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
