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Home My WebLink AboutHAMPTON HILLS #1 BLK 2 LT 16 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 /IH MAILING ADDRESS EGAL DESCRIPTION _OCATION .... lo_zol t.t_,4.1 'PTo I ] Well I Absorption area o~ D~STANCE TO: ~- Z Manufacturer ¢~ ILiq. capgcity in §allonsI ,~ ,j,~, ........ [ Inside length I lt~, I _ ' ............. ~: / ~..~1D,STANCETO' IWe"'H'~Z / .~ I ' I ~ [Manufacturer ~ ~ DISTANCE TO: II L~ ~ ~ ~ No. of lines , ~ Length of each li~ Total lengtl~o~li~es ~ ~ ~ Top of tile to finish grade Material beneath tim ~ Length Width Deptll ~ ~- I ~f crib Crib diameter Crib depth __ ~..~ DISTANCE TO: Well /°'assR Depth /~ 7 PHONE ~NEW ~t~'~'~JO I [~UPGRADE OTHFR PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS IWidth Material Nearest lot y~ J Trench,~d~ inches '7~ inch es PERMIT NO. No. of compartments Liquid depth PERMIT NO~ Liquid capacity in gallons PERMIT N~ ~056/ Distance between lines Total effectiv~b~o~r~ion area PERMIT NO. Total effective absorption area Building foundation Nearest lot line PERMIT NO. Sewer line N/'A Distance to lot line Septic tank ~ [ Abs°rpti°n~Ta? APPROVED (Rev. 3/78) DATE LEGAL IF:::" lEE I1::'::;;: I1'""II % "'IF' A,P F:'L :1: C;AN]' ;: A !.) L)1:1:::. o .... '1" ]Z M F:;'.E]',ISCI"~I...ER 65 :I.L'; BL..ACI':::BI::F~:F;:Y A N C H 0 F~'.A GEi:, A I< ? 9 5 () 2 2 '79 '"" 3 9 :!. 6 t...0"1~ S :lZ ZI!!: ',' F1A)( ]'31i: :) :;'.C)OMS system,, Ufc(:)~h:: 'Lb(:, c, pt:i. ol-i 'Lhat'. I:)(:~s'L f::i.t-.-:~ yc:)ur, si'Lc:,. DEF::'TH 'T'O F:'II:::'E: BOT"I"OI~I (F:]",,) GRAVI::].... DIEF:'TH (F:"T', "T'O]'AI.~ DE:F::'TH (F:'T,,) [i:¥~AVIEL.. W :1: D'TI .I (F::T., [~RAVE:I... LENGTH (1:::]".) GRAVEL VOLUME (CU,,YDS,,) "I"ANK SIZE (GALS) SOIL RA'I'IIqG (SQ.F:T. IBR) · ¢~-','!' 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Z[ C F:I I",1T ~ :!:!;::!;I...1[~ I) [3¥ D f:ITE::: MUNI(J[FAL. I ~Y UI- ANt.,IIUKAbh_. Department f Health and Environmenta~ Protection 825 ~ Street, Anchorage, AK. 9501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ ~:f~/c::~7'$' /~ELL AND~ ON-SITE SEWER PERMIT / Location: Phone Number: Legal Description: ~)~--/~ ~/~ /4/g2;~'~J ~i~_{S~¢~On size: Type of Soil Absorption System Is: Trench: Drainfield: _L~_,:~__ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: i~--P/ Soil Rating(sq.ft/br) .. The Required Size of the Soil Absorption System Is: DEPTH LENGTH ,~.~/ ,. GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~)~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residen~ is remodeled to Applicant include more~t~)3 bedrooms. Issued by~.~./',~-~/~-~~'~-g~ SWP/024(1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl_ PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST 2 4 5 ~16 7 8 9 10 11 12 13 14 15 16 17 18 19 2O DATE PERFORMED: SLOPE WAS GROUND WATER //X//O SL ENCOUNTERED? E Reading Date Gross Net Depth to Net Time Time Water Drop I- PERCOLATION RATE (minutes/inch) C' ,--' '-~ TEST RUN BETWEEN 72-008 (6/79) CERTIFIED BY: FT AND FT WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Seologicul ~ Geophysical Surveys Drilling Permit No. A.D.L, No. Io.llBorough Subd'l'vleion ' Lot Block: ~ '/4qtrl. Section No. TownehiPNO~ RonQe WELL LOG ' Feet Below 4. WELL.pEPTH: (final) 5. DATE OF COMPLETION Material Type Top Bottom ft. ..... diam. In. to ft. Depth · Stlckup~ ft. 9, FINISH OF WELL= D~P';. ur, HEALTH & " ENVIRONM~NTA~ ~o ......... : . Slot/MIIh Size: Length: ..... ~ Set between ~ Date --' ~ ~ ' " ' 12.0ROUTING Well Grouted: ~ Yea ~No' j , ' r. , I~. PUMP~ (If ovalloble) HP ..... . ' ' ~ Length of.Drop Pipe ft. oapaoHy g.p.m, 14L.~EMARKS: ' 16. WATER WELL qONTRACTOE'S CERTIFICATION: 15. Water Temperature ~__o ~ F ~] C TIll Eel Wai drt le~u~er~y Jut Jdlcllonand Ihi~report Is true rathe belt of ~y .knowledge and belief; . . gister~d Buil~es~e ' .~ ~ / ' Contract License .Number . 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. # _~'_)\~'h- o L - 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Day phone ~'"~G ¢;~'%i L; "b P-.L Day phone Mailing address Agent ~, ~, T'~ ~1 ,,'~ ~, ~ ~;:, A-- Address __ Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. 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. 72-025 (Rev ~/91) Front MOA *t21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date silown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply 'and/orwastewaterdisposal 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 - '~'.~" ~--~v<%~.~.¢~.~_c.~ '~,t.~- Phone Address ~0 "5 ~ I ~-~'7 ~ ~ '~ Engineer's signature ~ ~ ~ Date _ o DHHS SIGNATURE ~. Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: 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 DHHS 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. 72~25 (Rev 1/91) Back MOA ~21 Municipality of Anchorage DIF_PARTMENT OF HEALTH & HUMAN SERVI(~ C F iV E D Environmental Services Division 825"L" Street. Room 502 · Anchorage, Alaska 99501 ® (907) 343-4744 MAY 3 1 1996 Health Authority Approval Checklist Municipality of Anchorage Dept. Health & Human Services Legal Description: &. WELL DATA 1,~ IbL_~ Well type ~ _ Log present (Y/N) __ Total depth ] et~ '7 Parcel I.D. [f A. B. or C. attach ADEC letter. ADEC water system number Date completed t /$ ':2 / Cased to Casing height (above ground) Sanitary'seal (Y/N) _ Date of test Static water level Well production FROM WELL LOG __ g.p.m. WATER SAMPLE RESULTS: Coliform ¢ Date of sample: ~) ~ ~,/~ ~., B. SEPTIC/HOLDING TANK DATA Date installed ~&/~.~' 3 p/ Wires properly protected (Y/N) AT INSPEC'HON 3,1q l Nitrate ., Other bacteria Collected by: Tank size ~tcZS~r-> Nt, mber of Compamnents ~.~ Cleanm,ts (Y/N)__~_____ High water alarm (Y/N) Ix/ Foundation clcanout (Y/N) y' D f~ t' Depression (Y/NI I'q Pumper ~ qt.. C. ABSORPTION FIELD DATA Date installed ;¢..~/gI. Length_ re q/ Width Soil rating (g.p.d./ft2 or ft2Podrm) (~..~ '-~ System type .~..~,~_) I Gravel thickness below pipe ¢~,~ I '"~ Total depth Effective absorption area '~],52... Date of adequacy test Fluid depth in absorption field before test (in.); ,~ Fhlid.depth.~ _(ins.) Minutes later: Peroxide treatment (past 12 months) (Y~) Monitoring Tube present(Y/N) '-.~/_ Depression over field (Y/N) Results (Pass/Fail) ~' For .'~--~- bedrooms __ Immediately ,-ffter._~Otggal. water added (in.): Absorption rate = ~ ~tY'~2, g.p.d. if yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) High water alarm level at* '~Pump oa" level at* *Datum "Pamp off' level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holdiog tank ou lot ]O ~! Absorption field ou lot [ ~ ~ ~ Public sewer main N//~- Sewer/septic service line ~_:~47) I ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout ~'~/-~. Lift station SEPARATION DISTANCES FROM SEPTICfHOLDING TANK ON LOT TO: Building fouudatiou /_~ Property line ]o~ t Absorption field Water main/service line ]t.~l~ i Surface Water/drainage P~} 0 g ta~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ ! Surface water /N,] 0 14 ~ Curtain drain J~O 14~. Wells on adjacent lots Water main/service line ~ ~ ~ Driveway, parking/vehicle storage area F. ENGINEER'S CERTIFICATION Property line I certify that I have determined thrufield inspections and review of Municipal records tha't the above systems are in conJbrmance with MOA NAA guidelines in effect on this date. Signature ~ ~..x~t.~lff~,,c~) Eugineer'sNaxne-' |~ ~uf~~ ~ HAA Fee $ ~ ~Q ~ Waiver Fee $ Date of Payment Receipt Number Mtm, c p'al t,? of ,M chorage Department of Health and Human Services 825 'L" Street P.O. Box196650 Anchorage. Alaska99519-6650 June 24, 1996 Tobben Spurkland, P.E. 203 West 15th Avenue #203 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 16 Block 2 Hampton Hills Subdivision #1 Waiver Request #WR960021, PID 015-134-62, HA960207 Dear Mr. Spurkland: Your request for a waiver of the required 10 foot separation between the leachfield and the lot line has been approved. The waived distance is 3 feet. This approval applies to the existing septic system lot line and leachfield separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there are any concerns or questions regarding this waiver please call our office at 343- 4744. Sinc~5?' Robert W. Robinson Civil Engineer On-site Services RWR/ljm:Renschler ~UNICIPALITY OF ANCHORAGE Department of HeaLth and Human Services On-site Services Section Waiver Review Worksheet WR# WR960021 PID~ 015-134-62 Date Received: May 31~ 1996 Legal Description: ]Lot 16 Block 2 Hampton Hills ~1 Engineer: Tobben. ~purkland, P.E. 203 West 15th Avenue #203 Anchorage, Alas'ka HA# HA960207 Permit: 99501 Applicant: Tim Renschler Waiver Requested: Lot line waiver of 3 feet to property line Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons~for above: - ~ / ,~/-- / Name of Reviewer Rec ~: #01859/5739 Amount: $ 115.00 Date Paid: 5-31-96 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 RECEIVED Munici ~ality of Anchorage Oept, Health& HumanServ cas Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 May 31, 1996 Subject: Lot Line Waiver HAA Lot 16, Block 2, Hampton Hills Tim Renschler Gentlemen: During a HAA inspection it was observed that the drainfield for this property was 3 feet more or less distant from the lot line. The attached "As Built" survey shows the septic system location on the lot. The owner request a lot line waiver for the existing system. No repair or alteration to the system is contemplated. When the system is replaced proper separation distance will be obtained. Yours T!~p ~urldan~ ~,45~h~[t,lTS QF F, CCOPD, OTI,~N TH.¥L T,hC~J~_' ~OeiN ~ THE P_~COR:'.:~_O ~:CA?', AFvE NO~- 7'? ':C/,'ZE' J' - -:?2 :-.?,~i,L:F:S :~_: : !'/-:L:; DATE ! HER~' CbZ.q'TLF':' T~T ~ HA'lQ' PZ~,¢~D htD.q'TGAGETE'~ I.';~CTi~N .EZF THE FCiLLONiNG L~Z;T j~. ~L~7;': 2. HA,~iPTON HILLS S'U~. J'IJT HO, I AtqCHOR,,~,E;E ,q'~CCtRDil,tS DIS'IR[CT, ALAS~,,4 AND 'FH~ T THE ~N~ROVEI'~NTS ~!?LJA TED .~q'E iqJThTf'~ Y~ P~G'PERTY Et'~CfiOACH?4,~NT5' E;~'ISY OTHER THAN trOThS. ;gTH TED A f ANCHORAGE, ALASKA TH[~' _ ....... ~L?L T LAND MUNICIPALITY OF A}tCI-IORAGE DIVISION OF ENVIRONMENTAL NEALTH DEPARI~IENT OF fIEALTH AND ELrVIRO~ENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROV~ CERTIFICATE General Information Application Date . '-'~' ,~,~,"~.i (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Nam~L])..~ ' ~ '~ ~'"' ~ " ..> ~ ~ ~ .... , ~ z> / Ieleohone - Home .]~'~.. Business Applicants ~dtess (": ', / ~:.x.~, ~: ,-:,' ,:'~,, (c)Applicant is (check one)Lending Institution ~ ; O=er/builder Buyer [[2] ; Other ~ (explain>; (d) [,ending Institution ,'-/,,':v z .' I ("(zC)~t ' ,.~ /.~: /'~,~ <~' Telephone '{.. Address <: i' ~,i (,, /~'['*~ It/~ ,"f' ~ ~'.,/%' . ,':',: t,~_'~' '" ~'~. /' '~;. (e)ReaI Estate Co. & Agent Address ( Telephone Mail the tIAA to the following address: 2. [I'jyj?e of Residence S lng J_ e--F amiJ..y :f_: Number of Bedrooms Multi--Family Individual Well [: Community [::[ Public Note: If community well system, must have untitten conf~rmation from the State Department of Enviromnental Conservation attesting to t:he legality and status. Sewage Disposal 0nsite [i2 Public [l~[ Community Note: If community well system, must have ~titten confitmatiou fro~ the State Department of Environmental Couservatiou attesting to the legality and status, 0tm:r J.a_e s___c. Si_ b_e_)- .............................. [Page 1 of 2] 5. _E_n.~ineering Firm Prov_iding~_~I_n_s~e~c_t.i..qn_s__~ Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date sho~<~ below, I verify that my investigation of this Health Authority Approval shows that the one-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 based on the information obtained from the bMnicipality of Anchorage files and from my investigation and inspection, the one-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection~ Name of Firm__~ ~ ~e~ .~ g~. Address DHEP A~proval Approved for ~-~.~' bedrooms Approved -5<~f Disapproved Terms of Conditional Approvai CAUTION TIlE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF tIEALTH AND ENVIRONMEN'fAI~ PROTECTION (DHEP) ISSUES HJ~ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELt UPON THE REPRESENT-~ ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA° THE DHEP DOES THIS AS A COIU1TESY TO PURCHASERS OF HOMES AND THEIR I~NDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDEKAL AND STATE I~QUIRE- bIEN3:S. EMPLOYEES OF DHEP DO NOT CONDUCT iNSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. TIlE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSiONAl, ENGIN['iER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 WELL DATA Well Classification _°~ Well Log Present _(Y/N.) Total Depth ~ ~ 7 Cased to Static Water £evel ./ Casing Height Above Ground · Electrical Wiring in Conduit .(Y/N) Separation Distances f~om M~CIPALZ~ OF ~C~GE (M~) '~. $~ ~O~TY ~PROV~ (~) 0~'~' ~':~ C=CKLI= - FEBRU=Y 19B4 ~l,E C E % % Legal Description': [0~ If A, B, ~ C, D.E.C. ~p~oved(Y~) ~te ~le~d ~/~ Yield /~7 ~pth of G~outing ~ ~t At ~ Sanitary ~al on Casing (Y~) ~p~ession ~ound ~l~ead (Y~) To Septic/Holding Tank on Lot 10 I ~..~; On Adjoining Lots TO Nearest Edge of Absor~ption Field on LO,~ ~L~/~k~) ; Adjoining Lots To Nearest Public Se%~ Line C leancut/Nanhole Water Sample Collected By Wate~ Sample Test R~sults Comm~.nts too To Nearest Public Sewer To Nearest Sewe~ Service Line on Lot B. SE~T~C/~ TANK DaTA Date ~nstalled Od,7' I~'/'~ Size Standpipes (.Y~) ~' Air-tight Caps (Y~) ~p~ession ove~ Ta~ (Y~) ~ ~te ~st P~d P~ing~intenan~ Con~a~ on File (Y~) Holding Tank High-Wate~ ~am (Y~) ~/~ ~a~y Holdi~ Ta~k Permit (Y~) Sep~ation Distanms f~ ~ptic~olding Tank: To Water-Supply ~li To ImeOpert!; Line , TO Water Main/Service Line ~//J~ ., No. of Co~?a~tments Foundation Cleanout (Y/N~__~/__~. .7^ TO Building Foundation ~ To Disposal Field / '~ To Stream, Pond, [,3kc, c~ Major D~aina~e Conm~nts [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD [1ATA Soils Rating in Absorption Strata Date Installed O(J~- % ~/ Width of Field ~_~o I. Square Feet of Absorption A~ea ~/,~ Depression over Field (Y/N) ~/ Date of Last Adsquacy Test Results of Last Adequacy Test /'///m% Separation Distanoe frc~a Absorption Field: To k%ter-Supply Well ~ ~ ~ To P~operty Line Type of System Design Length of Field ~ ~/ Depth of Field t O ~//z Gravel Bed Thickness ~ ~ Standpipes P~esent (Y/N) TO Building Foundation. ~ Lot ~~ ; On Adjoining Lots To Water Main/Service Line ~)~ To ~t~(if To St~e~ond~ke/~ ~jo~ ~aina~ C~ To ~ivewa~, Pa~ki~ ~ea, ~ Vehicle Sto~a~ ~ea C~nts To Existing or A~ System De ST T ON N O N Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) PumpinG Cycles du~ing Adequacy Test. Meets MOA Corm~nts Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection.~ KB1/d5/s Date [Page 2 of 2] 2-15-84