HomeMy WebLinkAboutSTUCKAGAIN MANOR BLK 1 LT 7 (~_.~ MUNICIPALITY OF ANCHORAGE
( DEPARTMENT OF HEALTH & ENVIRONMENTAL. PROTECTION
, ENVIRONMENTAl. ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-472.0
ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELl. INSPECTION REPORT
-~AME PHO ~-~ ?~NEW
MAILING ADDRESS
LEGAL DESCRIPTION ~.
Material No. of compartments
Liq. capacity in gallons Inside ]el~ Width Liquid depth
~O IF HOMEMADE'. ~
~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ Manufacturer Material Liquid capacity in gallons
Foundation Nearest lot line PERMIT NO.
m,, NotT zoq
~Z~_Z~ No, of lines I Length'of each ,i}]~{~O ~ T~tal, length of lines Trench width/ ~OX6~,.s Distancebetweenlinesi~iA
N ~ ~ Top of tile to finish grade '* ~ Material beneath tile )' ~ I Total effective absorption are]
Length Width Depth ' I PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
INSTALLER ] I
APPROVED BATe LEGAL
72-013 (Rev. 3/78)
F!P F'L. Z CF~HT
LOC,fiT :[ ON
LEGRL
L. 7 E:::L :5'TUCKRG,'::I t N I ,HNUm
TYPE OF '--- _
:..,].L RBSORF'TZON S'¢?i"EM l':;: TRENCH
I'"IFIi:.:I!ML!M I'.ILi',IE:ER OF E~EDROOi"I:.E; ....
THE LENGTH DIMENE;ION IS THE LENGTH (IN FEET) OF' THE TRENCH OR DRRZNFZE:L.E:,.
THE DEF'Tlfl OF F! TRENCH OR PIT Z2; THE [:,IZ;TRNE:E 8ETHEEN THE E;URFRCE OF THE
GROUN[:, RND THE 8OTTOM OF' THE E~.::CFI',,,'RTZON ,::ZN FEET).
THERE IS NO SET H:[[:,TH FOR TRENCHES.
THE GRWv'EL DEPTH !:5 THE IdINIMUH DEPTH OF GRFIVE!... BE"i-I.4EEN THE OLITFFILL PIPE
RND THE E',OTTOM OF THE EXCRVRTZON ,::iI'-,I FEET.'.".
PERMIT FIF'F'L.T. CRI",IT HFIS THE F.:ESF'OF,IS:[E,';[LIT'¢ '1"C* INFORM ]"HZS DEF'RRTMENT DUR.T. NG THE
ZNSTRLL. FITZON ZN5:F'EE:]"ZOI"4S OF RN'¢ .t4ELL. 5; FIDJRCENT TO THZL:; PROF'ERT"r' Ri",!.D THE
NUHBEF-.' OF RESIE:,ENE:EE; 'THFIT THE i.4ELL Iq!LL
E R: KF Z L..L. I NG OF F!N'¢ S'¢:STEM I I ~'T'HOLF~- F I_'NFiL Z NE;F'ECT Z ON Ffi'4D F~F'F'R ~ b'RL EW ~ H
DEF'RRTMENT HILL E .......... IbJE_.]' TO PROSECUTZO,N.
H!N'_r..r,!LIM D](.'::_';TRI'.~CE BETWEEN Ff NELL RND RNY Oh,I-SITE ~,Et.,.IRGE DISPOE;FIL
:i.E~O FEET FOR R PR:[',,,'FtTE HELL. OR ±50 'FO 200 FEE']" FROH R PUBLIC 14ELL DEPEN[:,!NG
LIpON THE T'¢PE OF PUBLIC .14EL..L
HINtHUH DI"_:;TFII'4CE FROH. Fl PR:i:',,,'RTE !4EL. L TO R PRtVF!TE SE.WER LINE I.'.:.; 25 FEET FIND
'FO FI E:OHMUNIT'¢ '::;EWER L]:NE I:.E: 75 FEET.
F!ELL LOG':': RRE RE6!U!RE[.', FIND HUST BE RETURNEE:, TO THE ..F.:,EPRRTHENT !.q!TH.[N ]:E~
OF THE NELL COf,IPLETZON.
OTHER REC!UIREMENTE; Hla'¢ RF'PLY. ~-];PEC!FICR?'ION% RND CON~'CTRUCT!ON DIf:IGRRH. S
RVR:[L. FIBLE ]"0 INSURE F'ROF'ER INSTFIL. LRTZON.
_.~.I:,., _l r. -r THFIT
! F!H FRMILIFtR. I.,.!tTH THE RE~;!UIREMENTS; FOR _N-Z;tTE SE!.4ERS RND I,IELL~ ,-Iz,~:'- SET
I
±:
FORTH B'-r' 'THE i'"!LINICIF'FtLIT"r' OF Ffl"~CHORFIGE.
2: I I.,.!ILL I.N:5]-F!LL THE S"r'STEM IN FiE:E:ORDRNCE !.4:[".rH THE CO[:,E:5.
5::: ! UNE:,ERSTRND THRT 'THE O['.,!-5I"f'E SEWER 5;'¢':STEM r'tR'¢ REQUIRE ENLRRGEMENT IF THE
RES![:,ENCE !.S REMO[:,ELE[:, TO iNCLUDE f,!ORE THRN 4 DEDROOHE;.
FIF'F'L I C:FINT [:,ON E:URN:5
Test Hole A
Lot 7., Block I
.Depth in Feet
..From ~T_o__
0 1.0
1.0 7.0 '
7.0 16.0
W.O. #D13370
Date: 8/17/81
Logged by: TB
__Soil Oescr/_~_ption
Topsoil
NFS/F-2, Brown Gravelly Sand, (SP~SM), trace silt,
moist-wet, med. dense -- --
NFS, Grey Gravelly S_.a.n_d~ (SW), moist-wet, med. dense
Percolation rate = 1.0 minutes/inch
Water quickly seeped out of hole.
Bottom of Test Hole:
Frost Line:
Free Water Level:
16.0 ft.
none observed
none observed
Sa.
Type of
~ Unified
I 5' G SP-sM
2 10' G SW
3 16~ G SW
Remarks:
6A-5
1. Type o£ Sample, G=Grab, SPT = Standard Penetration,
U = Undisturbed.
2. Dry Strength, N=None, L=Low, M--Medium, H=High.
3. Group re£ers to similar material, this study only.
4. General In£ormation, .see Sheet 1.
5. Frost and TeXtural Classification, see Sheet 2.
6. Uni£ied Classification, see Sheet 3.
MUNICIPALITY OF ANCHORAGE ENVIR~ikNTAL SERVICES DIVISION
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
p.O. Box196650 Anchorage, Alaska 99519-6650
RECEIVED
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # _~"~J-~ ~ _((~.;,.3.,qh __ ,~ r.~ HAA # ~°~l~'~
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
)-I'~ P,H ~ Dayphone '.~ ~'-) ? ~ 0%
(~./(c:.(Lt~/ t) I\LE AtJcl~ AK,
Day phone
Mailing address
Agent _
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: Z/ ,~
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.
Se
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 regulations in effect on the date of this inspection.
Name of Firm _~ ~^~ 7% (. //,~ (.
Address . 7,~01 £. ~f~-t/~ /'\V~.,.~
DHHS SIGNATURE
-~ Approved for fl _
bedrooms.
Date 2;~. (~ ,,/¢_) (,
Disapproved.
Conditional approval for
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.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744
Health Authority Approval Checklist
LegalDescripfion: ~'f~ d tax A 6- I~l/-t /vi Al'-l O il ~r~D.
Parcel I.D.:
A. WELL DATA
Well type .~/V
Log present (Y/N)
Total depth / / O
Sanitary seal (Y/N) "/
If A, B, or C, attach ADEC letter. ADEC water system number g,///,~ ..
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform -- 0 ~
Date of sample:
Date completed
Cased to
FROM WELL LOG
%
Nitrate
Casing height (above ground)
wires properlyprot ted
AT INSPEC~ON
O~er bacteria
Collected by: ~'~-~ /'~D4
B. SEPTIC/HOLDING TANK DATA
Date installed ~&_/--]~&Tanksize /& 6~ NumberofCompartments ~ Cleanouts(Y/N)
Foundation cleanout (Y/N) J C ~ Depression (Y/N) ,/'v O High water alarm (Y/lq) a, o
DateofPumping )~> f0Af< 'b~,Pumper lSA,qq~5 ~r)C~,,~p~-,,
C. ABSORPTION FIELD DATA
Date installed '2/~- 1/{ ~
Length 2L _q , ~ Width ~ 0 ' / Gravel thickness below pipe
Effective absorption area ~ ~'?~:T2MonitoringTubepresent(Y/N) ~
Date of adequacy test ~//30/~ {~ Results(Pass/Fail)
Soil rating (g.p.d./ft2 or ft%drm)~ ~ cr?qo~Systemtype 7-a'~ C/J c~
'~. o ' Total depth ,~ D-f
Depression over field (y/N) A/
For ~/ bedrooms
Fluid depth in absorption field before test (in.); - o ~ Imraediately atter')g6 gal. water added (in.): 3 ~"
Fluid depth ~},lS_~(ins.) Minutes later: _'~}t3 Absorpfionrate = ~ '760 g.p.d.
Peroxide treatment (past 12 months) (Y/N) -~ O If yes, give date
D. LlYr STATION
Date installed ~,///~
Manhole/Access (Y/N) /'4 /~
High water alarm level at* fi,////~
Cycles tested /t/A
Size in gallons
"Pump on" level at*
*Datum A~
"Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
.; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation / ~_ ! . PropeWy line ~ ;)~ / Absorption field f ~_ /
Water main/service line /'-/.//~ Surface wateffdrainage .Av,,/.,A Wells on adjacent lots ~' ~_ O <3
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation g~, ~ Property Line J ~.~ Water main/service line
Surface water _ fi'v/ //t) Driveway, parking/vehicle storage area 0~'~'
Curtain drain /x/.//~ Wells on adjacent lots ~ ~. O0 /
ENGINEER'S CERTIFICATION ~. ,~..~. ~, -
I certify that I have determined thrufield inspections and review of Municipal re~_~t rl~d' abb~ts are
in conforntance with MOA It~gidelines in effect on this &te.
_
HAA Fee $
Date of Payment _
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
04/05/96 12:01 CT&E ESI ANCHORABE ~ 90? 333 l~B5 N0.873 Q05
CT&E Environmental Services Inc. 96-04-08 08:43 RCVD
Laboratory Division z~r~
Laboratory Analysis Report
CT&E ReL#
Client Sample
Matrix
Sample
961107.9118
L7 B1 STUCKAGAIN HTSI 1107-01
Drinking Water
Collected Data 04/02/96
Technical Director
Released By.~ ..../.~._,~ .....
200 W, Potter Drive, Anchorage, Ag 99818-1605 -- Tel: (907) 562-2343 Fax; (907) 561-5301
3180 Pager Road, FairDanka. AK 99709-5471 ~ Tel; {907) 474-8656 Fax: {907) 474-968,5
ENVtRONMENTAL FACILITIES iN At~$~, CAUFORNIA, FLORIDA, ILLINOIS, MARYLAND, MiCHiGAN. MISSOURI, NEW JERSEY, OHIO, WEST VtRGtND
04/05/96 13:32 TX/RX N0.1429 P.003 ·
:
CT&E Ref.#
Matrix
Client Sample ID
CT&E Environmental Services Inc.
Laboratory Division
9 .03 4-1 Laboratory Analysis Report
WATER
NONE GIVEN
Client Name SENTEC, INC. WORK Order 20939
Ordered By GREG PUTNAM Printed Date 02/02/96 @ 14:18 hrs.
Project Name Collected Date 01/30/96 @ 13:35 hrs.
Project~ Received Date 01/31/96 ~ 15:50 hrs.
PWSID UA
Technical Director STEPHEN C. EDE
Released By ~~~ ~
Sample Remarks: SAMPLE COLLECTED BY: G. PUTNAM.
QC Allowable Ext. ~ual
Parameter Results Qual Units Method Limits Date Date Init
Nitrate-N 2.2 m~/L EPA 353.2 10. 02/01/96 BMW
See Special Instructions Above UA = Unavailable
See Sample Remarks Above NA = Not ~nalyzed
Undetected, Reported value is the practical q~antification limit. LT = Less Than
Secondary dilution. GT = Greater Than
200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURi, NEW JERSEY, OHIO, WEST VIRGINIA
[