HomeMy WebLinkAboutFOREST RIDGE BLK 2 LT 4
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
· . ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Dispos.al System and/or Well Inspection Report
Permit Number: -~WcjqOIN7 'PID Number: QI7/Izc/'5''
Name: ~ Wastewater System: ~ New [] Upgrade
Address: ABSORPTION FIELD
Phc=~ ~ No, of B~drooms: ~ Deep Trench D Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION so, Rating: Total Depth fro~ original grade:
Lot: Block: Subdiv~ion: Depth to pipe ~ffom from original grade: Gravel depth beneath pipe
Township: I Range: ~ion: Fill added sbove original grade: ~ Gravel length:
I
WELL: ~ New D Upgrade ~ravel width: /~ Ft. Numbe[ of lines:~ Dis~n~ ~be~n'~lines:
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
' ~ / Casing HeightAboveGround:
SEPARATION DISTANCES ~ septic ~ Holding /
TO Septic Absorptio~ Lift Holding ~ubli~Private M~nufacturer: Capaci~n gallons:
Su~ace ,~ ,~ ' LIFT STA~
Lot Size in gallons: ~ Manufacturer:
"Pump on" level at: "Pump off" level at: ~ High water alarm at:
Remarks: BENCH MARK
Location and D~cription:
Assumed
Elevation:
ENGINEER'S SEAL
Reviewed and approved by: , . _ Date: ~- ~ ~- ~¢
72-013 (Rev, 9/91) MOA 25
Permit No. SW940147
Page 2_ of 2
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 System and/or Well Inspection Report
Legal DescriptioFnO:REST RIDGE SUBDIVISION, BLOCK 2, LOT 4 PID No.: 01711295
CO1 C02
GAL
i A B
FC0 2.5
C0~ 46.0 20.0
C02 53.0 28,5
M.~. 54.5 30.0
MTB 23.5 44.0
MTB 99.5 79.5
MT4 96.5 75.0
30.0' i MT1
GRADE Z"' ~NSUIAT~0N'" ~
94.8'
I02.4z
TOPSOIL ~ SEED
105i8' MT2
;RADE
102.9'- ~
i 4 BDRM ~ LOT 4
iI 1250 GAL
~2 ~ S.T.E.P.
sc~
NEW PRES
DISTRIBUTIO
1" =40'
BED
MUNICIPALITY OF ANCHOP~AGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW940147
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:WARE DANIEL L & KAREN P
OWNER ADDRESS:9806 RELIANCE DRIVE
ANCHORAGE, AK 99507
DATE ISSUED: 5/27/94
EXPIRATION DATE: 5/27/95
PARCEL ID:01711295
LEGAL DESCRIPTION: FOREST RIDGE BLK 2 LT 4
LOT SIZE: 53104 (SQ. FT.)
NLrMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOD-RS)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THIS SYSTEM MUST BE INSTALLED AS SHOWN ON THE REVISED AND
APPROVED DESIGN DATED 4/29/94. THE POINT OF ENTRY INTO THE
BED FROM THE LIFT STATION MUST BE AT THE MIDPOINT OF THE
?
DATE:
DATE:
1LEGAL FOREST RIDGE SUBDIVISION, BLOCK 2, LOT 4
I DRAWN J. ANDE:R$ON ICKD. R.A.S. I DA'E4--9--94 ISHT- 1 OF 2
DESIGN CRITERIA: STRUCTURrS. EASEUENTS. OR ENCROACH,ENTS
SHOWN ON THIS SITE PLAN ARE AS SHOWN ON
4 BDRM. = 600 GPD AN AS-BUILT SURVEY DRAWN BY:
SOILS = 0.5 GPD/SQ. FT. JEFFERY A. GASTALDI
600/0.5 = 1200 SQ. FT. REQ'D IT IS THE RESPONSIBILTIY OF THE CONTRACTOR
TO VERIFY EASEMENTS, REQUIRED SEPARATION
SOUTH DISTANCES. AND PROPERTY LINES PRIOR TO
qDSOR CIR. CONSTRUCTION.
RADIUS
CRITERIA
1.5' DEEP
6" GRAVEL OVER
DISTRIBUTION PIPI
2" INSULATION REO'D
2' MIN. COVER
12' WIDE , c,~'
100' LONO ~'xYLOT'5
TO CUT~ANK
LOT 5
WEt.L
PROPOSED
4 BDRM
HOUSE
LOT 4
PROPOSED
500GA~.
$.?.E.P.
· or ~'~D I
tO' UTIL £SMT
RECEIVED
MAY 2. 1994
Municipality ol Anchorage
Dept. Health & Human Services
CONTRACTOR IS REQUIRED TO
OBTAIN UTILITY LOCATES
PRIOR TO ANY EXCAVATION
\ ~ORK.
LOT 1 4
PLATTED
~ELL
GREENPOINT_ __
AVE_. ~ _ __
CLIENT
ILEGAL
DRAWN
FOREST RIDG]~ SUBDIVISION. RT,OCK P. I,f)T d
L. S. ULSHER IcED. R.A.S. IDATE 4/29/94 I SHT'2 OF' 2
PRESSURIZED DISTRIBUTION
SYSTEM:
PUMP = 20 OSl 05HH - 5 STAGE (~30 GPM)
4 LATERALS ~ 47' LONG EA. = 7.5 GPM/LAT
12 HOLES/LAT (4.25' O.C.) - 48 HOLES TOTAL ~
3/i6" DIA. HOLES FACED DOWNWARD
1 1/4" DIA. LATERALS
.6 GPM/HOLE
1" DIA. SOLID MANIFOLD
~ 0
DETAIL
r ~' TOP$OF.. & SEED
2" INS'OL~TION II / II /
{.5' Dm, m~ovE o~cs)J l~l I .
DIST. P S ~ wrr~IN'
SE~ER ROCK. 6' UNDER
& 2" OVER DIST. PIPES
PROFILE
RECEIVED
MAY 2 1994
Municipality of Anchorage
Dept. Health & Human Sen/iDes
ROBERT SHAFER. P.E.
ROGER SHAFER. P.E.
April l~ 1994
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
SEWER & WATER
ie~SPECTION
SITE PLANS
ROAD DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 'L' Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Forest Ridge Subdivision, Block 2, Lot 4
Request you Issue a permit to drill a well and install a septic system to
serve the proposed four bedroom house on the referenced property.
Test holes were excavated and percolation tests performed. The approximate
location of the test holes are located on the attached site plan. At the time of
excavation water was encountered at 8 feet in test hole one and after seven day
water monitoring water was found at 8 feet in test hole one.
This property has enough area fora future septic upgrade which can be seen on
the attached site plan. We do not anticipate any adverse effects on neighboring
oroperties by the installation of the proposed septic system.
ff you have any questions, or require additional information for your review,
olease contact us.
~s'~c°~~rt A. Shafer, P.E.
/ ~RAS/LSU/Isu
ONSITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP * SUITE 204 · EAGLE RIVER, ALASKA 99577
I LEGA{'FOREST RIDGE
I DRAWNJ. ANDERSON
TRENCH:
5.5' Dr£P
3.5' EFFECTIVE
2" INSULATION REO'D
5' WIDE
81' TOTAL LENGTH
SUBDIVISION, BLOCK 2, LOT 4
I CKD- R.A.S. I DATE4--9--94 I SHT' 1 OF 1
DESIGN CRITERIA:
4 BDRM. = 600 GPD
SOILS = 0.8 GPD/SQ. FT.
600/0.8 = 750 SO. FT. REO'D
SOUTH
)SOR CIR.
RADIUS ~
LOT $
STRUCTURES. EASEMENTS, OR ENCROACHMENTS
SHOWN ON THIS SITE PLAN ARE AS SHOWN ON
AN AS-BUILT SURVEY DRAWN BY:
JEFFREY A. GASTALDi
IT IS THE RESPONSIBILTIY OF THE CONTRACTOR
TO VERIFY EASEMENTS, REQUIRED SEPARATION
DISTANCES, AND PROPERTY LINES PRIOR TO
CONSTRUCTION.
LOT 5
PROPOSED
.OUSE LOT"~t
PRESSURIZED· DIST. SYSTEM:
PUMP = 20 OSI 05HH - 5 STAGE (~30 CPM)
LATERALS ,,, $8.5' LONG EA. = 15 OPM/LAT.
15 HOLES/LAT (2.75' O.C.) - 50 HOLES TOTAL
=~1 GPM/HOLE
DIA. HOLES FACED DOWNWARD
LATERALS
x, % CONTRACTOR IS REOUIRED TO
~ I ~ OBTAIN UTILITY LOCATES
\ PRIOR TO ANY EXCAVATION
x, .WORK.
70 CUT~NK
CO
S.T.E.P.
PRESSURE
SYSTEM TO
FOLLOW
OF LA.ND
10' UTIL ESMT
LOT 14
GREE_NPOINT_
AV.r._
CLIENT
ON-SITE WASTEWA TER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPEClFICATIONS
REFERENCE: Forest Ridge Subdivision, Block 2, Lot 4
GENERAL:
1.
The scope of this project includes the installation of a 1500 gallon septic
tank effluent pumping (S.T.E.P.) system and a pressurized five foot wide
drainfield to serve the proposed four bedroom residence for the referenced
property.
Construction shall be in accordance with the approved site plan and design
drawings; Municipal permit with any special provisions or conditions; and all
applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary
underground utility locates.
Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling. On all leachfield mound systems, the property owner shall be
responsible for ensudng a satisfactory vegetation growth over the mounded
area.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing
their own systems must also receive prior approval from the Municipal
Health Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4' cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
Page Two
Forest Ridge Subdivision, Block 2, Lot 4
April 10, 1994
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building
foundation. In the line between the tank and the leachfie/d there shall be
two adjacent cleanouts (unless an effluent pumping system exists within the
septic tank). These cleanouts shall be located on undisturbed soil not more
than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward
the leachfield. The second cleanout shall be to clean toward the septic
tank.
Final grading over the septic tank shall be such that a positive slope exists
away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The
bottom of the excavation shall be within 2 inches of level. If the sidewalls
of the excavation become smeared, they must be raked or scratched
(ruffed-up) before gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to be installed level with
the perforations faced downward. Gravel is then to be placed over the
distribution pipe to provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the finalgravel layer and the native
soil backfill. Ensure the silt barrier covers the entire gravel surface before
placing backfill.
Monitor tubes shall be of four (4) inch diameter and installed approximately
in the locations shown on the design. The portion of the monitoring tube
extending through the gravel shall be perforated from the bottom of the
trench to the invert of the distribution pipe. This is equivalent to the
effective depth of the gravel as noted on the design.
Backfill over the final gravel layer must not be less than twenty-four (24)
inches. Insulation must be installed when the backfill depth is less than
thirty-six (36) inches. The finish grade over the trench must be mounded
to prevent the formation of a depression after settling.
Page Three
Forest Ridge Subdivision, Block 2, Lot 4
April 10, 1994
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the
inspecting engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must
be installed between the final leachfield gravel layer and the native soil
backfill.
All leachfield gravel (sewer rock) shall be 0.5'-2.5" screened gravel with
less than 3% passing the #200 sieve.
When sand is being used as a filter material, it's gradation specifications
must conform to current M.O.A. or D.E.C. requirements.
Page Four
Forest Ridge Subdivision, Block 2, Lot 4
April 10, 1994
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the
installation of the wastewater disposal system. These inspections will occur as
follows:
The first inspection must be conducted after the excavation of
ditches, pits, trenches, or beds and before the installation of any
gravel. A septic tank may be set in place, but may not be backfilled
before this inspection.
The second inspection must be conducted after the placement of the
silt barder, gravel, distribution lines, standpipes, cleanouts, and
insulation, but before the placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the
installation of multiple trenches, sand filters, pressurized distribution systems, etc.
Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start
of construction. If necessary, a pre-construction meeting will take place on-site.
The inspecting engineer will not coordinate, direct or control in any way the
contractors activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and plans and in accordance with the attached M.O.A. permit.
There will be no contractual arrangement existing between the contractor and
S & S Engineering. S & S Engineering shall be the owner's representative and will
inspect the work as stated above to document the contractors activities. Final
acceptance of the contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or
omissions of the contractor or any other persons performing work on this project
or the failure of the contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer will not be
responsible for the construction means, methods, techniques, sequence,
procedures or the safety precautions incident to this project.
CONTRACTOR/CUSTOMER
PERFORMED FOR:
LEGAL DESCRIPTION: LI~ t_ i~-- ,.
1
2
:3-
7-
10
14
16-
72-008 (Rev. 4/85)
I . ~,(ENGINI~ER.'S SEAL)
825 '~' Street.
~ ~ ~anoe, Section:
WAS GROUND WATER
~,A~'O,~ ENCOUNTER ED?
/v
IF YES, AT WHAT ~ O
DEPTH? p
E
4
DiI~
SLOPE SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
12: ~ ~ ~ ~" --
:~ I0~,~ ~" I"
~ ~6 (o ', ~ ~"
1:o6 (~ ,. ~e" ~y ;
: /~ I~ - ~ ~e" ~y,'
20-
PERCOLATION RATE .
TEST RUN BETWEEN
COMMENTS
S & S ENGINEERING /
17034 E~gle Riv~ Loop Road No. 204 //~
PERFORMED BY: E.~;. R;,~,, A;..;,. ~r;3~*
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI~)~tlq EFF. I
I~::)'~ (m,nutes/,nch) PERC HOLE DIAMETER
/~'~T AND ~"~ FI
CERTIFY THAT THIS TEST WAS PERFORMED IN
T ON THIS DATE. DATE:
(ENGINEER'S SF-.~L)
Municipality o! Anchorage "~'~:"~/ '"~'~'~ °. "2 ·
DEPARTmEnT OF HEALTH & HU~ SERVICES
SOILS LOG -- PERCO~TION TEST
LEGAL OESCR,PTION: L~ ~ ~: ~T ~,D*E Townsh'p, g, Section:
SLOPE SITE PLAN
1
4-
5-
6-
7
9
WAS GROUND WATER
10 ENCOUNTERED?
I~ IF YES, AT WHAT
DEPTH?
12
13. ~i~?
Reading Date Time Time Water Drop
14-
15-
16-
17-
18'
19-
20-
PERCOLATION RATE ('"~'~ Immutes~mch) PERC HOLE DIAMETER
TEST RUN RETWEEN .~.~,~T AND ~ FT
ACCORDANC~LL ~TE AND MUNICIPAL GUIDELI~ECT ON THIS DATE, DATE:
72~ (Rev. 4/~) ~
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
0 I'1 '-113, _6~,.~' HAA# ~-~{~c~l~ ['~L'~ · ,'~
1. GENERAL INFORMATION
Complete legal description
Lot 4: Block 2; Forest Ridge Subdivision
Location (site address or directions)
Property owner
Mailing address
15141S. Windsor Circle
Anchorage, AK
Ron Kincannon Day phone 345-7924
630 Clippership Court Anchorage, AK 99515
Lending agency
Mailing address
Agent
Address '
Premier Mortqaqe
Day phone 563-7736
Day phone
Unless otherwise requested, HAA will be. held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
4 ',4
NOTE:
If community ~el! system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
TYPE OF WASTEWATER 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.
Be
STATEMENT OF INSPECTION BY ENGINEER.
As certified b~' my seal affixed hereto and as of the validation date sho~n below, I'verify that r~y '
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 inspect[on, 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 s & s ENGINEERING
17034 Eagle River Loep Roed No. 204
Engineer's signature. ~p~.~/~,, ~,~
Phone
Date
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Servi'ces (DHH$) 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. Th~ DHH$ does this as a courtesy to purchasers of homes
and their lending Institutions in orderto satisfy certain federal end state requirements. Employees of DHH$ do not
conduct Inspections or analyze data before e certificate Is Issued. The Municipality of Anchorage Is not
responsible for errors or omlsalons In the profeesional engineer's work.
~NICIPAiJTy OF ANCHO~--~
Municipality of Anchorage ~~ ~2 ~
DEPA~ENT OF H~L~ & HUMAN SE~ICES OCT 09 ]99~
En~mnme~l Se~s Dillon
825 L Street, R~m 502. ~chomg., Nas~ 99501. (90~ ~lVE -~ --
Health Authority Approval Checklist
LogalDescripfion:.£o7- # /~c0c~ 3. F~,~$r /f,a¢;~ ParcalI.D.: OI -/ -If ~ - '7 .f-
A. WELL DATA
Well type
Log present~/N)
Total depth
Data completad
Sanitary ssal (~) Y~ ·
If A, B, or C, attach ADEC letter. ADEC water system number
Cassdto ]11 Casing height (above ground) I -./-
Wires property protected (~N) ¥ ~ $
Date of test
FROM WELL LOG
AT INSPECTION
/o/;~
Static water level
Well production
WATER SAMPLE RESULTS:
O
Coliform
Data of sample: I o / ~. /
8.~'~'~OLDING TANK DATA
Nitrate
g.p.m.
0.1
Collected by:
Other becteda O
S & S ENGINEERING
;TG;-; ;..;. R;v,r Loop koaa ~o. zo4
Oatalnstalled ~/q/q?/ Tanksize /~''c~*'Y' Number of Compartmenta
Founclaflon cleanout C~/N) ¥~5' Depmsalon (Y4~j
~. , .' .
Data ~Pumpin. g '1o /~- Pumper /~
C. ABSORPTION FIELD DATA -
Date ir, stalled (; / q /~1~" Soil ratfog ~er ftaAxlrm)
Length. / o o .Wldt~ ' ~ ~
Effecfive al:mo~fion ama / ~' ~ ~
Dateofa~equacytast ~o / ~/'~(,
Grovel thickness below pipe
O. 3- ' Total depth 3. ~"
Monitoring Tube present (Y/N)~ Depression over field (Y/N) ~
Results (Pass/Fall) ~P/4 $ .( For ~//
Fluid depth in absorption field before test (In.); P'<' t( Immediately after ~ q ~/gal. Water add~cl (in.):
Fluid depth O (ina) Minutes later: ~- ~l (3 Absorption rate = (: o ~ -/- g.p.d.
Pemxtdetmatment(past12months)(Y/N) ~,,~/L ~:/-'G~,,../ Ifyes, givedata ~'
.bedrooms
)
72.026 (Rev.
D. LIFT STATION
Date installed ~ / ~ / ~/¥ Size in gallons
Manhole/Access (~N) Yf- J' 'Pump on' level at* (; q"
High water alarm level at* (o 5' *Datum 7o,~ ~;
Cycles tested 3
/3'00
"Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
T~6~'~olding tank on lot ! o o ~ ~
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Eft station
SEPARATION DISTANCES FRO~OLDING TANK ON LOTTO:
Foundation ~ o Property line ~ '~- Absorption field
Water maln/sorvice line 6'"~ '+ ~
,Surface water/drainage ! o o * Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line I o ~ Building foundation ~ o
Sun'ace water ) ~ o ' Y-
CurtaJndraln ~ve~,e ~<,~ ~'
Water maln/ssrvice line
Driveway, parldng/vehicle storage area
Wells on adjacent lots /
R
ENGINEER'S CERTIFICATION
are
Signature ~/~'~5~// '":-/---,YT..~ "
Receipt Number '/~3,~'
724326 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
OCT-(~J-I~O~6
(~'7:44
P.01
KLL
2540 LQI~ CI1~1
LOT 14 JL[ 12
grd Dt.t
Inv. Dr:
CUSTOItER P.O.
· ~IP VIA TERIIS
git NET ~0
KQ'D DATE O~D~R !
00544t
ORO'~ ~[P !10 ITT# Ill
! t O ImEAS1~4
! ! 0 Ira4!
I I O ImOSILIDS
~ ! 0 OStler
I I 0 0S[4004
LIK Till[ SYST~ IS~Q GN. 8J~E
LIFT RISER SADIST, 24'
LI~ RZ~ 4'
LI~ RI~ LTl, E I~A
LIFT P~sUFL~T~I,tl2 ~
LI~T PU~ PLT OSI 400Q
15~025.0Q t3,025,0¢
~ost-lt' b~nd fax transmit~J memo 7671
Thy TQ%eTs
Totd] Duel $$,02~,00",~.
TOTRL P.01
18/18/1996 18:14 907694121!
S A~ S E]qGIN:~_~ING
STAt ,z ALASKA
D~ARTMQ~IT O~"NATURAL RE~OURCE~
DIVISION OF' WATER
~VAT[R ~LL flsr~ORO
LOCATION OF WELL .,.. .. . ..., ·
Mata~t,Type a~ ~fo( ~m To
Os Ow
oe,,m of ho:e: //-~
Depth of caslng:~/~4/ ft
PAGE 02
P.01
7':
I'1 ground eu~faom
R FCE JVEg.l.:li:.!, il
oCT 10 199~.:i~ '"I~I
Municipality el Anch.c~.age-'-~:. j
Dept. Health & Human 8.ervl¢?~.". j
GROUT TYPE: Volume:
Oept~ from' it to _ _it
PUMP~G L~CL ~O YIELD:
PUMP ~AKE DEPTH: It Horaepowen
~D~NF~O UPON COMP~ION? ~ ~ HO
CONTRACTOR INFOR.'~,~TION: .. '. ' ;.. R~,tAF~S: . ·
~gist~t~O ~uslness Na~e '~ ~ .," ' ~ ,
DNR~ISION OF WAIER
~,g~t~e el Aut~Nzed Resprgs~ta~ve DaCe... ~CLE PO BOX 772116
RIV[R AK 99577-2116
· .,. '" ":'-·'CERTIFICATE OF HEALTH AUTHORITY : '
... APPROVAL FOR A $1NGLE FAMILY DWELLING - :~ ::'" :'""'"
Location (site address or directions)
· ,~. ,' Day phone
Property owner
- ~ailing address
..... '" ' ; Day phone
. . .... · .. ... , .- j..~,.,,..........,,. . :.:..~.. :.,:~,:~.~,. · ,.. . · ,., ..-
· NUMBER OF BEDROOMS: 4 · ' '" .....
3. TYPE OF WATER SUPPLY: · "
v en confirmation from State0
: DEPARTMENT OF HEALTH&HUMAN sER~/ICES: ':,' i~J~i~ "~?":'~.
.~,.:. Division of Environmental Services :-;:~..I.l~::li~
:'~."' ":'~'-~!'?;"" . , ~.., ~....:,,~,.;.On-Si~Servlc.es,.sectlo.n.:,,'_:;:~,~.':'3~.~5.~,
- ,~ .' ... ;:,.. :~*;.-.:?;-343-4744,:~:'::.?~'~.~ ~ .~.~:;:~.?:.:. ~.: :,~,,: ...
5. STATEMENT OF INSPECTION BY ENGINEER ' ' "',:': "-"' .* '
· ; [ As certified by my seal affixed hereto and as of the validation date shown below, I verify that mv '
.. Inv~tlgaUon of th~s Health ~uthonty Approval application show~ that the on-~ite water su~o ~":::
:.:~; al;Id/or wastewater di~posal syStem.is safe, functlo, nal and adequate for the number of .bedro?.,m.~ ~i
'i~ and tYpe ~f structure Indicated here,ri. I further ~enfy that I~a~e~ on'tl~ info r~11~1~"~ btm ned f~3~q'~. .' !~::"
· the Munic~pahty of Anchorage files and from my Investigation and Inspection, the on-~tte W~/t~ ~}- '
~ supply and/or wastewater disposal system Is in compliance with all Municipal and State codes, ;'
ordinances, an~ regulations in effect on the date of this insp~ion.' - ' ' '~.
................ · : -?'-~ :~ :?.
.. Name of Firm · : $&s ENGINI~ING Phone G~i'Y- 2~ ~/7' ¢' =.;" :' '.~',..
<..: ,, .,:.. ,,'~]4rr..~ltt.~rt,e~p..~l~ , , ....... ·
'.".;'Address.___ ' Rl~-~'/J~drc¢~,~77 .~',--*, .,. ,,.t ....~ .......: ':
Engineer's signature R :
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L
A, Wall Data
Well type
Log presenl~N) t'('t~"~..~
Total depth / I.~' ·
Sanitary sea,N)~"~, (~
Date of test
Static water level
Well flow
Pump level1
~ ~-- /C'o/~EST" Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~r'/?/~''~ Drillei'/Z~O/~u~' L~_K.L./~.~J~. ~
Cased to '1 ~ I ~' Casing height
~res property protected)
AT INSPECTION / -
SEPARATION DISTANCES FROM WELL TO:
Septic , - nk on
Absorption field on lot
Public sewer main ~'~,.('
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~)/('~ , Nitrate
Date of sample: '7_~/~,./~4- /
O, fO "~/,~, Other bacteria
Collected by: ,~"~ .~'
B. SEPTIC~.,'CLC',:;C TANK DATA
Date installed ~_p[c//,~/_.~ Tank size
Cleanouts~)'-'F~''~' Foundation cleanou~)
High w;ter alarm~N)
SEPARATION DISTANCES FROM SEPTIC/I'I~:O~N~TANK TO: -
Well(~s) on lot ~/(~Y,..~/"/-'" On adjacent lots
To property line ~O (-~ Absorption field
Sudace water/drainage /00 ~
(~/~ c.. Compartments ~.-
.C~ ~'C/ Depression (v~
Alarm teste~N) ~"r~'~'
Pumper
Foundation ~..O t
Water main/service line /(~/'/'-
CONTINUED ON BACK PAGE
C. UFT STATION
Date installed ~'/~' / ~'~"
Size In gallons
Vent ~N) y_~ 'Pump on' level at
High water ala~ level
Meets MOA el~l c~es~)
SEPA~TION DISTANCE FROM LI~ STATION TO:
Well on lot ~ ~ On adjacent Io~
Manufacturer
Uanhole/Access(~)N)
z~.. '~ '~ 'Pump off" Level at
Cycles tested
*~'(:~-~ '~' Sudacewater /o0/'-~'
D. ABSORPTION FIELD DATA
Date installed
Length /~00' '
Total absorption area
Date of adequacy test
Water level i~ absorption field before test
Peroxide treatment (Past 12 months) (Y~
4; / +- so, ,ating (GPD/Ft )
Width /-~/ Grovel thickness
/-~*O0 ~ Cleanout present(~l)
/~//,J~ '/J~J SY'-q~'~ Results (pass/fail)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~/0 0 ~ '
To building foundation /0/"~'
On adjacent lots ~---~C> r~..-
Surface water /~--~ 0 /'.'~'
Curtain drain /JotJ~: ~]~/,.J
System type
Total depth /, ~""
,Depression over field (Y~)
for ,/(~[/~r' ,Bedrooms'
· After test
If yes, give date fO//~J
Onadjacentlots /00 ~ Propertyline //0~'-
TO existing or abandoned system ~3n lot '~'//~
Cutbank~O ~ '- ' - Water mai~se~ line /0 f~
Driveway, pa~n~ehicle storage ama /~ ~
E. ENGINEER'S CERTIFICATION
I cer~fy that I have checked, verified, or confcrrned to alIMOA and HAA guidelines in effect on the date of this inspection.
Signature ' ' '
Engineers Name
HAAFeeS - >DO,/_~ , , WaiverFeeS
Date of Payment ~'-~;~,~-~ - 7.z~- Date of Payment
Receipt Number ,~04/ /"~' ~'~'F Receipt Number.
72-026 (3/93)° Back