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HomeMy WebLinkAboutBOWLBY LT 2 Municipality of Anchorage Page J 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: '~l,~l~.[(~'~[C~ PID Number: ~:~'"'JJ:~ ~ ~ Name: ~~ ~~1~~ Wastewater System: ~ New Upgrade A~~ ~~[~, ~-.-~' ABSORPTION FIELD Phone:~. ~~ jNo. of Be~,,s: ~ Deep Trench ~Challow Trench ~Bed ~Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION soi,,.~i.~: D.~s~.~t. ~' L°t: ~ B~~~ ~:bdi [~ , Deptht°pipeb°tt°mfr°m°riginalgrade: Graveldepthbeneathpipe ~,~ / Ft. Township: ~i ~ I Rang~~ ]Section: ~ Fill added above originat grade: Gravet length: WELL: B New ~ Upgrade Gravel~pth: ~1~7~ ' ~ Ft. Number of lines:~,lDistance between lines:_ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material~4 Driller: Date Drilled: Static Water Level: Installer: Date instatled: Yield: GPM I Pump Set at: Ft. I Casing Height Above Ground:Ft. TANK I SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding 3ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Well i~I i~I __ __.. ~ Material~~ Number of Compartments: Surface Water [~{~ [¢'~ ~ ~' ~ LIFT. _STUN Lot Size in gallons: Manufac~m~ Line ~/ J~ I ~ ~ Foundation ~ I ~/ ~ ~ -- "Pump on" level ~"Pump off" level at: I High water alarm at: CurtainDrain -- ~)~ ~ ~ ~ _ Pump Make &~l ~ Electrical Inspections performed by: Remarks: ~ ~N[~t~~ ~ BENCH MARK Location and Description: J Assumed Elevation: EN~~L Inspections performed by: ~~ ~t ~ ~s: 1st I~'~ .~/-%~ Department of Health and Human Services approval ,, ~'. ......~'~ Reviewed and approved by: ~o~ ~ ~ Date:/~ ~ ~t~.PROFESS~O~ 72-013 (1/91) MOA 25 Permit No., Page ~ of ~ Municipality Of Anchorage 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 Legal Description: 72-013 A (2/91) MOA 25 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:SW910319 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:BOWLBY RICHARD & OWNER ADDRESS:20532 JAYAHWK DR CHUGIAK, AK 99567 DATE ISSUED:10/04/91 EXPIRATION DATE:10/04/92 PARCEL ID:05115356 LEGAL DESCRIPTION: BOWLBY LT 2 SEC 8, T15N, R1W, SM LOT SIZE: 44348 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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 (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED ISSUED BY: DATE: DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN September 30, 1991 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Bowlby Subdivision Lot 2 Request you issue a permit to relocate the North 20' of the existing trench serving the referenced property. An adequacy test was performed on the existing system and the absorption capacity of the system was found to be adequate for a three bedroom house. The North 20' of the existing trench became encroached in an utility easement that came into existence when the property was replatted. Therefore we will be abandoning this portion of the trench and adding a new 20' portion parallel to the easement running Eastwest. If you have any questions or require additional information for your review, please contact us. Sincerely, sHt RJS/lsu 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: '~:="~' 10 11 12 14 15 16 17 18 19 20 ueLunH ~ U$1~eH 'ldeQ ,[o Xl!led.3iuniAi t66~ t, .L00 DATE Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT i~) t DEPTH? /~; pO Depth to Water Aften ~ . Monitoring? "[/~'-~'~ Dale: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop '?... ', ~o ' "pc, ~, ~/~' 4 --5-~ , ~o 4," i,~ PERCOLATION RATE ~ ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '~'~" FT ^ND ~'"',~ ,T COMMENTS S & S ENGINI:EI~INIG PERFORMED BY 17034 Eagle Rioter Loop Read Ne,. 2 - q ~ CERTIFY THAT THIS TEST WAS PERFORMED iN : Eagle River, Aiaska 99~77 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT O THISDATE. 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lob 2; Bowlby Subdivision Resubdivision of Lot 131; Section 8; Ti5N; R1W: S.M. Corner of Jayhawk and Bowlby Street Location (site address or directions) Property owner Mailing address Lending agency Mailing address Richard and Elaine Bowlby Day phone Day phone Agent Dick Brown/TARGET REALTY Day phone P.O. Box 774627, Eagle River, Alaska 99577 Address Unless otherwise requested, HAA will be held for pickup. 694-2388 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: "-4 XXX 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 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 information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & S ENGINEERING 7034 Eagle River Loop Road No. 2(~ Eagle River, Alaska 99577 Phone Date SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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 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. 72-025 (Rev. 1/91) Baci( MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~---~ 'Z-- ~-_-_-_-_-_-_-_-_-~.[~;2~ <~1~'~ Parcel I.D. A. WELL DATA Well type ~lZ..~J ,~','t'¢~ Log present. N) NJ Total depth L~-'~' Sanitary seal ~N) Date of test If A, B, or C, attach ADEC letter. ADEC water system number Date completed '~("~'~o I,/'] Driller~L.- ~'~¢..,~..~-,,..t~ Cased to ~' C) '~___~F:J;z.~ ~f (~- ~'o~:as i n g h e ig h t Wires properly protected ~YN) Static water level Well flow Pump level FROM WELL LOG % ~ (3, C) g.p.m. AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 1 ~,~ Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform ~ ~ Date of sample: Nitrate ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts~N) High water alarm (Y~) Date of pumping Other bacteria 17034 Eagle River Loop Roed No. 204 Eagle River, Alask~ 99577 Tank size ~ ~..~"D Compartments I. Foundation cleanout (~IN)~ y Depression (Y/J~ Alarm tested (Y/N) ~J/~' Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage 7 (Rev. 7/91) Front On adjacent lots Absorption field Foundation Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) -.---- ~......----- Vent (Y/N) "Pump on" level at ----~"Pump off" level at High water alarm level ~_J Cycles tested Meets MOA electrica~ SEPARATIO~j~I~TANCE FROM LIFT STATION TO: ~-=~'Fon lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed \~ Length ~'C> Width Total absorption area Depression over field (Y~ Results.4~fail) ~/~'~ Peroxide treatment (past 12 months) (Y~) Soil rating \ ~ Gravel thickness ,~"1. ~{-~-'~)/~,~leanouts present ~N) Date of adequacy test for /'J~/~--- t/-',''/~c"'/~ If yes, give date System type ~ Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~'~ ~ To building foundation On adjacent lots ~-~c~ Surface water ~ c:>c:~ Curtain drain ~ On adjacent lots ~ C~1~ ~ 4- Property line To existing or abandoned system on lot I Cutbank J~a,, Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S cERTIFICATIo I certify that I have Checked, Verified, Or conformed to all MOA and HAA guidelines in effecLo~.41~?t~e of this inspection. S & S ENGINEERING . . Signature .......... ~/u~ ~ag~e ~wer L~p En g Date ~-[~ .** / - Receipt Number ~ ;~O ~ ~ / ~ ~ ¢ Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALI$IS REPORT BI SAMPLE for W0R[ordert 38047 Date Report P~lnted: SE? il 91 ~ [5:54 FAX: (907) 561-5301 Client Sample ID:L2 BOWLBY $/D Client Name :S & S ENGINEERING PWSlD :UA Client Acct :SNSENG? Collected SEP 8 91 ~ 12:15 bzs. BPO ! PO t NONE RECEIVED Received SEP 9 91 ~ 16:10 h~s. Req $ Preserved with :AS REOUIRED Ordexed By : Analysis Completed :SEP 11 91 Send Reports to: Labo~ato[y SupeLv.~§o~ :~j~TEP.HEN C. EDE lis & S EN~IIISERING Released By : ~t./~ ~ 2) Chemlab Ref t: 914699 Lab Smpl ID: 3 Mat[ix: WATER Allowable Paramete[ Tested Result Units Method Limits NITP~TE-N 2.8 mq/1 EPA 353.2 lO Sample ROUTINE SAMPLE COLLECTED BI: RAY. Rema=ks: 1 Tests ?ezfo~med * 3es Special Instxuctions Above UA-Unavailable ND- None Detected "See Sample Remarks Above MA- Not Analyzed LT-Less Than, GT-Greater Than Member of the SGS Group (Socit~t6 G(~n(~rale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D.# ~ PRIVATE WATER SYSTEM Name Phone No. Mailing Address City State Zip Code SAMPLE DATE: Mo. Day Year SAMPLE TYPE: ~ Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION 2 I 31 4 I 5 I Time Collected Collected By TO BE coMpLETED BY LABORATORY sYatiS shows this Water SAMPLE to be: is faCtory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received q/~/C~/ Time Received I~[{~ Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* A.B.E.C. Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count Coliformll00 mi BEFORE COLLECTING SAMPLE Verification: LTB BGB Final Membrane Filter Results Reported By ~.~--~-r~c~/~/~-~' ' ~ Date Time: Coliform/100 mi - / /~ ~7 ('_")(._) a.m. p.m. TNTC = Too Numerous To Count OB = Other Bacteria PART ONE OF TWO REMAINDER TO FOLLOW 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 so~rp~t~ NO. OF BEDROOMS I.- ~ Manufacturer Matorial ~o. of commitments Liq. cap~c~y~lons IF HOMEMADE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well ~ Dwelling PERMIT NO. O Z ~ Manufacturer ~/~ Material Liquid capacity in gallons = Well , Foundation ' Nearest Jot li~e PE=IT NO. _ ~~ DISTANCE TO: ~ ~ ~ No. of lines Length of eac~ line Total length of li~e, Trench width Distance between lines ~--~ ~ Top of tile ~f~h grade Material beneath tile Total effective absorpti~ area¢ Length Width Depth 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 ~ , ,, ~ U ~. - ~o, REMARKS ~e ~ ~ e. ~e e ~ · ~e e e ele~ e e ~/ ~ Rob=d APPR~V E D _ ~" ~"~O~f~j~,~ 72-013 lev. 3/78) Department Permit Applicant: Location: Legal Description: r.~/L) ~ i bJ Type of Soil Absorption System Is: Trench: Drainfield: ~ Maximum Number of Bedrooms: ,,~ MUNICIPALITY OF ANCHORAGE ~ Health and Environmental 'rotection 825 , Street, Anchorage, AK. ~J501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT Phone Number: ~>~ -'! ~, ~ t ! ~ / Lot Size: Seepage Bed': Holding Tank: Soil Rating (sq. ft/br) DEPTH The Required Size of the Soil Absorption System Is: LENGTH _~" ~l ' GRAVEL DEPTH --'~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the. distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the.minimum'depth of gravel between the outfall Pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIlC(HOt.'I)TNG) TANK SIZE = /~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * 0(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution'. Minimum distance between a well.and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is. 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 ~drooms. Signe~: Issued by: Applicant SWP/024 the-trench or drai~fteld; The ',he surface of the ~round and ~o set-w~dth £or tranchem. ~tween the cuff all pipe and ~ 6ALLON$ e · ~form-thee-department during the tONS-ARE REQUIRED · e e ar~ approval by this dep~rtmen~ on-site sewage disposal syst_-m, is 100 fee a public well depending upon the ty~e well to a private sewer line 95 fee~. Well logs are ;-~1~ 30 days ~f the well c~pletton. tio~ .~ co~s~ctto~ diaqr~ are ~1)-~ l-'~ f~lii~ ~tth ~e requi~e~nts for on-site sewers an~ ~lls as I will install the syst~ ~ accord~ce with c~es.. ' . .. ~_._.,~ ..t ,or,h by the ,~loipaltty of ~chora~e - I ~S~d that the on-s~e sewer syst~ may re.ire enlargement ~ f02~ (1/81)" .$01LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: "'~ ,~_~ LEGAL DESCRIPTION: -"T"' ~-'~ ~ 1 2 3 4 5 6 7 8 9 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER .~~ I~ ENCOUNTERED? O P IF YES, AT WHAT E DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop :,,: ).. ~,'.t~;h:,- ' :.-,,' / PERCOLATION RATE 1%~ ~ (minutes/inch) TEST RUN BETWEEN FT AND ~ FT L.OG OF DRILLING by A & L DRILLING ,zn OF ~am ...... .~elne~,&..~e~l.~ .............................................. ,DDRE 88...~01~....~..s .................................................................................. vzz~_,~.t..X3l+,~a~..8,T~l.51[ ,....R~.,-...~I ................. ~ATZ--~,Z~.. ~,~- -19,- ....196T- ....................................................... RIND OF FORMATIOI~I F~M ......... 0 ............. ~: TO......~.~ .............. l~...S~lr...Ol~ ,.~OU'l d .FROM .......................... !~. COMPANY STATIC LEVEL OF WATER 1~....~.~. ..................................... DRAW DOWN FT ...... ~, ................................................................. GALS. PER HR~.................................................................. FROM .......................... FT. FROM .......................... FROM ......................... FT. FROM .......................... FT. ~O ........... : .............. ~ ..................... ~ ............ FROM .......................... FT, T~ ............. · ............ :FT .................... ~ ............ 60 ft.,.'.-]~eFremte& Oaejnl, ¢6--5o f,. ,eetmoa~eA. re'be eot at 55 ~t. fro~ freund level.