HomeMy WebLinkAboutUS SURVEY 3043 LT 13 PART 8 T10N R2E SEC 18Onsite File
Lot 13 P rt 112',
Effluizelo-rupw4d,
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
DEPARTMENT OF HEALTH & HUMAN SERVIC~=S
January 10, 1986
TO: Permit Applicant
Subject: Permit # 850453
USS #3043 Lot I3F
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
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 ~ private engineer inspected the installation of the on-site sewer system
the original as-built inspection report(three part form) must be sent to
this o~fice for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SE0/ljw
enc: Copy Of Permit
DEF'ARTMEN'T' OF HEALTH AND ENVIRONMENTAL PROTECTION
8R5 L STREET, ANCHORAGE, AK 99501
264-4720
PERMIT NO:
DATE ISSUED:
APPLICANT: DAVID C. HILL
ADDRESS: BOX 7,., .
G)] R1)W(][)I), Al.::] 99587
CONTACT PHONE: ~--76-~G88
LEGAL'DESCRIP:
L..OT SIZE:
SUDDIVISION: USS ~3043 LO-f: 1.3F
SEC] ION. 1'7/8 TGWNGHIP: 1ON RANGE: 2W
5445 (SQ. FT. OR ACRES)
E L,O(.k.. N/A
I cert:iFy that:
1. I am ~ami].iaP with the pequirements t'~r on-site seweps and wells as set
~o'rth by the Municipality o£ Anchorage (MOA) and the S{ate o~ Alaska.
2. I w.ill install the system in accoPdance with all MOA codes and pegula~.ions
and in compliance with the design cpiteria o{ this pepmit.
3. I will adi~epe to all MOA and State o[ Alaska pequirements ~p the smt back
distances From any existing well~ wastewatep disposal system op public
sewepage~ystem on this ~p any adjacent op neapby lot.
SIGNFD DATE: ,~ ........
APPL. ICANT: DAV~I~[]. HILl_ v --
Parcel I.D. #
1, GENERAL INFORMATION
Complete'legal description
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
- - :'-- :; '.': '~ i ~,,,,,,,: ,'..:~!, ·
T,ot'13~';"Sec 18/19; :T10~; ~2E
LOcation (site address or directions)
.,
NHN Jeremy Road ~
G~rdwood, Alaska
.. Property oWner
, Mailing address
David & Darcy Hill
C/O Jack White Real Estate
Day phone
Girdwood Branch
,.Lending agency
Mailing address '
Agent ~eorge ~cCoy/ Jack White
Address
Da~ Phone
Day phone
783-2937
NUMBER OF BEDROOMS: 3 ~
TYPE OF WATER SUPPLY:
Individual well
xx
Community well
Public water
NOTE: If community Well system, Provide written confirmation from State ADEC attest-
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
. :PUblic seWer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72~25 (Rev, 1/91) Front MOA~21
STATEMENT OF INSPECTION BY ENGINEER
r
As certified by;r~y,.~eal 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 ~f this inspection.
Name of Firm
Address
Enginee¢s signature
Alaska Water &
ALASKA WATER & WA~
Wastewater Consultants, b~c,a~
Shall be PAID $/Z~"
or. prior to, closing for the
Engineericg ServLces Provided.
DHHS SIGNATURE
/~ Approved for .-~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stiPula{i°ns:
Additional Comments '
The Municipality of An~'horage 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 enginesr 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 anatyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work,
D. LIFT STATIO~~~ /z~
Date installed ~ Si
Manhole/Access (Y/N) __ ~~ "Pump off" level at*
High water alarm level at*
Cycles tested......_ ~-~
E. SEPARATION DISTANCES
Septic/holding tank on lot
Absorption field on lot
SEPARATION DISTANCES FROM WELL ON LOT TO:
On adjacentlots
Public sewer main
Sewer/septic service line
/',J//::F On adjacent lots
~ S t~ Public sewer manhole~
Z~ /-I-
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: ~/J,,~ -
Foundation ~ Prope~y line Abso~
Water main/sewice line ~ace water/drainage ~ls on adjacent lots
SEPARATION DISTANCE~BS~ ~//~ --
,cedifythat~/~rm~h, ,.,dinspectionsandrevie
in conform~ce ~ip~O~ ~ g[ .lines in effect on this date.
Engineer's ~2~ ~ J~ ~-
/ / ' ,
ar~
HAAFee $ 'c~ ~
Date of Payment "~ /~ /~/~-~"
Receipt Number Z./Z'~ f ~
Waiver Fee $
72-026 (Rev. 3/96)*'
Date of Payment
Receipt Number
RECEIVED
MAR 0 5 1999
Municipality
of
Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICc,F.~iclP^U~Y
Environmental Services Division mVmONt~Nf^~S=RV~CE$
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description:
A. WE''DATA
Well type ~-\'J ~[F~ If A, B, or C, attach ADEC letter. ADEC water system number '
Health Authority Approval Checklist
Log present(~N) /~--~% Date completed
Total depth ~ Cased to c__~ ~
Sanitary seal (~N) y
Casing height (above ground)
Wires properly protected Y~.~)
FROM WELL LOG
AT INSPECTION
Static water level
Well production
g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample:
, ~ .tyl~//-. Other bacteria --(~
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~ Tank size
Foundation cleanout~
Date of Pumping ~
C. ABSORPTION FIELD DATA ~
Date installed __ __ _ Soil r~...~.g.p.d./fF or ft~/bdrm) __ __ System type
Length Width Gra"~.ckness below pipe Total depth
Effective absorption area Monitoring Tube"p%(Y/N) Depression over field (Y/N) __
Date of adequacy test Results (Pass/Fail) % For
bedrooms
Fluid depth in absorption field before test (in.);
Fluid depth (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
Number of Compartments .__ Cleanouts (Y/N)__
. Depression (Y/N) High water alarm (Y/N)
Pumper
Immediately a"~'~8~ffe gal. water added (in.):
Absorption rate --"~ g.p.d.
If yes, give date
FEB-Z4-99 14:59 FEOM-CTE ENVIRO~WENT^L 56i550! T-~48 P.GZ/(~$
CT&E Ref,#
Client Name
Projcc~
Cliem Sample ID
Matr~
Order~ By
PWSID
Sampl~ R~mar~s
Client: PO~
Primed Da~ e/Time 02/23/99 11.52
Colle~ed ],atone 02/17/99 00:00
R~elv~ D~Ff~o 02/18/99 10:05
T~hnJcal }}lr~or: Slephen C,
O,d~? 0,~00 mO/L EPA ~O0.O
CT&E Envir~nmen~l Services inc.
L~bo~mrf Division - ' '
200 W P~r~er Dnv~
Drinking Water Analysis Repor~ for Total Coliform Bactezia ^,~,,e.. AK =s~-~=o=
T~t: {~7) 562-~3~3
.r,n ,~CTRUCTION~ O~ ~V~E SIDE ~0~ COLLECTING ~MP~E F~x. ~7 561-5~ _
PUBLIC WATER SYSTEM
p~UVAT£ WATER sySTEM
~ ........ ~ ~ .... .~_~
Month Dsy
Rep~a~ ~ampl~ (for routi~ ~ampl~ 0 U~a~ W~r
with lib r=f, no. ~)
O ~,m~,le over 30 ho~ o1~ resa!ts ma~
~ample ~ ~g m
~w ~91a via ~ de~v~
. ~ N4~-r of ~Jg~l~ mi.
R~Ie Analys~
BACTERIOLOGICAL WATER ~YS~ ~CO}~
F~a~ Coliform Coaflrm~a.
g~,porc~ I~ ~
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Rd. Suite 2B ~ Anchorage ~ Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
March 5, 1999
Municipality of Anchorage
Department of Health & Human Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: T10; Sec 18/19; R2E; Lot 13F of Part 8
We are submitting for a Health Authority Approval on the referenced property. The
property is served by city sewer and a private well. It has come to our attention there is a
sewer cleanout within the 100 fi. well radius. The well was drilled in July, 1985 and the
city sewer was installed in September, 1987. Due to the encroachment occurring after the
well was drilled, the burden of obtaining any necessary waivers should fall on Anchorage
Water and Wastewater Utility (AWWU).
Recent water samples show nitrate levels of °66 mg/L and no bacteria, indicating the
private well on Lot 13F has been unaffected by the encroachment.
If you have any questions or require additional information, please contact us.
JAG/gd
/r
?
?.
~AND ~ C~CTION SURVEYORS-PLANN[R$-[NGINEERS
440 W~$T BCNSON B~'~, ~ lOa (fo~) 561-6~6
3,25' ~.UON. ~,uo~,uumT
A PORTION OF LOT 13,
U.S. SURVEY 5043
FROM
ALASKA WATER & WASTEWATER PHONE NO. : 90?3383246 Maw, 12 1999 01:1?PM P1
ALASKA 'WATER .AND WASTEWA. TE,R
~ .... " CONSULTANTS, INC," I ~m
.'. FncsimileTmnsmittnl.
6901 Debarr'l~oad,' Suite 29 * Anchorage, AK 99504 -,907.337.6,179 · Fc~ 90,7.338L3246~
' ' ' ' E-Maih awws~alosko.net ' . - L
FROM : ALASKA WATER & WASTEWATER
PHONE NO. : 90?3385246
/
Ma~. 12 1999 OI:I?PM P2
?,
BILL 5HEFFI[~LO, C, OV~RNOR
ANGHORAGE/W£STER~ DISTRICT OFFICE
437 "[" $~REET,
ANCHORAGE, ALASKA 99~01
RECEtVED
USKH
Anchorage, Alaska 99503
ATTENTIOn; £a~1 D. Ken,nra, P, E.
Alaska - 8~I-WAoii~
Trunk (Phase
I~ Anchot'age~
~av~nta:
~.eq:t~.ad :efove approval ~11 be g~.ante~.
ixten 3o~nts wi%n ~he "~ield
The Eayc~em Wp¢/e7 ay TP$ ~ea~ shvi~ sleeve should be used in
The ~ ~ls on-lo~ IZ-A should be gvou=a~ [o~ [/z ~mes the
exc~va=ton depth of the a~ace~t ss~ev llne ~rench.
~u~.Amtion urocedures during construction
1ns. ........ o e~u~ corrmct lnstalla~ian~{,
~eer con=tn~a]]y be presen~ [ '
Sincerely,
s~/dd
FROP1 : RLRSKR WRTER & LdRSTELdRTER PHONE NO.
Mar. 12 i999 01ti?PM P3
Mr. tteven Eng~ P.E,
~nvtronnmntal Eonservatton
437 '~E* Street .' ...... -:
Suite 2Oo
Anchorage, Alaska g950~
Re: Gtrdwood Sewer L.I.~. ~60-3
On beb~f a~ the ~nehoeege Water end Was~ewa~e~ U~tll~y~ ~e a~e submitting this
propes~l for a waiver of ROEG Well regulations for four s~all lots in Lot 13 of
U.s.s. tn the
October3~l{gB$. The lets {n question ere ,umbered'137, lIG. 13H and fSI and
are shown on the attached map,
along the southwest oounaar~
- 1so reposing to abandon tho ez~sting well on
four lots in question, We ar~.o ? .... . ..a t at lot, Which WOUld
result in a separa%lon of approximately ninetY ~u~ ,eot uc~w~- --~ . almost
and ~he man~ole et the end of the extende4 sewer.
adequate to ~et ~EC ~gulatlons (LO0 fee:) and ts la~gev by far than the fifty
(50) foot separation provided
and ~3BL).
We are proposing ~h(s waiver contingent on (~) obtaining the agreement of all
fou~ of the lot o~ees involved~ (g) ~onstructing the se~r extenMOn with
mechanical manholeS, "Flel~ Lock Gasket Joint" ductile (ran pi~e and heat shrink
sleeves, and tmplementat(On of an approved construction inspection program
indicated Hn your lo:tee to us of M~ ~, 1985, and~ (3) discontinuation of the
use of onS~ mewage
the proposed sewer aG Seen aS possible,
Than~ yo~ for your ~onstderatien
SincerelY,
Terry L. Waldale~
TLW/rcl /'
cc: DOn Keefer, A~WU
FROM : ALASKA WATER & WRSTEWRTER PHONE NO. : 9073383246 Mar. 12 lgg9 01:18PM P4
DEFT, 0F ENVIRONMI~NITAI, CONSI~BVATiON
4~? 'E' 5TRECT, SU£TE 303
ANCHORAS~, ALASKA 9¢50t
~ILL SHEFRI~LD,
U,S,~*H, ~
~hcreee, Alaska 9~03 ,7~
· al SePara~iO~ between gall and~er
Dear Sir:
The Department has reviewed the subject uaiver reqUeSt and
hereby conditionally waives the horizontal separation between
uells and sewer main to the {ollow~ng~
Wells to ~ewer Main, Lots ~3A & 81; ~0 ~t,
Well to Sewer Main, Lot 13F; 6S ~t.
Wall te Sewer Main, Let 13H; 90 ~t,
The 'waiver ts conditionally mpproved subJect upon contingencies
as addressed ~n yOUr October lO, 19&5 are ~ullY implemented as
stated,
above address er telephone number,
SincerelY,
RE'OEIVED
,GOT ~ ~. t9'~5.
· R~h. Water '& ¥'/a~
FROM : ALASKA WATER & WASTEWATER RHONE NO. : 9073~83246 Mar. 12 1999 01: 18PM PS
TEL:552-0824
< ,,'
,, f
LOT 13H
LOT
'1
LOT B2 I
I
STA.91*'O0
JOINTS WITH HEAT SHP, INK
LOT 12B
B1