HomeMy WebLinkAboutDEER HORN BLK 2 LT 7· ~ 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 '
~ UPGRADE
MAILING A~ESS
LEGAL ~SCRIPTION ~
LOCATION NO. OF BEDR~S
~ .an.f~turer O~~ ~e'/ NO. of com~ment,
~ 0 ~ DISTANCE TO: Well
~ Well Foundation Nearest lot line PERMIT
~ ~ DISTANCE TO:
~k Top of tile to finish grade ~ Material beneath tile Total eff~ti~ absorption area
0 ~ inch~
"~ DISTANCE TO: ~ t ~ Build~n,ation Nearest Io'li.~O
~ DISTANCE TO: Building foundation Se~r line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATIN
INSTALLER
~ . aRB 196X .
MUNI(]IPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET~ ANCHORAGE, AK 99501
264-4720
ON--SITE SEWER pERMIT
PERMIT NO:
DATE ISSUED:
840921
10/50/84
APPLICANT:
ADDRESS:
CONTACT PHONE:
C/O S & S ENG'G LIFESTYLE IND.
SRB 196X
EAGLE RIVER, AK 99577
694-2979
LEGAL~DESCRIP:
LOT SIiE:
MAX BEDROOMS:
SUBDIVISION: DEERHORN LOT: ?
SECTION: 4 TOWNSHIP: 15N RANGE: 1W
27911 (SQ.FT. OR ACRES)
4
BLOCK: 2
Listed below are the options available to you
system. Choose the option that best ¢its your' site.
DEPT. *0 PIPE BOTTOM ** \ 4.O
GRAVEL DEPTH (FT.) ! 5.0 I 0.~
TOTAL DEPTH (FT.) ' I 8.0= ;~ ~4.5
GRAVEL VOLUME (CU. YDS. ) \ 25.5 J 28.~ ·
TANK SIZE (GALS) ~ 1,250.0 **J 1,250.0 **
** DEPTH TO PIPE BOTTOM.< 5.5 FT. REQUIRES INSULATION
** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
in designing your septic
W. DRAIN
4.0.
.5.0
7.0
5.0
59.0
58.5
1,250.0 **
125
I certify that:
1. I am Familiar
2.
with the requirements For on-site Sewers and wells as set
forth by the Municipality of 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 of this permit.
I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well,' wastewater disposal system or public
sewerage system on this Or any adjacent om nearby lot.
I understand that this permit is val~id for a maximum of 4 bedrooms and
any enlargement will require an additional permit.
IF A
THEN
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
'APPLICANT: C/O S ~.~: S ENG'G LIFESTYL~ IND. ·
LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
(1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
ISSUED BY
· MUNICIPALITY OF ANCHORAGE
,,...._~,~._,~-~-~-~,~ OEPA..ME.T OF .EAST. A.D E.V,.O.ME.'~ P.O.~CT,O. []TEsTPERCOLAT'ON
~Jl~_ ~ 825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMEOFOR= Z/F~'~y'~ ~ O DAT~PERFORMED=,/O--ZX--a~
1
2
3
4
5
6-
7-
8-
9-
10
12
WAS GROUND WAT
ENCOUNTE~
SLOPE SITE PLAN
Dross Net Depth to Net
ding Date Time Time Water Drop
PERCOLATION RATE '-// ~ (minutes/inch)
TEST RUN BETWEEN FT AND FT
13
14
16-
17-
18-
19-
20-
COMMENTS /~C'~"/'/'//"~/~'~//~'/~--- ~-~Z~--~'"'
CERTIFIED B ~_~.~/~
·
S' 7125 OLD SEWARD HWY.
*& ENGINEERS. INC. ANCHORAGE. ALASKA 99503
S ~ 3,49 -6561 ' ,'~HCOt^T,O~frS[
SOILS LOG PEIICOLATION I'£$I
I
2 . ~ '- 2' ~ .-.,,~l,.,Is-.---
3
4
6
8
Xll
I1"
I0
II
12
13-
14-
15-
16-
I?
18
19
20
WAS GROUNO WATER
ENCOUNTERED~
PERCOI
COMMENt'S
CERI'i;iEO 0¥
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. If
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
ia) Legal Description (include lot, block, subdivision, section, township, range)
Lot ?t Stock 2 Deer Horn Subdivision
Location (address or directions)
N~-Corner of intersection o[ Deer Park Drive and Deer Park Circle
(b) Property owner ItUD *''/
Mailing Address
Telephone: (home)
Business
(c) Lending Institution
Mailing Address
Telephone
id) Real Estate Company and Agent Associated Brokerst Inc. (Sandra llJelmstad)
Address 640 W. 36th Suite #1 Anchorage, AK 99503
Telephone 563-3333
(e) Mail the HAA to the following address: (or check here r'l, if hold for pick up.)
List contact person and day phone number below:
Erdman & Associates Consulting Engineers
151 East Ilerning Avenue
Wasilla, Alaska 99687
Contact: Hike Erdman 376-6989
2. TYPE OF RESIDENCE
Number of bedrooms
Single-Family []
3. WATER SUPPLY
Individual Well []
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 rx; Public [] Community [] 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 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 investigati~)n of this
Health Authgrity Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional end 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 ERDMAN & ASSOCIATES Telephone 376-6989
Address 151 East: llernf, n~ Avenue
Wastlla~ Alaska 99687
Date July 27, 1989
6. DHHS APPROVAL ,.-- ~ ..
Approved for '/7/ bedrooms by
Approved ~ ' Disapproved Conditional
Terms of Conditional Approval
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
,,
A. WELL DATA S~rved by ~blic~ater System
Well Classification
Well Log Present (Y/N) Date Completed
Total Depth Cased to Depth of Grouting
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on L~t
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
MUNICIPALITY OF ANCHORAGE (MOA) ~
Health Authorlly Approval (HAA)
CHECKLIST - FEBRUARY 1984 '
343-4744
Legal Description: ~.o~- 7~ Block 2
Deer Ilorn Subdivision
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
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
;Date
Comments.
B. SEPTIC/HOLDING TANK DATA
Datelnstalled 11/8~. * Size 12.5o * No. of Compartments
Standpipes (Y/N) ¥ Air-tight Caps (Y/N)
Depression over Tank (Y/N) N
· Pumping/Maintenance Contact on File (Y/N) N/A
Y Foundation Cleanout (WN)
Date Last Pumped 7/27/89
; for N/A
Y
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well 2oo° +
To Property Line ' ' .5, +
To Water Main/Service Line 10' +
To Stream, Pond, Lake or Major Drainage Course
Comments
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
* *information from HOA file,
72-0~ {aR. 7.,~1) From Page I of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 85 [~-2/ER *
Date Installed 11/84 *
Width of Field ' 18, *
Square Feet of Absortion Area 522 *
Depression over Field (Y/N)
Results of Last Adequa~:y Test Pass
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well 200
To Building Foundation 20'
Lot
To Water Main/Service Line 30' +
To Stream, Pond, Lake. or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments * Information from NOA file.
Type of System Design
Length of Field 29' *
Depth of Field 3' *
Gravel Bed Thickness 6" *
Statndpipes Present (WN)
Date of Last Adequacy Test
SeepaRe Bed
Y
7/2~/89
To Property Line 10' +
To Existing or Abandoned System on
; On Adjoining Lots 30' +
To Cutback (if present)
100' +
l0t +
D. LIFT STATION
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 (Y/N)
Pumping Cycles during Adequacy Test.
*'Check Permitted Bedroom Rating Against HAA Request*'
I certify that I have checked, verified, or conformed to ill MOA and HAA guid..~,~lj~ on the date of this
Signed ~ ~..~ ¥'
/ 9
Company Erdman & Associates Consul~inR Engineers ~. .,
~eeeeee eeeeee e~ .... ~. inee~s Seal
Date July 27, 1989
. ,./
Receipt .o. ~/~ ~ ~ ~ Receipt .o.
Date of Payment ~~ ' ' Waiver Fee: $
Amount: $ /~/]' ~ [~ Date of Payment
~,~.~)e,c~ Page 2 of 2
"~=,' '- ERDMAN & ASSOCIATES
CONSULTING ENGINEERS
SEPTXC SYSTEM ~qUAC~ TEST
Location: L"i~/~.. ~I=~1~, HOl~t'-J
Number of Bedrooms: ~
Septic Tank Size: I~ (gal.)
Soil Abso~tion System: ~E~ ~E~
~/~/~
Date
Inspector
Project ~
Cum. Tank Change SAS Change
Time' Flor Vol · Vol. Level Tank Level SAS Comments
(gpm) (gal.) ($al.) (ft.) (ft.) (ft.) (ft.)
TEST RESULTS
:v~ Passed Failed
Underground conditions are subject'to change over the course of tl~e.
t54 Ea.',t HernlnD Avenue Waslllo. Alaska 996P7
9~7.,~ 7~,.~' '0
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 Chu~iak Utilities
Northwoods/Deer Horn S/D Water System is in compliance with the
State of Alaska Drinking Water Regulations.
Sincerely,
Cindy Thomas
Environmental Engineer
~ HUNI¢IPALITY 0F ANCRORACE
diVISION O~ ENVIROM~ENTAL RF_J~LT~
DEPARTMENT 0F I~ALTR AND ENVIR01~NTAL I'ROTE~TION
APPLICATION }'OR ltTJ~TH AUTROKITY APPROVAL CERTIFICATE
1. Ceueral Inforaation
Application Date
(a) Leg~,Descrip:ion..~ ~ ~.(include/)f~,,~/~d,f/~l°t' block, subdivision, section, township, range)
Location (address or directions)
(b)
(c)
(d)
Leudiu~ Insti~u~ion
Ad~ss
Telephone
(e) Real Estate Co. & Agent
Address
(f)
Telephone
/~/~ L- ,-;
'.--~{.~-l-1 the EAA to the following address:
2. Type of Residence
$ingle-Family~
Number of Bedrooms
3. ~ater Supply
Hulti-Family ~
O~her .(describe)
Individual Well ~ Co=uni~y ~-~ Fublic ~
Note: If community well sysCem, mus~ have written coufirma=ion from the Stats
Departmeut of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite? Fublic ~ Community ~ Holding Tank ~
Note: If community well system, must have written confirmation from the $~aCe
Departmen~ of Environmental Conservation a~testing ~o the legality a~d status.
[Page 1 of 2]
~o En~ineerin~ Firm Providin~ lnspecCioust TesCs~ File Search~ Data arui Information
As certified by my seal affixed hereto and as of the validation date sho~m below, I
verify chat my investigation of this Health A~thori~y Approval show that the on-site
water supply and/or wastevater disposal system is safe, functional a~i adequate for
the number of bedrooms and ~ype of stzucture indicated herein.- I further verify that,
based on the infor~atiou obtained f~om the N-nicipality of Anchorage files and from ~y
investigation and inspection, the on-site ~rater supply and/or ~astewa~er disposal
system is in compliance ~rlth all N~nicipal -~ State codes, ordinances, and regula-
tions in e~fect on the dace of this inspection.
Name of Firm
Address ~RB 198X
Date
DHEP Approval
Approved for
Approved~_~
bedrooms By ~
0
Disapproved
Terms of Conditional Approval
Telephone
Da~eZ
CAUTION
T~ ~ICIPALI~Y OF ANCHORAGE I~PARTM~NT OF ~TH ~ E~IROM~}~ ~0TECTION
(D~P) ISS~S ~TH A~H~I~ ~PROV~ ~ET~ICA~S B~ SO~LY U~N ~ ~SE~-
ATIONS ~N ~ P~ 5 ~0~ BY ~ ~PE~E~ ~OFESSIO~L ENGI~EE ~GIS~U~n
IN ~ S~ ~ ~S~. ~ ~P ~ES ~ ~ A ~SY TO P~SERS ~ H0~S ~
T~XK ~ING L~TX~XO~ ~ O~ER T0 SATISFY ~R~XN ~E~ ~D S~ ~QU~E-
~S. ~O~ES OF ~EP ~ NOT ~U~T ~SPECTIO~. 0~ ~YZE ~TA ~FOP~ A
~RTIFI~ ~ ~S~D. ~ ~I~IP~I~ OF ~CHO~ ~ ~OT ~SPONSIB~ FO~ '~O~S
O~ ~ISSIO~ ~ ~ ~OFESSIO~L ENGInEerS ~0~.
(DHEP SEAL)
RE4/eJ/Dl$
[Page 2 of 2]
7-19-84
,~* ',M.NTAL FL~Tr C~'~O~
JAN ? 1985
To Nee=est Public Sewer
To Ne=est Sewe= service Line cn Lot
! Date
seParatic~ Distances frcm Septic/He~ Tank~ /
To Water-Supply I~11 ~ ~uildin~ Foundatic~ ~
To l~c~e~cy l~ne /~ /~ To Disposal Field
TO Water Main/Se=vice Line "~:r~p 7~- To St~s~n, Pond, Lake, = Majc= ~ainage
Cex~se ~J
Date Paid:
[Page 1 of 2] 2-15-84
Ce
Date Znstalled //-~-~ length of Field
Squ~e ~t of A~SC=l~tic~ A~ea
Depth of Field 3 I
Gravel ~ed Thickness (~ '
~ Star~i~es Pzesent~)
Depzessi~ ove= Field (Y~ ~te of Last /~]eguac~ Test
Results of T~t ~i~]uacy Test ~
Se~a=ation Dlstsna~ f:=cm A~=7~ti~ Field~
To Wate=-Su~pl¥ W~ll ~ /4' <PWu,~.) To P=ogert"y Line
C~Amm~nts
Date Ir.S~'~! t ~d Dimensions
Si~e in Gallons Manhole/Access (Y/N)
· Pum~ On' level at ~ O~f' ~evel at
High Wate~ Alarm ~1 at ~ ~nt (Y~)
Ele~i~*~ ~S(Y ) ' .
[Page 2 of 2]
2-15-84
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, C.,OVERNOR
274-~533
~_~. 'q, Iq~'~
DATE:
,,ws I.O., ~l~f
To Whom it May Concern:
According to records on file in this office the~~/61~
~ Water System is in compliance.with the State Drinking
Water Regulations
Sincerely,