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HomeMy WebLinkAboutHIDDEN HILLS BLK 1 LT 30NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT 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 PHONE [] NEW [~]UPGRADE MAILING ADDRESS RD, LEGAL DESCRIPTION LOCATION Well / Absorptio~ area / Dwelling ~;~ DISTANCE TO: { ~,,~ ~ ~ ~: ~ I Manufacturer ~, ¢~ ~ ~ Material v~ ~Liqic~ n ga OhS ]nside ength *fA Width / ~ ~ IF HOMEMADE: I~ ~ I ~ ~ DISTANCE ~ Well Dwelling ~a I I Well _ z Fou~da{i~R ~ I Nearest lot Ji~t~ ~ t DISTANCE TO: I ~0o + ~o I ~1 ~ I/.4~_3 _ R~ I R,O i,~ ~ ~ I Top of the to fi~i~ gra~e / ' ~ M~teria] beneath tile .~ u~ I Length Width Oeptl3 , ~ I m~o,~r,~ Crib diam.t~r~ /A Crib depth I Total effective absorption ~ I Well /~ ~ ,u,ldin, foundation ~ I DiSTANCETO~ Building foundatio~ Sewerli~e V /n / S~pti~ t,.k 4-19Zl ANcHo~A~ ,AcAsK, A ?75~O2 NO, OF BEDROOMS PERMIT NO. No, of compartments P~RMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines ~ Total efJec£ive aJ)sorption are¢_ ! 2d5~ ~ PERMIT NC~. area PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS ~05'T FA, cTO iNSPE6'TIOA/ 2-":_W3%WA$~t ~oc~< ovE~ 5~We~ PtP~T FEINT PAPEF¢ OVER CAST .~b/~oz~ "C~_~a~ OUT" LEGAL F:'ERt'I I '1" NEL F:IPF'L i C:F:INI" ..)'EI',IN'T' FI2:EL.T l I',IE/FFb:ilgT i liEFi: L C)C I::1 "[' t 0 i",t L. EC~I::IL L::~[:O E',::L HIE:'E:'E:'N HZI...I....:L:i E:,.'"D i'IFt'XIHIJH NI.JI"IBE:I:~:'. OF' E:[ii[:,ROOH'-'{'; = ~: E;O I L. F::FFF ]: NG ':: LE, C! FrT,.'" BR ::' =:: :L ;25 THE RELT.!U I .F,::E[) i!~ I ZE OF ]"HE :iii:El I L. I'::IB:E',OI:;~'.F'T I ESI ~;"/~TEIfl I f::':: THE L. ENGTH [:, :1: l'lE.:.l'.,t:~; :[ 01",1 i :L:, THE L. EHGTH ':: l N I::'EET ::, 131::: THE TREI",ICH 13R [::,Fi:FI I I'.,IF I EI..E:,. THE C, EF'TH OF FI 'FF:.'I'ZNCH OF:'. PIT I':5 THE [::,ISTI::INC:E E',ETHEEN THE ~SIJF..:FFICE OF THIE GROLIbI[:., FIN[::, THE E',O"f'TOH OF:' THE: E::.:Xi:FI'v'FIT I ON ,:: I N F'EET ::,. "FHEF:E :i:S I'.,10 ~SE:T I.,.IiDTH F'OF: TF.:EblCHES. ,[ H,[:L E:ETHEEi",t 'T'HE 13Lrl'FFII....i.... I::'II::'E THE GRFF,,'EL. DE:I::'TH i:5 THE: i'IiNtHLtM DEF'TH OF ...... Fil'.,il:::, THE E:OTTEd"I OF-" 'T'HE: E;:.:;CFi'v'FiT't Oi'.,! ,:: :1: N F'EET >. F'EI;:I'I i 'T' RF'FiL 1[ C: Fl i',l "l" i...IFI:5 THE RI:.:.:SF::'OH'.:.; I E: I L t T"r' '1"O i NFEIF.:H "FH 1 5; B, EPFIRTFIENT I)l...ff~: I NG "FHIE i i',tS'T'FILLFiT I ON :[ i'.,I:SPEX::T I Oi'-,1'.:!; OF FIN'T' !,.iI::LLS FIL":,..TFIL-.ENT "f'O 'T'H Z iE; F'F4:OF:'EF4:T¥ FIND THE NUHE:[:T. F4'. OF' RE:::::;IE:,IENCE:!; THFIT TFIE HELL klILL :E;EF..:',/E:. ~;tdCI<:F ILL I l",lEi OF RN"r' :.::i;'T':E;'TEI'I ,t,.l I THOLFI" 1::' I i",lFl[... I N:i!;F'ECT i ON FIN[::' F:IF'F'I:;::EPv'Fil.... EP'r' 'T'H 19.; [::~E:F:'F:IIRTi'iEbiT i.,.i I L.L. E~E '.F.i;I...iE:..)'E:E:T' TO I:::'I:E:O:SECIJT I Obi. i'i]:l'.,I i HUH D t '5'Ff:d'.,tCE E:ETI.,.IEEhl FI [,]E:LI.~. FIN[::, Ftt",l"r' ON-'~i; I 'TIE SEI.,.iFIGE :.i..OO FE:ET FOR FI F'~;~:i:,/F:ITE HELL OR d:30 TO 200 F'EET F'RCdq FI t::'I.J[~:LIC HELL E:,E:F'ENDING UF'C)N THE: I""r'F'E 01::' F:'UBLIC I.,.tEL. L_ MZNIHLIt"! E:,I'i::TFII",iCE FP::OI'I F1 PF.:I'v'FFFiE HEL.L TO t:'1 F'F.:I'v:FFI"E :SEI.,.IER LINE T:5 ;;'::~!; F:'EET I:1t",11:::, TO F:I COHHUI",IIT"r= :SEi.,.iEF:: L. ZNE ]:'i'~; 75 i::'EE:T. OTHEF: F~'.[CC::!iJ I I:~.:Ei'IEi",FF% HF:I'T' FIF'F'L.'T'. :!i;I::'EE: I F:' I CI:'f'F I Olq'5, F:It",tl) (:;OI",ISTRUE:I" I Ed",l [::' ]: FIGRi:::II"'I:i~; F:IF4:E l::l'v'FI I LFIBLE TO Z i",I'/5UI:;-:E F'I;:Efi:::'EI:;i: i N'ii;TFd...LFIT I ON. I CE!iRT'IF"r' THFIT :L: i I::lt'"I FFII:'IlL/[Filq: Ni"i'H THE F:EQUIF:EH['ZI',IT~.5 FOF..: I31'.,!-.S::ITE :E;EHER:':T, FIND i.,.tEL. L:!~; I:tS; 'ii;ET FOF.'.TH E',"r' THE I'"II...Ii',iICIF'FII...IT"r' OF' FINCHOF.:FtGE. 2: I I.,.!ILL. iNS"FFd....L THE: :i.:,'T':STEH II",1 FIE:C:OR[:'F!NCE: HITH THE C:O[::'ES. ::ii.: I LIN[:,E:R~;TFiI",IE:, THFIT 'THE ON"":F;ITE 'ii;Et.,.IEF.: ::i:;"¢::'-:;T[F.:H I"iFW REC!UZF4:E ENLFIRGE:HEiqT IF' THE YI25 Ok~..$ewa~d Hwy. And~o~oge, A~sko 9950~ 349;6561I SOILS LOG - PERCOLATION TEST SOILS LOC, PERCOLATION TEST PERFORMED E O R :.~ LEGAL DESCRIPT,ON:/.-...~ 'T OL2,O' 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE WAS GROUND WATER ENCOUNTERED? NO SITE PLAN IF YES. AT WHAT DEPTH? COMMENTS_ 5~' P~/~_ _~ I/5 Gross Time Date PERCOLATION RA*[E ...... VI~,~)A ~ .... E (minutes/inch) TEST RUN BETWEEN .... ~ FT AND .~.(~-- Fi' 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.#. O/(~ ~/'Z'/"- ~G'~"'" HAA# ~:~OI ~¢"~. GENERAL INFORMATION Complete legal description Lot 30; Block I; Hidden Hills Location (site address or directions) 6311 Woode. d Cir~le~ Anchora,qe~ Alaska Property owner Mailing address Lending agency Mailing address Agent Address Brent Jennison Day phone 346-2500 P.O. Box 92772 Anchorage, AK 99509 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: . Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and sfatus of system. XXX If cornmunity wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify th. at my' investigation of this Health Authority Approval application shows that the on-site water supple, 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 17034 Eagle Ri.yz'~ L?op Engineer's signaturo~ DHHS ~IGNATURE J Approved' for ~ Disapproved. Conditional approval for bedrooms. Phone bedrooms, with the following stipulations: By: Additional Comments Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suqqested that a periodic testinq be performed to insure the wells continued suitability. Nitrate concentration is 5.79 mg/1. EPA ~~/~ma~ltnum ~.onc.~nt_ra~on(~i.~ ]tO.O. rog/1. 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 uy 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 engineeCs work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:/--cT ,'~d) ~C~ / A, Well Data Well type Log present (Y~ /U Total depth ~.~. ~', Sanitary seal(~)F~.% /-/1~/,,3 /41L4_~ Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date of test Static water level Well flow Pump level1 Date completed (./~. Driller Cased to 4 ©/Y- Casing height Wires properly protected~(~N) FROM WELL LOG AT INSPECTION g.p.m. ; On adjacent lots /00 ; On adjacent lots / OO Public sewer manhole/cleanout Petroleum tank ~ ~ ' SEPARATION DISTANCES FROM WELL TO: Septic/heidh,~-tank on lot Absorption field on lot _ Public sewer main l Sewer service line /00 x¢ WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/~TANK DATA Date installed ~:~'P'o.~_- Nitrate Other bacteria Collected by: ~.-.~.q[(; ~jvo~, AIr~'~a 99577 Tank size /00 o jzx) c_ Compadments ~ Cleanout~N) '~'(¢-.> Foundation cleanout (~) _ 7'~-: Depression (Y~ High water alarm (Y~I~ ,.,C/o Alarm tested (Y/N) Date of pumping ~/~ } / ~ ~ Pumper SEPARATION DISTANCES FROM SEPTIC/Ft~TANK TO'. Well(s) on lot /~/C) (-/ On adjacent lots //~O To properly line ~-0~'f~ Absorption field ~z~ Surface water/drainage ./,~o.x~¢~ F0undation "-/0 Water main/service line 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION ,/~) O,X.J~ Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electricalcodes (Y/N) ~ SEPARATION D~FT STATION TO: W~C~d~t On adjacent lots Manufacturer ~ Manhole/Access (Y/N) ~ ._.---~J~-p off" Level at ,~~Cycl~s tested Surface water D. ABSORPTION FIELD DATA Date installed ~-P'o~(¥ F/~-~ Soil rating (GPD/FF) Length ~'-~' f Width, ~' ' Gravelthickness Total absorption area ~z~"~.l ~i ~,~,C. Cleanout present Y~) System type Total depth Depression over field Date of adequacy test ~/~//¢:~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/~) Results~-'?fail) ./~,,~r..~'.~ for (~ After test /L/~'O~. ~ If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /~'..~ ''c- To building foundation On adjacent lots ~ Surface water ./0/o ~(¢ Cudain drain /'C/~E Cutbank /1/o,u~ /o4.C. jE/~7-' Water main/service line /oFL~.%'-,( ~7~ Driveway, parking/vehicle storage area On adjacent lots /(-~d:% ~¢- Property line To existing or abandoned system on lot E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in.;., Signature Engineer's ~,~o. x?, / / ..... of this inspection. HAA Fee $ / '~¢ '~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number zt __ :',11:49 CT&E ENUIRONHENTAL LAB SERUICES i; ,~i; N0,237 COMMERCIALTES'FING & ENGINEERING ENVIRONMENTAL LABORATORY .~ERViCES , :; ,~.~, !: ,, . .,, · . RBPORT of ANALYSIS Chemlab Ref.$ · :93.3963-3 Client SamPle ID :L30 Bi HIDDEN HILLS S/D Matrix :WATER 5633 B STREET ANCHORAGE, AK ?,9518 TEl.: (907) 56?,,2343 FAX: t907;, 561.530i Client Name :S & S ENGINFJERING Ordered By :R, SHAFmjR Project Name : P~oJect~ : PWSID :UA WORK Order. :69352 Report Completed :08/12/93 Collected :08/09/93 @ 16:57 Received :08/09/93 @ 17:20 Technical Director:Sl%~FBF2~ C, EDE Released By Sample Remarks: ROUTINE SAMPLE COLLECTED BY: Allqwable Ext, Anal Parameter Results Qua]. Units Melt)od Limits Date Date Ini~ Nitrate-N 5.79 mg/L EPA 353.2/300.0 10 08/]0 LL! * See ,Special Instruction~ Above UA ~-, Unavailable ' ** "See 'Sample"Remarks~ Above '" · -' : ,, NA =NOt, l. Anatyzed U'= ,Undetected,.~Reported~value is the practical quantification llmit,; '. LT = Less ,Than D = :Secondary dilution.":,. ' O T = Greater Than COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Member of the $G$ Group (Soci6t~ G~nbrale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA