HomeMy WebLinkAboutPETERS CREEK BLK 3 LT 12P ¢ k 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