HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 4 LT 15 Greatland
Estates #3
Block 4
Lot 15
#051-133-24
QGREAi'~'R ANCHORAGE AREA BORb~dGH
Department3330°f EnvironmentaIc Street (~uality
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL f~ MANUFACTURER ~____~)/'-~g,a~/_....,~ MATERIAL
INSIDE LENGTH //~'~- INSIDE WIOTH / LIQUID DEPTH
COMPARTMENTS
__LIQUID CAPACITY /-~'-O GALLONS.
SEEPAGE Pit:
/
NUMBER OF PITS"/ DIAMETER 20 ! / //./~'''
__. OR WIDTH 20, LENGt~2x~. DEPTH
LINING MATERIA CRIB SIZE: DIAMETER EPTH DISTANCE FROM: WELL
f TOTAL EFFECTIVE
BUILDING FOUNDATION¢t~) I, NEAREST LOT LINE 50 . ABSORPTION AREA (WALL AREA) ~'~O SQ. FT.
ADDITIONAL ABSORPTION / ~'~O ~ ~
WELL:
BUILDING NEAREST //
FOUNDATION LOT LINE
APPROVED L///~ DISAPPROVED
DISTANCES:
INSTALLED BY:
~"-C~ DEPTH
SEPTIC
~E2REST /I /~___.: TANK
, SEWER LINE (~/ ~ ,
REMARKS
PIPE MATERIAL:
LOT SLOPE:
DISTANCE FROM:
SEEPAGE
SYSTEM /~0
// ' W(./ '- dZ
DIAGRAM OF SYSTEM
DATE
RECEIVED A & L DRILLING COMPANY
BOX~7, EAGLE RIVER, ALASKAgg577 m TELEPHONESg4-2588
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE- Started
PERMIT NUMBER
:~ 7/~ o[ GA~. PER HR X OO
?-
Ended
KIND OF CASING
From
From :;;"'i Ft. to b~6 Ft.
From__Ft. to__Ft.
From Ft. to Ft
From__Ft. to__Et
From__Ft. to__Et
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.
KIND OF FORMATION:
From :') Ft. to / Ft. Dt)~"~dA~~/ From
~ Ft. to ~ ~" Ft. .~.~u/O ~qo~/.. ~ ~O~ta~Tff~~
~:3 C; Ft. to--Ft..53q ~'0 ~.~Oli- ~ ~' .., From~
From
From
From
From
From
From
From
From--Ft. to
Et. to__Ft.
Et. to Ft
Et. to Ft.
Ft. to Ft,
Et. to Ft
Et. to Ft
__Et. to Ft.
Et. to Ft.
Ft. to Ft.
__.Ft. to Ft.
Ft. to__Ft
Ft
From Ft. to__Et
From Et. to Ft
From Et. to Ft.
From Et. to Ft.
From Et. to Ft
MISCL. INFORMATION:
~j" O /9 A>/';' C..,'Y'o/;',.d~
DRILLER'S NAME
~. : , , DEPFIRTMENT HERLTH FIND ENVIRONMENTFtt~ ~O'I'ECTtC~N
RPPI..ICFINT R JERROL? [~LIRM 6:Iq8 NICKS;ON
L.OC:~TION F EIb. R,.> CREEK ...... .~ .....
LEC~RL I.._~[5 04 (]RERT i..,RN[:, Ef~'i'RTES ~3 L.OT S tZ[ 1t2~[g~$ SOUfFlE FEET
T'~PE OF' SOIl.., R6.~OF:.BIION, .::,~'.,IEI IS:
I~IR~<:INUM NUI"I[~ER OF E~E[:'ROONS ~:= 4
PIT
SO I L RFIT I
(,:;ia_, .,. FT/BR),= ""q
THE RE6~UIREI., S:IZE OF THE 550:t:1.. ~BE;ORPTION S'¢E:'TEM -c,'.
THE LENGTH DIMENSF, ION IS THE LENGTH (]:N FEET) OF EHCH SIDE: FOR FI SEEPRC~E PIT.
THE DEPTH OF Ft TREIqCH OR PI]' IS THE DIt~TRNCE BETWEEN TEIE SURFt~CE OF THE
GROUND fiN[:, THE BO"FTOM OF THE. ENCf~VFITtON (IN FEET).
THE (iF:.F-IVEL DEPTH I'/5 THE H1NIMUH DE:PTH OF f.'~iF'.RVEL F'~ETI,.IEEN THE OtYrFFtLL PIPE:
FINE:, THE BOTTOM OF' THE EXCRVRT!ON ,.',IN FEET).
8AC'.'KFiLI..ING OF FINY SYSTEH WITHOUT FINAL INSPECTION AND RPPROYRL BY ]'FILS
DEPARTHENT WILL DE,:.] 5]...IBJECT 'f'O PROSECUTtf.)N.
['IINIHUH DIgl"FINCE BETWEEN FI WELL RND FIN"¢ ON-SITE ~Et.4RGE DISPOSRL S¥S'¥EI'I
2LOO FEET FOR FI PR I',,,'RTE HEL.L. OR 200 EEET FOR R PUBLIC NELL.
I.,IELL L_OC¢.:; RRE RE6!UIRED FIND MUST BE RETURNED TO THE DEPFIRTMENT HI-FHIN
OF' THE WELL CO['IPLE'f':!: r N
.'SPECTFI'}FIT]ONS FIND E]NSTRJCTION D.~FtO. RRMS; RRE FIVI~IILFIBLE TO II¢.,!'.51JRE PROPER
I NSTF~Lt..fa T l ON
F: :?
I CERTIFM THFIT
:l.: I RH FFIMIL. IFIR WITH THE REQUIREMENTS; FOR ON-SITE SEWERS FINE;, WELLS RS :~;E'f'
FORTH 8V THE t,IUNICIPRL~T'¢ OF RNCHO~'.RGE,
2: t HILL. IN~TRL.L THE ~MS'f'EN IN RCCORDRNC:E WITH TtIE CODES.
]:: I IJt',I[;,ERSTRND THRT THE ON-S;tTE SEWER SIr'STEM MRgcRE(;IUIRE ENL.RRGEMENT IF THE
RESIDENCE I2; REHODELE[:, TO INCLUDE HORE THAN 4 BEDROOMS.
.ih ) "'i ......
/ ' ~PPI.]~:MNT ~ JERRUI..D t:~JvM
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alsska 99502 '~t76-2221
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
,ERFORMED F O R: _¢.'T'/E-.,~'~
_EGAL DESCRIPTION:
2
3
4
5
6
7
8
9
10
SLOPE
DATE PERFORMED:.-~/'~-~'f'~ '~; [c'~7'~--
SITE PLAN
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
11
12
15
1 6 T-'~ d -/' /21 r
17
18
19
20
Gross Net Depth to Net
Readin9 Date Time Time Water Drop
PERCOLATION RA'i- E
TEST RUN BETWEEN
(minutes/inch)
FT AND FT
PERFORMED BY: /"//OU.L~FZd~' ,"~T, ~f'Z~'
72.008 (7176) ,.!
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 AUTHOR!TY.A.PPROVAL
FOR A SINGLE FAMILY. DWELLING
Parcel I.D. O,.5" I - 1 3 ~ -;) "/ HAA# .~.~
,-, - ..-,. ration Date:
1..GENERAL INFORMATION
-.Current Property own,er(s). /~--~_l~-c':.~'-.o "]' ('~'~%r-Cz'-& Day phone
:. '. '" '
'" Mailing address"
Lending agency
Day phone
Mailing address
Real Estate Agent
Mailing Address
Day phone ~5'-'--'~-
NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Watei' 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 o[ Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of AJaska. Certificates of Health Authority Approval are required for the transfer of
title (except behveen spouses) for propedies 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 pdvate 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 are valid for one year for properties served by Class A er B wells or a public
water system. The Municipality of Anchorage is not responsible for errors cr omisslons in the professional
engineer's work.
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 outJined 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 flies 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.
'~ & ~ ENGINEERING
17034 Ea~b RNer Loop Road No. 204
Name of Firm ~,A,,; ............
Address
Engineer's P~'inted Name
5. DSD SIGNATURE
~ Approved for L1L
Disapproved.
ConditiOnal approval for
Phone.
Date /-///.3.;}/el
..
bedrooms, with the following stipulations:.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Weft Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:, /-'-/- - ~/-.?/'- O /
M~_micipality 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.cLanchorage.ak.us
(~07) 343-7~04
HEALTH AUTHORITY APPROVAL CHECKLIST
a Dascri,,tlon' [~'/'"! ~'' ,',~'~("~'- '~[.: ~x-~.~9~'Z-,,*~'~_~_ Pamello:O''T''l -)3)-3.~
Date completed C3_~./.~/, --7- Sanita~ seal (Y//N) ~"~ Wlras pr°pe~ Protected (Y/N' ~/¢~'~
Total depth L~. ~ft. ' Cased to '~"Lf'- ft. Casing height (above ground) / ~'~.tn.
Date of te~t
Static water level
Well production
WATER SAMPLE RESULTS:
FROM WELL LOG AT INSPECTION
-7!' ft. q~-
~' ~' g.p.m.
~- g.p.m.
Coliform ~, colonlas/100 mi. Nitrate /° ~'~ mg./L
Date of .ample: '/I2-/GI . Co, acted by:
B. SEi~FIC/HOLDlNG TANK DATA /
Tank Type/Material ~ /
Tank size ~ gal. Number of Compadments
C. ABSORPTION FIELD DATA
Date i s il,d Soil,ating
Length ~'O ft. Width
' Other bacteria '~ colonies/100ml.
Date Installed ~/'~2 ~/;~'' -2r-.
Cleanouts (Y/N) ~'~ '""'~
High water alarm (Y/N) /V/~A
Totaldepttl /4 It, Eff:abs.orptionama,~ ~Mo~itodn,,~ube~.~__
Fluid depth In absorption field before test ..,~n. Water added ~/~) gal.
Elapsed Tiree: ~ min. Final fluid depth ~ in. Absorption rate >=
Any rejuvenation tmatreent (past 12 mo.) (YiN & type) ~/'~ ~-,//~ If yes. give date "'""-
System type('~-/<'~
Gravel below pipe ~:~ _ ft-
Depression over field ~¥('~
For 4 bed;o/~ms
New depth/~-in.
'~e'~ ~ g.p.d.
O. UFT STATION ~
'PumP on' level at,~ in. 'PUmp off' level et
Datum ,/ Cycles tested.
E. sEPARATION DISTANCES
in,
Manhole/Acces~ (Y/N)
High water alarm level et
Meets ~larm & circuit requirements?
On adjacent lots
On adjacent lots
PubllG sewer manhote/deanout
SEPARATION DISTANCES FROM WELL ON LOT TO:
.' Septic ten.iR-station on lot
Absorption field on lot /~"~ /~'''
sewer main /~'/,~- .
Public
· Sewer/septic e;~wlce line. /,'~'~'/'~/'- ' Holding tank ~/~-
/
SEPARATION DISTANCES FROM SEPTICJHOLDING TANK ON LOT TO:
~- /
Building foundation 4~ .f_ Property line. ~' ~/- Absorption field
Water main '- ~ /,~ Water service line /~::~ ~ 8udace water
/
Wells on adjacent lots /t"~__Y'~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Pmpertyilne /~') '/- Bulldingfoundation. /~)-/- Watermain
Water Service line / ~ ~'/- Surface water
Curtain drain/~/,/,~V'a~',~/ Wells on adjacent lots
Ddveway, panVJng/vehlde storage
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections end
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name ~::~,~';-' (:::. ~-'~J,~
HAA Fee $
Pete P ment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
880 !
04-I?-01 15:~5 EROI~-CTE ENVIRON~NTAL 5615391 T-435 P,0]/03 F-510
,4~1'~.m~ v[mnmental Services Inc.
cT&E En
Cltent !'O#
c'r&E ITel.# 1011809002 printed DaterTlme 04/I7/2001 I4:35
Client Hame S & S ,~{~neeHng Collated Datefl'lme 04/12/2001 14:00
~roJ~t Ham~ H/A RKe[V~ Dat~ime ~112~001 16:55
Client S~mple 1D ~15; B4; O~a~d ~t fi3 T~hnlcal Dl~ctor Stephen C. ~e
a~l~ D~g ~ater
O~e~ By ~ ~
~SID O ·
Co~ected T~ott: ~ject ~ A~owable [~ ?~?~s t.it
Li~ Da~ ~te ....
I4itrate-lq
1.22
0.500 mg/L
ETA 300.0
10 n~x
04/12/1)1 SCL
M~.c~obJ, oloC~r Lab°~&t°~Z
Total Cotit"onn
0 col/IOOmL SMI8927.2B
04112/01 SKW
NUNiCIFALilY O~- AN(iHOHAGb ....................
P E PAP, TNEi':,, ,'OF r~EAL ~ d .m
ANu ENV~RONHEN'h~x, PROTECTION
825 L q~-~ ~ ~
....... e~_~, Anchorage, Alaska 99501
26d--4720
Date Received: December ~__z 1977
#i: ~lme __ fliSbX_i ...... ,rz: T~me .................... '.['}me
Date Date
Insp Insp
~,...e,.~ ....... FOR APPROVAL OF iNDIVIDUAL ~' ' .... WA~_ER FACILITIES
1. Lending !nstitutJ_on Request: First National Bank of Anchorage
Mail_ing Address: Post Office Box 4-2090 99509 Phone: _i~_~/-
Property Owner: R.Jerrold/Carole C. Quam Phone:
Mailing Address: __6__l_~_8__N_i_9_l.s_e_n__W_ay- 99502
Legal Description: Lot 15 Block 4 Great Lan~ Estates Unite #3
Single Family Residence: (x)
Hultiple Family Residence: ( )
Number of Bedrooms: Four
Number of Bedrooms:
Well System: Individual well (x) Community/Public System ( )
Permit # ._~__63_~_'~. ......... Depth of Well We]_l. Log on File ~ )
Construction Bacterial Analysis
¢'-~,- ¢'~, Disposal System: On-site System (x) Publlc Utility ( )
Permit ~ ~J~ ......... ~.,..~t .~led __~1~___ Installer
Septic .Tank Size .... ~}_ST ............... Manufacturer
Absorption ~'- ~ ' ""
_ ~.~e~_, Sol~s Rate Hakeriai
7. Distances: Well 'to Septic Tank to Absorption Area
P~b so.~. p u 1~, Area
to Sewer Line Nearest Lot line .....
to Nearest Lot Line
iVlUrllcipall[y Ot /-xncnorage
DEPARTh~,~!T OF HEALTH & ENVIRONMENTAL PR~_.~CTION
POUCH 6-650 ANCHORAGE, ALASKA 99502
279-2511
MuNiCiPALiTY OF ANCHL~k/',Gh
DEPT. OF HEAt.I'H ~:~
~NViRONMENTAL Ff, O~[::;~ iON
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. TYPE OF LOAN I 2. ASSESSORS PARCEL NUMB~'R-"t~'
3. LENDING INSTITUTION 4. REALTOR OflAGENT
{~:S~,Iqational BAnk of Anchorage
P.O. Box 4-2090 None
Anchorage, Alaska 99509
15. ~R - , 6. BUYER
:~ ~ :<~ ::~7 f:::: ?: None
6148 Nielsen Way
Anchorage, Alaska 99502
7. LEGAL DESCRIPTION 8. LOCATION/STREET ADDRESS
Lot 15, Blk. 4 Great Land Estates Unit #3 NHN Great Land Circle, Chugiak
9. YYP~ 0~ D~ELUM6 ]0. WAY~SUP~LY IL S~A6~0~SPOSAtSYSY~M
~SINGLE FAMILY RESIDENCE 4 BDRMS ~ PUBLIC UTILITY ~ PUBLIC UTILITY
~ MULTI-FAMILY RESIDENCE BDRMS ~ PRIVATE ON-SITE ~ ON-SITE
YEAR INSTALLED
INSTRUCTIONS TO REQUESTOR
1. Complete Items 1 to 11 above 3. Send to address above 5. Response will be returned to Jending
2. Remove the carbon 4. Please allow 10 days for processing institution
DATE RECEIVED DATE OF INSPECTION TIME OF INSPECTION INSPECTOR
TYPE DEPTH YEAR DRILLED PERMIT REFERENCE
~ CONSTRUCTION BACTERIAL ANALYSIS LAB REFERENCE NO.
YEAR INSTALLED INSTALLER TANK SIZE MANUFACTURER
~ DIMENSIONS CRIB CONSTRUCTION
~ ~ PIT
~ TOTAL LINE LENGTH TRENCH DEPTH GRAVEL DEPTH
~ ~ DISPOSAL
~ FIELD
~ FT. FT. FT.
TOTAL ABSORPTION AREA PERMIT REFERENCE
SQ. FT.
72-010 (11/76)
SEPTIC TANK .,ORPTION AREA SEWER LINES LOT LINES OTHER .,
~=u WELL TO: I
~ SEPTIC TANK ABSORPTION AREA WELL ABSORPTION LOT LINE
~ FOUNDATION TO SYSTEM T0:
F-
[] APPROVED [] CONDITIONAL APPROVAL
[] DISAPPROVED [] UNABLE TO INSPECT
DATE INSPECTOR
DIAGRAM OF SYSTEM
I certify that tile information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities
and these facilities are operating satisfactorily.
DATE SIGNATURE
~age Two
Department of Health and Environmenta'l
Request for Approval of individual Sewer and Waker Facilities
Legal Description: Lot 15 Block 4 Great Land Estates Unit ~3
Co~li~e!] t $ :
Affadavit Attached: (=~
Disapproved:
Letter Ahtached: ( )
[late:
Department Worksheet:
{~Bel$od ~nld) i~0£~91¥~ 031:IINB30 BO~ ].dl3031