HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 6 LT 15 GP~.ATER ANCHORAGE AREA BORO)-~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION ~/'/~ ~/~-~-d~ LEGAL DESCRIPTIONJ-~7~/~'/----J~..~,/~'/~J-~--~7~'~'-~'~-~/ SEPTIC TANK: LIQUID CAPACITY _//~'~' GALLONS. M A T E R i A L ~_,~/U,~,.,~.7~-~ ~,~,~.,~j/- NUMBER OF . COMPARTMENTS INSIDE LENGTH ~ I,,,~.jj INSIDE WIDTH ~'~ / LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PiT: NUMBER OF PITS / OUTSIDE DIAMETER LINING MATERIAL ~ .~) ~,~,.-~..~,.,~ OR WIDTH /~ ~' " LENGTH /L~ j' . . , DEPTH ~' / .°,STANCE FROMBU,LD,NO FOUNDA,,O ? NEAREST LOT LINE ~---) ~'' ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELt ~ ~ FOUNDATION , _ , NEAREST LO_.~LA~FE ~ OF LINES -'DEPTH: TOP OF TILE TO FINISH GRADE ~ DEPTH OF FILTER MATERIAL BENEATH TILE. .IN. ABOVE TILE WELL: Typr~,~_~_~ ~DE~ZE-~TH~:~ ~ DISTANCE FROM WATER ,BUILDING FOUNDATION. ~ SAMPLE ~ , NEAREST NEAREST ~ SEPTIC /~-'~'SEEPAGE ~ ~ OTHER ~ LOT LINE / , SEWER LINE /--~'~TANK , SYSTEM , CESSPOOl , SOURCES DISTANCES: DIAGRAM OF SYSTEM GAAB-HD-2 GREATEY-"ANCHORAGE AREA ~"'gROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT Case N o. ~ ~ ~ NAME OF APPLICANT ~///1~/! ~_ [,j~)! g~D.t RESIDENCE ADDRESS ~ c~ ~x~ ~ LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCE~ THROUGH ~-- , SEEPA[~ PIT , DRAIN FIELD TO BE INSTALLED BY_ MAILING ADDRESS,~4~)2-- ~)Z2~2'c~ ~X2C..............~HONE NO~?~3~',~? LOCATION OF INSTALLATION. ~ ,OTHER PERCOLATION TEST RESULTS ///~-Z//J~)~/)~// ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS ISTO SERVE AS ~r)~, ~-~(L:~C)~) , PERIVilT TO INSTALL A AS DESCRIBED BELOW· SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE.,/~)COL~-~ TYPE ~c~Fv~e-/O'T- SEEPAGE AREA DIAGRAM OF SYSTEM DATE ~,/~'~/~-~Z~ APPLICANTS SIBNATURE ..... . MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, b~subdivision, section, township, range) Location (address or directions) (b) Property owner /~LA£E/~ (J,~ ~-1 F-. ¢~. ~. Telephone: (home) Business Mailing Address 7~.(~C ~c,~ /c/,G6/~; (c) Lending Institution Mailing Address ~ (d) Real Estate Company and Agent Ad dress ./~j//~ Telephone Telephone (e) Mail the HAA to the following address: (or check here,~ if hold for pick up.) List contact person and day phone number below: 7z-/3 I/ 2. TYPE OF RESIDENCE Single-Family ~' Number of bedrooms ~ 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 th legality and status. 4. SEWAGE DISPOSAL On-siteX Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION, As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is Health Authority Approval shows that the on-site water supp~dz,-~ater disposal system is safe, functional .and adequate for the number of bedrooms~~ ~ted herein. J further verify that based on the information obtained f?_~4~u-~f ~d from my investigation and ~liance with all Municipal and inspection, the on-site water suppl~ State codes, ordinances, and regula Name of Firm Address Date -~/i//~c/ . ~-...¢} Engineer's Seal - / · .': 6. DHHS APPROVAL Approved for Approved Disapproved Conditional Terms of Conditional Approval Note: The well for this property meets existing State and Municipal Codes. There are nitrates present, however, it is suggested that periodic testing be performed to insure the wells continued suitability. Nitrate concentration is 6.2 mg/1. EPA maximum concentration is 10.0 mg/1. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 724)25 (Rev. 7/88) Back Page 2 of 2 · , A. WELL DATA Well Classification ~i%I~R'T~ MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Well Log Present (Y/N) ~,,! Date Completed Total Depth ,/,~c/'< Cased to ~57.J' Depth of Grouting Static Water Level / ~E)' Casing Height Above Ground ,-~" Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot lO0 ~ + To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~ J ~.P~Z~.V' Water Sample Test Results ~ ~, ? /~'M~(~ ,/ Comments "~- /.~¢ l/ t:.//¢ ~J I 3' if A, B, C; D.E.C. Approved (Y/N) Yield O,, 7.¢ ~f~ 5(" Pump Set At ~' /.~ ' Sanitary Seal on Casing (Y/N) ~/ Depression Around Wellhead (Y/N) i~ ; On Adjoining Lots / JO ' + ; On Adjoining Lots /OO' + To Nearest Public Sewer Cleanout/Manhole ~1//~ ;Date B. SEPTIC/HOLDING TANK DATA Date Installed / ~'70 Size Standpipes (Y/N) Y Depression over Tank (Y/N) PumPing/Maintenance Contact on File (Y/N) ~/~ Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well [ ~0~ ~ To Property Line ~_~O' + To Water Main/Service Line ~X(/~ To Stream, Pond, Lake or Major Drainage Course / Comments (O00,.~ct/ NO. of Compartments Air-tight Caps (Y/N) 7' Foundation Cleanout (Y/N) / Date Last Pumped '7//~/~ ~ ;for i\1 lA Temporary Holding Tank Permit (Y/N) To Building Foundation <~'-~ ~ ~ To Disposal Field ~ ~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata_ Date Installed . Width of Field _/~ ' X' /~' X'~' Square Feet of Absortion Area _~_~4 .:~ Depression over Field (Y/N) _ ~./ Results of Last Adequacy Test _ ,..('~ ?-/)" ,~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well //0 ' '~ To Building Foundation ~ '+ Lot./~ ,/A To Water Main/Service Line. To Stream, Pond, Lake, or Major Drainage Course ~ To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design _ Length of Field I6 ' 4' /~; ' ..~ Depth of Field_ /6r k' /(~/ A- ~'' Gravel Bed Thickness ./~( X/O' ~, ' Statndpipes Present (Y/N) . Y Date of Last Adequacy Test .. '7////~? To Property Line _ ~O ~ To Existing or Abandoned System on ; On Adjoining Lots ? ~ ~ To Cutback (if present) J(J,/~ D. LIFT STATION Date Installe~ Size in Gallon "Pump On" Level High Water Alarm L Tested for Meets MOA Electrical Comments at Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Per I certify that inspection. Signed Compan~ Date MOA No. !d Bedroom checke( Aga~st HAA Request** Iied, or conformed to all MOA ~nd HAACg~ Date of Payment_ Amount: $ 72-026 (Rev. 7/88) Back Page 2 of 2 Receipt No. _ Waiver Fee: $ Date of Payment s in effect on the date of this Engineer's Seal CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~'t2.'o;,~.;.I,[['~-~ FEDERAL TAX ID # 92-0040440 ~/C,-~,.=~ALYSIS REPORT BY S~MPLE for Work Order ~ 14694 Client Sample ID:L15,1~i'6 PROSPECT }[EIGHTS ! Client }lame : CORWIN & ASSOC PWSID :UA Client Acct: CORWINP Collected Jun IO 89 @ 12:0o his. P,O.~ NONE REC'D Received JUL 10 89 ~ 12:30 hrs. Req $ PreserYed with :AS REQUIRED Ordered By Analysi~ Con,plated :JUL 10 89 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE I)CORW!N & ASSOC Released By : ,_ ,~: ,f 2) Special Instruct: Chemlab Rai ~: 6183 Lab Smpl ID: i ~atrix: WATER Allowable Parameter Tested Result/Units Method Li~ts NITRATE-N 6.2 mR/1 EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY J. KRESS. 1 Tests Performed ~ See Special Instxuctlons Above UA~Unavailable ND~ }lone Detacted "See gamplo Remarks Above NA= Not Analyzed LT=Loss Than, GT-Greatez Than DATA :. -LOCATID/I OF ~IEL~ (Legal Description): ~IELL DEPTH: }3~ ~ FT. CASING: DATE DRILLIIIG CO:4PLETED: .-STATIC :.lATER LEVEL.(Top of' Casing): FT DRILLER: FT SCREE~I: i c)0% ' l Tine· = Elapsed Time Sincel . pumping'Sta?~ed/ J Depth to S~opped, Hin. ,t~a~r, f~. I o 10 I /~' :05' 2U 35 5O 55 " 60 (! hour). .120 (2 hours)l 150 I 180 (3 hours)l 210 I "' RECOVERY , J fi t0 1S 25 4O 5O 55 60 (1 hou.S) l~J (/ nuucs)i I$o' Orawdown/ J Pumping Recovery Race, C, PH Start "Il /~ · GALLON GALLONE METER THIS TOTAL PER TIME READING PERIOD GALL(: MINUTE SEPTIC TANK FIELD DEPTH DEPTH INCHES ' MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION + 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER ': I PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE MAILING ADDRESS D, LENDI~I~TITUTIO~ ~ PHONE I MAILING ADDRESS ~. ~EALTO~/AG~NT MAILING ADDRESS 5. LEGAL DESCRIPTION ;TREET LOCATION G. TYPE O~ RESIOENCE .... NUMBER OD DEDROOMS [] One [] Four ~ SINGLE FAMILY ~ Two [] Five [] MULTIPLE FAMILY Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM /N~ INDIVIDUAL/ON-SITE** PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth'-(at~ach Io~ if available.) ~)r~ )0~;,. **if individual/on-site, give installation date ,/~?/ If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INspEcTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) ' THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: ' 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED [~}PUBLIC UTILITY ~, ~ ~ Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: }' ,/'c~'(~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/H°lding Tank IAbs°rpti°n Area ISewer Line INearest L°t Line Absorption Area to nearest Lot Line 5, COMMENTS [~APPROV ED FOR "~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE By (Title) LEGAL DESCRIPTION JML John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907.279.8056 N~W PHONE NUMBER 276-41 13 SOIL ABSORPTION SYSTEM TEST TELEPHONE: DATE OF TESTS: ~,~0, OF BEDROOMS: ~ RECORDS ON FILE: TEST PERFOrmED iN ACCORD~,~CE WITH ~L STANDARD PROCEDURE ACCEPTED BY MUNICIPALITY OF ~YCHORAGE, DEPT. OF ~TVIRO1.D~¢TAL QUALITY ON ~ 7gTH THE FOLLOWING MODIFICATIONS: SURGE CAPACITY: SOIL ABSORPTION SYST~,[ (SAS) SEPTIC TA~TK PLUS SAS ABSORPTION RATE AVERAGE 24 hrs O,T.~"~p~ + 0 BSERVATIO~S: ! STEADY STATE 4~,,r-~ '~ , I RISE NOTES: ~. 9/zo/?Z JML DEPTH BRT,OW METER READING GALLONS PUMPED TIME ~.F~CE (, SA~50~S ) ( W~ ) --; -.-. ~L//~~ ~/?~a /~o /~ I John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907.279-8056 EXISTING DRAIN FI'm.O TE~T ~- PERCOLATION ADEQUACY REFER~CE: Y~ o~ ~/~4/rx o4/ C~v~ ,; ~C~,~Q ..... DATE 9/1~/?~ PERFORMED BY: ./~ Z~e LEGAL DESCRIPTION: Z~r z~- z~/~-~ .~.~ ~ DEPTH B~OW METER READING GALLONS PUMPED TIME ~EFE~E~CE ( ~ALLONS ) ( NET ) .-.. ~ .~' 7~~ ~Z ~o ~o ~ :~ ~" UNSU BD!VIDED 4 5 DTI001338 ADDITION NO ! i 90-21