HomeMy WebLinkAboutSOUTHPARK #2 BLK 1 LT 28 ~ MUNICIPALITY OF ANCHORAGE
~ DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720
/'~ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
v- .-..-.--, ~ TO SEPTIC ABSORPTION WELL
Addres~ FROM ~ TANK FIELD
Pho.e(s) Pe,~it .o. No of~e WELL pZ~o'
LEGAL DESCRIPTION
I [ Subdivision
.ot Z~ Block ~ ~ ~ ~ ~ FOUNDATION IO' %~' nJ~
Township, Range, Section AS-BUILT DIAGRAM (Show location of well, septic system, p opedy lines, [oundation
driveway, water bodies, etc.)
TANKS N
TYPE OF SYSTE" ;,/ -- ~ ~ ~_
~TRENCH ~ BED ~ W. DRAIN ~OTHER ~ ¢' ~, m..z ~
FlU added above odg~nal grade Gravel deplh beneath pipe
~ F1 J ~ FT
~ SQF1 /j ~ ~ F1 ~
I.staller ~ ~ ~5~ Date Installed
/
WELLS
~ PRIVATE ~ OTHER (Identifv)
Cla~ificat[o~ (A,B,C) Tota~ Depth Cased to ~ ;~ ~[''~
FT
Ins[~ller Date Installed:
REMARKS:
I ~ cedily Ihal this inspe~ion was pedormed accordinD Io ali ~/~ ~x~ % Louis
72-013 (3/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744
HAND WRITTEN PERMIT
Permit Number: SW90~Y~ Permit Type:~F~ F~F~r~t~/~J
Date Issued:~--~-~
Design Engineer: f. ~,~,~ ~ ~r~JxpiratiOn
E
Date:/~
Owner Name :~*,~ Day Phone:
Owner Address:~, F~ ~4~
Parcel ID:d2~-~-2g
Lot Legal: Subdivision:~r~N~ ~ Lot:29Block: /
Section: ~ Township:_~/~/ Range: 3~t/
Lot Size: 2f872 ( or acres)
Max Bedrooms: This Permit: ~ Total Capacity: ~
SEPTIC TANK: Minimum septic tank cspacity:/2~'~ gallons. Each
septic tank must have at least 2 compartments, insulation is
required if depth to top of septic tank(s) is less than 4.0'
Lift stations require an appropriate electrical inspection.
WELL LOG: A copy of the well log must be sent to DHHS within 30
days of the well's completion.
CERTIFY THAT:
1. I will install the on-site sewer system and/or well in
accordance with all codes and regulations of the
Municipality of Anchorage (MOA) and State of Alaska , and
in compliance with the design criteria of this permit.
2. I will adhere to all MOA and State of Alaska requirements
for separation distances from any existing well, septic
system, or surface water on this or any adjacent or
nearby lot.
3. I understand that this permit is valid for a single
family dwelling with a maximum of ~ bedrooms. I also
understand that any enlargement will require an
additional permit.
· ~. I understand this permit is issued for the calendar year
and expires on December 31 of the year issued.
5. I will notify DHHS prior to all inspections by the
engineer or well driller.
~6"%h~r / d e~ S~l ~g n e ? )
DATE:
db/ll5
~ ~ ~ 10' Util. Easement
~~ ~ - ~ HOLE
~ s - ~ONITOR TUBE
o - S~ER CL~NO~
...... PROPOSED L~CHFIE~
WATER LiNE
NO KNOWN CURTAIN DRAINS ~SE~ENT
S E PTI C S I TE P LA N
LEGAL: Southpork Subdv. Addn ~2 Lot 28, Block
OWNER: Turner Constructio~ Inc,
CONTRACTOR: N/A .
JOB ~ 90-0~9/.DATE. 05/17/901 SCALE 1" = 40'
P.O. Bo~ 773294 '"%:' "":' '.
(907) 694-5195 FAX: (907] 694-3297
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
525 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION:
SLOPE
SITE PLAN
1
2
3
4
5
6
7
8
9
10
s
WATER
TERED?
o
E
11
12
13
14
15
16
17
18
19
20-
Gross Net Depth to Net
Reading Date Time Time Water Drop
./ . ; ~- ~ , ~.~
TEST RUN BETWEEN
COMMENTS /~'~' 7~ ~ I~/~, ile ~ ~ /~ ~ ~ ~7. Z~ ,
FT AND FT
PERFORMED BY:
72-008 (6/79)
Eagle River Engineering Ser~ice~
P. U. Uox 173294
Eagle River, AK 99577
6~4-5195
CERTIFIED BY:
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOT 28, BLOCK 1, Southpark Subdv. ~2
1. The well and septic plan are for a single family residence only.
. 2. The drawing and or site clan shall be a 0ar.t of this'
· . ~peoffioatfon.
3. All materials and workmanship shall meet the Anchorage
Department of Health and State Depar~mens of Environmental
Conservation requirements.
4. All soil te~ts are advisory to the design and are to be verified
or modified in. the field by the engineer.
5. All excavations and depths are advisory and are to be verified
or modified in the field by the contractor to aeet Munfcipalit~
of Anchorage, D~partment of Environmental Conservation
requirements.
6. It is the responsibility of the owner to obtain all necessary
permits or easements and to locate any adjacent multi-family'
wells.
The excavation is to be e×aotly in the area shown on the site
plan, any deviation requires engineer approval.
It is always recommended that a surveyor locate the nearest lot
line position and the location of any easements.
o
1.
2.
3.
6.
.. 3..
The bed is to follow the natural land contour to maintain
uniform total depth of tbs bed bottom.
The bottom of the bed shall be lave;, plus or minus 1.5"
The tota] depth of the bed excavation is not to exceed 2' at
any point.
The sewer line is to exit the home at appropriate elevation to
allow gravity flow or a lift station will be reoui~ed.
The bed gravel is to be covered with typar fabric material.
Soil or combination of soil and extruded board insulation to a
depth of 4' or equivalent is to be placed over the leaohfield.
%he area over the bed is to be finish graded to prevent pondfng
of surface water runoff. A drainage path is to be constructed
to allow drainage away from the septic system.
The septic tank and leachfield must not be closer than 100' to
any existing private well. 150' to any Class "C" well, er 200
feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS
TOTA~ DEPTH : 2' GRAVEL DEPTH : 6"
Soil Rating = 125
Bedroom Capacity : 4
Septic Tank Slze= 1,250
· ~$NOTE: SAND FILTER NOT
DEPTH.
BED LENGTH = 42'
gallons
REQUIRED DUE TO PRESENCE OF GM
BED ~IDTH 18'
LAYER AT 4'
· *~NOTE: LIFT STATION MAY BE REQUIRED.
m~NOTE: 2" INSULATION OVER TANK, FIELD. AND SEWER LINES.
'~$mNnTF- ARANDnN UXIRTINS TEST WELL TO AWWA REOUIREMENTS/CODE;
Parcel I.D. #
1.
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
020-052-28
GENERAL INFORMATION
Complete legal description
Southpark #2 Lot 28, Block 1
Location (site address or directions)
4761 Southpark Bluff Drive, Anchorage
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Allan & Sallie Ross Day phone 345~8501
4761 Southpark Bluff Drive, Anchorage, AK 99516
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community wel'l system, provide written confirmation from State ADEC attest-
ing to the legality and status of system. ,
TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that m.y
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 Eagle River Engineering Services Phone 694-5195
Address P,O, Box 773294, Eaqle River, AK 99577
Engineer's signature ~
Date
DHHS SIGNATURE
k Approved for
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
'The Muh~cii~'~lity of Anbhorage Department of Health and Human Services (DHHS) issues Health Authority
Approval C~i .cates based only upon the representations given in paragraph 5 above by an independent
professional r ';~neer registered in the State of Alaska. The DHH S 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.
724)25 (Rev. 1/91) Back MOAif21
Legal Description:
A. WELL DATA
Well type d
Log present (Y/N)
Total depth
Sanita~ seal (Y/iq)
Date of test
Static water level
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street. Room 502 · Anchorage. Alaska 99501. (907) 343-474,4 -,'5',',',',',',','20 '~:,
· ~I,~, :~,
Health Authority Approval Checklist ~ ~ ~
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed e~
Cased to Casing height (abov
Wires p~d (y, rN)
FROM WELL LOG ~ AT INSPECTION
Ci
Well production
Date of s~e:
SEP~ICL!~OLDLN, G TANK DATA
~'~ g.p.m, g.p.m.
Nitrate Other bacteria
Collected by:
Date installed (~(~¢/9/-~ Tank size
Foundation cleanout (Y/N))/~-~ Depression (Y/N)
DateofPumping O~,/QLo Pumper ,~/ET'HL/~/VD
ABSORPTION FIELD DATA
Date installed
Number of Compartments ~
High water alarm (y/lq)
Cleanouts (y/N) /V~%
Soilrating ~.d./~2orl~2fodllIl) /~ Systemtype ~L)
Length q Z ' Width / ~' Gravel tkickness below pipe ~ I, Total depth ~_~ /
Effective absorption area '~L~/~ Monitoring Tube present(Y/N) )/~'~ Depression over field (Y/N)
Dateofadequacytest ~q/O~/~(~,, Results(Pass/Fail) /~/q~5 For ~ bedrooms
F~uld depth in absorption field before test (in.); t~b/ Immex~ately atter 5~0gal. water added (in.):
Flulddepth ~' (ins.) Minutes later: /~ qqO :~' ~ '
AbsorpUon rate 7t~ ~00 g.p.d.
Peroxide treatment (past 12 months) (y/N) ////~ If yes, give date
D. LIFFSTATION /V/~4
Date installed
Manhole/Access (YfN)
Itigh
~level at*
*Datum
"Pump off' level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
; Ou adjacent lots
Public sewer main Public sewer manhole/cleanout
Se~ce line Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /O /
Property line 6/9 ~
Absorption field
Water mal~ffservice line ~/O ~ 8nrface water/drainage 4-/~X) t Wells on adjacent lots
/7./
? Et.Z>/
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation -~
Surface water 7
Curtain drain
Property Line ~ t Water main/service line ~/~) /
Driveway, parking/vehicle storage area 7~/C3 /
Wells on adjacent Jots 7~ ~ /
F. ENGINEER'S CERTIFICATION
I certify that I have determined thrufield inspections and review o
itt conformance with MOA J-Z/M guidelines in effect on this date.
Signature
Engineer's Name ~0~/5 ~Oz~-B/q,, /~,
Date /7"~ / /-?~
Date of Payment
Receipt Number
ItAA Fee $ ,==~' ~
Rev. 8/95 eSS: baa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel i.D. # ~ ~::~-) _ [~.)~¢.~ _ ,~% HAA#-
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
~ 28 B~c_k. ~ South--S2
Location (address or directions)
Soutbpark Dr4ve~__An~hor~ge,
(b) Property owner ZE~zrner Construction _ Telephone: (home)
Mailing Address _P.O. Box 3489, Palmer,
(c) Lending Institution - N/A- Telephone -
Business
Mailing Address
(d) Real Estate Company and Agent
Address
(e)
Telephone
Mail the HAA to the following address: (or check here [], if hold for pick up.)
List contact person and day phone number below:
Pick ub__p_~ineer
2. TYPE OF RESIDENCE
Single-Family E~ Number of bedrooms
3. WATER SUPPLY
Individual Well [] Community;f] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site:E] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
Page I of 2
72-025 (Rev. 7;88)
IeUO!l!puoo
le^oJdd¥ IeUO!~ipuoo ¢o SLUJeJ.
pa^oJddes~O. ~, p@^oJddv
Xq suJooJpec(?)~,~.~c_/Jol pe^oJddv
qYAOl:ldd~' SHHQ '9
LL560 )[V 'J_a.,,.~.~ ~LS-~E{ '~6EELL xoM 'O'd ss@Jppv
CJ6LS-[~69 euoqdaleJ.soAS 5u~.~aau!.bu~ ~aA~ a'[bua[ LUJ!-IIOeUJBN
· uo!loedsu! s!q] jo e]ep @Hi u@ lo@/la u! suollelnSeJ pub 's@oueu!pJo 'sepoa
pub Ied!olunw lib ql!~ aoUelldUJoo ul s! ~e~s~s lesods!p Je~e~e~se~ ia/puB Alddns ~a]e~ ells-u@ eq~ 'uoi]oedsul
pub uo!]e6!]saAu! ~ ~o~I pub SelU e6eJoqouv ~o A~!led!o!unR eq~ ~o~ paul@iq@ uo!~e~Jo~u! eq~ u@ peseq
~eq~ XIHaA JaqpnJ I 'u!eJaq pe~o!pu! eJn~onqs ~o edX] pu~ s~ooJpeq 1o ~eq~nu eq~ Jol a~enbepe pub leUO!]oun¢
'ales s! ~elsXs lesodslp ~ele~e~se~ Jo/puB Xlddns Ja~e~ e~ls-uo aq~ ~eql s~oqs leAoJddv XHJoqlnv qlleeH
s!q~ ;o uo!~eb!~seAu! X~ ~eqi X¢!JeA I '~olaq u~oqs a~ep ua!lap!leA chi ~o s~ pub o~eJeq pex!~Je lees X~ Xq peij!lJeo sv
NOIZV~aOJNI QN~ viva 'HO~VaS 311J 'S&S~Z 'SNOliOBdSNI 9NIOIAOMd ~MIJ 9NI~BBNION] 'g
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: ~,o~.~,~.
Date Completed
Depth of Grouting
A. WELL DATA
Well Classification ~..~] c, .~¢
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
I'f A, B, C, D.E.C. Approved (Y/N)
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Y
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
B, SEPTIC/HOLDING TANK DATA
Date Installed G-~*~o Size
Standpipes (Y/N) ¥
Depression over Tank (Y/N)
Pumping/Mair~tenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well -I- '7. oo'
To Property Line ,W ~ '
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course Y-/~,~ /
Comments
I ,'7. 5 o No. of Compartments
Air-tight Caps (Y/N) 7' Foundation Cleanout (Y/N)
N Date Last Pumped ~,-,
~v//,~ ; for /v/4-
Temporary Holding Tank Permit (Y/N) N./A
To Building Foundation
To Disposal Field
72-026 (Rev. 7/88) Front Page 1 of 2
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
[)ate Installed ~- ~S - ~
Width of Field ~ ~'
Type of System Design
Length of Field
Depth of Field
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well -F "7_ co '
To Building Foundation 3¢1 '
Lot
TO Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area. or Vehicle Storage Area
Comments
Gravel Bed Thickness O,. co '
Statndpipes Present (Y/N)
Date of Last Adequacy Test t,¢~'~/
To Property Line 36. '
To Existing or Abandoned System on
; On Adjoining Lots '*:~'* f
To Cutback (if present)
/..-/~, ~.,
D. [.IFT STATION N/A
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA gpidelineS in effect on the date of this
inspection.
,
Signed lia¢0 flivcr Engineering Sorvlcos '"
P. 0. Box 773294 ,, _
Company
Date /~/' / ~','/~'/¢ 69,P5195 :,i, ~~,: :,~..:. Ehgineer's Seal
MOA NO. ?~ ",~ er
Date of Payment
Amount: $
Receipt No.
Waiver Fee: $
72-026 (Rev. 7188) Back
Date of Payment
Page 2 of 2
·
DEPT. OF ENVIRONMENTAL CONSERVATION
A~CHORAGE WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
October 17, 1990
STEVE COWPER, GOVERNOR
563-6775
FOR: Eagle River Engineering
Attn: Cindy
PWSID: ~213475
According to the records on file in this office, the South Park
Subdivision Water System'is in compliance with the State of Alaska
Drinking Water Regulations.
Sincerely,
EV~vR~ro~mental Spc~e'~alist
VEC:pf