HomeMy WebLinkAboutBEVERLY HEIGHTS LT 4
-' Municipality of Anchorage Page ]'
" 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
3
Remarks: Original design for 3 bdrms. BENCH MARK
Owner requested installation for 5 Location and Oescription:
b~ ~,,~ing c~n~-c~ion. A~- Grade at foundation at cleanout.
builts reflect design change and
show futurc rcplaocmcnt 3itc. I AsaumedElevaflo.:
I
127.5
From
Well 102 104
Surface
Water ~'100
Lot
Line 22 10
Foundation
68.~ 70
Curtain
Drain {-100 +100
Class,hcabon (Pr,vate. A.EI,C): Tot th: I Cased TO: Total absorption area:
F, F,. 660 SO ~,
Ordler: ~ :I $lahC Water Level: Installer:
~,. Hamann Constr.
~ Gp,~IPumps"l't: ., Ic's'""""g"lA~°v'G'";: TANK
SEPARATION DISTANCES ~ Septic
Tank F,eld StahO" Tank SewerLine~ Anch. Tank
Material:
Steel
LIFT STATION ~
"Pump on" level ~f" level at: I High water alarm at:
~el I Electrical Inspections perlormed by:
Inspechons performed by: C~. Dates: ls~~
Departme.t of Heal~ and Hu~ Se~lces approval.
Reviewed and approved by: Date:
n Holding [] S.T.E.P.
Cap~i~y~n~a.ons:
Tolal Depth from original grade:
10'
Gravel depth beneath pipe
6.0'
Gravel length:
55 '
F810; D3034
7-19-94
Ft
Permit Number: SW940247 PID Number: 051-232;,51
Name:
Judy Kleven Wastewater System: I~ New [~Upgrade
Address:
18905 Beverly Drive, Chuqiak ABSORPTION FIELD
Phone688--2759 INo'oI~edr°°ms: ~DeepTrench [] ShaIIow Trench r-IBed []Mound []Other
LEGAL DESCRIPTION soi, Ra,,ng:
1· 2 GPD/Sq FI
Lo~ ~e,ock: Beverly 11e~ghts 6.0' ~,
Township: I Range: I Section: Fill added above original grade:
15N 1W ,qW4..~P~IR varies 0 - 2' Ft
WELL: [3 New [] Up 2 '
AS-BUILT
WASTEWATER ABS[]RPTIF1N SYSTEM
LOT 4 BEVERLY HEIGHTS SUB
CLEANQUTS (TYP)
1~.~,1500 GAL TAN~
.ICHORAG~
FINISHED GRADE
UNCLASSIFIED FILL (FROM TRENCH EX)
(~'~O~'~)PIPE BOrln" SEWER ROCK PIPE BDTTOH
~'~TRENCN BOTTOH 55' TRENCH
]~OTTOH OF TEST HOLE 93.5
.I
55' TRENCH
53' 4' FSIO PERFORATED PiPE ~1 ~'~
DESIGN CRITERIA:
1. 5 BEDROOM x 150 GAL/DORM/DAY =750 GPO
2. SOILS RATING 1.2 GPD/SF
3. 750 GPO + 1.2 GPD/SF = 625 SF ABSORPTION AREA
4. 625 SF + (2)(6'D) = 52 LF TRENCH (MINIMUM)
5. 1500 GAL 2-COMPARTMENT SEPTIC TANK
PREPARED FOR:
JUDY KLEVEN
18905 BEVERLY DRIVE
CHUGIAK, AK, 99567
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
907-694-2359
AS-BUILT DETAILS
WASTEWATER ABSDRPTIDN SYSTEM
LBT 4 BEVERLY HEIGHTS SUB
PERMIT SW940247
PID 05123251
55'L X 2'W X 6' D TRENCH
FUTURE REPLACEMENT TRENCH SITE
1500 GALLON SEPTIC TANK
CO
C0
TEST HDLE
100' PROTECTIVE ~,/[LL RADIt
ING CRIB AND SEPIIC TANK
ED AND FILLED WITH SAND
PVC
81.8
94.8
76.5
68.5
PREPARED FOR:
JUDY KLEVEN
18905 BEVERLY DRIVE
CHUGIAK, AK, 99567
KND ENGINEERING
20441 PTARHIGAN BLVD
EAGLE RIVER, AK, 99577
907-694-2359
SCAL[, I° · 30' AS-BUILT
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
July 21, 1994
On-Site Services, DHHS
825 L Street
Anchorage,AK, 99501
Dear Sirs:
ref: Lot 4 Beverly Beights Subdivision
Permit SW940247
Attached are the inspection report, as-builts,and Health authority
checklist and application for the subject property.
During the installation of the absorption trench the owner
requested the system be installed for a five-bedroom house. We
redesigned the system to accommodate the owner's request. As shown
on the as-builts, the design criteria for a five bedroom system for
this property requires a 50' long x 6' deep trench and a 1500 gal
septic tank. The area available for a 5-bedroom replacement trench
is shown on the system as-built, and is adequate to contain a 50'
trench.
The 150' protective well radius shown is for a well on the adjacent
lot serving two houses. There are two private wells on this
property; the controlling well radius is shown.
The existing crib was excavated, crushed and backfilled, as was the
existing steel tank. During the excavation, we noted that plywood
was placed around the perimeter of the crib against the logs. We
feel this was the primary cause of failure of the crib by not
allowing the free flow of effluent to the perimeter walls.
Thank you for your prompt consideration in this matter. If you have
any questions, or need additional clarification, please contact me
at 696-6111 or leave a message.
Sincerely,
Kenneth M. Duffus, P.E.
KND Engineering
Attachments: as stated
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW940247
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:KLEVEN JUDITH A
OWNER ADDRESS:HC 78 BOX 2315
CHUGIAK, ALASKA 99567-2315
DATE ISSUED: 7/18/94
EXPIRATION DATE: 7/18/95
PARCEL ID:05123251
LEGAL DESCRIPTION: BEVERLY HEIGHTS LT 4
LOT SIZE: 24316 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK 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 (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS)
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: ~--~.~
ISSUED BY:~~
DATE:
DATE:
~%~D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6Ill/FAX (907)696-8lll
July 14,1994
On-Site Services
DH/IS
825 L Street
Anchorage, AK 99501
Dear Sirs:
REF: Lot 4, Beverly Heights Subdivision
Attached is our request for an on-site sewer permit for the above lot.
As shown on the site plan, there are no conflicts with existing on-site wells, sewer systems or
with potential reserve areas. In addition, the public well is not within 150' of the proposed
system.
This lot is generally flat with a 2%- 3% slope running south to north and east to west. There is
adequate area directly east and west of the test hole location on the lot to install both an
original and a replacement system. The natural slope will direct drainage away from the
existing well areas. This is a replacement for a failed system. The existing system presents a
health hazard and will be properly abandoned during installation of this system.
Thank you for your consideration of this request. If there are any questions, please call me at
696-6111 or leave a message.
Sincerely,
KND Engineering
Attachments:
On-Site Well and Sewer Application
Wastewater Absorption System Details
Site Plan
Soils Log/Percolation Test
SITE PLAN
REPLACEMENT ~/ASTE~/ATER ABSBRPTIBN
LDT 4 BEVERLY HEIGHTS gU3
/
Test
SYSTEM
LOT SIZE:
LESS: PERIMETER
HOUSE FOOTPRINT AND DRIVEWAY
TOTAL AREA AVAILABLE FOR
ABSORPTION SYSTEM
25,663 SF
24,600 SF
1,063 SF
PREPARED FOR:
JUDY KLEVEN
18905 BEVERLY DR
CHUGIAK, AK, 99567
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
907-694-:~359
DATE, 7-13=94 I DRA'dlNG #
DESIGN DETAILS
WASTEWATER ABSORPTION SYSTEM
LnT 4 BEVERLY HEIGHTS SUB
DJ
~D
r-1 CLEANOUTS (TYP)
-'r
~z --~T~r.c. ~OTTOM
FINISHED GRADE
UNCLASSIFIED FILL (FROM TRENCH EX)
PIPE BOTTOM
SEWER ROCK
38' TRENCH
4' PERFORATED LATERAL (TYP)
DESIGN CRITERIA:
1. 3 BEDROOM x 150 GAL/BDRM/DAY = 450 GPO
2. SOILS RATING 1.2 GPD/SF
3. 450 GPD + 1.2 GPD/SF = 375 SF ABSORPTION AREA
4. 375 SF + (2)(6'D) = 31.25 LF TRENCH (MINIMUM)
5. NEW 1000 GAL 2-COMPARTHENT SEPTIC TANK TO HAVE
2' HD INSULATION IF <4' GROUND COVER.
6. TRENCH TO HAVE 2' HD INSULATION IF
<3' GROUND COVER.
PREPARED FOR:
JUDY KLEVEN
18905 BEVERLY DRIVE
CHUGIAK, AK, 99567
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
907-694-2359
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: Judy klevPn
LEGAL DESCRiPTioN:LOt 4 Beverly Heights Sub
DEPTH
(FEET)
Organic
Brown Sandy Loam
'erc Hole Elev
Sand, Brown w/trace of
,Silt- Some lenses of
course sand
Township. Range. Section:
SLOPE
10 - ~ WAS GROUND WATER
ENCOUNTERED?
L
)F YES. AT WHAT N/A O
DEPTH? p
12- E
~;m to Wa~r ~.t~rNone 7/13/94
13 - IMonitming?
SITE PLAN
14 - Reading Date Gross Net Depth to Net
Time Time Water Drop
15 - 0 716194 ,q 0 6"
1 5 min 5 min R q/16" ? q/1R"
16-
3 14 rain 4 rain '7/ 9 )/16 ?'1/1~"
17- 4 1R rain 4 min ll ]/1;" 2"
5 20 rain ? rain 1.t 1/16" ~"
18-
19- * IJ~f~t- nddpr
20 min ll 5/8"
20-
PERCOLATION RATE ~ tmlnute~Jinch) PERC HOLE DIAMETER
TEST RUN BETWEEN 4 FT AND 5 FT
COMMENTS Hnl~ PrP~nnked pri~r tn tP~tfng
PERFORMED BY: CA1 / KND I KpnnPth Du ff'u~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: DATE: 7/~/94
72-008 (Rev. 4/85)
.~GRE~"~,R ANCHORAGE AREA
Department of Environmental Quality
~ 3330 CStreet
A~chorage, Alaska 99503
NAME ~1~
LOCATION
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
~:t~.~ e~ ~ MAILING ADDRESS PHONE
MANUFACTURER
INSIDE WIDTH
MATERIAL f~'~e~-- NUMBER OF
COMPARTMENTS
LIQUID DEPTH
I IQUID CAPACITY
SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
BUILDING FOUNDATION__
O~AME'rER ~,0 oR WIDTH IF,' LENGTH /5', DEPTH ~''
CRIB SIZE= DIAMETER ~iDEPTH ~1 DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE ABSORPTION AREA (WALL AREA) ~(E,O
ADDITIONAL ABSORPTION
GALLONS.
WELL:
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION ~ r~ IU~tlcJ DEPTH
NEAREST NEAREST SEPTIC/.--//
LOT LINE SEWER LINE TANK
OTHER SOURCES
DISAPPROVED REMARKS
DISTANCE FROM:
SEEPAGE 10~ ~
SYSTEM
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form NO. EQ-031
GR~EATeR ANCHORAGE AREA BOROUGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
PHONE
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF' ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
.pT,c TANK.'EE /~dO ~, ..PAGE AREA .,ZE
DIAGRAM OF SYSTEM
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
EEEPAGE PIT
/t~n / D.A,N .,ELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL.
GRAVEl. BACKFILl.
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
OwNER OF LAND ,J,j~OT ~. ~-.~fftd£r~J I)eI'TIIOF'.vELL
ADDRESS ~ ~ / ~o~ ~/~ c ~4,~ STATICLEVELOFWATERFr.
LEGALDESCRI~IoN ~-~ ~ ~ ~C~d~ I)RAWI)OWNFT.
DATE - St,aed ~/t~ Ended ~-- GA~.PER HR
PERMIT NUMBER KIND OF CASING
KIND OF FORMATION:
From O FI. lo ~,~ Ft.
From. ~ Ft. to ..TI Ft.
From ~'[ Ft. to .5"~ Ft.
From -s~'O Ft. to ~" Ft.
From. 1'%~" Ft. to 'fid Ft.
From 'c~O Ft. to/~ ~ Ft.
From /~D Ft. to /c)l Ft.
From /¢~! Ft. to 1~,0 Ft.
From I{~ FI. to leJ~O Ft.
Fromly'e~ Fl. to ~1~' Fl.
From ~)l,e" FI. lo ~2~ Ft.
From Ft. lo Ft.
From FI. to Ft.
From FI. to Ft.
From __Ft. lo Ft.
From__Ft. to FI.
Fromm. Ft. to Ft.
Front Ft. to. . Ft.
From FI. lo FI, t
From __ Ft. to Ft.
- ~_.~/"'From ; Ft. lo FI.
Front Ft. to FI
_ From Ft, to__Ft.
From ~ FI. to... FI.
Front FI. to ,, , FI.
Frolo Ft. lo__FI.
,~,'~ Td~'~7'~eSrom Ft. to Ft.
Fro~ Ft. to . Ft.
From Fl :i~.~__~.~3
From ~ Fl
From . ,: Ft. ,o~,~.~FI, r.
From Ft. t o~ .~ItT41H~_.~
t4ou _
From __Ft. to~
From Ft. ~ Ft
MISCL. INFORMATION:
77' °c" Tor, -
o%0 ,,
DRILLER'S NAME
, ~MUN I I:: ~'~AL I TY OF ANC~]RAGE
~] -~DEPARTMEN] oW HEALTH AND ENVIRONMENTA~ ~ROTEOTION .
825 L STREET~ ANCHORA~E~ AK ~501 ~
2&4-4720 ~
ON--S I TE WELL PERM I T
F'ERMIT NO:
DATE ISSUED:
850574
07/01/85
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
JUDY KLEVEN
SR 1 BOX 2515
CHUGIAK~ AK ~9567
688-2&58
SUBDIVISION:~BEYESLY H~IBHTS .......... Lo'T~' 4
SECTI0N: 18' .TOWNSHIP: 15N RANGE: 1W
52000 (SQ.FT. OR ACRES)
BLOCK:
I certify that:
1. I am familiar with'th~ pequiremmnts for on-site sewers and wells as set
~orth'by the Municipality o~ Anchorage (~OA) and the State of Alaska.
2. I will install the system'in accordance with all MOA codes and pegulations,
and In compliance ~ith the design criteria o~ this permit.
5. I will adhere to'all MOA and State o~ Alaska requirements for the set back
distances ~rom any existing well~ wastewater disposal system or public
sewerag?x/system on this or any adjacent or nearby lot.
APPLICANT: _/(] ~L~VEN .
ISSUED DY
/ unicipafity
o¥
Anchorage
POL ,.,H 6-650
ANCHORAGE. ALASKA 99502-0650
(907) 264-4111
TONY KNOV. q E,~
MA YOt~
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit ~:840040
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 4 Beverly Heights 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.
Sincerely,
Keith E. Bandt, Supervisor
Environmental Engineering Program
KEB/lJw
enc: Copy of Permit
SWP/057
I'lUt~ I C I PAL I T"-r' OF Ftt~OHOR~GE
DEPARTMENT OF HEALTH AND EHVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, RK ~3501
264-4720
Cl[~--5 I TE I~ELL PEArl I T
PERMIT NO:
DATE ISSUED:
~PPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
LOT LOCATION:
JUD~ KLEVEN
CHUGIAK, RK D9567
694-2225
SUBDIVISION: BEVERLV HEIGHTS
SECTION:
~2000 (SO. FT. OR ACRES)
BEVERLY DRIVE
LOT: 4 BLOCK
RANGE:
I CERTIFV THAT:
i. I Al.1 FAMILIR.R filTH THE REQUIREMENTS FOR ON-SITE SE~IERS AND ~IELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA> 8HD THE STATE OF ALASKA.
2. I ~.IILL INSTALL THE SYSTEM IN ACCORDANCE NITH ALL MO8 CODES 8HD REGULATIONS,
8ND IN COMPLIANCE hiITH THE DESIGN CRITERI~ OF THIS PERHIT.
'~. I I.IILL ADHERE TO ALL MO8 8ND STATE OF ~LASK8 REQUIREMENTS FOR THE SET B~CK
DISTANCES FROM 8NY EXISTING I.IELL, WRSTEPlATER DISPOSAL SYSTEbl OR PUBLIC
SB4ERAGE~STEM ON THIS OR 8NY ADJACENT OR NEARBY LOT.
RPPLICRNT:~BV KL~EN
POUCH 6-650
ANCHORAGE. ALASKA 99502-06,~,0
(907) 264-4111
~Permit #: 820756
.January 31, 1983
TO: Permit Applicant
Subject: Lot 4 Beverly Heights Subdivision
A permit issued by this department for an individual well
and/or on-site sewer system has expired as of December 31,
1982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerel~
Robert C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCP/ljw
enc: Copy of Permit
SWP/057
PER, MIT NO.
FIPPL I CRNT
LOCRT I OH
LEGAL
JUDY KLEVEH
L4 BEVERLY HTS
SR 80X 2~15 BI.I 99567
LOT SIZE
688-2638
999'99'3 SQURRE FEET
MIHIMUti DISTRNCE BET;.IEEN 8 WELL 8ND RHY ON-SITE SEWRGE DISPOSBL SYSTEM IS
±00 FEET FOR R PRIVRTE 14ELL OR 158 TO 200 FEET FROH B PUBLIC WELL DEPENDING
UPOW THE TYPE OF PUBLIC WELL
MINIMUM DISTBNCE FROM 8 PRIVRTE NELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO 8 COMMUNITY SEWER LINE IS 75 FEET.
14ELL LOGS BRE REQUIRED BND MUST BE RETURNED TO THE DEPORTMENT HITHIN ~0 D8'¢S
OF THE NELL COHPLETION.
OTHER REOUIREMEHTS MRY 8PPL%'. SPECIFICBTIONS 8WD CONSTRUCTION DIBGRBMS 8RE
RVBILABLE TO INSURE PROPER INSTBLLBTION.
PEF-:t4 I T E,"-~ P I I~'E'--'": [:,ECEt-IBEF: --~---::t...
I CERTIFY' THRT
l: I R£'1 FRHILIRR WITH THE REQUIREMENTS FOR ON-SITE SEI4ERS RND WELLS RS SET
FORTH E:Y THE MUNICIPRLITY OF 8NCHORRGE.
2: I~NSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
s ............
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DiL, ision of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
051-232-51 HAA# ~ (~OI ~'1 ~"~ ~"'~ L'~
1. GENERAL INFORMATION
Complete legal description Lot 4, Beverly lleights
.,{.L,~ocation (site address or directions)
~,....~roportyowner Judy Kleven
'~.~'M~[i~"~'dd~;es~ 18905 Beverly Drive, Chuqiak,
~.~:~ '~ ,,. . ~.'
~ndmg agency C~ty Mortgage
Mailingaddress
18905 Beverly Drive
Day phone
Alaska 99567
Day phone
Agent
Day phone
Address
688-2759
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
5
NOTE:
Individual well XX
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:
XX
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legafity and status of system.
5. STATEMENT OF INSPECTION BY ENGINEER
Se
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 waste.water disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm KND Enqineerinq, Ken Duffus, P.E. Phone 694-2359
Add~ess ??ti41 Pearmlgan Rlvd.. Eaqle River. Alaska
Englneer'ssignature ~' ~ Date
DH.H~.IGNATURE
Approved for ~"
99577
bedrooms.
Disapproved.
__ Conditional approval for
bedrooms, with the following stipulations:
Additional Comn~ents
Date
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 DH HS does this as a courtesy to pu mhasers 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 p?ofessional engineer's work.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 4, Beverly Heights Parcel I.D. 051-232-51
A. Well Data
Well type Ind.
Log present (Y/N)
Total depth 220
Sanitary seal (Y/N)
Y
Y
If A, B, or C, attach ADEC letter, ADEC water system number
Date completed 6/85 Driller Sullivan
Cased to 77 ' 8" Casing height 1.5 '
Wires propedy protected (Y/N) Y
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG AT INSPECTION
6-85 6-24-94
75' 65'
3 g.p.m. 5.1
unk 210'
SEPARATION DISTANCES FROM WELL TO:
Septic'holding tank on lot 102 '
Absorption field on lot 104 '
Public sewer main NA
g.p.m.
; On adjacent lots + 150 '
; On adjacent lots +100 '
Public sewer manhole/cleanout NA
Sewer service line 36 '
Petroleum tank + 100 '
WATER SAMPLE RESULTS:
Coliform 0. 7-18-94
Nitrate 0' 6-17-94
Other bacteria 0. 7-18-94
Date of sample: See above
Collected by: CAL
B. SEPTIC/HOLDING TANK DATA
Date Installed 7-19-94 Tank size 1500
Clea~o,~t~'(Y/N) ' Y Foundation cleanout (Y/N)
High ~ater alam3 (y/N) NA
D.ateo. fp~mping. NA - New installation Pumper
S~ATION DISTANCE~' FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 102 '
To property line 22 '
Surface water/drainage
On adjacent lots
Absorption field
+100'
+150'
6'
Compartments 2
Y Depression (Y/N)
Alarm tested (Y/N)
N
Foundation 68.5 '
Water main/service line + 7{') '
z~-o2e (~3)' Fm~t CONTINUED ON BACK PAGE
C. UFT STATION ·
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) 'Pump on' level at ~at
High water alarm level ~..~"y~d
· Meets MOA electrical codes (Y/N)
SEP~ATION TO: ,
..WeF~n Io~ On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date Installed
Length:':, 55'
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 104 i
To building foundation 70 i
On adjacent lots + 50 '
Sudace water + 100 '
Curtalr~ drain +1001
7-19-94 Soil rating (GPD/Ft~) 1.2
Width 2 ' Gravel thickness
660 SF Cleanout present (Y/N) ¥
NA - New sySt~sults (pass/fail)
System type Deep trench
varies 10-
Total depth 12 '
Depression over field (Y/N) N
for
After test
If yes, give date
On adjacent lots + 150 ' Property line 10 '
To existing or abandoned system on lot 20 '
Cutbank +50 i Water main/sen/ica line +75 i
Driveway, parking/vehicle storage area + 501
Bedrooms
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Waiver Fee $
Date of Payment
Receipt Number
Ztr
CT&E R~f.#
Cli~t Sample ID
Matrix
ClientName
Ordered By
Project Name
Project#
PWSID
Sample Remarks:
Commercial Testing & Engineering Co.
Environmental Laboratory Sewices
94.3011-1
L4 BEVERLY Iris
WATER
BLS & ASSOCIATES, LNC
UA
LABORATORY ANALYSIS ~EPORT
WORK Order 79583
Printed Date 06/23/94 ~ 16:37 hrs.
Collected l~te 06/17/94 ~} hrs.
P~ceiv ed Date 06/17/94 ~} 14:30 hrs.
Technical Director
STEPHEN C. EDE
ROIH'Rq~ SAMPLECOLLECTED BY: BLS.
Parameter Resul~
Ni~,'ate-N 0.10
qc
~ units
U rng/L
Method
EPA 353.2/300.0
Allowable Ext. Anal
Limits Date Date Init
10 06/'20/94 Cl~.
* See Special Instructions Above
** See Sample Remarks Above
U = Undetected, Reported valm is the practical quantification limit.
~ D = Secon&ry dilution.
UA = Unavailable
NA =Not Analyzed
LT= Less l~an
O'F= Greater 'limn
5633 B Street, Anchorage. AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO. FLORIDA. ILLINOIS. MARYLAND, NEW JERSEY. OHIO. UTAH. WEST VIRGINIA
Plat Status: Final
BOROUGH:. Engineer
~ealth Department
Public Uorks Department
Sand Lake Fire Department
School District
Tax Assessor
A~aska Department of Eighway~
Anchorage Natural Gas Co~p.
Central Alaska Utilities
Uhu~ech. Electric Association
Description of Property:
See attached plat.
CITY OF ~;O~ORAGE: Fire lI~rshal
Hunicipa! Light & Power Departnen~
Property Hansge~nt Officer ~
Public Works Departs, ant ;.
Telephone Utility
· Traffic ~n~ineer
l~ter Utility
~AB Teleco~unlcations, I~c.
Hatanu~ka Electric Association
/Iatanuska Telephone ~so¢iation
Assistant Superintendent of }lall~ ,
Raymnn J. and Beverly J. Emmons
Gentlemen:
Petition has been received by the Greater Anchorage Area Borovsh Pla,minE ...........
and Zoning Commission for the proposed subdivision of ~ubJect property.
Attached is a copy of ~e proposed plat. Will you please submit your
comments in writing, specifying any easements er other requirements that
your department or a~ency may need.
If we do not hear from you by 8/21/70
you do not wish to submit any comments.
, we will assur~e that
· If you have no further use for the attached.print, please return it with
your co~-aen ts ·
Plannin$ Departuent
Enclosure