HomeMy WebLinkAboutPETERS CREEK BLK 3 LT 12P
¢
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Block 3
Lot la
#051 - 115-12
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
NAME .... IP~tONE
.... [] UPGRADE
MAILING ADDRESS
//) o ~o~( //-72
LEGAL DESCRIPT]~
LOCATION4-- ~h~: ~/:~ Z~ NO' OF BEDROOMZ
' Well ~ Absorptio~re~ ~ Dwelling PER~ NO.
U ~ DISTANCE TO: ~ __ - /
~ Man ufacture~[~/ ~~ / No. of com~ments
Liq.~~alJons IF HOMEMADE: Inside length Width Liquid depth
~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ -- ~ Manufacturer ~ v Material Liquid capacity in gallons
Q Well /~ ~ Foun~ /,~ Nearest I~
~.~ ~S~A,C. ~O: __ _
~[i~ Lengtgo tin¢~ / ~
~ Z ~ No. of li nes// f~_ -- Total lengt~nes ~ Trench w~h~ inches Distance ~2 ~es
tile to finish grade
Total
~1. ~p~f Ma,~iaJbe~eathtile,, e~e~sorptionarea
Length 'Width ~epth ¢ PERMIT NO.
Type of cfi Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot Hne
~ DISTANCE TO:
~ Class ~ .. ~ Depth ~%~,~
~ ~-~/~/~ ~-.:~ A~_ .~, D~sm.~o,ot,.e ,~RM~NO.
~ ........... ~ui~din. found~tio~:~'~ ~.%:'~. Septi. t~nk Ab~omt~o..~.~(s)
~.- ~ ~ .~,-, ~
SOIL TEST R~NG ,~ ~ ~ .... . ~ ~,'
/ ' ' ~
I
z¢
DATE LEGAL
PERMIT NO.
r-lLIt-~ I C: I r'RL I T'-r" ElF Rt-~C:F~ ~'~RR~3E
[:,EPRRTMENT ,. HERLTH AN[:, ENVIRONMENTRL . .~OTECTION
,:,~._, "'L STREET., RNCHORRGE, RK. 99501
264-4720
~ELL ~-4~. C~-~ · TE ~E~-~E~ PE~'~ ~ T
RPPLICRNT
LOCBTION
LEGBL
BUCKHORN MOBILE HOMES
Ll2 B~ PETERS CREEK
PO BOX ii92 EBGLE RIVER
LOT SIZE
999999 SQURRE FEET
TYPE OF SOIL RBSORPTION SYSTEM IS: DRRINFIELD
MRXIMUM NUMBER OF BEDROOMS
SOIL RRTING (SQ FT/BR)= 190
THE REQUIRED SIZE OF THE SOIL FtBSORPTION SYSTEM IS:
E:, E P = ~ L E r-,I i...~i T H = 6 ~]1 i~ ~: R %,' E L
DEPTH= 5
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF 8 TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURFBCE OF THE
GROUND 8ND THE BOTTOM OF THE EXC8VRTION (IN FEET).
THE TREr-JCH L4IC, TH IS 5. ~Zl~Zl~]l FEET.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
F~:EQI_I I I~:E[:, :SEPT I I_-~. TRr-,II--.-:] S I ZE= 1£'~-3~-~ ~.3RLLC, I'-,IS
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
TbIC, (2) I r-4SF'EIZ:TIC,~-IS RRE RE,;!I_IIREE:,
BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS
DEPRRTMENT HILL BE SLIBSECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R HELL RND RNY ON-SITE SEWBGE DISPOSBL SYSTEM IS
100 FEET FOR R PRIVRTE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
F'EE:r-11 T E::-::F' I RES. [:,EC:ErIE:ER _~--. 1.. 1-~82
I CERTIFY THRT
1: I RM FRM ILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
S' I UNE:,ERSTRND THRT THE r ,= '~ . ,
_IN-z, ITE --.EWER SYSTEM MRY REQLIIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MOR. E THRN S BEDROOMS.~/r~~
s GNED' ..... _ _ , ' ,,
E, II~ FH~ 'N MLBILE HOMES
SOILS LOG
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
1
3
4
5
6
7
8
9
[] PERCOLATION
TEST
DATE PERFORMED: ,
SITE PLAN
10
11
12
13
14
15
16
17
18
19
2O
No, 1457-E
WAS GROUND WATER [
ENCOUNTERED? , O
P
IF YES, AT WHAT ~ (' E
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
PERFORMED BY:
72-008 (6/79)
TEST RUN BETWEEN FT AND /~ FT
~ ~:,,.,: ~ ~A~ CERTIFIED
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Sile Water and Waslewa~or Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 995t9-6650
www.cLanchorage.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
ParcelI.D. 0~[-//5"- I~
1. GENERAI."IN FO RMATIOt,I
Completelegaldescrlption [,of 1
Location (si ress or directions)
CQrrent Properly oWner(s) .~
Mailing address ,,
Lending agency
Expiration Dale:
~3~3~ Glenn Ct.
Day phone
Day phone
Mailing address
Real Estate Agent Pat Arnett / All
Mailing Address 2?(37
Unless of hen/vise requested, HAA will be hem by DSD 'for pickup.
2. NUMBER OF BEDROOMS: 3
.c;r~r R.F. Dayphone 561-7R27
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding. tank
[] Communily On-s~te
Public Sewer []
The Municipalily of Anchorage Development Services Departmenl (DSD) Issues Certificates of HeaIIh Authority
Approval (HAP,) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered In Ihe State of Alaska. Cerlificates of Health Authority Approval ere required for Ihe transfer of
title (except between spouses) for propedies served ~y a sing{e family on-site wastewaler dispose and/or water
supply system. DSD also Issues HAAs upon request fo homeowners. CeHi~cales of Health Authority Approval are
valid for 90 days from Ihe date of issue for properties served by a private or Class C well and may be reissued with
new wa~er sample results less than 30 days old. (Cortil~cates may be reissued for a period of up to one year with
vel{d water samples.) CeHific~les are valid I'or one year for properties served by Class A or B wails or a public
wa[er system. The Municipalily of Anchorage Is not responsible for errors or omissions In the professional
engineer's work.
4. STATEMENT OF INSPECTIO~J BY E~JGi~JEER
As cerfified by my seal affixed hereto and as ol Ihe valldallon da{e shown below, I verity Ihat my Inves{Iga{Ion,
based on procedures outlined In the Health Aulhori~y Approval Guidelines for this application, shows Ihat the
on-sile water supply and/or wastewater disposal system Is(are) safe, funcUonal and adequale for the number of
bedrooms and type of slmclure Indicaled herein. I furfl]er Verify fha[ based on the InformaUon obtained from the
Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or
wastewaler disposal system is(are) In compliance With all appllcable Municipal and Stale cedes, ordinances.
and regulations in effect at Ihe time of installation.
5. DSD SIGNATURE
Approved for
Disapproved.
Conditional approval for
NameorFirm S & S En~ineerin~ Phone 694-2979
Address 17034 N. Eagle River Loop Ste. 204 Ea~le River, AK 99577
Engineer's Printed Name Rol~ert C. Cowan Date ' ;o ///o/o ~
bedrooms. - -u ......... ..,
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic Syslem Advisory
Well Flow Advisory
X
Maintenance Agreements
SUpplemental Engineer's Report
Other
Original Certificate Date:
Mnnicipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 1g~850 Anchorage, AK 99519..6850
www.ci.anchorage.ak.us
(907) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /~,~r'[,~../' ~'Z.~C-(~- 3/,' ~~---/,,:~/~ Parcel ID:
WELL DATA
Well type IfA, B. or (
Date completed
To~ldep~
(Y/N).
ft Cased to lt.
Date of test '
Static water level
Wall
WATER
Coliform
Arsenic: rog,/1.
B.
g.p.m.
mi. Nitrate mG.fl.
Date of sample:
DATA
Well Log (Y/N) ~
~res properly protected,/~TN)
gpm.
Othfr ~da .. coloniC'lO0 mL
Tank Type/Ma~,~/~. /
· "' ~ ........ Number of Compartments ~
Tank s~ze ~, gal.
Foundation dean. o~ (YIN) ~' Depression over tank (Y/N)/V/
Da, of-pumping ~//~/~ ,Z~', Pumper
ABsoRPTION FIELD DATA
Date installed . ~ rating (g.p.d./it2 or'
/
Total depth ~'~' It. Eft. alosorption area ~ ~ Monitoring tube
Date of adequacy test !4~//O/O~,/' Results (Pass/Fail)
Fluid depth in absorption field before test ~ in. Water added:~_L~Jal.
Elapsed Time: ~,0 min. Final fluid depth ._~ in. Absorption rate >=
Any rejuvenation treatment (pa~ 12 mo.) (Y/N & type)
Date installed
Cleanouts (Y/N)
High water alarm (Y/N) /-/
System type ~--/--~/~..
Gravel below pipe ~-- fl.
Depression over field
For 3 bedrooms
New depth (~) in.
4~:) g.p.d.
If yes, give date
D, uFT STATION
Date instel~ed
'Pump on" level at
Datum '
E. SEPARATION DISTANCES
Size in gallons
'Pump off' level at
Cycles tested
Manhole/_Acce-._ _ =s (Y/N)
in. High vrater alarm level at in.
Meets almm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HJ:YcD~G TANK ON LOT TO:
Building foundation ~' ~ Properly line ~' ~
Water main /O ~' Water service line /~ ~
Wells on adjacent lots /~/~'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water Service line
/
Building foundation /~7 ~"
Su c w ter I00
Wells on adjacent lots
On adjacent lots
On adjacent lots /
Public sewer manhole/clip, out
Holding tank '/
Absorption field ~' /f'
Sur ce,.ter /OO %
F. COMMENTS
Water main
Driveway parking/vehicle storage
Lo ¢
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are/n
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name ~08e/C7- C. C0~,~//
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12A)1 )
U'cJ
Waiver Fee $
Date of Payment
Receipt Number
BASIS OF BEARINGS
NORTH 150.00 (R) 149.76 (M)
t~lf~E FENCE
%
NORTH 150.~' (R)
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HF~LTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) ._ ~/2 ,~ Y~ subdivision, section, township, range>
Locati 'n ( dd ess or directions)~/
(b) Applicants Name ~'zZ ~ ~'/~ lephone - Home Business
Applicants ~dress ~"~
(c) Applicant is (check ong) Lending Institution ~; ~er/builder~ ;
~y~r ~; Other ~
(d> Lending Institution <
Ad~i~ ss
(e) Real Estate Co. & Agent /~z~ /~/ ~
(f) ~ the ~ to the follo~ng ~dress:
Telephone
070 o
2. Type of Residence
Single-Family~
Number of Bedrooms
Multi-Family
Other (describe)
3. Water Supply
Individual Well~.~x Community ~-U Public ~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Pa§e 1 of 2]
5. Engineering Firm Providin~ Inspectioms~ Tes~.s~ File Search~ Data and Informatiou
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 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 Mmntcipality of Anchorage files and from my
investigation and inspection, the' om-site water supply and/or wastewater disposal
system is in compliance with all M~nicipal and State codes, ordinances, and regula-
tioms in effect on the date of this inspection.
Name of Firm Telephone
Approved ~ Disapproved __ Co~tt~on~
Te~s of Co~ition~ Approval
Address
DHEP Approval
Approved for
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ~R, ALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DttEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
ae
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (FAA)
CHECKLIST - FEBRUARY 1984
Legal Description
Total ~p~ /~ / / ~.d ~ /O, ~9~"
of G=outing
Sanitary Seal on Casing~
Dep=ession A~ound Wellhead
/ !
Static Water Level ~-- / Pump Set At
Casing Height Abo~ Ground j~
Electmrical Wiring in Conduit (.Y~
Sepa=ation Distances f~cm Well'.
To Septic/Holdin9 Tank on Lot ?~/ ~ ; O~ Adjoining Qots
To Nearest Edge of Abso~tion Field on Lot /6;~ ' -/- ; On Adjoining Lots
To Nearest Public Sewer Line /~//~ To Nea=est Public Sewer
Cleanout/Manhole %3 ~ To Nea=est Se~sr Service Line on Lot Z~ ;~
Water Sample Collected By~ '_3'.. ~V~/~ Date Z'~L~ ,~3'
Water Sample Test Results ~'~/~ -7? ~/~,c7~ ~
B. SEPTIC/HOLDING TANK DATA
;/
Date Installed ./~_//~/~'.9. Size . //~)z~ 0 No. of Compartments
Standpipes ~)---- Ai=-tight ~Ps ~*) Foun~tion Cleanout~
~ession o~= Ta~ (~ ~te ~.% ~d ~- ~
P~ing~inteD~n~ ~n~a~ ~ File (~ f~+ ; f=
~p~ation Distils ~ ~9tic~ Ta~: /
To Wate=-Supply Well ~2
To Property Line /O
To Water Main/Service Line
Course
To Building Foundation ~ ~
To Disposal Field ~ /
To Stmeam, Pond, Lake, Gm Major Drainage
ece pt
Date Paid:
Amount:
[Page 1 of 2]
2-15-84
ABSORPTION FIELD ~ATA
Soils Rating in Absozl0tion Strata /6.~ ~
Date .Installed /~./~ ~
Width of Field 6 0"
Squa=e Feet of Absorption A=ea
Depression over Field ~ Date of Last Ax~quacy Test
Results of Last ~equacy Test . ~/~ -t~f~/=F~c
Separation Distance frcm A~sc~Dtion Field:
TO Water-Supply Well /63&D (~ To P=operty Line
TO Building Foundation ~/7 ~
To Existing (=i Abandoned System cn
Lot /u/q9/-3~ ; O~ A~/join. ing Lots ~o ' ~
To Water Main/Service Line /dP ~ To Cutbank(if D~esent)
To Stream/Pond/Lake/c= Majo= D=ainage Course /~DO-,~3
To D=iveway, Parking Area, c~ Vehicle Storage A=ea 07~
Cc~ents X_3 ~o ~ ~
Type of System Design
Length of Field z/Z ~
Depth of Field ~ '
Gravel Bed Thickness 2 y
tandp~pes P=esent .~.~/~
D~. LIFT STATION
Date Installed
Size in Gallons
"Pump 0~" Level at
High Water Alarm Level at
Tested for
Electrical Codes,(Y/N)
Ccnm~nts
D~nsions
,,
vent
Pumping Cycles du=ing Adequacy Test.
Meets MOA
on the date of this inspection.
Check Permitted Bed~oon Rating A~ainst FAA Request **
I certify that I have checked, verified, c=. confcz~ed to all MOA HAA Guidelines in effect
[Page 2 of 2]
MOA No. ~O--~D ~
2-15-84
BILL SHEFFIELD, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
274-2533
March ll, 1985
Mr. Robert A. Shafer
S&S Engineering
SRB 196X
Eagle River, Alaska 99577
SUBJECT:
Waiver Horizontal Separation between Well and Septic
Tank, Lot 12, Block 3, Peters Creek Subdivision
(8521-WA-114)
Dear Mr. Shafer:
The Department has reviewed the subject waiver request and hereby waives
the horizontal separation between the well and septic tank to 92 feet
on the subject property for a 3 bedroom single family residence only.
Sincerely,
SWE/msm
District Engineer
APPLF NT FILLS OUT UPPER HA' ONLY .... '
~-,:6perty O'vner .~ b/4' ],,~' ~-)0(~ ~',' //~ ~,_, ,~ Phone
Address Zip Code
Lending Institution / ~ 2~'~ ~ Phone
Address ~, Zip Code
Realty Co. & A~nt Phone
Address Zip Code
Street Locati~
Type of Resi~nce
~Single Family ~
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
~ Individual ATTACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individual Year Individual Installed: / ~ ~
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
(3 ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE / "'~ '" '")""~'~ I~'L,,
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3/82)
EXCAVATION
ROBERT A. SHAFER
CIVIL ENGINEER
MUN iCl pA L6B~,.-I2,j~9,. NCH .'")~t A G E
January 15, 1983
WORK
Municipality of Anchorage
Department of Health and Environmental Protection
825 L. Street
Anchorage, Alaska 99501
RECEIVED
Reference: Our letter dated December 27, 1982, concerning
Lot 11 and 12: Block 3: Peters Creek Subdivision
This letter is to certify that the well seal which was
reported as broken in the referenced letter has been
repaired with a new well seal and is acceptable at this time.
If we may be of further service, please do not hesitate
to call.
RA/$//s s /'
cc: City Deposit
ATTENTION: Terry
SRB 196X EAGLE RIVER, ALASKA