HomeMy WebLinkAboutLAKE O THE HILLS EAST BLK 1 LT 3
,, , 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
MAILING A~DRESS __
LEGAL DESCRIPTION
LOCATION ~O. OF BEDHOOMS
Well ~ [ Absor0lion a~a [ Dwelling ~ ¢ PERMIT NO.
O~ DISTANCE TO: I ~/~ I 40 /W
~ Z Manufacturer ~__ ~ [ Materia~__ No. of compar~nts
~ ~ Liq. capacity in gallons ........... Inside le~j~. W~dth .,. ~ Ltqu,d depth
, .. I IWell Dwelling PERMIT NO.
~ D,S~ANC[TO: I ~r /'Z~ I
~ Manufacturer ~/~ Material Liquid capacity in gallons
Q I Well .~ I Foundation~ I Nearest lot line ~ / PERMITNO.
~= IDISTANCE TO: I ~/~ I /Z I /~
~ [ ~ No, of line~ Leng~of ~c~lJine Total I~g~Nof lines Trench wi~ . Distan2~ ~Jween lines
F~ I ~ I /~ ~% I ~ / I ~ ~ ,.~h~, ~//~ .
~ I Top of tile to finish grade '~ / ~ / I MAte[iai beneath tile ~ . ~ Totale~ct~orp~ area
I Length Width Depth PERM IT NO.
~ I Type of crib CribOiam~r] /~ CribOepth Total effective absorption area
~ I Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth ~ Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building fo Sewer line Septm tank Absorption area s
OTHER
PIPE MATERIALS
INSTALLER
RKS
LEGAL
Departmen~ ~u~g~i%~~i~ ~V~~[~ ?rotect~on '
,.~' '~ 825 '-~ Street, A~chorage, AK. '~9501
264-4720
* * * HANDWRITTEN PERMIT * * *
Permit ~ ~0~2-~ WELL AND/OR 0N-SITE SEWER PERMIT
Applicant: ~ ~ ~,~/~/,L~C~' Mailing Address: ~/~ ~/~
Location:/~ ~ ~/~ / ~ ~ ~ ~//~. Phone Number: ~- ~ /
Legal Description: ~'~ ~- r/~~~O Lot Size: ~3'
Tyue of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: __ Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br)
'The Required Size of the Soil Absorption System Is:'
DEPTH // LENGTH ~ GRAVEL DEPTH ~ WIDTH
The length di~aension is the length(in feet) of the trench or drainfield. The"
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~ ' GALLONS *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection.and approval by this department
will be subject to prosecution.
MinJ~num distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a cormmunity sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlar~ement if
the residence is remodeled to include more tha~ bedroom~/~
SW-P/024 (1/81)
pERFORMED FOR:
LEGAL DESCRIPTION: L.o~" ~.~
!
2
3
4
5
6
7
8
SOILS LOG - PERCOLATION TEST
SLOPE
DATE PERFORMED: ~//~
SITE PLAN
10
-~11
,12
,13
· 14
15
16
17
18
19
20
iN E. SW^NSO~/
]834-E
Pg0FESS~0~
WAS GROUND WATER HO ~
ENCOUNTERED? 0
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Eu~ Drop
_J ......... ~/(7 ...... ~_LLg.. ........ _~. ........... q ,,
P_ 3;~5 I~-,~ ~" I"
._ .3 ......... ~.;./_4 ...... t_.~,~ _ ~.~Z ........ ~,~" ._
~ 3;Id,~ o.~,~ 7.0" 0.5"
~ ~ . .... ~: ~ O. ~ m,n ~ ~/~ ~/~"
~ 3;l& t ~,~ ' "G'~' ........ ~/~"
........ PJ~ .....
I0 / ~20 I~,n 4 Y~" V~"
PERCOLATION RATE /~ ~ ' (minmes/inch)
TEST RUN BETWEEN' ~'~'~ . FT AND ~2/ 0 FT
CERTIFIED 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. # ('~/,~' ~3~- ~ :~
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) ///Z/ ////,~L~,~Z/~,"~ ~--~,~'~'
Property owner Jok, 4 Day phone
Mailing address ///Z/
Lending agency Day phone
Mailing address
Agent ~7~:~';~, /~/.~-- Day phone
Address
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
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
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.
Phone ~,~/-¢:'-~///
KND Engineering
Name of Firm
~'~,
. Eagle River,~K 99577.873~
Adaress
Enginee¢s signature
DHHS SIGNATURE
Approved for L/
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
See Attachment
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 courtesyto 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 ~YZ1
MUNICIPALITy O~ ANCHoi~v,i~
Municipality of Anchorage ENVIRONMENTAL SERVICE,S DI
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division JUL 1 7 1997
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
RECEIVED
Health Authority Approval Checklist
Legal Description: Za~/~ / ~-~./>~
A. WELL DATA
Parcel I.D.:
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
~ If A, B, or C, attach ADEC letter. ADEC wat~tem number
~ Date completed
Cased to Casing height (~ove ground)
'~, Wires properly protectech(~N)~
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
g.p.m.
AT INSPECTION
Coliform ~ Nitrate
Date of sample:
B, SEPTIC/HOLDING TANK DATA
Date installed ~'-~_ -~'-.~ Tanksize
Foundation cleanout (Y/N)
Date of Pumping
;ollected by: ~
Other bacteria; '""~
Number of Compartments ,~ Cleanouts (Y/N)
Depression (Y/N) /~/z/ High water alarm (Y/N)
Pumper
C. ABSORPTION FIELD DATA
Date installed ~'~t~.~
Length
Effective absorption area ~'~'~ Monitoring Tube present (Y/N) /.V' Depression over field (Y/N)
Date of adequacy test ~' ~'-- ~7 Results (Pass/Fail) /~ For
Fluid depth in absorption field before test (in.); 7 ~ Immediately after?/~ gal. water added (in.):
Fluid depth ~7~ (ins) Minutes later: ~/~/~Z-¢'/___.¢ Absorption rate = ~.z~2~ ',~ g.p.d.
Peroxide treatment (past 12 months) (Y/N) /~// If yes, give date
Soil rating (g.p.d./ff~ or ff~/bdrm) *~' ~ System type ~2~/
Width 3' 8G/ 71
Gravel thickness below pipe Total depth
bedroOms
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N) ~' "Pump on" level at*
High water alarm level at* /~ *Datum
Cycles tested
,/
Size in gallons
////~"Pu mp 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:
Foundation /,Z,..~ Property line /D 4-
Water main/service line ,/,¢ / Surface water/drainage //J¢ /
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field /~) ~
Wells on adjacent lots /dD '~
Property line //E) /-~ Building foundation /~ "¢' Water main/service line
Surface water /¢zP ~¢' Driveway, parking/vehicle storage area /.
Curtain drain /,¢(~ /¢' Wells on adjacent lots /Z:)o f-/'
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review
in conformance w/i~OA~elines in effect on this date.
Signature ~
Engineer's Name
Date
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
SEPTIC SYSTEM ADVISORY
HEALTH AUTHORITY APPROVAL NO. HA970293
Prior to a recent adequacy test on the septic system for
this lot, 79 inches of standing water was observed in
the absorption field. This indicates that approximately
94 % of the absorption area is inundated. Although
this system passed the adequacy test, the remaining life
expectancy may be limited.
This advisory must be attached to all copies of the subject
Health Authority Approval.
MUNICIPALITY OF ANCHORAGE
DI~fISION OF 5NVIRONMENTAL HEALTH
DEPARTMENT OF h~ALI~H AND ENVIRONMENTAL PROTECTION
APPLICATION FOR ~{F~LTH AUTHORITY APPROVAL CA~RTIFICATE
1. General information Application Date 3-7-84
(a) Legal Des~iption (include lot, block, subdivision, section, tcwnship, range)
LOT 3, BLOCK 1, LAKE OF THE ~ILLS EAST
Location (add~ess or directions)
(b) Applicants Name Bowen Oualitv Construction Co. Telephone 562-3208
Applicants Address 3605 Arctic Blvd. #1571 Anchorage, AK 99503
(c) Applic. ant is (check or~) Lending Institution ~-~ ; Owner/builder ~;
Buyer I" [ ; Other ~ (explain);
(d) Lending Institution Alaska Mutual Bank Telephone 338-78~,0
Address
Minn-Benson
(e) l~eal Estate Co. & Agent'
Address
Telephone
2. ~ of ~esidence
Single-Family
Number of ~edroc~s
~ Suppl
~. Water v
Multi-Family~
4
Other (desCribe)
Note: If cc~m~nity well system, must ha~ written confirmation ~om the State
Depa~tn~nt of Environmental Conservation attesting to the legality and status.
. . Is the well adequate fox the number of bedrccms specified i~ this 'HAA (Y/N))~es
4. Sewage Dis osp_q~
Onsite ~ Public ~--~ Co, aYanity ~ Holding TaDR ~--~ ' ·
Is the wastewater disposal system adequate for the number of b~drocms (Y/N)
yes
[Page 1 of 2]
2-15-84
Se
E_.nginee_winc[ Firm P~ovidin9 Inspections~ Tests, Data and Information
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in
effect on the date of this inspection.
Address_~/~5'
Signed
( ENGINEER SEAL)
6 ._DHE__P Approval
Approved for
Approved ~
~sapprovedf--q.
Conditional
Terms of Conditional Appr~oval
The Municipality of Anchorage Department of Health and Envirora~ntal P~_otection dces
not guarantee the continued satisfactory perfor~nance of the water supply and/or the
wastewater disposal system. This approval indicates t~hat, as cf tine validation date
shc~n above, based on the data and info~mation furnished by' an engineer registered in
the State of Alaska, the water supply and wastewater dispcsal system is safe arJ func-
tional for the ~lunber of bec]roams and type of structuve indicated.
(DHEP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
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2-15-84
A®
LOF,~ /~L-OG~(' ! /~4-~g~ co'~E
MUNICIPALITY OF ANCHORAGE (MOA)
HEALT~ ADT~O~TY APPROVAL (E/AA)
CHECKLIST - FEBRUARY 1984
Well Classification .(~i/~(3~)17~f ~ If(~
B,
Well Log P~esent (Y/N) Date Completed
Total Depth Cased to
Static Water Level Pump Set At
Casing Height Abov~ Ground
Electrical Wiring in Conduit (Y/N)
Sepazation Distances f~c~ Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Abso~t)tion Field on Lot
To Nearest Public Sew~ Line
~UNIC~PALITM O~ ANCHO~G~
DEPT. OF HEALTH &
ENVIRONMENTAL PROTE~ION
RECEIV,[
Or C, D.E.C. Approved(Y/N)
Yield
Depth of Groutin~
Sanitary Seal on Casing (Y/N)
DepressiOn A~ound Wellhead (Y/N)
; On Adjoini~g Lots
; On AdjoiningLots
To Nea~estPublicSewer
Cleanout/Manhole
Water San~ple Collected By
"Water Sample Test Results
To Neazest Sewer Service Line on LOt
; Date ~..1 ~WA~ ,~>zt
B. SEPTIC/HOLDING TANK DATA
Date Installed ~ -~_/~-~Z Size iZo~-C--~ ~,,q~L- No. of C~,~a~tments
Standpipes (Y/N) ~'-l~._~ Air-tight Caps (Y/N.) Y~5 Foundation Cleanout (~Y/N)
Depression over Tank (Y/N) .~__ Date Last Pumped /k/~7 J~7-~Q~
Pumping/Maintenance Contract on File (~/N) /JO ; for
H61ding Tank High-Water Alarm (Y/N) /d/~ Tempora~y Holding Tank Permit (Y/N)
Separation Distances f~om Septic/Holding Tank:
To Water-SupplyWell
To P~operty Line ~ /
To Water Main/Service Line
To Building Foundation I-~;
TO Disposal Field ~L~z
TO S~eam, Pond, Lake, Or Major D~ainage
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~:J~-.2_9~z/-
Width of Field ~7/!
Square Feet of Absorption A~ea
Depression over Field (Y/N)
Results of Last Adequacy Test ~//~
~,/~, Type of System Design
Length of Field ~7 /
Eepth of Field II /
Gravel Bed Thickness '"[ /
Standpipes P~esent (.Y/N)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Building Foundation ~[~ / To Existing or ~ndo~d System
Lot ~/~ ; ~ ~joining ~ts ~/~
To Ware= Main/~rvi~ Line ~ ~O/ To ~t~(if pre~nt)
TO Stre~ond~ke/~ Majo~ ~aina~ C~se ~ ~ /
To ~iveway, Parking ~ea, ~ Vehicle Stora~ ~ea : /~/ ~
D. LIFT STATION
Date Installed
Size in Gallons
Dir~nsions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles_du~ing Adequacy Test.
Meets MOA
"Pump On" Level at
High Water Alarm level at
Tested for
Electrical Codes (Y/N) '
CO~n£s
** Check Permitted Bedroom Rating A~ainst HAA Request
I certify that I have checked, verified, o~ conforr~ed to all ~K)A
on the date of this inspecti~on.
Signed~/~/fl//z~! ~/~ yff~d~¢~.~g~ Date ~L~, ~4~ ;3~/
KB1/d5/s
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