HomeMy WebLinkAboutPETERS CREEK BLK 4 LT 9Pete s
k
Block
Lot 9
MUNICIPALITY OF ANCHORAGE
DE ~TMENT OF HEALTH AND HUMAN SER~
Environmental Health Division
825 '%" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
',lame DISTANCES
_L~IZ--'"r" ~/,-,../1...-~=:::~-~ ~--_TO SEPTIC ABSORPTION
WELL
A,ddressf) , _ FROM~ TANK FIELD
p,'--o,e(s) I Permit ~o. ,INo. of Bedrooms
~¢~L'~'"'L'~E;~:~I ] ~ ~f"¢2~;)'C)'/J "~ LOT LiNE f+ / -'~
LEGAL DESCRIPTION
L°t ~.~ I Bl°ck ~., I Subd~~ ~2~¢__, FOUNDATION
Towns,ip, Range, Section
AS-BUILT DIAGRAM (Show Iocahoe of well, septic system, property hnes, foundation,
~~) ~X~ i~~ ~ drweway, waterboOies, etc,)
Man~lacturer Capacity m gallons
Material No, ol CompaAments
TyPE
~plpe bOllom from lotat OeOth ~rom on,mai ~raOe
or,g,na, grade ~'~ FT ~ FT
~ FT ~ ,~ FT ~l;~ ,.~~
Gra~'l%ngt, Gravel w,dth I P ~ ~J~
~' FT ~'FT .
~otal absorption area D~stance between hnes ~.
Number ol hnes P~pe material '
instatle~- Date Installed I ~
WELLS
/
~ PRIVATE ~ OTHER fldentifv) ~ ~,
Classification (A,B,C} }oral Depth ~ Cased to
~ FT] FT
Installe~ Dat~
REMARKS:
Scale:
Inspectio~ P~d~med by: ~ '., ;' ~ ',: ~ ';:'~.
I ., ~ ~ .. ~B ...¢~..., .~.?~, cedify that this inspection was pedormed
Health Depadment Approval: Date:
72-013 (3/85)
DEPARTMENT OF HE'ALTH AND ENVIRONMENTAl_ PROTECTION
825 L.. STREEI", ANCH[])RAGEE, AK 9950.1.
PERM I T NO:
DATE ISSUED:
E:} 5 () 6 (.'x:) ~- ....
() 9 t 113 / 85
AF:'PL I CANT':
A D D R E S S:
CONTACT F'HONE:
S%S ENGINEERING
SR BOX 196X
EAGLE RtVER, Al.:::
694-::7979
9957'7
LEGAL. DE,,.:~CF, I
L 0 T S I Z E:
MAX BEDROOMS:
SUBDIVI,:~ION: PETERS CREEP::
SECT I ON: .1.() TOWNSH I P:
9(')C)()~.--~- (SQ FT OR AE, RE,,.~)
LOT: 9 BLOCK: 4
15N RANt~E. .1, W
I....iste?d below are the optic)r~s available to yOLl in des.igning your' septic
system. Choose the ol~tion tha'L best fits your site.
DE:I:::"T'H 'T'O P I PE BO'T'TOM .(FI". )
f:.')RAVEI .... DIEPTH (FT.)
TOI"AL DEF:'I"H (F'T'.)
GRAVIEI,., WID'T'H (F'T'.)
GRAVEl_ I,,.ENGTH (FT.)
GRAVEl .... VOLUME (CU.YDS.)
TANK SIZE (GAL..S)
SI]IL., IRA]'ING (SQ. I=']". /BIR)
.~* TANK MLle, 1 HAVE A'l" I,...EAST TWO CL]MPARTMENTS
I certify t. hat:
:t.,, I am famil:iar' w'i.'Lh the r'equirement, s for on--site sewers anti wells as set
fol-t.h by the Municipality of Anchor'age (MOA) and the Sta'Le c:,f Alaska.
2. I will install 'Lhe system in a(zcordan'ce with all MOA codes and r'egu:l, at:Lons,
and in compliance with the design criteria of this per'mit.
3,, I w:i. ll adher'e 'Lo all IdOA and Stat. e (::)f Alasl.::a requirements for the set bac:k
distances t'nom any existing well, wastewat, er' disposal system or' public
sewer'age system on this o1" any adjac:ent o~ near'by lot.
4. I under'stand that th:i.s per'mit is valid Cer a ~a~;~il~Ltm o~' 3 bedr'ooms and
any enlapgement will pequir'e an additional permit.
IF' A LIF:"T STATI[:IN IS IAIS1ALLED I1'4 AN AREA COVERED BY MOA BLJILDING [,,ODE,,;~,
THIEN (,1.) AN EL. IFCI'RICAL' I'-E:.RM,I,T AND IN,~FE.C] ION MUST BE OBTAINEiD; (2) AS'":EUIL. TS
WIL. L. 1'40T BE: AF'PFd3VED WITHOU'T' AN IEL. ECTRICAL INSF'EC]~ION REF'DRT; AND (3) 'THE
t~OU(,t t 6-6!)0
ANCH(1)raA(.~[{, AI..A,%KA 99502-0650
264 411 i
MA Y ( II.~
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit 9:840905
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 9 Block 4 Peters Creek Subdivision
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs' to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as-built inspection report
and the yellow copy must be sent to this office for review
and approval, and for documentation.
If there are any further questions, please call this office
at 264-4720.
Sincere!y,
~Ba~s or
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/057
DEPAR'I]¥1EINI'I'' OF"- HEAL. TH AND ENVIRONMENTAl- F::'IROTIECTIOI',I
8;2.5 L. S]"REE:T, ANCHORAGIF-, AK 995() :L
264..-472()
F:'E:RM I T NO",
DAT'Ii'Z I SSLIED:
~""':l111"',41 ......... '.EY: LIE 'T' IE."E
84 () 9 () 5
.I.U, ,:::4.184,
· c:::~ lEE!!':: II,~Jl tEE:
APF'I_ I CANT .".
A D E) R E S S:
CONTACT PHONE:
LEGAL. DE'.SCR IF':
L lIT !El I Z E:
MAX BEI)I'"'~OOMS:
C/O S &. c: ,:~AI....E.~
~, EI',IG ' G. AR'l" o ..:
'SRB .1.96X
EAGLli':] IR I VER :, AK 9957'7
694-29'79
SUBDIVISION: PF'Z"I"I"]iRS (.,REEl ....
T []1,~11~1:~ I"'11F':
SEC T I 01',1: :1. () ' ~"
90()('~ (SQ. F"F. OR ACRES)
LOT: 9 BLOCK: 4
R AN GE:: 1 W
I istecl below are 'Lhe opt:i, orui~i available 'Lc) yc)u in designing your
System. Choose 'Lhe optior~ tlnat best fits your si'Le,.
' ......... "%" E~' F:" ~*~ C'~' fl':""~ [::~ f" IE} I~'~-.,, :E]' Fi: ~
DE:F::"I"H 'T'O F:']:F'E BO'I"'I'OIq (F'T'.) 4.0 6.0 ~ 6 ,, ()
GRAVEl_ DEF:'TH (F:"T.,) 4.. 0 ' 0. E~ ~. 1.0
]"OTAI .... DEPTH (FT.) 8. () 6.5 ~ 7.0
GRAVE:L NIDTLi (F:'T.) 2.,5 . 14.0 ~5.0
GRAVEL. L. IEIxlG"I"H (FrT,,) 32.0 28.0 ~ 45.0
GF~AVE:I... VOI_UME: (CU. YDS. ) ~:3,, 4 ' :1.4.6 ~ !2.5
]"ANI':" S I Z :' (GAl c; ) ~ ,, (") (")'(") . ('~ '~"~' 1, C)(')('~. (") .~.,~. ~ I ~, 0()0.0 '~"~'
-~'~-TANI< MLJS]" HAVE Al" L. EA~] TWO CC)IqPAF~TMEIqTS
I c:er'tify that:
1,, I am Familiar wi'Lh the requirements for on...-.site sewers and wells as set
Forth by 'Lhe Mun:Lc:il:~al:i. ty of Anchorage (MOA) and the Stai:,e c)f Alaska.
2. I will il")s'Lat], the system ir'l ac:cor'ch~tnce with a].], MOA (:c:)des aFld r'(agLt],a'Lior'is:,
and in c:omplianc:e with. the design c::r'ite~":i.a c:)f this per'mi't:.,,
3,, I will adhere to all MOA and State of Alaska r'equir'emenCs for the set
distar'lces From any exis'[.:Ll"~g we)l]., wastewater" disposal, system of public
sewer'age sys'Lem on 'Lhis or" any ~(d.jacent or r')(-:.:.tar'by ].or.
4. I L~l]deps'La~rld tha'[. 'Lhis permi'L is va].id For' a max:LmLm)
arly eF~].argement will require an ad(::l:i, tic)nal perm:i.t,,
IF A I_IF:']" STATIOIq IS IIq.~]AI..~I_ED IN AN AREA [][]VERED BY MC.)A BUII_I)ING CODE:S,
']~l...lliiElq (i) AN E.L,,IE:C'~L. F'ERMIT AND IIxlSF'ECT]ON MUS]I BE.:.: OBT~:I:I'qED~[~ (2) AS-BUII.:FS
N0'T' Xn' AN CaL :r. NSPE. C:.T:?N THE
E:].i. liii?ii]"F"~ ~ CAI..'"N(.,~'I':~;:7 BE~si; 'T' Gl\lED //~--~//////~:)J"~I'E/BY A I.., ICENE']ED EL..ECTRI [i I AI',I.. I}A'T'E: /? /~_,/:/~' /
/ ..........................................................................
~F' F L I £.,AN T, VC/~.) .... ..,. ,., E.I Io G ,, ~F~ I ,..~AL.E,, I
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
~ SOl LS LOG
[] PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: ,~'~ /.~~-'/~ f DATE PERFORMED: JO/~,//
LEGAL DESCRIPTION: ~-' ~"~ ~::~ ~ /~~P"' ~ f//~
SLOPE SITE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER ~ S
ENCOUNTERED? L
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
/
/
PERCOLATION RATE ~///~ (minutes/inch)
72-008 (6/79)
August 1, 1974
Mr. Dale £. French
P.O. Box 575
Chugiak AK 99567
SUBJECT: Lot 9, Block 4, Peters Creek Subdivision.
Dear Mr. French:
This department has received numerous complaints of junk and junk cars on
the subject lot owned by you in Peters Creek. The listed vehicles qualify
as junk as defined in tile ordinance enclosed:
Volkswagon, Alaska license plate 1874
Volkswagon Chassis
Volkswagon Red Panel Truck
Ford Station Wagon, Alaska license plate 48398
Volkswagon, Alaska license plate 17583
Volkswagon, Alaska license plate 49352
Volkswagon, Alaska license plate 53536
Volkswagon 1300 - No license plate
There were nmnerous other debris ltke a freezer, and a washer, etc., that
would probably list as Junk also. We are requesting therefore, that the
listed vehicles, as well as the miscellaneous Junk material be removed in
a satisfactory manner by Septe~er 16, 1974. Approximately six weeks should
be a fair amount of time for the clean up to be made.
It is unlawful to allow, maintain, or permit a public nuisance to exist
and any person who allows, maintains, or permits a public nuisance is
qutlty of a misdemeanor. Failure to comply with a request to remove a
~le E. French
August 1, 1974
Page 2wo
public nutsance may result tn leg&l actton.
Very s t ncerely ;yours,
John R. Lee
Eagle River District Sanitarian
sr
Enclosure
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE Of HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
1.
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
HAA# H
Expiration Date: .~r--_ / 7- O .~
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: ~
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
[]
[]
[]
[]
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ~
Individual Holding tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) 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) for properties served by a sing!e family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties se.wed by a private or C~ass C well and may be reissued with
new water sample results less than 30 days otd. (Ce~ificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B we!Is or a public
water system. The Munic!paiity of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto end as of the validation date shown below. I verify that my investigation.
based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system Is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances.
and regulations in effect at the time of installation.
NameofFirm F::l~f/c? "?-~f.,~,c~f .~¢~-~r~ Phone
Address
Engineer's Printed Name --r'A ,,o¢~'¢,¢-~ F. ~oo ~ Date
5. DSD SIGNATURE
~'"'"'Approved for
Disapproved.
Conditional approval for
ENGINEER'S
STAMP
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ..~-- J 7 ' ~
Co
LogaJ Description:
WELL DATA M.A.
Well type
Data completed
Total depth f.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-SIta Water & Wastawatar Program
4?00 South Bmgaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(9O7) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
ff A, B, ~x C provide PWSID #
~ s~ (Y/N)
FROM WELL LOG
Date of test
Static watar level
Well production
WATER SAMPLE RESULTS:
Coliform colonies/19O mi.
Date of sample:
SEPTIC/HOLDING TANK DATA
g.p.m.
Tank Type/Matarial
Tank size ~ gal.
Foundation ctaanout (Y/N)
Date of pumping
ABSORPTION FIELD DATA
Number of Compartments
Depression over tank (Y/N)
Pumper
~ree lc ..c /~ Parcel ID: ~) ~'1 - t/f - '~ ,7
Well Log (Y/N)
Wires properly pmtactad (Y/N)
Casing height (above ground)
AT INSPECTION
g.p.m.
in.
--, colonies/100 mi.
Date installed I o / 2. 3' /~,.~-
Cleanouts (y/N) 'r'
High water alarm (y/N) Iv. ,~,
Data installed 1t9/2..3/$~- Soil rating (g.p.d./fi; o~ ~/'odrm) ~)~' r~/~en,,,,System type Tr,
Length .-g'; ft. Wzflh :~ ft. Gravel below pipe '~..f' ft.
Total depth ~ ft. Eft. absorption area ~.~',C'ft; Monitoring tube Y Depression over field
Date of adequacy test ~' /tff/Zo~ ~. Results (Pass/Fail) t'~;' For ~t' bedrooms
Fluid depth in absorption field before test J~ in. New depth~.l,~- in.
Elapsed Time:nJ,~ min. Final fluid depth 17 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~/. 4[
Watar added '111 gal.
in. Absorption rate >:
If yes, give date
O. UFT STATION
Date installed
'Pump on' level at
Datum
E.
SEPARATION DISTANCES
Size in gallons
"Pump off' level st in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO: ~.
Septic tank/lift station on lit
Absorption field on lot
Public sewer main
Sewer/septic service line
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?,
On adjacent lits
On adjacent lots
Public sewer manhole/ctesnout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation, q 5' *
Water main ~. ~O
Wells on adjacent lots *~ too '
Property line .~
Water service line
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line.
Water Service line
Curtain drain A/o,~_
Absorption field Iq '
Surface water '~ Ic~¢,,
Building foundation ~' 2.' Water main
Surface water *;> too ' Driveway. parking/vehicle storage
Wells on adjacent lots '~/o~,,
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA tIAA guidelines in effect on this date.
Engineer's Printed Name '"T',/~ ~',~o ~E. /"=-./*-~c, o,"~.
Date Mc~,v
HAA Fee $ ~ '7~° ~
Date of Payment .~-/ t~' /O~
Receipt Number I~ ?F~'~/~" ~.'
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
in.
NO CORNERS SET THIS DATE.
i~:l ~RTl~Y .THAT I H~W SURVEYED THE
[!!~l~l ~,~ID'ES~RIBED PROPERTY,
~ ~T~ ~OIEN~OACH~ENTS E~IST EYCEPT ~S
},~ ~I~[~,'~HE RES~NSIBILITY OF THE
~ ~J~[~NINE THE EXISTENCE OF ANY
~ P~TA~ ~Eo~, BE USED FOR CONSTRUCTI ON
~I~ES;I.OR FOR EST~LISHING ~ND-
ASSOCIATES LA~D SURV~'~INC
SCALE;.
'~ATE'
'GRID:
DRAWNI
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 9; Block 4;
Peters Creek Subdivision
Location (site address or directions)
23211 Glenn Court
Chugiak, AK
Prope~y owner Ivan Nicks Day phone
Mailing address c/o Aurora Properties P.O. Box 671923 Chugiak, AK 99567
Lending agency
Mailing address
Day phone
Agent Nancy,' Stahly/ Aurora Properties Day phone
Address
688-4939
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOV 1996
RECEIVED
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
XXX
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.
Name of Firm
Address
Engineer's signature
S & S ENGINEERING
...... :.-.c ",.c,c,b P,o,d 'Nu. 204
Eagle River, Alaska 99577
Phone
Date I,/! :3 / ~ C
DHHS SIGNATURE
Approved for
Disapproved,
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date//-2 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 courte§y 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~21
MUNICIPALITY OF ANCHORA, a~'
Municipality of Anchorage ENVIRONMENTAL SERVICES
DEPARTMENT OF HEALTH & HUMAN SERVlC;E8
Environmental Services Division 1 <. 1996
825 L Street, Room 502 · Anchorage, Alaska 99501
Health Authority Approval Checklist
Legal Description:
A. WELL DATA
Well type J~)C.3~z~k/t, l~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Date corn pleted
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RES~'~:
Coliform /
~.~~of ~mple:
Cased to Casing height (above/g~und)
Wires properl~cted (Y/N)
FROM WELL LO~PECTION
g.p.m.
Nitrate Other bacteria
Collected by:
g.p.m.
B. SEPTIC/HOLDING TANK DATA
Date installed ~,~2_'-5 -~ 5'- Tank size ~ Number of Compartments 7---- Cleanouts{~l) ~
Foundation cleanout(~JN) ~/ Depression (Y~ ~ High water alarm (Y/N) ~'-~(A,
Date of Pumping [o ~ {~ .-- c~ L. Pumper ._.~.~q~ t ~
ABSORPTION FIELD DATA
Date installed ~.c~ .-'7_-~ -
Soil rating ~ or fF/bdrm) ~//~/&-- System type
Length ~'~ J ~ Width ~ I Gravel thickness below pipe ~ ,~ Total depth ~ ~ j
Effective absorption area ~ ~ Monitoring Tube present ~)~ Depression over field (Y~.
Date of adequacy test J~ I ~ -~ ~ Results~ail) ~ For '~ ~ bedrooms
Fluid depth in absorption field before test (in.); ~ Immediately affe~~ gal. water added (in,):
Fluid depth ) o (ins) Minutes later: /~/~[ Absorption rate = g.p.d,
Peroxide treatment (past 12 months) (~ ~ ~ /~o~f yes, give date ~/~
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* "~'u,,p off" 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
On adjacent lots
On
Public sewer manh ole/cleanout
Lift station
SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO:
Foundation ~ ~ 'J~ ~ ¥
Property line __~.. '[ O Absorption field
Water main/service line ~ ~ t '~
Surface water/drainage ~ c~o ~
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: "z~ ~Building foundation ~. ~ ~ '~
Property line
· Surface water ~, D ~
Curtain drain I'~ / .~
F. ENGINEER'S CERTIFICATION '
Water main/service line
Driveway. parking/vehicle storage area
Wells on adjacent lots ~-o o ~
I certify that I have determined thru field inspections and review of
in conformance with MOA,2A guidelines in effect on this date.
SignatUre
Engineer's Name
Date
HAA Fee $.,'. ~'J-). ~
Date of Payment /././~z///~ ~,
Receipt Number ~
72-026 (Rev. 3/96)*
Municipal record~ems are
Waiver Fee, //~. ~t..~
Date of Payment //////~//'/P .~
Receipt Number c:~.~/,)
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
December 9, 1996
Robert C. Cowan, P.E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject:
Waiver Request for Lot 9 Block 4 Peters Creek Subdivision
Waiver Request #WR960066, PID #051-115-27, HA960498
Dear Mr. Cowan:
Your request for a waiver of the required 10 foot separation between an on-site
wastewater disposal system and a lot line has been approved. The waived distance is 3
feet between the leachfield and the west property line.
This approval applies to the existing on-site wastewater disposal system lot line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separations 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 Services
DJR/ljm:Nicks
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
WR9 WR960066 PID9
Waiver Review ~orksheet
051-115-,27
HAS HA960498
Permit
Date Received: November 14~ 1996
Legal Description: Lot 9 Block 4 Peters Creek Subdivision
Engineer: Robert C. Cowan, P.E., S & S Engineering
Applicant:
99577
17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska
Ivan Nicks
Lot line waiver of 3 feet between the leachfield and the west.
Waiver Requested:
property line.
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Waiver is Granted: X Waiver is NOT Granted:
List Conditions or Reasons for above:
Date:
By:
Name of Reviewer
Rec 9: #02390/3399 .. Amount: $ 115.00 Date Paid: Nov 14, 1996
ROBERT C. COWAN, RE.
ROBERT A. SHAFER, RE.
HEALTH AUTHORITY
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
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
November 13, 1996
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
RECEIVED
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK 99519
NOV 1 4 1996
Municipality of ~'-~ci~o~ age
Dept. Health & Human Services
REFERENCE: Lot 9; Block 4; Peters Creek Subdivision
23211 Glenn Court
Request you issue a Health Authority Approval on the referenced
property and grant a waiver for the horizontal separation distance
between the leachfield and the west property line at 3 feet.
The propery is relatively flat. We do not anticipate any adverse
effect on adjacent properties. The property line is adjacent to Four
Wheel Drive.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/gk
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
AURORA.PROPERTIES
TEL No.907-688-1310 Nov.11,96 16:11 P.01
'IL:I,. Nn,9(,;?-688~1,310 Oc'~., 6,96 18:2f1 P.02
·
~:.St~ ,IL -'NO COltNER$ SET THIS DATE
I HE' E'I~Y CI:HN'If,'Y-TH~N I HAVt
I'OIL~ )~IN~ DESCRIBED PROPgRN'Y~ /~ .
~[) HA~ NO ~:N~OACHM~NI'$ E~I5~ E)'C~PT
fYI'I.. A'IED. IT 15 7HE RFS~NSIBILITY- OF THE ......
?~1~ ~.TD D~ER~INE THE E:XlSTENC[ OF ANY GI~ID~ ..............
I'AStI~'NTS~ COVENANTS, OR RES'TRICTION5 .
Y,'II~(~[~O NOT ~PEAR ON THE RE~DE~
VtSI,~N PLA'r. UNI)E~ NO CIRCUNSTANCES
~:',I." ~NCE LINEg, OH FOR EST~LlSHING ~ND- t ..2::2~":':-' .... - ....
S.$WA~D & AS$OOIATI~S
SCALE:. ,,.
