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Home My WebLink AboutSOUTHPARK #2 BLK 2 LT 12 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 '%" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT name DISTANCES Addres~'~-'J~J ~L~.AL. . ~kJ'~ ~J~ ~, ~ SEPTIC ADSORPTION WELL ~ TANK FIELD P,O. ~ ~/Zp~ No, ,o. of Badrooms AS-BUILT DIAGRAM (Show location of well, septic syste~, properly lines, loundation. TI I kl P.~ M %% dnvew~y, water bodies, etc.) ~ SEPTIC D HOLDING TYPE OF SYSTEM Fill adde~bove o~iginal grade 6,avel deplh beneath pipe Total absorption aree Distance he,wee, lines ~ PRIVATE ~OTHER (Identifv) " 4 JI ~ ~T ~ ~ ~ . . . InspectionsPeHorm~d~y: .... '" M~pal and8tatejuid~n~~ effect onIhis date: .... ~'~ 72-013 (3/85) Owner' Owner' Addl',~:)ss:~ PO .~.,[..]^ 91268 ~-..,t[.,nL~,",~.-~ .,c,, AK 995 :L 6 [)ay Ph orl c-z. ~ F:'ar c~.:)], lid: ()2C~..-.052-,.86 i...c)'L I.c..>ga ii.: Subd ti. v :i. !-7 i cn'~: EI[}LJ'I-HF:'ARK :~kP. L. ot ~ 18 B l!. oc I< :: L,.oI:. S:Lz(?~ 2.:I.()00 (sci,, fl'.,, of Max lf3edpc:)oms~', 'finis Per'rnit~ 4. To'La! Capacit,/~ 4 iJNS'TAL,I.,, i:::'l:ii;R EIqGiNEEiRS AT'T'ACI!E):) DESIGN,, .NOT];FY Dldl-48 PR:IiOFi C[}MI::'E IEiD ON SAMIE DAY UNI..ESS COVERED AND HEATED TO PRIEVEN'T' F'RIiE:2E~i]JN['L, ll"i]:S I:::'E;RMiT IS ISSLJEiD FCIR 'I'I"4E F'I...AIxlixlEI) Si[NGI..N F'AM]iLY DNE. I. LING ONI..Y AND EiXF'!MEE~ ON f o r' 'I'.. h b v ...... ., t.~,.= Huriic::t!]a].ity (::)f Ai"IC:I'IC~PE~(gE' (MI)A) and 'Lhe State c:)f Alaska. **LOTS ARE SERVED BY / / ~ , [~~/ok ~ ~ (4Bdrm)(150 soils)(1.5)=900s, ~ ~ ---~ ~%? ~ ~ % Construct Bed 20'x45'=900sq ~ ; ~3~ ~ ~ Install 1,250 gal oeptic Tan[ -~"~-%v - . ~ ~;~ ~ ~ M.O.A. Approved ~ ~ ~ ~ ~ Install Clean-outs between ~ ~ . o 0 { ~ ~ /~ tank and field, two in bed, ~ ~ ~ / ~ and at house foundation. ~9~ ~-F~ / ~ Install Gcc Fabric over ~ / ~ sewer rock, insulate if fill ~ / cover is less than 3 feet ~ / ! Install 500 gal li~ s~a~ion Insulate kank and lift statS~ if cover is less than ~ fee~ ~/~:-~~-~ .~'HD ~TyEOF~gtq~ ~L CONSTRUCTION TO MEET ~ Y _~3' / M.O.A._ SPECIFICATIONS SEWER SYSTEM 'LOCATION PLAN %~ -3 . ~~,~j~,; ~, NORTH :,; ~g_y ~ DIMENSIONS INDICAT*D HAVE BEEN ft t Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: AC EEA~I=_ ~'~/'~'T~_~ MS DATE PERFORMED: LEGAL DESCRIPTION: L.~-~ + 1 5 6 7 8 9 10 Township, Range, Section: IT"it I~ ~ .~O..J ..~ ~ SLOPE 11 12- 13- 15- 16- 17- 18- 19- 20- WASG"OUNDWATER ENCOUNTERED? SITE PLAN IF YES, AT WHAT 0 DEPTH? p E Del]Ih lo Water Ai~er~ ~,~ Monitoring? ,~-~ Dale: ~'~?.~O/,,~'~_ Reading Date Gross Net Depth to Net Time Time Water PERCOLATION RATE (minutes/inchl PERC HOLE DIAMETER __ TEST RUN BETWEEN __ FT AND · FT COMMENTs S_ 'P-- ~,~v ~,~1~,~/ .~J ~//,~¢,1/,/ ~-1-~¢,-7-~d t.~n :~.~ /~h~ PERFO.MED s~: ~) F_F_B? ~ FF~'~' i CERT,FV ~.AT TR,S TEST WAS RERFOR.ED IN ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/851 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ("~ ~.('~)~- ~. ~ - _,~" ~...t~ NAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions') Property owner Mailing address Lending agency Day phone Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. q NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well 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. 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 s~ueLUUUO0 I~UO!l!pPV .L: :suogelnd!~s BU!MOlIOJ eq~ H~!M 'su~ooJpeq 'swooJpeq Jo] leAOJdd~ leUOB!PUeO 'pe^oJddes!o Jot peaoJddv ~ :aanJJVNglS SHHCI · uolloedsu! s!tll ¢o elep eq~ uo ~oeJJ, e u! suop, eln§eJ pue 'seou~ulpJo eJnleuB!s s,Jeeu!Bus] ~. 0-~ sse~ppv "9 EI::IZINIDN:I ,Aa NOIJ. O::IdSNI ..-IO .LN::IIN:IJ.V.LS'g Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-,~'~' [~;~V~"),.; .~e~f-t"~ Parcel I.D. A. WELL DATA Well type A If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller. Total depth ·Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) Date qf test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION MUNICIPALITY OF ANCHORAGE 'ENVIRONMiNTAL SERVICES DIVISION JUli .- 5 1992 g'P'R'ECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot '~//A ; On adjacent lots Absorption field on lot Public sewer main Sewer servibe line ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~'//~3/40 Cleanouts (Y/N) .2_ High water alarm (Y/N) Date of pumping ~,J ~ Tank size I .~ ~ Compartments Foundation cleanout (Y/N) 1~,[° I¢'[o~.e--Depression (Y/N) Alarm tested (Y/N) 7'[o¢$ ¢_ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots t~//~'- FOUndation ~ Absorption field ~ Water main/service line 72-026 (Rev. 7/91) Front ~ "· CONTINUED ON BACK PAGE C, LIFT STATION [)ate installed Manufacturer Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~...~ Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) ~ Soil rating J ~=~ O System type Gravel thickness (¢ '~ Total depth Cleanouts present (Y/N) Date of adequacy test for bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot ~//,Z~. To building foundation . On adjacent lots Surface water Curtain drain ~'~ On adjacent lots f'C//'A Property line Ho ~OO&'~ To existing or abandoned system on lot Cutbank ~/o H ~ Water main/service line Driveway. parking/vehicle storage area I0 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect:on t~.e date of~ this inspection. Engineer's Date HAA Fee $ I'--/(~ Date of Payment ~/.~-'-- Receipt Number ~¢ "~/'5'I 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number S F"LJRI-:~L. AND F" . E] . 203 WEST ISYH. ~VENHE SUITE 206 ~NCHD~SE, ~L~SK~ 99502-3~04 (907) 279-3716 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LO]' 12 BLOCK 2 S[]UTH PARK Acreage Systems F'.O.Box 1].~.848 Anchorage; Alaska 99511-2848 o~ 1992 March ~-.~, Gent 1 emen; Per your request we inspected and tested the septic system at Lbt 12~ Block 2 South Park :~2~ on March 20~ 1992. This septic system was installed in March ~990. A dwelling was never constructed The septic system has therefore never been At the day o~F ir'lspection the snew cover was appro;.~imately three ~eet. The ground surface at the leach .~ield could there.~ore not be evaluated~ ho~.~ever the various standpipes had been uncovered and the .~:ield ceuld be tested and inspected. 1. One o'~: the .Field clean aL(tS could not be ~ound) 2. The cover ever' the bed was -~ound to be 18 inches , more or' ]Less. Th:i.s is less than the minimum 24 inches required by the Municipal The absorptien bed was charged with 1000 gallons o~ clean water. No water was ebserved in the monitor before or a.~ter the addition o~ this water. This indicates that the absorption ~ield will serve as designed. With the exception o~ the ~wo discrepancies mentioned above~ this septic system meets the requirement o~ the Municipal Health Department.