HomeMy WebLinkAboutPARK HILLS #1 BLK 2 LT 14
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Deve11pment Servlic.ees Department
Phone:
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907--3,, 3 04
V\Jastevvater Sec'U.-on
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Pump MstaHation Log
Well Drilling Permit Number:
Parcel Identification Number: 01? - 112 - 56
Date of Issue: - -
Legal Description Block Lot Property 0,,vner Name & Address:
Iq
1 Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: (feet
Purnp Manufacturer's Name:.
1! Pump Model:
r1lillp size: hp
P 'ifless Adapter Burial Depth: t feet
Pitless AdapterManufacturer's Name:
Pill -less Adapter installer:
Well Disinfected Upon Coniv, etion? FY'Ves 0 No
N/Jethod of Disinfection:
Comments:
P r
ump Installer Name: ANCHORAGE WELL & PUMP SERVICE
7640 King Street
CoDupany: Anchorage, AK 99518
PH: (907) 243-0740
Mailing Address:
Citi:
State: Zip:
Attention: The pump installer shall provide a pun -11) installation log to On-site within 30 days of hump installation.
', MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE si~WAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE ~t'O~-~ ~'~ [~NEW
C~O~ D ~ WOL F~ ~37- ~ UPGRADE
MAI LING ADDRESS
LEGAL DESCRIPTION
LOCATION
~')~ /~<el~ ~ NO. OF BEDROOMS
Absorption area / Dwelling PERMIT NO,
~ DISTANCE TO: ~.~-~ /~/ /~ ~0,T /~/ l~/~
~ ~ Manufacturer Material No. of compartments
~ ~ Liq. /O~capacityoin gallons IF HOMEMADE:' ~~ '~~
~ ~ DISTANCE TO: Well Dwelling PERMIT NO,
O ~ ~ Manufacturer Material Liquid capacity in gallons
No. of lines Length of each line Total I~ ~f lines Trench width
--~ / /~/ ~ inches
~ ~~ Top of tile to finish grade~ / Material beneath tiJ~
~~ ~ ~ {'~ ,~'} inches Total effective absorption area
Length Width Depth PERMIT NO,
( ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS ~E )~ ~ ~ ~
INSTALLER ~ · ~ .
REMARKS
APPROVED DATE LEGAL
~/78)
Certified .Well -
FOr ...... :....'~a ~-:~.~.:.;Co:r~s.:t~:'u-~.~io.r~.:-..:.....,-....,:'i
'Location ' Lot 1~ Block 2~ Park Hills Sub. ' ·
Date C°mpieted"::~'~?:~eCe~ber 26,-:1983
: . .') -: :. . :' ~ ;
Depth of WeH:::~..:....8.0... t ........ [...~....::'. .......................
· ~m' '. ~:t :. ' : )~.t.:[',...:.::L,.....;:.:.....: ~ '
S~e of c g'-: ..... ~' ;.:::;': .... ": :' ": '" ~1: '~"':'Y:
.- . ., ., ,, 18 ~ee .... ~ , , ~.-~ ........ ....
Dls~ce ~o W~r.~.~;...:~;~`.:...~.`;..`..;...`.::?~`"t~..:~~.~[`~:;~%~v.[~(~ft::.t:[~:?U.~''';7'''''''''': .',
::~i' D~ce'to Wat~"~~e :P~P~g Jf/",:l%~
- : . . ' ~' , .. - .g. :..:,'2.,?,~-::.:(~:r.';~' : : :?:::: . : :. :-
. .... ~.." : ~om to'
=oi~. ::::'.:'~::~,- :~0 :' ~0 .:.::,: :"
Brown
,:.:.50: - I 6?
I
' "- : I Certify'the above true.~d corr./ec.~ ·
'~o~ :v~ERVILLE WELL DRILLING
Permit ~ ~
Applicant:
Location:
Department ,f Health and Environmenta" Protection
825 k..~, Street, Anchorage, AK. ~j9501
264-4?20
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
!/~>~1F~-~ Mailing Address:
Phone Number:
Legal Description: /_.../~ ~:Q,. ~2~ ~.~ LOt Size:
Type of Soil Absorption System Is:
Trench: Drainfield: /~._ Seepage Bed:
Maximum Number of Bedrooms: ~3 Soil Rating(sq.ft/br) ~=~
The Required Size of the Soil Absorption System Is:'
DEPTH ~ LENGTH 73 GRAVEL DEPTH ¢~/--z~S WIDTH
Holding Tank:
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 excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(H~bg+N6) TANK SIZE TM /~ GALLONS ~ ~
Permit applicant has the responsibility to inform this department 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 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 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
available to insure .proper installation.
* * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage,
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the~/~~/~~/~z_~rcs~dence is~remod~led~ to include more tha~ 3 ~/~/~>~b~°°~
Signe~:~. .... Issued by:
'~-iicant Date: .,
SWP/024(1/81)
~_JlUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorago, Alaska 99501 2E~ ¢720
SOILS LOG-- PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR: iD~r'K. HiL&.~ .c3u~c:J qv'tStoP,.,~
DATE PERFORMED:
3
13
14
15
16
17
V4 ,Ut*
19-
2O
SLOPE
SITE PLAN
WAS GROUNP WATER $ ~
ENCOUNTERED? · ~ E,~, ~--- OL
P
IF YES, AT WHAT E
DE.T~,~ _Jig, !
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE c-~(~ (minutes/inch)
TEST RUN BETWEEN ~''~--- FT AND 4~"~ FT
eva'' ~uc c~ro~
36
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
1. GENERAL INFORMATION
Complete legal description
Lot 14; Block 2; Park Hill SubdivisionS\
Location (site address or directions)
Property owner
Mailing address
14751 Park Hill Drive
Anchorage, AK
Spud and Sandy Williams Day phone
P.O. Box 110265 Anchorage, AK 99511
345-5515
Lending agency
Mailing address
Agent April Lee
Address
Day phone
Day phone
257-0149
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~ ~'
TYPE OF WATER SUPPLY:
Individual well XXX
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:
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Fronl 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/orwastewaterdisposalsystem 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_tLgation 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
'17034 E-~jle River Loop
Address ~,
Engineer's signature ~~,~ - Date _
DHHS SIGNATURE
__/~_~ Approved for ~
Disapproved.
Conditional approval for
bedrooms.
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 pa, ragraph 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.
72~25 (Rev. 1/91) Back MOA $t21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~c,"F /'~ ~A~ Z ~/t,~K h~ig--- ,%/~'~Parcel I.D.
A. Well Data
Well type /~ 1 ~'/¢~' ~'~
Log present~_~)
Total depth gO r
Sanitary seal~N) ~-~
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed / Z-/~ ~/o~ Driller
Cased to ~ ( Casing height
Wires properly protected ~1) ~-~.~
FROM WELL LOG AT INSPECTION
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/hetdf~ank on lot
Absorption field on lot ~'~_o / ~ /-"//
Public sewer main /c.z~.~c~
Sewer service line
WATER SAMPLE RESULTS:
Coliform ~ //~-~7 ~ J' Nitrate
Date of sample: F/{'(o/~ 'v/
On adjacent lots /'~ (-(-- o-~ ~
; z
;On adjacent lots /~_2~.~ (~--
Public sewer manhole/cleanout /,J'O,c)g' //~./¢..(_.~d_,~
Petroleum tank .~F.~D~-~ ~uOr-Ot~.-J
Other bacteria
Collected by: .~--~-
B. SEPTIG/H~L~,i~TANK DATA
Date installed /(D / ~ / <~ } ''//Tank size
Cleanout~;~N) ~ '~ Foundation cleanou~)
High water alarm (Y~ _X/~
Date of pumping
~'~(-- //Compartments
~"~'~,~ ~/ Depression ( Y~.)~.
Alarm tested (Y/N) -'(-///~'
Pumper ,/~'t- /~/.//~' ~',{:C/'¢zj/~'-~f~ ''/
SEPARATION DISTANCES FROM SEPTIC/t,,I~iL~I~FN~rTANK TO:
Well(s) onlot //((-~! / On adjacent lots /~O (~ ~' Foundation
To property line ~' ('7~' / ~'
Absorption field / (~ ! "' Water main/service line
Sudace water/drainage .//-./'~ .~
72-026 (3/93)*Front CONTINUED ON BACK PAGE
C. LIFT STATION ./'(.~/,,.-%,,c," ~---d'-- ~-P
Date installed Manufacturer ,~-
Size in gallons Manhole/A~___
Vent (Y/N) "Pump on" level at ~ "Pump off" Level at
High water alarm level ...........~~ Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DIS~ FROM LIFT STATION TO:
We. Cl.odl~ot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Length /~ / ~'"' Width ~ /~ Gravel thickness ;~, ~' ~''''' Total depth
Total absorption area,/~.~ ~ ~ Cleanout present ~)
Date of adequacy test F~//~/~~'' Results~fa,l).X~5.S "-for
Water level in absorption field before test ~ ~ // i/ After test
Peroxide treatment (past 12 months)(Y/N) ~U~- N~ ~ If yes, give date ~//~
SEPARATION DISTANCE FRQM ABSORPTION FIELD TO:
Well on lot ~ / ~ U/ On adjacent lots /~ ~
To building foundation
Depression over field (Y~_~ .'C/L~
_?~o ('~Cutbank
On adjacent lots..
Surface water ,x,.J.~ /~/~¢...r~'7...r'7'- Driveway, parking/vehicle storage area' ,-~'(~)
Curtain drain ,X..,b,..,u-'L-¢-.
E. ENGINEER'S CERTIFICATION
,,~ ~"7'/-f/~E'(~. ) ~"Bedroo ms
Property line
To existing or abandoned system on lot
/6/ ~ Water main/service line
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspect/on.
Signature
Engineer's Name ~~, ~,,~F. MN(~ ~,.i
HAAFee$ /'~D
Date of Payment -7- 2..2_- c,~,
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1o General Information
Application Date .
Legal Description (include lot, block,, subdivision, section, ~town~hip, rang~)
(a)
Location (address or directions)
(b) Applicants Name XJ~A~ ~d~'~ Telephone - Home
Applicants Address .~ ~z~Ft~b
(c) Applicant is (check one) Lending institution ~--~ ~ Owner/builder~;
Buyer~ ; Other~ (explain),
Address
(e) Real Estate Coo & Agent
Address
Telephone
(f) Mail the HAA to the
.. ~ . roll,lng add_tess:
2. ~ype of Residence
Single~Family~
Number of Bedrooms
Multi~Family~
Other (describe)
3. Water Supply
Individual Well ~ Community ~ Public ~.
Note: If community well system, must have written confirmation from the State
Departmemt of Environmental Censervation attesting to the legality and status°
4. ~ewage Disposal
Onsite ~ 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.
[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 sk~owa 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 a~J ~equate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based on the infoznnation obtained from the Mmnicipality of Anchorage files and frc~ 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 regula-
tions in effect on the date of this inspection.
Name of Firm~ ~J~l~J~"~- L~?J~2~L ~. ilJ~ Telephone
Date '
DHEP Apprpv,a!.
Approved fo r' ~zi~'~-~L~?~J b ed r o Gms
Approved ~ Disapproved
Conditional
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTME~ OF h~ALTH AND ENVIIIO~-~AL
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPEN-0E~ PROFESSIONAL ENGII~ER
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURC~.SERM OF
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL A~'D
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR A~IL~L~ZE DATA
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPO~SIBLE
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK°
(DHEP SrO-L)
RR4/ej/D18
[Page 2 of 2]
MUNICIPALITY OF ANCHORAGE (MOA)
WELL DATA
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
Well Classification
Well Log Present0N
Total Depth. ~"~
Static Water Level
PAP/b//"~¢'" If A, B, C, D.E.C. Approved (Y/N) _
Date Completed //~' -~ '-6t~ Yield
Cased to ~"2..) / Depth of Grouting
/°~/ Pump Set At_ /4///4
Casing Height Above Ground
Electrical Wiring in ConduitON)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
Sanitary Seal on CasingON)
Depression Around Wellhead (Y~_~
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
; On Adjoining Lots
~'67(~ ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Date
B. SEPTIC/HOLDING TANK DATA
To Property Line
To Water Main/Service Line
Course
Comments
Depression over Tank (YO
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well //O
,0
Size /1~]
~'~ No.~of Compartments
Air-tight Caps (f~ ¢~5' Foundation Cleanout/(~
Date Last Pumped
;for_. /')/h
Temporary Holding Tank Permit (Y/N)
To Building Foundation
/,
To Disposal Field /~
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72 026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed _ ,/0 .~ z/- ~._~
GO''/
Width of Field
Square Feet of Absorption Area
Depression over Field (Y(~.
Results of Last Adequacy Test ,~,/~
Separation Distance from Absorption Field:
40'
To Water-Supply Well
To Building Foundation
Lot _
To Water Main/Service Line /d/,/~
To Stream/Pond/Lake/or Major Drainage Course _
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field _ /'-~ /
Depth of Field ~"¢" /
Gravel Bed Thickness _
Standpipes Presen~)4)
Date of Last Adequacy Test
f
To Property Line //~
To Existing or Abandoned System on
· On Adjoining Lots /¢'0 / --/~
To Cutbank (if present)
LIFT STATION
Size in Gallons ~
"Pump On" Level at .
High Water Alarm Level at
Tested for
Dimensions
~ole/Access (Y/N)
Off" at
(Y/N)
~g CycLes during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that l h,~/~ch/~k~d, ~r~fied, or conformed to ail MOA a~d.d.d~AA guidelines in effect on the date of this inspection.
Signed ~--~- /~/~'~ Date~
Company /¢~_~- ~_.,,4' MOA No.
Receipt No. ~l~(~,)
Date of Payment ¢~"
Amount: $ ~'~
Page 2 of 2
72-026 (~ 1/84)
Seal
/
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/~ESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, GOVERNOR
274-2533
July 3, 1985
Alaska Environmental Control
Services, Inc.
1200 W. 33rd Avenue, Suite B
Anchorage, Alaska 99503
SUBJECT:
Dear Sir:
Waiver Horizontal Separation between Well and Septic
System, Lot 14, Block 2, Park Hills Subdivision,
Anchorage, Alaska (8621-~4A-005)
The Department has reviewed the subject waiver request and hereby waives
the horizontal separation between the well and septic system to 96 feet
on the subject property for a 3 bedroom single family residence only.
Sincerely,
.~SteYen Id. Eh§, P.E.
District Engineer
SWE/msm