HomeMy WebLinkAboutLILAC PARK BLK 2 LT 4
) 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
NAME PHONE I~.. ,~NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION N~OF BEDROOMS
Well Absorption area Dwelling PERMIT NO.
~ ,-~ Manufacturer C)/e ~=e--/~ - MS,~,/ No. of com~ments
Liq~al~acity in gallons Inside length Width Liquid depth
~ ~ IF HOMEMADE:
DISTANCE TO: Well Dwelling PERMIT NO.
Manufacturer Material Liquid capacity in gallons
Length~f eag),jIbe $' ~ Total iges Trench.~i~tb¢ Distance between lines
~1'; Top of tile to finish grade ~ ~ Material beneath tile /~ 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
DISTANCE TO:
~ Buildin f ~ ation Sew~ / Septic ta ~ ' Absorption area(s)
OTHER
PIPE MATERIALS
J
REMARKS ~ ~ /
72-013 (Rev. 3~78)
rV~-W DRILLING, Inc.
P.O, Box 10-378 · 10300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
Well Owner
Location
DRILLING LOG
fi~ ~i ',Vi'~ ~: 'v','l 'N ~ '[ ;'-'ii 'r &~ j
· ' ' Use of Well
address of: Township, Range, Section, if known; or distance main road
Size of casing · Depth of Hole
Static water level .. 2., ft.
Screen ( ); Perforated (
I, ,, feet Cased to 16 I feet
(below) land surface. Finish of well (check one) open end (
).
Describe screen or perforation
Well pumping test at "(] gallons per ~I~b~Qi
of drawdown from static level.
Date of completion ('~a~'~:~ber 3, ]
(minute) for 1 hours with
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
?;J, lt.'/
0 .TO.
2 .TO
26 .TO.
x.~ _TO.
.50 .TO.
6:; _TO.
911..TO.
i31 .TO.
] 55 .TO.
.TO·
__.TO.
.TO.
__.TO.
__.TO.
26
35
50
91!.
131
16!
Silty
~.? J':e'.U] ),~,(i~3:[ !.¥:' .('r;
3--CONTRACTOR
]O/"c
L. EYI' S) l ZE: ~
!!!i!..IB:(:) IV I !3:1: OIq: I..~ I I_AC PARK
SE[CT I (:)FI: 2~":] 'T'[:)l...'aq~3H :[ F':
(!3[;!. 1:::'1". []1::~ ~:~[:ff:;:llii:!~ )
Fc~r"M"l i::~y i'..he I"h..u"l:i.c::i. pal:i.'Ly c:~F (.~r'l(::l"lor~agi~:? (I"I[:)F%) and l'..hc.]
and :i.n c:c~mp]. :i. anc:(s) v~J.i'..h i:.he) c:lex~:i.c~r'l [::p j.'l:.~.)r :La c)F 'Lb :[% pcer'm:i.i:.,,
:::.~,, Z ~]J.].]. adl"~ere 'La a:l.]. MC]h and S'La'Le (::~' ~:La~[~l.::a r'eqL.t:i.P(eme-u'q'L?~ f(:n~ 'Lh(.:g s~(z-)'L [:)ac:l<
c:J :i:E[~t. atl'l(:::(.~% f' r'c)m any e)x J. sst:. ~.rig ~.:.)]. ]., ~a~s'Le~,.,Ja't. car' d :i. spc)~;a]. %ys~i:.~.)m (:~r' pub ]. :i.c:
q-,, [ L.Lf'ldl:.)r's~'['..arld /ha't. i'.lq:i.~T, pe~r'm~'L :i.~ va].:i.d for a max:J, mum c:)[ ~) J:t~.~,dr'cx:)nn~ and
any (~-wi].ar'g(~un¢.)nt. v~:i.:l.], f'C.:H:]LIJ, r'(:~ arl adct:i.'LJ.c~r'laZ
N]:I...L.. lq[Tl" I.:':~l[~ ~:q::'I~C:)VE~]) N]'T'~ ]L .... ~x '~: ~Cff'l:~IC:~l.. :[IxlS~F'E:CTZ[)~I F~F~'I:::'C)FUF[ F.~IqD Cq) Tr..IE~
"' ['"'~T~ .... ~ N ..... ', c" ~ ..... x- ~ ........ ' ..................... " ' .... ' ....
:::.-. :::.- ' .......... :"~ . ~: I I:.t::., I)[.)l tE: :E.Y ~ L...[[.,I::.IxL::~I:::D E:.L.I::.L, t IX.I.L.:.I.j..~Ixl,
Permit
'~NICIPALITY OF ANCHORAGE
Department ~ Health and Environmental . otection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
Applicant: ~._~7~
Location: /~9~- _~ ~. ~ ~//~.~_//~,~ PhotO. er: ~'~ Z ~ ~/Z
Legal Description: ~ ~''f~~'x ~ '~ d~ ~ Lot Size: ~ ,~ ~/
Type of Soil Absorption System Is: ~ . k,,
Trench: ~ Drainfield: Seepag~ Bed. ~ Holding Tank'
Maximum Number of Bedrooms: ~ ~ S~}~,,,~a~n~(~.~fDr) /~
depth of a krench er p~ is~Sho dS~ance~okwoen ~ho ~ur~ace o~ ~ho ~rCun~ and
· he ~rave~ depth ~s ~he m~nS~[fim d~h ~f ~r~el between ~ho ~u~fail p~pe and
· * REQUIRED SEPTIC(HOLD~N~ T~N'< SIZE = I~7~0 GALLONS'~*
P~rm~ ~=~nt h~ t~po=~N=~tyk~o =n~o=m ~h~ a~r~m~=~ ~u=~n~ th~
instal, la,ion inspections of~ny we~s ad[acen~ to this ~roperty and [he numbe~
we .=l N
· *.* TWO(~) INSPEC~NS ARE REQUIRED * * *
Backfilling o% any system w~th[ut fina]_ inspecCion and approval by this departmen(
~in~mum d~sCan~e between a woll {nd any on-s~e sewage dSsposal sysCem ~ 100 foet
~r a pr~vako w~ll or 150 ~o 200 ~ee¢ from a pubiic well depend~n~ upCn Che ~TPe
of public wel~. ~ Minimum ~istanc~ from a private well to a private sewer line
is 25 feet and t~ a co~un~ty sewe~ line is 75 feet. Well logs are required
and must be retu[~ed to this d~ar%ment within 30 days of the well completion.
Other require~entskmay apply. Spe~J. fications and construction diagrams are
available to ~s~e~prop~ instail~tion.
_ * D C MB R 1 9 * *
I certify tha~: ._ . ~ . ~ / =
(1 I am familia~~e requirements for on-oite sewers and wells as
set forth by the Municipality of Anchorage.
(2I will install the system in accordance with codes.
(3I understand that the on-site sewer system may ~equire en~ement if
ce is remodeled to include more ~3 bed[oo~ ~
t t~ re side~ _~ Issued y ~~~~/~
Si~ne~:
Appl~cank
Date: _ ~/¢/~
SWP/024(1/81) ./) _ /
WELl_ AND/~II ON-SITE SEWER PERMIT
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
PERCOLATION
TEST
LEGAL DESCRIPTION: ~ q
SLOPE
SITE PLAN
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
WAS GROUND WATER ~
ENCOUNTERED? /~.)O,
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
0o¢¢ o o ~" -
o~.~ ~ 'z~ 0 ~/" '-
" 'z. ~ 6 ~/~ o ~ ff.~,~ 5" I"
" ~30,~ o~ ~f,~ ~" 1"
FT AND
(minutes/inch)
~ ET
72-008 (6/79)
4
5
6
7
s
& ENGINEERS, INC.
s
7125 OLD SEW/~RD HIGHWAY
ANCItORA6£, ALASKA 99502
SOIL LOG
PERCOLATION TEST
'~¢ SOIl. LOG
b-// PERCOLATION
~ ES7
(907) 349.6561
JoB NU,~BER:_
PER'PORMED FOR: ~___ Z ................. TE PERFORMED:
11-
12-
SLOPE SITE PLAN
Gross Net Depth to , Net
Reading Date Time Time Water 'Drop
f
15--
16--
17--
18--
19--
20--
16,a,o~ Sq.
PERFORMED BY /{×J ~,/'~,4~/'/~//~, '~'~-~/,,~. GERTIFIED BY ......... DATE:
(
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.# /"1 ~,- ~1-r'3~ HAA# t~ ~,<:~t'~ ~--~
1. GENERAL INFORMATION
Complete legal description ' ~t B 2, Lilac p~k S~.vision
"LocatiOn (si;~e address or directions) 12210 Lilac Circle Off Huffman Road
· '' ' ': :-:,--,,'prOpe~y-'"OWner ~Le~n&- Canqe : rh~v 229:-5636
...: ., . . : -_. phone
Mailingaddross~ - -
Day phone
-- .'- -':" ,,,'%-. dd ess~--" -'--- · ............
. ""~=;ff: ",2,' ?tNUMBER OF BEDROOMS:· ;...
~" 3, ~PE OF WATER SUPPLY: ' ~
Individual well X
. . Community well
' , . . Public water -
. '.. '.:~,.,:': .'.,.: ..,,.:. ~; '. ~.. · -,.,..::: _ ---_~-' ~- . . :.~ ·
." : ';" NOTE: ;If Community Well system, provide wri~en confirmation-fro
~ng to the legali~ and Status of system :
-.., .... · .....
4. :'TYPE OF WASTEWATER'DISpOSAL: - :.,.."_'.... ".
_- . ...... _
Individual on-site.,
. .-.- ._. - , ...... - -: ._,-..~'., ::;_: . .- ..... ..... : -. .... .'.. .,
· .......... .,.Hodngtank - ~-'"~..,::: ' . :. ;.- ;-. ~
' NOTE: If community CaCt~water system, Provide wri~en confirmat~o~ a~esting to the legality and status of system.
72-025 (Rev. 1/91) Fron~ 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 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 Environmental'Manaqement,~Inc. Phone 272-9336
Address 206 E. Firewe4L~', ~te 201~,/Anchoraqer AK 99503
. ' . · · " ,,?,,% OP'4~ -~,
· -,'-..- -' // ........
-' . ..... . ~ c~',-' ....... /A. ""~i?~.,
' ' - ' '-:" ' ' ' ' ' ' .......... '
i-':" ,_._, . . '.':." . . .-..-
,_ ,___.~_~: ~ ........ . ........... . .. ~ . ...... ..:.~.../~>~,.~,... ,..,..~ ~ ..
.... ........ . .... .. .
...................................... ~'cO~ :"7'"~' ~ -%~ ....
, .:.. :.... , , .... · -,. . ......... ·
...... : ~ DHHS.S~GNATU~E .... .... ,
' ~..:,-~' ' -,:'~Q'-. '-t..t~ 5-::,.. , _..~;,~.'; ::'.:_.-;Lt~i'_t~(i:?t~4.?:~t]4'~t':~ t'i-:'~ [%:'~;'~L?'-:';??~T.~L: -~"~' '::~'"/~'.'Lt:' ::'):~L::t~-L' "" ~ ': .
. ..... --' ~'~..." ' ....... ?'~' ' "' :"Cond~t"~' '; ;onal a' pro~ '~al .... 'for ' .-' ....... '"- ' 'b~roOms;
':;4 ~ .t' -2~:7.1'f. 'n~ ~ ~ ~. -- : --~; -?'t : -'.'.. _ ::'; " ': ' :'~:F"'::: ;:,::~K' ~'~ ....... ~;t]F ~Li'.~ -''.~"- .~-. .-
Additional Comments
-~i.':~ -::-: .: ' !:::':?;~" ~,:i'! ' ' ": '
~ .... " ' Dep~rtme~it Oi Heaiih ~nd HUrnanse~/ices (DHHS)issues Health AuthoHty
Oerti' only upon the representations given in paragraph § above bY an .independent
istered in the 8tate Of Alaska~ The BHH$ d~es th s as a courtesy to purchasers of homes
iiit~ficns in orde~ t~ticn/~rtain ~ed~rai and-stat~ requirements, EmPloYees of BHH8 do not
· c~6dsot inspect OhS 'or ana y~e data before a certificate'is i~ed; ,The Municipality of Anchorage is not
resPOnsible for errors or omissions in the professional engineer's work, ·
72-O25(Rev. 1/91) Back MOA~21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type Private
Log present (Y/N)
Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
Y Date completed Oct. 3, 1984 Driller M-W Drilling
Total depth 161 ft. Cased to
Sanitary seal (Y/N) Y
161.1 ft. Casing height 12 inches
Wires properly protected (Y/N) Y
FROM WELL LOG
Date of test Oct. 3, 1984
Static water level 133 ft. below land
Well flow 10 g.p.m. .g.p.m.
Pump level1 no record
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 100 ft. +
Absorption field on tot 135 ft.
Public sewer main none observed
Sewer service line none observed
April 18, 1995
113 ft. below land
6-7 g.p.m.
u~no~
; On adjacent lots
100 ft. +
; On adjacent lots 100 ft. +
Public sewer manhole/cleanout none observed
Petroleum tank none observed in area
WATER SAMPLE RESULTS:
Coliform O ¢01~ ~Or'm/100ml Nitrate
Date of sample: April 18, 1995
O. 8~ ¢"%~/L Other bacteria O col/IOOml
Collected by: Simon Schroeder
B. SEPTIC/HOLDING TANK DATA
Oct. 1984
Date installed Tank size
Cleanouts (Y/N) ¥ Foundation cleanout (Y/N)
High water alarm (Y/N) none found
Date of pumping /~cit ~// IClCt~
2,000 gal. Compadments 2
Y Depression (Y/N) N
Alarm tested (Y/N) N/A
Pumper /9) Oc¼ o r'c~3 ¢._
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 148 ft. On adjacent lots 100 £t. +
To property line 82 ft. Absorption field 7 ft.
Surface water/drainage none observed in area
Foundation
Water main/service line
6 ft.
10 ft. +
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (WN)
High water alarm level
Not Applicable
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Soil rating (GPD/Ft~) 0.40
2.5 ft. Gravel thickness 12.0 ft.
Cleanout present (Y/N) Y
Results (pass/fail) Pass
60 inches
Surface water
I certify that I have checked, verified, or conforFed to all MOA and HAA guidelines in effect on
Signature ~ ~ L.---<_../~'-I¢- ~
HAA Fee $ ~' ~ Waiver FeeS
Date of Payment
Date of Payment
Receipt Number ~ ~¢~ Receipt Number
72-026 (3/93)* Back
Well on lot 135 ft.
To building foundation
On adjacent lots N/A
Surface water none observed
Curtain drain none observed
E, ENGINEER'S CERTIFICATION
On adjacent lots
15 ft.
100 ft. + Property line 24 ft
To existing or abandoned system on lot 'N/A
Cutbank 50 ft. + Water main/service line 50 ft. +
Driveway, parking/vehicle storage area
16.0 ft.
N
Bedrooms
80 ft. +
~te of this inspection.
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Date installed Oct. 1984
Length 95.0 ft. Width
Total absorption area 2,280 SF
Date of adequacy test April 18, 1995
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N) N
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
System type Trench
Total depth
Depression over field (Y/N)
for si× (6)
After test 60 inches
If yes, give date N/A