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HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 5 LT 5#3 Lot § Block #051-133-06 Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~'~ '/I~- C['-e*~' ? LOCATION MAILING ADDRESS LEGAL DESCRIPTION LoT ~- ~)lOr-IC ~ PHONE SEPTIC TANK: DISTANCE FROM WELL MANUFACTURER ~-J[l~l~, I_l"OU MATERIAL NUMBER OF COMPARTMENTS INSIDE LENGTH_ INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /0¢~ GALLONS. SEEPAGE Pit: NUMBER OF PITS ~ DIAMETER /.~1 LINING MATERIAL ~"~4¢~.~P~. CRIB SIZE: BUILDING FOUNDATION OR WIDTH I'Z' LENGTH J~'J, DEPTH 12' DIAMETER DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE ':~ ~ li~ BUILDING FOUNDATION __ CONSTRUCTION (~7~ tJ OA ~ D NEAREST NEAREST LOT LINE SEWER LINE DEPTH SEPTIC TANK DISTANCE FROM: SEEPAGE SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: PIPE MATERIAL: DIAGRAM OF SYSTEM LOT SLOPE: Form No. ! P £ APPROVE~/~L.~ ~ I.// G.A.A.B. GREATER ANCHORAGE ArEa BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C' STREET ANCHORAGE, ALASKA 99503 TELEPHONE 27/[-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. NAME OF APPLICANT '"? / INSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK SIZE OF FACILITY TO BE SERVED TYPe AND F~NANCED THROUGH MAILING ADDRESS SEEPAGE PIT ~-~ , DRAIN FIELD . PHONE ., OTHER SOIL TEST RESULTS NOTE: THIS PERMIT lb NOT VALID WITHOUT BOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCEB, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT -~ ~/~ DRAIN FIELD SEPT,C TANK TO SEEPAGE PIT WALL SEPTIC TANK ~ TO NEAREST LOT LINE. WELL TO SEPT,C TAHK /~J DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FielD , SEEPAGE PIT ~ . DRAIN FIELD .SEEPAGE PIT /~ ALSO CONSIDER AREA WELLS. . SEEPAGE PiT. SEPT,° TANK..//)Z)' ; SEEPAGE p,T/, DRA, N P, ELD TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER ~AST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. SEEPAGE AREA SIZE TYPE DIAGRAM OF SYSTEM I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THaT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANTS SIGNATURE ~ ' [] SO~LS LOG ~.-,= ~ MUNICIPALITY-=~J~ ANCHORAGE ~ .. MUNICIPALITY OF ANCHORA(~t~PT. OF HEALTH & DEPARTMENT OF HEALTH AND ENVIRONML:~I~/~i~IFoNIt[J?C~8~cTION~ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720~ ,JUN 2 g 1981 SOILS LOG- PERCOLATION TEST 3 s /60 7 / 10 11 12 13 14 15 16 17 18 19 20- COMMENTS WAS GROUND WATER j~0 SL 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: 72-00g (6/79) cERTIFIED B~~ MUNICIPALITY (SF ANCHORAGE by RECEIVED A & L D [LLING COMPANY BOX g~, EAGLE RIVER, ALASKAB9577 · TELEPHONE~4-2588 OWNER OF LAND ADDRESS LEGAL DESCRIPTION- DATE- Started ]/ PEI~MIT NUMBER ~ (~[:~i,:...4 1 &;4,. .... DRAW DOWN FT. Ended z'i//:9-<}/'F,~ GALS. PER HR KIND OF CASING STATIC LEVEL OF WATER FT. KIND OF FORMATION: Frmn ~') Ft. to ':-'~ Ft /)~ ,~.'--,~ z~/<)/::'d:,~;"; From Ft. to- Ft From :X Ft. to~ O Ft._ ~3r''~''4~ t~, (Sq,-',~z From Ft. to_~Ft. '- ~A' ' ~-'~ Z<57,,eS: =,./.)<:~, From Ft. to_ Ft. From~O _Ft. to .f, W rt.? From-~]O Ft. to_') t ,Y Ft. i From _Ft. to Ft.;'*'/ (5:)t''r'~'~ Z~c,i','dX '"'From From_<O -5'~Ft. to .~77) d G Ft. From_- Ft. to.~Ft. From From _Ft. to Ft._ From~ From ~_Ft. to_~Ft. From_ Froln~Ft. to ~Ft. From From ~Ft. to_ Ft. From_~_ From_ Ft. to ~_Ft From_~ Ft. to_ _Ft= Ft. to__Ft Ft. to__ Ft. Ft. to Ft. Ft. to_ Ft. Ft. to_ Ft._ Ft, to__Ft Ft. to Ft Ft. to__Ft. Ft. to__Ft. __.Ft. to__Ft._ Ft. to_ Ft. Ft. to_ Ft. Ft. to__.Ft. MISCL. INFORMATION: I I(-) '5 Il ~.~ .~- .. ,. /¢ '7 DRILLER'S NAME PERMIT NO. [:,EPRRTMENT . HERL.'TH RND EN'¢IRONMENTRL~ OTEC'I"ION '-"= ' '~ -,- r (..I[:,C~R 9 z? d ~_:'l ?' ,.¢.. ... i. ;=, E. F.:[:,.., FINCHORRF'iE., Fff::.:. 276-221.-::± I~,~ E=.F. IL.. L_ F" E F-: tt"'"~ % ]'- ( 76;7:."1.':7 ) RPPL I CRNT .'.~E !;.'HERF.:"r' LOCR'I" I ON - HRRDROCI< DR I VE LEGRL L5 B5 GRER'T LRND ESTRTES BO:,..',' :.1. 05 CHUG IRK LO]" SIZE 688-2388 8080~ S~URRE FEET MINIMI_IM DIS'TRNCE BETWEEN R ~4E[..L AND RNY ON-SITE SE~,.IRGE DISF'OSRL. S'.r'S"FEM IS · 'IEIE-~ FEET FOR R F'RI',,,'RTE 14ELL OR 20E'~ FEET FOR R PLIBLIC WELL WELL LOGS RRE RE6!UIRED RND MUST BE RETURNED TO THE DEPRR]"MENT 14ITHIN ]i:E~ DR'-r'S OF THE WELL COMPLET]:GN. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE R',.,'RIL. RBLE TO INSURE PROPER I NSTRL. LRT 10[4. F' E F..: ~',,'l Z 'T' '%-" R L_ ][. [:,, F= ,]ii tr-~: ii], l"-.1E.: "'-r" E ~-'-4 F=: F' F4:,3 P,-~ T S .?.;, LJ I CERTIFY 'T'HRT · 1.: I RM FRMILIRR WITFI THE REQUIREMENTS FOR ON-SITE SENERS RND WELLS RS SET FORTH B'"r' THE I"'IL.INICIPRLIT'¢ OF RNCHORRGE. 2: I WILL INSTRLL THE S"r'STE:M IN RCC:OR[:'RNCE 1.4ITH THE CODES. S I GNE[:': ............................ . . HF F'L I L~e~NT K~CLE CHERR"r' Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. cLanchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-133-06 GENERAL INFORM'ATION Complete legal description Lot 5, Location (site address or directions) Expiration Date: Block 5, Greatland Estates #3 19657 Creek Way Road Current Property owner(s) Rh°nda & Joe ,"lanson Day phone Mailing address 19567 Creek Way Road, Chugiak, AK 99567 688-2909 Lending agency Mailing address Day phone Real Estate Agent Remax/Sharon Minsch Day phone 694-4200 Mailing Address 16600 Centerfield Dr., Ste 201, Eagle River, AK 99577 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:~_~/Z ~ NUMBER OF BEDROOMS: 3 ~1/,~ 3'/~o TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [] Community On-site Public Water System [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. Oh00F 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 based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone Address Eagle River, Alaska 99577 Engineer's Printed Name Robert: C. Cowan Date c'l / ~- bedrooms, with the following stipulations. DHHS SIGNATURE Y Approved for '~ bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: / 52. - / 'Z ~ o O Original Certificate Date: _ c~_ / ~ ~ O o Reissue Date: 72.025 fRev 01,00F ..... Municipality of Anchorage SEP 0 . L~bI-'AHTMENT OF HEALTH & HUMAN SERVICE,S. ..~t~ Environmental Services D v s on ~!.~,IICIPAI.ITY OF 825 · · L Street, Room 502 Anchorage, Alaska 99501 (F:~_~ Health Authority Approval Checklist Legal Description: Z~.~'~.,4-' ~__~,~/¢~ ~¢-.'~ 3 Parcel I.D.: A. WELL DATA Well type Log present ¢~YN) Total depth Sanitary seal ~J)' Date completed Cased to I~?~/O FROM WELL LOG If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) y Wires properly protected~/N) y AT INSPECTION Date of test ~*-~-- ~ ' 7/~ ~ ,'~ ~ ~3 ~ Static water level ) I~ ~ /1~' Well production Z~,O g.p.m. =2. ¢ g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate /. ~ G Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed '~ 7 ~/ Tank size Foundaton ceanout~/N) y Date,of~Pumping ~,, C. ABSoRpTION FIELD DATA::": Date i,nst~lled ?"7/5/ Length /,,~ ' · ~ Width Effective abSorption area Date of adequacy test c/ /OOo Number of Compartments _/ Cleanouts~/N)_/~__ Depression (Y~l) ~) High water alarm (Y/N) Pumper Soil rating (g.p.d./fF ~ /,,~ Gravel thickness below pipe Monitoring Tube present~'N) ~' Result,~C~/Fail) ~' System type ~' ~ Total depth Depression over field For ~ bedrooms Fluid depth in absorption field before test (in.); ,..25" Immediately after.,~',~ ~ gal. water added (in.): Fluid depth -,25"~ (ins) Minutes later: ,~ ~"J, Absorption rate = _g.p.d. Peroxide treatment (past 12 months) (Ye /Jo,.)E, /,<,J~¢ ~4),J If yes, give d at e 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* _ P~_¢~~ E. SEPARATION DISTANCES Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /'~,~%- ! On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LC)T TO: Foundation ~¢ / Property line ,.¢.'.5- ~ ¢- Absorption field ~ Water main/service line /0, ~4-- Surface water/drainage /~'¢__/~ Wells on adjacent lots /~,~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~, I ¢'- Building foundation _2"/' i Water main/service kine /~ /4-- Surface water /'~ I ¢' Driveway, parking/vehicle storage area /¢ t~v.--- Curtain drain ___ ¢'~2,.~ Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that lhave determined thru field inspections and review of Municipal records.~.~..~C.,~bo~'.~_.~, are in conformance with MOA HAA guidelines in effect on this date. '~ ,~2 Signature ~/~ /~ ~, S ..... ' CJ ~,~ ROBERT C. COWAN HAA Fee $. Date of Payment Receipt Number Waiver Fee $ Date cf Payment Receipt Number 72-026 (Rev. 3/96)* 90? 694 1211 P.03/03 Sample POL U~ Client PO~ Prlnte~l DatefTime 0~/01/2000 1~:07 Colle~tefl Date~Tlme 08/29/2000 1~:00 ]~'elved D~te/Tin'~ 08130/2000 8:40 Te~nl~l Birder Stephen C, Ede Rele~ed By ~~ Ni~atc-N l.a6 0.500 mg/L EPA 300.0 Da~ Datc o~/~0~0o SCL Total C~lif~m I OB, No Coli col/100mL 5MI 8 9222B 08/30/00 YAP ,.. , ,-,,,,,,. ............ TOTAL P,03 DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services _, On-Site Services Section Or P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O~'t -I] 3~(2(~' 1..,-GENERAL INFORMATION Complete legal description NOV ] 9 1997 HAA# Lot 5; Block 5; Greatland Estates ¢3 Locat!on (site address or directions) ,.:" Property owner "Mailing 'address Kyte Cherry_ P.o. Box 670105 ]965~ Creek Way Rd. Chugiak, AK Day phone Chugiak, AK 99567 688-3341 k Le..nding agency 'Mai!i'ng address Day phone Agbnt ' Day phone Address Unless ~therwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: .3 TYPE OF WATER SUPPLY: Individual well ×x× 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) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER ~ As certified by my sea] 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 !7_n~4 Eagle Pl,,,~r I nnp ~,.~r! ~n. ~r~ Phone ~'~ Y - ;~ r4 7 ~ Address Engineer's signature Eagle River, Alaska 99577 Date J///,,i/O ? DHHS SIGNATURE ¢/'/ Approved for /1~-' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: '~,//~¢;~/,-c4..-ud.~~,. C. /'~.4¢¢~ Date (~' Z' ¢ 7 '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 engineeCs work. 72-025 (Rev. 1/91) Back MOA #21 Legal Description: A. WELL DATA Well type CP'' Log present ~N) Total depth Sanitary seal ((~/N) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVlCES~V/~o~mA Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) Health Authority Approval Checklist If A, B, or C, attach ADEC letter. ADEC water system number "-" .Date completed ~ / ''~ ¢//7 G ¢ Cased to I,~ ~' Casing height (above ground) '~ ' Wires properly protected ~,N) FROM WELL LOG Date of test Static water level Well production ~ g.p.m. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: il /¢ o / '7 B, SEPTIC/HOLDING TANK DATA Date installed q~/~l / ~¥ Tanksize /0 oo Foundation cleanout (~/N) ¥'~ ~ Depression (Y/,.~} Date of Pumping Io [ 3-"~/'~ ? Pumper 3'- /~ Collected by: Other bacteria O $ & S ENGINEERING 17034 Ea~jle River Loo~ Road No. 204 Eagle River, Alaska 9~577 Number of Compartments / Cleanouts~..~/N) ~/¢5 ~ 0 High water alarm (Y~) /" <~ C. ABSORPTION FIELD DATA Date installed (-'J /'~ / '/¢ Soil rating (g.p.d./fF o~ff~il~i~I ¢) (~ System type (,2 ~, Length i 3- Width I ~ Gravel thickness below pipe (~ f Total depth Effective absorption area ;)' ~g ~¢r-~t. Monitoring Tube present C/N) V~' Depression over field (Y/~-~ Date of adequacy test 11/'0 if'el 7' Results~'~Fail) /)'¢$J For Fluid depth in absorption field before test (in.);. O Immediately afterz/~'~- gal. water added (in.): Fluid depth 0" (ins) Minutes later: /'//~) Absorption rate = ~:~"-0 -/ g.p.d. Peroxide treatment (past 12 months) (Y/N) /v ~/, { Y-,-"c ~ ~ If yes, give date bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) "Pump on" level at* High water alarm level at* ~ CycLes tested ~ Size in gallons ~vel at* E. SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: / Foundation ~0 / Property line ,.C -p- Absorption field r ~'~ Water main/service line lO -/- Sudacewater/drainage SEPARATION DISTANC~'~ROM ABSORPTION FIELD ON LOTTO: / Propertyii'n'e J ~ / '/- Building foundation "3 0, Surface water Curtain drain ~vo.,,, 4. ~ ,,,'o ~J ~' Wells on adjacent lotS Water main/service line Dnveway, parking/vehicle storage area Wells on adjacent lots /O ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance with MOA H~A guid~nes in effect on this date. Signature 'O ' Engineer's Name ¢~ ~ / / HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ~tK CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/// Client Sample ID Matrix Ordered By PWSID Sample Remarks: 976991001 S & S Engineering Lot 5, Bk 5 Greatland Est No 5 Lot 5, Bk 5 Greatland Est No Drinking Water Client PO# Printed Date/Time 11/19/97 10:00 Collected Date/Time 11/10/97 16:00 Received Date/Time 11/11/97 16:30 Technical Director: Stephen C. Ede Relcased B3~ ,~ ffff/_ ~ Results PQL Units Method Allowable Prep Analysis Limits Date Date Init Nitrate-N Total CoLiform 1.40 0.00 0.100 mg/L EPA 300.0 col/lOOmL SM18 9222B 10 max 11/12/97 RMV 11/11/97 TMW