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HomeMy WebLinkAboutSANDI HEIGHTS LT 7AJAIM C)i 1-aaa-3'"I Municipality of Anchorage Page I of 3 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 Permit Number: laZ0 169 PID Number: Name: I I 1 le lad J LlWfi fWastewater System: ❑ New Upgrade Address: lot as3`f`f`-�� ABSORPTION FIELD Phone:3-- �� No. of Brooms:ozli p Deep Trench X I � ' ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 1. a Total Depth from original grade: GPD/Sq. Ft. Lot: Q Block: Subdivisi n' �' �Hr�I0� Depth to pipe bottom from ori nal grade: Gravel depth beneath pipe 1 f�iff�'u Ft. Ft. Township: Range:Section: Fill added above original grade: /� t Gravel length: I S (l Ft. Ft. WELL: ❑ New ❑ Upgrade Gravel dsf=: IF WIDTH S Ft. Number of lines: ! Distance beween lines: /V%} Ft. C sification (Private, A, B, C): Total Depth: Cased To: Total absorption area: Pipe material: F$10 PMr-. kk�LL Ft. Ft. SO. Ft. 03 %( p ler: Date Drilled: Static Water Level: er: InstDate "TETE installed: c� Ft. Ex. Yield:Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufact er: Capacity in gallons: From Tank Field Station Tank Sewer Lines `660 Well �(w ^�� Material: Number of Compartments: � Watere /(��} /Wf LIFT STATION Lot �G I.lot Size in gallons: Ma turer: Line Foundation " f f "Pump on" level at: "Pu " lev High water alarm at: Curtain NONE NON — Pump Make el Electrical Inspections performed by: Drain wowo KNwO Remarks:S—jL ( BENCH MARK ! � �� {{�� /1 ill 7%f lV � D Q G1�c i K G4 Location and Description: �^ E C�..k. 0 . W, S 7E owIhE122 1(4dF& OM&L.-. LAI SVILIE19 2- ACA+ EN T Assumed Elevation: Oct ENG�I4LAK4 jVAL Inspections performed by: Dates: 1st lay 94 Ro6""m`® 2nd ��� ROR �iHAFER� Department of Health and Human Services approval to:: ®e*000000_ No. 8215 r Reviewed by: a �@��pRAFESS1aN��`�do and approved Date: 72-013 (1/91) MOA 25 Permit No. &w 9�U 1ect Page—of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0. Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Leaal Description: Lo -r _,i',4 141SWITS PID No.: ()tl�o��3� 72-013 A (2/91) MOA 25 _ Permit-No. S W cm Igq Page 3 of 3 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 Description: L-L:>'r TASANDm ri 161rtta PID No.: 01 Ua2l? 72-013 A (2/91) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502-/ ANCHORAGE, ALASKA 99519-6650 i 9,G}'jDiG1( �srS' ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920189 DATE ISSUED: 7/17/92 %r DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 7/17/93 OWNER NAME:BURKE MICHAEL J & OWNER ADDRESS:1011 East Tudor Road Anchorage, Ak 99503 PARCEL ID:01122237 LEGAL DESCRIPTION: SANDI HEIGHTS LT 7A LOT SIZE: 12150 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: `'✓ ISSUED BY: DATE:, DATE: -7 6762� p-, 14 1 Ju.2y 10, 1992 ROBERT SHAFER, P_E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY „ p APPROVALS Munticipat cty o6 Anchonage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 SEWER &WATER Anchonage, Ata,6ka 99519-6650 MAIN EXTENSIONS REFERENCE: Lot 7A; Sandi. Heights Subdiv,i6 ion; Reque,st you .idbue a penm,it to upgnade the septic system senv.ing the 3 SEWER &WATER bedn.00m house on the n.e4en.enced pn.opetty. The existing system ,iz in a INSPECTION state oU 6a%2uae with pen i.od.ic 3wc6ac,i,ng o6 wastewateA e66tuent. A teat hote was excavated and a peAcotation teat pen.gonmed .in the an.ea og .the pnopozed upgnade. The applLoximate tocati,on o4 the test hote Z ENGINEERING STUDIES shown on the attached design. The gnoundwateh monitoring tube has been AND REPORTS checked and 4ound to be dn.y. This pn,opercty is served by a community water. 3y.6tem. There ane no protective wet radii, which enc,%oach upon the ptopenty. we do not WELL INSPECTION anticipate any adveAse e44ects on neighboring propehtiez by the &FLOW TEST .in taU-ation o4 the propozed septic upgnade. IU we may be of burther seAv.ice, ptease contact u3. SITE PLANS ���CeQ}�Z�II�/y/(///7 / l'������ V•/WV J Y ���'l1 �1 "'vG JAMES P. WILLIAMS ROAD DESIGN C.ivit Engineer �G SOILTEST ROGER J. SHAFER, P.E. JPWI gm PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE RaQFJlG � No WElcs 14117111AI aao ,- S p° O6 Oo E �0 o o o -P CN iia NSI D m m OD N -CS W ia�s E� e��� .+� CA 3. '11 0° •� e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: `-'C_ t \��1ER ! V tICHE� �oRn� DURIc�. DATE PERFORMED: L%! 2 LEGAL DESCRIPTION:L—r �/7" �ArjoZ PC16#7S Township, Range, Section: ,SEPTA? SLOPE SITE PLAN 1 2 3 4 5 PCar,- 6 7 8 9 10 11 12 13 D . o •. a O�4LrFlrJIGS SIVA (S w Sir/GT CLEAN 3Lr_ GRAu5U y SA -NZ . Cl(W-, cfiP'u6.L) 14 15 (3tirl} 16- 17 18 19 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? NO S L O P E Depth to Water After �('Y) -I )_ L Monitoring? © gate: Reading Date Gross Time Net Time Depth to Water Net Drop o0K F_D yet, &IS PM to t 0'/ ° " :as to V6. a? 626S PAA 10 `tS " ayL S '4 NA 10 9}1g° aw 6 t3 : SsPAA to s" a i2 U o 20 u PERCOLATION RATE� (minutes/inch) PERC HOLE DIAMETER 6 ^l TEST RUN BETWEEN 6� FT AND FT COMMENTS �JZ� S(AN(J V3 17 14 L-I,11(_C GAEL 7H(2dU4+('-Uw7 i�S7 /'{yCc PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No. 204 -7 r o �Z— ACCORDANCE WITHeP,1L�S"M3�1.,1kyat� O�l tGUI DELI NES IN EFFECT ON THIS DATE. 72-008 (Rev. 4785) �"y� DATE: GRAB -HD -I GRE' \ 'ER ANCHORAGE AREA 6VKVUf ' DEi';,�TMENT OF ENVIRONMENTAL QUALIT-,-/ 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279.8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME Aa -h, , 11%;wf/r ADDRESS 16Y)LC 1./Gl'.. llC4/'r.%/..�Jryl. PHONE LOCATION�/(f!1/lch Likth !_ - LEGAL DESCRIPTION 41,1 SEPTIC TANK: NUMBER OF DISTANCE FROM WELL ��( %" lil /17"lC%R/ _MATERIAL�S� '�� �(� %/ %%�' COMPARTMENTS = LIQUID LIQUID CAPACITY /%(0, GALLONS. INSIDE LENGTH -- INSIDE WIDTH - DEPTH_ SEEPAGE SYSTEM: SEEPAGE PIT NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH �� LENGTH /!-- DEPTH LINING MATERIAL-f/(aIl i� -DISTANCE FROM WELL BUILDING FOUNDATION NEAREST LOT LINE -� TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) -SQ. FT. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL FOUNDATION , NEAREST _LOT LINE-` OF LINES NUMBER OF LINES DISTANCE B.ETWEEN--LINES TRENCH WIDTH ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE WELL: LOT LINE DISTANCES: TYPE (li'LiU7li iffi," NEAREST SEWER LINE ,7ruc�c•�_,LLI LLd�C�- tt�tl_ IN. TOTAL EFFECTIVE OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE DISTANCE FROM DEPTH , BUILDING FOUNDATI WATER SAMPLE , NEAREST SEPTIC SEEPAGE OTHER TANK , SYSTEM , CESSPOOL , SOURCES_ DIAGRAM OF SYSTEM DATE��-G YLc 1 a ISI �� APPROVED G.A.A.B. MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Sox 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ©I 1 -� -Z - 37 HAA# 1. GENERAL INFORMATION Complete legal description Lot 7A; Sandi. Heigham Subdivision Location (site address or directions) Kavik S.tAe.et Individual on-site XXX 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. i 72-M(Rev.1/91) Front MOA#21 - s. STA7rIEMENT 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 all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of FirmS& S ENGINEERING _ Phone 6 9 y_ a 9 Eagle River Loop Road No. 2 Address Eagle River AlaxkW9.577 /;L > _ Engineer's signature �- Date 7 6. DWS SIGNATURE. Annroved for bedrooms. By: 0 M ROBERT C. COWAN••Cx,. CE-88oi Disapproved. �.m Conditional approval for bedrooms, with the following stipulations: Additional Comments 1IITIC 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 engineer's work. 72-M (Rev. "1) Back MOA WZ1 ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:L7- ?,4; SA/ooi 4Fi6ft7_f Parcel I.D. (0/ / _&12_ 3� A. Well Data Well type Ctwwatoct� If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed A Driller Total depth /�,/� Cased to YU} Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Li 4A L MUNICIPALITY OF ANCHORAGE Static water level �IIZA Alz2 ENVIRONMENTAL SERVICES DIVISION Well flow ,w/t4 g.p.m. Nd g•P•m " IN 2 7 1995 U Pump levels # �i RECEIVED E r E I SEPARATION DISTANCES FROM WELL TO: 4 Septic/holding tank on lot a66 `{' ; On adjacent lots Absorption field on lot `- ; On adjacent lots Ilk Public sewer main /U %j Public sewer manhole/cleanout Sewer service line &J& Petroleum tank WATER SAMPLE RESULTS: Col•Iform 1�f�1 Nitrate Other bacteria IJA Date of sample: LZL Collected by: I✓A B. SEPTIC/HOLDING TANK DATA Date installed Tank size /dUC) Gac- Compartments Cleanouts &N) YES Foundation cleanout &N) kS Depression (Y/6 OJb High water alarm (Y/* d` -JR Alarm tested(Y/O P44 C Date of pumping 6 I a� °I S Pumper A S } Nc�MI= ERuiczS SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot If 1_)b On adjacent lots CXC)0 f Foundation /U To property line )y rt Absorption field !04 Water main/service line W �� Surface water/drainage f 00 ' f 72-026(3t)•Front CONTINUED ON BACK PAGE C. LIF TION N Date installed _� Size in gallons Vent (Y/N) High water alarm level "Pump on" Meets MOA electrical codes (Y/N) SEPARATION DIS i3ANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y. tested off" Level at lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed �r -� 6'�l 2 Soil rating (GPD/Ft2) �r� System type //vrOL ��iZA/nom Gravel thickness Total depth Lengthy Width Total absorption area �S Cleanout present (Y/N) �S Depression over field (Yltt No Date of adequacy test 6 a.8A5S Results (pass/fail) for 3 Bedrooms Water level in absorption field before test m 1 >2� After test l Peroxide treatment (past 12 months) (Y/N)If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ..On adjacent lots 0�O b Property line To building foundation /6 f To existing or abandoned system on lot _ On adjacent lots__ ac)14- Cutbank / %/A Water main/service line Surface water- ) 66 f Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION /d I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature_r� A. ti 77` F'.O..,iYO=: .ift ��+�+ M1 Y'l i-iiP.l Engineer's Name _ %G 0 /�.• t 'i ' �. / Sf ROBERT C. COWAN a <Q, Date _ 6 ( 7 S� ����i CE.8801 HAA Fee $ ��� �> , �'� Waiver Fee $ _ Date of Payment Date of Payment y Receipt Number C>\ .3�, Receipt Number 1n nn. 10,M). 11m4