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HomeMy WebLinkAboutDEER HORN BLK 2 LT 1 -' ~'* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE /.*~ NEW MAILING ADDRESS 8 & ~ E~GINEERIN(t ' LOCATION NO. OF ~ ~ DISTANCE TO: ]~ ~ ~ Menuf~turer C~ ~ -- M~ / No. of comp~ment~ ~ ~ ~ DISTANCE TO: Wet, pwe~ PERMIT NO. O ~ Manufacturer ~/~ Material Liquid ca.city in ~ Well Foundation Nearer lot Imp PERMIT No. of lin~ Length of e~lin ~otal length of lines Trench width Distance ~t~en lines ~ inches ~ ~ ~ Top of tile to finish grade Material ~neath tile Torsi eff~tive absorption area Q inches ~.~ Type of ~,b :rib diameter Crib depth :--_ Total ,"~ti~r.~/J " DISTANCE TO: '~ Nearest lot Fine ~ Oriller istance lo lot line PERMIT NO. ~ DISTANCE TO: Building foundatio~ Se~r line Septic tank Absorption area(s) OTHER " r. REM~KS I., ,-~ .: . ~,.~_ H~II,_.! ,,1~ 72~t3 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L ,STREET, ANCHORAGE, AK 99501 264-4720 ON--SITE SEWER PERMIT PERMIT NO: DATE ISSUED: 840950 11/01/84 APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS: C/O S & S ENG'G LIFESTYLE INDUSTRIES SRB 196X EAGLE RIVER~ AK 99577 694-2979 SUBDIVISION: DEERHORN LOT: 1 SECTION: 4 TOWNSHIP: 15N RANGE: 1W 28142 (GQ.FT. OR ACRES) 4 BLOCK: 2 Listed below are toe options available to you in designing your septic system. Choosethe option that best fits your site. BED DEPTH TO PIPE BOTTOM (ft.) 2.5'** GRAVEL DEPTH (FT.) 0.5 TOTAL DEPTH (FT.) 5.0 GRAVEL WIDTH (fT.) 18.0 GRAVEL LENGTH (FT.) 29;0 · GRAVEL VOLUME (CU.YDS.) 19.4 TANK SIZE (GALS) 1,250.0 ** SOIL RATING (SQ.FT./BR) 85 ** DEPTH TO PIPE BOTTOM < 5.5 FT. REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION ** TANK MUST HAV~ AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar 2. with the requirements for on-site sewers and wells as set ~orth by the Municipality o~ Anchorage (MOA) and the State of Alaska. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria o~ this permit. I will adhere to all MOA and State of Alaska' requirements ~or the set back distance~ from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. I understand that thi~ permit is valid for a maximum o~ 4 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS EWLIEL~T~iO~ALBE APPRDV~IIT~twORK~M~ST/BE D~NU~ BAyN '~LLEICcTERNIsCEADL EILN~TERCITcI~ANN.REPORT; AND (5) THE' SIGNED ~ DATE: -/L_~_~_I~__ _~_- APPLICANTC~C~ S & S ENG'O LIFESTYLE INDUSTRIES ' ................ . iSSUED BY DATE. ~,~' ~ ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street. Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST ~ SOILS LOG r-I PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 SLOPE DATE PERFORMED: /~0 ~' "ZI-~' ~ SITE PLAN \ 10 13- 14- 15- 16- 17- 18- 19- 2O COMMENTS PERFORMED. ;. Pti. 72-008 (6r/9) WASGROUNDW^TER .,~..../0 ~ ENCOUNTERED? ~ E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop / ! PERCOLATION RATE ~"~' /t~' {minutes/inch) TEST RUN BETWEEN FT AND FT 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 ~5' / d~ D.---~- NAA# /*''~''~ ~°~'~ ~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1, Block 2 Deer Born Subdivision Location (address or directions) NIIN D~er Park Drive (b) Property owner Mailing Address Telephone: (home) Business (c) Lending Institution Mailing Address Telephone (d) RealEstate Company and Agent Associated Brokers. Inc, (Sandra tlfelmstad) Address 640 W. 36th~ Suite #l Anchorage! Alaska 99503 -- Telephone 563-3333 : (e) Mail the HAA to the following address: (or check here l-I, if hold for pick up.) List contact person and day phone number below: .. ERDHAN & ASSOCIATES Consulting Engineers 151 East Ilernin§ Avenue ~asilla, Alaska 99687 Contact: Hike Erdman 376-6989 2. TYPE OF RESIDENCE Number of bedrooms Single-Family rx 3. WATER SUPPLY Individual Well n 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 · Public [] Community r-1 Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I 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 ERDH/d~ & ASSOC'[ATES Telephone 376-6989 .' * Address 151 East llern{n~[ Avenue Wasilla~ Alaska 99687 Date August 10, 1989 6. DHHS APPROVAL Approved for ~7' . bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional 'fiT',Iii'Ii The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 engineer's work. Page 2 of 2 · ,,o ~ MUNICIPALITY OF ANCHORAGE (MOA) ~ - ' ~ ' ~,~'[*~[{l~,~ Health Authority Approval (HAA) ~. ' .~,..,~// CHECKLIST - FEBRUARY 1984 · ~ _C" .c~o~ 343-4744 ~"~':~.~; ~ \~V~'/ Legal Description: Lot 1, Block 2 Oeerhorn Subd. WELL DATA C~%~x'~ Served by Public I/ater System ~ . .... '', .... Well Classificati~o~ ~-~ ~/, ~ Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground · 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 To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments. Date Completed Depth of Grouting If A, B, C. D.E.C. Approved (Y/N) Y Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) · , On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer CleanoutJManhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed 11/21/8~. *Size Standpipes (Y/N) Y Depression over Tank (Y/N) · PumPing/Maintenanc. e Contact on File (Y/N) Holding Tank High-Water Alarm (WN) N/A 1,250 * No. of Compartments 2 * Air-tight Caps (Y/N) ¥ Foundation Cleanout (WN) N Date Last Pumped 7/27/89 ~I/A ; for Temporary Holding Tank Permit (Y/N) Y SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well 2OO' + To Property Line To Water Main/Service Line 10~+ To Stream, Pond, Lake or Major Drainage Course Comments * Information from NOA To Building Foundation 15'+ To Disposal Field 9~ * lOOt+ xr,,,,, / / / ~-~(.~. 7/~) ~ Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 85 ft2/BR Date Installed 11/21/84. * Width of Field 18' * Square Feet of Absortion Area 522 Depression over Field (Y/N) Results of Last Adequacy Test Passed * . Type of System Design Length of Field 29' * Depth of Field 3' * Gravel Bed Thickness 6" * Statndpipes Present (Y/N) Date of Last Adequacy Test Seepage Bed * ¥ 7/25/89 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well 200' + To Building Foundation 20'+ Lot 30, + To Water Main/Service Line IO, + To Stream, Pond, Lake. or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments *[nformatton from HOA file, To Property Line 10'+ To Existing or Abandoned System on ; On Adjoining Lots 30'+ To Cutback (if present) N/A 100~+ D. LIFT STATION N/A Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (WN) 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 inspection. Signed ~ Company Erdman & Associates Consulting Engineers Data August 10, 1989 MOA No. ReceiPt No. Waiver Fee: $ Date of Payment Page 2 of 2 ERDMAN & ASSOCIATES CONSULTING ENGINEERS August 10, 1989 MOA Dept. of Health & Iluman Services Division of Environmental Services 825 L Street Anchorage, Alaska Subject: Lot I, Block 2 Deer Horn Subdivision Septic System Adequacy Test Project #89133 Dear Sirs: On July 25, 1989, our firm performed an adequacy test of the onsite septic system serving the four bedroom home at the referenced property. A total of 1,323 gallons of fresh water was discharged into the system over a period of 160 minutes, all of which was absorbed by the seepage bed. Our test showed the system to be adequate for the four bedroom residence. Please call if you have any questions. Sincerely, Michael R. Erdman, P.E. t5t East Hernlng Avenue Wasllla, Alaska 99687 907-376-6989 ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 563-6775 DATE: August 10, 1989 PWSID: 213001 TO Whom It May Concern: According to the records on file in this office, the ~ies Northwoods/Deer Horn $/D Water System is in compliance With the State of Alaska Drinking Water Regulations. Sincerely, Cindy Thomas Environmental Engineer ~ M~JNICIPALITY OF'ANCHORAGE f~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264~4720 Application Date GENERAL INFORMATION (a) Legal D~scription (include lot block subdivision,'section, township, range) f Location (address or directions) (b) Applicant Name ['/7~ ~"~$,,~t~-.,e..e.,¢) Telephone: .ome~'~'~' ..m~,~' Business App cant Address ~"..~-~"-.' ~ (c) Applicant !s..(check one): Lending Institution ri; Owner/builder J~; Buyer []; Other [] (explain); (d) Lending Institution - Telephone Address (e) Real Estate Company and Agent Address Telephone (f) ~'~-aTl'the HAA to the following address: 2. 'TYPE OF RESIDENCE * Single-Family ~ Multi-Family ri ' ' Number of Bedrooms Other 3. WATER SUPPLY ,/y,~ ~g'~..4.,*~ / Individual Well [] Community [] Public [~ Note: If community well system, must have written confirmation from the State Department o! Environmental Conservation attesting to the legality and status· 4: SEWAGE DISPOSAL · Onsite~ P~Jblic [] Community [] Holding Tank [] · Note: If community well system, must have written confirmation from the State Department of Environmental Conservation .......... 'r attesting to the legality and status. Page I of 2 ENGINEERING FIRM PROVIDIh~ INSPECTIONS, TESTS, FILE SEARCH, ~)A ~ A 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 ; .~; ;'n~tn~rln~ Telephone SRB 196x Address Eagie .'.iver, :.;;$L-,~ ?)577 / / Date ~/~.7/ ~' {~ DHEP APPROVAL ~ &... /z~ Approved '~ Disapproved Conditiona~ Terms of Conditional Approval Date CAUTION The'Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues HeaIth Authority App"oval certificates based solely upon the representations given in paragraph 5 above by an independent professional · engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending .... instituti'ons in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or - analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in !!~e.. professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MO~,,i MUNI~;;~rt~FC~HEAA~AUTHORITY APPROVAL (HAA) p~CKLIST - FEBRUARY 19M 8 ~9~6 Legal D~ription: ~ ~ ~ RECEi .ED. Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Jde~fr~ 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 A If A, B, C, D.F-C. Approved(~N) Date Completed Yield Cased to De~l~h tf Grouting ! "~' ~/.Pump Set At ,~;~ttary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/J;~-DTI~TANK DATA Date Installed (~, "' '~-~ -~'Size Standpipes (~)N) Air-tight Caps (~N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N)t,, Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic.~;te~ank: To Water-Supply Well ,~ I,,~.. To Property Line J ~ ~-,I.-- To Water Main/Service Line Course Comments ,~ No. of Compartments Foundation Cleanou~N) . Date Last Pumped I~ ~u,,-~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed [ [ - "Z.-~ Width of Field I. ~ Square Feet of Absorption Area Depression over Field (Y/J~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation '~"~"~ Lot Type of System Design "~ Length of Field Depth of Field '~ t c3~-...~-,,-i. ~ % t ~ ~::::tt,...~.- Gravel ~ Thickn~ [~ ~ I Standpi~s Pr~nt~N) Date of Last Ad~uacy Test ~ To Water Main/Service Line ~ ~ ! ~ To Stream/Pond/Lake/or' Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~ c::::'t ~ To Existing or Abandoned System on ; On Adjoining Lots ~ t~... ~ TO Cutbank (if present) IJ/~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions //i Ma n h ole/A c c,e.,ss (Y/N) "Pump Off' Level at · ' Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments *' Check Permitted Bedroom Rating Agelnsl 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 S & $ Engineer|nil Date / /7/~ ~ Company =--~-_..~__ ~....., ..... _~,,[, ;~ MOA No. ~7 Receipt No. ~~,,iI Date of Payment ~-'~,,%:~j Amount: $ r~ ~_ ~ Page2of 2 ~5 ~. I~ .~.~: ~ '-.. .~ -?;'~ DEPT. OF ENVIRONMENTAL CONSER%~TION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA q950! BILL .~IEFFIELD, GOVERNOR ~ddres~: 274-~533 To Whom it May Concern: According to records on file in this office the /~ 4~-'~/~oc/.f ~-~/./~ Water System is in compliance with the State Orlnkin'g Water Regulations Sincerely, ~ HUNICIPALITY OF ~NCHORAGE ~, DIVISION OF ENVIRO~MENTAL HEALk~ DEPAR~HENT OF HEALTH AND F2flriRONH~NTAL PROTECTION APPLICATION FOR H~LTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lo~, block, subdivision, sec=ion, township, range) Location (address or directions) Applicants Address ' - "~ T,.~z~. ~.L ...... · £?~.. (c) Applicant is (check one) Le~d'in~-'i~-[i~u=ion ~-~ I Owner/builder ~ Buyer ~-~; Other r-~ (explain)i ' (d) Lending Institution Ad~_e.s s Telephone (e) Real Estate Co. & Agent Address (f) Telephone "~:/~e HA.A ~o the following address: 2. T~pe of Residence Single-Family~. Number of Bedrooms 3. Water Suppl7 Individual Well~ Multi-Family Community Ocher (describe) Public .~' Note: If community well system, must have ~itten confirmation from the State Department of Environmental Co~servation attesting to the legality and status. Sewage Disposal Onsite~ Public~--~ Ccmmunityr--~ Holding Tankr~ Note: If community well system, mus~ have vrit~en confirma~ion from the State Department of Environmental Conservation attesting to the legality ami status. [Page 1 of 2] 3. En~ineerin~ Firm Providin~ :rnspectio~s~ Teets~ File Search~ Data and Infor~ation As certified by my seal affixed hereto and as of the validation date shown below, Z verify that my investigation of this Health Authority Approval sho~m that: the on-site vat:er supply and/or waste~ater disposal system ia safe, funct:ional and adequate [or the number of bedrooms and type of structure indicated herein.. I further verify that:, based on the information obtained from the l~unicipality of Anchorage files and from my investigation and iuspection, the on-site ~rater supply and/or wastevater disposal system is in cc~pliance urlth all ~nicipal and State codes, ordinances, and regula- tion~ in effect on the date of this inspection. Name of Finn Telephone Address Approved CAUTION TH~ ~IUNXCIPALITY OF A~CHOP. ACE DEPAR~fE~ OF ~TH ~ E}~O~ ~OTECTION (D~P) ISS~S ~TH ~HO~I~ ~PROV~ ~RT~ICA~S B~ SO~LY U~N ~ ~SE~- ATIONS GI~N ~ P~ 5 ~0~ BY ~ ~EPE~E~ ~OFESSIO~L ENGI~ER ~GIS~ IN ~ S~ OF ~S~%. ~ ~P ~ES ~ ~ A ~SY T0 P~SEKS OF H0~S ~ ~IR ~XNG ~TX~IO~ ~ O~E~ TO SATISFY ~R~XN ~DE~ ~D S~ ~QU~E- ~S. ~O~ES OF ~EP ~ NOT ~UCT ~SPECTIOL~ OR ~E ~ ~FORE A CERTIFICA~ ~ ISS~D. ~ ~ICIP~I~ OF ~CH0~ ~ NOT ~SPONSIB~ ~ ~0RS 0~ ~ISSIO~ ~ ~ ~0FESSI0~ ENGInEerS ~0~. (DHEP SEAL) l~4/el/D18 [Page 2 of 2] 7-19-84 Separati~ Distances fxcm Septi~ttml~kW~Tank: To Nates-Supply I~11 /~ ~/C.- To ~uil~ir~ Fct~ndaticn,. /8 / To Property Line /~ 7~ To Dis~mal Field ~ / To Wa~er Main/Set. ce Line ~ To Stze~. Porxl. I~ke. = Majc= Drainage B~ceipt ~ Date Paid: Amount: [Page 1 of 21 2-15-84 Ce Soils Rating ~n ~tic~ S=a~a ~t~ ~,~ued //- 2- ~ -~ Wid~ ~ Field /~ ' squa~ ~L~et c~ ~sccptic~ A~ea Date Xram'*1 led 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION / ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, C, OVERNOR T~lel~hone: (907) Address: 274-~533 fi~_ru~. ~t, Iq~b~ DATE: t/ ~s I.,~.,~ To Whom it May Concern: According to records on file in this office the~~ ~U~ ~lt.~ Water System is in compliance.with the State Drinking Water Regulations Sincerely,