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Home My WebLink AboutSOUTHPARK #2 BLK 3 LT 18 ) 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 [] UPGRADE LOCATION NO. 0F BEDROOMS ~ DISTANCE TO: IWell t~ ~ I Abs°rpt~'~r~a ¢ Dwelling ~ ~ Manufacturer Mater~l No. of compartments Liq. ct~;;~in ,aliens IF HOME~D,: inside length Widt~ Liquid depth ~ ~TANCE TO: Well Dwelling PERM,T NO. ~--~O ( Manufa~urer MaterlaJ Liquid capacity in Q Well ~ DISTANCE TO: k~ ~ F°undati°n~q% Nearo~l~ ~'o PERMIT NO'~ ~ S--~ ~ rench ' th . ~~ 'o. of Hn.s~ k~ o~a~ lln. T°t"l I°noth °f lin°s ~~.chos Total o otivo absor~ i n oroa ~""~ ~ Type o~t Crib ~meter Crlb~:pthx. Total of fective absorption area ~ '. Nearest lot line ~ DISTANCE TO: Well ~ Buildin foundation , , Class [~[ ~pth ~ Dr,llor ~ D,st.nco to lot Hn~ m '~uildlng foundation Sewer llne Septic tank Absorption area(s) ~ DISTANCE TO: OTHER 72-01~ (Rev. 3/78) F_RtlI] N- ~P F L _ _.HNT LOC:laT I ON LEGFIL [:,EP~RTNENT UF HEFILTH FiND ENVIRCINMENT~L 825 '"L"' STREET., RNCHORRGE., 264-4'720 HIKE WHEFtT L±~. Bi. _,uLITHFHRk. ~.'-" LOT =,I~.E '.~'~9'=~"~'~ S6!UlaRE FEET T'r'PE OF SOIL BBSORF'TIL]N ._f:TEIt IS: TRENCH .... i','IRXINLIM NLli'I_,ER OF EE[.RI_tU I-, - E~ .:,LZL RRTING ,::Sg! FT,. E,R..¢ 246 IH~ REb~UZRED :,Z~E uF THE =,uIL HB_,L~RFIZUN _,~tEII Z_,. ~ L)EF'TH--- i2 L E['-4,JTH = 47' GE.R%mE[-- E:,EF"TH= :E: THE LENGTH DIMENSION IS THE LENGTH (IN FEET::, OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR F'IT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE E:-qCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRlaVEL DEPTH tS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE E:.'<CRVRTION (IN FEET). -c -. ,= .- c , ,, FHI_, [:,EF'laRTMENT D IRING THE PERMIT laPPLtCFINT HH_, TNE i~.E_,FuF.I_,IE, II_IT.¢ TO INFORM ' ''=' - IhL I HLLHt IUIq .l.l.i_l-EL. TIuN_ OF RN'¢ WELLS R[:,JRC:ENT TO THIS PROF'ERT"r' RND THE NUIIbER OF RESi[:'ENCES THRT THE WELL WILL SERVE. T L--~ ,2.;, ,:'..._"':' '::, :t 1'-4 ¢'__- F" E ,-"_- T Z '- '-- - - -- BRCKFiLLING OF RN"r' _,-r_,TE NiTHOi_IT FINRL IN=FEL. TIuN FIND MFFF_¢HL THIS DEPRRTMENT WILL BE SLIBJECT TO PR]ISEZ:LITION. MINIMLIM DISTRNCE BETWEEN R WELL RND RN'~' ON-SITE SEWRGE DISPOSRL S'¢STEM IS ~t. ElO FEET FOR R PRIVFiTE WELL OR ±50 TO 2CIEl FEET FROM R PUBLIC WELL DEPENDING UPON THE T'¢PE OF PUBLIC WELL. NINIMUN DISTRNCE FROM R PRiVRTE WELL TO R PRIVRTE SEWER LINE IS :25 FEET RND TO la COMMUNITY SEWER LiNE IS 75 FEET. OTHER REg!LJiREi'"IENTS Hla~F laPPL'¢. SPECIFICRTIONS laND CONSTRLICTION DIRGRlaMS faRE laVlaILlaBL. E TO INSURE PROPER INSTlaLLlaTION. i CERTiF'¢ THRT :L: I laM FlaMILIRR WITH THE REg~UIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTFI E!:"F THE HUNICtPRLIT'¢ OF laNCHORFtGE. 2: t WELL. iNSTBLL THE Sk'STEM IN RCCORDiRNCE WITH THE CODES. .::,~:c .... RE~:)L I RE ENLRRGEMENT I ~' THE~ ~ 2.: i UNDEF'.STRND THRT THE ON-SITE SEWER ....... I EII f"lRY . .. , E EDRCLII_,. ~ t ; .... - ...... = ~mI'.JL:'ELE[' TE INCLU[:,E MORE THRN 3: ' ' ' --c _~I uN[[.: ............................ ~F F'LIC:RNT ["liKE WHERT V4. C1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG PERCOLATION TEST SOILS LOG - PERCOLATION TEST PERFORMED FOR: CATE LEGAL DESCRIPTION: 2 3 SLOPE 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS SITE PLAN WAS GROUND WATER i~.,~ ~-~ SL ENCOUNTERED? pO E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Wate¢ Drop PERCOLATION RATE ~ (~ (minutes/inch) PERFORMEDBY: ~'V~*~'/,J& CERTIFIED 72-008 (6/79) CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION. PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT :~[ans for the construction of public water system located Alaska, submitted in accordance with ]8 AAC 80.].00 h? ~/:-- .. have been reviewed and are approved. conditionally apj~roveci (se~ attached conditions), ~BY TITLE -' DATE f construction has not started within two years of the approval date. this certificate is void and new plans and specifications must be submitted for review and approva~ before construction. APPROVED CHANGE ORDERS Change (contract oreer no, Approved by Date The '"APPROVAL TO OPERATE" section must be corn pleted before any water is made available to the public, APPROVAL TO OPERATE The construction of the '%~(~U,'Ft-~ ,(~'~ ~'~'-'J.C, ~ I~,,' t~ n? ~ public water system was completed on /~ .... (~ -~? ¢¢ (date). The system is hereby greeted interim approval to operate for 90 days following the cpmp et on date. BY TITLE DATE As-built plans submitted during the interim appr6val period, or an inspection by the Department has confirmed the system was constructed according to the approved plans, The system is hereby granted final approval to operate. ..... ,~.~..,._ ,~, ::. 'e%~ '-- ' TITLE DATE WHEAT FRAMING, INC. 6900 ARCTIC BLVD #113 - ANCHORAGE. AK 99502 6,., ,' /.,o o,o ¸1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION · DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name /'~2,/~',¢ ~"~ 'l:elephone:..Home ~ Business Applicant Address (c) Applicant is (check one): Lending Institution ¢; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well [] Community~ Public Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL ~ Public [] Community [] Holding Tank [] Onsite Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 {11/84) Paae 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 end State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm &~'~/~ ,~q'~-~) ~'.~.~c.,'*~P_..5' Telephone ---~¢~ //~ Address /~/ ~ ~ ~~ ~/~ ~/& Date Engineer's Seal DHEP APPROVAL Approved for ~.~_~ ~edroom~ ~ Approved ~ Disapproved Conditional Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. 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. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description' MuNIcIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL pROTECTION ,IAN 201986 RECEIVED WELL DATA Well Classification Well Log Present (Y/N) Total Depth ~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) If A, B, C, D.E.C. Approved (Y/N) Date Completed ~ Yield ~ Depth of Grouting Pump Set At - "' Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) Ceparation Distances from Well: To Septic/Holding Tank on Lot ~ . .~ ~ ; O joining Lots To Nearest Edge of Absorption Field on Lot 1'..~'¢"' ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results To Nearest Public Sewer To Nearest Sewer Service Line on Lot Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~ Size ~__ Standpipes (Y/N) Y Air-tight Caps (Y/N) Depression over Tank {Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ./jX'~ ~ To Property Line To Water Main/Service Line %-~,.~ Codrse No. of Compartments Y Temporary Holding Tank Permit (Y/N) To Building Foundation ,~ ~ To Disposal Field ,/~) ~ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72~026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~-,,~0 -~ Width of Field ~ ~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test / Separation Distance from Absorption Field: To Water-Supply Well /,4,~O To Building Foundation ~ · Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course ;~¢*/~./~' Type of System Design Length of Field ')(" Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) To Driveway, Parl,>;,ng Area, or Vehicle Storage Area Comments '~ f~¢-.~i;'/ LIFT STATION Date I nst alle'"'~d "~ Dimensions ~ Size in Gal, l, ons ~"'~'~.__ Manhole/Access (Y/N~ "Pump On Level at '~'~,~ __ High Water Alarm Level at ~/ ~-'-,,..V.~nt (Y/N) Tested for J Pum~ng Adequacy Test. Meets MOA Electrical Codes (Y/N) J ~-~ Comments _~ ~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company ~,,~!~ Receipt No. Date of Payment Amount: $ Date MOA No. Page 2 of 2 72-026 (11/84} Engineer's Seal DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (BO7) Address: 274-2533 DATE: PWS I.D.# To Whom it May Concern: According to records on file in this office the ~ater ~egulat~ons Water System is in compliance with the State Drinking Sincerely, DEp'f OF ~E~~L'HOP'AGE. · ~LTH & ENVIRoNMENT~ PROTECTION RECEIVED MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF [~ALTH AND LABfIRONMENTAL PROTECTION ' APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. GeEe~al Information Application Date ~/~ /~- (a) Legal Description (include 10t, block, subdivision, section, townsh'ip, range) Location (add~ess or directions) Applicants Address / ~ :~f) ~ C~Zo ~% (c) Applicant is (check one) lending Institution Buyer~--7 ; Othe~l t (explain); (d) lending Institution /~f~'~' ~ ~ j,~_~> Address ~ A~'t~ Li~'t~ (e) Real Estate Co. & Agent /~///~ Telephone L--~; Owner/builder ~. ; Telephor~ ,2 7 ~ Address Telephor~ 2. Type of Residence Single-~mnily[~ Number of BedroclrS Multi-Family~-~ Othe~ (describe 3. Water Supply. Individual ~11 ~-~ Cor~unity ~~ Public ~-~ Note: If co~N~nity ~11 system, must have w~itten confirn~tion f~cm the State Depa~n~ent of E~vironm~ntal Conservation attesting to the legality and status. Is the ~11 adequate for the nL~mber of bedrcc~s specified in this ~L~A (Y./N) 4. Sewage Disposal onsite Co nity ol ing Is the w~stewater disposal system adequate fc~ the nun~er of b~droc~s (Y/N) [Page 1 cf 2] 2'15-84 Engineering Firm Providing Insioecticns, l%sts~ Data aa~d Information I certify that I have d~ecked, verified, or confo~ned to all k~A HAA Guide!ir~s ir~l effect on the d~te of this inspection. ~ c~')J~y ~{*~+ ~6~ ,~,f~r~%~ ~u~- Name of Firm Date ~ /~ 6. DHEP Approval Approved for ~ Approved ~ Telephone '~_/-1-"-~" fi- ? II _ Terms of Conditional Approval The Municipality of Ancho_~age Depa~t~e. nt of Health and Enviror~ental Protection dc _ t..e continued satisfactory ~erformance of the watezr supply and/or t?J not ~uarantee ~ waste%~ater disposal system. This approval indicates that,, as of t.he validation dg shc~n above., based on the data and information furnished by an engir, eer registere( the State of Alaska, the water supply and wastewater dispcsa! system is safe and tional for the number of hedrcor~ and type. of structure indicated. (DHEP SEAL) 7. Mail the HAA to the follcwing address: KB2/dS/s [Page 2 of 2] MUNICIPALITY OF /%NCHORAGE DMSION OF ENVI~OI%~NTAL HEALTH DBB~RTMENT OF HFALTH AND M~MDNMSNTAL ' -APPLICATION FOR HEALTH ~JT~ORITY APPROVAL CERTIFICATE (a) Legal D~sC~iption (include lo~, block, subdivision, section, townshilp, range) (c) Applicant is (¢haC~ or~) ~ending Institution Adck'es~ Numb~ of ~dr _ .......... ~ote: If ex~,~t~ntty ~I1 system, ~ust have ~itten eonflr~ation.bc~ the State Depa~U~ent of Environmental Conservation attesting to the tegaIit~ and status. Zs the well adequate fo~ the number of bedrooms specified in this HAA (Y./N) .~J/~$ _ ~i.~ $9. wage Disposal [Page Z off 2]' 2~1.5-84 5. Enginserin~ Firm P~oviding Inspections, Tests. Data and Infok~cetion I cs=tffy that I have checked, verified, c~ confcz~ed to all MOA HAA Guidelines in effect ~n th~ d~Le of this inspection. ! c~r~,'~¥ ~g~% ~h~ ,. Ar ~4~ 'Nrare of ffim ~-/m~A~, ~e TelephOne ,, " - ~ (~G~ ~:~:~ S~) ........ Ap~o~d for ~ ~ . "w~ dis~sal syst~. ~is aDD. Oval lndi~ ~t,'a t~ State ~ ~aska, ~e ~te~ supply ~d ~stewa~ dis~al ~tem ~s safe ~ f~ tio~l fo~ ~ ~ of ~ ~d t~ of s~u~e indicted. (DHEP SEAL) 7. Mail the HAA to the foltcwin~ address: :7 ' , .... :,_7 ' ,.~' KB2/d5/s ~. '- . [Page 2 of 2] 2-15-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification ~//~5 Well Log P~esent (Y/N)/~z~ ~.p/~Date C~.~leted Total ~p~ ~/~ Ca~d to Static Water ~1 ~ ~t At Casing ~ight ~ Ground Elec~iCal Wiring in ~nduit (Y~) ~//W ~p~ation Distan~s ~ ~11: To ~ptic~olding Ta~ ~ ~t ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /O~P'~- ; On Adjoining I~ts/~3<'~)'-~- To Newest Public ~ Line ~/~ To ~est ~blic ~r Clean.t/Manhole ~/~ To ~est ~ ~rvi~ Li~ on ~t Wate~ S~le Colle~ed~By ~ ~/~ ; ~te ~ Wate~ S~le Test ~sults ~ ' C~'~ nts B. SEPTIC/HOLDING TANK DATA Date Installed /~-~d)-~-~ Size /~%kS)~fP.~,~4g No. of Ca~a~tmmnts ~__ Standpipes (Y/N)~/~5~ ~) Air-tight Caps (Y/N) ~/~ Foundation Cleanout (Y/N)~ Depression over Tank (Y/N) ~/~ , Date Last Pumped /~x3 .~q.~ ~'~ Pumping/Maintenance Contract on File (Y/N) j3/~ ; for ~////~ Holding Tank High-Water Alarm (Y/N) /i//F~ Temporary Holding Tank Permit (Y/N) ~I;/A~ Separation Distances f~cm Septic/Holding Tank: To Water-Supply Well /~! ~ To Building3 Foundation ~' To Propert~ Line ~/ To Disposal Field /~'3' To Water Main/Service Li~ne .~'.~) To Stream, Pond, Lake, c~ Major Drainage Course ~///~ Comnents ( [Page 1 of 2] 2-15-84 C. ~BSORPTION FIELD DATA Soils Pating in Absorption Strata Date Installed / ~' '? '~" 5,' ~ Width of Field <~ / i Square Feet of Absorption A~ea Depression over Field (Y/N) ~/~) Results of Last Adequacy 'ilast ,/,&~/??] Type of System Design Length of Field ___~. ! ~p~ of Field ,, , ' stan~ims ~esent (Y~) ~te of ~st A~ao/ ~st Separation D. istance f~om Absorption Field: To Water-Supply %~11 /~/7~. To Pcoperty Line _ ~Z~"' To Building Foundation ~ ~/'~ ~) To Existing or ~ndot~d System To Water Main/~vi~ Line , ~ / _ To Cut~nk~if pre~nt) ~<Y~ To St~e~ond~ke/~ Majo~ ~aina~ Co~se ~/f[~, Date installed Si~ in Gallons "Pump On" Level at __ High Water .Alarm Level at Tested for Dimensions Menhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Electrical Codes(Y/N) Corr~nts ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, o~ conformed to all MOA HAA C~idelines in effect on the date of tJ~s inspection. ~rm~ 7/; .~/ /~G ~ Date "~-/,,~/,~'~