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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 9 LT 11 Municipality of Anchorage Page ~1 _ ct '~'- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, A~aska 99519-6650 ® Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~u~ ~1 PID Number: ~- Bedrooms: LEGAL DESCRIPTION Lot: II Range: Township: WELL: New ification (Private, riller: SubdiviSio [] Upgrade Depth: ed To: ; Ddlled: Set at: Height GPM SEPARATION DISTANCES Tank wel~ j ~Z ~'l- Surface Water Lot Line lO 'l' ,undation Curtain Drain Remarks: ~ Fl. Fl. Ft. ,J£eJo lastewater System: [] New ~ Upgrade ABSORPTION FIELD [] Deep Trench [] ShaLlow Trench 'j~,Bed [] Mound Total Depth from original grade: Rating: '2 ,..~, to pipe bottom from original grade: iravel depth beneath I "~. G1 Ft. 0 Ft. added above original grade: ~ravel length: ~ (o ~ Ft. 0 *"7 ~ ~ Distance between lines: ravel width: ~ O,.~t Ft. material: ~1 absorption area: ~"/8~ sa. _,v.~ TANK [] HoLding '~S.T.E.P. Capacity in gallons: nufacturer: ~ r of Compartments: ~atarial: ~1.~ c.. "7.- LIFT STATION gallons: ~nufacturer: on" level at: off" level at: Make & Model ~[ inspections pedormed by: BENCH MARK Location and Description: Assumed Elevation: ENGINEER'S SEAL ~., .... ~&La~ka Wate~ & Wastewate~ Dates: 1st_ '1 Inspections P~-u,,,'~0 ~s;5t~,cte Anchorage, AlasKa ~u~ Department of Health and Human Services approval JAMES P. W~LL~,MS, ~10. 0608 ~E,.'.,'rSWgS0,N.,.,~E.6~ AS--BUILT ]DRAWING 017-~91-45 /.~d 02.1 MN s'r2 / :~/~" ~v~ ~'r~s ('~,~)-/ ~ '~ I MT4 ~I-'INAL GRADE /M-rz / ~ i ORIGINAL GRADE--- ~ X 11:,.50 / /--FILT~ FABRIC ~__~., , ~ II . 1~ ' -~ ~-- 2000 GALLON ¢ ~A~,~ o~ .va" ,~-, LJL_ _ ~,_ ~ ~ J(DEEP BURIAL TANI() j ~l'Er~tS BURIED MIDWAY ~ ~ ~ ~ ~ ~ ~ E~. ~ ~ ~ AIR LINE 18" DEL,OWm*¢~ / / / SAND FILTER (10.5' x 5fi' ISF//% ;1111~ 'EDP o~' sAND / / / 7 ~% i/lift 107.72 OYP.)-~ ~ BT2 ¢~/~/, ~ / .,m,.~ // /~N~ 2000 GALLON ~ ~'~~. ,/ / s.'rE.P. S~STEM MH 6475' 5750 % / X % / ~ % ' PREPPED BY: ALASKA WATER g WASTEWATER ~- oF =.=~,.,o.: ~"" ~"~o ~OUNTAIN PARK ESTATES, LOT 11, BLOCK 9 ,',~}/ 4-9~'~;~I AS-BUILT OF SEPTIC SYS'rEU UPGRADE [..) .. ~/. ~.JAMES P. WlLLIAMA PREPARED FOR: PHONE NUMBER: ~ '. NO 9608 .' DECKLE BROCIES 261-7546 ]~,"... C.E. ...".,4~ · - ~ ~ '. ........... A.C.G. I :: 40' 2 OF 2 ~,,~ ..... '.; - ~ : .... -:. ..£,, !-.. -- PROPERTY O~.~rlgR AGltggbiE.re'r FOR '~ MAnN. CE OF ~ ON-S~ WA~TEWA'~R. DISPOSAL SYSTEM sy0tem on the subj~t property. op~rafio~ ~mt~m~ ~oa ~ r~gi~m~'d prof~ssioa~ *~h~r. ~s ~pectfon ~d pu~p~, t~ers, ~d ~a~, ~d ~ha: m~y defioie~eies have been reputed ~d t~ the , ,..-/~ .. /;/ . / / ' /,' , / -- ........... "; ' ' '/r / , ' ' '/" .~, { ~ . ,'., ' t ':,~1~ .. il ' /;".' · /' :.- ,~. ----- who~a ld~ntt.ty I proved on =he b~ct~/~f~irmati~n o~ , a er*d~h].~ signer of ghm above document, and ha/ghe acknowledged that h~/she ~lgned :[t, 8~ATE OF ALASKA ~ Notary Publ. ic ....... MUNICIPALITY OF ANCHORAGE Depa~?ment of Heallh and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTFWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 11, 1998 Expiration Date: Jun 11, 1999 Permit Number: SW980165 Design Engineer: Alaska Water & Wastewater Services Owner Name: William Reavis Owner Address: c/o Dynamic Properties 3111 C St. Anchorage , AK 99503- Parcel ID: 017-391-45 Legal Description: MOUNTAIN PARK ESTATES BLK 9 LT t 1 Site Address: 006061 BRISTOL DR Lot Size: 21500 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: iv'l Disposal Field [¢' Septic Tank Holding Tank Privy Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2, All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ), 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. This permit is for a bottomless intermittant dosing sand filter system. A notarized system maintenance agreement shall be part of the as-built package. Received By: Issued By: ~~ Date: ,~ ~'// - ~-'~'~ Alaska Water & Wastewater 7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers May18,1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Sewer Upgrade for Lot 11, Block 9, Mountain Park Estates To whom it may concern: The existing 5 bedroom house is served by an onsite septic system, and a private well. The existing drainfield is completely surcharged and will need to be upgraded prior to the sale of the house in order to obtain an HAA. Comments regarding the proposed upgrade are summarized as follows: 1. GENERAL: There are a number of site restrictions which limit the available spots to put the new drainfield. These restrictions are summarized as follows: The location of the existing septic system · The location of the well serving this property · The topography ofthe property. Given these restrictions, there is limited space on the lot to put the new drainfield; therefore, we are proposing to install a bottomless, Intermittent Sand Filter (ISF). 2. SOILS: On May 9, 1998 a test hole was excavated and percolation test performed at the area of the proposed septic upgrade. As can be seen from the attached soils log, there was an 18 inch organic layer. The soils below the organic layer was a GM layer to a depth of 12 feet, and then transition to a SM/ML layer to a depth of 16 feet (bottom of hole). No groundwater was encountered at the time of excavation. 3, TRENCH DESIGN: Bottomless Intermittent Sand Filter (ISF) a. Percolation Rate: 34.3 minutes/inch b. Allowable Application Rate for ISF: c. Number of Bedrooms: 5 d. Design Flow: 750 gallons per day 2 gallons/day/ft2 e. Minimum Absorption Area: 375 ft2 f. Effective Depth below pressure pipes: 2.5+ inches g. Width: 10.5 feet h. Length: 36 feet. i. Effective absorption area = 378 ft2 (>375 fi2 OK) j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank". k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank". 1. Sand Material: Central Paving Products "Winter Road Sand" m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and less than 1% passing the #8 sieve. We are proposing to excavate down to a depth of 6 feet, place a minimum of 6 inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. We are proposing to make the sand filter 3 inches wider on each side (a total of 6 inches) than the standard 10' x 36' bottomless sand filter. We are proposing to do this in order to meet the minimum square footage requirement. 4. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 5. TOPOGRAPHY: Starting at the north corner of the property, the topography slopes at approximately 1% to 3% towards the existing house. Approximately 10 feet southwest of the test hole, the grade increases to an average of 20% and than tapers out at the existing trench to have flat backyard area. With the burial depth of the proposed sand filter, it is our opinion that there will be no slope concerns. 6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this document prior to construction. Copies are available at the Municipal Onsite Services office (5th floor, 9th & L St.). 7. CLOSING'. Given the site restriction, I think the ISF is the most viable option for this lot, short of install a Recirculating Upflow Filter, which would probably be more expensive. I am open to any suggestions from your department, which would be an improvement to the proposed design. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistant. · ely, ? S. I.OT 14, BLK MOUNTAIN PARK IL~F. I.OT 1:~, MOUNI'AIN LOT 6, DLK 8, !JOUNTAIN PARK EST. El, LOT 10, [JLK 9, MOUNTAIN PARK EST. I.OT 12, BLI( 9, MOUNTAIN PARK EST. / ~ -iit~1+ EXISTING LOT 7, BLN 8, MOUNTAIN PARK EST. LOr 9, I~LK B, MOUNTAIN PARK EST. MOUNTAIN PARK ~S'L ~, ~ ", / MOUNi'AIN PAR~ EST. PItEP~ED DY: LEOAI_ DESCRIP'IION: TYPE OF WORK: PREPAREO FOR: '~'A'r~: LO'F ~, BLK 12, MOUNTAIN PARK EST. LOT g, BU( 12, MOUNTAIN PARK ES'r. MOUNTAIN PLACE \ \ LOT 2, BLK 13, MOUNTAIN PARK EST. ~0~ · ALASICA WATER & WASTEWATER MOU,TN, TAIN PARK E~ 11, BLOCK 9, W/ DYNAMIC (907)261-7546 BECKIE BROCIES , ~: 5/18/98 rD~uN iso,~E: , JPA~.: J.L.M. 1 = 100 1 OF 5 MOUN'FAIN PARK EST. LO'F 4-, BLK MOUNI'AIN PARK EST. , "h~,,"'... ...'"A~ NnTES, WILL NDT 'darK. PRDPDSED ])L]'rTI]MI.ES$ THE AIR CI]MPRES~DR SHALL ~E A YHDNAS IN~U~TIE~ MBBEL SAND FILTER ~070, A8 SUPPLIE~ ~Y ANCHI~RAGE TAN~, THE AIR LINE (~EE ~ETAIL ~RA~ING) X /~ ' ~HALL BE ~/~ INCH ~IA, H~PE (1 PIECE~, INSULATED ~ITH 1/~ INCH FOA~ PZPE ~RAP (R3 VALUE>, INSIDE A ~ INCH ~CH,4~ L~5 INCH I IDPK L~NE ~LLIPE~ i~AC~ ~ ~/ I I -- T~ LIFF NI'ATIBN F~R LINE, N~ LBW ~POTN A]]ANDDNE~ ~UCH 'I'I~A'I' IT MAY ~ ~ ./ ~ ~ ] ~,1 , , 9E U~ED IN THE FUTURE. EXACT LUCATIDN mi:' TRENCH IS UNKNI]WN,--~. EXISI lNG SEPTIC FA N 'rD ~E A~ANDE]NED C[]HPLE'i'ELY ~/ '' ~ / / ~[1PE]] 1/4 IN/I~ %, I/~ / ~ ~ / ~% ~ ~ EQUIPPED WITH A INTERNI1-TENT '~ ~~ j%~ ~ ~ BE LJ'FILITY RODM, INS'FALL ~UAL. =~/~ ~ ~ U/-~ ~ ~ MAY REDUIRE A ]]EEP ~IIRIAL, USE ~RI~]R TO 00N~~HE CD~XCJ~DR PROD AL~O, THE 100 FDOT WELL RADIUS LiNE FidGEtY a ~STERED ~ / ~ j L PRDI~]NA~ANg SURVEYOR, ~ / / j A,LAS WATER & WASTEWATER MOUNIAIN PARK ESTATES, LOT 1 1, 8LOOK ..... ~PE OF WORK: PREPARED FOR: PHONE NuM.ER'. ~a~ 'j ~S-7953 .-'~ (g07)261 --75~6 DECKLE BROCIE W/ DYNAMI~ N~Fo".. .... ."o~j~ / / I '~-~'~ ~ ~ IN~, (~LL I/~ INCH PlA H~) PLAN V~EW ~'r ~/4" PVC LA~5 ( ~',~)-~ Mf MIPWAY IN I~ ~UM,-.~ ~?~)~~~ ~ 2FCBfMIN, OPFILIBRS~9- . _ ALAS~ WATER & WASTEWA~R ~ .. .~ MOUNTAIN PARK ESTATES, LOT 11, BLOCK 9, ~ ":' '"~ ~PE OF worm ~-' ~~"'"'"' BOTTOMLESS SAND FILTER (ISF) DETAIL PREPARED FOR: PHONE NUWBER: BKCKIE BROCIES W/ DYNAUlC (~07) 261 .' J.L.M, N.T.S, ALASKA WATER & WASTEWATER PHONE (go7) ~7-fi17§ * FAN (go7) 338-.]246 " LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES; LOT 11, BLOCK 9, '" '" .... PERFORMED FOR: BECKIE BROCIES W/ DYNAMIC PROPERTIES~,_,f/l/-r~ DEPTH ~-~'~ SOIL C~SSIFICATIONS ~ ~ [SITE PLAN[ ~" GROUNDWATER DATE 'P :,,> DRY 5/18/98 11 --~' DATE READING CLOCK NET TIME WATER LEVEL NET DROP ,:, :~ , TIME (MINUTES) READING (INCHES) 12~ 5/9/98 - PRESOAF ED 4 HOURE PRIOR TO TESt ~ ~ ~" 6" .,~, ~,~,~(SOFT DIGGING) 4 30 MIN. 6 1/8" 7/8" ~IT~??/~] 6 50 MIN. 6 1/8" 7/8" 16--~.0.H. 17~ 19~ ~ PERCOLATION RATE 34.3 (HIN./INCH) PERC. HOLE DIA. 6" (INCHES) 20 TEST RUN BETWEEN 6.75 FT. AND 7,25 FT. COHHENTS: PERFOMED BY A~SKA WATER a WASTEWATER l, JEFFERY A. GARNESS , CERTI~ THAT THIS WAS PERFORMED IN/ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DEPTH TO GROUNDWATER DATE DRY 5/9/98 DRY 5118/98 PROPERTY OWNER AGtLEEMENT FOR TIlE MAINTENANCE OF ~ ON-SITE WASTEWATER DISPOSAL SYSTEM kis agreement, dated_ ~1997..~, 1s made be~veea the Municipality of Anchorage Department of Health ',uJd Human Services fl)HI-IS) ami the property owner(s) of:~ . _ _ .... This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owners agree to ~e following: Submit to the Munk:ipality of Anchorage, on an annual basis, an kk~ecfion and operation statement from a registered professional engineer. This inspection and opera~ion statement shall verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any deficiencies have been repaired and that system is functioning as designed. J (S~gaature) ~/ "<' / ' (Signature) .... . ? , /.. _ /-~, . / ;.~ , t /4;' / / . _ .... ' / .~./'7 / (Printed Name)" (Prated Name) .................................. Notar±ze Here ...................................... State of ~,~_ On this /q~,_ day of ~)~,55b ~'1~.'7~.,",~1"I~__ personally appeared before me, ~ who is personally knowll to me ~ t / whose identity I provdd on the ~ath/afflrmation o{ , a credible witness gO Be she signor of ~he aboyp document, and he/she acknowledged that he/she signed Notary Public SPECIAL POWER OF ATTORNEY STATE OF ~ ~I2J% ) ) ~ SS. KNOW ALL MEN BY THESE PRESENTS, that, I/we h--~-~-m~d~, constituted'~' and ppolnted and by these presents, do make., constitute and appoint re.V/ouz~ ~rue"'and lawf~torney for me/us and in my/o~]'~ name, place and stead, and for my/our use and benefit to do any and every act and exercise any and every power that I/we might or could do if personally present, or exercise through any other person that he shall deem proper or advisable, insofar as suc~ action is or may relat~ to real property located in the ~0~ ~ ~& C , State of ~ , described an~ lntar~st the~e]n and ~,¢ ¢¢~ not o . Izm~ted to, the D ~.~ ~, ....... n, 3nclt~dlng, but ~ow~r ~ ~u~uu ~or tR8 pu~ohase or sal8 of, to purchase or sell, to convey and warrant title thereto, ~o take or give possession thereof and of evidence of title thereto, to lease the same for any term or purpose, to mortgage, brans¢er in trusb, or otherwise encumber or hypothecate the r r b g te en°n-~]egc~ t iab~a n°teat~n1 confirming whatsoever my/our said attorney shall or may do ' ~ nb, hereby ratifying by virbue hereof in tlaa premises, and I/we agree and represent to those dealing with my/our said attorney that this Power of Attorney may be voluntarily revoked alone by' revocation given the same general distribution as this original Power o~ Attorney. MUNICIPALITY OF ANCHORAGE DE. ,tTMENT OF HEALTH AND HUMAN SER~ Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION 'rANKS SEPTIC [] HOLDING No~Com/~a d Merits TYPE OF SYSTEM ~.TI:iENCH W. DRAIN [] OTHER BED FT .~ ' ~'~,~ ~ Fl' Z-~~ so [~l PVC D~O d WELLS ~PRIVATE ~] OTHERfldentffv) FT F'D DISTANCES -- ~ TI'I SEPTIC ABSORPTION TANK FIELD WELL WELL LOT LINE FOUNDATION AS-BUILT DIAGRAM ~Show Iocahon ol WOrt sepl~c sys em. p oper~y hnes, fOLmdahOll. drlVOWSy Walor Dool6s, Health Oeparh'Nent Approval: 72 013 (3/85) ENGINEER'S SEAL L..EIT,~ :l. 1 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~-OT' ~'/ /,~C,:~i~/ ~/ 1 2 3 4 5 6 7 8 9 12 13 15 16 17 18 19 20, / __ __ DATE PERFORMED:~ Township, Range, Section: SLOPE WASGROUND WATER ENCOUNTERED? Dale: __ Date Gross Time ~F'~' ~ ("'[ N0 IF YES, AT WHAT DEPTH? /,.%' p) ~t ~ _ Oo~ Io Water Alter Reading SITE PLAN Net Depth to Time Water Net Drop PERCOLATION RATE __ (mJnutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN -- FTAND -- FT COMMENTS ~ ' ' ' 7 ¢ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORD^"OE ,TRALLST^ EAND ES'NEFEECTONTH,SOATE. °ATE: 72-008 (Rev. 4/85) ~]~F. OF ~iNVIR(}N~£~TAL CONSER%~ATiON ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 August 6, 1985 BILL SHEFFIELD, GOVERNOR 274-2533 D. ltigh Engineering 3605 Arctic Boulevard Suite 993 Anchorage, Alaska 99503 SUBJECT: Dear Sir: ~aiver Horizontal Separation between Nell and Septic Tank, Lot ll, Block 9, Mountain Park Estates, Anchorage, Alaska (8621-WA-035) The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 80 feet on the subject property for a 5 bedroom single family residence only. This waiver is subject to the following conditions: 1. Both septic tanks must be equipped with calder couplings and must be structurally sound and watertight. 2. Item #1 must be verified by an independent registered engineer. Sincerely, ~P.E. District Engineer SWE/msm G"' fER ANCHORAGE AREA BORG' H u ,rARTMENT OF ENVIRONMENTAL QUAb,, 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING .ADDRESS <~,(/? ~/~(.,~_1;, / /:' __LEGAL DESCRIPTION --PHONE SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY __MATERIAL ~ A"( J. NUMBER OF COMPARTMENTS GALLONS· INSIDE LENGTH ..... INSIDE WIDTH LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / __OUTSIDE DIAMETER " OR WIDTH /7 LINING MATERIAL ('(/~(~L r'~_~ I~/(~(t~'_~_'~ [~lt?l~L~, L . DISTANCE FROM WELL / NEAREST LOT LINE /'~ ' ' ' ) ' ' t (" ~ (., TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) TILE DRAIN EIELD: __, LENGTH ;~ ! DEPTH BUILDING FOUNDATION..~ 6-.7 ..~' .SQ. FT, DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE"fO FINISH GRADE FOUNDATION ' , NEAREST lOT LINE DISTANCE BETWEEN LINES TRENCH WIDTH SQ. FI. LENGTH OF EACEI LINE .DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES. IN. TOTAL EFFECTIVE tN. ABOVE TILE WELL: r x, ,) / ,',; u) (mz TYPE h~,~/,'Zc/) , DEPTH · NEAREST / y z'r' LOT LINE(?J~-,'/i '~ / ,; z , SEWER LINE DISTANCE FROM .' WATER .c ., BUILDING FOUNDATION / ./ __SAMPLE__/¢,r(/( SEPTIC , r/ SEEPAGE TANK ~ ') (J , SYSTEM__.Z~.:(.'" --, CESSPOOL NEAREST OTHER SOURCES ,~/;~ ' ' DISTANCES: Iii ~'i /-)~ Z~i by ' DIAGRAM OF SYSTEM '/ ~,t) i lc' GRE/~IER ANCHORAGE AREA BONu'UGH BEP~RTMENT OF ENVIRONMENTAL QUALITY 3500TUDOE ROAC POUCH 5-S~D ANCHORAGE, ALASKA 99502 TELEPHONe 279-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION P"ONE LEGAL DESCRIPTION iNSTALLATION OF: SEPTIC TANK TYPE AND SiZE OF FACILITY TO BE SERVED FINANCED THROUGH COMPLETION CATE ANTICIPATED SEEPAGE PIT . DRA~N FIELC OTHER NOTe~ THIS PERMIT IB NOT VALID WITHOUT SOIL FINAL INSPECTION= 2:4 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL SE BUBJI-'CT TO PROSECUTION. - TYPE (' " / MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTrC TANK SEPTIC TANK TO SEEPAGE PIT WALL DIAGRAM OF SYSTEM . DRAIN FIELD WELL TO SEPTIC TANK- i~ . SEEPAGE Pit __ WATER MAIN TO SEPTIC TANK . DRAIN FIELD SEPTIC TANK, SEEPAGE PIT TO RIVERi LAKE, STREAM. CAST IRON INTO ANB OUT OF SEPTIC TANK AND IN__T_..O.~CRJB CROSSING GAP Of 4 INCH DIAMj~TJ~:~/~,ST IRON SIPHON P PES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH I~EGULATIONS REGARDING INSTALLATION. LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE With BAlD CODE. /~ ~ ~_ ,~.~ r~ DATE ~/~ ./ ~/ APPUCANT'S SIGNATURE ...... ' ~t,lbnUKA~b AREA BOROUG~ DEPA ,ENT OF £NVIROI~McNTAL OUA'~ CASE 14 3500 TUDOR ROAD ~(~$~ A~cuo~E, ~S~ ~50~ Performed For ~,~- Legal Descrip~~~,~~~Date Performed This Form R .... ~Z"~?~J'~ u'uuK~UDOlViSion ~,~, ,~,, Depth F e e__t __ .Soil - 2 '-L~ Characteristi cs Was Ground Water Encountered? If Yes, At What Depth? Reading Date .... ~ d~ Proposed I n s t a TT-a-~-T6 n-:' Gross Time uepth to H20 Seepage Pit Net Drop Depth Of Inlet Drain Field COMMENTS: lc'<' ~:~-~-~.- ~_Dept--~'-~'~--o B-~-~-tom Of Pit Date: 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) R 3~I (b) Applicant Name 'l)~3_~Z{j~;h Tel?boone: Home -.3~lh.~---- Business _?~;,7~:,,,5~_,1~4 Applicant Address _~0,~ ~rotic Su.:[te;~.~., ,4.,,, (c) Applicant is (check one): Lending Institution'L~;'~.dwner/b4~e~; Buyer L--]; Other [] (explain); (d) Lending Institution ~R~in.i~lr Address _)4'79'? ~3,.i~ae~,~ (e) Real Estate Company and Agent ~,~ Address 'relephor~g Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Family~: Multi-Family [] Other Numberof Bedrooms~ (g.)_ .... 3. WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite:t~ Public [] Community [] Holding Tan~ [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72025t]1 84~ ENGINEERING FIRM PROVIDINL ,~SPECTIONS, TESTS, FILE SEARCH, DAh...&ND 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 o!._ th. is loi'¢s.p, ecti°n'.. Name of Firm D,,~-]ZG.H ENG:[NE]s'~'~(}, Telephone Address ~'-~,~--Su.g&e. 993 .¢nch~ge~ /'.,'lCsk~ 99,5~03 Date r Engineer's Seal DHEP APPROVAL Approved for ~_/_ bedrooms by,5:~; /~-,n -/~.?~e...~fc..- *"'"'-'/~ ~__.})ate Approved __~) *'"~~ Disapprov6~d Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Iqealth 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. Page 2 of 2 72-025 (I ~/84) WELL DATA Well Classification\ - Pr:~ Well MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 MUNIC~PAUTY OF ANCHO~AG~ c T F, HEA~f & Legal Description: ~ - "~P' ~ ~eo~6~2N R3W ~ Well Log Present (Y/N) %res___ . If A, B, C, D.E.C. Approved (Y/N) Date Completed - 1 972;~/- Yield __~; OPM Total Depth 2}~.0~ Cased to _ 2h.O~ -- Static Water Level 190~ Casing Height Above Ground -'LS~ Electrical Wiring in Conduit (.Y/N)I --% Separation Distances from Well: ~,)j.r To Septic/Holding Tank on Lot - To Nearest Edge of Absorption Field on Lot3~-0~ To Nearest Public Sewer Line Cleanout/Manhole - Water Sample Collected by __Dee S,~tis£~ctory Water Sample Test Results _~None n.___o'b e~ Depth of Grouting Pump Set At ' ,' __ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) lq 200~ +,~ ; On Adjoining Lots ':_; On Adjoining Lots -- ']-7~~- +/- To Nearest Public Sewer 1'o Nearest Sewer Service Line on Lot ?;~/A ;Date _ ]. 0/~1L'7_,~8~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed _~_8/27,73~ _ Size ~ _~OQ_E¢:L~ No. of Compartments Standpipes (Y/N) 7:' Air-tight Caps (Y/N) -- Depression over Tank (Y/N) ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) _~/_A__ Separation Distances from Septic/Holding Tank: To Water-Supply Well _ (~L To Property Line To Water Main/Service Line _ N~ Course ~one No Foundation Cleanout (Y/N) Y Date Last Pumped - N/A New: T~r~k ; for N/A Temporary Holding Tank Permit (Y/N) _ To Building Foundation ~,q_9.~ To Disposal Field 39' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 8_~/~_7/85' Width of Field ~.8 ~ Square Feet of Absorption Area Depression over Field (Y/N) ~ Results of Last Adequacy Test Separation Distance from Al~sorption Field: To Water-Supply Well __'L] O~ To Building Foundation ~4. O~ Lot . 2~t To Water Ma!n/Service Line _ To Stream/Pond/Lake/or Major Drainage Course Type of System Design Length of Field __'75'~ Depth of Field ~t to-- l~ Gravel Bed Thickness r.¢~ ~ Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line _ ,'LO~ To Existing or Abandoned System on ; On Adjoining Lots ~LO0~ +_/'- _ To Cutbank (if present) To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed N/A 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 during Adequacy Test. Meets MOA Comments ** Checl~Tm~ Bedroom Rating Against HAA Request ** I certify th~l~ave ~"~eckq~r~.le~nformed to all MOA and HAA guide ines,in Signed ~_~ _ Date ~,,,2',~'/ ~ __ _ effectonthedateofthisinspection. Company D~G~~Ri[~ MOA No. _$T85'~2.c)~K __ ' Receipt No. _ Date of Payment \C~- Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal APPLIC tIT FILLS OUT UPPER HAL ONLY Property Ownez Mailing Address Buyer Address Phone Zip Code Phone Zip Code / r_/ ~ ---' .~ ;~= ~ Phone Lending Institution Address Bealty Co. & Agent Address Zip Code t.egal Description _S.t reet Locatio¢, Type of Residence ~ Single Family ~ Multiple Family ~ Other y / Water Supply .~ Individual Community [] Public Utility ATTACH WELL LOG. A well log is required for all wells dritled since June 1975. For wells drilled prior to that date, give well del)th (atlach log if available). Sewer Disposal /f~ Individual [] Public Utility ~] Holding Tank When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Inspector Inspector Inspector Date Field Notes: MUNICIPALITY OF ANCHORAGE "EPL ©F .U:-/,LTil ~ P N V it'~O N"v"£ ?'l}'A L PROTLC/ION ,._~) APPROVED BEDROOMS ( ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' - II ~ C DATE _. .~' 'CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size