The URL can be used to link to this page

Home My WebLink AboutPARK HILLS #1 BLK 1 LT 8 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O. Box 196650 $ Anchorage, Alaska 99519-6650 ® Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~\,'-J ~;'-~ i 0 I~'~ PID Number: (/~ / :~' i 4 ~a~e~/l~~ ~',~__j~X~"~\ ~j~ WastewaterSystem: ~ew ~Upgrade ~ ABSORPTION FIELD Phone: ~. ~ ~ ~ ~. ./ ~No. of~drooms: ~DeepTre~ch ~hallowTrench ~Bed DMound ~Other Total Depth from original grade: LEGAL DESCRIPTION so'~i.~: ~, '~ ~/sq. ~t. ~.~ Lot:L/~) Block:-~ .~Suhdivision:~[~-- 1 Depth to pipe bottom~.~/from original grade: Ft. Gravel depth~/beneath pipe Ft. Township: Range: ~ Section: Fill added above original grade: Gravel length: I ~ew ~ Upgrade Gravel~: ~ I~ ~'~/ - t Ft Numbe~f~ lines: Distance~between linesFt. WELL: CiassJfica~n (Private, A,B,~): Total Depth: Cased To: Total absorption area~ ~ Pipe material: Driller: Date Drilled: Static Water Leveb Installer: Yidd: ~ Pump Set at: Casing Height Above Ground: ~.~J .t. .t.TAN K SEPARATION DISTANCES ~optic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private M~nufacturer: Capacity in gallons: From Tank Fie]d Station Tank Sewer Lines Material~ Number of Compa~ments: Surface WaterLot -- . / N~~LIFT STATION Line ~,~ ~¢ Size in : Cudain J ' Dr.,~ -- ~)~ ~.~O~d 4 ~- PumpMake&~ode, EiectricalJns,eotionspe,ormedby: I Remarks: BENCH MARK Location and Description: I AssumodElevati°n: Inspections performed by: ~{~ ~[dllqP~l ates: lst~-J&-q] ( ~~i:U~ Department of H uma ces approval ~ ,~.e?o.,. -,w. ,.. ~¢~ '~ '~ Reviewed and approved b ate: 72-013 (1/91) MOA 25 ' Permit No. '~101 '~ Page '~' of ~' Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAl. SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report PiD No.: ~1':/' IzI":Z-I ! RECEIVED ~ept. Health &Human ~ervices [ C~0~/ 72-013 A ('2/9~/} MOA 25 STATE OF ~I~%SKA DEPA/~MENT OF NATUW~J~ ~ESoUI~CES DIVISION OF GEOLOGICAL AND GEOPHYSICAL SURVE WATER WELL RECORD .LOCATION OF WELL DIRECTIONS: MF~ASURING POINT: ~top of casing D ground surface Dother: BOREHOLE DATA: Material type and color ):),JVlI~¢:,I, JMENTAL SERVICES DIVISION Depth S~CT~ON OT~S I TO~SH~P I ~G~ JM~RIDI~~SD. []w DE D ' J DATE 0/' ~ / of hole: lO~ ftJ . ~ Depth o~ ca~*n~~,J '/ -/~- ffl Depth METHOD OF DRILLING: ~air rotary ~cable tool I I other: USE OF WELL: ~domestic ' ' / []irrigation Dmonitor ~]public supply ~other: CASING: Stick-up, Z ft~ Diam: ~ in WELL INTAKE: ~ open end ~screened ~ perforated ~open-hole Depths of open~r~gs:=~2~_ to /~Lft SCREEN TYPE: Diam: Slot/Mesh size:: . Length:7 Set Between, 'and. ft in 'G[{AVEL PACK TYPE:. 'Valumeused: ' "' Depth to top:' GROUT TYPE: Volume: Depth: from ' ft to ft DEVELOPMENT ME~HO~ ~¢/ ~ Duration: PUMPING LEVEL AND, yIELD: ~- ft after ~ hrs pumping 4 gpm .__O._)i'.'r-l.u ,, .....a.. <, < ,, OONTJ~%OTO~ INEORM&TION: Reg.iy~ered Busings Name./ ' Sig.,nat~re of' Authorized ~resentat~ve Date PUMP INTAKE DEPTH: ft Horsepower: Date Pump Installed - WATER CHEMISTRY SAMPLE TAKEN? [q yesF]no Well disinfected upon completion? E~es ~no PLEASE MAIL WHITE COPY OF LOG WITHIN 45 DAYS TO: DGGS PO BOX 77-2116 EAGLE RIVER, AK. 99577 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 NUMBER:SW910178 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:MURPHY MARK & BRANDI OWNER ADDRESS:P.O. BOX 110181S DR ANCHORAGE, AK 99511 DATE ISSUED: 7/01/91 EXPIRATION DATE: 7/01/92 PARCEL ID:01714211 LEGAL DESCRIPTION: PARK HILLS #1 BLK 1 LT 8 LOT SIZE: 50682 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 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) AND DRINKING WATER REGULATIONS (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER MUST NOTIFY DHHS AT LEAST TWO HOURS PRIOR TO EACH RECEIVED BY: -~ . L June 23, 1991 ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE pLANS ROAD DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 8; Block I; Park Hills Subdivision; PER~IT REQUEST NARRATIFE Request you issue a permit to drill a w~lland install a septic system in accordance with om design dated June 22, 1991. On the prop~y wh~re the house is locked is r~latively high level ground which gradually slopes to the west at about 12% where the proposed septic system is to be installed. Most adjacent properties are currently vacant. Due to the large lot sized in the area we foresee no negative impa~s on the n~ighboring properties due to the installation of the proposed well and septic system. If you have any questions or require additional information for your · t ev.cq~w co nta~t us. SOIL TEST PERCOLATION TEST A. SHAFER, P.E. im STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM OESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE I PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 9, 10 11 12 13 14 15 16 17 18 19 20 DATE PERF ,EAL) Township, Range, Section: SLOPE WAS GROUND WATER q/~ ENCOUNTERED? s IF YES, AT WHAT DEPTH? ~ (~ p E Depth to Water Alter I ~onilorJno? ~, ~ Dale: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER __ COMMENTS o TEST RUN BETWEEN~AND PERFORME ~ ~ ~. ~l~cL-~ ~e~?' I // ~ ~T,~ IN ACCORDANCE WI~H ALL STATE AND MUNICIPAL GUIDELINE~ E~CT ON ~IS D~E DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: DATE PERFORMED: 1 2 3 4 5 6 7 8 9 I0 11 12 13 14 15 16- 17- 18- 19- 20- ~'~ ~L.L.~ ~:pwnship, Range, Section: SLOPE WAS GROUND WATERN/t/~ ENCOUNTERED? S ! L IF YES, AT WHAT DEPTH? ~1 pO E Depth to Waler Alter ~ ~ Moeitoring? Date: ~"'"~"'J '~ ~L SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~" (minutes/inch) PERC HOLE DIAMETER ~ ~ TEST RUN BETWEEN ~7~D ~' FT COMMENTS PERFORMED BY: ~j~¢ ~[yc.~, A!?E~ 995.77 ' ' I~/~////,~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES I~E.E~ ON THIS DATE. DATE: 72 OOB (Rev 4/85) I,// . . "~:- ' MUNICIPALITY OFANCHORAGE '";~':~':' ~' ( DEPARTMENT OF HEALTH & HUMAN SERVICES_ -- ' Division of EnvironmentaIServices . On-Site Services Section . ...... · . P'.-0~ B~3x 196650 Anchorage,'Alaska 99519-6650 .-: -: - '-_ ?-, :'L -:.;'. -~:', -:_ : CERTIFICATE OF HEALTH AUTHORITY ..... ' - ' ". -' APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # c:~ I=.~.- Iq~.~'i'l NAA#'_ "GENERAi"iI~FORMATION ." "* ComPlete i.egal description ~_c~ g% ~ ~oe ~ 1 Location (site address or directi(~ns) Property owner.?,~a~ t:~-~ mu~,-~ Day phone- .'", Lending agency Day phone Agent ay phone ':~ g ""--~'" '~' - "~f'~'~:~'~' ~' ~'-~-~"~'~'" '~': ' - " ~"!'"' ?:~ "~';'.~.%~L~'~?,?~-~:--- '-':':' ": : '-o~,..~.-.--:~.-,~..: ' - - ' ..: :,,~?.:..:._/.:?Addr~ss. ~:~:~:;?.~?~:~/~:V.?.::~-?:-:-'-~': '.: ..... :':~' '.:'- :; - ' - '.:-'~'~':~:~?:~? .-- ..?~.~. ,~;?~_.~ othe~se requested, H~ wd/ be held for p/ckup ....... .......... ,:----.-~-~:,..~?-,~:::~ :-' :.. :- - :.- ' 2 .................... OZ · : ' . : NUMBER OF BEDROOMS: .... ~ ~ :? - "_' - .~':'-_~?.'.' ~.?,~;';.~..: z - . WpE.OF'WAT R '-: ...... : ......... .... .. :.. ~..,-..." Indw~dual well · . ~ .... ~. -:'; ~ :'-.'~.'::'-' .: :.:?~'.'~; f;~'~ :~rCommunitY well . - ' · -. - ' ' ' '~', -~-~. 7 '77'.~,~.i~-~,-~ "~ -' · ...... ~'~-~:, .;-'.;~. Pu'bli~-water ::::. . ................ _ _ -: .::--.- ' . . .... : -~"'~ ' :' .;.'- '' ' ' - . : -__::_:.; .... ::2~'~;'":~' ' ' ' NOTE: 'If cOmmuni~ well system, ~rovide wfi~en confirmation from st~e ADEC a~est- ..... ~ ing to the legali~ and status of system ....... ~"-'-; 4. .TYPE OF WASTEWATER DISPOSAL; .......... -'. ~ ;,~. ,, : ~.' · ' - Indivdualon-site ~ ; ,,~ 2 ........... Hodn tank-? .......... . ~,~.-...:. ....... ,. . . ~ ... .~ ~ . 5 '~-~ ~Q ~ .... ':.. · ., Communtyon-ste . '~;-:-~Ah -~u -.,..:..,:~ _ r~ . :' -, ',,.,;-" .... ',: ' . . ,.... :-.~ , .., . ' . '~ -;~). ~. . ~ ..'~<',~ ' ~ ~i'" .:,; ~; ~'.-- ' .' ,...' ~]~ ~f) )~,' .' ~, '''~,' .... '~' ..... -, ~Pubhcsewer .. - · .:. .... ~:... ....... %..~),7 NOTE: if communi~ wastewater system, provide wri~en confirmation from State ADEC a~esting to the/ega/i~ and status of system. ---. - -- _ :-,-.: ..i.~?q_.-. 72-025 [Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION~ BY~ ENGINEE ' 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 ~hat 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 furtherverifl/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. . . Phone Name of Firm ~'-r-zZ.-~'~.-~'J ~.~,~'~ ,~'~ · Address ~-'~'~'%~'~ ~' / ~2~'2,z, A.~c ~ ~-'~r,,~ , Engineer's signature 6. DHHS SIGNATURE ~A'~:" ':.'~'edrooms. ' ":... Additior~l'Comments '- ' '' :' '--r:'' ' ',The Muh: ¢~lity ,-< Department of Health and Human Services (DHHS) issues Health Authority Approval Certd~cates~based only upon the ·representations gwen in paragraph 5 above by an independent /~ , - - ' ,, prof~ssi~)na~ eng meet Cegistered in the State of Alaska. The D H HS does this as a courtesy to purchasers o! ho roes and their, lending institutions in order to saUsfy 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Well Data Parcel I.D. Of--~-- Well type '--'-'-~.,~-D. Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number .Date completed ~ I q~ '~1 Driller /,3¢~X~'~.,~/z_~ Cased to ~1 :z-.,.,-,-~ %,,----o ~ ~ Casing height [ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION ~ g.p.m. ~, ~ g.p.~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot / / Absorption field on lot Public sewer main ,'~/'/& Sewer service line Nitrate ; On adjacent lots / ; On adjacent lots / ¢c:, Public sewer manhole/cleanout /"J/'f~ .Petroleum tank WATER SAMPLE RESULTS: Coliform ~ O ~ Date of sample: '~-~/~-- ~ B. SEPTIC/HOLDING TANK DATA Date installed '~-¢ 9- - ~ I c~, / c/ Other bacteria Collected by: -%. ~.,q c.r- Tank size Compadments '-~ Cleanouts (Y/N) I High water alarm (Y/N) Date of pumping '--,'-2- ~ ~( ~ ~-..~- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot [ 1,3 To property line ~/~ ' Surface water/drainage Foundation cleanout (Y/N) Depression (Y/N) Alarm tested (Y/N) ~ On adjacent lots Absorption field .,h/o0 c Foundation E~Pr Water main/service line ~, ~._~-/ 72-026 (3/93)° Front CONTINUED ON BACK PAGE C, LIFT STATION ...Manufacturer Date installed ./V~'nt (Y/N) J Manhole/Access (Y/N) _Cycle.~e~e~ Level at High water alarm level Meets MOA e~ (Y/N) S~.~N DISTANCE, welI on lot FROM LIFT ~ ,/O',On adjacent lots .-S~dace water D. ABSORPTION FIELD DATA Date installed ~- t ~-- ~ Length ~ ~' , Total absorption area Date of adequacy test Width . Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) ! ' .%-, o Gravel thickness Cleanout present (Y/N) "~ Results (pass/fail) ~;PA.s_~ fo r After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / To building foundation On adjacent lots Surface water Curtain drain ,~/c~ ..System type t~o,b¢ --c¢~¢1¢ Total depth -'-~--~ Depression overfield (Y/N) ~ _ ~ vr On adjacent lots ~ ! o ~ Property line To existing or abandoned system on lot Cutbank_ ~ ,S-o Water main/service line Bedrooms I\L~..LI V ED JUL. 2 8 19",)5 Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION Municipality or' Anchorage ..-~. D~Pe~tHealth&HumanSer~ces,n I certify that I have checked, verified, or conformed to all MOA and HAA guide)fries 'in e date of this ins¢ec[¢o, Signature - ~~ Engineer's Name Date Waiver Fee $ Date of Payment Receipt Number. Parcel I.D. # 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 HAA # 1. GENERAL INFORMATION Complete legal description Lot 8; Block I; Park Hills Subdivision #I Location (site address or directions) Property owner Mark & Brandi Murphy Mailing address Lending agency Mailing address. Agent Address Dayphone ~: 783-2110 P. 0. Box 110181 Anchoraq¢, Alaska 99511 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 'NUMBER OF BEDROOMS: 5 TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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 Name of Firm ~ o , 17034 Eagle Ri~er Loop Road No. Address .......... Engineers signature Phone 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 suppiy and/orwastewater 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. bedrooms. - SIGNATURE // "-,.~ Approved for Disapproved. Conditional approval for Date bedrooms, with the following stipulations: Additional Comments 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 (Re'/. 1/91) Back MOA #21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST I~!~l~-~ '~t Parcel I.D. A. WELL DATA Well type~"~~ Log present~N) Total depth Sanitary seal ~_.~'N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed 7- I~ -~ ~l Driller Cased to ~ / Casing height J Wires properly protectedd~)'N) y FROM WELL LOG Date of teSt Static water level Well flow Pump level g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot AT INSPECTION Public sewe~ main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout~ pe[roleum tank WATER SAMPLE RESULTS: Co,form Nitrate Date of sample:~ ~ ~ ~ ~,~h~r bacteria ~ B. SEPTIC/HOLDING TANK DATA Date installed "~1 ~ -~1 [ Cleanouts (:~'N) High water alarm (Y/N) Date of pumping Tank size [ ~'~::~'-~ Compartments ~- Fo/undation cleanout (:3~;~1) y D~Pr~Ssior~ (Y~ Alarm tested (Y/N) ~ Pumper ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ ~ On adjacent lots To property line ~ I ~ Absorption field Surface water/drainage I ~:;'c~ ~ Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date i n s~rHed 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 teste~l-' - - ---_ _ Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~ I xz75 -'¢'~ Soil rating / ,'% ~m~/'"/~~- - System type Length ~ Width ~ Gravel thickness % Total depth Total absorption area ~¢ ~ ~ Cleanouts present) Depression over field (Y~ ~ Date of adequacy test Results (pass/fail) , for Peroxide treatment (past 12 months) (Y~ ~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots ~::;~ Surface water Curtain drain On adjacent lots ,/~gD /-¢~ Property line /'7 To existing or abandoned system on lot ;utban k //~E~/,J~ 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 on the date of this inspection. S & S ENGINEERING 17034 Eagle Ri,vet Loop Road No. 2e4 Signature b. agie i,dver, Aiaska Engineer's Name Date Date of Payment 2'. ,K//_ ¢/ / Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number