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Home My WebLink AboutWALTER G PIPPEL #2 BLK 12 LT 4 HORSESHOE HEIGHTS Municipality of Anchorage Page / of__ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box '196650 · ^nchorago, Alaska 99519-6650 ·Telephono: 343-4744 On-Site Wastewater Disposal System 'and/or Well Inspection Report Permit Number: · ~J ~ ~ PID Number: ~ ~ Name: ~ci~ ~C~ ' Wastewater System: ~5~Upgrade Address:/~/~ ~ ~/~ ~~ ABSORPTION FIELD ~, Phone: ~7~'-~S7~ ~N6. of BJooms:. ~DeepTre~ch ~ShallowTre~ch ~Bed ~Mound~Other Tolal Depth from original grade: LEGAL DESCRIPTION S°ilRating: ~ ~ GPD/Sq. Ft. Lot: Block: Subd[v~on: Depth to0~' bottom from original grads: Gravel depth beneath pipe Township: 'r/~ Ranoe:~ ~ ~ ~ Secti~ Pill added above original grade: Gravel length: Ft. /~ Ft. ~/~/~ ~ Gravel width: Number of lines: ~ Distance b~een WELL: ~ New ~ Upgrade /~ ~t. ' ....~ Ft. Classification (Private, A,B,G}: Total Depth: Cased TO: Total absorption Pipe material; ~/U~ /O~ Ft. ~ Ft. a~ SO. Ft. ~ Driller: Date Drill~: StaticWaterLevel: Installec Date installed: Yield: ~ ~ ~ GPM Pump Set at: Casing Height Abo~e Ground: q/=. ~t. ~, ~. TANK SEPARATION DISTANCES ~soptlc ~ Holding a S.T.E.P. To Septic Absorption Li~ Ho]di~g )ublic~r[vat~ Manufactur~ Cap~ci~ ~n gallons: From Tank Field Station Tank Sewer ~nes ~4~ ~ Material: Number of Compadments: Lot Sizein gallons: Manufacture~ Line ~ ~ ~ ~ ~ Foundation /~ ~+ ~ ~ ~O~ "Pump °n" level at: l "Pump °f" level at: t High water a~rm at: Cu~ainDrain ~ ~ ~ ~ ~ Pump Make&Model ~Erectrical,nspectionspedormedby: Remarks: ~/~ O ~Y~ BENCH MARK ~/~,~ ~.~,~ ~ Loca~on and Description: J Assumed E~evation: / ~ ~ Ft, ENGINEER'S SEAL Department of Heal and Huma ervlces app ovab L~:%: ,;~c,. ,;~t~;.,~., Reviewed and approved by:. , Date: "~ ......... ,x, /z*****, ?:,$'¢~> ....: ~' 72-O13 (Rev. 9/91) MOA 25 Permit No. Page ~ ' of · Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES, ENVIRONMENTAL SERVICES DIVISION ,,, P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal Syst~em and/or Well Inspection Report Legal Description: ~ 4~- ~/2~44~. ]~-- ~o.A~_r~,=~r_ pz/~,~'z~_ ~'2~PID No ' ' ENGINEER'S SEAL 72-013 A (2/91) MOA 25 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, ,~nchorage, Alaska 99502-0650 SOILS LOG M PERCOLATION TEST PERFORMED FOR: ~)tc H~ ~_~¢.-~) _~ LEGAL DESCRIPTION: /-O'T" ~ ~c. l~_. 2 3 4 5 6 7 8 g 10 11 12 13 14 15 19- 20- COMMENTS WAS GROUND WATER ~,/.~ ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Alter/, D'ATE PERFOR[v Town, ship, Range, S~ction: SLOPE ~ITE PLAN Reading Date Time Time Wa ter.[~.~qo[ ~op I ~:zG -~. !~,w G~~ ~" ~,~ PERCOLATION RATE ~, / (minutes)inch) PERC HOLE DIAMETER TEST RUN BETWEEN · ~ ET AND ~' FT David R. Dayton P-E. ~[-~/~ ~"~ ..~. PERFORMED BY: __ UglaK, ~lasKa v,Do,Chug,ak; Alaska 99567 Z ,-- ~'~~ CERTIFY THAT THIS~E~T WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES tN EFFECT ON THiS D~TE. DATE: 72-008 (Rev. 4/~) DOC Co. dba SULLIYAN W/ TER WELLS P, O. BOX 272, CHUGIAK~ ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS '~'/~' LEGAL DESCRI~ION ~E~ff NUMBER t' DEPTH OF WELL [ oO STATIC LEVEL OF WATER FT. f~<~'DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From D Ft. to ~''' Ft. From ~ Ft. to 17 irt. · From__ Ft. to;.?' - ~t. ~" 'From Ft. to; - .Ft.k 2- From Ft. to ~ From .Ft. to ' .. Ft '~;,From____Ft. to'' Ft.~' ~"? From ' ' Ft. to"': '.Ft. ,~}, F$om Ft. to ;,' Ft.__ :'" From ' Ft. to' Ft. From From ' From __ -~'~'~ ~ l~rom From From - From ;om From From From Ft. to_--Ft, From From From.__ From Ft. to Ft, to Ft. to Ft. to .Ft. to Ft. to Ft. to Ft. to Ft, to' Ft. to Ft. t0 ,Ft. to Ft. to_ Ft. to Ft. to Ft. to Ft. to Ft. Ft, Ft Ft. Ft._ Ft. FtJ Ft. Ft. · _Ft Ft. ,Ft. Ft. Ft. Ft. ' M~CL ~NFORMATION: ½ / ' DRILLER'S NAME Parcel I.D. # 1. 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 GENERAL INFORMATION Corn plete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Location (site address or directions) /~/~ ~ ~ Property owner Mailing address Lending agency Mailing address Agent Day phone Day phone Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Pub lic water NOTE: If community well system, provide written confirmation from State ADEC attest- ''" lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site ,:..- .,, Community on-site '"";~"' ": ~-::; Public sewer '~: : ...... ~":'-' :- ~NOTE: :'If community wastewater system, provide Written confirmation from State ADEC attesting to the legahty~nd status of System./;:" ~' ~'' ' '~ .. ~,,;-~ , :., ~i,- ~. ~;;-,, : 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. ~ '. t. Davld R, Dayton P,E, ' :' Name of Firm Address Engineer's signature Chuglak, Alaska 99567_ Date 6, DHHS SIGNATURE ~ ~'"'~ Approved for ::: '_'-~ bedrOorriS. '. ~ Disapproved. Conditional approval for bedrooms, with the following Stipulations: By: Additional Comments The Municipality of Anchorage Department ~)f 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 orderto 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 i~n th~.p,ro,f, essi~na! engineer's ~w(~k~, ,: .... ~ ,.~.. ,,.~,. ,,~. ~; ~., Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /~,/ ~- ~/~/-'Z~ Parcel I.D. A, Well Data Well type t'~/~/c')/{~--- if A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) y Date completed ~/~'"'/~¥) Driller ~'~,,~-","-~/ Total depth /o~:~ ~ Cased to ,~'~-.~-~ / Casing height Z. / Sanitary seal (Y/N) ? Wires properly protected (Y/N) ~' FROM WELL LOG AT INSPECTION Date of test /~//~,~/~ Y/-~'~/,~ Static water level ~--0 1 ..~ r1"1 Well flow Pump level1 ~//~-- ~/~, SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots /o~;~ ; On adjacent lots /~,L~ ~- Public sewer manhole/cleanout /(-2/'/2- g.p.m.r'tl '-' ,- Petroleum tank WATER SAMPLE RESULTS: .~o Coliform ~ Nitrate Dafeofsamp,e: B. SEPTIC/HOLDING TANK DATA Other bacteria Collected by: --~, Date installed /~/'?,¢' Tank size I ~,>~-' Compartments Cleanouts (Y/N) "~ Foundation cleanout (Y/N) /d Depression (Y/N) High water alarm (Y/N) ~,/Ih Alarm tested (Y/N) '~/-'~ Date of pumping ;~/3//'~/~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Sudace water/drainage On adjacent lots / o ,~ -.~ .... Foundation /' -~' Absorption field [' ~;"? Water main/service line / aC 4-- 72-026(3~93)' Front CONTINUED ON BACK PAGE 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) Manufacturer Manhole/Access (WN) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LiFT STATION TO: Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed Soil rating (GPD/Ft2) ~ ~- System type Length /~ Total absorption area Date of adequacy test Water level in abSorption field before test Peroxide treatment (past 12 months) (Y/N) Width /;~ Gravel thickness ~ Total depth Cleanout present (Y/N) ~ Depression over field (Y/N) ~/~'~//~ ~ Resu,s (pas~fail) ~ fo~ ~ Bedr~ms ~' After test ~7~/'~-/~~ ~ ff yes, g~e date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / To building foundation On adjacent lots Surface water/~/o,,,~ Curtain drain On adjacent lots 1 ~>¢-~ ~,'~ Property line 7_ ~ To existing or abandoned system on lot Cutbank '~/-~-~ ~ Water main/service line Driveway, parking/vehicle storage area ENGINEER'S CERTIFICATION I cern'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the dale of this inspect'on. 20210 Doaatar St. ..: Engineers Name .,. Waiver Fee $ Date of Payment Receipt Number D. R. DAYTON, P.E., R.L.S. 20210 Donalar Chugiak, Alaska 99567 (@07) 6@6-2417 September 15, 1994 Municipality of Anchorage Dept of Health & Human Services P.O. Box 196650 Anchorage Alaska 99519-6650 Re: Lot 4, Blk 12, Walter G. Pippell Subd. #2 The Attached HAA aplication is for documentation of an existing system. The system was built in 1978 and consists of a 1000 gallon tank and seepage pit. An adequacy test shows the system to be adequate for a 3 BR home. Al~ test hole revealed no water within 6 feet of the bottom of the pit. The perc test shows the soils to be adequate and the system large enough for the required 3 BR' s. The well flow test shows the well to be producing at 0.5 gpm and the house is equipped with 600 gallons of storage. Water tests showed 0 coliform, 0.10 nitrate. Other bacteria were present and a retest is at the lab. (results will be submitted as soon as available) Please review the application and issue a HAA Apprival as soon as possible.