HomeMy WebLinkAboutEARL RAY BLK 3 LT 25Earl Ray
Block 3
Lot 25
#051 -113- 29
' ~ MUNICIPALITY OF ANCHORAGE
//~-'"i~'~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
((i.,~l~.'-'j)) ENVIRONMENTAL ENGINEERING DIVISION
' ~--~1~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
~' ON-SITE SEWAGE DI~OSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME ~ ' P N · ~EW
LEGAL DESCRIPTION --' '~ / ~ ' . ~ /
LOCATION~~~ ~~ /' elln NO. OF BEDROOMS~
Well Absorp~n area Dwi ~ ~
DISTANCE TO: '/t~ ] O ' ~ PE"~'T
~ ~ I ~ ~ ~ I [ '~ No. of compa~nts
~ ~ Manufacturer~ _ M~r~_ ~ ~
~ [Liq ~t~aH°nsI IF HOMEMADE: Inside length I Width Liquid depth
DISTANCE TO:
~ ~Qi Manufacturer~ IWell ' Dwelling
LUO
I No. of,,ne .engt,
I-~_ Top of tile~to finishgradel
Length Width ~ Depth
~ [ Type of crib Crib diameter
~ DISTANCE TO:
~ ~ Well
Class Depth Driller
~ ~ DISTANCE TQ: Building foundation
I
Foundation
Total length of lines
Material
Nearest lot lin~//~) /~'
T r e n c ~b,,~id~
~__~ C~ inches
inches
PERMIT NO.
Liquid capacity in gallons
PERMIT NO[~o~0 ~ B?
Distan~e.~,)",~jJi?as
Total ef~.~a~rpti on area
PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Distance to lot line PERMIT NO.
Sewer line Septic tank Absorpt on area(s)
OTHER
P I P E~AT E R I A L,~.--~
REMARKS
L/~GAL j
72-013 (Rev. 3/78)
F!F:'F'L T '":F¢4T
LE C FI'[' I
LEGiaL
!}EF'Fff~:THENT ;~ HEF!L. TH FIND EF.!V:[F:CINhiE?'~TF!L.,~OTECT:£ON
S;[.i:D '" STREET., F~F,!CHORF~(3E,, F:iK. ?:..
:;.:i:5~i.~¢E~ '5 :)UFtRE FEET
Th.'PE OF '.::'; ] t L F!E:S';ORPT I ON E;'¢tS'T'EH i S;: 'TRENCH
:l. 4 ....
HRXIMUM FitJMBEf~' OF 8E[:,F:.tO()H'L:; ..... ~. E;C'[L .... RF:FFING ,": :' .~:"~",,-"PP*' =,...*...
THE REQUIRED SIZE OF THE SOIL Fff:'!:.~':::P:.PTIEF¢ ':]h".'-Y',r'E:M ]"::
'THE LENGTH D!MENSI'ON ):?]; THE LENGTH (IN FEET) OF THE TRENCH OR DRFI!HF'IEL.[:'.
THE DEPTH OF' FI TF:ENCH OR P:[T iS; THE DI:~;"FRNCE BET!.,JEEN THE SURFFICE OF THE
GROUND RN[:, THE BO*TTOH OF:' THE EXCRYR"F ): ON (IN FEET).
THERE !S i'*,!O SET I.,.!IC, TH FOR TRENCHES.
THE GRF?,/EL DEPTH I:S THE M:[N!t%IM DEPTH OF GRRVEL. E~E"FI.4EEh! THE OUTFF:ILL. PIPE
RND THE BOTTOM OF THE EXCF!VRTZON <ZN FEET).
F'ERi"! I T RF'PL ! CFtNT HFI':'~'; THE RE:..:.;F:'ON~; I E: I L I 1"? T 't t I'.,IFOI:~:H TH 1:5 [,EF:'Fd:~:THEtqT [:,L R I NG THE
i NS':]"FILL. FFT I ON I .,".4'.:; PE ~ ]" T. E i'.,l'S; OF F~,N"r' t.,EL !. '~ F:I,[:,JB(]:ENT ]"O TH I :::; PROPERT"? RN[:' THE
R,:..:,-,I ....... t .......... THF!T ]"HE i.,.!EL.L. !.4ILL
NUMEcEF: OF ~,c ,- '~ ". r'I * "*~::',: ....... ' '"
E:F4C:KF'ILLING OF FtN"r'
'-' -' fi:":' "-T . ................
[:,EF'F!RTHa,~.,P," 141LL E)E
MINIHUM DIt~;TFIF.!CE E~ETI.,.iEEN R FJEEL. L RND F!N'..¢ ON-SITE SEi.4FIGE £)I:SPO:E.;RL S'¢S;"r'EH IS
±EiEi FEET FOR B PR!VF4. TE i.,.!ELL OR J.!.SO TO ;;?.EtEf FEET FROH F! PUBLIC: I.,.tEL.L.D.EPEN[:,ING
UF'ON THE T'¢PE OF PUBLIC HEL, L..
MINIMUM DISTRNE:E FROM F! PF:I',/R'I"E HELL. TO Ff PRI'¢RTE '_:SEt.,.tER LINE IS.i ;25 FEE]" FIND
TO ~::~ COMMUNIT'¢ SE,WEF-.'. LINE tS 7'5 FEET.
O"FHER RE(..]UIREidENTS h't,'::l'.¢ F!PF'L.'¢. ':'i:';PEC!I::ICI::IT:[ONS RH[.'.', CONSTRUCTION DiFtGRRME; FIRE
R',,,'Fi' I L.I::!BL.E 'T'O T. NSUF.:E F'ROF'E:F: I NSTF!LLRT I ON.
! CERT!F'¢ "FHRT
:t.: ! BM FFIMIL!P"iF: I,,!ITH THE REE!U:EF'.EMENT2:: FOF,.: ON-$i'TE: :!SEWE.".F:S ~qt'-,tD !,,,EEt,..LS RS SET
F'ORTH E.::'.r' THE MUN l C Z F'F!L Z '!"'.? OF: F!NCHORFI(3E,
2: I i.,.!!'LL. INSTI.3LL THE S"r':E;TEH IN
Z: I UNDER!.:.~TRND TF.ff:~T THE OI'.,F-.:~;ITE SEWER F.:'.¢S:;TEH HF:t'-r' REQUIRE ENi...F!F;:GEPtENT
RE~4; I DENCE :.r.!~:EMO[:,ELED TO
! F:* "F HE
' ','
Russell Oyster
694=2774
O & E ENC.NEERING & DEVELO, MENT CO:
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Performed fo~':
Legal Description:
Depth (feet)
Name' ~/'~'~
Earl EIl~
SOIL LOG 688-2280
~-~, f i~/--/~-;~T~d Tel. N0 ~' '~5~
Soil Characteristics
11__
12__
13__
PLOT PLAN
14
15__
16__
Ground Water Encountered; Yes.__
Proposed Installation: Seepage Pit
Comments: .,~,~-~,x_ ~)~ ~F'
No ~'~' If yes, what depth
Drain Field. ~
PERC. TEST
Date://~J~ /~/ /~'~'~
DOC Co. dba
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND ~f <~ /C
ADDRESS ~'O ~,~ ¢:) ~
LEGAL DESCRIPTION ~ ~ ~ ~L/~
DATE- Sta~ed j ~ / ~ o ~ ~ o Ended
PE~IT NUMBER ff~O a ~ ~ ~
JAN 9 I981
RECEIVED
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KINDOF FORMATION¢
From (? Ft. to ~ Ft. ~9~,~/ff~d'd,~t::7~..~'
From__ Ft. to
From~:~L:~ , Ft. to //.5~
From-- Ft. to
From ; / ~ Ft. to //~
From Ft. to
From__.Ft. to
From__Ft. to Ft~
From Ft. to Ft.
From Ft. to__FL
From__Ft. to Ft.
From__Ft. to Ft.
From Ft. to Ft.
From Ft. to___Ft.
From Ft. to ___Ft.
From Ft. to___.Ft.
From Ft. to Ft.
From Ft. to Ft._
From Ft. to Ft.
From Ft. C~ Ft,
From Ft. to Ft.
From Ft. to Ft.
From___Ft. to Ft.
From Ft. to. Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft
From Ft. to Ft.
From Ft. to Ft
From Ft. to Ft.
From__Ft. to Ft.
From Ft. to___.Ft.
MISCL. INFORMATION:
DRILLER'S NAME
PERMIT NO.
MUN I ¢ I~ AL I T'~' OF AN¢~ RAGE
DEPARTMENT b~' HEALTH AND ENVIRONMENTAL r~OTECTION
825 "L~' STREET~ ANCHORROE~ AK. ~501
2~4-47~0
~4ELL PER~ I T
RPPLICRNT PETERS CREEK CONST. INC PO BOX ~0~ E.R.
LOCATION MILE 21 GLENN HIWY
L~[~ ~ EMRL R~ LOT SIZE 3?000 SQUARE FEET
!~ UM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR R PRIYRTE WELL OR i50 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRI~RTE WELL TO R PRIYRTE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIAGRAMS ARE
RYRILRBLE TO INSURE PROPER INSTALLATION.
PERM I T £~P I R~ D~¢~MBER ~l., i~80
I CERTIFY THAT
l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS'AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
~ I WILL IN~LL THE SYSTEM IN ACCORDANCE WITH THE CODES.
SIGNED: ..... ~ ...................
CREEK CONST. INC
ISSUED BY ................ DATE- -
¥4, 0
Municipality of Anchorage
Development Services .Department
. Building Safety D vimon .....
: ' On-S te Water and Wastewater Program '
~... 4700 South Bragaw St. ~ -
~.O. Box 196650 Anchorage, AK 99519-6650 .
www.cLanchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.O5'-/--II 5 - ~-~ '
,ii.:. GENERAL INFORMATION
· ' '.'" '"'
".: Coml~letelegal ption I~OT 25 ~R~',OC,,~ '~ ]~A~r. ~A¥
· , .cLocation(sitead,dres, s or directions) 20920 Chickadee Ln Peters Creek
<' Current Pr0pertyo~ner(s)
';;;:.Mailing address
· ', L(~n~ing agency
Maiiing address
Real Estate Agent
Expiration Date: I !" 7- O /
Richard Sunds Day phone 688-3332
p.O.Box 770509 Ea£1e Ri'~er.AK.99577,
Day phone
Day phone
First National
Mailing Address
Unless otherWiSe requested, HAA wilt be held by DSD for pickup.
2. NUMBER OF BEDROOMS: tv
3. TYPE OF WATER SUPPLY:
· .Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
I'~ 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 single 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 served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates ere 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.
4. STATEMENT OF INSPECTION BY ENGINEER
*As certified by my seal affixed hereto and Es 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 h~rein.' 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.
S & S EnKineer~nK
Name of Firm
Address '17034 N. EaRle River Loop Suit'e 204
Engineer's Pdnted Name Robert C. Cowan P.E_
5. DSD SIGNATURE
Appi'oved for. -' ~ bedrooms.
Disapproved.
Conditional approval-fOr __
Phone, 69&-2979
Eagle River, AK 99577
.Date 1,~'~1'1'1'.v 9NN1 .
,.'~c... OF A,-'~. '
~ 1';'~ .." ........ ."'~
%~' ~ .
·
~.~: WATER AND :
-'- ';. WASTEWATER: _-=
%;% ". ,"
-~ote:The well for fins property meets existing State and l~lunJc|pal Codes.
There are nitrates
present. It is s,ffEcsted that perindh- fp~/;no~ ~ ~erform~fl, '- ..... ,, ...... ,, ..... ,
Current nitrate concentration is 6.04 mia. EPA maximum concentration is 10.0 mill. More
information ~ii illti'at~ ia a*aiiablc from tile On-bAte Services Program, at 343-7904.
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
/vlaintenance Agreements
Supplemental Engineer's Report
Other
Original Cedificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl,enchomge.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
A. WELL DATA
Well type
Date completed
Total deptil [ I,,~ ft.
If A, B, or C provide PWSID # ~
Sanite~ seal (Y/N) .~
Cased te
Date of test
Static water level
FROM W~ ! LOG
Well production
WATER sAMPLE RESULTS:
Coliform O .colonies/t00 mi.
Per~
w~ Log (Y~N)
Casing height (above ground) / ~ 'f' in.
AT INSPECTION
~:~' ft. ft.
~"' g,p.m. 4' ~
Nitrate G.o9 mgJI. Other bacteria __
Date of sample: ~
B. SEPTIC/HOLDING TANK DATA
Tank Type/Materiel
TanksizeI !~) gal.' ." '. Number of Compartments ~'
C. ABSORPTION FIELD DATA
g.p.m.
O colonies/100 mi.
Date installed ~
Cleanouts (Y/N) .~'.~
High water alarm (Y/N)
Date installed ~ Soil mfing (g.p.d./ft~ o(~ /4 ~
La.~h ~'~' ft. w~ ~ ".
Fluid depm ~ aba~on field ~e ~t ~in. W~r add~.
Baps. T~e: ~ ~. m~. F.I fluid dep~ ~ in.
~y mjuve~on ~nt (past 12 m.) ~ & ~) ~ ~
System type 7?~L--~/C.,~
Gravel below pipe (~' ft.
Depression over field ?N ~
For "~ bedrooms
New depth I~> in.
~ g.p.d.
ff yes. give date. "-
Absorption rata >=
O. UFT STATION
Date installed / Size in gallons
'Pump on' I . 'Pump off' level at __
Datum Cycles tested
E. SEPARATION DISTANCES
Manhole/Access (Y/N) ...
in. High water alarm level at in.
Meets alarm & drcuti requirements?
Absorption field on lot
Public sewer main
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanWIl~ on lot
f
S. Jw~T"lsepflc sewloe line
SEPARATION DISTANCES FROM SEPTIC/I:IDL-I~TANK ON LOT TO:
Building foundation ~ -t'-
Water main /1~/~t'
Wells on adjacent lots I OD ¢ ~L
Qn adjacent lots L OD '*-
On adjacent lots ! OD 1 4-
Publlo sewer manhole/cieanout r ~ /~
Holding tank ~J/~-
Absorption field
Surface water
Pro~erly line ~'
Water sen, ice line
IOo '~-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ! (3 t jfl. Building foundation ) ~ f'/'- Water main /~J/~
! t
Water Service line I/0 .I-- Surface water ~ O ~:~ 4.--- Driveway, pa,'td~/vehicle storage
Curtain drain ~ Wells on adjacent lots ~
F. COMMENTS
review of Municipal recon~ that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12~0)
3 00. e~
o o '~ .~
Waiver Fee $
Date of Payment
Receipt Number
JUL-ZI-UI 1~:49 t'ROM-CI&E ENVIRUN~NIAL
"~T~. CT&E Environmental Services ,.c.
I-lO0 P.02/03
~T&E Ret.# 1014607001
Client Name S & S Engineering
Pro]ecl Name/fl L25 B3 End ~y S~
Client Sample ID ~5 D3 Earl ~y S~
Matrix Dzin~g Water
Ordered By
PWSID 0
Sample Remmks:
Client I~O#
Printed Datefl'lmc 07/27/2001 13:15
Collected Date/'flme 07/23/2001 15:30
Received Date/rime 07/24r2001 ID:03
Technical Director Stephen C. Ede
Patam~n' Re~ntt~ PQL
Natorn Dopartment
Nif~nte-N
Allowable p,q, Analyall
Units Metlmd Limit~ Date Date Init
6.04 0.500 mF./L EPA 300.0 (<I0) 07/24/01 SCL
N:Le~rob:l.o logy Labo2:at-ory
Tome Coli£orm
0 col/100mL SMI8 922213 (<11
07/24/0 ] KAP