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Home My WebLink AboutELMORE #1 BLK 3 LT 8 Municipality of Anchorage Pag~L 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 Permit Number: r~ --O6~((,~ PIDNumber: O[~-- (?I Name: /~l~e/ ~; 40~ WastewaterSystem: ~New ~Upgrade P~o.e~ .~ ~ ~ ~No.o~ms: ~D~pTrench ~hallowTmnch OBed ~Mound OOther LEGAL DESCRIPTION ~ ~.o~ ~, SEPARATION DISTANCES ~eptic = Holding ~.T.E.P. Sudace Re~arks: ~*C~ (t ~ ~;n ~ BENCH MARK L~tion and De~pt~n~ ENGINEER'S Depadment of Health and Human Se~ices approval ~ e, ~ Permit No. SW 980016 Page ~ of 'Z- '.' Mun[cipallty of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 543-4744 On-Site Wastewater Disposal S.vstem and/or Well Inspection Report Legal Description: LOT 8, BLOCK 3, El. MORE SUBDIVISION PID No.: 01817134 - SHOSHONI AVENUE - ' ~ --~. [ N 89'~6'30" E: 208.71' ~ ~. ~ 20' CREEK "~ RELOCATtON ESMI. \~. / . ~.~ /~ / 10' UTIL. [~T. ~ 89'46'~' E / ~ I / SCALE: 1"~40' 1o' ACCESS / EASEMENT ~ I .... ~ MARK A B ' * CO~ 23.6 5.7 C02 35,5 ~C01 35.6 ~C02 36.7 19.7 ~C02 . 37.9 21.9 ~.,.~ ~,~ ~'~q~Lo" . ~,~ . ":"~7'~ I ~, ~; · cE-77~ .. -,. F~b. ~-'3. I.~S 0'~: 0=1 RI.I F'01 LOCATION OF WELL I LOCATIONtSKIrlCH: DEPTHS MEASURED IrROM:~ca$ing top [-]ground surface BOREHOt. E DATA: Depth Mate~al Type and Colur From TO STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCE~ DIVISION OF MINING & WATER MGMT WATER WELL RECORD WELL OWNER: ~/ELL DEPTH: / , ,r_ DATE OF COMPLETION DEPT~,,TO STATIC WATER LEVEL: '~ "~ ft be~ow/'i~ top o! casing O groundsu~ece METHOD OF DRILLING: ~ir rotary r-I cable 0 other J~domestic ri irrigation r~ mor~tor public SUpply 0 other. It. In. ~to It Caslnfl in. to ft WELL INTAKE OPENING TYPE.,~,Open end I"1 screened [] perforated ~open hole DeDths of Openin0s: Io ft SCREEN TYPE: D[em: S;ot/IVlesh Size: Length: GRAVEL PACK TYPE: _. Vokm~e uscd: De~th to tOD: GROUT Depth: from ft to ft DEVELOPMENT METHOD: PUMPtNQ LEVEL AND.YIELD: I ~ t~ afte, PUMP INTAKE DEPTH: tt Horsepower. _ WELL DISINFECTED UPON COMPLETION? CONTRACTOR INFORII4~ATION: ~. RE]V[ARKS: ,,,~'~ - _ _~ .~.~"/~/~/_ . ~__ / ~ PLEASE MAIL WHITE COPY OF LOG TO: ~'~~ ~ /~~ ~ -1~ ~ DNR~ISION OF MINSQ & WATER M~T Sig~ture of AutKo¢ized Hespresent~ ~ 'Oate 3601 C St, ~lte 800 / ~CHORAGE AK ~9~03-5935 Phone 1907]269-8639,Fe. 190715~;2-1314 PAGE I OF i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGEt ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW980016 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:ANDERSON MICHAEL NEAL OWNER ADDRESS:4640 SHOSHONI AVE ANCHORAGE, ALASKA 99516 DATE ISSUED: 2/17/98 EXPIRATION DATE: 2/17/99 PARCEL ID:01817134 LEGAL DESCRIPTION: ELMORE #1 BLK 3 LT 8 LOT SIZE: 37299 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONSTRUCTION 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 (iSAACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: /~_/~4/v~' ISSUED BY:~ DATE: DATE: Febr~ar~ 6, 1998 Glenn Melvin, P.E. 9310 Emeral Street Anchorage, AK 99515 (907) 248-7151 Department of Health and Human Services P. O. Box 6650 Anchorage, AK 99519-6650 (907) 343-4744 Office (907) 343-4786 Fax Re: Lot 8 B 3 Elmore Subd. I1 Dear Jim Cross, P.E. This a request for an on-site septic and well pezmit. Two test pits were excavated and found to ~erc et 2 minutes ~er inch. The soils consisted of a stiff gravel-sand-silt mixture (G~4) to a depth of 11 feet then changed to a stiff silty sand (E~4) from eleven feet to the bottom of the hole. The excavation of the test holes was terminated at 13 feet because the stiff silty sand would hold any water at the interface of the G~ and SM during high water run off in the spring until it ~erced into the slower S24 material. The SM perced at 50 minutes ~er inch. For this reason a four foot minimum separation will be maintained to the interface of the The existing systems on the surrounding lots appear to be perform/ng adequately. The topography of the lot is flat where the house will be const~lActed.&nd then sloping to the north west es shown on the plan. The 100 fo~t ~&tba~k\for Rabb~t Creek has also been shown on the plan. GIenn Melvin, P.E. N SHOSHONI ADJACENT ELMORE SUBDIVISION AVENUE CREEK RELOCATION i 6 : 7 10.0' 10 -- -'---T NATRONA AVENUE ......... "1 , I-- .............. --I .................... T- ltd ~1 I I I I i I ANDERSON RESIDENCE LOT 8, BLOCK .3, ELMORE ADDITION #1 SCALE: 1"=100' , DATE: 2/6/1998 L t 208.71 EI 50.0' 1 VACANT LOT DESIGN CRITERIA: 5 BDRM = 750 GPD SOILS = 1.2 GPD/SQ. FT. 750/1.2 = 625 SQ. FI', REQ'D TRENCH: 6' DEEP 4' EFFECTIVE 2.0' WIDE (2) 40' LONG AVENUE -1' ~OR '~cccccc -11' 12.d =1 -13'1"-45W Z /,r-GRADE i ~,---2' INSULATION OVER FILTER FABRIC -DRAIN ROCK ANDERSON RESIDENCE LOT 8, BLOCK 3, ELMORE ADDITION #1 SCALE: 1"=50' DATE: 2/6/1998 PERFORMED FOR: MuniclpaJity of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6- 7' 8- 9- 10 II' 12 14. 15- 16- 17- 18- 19- 20- Township. Range. Section: SLOPE SITE PLAN WAS GROUND WATER ENCOU~EflED? IF YES. AT WHAT DEPTH? Reeding Date Time Time Water Dro~ /0 ~" PERCOLATION RATE ~ immures/taCh) PERC HOLE DIAMETER TEST RUN BETWEEN I~' FT AND C' FT PERFORMED ri*: 'J~ , / ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCEWITHALLSTATEANDMUNICIPALGUIDELINESlNEFFECTONTHISDATE' DATE; ~""'~P ~'' ~ O t I~q~-~ 72-008 (Rev. 4,8~) PERFORMED FOR: Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3- 4- 5- 6- 7- 8 9 10 11, 12- 14- 15- 16- 17- 18- 19- 20- Township. Range. Section: SLOPE WAS GflOUND WATER ENCOUNTERED? S IF YE$,ATWHAT DEPTH? E SITE PL.AN PERCOLATION RATE ~"~) (mmutes/~ncn) PERC HOLE DIAMETER ~ TEST RUN BETWEEN I ~ FT AND ( ~ FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; Munictpailty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street. Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMEO FOR: ~tt'~ el /~ ~ 10 11' 14- 15- 16- 17- 18- 19- 20 Township. Range. Section: SLOPE ENCOUNTERED? IF YES. AT WHAT DEPTH? SITE PLAN E Grou Net Depth to Net Rem:Jlng Date Time Time Wet~ Droo PERCOLATION RATE Immures/tach) PERC HOLE DIAMETER PERFORMED BY; TEST RUN BETWEEN FT AND FT CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; 72-008 (Rev. 4,85] .(~ 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 I.D. 1. GENERAL INFORMATION,;. ~:,, ,.. .~.'. . ; -:;;'. '~."'"'. ';. .',. Completelegaldescription Lo ~ ~ ~ ~ ~[~,~ ~_ ,~/ Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone ~'/"'~"~"~"~-~)"' Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well ~- Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 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 inform.~tion obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or waste~vater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in ~ffect on the date of this insp..e~.tion. Name of Firm .F~2.( ~' ,-~.p F'D-- ';'" Address ~ /~ ~[&.~.~ Ot ~n~ ~ ~n~in~s'~'i~ ~ ~ ~;~" ' Date ~/~ ~ ~ DHHS SIGNATURE ~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 registe red 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. J ECEI VI:L, A, Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICES dUN 2 1 19~ Environmental Sewices Division , ~n~r~-a 825 L Street, Room 502 · Anchorage, Alaska 99501° '~"'~Wu~gm~CSaWK:~~"'~"M~'4~O~ ~OnASlON Health Authority Approval Checklist' A. WELL DATA Well type ~ If A, B, or C, attach ADEC letter. ADEC w~ter system number Log present (Y/N) y,~ ~-~ Date completed ~ T~ d,pth [ ~' '5 ' C.,d ,o [ C' ~ Casin~a height (above ground) Wires properly protectad (Y/N) FROM WELL LOG AT INSPECTION '20 g.p:m. ' "" Nitrate "(~_~ /, ~ ~ Othar bacteria g.p.m. Date of test Static water level Wall production WATER SAIMPLE RESULTS: B. SEPTIC/HOLDINq T~.. _N~: DATA ,~c · ,,,,,- · Dam in,led ~ T~k s~e [ ~ O Numer of ~pmn~ ~ ~e~ ~) ~ F~Uon de~o~ ~) ~ ~ ~pm~on ~) ~ High water Ma~ ~) ~ ~ Da~ ~ Pumpiog ~ Pum~r ~~ ABSOR~ON RE~ ~AT~ ., Da~ I~1~ ~ Soil m~ng (g.~.d~ or ~) ~ S~em ~e ~. Eflecflveabeorpflonarea ~ 'Z.~'- MonltoflngTupepmsent(Y/N) ~X' Depmssionoverfleld(Y/N) I~ Date of adequacy test ~,~ ~ ~..~ Results(Pass/Fall) ~,.[ '"e' ~..~ For ~ bedrooms Fluid depth in abe=on field before test (In.): ~'~-ta3 Immediately a~.~'~gal, water added (In.).~ / Fluid depth .~'~ (ins) Minutes later.. Absorption rate' = ~'~ '~'~ g.p.d. Perox~le treatmem (past 12 months) (Y/N) ~ D If yes, give data 72-026 (Rev. 3/96)* D. UFT STATION Manhole/Access (Y/N) ~ Size in gallons 'Pump on" level at' ~, ~- 'Pump ~ level at' ~ ~ H gh water alal~n !le%,el at', :. Cycles tested ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM M/ELL ON LO'~ TO: Septlcff~l~llng tank on lot Absorptton field on lot / Public sewer main (~/~ Sewer/septic terrace line /z 0 0 ~ Surface water ...C4Jrtain drain F, ENGINEER'S CERTIFICATION ./O O'~- '-' ' On adlacent lots [OO 'Jr On adjacent lots Public sewer manhole/cleanout SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: , · '. Foundation O~'~'~:~ Property line ~ 4 Absoll~flon field. Water maln/sewice line _/0 0"{- Surlace water/drainage /'0 d ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPI'iON FIELD ON LOTTO: Property IIn;~ ' ..~.. r?~":.Jr- : .~ .Building foundation ~-~"~) J~ Water main/service line /dS)C:) '~ Driveway, parking/vehicle storage area Wells on adjacent lots I certify ~hat I I~jt~'e determined thru ~elq inspections andmvt~w of ~ in confo~ MO~A HA~_,,gu,,l~li?es in effect on ,ls date. Date ' ~/~//__J~ [(~ '' Date of Payment- Receipt Number ( ¢7'"--9 · Wal~er Fee $ Date of Payment · Receipt Number 72-028 (Rev. 3/96)' T-038 P.03/03 F-40Z CT&£ RcL# Client N~une ProJec~ Name/# ~L~trLx Ordered ?WSID gg2871001 Susan Oswalt & Assoct.~-Tes LI 8 Bk 3 Elmorc 4640 Shosl~.om 14 8 Bk 3 Elmote-4640 S~os.b. om DTinL-in~ Client Pdnted D~te/Tlme 06~22/99 11:45 CoH~ ~te~e ~/18/99 10:17 R~eiv~ ~te~e ~/18~g 10 50 T~h~l ~r~or: Stephen C. ALLowabLe Prep AnaLysiS Limits Date ~ate ~lT 1.89. T#TC 0~/100 k: 0.500 ~/k EPA 300.0 S~18 92226 10mar 0b/18/99 06118/99 SCL 06118199 r~r