HomeMy WebLinkAboutWILLIAMSON #2 BLK 3 LT 8
ANCHORAGE AREA BOR ,dGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM
SEPTIC TANK:
FROM WELL~ ~3~ _ MANUFACrURER ..... ~RIAL _ COMPARTMENTS
INSIDE
LENGTH
~-- / Foq AL LENG FN
~FOUNDATION NEA'EST LDT LINE OF LINES
DISTANCE EROM WEL. L/F ....
NUMBER CE LINES DISTANCE BETWEEN LINES _ .i'RENCN WID'FH~ IN. TOTAL EFFECTIVE
ABSORPTION AREA ~ SO, . L~ GTI40 EACII LINE _ ~ . __
DEP'I'Id; TOP O~ TILE lO FINIS]I GRADE ~' MAIERIAI_ BENEATH TILE /~ _}~. ABOVE TILE ~_ IN.
WELL:
TYPE '"~ ~ ~'-:~
BUILDING
FOUNOATIC)N
_ CONS'I RUCTION DEPTH
NEAREST NEAREST SEPTIC SEEPAGE
LOF LINE SEWER LINE .... TANK _, SYSTEM
DISTANCE FROM:
CESSPOOL _, OTIIER SOURCES
APPROVED DISAPPROVE[) REMARKS
DISTANCES:
7
PIPE MATERIAL: _ _ .
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
// -- G.A.A.B. ;
Form LQ-C32
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MUNICIPALITY OF ANCHORAGE
DeL, artment of Health and Environmental Protection
SOILS LOG
PERCOLATION TEST
Per fomned for
Legal Description
2
4
6
8
10
12
14
16
18
20
William Salmon Date Perfo~]ed 7/18-19/76
L~t__~8_ Bloc~ 3, Williamson Subdivision, A~dit__ion t~2
(See back for test hole location.)
Organics'
Moist red--brown, silty, sandy gravel (GM)
Perc rate = 225 ft.2/bdrm.
Large cobbles from -10 feet to -15 feet.
Gray, fine, poorly grade sand with trace silt (SP)
Perc rate - 150 ft.2/bd~n.
Total depth = -20 feet
No water table encountered.
AVERAGE PERC RATE FROM SOILS LOG = 203 ft.2/bdrm.
Date
_ 7/1~/76
Percolation Rate
Performed By
Net Time
Depth
1495 min.
168 in.
Net Drop
154 in.
minutes/inch = 170 ft.2/bdrm.
NORTHW~ST E XP~Q~~V_IC]~q ~NC.
Parcel I.D. #
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
o/o-- o'? ¥ -o ¢
GENERAL INFORMATION
Complete legal description ~}/'~
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
_ Day phone ,.,b~¢,.~ ~ .,~-6 ~ g~
Agent
Day phone
Address
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-
lng to the legality and status of system.
TYPE OF WASTEWATFR 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.
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 / ~'/¢'~ ~ ~ c, ¢ ~,_ i~ ~f ?. Lc_
Address r.¢¢,-0 7'~ ~ /_~,/--'¢¢ /=/~ '~
Engineer's signature '"~ ~~:
Phone a~" 7 L~
Date
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date 7 -/7-~'~
The Mudicipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Ce~ificates 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 ecu rtesy 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 SERVI(,ES
.... Environmental Se~ices Division
825 L Street· Room 502e Anchorage, Alaska 99501. (907)
Hea th Authority Approval Checklist
LcgalDcscr,paon: ~'~16~3' ~lllle~ Parcell. D.:
A. WELL DATA
Well type--
IrA. E. or C. attach ,&DEC letter. ADEC water system number
Log preseat (Y/N)
Date completed
Total depth _ Cased to
Casing height (above grouad)
Saaimty seal fY/N)
Wires properly pretected (Y/N)
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
Well production g.p,m, g,p.m.
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample
Collected oy:
[I, SEIEFIC/ItOLD1NG TANK DATP,
Fouedauoa clcanoat fY/N} ~d
Date of Pumping [¢~ ~
C. ABSOR~ION F~LD DATA
Date installed [0/X/~ ~
Length ~ I Width
tt~ i5t3 Namber of Compartments ~ Cleattouts (Y/N3_ ~
Depressioa (Y/N) _f'"4 _ High. water alarm (Y/N) y
Fluid depth in absorption field before test (in.):
Fhdd depth (ins.; Minutes later:
Peroxide treatment q)ast 12 moaths) (Y/N)
Soil mtmg (g.p.d./ft2 or ft2/bdrm) ~-d~
Effective absorptioo area
Date ofadeqaacy test ~'7/q
__ 1%4 . If yes, give date
Sysmm type _ '~/~.~,d
/ , I
Gravel thickness below pipe lo Total depth
Mo.itofi~g Tube preseot(Y~)~_ D~l~mssion owr field (Y~
~sults (Pad.ail) F For ~
hnmediately afler~gal, water added (in.):
Absorption rate =_ ~ ~"~) .g.p.d.
Pumper I ~o~d. e,t,~
D. LIlT STATION
Date installed
Size in gallous
Manhole/Access (Y/N)
"Pump ou" level at*
"Pump off" level at*
ltigh water alarm level Itl*
*Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Scl)tic/holding tank on lot
: On adjacent lots
Absorption field on lot
; On adjaceut lots
Public sewer main
Public sewer manhole/clcauout
Sewer/septic sepAce line
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
_t I
Building foandation l,~ Property lille ~ ] 0 Absorption field 7
Water ntain/ser,/ice line .~fi ~ Surface water/drainage N o ~ Wells on adjacent lets I~l
Building foundation
Surface water
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Water malty'service liae ~> ~
Driveway, parking/vehicle storage area
Wells on adjacent lots ] ,~ I Property line
Ir. ENGINEER'S CERTIFICATION
1 certij, i: that I bave determined thrufield iaspections and review of Mtmicipal records that the above systems are
in cot~brmance with MOA llzM guidelines in effect on this date. .
........................................................................................... .:2= ..........................................
Date of Payment '~/..-~t/~ ~ /
Receipt Number c:~/,¢:~ ( ~),,,~..,~¢ J
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Paytnent
Receipt Number
203 WEST 15TH. AVENUE SUITE 203
ANCHORAGE, ALASKA 99502-3904
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM ADEQUACY TEST
LEGAL:
LOCAl?ION:
OWNER:
Lot 8, Block 3, Williamson S/D
5035 E98.th. Ave
Bruce Jones
I~'JSIDENCE:
WELL:
SEPTIC SYSTEM:
Single Family, 2-Bedrooms
Conununity Well
FROM MUNICIPAL RECORDS:
TANK: Jet Aeration 1250 Gal;.
ABSORPTION SYSTEM: Trench
ABSORPTION AREA: 560 Sq. Ft.
SOIL RATING: 225
INSTALLATION DATE: 10/25/76
WAIVERS GRANTED: None Required
It
DATE OF LAST PUMPING:
3 Bedroom System
Isaacs, June $, 1996 .... ' ' '
DATE OF TEST: June 27, 1996
TEST PROCEDURE: System was inspected and measured. Tank was found with 2.5 feet of
cover and with a liquid level of 55 inches. Trench clean out was not found. Monitor was
blocked by rocks at 5.5 feet. These rocks could not be dislodged. Horizontal pipe could be seen
3 feet below ground surface. No water was observed The property is completely fenced in
and landscaped. Access for a backhoe would mean tearing down both fence and landscaping..
A 8 feet long, 2 inch steel probe was driven into the trench next to the monitor. The steel pipe
penetrated 5 feet or more into the rock. No water was observed in the probe. Approximately
3200 gallons of clean water was added to the trench via the steel pipe over a 7 hour period. No
water showed up.
TEST RESULT: This system meets the code requirements of the Health and Social
Services Department of the Municipality of Anchorage.
NOTE The operational life of all septic systems depends on the local soil conditions,
groundwater levels that may fluctuate during the year, and the water usage of the family being
served by the system. These conditions are outside the control of the evaluator of this septic
system. We can therefore not give any estimate of how long this system will function satisfactory
for current or future occupants. All septic systems ultimately fail. Some systems last 15-20 years,
others fail after less than 5 years.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICFS
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, su,bdivision, section, township, range) (
.t~oc~ ~0n' (address or, dl'recbons
(b.) p y.
,/
',¢~u,~, · Business
Telephone: Home ,~'Y~ - ~/ ·
. MaiJing Address :~0,~5.~, ,~7 .,~,~/¢¢ ///7~
.... ,. - o77-
(c)~, be~ding Institution .'~/~.¢~/~ ~A~ ~ .~. Telephone '
~,,.,,. ,. , ..,'. ;;'~.~ ~_,,
(e) Mail the HAA to the followine address: or: Check here ~, if hold for pick up.
List contact person ~nd day p~one number below. .
TYPE OF RESIDENCE
Sin gle- Family'"~
Number of Bedrooms
WATER SUPPLY
Individual Well [] Community~. Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsitet'~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Departmenl of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 fRev 8/861Fronl
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MUNICIPALITY OF ANCHORAGE (MOA)
HEAt. TH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description: -~p'7~r)~
~ Pres~ Y/N) _
Total De-'PCb... Cased to
Static Water L8~....7.~__
Casing Height Above Gl'auld __ _
Electrical Wiring in Conduit (Y/'N').~
Separation Distances from Well: ~'---~.
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line.
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
If A B, C, D,E.C, Approved~4Y/.Y/~)
Date Completed Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Deeression Around Wellhead [Y/N)
: On Adjoining Lots
~ Adjoining Lots
To Neare~t'~h~.~Sewer
To Nearest Sewer Ser~-~e..Line on Lot
Date __'"'"'-.
B. SEPTIC/HOLDING TANK DATA
Date Installed /,0
Standpipes~.l)
Depression over Tank (Y~.f~I~)
Pumping/Maintenance Contract on File (Y/N)
/
Holding Tank High-Water Alarm (Y/N) ,~..,,7~
Separation Distances from Septic/Holding Tank
To Water-Supply Well
.To Property Line
.;TolWater Mair~Service Line _
~ Course
Size
Air-tight Caps~'~N) Foundation Cleanout
Date Last Pumped _
/-)/~ ;for
Temporary Holding Tank Permit (Y/N)
No. of Compartments ~'"~7"' /¢z;.C-.C-FZc4w'/~_ ~)
To Building Foundation
To Disposal Field
To Stream. Ponc Lake, or Major Drainage
Page 1 of 2 '
72-026(11184)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /O .-Z-~¢- ~'.
Width of Field
Square Feet of Absorption Area
Depression over Field (Y~fl.
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
To Water Main/Service Line /O '/
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field .Z---~¢'
Depth of Field ?:"
/
Gravel Bed Thickness /~
Standpipes Presen (t~)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots 2~,o
To Cutbank (if present)
Comments
Dm LIFT STATION
Dat~ ,/' Dimensions
Size in Gallons ~-~-,.~ Manhole/Access (Y/N)
"Pump On" Level at ~ "Pump Off" Level at
'~ ' Vent (Y/Iq)
High Water Alarm Level at
Tested for Pure--during Adequacy Test.
Electrical Codes (Y/N)
Comments
Meets MOA
** 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 inspection.
Signed ~-~¢,~'././_-~z~ Date
Company /~d.~
Receipt NO.
Date of Payment
Amount: $
Page 2 of 2
/¢-,¢¢,:,,,///¢,/r¢ -
72-026 (11/84)
':~ 111 ,. lb. ,,;x,
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
STEVE COWPER/ GOVERNOR
274-2533
DATE: June 19, 1987
PWS I.D.# 210639
To Whom it May Concern:
According to records on file in this office the
DIVISION
Water Regulations
WILL IAMSON SUB-
Water System is in compliance with the State Drinking
for bacteriological sampling. '~
Sincerely,
Michael P. Lewis
Environmental Engineer
*NOTE:
However, our records indicate the last primary inorganic
sampling was taken March 6, 1981. State Drinking Water
Regulations require that primary inorganics be sampled
every three (3) years for groundwater sources, and every
year for surface water sources.
As this system is from a groundwater source, it is presently
not in compliance with 18 AAC 80.060(g), and will require
require a current primary inorganic sample be taken and
results submitted to this Department immediately.