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Home My WebLink AboutBENITO BLK 1 LT 5 GP-'tER ANCHORAGE AREA BOROI~""-I HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-::511 N? 678 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATiON__./T~Z:/Z SEPTIC TANK: MAILING /'/ /- ,~ -, ,'~ b? ' LEGAL DESCR.PT.ON ZZ"/,'<:: ./¢Zt-"V DISTANCE FROM WELL_ LIQUID CAPACITY GALLONS. )"/~,,. Z' ... / NUMBER OF ' ' COMPARTMENTS MATERIAL. '~/ LIQUID ,5::-~ir/d ,~'/i z' 2 /~ y :~ ~,ug p ~ // INSIDE LENGTH __ INSIDE WIDTH ............. DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: / / NUMBER OF PITS__ '/ OUISIDE DIAMETER__. OR WIDTH ,~"(' ~ ..... LENGTH '~'~'' , DEPTH ~ DISTANCE FROM WELL~ BUILDING FOUNDATION NEAREST LOT LINE (~/ /O ~://J'/ TOTAl. EFFECTIVE ABSORPTION AREA (WALL AREA).__ ~' y~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELl. NUMBER OF LINES ABSORPTION AREA ...... FOUNDATION_._ D STANCE BETWEEN LINES NEAREST LOT LINE__ TRENCH WIDTH ___. TOTAL LENGTH OF LINES__ ___IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAl_ BENEATH TILE IN. ABOVE TILE q¢ ' ~).~'/]Z //~ ' DISTANCE FROM WELL: TYPE ¢ --' DEPTH BUILDING FOUNDATION / /' '/"? / NEAREST SEPTIC , SEWER LINE , TANK /_~' , SYSTEM LO[ LINE DIAGRAM OF SYSTEM WATER SAMPLE 1~' ?6/Z Y NEAREST OTHER CESSPOOl ...... SOURCES DISTANCES: DATE APPROVED_ tt EAL~,,AUTHORITy/ GAAB-IID-2 GREATEI, 327 Eagle Si. NCHORAGE AREA III,,AL FH DEl ARIMEN F Anchorage, Alaska 99501 SEWAGE DISPOSAL SYSTEM - APPLICATION 'ROUGH Case $0. 279-2511 & PERMIT NAME OF APPLICANT //:' :~/J ~' ';~?"/:'~'- MAILING ADDRESS ~:'~' '~ ~r~ ~' // ?~ RESIDENCE ADDRESS LOCATION OF INSTALLATION LEGAL DESCRIPTION /c~ ~../.~-~/~.~" / ~j,~, "':'!q~ ~,~.~"'~-. APPLICATION TO INSTALL: SEPTIC TANK ~ ,SEEPAGEPIT~'~ ,DRAIN FIELD ,OTHER ,¢~,~C '~.~-, .... ~, //%: TOSERVETHE FOLLOWING FACILITY. · .;/~ ~[(',,.; PERCOLATION TEST RESULTS / '-~- /~/~"A'~yIcIPATED DATE OF COMPLETION ~r,~..~, 7¢,,~-~( BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT PHONE NO.&k/..`. '/&~ ::' THIS IS 'r0 SERVE AS ~[" ~:i; :&i :' PERMIT TO INSTALL A -[, AS DESCRIBED BELOW. SIZE OF UNITTO BE SERVED "/ SEPTIC TANK SIZE ~ .2~ ~ TYPE/~lk'~l' '~ SEEPAGE AREA ./?:'~.("[t).{' ..rYPE.~.,~,V~ /.~/' ~,~,v,.,. ~z(~ DIAGRAM 0F SYSTEM DISTANCES: / HEALTH AUTHORITY OR I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that th.e DATE ~ " APPLICANTS SIGNATU RE. ~~? ~ ¢ .z/~:..%:-~ ,~ 0 0 0 0 0 0 0 0 0 0 0 0 ~ ~ ~ ~ ~ [-- ~ ~ F~ [~ ~-~ [~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Z < Z ? 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. # (~'O CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~-'7 1 ~'~S"" NAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Day phone Mailing address_ 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- ing 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 5. 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 verify that based on the information obtained from the Municipality of Anchorage files and from my inves_ti_gation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regul~aatvi~ar~' [~a~.L~.n the date of this inspection. 20210 Donalar St. Name of Firm Chug|ak, Ala~k~ ~$G7 Phone_ Address ~ Engineer's signature ~ ~/~~/~ Date DHHS SIGNATURE ~' Approved for __~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality 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 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. 72-025 (Rev, 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST -., Z~/~' / /,~,?¢o /z.., Parcel I.D. Legal Description: ,~--"~T' ~- .7 A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) /)~/~J'/~/'~E If A, B, or C, attach ADEC letter. ADEC water' system number )'/ Date completed ~/z J/Z~____ Driller /c,,c,~ Cased to / ~ 6- Casing height ¥' Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION MUNIOPALIi'f ~v Ar, i, HL~k,~b ENV~RONMEN1 Al_ SERVICES DIVISION AU(; 15 1995 g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot~//L/o,¢'~'~ ,'Tcc)~(..¢~ .':~'-~; On adjacent lots Absorption field on lot ...... Public sewer main ~l~ (~¢~ Sewer service line WATER SAMPLE RESULTS: Coliform ¢-~ Date of sample: B. SEPTIC/HOLDING TANK DATA ; On adjacent lots ...... Public sewer manhole/cleanout'~,'~ Petroleum tank ____ Nitrate d. ~,~( Other bacteria Collected by: Date installed Tank size Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) Alarm tested (Y/N) Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots Foundation To property line Absorption field Water main/service line Surface water/drainage 72-026 (3/93)* Front 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) SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y/N) __ "Pump off" Level at Cycles tested Well on lot D. ABSORPTION FIELD DATA Date installed Length Width Total absorption area Date of adequacy test On adjacent lots Soil rating (GPD/FF) Gravel thickness Cleanout present (Y/N) Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Surface water System type Total depth Depression over field (Y/N) for After test . If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Su trace water Curtain drain __ On adjacent lots __ Property line To existing or abandoned system on lot Cutbank Water main/service line Driveway, parking/vehicle storage area E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect Signature Engineer's Name Date David R. Dayton P.E. 20210 Donalar St. Chugiak, Alaska 9956,7, HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number D. R. DAYTON, P.E., R.L.S. -- ~xx~'~l~x:~ Chugiak, Alaska 99567 20210 Donalar 696-2417 August 9, 1993 WELL FLOW TEST Legal Description: Lot 5, Block 1, Benito Subdivision Date of Test: August 7, 1993 Well Depth: 106' Static Water Level: 94' Driller: Williams Drilling. Requirements: 4 BR - 600 gallons per day Test: The well was tested with the existing pump through an outside hose bib. The valves were fully opened. Volume, and drawdown were measured at regular intervals. Results: The well produced 606 gallons in 80 minutes at an average fl~w rate of 7.6 gallons per minute. Total dwawdown was 1'. The drawdown was fully recovered within 2 minutes after pumping was stopped. The well is currently producing adequately for a 4 BR home. COMMERCIAL TESTING ENVIRONMENTAL LABORATORY SERVICES & ENGINEERING CO. .............. REPORT Cheml. ab Ref.~ :93.3921--1 C].ient Sample IE) :LB BE,K1 BONITO S/D Matrix :WATER 563,3 B STREET ANCllOI~AG[(, AK 99518 rFL: (907) ,562-2343 FAX: (90/) 561-5301 Client. Name :DAVID DAYTON, Ordered By : Project Name : Project~ : PWSID : UA ~IORK Order : 6919'7 Ret,or'i_', Compl. eted : 08/.I. 0/93 Co]. '[ect ed :08/02/93 @ t1:30 hrs. Received :08/0(!;/93 f~ 01:00 hrs. Technical Director: STEPHEN/C. EDE Released By : Samp.l.e Remarks: ROI1TINE SiAM[-'[,E CO[,[.ECTEB BY: DR[). Parameter' Resull;s Qual Units Me[hod Limits 13~t.e Da'he Init Nii:;rate.-N 73.58 mg/L EPA 353.2/300.0 10 08/09 * See Special Instruci;iol~s; Above UA , Un,'-tvailab[[e *'* See Samp].e Remarks Abow~ NA ~ Not: An,~-~lyzed U = Unde'heched, Reported value is fha practical quanl-.if:[catior~ ]Jmih. I,'!.' :~ l,ess Than !) = Sec'ondar'y diluk, ion. GT :: Grea~er Than Member of the SGS Group (SocietY, Gon~rale de Surveillance) ENVIRONMENTAl SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OttlO, MARYLAND, WEST VIRGINIA, NEW JERSEY, S()UTlt CAROl INA -- DATE RECEIVED TIME TIME TIME ! DATE DATE DATE I NSP ECTOR I NSPECTO R INSPECTOR DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED 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. PHONE 1. P~RTY~NER ~'~, t: MAILI~ADDRESS PROPERTY RESIDENT (If different Wom above) · PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDIN~INSTITUTION [ PHONE . . ..... p-- , I MAILING ADDRESS .=n,r~LTOR/AGENT :. PHONE' MAILING ADDRESS ' ' ~ ' /' ~ - -: ' ' 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE 'J~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One ~ Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM 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 welt") depth (attach log if available.) ~ ~' ~ '~_~:. i \ \' ~-\ ,9.~4_ 7¢/' YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Hotding Tank Size: If Tank is homemade give dimensions: [] ONE [] TWO PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATEINSTALLED NSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [] THREE [] FIVE [] FOUR [] SiX [] OTHER Septic/Holding Tank IAbsorption Area lSewer Line Nearest Lot Line 5. COMMENTS DATE APPROVED FOR /~, BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79)