The URL can be used to link to this page

Home My WebLink AboutT15N R1W SEC 8 LT 199 ~- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~ (10 ~/[0~'1 $~ ~ TO SEPTIC ABSORPTION WELL p5%~~ ~a_~7c Permit NO NO of B~ooms FOUNDATION TANKS N Material No. of Compa~ments TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~ OTHER '~ ~;~ ~ t 5,~ Depth to pipe bottom Irom Total depth from original grade Fill added above original grade Gravel depth beneath pipe Total absorption area Distance between lines Number Ol/~i.e~ S°~ SO FT Pipe material WELLS ~ PRIVATE ~ OTHER (Identify) REMARKS: 72-013 (3/85) DAV]:D 7El()() DIE [)ARR SI:::'ACEZ 466 AIxlC I'"l ~, AK 99504 I:::'a P I::: e 1 [ d:0 5 ;f, '"' :L ',,';i3 "' L-:: 7 l.~::)'~ I (...)c. la J :; Si.fi:ii d i v ii !iii ;i. (;:~l"/',1 ()C~O()()O()C~ Lcd:. ~', :1 Sec t .i on ~ 8 'f OWl"l sh i. p Il 15lq I::larl g e: :t. W I,..(::)K ':B :i z e :!, 08q~o() (~i/::I ,, f t ,. (::) r :":u;:: r es ) Max f{l(o(':l p (::iCl/Ti~]~ ~l ~ Il k ~; I;;:'eP iii ~ 't ~l ii; l'cita :!. Cal:.lac CI 00 () Ii:)0 Ii) liii: a i::: Ii ~;i e,l::) t. :i. c: I:.aril:: (!~) ::] ,q,, () !ql:ij.l.;.. I...(:;i(l taus!, be sul.;!m:L'!:.'l:ed 'L:(::) Ivtu. rt:Lc;i, pa].:Lt.y (:;/~' r~lc;l'i(;:)r.:~E,.q(:e F4 V I:'Jll Z!} lIN ? i:!i :t. 190. NCII I1::: V' DI. IIIS BIEl:::Cil::dii: (:q..I... IIqSF'Ii!:CN']iON!iii,, A I.. I F f (i IA I: t:)N 14:1: ',.I.. Rlii::B!lJ :t: RIE Abl E]...t!!:t::il I::i.' :1: [:iAI... ]: bI!BF;:'I![i:C; 1 I Clb.! ,~ fHi iii I:::'E:RIq :1: I' :1: S F: C)I:;: ::/ :3.!'~Iii:DROOM ::iii :1: NLq..Ji[!: I::'AM I 1.. Y Rliii:S 1 ])Ii!:I',ICE OblL ¥ ,, AND [ii: X F:' I RES ON :[ ;: ,' 3:1 /9ii:) ,, CiI:E:I::,~ I' i F:'Y 11'I~.~ I II ! am l' am :i ]. ]. ,:..l r w J. I: Ii 'L I'1 c! r' i:.!:,(::tu :i. [' i:..:,mi~!nt s t' (:~r' tin-s :L I:.l.~:, !:ile~,,,~i.ii!r' s arid ~:,~(~.): I. cml:h I::)y 'l'h~'e I"lun:i.c:i.l::hE:~].:i.'Ly (:~ Aritho)rage (MOA) .and 'l:.he State c)f 1 ~,~:i. ] I :i.!ls'i:~':'~.l ] '['.l'l,~:)) sys'~:.i:..h"n ir'l ac:c;C)l"clari(:::(~.)) w:~.'l:.l"~ ail. 1 MOA cc)des and pegu:l, at:ic;-r~s, and :Lr"~ (:::cmlp].:~ar'~ce l, gJ.'J:.h '[:J"l~.~~ (::les:i.~in c:r'i'l:.(~.:~,r':i.a cif 't.h:i.s i::)ePm:L'l:.. I ~:i.:l.] a,:::lher(:~, t(] a:l:l. MOA aiqd SLa't'e (::)i Alaska r'(..~)qu:~r'emerit, s icH' I:.he se~L I::)ac:l:: ':[(:..)~)(:.:)i'~i~.l~,~ iiiiv~iiil'..c.,m chi [J"i:l.!~i (;:It" ally a(::l.j~Icl.:..Hqt [)1" l'l(::!~'~:lt'l:)v :L uti d.?r' s'L an d .1:. I'i a'i:. 'f'.h i s p er' m i 't. :L s va ]. i. d f (:~ r' a max :i. mt.[.m (::~ f' 3 I::) ed ;:~].!iiic) L.U']Cii~H'~iii'LaI'IIi:J 'L.J]c;!'~. 'Ll"lt:;.) (:::,':;/j::iac:;i.t¥ (;:il' 'Lhe tcrLa]. ~[!~ys'il.i::mi ;i.~iii :]; any ~:.:u',:,.a,-'.~n',' ~,:i:t.:, ~,.:i. Ta.n ac, d:i. tic~,'~a.:l l::,e,'"m:Lt.. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3- 4- 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DATE PER FO~ME[ Township, Range, Section:,~..~,,,~/ SLOPE WAS GROUND WATER ENCOUNTERED? iF YES, AT WHAT DEPTH? pO E Monitoring? / 7' ¢'-~ Dole: , SITE PLAN I Ill I, Ill I.II Gross Net Depth to Net Time Time Water Drop ~ ~ .~.~ //~ ~ ~ ~o ~ /o~" Z ~" /~ bo /~ ,, ~ ~ PERCOLATION RATE / '~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FTAND ~ FT ACCORDANCE WITHALLSTATEANDMU.ICiPALGUlDELINESINEFFECTONTHISDATE, DATE: ;X;7; 72-008 (Rev. 4/85) // - '/ David R. Dayto~ P~E, HC 78 Box 102~ Chuglak; Alaska ~9567 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 c~.%'-I .- /.~- .~:;z_ ' . HAa # ~ ~ 1. GENERAL INFORMATION Completelegaldescription c~/'h-- /~'-r- ~'~'ff; ~.T-~-~F~, ~lt.~,/ $~ Location (site address or directions) Prope~yowner ~AV~ ~.~ Mailing address Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup· 2. NUMBER OF BEDROOMS: ~-~ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site ~ Holding tank Comm unity on-site .. Public sewer If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. ~ 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 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 ~7> - C~ ,%~o~ / ~?~ '~- Engineer's si~nature~ Phone '~-~- ;~'z I R Date DHHS SIGNATURE 2-~ Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date Department of Health and Human Services (DHHS) issues Health Authority given in paragraph 5 above by an independent 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 sat sty certain federal and state requ rementS Employees of DHHS do not conduct inspectiOns or analyze' data before a certif cate I~ issbed The Mu~icipality of Anchorage s not resPonsible for error~ 0~-'0miSSlo~e in the P~0feSSional engin~r'~ worl<~ Municipality of Anchorage = C E I V E 13 DEPARTMENT OF HEALTH & HUMAN SERqI'G~E~ Environmental Services Division 825L Street, Room 502. Anchorage, Alaska 99501. (9~34394~z~L Municipality of Anchorage Health Authority Approval Check°i~" Health & Human Services Legal Description: L l,~ q : ~ ~.. 'T-I E,,.~ ,, fz { co A. WELL DATA Well type Log present (Y/N) Total depth / c// Sanitary seal (Y/N) Date of test Static water level Well producti0h If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to / q ! FROM WELL LOG WATER SAMPLE RESULTS: Coliform '-- (~ ---. Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~/.~[q ~_~ Tank size Foundation cleanout (Y/N) Date of Pumping /c'/-/,5-~ ~ C, ABSORPTION FIELD DATA Date installed ~ Length ~, (~-E~ Width Effective absorption area Date of adequacy test ~ ~! Fluid depth in absorption field before test (in.); Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m. ~:~ ''~ g.p.m. Nitrate ~ ~ t mc) Other bacteria Collected by: /moo Number of Compartments 7__ Cleanouts(Y/N) ~" ~ Depression (WN) ~ O High water alarm (Y/N). Pumper Soil rating (g.p.d./fF or ft=/bdrm) / '~S System type ,~j' 1 ' *~- ~ Gravel thickness below pipe Z.] Total depth ~{'c'~ ~[ Monitoring Tube present (Y/N) ~ Depression over field (Y/N) ~k~ Results (Pass/Fail) ~ For --"~ bedrooms Immediately after~3,.,~O gal. water added (in.): .,"~ ~( Fluid depth/qq~/ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Absorption rate = Jl~ W~cp ~ If yes, give date '------ D. LIFT STATION Date installed ~/ Size in gallons /~/"~"~/~ " "Pump off" level at* Manhole/Access (Y/N) High water alarm le Y [/~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ! l~,'~p_'~ / ~:~"~ On adjacent lots Absorption field on lot I On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Lift station / c'~o '(- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~'c~'t.~_~ .... Property line '~z~'~3 Absorption field Water main/service line '~<~-~ Surface water/dra nage / C~,'~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~") Building foundation Water main/service line Surface water Driveway, parking/vehicle storage area Curtain drain Wells on adjacent lots / c~ ~ '~- F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that th:~ ~i;,e ~s~e~s are in conformance with MOA HAA guidelines in effect on this da~e . Signature.,.~'~ e,~ (_ Engineer's Name Date '~ --'~ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ii, Steven R. Pannone, P.E. Consulting Engineer (907) 272-8218 P.O. Box 142025 Anchorage, Alaska, 99514 (907)272-8218 Fax February 26, 1997 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Gov't Lot 199, Section 8, Township 15N, Range lW Health Anthority Approval RECEIVED MUnicipality of Dept. Nee *~, ~,. Anchoracte .,, e, ~Uman Services Gentlemen: My firm conducted a Health Authority Approval inspection on the above lot on February 1, 1997. The soil absorption system was tested and found adequate for a three bedroom house. The owners of the lot are currently constructing a domed three bedroom house east of the current trailer location. The owner has connected the new house to the existing system, though the house is not completed as of this date. The new supply line from the new house runs under the new drive way. During your investigation of this request for an HAA you posed the question "is the supply line under the driveway insulated?" I have contacted the contractor that installed the new sewer line. He assured me that it is his standard procedure to insulate lines running under driveways and that this particular line is insulated with two inches of rigid insulation (blue board). I think this answers all the questions you had concerning this property. If you have any further questions about this property, please contact me at 272-8218 o, ,ye:ncere'- ' : P E .:! : Attachments: ~2/13/1997 17:85 907-563-500~ SOFTWARE 02/06/9? 19:46 CT~E ESI ANCHORAGE ~ 909 2?2 0218 NO. 08i ~l~m~ c'r&E Environmental Services Inc. Samplc R~n~u'ks: Client PO# Printed Date/Time 02/06/97 12:09 Collected Date/Time 02/02/97 15:30 Received Date/Ti:ne 02/03/97 08:30 Technical Director: Stephen C, Edt Released By ~ ~- ,~aramoter ,. Nitrate-N TotmL CoLiform O.lOO u I oB ~/o OOLI PQL Units o.qo0 mg/L AILowablo Prop AnolyMa ~ethod Limits Dete Oete Init SMI8 4500-NO]F 10 m~x 02/04/97 EMB $M18 9~22B 0~/0~/97 TAV MUNICIP'ALITY 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 ~"~¢"~ \- ~'~- '~ -"~'~ HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~),,¢~'/~ Mailing Address ,Tff~ z~C ~,~ (c) Lending Institution Telephone: (home) 3.¢,,c''-'¢-r;~(-'' . Business Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here [], if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY individual Well J~ 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/'E~. 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. 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 th is 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. Telephone Engineer's Seal 6. DHHS APPROVAL Approved for ,,~ bedrooms by Approved ~ DisapprOved Terms of Conditional Approval Date ~, Conditional 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 M u nicipality of Anchorage is not responsible for erro rs or omissions in the professional engineer's work. 72-025 (Rev 7/88)Back Page 2 of 2 MUNICIPALITY OF ANCHOP~I~ DEPT. OF HEALTHJ~,_,,_ ENVIRONMENTAL PR~ RECEIVED MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: A. WELL DATA If A, B, C, D.E.C. Approved (Y/N) Date Completed ~.~/?/~'~ Yield //?// 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 Cleanout/Manhole Well Classification Well Log Present (Y/N) Total Depth /~'/ Cased to . Static Water Level ,'~, Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Y' SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ;Date SEPTIC/HOLDING TANK DATA Date Installed ,~,¢ ~ ¢'O Size Standpipes (Y/N) ~/ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) '~ Holding Tank High-Water Alarm (Y/N) /4./¢ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: /¢,oc~ 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 To Disposal Field ~ To Water-Supply Well /~'~ To Property Line '~ To Water Main/Service Line 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 - -~'~t Width of Field ~ ! Square Feet of Absortion Area ,~';~ Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot /~./o,,,-~ 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 4/---43 To Existing or Abandoned System on ; On Adjoining Lots ~::~o ~/'~- '~ 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 inspection. Signed Company Date MOA No. on the date of this Engineer's Seal ReceiptNo. Date of Payment Amount: $ 72-026 (Rev. 7~88) Back Receipt Waiver Fee:. $ Date of Payment Page 2 of 2 PROJECT: LOCATION OF WELL (LEGAL DESCRIPTION): WELL DEPTH: /~/ FT. CASING: DATE DRILLING COMPLETED: ~ !~ STATIC WATER LEVEL (TOP OF CASING)' DATE OF TEST: FT. SCREEN: FT. DATE: CLOCK ELAPSED METER DEPTH TO DRAWDOWN/ PUMPING REMARKS TIME TIME READING WATER, FT. RECOVERY RATE, GPM /~,'~-? '~ O ~5~O ?~:/" (SWL) 0 0 START /o z 5~ / ?~97 UccC5'' 9z: g,, /? 11:~7 lO Z~7~ ~Z'~?" ~c~" /~,z //,'/? 239 da$? ,~/'- ?" 5 ,_ ~ ,, .,~,~ /l~ff? ~ FI87 ~2'- ~" _ ~3" ~,~ ~/ ~. ~ ~Z// FZ"W' ~ ~ ~" ~ ~ Ia ~ z ~ ~o ~/o ~ ~ ~" ~ ~ ~ ', ~ 6 /Z.'~7 I~ ~z~ ffS~' 8~'' 7, / /"~7 /~ ~ ~ ~ Z" /~ ~ i . 7 ~ _ /~-7 lbo ~/1~ FF~" Il'H" _~.1 ,'' CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907)562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BT SAMPLE io~ Work Order # 27352 Date Report Printed: OEP 24 90 @ 12:10 Client Sample ID:L199 SEC 8 TI5N H1W PWSID :UA Collected OEP 18 90 @ 19:00 Received OEP 19 90 @ 11:55 hrs. Presezved with :AS REQUIRED Client Name : DAVID DAYTON. P.E. Client Acct: DAVIDDA P.O,{ NONE RECEIVED O~de~ed By : Analyeie Completed :SEP 19 90 Send Reports to: Laboratozy Suporvisor~..~STEPHEN C.o EDE j I)DAVID DAYTON. P.E. Special HOLD EOH PICK UP. CALL 696-2417 UPON CO~iPLETION. Instruct: Chemlab Ref $: 903742 Lab Smpl ID: 1 Hat,ix: WATER Allowable HITRATE-H ND(O.IO) r~/1 EPA 353.2 10 Sample ROUTINE SABLE. Remarks: 1 Tests Performed See Special Instruction~ Above UA-Unavailable ND- Hone Detected "See Sample Remarks Above NA- Not Analyzed LT-Lees Than, GT-Gzeate~ Than