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HomeMy WebLinkAboutGOLDEN HILLS BLK 2 LT 2 · , ,~ DE RTMENT OF HEALTH AND HUMAN ~EI{..EB ~'J / ~ J ~ ' · . . 82'5 "L* $,treei, AnchOr~o ,A~& ggt~O~, Tetephor~e 2~1~47,20 ' - oN'SITE SEWAGE DISPOSAL SYB'FEM AND/OR WELL INSPECTION REPORT Department o~ Health & Human Anchorage, Alaska ~501 j:. , : -. '. ',j · Day LANE. , AK ~951~ ,:'..r..'--' ..' .... ._ apartment of Healt · ~:; %'%:.i~h~re '~o al I .n~ ...... ; .... ;, n,l~ ~e, mit..' ,.dlstanc~t..from- a~v ~t~t ~....~,,, . .- . ~ .equ~r~n~ 'fOr ~1~ ~759.71' .? iiEO~Li"~T'P--')BLOCK ~, GI1LD£N HILLS ~[:ONTRACTOR, ~N/~ ,~, . _ I:A~E, RIVER '.ENG[NEERZNO SERVICES ~t~O BX :'773E94' . ' ~i:AGLE RiVEE AK. 99577  MUNICIPALITY OF ANCHORAGE DIEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECII'ION · -:" ' SOILS LO~ - PERCOLATION TEST' " 9PECZFZCATZON9 FOR ON-SZTE GOLDEN HZLLS; LOT 2, BLOCK 2 G~N~RAL All · mmte~ials ~nd Horkmanship shall meet the to the design and-ars to ~':~rtfi~, All exOavations', and depths ,ars a~sory :and'are Ano~rage, Department of Environmental ~nSarv~tJon ,.;~'8.~f]t, -is,. a/waYs reoommende~ that:,a ~rVeyor l~)ite. tO, fOllo~ the' natural land confer to ~th'-~of, *the trench excavation tm not. to.e~oeed" tO ~ oohneoted into.the eAis trench: ConnMotion iS.to i·~&tton of,, soil -.and 'e~tr~Jded board trench'is.to be ~tni~h.'gra,ded to l '~PTH = 6' TRE:NOH LENGTH ='SO' TRENCH WIDTH NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL FROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 QN-SlTE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT IPHONE ;RADE ~AI LING ADDR ES~.~. LEGAL DESCRIPTION LOCATION Well ~-- ~ Manufacturer . ~ [L~q. ,apaclty m gallonsI IF HOMEMADE: I DISTANCE TO: Iweu -/OV I ~ Length of ea [, I'n~ m ngth Width < ~ m Type of crib Crib diameter ~ ' D~ ~ ISTANCE TO: Well ~ mcm~ Depth ~ m DISTANCE TO: ~)uddmg foundatmo~ Insidelength Dwelling ,f- /O Material Width NO, OF BEDR(~MS No, of cornpartrnents Liquid depth Dwelling PERMIT NO. Liquid capacity in gallons PERMIT NO, Material Foundatio,~ ~.,f/' ~,) Near~¢,. l? I~)e Total len(tth pf lines Trench width Materialben~?e ~ . Depth inches Distance between lines Total effec i~ a rption area PERMIT NO. Crib depth -Fetal effective absorption area Building foundation Nearest lot line Driller Distance to lot line TPERMrT NO. I- Sewer mine Septic tank /~o~aarea(s) ± OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER /:~/C ~,,¢¢ 0.5 7" REMARKS APPROVED DA-rE LEGAL -/ucz/E.s PERMIT NO. [:,EPRRTMENT Of::' t. IIEIaLTH FIND Eiq',,,'IRI]I",If'I[~:NTFIL PRO'rEC. T ZOI'.,I :~:25 "1.." s"rREE'r., RNCHORRC:iE., F:II<. 995Ed. E: L... l_ II::::tl i"-~ E> 780487 ::, L. EGRI... L 2 B 2 GOL.[:'EN HIL.L.S SUE: LCrf' SIZE ii: 4 9-.-46; ]i:::t.. 5]M..i.::~S 15C:;!I..If::tf4'.E FI<lET 'I"¢PE ElF' SCiIL FIB:SOREK['I ON S"r%'T'EM IS: 'FRENC:FI MI::I',qIMUM NUMBER OF E:E[:'ROOMS = 4 :SOIL RF]TING (Sg! FT,."E:f;~'.:: ..... :[.25 '['HE REQUIRE:E:, EXIZE OF 'rilE SOIL. FIE:SORF'TION S:;'¢S'f'EM ]:fi;: THE L. ENGTH DIMENSION IE; 'tHE LEi'.,IG]'I-] ,::IN F:'EET) OF THE: TRENC':H OR [:,RflINFIE:L.[:,. THE I)EPTH OF' FI TRENCH OR PIT IS THE DISTI:INCE 8ET!4EEN TH[E :SIJRFFtCE CIF THE CiROLIN[:, FIN[) THE BOTTOM OF THE E',4CFI',/RTION (IN FEET). 'rHERE IE; NO SET .t,~I[)Tl.~ FOF.: TIRENI:i:HES. ]HE GRFIVEL. DEPTH I$ THE MINIMUM DEPTH OF' GRI:::t',ZEL 8ETP.IEEN THE OUTFFILI.. F'ZF'E RN[':, THE BOTTOM OF THE EXE:FIVRTION ,::ZN FEET). PERMIT FIF'PL ICFINT PIFI5 THE: RESPONSIBIL I T'¢ TO INF:ORM TI...IIE; DEF'FIR'T'MI!!!:NT [:,URING THE: I 1'.4STRLLFIT 101.4 I NSPEC:T):. ONS OF FII'.,I'¢ P~IELL.% FI©..IF~CENT TO TH I :.::'; F'ROF'ERT'T' Ri'.,I[::, THE i'.,ILIf"IDER OF RESI[:,ENCES THFrr THE [4EU... !.4IL. L E;ER',,,'E. BF:IE:I<F .t LL. ~ t'46 OF I~IN'¢ ..'5'¢STEM P.I I THOUT F./;. NflL Z NSI::'ECTI ON FIN[) FIPPRCWFtL [~'.~.' TH I :.:5 E, IEF'RF.:TMENT W ILL. BE .'S, UE,'JEC:T TO PROSEC:LIT I CiN. FtINIMI..IM [:,IS'['Rf..II.'.i:E BETWEEN FI !.,.IELL RN[:, Ri'.,I'¢ Ii)N--SITE SEP.IFIGE [:,ISF:'OSFIL S'.r'S;TEM IS 21.~8 FEET FOR R F'RIVRTE !.4EI..L.~ OR :LSE'~ TO 288 FEET FROM FI F'L.IBI...IC WELL [:,EPEI"J[':'ING I...IPC~N THE ]"','F'E OF' PLtE~LIC I.,.IE[.I 1.4ELL. LOGS FIRE F.:EL.]tfllREE:, fiNE:, MUST E:E RETIJRI'.4ED TO THE [:'EPF:IR]"MENT P.IITHII".I ]i:E~ [:ff::l'T'::~; OF THE I,.IELL COMF:'LETZON. OTHER I';.'.E6.~t.IIREMENTS I'iF:l'¢ RPPL'¢. %PECIF:ICFITIONS FIN[)COI'45;]"RUC'TICd',I [:,IFIGF4'.flMS FIRE I:]VFIII...RBLE TO INSURE [::'ROPER INSTFILLF:ITION. I CERTIF'"r' THFtT :l.: I tiM F'FIMIL. IFIR NITH THE REQUIREMENTS FO[;~'. I]hI-SITE 5;EP.IERS; ['"lhlD I.,IELL...S; F:I:.~'.'; fi;ET FORTH 8'¢ THE MUNIC:IPF:tLI'f"¢ OF RNCHORRGE. ;-7:: I I,.IIL. L INSTFILI.. THE $'¢5;TEM IN FICCORDFff41]:I!:: klI'T'f"l THE CO[:,E'i;. ]:: I LIN[)ERSTFIND THRT THE OI'.,I.-.SITE %EN[i']R Sh.'STIEM f'lFl'¢ RE(;!I.IIRE ENLFfRGEMEN]' IfF: THE RI~;{f.:;II}ENCE ~/EMC,[)EI.~_ TO IN~Jl.]:,E MORE TH,N 4 [~,E[:,RC, I:)I"I:i!;. 5 1. L:iI'.4E[..: ' "If4T ~ ........................................................... ,,,...,,_.., .,,, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl. PROTECTION Pouch 6-950, Anchorage, Alaska 99502 276-2221' SOILS LOG - PERCOLATION TEST DATE PERFORMED: ~"'SOI LS LOG [] PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE SITE PLAN 0 EP 14- 15- 16- 17 18 19 2O Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) T,,EST RUN BETWEEN, ~ FT AN~) FT 72-008 (7~76) ::z 7 ~ - 2 o.zS' MUNICIPALITY OF ANCHORAGE DEPT. OF I 7ALTH & ENVIRONMENTAL 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 Parcel I.D. # ~ l .~F~ / ~.'Z. - .~' ~ 1. GENERAL INFORMATION Complete legal description /-m--r- ~. Location (site address or directions) Property owner ,, Mailing address Lending agency Day phone Day phone Mailing address 4 ~' 0 //~ ~-~'o~--d/-- Agent Address 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.. lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer · 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Fi~m ~-r"~_',/e.,~.'-~.,~,o~,oF_..,. ~P. ~. Phone '~-~' ~ Address ~-c~.%:z,c>"¢C /~'?_.c>'-~._.~-/ /q,~¢C~Lo,~/~c~E- ~ ~ ~~ signature~~~,~~ ~ Date ~ - ~ --~ Engineer's DHHS SIGNATURE Approved for '~ Disapproved. ' Conditional approval for bedrooms. ~ ~ ~feven R. Pannone ~' m . - :~ :. bedrooms, with the following' ~tipUlations: Additional Comments Date 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 engineers work. . 72-025 (Rev. 1191) Bsck MOA~ff21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /-~'T-~.~L~¢K~- ¢_~c,c~.¢~/u..& Parcel Ao Well Data Well type'"~ tvA-¢- ~_... If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) "? ~- ..~ Date completed ~-/~ - '7- ~ Driller Total depth / ~--..~ ~ Cased to "¢'o ' '¢' Casing height / :~, Sanitary seal (Y/N) ~¢-.s Wires properly protected (Y/N) ~'~.s FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: '~.-/~--9,s'- /~ ~/~,-~'5~ Collected by: Other bacteria .~, c~,,5 Lo/'& B, SEPTIC/HOLDING TANK DATA Date installed /o -'~ ~'-.F- ~' Tank size / '~-~' ~ Compartments Cleanouts (Y/N) "~ High water alarm (Y/N) Date of pumping Foundation cleanout (Y/N) _ ~ Depression (Y/N) -- Alarm tested (Y/N) _oa ~- Pumper h4co--r# ~A/w'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~/~o To property line ~ ~ Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed h4. / ~ Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~ - z43 - :7-0 Length .5-¥=' Width Total absorption area Date of adequacy test Soil rating (GPD/Ft2) / ~_~-- Gravel thickness Cleanout present (Y/N) Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) After test System type ~:~ T- Total depth Depression over field (Y/N) for ~ Bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ To building foundation /...~' '/.5'-.~4 To existing ~system on lot /_./¢ t On adjacent lots Sudace water ~ / c,c, c Curtain drain Cutbank % .~--c,r Water main/service line Driveway, parking/vehicle storage area ? .~;~'¢ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelir~es in date of this inspect/bn. Sig natu re_.~~'~c::>-~ ------- Engineer's Name ,~-'T-~=_'-¢'~,,.~ ~-'~.~'~/t-,~t,~-¢'-~ ~-, · Date ~. -- ~ l -- ~..-~ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number CT&E Ref. ~ Client Sample ID Matrix CT&E Environmental Services Inc. Laboratory Division ~ 9s.0s96-1 I aboratory Analysis Report L2 BLK2 GOLDEN HILL WATER Client Name p~/gNONE ENG SRV. WORK Order 12642 Ordered By STEVEN pANNORE Printed Date 02/15/95 @ 11:16 hrs. Project Name Collected Date 02/12/95 @ 14:37 hrs. Project~ Received Date 02/13/95 @ 08:25 hrs. PWSID UA Technical Director STEPHEN C. EDE Sample Remarks: ROUTINE SAMPLE COLLECTED BY: S.O. Qc Allowable Ext. ~nal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 2.90 D m~/L EPA 300.0 ION 1.0 02/13/95 MCE * See Special Instructions Above ** See Sample Remarks Above T3 = Undetected, Reported value is the practical qnlantification limit. p = Secondary dilution. UA = Unavailable NA = Not Analyzed LT = Less Than GT = Greater Than 200 W. Potter Drive, Anchorage, AK 99518-1605 --'Fei: (907) 562-2343 Fax: (907) 561-5301 IMJNIClFALITY OP Alet~4Ol~AOIt (MOA) AUTI4OI#TY LL ,'iS;C,;MUNiCiPALiTY OF ANCHORAGE DEPT. OF HEALTH & EN¥1RONM~:NTAL ..... OJ?.,%C9_Lgzg_ ............................. ~--FT~'5~,T~ ................ ' :: JE ,';,bF Z!SPOSAL SYSTEM :__ PUBLIC UTILITY · D' i7: Ti4E ~1',,~, ~¢ .0~ FEE MUST ACCOMPANY EACH REQUEST BEFORE PF, QCE::::,~zvG CANt~' ":.l~'~.,-iI,~'"~l~:D. 19'79 Ton i Drown % ,3'auk Wi~.i-;:~.; Company 3203. C SLreet AY).cborage ~ Alaska 99503 LOt .... ~lou~. 2 Golden UJ..i!s Subdivision Greg Johnson Property ;terJartmep{:~ ..... . can not issuo a health approval,. _ on tho property TOW the rollo,~/ing £(~a,;.,Oll.:~t (t) his sealo office at 264-,4720° Associate Specialist Honda Fed~ral ~h~vin9~ and Loan 535 D Street 99501 Constructin~y Engineers, Inc, Star Route A Bo~z 60 99507