HomeMy WebLinkAboutSPANISH HILLS LT 7 MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
· Environmental Health Division O/7 - / ''~-/
825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Na,~e DISTANCES
Address TANK FIELD
Phone(s) PermU NO. Uo.o,e~
LEGAL DESCRIPTION
Lot ? Block~/~ SubdMsio~,~ /1,~ FBUNBATIDN
Township, Range, 8eclion
TANKS
Manutacturer Capacdy ~n gallons
~aterial No. ol Compadmems
TYPE OF SYSTEM
Number of lines Soil rating Pipe ma,erial
~ PRIVATE D OTHER {Identifvl
FT FT ~ Y
Installer Date Installed:
Scale: ~ ENGINEER'S SEAL
{ ' ' cedily thai this inspection was pedermed according Io all
Municipal and State guidelines in ellect o~s date:
Heallh Depadment Approval: ¢ Date;
72-013 (3/85)
ALASKA
EF1UIROnm~F1TAL COFITROL SERUIC~S, IRC.
~nc~Jr,¢¢,'i,~q & ~nui,'ol',m¢,~tol Studies
1200 ~esl 33rd Auenue, SuJl¢ [~, Anchora§e, Alaska 99503 ~,(907) 561-5040
TO
[) N .... [i!t I T 12: S E W lei: I:Z P El: IR M I "1"
2 '7 A-. a z~ O 1
I::'a r' c:(,ze ]. :1: cl ',', O !'7"'" :1. 5:1. '""O'7
l....c)t. L.I.?..X:.:] a 1 ,", Sub cl :i. v i
Max Bedt'c)cxm~a 'Iisi?,
SI!!!:I:::"T:[C "l'(.~lxll-:::~ M:i.r'~:i. mLmt t. ot. al ~s(.~]p'L:i.c t. anl..'.' c:apa(:::i.t.'~,x :1.~,250 ga:L].c)n!~, Each ~!~e:l:)t.:i.c:
~' (::.)~:vl.... i" (.::)(::11..~ :i. i". (:.):!i~ i t"'~ !iiH.I ]. at. i C)l'"~ c)v(.?..~r, t.a[11< ( ![~ ) .
I NSTAL..I.... I:::'EF~: EI',II!.) I t',II}]~i:RE~ :l:)li!i:S I I'.~llxl ~, A BE[) TYF:'IZ AB[~OtRF"T']: Olxl SYS'T'E:M ,,
t:~B~[i[)I::~F"T]:Ot',I (~t:~l~:h :1:'.~i "['O BIZ (:~ M]:Ixl]:MLIM g<)O ~l(:'~!, I::'T. WI'TH 2: .Cfi::'
[.:: X I:::' I I::~ES :1. 2/;~; 1/88, I~[..E[C'I"IR ]: [:hL. F'ERM ]: T :[ S I:~l~:l:;~l.J :[ RED.
]: I:::'Y "I"H[-YI":
alii l'~::'mlil:i.a'd'~ l.~:i.t.l'"~ 'l'.h~:.~ r'~?cluiPi.:~me, rl±.~i t'ciP on.-~i~i:i.t.e) s(.:..)we)P~] arid we~:l.:l.~i al~
i'or.t.l't [:~y t. he IflLu'~:iC:il:)al:[t.y O~' (~ncho~age (1"11])(~) and t.h(.'.~, ~tat. e) c)l' ~.~].a~l<a,,
~z~:i.:t.]. :i. lqs'l'.a].l t.l'~6) ~iy~[rt:.~:~ml in ac:c:opdar~c:l.:.:.~ wit, hall I"lt::)~ c[~d~.'..'.~ and
w:i. 1]. acll"~e)r.~.::e t.o all I~IC)(~ and [~it.a't.~.?..) of ¢~la~:fl<a I"e)qL.liPl6)llle)r'Yl:.~:~ t'l::~P t.l"~(.~) ~.:.~'1:. bat:l<
d:i.~t.a'd"tc:(.)~ {roln any E)~lJ,~'[',.:i,l~l(:':l ~,'.i~:~:l,:[~ ~,ga~i'..i.~,~ga'L~er. cli[[~pc,~ia], ~y~t.(~.z,m CH"
~(?.)wc.)r'ag(.:¢.) ~iy'~[~'l'..~:..~lli c)l"~ t.l"ii~i (::)1" any a(J.jac:(~:¢,n'l:, c)P n(.~)avby lot.,,
ur'~(::l~::ar'~t.,:ar'~cl 'Lha'L t.l"li~. F~(¢~Pm:i.t. i~i[~ ',/al:i.d ~'c),". a maximum (::~{' q. I::)~.:~,clPooms,,
~,~l'~ ~.r.> r' ) ,:~ ,, J. l'..:ll::~ E (31...I T
ALASKA eFIUIROnmI F1TAL COIITROL $1 RUICE!S, IFIC.
(~§ineeH~ 6 ~nui~onmcnld $1udi~s
SPECIFICATIONS FOR ELI".VATF. I) I31'1I)WASTF. WATER TREAT,X[ENT SYSTEM
LEGAL DESCRIPTION: LOT 7. SPANISIt HILf,S SUBDIVISION
1 . 0 GENI`1RAL
The ¢/rawJngs, sheets ] thr'ough 4, shall he part; of [his specifica_t, ion.
All materials and workmanship shall meet ::he ~'equiremen~s of the
}~uuJcipali~y of Anchmmae, Department of Ileall:h & IImnan Services (DIIHS),
the condition:-:, of Lite peru:it, and all app].icab]e mt]es and regulations
cttri~e!~tl~j in effect.
Alit excavat:ions cad depths are advisor~,, and are Lo be verified or
modified i.n the fJe].d by the Engineer or inspecting a~ency.
I, 4
It is 'l-he ~esponsibitii:~ of the owner of iastalle~~ lt(~ adher~e ~.o approved
design fo~' the installation, to maintain the specified separation
distances and ho have {he al)propr.iate iuspectiorm.
1.5
If the installation is not inspected by an AECS engineer, AECS will not
be responsib](.~ for the Jnsi_a]]ed system. An engineer at AECS should be
consulted p~_'ior to construction, to determine the nm,bet? of iuspections
that w.itl be required and to explain what [:hese inspections will involve.
2.0 SEPTIC TANt(
i[ the~'e ia an existing sepl:ic hark it may be used if it meets the
capacity requirement for the residence and the app,'oval of ]]IfHS.
2.2
The sepi::ic lank shall be a UPC-Approved two. compartnm, nt taut, consht-ucted
of ]2-.gauge steel with bitumastic coating and set level on undisturbed
soil. If the Lank is buried at: a depth of 4 feet: or less, iL inus[; be
].nsulated wi. th an over'lying laye~ of 2 ]nth burial type polystyrene
rigid board
2.3 Tit(; septic tank shall b(; a minimum of 5 feet from the house foundation,
and a IIiJllilnuln of 5 feet frem the absorption area.
2.4
The septic tank cud bed shall be a m:[nimum of 100 feet: from any pt':[vate
well or body of water~, 150 feet fuoln Class C [vel]s, and 200 feet front
Class A or B wells, unless otherwise specified, l,ess than ~he required
separation dJ stallce lilnst have prior approval of waiver by DHHS o~' Alaska
Depar'tlnent of Enviroul,enta] COlmepvatinn (ADEC).
2.5
Piping shall l)e ~itted with a mechanica] wateptJght calder coupling on the
outlet and iulet o[' the septic tank. Piping shall be 4 J. llch soJid PVC
AST~{ D3034 of east; iron, sloped a iiiJll[mtllll of 1/4 inch pe~: lineal foot.
If the pip:ing is hurled at a depth of 4 fee[ or less, it must be iusulated
with an over]y.[n~ layep of 2 inch baria] type po]ystrene rig.id boat'd
insulation.
1200 [Ues] 33rJ Buenue. Suite B o Anch0raqe, Alaska 99503.(907) 561-5040
2.7
3.2
3.3
3.4
3,5
3.6
3.9
C le~ neu t.s sim] l be :insta] ] ecl as de, si gnate, d and capped w'i th aJ p-.ti sbt rain
caps (gini caps or equivalent), and extend a illlllillltllll of 1 £oot above
~l'OtlDd leve] ,
If a ]ifL sD~tion is re, qu:ired i/ shall be a combinaCion lift stakion
septic Lank per Anchorage Tank and Welding, Inc, desJan.
SEEPAGE }lEI)
The sand, :ii' specified, shall have a slze distpJl)ut::ton which meets the
requiremenLs of bIOA (;ode 15.65.077.
The gl'ave] fop Lite bed shall be 0.5 to 2,5 inch, screened rock w:i~h less
than 3sa passing 8200 sieve residual, All substitui;es mist have prior
DIHIS approval.
Tit(; bot~o]n of [he excavat:ion shall, be ]evel and pal(ed i~,i~h t:he backhoe
blade to insure thaC Lite boCtom has not been compacted during excavation.
The distrJbukion pipe Mm:Ii be perforated 4--inch rigid PVC wlLh a! minimum
crush strength of 1500 pounds and sha]l meet the approval of l)ttIlS for use
as drainfJe:ld pipe. All pipes shall be laid level, and spaced accord.ing
to the drawings.
,Xlonitop standpipes shal:t be placed as shown hi the drm~dngs. They shal]
be 4-inch rigid PVC ASTM 1)-2034, or cast lpon. The section shown with
ho]es may be e.ithep dr:illed 0.5 il]ch holes on 6 inch centeps on opposing
sides of klm p~pe, or a section of regalar perfopaked sewer pipe may be
clmnped i:o t;he solid secl:ion w:iLh a no-]mi) coupling or so]periL jeln(.
Perforaked section sha~l be located in ~rave] only. The portion of pipe
above the sewer rtmk sha]] be so]id. A pubber caincap (J:im Cap oc
equivalent) shall be placed over ~he top of the pipe,
InsuJaklon Js required, using bur.iai Cype polystene rigid board
insulation. There shall be 1. inch of insulation for every foot of soil
less Limn ~he required 4 feel of cover, bu'L there must be a~ least 24
inches of soil even ~hou2'h insulation is used. The solid pipe extending
from the septic Lank to the drainfield aha]] also haw~ 4 feet of cover or
an equJvalen~ ]ayep of insulation combined with soil.
Tile side wails of the sand and gravel shal] be lined wJkh v:i squeen.
The side slope of t:he mound sha]t be sloped ] foot vertical to 3 foot
hop J zon tal.
The Lop and sides of the })ed shall be planted wJLh a white clover and red
fescae mix or blue grass.
4,0 INSPECTIONS
4,i
Th'is bed w.i]] require a llJJ. ltimum of four ilmpecl:;lelw.,, The £ir',',]'h Lnspec'[:;ion
will be o~ the open excavation, 2o assure that the sysheln J.s installed
the proper soil i.;tpaLa, COl. pec[l depth and mee,~ mini,mm specified design
parameters.
4.2
The second inspection ~.q[]l be performed after ,sand ['ill. is insimlled,
but prior to placement of gravel and dJstrJ, but]on pipes. TMs inspection
will vepJf~ that 1. he filler :is properly instatle, d, that it. m;e'ts
specifications and tha~. it ful£ills the intention of the design.
4.3
The third inspection will be after placement of gravel, monit:or
standpipes, and di.,'~tribution pipe, te verify proper insta].lation and
pOSi[iOI1 of p:ipes pPiOP tO backfill,
4.4 The fourth inspe(;tion will be after final backfill and grading to ensure
~ha'h adequate soil cover has been provided over thc bed.
4.5 The inspection of the septic tank installation can be incorporated with
any one of 'the above li,'.~ted inspections.
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
po:.i~._.-- ,
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...,~,:_.~ ...... -_ ~ ~/_~ ..... ¢' ~ ........
..... :,/F ~~: ~-. ,~
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· ~- :~:~'~ ~ ~7 ~. ~ ~ .........
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO. ~
OF
CALCULATED By ?, JT~_~ r (~ DATE
CHECKED BY. DATE
/"~~
8CALF
£A
%:¸
PERFORMED FOR:
Municipality of Anchorage
DEPA.R,T.MENT OF HEALTH & HUMAN SERVICES
825 'L Street, Anchorage, Alaska 99502-0650 ~°~°°
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
T~/~.¢o, / ~.--,3"
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
Township, Range, Section: ,7-,,6p/u/'~,.7b¢ ~',p
SITE PLAN
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~L
DEPTH? p
E
Deplh to Waler Alter
MonitodnD? JZ~r ? Dale:
Reading Date Gross Net Depth to Net~~
Time Time Water
PERCOLATION RATE __ (minutestJnch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~FTAND ~FT
COMMENTS, J
PERFORMED BY: /, ~c~,~/ I --
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNiCiPAL GUiDELiNES iN EFFECT ON THiS DATE. DATE:
72-008 (Rev. 4/85) ~'.~ ~: 4 5/~'7¢ ~7~ /
INSPECTION REPORT
MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION
3500 EAST TUDOR ROAD
INSPECTIONS (907) 563-3464 INFORMATION (907) 786-8211
FOOTING [] ELEC. TEMP. __ []
FOUNDATION_ [] ELEC. SERVICE_ []
BOND BEAM __ [] ELEC. ROUGH __ []
FRAMING [] ELEC. FIl¥~ /~)t~__ []
INSULATION [] OTHER~ []
SHEETROCK __ []
STRUCT. FINAL __ [] FIRE FINAL []
OTHER [] ZONING []
~NO NONCO'~'P'LIANCE OBSERVED
PLBG. UNDGR.__ []
PLBG. ROUGH __ []
GAS TEMP. __ []
GAS []
MECHANICAL_ []
MECH. FINAL __ []
PLBG. FINAL __ []
OTHER []
[] CORRECTIONS ESSENTIAL AS
EXPLAINED BELOW
[] WILL REEXAMINE AT NEXT INSPECTION E] DO NOT CONCEAL UNTIL REtNSPECTED
COMMENTS
WHEN CORRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION.
DO NOT REMOVE THIS NOTICE
MUNICIPALITY OF ANCHORAGE
Hea .h and Environmental Prote ion
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
INSPECTION REPOI,~T ON-SITE SEWAGE DISPOSAL
SEPTIC TANK:
DISTANCE _0~ ~ NUMBER OF
FROM W;,LL .... M/'d',~UFAC'IURE R 7__ __ MATERIAL ............... COMPARTMENTS ~
INSIDE LENG'rtt INSIDE WIDTH LIQUIO [)EPTFt _ LIC~UID CAPACITY~_ GALLONS.
TILE DRAIN FIEL[)'.
TOTAL LENGTH
DISTANCE FROM WELt ...... FOUNDATION ...... NEAREST LOr LINE ..................... OF LINE _ ~
¢ of Lines .......... I)ISIANCE BETWEEN. LINES ......... FRENCI-I WIDTH~IN. TOTAL EFFECTIVE
ABSORPTION AREA__.~_~ SQ. Fl. t_ENGTFI OF EACtl LINE
[3EPTIt OF [:ILTER ~ /~
DEP]II: lOP OF q ILl:; qO PIf',iISII GRAf)E ......... MATERIAL BENEATH TILE._~/ IN. ABOVE -rILE IN.
SEEPAGE: PIT:
DI/\METER .... OR WIDTH ___ LENGTH .... DEPI'N
Log Crib Rings
BUlL[DIN(; FC, UI,~ DAT IOhl
Crib Size: DIAME-FER .... DEP¥1t .... OISTANCE FROfvl: WELL.
'1'O T/'M.. EFFECIIVE
NEAREST LOF LINE ..... ABSORPTION AREA (WALL AREA)
Sd), FT.
Well
Class: Depth:
Well Distance To: Lot Line
Bldg: Sewer Line:
Pipe Materials: ~
tl of Bedrooms: ~ _
Installer:
Remarks:
.c.) ~ p Ix.)
Ko i~,
Ko id-ii::{
.. ' i',:
?b h3 h-,.
f::,IEF:'FI~tTi','IF~:N'T' ' HEF;:II..TH I.:fl'.J[::, Elq',/;[ REd'.,IHEIqTFII... ' ';:OTEC'T ]; ON / ~.
:"';; ." '::'"'~'l:*P-l" t:II'J'"'Ft"F.'R'.:i: RI'" ':'; -.'fl /
..... ~"' ' .................. ' ...... ' ................ ' .... ' ......... /
I.. 0 IZ:1:'4 "r :[ o N C: I::l ~t :[ 'T' I:::1
I...IEJ:;-iFII [..T. 7 tE;F'F:IN :1: E;H H :1: L.L.2; E;,-"[.':' LOT % :1: ZE ,,:1.4;?'.'55 :SQI..IRt';::I:~E FEET
T¥1-:'I.:.: OF .'.E;E~]:L. FIBF:;ORB~r:[oI'.,1%'.r'¢;'l"E.'l;1:1:~:!;: TRENCH
HR,'.'-.',' ]' i'"IUH I',JI...IHE:IE[,:.: OF E.:,'E[Z:,I'4'.[E]OHE; = 4 SI.'):[L 17FII"]:NE4 (%(;:! F"f',.."E:I;? :) -";:
THE I;~!EEI;!I..I ]; RE:I> E; :[ ZE ~'JF' THE so ]: L. I:IE:SORF'*I"Z ON f;'T'STIE:H ]~ 5:
I!::::, IEE F" "~"~ It--fl :== :!t. ~.'_"-..'~ It.... !t~': ft'-,,lt E:':'~ "'IF' IF-It =..-= :~ "P" u:::.:2~ E~2: Fi %," E: II ..... IE::, IE-'E IF::" ""fi- tl--~1
THE LE:I"JGTH r_:, :I: HEt'.,I!E; :i:. OI'.J :I:S ]'HE LEI'-JGTH ,:::IN FEE'T.':, OF THE; I"RENCH OF.:
THI:E: [:.~EF'TH OF: FI TRENCH O1:;~: P]:T .~F THE: E:, :[ S"I"RNE:E E~E'1"NE:E:N THE SU~tFI::ICE: OF:' "FHE
GFd3tJNE:, FIND 'l't4E: BOTTOH OF THE EXCF:IVFrT.T. ON ,:.':I:N FE:I.E.T::,.
"f'HEF.'.[:.: ]:S NO .?.:ET kI :I: [.':,TH FOF.'. TF..'IEi'.,ICHI:~:S.
THE GRFIVEL. I)EFq'H :l:S THE: H]:N):I',IUH DEPTH OF C-iF.'.FIVEL BE:TNEEN THE: OI...ITFFiI...I_. F:' ]: F::'IE
FINE::, 'T'HE E:OTTOH O1::' 'fTJE EF,',E..'R',,,'RT ]: ON ,:: .'[ N FIEE:T ::,.
II:;~:t liE:: n'Z:~ !UI ::tt:: I~;:-.'.". ~-3: #3:, .".~; E': F" -'iF 7tf: hZ:: -r IFil i"-4t IF:::: ::Ei; :E ;;Z'Z ~.~ ~ :~.. ;;?. EE~ ¢C~ ~LE~
................................ F' It:al [3: tt,,4.: Fn E:"i E: P L, IFt i'-.tl -I- E.-.:~ F" "it'" :E ~::,~ Ii-,Ii
F:I F'FIE:I.:::F-IGIE F'L. RNT I"IR¥ BE :[I'.,I'..:;,TFILLE[.':, FIT THE F'EF.'.H:!:TTEE"L::; OF'TI:ON SUB...TEf:;T Ti:) THE
F'Efl. J...Okl :[ NG C:ONE':, Z T ]; ONe4;:
% E]:'T'HE:I;..' R (::I..FISE; :1: OR ]:.'1: N~E;F FIPPROVEI) PLRNT HR'¢ BE .'I:NL~TFE..I...EI:::,.
;:?. FI C(:)N'T]:NLIOU5 HR:[NTEI'.JF:II'.,ICIE i:fl:.~REEI',llENT :t:5; RE[.;!LI:I:REI% :IF FI t','IR.T. NTENF~NCE
RGI~'.EEI',IENT ]:E; NOT k:EPT E:I..II~'.RENT ~OU HR'¢ BE RE~:.'~I...I.T.F..'E[.;, "FO ENL. RF,'EiE THE SO]:[.
F-II!F~:!.:.;OF::PT]:OI",! ~;'.r'2;TEI"I FINI),/OI:;.: "r'OIJ P1FI"r' E:F tE;IJB.TECT TEl PF~'.OSE:CUT.I:OI",I.
BFtCI<:FIt.I_:[NCi OF FIIq"r' S'~'r~"I*EI"I 14ITHOUT FINial... II'4SPEE:'T]:ON FIND RPPRO'"/RL B'¢ "I"HI'L':;
[::,EF'FIF~'.I"P'ilEN'I' k! ]: L.l.... BE EiIJE:.,]'ECT 'f'EI F'F..'OLR.'ECt..IT;[ON.
H ]: I'.J:t:I'"IUH [." ]: S'TAI"JE:IE: BE:T!4EEN R klELL RN[::' FtNY ON'"'2;:['I"E SE:~,.IRGE D
:~..~:)E~ F'EE"f' F'OR FI PF.'.ZVF:r'f'E 14ELI... r)R ;:;~;!~O FEET FOR FI PUBL]:C [,IEl....I ....
LqlEI...L LO(aS FIRE: l:~:El:.:4t..I]:l~'.E.r.:, FIN[) I','lt..IST tF.~E [~:ETIJF..'NEI::'., TO THE: I)EI::'RF~:Tt"IENI" I.,.I :t: TH :[ N
OF* THE I.,.IEI...I.. COHPLET;[E~N,
EFrI.-IEF~'. R.F.'.:(;4t..I]:F.'.Ef,IEt'.JTS HR¥ RPF'L.¥. SPEC:[F]:CFIT_TONE; RNE.', COI'.JE;TI~tlJC'T':[ON
iq',/Fl:[ I..,RBI..E: TO ]: N%URE PRi3F'E:R' ]: NE;"FRI....t~I::I'T .'[ ON.
]: C.'ERT]:F'¥ THRT
:1.: ]: FIH FFiH:[I..,.:[F:IF4: kI:[TH THE: RE:i:;:~UIREI',IENTE; I::'O1:~'. ON-2;ITE SE[,,IERS FINI) klEL.I..E; FIE:: :F.;IET
I:'OF~'.'T'H E:¥ THE I"lt..IN ]: C::[ F'Ftl... :[ 1"'¢ OF FINCHOF..'FIC4E.
2: ]: kl]:L.I.... :I:I'.,ISTFIIJ_ THE S¥S'T'E:f'I ]:N FICCt)RI)FINCE 14:[TH THE CODEE;.
:2'-::: ]: UNt:.':,E:i'~t'.!kTI'FIND THRT THE ON-'.~]:TE %EI41EF..'. E;'.r'STEP1 I'flF:W RE6!LI]:F.'.E EI'.,!L.RF-.".GEf'IEi'.,IT :IF' THE
P.E:fEi ]:I:.',E:NCE :1: E; I;~tE'HOf.')E..:IJE.'I:) 'f'O ]: NCI...LIE:,E 1',1014'.1E THRN 4 F.'.','E:DRCIOH'.:E;.
FII::'F'I 1' f':FIl'.,lff? .,:JOHN I:.:il::ll;]C ]: FI
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-6§0, Anchorage, Alaska 99502 276-222'g
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
lO
11
12
13
14
15
16
17
18
19
2O
DATE PERPOR.ED= a,,.$,
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTFI?
Gross Nat Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
CJ'~.,~ , TEST RUN BETWEEN ~'-"'~-- FT AND ~ F..T-.
72 008 (7/76)
MUNICIPALITY O, :HOR/;.;E
DEPARTMENT OF HEAL1 id 'UMAN SERVICES
Division of Environmt~ al Services
On-Site Services ,:,ection
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D.
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
7
Location (site address or directions) 12~ ,~ o I ~___c~.,,~-~-~,.
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
N
~otavt~k'i~t~t~,e---~L Dayphone ~-.~3-%V~,~
Day phone
Unless otherwise requested, HAA will be held for pickup.
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.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
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.
Name of Firm I ~ ~, b ,-,-n
Address ¢~.40'5
Engineer's signature
DHHS SIGNATURE
~ Approved for
Phone
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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.
72-025 (Rev. 1/91) Back MOA #21
DIHOND
~]N C HO R f~E;F.', ..... ' ......
(907) 279--~916
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. # () i ~7 ~
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Day phone
Lending agency
Mailing address
Day phone
Agent
Address
Day phone ~"'~ % ~~"~- ~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: L~ .,~
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.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: 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.
Name of Firm
Address
6, DHHS SIGNATURE
Approved for
bedrooms.
Disapproved.
Conditional approval for /7L
bedrooms, with the following stipulations:
Additional Comments
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 DH HS 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, 1/91) Back MOA #21
RECEIVED
JUN ~ 199;~
Municipality of Anchorage
Dept. Health & Human Services
6751 ~J, DII'iDI~D BLVD.
(907) 279.-.~9t6
Municipality of Anchorage //~-~%
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
'% ul ¢)
Date of test
Static water level
Well flow
Pump level1
Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
~/ Date completed ~/t ?~ / 77 Driller
Cased to :6 ~-[ L~ Casing height
FROM WELL LOG
(/-- ,C? g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line '? /
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
; On adjacent lots
; On adjacent lots / ,' /
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample'. .i~ (,~
/ )~- Other bacteria
Collected by: ~ f/-c-~.c-t_-~
B. SEPTIC/HOLDING TANK DATA
Date installed / E,/~//,,~? '7
Cleanouts (Y/N) "7/. Foundation cleanout (Y/N)
(
High water alarm (Y/N) ~"///-k.
Date of pumping ~'~/~/l )
Tank size / .;-; ~9 ~-,- Compartments
: Depression (Y/N)
Alarm tested (Y/N)
Pumper /~\ '/~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot //(-)
To property line ">
Sudace water/drainage
On adjacent lots
Absorption field
Foundation /~'
' '-'F 0
Water main/service line )
CONTINUED ON BACK PAGE
72-026 (3/93)* Front
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) ~/
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Manufacturer /~ t~, r_:~ ~ ~:'
Manhole/Access (Y/N) y
/'// "Pump off" Level at
Cycles tested ~/
Well on lot ~./,~r) On adjacent lots
Sudace water
D. ABSORPTION FIELD DATA
Date installed--"'7/'~J'i .~' ~-
Length ~;, £) Width
Total absorption area IU~.~ ~ r,..~
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Soil rating (GPD/FF) /.~*
~'~ Gravel thickness
Cleanout present (Y/N) "'/
Results (pass/fail) i
System type '/,~',4~
t( ,~
Total depth
Depression over field (Y/N)
for // Bedrooms
After test
If yes, give date
Well on lot '?
· To building foundation ~> .~
On adjacent lots
Surface water
Curtain drain
On adjacent lots ~ ¢"¢2..~2 Property line
To existing or abandoned system on lot
Cutbank N r'.~'~ Water main/service line
Driveway, parking/vehicle storage area ~,~
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to ali MOA and HAA guidelines in eff~adt 'on the date of this inspection.
HAA Fee $ //7D4'~
Date of Payment
Receipt Number
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number
~ - DA~ RECEIVED
~ INSPECTION APPOINTMENTS
TIME TIME TiME
DATE DATE DATE
INSPEOTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE
D~PARTMENT OF HEALTH & ENVIRONMENTAL PROTECTi~NiCiPALiTY
OF
ANCHORAGE
~ DEPT. OF H~/d_T~I &
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAl- P, ~J~ECTION
Telephone 264-4720 S~ ~ ~
REQUEST
FOR
APPROVAL
DIRECTIONS', Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing,
1. PROPERTY OWNER PHONE
Thomas E. & Judith A. Canfield 345-~422
MAILING ADDRESS
PROPERTY RESIDENT If different fro~ above PHONE
2. BUYER PHONE
Unknown at this time.
MAILING ADDRESS
3. LENDING INSTITUTION ~ PHONE
Unknown at this time.
MAILING ADDRESS
4, REALTOR/AGENT ~ PHONE
Elliot C. Lawson, Jack White Company~ 277-1553
MAILING ADDRESS
3201 "C" St., Suite 100, Anchorage, AK 99503
*NOTE: Please send all information to Elliot Lawson at above address.
5, LEGAL DESCRIPTION
Lot 7, Spanish Hills Sub.
STREET LOCATION (Up Dearmoun Rd. 3.2 miles...Carita Lane is on right--just past
NHN Carita Lane Greenbrook Sub. on opposite side of Dearmoun)
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [~ Four [] Other
[~] SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7, WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8, SEWAGE DISPOSAL SYSTEM
[~}( INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
1.977
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
.t/2-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[~-' SING LE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO ~ OUR [] SIX
PERMIT NUMI3ER
2, WATER SUPPLY
~"~iNDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[~INDIVIDUAL/ON-SITE DATE INSTALLED //
[]PUBLIC UTILITY 7
Connection Verified
INSTALLER
[~'~eptic ~-~,nk or [] Holding Tank
Size: /.~/9-D If Tank is homemade SOILS RATING
§ive dimensions:
TYPE OFTA_~K ~ ~ ~ / \ MANUFACTURER.--~
TOTAL ABSORPTION AREA MATERIAL _~._~..2~_
4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
I~J CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev, 6/79}
ANCtlORAGE, AL,~,~KA
26'1 4111
GEOflG$! k,'t. SUI I IV/dj,
QEPARTMEN'I OF IiEAL'fl! AND [{NVilIONMiLN I Al_ PF~O'Ff~C'I IOl',l
October 12, 1981
Thomas E./Judith A. Canfield
% Elliot C. Lawson
Jack White Company
3201 C Street, Suite 100
Anchorage, Alaska 99503
Subject: Lot 7 Spanish Hills Subdivision
Thank you for the follow up on tile above subject property.
The adequacy test is not necessary, due to the date of
occupancy.
If. there are any further questions, please call this
office at 264-4720.
Sincerely,
James S. Roberts
Associate Environmental Specialist
JSR/ljw
REAL ESTATE
CALAIS OFFICE CENTER · 3201 "C" STREET
ANCHORAGE, ALASKA g9S03
PHONE 19071 277-1S~3
198i
RECE! ED
Mr. James S. Roberts i;A'i'~! Oct. 5, 1981
Dept. of Health and Environmental Protection
Munic. of Anchorage SUlhit!CY DEQ Approval
Lot 7, Spanish Hills
Dear Jim,
Reference your letter of Sept. '14, 1981 on the above property (Owner:
Thomas E. Canfield) .... the following items are being submitted
for your records:
1.Chem Lab test results for water sample
2.Pumping receipt .... per owner, bill for pumping paid 4-16-80.
3.Owner will have septic tank standpipe raised above ground .... I
will notify you when this is accomplished so that you can
verify.
4.As mentioned, Canfield told me that they were first owners ....
enclosed is his letter to this effect, and a closing statement
from the bank indicating a closing date of 1-26-79. Based on
this documentation would you please advise if your requirement
~4 of your Sept. 14 letter is now rescinded?
Many thanks for your review and help.
E~i~?cerely'[
Associate Broker
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
1981
MUNICIPALITY OF ANOtORA~L__ n. 'P',',~'~: ,.,l.' LO,,',N
DEPT. OF lL2'4.1'ii & I. [7] l.'ll^ '-'[2 Frail^ 3. ~,{:ONV. UN{NS.
ENVIRON , · ~: ~'[~ETIO ~-: CONY.
" .... ~ [J[,l ;' ~r~p', 12.t 02 ()g~ 0246391
SE'iTLkqMEN, I' o]ATE. Mkl I' d h~,~
C. N(}'I'I:: J'Jll.~ f,,rm i.~ .i",,,.d~.,,I t,, ~ , , ,,q ,; .~h:l,'nt, tt~,T/~,~fP.s~'ft%'~ fee c,,x{~. 'JIIIO,IIIIA pk~ { I,~ ,md by the sel,'hvnent %~elll ore
and l!ePt:h:t A.
.~[ .... LI/ ~ PACIFIC .'.'IORTGACE COR]
246C Wt,:;t 26th Ave. hue
hen',er, Colorado 80211
/
Nil)! CarJ. t a
Anchorage ,
Lot 7 Spanish Iii !1:4 'PL~(2:t~,%T-,,~k~T/:;~;?~T~ ..........................
' .IUI.] Y. aSk Fudc:,r [{o.a,I Suite 190 J 1/26/79
Anchc::age, ALaska 9'~507 (PH:276-1933~.J__
j
~' I.'ht),U It(HJ.h%ql J,.'R [ 157.217.7g
K. SUMM,\RY OF' SELI, FIL'S TIiA2;SACTION
.!.OIL (?R()$S. LUO!,7?T L( '/:. ?)) SELLER:
tis2 ~oo_2o.:_oo
-lrJl,tXt,nt'nt.~ f~,r th'm': JUi,] bY ,¢e!b~r in
7
40g.
410,
~!'!~.. ~i.xiittJ, gjt)~_nl~_t.!;[,.en h,.bj.tS£ to
~M, "1 "S'[ HI. E'I
ANCIIORAGILi, Al ASKA
(.90/) 264 411 ]
DEI'AR'rMENTOF HEA[TII AND ENVIRONMEN'rA[ PI?O'rECIION
September 14, 1981
Thomas E./Judith A. Canfield
% Elliot C Lawson
Jack White Company
3201 C Street, Suite 100
Anchorage, Alaska 99503
Subject: Lot 7 Spanish Hills Subdivision
Approval for the'individual sewer and water facilities
cannot be granted until the following items have been
completed:
The water analysis report needs to be submitted to this
office from the Chem Lab, 5633 B Street, for our
review.
(2) The standpipe to the septic tank needs to be raised
above ground level and reinspected by this office.
(3) The septic tank pumped with a receipt submitted to this
office.
(4)
An adequacy test needs to be performed on the existing
leaching'area. This test will determine if the system
is adequate according to National Standards. A listing
of private firms performing the test is enclosed for
you. This report needs to be submitted to this department
for our review.
If 'there are any further questions, please call this office
at 264-4720.
Sincerely,
James S. Roberts
Associate Environmental Specialist.
JSR/ljw
- MUNICIPALITY OF ANCHORAGE " '
~~'~"~ ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1._PR~PERTY OWN,,E~ ~ I PHONE
I
MAILING ADDRESS
PRO~F~T~ RESI D-EN-T (If differeet from'~b )
PHONE
2~. ~¥ER ·
s. END,N. ,NST,TUTO - t -'
4. REA LTO R/AG EI~,T ' ~~, PHONE
MAI LInG ADDRESS
S"-T~ E E "t' t~OCATION
6. TYPE OF RESIDENCE
SINGLE FAMILY
MULTIPLE FAMILY
NUMBER OF BED.RO_.~MS~_~
~:] One ~ Four
[] Two [I--i Five
[] Three [~ Six
[] Othe,
7. WATER SUPPLY
~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975, For wells drilled prior to that date, give well
depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTI L TY
**If individual/on-site, give installation date ~'~ (~'(~ ?
If system is over two (2) fears old an adequacy test is required
by this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONL
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
I NSP ECTOR I NSP ECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[]~SING LE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO F-1 FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[~/INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
E~HI~IVl DUAL'ON -SITE DATE INSTALLED
E~] PUBLIC UTILITY /(~.~
Connection Verified
/ INSTALLER
[~eptic Tank or [] Holding Tank
Size: ~ ~ If Tank is homemade SOILS RATING :
give dimensions:
TYPE~ MANUF~
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septia/Holdin§ Tank Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
~' APPROVED FOR ~/' BEDROOMS
[] CONDITIONAL APPROVAL (Petter must accompany certificate)
[] DISAPPROVED
DATE BY (Title) / /
''
LEBAL DESCRIPTION
72-010 (Rev. 3/78)