HomeMy WebLinkAboutSOUTHPARK #2 BLK 3 LT 24 ~ ,~"% MUNICIPALITY OF ANCHORAGE
~ DE ITMENT OF HEALTH AND HUMAN SER~. -;S
~ Environmental Health Division
825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
N,r,e DISTANCES
("~.riF=A'F ( A~ ~O~T~(~_T[O~ ~ T~ SEPTIC ABSO,PTION
Addres~FROM~ TANK FIELD
WELL
) driveway, water bodms, etc.)
~anufac, .... Capacity in gallons I. 0
TYPE OF SYSTEM ~ _
~TRENCH ~ BED ~ W. DRAIN ~ OTHER ~,: ....... ~. ,-
Depth to p~pe bottorn f~om ~ Total deptl~ Irom original grade ~r~ ~ ~ '
~ 0 0 SQ FTI ~ FT
WELLS ~ ~
~ PRIVATE ~OTHER ~ldentifv)
REMARKS: L
/ Scale: ~ ~ . ENGIne'S SEAL
TO ~ ~ ~.~ ~ ~ % Inspections Pedormed by: 0
I /,~-- - / / cedily that this inspecti°n was Ped°rmed ac°°rding I° al~
Municipal and State 9ui~elineCn er[ecl on Ihis dale: R - ~ ~ -t ~
72-013 (3/85)
DEPARTMEN'¥ OF HEALTH AND ENVIRONMENTAL. PROTECTION
825'L STREET~ ANCNORAGE, AK 99501
2.64-4720
It:::~ [',4 '-'- S Z IF tE S E k~ E R P (fEZ F'4 M % -r
F'ERMIT NG:
DA]'E
AF:'PL I CAN'T':
ADI)RESS:
CONTAC] PHONE:
t...E[~AL DESCR I F':
LOT SIZE:
MAX BEDROOMS:
GREAT LAKES CONST..
200 WES]'
::~;.~1.-I"1.,.I, AVE. SUITE 607~
344-C)880
AK 7750~;
SUBDIVISION: SOUTH PARK ¢~;~ LOT: 24
SECTION: .3 TOWNSNIP: l:tN RANE~E., 3W
.5A (GQ.FT. OR ACRES)
4
'BLOCK:c.="
I_isted below ape the options available to ¥OLI in designing yDup
system. Choose the op'Lion that best ¢it.~ your site.
septic
DEP"I'H FO PIPE BOTTOM (FT.) 4.0¢~,. 4.5 4.0
GRAVEL DE:PTH (FT.) 6.0 0.5 3.E ·
TO1AL DEEF"I'H (FT.) 10. Q ' 5.o 7.5
GRAVEL WIDTH ([:"1-,) 2.5 20.0 5.0
GRAVEL I_ENGTH (FT.) 42.0 38.0 54.0
GRAVEL VOLUME (CU.YDS..) "*~= ~ 28.o 40.0
'I-ANI'( SIZE (GALS) 1.~25(
"~ '" 125
SOIL R~'TING (SQ.F'T,
** YANK ML.IGT' I-lAVE A'T LEAS] TWO COMPARTMENTS
c:er't i fy
].. I am
2.
3.
that:
Camiliar with the requirements for on-site sewers and wells as set
£or'th by the Municipality o£ Anchorage (MOA) and the State of Alaska.
I will install the system in accordan{ze with all MOA codes and regulations~
and in compliance with the design criteria of this permit.
I will adhere to all MOA and State o£ Alask:(a requirements £or the set. back
distances £rom any exis'~ing well~ wastewater disposal system or public
sewerage system on this or any adjacent mr nearby lot.
I tCnderstand that this permit is valid £or a maximum of 4 bedrooms and
any enlangement will require an additional permit.
IF A
]"HEN
WILL; NO'T BE APPROVED WITHOIJT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
_ ....... - .......... -'-' ...... .............. :'-; ............... , ........ ....
LIFT' STATION IS INSTALL. ED IN AN AREA COVERED BY MOA BUIL. DING CODEo,
(1) AN ELECTRICAL PERMIT AND INSPECTION NUST BE OBTAINED; (2) AS-BUILTS
PERMIT NO:
DATE ISSUED:
DEPARTMENT or F-li:.~ALTF'I AND ENVIRONMENTAL r-ROTECTION
825 L S1RT'-ET, ANCHORAGE~ AK 99~.. 1
264.--4.720
850368
06/27/85
APPLICANT~
ADDRES8:
CGNTACT PHONE:
LEGAL DESCRIP:
EOT SIZE:
MAX BEDROOMS~
GREAT LAKES CONST
200 W. 54TH, SUITE 607
ANCHORAGE, AK 99503
344-0880
SUBDIVISION: 80uTHPARK ~
SECTION: 5 TOWNSHIP:
21780 (SQ.FT. OR ACRES)
LOT: 24 BLOCK: 5
RANGE: 3W
DEPTH TO PIPE BOTTOM (FT.)
GRAVEL DEPTH (FT.)
TOTAL DEPTH (FT.)
GRAVEL WIDTH (FT.)
GRAVEL. LENGTH (FT.)
GRAVEL VOLUME (CU. YDS. )
Listed below are the options available 'Lo you in designing your septic:
system. Choese the option that best ~its your site.
']1- R E !'"~ I[] ~-t BED
2.0 *.~- 2.0 ** 1.5 **
2 ,, 0 / 0 ,, 5 2.5
4.0~ 2.5 4.0
~4. L 5.0
. 220.0 ~ 48.0 1
51.0 42.7 62..i.
TANK S I ZE ~GAL. S) ~~I 1,000~._~. 0 ** 1,000~. 0= '~
SOIL RATING (SQ.PT. /BR) o:~
~.~ DEPTH TO PIPE BOTTOM < RES ADDITIONAL GROUND COVER
' ~ = FT, REQUIRES INSULATION
~ DEPTH TO PIP[< BOTTO~ ~
~ DEPTH TO PIPE BOTTOM < 4,0 FT, MAY REQUIR~ A LIFT STATION
*~ GRAVEL LENGTH > 75 FT, REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT, EACH)
.~. TANK MUST HAVE AT LEAST TWO COMPARTMENTS
I' certify that: .
1. 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.
3. I ~ili adhere to all MOA' and State o~ Alaska requirements ~or the set back
distanc:es f'pom any e. isting ~ell, wastewatep disposal system op public
sqwerage system on this or any adjacent o~ nearby lot.
4. I understand that this permit is valid ~or a maximum oF 3 bedrooms and
any enlargement will require an ~ddi~ional permit.
],~ INSTALLED IN AN AREA COVERED BY MOA BUILDIN8 CODES, '
IF A LIFT STATION '~' ' - '
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE,APPROVED WITHOUT AN ELECTRICAL INSF'ECTION REPORI. AND (5), THE
E. LEC]RIJ~AL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONIV]ENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
4
5
6
7
8
9
SLOPE SIT'E PLAN
b
10
11-
12
13
14
15-
16-
17-
18-
19-
20-
WAS GROUND WATER ~
ENCOUNTERED? ~'~ 0 ~
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN EETWEEN
PERFORMED BY: '~:~ I~A~,,.)I
72-008 (6/79)
PERFORMED FOR:
,~ /~ J SOILS LOG
MUNICIPALITY OF ANCHORAGE
[~'/J PERCOLATION
SOILS LOG - PERCOLATION TEST
9
10
11
13-
14-
15
16
SLOPE SITE PLAN
WAS GROUND WATER PO SE
ENCOUNTERED? pO
E
IF YES, AT WHAT
DEPTH?
Reading E~ate Gross Net Depth to Net
Time Time Water Drop
-,,0~ ~ I~..,-i q':Ho Io~.,
',,
PERCO,A'nON R ,TE I
. /TEST R~N BETWEEN J~' ~,. FT AND
(minutes/inch)
· - , FT~
Z2
PERFORMED BY; :~- i./E 1~.) ~
CERTIFIED BY:
72-008 (6/79)
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
¢:~ ,'~,~ '- ,'~1 HAA#
GENERAL INFORMATION
Complete legal description
Location (site address or directions) I.~(,=,,¢.c, ,.~-/-~.~u..~-~,~¢ ~.¢'r"
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone,
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
So
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 / ¢,/¢/~/,-1
I
Address ¢9..O E,
Engineer's signature
DHHS SIGNATURE
~ Approved for
Phone ~."~ _,~c/l ,G.
~..//'¢~ ~(¢, ~) be d ro o m s.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:
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 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.
Municipality of Anchorage '
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
ParcelI.D. 0~-0-- ~5'3- ~1
If A, B, or C, attach ADEC letter.
Date completed
Cased to
ADEC water system number '~l~:) ~, 1~l 7~'-
Driller
Casing height
Wires properly protected (Y/N)
Date of test
Static water level
FROM WELL LOG
AT INSPECTION
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
g.p.m.
; On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B, SEPTIC/HOLDING TANK DATA
Date installed ~'~{' ' ~-~
Cleanouts (Y/N) 7
High water alarm (Y/N)
Date of pumping
Other bacteria
Nitrate
Collected by:
~ /Compartments
/
Foundation cleanout (Y/N)
Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
On adjacent lots /'~///"~
Absorption field ~ -
r/lo
Foundation
Water main/service line
72-026 (Rev. 7/91)Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Date installed ~¢~' l (¢ - ~ .~ Soil rating _
Length ~ Width
Total absorption area ~ ~
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~*'J//¢'~' On adjacent lots
To building foundation
On adjacent lots ,~ ~
Surface water ~k,~
Curtain drain ~'~ ~'~
Surface water
Gravel thickness
Cleanouts present (Y/N)
System type
Total depth
Date of adequacy test
for ~ bedrooms
If yes, give date
Property line ,/--~
To existing or abandoned system on lot
Cutbank ~,~ ~ ,,4 ~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date,(~f this inspection.
Signature .
Engineer's Name !; {'~ ~'~-"~ *%~ ~' ~'~tl~ ~ ~~-~
Date (~c...~- ~ ~ ~ ~ 7.
HAA Fee $ ~/,7~
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA
Waiver Fee: $
Date of Payment
Receipt Number
DEPT. OF ENVIRONMENTAL CONSERVATION
WALTER J. HICKEL, GOVERNOR
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
(907) 349-7755
October 1, 1992
Mr. Tobben Spurkland
SUBJECT: South Park Terrace Subdivision
Class "A" Public Water System, PWSID 213475
Dear Mr. Spurkland:
I have completed a review of this office's files concerning the monitoring status of the
above-referenced Class "A" Public Water System and found the foltowing:
The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on September 11, 1992. This does meet the provisions
of 18 AAC 80.200(a), of the State Drinking Water Regulations.
The last inorganic Chemical Contaminants Sample results were submitted
to this Department on November 15, 1991. Thi~s_d~o.__e.~_m__~e..e_t~ the provisions
of 18 AAC 80.200(a), of the State Drinking Water Regulations.
The last Radioactive Contaminants Sample results were submitted to the
Department on October 12, 1988. This does_m__.e¢ the provisions of 18 AAC
80.200(a), State Drinking Water Regulations.
The last Organic Chemical Contaminants/Volatile Organic Chemicals were
submitted to this Department on November 6, 1991. This..~_~_.~does .meet ..... the
provisions of 18 AAC 80.200(a), State Drinking Water Regulations.
Issuance of this letter does not imply that the above-referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations.
If you have any questions on the above information, please do not hesitate to contact this
office at 349-7755.
Sincerely,
Michael Lu
Enviornmental Eng. Asst. II
MUNICIPALITY OF ANCHORAGE ~
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date ~Z- %O- g~
\
(a) Legal Description (include lot, block, subdivision, section, towaship, range)
Location (address or directions)
(C) Applicant is (check one)
Buyer ~ ; Other ~
(d) Lending Ins~IgutioR ~/~ -- Telephone
Business
(e) Real Estate Co. & Agent ,~
Address
Telephone
(f)
Mail the H~ to the following address:
2. Type of Residence
Single-Family~
Number of Bedrooms
Multi-Family~
q
Other (describe)
3. Water Supply
Individual Well~ Communtty~ Public~
Note: If community well system~ must have written confirmation from the S~ate
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 written confirmation from the State
Department of Environmental Conservation attesting ~o the legality and status.
[Page 1 of 2]
.En$ineerin$ Firm Providin$ Inspections~ Tests~ Pile Search~ Data and Information
As certified by my seal affixed hereto and as of the validation date shp~wn below, I
verify that my investigation of- this Health ~_xthorlty Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and ~ype 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 regula-
tions in effect on the date of this inspection°
Name of Firm ." c~'C ~ -~ ' '" '- .~ i. 2---. _ .-- Telephone ~6~-1~t~
~ -- ' /(z~ '~7
Approved for ~ bedrooms B~a~e /,/ ~,/~
Approved ~ Disapproved Co~i~ion~
Te~s of Co~ition~ Approval
CABTION
THE MUNICIPALITY OF ANCHORAGE ~EPARTMENT 0P 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 0P DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICAIM IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/eJ/D18
[Page 2 of 2] 7-19-84
MUN~CIPALiTy/..~ ANCHo
ENVIRONMENTAL PROTECTION
,~ ~.~ C]:PRLITY OF ANCHORAGE (MOA)
JAIN ~ ~r~ ~Or~°~aT~ N~PROV~S (m~)
R E C E I V E . F Ru Y 984
Well Classification ~
Well Log P=esent (Y/N)
Total Depth Cased to
Static Wate~ Level
Casing Height Above Ground
Electrical Wi~ing in Conduit (Y/N)
Sepa=ation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Fisld on Lot
To Nearest Public Sewe~ Line
C leancut/Manhole
Wate~ sample Collected By
Wate~ Sample Test Results
If A, B, o~ C, D.E.C. Approved(Y/N) y
Date Completed Yield
Depth of G~outing.
Pump Set At
Sanit83~y Seal on Casing (Y/N)__
Depression Around Wellhead (Y/N)~
; On' Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewe= Service Line on Lot
; Date
Bo SEPTIC/HOLDING TANK DATA
Date Installed ~-~6 ~ Size /.'7 ~--(~) NO. of Ccmpartments
Standpipes (Y/N) ~/ Ai~-ti?ht Caps (.Y/~N) y Foundation Clea~out (Y/N)
Depression ove~ Tank (Y/N) ~ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N)~3/AN ; fo~
/
Holding Tank High-Wate~ Alarm (Y/N)~3//A Temporary Holding'Tank Permit (y/N)~///d~
Separation Distances from Septic/Holding Tank:
To W. ate~-Supp]y We 11 ~h 0~ / '+
TO Property Line ~
To Wete~ ~ain/Se~vice Line
To Building Foundation ~z
To Disposal Field ~/
TO Stream~ Pond, Lake, c~ Majo~ D~ainage
[Page 1 of 2]
2-15~84
C. ABSORPTION FIELD DATA
Soils I~ating in Absorption Strata
Date Installed %~ _ ( ~ ~ ~ ~-
width of Field .~ - ~
Square Feet of Absorption A~ea
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System D~sign
Length of Field ~O ~ ~
Depth of Field ~( ~
Gravel Bed Thick,ess ~ ~
Standpipes I%zesent (Y/N)
Date of Last Adequacy Test
Separation Distance f~om Absorption Field:
To Water-Supply Wall r~ ~/e To P~operty Line /~
TO Building Foundation r~ ~t · To Existing or Abandoned System cn
Lot ~3.z//~ ; On Adjoining Lots .~ (~
TO Water Main/Service Line I.~ r~ To Cutbank(if present)
To Stream/Pond/Lake/o~ Majo~ Drainage Course
To D~iveway, Parking Area, o~ Vehicle Storage Area 1 ~5
Co~¥,,~nts ~ ~ ~,~ +
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested fo~
Electrical Codes(Y/N)
Cc~n~nts
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Te~t.
Meets MOA
** Check Permitted Bed~ocm Rating Against HAA RequeSt
certify that I have checked, verified, o~ conferred to all MOA HAA
on the date of this inspect_j~on.
Date ~ %~B O ~ ~ ~
KB1/d5/s
· n effect
[Page 2 of 2]
2-15-84
DEPT. OF EN. VIRONMENTAL CONSERVATION
ANC~0RAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, :GOVERNOR
274-2533
DATE:
PWS I.D.#
To Whom it Hay Concern:
According to records on file in this office ~h~
Water Regul a~.ions
Water System is in compliance with the S'tate Drinking
Sincerely,