HomeMy WebLinkAboutTUXEDNI PARK BLK 2 LT 3
Name
Address
Phone,s) ~Pe m t ~o. No, Ol Bedrooms
~7-735ql q~ ~
Township. Range, Section
TI3_N
MUNICIPALITY OF ANCHORAGE D ~/--O~_~--Z t/
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
DISTANCES
SEPTIC ABSORPTION
TANK FIELD WELL
TANKS
[] HOLDING
Capaoty m gallons
No. ol Compadments
TYPE OF SYSTEM
'~ SEPTIC
Manutaclufer
Mater~al
FT
[] TRENCH ~BED
Depth tO p~pe 1~3ttom horn
~.~ FT
~ Se FT
! .,~SQFT ~05q ~
[] W. DRAIN [] OTHER
Total clepth Irom orlg,nal grade
FT ;z ?,_ - ,-//'z_ FT
Gfave~ Oepth ~neath p~pe
~. q FT
Gravel
~ FI
FT
(PRIVATE
WELLS
[] OTHER Ildentifv)
] Dial Deplh I Cased to
~ / FTI ~ I FT
Dale Insiaued.
REMARKS:
WELL
LOT LINE
FOUNDATION h, Jo Jr
AS-BUILT DIAGRAM IShow location of well. sephc eystem, property hnes. Iounoatlon.
13~lveway. water boches, elcl
-- ' Ins~s Pedormed by: ~,~ ~r ~1 ~" ~ ',
I
72-013 ~3/85)
M U N I C I P A L I T Y O F A N C H 0 R A G E
Department of Health &. Human Services
825 L Street, Anchorage, Alaska 99501 .34.3-47~0
0 N - S I l- E S E W E R,~ W E L L P E R M I T
Date I~mut?d: 09/21/90 Enginee~ Designed
Owner' Name: ROBERT LARSEN
(]wn~;.:r Address: 4784 MILLS I)RIVE
ANCHORAGE, AK 99508
Day Phone:
337-7554
F'arc~l Id: 041-022-24
Lot L~,gal: Subdivision: TUXEDNI PARK Lot: ~. Block:
Section: 6 Township: 12N Range: ~W
Lot Size 77989 (sq. ~t. or acres)
Max Bedr'ooms: This Permit: 4 Total Capacity: 4
SEPTIC TANK: Minimum total septic tank capacity: 1,~50 gallons.. Each septic
tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0
fe~.crL eequiro~ insulation over tank(s).
WELL_: Log must be submitted to Municipality of Anchorage Department of Health
and Human Services within 50 days of well completion.
]'FILS PERMIT EXPIRES 1~/31/90 AND VALID FOR A SINGLE FAMILY HOME.
I CERTIFY THAT:
1.. I am familiar with the requirements for on-site sew~_~rs 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,
anc! in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State o~ Alaska require.~ments for the set back
dis'Lances ~r'om any existing well, wastewater disposal system or' public
~(?,,,*oraqc? system on this or any adjac,~nt or nearby lot.
4. I unde~rstand that this per-mit is valid !'or a maximum of 4 bedrooms. 1
also undt{)rstand that the capacity of the total system is 4 bedrooms and
any c)nlarooment will require mn additional permit.
Signed: ,~' ~
(Owner)
I ~su~d By:
ALASKA I UIROI I i EITAL COI TROL $ RUIC S, IFIC.
~qinecrioci ~ ~nuironmcnlel Stuclics
SPECIFICATIONS FOR BED WASTEWATER TREATNENT SYSTEN
LEGAL DESCRIPTION: LOT 3, BLOCK 2, TUXEDNI PARK SUBDIVISION
1.0 GENERAL
1.1 The Drawings, sheets 1 through 5, shall be part of
thls specification.
1.2
All materials and workmanship shall meet the
requirements of the Hunlcipality of Anchorage,
Department of Health & Human Services (DHHS), the
conditions of the permit, and all applicable rules and
regulations currently in effect.
1.3
All excavations and depths are advisory, and are
to be verified or modified in the field by the
Engineer or inspecting agency.
1.4
It is the responsibility of the .property owner or
installer to adhere to approved design for the
installation, to maintain the specified separation
distances and to have the appropriate inspectibns.
1.5
It Is the responsibility of the property owner or
Installer to report to the engineer any observed
conditions which would put the system in violation
of state or Municipal regulations.
1.6
If the Installation is not inspected by an AECS
engineer, AECS will not be responsible for the
Installed system. An engineer at AECS should be
consulted prior to construction, to determine the
number of Inspections that will be required and to
explain what these Inspections wtll involve.
2.0 SEPTIC TANK
2.1
If there ts an existing septic tank It may be used
If It meets the capacity requirement for the
residence. The structural Integrity of the tank
must be verified.
2.2
The septic tank shall be a UPC-approved
two-compartment tank, constructed of 12 gauge
steel with bttumasttc coating and set level on
undisturbed soil. If the tank ts buried at a
depth of 4 feet or less, it must be insulated with
an overlying layer of 2 Inch burial type
polystyrene rigid board insulation.
(907) 279-5553
2.3
2.4
2.5
2.6
2.7
The septic tank shall be a minimum of 5 feet from
the house foundation, and a minimum of 5 feet from
the absorption area.
The septic tank and bed shall be a minimum of 100
feet from any private well or body of water, 150
feet from Class "C" wells, and 200 feet from Class
"A" or "B' wells, unless otherwise specified.
Less than the required separation distance must
have prior approval or waiver by DHHS or Alaska
Department of Environmental Conservation (ADEC).
Piping shall be fitted with a mechanical
watertight calder coupling on the outlet and inlet
of the septic tank. Piping shall be 4 inch solid
PVC ASTM D-3034 or cast Iron, sloped a minimum of
1/4 inch per lineal foot on the inlet side and 1/8
inch per foot on the outlet side. If the piping
is buried at a depth of 4 feet or less, it must be
insulated with an overlying layer of 2 inch burial
type polystyrene rigid board insulation.
Cleanouts shall be installed as designated and
capped with air-tight rain caps (Jim Caps or
*iequtvalent). and extend a minimum of 1 foot above
ground level.
If a lift ,station Is required it shall be a
combination lift station septic tank per Anchorage
Tank and Welding, Inc. using an ORENCO lift
station design. Specifications and design
drawings are on file at the Municipality and with
the engineer.
3.0 SEEPAGE BED
3.1
The gravel for the bed shall be 0.5 to 2.5 inch.
screened rock with less than 3 percent passing the
No. 200 sieve. All substitutes must have prior
DHHS approval.
3.2
The bottom of the excavation shall be level and
raked with the backhoe blade to ensure that the
bottom has not been compacted during excavation.
3.3
Sand. for leveling, shall have a size distribution
which meets the requirements of MOA code
15.65.077.
3.4 The distribution pipe shall be perforated 4 inch
rigid PVC with a minimum crush strength of 1500
3.5
pounds and shall Beet the approval of DHHS for use
as dratnfteld pipe. If the systeB is a pressure
distribution systeB, see Section 5.0. All pipes
shall be laid level, and spaced according to the
drawings.
Nonttor standpipes shall be placed as shown in the
drawings. They shall be 4 Inch rigid PVC ASTM
D-3034, or cast Iron. The section shown with
holes Bay be either drilled 0.5 inch holes on 6
inch centers on opposing sides of the pipe, or a
section of regular perforated sewer pipe Bay be
clamped to the solid section with a no-hub
coupling or solvent Joint. The perforated section
of the ~onttor tube shall be located In gravel
only. The portion of pipe above the sewer rock
shall be solid. A rubber raincap (Jim Cap or
equivalent) shall be placed over the top of the
pipe.
3.6 The gravel shall be covered with a layer of
nonwoven engineering fabric.
3.? The side slope of the Bound shall be slope ! f~ot
vertical to 3 feet horizontal.
3.8
The bed shall be planted with a white clover and
red fescue mix, or with Kentucky bluegrass.
4.0 INSPECTIONS
4.1
This 'bed will require a minimum of three
Inspections. The first inspection wtll be of the
open excavation, to assure that the systeB is
Installed In the proper soil strata, correct depth
and ~eet BlntmuB specified design paraBeters.
4.2
The second Inspection wtll be after placeBent of
gravel, monitor standpipes, and distribution pipe,
to verify proper Installation and position of
pipes prior to backfill.
4.3
The third Inspection will be after final backfill
grading and seedinz to ensure that adequate soil
cover has been provided over the bed.
4.4
The Inspection of the septic tank or lift station
Installation can be incorporated with any one of
the above listed inspections.
4.5
The lift station will require either an MOA
electrical Inspection or certification by a
licensed electrician depending on whether the
building code applies to this part of the city.
5.0 PRESSURE DISTRIBUTION SYSTEMS
5.1 The lateral and header pipes are to be Schedule 40
PVC or ABS in the sizes indicated on the drawings.
5.2 The laterals are to be level within plus or ntnus
one Inch.
5.3 All Joints are to be solvent welded.
5.4 There shall be 2.5 inches of rock over the top of
the headers and laterals.
5.5 The holes In the pipe are to be properly sized and
spaced.
5.6 The holes shall be clean with no cuttings still
attached to the pipe or left free inside the pipe.
5.? Holes may be reverse beveled If it does not
Increase the outside hole size.
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET "0. / OF
CHECKED BY DATE
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PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG m PERCOLATION TEST
LEGAL DESCRIPTION:
DEPTH
(FEET}
7 - .~.'-.':: '
, -
9 - '* ' '~°,
11 -,>-...%
12-
Township. Range, Section:
SLOPE
13-
SITE PLAN
?
· WAS GROUND WATER
~ENCOUNTERED?
L
IF YES. AT WHAT O
DEPTH?
p
Depth to Water
7 0,,e:
- Gross Net Depth to Net
14 Reading Date Time Time Water Drop
15-
16- /
17-
18-
19-
20-
PERCOLATION RATE
{minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN ~ FT AND __FT
PERFORMED BY; '~' ~ '¢~/ I ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:----
72-008 (Rev. 4/85)
·. DOC Co.
SULLIVAN WATER WELLS
F
P.O. BOX 670272, CHUGIAK, ALASKA 99567 * TELEPHONE 688-~759
OWNER OF LAND ; /..~/?' //~,/~..~'A=,:c.J DEPTH OF ~'ELL ~/ ,~
ADDRESS ~'~' ~/~ ~ ~;~' ~ S/ATIC LEVEL OF WATER F'r.
LEGAL DESCRI~ION~ ~-~ ~/ff "& ~ -{ ( ) ~ .~D.~ I ~ ,-~ I)RAW DOWN:FT.
DATE -Started Ended / O GALS. PER HR '
PERMIT NUMBER / KIND OF CASING ~ ~ S~-*' -
KIND OF. FORMATION:'. ~ /~ .... ' ....., ~
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~CL. INFORMATION:
T. S F'URI.(I A I~ID F'. F.,_
6751 ~. DIHOND ~LVg,
(907} 279491&
Municipality of Anchorage
Division of Environmental Health
Department of Health and Social Services
820 I Street
Anchorage, Alaska 99501
Subject: HAA for Lot 5, Block 2 Tuxedni Park
June 4, 1995
Gentlemen;
We are applying for an HAA for subject property. Both the well
and septic system was installed in 1990, but the residence is in
the process of being finished at this time. The owner is con-
verting the construction loan to permanent financing.
Yours
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.# ~/'
1, GENERAL INFORMATION
Complete legal deScription
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
e
e
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address '
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: .-~,
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Day phone
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing 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.
72-02,5 (Rev. 1/91) F~ont MOA
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Legal Description:
A. Well Data
Well type ~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage ~,
Department of Health and Human Services ."
HEALTH AUTHORITY APPROVAL CHECKLIST
Y
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed t O/1 O l ~ O Driller
,~ I Casing height
Wires properly protected (Y/N)
Cased to
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
Date of sample:
Nitrate
AT INSPECTION
g.p.m.
; On adjacent lots
; On adjacent lots
'Public sewer manhote/cleanout
Petroleum tank
/, ~"(-~ Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N) ~'/
High water alarm (Y/N)
Date of pumping
Tank size ! ~-~'pO Compartments ~.,
Foundation cleanout ~/N) y Depression (Y/N)
Alarm tested (Y/N)
i~J//~ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot t~ ~ ~
To property line ~{~
Surface water/drainage
On adjacent lots ~ 1 ~.9.~ Foundation
Absorption field ! '~ Water main/service line
72-no6 {3/93)' Front CONTINUED ON BACK PAGE
C. LIFT STATION ~,,~//.~ _
Date installed
Size in gallons
Vent (Y/N) 'Pump on" level at
High water alarm level
Meets MOA electrfcal codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION
Well on lot ~. On adjacent lots
Manufacturer
Manhole/Access (Y/N)
'Pump off" Level at
Cycles tested
Surface water
D. ABSORPTION FIELD DATA
Date installed ~ 0 It o I ~ O
Length /-~_'~ Width
'Total absorption area ~'~)
Date 'of adequacy test
Water level'in ~bsorption field before test
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~ ~'~
To building foundation
On adjacent lots
Surface water ~%J ¢-) ~-t.~
Curtain drain
Soil rating (GPD/Ft~) /~ .~
Gravel thickness
Cleanout present (Y/N)
Results (pass/fail)
System type
Total depth
"/ Depression over (Y/N)
field
for
If yes, give date
On adjacent lots ~/'/-~.~ Property line /'~.~
To existing or abandoned system on lot r~/,~.~..
Cutbank ~ ~,~-71~ Water main/service line '> .~,'- O
Driveway, parking/vehicle storage area ~ L~
E. ENGINEER'S CERTIFICATION
Bedrooms
I certify that I h. ave checked, verified, or conformed to all. MOA and HAA guidelines in effect. . on.the, date of this inspection.
HM Fee $ //
Date of Payment
Receipt Number
· Waiver Fee $
Date of Payment
Receipt Number
7~-026 (3/93)* Back
COMMERCIAL TESTING & ENGINEERING CO.
ENVIRONMENTAL LABORATORY SERVICES
"'~=~ '~ REPORT of ANALYSIS
Chemlab Ref.~ :93.2578-!
Client Sample ID :L3 B2 TUX~NI
Matr ix : WATER
5633 B STREET
ANCHORAGE. AK 99518
TEL: (907) 562-2343
FAX: (907) 561-5301
Client Name :TOBBEN SPURKL~ND, P.E. WORK Order :66871
Ordered By :. Report Completed :06/08/93
Project Name : Collected :06/04/93 @ 09:00 hrs.
ProJect~ : Received :06/04/93 @ 13:40 hrs.
PWSID :UA Technical Director:STEPHE~C. EDE
Released By : ~C ~_.
Sample Remarks: ROUTINqE SAMPLE COlLeCTED BY: UA.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
Nitrate-N 1.26 mg/L FPA 353.2/300.0 l0 06/07 LLH
* See Special Instructions Above UA = Unavailable
** See Sample Remarks'Above NA = Not Analyzed
U = Undetected, Reported value is the practical quantification limit. LT = Less Than
D = Secondary dilution. GT = Greater Than
~,~5~'~ Member o! the SGS Group (Soci~t~ G~n~rale de Surveillance)
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