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Home My WebLink AboutHILLSIDE NORTH #3 BLK 1 LT 1 RECEIVE_l) Municipality of Anchorage Page ~ of -~ SEP 0 ? 1994 DEPARTMENT OF HEALTH AND HUMAN SERVICES Mu,licipaliiy ol Anchorage ENVIRONMENTAL SERVICES DIVISION }ept. Health ~.~. ~oSx~r¥~rl~50 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~Ot~ PIDNumber: O~l- Name: ~[~, ~ ~ F ~ ~ ~ Wastewater System: ~ New ~ Upgrade A~s~: ~11 ~L~~ cou~ ABSORPTION FIELD Phone: No. of Bedrooms: ~eep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other Total Depth from original grade: ,, LEGAL DESCRIPTION SoilRating: . ~ GPD/Sq, Ft. 8 Lot: Block: Subdivision: Depth to pipe bottom horn original grade: Gravel depth beneath pipe Township: Range: Section: :ill added above original grade: Gravel length: WELL: ~New ~ Upgrade Gravel width: Number of lines: Distance between lines: Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~/~j~ Date Drilled: Static Water Leveh Installer: ~- ~ Driller: SEPARATION DISTANCES ~ptic ~ Holding ~ S.T.E.P. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacityin gallons: Material: Number of C~rtments: Surface LIFT STATION Water N i) ~ ~ LineL°t ~ ~ Size in gallons: Manufacturer:{ .... ;, "Pump on" level, at: ,"Pump ~ff" level at: ~ High water alarm CurtainDrain ~ )~ Pump Make & Model .:Electrical Inspect ons. ,perf°rmed by: Remarks: ', BENCH, ., ~ARK Location and Description: ~ I Assumed Elevation: ~ - E~~L Insp~ctionsperformed by: ~, Dates: 1st 1/1~ ~ Department of Health and Human Services approval ',~..,~ ~t~ .~,~,, ....... .,.".~,~.>..~;,~ ~sthoLe / r~---- 25 0 25 50 75 SCALE; I_~ = SO FT, TOBBEN SPURKLAND P.E. 20,5 W 15TH. AVENUE ANCH. AK, 99501 (9~7) Z79-.~916 LOT I BLOCK I HIL$IDE NORTH //3 JEFF AND SUE ALLEN I I SEPTIC SYSTEM ASBUILT DATE: SEPT, 6, 1994 SHEET: 2J$ GRID: 2145 TRENCH CLEAN OUT TRENCH MONITOR DOUBLE CLEANOUTS 1250 GAL SEPTIC TANK STANDARD 75 'LONG lO' DEEP 5' ROCK TRENCH CLEAN OUT TRENCH: FOUNDAtiON CLEAN OUT 9,5.; M/F'o£1 i40 90. I S £-b o£ £ept:ic r2ock C{eonou~s PloD/~or ND SCALE ,~ 96.4 1~50 90~, septic ?onk Oreer Tonk SPURKLAND P.E. 203 Wl5th Ave Ak 99501 SOT I BLOCK I HILLSIDE NORTH JEFF AND SUSAN ALLEN SEPTIC SYSTEM ASBUILT DATE: SEPT. 6, 1994 SHEET: GRID: 2143 ~/ell Log AIJ.t,~ Now-'~/olll¥lrn'. DrllJilng 1224 I Anchorage, Alanka (907) a45~417 I J~rou~h ] $~bdlvt~i_or~ j Lot_ J -Bi~k l Section No J TownBhlp Range . ,, Her'dtJn IAnchorage .....jHiibideN J Il 1] I ~l/elI Log Ft, Below Surface Well DepLh (ft.) Dale of Co_rap. lotion Iflsterl-l Type Top Bottom [ I:~21 Use Ido es.uc ] 'brown ~andg ..... 0 15 revel /cobble~) 1 ~ 45 ,hard silly bra g_~avel/cobbles 45 go brn silty hard pan, damp ,, gO 100 !b_r-n silty hard pen>ten~s"~san.d'y'.gr~vel/ .... I00. . 's~page ~ 2_gpm In lenses ~loped formation Lo produce 20 g~m · 1Z~-132 132 Driltln~ Hethod .... I Depth (fl,) Welgh~.'~ (lbS/It) PumplnJ Level Below T of C (Ft..) After (hr~) Pumpin~l (g,p.m) 6routing YesR Haterlal Pump HP Capacity . TTpe I Selling (~) very ltghL formation, much development Jrequ red Lo extract 20 gpm. This welt was drllJed under my jumsdictlon and t. hls report tS t~ue to ~e best Of my knowledge and belief, Date PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT ~ER:SW940153 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:ALLEN JEFFREY S & SUSAN L OWNER ADDRESS:6811 ELMRICH COURT ANCHORAGE, ALASKA 99504 DATE ISSUED: 5/31/94 EXPIP~ATION DATE: 5/31/95 PARCEL ID:04103181 LEGAL DESCRIPTION: HILLSIDE NORTH #3 BLK 1 1 LT LOT SIZE: 128047 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) ~ DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~i T.SPURKLAND P.E. 203W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 1 BLOCK 1 HILLSIDE NORTH #3 JEFF AND SUE ALLEN NO Ground Water or Impervious Layer to 16 ft. Use Standard Trench Soil Rating. From test May 12, 1994 12 min/in = .8 gal/sq, ft. Required Area per Bedroom: 150/ .8 = 188sq.ft.. Testhole Total Depth 16 ft Less 6 feet 10 Less 5 Cover 5 Rock Depth 5 Number of Bedrooms 4 Length of Trench 188 x 4 / (2x5) = 75 ft. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 75 FT TOTAL WIDTH 2 FT TOTAL DEPTH 10 FT ROCK DEPTH 5 FT COVER 5 FT SEPTIC TANK 1250 GAL The installation of this well and septic system will not impact adjacent lots. The well location conforms to the siting of the existing wells in the area, and will not prevent the adjacent lot owners from developing these lots or replacing the existing septic systems. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. Septic System Design Lot 1 Block 1 Hillside North 13 pg.1 100 0 LOT 1 / LBT 9 CLASS I00 £00 300 400 SO0 SCALE: I" = 200 FI, :OO LBT I TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 LOT I BLOCK I HIL$IDE NORTH//3 JEFF AND SUE ALLEN SEPTIC SYSTEM DESIGN DATE: MA)' 24, 1994 SHEET: 1/$ GRID: 2143 Proposed Building LocoHon Pr/mar)/ Trench Secondary trench ale 1250 8ol SepHc ton/( L oeo ¥1on Proposed k/e~ / / / / SCAL£; l' = 58 FT, I00 1~5 TOBBEN SPURKLAND P.E. 205 W 15TH, AVENUE ANCH. AK. 99501 LOT I BLOCK I HILSIDE NORTH JEFF AND SUE ALLEN I I SEPTIC SYSTEM DESIGN DATE: MAY 24, 1594 SHEET: 2/$ GRID: 2145 TRENCH CLEAN OUT TRENCH tWON/TOR H/t~o Fi t40 N17 SCALE TRENCH CLEAN OUT oI, STANDARD TRENCH: 75 'LONO 10' DEEP 5' ROCK DOUBLE CLEANOUTS 1250 OAL SEPtiC ~NK [] FOUNDAtiON CLEAN OUT o C~eonou~s Mon/%om 4' ropso/{ S' Cover Exist, Ground 4' Nin CoverI TOBBEN SPURKLAND P.E. 205 WlSth Ave Anchora, Ak 99501 SOT 1 BLOCK 1 HILLSIDE NORTH JEFF AND SUSAN ALLEN SEPtiC SYSTEM DES/ON DATE: MAY 24, 1994 SHEET: GRID: 2 ! 45 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 9 10 11 12 13- 14- (ENGINEER'S SEAL) DATE PERFORMEI~¢' ,-/ 15- 16- 19- Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth to Water Afte~,, Monitoring? !~' ',c ~ Date: . SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop ~ ; 3D 10 7~d~ i' 20- PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN (,0 FT AND FT COMMENTS ^CCORDANOE W,T. AL' STATE AND ~UN,C,,AL GU'D~LINES'N E""EOT ON T"'S DA~E. DATE: 72-008 (Rev. 4/85) 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A S lNG LE FAMILY DWELLING Parcel I.D. # O~[-~l~ ~( 1. GENERAL INFORMATION Complete legal description Location (site address or directions) [C ~LC ~ ;' ~r ~L- ~'~' Property owner Mailing address Lending agency Mailing add?ss ~.x~'-~ ~ ~ ~ ~.~ .~ Agent "~¢-~ ~ *- ,¢~ ~-~-'~'~' Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: m TYPE OF WATER SUPPLY: Individual well Community well Public water m NOTE: ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: NOTE: If community well system, provide written confirmation from State ADEC attest- Individual on-site :'~ .; ~ '?i Public sewer ' ~"? Cj ;,?~ - ff community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) F~ont MOA#21 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 investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance .with all Municipal and State codes, ordinances, and regu__l.l~tions in effect on the date of this inspection. Engineer'ssi;nature ~ Date~ .. :2-/'~-I/~-- DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date -~- 7- ¢.~'-- 'U The I~dnic!Pality of~nch°rage Department of Health and Human Services (DHHS) issues Health Authority' · ·'~pprova. . . ce~ f c~'~b~sed.(.~ .~ ... onl7 upon the representations given in paregreph 5 above by an '~ndependent pro~ .~,~onal engineer registered in the State of Alaska. The DHH$ does this as a courtes¥ to purchasers o~ homes and th'eir ~nd ng nst tut ons in order to satisfy certa'n federa and state requ'rements. Emp oyees 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 Legal Description: A. Well Data Well type ~--~. Log present (Y/N) ParcelI.D. 0~/- 0:~1-9 I If A, B, or C, attach ADEC letter. ADEC water system number ~"~X""~ - F Date completed -7/~/~, ~ Driller /~~ Total depth t ~ Z_- Cased to Sanitary seal (Y/N) "'/ / FROM WELL LOG Pump level1 SEPARATION DISTANCES FROM WELL TO: Date of test Static water level Well flow Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line 1 ~0 Casing height l, r~ F~nL- Wires properly protected (Y/N) ~ g.p.m. AT INSPECTION ; On adjacent lots g.p.m. {'"'3 ~-o >r- ~' ; On adjacent lots Public sewer manhole/cieanout Petroleum tank Z WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ~ ~8'~ Other bacteria Collected by: ~--~ -~ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) "/ High water alarm (Y/N) Date of pumping Tank size ] ~ ~ c~ Compartments Foundation cleanout (Y/N) ~/ Depression (Y/N) / //,z~ Alarm tested (Y/N) F'7'//~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots ' )/,~O Foundation Absorption field l ~ Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed Length '7--~ Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Width 7 ~(-~ Cleanout present (Y/N) ¥"///-~- Results (pass/fail) Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Soil rating (GPD/FF) G ravel thickness SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Surface water Well on lot / ,/.~ ~:~ On adjacent lots System type Total depth Depression over field (Y/N) for After test If yes, give date Bedrooms Property line To building foundation On adjacent lots Surface water Curtain drain To existing or abandoned system on lot Cutbank /~/¢ ~/~-- Water main/service line Driveway, parking~ehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ c'~ ~-~ ' ~ Date of Payment ,~/2-~- / ~ Receipt Number ~7~ :~ _(~/~ Waiver Fee $ Date of Payment Receipt Number CT&E Ref.~ Client Sample ID Matrix CT&E Environmental Services Inc. Laboratory Division ~~,.jjj.~r~.~r~-jf~,;,~'~-~r~jr~ 95.0615-1 [ boratory Analysis Report L1 BLK1 HILLSIDE NO WATER Client Name TOBBEN SPURKLAifD, P.E. WORK Order 12666 Ordered By Printed Date 02/17/95 ~ 12:05 hrs. Project Name Collected Date 02/14/95 @ 11:30 hrs. Project~ Received Date 02/14/95 @ 13:19 hrs. PWSID UA Technical Director STEPHEN C. EDE Released By~/~~~ Sample Remarks: SAMPLE COLLECTED BY: T.S. Qc Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 1.83 m~/L EPA 353.2 10o 02/15/95 CMR * See Special Instructions ~2oove UA = Unavailable *~ See Sample Remarks Above NA = Not Analyzed ~ = Undetected, Reported value is the practical quantification limit. LT = Less Than 3 = Secondary dilution. GT = Greater Than 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301