HomeMy WebLinkAboutWOODBOURNE BLK 1 LT 10 MUNICIPALITY OF ANCNORAGE
DEPARTMENT OF HEAl. TH & ENVIRONMENTAl. PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SII'E SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
MAILING ADDRESS
PHO~ NEW--
LEGAL DESCRIPTION
LOCATION
~ N ~Liq. capacity in gallons I
Absorption area
Manufacturer f Material
----- Well . ~ Foundation ~ ~'ot line
NO. OF BEDROOMS ~.~
PERMIT NO.
No, of compartments
Liquid depth
PERMIT NO.
Liquid cap~city in gellons
PERMIT NO.
Distance between lines
Total effective absorption area
PERMIT NO.
Total effective absorption area
Length ~/t $ ~m Depth
C~_~ Depth Driller Distance to lot Hne
PERMIT NO.
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTAL[ ER
x,,4.
REMARKS
LEGAL
72-013 (Rev. 3/7S)
Date D~tlle~
Static Water Level.
feet
Gallons Per Minute
d' ~ou~e Subd~
D~w Down N~A . feet
Total Feet of Caei~ 63
Material Drilled~
0 feet
to _~ Mixed clay w/urave!
. to _~urface water
to ~
, to ~
to
Hefty Drilling
S.R.A. Box 1553 H
Anchorage,Alaska
99507
D~te Drilled~
c~. 1 'J .-,q4
~ELL LOG
Static Water Level
feet
Gallons Per Minute
Dr~w Down '~' '
. _ feet
Total Feet of Uasing ~
Type Material Drille~l
0 feet
to m
to
_ to
Hefty Drilling
S.R.A. Box 1553 H
Anchorage,Alaska
99507
DEF'ARTHENT Gl:: HI.EALTH AND ENVIROI'4MIENTAI... PF~OTECTION
825 L STREEET, ANCI-IORAGE, AK 99501
264'"'4720
F~ERH I'1'' ND:
DATE ISSUED:
8 .I.c.)6.~ .... IENG I NEERED DESIGN
07/26/84
APPL I CANT:
ADDRE.,~,~ ,,
CGNTACT F:'HONE-"
HARE; HOLCDHB
2:!;4 E,, 15TH ,'J:4.0 1
ANCHOF~AGE, AK 9950:[
274-2662
I,.,.EJ:~L. DE,,.)CF~.I.I.
I...DT !sIZE:
SUBDIVISION:: NODI)BURNIE LOT:
SECTION: 24 TOWNSHIP: 12N RANGE:
:5.4:..'~A (.,C.. FT,, OR ~CRES)
E I...(3 (..,I .... .1.
]: cer"Li.1'y that,:
1., I am familiar
with the f'equiP6H¥1ent~,:.; f'ClP (][t--Eii't,~ !~WWlg~f'<~i and we]:Is at~
foPtl"~ by {he Municipality oF Anchorage (HOA) and the Stat~:~ of Alaska.
I wi].l ins'L~].l the system in accopdanc:e wi'Ua all MOA (:odes and r'egulations~
arid in coropliance wi'Eh ithe desigri criteria of this per're:Et.
I ~:i. 1]. adher'e to all MOA and State of Alaska P6H~IJiI"(,::!m[~FWES t'Of' the.
distar]ces From ~]Fly e]>{J, StiFIg ~B],l[~ Naste~a'Ler' d&!sposa], system of pulm],ic
I F:' A
THEN
WILl ....
IEI_ECTF~ICAI.. WI]RI< HUST BE DGNE BY A I..~ICENSED ELECTIRIEI:AN.
.~ 1. bi lED DATE
~1 FL. IL,~I I] ·
( ,:~c)LIED BY I)ATIE:
I..I1=¥ STA'TION IS IIqSTAL. LED IIq AN AREA COVERED E'~Y HOA BUILDIIIG CODES,
(1) AN EI..ES'I"RICAI_ PERMI'I' AND IIxlSPECTIGN MUST BE OBTAINED; (2) AS,'-.BtJII...'I'S
NG'T BE AF'F:'IROVE~D WITHOLJT AN EL. ECTRICAL INSF:'ECTION I~EI'OhT, AND (...:,) THE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMEN-rAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
DATE PERFORMED:
SOILS LOG
PERCOLATION
TEST
Ib.O
SLOPE
SITE PLAN
<_ Io°
10
11
12
13
14
15
16
17
18
19-
20-
COMMENTS
PERFORMED BY': ~')~-C '~'
DEPTH? ~ II II _Ill '1 I'll ,]l
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION R
(minutes/tn~)
TEST RUN BETWEEN . (~ FT AND ~:-- FT
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMEN'FAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
//~ SOIUS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
3
4
5
6
7
8
9
10
11
12
13
14
15
16-
17
18
19-
20-
DATE PERFORMED:
i~.r2-
SLOPE
SITE PLAN
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND -- FT
PERFORMED BY: 79~ ~0~ ~[~r O~ y CERTIFIED BY: / '~ DATE:~/~
72-008 (6/79)
ALASKA B iUIROFImE FITAL COFITROL SehdlCeS, IrlC.
~nqineeeinq $ ~noiPonmenlcd $1udie$
SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM
WOODBURNE SUBDIVISION LOT /O BLOCK
1.0 GENERAL
1.1 THE DRAWINGS, SHEETS 1 THRU 4, SHALL BE PART OF THIS
SPECIFICATION.
1.2 ALL MATERIALS AND WOR16MANSHIP SHALL MEET THE
REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND
ENVIRONMENTAL PROTECTION PERMIT.
1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY A/qD ARE TO BE
VERIFIED IN THE FIELD BY THE CONTRACTOR.
2.0 THE LIFT STATION (NOT USED)
3.0 SEEPAGE BED
3.1 THE GRAVEL FOR THE BED SHALL BE SCREENED TO THE SIZES
INDICATED; 0.5 TO 2.5 INCHES.
3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE
BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN
COMPACTED DURING EXCAVATION.
3.3 TWO OBSERVATION PIPES SHALL BE PLACED AS SHOWN IN THE
DRAWINGS. THEY SHALL BE RIGID PVC, ASTM 3003 D-3034.
THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLlgD 0.5"
HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE
OR A SECTION OF REGULAR PERFORATED SEWER PIPE MAY BE
CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR
SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL)
SHALL BE PLACED ON THE TOP OF THE PIPE.
3.4 INSULATION,IF ANY/SHALL BE DOW EXTRUDED BLUE STYROFOAM
BOARD OR EQUIVALENT.
3.5 THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A
WHITE CLOVER AND RED FESCUE MIX OR BLUE GRASS.
3.6 THE SEPTIC TANK OF BED MUST NOT BE CLOSER THAN 100 FT.
TO ANY EXISTING PRIVATE WELL OR BODY OF WATER AND SHALL
BE NOT CLOSER THAN 150 FEET FROM EXISTING CLASS C WELLS
OR 200 FT FROM ANY CLASS A OR B WELL.
3.7 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR
POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL.
3.9 THE SAND SHALL HAVE AN EFFECTIVE SIZE OF 0.4 TO 0.6
MM AND A UNIFORMITY COEFFICIENT OR NOT MORE THAN 4.
3.10 THE BERM AROUND THE SEEPAGE BED SHALl, BE CONSTRUCTED OF
IMPERMEABLE MATERIAL, AND ON A SLOPE OF 3. FOOT VERTICAL
TO 3.0 FEET HORIZONAL.
~200 [Uesl 33rd Auenue. Suile [~,r~nchoenqe, Alnskn 99503,[907) 561-50z~0
ALASKA ENVIRONMENTAL
CONTROL SERVICr INC.
1200 West 33rd Avenu~ Suite B
ANCHORAGE, ALASKA 99503
Phone 276-1561
CHECKED BY DATE
ALASKA ENVIRONMENTAL
CONTROL SERVICr INC.
1200 West 33rd Avenu~ Suite B
ANCHORAGE, ALASKA 99503
Phone 276.1361
SHEET NO. OF
CHECKED BY DATE
ALASKA ENVIRONMENTAL
CONTROL SERVICf INC.
1200 West 33rd Avenue Suite B
ANCHORAGE, ALASKA 99503
Phone 276-1361
ALASKA ENVIRONMENTAL
CONTROL SERVICr INC.
1200 West 33rd Avenue Suite B
ANCHORAGE, ALASKA 99503
Phone 276-1367.
.'
SHEET NO OF
SC^LE
MUNICIPALITY 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
61,~- ~.~'1 I Lo HAA# '~"'~"¢' ~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location
(b) Property ~"~,~_t"~' :"~'~ ~Telephone: (home)
Mailing Add~0~.;
(c) Lending Institution- ,,., ,~ Telephone
Business
Mailing Address
(d) Real Estate Company and Agent
Address ~,~/
Telephone
(e) Mail the HAA to the following address: (or check here'(2![, if hold for pick up.)
List contact person and day phone number below:
2, TYPE OF RESIDENCE
Single-Family~f, Number of bedrooms
3, WATER SUPPLY
Individual Well 1~
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';l~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 [Rev 7/88) Page 1 of 2
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 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 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 /Z~E'-~ ~ Telephone 2-7 ¢-5"5"~
Address /¢/~' '~J ..z.~'~ /¢.Jc,,,¢ ~ ¢'75"o)
Date
6. DHHS APPROVAL
Approved for --~ bedrooms by
Approved ~ Disapproved
Terms of Conditional Approval
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 $ 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.
~ MUNICIPALI'FY OF ANCHORAGE (MOA)
MUNICIPALI~Y ~,~_I,t~RAGE Health Aulhority Approval (HAA)
ENViRONMENT^L'(~_~/DIV~S~ON CHECKLIST- FEBRUARY 1984
APR 2 8 1989
RECEIVED
A. WELL DATA
Well Classification
343-4744
Legal Description: /--/~ ~'/
Well Log Present ~N) Date Completed ?-//~'/
Total Depth ¢'~ / Cased to ~'~ '/ Depth of Grouting ~/,~
Static Water Level ~ - /,~7~/~¢' Pump Set At
If A. B. C, D.E.C. Approved (Y/N)
Yield '~/, ¢ '~'):'/¥
Casing Height Above Ground
Electrical Wiring in ConduitCN)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ,~/,4-
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments ,~'£Z¢- ,~'~ '7~'~"
Sanitary Seal on Casing(~N)
Depression Around Wellhead (Y(~
; On Adjoining Lots
//~ ¢' ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole /J/~
/_.j/,~r,~/ ;Date
B. SI-'PTIC/HOLDING TANK DATA
Date Installed //-("-~'¢_Size
Standpipes ~)'N)
Depression over Tank (Y~
/~'~ No. of Compartments
Air-tight Caps~N) Foundation Cleanout(~N)
Date Last Pumped
,/~
Pumping/Maintenance Contact on File (Y/N) /J//+ ;for ~?//"
Holding Tank High~.,a~er Al~a.~h%(.Y/N) /~ Temporary Holding Tank Permit (Y/N)
SEPARATION DIS~AN~ES:FROM¢SEPTIC/HOLDING TANK
To Water-SuBpl~¢~ll ,'~, ,.,,,,~ ~¢' ' TO Building Foundation _
To Property~n'6~**~*'"~"~"~*~"/~O'' ~" ' To Disposal Field / ~
To Water Ma~'~¢~'~ ~, ;; '¢¢ .:;¢
To Stream, '
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed //- ~'
Width of Field / ~
Square Feet of Absortion Area
Depression over Field (YO
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
To Water Main/Service Line /~' ¢'
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field /
Grav~el Bed Thickness
Statndpipes Present(~N)
Date of Last Adequacy Test
To Property Line lO C-
To Existing or Abandoned System on
; On Adjoining Lots
To Cutback (if present)
Comments.
D. LIFT STATION
d
"Pump On" Leve~%
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 guidelines in effect on the date of this
Signed
Company
Date
MOA No.
Date of Payment
Amount: $
72-026 (Rev 7188) Back
Receipt No.
Waiver Fee: $
Date of Payment.
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~°'
,~~ FEDERAL TAX iD # 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Orde~ # 12872
Date Repo~t Printed: APR 25 89 0 12:39
Client Sample ID:LiO. Bi, WOODBOUDNE
?WSID :UA
Collected APR 21 89 0 14:30 hrs.
Received APR 21 89 ~ 16:00 hrs.
Preserved with :AS REQUIRE])
Client }tame : A E C S
Client Acct: AKECNMP
P.O.~ NONE REC'D
Req ~
O~de~ed By : A. WIEN
Analysis Completed :APR 24 89 Send Reports to:
Laboratory Supor¥i~or /3T~N Ch EDE i)A E C S
Released By : ~~'. ~ 2)
Special
Instruct:
Chemlab Ref ~: 4985 Lab Smpl ID: 3 Matrix: WATER
Allowable
Paramete~ Tested Result/Units Method Limits
NITRATE-N 0.86 m~/1 EPA 353.2 Ia
Sample SAMPLE COLLECTED BY A.W.
Remarks:
Tests Performed ' See Special Instructions Above UA=UnavailaDle
None Detected '* See Sample Remarks Above
Not Analyzed LT.=Less Than, GT=Greatez Than