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Home My WebLink AboutPURINGTON LT 10 HEALTH DEPARTMENT ~T? 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCAT,ON ' /:'I': SEPTIC TANK: DISTANCE FROM WELL. //' '('' - LIQUID CAPACITY j .;v r~,/~, GALLONS, MAILINGADDRESS /~"/ '-// LEGAL DESCRIPTION/--L' / · / MATERIAL )'' /F~ 4~ NUMBER OF ~'1;..,.. ii ..:L" ('? / ~NS~DE LENGTH .~NSlDE WlDT~ LIQUID DEPTH___ SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAl NEAREST LOT LINE SEEPAGE Pm OUTSIDE DIAMETER OR WIDTH DISTANCE FROM WELl TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) .,LENGTH. , DEPTH BUILDING FOUNDATION__ SQ, FT. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION NUM. BE~DF LINES .... --' DISTANCE ~'ETW~EN LINES ABSORPTION AREA TOTAL LENGTH NEAREST LOT LINE , OF LINES TRENCH~WII~t-HE ......... ' IN. TOTAL EFI~'ECTIVE SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__ WELL: LOT LINE TYPE(L~ ' ~ '~?( , DEPTH ~;' '~ / DISTANCE FROM -, BUILDING FOUNDATION · · NEAREST / SEPTIC //~;~ i SEEPAGE /~ , SEWER LINE ~' ,TANK , SYSTEM WATER SAMPLE , NEAREST OTHER , CESSPOOL ' -'- , SOURCES' ' DIAGRAM OF SYSTEM DISTANCES: DATE '" : A._~ HEALTH AUTHORITY GRE¢-,/ER ANCHORAGE AREA BOF~OUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONe 279-8686 ~X~, ~:~ SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK / SEEPAGE PIT ~""'"'~ , DRAIN FIELD . , OTHER SOIL TEST RESULTS NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOil TEST FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO pROSECUTION. SEEPAGE AReA SIZ TYPE /--~g:l~J~ ~¢/~/ MINIMUM DISTANCES, REQUIREMENTS fOUNDATION tO SEEPAGe PIT SEPTIC TANK TO SEEPAGE PIT WALL WATER MAIN TO SEPTIC TANK /~ / DRAIN field /~ / , DRAIN FIELD ,,~ /x SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEePAGe Pit TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIBCROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL, FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH ACUTHO R ITY OR LICENSED DESIGNER DIAGRAM OF SYSTEM Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater. Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904. CERTIEICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Pamel I.D. 008-052-24 1. GENERAL INFORMATION -HAA#' C) z/OIL/'/ Expiration Date: "7- ~ ~ --0 /'~ Complete legal description PURINGTON SUBDIVISION; LOT 10 Location (site address or directions) 412 D BRANTLEY PLACE Current Property oWner(s)` Mailing address Lending agency Mailing address Real Estate Agent Mailing address * ANCHORAGEr AK VA OCWEN FEDERAL BANK Day phone '4121 BRANTLEY PLACE * ANCHORAGEr AK * 99508 · Day phone * 99508 JASMINE KLUEVER .Day phone 762-31 3201 C STREET, SUITE 200 * ANCHORAGE, AK * 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: · Individual Well I Individual Water Storage III · COmmunity Class Well Public ,Water System TYPE OF wASTEWATER DISPOSAL: Individual On-site I-'l Individual Holding tank I--I community on-site III Public Sewer i The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for propedies served by a single-family on-site wastewater disposal and/or water s~pply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for propedies served by Class A or B wells or a public water system. The Municipality of Anchorage is not [esponsible for errors or omissions in the professional engineer's work.. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and a~ of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authodty Approval Guidelines forthis application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy 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(are) in compliance with 'all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 5701-E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 337-6179 Date A~ [7..-z., ~. Engineer's comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious enginee~fng analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results desc#bed the performance of the system under the conditions encountered at the time of the test, and seParation distances measured to readily identifiable features. The operational life of all wefts and 'septic systems depend on the Ioca/ ~oils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being sen/ed by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test - results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system wi//conb'nue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for ' the sole benefit of the ownerlistedabove. Anyreliance upon oruse of this report byany other person or party is not authorized, nor wi//it confer any legal right whatsoever. DSD SIGNATURE ~ Approved for Disapproved. --~ bedrooms~ Conditional approval for bedrooms, with the fllowing stipulations: .... -.' WATER AND : m'.: Attachments: HAA.' Checklist Septic System Advisory r Well Flow Advisory · WASTEWATER: : · .... ..' Manitenance Agreements Supplemental Engineers Reo~ Other Original Certificate Date: (Rev. 12/01) .Legal DeScription: Municipality Anchorage op part Devel mentlser~lcos De ment · Building Safety DiVision OmSite Water & Wastewater Program 4700 South Bragaw St. P.O.'Box 196650 Anchorage, AK 99519-6650 www.ci.anchOrage .ak.us- (907) 343-7904 ' ' HEALTH AUTHORITY /~ppROVAL!.CHECKLIST PURINGTON SUBDIVISION; LOT 10 'Parcel ID: T- A. WELI.;DATA *PER NEIGHBORING WELL LOGS Well tYlSe t=PRIVATE. IfA, B,"0r C provide PW~SID# N/A 'Date c6mPleted 1961. £ Sanitary seal(y/N)~ES Total'd~pth~: 44 + ft. ' ~cased to 40'+-'ft! ~:. ~i!~ :l . R O Date bftESt · ' · Statlclw,aterleve, ' ,~ ft.: Well p,r0d~ction ~O.-"' g.p.m. WATER SAMPLE RESULTS: '~ ' Coliform ~':0 colonies/100 mi. : Nitrate 0.10t mg;/L. 008-032-24 NO YES Casing height (above ground) 12" in. AT INSPECTION ' 4/19/2004 27 ft. 5;86 g.p.m. i Other I~aCteria 0 colonies/100 mi. Ce :":1! ?~/A mg./g Arsenicl SEPTIC/HOLDING TANK DATA Tank, :Type/Material Tank size ~, I- gal. Date of sample: ?/19/2004- :Collec{~d by: PUBLIG SEWER iDate initialled Number of Compartments i': 1:'~,?.? ' ~ Foundafi'oh'~l~anout (Y/N) ' ver tank (Y/N) ':: High Water alarm (Y/N) ' Pumper.' ~ : ': ABSORPTION FIELD DATA PUBLIG' SEWER Date ,nstaIled Soil rating (g.p.d./ft=or ft2/bdrm) system type Length[ ~; .ft. ., .Width . !. ft.. Gravelbelowp'j~-'~'~~ft. Total ~ "'i~": ft' Eft absor ti(~n area 1= ~: ~,~ ~~'.' p ~ . . p' Fluid depth in absorption field b~~. ~ter added: ga~.; : , New depth in ElapSe~ ~ime: . Final'fluid depth ' '] in., ' .AbsorPtion rate >= g p d ~¢enation treatment (past 12 mo.) ~/N & ~pe) [ ' ~ If yes, give date GEG., Ltd. Well Log (Y/N) Wires properly protected (Y/N) LIFT STATION Date installed i-Pump on" level at in. E. SEPARATION DISTANCES .. ; .Size ing~lionsi _ i ~ Pump off' m. ' High water alarm level at in. Cycles tested -~ Meets alarm & circuit requirements? GJ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot'" Public sewer main, Sewer/septic service line ' 'N/A ' N/A 75'+ 25'+ On 'adjacent lots 100'+ On adjacent lots 1 oo'+ Public sewer manhole/cleanout . Holding tank N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT .TO: Build!ng foundation Water main .'.PUBLIC. SEWER Properly line .. Absorption field Water service li_!3~, u ace water. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: PUBLIC SEWER Property line ' Building'foundation Water'main Water service line Surface water__..__ ' ' ~lvehicle stOrage ' Wells on adjacent lots coMMENTS ENGINEER'S CERTIFICATION .~ I certify that I have determined throUgh field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS HAA Fee $ ~ iI' L~O~-- ~176 Date of Payment' /-'J I ~/iD~ :,, '~ Receipt Number 0,¢')06J(¢C( ' ~' (Rev. 12/01) WaK, er Fee $ Date of Payment Receipt Number 4--22--04; 4:SlPM; ;907 5615301 - # 2/ 3 ;GS Ref.# ;llent Name ?roject Name/# ~lient Sample ID datrix 1041835001 Garness Engineering Group, Ltd. Hose Bib 4120 Brantlcy Place Hose Bib 4120 Brantley Place Drinking Water :ample Remarks: All Dates/Times are Alaska Standard Time Printed Date/Time 04/22/2004 15:02 Collected Date/Time 04/19/2004 14:25 Received DatedTime 04/19/2004 14:37 TechnlcalDirector _ Stephen ~Ede Results Units MeO~od Allowablc Prep Analysis Conmlner ID L~m Pts Date Date Init fater-~ Department Nitrate-N O.IOOU 0.100 mg/L EPA 300.0 B (<=10) 04/19/04 JIB L~crobiology Laboratory Total Coliform col/100mL SM18 9222B- ^ (<=1) 04/19/04 DKC APPLIC FILLS OUT UPPER HAl ONLY Property Owner "'~. ~: \ ;q ~. ~-~ ~ . ~ \:'. ~(.. \ ~ Phone Mailing Address. .... ]] ~'~', '~-~ ~- ~:~. i,,- ,'t Buyer \~ ~., ':\ , , .:, ,:: Address Zip Code Lending Institution ~ , .,, <-, , * ~"~'<: (:t- \ ¢.:--~- c, ~-.~.. Phone Address :.( ', (~ ~:) j'~"~ ,'. t Zip Code Realty Co. & Agent ' -t- ;--,. ~ v'~. -17 ' Phone , . , '::~ Address \'~ .?. i.[ ); ~ . ~ L-~:'-C ~-; ; ~ ,. ~.. ~-[~(, ~ , ~ ~x. Purington Additions Legal Description Street Locati~ ~ I ~ ?. ~ ~'~;~ ..... ¢ ,¢t ~:~'(' ~_- ~ype of Residence ~ -- ~gle Family - :, ~ Multiple Family No. of Bedrooms ~ Other Water Sypply ~¢f~dividual ] ',(' ( ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ~ Community*~ ( ~ ~ For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal ~ I~ividual Year Individual Installed: ~,.'Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: l( MUNICIPALITY OF ANCHORAGE ~ OEPT. OF RECEIVED (~ ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL Soil~ R~tin~ Date ~wer I~talle~ Well To A~so~ptio~ Area ~ell Lo9 Receive~ Well to Tank Septic T~k Size 72.023 (3182) .... :)ATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR~ INSPECTOR INSPECTOR MUNICIPALITY OF AHCHO~AG~ MUNICIPALITY OF ANCHORAGE DEFT. ()F DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~"/IRONM[NI/q- ) 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND 8EWER FACILITIES DlflECTIONS: Complete all parts on page 1. Incomplote requesls will not be processed, Please allow ten {10) days for processing, OWNER PHONE PROPERTY RESIDENT~nt from above) 2, BUYER MAI~ING ADDRE88 '' ' PHONE ~ LBNDING INSTITUTION ~AILING ADDRE88 5. LEGAL DESCRIPTION L'o7' tO STREET LOCATION 6. TYPE OF RESIDENCE .' SINGLE FAM)LY [] MULTIPLE FAMILY N~M~ER ~~ One ~ Four Two ~ Five Three ~ Six [] Other 7. WATER SUPPLY ~ ~t~' INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY * ATI'ACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72:010 (Rev. 6/79) C.-~,~ '~/ .... ~ ,I THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OFBEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX [] OTHER 2. WATER SUPPLY INDIVIDUAL COMMUNITY PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE [~]PU BLIC UTILITY Connection Verified []Septic Tank or [~] Holding Tank Size: If Tank is homemade give dimensions: PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line Septic/Holding Tank JAbsorption Area ISewer Line INearest Lot Line '5. COMMENTS /~ ~'~ APPROVED FOR ~ BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE 72-OLO (Rev. 6/79) October 5, 1981 James Ridder 1515 Medfra Anchorage, Alaska 99501 Subject: Lot 10 Purington Addition Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: (3) The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street for:our review. The seal on the well head needs to be tightened so that Jt is water tight. The wires to the well head are in violation of the Municipality codes and need to be placed in conduit. Please notify this office for a reinspectJon when the noted descrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, James S. Roberts Associate Environmental Specialist JSR/ljw cc: Alaska Bank of Co~nerce 3230 C Street 99503 GhEAIER ANbHO~,AG~_: AREA BOROUGtt Department; of iinvironmental Quality 3500 Tudor ,{oa.t, A~choY~%% Alaska 99507 279-8686 Time of l'nspection REQUEST FOR At -kOCAI. OF INDIVIDUAl, SEt~ER & WATER FACILITIES A. Type ~ ' B. Depth "' ........... 7 .................. , ' - ....... ':.Z' .' ,,-/,2 N 7, Sewage Disoosal Svste~: /. ~ _/ /: ~ /. A. ~nstalled. '~'tj /: :-~2/~V//~:~>(~. Installer Manufacturer E, Disposal Field: Total Length of Lines Distances: A. Well To: Septic Tank ..... , Absorption Area ~ "~ , Sewer Lines , NeaYest Lot I. ine_~i"' , Other Contamination · Foundation to S~ot~c ., ;, Ab,~orpt] on Area ~ ~ / . .' C, Absorption Area to Nearest Lot I,ine Request for Approval of .~ .,ividual Sewer & Water Facf].itit Page Two Approval Va].~d for One Year From Date Signed Greater Anchorage Area Borou~h, Department of Environmental Quality [)IAGf~A~A OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities located at: Signed Date GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 Eagle Street Anchorage, Alaska 99501 Phone 272-6467 June 1~, 19~8 Mm. Don Schmider Bo;~ 2113 Anchorage, Alaska 99501 SUBJECTs Sewage Dimposal System Serving Lot 10, Purlngton Suhd. This notice is to remind you of the conditional approval of Zh9 subjec~ system by this office. The conditional approval expix~s on J%~ly 1, 1968, Please contact this office to schedule final inspection of the mequi~ed modifications p~ior to backfilling. If we have not heard from you pr. lot to the above expiration date, the system will automatically be disapproved. Sincerely, DAVID R. L. DUNCAN, M. D. Medical Director DBH/s~m BY: cci Civilian Hilita~y Referral Office f~ ,~,~ ......... REQUEST FOR APPROV~.L OF ~J~ _~-~O~O ~ INDIVIDUAL SEWAGE A4D WATER FACILITIES ~: ~' '~ Name of emso ' . ~~ (F1].i out in TP1DllcZ.) -' p n requestzng approval__~ 2, Name of property owner~_~/.2Vc_.~L_ 5. Water Analysis: , /'C/LF°~f~g) ' , DSstancs f~om ~e22 to closest sx~stin~ 1. Sewer line Sewage disposal system, a. Age of system 2, Septlc tank 3, SeepaFe Area 5 P .... 6. Other sourness of poss uouses, sam b. Septic tank capacity in gallons__/~,'~zL2 c. Name of septic tank manufactu~e.r 1. If "home made" show diagram on reverse side of this forum. Disposal field om seepage pit size and type 1. Distance to property ].ine~ ~ to house foundation___~J/'