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HomeMy WebLinkAboutPRATOR BLK 2 W2 Municipality of Anchorage Page / of ---~'~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: --~f' ~ ~-~:)'::~ '~) PID Number: N~:~t? ~(~: ~/_~ Wastewater System:- ~New ~ Upgrade Addres~~ ~ ~b ~'~ ~/~-- ~A~.~/~ ABSORPTION FIELD Phone: No. rooms: Deep Trench D Shallow Trench ~ Bed D Mound D Other Soil Rating: . Total Depth from original grade: LEGAL DESCRIPTION ~.~ ~PD~s~. FL Lot: Block: .~ubdiv~ion: m Depth to pipe bottom from original grade: Gravel depth beneath pipe T°wnship:l Z ~ ~' ~' ~ I ' Ft. ~ Ft. Number of~nes: Distance between lines: WELL: ~New D Upgrade G~a~e~w~: ~ FL ~. Classificetion (Private, A,B,C): Total Depth: Cased To: . Total absorption are~: Pipe material: Driller: ' ~ . D~te Drilled: StaticWaier Level: Installer: , D~te installed: Yield: ~ GPM Pum~ Set ~ Ft. Casing Height/~ ~Ab°ve Ground:Ft. TANK SEPARATION DISTANCES ~Sep,~ a Ho~din~ ~ S.T.E.P. TO Septic Absorption Lift Holding Public/Private Ma~acturer: Capaqity in gallons; From Tank Field Station Tank S .... Lines ~ ~¢, ~ ~ t '~¢ Foundatio~ "'"~P °"" '** *: -~I~: IHigh water alarm at: Cu~ainDrain /~' ~ ~ 3amp Make_.~od~" Electrical Inspections pe~~ Remarks:~Ol¢e-/~ C/~>~C/ ¢0 ¢~'¢~ BENCH MARK Location ~d Description: Inspections performed by: J~ff~~ ~~ Dates: 1st ~I.~:~ ~, ~z~~ ~b, Department of Health and Human Services approval ~. 72-013 (Rev. 9/91) MOA 25 Permit No. .5 \~,/~' 4-O..~ ~ Page ~ of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ~,[ ///~- /'~LT_j '~/-~ T©,r-~ -5 UD.E,). PID No.: ENGINEER'S SEAL ~,,~,~¢. OF 4,4 ~ ............................................. . ........................................... ;.4 ........................................................................................................................................................................ e ~e~a~4e~ ~ 72-013 A (1/93) ' k%~%~ Permit No. -.~V-,/~ ~-~-~'~-~:~ Page Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ~./-~ ~L~_. ~/:~,AT'(9!:~ .~t?~ PID No.: ENGINEER'S SEAL Size ~ore 72-013 A (1/93) ' WELL LOG Date Drilled: Static Water Level Draw Down_ ~J/A '7/~ feet feet Gallons Per Minute Total Feet of Casi.ng Type Material Drilled: 0 feet to to o0~ ~+. to to tO tO HEFTY DRILLING 8540 AKULA DRIVE ANCHOFLAGE, AK 99516 (907') 345-0593 RECEIVED .SEP' 9 1995 Munic~pah~y o~ ,~ncnorag. e Dept. Health & Human Services MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940348 DESIGN ENGINEER:JAMES SIZEMOORE & ASSOCIATES OWNER NAME:HOSKEN BRIAN D & MARCI J OWNER ADDRESS:6931 R3~BBIT CREEK RD ANCHORAGE, ALASKA 99516 DATE ISSUED: 9/19/94 EXPIRATION DATE: 9/19/95 PARCEL ID:01709167 LEGAL DESCRIPTION: PRATOR BLK 2 W2 LOT SIZE: 61645 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 4 o 5 o THE ATTACHED APPROVED DESIGN. 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) . THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ~?-~7 ;k 6410 Switzerland Drive (907) 345-1572 James Sizemore & Associates Civil Engineers & Surveyors Anchorage, AK 99516 WASTEWATER DISPOSAL SYSTEM SPECIFICATIONS Wl/2 BLK2, PRATOR SUBDIVISION 1.0 GENERAL: 1.1 The scope of the project consists of installation of a 1250 gallon septic tank and a 54' long by 10' deep, deep trench drainfield. 1.2 Construction shall be as shown on the approved site plan and design drawings. Deviations from the drawings shai1 be co-ordinated and approved by the engineer conducting the inspections. 1.3 Ail construction procedures and material used to construct the system shall comply with Municipal and State regulations. 1.4 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading areas after the soil is compacted. Placement of topsoil and reseeding all areas disturbed by construction is also the responsibility of the homeowneer. 2.0 SEPTIC TANK: 2.1 The 1250 gallon septic tank shall be Municipally approved. 2.2 The septic tank shall be set level and shall be bedded as necessary to prevent settling or shifting of the tank. 2.3 Ail pipe connections to the septic tank shall be equipped with waterproof mechanical couplings. A cleanout shall be .installed within 5 feet of the house foundation. A double cleanout whall be installed within 5 feet downstream of the septic tank. 3.0 SOIL ABSORPTION DRAINFIELD: 3.1 The soil absorption drainfield shall be a deep trench constructed to the dimensions shown on the drawings. The 10' deep by 54 foot long trench shall be level. The trench shall be dug parallel to the contour of the lot. 3.2 Sewer rock shall be 0.5 - 2.5" screened gravel, with less than 3 % passing the #200 sieve. 3.3 Cleanout pipes and monitor tubes shall be 4" diameter and installed in locations shown on the drawings. The portion of the monitor tube extending through the sewer rock shall be perforated. 3.4 Approved filter fabric shall be placed over the top surface of the sewer rock. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation will be placed over the entire top surface of the sewer rock. 4.0 INSPECTIONS: 4.1 A minimum of three engineering inspections will be required during construction of the system. One after setting of the septic tank, one after excavation of the bed area prior to placement of the filter sand, and one after placement of the distribution piping. In addition to the three mandatory inspections it is suggested that prior to start of construction that the contractor and the engineer hold a site meeting to discuss the project. 4.2 The contractor shall coordinate with the engineer at least 24 hours prior to start of construction. PROBABLE IMPACTS TO ADJACENT PROPERTIES A) WELLS: The proposed disposal system is designed in accordance with the current 1994 Municipal Wastewater Disposal Regulations. The separation distances from wells on adjacent properties is greater than 100 ft., and the proper separation from the bottom of the trench to the ground water table is maintained; there should be minimal impact to adjoining property from this system. B) WASTEWATER SYSTEMS The size of this lot should minimize the impact on wastewater systems. adjacent C) RESERVED SPACE/SURFACE AND SUBSURFACE There is enough space on this lot replacement system and still maintain the radiaa between wells and the disposal system. to put in another required protective D) DRAINAGE The location of the disposal system will not interfere with any drainage. The area disturbed during construction of the system will be graded and sloped so as to not pond water. . ~,~,_~_~.." ~"..'"~'.,: ~ I Municipality of Anchorage ~F '"'¢~° : ~ a,~-¥_ ,~ I DEPARTMENT OF HEALTH & HUMAN SERVICES ~49~ I 825 "L" Street, Anchorage, Alaska 99502-0650 ~~~.~.~_~ so~Ls Lo~ - p~,co~T~o, T~sT ~X"Z... ~. ~- :.~ LEGAL DESORIPT,O.: ~ ~ ~/~7 . p~(/~ownship, Range, Section:~/~d~ ~ ~/~ ' - Y SLOPE ' SITE PLAN 10 WAS GROUND WATER ~0 ~"' ENCOUNTERED? S 11 L IF YES, AT WHAT DEPTH? pOi 12 E Depth to Water After 13- Monitoring? /v Reading Date Gross Net Depth to Net Time Time Water Drop /~[ /f 7-z.I -z_.~ z ~ ~-o~7,~ 14- 15- :6---..-.- ~_~ ,¢-~ 17 18 20 PERCOLATION RATE //~ 4-~(minutes/inch)PERC HOLE DIAMETER TEST RUN BETWEEN ~¢ FT AND FT COMMENTS PERFORMED BY: J ~' ~'~ [' -~--~'~¢')/¢~ ¢l CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 2 '-'-~ ~')~ ~ ~4~-~' 72-008 (Rev. 4185) 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 HAA# \'~- 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner M ~il.in.g,,ad ? re,,s~- Lending agency Mailing address Day phone ~ ~l'-~ ~J ~-.~, ? Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system, TYPE OF WASTEWATER 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 indicated herein. I further verifythat 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. Nameof F,rm, Address ~ ~ ~ ~~.~/~/~'~/~ Engineers signatur~~~~~~ Date DHHS SIGNATURE Approved for d Disapproved. Conditional approval for bedrooms. . J bedrooms, with the following stipulations: Additional Comments Date The Municilb~lity of A~8horage Department of Health and Human Services (DHHS) issues Health Authority Approval cei-tificate`s based only upon the representations given in paragraph 5 above by an independent profeSSional engin~,,~: registered in the State of Alaska. ThC DHHS does this as a courtesy to purchasers of homes and their Fending 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. 72-025(Rev, I/91) Back MeAtY21 Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 MUNICIPALITY OF ANC r'NVIRONMENTAL SERVICES DIVISION Health Authority Approval Checklist A. WELL DATA Well type Y]/gi~o~ '~'~ If A, B, or C, attach ADEC letter. ADEC water system number Log present Cf/N) Y Date completed Total depth ~ O ~ t' _ Cased to Sanitary seal (Y/N) DEC Casing height (above ground) //~-~ Wires properly protected Cf/N) ~ FROM WELL LOG Dateoftest ' 5~ /'~?~-~ ! Static water level "~ <~ Well production -,5 AT INSPECTION g.p.m, g.p.m. WATER SAIVlPLE RESULTS: Coliform ~ Nitrate Date of sample: /~/~/ B. SEPTICJHOLDING TANK DATA Date iustalled ~o,_~), 2-1/~rank size Foundation cleanout Cf/N) Date of Pumping (~, ~, .¢ '? f f /~. Other bacteria Collected by:, I / ~ ~y ~-'(~'"/'~ Number of Compartments ~ Cleanouts (Y/N) )/ 'y Depression (Y/N) /L/ High water alarm Pumper C. ABSORPTION FIELD DATA Dateiustalled c~//_~p -~'2-[ )?~tL'Soil rating (g.p.d./ft2 orfi2/bdrm) f~/ ~' System.type 0C:~>/i~ f~/~?~ Length ',-~4- ~,~' Width '~-f ~ Gravel thickness below pipe '~ Total depth -/~ / Effective absorption area ~57,v5 Monitoring Tube present(Y/N) Y Depression over field (Y/N) /L} Date of adequacy test /~1-~ ~ °'"~ ~ ?~L-~ ~ ~ bedrooms Results (Pass/Fail) For Fluid depth in absorption field before test (in.); Immediately after Fluid depth Minutes later: (in.) Absorption rate = __ gal. water added (in.): g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date D. LII~I' STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size itl gallons "Pump on" level at* *Datum "Pump off' level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tamk oil lot ] ~ ~ / Absorption field on lot ] ~_) ~ [' Public sewer main Sewer/septic service lille ~> ~) / C'q' ~ · On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Foundation __' Property line ) (~_) f Absorption field ff~,).5;~ / Water main/service line 5¢ (' Surface water/drainage /(,'/l~)ff ~.w Wells on adjacent lots ,~ [' 69(¢~ __ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain Water 2nain/service line __ Driveway, parking/vehicle storage area -'>'/'CPC) Wells on adjacent lots F. ENGINEER'S CERTIFICATION Icer ....... tify that I have determined thrufi~eld map ectlons and revtew of ~klumctp al records in conformance with MOA [t~ guidel~s in effect on this date· - ~ ' ~a ~'x ........................... HAA Fee $ ~, 6~ W~ver Fee $ Date ofmayment_[ ~/~ [~, Date of Payment Receipt Number ~2~ ~ ~&~ Receipt Number Rev. 8/95 OSS: haa.wk.doc