HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 11 LT 5
.J~¢~'~"/~ ~,N, MUNICIPALITY OF ANCHORAGE
ENVIRONMENI'AL ENGINEERING DIVISION
"~ [~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
- ON-SITE SEWAGE DISPOSAl- SYSTEM AND/OR WELL INSPECTION REPORT
PHONE._ ~RADE
NC. OF BEDROOMS
r [Well Absorptionare~ '' ~welling ' I ~ PERMITNO. ~ ~ (~
~ ~ ~ tnside length Width LiqLgd depth
Liq, capacity in gallons
/ 2 ~O IF ROMEMADE: _ _ ~
- ~ell Dwelling PERMIT NO,
[~ DISTANCE TO:
~ MatoFial Liquid capac~t~ in gallons
m Well f Eoundation Nearest lot line PERMI~'NO.
~ Z No. of lines ~ Length of qacb lin0 ~ Total length of lines Trench width Distance betw n~s
toff grade Material beneath tile i~ Total effective absorptlon/.~O area
Length " Width De~th PERMITNO.
~ Type of crib Crib diameter , Crib depth Iotal effective absorption area
m Well Buiiding foundation Nearest tot line
m DISTANCE TO:,, ,-
j Cia ~epth Drill'er Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
APPROVED ',, DATE LEGAL
F'ERHIT NO.
FIF'F'L ]: CRNT
L 0 Ii: FI 'T' I Iii N
L. E G R L
I ~F..ILF FIOFSETH
F H ..., ESTRTES
L.'_-'i B::L't I"IT '~"'R't"
[::,EF'I::IF::"I'HE1,'iT C HEF'ILTH FIND E1,'¢,,,'IRON1,'IENTAL r ')TEF:'['ICdq'
//
,:,.-:, ..~.~ .
,:,¢.._ "L $ T F:E E "i"., FIN C:H 0 F.: AG E., FIK. 9'_=.[ f'z,~_', ± /,
R...-H IE IL._ I1 .... ~::~ ~'-,I I[:::. ~]2~ IP-JJ ..... .._,:=' ]C
"FYF'E OF' SOIL. FIE:SORPTIFIN :-r.zlEII IS
T F: E I'.4 C H ~.~'
SOl:I_ F.'tRTTNG ,:: '=; L';.! FT,.."BF.:::,= :':':00
THE F:EI;iU:[RED SIZE OF 'r'FIE: L--,NIL RBSOF.:F:'TION S'T'STEH IS:
E; IF::" ~T' 11.-I~ == j.. I~:Z~ L E: ~'-.I ,:3i T ia :== ::L 2 ~Z, ,ii f;: R ",..' E L. [::, F'~: F' 1' IH == (:2;
"I"HE LENGTH r:,.'[HENS:[ON IS THE LENGTH ,:.'Ir,I F'EET) OF THE 'i"I~RENCH O.F..., DRFIINFIELD.
THE DEPTFI OF' FI TF'.[:NCH OR PIT I.'E, THE DISTFINCE BETHEEN THE SURFFICE OF THE
GF.:OUN[:, RND THE BOTTOH OF THE EXCFIVFIT :[ ON 4:[1'.4 FEET.':,.
THERE ZS NO SET H:[I:::,TH FOR TF.'ENCHE'..'~.
THE OF.'.'FCv'EL DEPTH IS THE I','I]:NTHUH DEPTH OF G.FRFI'¢EI_ BETIIEEN THE OUTFFILL F'IF'E
AND THE BOT't"OH OF THE E',:..ICI.':I',,,'RTIOhl ,::I1,.4 FEET;,.
HH:., ' '-'- ' - '- ' - ' ' ' .-
FEF. III i' FIF'F'LiC:RI'.~IT "- TFIE I;;.Ez, FL1,.~I.::,IBI/.ITY TO INFORM I"HIL--., DEFi-..IRT1,1Ei',IT [:,lIFtING THE
INSTFILLRTI01,.,I IN.:,FE_.I IONS OF I::INY HELLS RD..TRCENT TO TFII.:, PF..:OF'ERTY FIIqD THE
_ ;:' '~ ' ' ' 1" '~ ''~ '=' ' ~' '~ '
1,.,1 ff"IE:ER OF [:.E.:.[[EN_.E::, THFIT THE klELL klILL ..ER,E.
.................. 'T' I.,..~ ,3, ~:::
_ _ "' ""-, - EfT'
E:FIC:F.:FII_LING OF RNY SYS;]"EH I,,.IITHOUT FINFIL IN'r-]F'Ef':'I'ION FIN[:, HFFfi_ ,HL 'THIS
z, IJE,.][: _. r TO F'F.'C '_-]E ]:lIT I C 1,.I.
[:,EF'FII;;'.THEi'.,IT HILLBE
FIINtHL.IH D]:'.'qTFII'.IE:E E:ETI,.IEEN FI HELL RN[:, FI1,.,1'.¢ ON-SITE 2;E!IRGE DISPOL:;RL SYS"I"EH IS
:tOO F:EET FOF.: R PR.'[',,,'FITE HELL OR :t. 50 1'O 200 FEET FF.'.OH R F'UBL:[C HELL DEPENDZNG
UPON ]"FIE TYF'E OF PUBLIC klELL.
h'IZNZHLIH D]:STF:I1,.,ICE FROH R PF..: :[ ',,,'RTE HELL TO R PRI',/RTE SEI.4ER. LINE :~'-.=; 25 FEET FINE:,
"i"O FI OOPlI"IU1,4ITY SEklER LINE IS 75 FREE'['.
HELL LOGS FIi:~'.E REQUIRED RN[:, i"IUST BE RETURNE[:, TO THE [::,F'PFIRTHENT !.4ITHIN 2::0 E:'R"r".E;
OF THE HELL. COMPLETION.
OTHER F.'flEQUIF.:EMEN"I"'E, HRY RPPLY. SPEE:IFICF]TIONS FIN['.' CNI"'ISTRUCTION [:'IF:IGRRHLq FIRE
RVFIILF:IBL. E TO INSURE PROPER IN'E, TFILI..FI"I"ION.
t CEI:;SI"IFY "I'HR"I"
::L: I I::11"1 FFIHII..IFIRR 14ITH THE REC!UIF.:EMENTS [:OR ON-L=;',ITE SEP.IERS RND HELLS laS; SET
FORTH E:Y TF.IE I"IU1,,I]'C:[PFILITY OF RNC:HF~.FRlaGE.
;-2: I I.IILL II'.~I:STFILL THE SY2;TEH IN RCCORDFINCE HITH THE CODES.
2: I Ut"iDERSTFIND 'iq"'IRT THE ON-S]:TE '::;EHER Sh"STEH i"lR"r' REQUI'~:E ENLRRr~Er,IENT ZF THE
RESIE:,ENCE ZS F.:EI',IOB, ELE[) TO ZNCLUDE 1,,If'IRE THRN q.
,
I .~NE t: F:IF'I::'L I I TO H
]: E;S';UED E:Y . .... [ L.,H'f E__ - ',,,',¢. 0
[] SOILS LO6
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR: *"7~)/~ L. L.,) ~
LEGAL DESCRIPTION: ~'" '~ /3 L
// ,,,¢¢ T ,P/4 &--.~ '~
SLOPE
DATE PERFORMED:
SITE PLAN
1
2
3
4
5
6
7
8
9
-~.-~-;~-~10
11
12
13
14
15
16
17
18
19
20
COMMEN~S'
WAS GROUND WATER
ENCOUNTERED?
~*O I,¥') e-- "~ ~ '¢'~ ~,,[ IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~' ¢~' _(minutes/inch)
.TEST RUN BETWEEN ~ FT AND ~ . FT
d//~f ' ' - ~* / 5~, ~0
CERTIFIED BY: /~/)~¢~ DATE:,
72-008 (6/79)
BOX 1369, STAR I{OUTE A ANCHORAGE, ALASKA 99502
844-7'714
7Z~ ~.
SIX INCH WATER WELL DRILLED AND CASED OUT TO The DEPTh OF
DRILLED at The RATE Of ~I9.00 Per FOOT.
I~. Tow. uL~ Ho~e~e.~ 344-3518
PROPERTY OWNER
195
DRILLER
WELL~ LOG:
Co4~ o~ ge.U.$ead.: ~22.50
MUNICIPALITY OF ANC'HOI~a,(~I~
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTIO~
AUG 3 0 lg85
RECEIVED
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLINg.
WRITE CHECK PAYABLE TO rAMPART DrilliNg WORKS fOR the SUM OF ~37~?. ~0
DATE.
BERN!F~_E~AOS Of RAMPART DI~ILLING WORKS
6ERVICI" CHARGEOF 1Vi% PER MONTH Wl~ BE ASSESSED ON PAST DUEACCOUNT~.
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
Parcel I,D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFOF:IMATION
Complete legal description
Location (site address or directions) /
Property owner
Mailing address
Lending agency
Mailing address
- Day phone
Day phone
Agent
Address
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Unless otherwise requested, HAA will be held for pickup,
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWA"rER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA ~21
STATEMENT OF INSPECTION BY ENGINEER
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 application 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[ndicated 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
Phone
Address (/~-¢ ~ ~ )~"-~-'/ /:¢',¢~¢/"~
DHHS pSIGNATURE
Approved for '~
bedrooms.
Date
Disapprdved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
The Mun, icipality 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 th is 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
Legal Description:
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
A. Well Data
Well type '~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
?
7 ¥
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~) ¢/~//,¢"O Driller ~(~,~4r
Cased to i (¢~ Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test d
Static water level
Well flow
Pump level1
SFPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot _
Absorption field on lot
Public sewer main
Sewer service line ,~'
g.p.m.
AT INSPECTION
MUNICl PALl I Y OI- ANCH(.II<AL~L'
ENVIRONMEN-rAL SERVICES DIVISION
g.p.~.CT 0 $ 1993
RECEIVED
; On adjacent lots _
; On adjacent lots ~/~..~
Public sewer manhole/cleanout I~//,~.
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed i 8~ i" ~ Tank size _ [c'~L~ O Compartments ~
Cleanouts (Y/N) 7' Foundation cleanout (Y/N) y Depression (Y/N)
High water alarm (Y/N) l'"///¢~ Alarm tested (Y/N) t4//,ff
Date of pumping E//~/~ '-~ Pumper t~, ," J'~/,~.
SI=PARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I 6) ~ _On adjacent lots
To property line ~ ~ Absorption field
Surface water/drainage i~ I O
72-026 (3/93)' Front LJ,.)-.~[2 ~'~ -0~.(2..( ~(~'L~. ~'_"[
Foundation ~ L/
Water main/service line ,/~ ~' O
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed i 0 ,
'~Length /--//¢2 ¢/¢t:¢ Width
Total absorption area
Date of adequacy test
'~/¢Water level in absorption field before test
Soil rating (GPD/Ft
~t
~'~. 6) Gravel thickness ~/p
Cleanout present (Y/N)
Results (pass/fail) "~
Peroxide treatment (past 12 months) (Y/N)
System type ' /
Total depth /
Depression over field (Y/N)
for
Aftertest ~'~ /
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Bedrooms
Well on lOt .,~
To building foundation ~/~
On adjacent lots
Surface water
Curtain drain
On adjacent lots ~ /OJ2~ Property line
To existing or abandoned system on lot
Cutbank ~ ~,-~44 (~ Water main/service line
Driveway, parking/vehicle storage area t/~
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
HAA Fee $ ,,~d30
Date of Payment i
Receipt Number o~_%~ ?,/
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
COIV MERCIAL'T STING & ENGINEERIING CO.
ENVIRONMENTAL LABORATORY SERVICES
Chemlab Ref.~ :93.4773-1
Client Sample ID :5/11MPE
Matrix :WATER
REPORT of ANALYSIS
HOSE E. OUTSIDE FAUCET
5633 8 STREE I'
ANCHORAGE, AK 99518
TEL: (907) 562-2343
FAX: (907) 561-5301
Client Name :TOBBEN SPURRLAND, P.E. WORK Order :70874
Ordered By :TO~EN SPURRLAND Report Completed :09/20/93
Project Name : Collected :09/13/93 @ 15:26 hrs.
Project~ : Received :09/13/93 @ 17:00 hrs.
PWSlD :UA Technical Director:STE~H~E~/C. EDE
Released By :/~~~'-'~.
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: STUART.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
Nitrate-N 1.7 mg/L EPA 353.2/300.0 10 09/15
* See Special Instructions Above UA = Unavailable
** See Sample Remarks Above NA = Not Analyzed
U = Undetected, Reported value is the practical quantification limit. LT = Less Than
D = Secondary dilution. GT = Greater Than
Member of the SGS Group (SociCt~ G~n6rale de Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION O1:: ENVIRONtVlENTAL HEALTH
CERTIFICATE OF INSPF_CTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE S~WER AND WATER FACILITY
264-4720
Application Date
1. GENERAL INFORMATION
August 13, 1985
(a) Legal Description (include ioL [)loci(, subdivision, section, township, range)
Location (address or directions)
.... ~.~4~ A3~in~_?r~y~, Anchorage, AK 99516
(b) App[ican~ Name Torulf Hofseth Const. 7~Dhone: Home ._..3~_~Y~.8_~ ...... Business Construction
Applicant Address 12431 Alpine Drive, Anchorage AK 99516
(c) Applicant *s (check one): Lendin9 Institution E]; Owner~builder ~; [~uyer ~; Other ~ (explain);
(d) Lending institution ................... Telephone
Address
(e) Real Estate Company and Agent NA
Address
Telephone
¢) Mail the HAA to the following address:
Tourlf Hofseth Construction Co.
12431 Alpine Drive
Anchorage AK 99516~3121
TYPE OF RESIDENCE
Single-Family[] Multi-Family
Number of Bedrooms 4
Other
WATER SUPPLY
individual WellE~ 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:,~J Public L~ Community [] Holding Tank
~: . Note: II comrnun~ty welt systel'fl, must have ,,w ~tten confirmation lrom the State Department of Environmental Conservation
: ~ attesting to the legaldy and status.
·
EejGfNEERI~IG FtRt"?I PROVIDING INSPECTIONS, 'I'EST~,~, FILE SEARCH, DATA AND INFORMATION
As¢4d~ ¢~ed by my seai affixed hereto and as of the validation (late shown below, I verify that my investigation of this t4oalth
A~-';J~or~y App~o'.,a~ shows that the on-s to water supp y a ~d/or wastewater d sposa system is safe functional and adequate
~¢~;e r~u~nber of bed¢ooms and type of structure indicated herein. I further verify that based on the information obtained
¢r¢~:; ~,e ,. ur ~c p:mty of Anchorage files and from my investigation and inspection, ti~e on-site water supply and/or
'~,~:.~wa~e¢ d~sposaJ system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
~r~ dixie of th~s inspection.
C'ons tr t~c:ti~g Engineers T~lenhone 346-2000
~j~e ~}~ ~r¢e ....... ~r ................................... ~- ~
, c~¢~7 ~.d~v Werner Lan;, A]chorage AK 99516
:~d ¢¢%5 .... -'.~ '¢~-~.~m 3 '~ ...... ~ ....................................................
~e .... ~:~ust !3, 1985
DHEP A PPR 0 VA~t;~
*r~,?.:. ,c? L;~ . .,o ,, ,,p/oval
CAUTION
,~.0.mc~pahty of /,ri(borage Department of Health and Environmental Protection (DHEP) issues Health Authority
certificates ,.~ased solely upon the representations given in paragraph 5 above by an independent professional
re2mtered m the State of Alaska. The DI-tEP does this as a courtesy to purchasers et homes and their lending
:."s:!,;~ons in order'.o salmfy certain federal and state requirements. Employees et DHEP do not conduct inspections or
date B.cdfore ~- 3ertificate is issued. The Municipality of Anchorage is not desponsible for errors or omissions m the
¢;~,~ioriel engm88~ s work.
Pa~.~e 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
^~ ~,~c~O~/,,G~HEALTH AUTHORITY APPROVAL (HAA)
tC~3~O?~fO~ut~,k¢~ ~C.[~OH CHECKLIST-FEBRUARY 1984
0~'.~ .,~ ~C ~O~ ~. 264-4720
Well Classificatio~'~ ~[~ ~ ~ ~
Well Log Present (Y/N) ~_~ Date Completed ~ -/-- ~0
Legal Descriptiol. l: L.~' "~ ('/ ~H¢, p~", E,...%"¢/;,
Total Depth [~' .'5' ~ Cased to
Static Water Level t (¢ 43 i
Casing Height Above .Ground ~ ~
Electrical Wiring in Conduit (Y/N) ___
Separation Distances from Well:
If A, B, C, D.E.C. Approved (Y/N)
Yield _
Depth of Grouting /~J ~'
Pump Set At f'~ I '
Sanitary Seal on Casing (Y/N) _ /
Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot ./O~ -'/-o
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~/~
Cleanout/Manhole f,.2 ~
~¢'~'~J¢(p~' ; On Adjoining Lots + I OD
,4- /'OO~ ; On Adjoining Lots .4- I DO '
To Nea'rest Public Sewer
To Nearest Sewer Service Line on Lot ~'~
Water Sample Oollected by ~- m~)v ,~ i Date
Water Sample Test Results ~ 4 Z / S .~ 4 CZ"~/~ ~ .
Comments ~/¢~ /~ ~ ~- ~ ~¢/-¢ ~ --
SEPTIC/HOLDING TANK DATA
Date Installed
Standpipe~ (Y/N) ~)/' I Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/~L/? ~// ~
Holding Tank Fligh-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line "/-/''~-
To Water Main/Service Line ---~
Course ,'~/~ '
No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~-- ~
To Disposal Field ~ /
To Stream, Pond, Lake, or Maior Drainage
Comments
Page 1 of 2
72-026{11/84)
rulf 3l f etl (g natruetinn
SF~A 3552 HUFFk4AN F~OAD
ANCHOI~AGE, AI-ASKA $~07
907~345-0844
August 20, 1985
TO WHOM IT MAY CONCERN:
As builder of Lot 5, Block 11, Mountain Park Estates, I certify
the well and septic system were first used at this location in
July 1985.
Sincerely,
Pauline Hofse -
TORULF HOFSETH (p.o.a.)
General Contractor