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HomeMy WebLinkAboutSEA TURN BLK 2 LT 13atur'n Block 2 Lot 13 #017-121-35 NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE ~NEW [] UPGRADE MAILING ADDRESS NO. OF BEDROOMS Manufacturer ~.'.'.'~ 1l* ~ ~,, ¢' Liq.~ ca )ac?~)gallons IF HOMEMADE: -DISTANCE TO: Well Manufacturer DISTANCE TO: I I~:~ No. of lines Length of eech line Top of tile to finish grade Length Width No. of compartments Inside length Liquid depth Dwellin§ PERMIT NO. Foundation Total length of line~ Material beneath tile Material lWidth Material Nearest lot line I Trench width¢l Depth Liquid capacity in gallons PERMIT NO Distance between lines Total effective absorption area PERMIT NO, Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO, DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS so,, ~MAR~S .APPROVED DATE LEGAL 72-013 (Rev. 3/78) C:Eir,4T Ai]:T' LI!!X'.}~AL.. !..X]T S '.[ XE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST y, SOILS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: ,~¢, -[~r'.,.;~ .~'~,~iv,'~l'o,'~ ~- 5 6 7 8 SLOPE SITE PLAN 10 ~,. 11 12 13 14 15 16 17 18 19 20 COMMENTS -~,' WAS GROUND WATER S ENCOUNTERED7 ~/c~ L O P E IF YES, AT WHAT DEPTH? ~" 2~'~ ~,".-~ Gross Net Depth to Net Reading Date Time Time Water Drop /;S-/ " ' 5-'8~ '- ~ ~o~ /o .,.~-o · ~' 2 ~i / /o ~-/ 2' ~i to ~'-( PERCOLATION R AT E _~ TEST RUN BETWEEN fi/ FT AND ~ ~/2-... FT IJ'/,L__ PERFORMED BY:, Z~¢z,- ~ ~, ~10/:/ ~'~- C) ,Z.¢'~ / / CERTIFIED BY: 72-OO8 (6/79) 0 © 7~.4Z c.e.u.o./. ,I:~.Z,LZ.Z/~z ~23.00 ~ ~ X 7~ Cz; co,~r INCLUDES Att LABOR AND HATE:RIAL, FOR COMPLE:TION OF' ~AID WRITE: CHECK PAYABLE: TO RAMP).RT DRILLING WORKS FOR 'THE: SUM OF THAN,< YOU VERY MUCH. DATE BERNIE: CLAUS OF' FAMPA~I' DRII t INO WOI~XI CERVIC[ CH^I~GE:OIr I~/~% PF'R MONTH WILL BE Parcel I.D. OI'7 - I '"J-I -- "~-~ 1. GENERAL INFORMATION Complete legal'description LE)T Location (site address or directions) Currant Property owner(s) Mailing address Lending agency Municipality of Anchorage Development Services Department Budding Safety Division ~ . ~. ~ On-Site Water and Wastewater Program . ~ . :'-:.4700 South Bragaw St. ·. ' ~' P.O. Box 196650 Anchorage, AK 99519-6650 . ; ,, .... ci anchorage ak us ;!. (907) 343-7904 ,,.,-CERTIFICATE OF HEALTH A,UTHORITY APPROVAL FOR A SINGLE FAMILY. DWELLING' .. · ": . : . ~ ;~ ':. ~.'~ ,... Exp ration Date. ~ ~'~./-~/ Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Day phone '" 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site [~ Individual Holding tank Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Cedificates 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 AJaska. 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 privale or Class C well and may be reissued with new wate{ sample..results less than 30 days eld. (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 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 INSPECT'I°N B¥'EN'GINEER .' : :~ · ' , .,~. !. '. ,.' "l '; '; . ' ' ; 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 this application, show~ that the on-site water supply and/or wastewater dispi3sal system Is(are) sa[e, functional and adequate for the'number cf bedrooms and type of structure Indicated herein.'l further verify that based on Ihe information obtained from the Municipality of Anchorage tiles 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 i ~,/~/~ ..~b~,~-V..t~.k ~h~ne Address ~O~5 Ug/ I? ;;;:7.D2_~~ . _.. Engin.eers Pn~nted Name'" ~,,'~, ! ~5~u r · ,Date .- · ,,,.~t~... ~,: .o..~:,.. . .,.: :. ,*, . . . ,, 5" C;'EhG NEER'S' .... ~" _. ?... !! 5. "DSD SIGNATURE ' ' ,: ': ' ' ~'J ~ ~ , "~ ~'n,'.o ;X Approved for _,eL--:- bedro?,ms. ,., - ~C~'/;,;-.' ...... .................... · :;. · . . : ,.i:: . . ~: Disapproved. Conditional approval for . bedrooms, with the following stipulaticn~: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date:,,~- 2/' O/ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bmgew St. P.O. Box 196650 Anchorage. AK 99519-6650 www,d.anchomge.ak.us (~07) 343-?~04 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L~rT'/c..*~ 61~ ~. .~ ~<TU I~ Parcel ID: 017-1;31- A. WELL DATA Date completed Total depth .~DO f. If A, B, or C provide PWSlD # ~._~- . Sanltery seal (Y/N) y Cased te ,,2~ ft. FROM WELL LOG Date of test ?~.~'- Static water level / Well production g.p.m. we, Leg (Y/N) Wires property protected (Y/N) Casing height (above ground) 1,7., in. AT INSPECTION ft. g.p.m. WATER SAMPLE RESULTS: Coliform ..~coloniesJl00.,f..//__j .mi' Date of sample: ~ B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size ~ gat. Number of Compalmente Foundation oleanout (Y/N) Date of pumping Depression over tank (y/N) Pumper ,,~ Other bacteria t"~_[)colonies/100 mi. Cleanouts (Y/N) High water alarm (Y/N) C. ABSORPTION FIELD DATA Date installed ~"' Soil rating (g.p.d./ft= or ~/bdrm) __ Length ~ ft. Width U Total depth /~.'~ ~Y Eft. absorption area/~7.ft; Monitoring tube Date of adequacy test ~ Results (Pass/Fall) '~ Fluid depth in absorption field before test ~__~ in. Elapsed Time: · min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type ft. Grovel below pipe 7 fl. . Depression over field For K bedrooms Water added S'¢3r..)gal. New dep~'"/~..~n. in. Absorption rate >= J~ If yes, give data UFT STATION Date installed 'Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Acce_ _ss (Y/N) High water alarm level at Meets alam~ & circuit requirements?. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot (~ ~' Absorption field on lot ~ (~ ~ Public sewer main Sewer/septic se~rvlce line SEPARATION DISTANCES FROM SEPTICfHOLDING TANK ON LOT TO: Absorption field ...Su .rP. ace water On adjacent lots ~' i o~ On adjacent lots ) Io~ Public sewer manhole/cleanout Holding tank I~/,~ Building foundation I._~ Property line ) i O Water main I~J/,~ Water se~ice line ~% -'~ ~' Wells on adjacent lots ,,%f0"0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line .) I 0 Water Service line ,~' ~'" Curtain drain t~l C~ Building foundation ~.~, Water main l~/~ Surface water J~ I O Driveway, parldng/vehk:te 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 recorcls that the abo~e systems are in conformance with MOA HAA guidelines in elect on this date. Engineer's Printed Name I Date of Payment Receipt Number (Rev. 12/(30) ~-- Waiver Fee $ Date of Payment R~ceipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchora$c.ak.us (907) 343-79O4 Waiver Review Worksheet WR#: WR010014 PIDO: 017-121-~$ HA#: HA010098 Permit~: Date Received: 3-19.01 Legal Description: SEATURN SUBDIVISION BLOCK2 LOT13 Engineer:. TOBBEN SPURKLAND 203 WEST lb'TH AVENUE~ SUITE 2037 ANCHORAGE~ ALASKA 99501 Applicant: DIANE DENSON Waiver Requested: ON-LOT WATER WELL TO WASTEWATER SYSTEM OF 95 FEET Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: X Waiver is not Granted: List Conditions or Reasons for above: ~' ~'£ R~T/~ ~' H £O Date: Name of Reviewer Rec~: 1747 Amount: 920 Date Paid: 3/13/01 MunicipaliW ,of Anchorage Buildh~g $,'ffcty Division ILO. Ih)x 1!)4~k-50 * -~7(X) S. Bragaw Street Anchorage, Alaska ~)519-GC~0 * (907) I Ii)://wv,'w.¢i.al~¢hor~¢.nk.us 03/19/01 Tobben Spurkland, PE 203 West 15th Avenue, Suite 203 Anchorage, Alaska 99501 Subject: Waiver Request for Seatum Subdivision Block 2 Lot 13 Waiver Request #WR010014 Parcel ID #017-121-35 Health Authority Approval Certificate Number HA010098 Public V,'o rks Dear Mr. Spurkland: Your request for a waiver of the required I00 feet horizontal separation from the on-site wastewatcr disposal system to private well has been approved. The approved separation distance is 95.0 feet. This waiver approval applies to the existing on-site wastewaterdisposal system to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, -- Daniel J. Roth Civil Engineer On-Site Water & Wastewater Program . ; : 15001 2 1~051 15101 58q0 '14'83C 60Ol 15040 9 ~6051 .7 -8 14901 6101 ; '.,6200 ': · · 62~0 6212 ': .' ,4 15201 A 5820 15401 3 1~40: T.SPURKLAND P.E, 203 W, 15th. AVE. SUITE 203 ANCIIORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Development Services Department On Site Water and Wastcwatcr Program 4700 South Bragaw St. Anchorage, Alaska 99519 March 12,2001 Subject: Waiver Request Lot 13 Block 2 Stature S/D PID 017-121-35 (]cnllenlcn; We are applying for a waiver of ibc separation distance required between the septic system and thc well serving this lot The septic tank stand pipe and the trench clean pipe are located approximately 98 feet from the outside oftbe well casing. There are no markers (standpipes) defining the start ortho trench. We request a waiver to 95 feet for both the tank and the drain field. The submitted siteplan, shows the approximate location of thc stand Plpes of the septic system and the location of the well. The well and septic system was installed in 1985 with a reported separation distance of 106 feet. A field measurement on Feb. 27, 2001 showed 98 feet separation. Copies of well logs from this lot and from Lots 12, 13, and 14 of Black I, and Lot 4, Block 2 of Eaglebrook S/D can be utilized to evaluate the contamination potential. The static water levels in the wells are reported as boeing $0 feet more or less below ground surface. Total well dcpthd are 150 feet or more. Well yields are 15 gpm. or more. There are several thick layers of hard pan or clay reprted. Thc justifications for granting this waiver are: Water sample taken Feb. 27, 2001 shows no concentration of Nitrates or bacteria of any kind. 2. The well logs show several impervious layers between the surface and thc intakes of the wells. 3. Over land flow from the septic system standpipes will be channeled by the drive way away from thc well casing. T. Spurkl Mar 12 O1 12:30p FrantzHildonen 2748688 p.l £OT t~ "::T-T '"" / ~ ee L~.," ~ Itl~.' "~/ '" tx ,/. i LOT SURVIE~ CERTIKICATION MUNICIPALITY OF ANCHORAGE DEPARTMENT OF NEALTH AND ENVIRONIVIENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEAl. TH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER ANE) WATER FACILITY 264-4720 1. GENERAt. INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ._._! i0. ~_~ ~w_~_ ..... Applicant Narne t~ ,,'(:..~ L~: t Applicant Address _L/'¢ /f / (c) Applicantis(checkone):Lendinglnstitution~;Owner/builder~;Buyer~;Other~ (explain); (d) (e) '"__ .~ ",-',,: ." Telephone Add~ess -- _ ...... _~: __ ~ ....... Z ....................... (f) Mail tile HAA to the following address: .... ''- ' Z ' ~'~ ..... .... -"/.._ %/- ~,, -~-, .... ~..~-' ~_=~-----~ .... L¢~: ................... x ......~ ,. ........... /. ,'-..'_ ..... TYPE OF RESIDENCE Single-.Family(~/J Multi-Fc, Lnily E] Other Number of Bedrooms _if WATER SUPPLY Individual Well ~:~J, Community [~ Public E] Note: I1 community well system, ml.lst have \w-itten confirmation from the State Department o[ Environmental -'"'~' .... :~' * ettestin9 to the legality and status, SEWAGE DISPOSAL Onsite~[~ Public [] Community [~ Holding Tank [] Note: If community well oystem, must have written confirmation from the State Department of Em ronm~;n attesting to the leg¢lity and status. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA Al,ID INFORMATION As certified by my seal affixed hereto and es of tile validation date shown below, I verify that my mve3t,gahor~ of this Health Authority Approval shows that the omsite water supply and/or wastewater disposal system is safe, fimctv'Jnal ar, d adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the reformation obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-s~te water 3upply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulat~or, s in effect tho date of this inspection. /I Narne of Firm~._(-__~ ~- , ~ Telephone _,¢-/£2~ _-=1_%_~'_1-_2:/ Approved for"~ ........... bedrooms Dy _~ Date Approved ............... ~s~pp~e ye d .%~ Conditional 'Forms of Conditional Approval ~ CAUTION Tho IVlLmcipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Ai.proval cerdficate., be.md aolely upon the representations given in paragraph 5 above by Cn independent professio~,a~ (mgineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of hom~ and their itl order to satisfy certain federal and state requirements. Employees of DFIEP do not conduct inspection8 o;r :l .nhlyze data before a certificate is issuedproks,~io a (,~' er,r", wor, The Menicipahty of Anchorage is not responsible for orrors or omissions in the~ ~' , ..... A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264..4720 Leqai Description'. ~-..~'_~ Well Classification ~l~-, 'i ~J'(').-'~-- I, A, B, C: D.E.C. Approved (Y/N) ' Well Log Present~'~N) i Date Completed ~"->-"~P -- (~ ~-' Yield Total Depth ' .'-~.OO _ Cased to '~(~-)~:) / Depth of Grouting ~ ~ Static Water Level I ~ ¢ Casing Height Above Ground Electrical Wiring in Conduit ~)N) Separation Distances from Well: Pump Set At ~_ Sanitary Seal on Casing Depression Around Wellhead (Y~)') To Septic/Holding Tank on Lot /C_~f¢~ t..'~'~- ; On Adjoining Lots ~ OS.! To Nearest Edge of Absorption Field on Lot _/~__.~O t¢¢- '- ; On Adjoining Lot.', - ]OO! To Nearest Public Sewer Line ~L~¢-'"' To Nearest Public Sewer Cleanout/Manhole,~]~(~_. To Nearest Sewer Service Line on Lot ~ ~ Water sample Collected by '~ Date ~'/~'/~ Water Sample Test Results .~.~__.~,S~¢~_.:~ ~k~//" Comments B. SEPTIC/HOLDING TANK DATA Date Installed "~-i,3- ~-3-~¢L~ize,/2'~-'~-- - .... NO. of Compartments Standpipe~:N) Air-tight Caps ~N) Depression over Tank (Y'~"~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~/L/'.~.) / To Property Line ~, To Water Main/Service Line _ ~ ~ Course Comments Foundation Cleanout<~) Date Last Pumped ~//'~ ;for /¢'¢¢ Temporary Holding Tank Permit (Y/N) ,,//~ To Building Foundation -~¢'-~'-3 TO Disposal Field _ 3 To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-02~(ll/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed 7----:~'-~''~5~-' Length of Field v ~.t Width of Field Square Feet of Absorption Area Depression over Field (Y/~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ,-~ ~ / Lot ¢~J' IQ To Water Main/Service Line ~ [~- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Depth of Field //// Gravel Bed Thickness -- I2-37 Standpipes Present ON Date of Last Adequacy Test To Property Line /~""/ To Cutbank (if present) To Existing or Abandoned System on ; On Adjoining Lots Comments LIFT STATION Date Installed ~ Dim~ons Size in Gallons ~'-,,,_ ~ ~anhole,lAc~ess (Y/N) "Pump On" Level at ~ I ~,1 "Pum~ Level at High Water Alarm Level at ~ f/ Vent (y/N) . Tested for ~'-._ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ~~ Comments ~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I~ve c.becke¢, verified, or conformed to all MOA and HAA,.~.guidelines in effect on the date of this inspection. Signed ~"/'~L~ Date ~ '-~(~;) '-~ Company /I.,Z~% MOA No. ~..~(~ '~-- ~--~('/ Receipt No. ,¢9-F__9~-i~.2')~,'~ Date Of Payment Amount: $ Page 2 of 2 72-026 (11/84)