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Home My WebLink AboutHILLSIDE PARK PUD LT 26DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE [] UP~RA~E LEGAL DESCRIPTION ~, DISTANCE TO: IWeg ~O AbsorptJonar~ ,Dwelling /'~ PERMITNO~/ ~,~ Manufactur~ ~~ Mat~ No. o~mpartments ~ ~ Liq. capacity in gallons Inside length Width Liquid depth /~ ~ IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. Q We]l~ Foundation ~ Nearest lot line PERMIT NO,~ No. of :,ne~ ~ Length of each li~, TotaJ length of :ine~ ,Trench width -~ ~ ~ ~ Top of tile to finish grade , Material beneath tile . ~. ~__ q ~ Totaleffectiveabsorp[ionarea~¢O Length Width Depth PERMIT NO. "~O Type of~ ~i' d ame~ ~depth / ~~ ~ Class~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line~ ~ Septic tank ~-~ 0 Absorption area(s) OTHE~ PIPE ~ATE~IALS iNSTALLE~~s . _ REMARKS APPROVED ~ DATE LEGAL DEPFIRTMENT iL HEALTH RND EN',/IRONMENTRL . ]TE':TI]N ' ,S2.5 "L" S"FREET., RNCHORRGE., AK. '9'950± F'ERM'r T NO. U~t"-4 ~. :E 'T~ ,' 810568 ', FtF'PL I CRN"r LOL-:RT I ON LEGRL DRHL L. UN::,F. INC. EFIST TREE [:,RIVE ~, HILLSI[:,E F'FIRK S.."D ]%"PE OF =,UIL HE, z,..F. FTILN =,~_ FEM IL":,: TRENCH MFINIMUM NLtMBER OF BEDROOMS = 4 =,UIL F. HTIN-~ "'::~ FT,'~'BF.'.)= '" """ ] .' ' '- "-- I S: TFIE REQtJIRED SIZE FIF THE SOIL RE,--,LRFTION ,1[: d lc. ±9800 SQl/IRE FEET [:, L---- F' T ~-~ =: "'"'" -:-1. _S-: · ..-:. L E t"-.I ~.S ]- H =: G F.: R %.' El L [:, E P T I-I == THE LENGTH DIMENSION ID; 'THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF' R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF 7'HE ENCFI',,,'RTION (IN FEE]"), THERE IS NO SET NIDTH FOR TRENCHES. THE GRR'¢EL DEPTH IS THE MINIMLIM DEPTH OF GRFIVEL BETt,,,IEEN THE OUTFFILL PIPE FIND THE BOTTOM OF THE EXCFI',,,'RTION ,::IN FEET]'. PERM I T RF F L.. I L. HN7 HAS TFIE F.'.E_~F U[,L, I E, I L I T"r' TO INFORM I"H I b DEPARTMENT DUR I NG THE INSTRLLFITION IN_4 EUTIUN_, OF RN'¢ NELLS RDJRCENT TO THI':'_, F'ROPER,'T"¢ AN[:, THF'_ NI_IME, EF4.. OF R[:z, IE. EN_,E=,, TFIRT THE NELL NILL SERVE. ........ TL-~C, ,:: 2 ::, I 1'4::.1:- EL.. T ][ Eii%l_. RF:E BACKFILLING OF FIN'¢ .:~_TE.M NITHOUT FINRL INSPECTION AND APPROVAL E'¥ THI DEPFIRTMENT 1.4ILL DE SUBJECT TO F'ROSECJTI]N. MINIMUM DISTFINCE BETWEEN R WELL AND FINY ON-SITE SEWAGE DISF'OC-;RL S'¢STEM IS ±00 F'EET FOR R PRIVRTE NELL OR :1.50 TO 200 FEET FROM R PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC NELL MINIMUM DISTANCE FROM R PRI',/BTE NELL TO Ft PRIVATE SENER LINE IS 25 FEET FIN[:, 'TO R COMMUNITY SEI4ER LINE IS 7.5 FEET. OTHER REQUIREMENTS MFCr' RPPL'¢. SPECIFICFITIONS AND CONSTRUCTION DIAGRAMS ARE RVRILRBLE TO INSURE PROPER INSTRLLFtTION. I CERTIF'T' THFIT ±: I FIM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND NELLS RS SET FORTH BY THE MUNICIPRLIT'¢ OF ANCHORAGE. 2: I WILL INSTRLL. THE SYSTEM IN RCCORDFINCE I,.IITH THE CODES. 2:: I LINDERSTFIND THRT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. S I GNED: ................................................ RF'PLIE:RNT DRHL UUN-,T. INC. ',,,'4. ISS_ED_ E ;'.¢ ................................... [:, R T E_N~.:_, .~..%z~-., ........ '~-xJNICIPALITY OF ANCHORAGE " Department o~ Health and Environmental _£otection ~ 825 L Street, Anchorage, AK. 99501 264-4720 · . * * · H A NDW R ITT EE~N_~D ERJ~LI T ~.O-~I_TE SE~ PERMIT Applicant: ,l~/ ~E/ ~ . Mailing Address: j~ ~ -~ ~ . .~ T~pe of Soil ~sorption System Is: ~,Tr~nch: ~ Drainfield: Seepage Bed: Holding Tank: ~ax~ N~ber of Bedrooms: ~ Soil Rating(sq.ft/b~ ~The Required Size of the Soil ~sorption System Is: DEPTH ~ LENGTH ~~" GRAVEL DEPTH ~' W~. The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavati6n(in feet). There is no set width for trenches. The gravel depth is the minim~ depth of gravel between the outfall pipe and the bottom of the excavation(in feet), ~ (u~: ~ ~ /~,~ GALLONS ~ ~ REgUIRED SEPTI~ ....... TANK S~'ZE = , Pe~it~applicant has the responsibility to inform this dep~rtment during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this department will be.[subject to prosecution. Minimum distance between a well and"any on-site sewage disposal .system is t00 feet for a private well or 150 to 200 feet from a-public well depending upon the type of public well. Minim~ distance from a przvate well to a private sewer-line is 25 feet and to a co--unity sewer line ~s 75 feet. Well .logs· are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are a~ailable to znsure proper installation. · * * PERMIT EXPIRES DECEMBER 31~ i 9 8 1 * * * i certify ~hat: (1) I ~ f~iliar with the requirements for on-site sewers and wells as set forth by the Municipality of ~chorage. (2) -I will install the system in accordance with codes. (3) Z understand-that'the on-site sewer system may requi~e enlargement if the,residence is'remodeled to include more ~hat 3 bedrooms. Applic'ant SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST I 2 3 4 5 6 7 8 9 10~ 12 13 17 2O PERFORMED BY: ~ ¢~'1[ ~,~..~ DATE PERFORMED: SLOPE SITE PLAN WAS GROUND WATER f~ ~ ~ ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to , - Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN~ETW. EEN FT AND ~ FT CERTIFIED BY: DATE: 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~5' CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION CompletelegaldesCriPtion '. ~,o;~ ~ I-)~11.~,~'~ ?~ t~.c~, P Location (site address or directions) 700 1 ~:~/- T'~'~c (o~,,'.,z Property owner ~,~ ~'~'v? {. ~-¢if /w~-c<il/ Dayphone Mailing address ~oo/ ~ Tr~e ~ ~c~o~¢ ~ Lending agencY" ~ ~or~ ~ Day phone Mailing address ~gyI "~'" E/2 ~c~ o~ ~ Ce~ ~ Agent ~ ¢~ ~ra~¢ R~ ~¢x ~cfi~ Day phone Address ~EO0 (o~ov~ ~/; ~c4o~/ ~ 9~o~ 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 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, Phone 3' '/4- - ~ 3' .~-.-~- ordinances, and regulations in effect on the date of this inspection. Name of Firm f='l~ Address . I¥ ~ Engineer's signature ,~'~ Approved for ¢ Disapproved. Conditional approval for bedrooms. DHHS SIGNATURE Date 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. ENVIRONMENTAL SERVICES DIVISION DEC Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SER¥ CE$ R E Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: ~o/- ~o~/ A. WELL DATA Welltype d?[ox.r '~" Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed 7[ ? / ~ I Foundation cleanout (Y/N) Date ofPumping 9 / t2 C. ABSORPTION FIELD DATA Date installed '7 ! 9 / ~ t Length 'Y$" Width Health Authority Approval Checklist /-}tllj~c/¢ ?attic ~.~.'D ParcelI.D.: IfA, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG g.p.m. Casing height (above groined) Wires properly protected (Y/N) AT INSPECTION Nitrate Other bacteria Collected by: Soil rating (g.p.d./fi2 or ft%drm) Ob- ~ System type 7-rent6 ~'Dl~r"t ,C ' Gravel thickness below pipe q' Total depth '7o~" tT~ Z. Effective absorption area ~0 t'J' Date of adequacy test I ~/1~1)~ . Monitoring Tube present(Y/N) ¥ Depression over field (Y/N) /v Results (Pass/Fail) ?~,.cr For Fluid depth in absorption field before test (in.); Fluid depth O (ins.) Minutes later: I Peroxide treatment (past 12 months) (Y/N) I~On¢ 49 Immediatelyafter~at gal. wateradded On.): Absorption rate = ~> 6'00 g.p.d. Icno~,~ If yes, give date AA A, bedrooms Tank size I Z,~'~,ot Number of Compartments __ Depression (Y/N) N Pumper Al ~ r t% '~ Cleanouts High water alarm (Y/N) N, ,'~. D. LIFF STATION b/, ~-. Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* *Datum Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: (~t. ~.) "Pump off" level at* Septic/holding tank on lot Absorption field on lot /~. A. Public sewer main /V. Sewer/septic service line M. ,4. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Lift station ~ ~oo ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ ?.,' Property line :~ O' Absorption field Water main/service line ~ tO' Surface water/drainage > t oo' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain Property Line 3~" Water main/service line Driveway, parking/vehicle storage area '7 0' Wells on adjacent lots ~> Eeo ' ENGINEER'S CERTIFICATION ~ ~.,~ ~ ~ ~ I certi~ that I h~e determined thru field inspections and revtew of Municipal records: that t)~ abov~ ~te~8~re ln conformance wtth MOA ~ guldeltne~ tn effect on thls date. ,~ :,~. ,~;' Signa~e Engineer's Name 'T'~Eot~-o,"~' /~. r-too r~ Date HAA Fee $ ~'OO ~ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number 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 SINGLE FAMILY DWELLING Parcel I.D.# HAA # 1. GENERAL INFORMATION Complete legal description ~-oT 2 Location (site address or directions) 7ool EAST' T~E Property owner. Mailing address Lending agency Mailing address Agent N, 4, Address 70o I £/)$T TREe Day phone Day phone Day phone 5&l - 257~ UnleSs otherwise requested, HAA will be held for Pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water 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 NOTE: Public sewer 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 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 regulations in effect on the date of this inspection. Name of Firm GLATT ~ Address Iq53o ]ZCHo ST. A~CI~. ~}lC Engineer's signature '"~ o DHHS SIGNATURE : ~'X Approved for ~:~.z~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~.~,~..~ ~_~ Date / 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 Legal Description: A. Well Data Well type ~'/-/~$ Log present (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 Cased to Casing height FROM WELL LOG Wires properly protected (Y/N) AT INSPECTION .g.p.m. MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION SEP 1 0 1993, g'PRmECE i VE D SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA / Date installed 7 / ~ I Cleanouts (Y/N) ~ High water alarm (Y/N) Tank size I?_ 50 Foundation cleanout (Y/N) Date of pumping ~ / 7 ('?.~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N./~. On adjacent lots N. A. To property line ~ 3o Surface water/drainage ~',fl L Compartments y Depression (Y/N) Alarm tested (Y/N) N, A Foundation IL~' F~ot~ C.O · Water main/service tine ~> hto Absorption field /oo CONTINUED ON BACK PAGE 72-026 (3/93)* Front C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Width ~0 F~~' Soil rating (GPD/FF) I. ~ System type T~c~cf/ Gravel thickness H Total depth g ~- ~/ Cleanout present (Y/N) ~/ Depression over field (Y/N) N Results (pass/fail) PA~;5 for ~- Bedrooms o m $~,~P Aftertest O NoNE KNowN If yes, give date N ,A. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N ~ , To building foundation 32 On adjacent lots Surface water .~' /co Curtain drain On adjacent lots ~./~ , Property line To existing or abandoned system on lot Cutbank N, A, Water main/service line Driveway, parkingh/ehicle storage area '~ Go E. ENGINEER'S CERTIFICATION / certify that / have checked, verified, or conformed to all MOA and HAA guidelines in e~iL~t~e~ of this inspection. Signature Engineer's Name Date ~t~ HAA Fee $ Date of Payment Receipt Number ~, ;~*~., o. CE - 3589 Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAl, CON~I~;ltVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 August10,1993 ~07) 349-7755 Mr. Ted Moore FlatTop Technical SUBJECT: Lot 11, Hillside Park (10301 -Free Top Lane) & P.U.D. Class "A" Public Water System, PWSID 212461 Dear Mr. Moore: I have completed a review of this office's files concerning the monitoring status of the . above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on July 9, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on July 9, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results were submitted to the Department on December 2, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on November 12, 1991. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply tlnat the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. Unless otherwise noted, this letter is valid for 30 days and is for the specified legal description noted above only. August10,1993 Page 2 lfyou have any questions onthe aboveinformation, please do nothesitateto contactthis office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II ML/pf STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS PROPERTY DESCRIPTION Hillside Park P.U.D. PWSID no. 212461 This approval does not constitute a guarantee of any kind, explicit or implied, as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY A recent' water sample was tested and found to meet Department of Environmental Conservation drink- ing water standards for total coliform bacteria. ~i,,~Environment a 1 Date F~g.~_AsSt. II Au~. ]0:'93 WASTEWATER DISPOSAL The domest~ater system was: [] inspected .b.y the'De.p..artment of Environmental Conservatio~0.erhd found to be in compliance with applicable ~equireme~.~8 AAC 72; .~ [] inspected by a Professional E'~kg. ineer W~p..~%rtifies that the system complies with applicable re- quirements of 18 AAC 72; /.~ [] installed bya Certified Inst.a.~t r~who cert~f'i i~e~, that the system complies with applicable requirements of 18 AAC 72; or ~ '~. [] tested by a Pro/f.e"ssional Engineer who certifie~e performance of the system is satisfactory and that t~.~system complies with the minimurn s~Pa'r~distances specified in 18 AAC 72. This approval is valid for a [] single family I I mul{i-family unit~tal of bedrooms.