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Home My WebLink AboutBRUIN PARK BLK 4 LT 17 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 [~ I [~I~NEW weJ'/ []UPCRADE MAILING ADDRESS ~E6AU DESCRiPTiON ~ ~, . LOCATIO~ -- NO. OF BEDROOMS~ Well / Absorption area / Dwelling PERMIT NO,/ ,, ~ DISTANCE TO: I~ ~ 'I1' H~gd~rz H~ N Z Manufacturer Mate~ll No. Liq. capacit~a~ns IF HOMEMADE: Inside length Width Liquid depth ~ O ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ Z O ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line No. of lines Length of ," Distance betw~s ea~ Total length of lines/ Trench wi~t~ -- n~ inches ken,th ~idth Depth ~MIT ~0. ~ ~ Tgpo of crib Crib diameter Grib dopth Total offective absorption area m Well Building foundation Nearest lot line m DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) PIPE MATERIALS SOIL TEST RATI~ ~ :2 / R EMAR KS 4 ~ 72-013 (Rev. 3/78) ! Sizeof casing · i 6 InCh ' " D's r ................... , e c iption, of jF, c~'~.n~,~tion ?(i~' .~" :i :. from, $O~ERVILLE WELL DRILLING ~;, · ·Anchorage, Alaska . .i'/~ We advise you to, attach this certificate to your deed. MUNI,~ I PALIT~" OF A~-~CHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET~ ANCHORRGE~ AK 99501 224-4?20 ON--SI TE SEWER & WELL PERMIT PERMIT NO: DATE ISSUED: 840~t5 HAND WRITTEN 05/08/84 APPLICANT.: ADDRESS: CONTACT PHONE: MIKE ROCKWELL 401i MARQUIS WAY ANCHORRGE~ 8K 99502 24~-1780 LEGAL DESCRIP: LOT SIZE~ ~I¥I~tO~: B~IN PARK SECTION: 20 TOWNSHIP: i2N t9000 <SQ. FT. OR ACRES) LO~: RANGE: BLOCK: I CERTIFY THAT: i. I AM FAMILIAR WITH'THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA> AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS~ AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. ~. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY E~ISTING WELL~ WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. IF A LIFT STATION IS INSTRLLED IN AN AREA COVERED BY MOA BUILDING CODES~ THEN (l> AN ELECTRI,CRL PERMIT AND INSPECTION MUST BE OBTRINED~ (2> RS-BUILTS WILL NOT BE APPROVED WITHOUT 8N ELECTRICAL INSPECTION REPORT~ AND <~> THE ELECTRICAL.WORK MUST BE DONE BY A LICENSED ELECTRICIAN. S'IGNED DATE: APPLICANT: MIKE ROCKWELL ISSUED BY DATE~ MUNICIPALITY OF ANCHORAGE ~ Department Health and Environmental 'rotection ' 825 ~ Street, Anchorage, AK. ~9501 , 264-4720 ' ~ "~ ~ ~ ~ HANDWRITTEN PERMIT ~ ~ Permit ~ _ 0~/~ WELL AND~ ON-SITE SEWER PERMIT Applic ant, ~/./~.. ~OC/C~ ~'C Mailing Address: ~0 ~ [/~,~~ ~. ~/~ ... Location: ~~X /1~ Phone Nu~er: ~ Y3-17FO .... Legal Description: ~/~ ~ ~, ~~ ~ Lot Size: TYpe of Soil ~sorption System 'Is: ~~- ~//~ 0.~ ~//~' Trench: ~ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) /~' ~/~/~ . The Required Size of the Soil ~sorption System Is: The length dimension is the length(in feet) of~~ 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 minim~ depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /JJ~ GALLONS Permit applicant has the responsibility to inform this department during the instailation inspections of any welis adjacent to this property and the n~er of residences that the well wii1 serve. ' ~ ~ ~ TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet f6r 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 community 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 31, 1 9 ' ' 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 enlargement if the residence is remodeled to include more p-l~cant -- - - SWP/024 (l/el) Issued Date: that 3 bedrooms. LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SOILS LOG MUNICIPALITY OF ANCHORAGE \/ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION /~ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? -7 Gross Net Depth to Net Reading Date Time 'rime Water Drop / PERCOLATION RATE ~ 6~') (~ (minutes/inch) / CERTIFIED BY: ALASKA t~i,,.,iRonml~rlTAL COFITROL $1~Ru,deS, IrlC. J~inetrin~l ~ J~nuironmenloJ Sludi~s PERCOLATION TEST DATA SHEET ~o~ ~.. ~ .o~ ~. ZONE TESTED ~ ~9 ft TO_ ./0 _ ft READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (rain/in) DATUM FINAL PERCOLATION RATE PERFORMED BY "'(, .... (min/in) 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 ~1.,~ - ~ I ~ ~ .~c~ HAA # ~ ~to~c~ (~ t~ ~"~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) II ~ 3 0 Polar Dr~, ~_ (b) Property owner Mailing Address (c) Lending Institution Mailing Address Telephone · (home) Business Telephone ~ 6'~--- /, (d) Real Estate Company and Agent Add ress ~- ~ 0 ~ ~r' Telephone ~--70' - ~ ?6"/ (e) Mail the HAA to the following address: (or check here [3', if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Number of bedrooms Single-Family [] 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, I verify that my investigation of this 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. NameofFirm /='(~z/c~ 7~c/~'c~/ ..C¢¢'v'~r~, Telephone Date II / I I / 'DHHs APPROVAL Appr'~/ed for ~'.~ bedrooms by Appr~'~/ed ~_ Disapproved Terms of Conditional Approval Conditional Engineer's Seal The Municipality of Anchorage Department of Health 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 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: /_of /7, z t'oc Y, A. WELL DATA Well Classification Well Log Present (Y/N) __ Total Depth 1'7~ ' Cased to I"¢~ Static Water Level Casing Height Above Ground 5"" Electrical Wiring in Conduit (Y/N) Y Date Completed d'/t If A, B, C, D.E.C. Approved (Y/N) /V,,~. Yield :> Z?~/,z~., /-~,~u" tl/~/6~ __ Depth of Grouting Pump 8et At Sanitary Seal on Oasing (Y/N) ¥ Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N, A. To Nearest Sewer Service Line on Lot Water Sample Collected by f::~'~'/~/" Water Sample Test Results Comments No n,~¢cZ /~ exA¢~. Co',/'t,,,,,~ % /Z" Date Installed ; On Adjoining Lots I 05'' ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole 5'u-~, ; Date it / 7/~0 - 0 cc..,I,~o,.., / too ~4 no~ ~~le Size IO00~c4/ No. of Compartments Standpipes (Y/N) Y' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Foundation Cleanout (Y/N) Date Last Pumped Il/tt{8¢ ~/, ; for Temporary Holding Tank Permit (Y/N) N, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well IOZ ' To Building Foundation To Property Line '~' To Disposal Field To Water Main/Service Line ~. E3-' lO ' To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/E.~ / ~ ~ Width of Field ~.5'/ Type of System Design Length of Field 3' Y/ Depth of Field II. ~' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Gravel Bed Thickness ~..~-' Standpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation I~" ' Lot /kl~ {~, To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line 3'8 ' To Existing or Abandoned System on ; On Adjoining Lots ~ ~0 ' To Cutback (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ._~~ ~. ~'~ Company ~'(~/"~'/' T~c/,/ f/;c~( ...c~,~-~,,c'.~ Date Alou, I(., 1~9 MOA No. ~,~ -05 ~ ReceiptNo. c'~/-.~'~'''~'''~ ('"~"'0~) Date of Payment //-~/~ ~ ~ Amount: $ / ~ ~ ~ .............. Receipt ~o. Waiver Fee: $ Eng neer's Seal Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 ~k CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 Date 5epor~ ?~inted: 14OV 9 89 Clie~ Sample tD:BRUtN PARK Collected NOV 7 89 ~eceived NOV 7 P~ese~wed with :AS ~EQUI~ED Client ~ame : Client Acer P.O.~ NONZ RECEIVED Ordezed By : TED MOORE Anaty~is Completed :NOV 8 89 Send ~.epozts to: Labozato~? S~lpe:(¥}¢?I }STI~I~[IE.}] C. EDE I)FLATTOP TECHNICAL SRV ~peciat. HOLD EOR PICK-UP UPON CO~LETION, Instruct: 84~ I, ab Smpl ID: 3 ~atzi×: Chemlab ~ef $: Allowable Parameter ~es~od R$~ult Ur~t~ Method NITRATE-N ~D(O,~O) m~/1 EPA 353.2 Sample ROUIINE M~MPLE Renm:k~: SAMPLE COLLECTED g~ T.F, MOOgE. Performed ' See Special !nstzuc~ions Above UA-Unaveiiable MUNICIPAJ~ITY OF ANCHORAGE DIVISION OF ENVIROI~qENTAL HEALTH DEPA~RTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ~.{>~ ~ (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b)Applicants Name {M,'c~e ~ ~oc ~.~¢ ~ Applicants Address } I Z. 50 Po}~ Buyer ~--~ ; Other ~--~ (explain); ' '~ (d) Lending Institution Telephone Telephone - Home 3~{ ~B~ness ~6.'g P~c',(>~ Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single-Family.. Number of Bedrooms 3. Water Supply Individual Well.~. Multi-Family ~-~ Other (describe) Community~ Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite ~ Public ~-~ Community ~ Holding Tank ~-~ Note: If community well system, must 'have wri.~ten confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] me . Information En~ineerin~ Firm Providin~ Inspec.tions~ Tests~ File Search,. Data and 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bed,%ms 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 ~spection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm. Z~/.z~'/~ .-~c~.,;-~,v,~.7.~./ ~.~Z~/ ~f~.~ f~ Telephone Address /'Zoo ~ ~'~ '"~- q DHEP Approval Approved ~ Disapproved Te~s of Conditional .Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED° THE MUNICIPALITY OF ~NCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP S F~kL ) RR4/ej/D18 [Page 2 of 2] 7-19-84 I ae Be Total Depth { ~r' ~ · Cased to Static Water Level Casing H~ight 32:~ve Ground Electrical Wiring in Conduit~N) Sep~ation Distano~s If A, B, C~ C, D.E.C. App~oved!.Y/N) ~/4 . Date Completed -~n¢ 1. ~7 ... Yield , / 7 ~ ~ ~ o~ ~ng ~ Sanit~ ~al on Casing ~ ~essi~ ~nd ~l~ead (Y~ To Septic/Holding Tank on Lot I ~ ''b~ (~; ; On Adjoining Lots To Nearest Edge of Absomption Field on Lot I0.~ ~ (,I); On Adjoining Lots To Nearest PUblic' Sewer Line /V~ To Nearest Public Sewer Cleancut/Manhole A/~ To Nearest Sewer Service Line on LOt MA Water Sample.-Collected By ~i>~ .... ; Date Water Sample Test Results Comments ~ Io~ ,~o¢' ~+ ~4-4~ ~sr,~3 ~l,'t% ~-'t- ,.~ .~l.,.c z~ SEPTIC/HOLDING TANK DATA Date Installed 5-,'~q' ~"f Size I0oo e~,elle~ No. of Compartments Standpipes ~) ~ Air-tight Caps ~N)_ q Foundation Cleanout Depression over Tank ~ h~ Date Last Pumped- Pumping/Maintenance Contmact on File (y/N) ~/6 ; fo= Holding Tank High-Water Alarm (Y/N) ;~ Temporaz-f Holding Tank Rermit Separation Distances f=cm Septic/Holding Tank: 10'5 To Building Foundation To Disposal Field TO Stmeam, Pond, Lake, c~ Major D~ainage To. Water-Supply W~ll To ~om~.t~ Line To Water Main~??vice Line [Page 1 of 2] ~ '7~o'77oF 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I ~5 I2'/i Type of System Design Date Installed 5 -~9 -f~ Length of Field Width of Field ~5__~.1 Depth of Field (~ ~-~ f1,' .mm Gravel Bed Thickness Square Feet of Absorption A~ea~ standpi~s P~esent ~'~/N) Dep=ession over Field (Y~ ~J Date of Last Adequacy Test Results of Last A~equacy Test /v~ Separation Distance f~cm Absc~ption Field: To Water-Supply Well /o S~ ~ TO P=operty Line ~ ~ To Building Foundation , ,~ ~-' ~ TO Existing or Abandoned System cn Lot /~ ; On Adjoining Lots TO Water Main/Service Line , ~ TO Cutbank(if present) To Stream/Pond/Lake/c= Major D~ainage Course zoo To D=iveway, Parkin~ A=ea, c~ Vehicle Stc~age A=ea z~/'~ Cc~ment D. LIFT STATION bI M~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Ccm~ents Dimensions ~~~ Ma~e/access (Y/N) "~m~ Off" Level at Vent (Y/N) ~/~ du~ing Adequacy Test. Meets MOA ** Check Pe=mitted Bed~ocm Rating Against HAA Request ** I ce=tify that I have checked, verified, c~ conformed to all MOA HAA Gu on the date of this inspection. Signed ~'/~,~ ~ .... Date ~-+ '$9 Company -/~,/C~-S' /,9 ~- MOA No. Sr 9¥ ~ ~ KB1/d5/s [Page 2 of 2] 2-15-84