HomeMy WebLinkAboutCOLONIAL PARK BLK 4 LT 16A
* , MUNICIPALITY OF ANCHORAGE
' DE ~TMENT OF HEALTH AND HUMAN SER ES
Environmental,Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
Address ~ SEPTIC ABSORPTION
~ TANK FIELD WELL
PhOne(s) -- I Perm,t No. ' lNG. of Bedrooms WELL --
I
LEGAL DESCRIPTION LOT LINE L/~/ /
Lot [ Block [ Subdivision
Township, Range, Section
AS-BUILT DIAGRAM (Show Iocahon of well, septic system, property hnes, foundation,
/~f /Zl V~, 5 ~ dr,veway, watefbod,es, eto.)
~SEPTIC ~ HOLDING ~ P ~
Manufacturer Capacity ~n gallons
~aterial No. of Compa~ments
TYPE OF SYSTEM
~RENCH ~ BED ~ W. DRAIN ~ OTHER ~
Depth to p~pe bottom from I Total depth from original grade %
UD
or,g,na, grade q FT /O FT ~ :
Fill added above original grade Gravel ~epth beneath p~pe cLAJ L
Gravel length Gravet w~dth
Total absorption area Distance between hnes
%/0 SQ FT~ ~ FT ~
Number of hnes J Sod rating P~pe material ~1~4 ~1
Installer Date Installed
WELLS
~ PRIVATE ~ER ddentifv)
Olassd~cat~on (A.~,C) i Total Depth J Oased to
~_~~ ~Y5~ FTJ FT
InstaHe~ Date Installed:
REMARKS: :, ,=
I SR B 196X cedify that this inspqclion was pedormed according to all .,j, ~~7~
Municipal
Health DepaAment Appro , Date:
72-013 (3/85)
AI:::'I:::'I... I E:AIq'I" =
A D D R E S S:
CONT'AE;T F:'HONFZ:
LEGAl .... DESCRIP:
I.... O'T' S I Z E:
MAX BEDROOMS:
DAN J ANI<IE
S R B 196 X
EAGLE RIVER, Al-,::
694-2979
S[JBD I V I S I lIN: COLON I AL PARK
c:E:.L, t .[ (..)1',1: ":¢' 'I"OWI',ISH '.r. F:':
1.1.".;¢. :1.9 (SI;l,, I:::'"1". OR A[:;I:.~dES)
LO]': :I. 6A E L..LH.,I-:... 4
141'4 R AIq GE: .1. W
DIEF::"TH ]"0 P I PE BO'T'TOM (F"I".)
GRAVEL .DEF::"T'H (F'T.)
TOTAL. DEF::'TH (FT.)
L".,I"',-~vI::.t .... WIDTH (t:::'T.)
GRAVEL.. L...I.ENGTH (F']".)
GFi.'AVEI ....VOL. UME (Ct J,, YDS, )
TANI< St' ZE (GAI....S)
SOIL RA'TII',IG (SG!,, F:'T,, /BF:;:)
I.... :i. s't:. ecl b e 1. o w a r' e t h e o p t .i. o n s a v a i I a I:::, ]. e t o y o u i n d e s i g r'l :i. n g y o u r' s; e p 'L :i. (:::
system, Choose 'L'~e optic)r'~ tf'~at best fits your site,,
1(),0 ~ 7,,0 8,,()
2.5~ 18,() 5,,0
,, () 35 () 59 ()
........... 4 ,27.4
.x-.~(. 'TANK MUST HAVE AT L. EAS'I .... I"~,0 COMPARTMENTS
I (:::e~',tify that:
1. I am Famil:i. ar ~:i. th 'Lhe requirements for' or'~-site sewers ancl ~el;t.s as set
F,:::~rtl"i by the Mur'l:i. cipal:i.'l:.y oF Anchorage (MOA) and the State c,f' Alast<a,
2, t will install the systeni in accor'dance with all MOA codes and r'egulat:i, cn",s,
ar'id in compliarH:::e tw:i. th the des&gn cri'Ler'ia of th:i.s permit.
3. I will adhere to all MOA and State of Alaska l-eqL.t:i.r'eifler'~ts for' 'l. Lh,:.) set back
d &stances f r',::;)lY~ ally ex :i. st :Lng wel 1, ,ast. e~ater' d :i. sposal system of pt..d;)]. :i.c
sewer' age system on this or any adjacer'it or near'by lot,,
.q.,, I under'stand that 'Lhis per'mit :i.s valid I:'or' a max:i, rnum of 3 bedr'cx:::,ms arid
any enlal-gement w~].], require an add:i.t:i, onal per'm:~-I:..
T'Hl!i']',.i (1) AN I!.;.;t...ECTI'iIC/-'IL. PIERMIT AND INSPIECTION MUST BE OBT'AINED; (;?.) AS-BUII...TS
W i L.I .... I',IOT BE APPF;'.OYIED W ]: 'T'HOtJT AI',I EI....ECTI:;.'. I CAL INSPECT I ON F."dF=]:'ORT ~ AND (3) THE
!
· S & S ENGINEERING
SRB 196X
EAGLE RIVER, AK 99577
su~c~': ~/~/:)- B I ~
COMPUTATION SHEET
DATE:
SHEET
BY
CKD
OF
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
~RFORMED FOR~J~I~J
EGAL DESCRIPTION: C/~,A i~(....l(. L/
'~ lc T' y - 5o/e-
9 I q° ~r//3/-L'
10
11
12
13
15
16
17
18
19
20
Township, Range, Section:
SLOPE
ITE PLAN
WAS GROUND WATER
ENCOUNTERED? ~ O
S
L
IF YES, AT WHAT ..,----- O
DEPTH? p
E
Depth to Water Alter
Monilorin,? ~ Dale: ?~'/eC~
y /
~,.~ N
Reading Date Gross Net Depth to Net
Time Time Water Drop
?? -
PERCOLATION RATE
TEST RUN BETWEEN
COMMENTS ~ ')('~ I'~0t-"~ ~'~ '~ ~ ~ , -~
(minutes/inch) PERC HOLE DIAMETER
FT AND (42 FT
~.7;b ~,~ + ~"~.~2o 0-~.
I,~I /
~o.u~'~. S & S ENGINEERING ,~ CERTIFY THAT T~'S TEST WAS PERFORMED IN
72-008 (Rev. 4/85) ~GLE RIVER, AK 99577 / / /
GREA ER ANCHORAGE AREA BORUdGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME Bud Schulz
LOCATION F~gle River
MAILING ADDRESS $ Box 931 PHONE
LEGAL DESCRIPTION Lot 16 A Colonial Park Subdivision
SEPTIC TANK:
DISTANCE
FROM WELL Public
INSIDE LENGTH 8'
MANUFACTURER Greet MATERIAL
INSIDE WIDTH ~' LIQUID DEPTH
NUMBER OF
Steel COM PA RTM ENTS 2
4' LIQUID CAPACITY ! ~000GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES 1
Public FOUNDATION 14
DISTANCE BETWEEN LINES
TOTAL LENGTH
NEAREST LOT LINE 10'+ OF LINES 72
.... TRENCH WIDTH _36 IN. TOTAL EFFECTIVE
ABSORPTION AREA 576
DEPTH: TOP OF TILE TO FINISH GRADE
SQ. FTo LENGTH OF EACH LINE
DEPTH OF FILTER
4~ MATERIAL BENEATH TILE_
32 '
WELL:
TYPE_ Public
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE__
REMARKS
SEPTIC
, TANK __
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY: Bud Schulz
SEWER LINE DEPTH: 4'
PIPE MATERIAL' CaSt ~on ..
LOT SLOPE: Gentle
REMARKS:
DATE
APPROVED
G.A.A.B.
Form EQ-O32
PERMIT NO.
MUN ! C I AL I TY OF ANCF
DEPARTMENT _ .. HEALTH AND ENVIRONMENTAL . ROTECTION
25i0 E. TUDOR RD., ANCHORAGE, AK. 99507
276-222i
ON--S I mE SEWER PERM I m
APPLICANT
LOCATION
LEGAL
FOREMOST SERVI.,C~ 2525 BROOKWOOD
E.R. RD ~
Ll6A 04 COLONIAL PARK SUBD LOT SIZE
278-~44
1t71~ SQUARE FEET
TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBE~ OF BEDROOMS = 3
SOIL RATING (SQ FT?BR)= 125
THE REQUIRED SIZE O~ THE SOIL ABSORPTION SYSTEM IS:
DEPTH,"- 12 LENGTH"- 24* GRAVEL DEPTH-" 8
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) O~ THE TRENCH OR DRRINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCFl¥FlTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCFlYRTION (IN FEET).
REQU I RED SEPT I C TANK S I ZE"' I OO1~ GALLONS
BACKFILLING OF tiNY SYSTEM WITHOUT FINPJ- INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND I::~Y ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR fl PRIVATE WELL OR 200 FEET FOR fl PUBLIC WELL.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
PERM I T VAL I D FOR ONE YEAR FROM ! SSUE
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
5: I UNDERSTAND THAT THE ON-SITE SE~R SYSTEM MAY REQUIRE ENLARGEMENT
h~FI~T/FOREMOST SERVICES
IF THE
Performed For
Legal ~escrintion: Lot 16~ABlock~4 Subdivision
This ~orm Renorts Soils Lo~
,,Oneteslis~orlhalhousando?iniohs'°
220~ C~eveland ~¢~o~age, ~Zaska 99503'
Foremost Construction Date Performed 4/21/76 --
Col~nial,P~rk Subd. Rngl~ River
~ercolation Test
Topsoil S~cteris i cs
6 ,,. , Sandy Gravel
8--- (GW-GP)
16----
Bottom of test hole
18---No ground water or
bedrock encountered
Was Ground Water Encountered? NO_
I¢ Yes, At what Depth?_ i --
Readinq
Date
Gross Time
Net Time
Depth to H20
Net Drown
Percolation Rate Hinute
Proposed Inst~'l"la'tio-~: Seenaoe Pit Drain Field
Dept-'~'--~ Bot{om Of Pit Or Trench
CAMI~ENTS
Performed
Data Cer~i fled B9: CONSTRUCTION TEST
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 /'~,~'/Y ,~,~,~',,t' Telephone: Home Business t~g ~'" ~ Z ~ ,,~
Applicant Address /~Z.'~J'/,cm /~)C./~'~' ,~/~c~e,-?'~..,~. /O1 x:~'~'~,,'~'o,',J · ,,"J,~/c~-~, .
(c) Applicant is (check one): Lending Institution,~; Owner/builder []; Buyer []; Other [] (explain);
Institution-
(d) Lending
Address
(e) Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address:
S & S ENGINEERING
SRB 196X
EAGLE RIVER, AK 99577
TYPE OF RESIDENCE
Single-Family~ Multi Other
Number of Bedrooms~
WATER SUPPLY ve~en co
Individual Well[] Community[] P .
Note: if community well system, must ha nfirmation from the State Department of Environmental Conservation
attesting to the legality and status., ,~ ~,; \ t, f ~
SEWAGE DISPOSAL
~ !~E]' i~l,Holding
e~J~ Tank []
Onsit Public [] Community .; . ~ t
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 (11/84)
ENGINEERING FIRM PROVIDII~ INSPECTIONS, TESTS, FILE SEARCH, D~ I'A 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 and State codes, ordinances, and regulations in effect on
the date of this inspection,
Name of Firm S & S ENGINEERING Telephone ~'? .~- ~-.-~ 7 ~'
SRB 196X
Address
Date
EAGLE RIVER, AK 99577
./4)-/'~ - E, ¢
Approved /,~ Disapproved Conditional
Terms of Conditional Approval
Date
CAUTION' ~ ~'1'~tl/ ,,~ .
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 CO~u~s'y~t0 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.
Page 2 of 2
72-025 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description:
D/-~/,,~~/--, (' (' ~)B, C, D.E.C. Approved (Y/N)
Well Classification /
Well Log Present (Y/N) Date Completed Yield
Total Depth Cased to Depth of Grouting
Static Water Level Pump Set At
Casing Height Above Ground Sanitary~
Electrical Wiring in Conduit (Y/N) . ~n Around Wellhead (Y/N)
Separation Distances from Well: ·
To Septic/Holding Tank on Lot ~ ; On Adjoining Lots
To Nearest Edge of Absorpti~on Lot ~; On Adjoining Lots ~
To Nearest Public S~ublic Sewer
Cleanout/.~,~Le~ ~ To Nearest Sewer Service Line on Lot
Water Sa.~..Le'Collec. ted by ~ ;Date
Wate ample Test~esults ~ . .,
comments '~~ ~'/ //'"~t",~/..,/,"' ,~../,~ ,~,,~' ~"~.~"~----,~
B. SEPTIC/HOLDING TANK DATA
Date Installed /~7~
Standpipes (~N)
Depression over Tank (Y~)
Pumping/Maintenance Contract on File (Y/N) ~/~ ; for
Holding Tank High-Water Alarm (Y/N) J4///'3-- Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/H;;a;~Tank:
To Water-Supply Well ~C~:) -~ To Building Foundation
To Property Line /'O ¢./L To Disposal Field ,,~'~"
Size /~;) ("3D No. of Compartments ~"
Air-tight Caps{~N) Foundation Cleanout (Y~)
Date Last Pumped ~-t~ Jl~/~ ~
To Water Main/Service Line
Course ~ ~ '~ ~''
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /4~//,,~/f~
Width of Field _~, ~ ¢
/70 Type of System Design
~(z3 ~'/'~,/¢ Length of Field z./4'~.~ '
Depth of Field / 0
Gravel Bed Thickness_ ~ '
,5"'//. Standpipes Present(~N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
Square Feet of Absorption Area
Depression over Field (Y~___~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~ ~ ~ -/-
·
To Building Foundation
Lot ,~0
To Water Main/Service Line /o t-F
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area ,
Comments ~-¢ ~'~' t.4 ~ o~.~,~
t
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
anhole/Access (Y/N)
't~_~ff" Level at
l~"~Ve nt (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in ef.fect C n,the date of this inspection.
.,~.,..~,,.~,
Signed S & $ ENGINEERING Date ,b/O~ '-,//'- ~' ~' '"'~
SRB 196X
No. 5'~;- ~ ~
Company ~GLE RIVER, AK 995~M~A
Receipt NO. ~ ~ / ' ~~
Date of Payment I 0 ~/~ 7_ ~_
Amount: $ ~ 5~
Page 2 of 2
72-026 (11/84)
Di~PI'. O; i. ~, :,
MUN lC IPAL ITY O F ANCHORAGE :L;"!'/t,~:o~:,l~!i', l,",~. ,,~,, ;.,. ~.~ iON'
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 APP ~ 9 '1W7
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO. VA FHA.
2. Property Owner: Charles Schulz
Mailing Address: Box
3. Name of Buyer: Pumphrey, Philip S, &
Mailing Address: 707.5 Weimer Apt
4. Name of Lending Institution: Alaska Bank
Mailing Address: Pouch 7012 AnCho :AkoC)9510Phone:
5. Name of Realtor or Agent: Jeanne Webster
Mailing Address: 0~ Totem Realty
6. Legal Description: Lot 16A, Block
Location: NHN First Street
Day Phone:
Charlotte E.
Day Phone:
of Commerce
276-5~00
CONV xx
279-5641 ext _B17
Phone: 272-0571
Colonial Park Subd,
Eagle River~ Alaska 99577
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply: Public Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Publi.c Public Utility
If Individual, date of installation
No. Bdrms. 2
Individual
Individual (on-site)
72-003(3/76)
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