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HomeMy WebLinkAboutLot 02 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SIYE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcell. O.# (~- ;~':"~-')~-I~'J HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) LOT 2; Se~on 12; TI4N, R2W, S.M. Location (address or directions) 17(730 WZ.6b~s D~u/.ve (formerly 119 Foot/'~b66 or #2 Baranof) (b) Property owner ARTHUR HAUVER Telephone: (home) Mailing Address 4700 42nd Avenue S.W., Suable #670 SeattZe, WA 98116 (c) Lending Institution Telephone (d) Mailing Address Real Estate Company and Agent Address Telephone Mail the HAA to the following address: (or check here,J~ if hold for pick up.) List contact P.erson and day phone number below: S & S ENGINEERING 17034 Eagle R~ver Leop Read Ne, ~ Eagle PJver~ Alaska ~9577. (e) 2. TYPE OF RESIDENCE Single-Family JO( Number of bedrooms 4 3. WATER SUPPLY Individual Well [2¢( Community [] Public [] Note: If commt~nity well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ 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 this Health Authority Approval 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 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. Name of Firm Telephone $ & $ ENGIN~.I~RING Address 17034 Eagle River Loop Road No. 2G4 Eagle River, Alaska 99577 [~[/~ /~, _ / ,, ~ Date 6. DHHS APPROVAL Approved for ,Z~ bedrooms by Approved~.~'~'. - Disapproved Terms of Conditional Approval Conditional 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. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health AulhorJty Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 A. WELL DATA Well Classification _'~. ~. Well Log Present (Y/N) /'J Date Completed Total Depth 'z'/Ot '~ Cased to Z/O~-- Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/~g Tank on Lot / To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line AJ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) ~'J ; On Adjoining Lots ! CO /~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole / B. SEPTIC/HOLDING TANK DATA Date Installed [~ J~ Size Standpipes (Y/N) F Depression Over Tank (Y/N) (~'-O No. of Compartments Air-tight Caps (Y/N) F Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~/~ I ' Foundation Cleanout (Y/N) F Date Last Pumped /5 / ~l,)lu ~ Temporary Holding Tank Permit (Y/N) /~//'~' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: TO WaterrSupply Well // ~0 ~ TO Building Foundation To Property Line [ I~ '~ To Disposal Field To Water M~'n/Service Line / ~po -~ To Stream, Pond, Lake or Major Drainage Course Comments ~'~c.~- D 0 ~'~)~.r-3/ ~) C~ 72-026 (Rev. ?/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed t ~' "-+ ¢ Width of Field ~) J~' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Water-Supply Well To Building Foundation Lot To Water Main/Service Line SEPARATION DISTANCE FROM ABSORPTION FIELD: / (2¢ '7L To Property Line /' 0 ~;;~ C~/~/~ To E/~.[g or Abandoned System on ; On Adjoining Lots ,/f~O '7L /~o/~utback (if present) /~/¢~ To Stream. Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed ~ Size in Gallons ~ /~l ~ "Pump On" Level at X"x'x' ~ [~(2~ High Water Alarm Level at ~ Tested for "~ Meets MOA Electrical Codes (Y/N) ~ Comments ~ Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. 17034 Eagle River Loop Road No. 204 Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~v.~ 5633 B STREET ANCHORAGE. ALASKA 99518 TELEPHONE (907) 562-2343 ~ ~o.^ o. s~/'~----'.'',E-x FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE fox Work Oxdex % 15146 Date Report Printed: JUL 31 89 @ 20:53 Client Sample ID:L2 SEC 12 T14N R2W SM PWSID :UA Collected JUL 20 89 @ 15:00 h~s. Received JUL 21 89 @ 12:30 h~s. Preserved with :AR REQUIRED Client Name : S & S ENGR Client Aect : SNSENGP P.O.# NONE REC'D Req # Ordexed By : Analysis Completed :JUL 21 89 Send Reports to: Laboratory Supervis% :~TEPNEN C. EDE 1)S & S ENGR Released sy: Special Instruct: Chemlab Rei ~: 6491 Lab Smpl ID: 1 Matrix: WATER Allowable Paramete~ Tested Result/Units ~ethod Limits NITRATE-N 1.7 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE ge~mrks: SAMPLE COLLECTED BY RJR. 1 Tests Performed See Special Instructions Above DA=Unavailable NO= None Detected '* See Sample Remarks Above NA= ~ot Analyzed LT=Less Than, GT=Greate~ Than MUNICIPALITY OF ANCHORAGE DMSION OF ENVIRONMENTAL HEAL%]{ DEPARTMENT OF PJSALTH AND ENVIRONMENTAL PRC~DECTION APPLICATICkN FOR HEALTH ALrl]{ORITY APPROVAL CERTIFICATE 1. General information Application Date ~//~/~6/~' (a) LeGal l~scription (include lot, block, subdivision, section, township, range) Location <add~ess or..directions) ~~ 7---/' Applicants Z Telephone Applicants Ad.ess (c) Applicant is (che~ o~) ~nding Institution ~; O~ner~F ~; Burr ~; ~her ~ (e~lain); (d) ~nding Institution Telepho!~ Address Address Telephone 2. ~ of Fesidence Single-Family ~ N,umber of Bedrooms 3. Wate_~ Suppl}L Individual ~11 ~ Multi-Family Other' (describe) Com~anity~-] ~lic~ Note: If coaw~nity ~11 system, must have written confirmation f~om the State Department of En~ironn~ntal Conservation attesting to t~k legality and ~atus. Is the ~11 adequate for the numker of bedrocks specified in this HAA ) _S9, wage Dispos~ Onsite~ Publicl---] Con~nunity~ HoldingTark~ Is the %~stewater disposal system adequate for the numbe~ of b~drocrns (~ [Page 1 of 2] 2-15-84 5. E~ir~ering Firm Providing Inspections, ?ests, Data and information I certify tha~h~e ch~.d, verified, or conformed to all effect on ~ dat~vo~nspection. d~///~ Date $igne .~ Nar~ of/Fi~n Te le .Dhone Address Date (ENGINEER SEAL) 6. DHEP ADDroval Appros~d for ,. _/~7/ b~drCOa's Conditional Terms of Conditional Approval [[he Municipality of Anchorage Department of Health and Environmental Protection d< not guarantee the cr3ntinued satisfactory performance of the water supply and/or t~ wastewater disposal system. This approval indicates that, as of the validation ~ shown abo%~, based on the data and information furnished by an engineer regist~re< the State of Alaska, the water supply and wastewater disposal system is safe and tional for the muncher of bedrcc~ns and type of structuze indicated. ( DHEP SEAL) 7. Mail the HA_A to the following address: KB2/d5/s [Page 2 of 2] ~PT. O~ HEALTH & EN¥~©N~Ei. qL~L PROTECTIOn' MUNICIPALITY OF ANCHORAGE (MOA) AUT O TY PPROVAL !~A~ ~ ~ ~984 CHECKLIST - FEBRUARY 1984 ~.~V ~ D Legal.~7~r~ti~%~ ~ / 2~ Well Classification ~ If A, B, c~ C, D.E.C. Approved(Y/N) Well Log P~ese ~t_(~. Date Cc~ple ted ~ ~ Yi~eld~~ Total Depth ~_~-J4~/~ff~ed to -~7~ ,~6~t'h of G~outing Static Water Level' O"--~ / ~ Pump Set At ~ ~ GrOund ~O /! Casing Height Above ~-. Sanitary Seal on Casin Conduit~,~ Depression A~ound Wellhead Electrical Wiring in Separation Distances f~cm Well: To Septic/4~idi..~Tank on Lot /~O ~ ; On Adjoining Lots To Near, st Edge of Absorption Field on Lo ~/~D '~ ~ O~ Adjoining Lots To Nearest Public Se~r %i~ /~ ,//~ To Nearest Public Sewer Cleancut/Manhole ' /~] ~ ~ .To N?a~?StDa~teW~r ~v~.~.Li~n~v~Lot Water Sample Collected By ~i~-~//~//~ , ,/ "./6 . Water Sample Test t~sults ~-~/~P~¢~q-/ ' C¢~ents Be SEPT i C~I~F~xx~W~-TANK DATA Date Install~ /¢7~ . Size /~ ~ Standpipe ~ ~Al~-t ight Caps~ Dep~ession~o~r Tank (~)y Date Last%L Pumping/Maintenanc~ Con~/aact on Fil,.e~ ~Y/~. Holding Tank High-Wate~ Alarm (Y/~//~ No. of Compartments ~'( ~'~ Foundation Cleanout~Y~ for / Tempol~a~y Holding Tank Permit (Y/N)/~/~ Separation Distances f~om Septic/N~ Tank: To Water-Supply Well /~ ~ To P~operty Line ~ ~z~ To Wate~ J~m&-~/Service Line /~3d:) Cou~ze Conments / To Building Fcundation ~ ~ To Disposal Field /~) / To Stream, Pond, Lake, c~ Majo~ D~ainage C. ABSORPTION FIELD DATA Soils Rating in Absorption St~ata~'/~'' Type of System Design~/)/// Date Installed /~6 Length of Field ~ Width of Field ~ ~ Depth of Field ~ / Gravel Bed Thickness Square Feet of AbsorDtion~ea C~_ ~ Standpipes P~esent/~/~) Depression over Field (~)~ ~, Date~ of Last Adequacy Test Results of Last Adequacy Test .-~///~'~.~ Separation Distano~ from Absorption Field: / To ter-su ly To o rty ine / TO Building Foundation ~ ~-~ To Existing or Abandoned System cn Lot ~.//~- ; On Adjoinin~ Lots /~3 To Water ~/Se~vice Line /~ ~ To Cutbank(if present) /~JF/ To Stream/Pond/Lake/c~ Major D~ainage Course To D~iveway, Parkin~ A~ea, or Vehicle Sto~age A~ea /J / /~ Comments D. LIFT STATION Date Installed Sits in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimsnsions Manhole/Access (Y/N) Pumping ~ycl~sVdu~ing Adequacy Test. Meets MOA Comments Check Pe~/t~ed Bedroom Ratzng Against HAA Request I ce~tify~hat I/h~ave. c3~e.~k/ed, verified, or confc~msd to all MOA HAA Guidelines in effect on the ~3~k/~ of ~f/~tz~ion. / / KBl/d5/s I ,PH, 694..~.~.~7~ [page 2 of 2] .5-84 MUNICIPALITY OF ANCHOR~_. J~ ~ J ~ DEP~ OF 14~L~& DEPARTMENT OF HEALTH & ENVIRO EN~ T ~N~~NVIRON~ENTAL- ~OJ~ UG t 5 1979 Telephone 264-4720 ~ ~ ~ ...... ~ .EQUEST FO~ APP.OVAL OF INDIVIDUAL WATE. AND 8EWE. FAg [~ ~J V~ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. I~/_PERTY O~NER/ PROPERTY RESIDENT (if different from above) PHONE PHONE PHONE 2, BUYER MAILING ADDRESS 3. MAILING ADD 4, REALTOR/AGENT MAILING ADDRESS STREET L TI~N ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One ~ Four [] Two [] Five [] Three [] Six [] Other .IND~IVI DUA * ATTACH WE LL LOG. A well Icg is required for all wells drilled L ~iTy since June 1975. For welJs drilled prior to that date, ~l]t/e well ~" '[] depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ iNDiVi DUAL/ON_SiTE~ [] PUBLIC UTILITY **If individual/on-site, give installation date ~ ~'z~'c~' "~. 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. THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED '~'~' INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE NSPECTOR iNSPECTOR INSPECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE E] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] 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: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ~¢I~'PP R OV E D FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~__~~ DATE BY (Title) LEGAL D RIPTI 72-010 (Rev. 3/78) STEVEN A. JOHNSON and Associates P.O. Box 76 · Chugiak, Alaska 99567 · (907) 688-3085 September 9, 1979 grr. Ron Hauver 119 Foothill Drive Eagle River, AK 99577 Re: Results of an adequacy test performed on Government Lot 2, Sec. 12, T14N, RtW, Seward Meridian. Dear Mr. Hauver: Transmitted herein are the results of an adequacy test performed by me on a septic system serving a four bedroom residence at the above-referenced location. ~qg System Design and Condition The system in service at the time of this test consisted of a 1250 gallon steel tank and a leach field of unknown length. Although no installation record was available, the system was reportedly installed in 1976 by the previous owner. It appears that four inch diameter cast iron pipe was used in constructing the system. ~de_~uacy Te?t Procedure and Results Inspection of the leach line clean out on September 8 showed the leach llne to be full. Approximately 200 gallons of water were then introduced int9 the leach line through the clean out pipe. During this process the water level in the septic tank cleanout pipe rose 12 inches. The flow was then stopped and the leach line allowed to stand overnight. Water was added to the leach line on September 9, 1979. After 200 gallons were added, the fluid level in the septic tank clean out had again risen 12 inches. The flow rate was maintained until the fluid level had risen 18 inches. At this point the flow rate was reduced to 9 gallons per minute and another 1000 gallons of water were added to the leach line while maintaining the fluid level in the septic tank cteanout pipe. Approximately 1200 gallons of effluent was then pumped from the septic tank. Based on my measurements of the fluid levels in the septic system over the course of this test I conclude that the septic system in its present condition: Consulting services for: On-site water and sewer systems, geotechnical and mineral exploration programs, site suitability studies ~r, ROn Hauver September 9, 1979 Page Two 1) has an absorption capacity in excess of 300 gallons per day per bedroom~ is capable of absorbing 1000 gallons in 103 minutes, which is equivalent to a short term surge taste of 9.7 gallons per mlnute~ settlement of the septic tank on the order of 12 to 18 inches relative to the leach field line has occurred. Outflow to the leach field occurs when the tank becomes overfull as indicated by the fluid rise into the septic tank clean out during the test. Thank you for contacting me regarding this adequacy test. Should you have any questions please feel free to call. Sin~,e:f ly, ~, Steven A. Johnsor~ Engineering Geologist