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HomeMy WebLinkAboutHILLCREST BLK 2 LT 6 GR TER ANCHORAGE AREA BOROL, DEPARTMENT OF ENVIRONMENTAL QUALITY 3§00 TUDOR FIOAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM MAILING ~,c.2/F.(~_~.~_~,/..~ .~'~,~_r~.,,~. PHONE '~_ NAME -~J' ~..~9/-'/V" L7 -~_~,~-~, ~"~_ '~"~ ~ ADDRESS _ LOCA TIO_N ~"~,r~'~ z.>'. //~x~.,~ f~, _~/.z_ _/~-'~_.~/~/~'Z-~ LEG AL DE SCRIP TION -~'~-~/2,~'~ ~_~Y:~--~-~_~_z~:./'/~'~-~/~'~FI SEPTIC TANK: DISTANCE FROM WELL-(_~._._._._._._._._._~r LIQUID CAPACITY ~' -~'''/4'O GALLONS. LIQUID DEPTH ____ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LI NIh,IG MATERIAl ~~AMETER NEAREST LOT LINE OR WIDTH__. , LENGTH , DEPTH_ DISTANCE FROM WELl ~.~., B~UIL.~JN.Gm~D~rcTI~7-~-~.~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FI. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION NUMBER OF LINES .DISTAN~C-'~r~WEEN LINES ABSORPTION AREA~Q. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE · N~ST LOT LINE Th WIDTH DEPIH OF FiLlER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE -.--..~.~, IN. ABOVE TILE lYPE -L:-~*~*~*~*~*~*~*~*~*~/'~/- · , , DEPIH. NEAREST SEPTIC LOT LINE L.~-~ ., SEWER LINE ~' , TANK DISTANCE! FROM , BUILDING FOUNDATION SEEPAGE , SYSTEM WATER SAMPLE , CESSPOOL ., NEAREST OTHER ~ , SOURCES~_- DISTANCES: DATE DIAGRAM OF SYSTEM GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF' ENVIRONMENTAL,. QUALITY SSO0 TUDOR ROAD POUCH 6-650 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT / NAME OF APPLICANT INSTALLATION LOCATION ~-~f ~ 'EDAL DESCR'PT,ON INSTALLATION OF: ~ TANK TYPE AND SIZE OF FACILITY TO BE SERVED SEEPAGE PIT DRAIN FIELD , OTHER NOTE~ THIS PERMIT I$ NOT VALID WITHOUT SOIL TBS7 FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEAL.TH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSEC, UTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO '~lC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL · ~tC TANK , SEEPAGE PIT ., DRAIN FIELD TO NEAREST LOT LINe, WELL TO-~,PTiC TANK SEEPAGE PIT D~AIN FIELD ALSO CONSIDER AREA WELLS. //~-~ -~/~ / ~ WATER MAIN TO~E~lC TANK , SEEPAGE Pit DRAIN FIELD ~ BE~ TANK, SgEPAGE Pit , DRAIN FIELD ~ TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORMTO BOROUGH REGULATIONS REGARDING INSTALLATION. Ao. TNOR,TM SEEPAGE AREA SIZE TYPE DIAGRAM OF SYSTEM I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA ~3OROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE· DATE APPLICANT'S SIGNATURE GAAB#HD-2 GREATER 327 Eagle St. 4NCHORAGE AREA HEALTH DEPARTMI"JNT Anchorage, Alaska 99501 OROUGH 279-2511 Case N 0. ~-~ ~-~Z SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT RESIDENCE ADDRESS LEGAL DESCRIPTION ~'~'~'~' MAILING ADDRESS ~/o/~.;~.~ PHONE NO. APPLICATION TO INSTALL: SEPTIC TANK ~" X' ,DRAIN FIELD OTHER , SEEPAGE PIT , TO SERVE THE FOLLOWING FACILITY ,/'~/~.,~'.~'C~ ,~, ~,(',~,~.[(],~.;~) FINANCED THROUGH ,,~[~ ~ ' ~ ~ TO BE INSTALLED BY. --~ PERCOLATION TEST RESULTS .~/~4~ ANTICIPATED DATE OF COMPLETION /~7 ~~' BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS AS DESCRIBED BELOW. · SEPTIC TANK SIZE .-~77';~ DISTANCES: . , PERMIT TO INSTALL A ./f~e¢,;...¢~ ~/)~/~.]<.~c_. ,- SIZE DF UNIT TO BE SERVED /'f)'~"~'/~-" AR EA .~¢'~'~L~ TYPE TYPE ~_¢~ SEEPAGE DIAGRAM OF SYSTEM ~/ ~ ' I~certify that I am familiar with the requh'ements of Greater Ancho:rage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code._..~/ , // DATE ) b }Of??~'t..f ,~ d iL" C~ : Parcel I.D. # O/L, 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# ~('~c'-~t~ ~\¢,~. 1. GENERAL INFORMATION Complete legal description Lot 6; Block 2; Hillcrest Subdivision Location (site address or directions) 1215 Calamity Court Anchorage, AK Property owner Mailing address Lendihg agency Mailing address Scott Hough Day phone c/o Cr]t~rium Engineering P.O. Box 111790 Anchorage, AK Day phone 99511-1790 Agent Ron Anderson/ Polar Realty Address Day phone_ 244-6449 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. 4. TYP'E OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer XXX 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 STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I ~,erify 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 Address Engineer's signature S & S ENGINEERING Eagle River, Alaska 99~/~ Phone Date DHHS SIGNATURE Approved for ~- Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments ff; .'l I Iff i 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 DH HS 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{Rev. 1/91) Back MOA~I F~NVIRONMENTAL SERVICES DIVISION Municipality of Anchorage DEPAFITMENT OF HEALTH & HUMAN SERVICI~ C E iV E D Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 843-4744 Health Authority Approval Checklist / Legal Description: '~-~'T' ~-(-~ '~[~i/-~ 2- ~IL/L.~; ¢~-~'I' ParceJ I.D.: A. WFLL DATA Well type ~)¢'~d f~-,~-¢~ If A, B, or C, attach ADEC letter, ADEC water system number Log present,.~N) t-J Total depth 'b~ ~ I Sanitary seal,~Y~N) Date completed Cased to L[ ~ i FROM WELL LOG Casing height (above ground) J Wires properly protected .~_~'-4) ,-j ¢~ ,~- AT INSPECTION Date of test Static water level Well production g.p.m, b, o ~'- g.p.m. WATER SAMPLE RESULTS: Coliform ~) Nitrate Date of sample: /~3 -- ~, - 76. .//.~ LO,/~/ Other bacteria Collected by: ~7:L~ ..,fk ~ ~:Tt~ L-~ , pi) B. SEPTIC/HOLDING TANK DATA .-- ~_~ ¢) L_ ~. (_ Date installed Tank size Number of Compartments __ Cleanouts !Y/_~ .~ Foundation cleanout (Y/N) High water alarm (Y/N) D¢~:ff'P~r~ping Pumper C. ABSORPTION FIELD DATA Date installed Length Width Effective absorption area Date of adequacy test Fluid depth in absorption field b~ore~t'~st (in.); Fluid depth .~-~"-~]ins) Minutes later: Pbroxide treatment (past 12 months) (Y/N) Soil rating (g.p.d./ft2 or ft2/bdrm) System type . ~ Gravel thickness below pipe T~ota_Lde~ Monitoring Tube present (Y/N) ..~¢~-D~epressiOn over field (Y/N) Results .(P_.asslF~a~) For bedrooms Immediately after gal. water added (in,): Absorption rate = g.p.d. If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at*~_~-~mp off" level at* High water alarm level at* _ ._~-~/ *Datum E. SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: / ¢ On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line Absorption field WatermTaTdT~vice line Surface wateddrainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation Water main/service lin¢_~ Surface water CL~rta~rF-dra~n ~_-.---~-~-~Dfiveway, parking/vehicle storage area Wells on adjacent lots ENGINEER'S CERTIFICATION I certi~ that I have determined thru field inspections and review of Municipal re~t~'~be'~_~¢ms are in conformance with MOA. H~A guidelines i~ffect on this date. Date HAA Fee $ Date of Payment /,,~//'//~/~ Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number CT&E Environ'mental Services lac, 96.6477 Drinking Water .Analysis Report for l°tai Coliform Bacteria 2oo,,v. Anchorage, AK 99518-1605 R£.4D I.,VSTRUCTIOiVS O:Y KEVERSE SIDE BEFORE COLL£CTIYG SA:~r?L£ Fei: (907] 582.2343 . ,Fax: (907) 561.5301 NFO'ST BE COM?LETED BY WATE?,, SbT?bIER PUBUc WATER S¥ST~ Z.~. ~ [llll ~ Serif Invoice 0 SendResuIr$ ~ Sendln~'oi¢.: S.~.:',,I ? L E DATE: Month SAMPLE TYPE: Routine Repeut Sample (for rounne sample with lab ret'. no. ) 0 Special Purpose SA.'vLP L E LOCATION Day Year O Treated Water 0 Untreated Water Time Collected Collected By TO BE COMPLETED BY L.~O~&TORY Analysis shows this ',,\"ater S.-~MPLE to be: Saris factoQ, Unsafi s~'ac o~' 0 Sample over 30 hours old. results may be unreliable Sample too long in ~ransk: sample should not be over 48 hours old ac examination to indicate reliable result. ?lease send n:sv sample via special delive~ mail. Date Received l~-~'~ Time Received . ~ 'flq~ /~ ~ Analytical ~lethod: ~ Membran~ Fih:r MMO-MUG · Number of colonies/lO0 mi. Lab Ret., ,,No, Result' .,~nalyst Sent lo A.D.E.C. Anch . Fbks Jun Client notified o1' unsat sfactor?.' results: Phoned Spoke with Date: Time: Faxed © Commen[s: BACTEPdOLOGIC.a~L WATER .*NALYS~S RECOP,.D 3h'HO-;slUG Result: Total Coliform 3lembrane Filter: Direct Count E. Colt ColoniesllO0 mi · Verification: LTB BGB COLIFIR31 ~.~li fo r m,'l O0 mi Time/~P~ hfs Member olIhe SGS Grouo (Soci~t~ G~n~rale de Surveillance) lCT&E Environmental Servioes Inc. CT&E Re['.// 966446001 Client Name S & S Engiaeeriag Project Name/// N/A Client Sample ID L6 B2 Hillcrest* Matrix Drinking Water Ordered By PWSID Sa,mpte Remarks: 12t5 Calamity Court Client PO// Printed Date/Time 12/09/96 11:25 Collected Date/Time 12/06/96 12:58 Received Date/Time 1.2/06/96 13:30 Technical Director: Stepheu C, Ede lotal Coliform Eesutts PQL Units ALlowabLe Prep AnaLysis Method Limits Date Date Init 0.161 0 tntc ob 0,100 m~/L S~18 4500-HO3F 10 max O cot/lOOmL SM18 9~28 12108/96 WEP B'AACSO~020 ~t.h ~.n 'HL,tlere.t. ' ~eeAdenoe, M:ad~acen~ . 75 £eet ~'11~1~ Re L¢1 ~'..' ', ' 32 Fee~ ~rom top casin9 OF IiEALTtt AND ~r-;,~R0k~EN~,...~. PROTECTION L otro~.t:, Anchorage, Ala.sK~ 99501 279-'25!], ext. 224 o:~: 22!5 ~i 2: J..u . .. T Line "REQU~ol' ~ '~;"~" FOR APPROVA.I] (3~:"' INDIVIDUAL SEWEI~, AND WA'I'Ell FACILITIES i-~ La?)<:tin~ InstJ %u't:J on ,Roq~_t:.ot.: Mailing Address: Phone: ' '>~'~ ~* k - e~ Robert/Patric~a Cope Phone: 272-2474 ,~,,~ I ,,.~pe.r .y~ Own ,J..: ...................................................................... · ................................... Mai. thug Address: 3900 Greenland Dr~w~ 99503 Legal !)osOrJ. pt:i.ort: Lot 6 Block 2 ~~ Subdivision 4, Slnq.l.e Family Residence: (~ Number of Bedrooms: .~9 Multiple '~ ' ~. ~,J,~l.~y Residence: ( ) ~A]rnber of Bedrooms; 5~ 'Well System: Individual Well_ ~j Commun3. ky/Public System ( r,. Perm]... ~ DepLh of Well Well_ Loq on File r, Construc'?:ion. Bac'l~eri0.'L Analy'~; is Sewage I)i.<qposa] System: On-o.l. uc, :-kVot. cm Permit: ~l' Insta].] ed 1977 - 4,00~0',~g~llDn~ holding tank Absorption Area -'--- Soils Ra~e Dise. ances: We].l to Septic Tank -to Sower Li~ie Nearest to Nearest Lot Line t:o Absorption Area Absori-)bi.oz~ Area MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA .FHA 2. Property Owner: Mailing Address:.~~-~ Name of Buyer: CONV. Day Phone:. _ Mailing Address: Name of Lending Institution: Day Phone: Mailing Address:. _ Phone 5. Name of Realtor or Agent: ' Mailing Address:?~ 6. Legal Description: ~-~'" ~, Location: //~' ~5¢ 72-O03(3/76) 7. Type of Facility to be Inspected:.. 8. Water Supply Type of Supply: Public Utility No. Bdrms. _~ Individual If Individual, number of dwellings presently served_ / If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site)_ If Individual, date of installation _~Ot/V'~ / ~ ? ~ ~-~U Please note: As of May 24, 1977, the fee schedule went in~o effect. There is a $25.00 fee that must accompany each request b~fo~e~we ca~_pro~.,p~s~s~%he paperwork /:::::~Any qu~s~ions~p~s~e con~c~/m~ ~'t 279-2511, extension 224 o~ 225. Thank you. . Laura Harrison ~ ! D. epartnlent of Health an(] Env:L'conmc:~TLa;i Protc. ckion ~.~ ~ R~uest...~. f~.r Approval of Individualoe~vc.~_" ...... and Wa~er' ~-~ ' ' i~:,.. .,.. Lot 6 Block 2 Hillcrest Subdivision ' ·~ +~; ','-~ ,i · ~.~fad. a,vit A'ttacl:led: ( ) Letter A'htached: ( ) A~ ' ' ' Da'ce p~ovea: _. _ j Disapproved: Date: