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HomeMy WebLinkAboutFISCHER BLK 1 LT 4B-2Fischer Block 1 Lot 4B2 #015-292-41 SEP 0 ? 1994 Municipality of Anchorage Page Municil~ah[y ol ^r,cno, ag~E"PARTMENT OF HEALTH AND HUMAN SERVICES ;h,pt. Health &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: .~V~' °fL~ OI ~ ~ PID Number: Name: ~ ~lc~ ~t~ ~,~ Wastewater System: ~ New ~ Upgrade Address: ~ ( ~ ~ ~ C~ ~ ABSORPTION FIELD Phone: ~No. of~moms: ~eepTrench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION so, n~,~: Total Depth from origina~ grade: I. ~ ~pwsq. Township: I Range: Section: Fill added above original grade: [ Gravel length: iI ~ Fb ~ O Ft. WELL: ~ New ~ Upgrade ;Gravelwidth: Numberoflines: l Distance between lines: ~ Ft. ]I -- Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total ~bsorption area: Pipe material: Ft. Ft. ~ SQ. Fb ~riller: ~ Date Drilled: StaticWaterkeveh installer: . , Datei st led: Yield: GPM I Pump Set at; Ft. I Casino Height Ab°ye Gr°u;~: TANK SEPARATION DISTANCES KSeptic U Holding a S.T.E.P. TO Septic Absorption LiS Holding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines A~, ~ "Well 1 ~ ~ ~ ~ O ~ Material: ~ ~ Number of Compartments: Surface Water ~[t ' ~¢ LIFT STATION.. LineL°t ~ ~ Size in gallons;]J Manufacturer: . ': Foundatiog ~ '~ "Pure p on" level at: [ "Pump off" level ':t:~ ~ High water alarm ab Remarks: BENCH MARK ' Location and Description: Inspections performed by: ~ Dates: 1st ~ ~ Department of Heal.and Human Services approval Reviewed and approved by' ~~ ~ ~ Date' ¢-2~-¢~ 72-O13 (Rev. 9/91 ) MOA 25 15 0 15 30 45 60 75 90 SCALE; l' = 30' 20.3 W 15TH, AVENUE ANCH. AK. 99501 LOT 4B-2 FISCHER S/D WILLIAM £E/CKW£LL SEPTIC SYSTEM ASBUILT DATE: SEPL ~ 1994 SHEET: 2/3 GRID: 2537 Standard Trench .' £' Wide 40' Lan9 9' Deep 4' CoveP Yon,'tor Clean Out 52 C/man [Tm~l. NB SCALE 1000 90/ Septic tank C/eanouts pMan/tom M/PaP/ 140 B~.B~ oF Septic Rock NO SCALE 84 TOB£EN SPURKLA~VD P.E. 205 Wl5ih Ave Ak 99501 LOT 4B-2 FISCHER WILLIAM BMCKWELL 95.$4 1000 9oL se~tlc tank Anchoroge T~nk BENCH MARK: TOP FOUNDATION ASSUI~ED ELEVATION; I00.00 FL SEPTIC SYSTEM ASBUILT DATE: SEPT. 6, ~994 SHEET: GRID: 2557 PAGE 1 OF 1 MUNICIPALITY OF ANCH0tLAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940162 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:BRICKWELL WILLIAM P & OWNER ADDRESS:8112 PARKRIDGE CIRCLE ANCHORAGE, AK 99507 DATE ISSUED: 6/01/94 EXPIRATION DATE: 6/01/95 PARCEL ID:01529241 LEGAL DESCRIPTION: FISCHER BLK 1 LT 4B-2 ? LOT SIZE: 25391 (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: ./~ ~ ~'~ DATE: T.SPURKLAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 4~2 FISCHER S/D DAWSON DEVELOPMENT No Ground Water or Impervious Layer to 15 ft. Use Standard Trench Soil Rating. From test May 10, 1994 <1 min/in = 1.2 gal/min Material at 11 feet 82% poorly graded sand Required Area per Bedroom: 150/1.2 = 125 sq.ft.. Finished Floor Elevation Lowest Floor Ground Surface at Absorption Field Testhole Total Depth 15 Less 6 feet 9 'Less 4' Cover Rock Depth Number of Bedrooms Length of Trench 97 96 3 125 x 3 / 10 = 37.4 CONFIGURATION STANDARD TRENCH TOTAL LENGTH 40 FT. TOTAL WIDTH 2 FT. TOTAL DEPTH 9 FT. ROCK DEPTH 5 FT. COVER 4 FT. SEPTIC TAIqK 1000 GAL. The installation of this well and septic system will not impact adjacent lots. The well location conforms to the siting of the existing wells in the area, and will not prevent the adjacent lot owners from developing these lots or replacing the existing septic systems. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. Septic System Design Lot 4~2 Fischer S/D pg. 1 Municipality of Anchorage DEPARTMFNT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST · EG^L DESCR, T,ON: LoT t ;1.4 HL 4- 5- 6- 7 8 9 10 12 13 15 16 17 18 19 20 Range, Section: WAS GROUND WATER 'kl ENCOUNTERED? ~'t O S ~., /,~ rF YES, AT WHAT O DEPTH? p E SLOPE SITE PLAN I Ai Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE < I (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ~ FT AND ~:) FT COMMENTS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE;' 72-008 (Rev. 4/85) + Well LOT 3~5 ~ I , 3A4 / ~ SEL~£N CIR, II LOT 4~ II 3A3 II L~I l~e H 3195 $~4 50 100 150 ~00 850 £CALE; l" = i00 Fl, 3~6 3~7 SPRUCE CREEK CIf~ 300 I I SEPTIC SYSTEM DESIGN DATE: I~AY 12, 1994 SHEET: l/J GRID: 25J7 TOBBEN SPURKLAND P.E. LOT 4B-2 BLOCK I FISCHER S/D 203 W 15TH, AVENUE ANCH, AK. 99501 DAWSON DEVELOPWENT 1000 GAL SEPtiC 95,6 50' LONG TRENCH WI5' OF PROP. RESIDENCE FF 97,0 Tes%h, x~/WATER LINE FROM WELl N PRIMARY TRENCfll REPLACEMENT [R~NCH i5 30 45 S£ALE: 1' = 30' 60 75 J J SEPTIC SYSTEM DESIGN DATE: MAY 18, 1994 SHEET: 2/$ GRID: 25,~7 TOBBEN SPURKLAND P.E. LOT 43-2 FISCHER 205 W 15TH. AVENUE ANCH. AK. 99501 DAWSON D£VELOPW£NT Standard Trench ,' 40' Lan9 Deep Sewer rock Cover ND SCALE Septic tank C{eonoufs ~ Mir'o£/ i40 ~ ~ 5 Pt o£ Septla Roar N£ SCALE 4' Min Cover over Tank Ex,st Ground i000 9aL septic tonk TOBBEN SPURKLAND P.E, 205 Wl5~h Ave Ak 99501 LOT 4B-2 FISCHER DAWSON DEVELOPMENT SEPTIC SYSTEM DES/ON DATE: MAY 19, 1994 SHEET: GRID: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL) 7 8 9- 10- 13- 14~ 15- 16- 17 18 19- 20- ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth te Waler ADer Monitoring? __ Dale: SLOPE SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ / (minutes/inch) PERC HOLE DIAMETER __ COMMENTS TEST RUN BETWEEN ~ FT AND -- FT 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 Farc Lb. # oil- qi 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Location (site address or directions) / ooF-_ Property owner Mailing address Lending agency Mailing address Agent ~ Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: --~ TYpE OF WATER SUPPLY: NOTE: Individual well Community well V ~ z/,2-/- ~'A - -,~--~ c[ 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: 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 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. NameofFirm '-~o~b~vt ~-~bgv'~L~ '~. [~ Phone ~-.-?~'::JJ/-~ Address ¢¢--0 '~ Engineer's signature ,S DHHS SIGNATURE ~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 purchasers of homes and their leading institutions in order to satisfy certain federal and state requirements. Em ployees of DH HS 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. M~NICIPALITY OF ANCHOP. AGE ENVIRONMENTAL ~ERVICE~ DIV~ION Municipality of Anchorage APE 0 3 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 4~.~4~ i V E ~....~ 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907), 3 Health Authority Approval Checklist Legal Description: ~o"~:. J//'~,,~)., ~"/~,c~ ~ Parcel I.D.: A. WELL DATA Well type ~/~-~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Total depth Cased to Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. . g.p.m. WATER SAMPLE RESULTS: Coliform hi J) Nitrate 1~' I Other bacteria N ,~'~ Date of sample: '~/*~//~"'] Collected by: '~, S. SEPTIC/HOLDING TANK DATA Date installed ~/~.z/ Tanksize /~'~.) ,umber of Compartments ~.- Cleanouts(Y/N) . Foundation cleanout (Y/N) y Depression (Y/N) ~q' . High water alarm (Y/N) Date of Pumping y/'5/~ '~ Pumper ABSORPTION FIELD DATA Date installed 7/~'/~1~ Length ~//~) / Width c,~ I Effective absorption area ~//'~ Date of adequacy test '~/~//~7 Fluid depth in absorption field before test (in.); Fluid depth ~ o ~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Soil rating (g.p ............ ) I Gravel thickness below pipe Monitoring Tube present (Y/N) y Results (Pass/Fail) ~ System type Total depth · Depression over field (Y/N) For ,.~ bedrooms Immediately afterT.,?-o gal water added (in.): Absorption rate = ~'/'//~'~ g.p.d. If yes, give date 72-026 (Rev. 3/96)* Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/,~:a;~lip~ tank on lot Absorption field on lot / 7rP / Public sewer main l~//,,,,,A On adjacent lots On adjacent lots Sewer/septic service line Public sewer manhole/Cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ O~ Property line Absorption field Water main/service line ~ O Surface water/drainage ~,,~, ! ~) Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Building foundation /.,~ ~' Water main/service line Driveway, parking~'ehicle storage area 5 Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections~ in conformance with MOA HAA guidelines in effect on this date. Signature "~'~ ~-~ Engineer's Name Date HAA Fee $ ~-~-~ ~' Date of Payment /~ {~/L ~Z'. Receipt Number ~ ~/~, 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ~TATE, OF: ALA:SK./k DEPAF~TMENT OF ENVIRONMENTAL CONSTRUCTION AND OPERATION for PUBLIC WATER SYSTEME A, APPROVAL TO CONSTRUCT Plans for the construction or modification of {VATI©N :ERTIFICATE ' '-' aoP, roved- / ~_ conditionally app;eved {aaa attached conditions), ¢ S0 construction h83 not stoned within two years of the approval date, ti ~pecificatlons must be 3ubmtited for review and approw[ ~efote con B. APPROVED CHANGE ORDERS The "APPROVAL TO OPERATE" ~ectlon ~ust be completed and aigr i$ made available to the p'c:blic. THe construction of the ~ ~ , ~/X ~' w~Ier ~y~tem w~s ~mpleted on ,. granted Interim approval to operate for 90 days following 1he temple &_~/publlc wafer system located :ted in accordance with 18 AAC 80,100 have been reviewed and are DATE is csrtJflosfe Is void and new plans and tructlcm 3 by the Department before any wafer public (date). The system Is he¢eby don dafe, As-built pisns au~>mitted during the interim &pproval period, or cn ins the System WaS constructed according to the approved plans, "he s Poet. It'~ brand lex tr~n~mitIal ~emo 7~! ~ p~ ~ ',d --~ ' OE, E,E, ~Z~ ZF1E, ADFi3g~U t]NU~;~BH 3H1 I,iUZT :80 ~ctlon by the Department, has confirmed ~tem Is hereby granted final approval to 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 01,~' - ~l.~,,'7._- Llt'/ 1. GENERAL INFORMATION Complete legal description HAA# LoT Ur Location (site address or directions) Property owner Mailing address Lending agency Mailing address. Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '-~ 3. TYPE OF WATER SUPPLY: NOTE: ~!~ ~' f' (4' . Individual well Community well ~ [~.~.q, Public water ~-. ~f communi~ well system, provide wri~en confirmation from State ADEC attest, lng to the legali~ 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. ~ ....: , : ) ' 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. Phone Address ~ Engineer's signature DHHS SIGNATURE /~ Approved for-~-'- bedrooms. Date Disapproved. Conditional approval for bedrooms, with the following stipulations: ,,~ Add~bonalComments 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 purchasers of homes and their lending institutions in orderto 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~I~CH~P__ Ci,'~.. Lo.~ q ~--~2_ Parcel I.D. A, Well Data Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date of test Static water level Well flow Pump level1 Date completed Driller Cased to Casing height Wires properly protected (Y/N) AT INSPECTION FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot/TD Absorption field on lot / Public sewer main I'"/~,z~ Sewer service line ~> ! WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: .g.p.m. g.p.m. ~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ] ~ ~ ~ Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size ~ ~ ~<:P Compartments Foundation cleanout (Y/N) "'// Depression (Y/N) Alarm tested (Y/N) Pumper r~,,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot t'~// To property line ..¢_.. ~.,) Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at Manhole/Access (Y/N) "Pump off" Level at High water alarm level Meets MOA electrical codes (Y/N) .Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/'~ Length /--/C~ Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) Gravel thickness Cleanout present (y/N) ~'/ Results (pass/fail) System type *~--'-~d. Total depth Depression over field (Y/N) for ~ Bedrooms After test If yes, give date J"7//,/--~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ //' ,/~ On adjacent lots To building foundation On adjacent lots ~ ~ Cutbank Surface water Curtain drain /'7 0 ~ Property line To existing or abandoned system on lot NO v~-~._ Water main/service line Driveway, parking/vehicle storage area 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. Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number