HomeMy WebLinkAboutOVERLOOK ESTATES BLK 2 LT 6
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Address
Phone(s) P'ermit N'om No of Bedrooms
Township, R~ge, 8ectio~
TANKS
~ SEPTIC [] HOLDING
Manulacturer Capacity in gallons
DISTANCES L~b ?- 0~//~/;~
SEPTIC
TANK
WELL
LOT LINE
FOUNDATION
ADSORPTION
FIELD WELL
AS-BUILT DIAGRAM (Show Iocahon of well, seplic system, property hnes. foundahon,
driveway, water bodies, etc.]
Compadments
s;T'E F_L
TYPE OF SYSTEM
~ BED [] W. DRAIN [] OTHER
TRENCH
Depth to pipe bottom from
original grade /~ I
Fill added above original grade
Gravellength
Total depth lrom original grade
iravel depth beneath pipe
FT ~J
~ravel w~dth
ET /(d~'
Total absorphon area j Distance between lines
· WELLS
/~PRIVATE
Class,flcaUon (A,B.C)
[] OTHER (Identifv)
Total Depth FT Cased to
Date Installed:
REMARKS:
FT
FT
FT
FT
FT
Municipal and State guidelines in effect on this date: ~//7 / ('~' /
Health Department Approval:,~'~ ~
certily that this inspeclion was pedormed according to all
Date: '/--.__,_~
72-013 (3/85)
F:'EI':;'.H ]: T' Ei: X F:' ]: [;,'l!!i~i DECEME!EF:~: :31 ~ 1990 ,,
ND"I' :I: I::'¥ .Ol'..IH::ii~ (IF: ]: N~:~F:'I!i!X]:T I C)N!B A,T :];4-:3-.4'7~-4, Cf!::;: :];z,[:];-4.6~i 1 ,,
E×C('~'v'AT):C)Iq I"ILJ!~F'I' BE:: OF'E:I',II~i:D P,N.'O CI....C)!i~;.',CD ON SAME
F:'RC)V:i:OE: I~.Jl:ii:l....L.. I..Ol:':) F:OR li~:XI!TI]:NE';N,EI_L. CH',!
,i: CEI::;,"i" ]: !::'Y 'i"HW!':
',!.. ]: ~:~n'! fa'~mi],i,::~p !,~;it.h t.h~.',~ i:~:~qL-'.:Lr'e:'l¥ie)i-.'t.s~ (or~ c:,n-'~;i'Le:, ~,:~,'~(,;:,~'~; arid
2. :I: ~:i.:l.:!.:in~;irl:.al:t. t.l'ls~ ~;;;y~;~-t.~.'..:~rn in ac:c:cmdanc:e:-~ v,~:i.'Lh all I"ICIF~ c::c~ds~s
.:::~.r"~cl il"i c::ch"np ! :i.~tru::e v~it.h the design cv it. er'. :i.;.;~ o[ 'i'..]"iJ.~
.:;.;~, :i: v~i].:l,au::lh~.:..~i~e) t.o a':t].! l't(::ir~ .;:zr'icl St.a'~t.e:.::, c)f (:~14;tusl.;:a r~[~qu:i, rs~m~z(,r"rL~;~, ic:m t.l"~;,:~ ~x.~d:. ~::,~:;~::[::
d :i. st.;~:u'tc:~::,~,~, f' r.(::*m a.n'./ ~z:n-~ i~st'. :Lng ,,~,:1. ]., wasst.~:~v~¢:*.t:.c<,r' d:i. sl::,os¢~! s'y:~;t.~:~,n'i c)r' i:)~.d:i ]. ic:
!B(.gVx~E.:q'" ~F~i.::J(..~e !i:~-')~!~i'~'..i;:~ffl Of'i t.h i ~B c)r' ~F:d"~w ~e*cJ.j a~.C:i.Z.)I'Y~'., tip Iq~alP~:)'~ ]. or.,
z!.,, I unch.zm~a'L~ar'tcl 'i'..ha?cL t. hi~is per. mit. j.~ v~a].id [cir' a~ matx:i, mum c:,f 4
/
dOTE: i
All Dimensions And Locations
Bust Be FieZd Verified Prior ~o Construction
SEWER SYSTEM LOCATION PLAN
,~CTION 1 TOWNSHIP/' RANGE
NORTH
SCALE'
A P/;EOX. / % 1oo'
DRAWN DY'
,
SUOOIVI SION
r
~ '. f, Auniclp~li~y of A. nchoca§e
E)EFJARTMENT OF HEALTH & HUMAN SERVICES
825 "L" $lr~l, Anchorage, Alaska 99502~650
SOILS LOG ~ PERCOLATION TEST
LEGAL OESCRIPTION: ~-~j~ :, IS ~ <~ V1.~'~(.-(2~4~ Township.SLOPERange. Sec,.ion:
5
6
7
8
9
10
Ef4COUNTEREO?
11
12-
14-
15
16
17
I8
SITE PLAN
IF YES. AT WHAT O
OEPTH? P
pERCOLATION PATE (m~,,,Ae~i,~,l PE.RC HOLE OIAMETER __
3'7
COMMENTS
TEST RUN 861'WEEN FT ANO
^CCORO/L~ICE WITH ALL STAi'I~- ^NO I,~IJNICIP^L ,GIJIOEUNES Cfi EFFECT ON THIS DATE. OATE: ( '~- ~ I '~(¢~
(Rev. 4'851
./
TEL£PIIONE 2'45,4071 _ - ,_,.~,
~ - - -BIk Sv'l:f,_ .. WELL,
PLEASE PAY FROM THIS INVOIO£
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
0~8 Of~¢.~ .-. ~ '-~ HAA# O-~-'~,~(~(..,~1
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
(b)
Location (address or directions)
Property owner (~ tl..~.O ~0¢~ [~'l.~.%"~u~ Telephone: (home)
_Business
Mailing Address
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent
Address
Telephone
(e)
Mail the HAA to the following address: (or check here~, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family~i¢.. Number of bedrooms g
3. WATER SUPPLY
Individual Well ~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) 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 shown below, Iverifythatmyinvestigationofthis
Health Authority Approval 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
Address
Date
6. DHHS APPROVAL
Approved for ~ bedrooms by
Approved ~p,~ _ Disapproved
Terms of Conditional Approval
~,1,~, r~.-k Date l '7-'//O/' ~O
Conditional
The Municipality of Anchorage Department of l4ealth and Human Services(DHHS) issues Health Authority Approval
cerificated 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 ordertosatisfycertain federal and state requirements. Employees of DHHSdonotconductinspections
or analyze data beforeacertificateisissued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
A. WELL DATA
Well Classification /'~ [~'b~ '
MUNICIPALITY OF ANCHORAGE (MOA) ~
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: ~.0~" ~, ~/--~1~. 'Z.-
Well Log Present (Y/N) Y Date Completed
Total Depth ~-"'¢¢0 Cased to ~
· Depth of Grouting
Static Water Level ~ ~'! Pump Set At
&'
Casing Height Above Ground ~ Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Yl~ Depression Around Wellhead (Y/N)
If A, B, C, D.E,C. Approved (Y/N) ,~/4 ~,
Yield ~ ~"ff~¢~ dI~''0~'~0)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line '
To Nearest Sewer Service Line on Lot
Water Sample Collected by I(-~J
Water Sample Test Results ~/~"
Comments ~.J~.~ ~-.~ & ~
; On Adjoining Lots '~
~-- ~[ O ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole J~J/,~
B. SEPTIC/HOLDING TANK DATA
Date Installed [ / ~ 0 Size
Standpipes (Y/N) 7
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
[, ,~0 No. of Compartments
Air-tight Caps (Y/N) Y~5 Foundation Cleanout (Y/N)
/,~ 0 Date Last Pumped ~
~O ;for IJ IA
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well ~ C~O
To Property Line ,~0
To Water Main/Service Line ~'~.-~
To Stream, Pond, Lake or Major Drainage Course
To Building Foundation
To Disposal Field
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorptijcn ,~Stre/ta
Date Installed t 11 ~
Width of Field (8
To Water-Supply Well
To Building Foundation
Lot "~'
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water Main/Service Line
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 O. ~'
Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line IO
To Existing or Abandoned System on
' On Adjoining Lots "&,O O
To Cutback (if present) ~J //~
IA
(0
'~D..LIFT STATION
Date I r~s(alled -_
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y~).~_-~-
Comments - ~ -
Dimensions
Manhole/Access (Y/N)
"Pump Off~SL-ev6'l '~t
. .... ~ ....... Vent (Y/N)
· Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verifie~or conformed to all MOA and HAA guidelines i.neff(Cot:or~.the date of this
inspection. ,~ ~/~ ~ ?/
MOANo. E6: ~-'~[O ¢~0 ¢' ~ ...... ':' ' "'
f./ , . ......
Receipt No. c--~ c~ ,~ '~/ ('~/"-~ O~ ~-- .) Receipt No.
Date of Payment ,'/O- ~ ~ ~ '0 Waiver Fee: $
Amount: $ / .~ ~ O) ~ Date of Payment
72-026 (Rev, 7/88) Back Page 2 of 2
KE KNIEFEL ENGINEERING
8441 Miles Ct., Anchorage AK. 99504
(907) 337-1121 · Fax (907) 338-1874
Date of Tt~eting: December 3, 1990
Legal Description: Lot 6, Block 2, Overlook Subdivision
Street Address:
Number of Be. drooms; 4
Well Flow Test: Depth of Well: 250~ Static Water Level 65~
Average Flo~ RaBe: > 4 gpm
Results of Water Quality Analysis: ~otal Coliform -'~ 0 colonies
Nitcate--N ---- <0.1 mg/l (10 mg/l allo~abl8)
ResulBs of Septic System Adequacy:
Ne~/a System, Checked and found standpipes, and (sleanoute.
,E.$.Ca,g,,$...E.~,B,~l),&.;%,.,,,Q?,,_,,&.b,aL..-.~,QS ...... The sep'bio system was f]sM and not
Beeted for ad~qua(sy, oi]].y to insure the stqndpipes and CO were in
the proper position.
The sys I';em was tested in accordance with HOA policy and
~egulations in focca at the time of this test.
!:
NORTHERN TESTING LABORATORIES, INC.
2505 FAIRBANKS STREET
3330 INDUSTRIAL WAY
Knlefel Engineering
8441 MAles Court
Anchorage AK 99504
A~tn= Rober~ Kniefel
A107322
Wate~
Ou~ Lab #~
Looa~lon/~roJec~
¥~ur Sample
Sample Matrixl
Cormments~
ANCHORAGe. ALASKA99§03
FAIRBANKS. ALASKA g9701
Method Parameter Units
Report Date:
907.277.8378 · FAX 274,9645
~07-~,5~3116 * FAX 458-3125
~2/05/90
Date Arrivedi~ 12/0~/90
Date Samp~edi: 12/03/90
Tim~ Sampled~ ~115
Ooltected By? Kniefel
~lag De~ini~ioa~
U = Below De~ection Limit
DL ~tatgd in Result
~ = ~elow Regulatory Min,
H ~ Above Re~ula%ory Max.
E ~ ~elow DeDeo=ion Limi~
~stima=~d Value
I Date
ResultiFla~ Analy~ed
300.0 Nltrate-N mg/1 0,1~ U 12/04/90
Repor~e~ S¥: Francois ~odigari
Anchorage Operations Manager
NORTHERN TESTING LABORATORIES INC.
~05 FAIRBANK~ ~F/'FIEET
600 UNIVERSITY PLAT~ WE~T, SUITE A ANCHORAGE, A~ 99503 ;
~AIR~NKS, A~KA ~0~ ~ g07.~7.8378 · F~ 274,9045
Drinking Water Analysis Repo~ for::
TO BE COMPLETED BY CLIENT
' ' TO 8~ COMPLETED BY ~BO~TORY
/J~PRIVATE WATER SYSTEM ; ' - "; ' '
~ ,. ~o .,~,,.
MO. D~y Year
Purchase Order No. , ._
SAMPLE
.~ Routine
'- ~ T~eetec Wa~er
~ ~peciai Purpose ~ Untreated Water
~ Check SampJe (for original conteminated
sample with la~' reference
No, ~on
4
5
6 _
7
I
F-OR LAI~ORATOFtY USE ONLY
.I
Time Received _.
Next ~ample Due
COMMENTS:
SATISFACTORy
UNSATISFACTORY
RESA~PLE
OTHE~ B~CTERIA
TOO NUMEROUS
TO COUNT
of!Total Coliform Colones I;~er lO0..,rnls,