground) FROM WELL LOG Date of sample: g.p.m. Nitrate ~. J'~ Other bacteria Z~ Collected by: -~ ~ .~' ~¢/~'Z B. SEPTIC/HOLDING TANK DATA Date installed ~-" 7 ~'¢'"'Tank size Foundation cleanout~N) ~/ ' DateofPumping ~-~1~"~ pumper ~'ffI~, ~)~)~?/~J~ r C. ABSORPTION FIELD DATA Date installed -~ '" 7~'~-'; Length ~-~; Width /~"~'-¢' Number of Compartments ~ Cleanouts~/N)?~ Depression (YJ~ ~ High water alarm (Y/N) ~ 1~ -- Effective absorption area Soil rating ~ or ~fC/b4~m) //, ~ J~' / Gravel thickness below pipe ,.~'-/o'¢ Monitoring Tube presen~YN) ',// u//¢( ~-~,,7 ResultS/Fail) Date of adequacy test Fluid depth in absorption field before test (in.); Fluid depth ~) (ins) Minutes later: ~ Peroxide treatment (past 12 months) (Y~). /~)o~ ~//'~ystem type /~ ~ E:~ Total depth . Depression over field (Y~} For ¢ bedrooms Immediately afterb'~° gal. water added (in.): Absorption rate = ~'O~ g.p.d. /,/-~<,dq)ff yes, give d ate ~J/~ 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) Size in gallons . "Pump on" level at* High water alarm 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 Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation .~. I 4-- Property line ~.. I + Water main/service line Absorption field ') ~ Surface water/drainage Ic, o ~''Y Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line "¢ ~0 1'4¢~' Building foundation ~'0 t-cb. Water main/service line Surface water /'¢~ 0 /'¢' Driveway, parking/vehicle storage area Curtain drain ~/pr Wells on adjacent lots /~ 0~ ¢ 4-- F. HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ENGINEER'S CERTIFICATION " .~','.':~ '"- -: .~':~: I certify that I have determined thru field inspections and review of Municipal reco,~l~~tems are in conformance with MOA HA_A guidelines in effect on this date. Signature -~ "~,----- Engineer's Name J/~O~ &~ 7~ ~'' (o~v~ Date ' '~ O0 Waiver · ::'- ¢7 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Lot 13; Block 4; Grcatland Estates #3 Location (site address or directions) John Bennett Day phone 746-1880 Property owner Mailing address P. 0. Box 871145 Palm.t, Alaska 99687 Lending agency Mailing address Day phone Agent Steppers Construction Address Day phone Unless otherwise requested, HAA will be held for pickup. 4 '~ NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well XX NOTE: 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 NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front 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 ofstructureindicated herein. Ifurtherverifythatbased on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municfpal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 & S 17034 Eagle River Loop Road No, Address Eagle River, AJas[(a Engineer's signature DHHS SIGNATURE Approved for Disapproved. Conditional approval for Phone bedrooms. Date bedrooms, with the 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 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. 72~25 (Rev. 1/91) Back MOA #21 Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ,L. Parcel I.D. A. WELL DATA Well type ~1~t¢/~ If A, B, or C, attach ADEC letter. ADEC water system number Log presenl~) y Date completed ~ -'~Z-~ -- ~[ I Driller Sanitary seal (Y/N) Wices properly protected (Y/N) FROM WELL LOG Date of test ~:~/~:~ Static water level Well flow Pump level g.p.m. AT INSPECTION g.p.m. ~ ~c Absorption field rOn lot Public sewer main SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot--- ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~ ~"~ -~:~ Cleanouts~) High water alarm (Y/N) Date of pumping Tank size ~ ~. ~--c~ Compartments Foundation cleanout<~-,~N) "~ Depression~V~ Alarm tested (Y/N) /~ ~ "~'~-~'"~ ~-~------- Pumper f'~/~:~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ "~ ~ On adjacent lots To propertyline ~. E:::> t J¢ Surface water/drainage Absorption field Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed "~ -'~ Length '¢--~ Width Total absorption area Depression over field (Y/~"--(~ Results ~fail) Peroxide treatment (past 12 months) Soil rating Gravel thickness \.~?~ ¢'¢'.//'~'~"~- System type ~ ~::;:~'~-~ ~ Total depth Cleanouts present. N) Date of adequacy test for 4~ bedrooms If yes. give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ~' To building foundation On adjacent lots ~ Surface water / ~-~-~ Curtain drain (",,,l ~ t,~ Cutbank On adjacent lots \ ~;~ ~ Propertyline_ To existing or abandoned system on lot ~---z.;-~ t Water main/service line ~, ~ / Driveway. parking/vehicle storage area ~-~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & $ ENGINEERING 17034 Eagle River Loop Road No. 204 Signature ~!e ~h, er, -~_!.-*."-k~ 99577 Engineer's Name Date HAA Fee $ / 7~~'''~ © O Date of Payment~/~ ~- ~2 Recei,t Number (' /,%/? Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21