HomeMy WebLinkAboutSOUTHPARK #2 BLK 3 LT 6 ~ 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
[] UPGRADE
LEGAL D ESCR JPTION
LOCATION NO. OF BEDROOMS
Well %~ I Absorption area Dwelling PERM'~O 7~¢
~. DISTANCETO: I f{O ~~ I 0
Man turer
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ Well, Foundation , Nearest lot line~ , PERM[T N~
N°'°flineso ~ ~ Length ofe~ Total length oflin~o Trench wid~ ¢ inches Distance ~7~nes
Total effectNe abs rption area
~ Top of tile to finish grade ~ Material beneath tile ~ ~s ~0
Length Width Depth PERMIT
~ DISTANCE TO:
s ~ Depth Driller Distance to lot line PERMIT NO,
OTH~B
SOIL TEST RATING
APPROVED /~ ~ DATE LEGAL
72-013 (R 3/78)
FERIII t NQ.
RPF'L I CFINT
L.C,::FIT i ON
LEGFIL L
TYF'E OF =,i_iL HE,_-,Ui'..FTtLN _-,.r=TEII IS:
6 B ]- :,YE tH F'FIRK
TRENCH
i'IFI::<IHUi'I NIJi"IBER CIF BE[:,ROIDMS = 3: St]IlL RRTING
-THE REQUIRE[:' ':' '~: c,,,: .... =.
_,I ¢..E OF THE SCi T L: FIBSORF'T I ON _, T- TEl 1
THE LE',.bTN DIMENSION IS TNE LENGTH (IN FEET::, OF THE TFEN_.H ]R [:,RRINFIELD.
THE [:,EPTH OF R TRENCH OR PIT I=, THE [:,ISTRNCE E, EIHEEN THE :,URFR_.E OF THE
GROUN[:, R[',I[::, THE BOTTOM ElF THE E,-~L.H,HTIuN ,::IN FEET::'.
THERE IS NO SET WI[:,TH F3R TRENCHES.
'";,-"- , '' =RH EL BETWEEN THE OUTFRLL PIPE
THE JF.H,~L DEPTH IS THE MiNZMIjM CEFTH OF
RN[:, THE BOTTOI'I OF THE E;,:;CRVRTZON (IN FEET::,.
-'- l ..... -'-'- ' "TO INFORM THIS [:,EPRRTMENT [¢I_IRIN~ THE
PERHIT MFFLI..MNT HFIS THE REz, Fuhlc, IE, ILITT ·
IMLLHFILi4 .[N_,FEL. TIuN_, OF Rl".Fr' WELLS HDJRLENT TO THI- FRbFERTT FIND THE
lEER OF REc, IDENL-E-,. THRT THE WELL HILL :,ER E.
BML. F..FILLIhtu OF RN'T' =,T_.TEH WITHOUT FINRL INSPECTION RND RFFFL~ML FHI-,
DEF'RRTMENT WILL BE SUE:JECT TO PROSECUTION..:,
LOT _,I=E 2'~FIA~ SQLIRRE FEET
,::~Q ',FT/BR) = M._, ~4~¢~
MINIMUM DtSTFINCE BETWEEN R WELL RND RN¥ ON-SITE SEWRGE DISPOSRL SYSTEM IS
i00 FEET FOR FI PRIVRTE WELL OR ±50 TO 200 FEET FROI',I R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTRNCE FROM R PRIVRTE [4ELL TO FI PR~VRTE SEWER LINE tS 25 FEET FIND
TO FI COi"IMUNIT'-r! 'SEWER LINE IS '75 FEET.
OTHER REL.';.!UIREHENTS HR'-A RPPL."¢. SPECIFICRTtONS FINE:, C:ONSTRUC'~'ION C, IFIGRFIh'IS FIRE
RVFIILFIBLE TO IHSURE PROPER INSTFILLFITiON.
F'EF:~-'I Z T E:=-~F' ]: F:'E$ I-.EL-El 1E. ER 2c1.- ' ' ':"':?
I CERTtF'¢ THFIT
±: I FIM FRMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SBWERS RND WELLS RS SET
FORTH BY THE'MUNI!]:IPFILITY OF FINCHORFIGE.
2: I WILL tNSTFILL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
~-: i UNDERSTFIND THRT THE ON-SITE SEWER SYSTEM MR'¢ REQIJIRE ENLRRGEMENT IF THE
RES IDENC~~:,ELE[:, TO INCLUDE MORE THRN 3: E:E[:,ROOMS.
~ SSLIEE:, ~ 'r'_ ................. DHTE ..............
'¢4. 0
$ ~ ~ 7125 OLD SEWARD HWY. .....
&, ENGINEERS, li~C, ANCHORAGE, ALASKA 99503
, S ~ 549 - 6561 ~ PEI~COLATIONrEST
SOILS LO(] - PERCOLATION 1'ES7
1
§-
6
7
10
11
12
13
16
!?
20-
5L
SLOPE
WAS GROUNO WATER
ENCOUNTERED~
IF YES, ATWIIAT
OEPTH~
Time
TEST'RUN 8ETWEEN r~ FT ANO __~____ FT
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEP~RTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
A~PLICATION FOR t~TH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a) Legal Description (include lot, block, subdivision, section, towaship, range)
Location (address or directions)
(b) Applicants Name_G~/Z~ ~7-~b/W_c~<zY Telephone -
Applicants Address
(c) Appliqant ~is (check one).Lending Institution
Buyer ~--~ ; Other ~ (explain);
(d) Lending Institntio
Address
0Whet/builder ~;
Telephone
(e) Real Estate Co. & Agent ~
Address
Telephone
(f)
Mail the H~ to the following address:
2. Type of Residence
Single-Family~ Multi-Family~ Other (describe)
Number of Bedrooms
3. Water Supply~
~ndivt~ual Wel~ ~i] Gemm=ity ~ Puhlic [2]
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Sewage Disposal
Onsite ~ Public ~ Community ~--~ Holding Tank ~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status°
[Page 1 of 2]
5o 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 informauion 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 regula-
tions in effect on the date of this inspection.
~ z~
Telephone ~>~/~/
(ENGINEER SEAL)
DHEP Approval
Approved for ~t.~J~edrooms
Approved ~__ Disapproved
Terms of Conditional Approval
By
Conditional
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTR AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HBALTH AUTHORITY ALPPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. Tt{E DHEP DOES THiS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERT_~IN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN TH~ PROFESSIONAL ENGINEER'S WORK°
(DHEP SEAL)
RR4/ej/pl8
[Page 2 of 2]
7-19 -84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Descr~tion: ,Z~ ~ ) ~-, "~,
MUNICIPALITY OF ANCHORAGE
DEPT. OF H~ALTH &
ENVIRONMENTAL PROTECTION
WELL DATA
Well Classification ~e/'¢/¢, I,,V~/./_ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) /k/ Date Complete~ Yield
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Distances from Well: /~,~
Separation
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
;Date 9~'~O~ ~--
CE.' W'6LL
B. SEPTIC/HOLDING TANK DATA
Date Installed /o-//~ ~
/
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N) ,4/'
Holding Tank High-Water Alarm (Y/N) ,4/
Separation Distances from Septic/Holding Tank: /V//~
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course ~//~
Size /000 No. of Compartments
Air-tight Caps (Y/N) ~/ Foundation Cleanout (Y/N)
/"/ Date Last Pumped
; for --
Temporary Holding Tank Permit (Y/N)
/
To Building Foundation ¢0
To Disposal Field /~!--
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field ~ /
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation '~'
Lot
~-~'<' '~'~'-,~'~-"~'- Type of System Design
Length of Field
/
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
; On Adjoining Lots
/~(-~-- ~' './(-EJ ,/~' To Cutbank (il present}
/
To Property Line
To Existing or Abandoned System on
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ,~"~,~
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I/~ e ~¢:~cke~, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
..,
Signed --~--~.- /- ~ Date /
Company .z~zE~7/~_Z../Op~'/.~//_~.~ ,h MOA No.
/
/
Date of Payment /~
Amount: $ ~()~ Engineer's Seal
Page 2 of 2
72-026 (11/84}
, /
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
MUN!C PALITY ,,C~'F -':
DATE: October 11, 1985 L~;i ~ ~ 1985
PWS I.g.~ 213475
To Whom it May Concern:
According to records on file in this office the
SUBDIVISION
Water Regulations
SOUTH PARK TERRACE
Water System is in compliancewith the State Drinking
Sincerely,
Michael P. Lewis
" Environmental Engineer
APPLI¢' NT FILLS OUT UPPER'HA[' ,ONLY
Lending Institution
Address Zip Oode
Realty Co. & Agent Phone
Address Zip Code
Legal Description
Type of Residence
[] Single Family
[] Multiple Family NO. of Bedrooms
2
[] Other
Water Supply
[] Individual ATTACH WELL LOG. A well Icg is required for ail wells drifted since June 1975.
ommunity
Public For wells drilled prior to that date, give well depth (attach Icg if available).
Utility
~lndividual Year Indi¥idual Installed:
[] Public UBlity When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE iHITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
( ~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) CONDITIONAL APPROVAL*
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
ALASKA eI dlROnlI1EI1TAL COIqTROL SERuICE$,
~n§Jneeeinq ~- ~nuieonmentul Studies
InC.
January 19, 1984
Department of Health & Environmental Protection
825 L. Street
Anchorage, Alaska 99501
Attn: Robbie Robinson
Dear Robbie:
On January 19, 1984 our company inspected the sewer system located on
Lot 6, Block 3, South Park Subdivision #2. The Subdivision is served by
a community water system and is approved by the Alaska Department of
Environmental Conservation.
All the standpipes were above ground and capped.
The ground is sloped away from the sewer system.
Sincere ly,
Laura Ogar
Environmental Health Specialist
Approved by:
1200 LUest 33r~ ~uenue, Suite ~ · ]~nchoru§e, ~ktskd 99503 · (907) 276 1361