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HomeMy WebLinkAboutGRAHAM LT 13 DIEF'AF;Ef'MENT OF HEAI,...TH AND IENVIF:;'.OI'",tME~]qT'AL PROTIECTION E4. E'.5 L. ST'F~EET, ANCIdOI::;,'AGE, At< 99501 264-'47.20 PERM I T 1'40: DATE ISSUED: API::'L. I CAN'I = ADDRESS: COI',Ft'ACT PHONE L. EGAL DIESCR IP~ LOT' S i Z E: 86() 1 .iL.' 4 S. M ,, C 0 N S T R A ]" I N G 5131 E:,, 98'f'H AVE. ANCHORAGE, AK 99515 346-. 1196 SUBDIVISION: GRAHAM SUB ..:C] iDN: 6 TOWNSHIP: 8() } } (SC-! ,, FT. (]JR ACF;.'.IES ) LOT: 13 BL. OCK: NA :t.,=:.N RANGE: 3W S I GNED APPL I CANT ISSLJED~:""' I cect. i['y t. hat~ 1, I am {amiliar' with t. he r',:~quir'ements ¢cn- on-..-site sewei"s and wells as set forth by t. he Mur'iic::El:,aI:i. ty c:)f' Arichopag((a (ldOA) and the State oF Alaska, ;;?,, I will J. nst. al l 'Lhe syst. em in acccmdance wit. h all MCJA codes and r'egulat, ions, ar;el irt ccmll::)].iarJc:e ~.~J. th the design Izr'.iter'ia of' Chis per'mit, 3,, i ~J.].:t. adl"~er'e t.o all MOA and St. at.e ,::)~' Alaska r'equicememts {oP the) set. back dis'Lances {'r'om any 02xJ. sting ~,~eil, wast. ewater' disposal system of public se~er'.ag(.:a syst. em on this (:)f" any adjacent, c~- near'by lot. S.M. CONEFTT~A]" I NG {..-I-7 TOP OF FOUNDATION WALL ELEV.,. ELEVATIOHS BASED ON PREPARED FOR: PLOT PLAN DATUM, OR.AWN J DATE '--- ~ ~J ~/,../~"-' I ~OB ,~. IT SHALL BE THE RESPOIlSIBILITY OF TIlE BUILDER OR OWNER TO VERIFY THAT ' ' .U,LD,.. LOC.T,. s.ow..ETS .LL ~USDIVlSION COVENANTS AND LOCAL · o.,.0 ~o.~,...o ' LOT 15 , BLOCK ~ '~ .. ! HEREBY CERTIFY THAT ALL PROPERTY ~.""~ ......... 'CORNERS EXIST THIS DATE AS SHOWN. P.O. L~X 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES June 23, 1986 S.M. Contrating 5131 East 98 Avenue Anchorage, Alaska 99515 Subject: Lot 13 Graham Subdivision On-site Well Permit #860124 - Issued May 14, 1986 On May 20, 1986, The Anchorage Assembly approved a new ordinance regulating on-site wastewater disposal systems (septic systems). Ail septic systems constructed after the effective date of this ordinance are subject to the provisions of this ordinance. Our records show that you currently hold a permit for the installation of a septic system. We strongly urge that you contact this office prior to constructing your system. Any changes in the code that could impact the construction requirements of your septic system will be identified and brought to your attention. Please contact the Environmental Services Division at 264-4720. Thank you for your cooperation. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/SSM/ljw 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParceJ I.D. # O~.~_-- I ~1--}~ 1. GENERAL INFORMATION Complete legal description HAA # Location (site address or directions) '"7 .~ ~_- ~2:) ~ r~-~ ~.~L~-- Property owner Mailing address Day phone Co,.~q~-- /&-~-~r['" Lending agency Mailing address Agent tt Address Unless otherWise requested, HAA will be held for pickup. NUMBER, OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Day phone Day phone Public water 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. 72-025 {Rev, 1/91) Front MOA #21 Sa 5. STATEMENT 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. Alaska. Water & , Name of Firm ~.~s?~;~Ie,r S. ?vi?,s / Address ; ..... Engineer's signature %/~/ ~ Date. DHHS SIGNATURE '~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 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. 72-025 (Rev. 1/91 ) Back MOA ~1 Legal Description: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES .... Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist CbT- tgo ~.¢..l%.¢k/s,~ .g Ig2, Parcel I.D.: O t~ - t A. V~ELL DATA Well type "~ O-Yx If A, B. or C, attach ADEC letter. ADEC water system number Log present (Y/N) "-{ ~-----~q Date completed /o/:~/8 ~ Total depth ~. O c>[ Cased to I (3 ~ Casing height (above ground) Sanitar,j seal (Y/N) "-1 ~----,~ Wires properly protected (Y/iff) Date of test FROM WELL LOG AT INSPECTION Static water level g.p.m. ~ ~ o~- O(~:~JOO~''JM ' Wellproduction ~ ("~--~'~ g.p.m. % ~' ~ WATER SAMPLE RESULTS: G- I r~ ~,J ~n-~ . Coliform <~ Nitrate · ~ ¢~r}/J~ (bJ,0) Other bacteria Date of sample: (:,/Z, 5"/q'~, Collected by: ~t:x~-~ ~---,£ g' TANK DATA Date Tank size Number of Compartments __ Clem~outs ~ Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Date installed Length Width Effective absorption area Date of adequacy test __ Fluid depth Soil rating (g.p.d./ft2 or Gravel ; Tube present(Y/N)___ __ Results (Pass/Fail) (in.); Inunediately after (ins.) Minutes later: System type Total depth Depression ~FN) For___ __ ~-t~oms gal. water added (in.): Absorption rate = .g.p.d. (past 12 months) (Y/N) If yes, give date Do Dale installed ~_~ Size in gallons Manhole/Access (Y/N) __-"--~k!3p_ off' l~Lcy.~ . "Pump off' level at* High water alarm level at* E. SEPARATION DISTANCES Septic/holding tank on lot Absorptiou field on lot Public sewer main SEPARATION DISTANCES FROM WELL ON LOT TO: /"J/P' ; On adjacent lots /,.)/A ; On adjacent lots Public sewer manhole/clcanout > ( CO / Sewer/septic service line ~2)/~ Lift station I'-J/~ ~DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundatt-~n._. Property line Absorption field :ater mailYservice line~'"'"--""~S~c water/drainage__ _.~77~__ __~~°ts EPARATION DISTANCE FROM ABSORPTIO ;~D ON LOT TO: Building foundatiou ~ Water mai,ffse~m~e-lhle Surface water / Driveway, parking/vehiclestoragear~/'ea--,~ ~ Wells on adjacent lots Prope~""~ F. ENGINEER'S CERTIFICATION ~ -'~ /// I certify that 1 ha~ern~l thr, ffi~'ldi/P[s/~ections and review of Munic,)ga/ .................................................................................................................. HAA Fee $ Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc. Laboratory Division Laboratory Analysis Report CT&E Ref.# Client Sample ID Matrix PWSID 0 Sample Remarks: 962544.962544002 Lot 13, Graham S/D Drinking Water Collected Dat~ 06/25/96 Technical Director: Stephen C. Ede Released By .~~ ~'. ~ Parameter Nitrate-N Total Coliform Results QC Qual PQL Units Method Allowable Prep Analysis Init Limits Date Date 0.100 U 0.100 mg/L EPA 353.2 0 0 col/lOOmL SM18 9222B 06/26/96 ESC 06/25/96 TAV U - Undetected LT - Less than GT - Greater than D - Secondary Dilution J - Below the calibration range 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 -- Tel: (907) 474-8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA "Ave E8Olh i /O2. O0 84,00 94.00 __B_RA.N_C.HE _ DRIVE.__ © MUNICIPALITY OF ANCHORAGE 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 GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or direction's) Applicant Name ~blrh~/~O¢;~LS'/~11/~ C¢~/r~¢re&~lephone: Home Applicant is (check one): Ler~d'i~g Institution []; Owner/builder ¢J(; Buyer []; Other [] (explain); Bus,ness (d) Lending Institution Telephone Address . /./'~ (e)Address Real Estate Company and Agent .~' ' ' ~' .~ Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family.~ Multi-Family [] Number of Bedrooms ~'~ Other WATER SUPPLY Individual Well ~' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] 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 72-025 (11/84) the date of this inspection. Name of Firm Address !~-~)[ Date ~ ENGI'NEERING FIRM PROVIDInG/INSPECTIONS, TESTS, FILE SEARCH, D~"I'/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 Telephone '~g/- ',~:) ~) DHEPAPPROVAL -- ~ ./AL~ ,, ~ ..rove.,or Approved ~ Disapproved Conditional Terms of Conditional Approval ~, CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP 'dbes this as a courtesy to purchasers of homes and their lending institutions 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 the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: Well Classification IN 0i ¢ I ~)(,,)JCJ'~.- If A, B, C, D.E.C. Approved (Y/N) Well Log Present ~N) Date Completed ~/'_~/~O Yield Total Depth I O~ / Cased to Static Water Level ,r.~)" / Casing Height Above.Ground Electrical Wiring in Conduit Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~'~ Cleanout/Manhole 1 Water Sample Collected by Water Sample Test Results Depth of Grouting /~// ~r Pump Set At IO~ ~ Sanitary Seal on Casing ~)N) Depression Around Wellhead (Y~) .3 EFF ; On Adjoining Lots, ~.,f ] t'~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Compartments --¢'/¢¢'~ Standpipes (Y/N) Air-tight Caps (Y/N) Foun~t. i0~n Cleanout (Y/N) Depression over Tank (Y/N) __-- Detest/Pumped --- -- Pumping/Maintenance Contract on FeiI (Y/N) ~.,./ ; for __ __ Holding Tank High-Water Alarrr~fN/~ ~¢,~Temporary Holding Tank Permit (Y/N) Separation Distances from Sep~c/~-I?di~g)Tany To Water Supply Well -- ~ To Building Foundation To Property Line J To Water Main/Service Line J Course j Comme~./ To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(H/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test __ Separation Distance from Absorpt To Water-Supply Well __ To Building Foundation Lot To Water Main/Service Line __ To Stream/Pond/Lake/or Ma Course To Driveway, Parking Are~, or Vehicle Storage Area Comments Type of System Desi Length of Field __ Depth of Field Gravel Bed Thick~ Star )es Present (Y/N) Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Man hole/A.,~es~Y/N) __ "P...~l~'Off" Level at __ J puVmep~tn(gY~)cles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify t hat.ii ha~enc~ .ck,,d, v~erifi~d, or conformed to all MOA an.d HAA guidelines in effect on the date of this inspection. Signed ~,~ J ~~.J~--* Date '~/Z ~¢?~'~:7~ Company I¢ ~.~ [~r~... MOANo. ' /~:P~O.~ ¢ Receipt No. 40 Date of Payment Amount: $ 72-026 (i 1/84} co,T.o, sE,w~r ~, ~.c. ~ 1200 West 33rd Aven'~','~ Suite B ANCHORAGE, ALASKA 99503 (907) 56;t-5040 SHEET NO. J~,./.~.j~ CALCULATED BY OF DATE CHECKED BY .