HomeMy WebLinkAboutALPINE TERRACE BLK 3 LT 80
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C�eveiopnent Services Department
Building Safety Divisicn
On -Sita Wcter &Wastewater program
4700 Sragaw Street
0t n;
?.0 Bax 196650
Mark 6egich
Anchorage,,Al" 99519-6650
Mayor www muni.arn/ansiTE
(907)243-7904
pump Installation Log
Well Drilling Permit Number: SW_ Date of Issue: _
Parcel Identification Number:_
Legal Description Property Owner Name & Address:
/-A L P1146 T e R (SIG_ '� ,✓llr�u�zL
G-3 _s�?
pump Installation Date:
pump Intake Depth Below Tap of Well Casing: e/Ofeet
pump Manufacturer's Name: �2 j< J- ,,j
Pump Model: 7 'FL11V7 505 oZ3
Pump Size hp
Pitless Adapter Burial Depth: 8' feet nn
Pitless Adapter Manufacturer's Name: ✓:�'b tis
Pitiess Adapter Installer: n) ✓+
',Veil Disinfected Upoa Completian?'�es No
Method of Disinfection: C L, L J . 1 0
Comments: [�
Pump Installer Name: �� �1�Laf Y\
All
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installaticm.
--�,
M-unicipalit-v of Anchorage
• �`
Development Services Dep�rrent
Building Sefety Division
On -Site Water enoF WastewCAter Progr2m
4700 South Br rgaw
P.O. Box 195050 Anchor -Coe, AK 99519-5550
wwwCi.cncho naae.ak.uS
(90 a!) 3-44�-7 904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel 1. D. 0 / ,S+ - 2 � 3 -- / /
1. GENERAL INFORMATION
-7 f I ;"i'
ExP1rGtion DGtts:
Complete legal descripticn
occ:tion (site Gdd-recs or dirc;Ctions)
C' lrr cell i ope(- o t,Aj r-j p r I.S
i
Lending agency (A'I k* -,,,:.,:.,,..
J .
Mailing address
t c1 ESt2te Ae n t ;., ;
4/y��e
Mailina , d dress
L
U� leS ol"3 evil e req( est'ed, I ', Al hic-ld y
2. NUMBER OF BEDROOMS:
3, TYPE OF WATER SUPPLY.: TYPE OF WASTEWATER DISPOSAL:
Individual Well '
ndlvidual On-'--i:_ }C.
IndividLICa1 VV2-t,'i- ,'rl!'Ji' �id- 12I Holding t2nk
Comm II ! 7lin`aty ClCr.`.w o,. o I kI! Su lily OI i sice i
Public VV2ter Sys:: m r 1 Public SE::'Ne,
T 7 - , .-y _
i ne N/11uni-iialii ,^_ n �,„r _,. -- -' _ ,- ;� S �, t�:=
FF i �.� . f--.. �; n+• r'V� ..� ►+ + � v .+ ! `1 .� ..-, f r �` to � � (ry 1i j] ` r �\ r" .-� ♦ 1 i! �(^�-' I J�JS�+
V • �T `I i !-�'.k f'Vi IL.I I Ga.. v ai { VtV V 1 ! •�... a 4 Ls . 'f vwr+ ..e5?,f i 1Lft kl (D`./ D) J v��...%4 ✓ ^ i V� 1 i.� / ♦�� ✓+f
AC;Crc-,V l (1 ►`AA.) bc� .d c ni'�` upon r'�� r�'� "� �:� "�� =" in c�rGgr h 4 GV an IriCe�`��`� �`i �(OieS` QnGl C;�t>�;
t Z.-sJk %•tea ^ .... ;•.. `�f'w, i F a ID
. t.•Vi �F � 1 v :e t
ncineC, reQlSiereo In the State of r,lGska, Ce. C':Ci ; ith Authority Approv l 3r e re;:uired for the transfer C
F
ill (-except ertitiven so0u 0S} roe �rO e IL- cc�,f�n by - _ nglc-7�1 ;1i`r' Oki- ii: v°FicS C:`��IctZ_, ui c`?.OSGI cridaCr
• r. \ i 1 i r .� j L^ r.
� IIJGiIy 4VS?e rrl. fiD 1 0 IstiuS l lAA,s UCOri reou Si C r�0r o`r'�"- ::ram, Ce 'L]i,ca' 0i I- .�.,,it i r,ut,1;Gk i -y r',DPr0 <n �
^
1fr-. id for 90 days from I, 1`�I- date r'`f issue 'Cr ►'� "F 1_ ies s � er: y = n i\i^'f (� (-^� (_' t[, �1
e.• Ld F w tie 1.J r U 1 t . f .,,,. �... L� '% `. ►., r k s c L v r V v v 4i Y Yt �w `{ 3.,,/ i `•~i I v y ::vim
R jCLi-. I-^ S+e results. ; V `e r-ffic :s\es f 1 Ia`f i ri I eiQcz- U„w � v r ,'r.+ p V i icd oI u,ram+ 1, ur!e ^ •- h � i 1 -.. vim. r'` ( ^
r, _ _�. _ _.. ,� ► �1l�: t vcll0 lJ�.�,r �.iil
../ei" ^^+- r'= I 1F0 r '7^ ^/ I ' •-\ ... J C....,.... 1' E t r" public Yv ,I�r �'�'� l=, t. i r'.•
� ii�;L.�.w�',,..a Cii, \ t (, /.-�"'r ?�I p��' r!iG �'--'� ! �+. � >~ vf^.�{ J-' ^ S ^` w �..4
(j j )''+ Y ice. t I L� ! G I ,..i ( `.� ..+. r..i i 4.., ail ... ! r... 1..) r !� r v , i ` C
I,d! I l.2 1 1 I t .' t
Ciz� ��'c c p :e
i to l� re; �.,..:� I ,c .,ny ►1 r s ��Vcrrt,
.. 1 .. ;
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my se.i (alffixed hereto and Calls of the v(alidcaticn 012-te shown bed I verify -1-h-t mv
I L d inveSztiQaL1(Dn,
based on procedures Outlined in the He2ith /uthoriti Approval aGuidelines for this applicat
ion, :shows that the on -
Site water supply and/or wastewater disposal system is(are) safe, functon-1 and adequate -c r the number 0�
Z-, 101 L I T
bedrooms and type o-F structure indicated herein. I further v;E,�,ri-I'V that bal'sed on the inform'2110111 obtr--Ined from the
Municipality of Anchorage files and from my investioation and inspection; the L on -site water Lt;r supply 2-MCl/or
wastewater disposal system isklare'� in compliance with (-:Ili applicc-3-ble Municipal and State I I L t code-,.-,-, ordinances.
and regulations in effect at 'Lhe "Lime of Installation.
dame of Firm r— �a I-0a 7_/( c
Phone
41
A d, d r e s s C.
Encineer's Prated Name Date
5. D%':.Z;D SIGNATURE
ppro7)
oerrooms.
ved f7cr
D i s 2 p p 1- o v r;
Conclitl'onP1200rovad fb le dronsvvith-=_
S.lcul
osniIlan:
A t_ I Comments
o'
2 7
NJ
ALL�
H4, -t Maintenance- Alkareements
C] V I S 0 ry Suppiementca-1.1 Engineers Report
4
( I-N � f
E"
D-te: C-
n
Muni cipality of Anchorage
Development Services Department
Bu;ldlng Safety Division
On -Site 'Water & Wastewater Prog.rart
4700 South Bragaw St..
P.O. Box '196650 Anchorage, AK 99519-6650
wwvv. c i - a n c h o ra q e. a k us
(907) 3,183-7904
HEALTH AUTHORITY APPROVAL CHECKLI"
. T
Leg-1 C)ncorip t i, o n - f/1) Paroc al I D: 0C 2 Y 3
A. WELL DATA
Well type. rvk If A B. or C provide PVVS1D # V, /1.
Weli I og (YIN* __A-1
Dcatc-wl
Sanitary seal (YIN ) Y S pr,�Iperly protected ("ON) ......
Tot-c-i! depth IA -
Cased to Casina height (abc e gro ri� Z
F':�OM WELL LOG
Da te -D fl' lest
Static vva',:ar level
Well production
WATER -'E3,A'_\MPLE R,r_-_SLJLT
A i I IN S P E 10 IN
'g-P.M.
C a TO F rl coionies/i 00 mi. 1'6L":-�
y. 7�_M
tb7c 'eCLOererlr0_ colonic CDC rnl_
Arsenic-
_
rn. ./I. D_t'Z of simply: 'q
_Z3,010 2
)4.e,,-
B. SEPTIC/HOLDING TANK DATA 14
Tank Tyne/Material Sep etc 60 0"-A C I- e- Ae Date installed
Tank size Z S-0 cal, NumbeF of Cornpartments
Foundation cleanout (Y/N) N Depressicn over tank (YIN) Hqh wat-er alarr� (Y./IN",
Date Of primping Pumper v A:> R0
C. ABSORPTION FIELD DATA
./ft2 �2
D'L,e installed 19 6S Soil rating (g.p.d or L /bdrm) A
P7F
L
Length 6,( /1 I< Wi d t h ft. Gravel bek--w/ pipe 6-(1-) L--, '11
Total depth ft. Ef. absorption area t4n ft' Monitoring tLibe "*7'
DeP_res,--ion over field AJ
Date of adequacv test /0 Results 'Pass'Faik /I cc Ej-
.1 r-cr bed
, t�",
Fluid depth in absorption field before test in. Water a d d,%c-- d -7 3 Z g - j.
C14 Nel�-v depth 6'7- 1 in.
Elapsed Time-200 min. Final fluid C e;D t h 'Y 9, �5- i n. >:7
Absorrtion rate --
g. p.;j
Anv I-e uvencation trim atmen t 'past 12 mo.) 'Y/N type)
Y L L le_r) C> cic.t/_)
if y 7.0, give date Ail
t-(� 44 1 t-e /10 (:Z /),' nz Lv Cf, /0
C, m ty S ce
L.IFT STATION
installed
'Put-np on," level at in.
Daturn
H.- SEPARATION DISTANCES
l.ti i ri a a a r is it i i7`' i
"Pump off levie--! ait- HK 4 ri ai-:3rn- ievel c,---Z'
Cycles tested. a -
SEPARATION DISTANCES FROM VVELL ON f-OT
��eptfc tank/lift station on lot 11,671
Absorption field on lot to (5
Pdblic: sewer main
11-1k
,,.;n adjacent lots, *a 5
Or, adjacent leis
Plic Sewer ry"
Z,91 I ol-iding tcll
Sewer /lstept;�c, service line > an k 33EPARATION DISTANCES FROM ON LLOT
Building foundca:flon 9 Property !iF!c- 1�—,
`Ah- a r main
VVater r
-:3 Jr
Able-lis on adjacent lots 105,
SEP RATION DISTANCE FROM ASSORT--7-10N I LOT Ly
T0-
TDroptelt line Building found-tion 7VV-Itnt,
'•A/at-ear Service line wcate:
(Z
cl: s o n a d *,a Clr-z n t 1 cTcz
Cur-t `- drain LO j9/,)
('%.*OMW!ENTS
chine- e 7`-Ir-ln e 14-cn
�- r& /-n c in,,- 74r-t ---I -,
�>e J�-) -�- ' 9 f /�c,, C -e , 4 -e
C�- ENGINEER'S CERTIFICATION kle, J/n lclt(5,102
-ertfify that / have defen-nined throe-igh field inspnect 0 17 S C, 3 ri
T Municipal records
Jett
t'OvieW of that the above syste!-Ds are j,-, A4.%---
06000.000 to tr,
co-inform.-Mce 1with MOA HAA guidelines in effect (--)n this r,Pte-, !i V/
s.
Engineer's Printed Name 1 e� -10ro- AV
Date 0,- As zoo
HA.,A Fee -7
D.-7-je of Payment
. � ipt Number� i � � __
(Rev- 12/011)
Date of Paym-ent
Receipt Number
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)
(b)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions) . r
Applicant Name ~0.~ ~u~k5 Telephone: Home
Applicant Address
~q ff ' '715q Business
(c) Applicant is (check one): Lending Institution [] · Owner/builder []1"'Buyer []; Other [] (explain);
(d) Lending Institution LM~,>-f-~
Address ,400 L,~ -~"~'F
(e) Real Estate Company and Agent
Address
Telephone
Telephone
(f)
Mail the HAA to the following(..~dress:
TYPE OF RESIDENCE
Single-Family [~Multi-Family
Number of Bedrooms
Other
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.
4. SEWAGE DISPOSAL
Onsite [~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 (11/84)
Page 1 of 2
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 this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequ, ate
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 of this in~spection. . ,/,
Name of Firm O~'o~.c~, Telephone
Date 30 d?r,'l:
Enginf~er's Seal
Approved for
Approved
bedrooms by /l,
Disapprove¢
· · Condition~a;._~
Date
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health 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 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
MAY 0 9
Legal Descri~,~Tg,
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth
Static Water Level
Casing Height Above Ground
.Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
1") f' ~ ~/O.~-. If A, B, C, D.E.C. Approved (Y/N)
I j~ Date Completed
Cased to
Depth of Grouting
Pump Set At ~'
Sanitary Seal on Casing (Y/N)
~ Depression Around Wellhead (Y/N)
I
· On Adjoining Lots /00 ~
! '
· On Adjoining Lots
To Nearest Public Sewer
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~//~
Cleanout/Manhole /q/~ To Nearest Sewer Service Line on Lot
Water Sample Collected by /. O(;~,r' ; Date ~(~
Water Sample Test Results ~-u,.~ ,.~;~, .Ti~_ ¢
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed / ?b$
Standpipes (Y/N) U ~
/
Depression over Tank (Y/N)
Pumping/Maintenance Cc ntract on File (Y/N)
/
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding 'Tank:
To Water-Supply Wel /~)O t
To Property Line ~
To Water Main/Service Line Course /~O ~ '/'
Size 1,~50 'P ~'~
No. of Compartments
Air-tight Caps (Y/N) y ~,~ Foundation Cleanout (Y/N)
Date Last Pumped ::5' ' I -
/N/A ;for --
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Iisll®sal Field
Te Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field LutA.
To Building Foundation
Lot .
To Water Main/Service Line
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well j ~.1
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)'
Date of Last Adequacy Test
; On Adjoining Lots
To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course . ,/OO f
To Driveway, Parking Area, or Vehicle Storage Area ~)
Comments
u
To Property Line ~0 ~'
To Existing or Abandoned System on
Date Installed
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
** Check Pe~rr
I certify
Com
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
tted Be/m Rating Against HAA Request **
;ire ch~d, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
¢~"'/~-'~' "~ ~' Date 30 (~Sf'~[! ~6~f¢
IN"qlCE ~ - 013 813
"/~ ~ ~~ CLEANING SERVICE
~ ~ ~"
P.O. BOX 112688
Job Address
PHONE 345-2513 ANCHORAGE, ALASKA 99511-2688
ROTOR ROOTER SERVICE CALL HRS. (~,
STEAM THAWING HRS.
TRIP CHARGE HRS.
OVERTIME CHARGE HRS,
ADDITIONAL LABOR CHARGE HRS.
PUMPING SERVICE ///~/~O1~(GAL) HRS
HYDRO-JET SERVICE HRS
PLEASE PAY FRGM THIS INVOICE
CUSTOMER ORDER #
TOTAL
TOTAL FOOTAGE CLEANED OR THAWED BLADES USED
PROBABLE CAUSE OF STOPF~AGE ~~A. (~") J~
APPLIC 'iT FILLS OUT UPPER HAL' JNLY
Prop~, tyOWn6r Authur F. & Jean M. Johnson Phone
385--0793
Mailing Address SR Box 2392, Anchorage, AK. mpCode 99507
Buyer Joseph P. & Judith H. Burroughs
Address ~ Zip Code
Lending Institution Alaska Mutual Bank (Benson Branmbl~ Phone
[~R~}l;{]~,.~r;~ 00 }l< .... z,p Code 99509 274-3561
Address
Realty Co.&Agent Associated Brokers Thc. Phone
Lof~se D. Campbell 563-3333
Address ~i.~ W ?Rt:h dl Anehnr~[~_=
Legal Description L8 B3 Alpine Terrace
Street Location ~.1830 Circle Dr['.
Typ.e of Residence
3~J[ Single Family
[] Multiple Family No. of Bedrooms
[] Other
wate, Su,p~y Well Drilled 1965
ATTACH WELL LOG. A wetl log is required for all wells drilled since June 197,5.
_.~ ~nd~v~dua~ NO log available
[] Community For wells..ddlled prior to that date, give well depth (attach log if available).
[] Pub,cUt,~ty Depth is 43fL
Sewer Disposal
~] Individual Year Individual Installed: ~-9 6 5
'~ Public Utility When Connected to Public Utility: _I~./_A_
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time '~ Time
Date Date Dat,~e Date
Inspector Inspector Inspector InspeCtor
/\
Field Note~ , DEPT.
( ) DISAPmOVED
( ) CONDITIONAL A~ROV~
w ~
Soils Rating Date ~wer Installed Well To Absorption Area /~ 0 ~ Well Log Received
/~ ~ Well to Tank /'~ '7 Septic T~k Size
72-023 (3182)
STEVEN A. JOHNSON
P. O. Box 76
Chugiak, Alaska 99567
(907) 688-3085
August 2, 1983
Arthur F. Johnson
P. O. Box 2392
Star Route
Anchorage, Alaska
99507
Re: Septic system adequacy test results
Dear Mr. Johnson:
Transmitted herein are the results of an adequacy test I performed on a
septic system serving a four-bedroom residence located on Lot 8, Block 3
of Alpine Terrace Subdivision.
Existin~ System Design
The system in service at the time of this test consisted of a 1250 gallon
concrete two compartment septic tank and a concrete ring seepage pit.
Four-inch diameter cast iron pipe was used in constructing the system.
The system was installed in 1965.
Adequacy Test Results
Adequacy testing was begun on June 19 and completed on June 20, 1983.
During the course of the test, 1600 gallons were added to the septic tank
at a rate of 4 gallons per minute. The fluid level in the septic tank
was monitored as the test volume was added.
Based on my measurements of the fluid level in the septic tank and the
rate at which water was added to the septic system, I conclude that this
septic system at the time of the adequacy test:
has an absorption rate in excess of 200 gallons per
bedroom per day;
August 2, 1983
Arthur F. Johnson
Page 2
is capable of absorbing 265 gallons in 49 minutes
which is equivalent to a short-term surge rate of 5.4
gallons per minute.
Thank you for contacting me regarding your adequacy test.
you have questions.
Please call if