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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) ':IN~9 ~I'~A I~1 399V3 / '~ 9 'B O0'Og Z .-.-, Z oOO ~- M ..c~ j- .,00;~1 (...) 0 o00 N '